תוצאת חיפוש

Color Doppler Imaging of Central Retinal Artery in Retinopathy of Prematurity

Alon Harris, Hanna J. Garzozi, Mira Harris-Izhak, Nir Shoham, Daniel R. Holland

Depts. of Ophthalmology, Indiana University School of Medicine, Indianapolis and of HaEmek Medical Center, Afula; and Eye Health Northwest, Portland, Oregon

Color Doppler imaging (CDI) is a noninvasive technique, combining 2-dimensional brightness-modulated (B-mode) ultrasound evaluation of eye and orbital structures, with simultaneous color-coded Doppler imaging of orbital blood flow. It has been used to characterize various ophthalmic disorders in adults. Currently there is no data describing orbital blood flow parameters in either normal children or in those with ophthalmic disease, such as the retinopathy of prematurity (ROP).

We evaluated blood flow in the central retinal artery of preterm infants undergoing examination for ROP. We also investigated whether useful readings could be obtained on a consistent basis, and the reproducibility of differences in central retinal artery blood flow between subjects with and without ROP (including the influence of "plus" disease).

We obtained hemodynamic readings in 43 of 46 eyes of preterm infants. 13 eyes had no signs of ROP; 18 had ROP (at least stage 1) without "plus" disease, and 12 had ROP with "plus" disease. There were no statistically significant differences in systolic blood flow velocity within the 3 groups. However the average velocity was slower in the "plus" disease group, correlating with the clinical finding of dilated and tortuous blood vessels which characterize the posterior retina of ROP eyes with "plus" disease.

Relationship Between Preterm Birth and Exertion During Pregnancy

S. Gazit-Nissim, E. Sheiner, M. Mazor, I. Shoham-Vardi

Depts. of Obstetrics and Gynecology, Epidemiology and of Health Services Evaluation, Soroka-University Medical Center, and Ben-Gurion University of the Negev, Beer Sheba

The relationship between physical activity at home and at work during pregnancy and preterm birth was studied. Using a case-control design, 99 women who delivered preterm were compared with 189 women who had term deliveries. The risk of preterm birth was tested in relation to characteristics of work in and outside the home. All women were interviewed post-partum before discharge.

There were no statistically significant differences between the groups in relation to sociodemographic and obstetrical factors, but level of education was significantly lower in the study group versus the control group (p=0.001).

Women who delivered preterm had devoted less time 3 months prior to delivery to household chores (mean of 3.7 hours vs. 4.8 hours in the control group, p=0.002). They also had spent less time walking around the home than the controls (1.2 vs. 1.5 hours, p=0.02). There were no differences between the groups in relation to physical activity outside the home, not during working hours, nor in duration of work. Significantly fewer women who delivered preterm were active in sports (odds ratio 0.22; 95% confidence interval 0.50-0.65; p=0.002).

A low level of education was significantly related to the risk of preterm birth, which may have resulted from lesser compliance with their physician's recommendations. It appears that in women not used to significant physical activity but who had access to adequate prenatal care, physical effort during pregnancy was not related to a higher risk of preterm birth.

Conservative Approach in Abdominal Trauma in Childhood

Nir Shoham, Yechiel Sweed

Dept. of Ophthalmology, HaEmek Medical Center, Afula and Dept. of Pediatric Surgery, Nahariya Medical Center

To determine the results of the conservative approach in the treatment of pediatric abdominal trauma, we retrospectively analyzed data from the files of 95 cases of abdominal trauma in children during a 5-year period.

51 patients (54%) had isolated abdominal injury, while 44 (46%) had multiple trauma. The most common causes of injury were road accidents and falls from heights (74%). CT scans were performed in 61 (64%) with positive results in 90%. Ultrasonography was done in 22 (23%) and was positive in 55%.

The spleen was the most vulnerable intra-abdominal organ (33 patients, 35%), as well as the organ most severely damaged. Other injured organs were: liver (30 cases), kidney (16), stomach (2), large blood vessels (2), and pancreas, duodenum and diaphragm (1 case each).

83 patients (87%) were treated conservatively, while 11 were operated on for penetrating abdominal trauma (3 cases), hemodynamic instability (3), positive DPL (3), and Scale 4 splenic injury and free intra-abdominal air on CT scan (1 case each). Early and late complications were mild.

It is concluded that CT is an efficient and reliable imaging method for diagnosis and staging of severity of injury in blunt abdominal trauma. Nonoperative management of solid organ injuries under careful observation in a pediatric trauma center is safe and appropriate. Most Scale 4 splenic injuries can be treated successfully without surgical intervention. Using this conservative approach there were no late complications.