Congenital valvular aortic stenosis is a common congenital heart malformation. The rate of progression in childhood, however, remains to be established. We assessed the progression of peak aortic velocity before intervention as well as the frequency of intervention in paediatric patients with isolated congenital valvular aortic stenosis.A retrospective cohort study was performed in 245 consecutive patients with aortic stenosis. Both clinical and echocardiographic data were obtained.Over a period of 9.0 (SD 5.2) years (range 0.1-19.4), the mean annual increase in peak systolic velocity was 0.04 m/s/year (95% CI 0.028 to 0.056 m/s/year; p<0.001) as shown by ANOVA. 40 patients underwent a cardiac intervention shortly after their first echocardiogram. Another 33 patients underwent intervention during follow-up. Interventions were performed significantly more often in patients diagnosed at a younger age and/or with a higher peak velocity at diagnosis (p<0.001). Mortality was considerable in those diagnosed in infancy (5-year survival rate of 73% (SD 9%), whereas it was nearly absent in patients diagnosed after infancy. Most patients who died during infancy had progressive left ventricular dysfunction despite adequate relief of left ventricular outflow obstruction.Valvular aortic stenosis in the paediatric age group usually has a good prognosis beyond the neonatal period. Progression over time is usually limited, although a considerable proportion of patients need intervention shortly after initial diagnosis. Mortality, except for the neonatal age group, is nearly absent.
To establish the impact on morbidity and mortality of prenatally versus postnatally detected duodenal obstruction in a retrospective study design. The prenatal subset consisted of 28 pregnancies with a fetal double bubble sign suspect of duodenal atresia during the period 1991–2003. The postnatal subset was represented by 66 infants with a suspected duodenal atresia admitted to our pediatric surgical department during the same period. Relevant data were gathered from hospital databases and patient records. Statistical analysis included Student-T test for continuous variables, chi-square for dichotomous variables and Kaplan-Meier for survival-rates. In the prenatal subset there were 28 infants with a confirmed duodenal atresia which was sonographically detected at a mean age of 31.3 weeks (range: 20.3–37.3 weeks); the final surviving subset consisted of 23 infants. The postnatal subset consisted of 66 infants. There was a significant difference in severity of the duodenal defect: duodenal stenosis was established in 41% of the postnatal subset versus only 13% of the prenatal subset (p = 0.004). The time interval between birth and final diagnosis of duodena atresia was 4.5 days in the postnatal subset versus only 0.6 days in the prenatal subset (p < 0.001). Morbidity and mortality were not significantly different between the two subsets. The advantage of prenatal detection of duodenal obstruction is optimal adjustment of obstetric and neonatal management and faster diagnosis and treatment in the postnatal period.
In this study, it was shown that the diagnostic accuracy of antibody detection by a counterimmunoelectrophoresis technique could be improved by using cytoplasmic antigens depleted of mannan residues. The specificity of the counterimmunoelectrophoresis increased from 28.6 to 78.6% when cytoplasmic antigens depleted of mannan were used, while the sensitivity slightly decreased from 80 to 70%.
An immunodominant antigen with enolase enzyme activity was purified and used for the development of an assay to detect antibodies directed against this antigen in sera from patients with either invasive candidiasis or Candida colonization. The Au enzyme-linked immunosorbent assay established with the Candida enolase antigen was able to discriminate significantly between invasive candidiasis and colonization in both immunocompetent and immunodeficient groups of patients. The test had a sensitivity of 50% and a specificity of 86% in the immunocompetent patient group. In the immunodeficient patient group, a sensitivity of 53% and a specificity of 78% were established. Antibody levels determined by a counterimmunoelectrophoresis assay with the same set of sera resulted in a better sensitivity for sera from the immunocompetent patient group but a lower specificity, i.e., 80 and 29%, respectively. The counterimmunoelectrophoresis assay of sera from the immunodeficient patient group was not able to discriminate significantly between invasive candidiasis and colonization. With the use of more serum from each patient, the sensitivity of the antibody detection assays increased, while the specificity was maintained. The increase, however, was not statistically significant. Combining the results of the antibody assays with antigen titers obtained by the Cand-Tec assay did not improve the predictive value with respect to invasive candidiasis, as determined by multivariance regression analysis. Furthermore, it was demonstrated by performance of Western blots (immunoblots) that sera from patients as well as a rabbit antiserum cross-reacted with the Candida enolase and baker's yeast enolase enzyme. However, by tandem crossed immunoelectrophoresis it was demonstrated that the antibodies were directed toward different epitopes of the antigen.
Journal Article Factors influencing the outcome of successive IVF treatment cycles in attaining a follicular puncture Get access M.C.W. Scholtes, M.C.W. Scholtes 1 1To whom correspondence should be addressed Search for other works by this author on: Oxford Academic PubMed Google Scholar W.C.J. Hop, W.C.J. Hop 2Biostatistics Growth and Reproduction, Academic Hospital Rotterdam-Dijkzigt, Erasmus UniversityDr Molenwaterplein 40, 3015 GD Rotterdam, The Netherlands Search for other works by this author on: Oxford Academic PubMed Google Scholar A.Th. Alberda, A.Th. Alberda Departments of Gynaecology and Obstetrics, Growth and Reproduction, Academic Hospital Rotterdam-Dijkzigt, Erasmus UniversityDr Molenwaterplein 40, 3015 GD Rotterdam, The Netherlands Search for other works by this author on: Oxford Academic PubMed Google Scholar H.A.B. Janssen-Caspers, H.A.B. Janssen-Caspers Departments of Gynaecology and Obstetrics, Growth and Reproduction, Academic Hospital Rotterdam-Dijkzigt, Erasmus UniversityDr Molenwaterplein 40, 3015 GD Rotterdam, The Netherlands Search for other works by this author on: Oxford Academic PubMed Google Scholar R.A. Leerentveld, R.A. Leerentveld Departments of Gynaecology and Obstetrics, Growth and Reproduction, Academic Hospital Rotterdam-Dijkzigt, Erasmus UniversityDr Molenwaterplein 40, 3015 GD Rotterdam, The Netherlands Search for other works by this author on: Oxford Academic PubMed Google Scholar H.C.van Os, H.C.van Os Departments of Gynaecology and Obstetrics, Growth and Reproduction, Academic Hospital Rotterdam-Dijkzigt, Erasmus UniversityDr Molenwaterplein 40, 3015 GD Rotterdam, The Netherlands Search for other works by this author on: Oxford Academic PubMed Google Scholar G.H. Zeilmaker G.H. Zeilmaker 3Endocrinology, Growth and Reproduction, Academic Hospital Rotterdam-Dijkzigt, Erasmus UniversityDr Molenwaterplein 40, 3015 GD Rotterdam, The Netherlands Search for other works by this author on: Oxford Academic PubMed Google Scholar Human Reproduction, Volume 3, Issue 6, 1 August 1988, Pages 755–759, https://doi.org/10.1093/oxfordjournals.humrep.a136779 Published: 01 August 1988 Article history Received: 30 December 1987 Accepted: 08 April 1988 Published: 01 August 1988
PURPOSE: This study was designed to compare two different types of anal retractors (Parks vs. Scott) with regard to their impact on fecal continence after fistula repair. METHODS: Between November 2000 and November 2001, 30 patients were randomized into two groups. In Group A (n = 15), a Parks retractor was used during fistula repair, whereas in Group B (n = 15), the repair was performed with a Scott retractor. Before and three months after surgery, maximum anal resting pressure and maximum anal squeeze pressure were recorded. In addition, continence status was evaluated using both the Rockwood Fecal Incontinence Severity Index and the scoring system according to Parks. RESULTS: In Group A, the median anal resting pressure dropped from 76 mmHg to 42 mmHg. In Group B, no significant difference was observed between the preoperative and postoperative anal resting pressure. The difference in the changes from baseline between the two groups was statistically significant (P = 0.035). No significant changes in anal squeeze pressure were observed. In Group A, the median Rockwood fecal incontinence score increased from 0 to 12. In Group B, the median Rockwood fecal incontinence score did not change after the operation. The difference between the two groups was statistically significant (P = 0.038). CONCLUSIONS: The use of a Parks retractor during perianal fistula repair has a deteriorating effect on fecal continence, probably because of damage to the internal anal sphincter. Because this side effect was not observed after the use of a Scott retractor, we advocate the use of this retractor during all fistula repairs.
