Value of serial sonography in the in utero detection of duodenal atresia.

Duodenal atresia can be fatal unless promptly diagnosed and treated surgically. Death occurs in the newborn secondary to emesis, aspiration, and electrolyte imbalance. Serial ultrasound scans were obtained for 2 patients, but duodenal atresia was not detected until 29 and 32 weeks' gestation, respectively. With prior knowledge of an infant with Down syndrome and duodenal atresia, management of fetal distress with subsequent operative delivery can be altered. Early prenatal diagnosis by ultrasonography and subsequent amniocentesis plays an important role in the antenatal and postpartum counseling and management of these patients and neonates.

Single dose carbenicillin versus T-tube drainage in patients undergoing vaginal hysterectomy.

In this study, a prospective, randomized, non-blinded report, single dose carbenicillin prophylaxis preoperatively is compared with T-tube suction drainage postoperatively in 50 patients undergoing vaginal hysterectomy. A higher incidence of febrile morbidity, fever index units, cellulitis of the vaginal cuff and prolonged hospitalization postoperatively was experienced by the group patients with T-tube suction drainage, P less than 0.05. Our satisfactory results with single dose carbenicillin prophylaxis preoperatively are similar to those of previous studies using more extended antibiotic prophylaxis perioperatively.

Vascular and uterine responses to dobutamine and dopamine in the gravid ewe.

Dopamine, a naturally occurring catecholamine precursor of norepinephrine, has been used in the treatment of cardiogenic shock. Following intravenous administation it increases cardiac output, blood pressure, and renal blood flow. Dobutamine is a directly acting inotropic agent which increases myocardial contractility without significantly changing blood pressure. This study was devised to compare the effects of these two drugs on uterine blood flow (UBF), uterine tonus (UT), mean arterial blood pressure (MAP), and heart rate (HR). Chronically instrumented pregnant ewes near term were infused with differet concentrations of dopamine and dobutamine while HR, MAP, UT and UBF were recorded continuously. Dopamine produced a decrease in UBF and an increase in MAP and UT while the HR response was variable. Dobutamine administration resulted in a marked increase in HR and a decrease in UBF, while MAP and UT remained essentially unchanged. Uterine vascular resistance increased with both drugs during high-dosage administration, but the rise was more pronounced following dopamine infusion. Since dobutamine exhibits less alpha-adrenergic activity than dopamine this drug would seem to be preferred when an inotropic agent is required for treatment of the pregnant patient.

Effects of nitroglycerin and nitroprusside on the uterine vasculature of gravid ewes.

The effects of nitroglycerin (TNG) and sodium nitroprusside (SNP) on mean aortic pressure (MAP), uterine blood flow (UBF), uterine vascular conductance (UVC), and pulse rate (PR) were compared when the two agents were infused to prevent and treat hypertension induced by norepinephrine (NE) in gravid ewes. When infused alone, TNG, 19 microgram/kg/min, decreased MAP 19 per cent and increased PR 33 per cent from control values (P less than 0.05), but did not significantly change UBF or UVC. In comparison, SNP, 3 microgram/kg/min, decreased MAP 20 per cent and increased PR 43 per cent (P less than 0.05), and did not significantly change UBF or UVC. When given alone, four successive 2-min infusions of NE produced dose-related increase in MAP and decreases in UBF, UVC, and PR; values were significantly different from control with the two higher doses of NE. Although MAP, UBF, and UVC were still significantly changed from control levels when NE was given in the presence of the above infusions of TNG or SNP, MAP was lower and UBF and UVC were higher compared with when NE was given alone (P less than 0.05). When given to control hypertension induced by a continuous infusion of NE, TNG or SNP produced uterine vasodilatation and significantly increased UBF. Nitroglycerin and SNP were equally effective in counteracting the maternal hypertension and antagonizing the uterine vascular effect of NE. It is concluded that TNG and SNP counteract uterine vasoconstriction resulting from alpha-adrenergic stimulation and do not produce a shunt of blood flow away from the uterine vasculature when used to control hypertension in gravid ewes.