Efficacy of signal-averaged electrocardiography in the young orthotopic heart transplant patient to detect allograft rejection.

Endomyocardial biopsy is the gold standard survey for cardiac graft rejection. Signal-averaged electrocardiography (SAECG) identifies slowly conducting, diseased myocardium. We sought to determine whether SAECG is a sensitive, noninvasive transplant surveillance method in the young.Ninety-four SAECGs recorded prior to biopsy in 20 young transplant (OHT) patients and those from 15 healthy age-matched controls (CTL) were analyzed. In the OHT group, 56 no-rejection (NOREJ) (ISHLT grades 0 or 1 A) and 37 acute rejection (REJ) (ISHLT grades IB, 2, and 3A) SAECGs were compared, SAECGs were filtered at 40-255 Hz. Total QRS duration (QRSd), duration of terminal low amplitude of QRS under 40 microV (LAS), and root mean square amplitude of terminal 40 msec of QRS (RMS40) were compared.SAECGs were significantly different in CTL vs NOREJ but not in NOREJ vs REJ: QRSd, 81.7 +/- 8, 107.2 +/- 18.4, and 112.3 +/- 21.6 msec, respectively; LAS, (18 +/- 5.8, 23.6 +/- 10.7, and 27 +/- 14.8 msec, respectively; and RMS40, (169.3 +/- 100.4, 68 +/- 48.8, and 57.5 +/- 45.6 microV, respectively. Children following OHT exhibited significant differences in the SAECG compared to controls. Differences between the NOREJ and REJ groups were negligible. Therefore, SAECG may not be effective in detecting OHT rejection in the young.

An in vitro validation of a commercially available metabolic cart using pediatric ventilator volumes.

Our objective was to determine the validity of the SensorMedics 2900 Metabolic Measurement Cart (SensorMedics Corp., Yorba Linda, CA) for use at pediatric ventilator volumes by designing an in vitro validation study. The study was performed using a previously described nitrogen dilution, carbon dioxide infusion technique in which known amounts of nitrogen (N2) and carbon dioxide (CO2) are infused while a test lung is ventilated. Metabolic measurements were made at tidal volumes (Vt) varying from 50-500 mL at a peak end-expiratory pressure (PEEP) of 0 and 12 cm H2O and at inspiratory oxygen fractions (Fi,O2s) ranging from 0.21-0.60. Each study was repeated six times to assess reproducibility of measurements. At a PEEP of 0 cm H2O, the measurement of oxygen consumption (V'O2), carbon dioxide production (V'CO2), and minute ventilation (V'E) were all within +/-10% of predicted values at all Fi,O2S except when Vt(t) was 50 mL. When PEEP was increased to 12 cm H2O, error in measurement of V'O2 increased and became unacceptably large as Fi,O2 was increased. Each study consisted of six trials, and results showed acceptable reproducibility as demonstrated by narrow 95% confidence intervals. For V(t)s of 100-500 mL, the metabolic monitor provided accurate and reproducible results under in vitro testing conditions when PEEP was low. Accurate results could not be obtained with a Vt of 50 mL or at elevated PEEP.

Acetaminophen toxicity in children: diagnostic confirmation using a specific antigenic biomarker.

Chronic acetaminophen (APAP) toxicity poses a difficult diagnostic challenge to the clinician. Signs and symptoms are nonspecific and no currently available laboratory study can confirm APAP as the causative agent of hepatic injury. In this study an antigenic biomarker for APAP toxicity was used to confirm the diagnosis of APAP-induced hepatic failure in two children with chronic APAP toxicity. APAP that has been metabolized to N-acetyl-benzoquinone imine (NAPQI) reacts with cellular proteins to form 3-(cystein-S-yl)-APAP protein adducts (3-Cys-A). Serum from both patients was submitted for quantitation of 3-Cys-A by a competitive inhibition enzyme-linked immunosorbent assay (ELISA). Concentrations of 3-Cys-A in the two patients were 1.97 and 2.77 nmol/mg protein, which are similar to concentrations found in adults with hepatic injury secondary to an overdose of APAP. Individuals with no exposure to APAP have no detectable 3-Cys-A in serum. It was concluded that 3-Cys-A is a useful marker of APAP intoxication after long-term ingestion of APAP when total dose and time course of ingestion are uncertain, and may prove to be a useful clinical and investigative tool in the study of APAP intoxication.

Psychosocial stress in pregnancy and its relation to the onset of premature labour.

A modified life events inventory was presented over a four-month period to 132 consecutive women going into spontaneous labour in Hull and Manchester. Three study groups were identified according to the duration of pregnancy. The levels of psychosocial stress in pregnancy were found to be particularly high in the mothers whose babies were born preterm. Stressful events may precipitate preterm labour in some women. The concept of antenatal care may have to be broadened if the incidence of premature labour and resulting perinatal mortality are to be reduced.