Octreotide - Additional Conservative Therapy for Postoperative Chylothorax in Congenital Heart Disease

INTRODUCTION: Chylothorax is a rare but serious postoperative condition in children with congenital heart disease. Conventional medical treatment consists of specific long-term dietary modification, and surgical reintervention, such as lymphatic duct ligation, may be indicated in refractory cases. In recent years, an additional conservative treatment, octreotide, a synthetic analog of somatostatin, has been used in management of congenital and postoperative chylothorax. METHODS: The objective of this work was to analyze the efficacy and safety of this treatment for chylothorax after congenital heart surgery. We reviewed the records of sixteen patients with chylothorax after surgery for congenital heart disease between January 1999 and December 2007, and collected the following data: demographic information; type of surgical procedure; onset, duration and management of chylothorax and treatment; and duration of hospital stay. To analyze efficacy we compared these parameters in children receiving conventional treatment only with those receiving octreotide. To analyze safety we compared the adverse effects of both treatments. Octreotide was administered at a dose of 4 to 10 microg/kg/hour, with monitoring of side effects. RESULTS: The incidence of chylothorax in our population was 1.6%. It occurred more often after Glenn and Fontan procedures (8 patients). Octreotide was begun three days after diagnosis of chylothorax and continued for a median of seventeen days (ranging from 4 to 26 days), until complete resolution. Side effects were frequent (in 3 of the 8 patients) but of no clinical relevance. All patients responded to the therapy and there was no indication for further surgical intervention. DISCUSSION AND CONCLUSIONS: Octreotide is safe and effective in the treatment of postoperative chylothorax in children with congenital heart disease. It is a useful adjunctive therapy to the conventional treatment of this complication

Explosive development of winter storm Xynthia over the subtropical North Atlantic Ocean

In winter of 2009–2010 south-western Europe was hit by several destructive windstorms. The most important was Xynthia (26–28 February 2010), which caused 64 reported casualties and was classified as the 2nd most expensive natural hazard event for 2010 in terms of economic losses. In this work we assess the synoptic evolution, dynamical characteristics and the main impacts of storm Xynthia, whose genesis, development and path were very uncommon. Wind speed gusts observed at more than 500 stations across Europe are evaluated as well as the wind gust field obtained with a regional climate model simulation for the entire North Atlantic and European area. Storm Xynthia was first identified on 25 February around 30° N, 50° W over the subtropical North Atlantic Ocean. Its genesis occurred on a region characterized by warm and moist air under the influence of a strong upper level wave embedded in the westerlies. Xynthia followed an unusual SW–NE path towards Iberia, France and central Europe. The role of moist air masses on the explosive development of Xynthia is analysed by considering the evaporative sources. A lagrangian model is used to identify the moisture sources, sinks and moisture transport associated with the cyclone during its development phase. The main supply of moisture is located over an elongated region of the subtropical North Atlantic Ocean with anomalously high SST, confirming that the explosive development of storm Xynthia had a significant contribution from the subtropics

Kalman filter physical retrieval of surface emissivity and temperature from geostationary infrared radiances

The high temporal resolution of data acquisition by geostationary satellites and their capability to resolve the diurnal cycle allows for the retrieval of a valuable source of information about geophysical parameters. In this paper, we implement a Kalman filter approach to applying tempo-ral constraints on the retrieval of surface emissivity and temperature from radiance measurements made from geostationary platforms. Although we consider a case study in which we apply a strictly temporal constraint alone, the methodology will be presented in its general four-dimensional, i.e., space-time, setting. The case study we consider is the retrieval of emissivity and surface temperature from SEVIRI (Spinning Enhanced Visible and Infrared Imager) observations over a target area encompassing the Iberian Peninsula and northwestern Africa. The retrievals are then compared with in situ data and other similar satellite products. Our findings show that the Kalman filter strategy can simultaneously retrieve surface emissivity and temperature with an accuracy of ± 0.005 and ±0.2 K, respectively

The Role of Propranolol in the Treatment of Infantile Hemangioma

INTRODUCTION: Infantile hemangioma (IH) is one of the most common childhood tumors. There are various medical or surgical therapeutic options, all with suboptimal results. Recently, the successful use of propranolol for involution of IH was described. We report the results of a single-center experience with this therapeutic option. OBJECTIVE: To prospectively assess the efficacy and safety of propranolol in children with infantile hemangioma. METHODS: We performed a prospective analysis of clinical data of all patients with IH referred to a pediatric cardiology center for baseline cardiovascular assessment prior to propranolol therapy. Propranolol was given at a starting dose of 1 mg/kg/day and titrated to a target dose of 2-3 mg/kg/day according to clinical response. Efficacy was assessed through a photograph-based severity scoring scale. Safety was assessed by collecting data regarding significant side effects. RESULTS: Starting in 2010, 30 patients (15 female) were referred for propranolol treatment of IH, at a median age of six months (1-63 months). The mean target propranolol dose was 2.8 mg/kg/day, with a mean duration of therapy of 12 months. All patients experienced significant reduction of IH size and volume. There were no side effects. CONCLUSIONS: In our experience propranolol appears to be a useful and safe treatment option for severe or complicated IH, achieving a rapid and significant reduction in their size. No adverse effects were observed, although until larger clinical trials are completed, potential adverse events should be borne in mind and consultation with local specialists is recommended prior to initiating treatment

Observation of Surface-Avoiding Waves: A New Class of Extended States in Periodic Media

Coherent time-domain optical experiments on GaAs-AlAs superlattices reveal the exis-tence of an unusually long-lived acoustic mode at ~ 0.6 THz, which couples weakly to the environment by evading the sample boundaries. Classical as well as quantum states that steer clear of surfaces are generally shown to occur in the spectrum of periodic struc-tures, for most boundary conditions. These surface-avoiding waves are associated with frequencies outside forbidden gaps and wavevectors in the vicinity of the center and edge of the Brillouin zone. Possible consequences for surface science and resonant cavity ap-plications are discussed.Comment: 16 pages, 3 figure

Expressão fenotípica da miocardiopatia hipertrófica e realce tardio na ressonância magnética cardíaca

INTRODUCTION AND AIM: The prognostic value of late gadolinium enhancement (LGE) for risk stratification of hypertrophic cardiomyopathy (HCM) patients is the subject of disagreement. We set out to examine the association between clinical and morphological variables, risk factors for sudden cardiac death and LGE in HCM patients. METHODS: From a population of 78 patients with HCM, we studied 53 who underwent cardiac magnetic resonance. They were divided into two groups according to the presence or absence of LGE. Ventricular arrhythmias and morbidity and mortality during follow-up were analyzed. RESULTS: Patients with LGE were younger at the time of diagnosis (p=0.046) and more often had a family history of sudden death (p=0.008) and known coronary artery disease (p=0.086). On echocardiography they had greater maximum wall thickness (p=0.007) and left atrial area (p=0.037) and volume (p=0.035), and more often presented a restrictive pattern of diastolic dysfunction (p=0.011) with a higher E/É ratio (p=0.003) and left ventricular systolic dysfunction (p=0.038). Cardiac magnetic resonance supported the association between LGE and previous echocardiographic findings: greater left atrial area (p=0.029) and maximum wall thickness (p<0.001) and lower left ventricular ejection fraction (p=0.056). Patients with LGE more often had an implantable cardioverter-defibrillator (ICD) (p=0.015). At follow-up, no differences were found in the frequency of ventricular arrhythmias, appropriate ICD therapies or mortality. CONCLUSIONS: The presence of LGE emerges as a risk marker, associated with the classical predictors of sudden cardiac death in this population. However, larger studies are required to confirm its independent association with clinical events

Isolated Aortic Coarctation: Experience in 100 Consecutive Patients

INTRODUCTION: Coarctation of the aorta (CoA) is a stenosis usually located in the descending aorta. Treatment consists of surgical or percutaneous removal of the obstruction and presents excellent immediate results but significant residual problems often persist. OBJECTIVES: To describe the presentation, treatment and long-term evolution of a population of 100 unselected consecutive patients with isolated CoA in a single pediatric cardiology center. METHODS: This was a retrospective study of all patients with isolated CoA treated during4 the last 21 years (1987-2008). RESULTS: The patients (n=100, 68.3% male) were diagnosed at a median age of 94 days (1 day to 16 years). The clinical presentation differed between patients aged less or more than one year, the former presenting with heart failure and the latter being asymptomatic with evidence of hypertension (88 and 63%, respectively; p < 0.01). Treatment, a median of 8 days after diagnosis, was surgical in 79 cases (20 end-to-end anastomosis, 31 subclavian flap, 28 patch) and percutaneous in the remaining 21 (15 balloon angioplasty, 6 with stenting). The mean age of surgical patients was younger than in those treated percutaneously (3.4 vs. 7.5 years; p < 0.01). Immediate mortality was 2% and occurred in the surgical group. There was no late mortality, in a mean follow-up of 7.2 +/- 5.4 years. Recoarctation occurred in 8 patients (6 surgical, 2 percutaneous). There are 46 patients who currently have hypertension (19 at rest, 27 with effort), their median age at diagnosis being older than the others (23 vs. 995 days; p < 0.01). CONCLUSIONS: Isolated CoA has an excellent short-term prognosis but a significant incidence of long-term complications, and should thus no longer be seen as a simple obstruction in the descending aorta, but rather as a complex pathology that requires careful follow-up after treatment. Its potentially insidious presentation requires a high level of clinical suspicion, femoral pulse palpation during physical examination of newborns and older children being particularly important. Delay in treatment has an impact on late morbidity and mortality. Taking into account the data currently available on late and immediate results, the final choice of therapeutic technique depends on the patient's age, associated lesions and the experience of the medical-surgical team. Hypertension should be closely monitored in the follow-up of these patients, as well as its risk factors and complications

Biologia reprodutiva de Passiflora cincinnata Mast. (Passifloraceae) na região de Petrolina (Pernambuco, Brazil).

O trabalho objetivou verificar a fenologia, a biologia floral, o comportamento e a freqüência dos visitantes florais em condições de cultivo. P. cincinnata apresentou antese diurna (06h), com tempo de vida da flor de aproximadamente nove horas

Photoinduced suppression of the ferroelectric instability in PbTe

The interactions between electrons and phonons drive a large array of technologically relevant material properties including ferroelectricity, thermoelectricity, and phase-change behaviour. In the case of many group IV-VI, V, and related materials, these interactions are strong and the materials exist near electronic and structural phase transitions. Their close proximity to phase instability produces a fragile balance among the various properties. The prototypical example is PbTe whose incipient ferroelectric behaviour has been associated with large phonon anharmonicity and thermoelectricity. Experimental measurements on PbTe reveal anomalous lattice dynamics, especially in the soft transverse optical phonon branch. This has been interpreted in terms of both giant anharmonicity and local symmetry breaking due to off-centering of the Pb ions. The observed anomalies have prompted renewed theoretical and computational interest, which has in turn revived focus on the extent that electron-phonon interactions drive lattice instabilities in PbTe and related materials. Here, we use Fourier-transform inelastic x-ray scattering (FT-IXS) to show that photo-injection of free carriers stabilizes the paraelectric state. With support from constrained density functional theory (CDFT) calculations, we find that photoexcitation weakens the long-range forces along the cubic direction tied to resonant bonding and incipient ferroelectricity. This demonstrates the importance of electronic states near the band edges in determining the equilibrium structure.Comment: 9 page, 3 figure