Patent ductus arteriosus. Follow-up of 677 operated cases 40 years later.

BACKGROUND: This review is about the patency of ductus arteriosus (PDA), with particular care concerning diagnosis, surgical techniques, survival and postoperative pregnancy in operated females. METHODS: a) Sperimental study: the research has been conducted retrospectively and the follow-up is 40 years. b) ENVIRONMENT: all the patients were operated on in the Division of Cardiac Surgery, University of Turin (public structure) and in the Italian Institution of Cardiac Surgery (private structure). c) PATIENTS: from 1958 to 1987, 677 patients were operated on: mean age was 11.5 +/- 8.7 years. A complete follow-up was made on 487 patients (72%). d) Technique of operation: left lateral thoracotomy was often performed; in younger children, however, the tying of PDA was frequently made within the pericardium by left anterior thoracotomy in the third intercostal space. In uncomplicated situations, PDA was tied more frequently than divided, by two purse string stitches and one or two transfixed ligatures. e) SURVEY: overall early and late mortality, the clinical conditions of all patients, pregnancies and preor postoperative miscarriages of operated women were examined. RESULTS: From 1958 to 1967 overall early mortality was 5%; during the following years, there was no hospital mortality. The recurrence of PDA occurred only in 4 patients. 72% of the operated females became pregnant. CONCLUSION: Life expectancy is normal after surgical closure of an uncomplicated PDA in infancy or in childhood but premature death may not always be avoided operating on adults with long-standing chronic congestive heart failure. At least, postoperative pregnancy is not a risk factor for the mother and PDA seems not to be correlated to foetal transmission.

Dietary consumption of Lathyrus sativus seeds induces behavioral changes in the rat.

Neurolathyrism is a degenerative disorder due to an excessive consumption of Lathyrus sativus (LS) seeds, which contain the neurotoxic amino acid beta-N-oxalylamino-L-alanine. In this study, a population of Wistar rats was fed a diet with LS seeds up to 8 months. Two control groups were chosen, one receiving standard food and the other Cicer arietinum seeds (a nontoxic legume). At the end of the dietary period, the groups previously fed the seeds were switched to standard food for 1 month (wash-out). All animals were submitted to a neurological examination and observed in an open-field situation before, during the diet (at 4 and 8 months), and finally after wash-out. Neither LS-fed rats nor controls ever showed neurological deficits. By contrast, in an open-field the activity was significantly increased in the LS-eating rats at both the 4th and 8th month. The effect was indeed reversible, since it disappeared after the wash-out. It is suggested that the enhanced open-field activity seen in the LS group might indicate a reversible excitable status. However, there is no evidence at present that the behavioral changes described represent a marker of neurodegeneration in this animal species.

[Fetal macrosomia. Maternal and fetal implications]. / Macrosomia fetale. Implicazioni materne e neonatali.

Ninety-six cases of fetal macrosomia have been tested to focus on the factors necessary to select women running the risk of delivering macrosomic fetuses. The results of these studies are the following ones: a) pregnant women with pathology are multiparas; b) they are usually characterized by peculiar weight increase in pregnancy; c) they have gone beyond pregnancy term; d) they have previously delivered macrosomic fetuses. The Authors focus on the necessity to anticipate diagnosis and to plan caesarean section in order to avoid the traumatic lesions this kind of babies are frequently affected by.

[Analysis of factors associated with very low birth weight (less than or equal to 1500 g)]. / Analisi dei fattori associati con la nascita di neonati di peso molto basso (meno o uguale a 1500 g).

In 7675 deliveries performed at the University of Messina between November 1, 1983 and October 31, 1988 we determined the incidence and obstetric factors specifically associated with the birth of very low weight infants (less than or equal to 1500 gm) (VLBW). Our purpose was to characterize these factors in order to determine what may be done to limit delivery rate of VLBW. Information obtained concerning the mothers' included socioeconomic status, age, parity, previous obstetric history, any maternal conditions affecting the pregnancy, route of delivery (vaginal or operative). The incidence of infants under 1500 gm was 1.1 per cent of live births. The etiologic analysis showed that preterm labor is more frequent cause of VLBW. In women under 17 years of age the incidence of VLBW was 5.2 per cent as opposed to 1.1 per cent in the total population. Absence of prenatal care was shown in 40.8 per cent of VLBW. The previous obstetric history reported 1 or more abortions in the 53 per cent and 1 or more perinatal deaths in 17 per cent of VLBW. The clinical implications of these results are discussed.