Pre- and postnatal diagnosis and outcome of fetuses and neonates with esophageal atresia and tracheoesophageal fistula.

OBJECTIVES: Clinical symptoms and ultrasound signs during pregnancy could suggest the presence of esophageal atresia (EA). However, most often EA is diagnosed postnatally. The aim of our study is to evaluate the course and outcome for prenatally and postnatally diagnosed EA. In addition, we studied the outcome of isolated versus nonisolated EA. METHODS: In a retrospective data analysis, ultrasound characteristics, maternal and neonatal variables as well as clinical outcome were compared for fetuses/neonates with prenatal (n = 30) or postnatal (n = 49) diagnosis of EA. Clinical outcome in terms of morbidity and mortality of isolated EA was compared with that of EA complicated by chromosomal or structural anomalies. RESULTS: Prenatally diagnosed children were born 2 weeks earlier than postnatally diagnosed children (36.4 weeks vs 38.2 weeks; P = 0.02). The former had higher mortality rates (30 vs 12%; P = 0.05) and more associated anomalies (80 vs 59%; P = 0.04). In both subsets, there was a high morbidity rate in the survivors (not significant). Nonisolated EA was associated with greater occurrence of polyhydramnios (53 vs 27%; P = 0.04) and higher mortality rate (28 vs 0%; P = 0.002). CONCLUSIONS: Mortality was significantly higher in prenatally diagnosed infants and in infants with additional congenital anomalies. Isolated EA is associated with good outcome.

The impact of cooling ponds in North Central Texas on dairy farm performance.

The objective of this study was to determine whether measurable differences existed between farms with and without cooling ponds. Data from Dairy Herd Improvement records for 1999 through 2002 were obtained on 42 herds located in North Central Texas. Nineteen herds had installed cooling ponds, whereas 23 herds had not. Monthly somatic cell counts for each herd were obtained from the Federal Milk Market Administrator. Data were analyzed using the PROC MIXED regression model of SAS. Within and across herd groups, milk production from June to October was significantly lower compared with milk production for the rest of the year. Although there was numerically higher average milk production per cow per day throughout the year for herds that used cooling ponds, differences between herd groups that used or did not use cooling ponds were significant only for August production. Herds without a cooling pond had 4.8 kg/d per cow lower production in August than in the cool-season months of November to May (26.4 +/- 0.6 vs. 31.2 +/- 0.5 kg/d), whereas the difference in August production was only 2.9 kg/d per cow in herds that used cooling ponds (29.0 +/- 0.7 vs. 31.9 +/- 0.6 kg/d). Differences caused by seasonal use of a cooling pond in culling, days to first service, days open, percentage of estruses observed, and somatic cell counts were not significant. Bulk tank milk samples cultured for 10 different bacteria showed no difference between cooling pond and noncooling pond herds in 2002. Also, there was no difference in incidence of violations from the Texas Department of Health for herds that used or did not use cooling ponds. However, herds with cooling ponds did have a lower percentage of successful breedings, fewer days dry, and a higher percentage of cows in milk compared with dairy herds that used other forms of cooling. Such differences may or may not be attributed to seasonal use of a cooling pond. Therefore, cooling ponds may provide relief from heat stress without adversely affecting most important measures of herd performance.

Factors influencing the occurrence of active cytomegalovirus (CMV) infections after organ transplantation.

In this study, several factors influencing the occurrence of active CMV infection after organ transplantation (Tx) are analysed. For this purpose, 105 heart, kidney and lung transplant recipients who were CMV-positive or had a CMV-positive donor, were closely monitored for active CMV infection by antigenaemia, cultures, CMV serology and lymphocyte proliferation (LP) to CMV. Univariate and multivariate regression analysis were performed. As pretransplant risk factors the HLA-type and numbers of HLA mismatches between recipients and their donors, and the CMV serology of the recipient and donor were analysed. A new finding was that recipients of donors positive for HLA-B7 were especially at risk for developing active CMV infection (P = 0.03) and CMV disease (P = 0.03). This was not due to increased rejection treatment in these patients. Post-transplant risk factors for development of active CMV infection were absence of detectable cellular immunity to CMV (lymphocyte proliferation) after Tx (P < 0.01) and rejection treatment with OKT3 or ATG (P = 0.05). High levels of IgG anti-CMV did not prevent occurrence of active CMV infection or CMV disease in the CMV+ recipients.

D-Dimer latex assay as screening method in suspected deep venous thrombosis of the leg. A clinical study and review of the literature.

We examined the usefulness of a new commercially available latex agglutination test, measuring cross-linked fibrin degradation products (D-Dimer) in patients suspected clinically of having deep venous thrombosis of the leg. In 33 patients both contrast venography and D-Dimer latex assay were performed. In this group the test had a sensitivity of 48% for the diagnosis and a specificity of 100%. With a prevalence of 64% in our group the negative predictive value was 52%. We conclude that the D-Dimer latex assay is not useful in the initial evaluation of patients with suspected deep venous thrombosis of the leg. A review of the literature is given.