Evaluation of left ventricular function in preterm infants with bronchopulmonary dysplasia using various echocardiographic techniques
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Aim Echocardiographic evaluation of left ventricular function in preterm infants with and without bronchopulmonary dysplasia. Methods In 82 preterm infants (32 in no‐bronchopulmonary‐dysplasia group, 35 in mild‐bronchopulmonary‐dysplasia group, and 15 in severe‐bronchopulmonary‐dysplasia group), echocardiography was performed on the first day of life, at 28 days of life, and at 36 weeks postconceptional age. Results The mean E/A ratio at 36 PCA was 0.94±0.31 and 0.73±0.12 in the mild‐ and severe‐bronchopulmonary‐dysplasia groups, respectively ( P =.037). The mean E′‐wave velocity was 5.62±1.61 cm/s vs 4.32±1.11 cm/s at 1 day of life ( P =.006) and 6.40±1.39 cm/s vs 5.34±1.37 cm/s at 28 days of life ( P =.030) in the no‐bronchopulmonary‐dysplasia and mild‐bronchopulmonary‐dysplasia groups, respectively. This measure tended to be lower in the severe‐bronchopulmonary‐dysplasia group compared to the no‐bronchopulmonary‐dysplasia group (5.25±1.29 cm/s at 28 days of life; P =.081). The E/E′ ratio differed between the no‐bronchopulmonary‐dysplasia (7.21±1.85) and mild‐bronchopulmonary‐dysplasia groups (9.03±2.56; P =.019) at 1 day of life. The left ventricle myocardial performance index decreased between 1 day of life and 36 postconceptional age in infants without bronchopulmonary dysplasia and those with mild bronchopulmonary dysplasia, but not in those with severe bronchopulmonary dysplasia. Conclusion E/A and E/E′ ratios are the most sensitive indicators of impaired left ventricle diastolic function in preterm infants with bronchopulmonary dysplasia.Keywords:
Bronchopulmonary Dysplasia
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Cytologic evaluation of tracheo-bronchial washings from neonates on oxygen-respirator treatment results in a fairly distinct sequence of changes. Significant cellular alterations occurred in this study at an earlier date than expected but the results correlate somewhat with the histologic changes as reported by Banersee, Girling, and Wigglesworth. However, cytomorphic changes occured with lower oxygen concentrations than anticipated and the data thus far have not allowed us to define which infant will develop the long term sequella of bronchopulmonary dysplasia. The preliminary data does suggest it may be possible to identify those infants who will develop severe metaplastic-dysplastic changes at an earlier date than usually expected.
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Bronchopulmonary Dysplasia
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Aim: To evaluate the oesophageal function in patients with different types of oesophageal metaplasia and in cases with dysplasia on the basis of the Montreal definition of gastro-oesophageal reflux disease. Patients and Methods: 270 consecutive patients [M/F 151/119, mean age 54.2 years (19–84)] with endoscopic and histological evidence of oesophageal metaplasia were prospectively studied: patients with specialized intestinal metaplasia (SIM, n = 109) and patients without SIM (n = 161). Patients with SIM were subdivided into a dysplasia-positive (n = 34) and a dysplasia-negative (n = 75) group. All patients underwent reflux symptom analysis, oesophageal manometry, and simultaneous 24-hour pH and biliary reflux monitoring. Results: Patients with SIM were significantly older and had a significantly higher body mass index than patients without SIM. A significant male predominance was observed in patients with SIM and dysplasia compared to the dysplasia-negative group. The clinical symptom spectrum and the prevalence of erosive oesophageal lesions were similar in all groups. Patients with SIM had longer metaplastic segments, which was further increased in the dysplasia-positive group. During oesophageal manometry, pH and biliary reflux monitoring, patients with SIM had more severe alterations than patients without SIM, and these were further increased in patients with SIM and dysplasia. Conclusions: Patients with SIM had more severe oesophageal function abnormalities than those with other types of oesophageal metaplasia (e.g. gastric). The oesophageal function was further impaired if dysplasia was present in the metaplastic mucosa.
Intestinal metaplasia
Metaplasia
Esophageal disease
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Few studies have evaluated the change in serum pepsinogen (sPG) levels after the eradication of Helicobacter pylori. The aim of this study was to evaluate the effect of H. pylori eradication on sPG levels in patients with gastric cancer/dysplasia in comparison to a control group.We prospectively enrolled 368 patients with gastric cancer/dysplasia and 610 control subjects. H. pylori status and sPG levels were measured before and after eradication. The follow-up time points were classified as < 12, 12-23, 24-35, and ≥ 36 months.In 179 H. pylori-eradicated patients with gastric cancer/dysplasia and 168 control group subjects, sPG I significantly decreased, and the sPG I/II ratio significantly increased after eradication compared to baseline, and this improvement in sPG values was maintained during all follow-up time points. Significant differences in sPG I and the sPG I/II ratio were observed between the gastric cancer/dysplasia group and the control group < 24 months after eradication. However, these differences in sPG values disappeared after ≥ 24 months of follow up. Moreover, significant differences in the intestinal metaplasia grade were observed between these two groups before eradication until < 24 months after eradication. However, these differences in the intestinal metaplasia grade disappeared after ≥ 24 months of follow up in the corpus.The sPG values and intestinal metaplasia grade (corpus) in the gastric cancer/dysplasia group became similar to those in the control group at long-term follow up after H. pylori eradication. It might be related with the reduction of metachronous gastric neoplasm.
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* Abbreviations:
BPD — : bronchopulmonary dysplasia
RHO — : recorded home oximetry
Bringing a healthy newborn home for the first time can be overwhelming. Bringing a medically fragile, technology-dependent preterm infant with bronchopulmonary dysplasia (BPD) home can be life altering. Peri-discharge communication between multiple inpatient and outpatient providers is often fragmented, leaving families vulnerable and stressed.1,2 The equipment commonly used for home monitoring of infants on supplemental oxygen does not communicate with the providers responsible for decisions about titration of the support after discharge. Parents are therefore expected to intermittently report (by recall or by manual diary) the infant’s respiratory status and oxygen saturation trends to the clinicians. Clinicians must make decisions on the basis of the parental history and brief direct observations. Novel approaches to providing high-quality data to the clinicians responsible for postdischarge management of technology-dependent infants with BPD are urgently needed. The recorded home oximetry (RHO) trial reported by Rhein et al3 in this month’s issue of Pediatrics is the first rigorous study to record pulse oximetry in the home environment and use these data to guide the care of preterm infants on supplemental oxygen …
Address correspondence to Sara B. DeMauro, MD, MSCE, Perelman School of Medicine, University of Pennsylvania and Robert’s Center for Pediatric Research, Children’s Hospital of Philadelphia, 2716 South St, Philadelphia, PA 19146. E-mail: demauro{at}email.chop.edu
Bronchopulmonary Dysplasia
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