Masanori Murase

Familial Cases of Periodic Fever with Aphthous Stomatitis, Pharyngitis, and Cervical Adenitis Syndrome

We report three familial cases of periodic fever with aphthous stomatitis, pharyngitis, and cervical adenitis syndrome, including a pair of monozygotic twins and their mother. It suggests that periodic fever with aphthous stomatitis, pharyngitis, and cervical adenitis syndrome may have a certain monogenetic background.

Serial Pulsed Doppler Assessment of Early Left Ventricular Output in Critically Ill Very Low-Birth-Weight Infants

AbstractSerial, detailed assessments of left ventricular output (LVO) in critically ill very low-birth-weight (VLBW) infants of four different gestational ages were performed in the early neonatal period using pulsed Doppler echocardiography. Initially, the LVO values of all groups at 3 hours of age were relatively high. However, LVO dropped transiently at 12 hours and then increased again after 24 hours reaching a steady level of 160–180 ml/kg/min after 48 hours of age. In all four groups, heart rate also decreased significantly at 12 hours of age but did not increase at 24 hours of age. Both the left ventricular stroke volume and the left ventricular ejection fraction in all groups exhibited similar longitudinal changes to those observed for LVO. The LVO values observed in the lower gestational age group were significantly lower than those observed in the upper gestational group before 24 hours of age. Both patent ductus arteriosus and mechanical ventilation did not significantly influence the changes in LVO of VLBW infants at least before 36 hours of age. Our results suggest that in the early neonatal period, there are drastic changes in LVO of VLBW infants that reflect not only changes in heart rate but also changes in myocardial contractility.

Serial assessment of right ventricular function using tissue Doppler imaging in preterm infants within 7 days of life

BACKGROUND We aimed to evaluate right ventricular (RV) function longitudinally using tissue Doppler imaging (TDI) echocardiography in preterm infants. METHODS We selected 101 very-low-birth-weight (VLBW) infants for the study. Echocardiographic examinations including TDI were performed serially within 7days of life. Pulsed-Doppler TDI waveforms were recorded at the tricuspid valve annulus, and peak systolic velocities (Sa), early diastolic velocities (Ea), and late diastolic velocities (Aa) were measured. RESULTS Sa, Ea and Aa were all reduced significantly from 3h to 12h, and then increased gradually thereafter. These three velocities also increased with gestational age in the early neonatal period. The ratio of Ea to Aa (Ea/Aa) did not change significantly within the first week of life. The ratio of E to Ea (E/Ea) in VLBW infants also seemed to remain stable from birth to day 7. The values of Sa appeared to be associated with cardiac output in the early neonatal period. Both Sa and Aa in intubated infants were significantly higher than in non-intubated infants. CONCLUSION RV TDI velocities of preterm infants in the early neonatal period are influenced by gestational age, postnatal age, and respiratory status, although the RV E/Ea ratio appears to be almost stable throughout the neonatal period. Our findings may provide some basis for assessment of RV function in critically ill preterm infants.

Echocardiographic assessment of early circulatory status in preterm infants with suspected intrauterine infection

Objective: To assess early circulatory status in very low birthweight (VLBW) infants with suspected intrauterine infections. Patients: Thirteen VLBW infants who were diagnosed with prenatal infections because of raised serum IgM at birth (infectious group), and 39 infants matched for gestational age and birth weight (control group). Methods: Echocardiographic assessments were performed consecutively from birth to day 28 in all VLBW infants. Left ventricular output (LVO) and left ventricular stroke volume (LVSV) were measured using Doppler echocardiography. Pulsed Doppler assessment of pulmonary artery pressure (PAP) was performed using the corrected ratio of the pulmonary artery acceleration time to the right ventricular ejection time (AT/RVET(c)). Blood flow in the superior mesenteric artery (SMA) was also evaluated by Doppler ultrasound. Results: Mean LVO and LVSV were both significantly higher in the infectious group than in the control group at 12 hours (LVO; 188 v 154 ml/kg/min) and 72 hours (LVO; 216 v 173 ml/kg/min) of life. Pulsed Doppler assessment of PAP showed that mean AT/RVET(c) values were significantly lower in the infectious group than in the control group at 48 hours, 96 hours, day 14, and day 28. In the analysis of SMA flow velocities, both peak systolic velocities and time averaged velocities had decreased significantly in the infectious group compared with the control group at 24 hours, 36 hours, 96 hours, and day 28. Conclusions: VLBW infants with suspected prenatal infection showed a unique circulation status, namely high cardiac output, latency of high PAP, and low organ flow.

Tissue Doppler Analysis of Postnatal Circulatory Dysfunction in Recipient Infants of Twin-Twin Transfusion Syndrome

Background: A recipient infant of twin-twin transfusion syndrome (TTTS) may often suffer from severe circulatory dysfunction postnatally, but an adequate method that can assess early cardiac failure has not been established. Objectives: To examine the clinical utility of tissue Doppler imaging (TDI) echocardiography for management of circulatory dysfunction in preterm TTTS. Methods: Out of 172 very low birth weight (VLBW) infants admitted from 2004 to 2007, five recipient infants of monochorionic diamniotic twins were defined as recipient group (n=5). Three to five control infants matched for gestational age, birth weight, gender were selected from the remaining VLBW infants in the same study period (control group, n=20). Serial echocardiographic examinations including TDI were performed from birth to days 7, then peak systolic velocities (S), early diastolic velocities (Ea), late diastolic velocities (Aa), and myocardial performance index (MPI) were measured at the lateral annulus of mitral and tricuspid valves. Results: There were no significant differences in longitudinal changes of mitral S, Ea, Aa. Values of left ventricular MPIs assessed by TDI in the recipient group before 24 hours after birth appeared to be significantly higher than those in the control group. Early values of tricuspid S and Ea values in the recipients significantly decreased compared to those in the controls. Right ventricular MPIs of recipient infants before 24 hours were also significantly higher than those in the control infants. Conclusions: These preliminary comparisons suggested that early circulatory disturbances of the recipient infants with preterm TTTS might be accurately assessed by TDI.

Assessing ventricular function in preterm infants using tissue Doppler imaging.

ABSTRACT Tissue Doppler imaging (TDI) is a new echocardiographic technique that directly measures velocities in the myocardium. In adult cardiology, it has been well established that echocardiographic assessment using TDI in patients with heart failure should be essential. Recently, TDI assessment has also been applied in children, infants, fetuses, and preterm infants. In very preterm infants, we serially performed echocardiographic assessment including TDI prospectively, and found that TDI velocities at both the mitral and tricuspid valve annulus changed significantly within the first 24 hours of life. It was suggested that the E/Ea ratio for both ventricles in very preterm infants might be almost stable in the early neonatal period. It is suggested that assessment of ventricular function using TDI in preterm infants might be of great value because it allows assessment of both diastolic ventricular function and right ventricular function.

Postnatal Myocardial Performance Index (MPI) in Recipient Infants of Twin-Twin Transfusion Syndrome: A Pulsed-Doppler Study

Twin-twin transfusion syndrome (TTTS), which is a complication of monochorionic diamniotic (MD) twin gestations, is known to be one of the most hazardous events in the perinatal-neoatal period [14]. In the womb, TTTS sometimes result in hydrops fetalis, severe intrauterine growth restriction, and fetal death. In postnatal infants with TTTS, especially in their recipient infants, it may be possible that intractable cardiorespiratory disturbances emerge promptly after birth. Neuronal damage such as periventricular leukomalacia (PVL), which cause occurrence of cerebral palsy in the growth stage, may be followed by these early neonatal events. Several past studies revealed that the pathophysiological basis of TTTS lay upon fetal heart failure caused by major vascular anastomoses in the common placenta [1-4]. Although both early assessment of cardiac performance and appropriate care for heart failure are essential in these infants for stabilization of their general status in the early neonatal period, accurate, detailed examination of cardiac function using methods such as invasive cardiac catheterization may be difficult or impossible[5-8]. Despite improvements in neonatal echocardiography as a non-invasive tool for assessing early cardiac function, there is still no consensus about which indices are most useful for this purpose in very premature infants. Recently, Tei has proposed a new cardiac performance index based on Doppler echocardiography that allows assessment of both systolic and diastolic ventricular function [9-11]. An abnormal increase in this myocardial performance index (MPI) has been proved to be a reliable indicator of the early phase of chronic heart failure in adults [9-13]. Several authors have also suggested that MPI might be of value in children with congenital heart disease and cardiomyopathy [14-16], and more recently in fetuses, neonates and premature infants [17,18]. The purpose of the present study was to assess the usefulness of MPI for postnatal circulatory management of recipient infants of TTTS.

Early gastrointestinal function and nutritional status in preterm infants with cystic periventricular leukomalacia

Objective: To retrospectively investigate the early gastrointestinal function and the nutritional status of very low birth weight (VLBW) infants with cystic periventricular leukomalacia (PVL). Methods: Sixty-five VLBW infants who were admitted to Kakogawa Municipal Hospital were divided into 2 groups: 5 infants were in the PVL group, and the remaining 60 infants were in the normal group. The gastrointestinal function of the infants in the early neonatal period was compared between the 2 groups using an analysis of gastric aspirates and abdominal radiographs, and pulsed-Doppler ultrasonographic measurement of the flow velocity in the superior mesenteric artery (SMA). Results: In the first week, there were more days in which abdominal gastric residual fluids occurred in the PVL group than in the normal group. The occurrence of abnormal findings in the abdominal radiograph within the first 7 days was significantly higher in the PVL group than in the normal group. Longitudinal ultrasonographic comparisons of the SMA flow velocity showed that the mean values in peak systolic velocity and in time-averaged velocity were both significantly higher in the PVL group than in the normal group before 7 days of life. Both the total volume of milk ingested and the total energy intake in the PVL group were significantly lower than in the normal group within the first 2 weeks of life. Conclusions: Despite the low number of infants with PVL, we may suggest that the gastrointestinal function of the preterm infants with cystic PVL may deteriorate significantly compared to normal infants in the early neonatal period of life, and consequently, the early nutritional intakes in the PVL infants are inferior to those in the normal infants.