PubMed · 13478943
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M AUBRY, G SENECHAL, R NATALI. 1957. [Modified Rethi operation].. https://pubmed.ncbi.nlm.nih.gov/13478943/
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OBJECTIVES: Umbilical venous pulsation is an important sign of hemodynamic compromise, but is also found under normal physiological conditions. Mathematical modeling suggests that vascular compliance is a determinant for pulsation, and we tested this by studying velocity pulsation at three sites on the umbilical vein. METHODS: In a cross-sectional study of 279 low-risk pregnancies (20-40 weeks' gestational age) blood flow velocity in the umbilical vein was determined before, within and after the umbilical ring in the fetal abdominal wall, and the incidence and magnitude of pulsation (the difference between the maximum and minimum velocity during a pulse, and pulsatility index) were noted. Based on the fact that the vessel cross-sectional area is an important determinant of compliance, we measured the diameter and time-averaged maximum velocity to reflect variation in diameter and compliance at the three sites. RESULTS: The incidence of umbilical venous pulsation was higher at the umbilical ring in the abdominal wall (242/279, 87%, 95% CI 82-90) than in the cord (43/198, 22%, 95%CI 16-27) or intra-abdominally (84/277, 30%, 95% CI 25-36) (P < 0.001). When pulsation was observed intra-abdominally, the pulsatility was not different from that at the umbilical ring (P = 0.16). However, the lowest pulsatility was found in the cord vein (P < 0.0001), where the largest vein diameter was found. CONCLUSION: The high incidence of venous pulsation at the umbilical ring where diameter and compliance are low supports the suggestion that local compliance is an important factor influencing pulsation in fetal veins.
PURPOSE: The efficacy of peritoneal drainage (PD) as an alternative to laparotomy (LAP) in the management of bowel perforation (PRF) in very low-birth-weight infants (VLBW < or = 1,200 g) remains uncertain. The authors hypothesized that survival of VLBW infants with PRF depends on the severity of illness rather than on the initial surgical approach. METHODS: Demographic, clinical, and outcome data on all VLBW infants were abstracted prospectively over a 12(1/2)-year period. Infants with PRF were stratified by PD or by LAP. Illness acuity was compared using the sum of a 7-point scoring system based on the clinical signs determined to be of prognostic significance. The factors associated with adverse outcome and the epidemiology of PRF were also examined. RESULTS: Of 937 infants, 78 with PRF required surgical intervention, consisting of PD in 32 (41%) and LAP in 46 (59%). Mean birth weight, illness acuity score, and the number of infants with NEC were significantly lower in PD (P =.0005). A higher proportion of PD infants received indomethacin (P =.01). There were no other differences between the 2 groups. Regardless of the choice of procedure, birth weight did not affect mortality rate; however, a shorter interval between PRF identification and surgical intervention was associated with improved survival rate (P =.001). Postoperative liver dysfunction, short gut syndrome, and enteric stricture were more common among LAP. Mortality rate, however, did not differ. When severe thrombocytopenia (P <.03) or neutropenia was present (P <.03), outcome of LAP was better than PD. Rescue LAP for 8 of rapidly deteriorating PD infants saved 5. Regardless of surgical approach, coagulopathy (P <.003), severe thrombocytopenia (P <.005), neutropenia (P <.0001), and multiple organ failure (P <.0001) were all predictive of fatality. CONCLUSIONS: Choice of surgical approach should be based on the underlying illness and not on birth weight. In the presence of clinical indication of necrotic gut, or profound abdominal infection, LAP is a better choice. PD, however, is far less morbid and should be considered for isolated PRF. Rescue LAP must be considered without delay when PD fails.
We describe a case of the posterior interosseous nerve (PIN) syndrome in a patient with gout. Exploration of the PIN revealed multiple hourglass-like constriction of the PIN, which did not correspond to any extrinsic compressing structures. Hourglass-like constrictions of the PIN is one of the causes of the painful PIN syndrome.