Identification of virus infections of European eels intended for stocking measures

The spread of viral diseases in eels is suggested to severely affect the European eel (Anguilla anguilla) panmictic population. The European Commission has initiated the Eel Recovery Plan (Council Regulation No. 1100/2007) to try to return the European eel stock to more sustainable levels within that measures eel restocking. However, scientific evidence evaluating the efficacy of stocking remains scarce. In addition, knowledge about the impact and contribution of eel stocking on the distribution of infectious diseases is insufficient. In this study, we aimed to investigate virus infections in batches of eels intended for restocking. We analysed samples of glass eels from certified fisheries and farmed European eels from different aquaculture farms. All analysed eels were purchased within a North Rhine Westphalian conservation program. Via a combination of cell culture and qPCR-based techniques, we detected infections of glass eels with the rhabdovirus Eel Virus European X and anguillid herpesvirus 1 infections in farmed eels (10-15 cm).

Virus infections of the European Eel in North Rhine Westphalian rivers

Viral infections have been suggested to play a role in the decline of the panmictic population of the European eel (Anguilla anguilla). However, despite the importance of knowledge about pathogenic eel viruses, little is known about their spread in the wild European eel population and only a few eel pathogenic viruses have been described so far. In this study, we aimed to investigate the health status of the A. anguilla stock in North Rhine Westphalia (NRW) State of Germany. For this purpose, we examined tissue samples of 16 elvers, 100 yellow eels and 6 silver eels, sampled from the rivers Rhine, Lippe and Ems. Virus detection was performed via a combination of cell culture and PCR. Next to the detection of frequently encountered pathogenic eel viruses (anguillid herpesvirus 1 and eel virus European X (EVEX)), we isolated the eel picornavirus 1 (EPV-1) from tissue of yellow eels and elvers and demonstrate the distribution of EPV-1 in wild eel population in NRW.

Is humane slaughtering of rainbow trout achieved in conventional production chains in Germany? Results of a pilot field and laboratory study

BACKGROUND

Rainbow trout, Oncorhynchus mykiss, is an important fish in European freshwater aquaculture. This industry sector is dominated by small family-owned enterprises located in rural areas. A large percentage of rainbow trout produced by these small enterprises is marketed directly and killed on demand and not processed in commercial processing plants. EU and national regulations stipulate that fish shall be stunned prior to killing and slaughter. The overall objective of this study was to monitor how stunning interventions were integrated into the production chains of German conventional trout aquaculture in order to safeguard animal welfare during stunning and killing. For this, the stunning and slaughtering processes were monitored on 18 rainbow trout farms in various German federal states. During the on-farm research, (i) the stunning success, (ii) injuries related to the stunning procedure, (iii) duration between stunning and killing, and (iv) visible responses at the time of slaughtering were assessed as welfare indicators. In addition, haematological and biochemical blood parameters were measured as indicators for physiological stress. Due to the fact that stunning interventions should induce a loss of consciousness in fish, in a laboratory study, it was examined whether the absence of the brainstem/ behavioural responses, opercular movements (OM) or eye-rolling reflex (vestibulo-ocular reflex, VOR) was correlated with the stage of insensibility.

RESULTS

The majority of rainbow trout farms applied manual percussion (38%) or electrical stunning (48%), while on 14% of the farms, the fish were stunned by electrical stunning which was immediately followed by manual percussion. After percussive stunning, about 92.3% of the rainbow trout displayed no OM or VOR as brainstem/ behavioural indicators of consciousness. This percentage varied on farms which applied electrical stunning. While on the majority of farms, 95 to 100% of the fish were unconscious according to the observation of brainstem/ behavioural indicators, the stunning intervention was less effective on farms where rainbow trout were stunned at current densities below 0.1 A dm² or for a few seconds only. The laboratory study confirmed that the absence of brainstem/ behavioural indicators correlated with the absence of visually evoked responses (VER) of the brain to light stimuli as a neuronal indicator of insensibility. Therefore, the brainstem/ behavioural signs can be used to interpret the stage of insensibility in rainbow trout. A stage of insensibility could safely be induced by exposing portion-sized rainbow trout to an electric current density above 0.1 A dm². This was not influenced by the orientation of the electric field.

CONCLUSIONS

In conventional aquaculture, rainbow trout can effectively be stunned by manual percussion or electrical stunning. Consciousness can be monitored by the absence of opercular movements or the eye-rolling reflex, which are lost approximately at the same time as neurological responses like VER. For safeguarding animal welfare during stunning and killing of rainbow trout in conventional production processes, the stunning process requires careful attention and the operating personnel need to be trained in using the stunning devices and recognising indicators of consciousness.

Detection of piscine orthoreoviruses (PRV-1 and PRV-3) in Atlantic salmon and rainbow trout farmed in Germany

Piscine orthoreoviruses (PRVs) are emerging pathogens causing circulatory disorders in salmonids. PRV-1 is the etiological cause of heart and skeletal muscle inflammation (HSMI) in farmed Atlantic salmon (Salmo salar), characterized by epicarditis, inflammation and necrosis of the myocardium, myositis and necrosis of red skeletal muscle. In 2017, two German breeding farms for Atlantic salmon and rainbow trout (Oncorhynchus mykiss) experienced disease outbreaks with mortalities of 10% and 20% respectively. The main clinical signs were exhaustion and lethargic behaviour. During examinations, PRV-1 in salmon and PRV-3 in trout were detected for the first time in Germany. Further analyses also indicated the presence of Aeromonas salmonicida in internal tissues of both species. While PRV-1 could be putatively linked with the disease in Atlantic salmon, most of the rainbow trout suffered from an infection with A. salmonicida and not with PRV-3. Interestingly, the sequence analysis suggests that the German PRV-3 isolate is more similar to a Chilean PRV-3 isolate from Coho salmon (Oncorhynchus kisutch) than to PRV-3 from rainbow trout from Norway. This indicates a wide geographic distribution of this virus or dispersal by global trade. These findings indicate that infections with PRVs should be considered when investigating disease outbreaks in salmonids.

Stunning of common carp: Results from a field and a laboratory study

BACKGROUND

Common carp Cyprinus carpio is an important food fish in Central Europe, which in some regions is consumed as part of local tradition. The majority of carp are sold by small retailers and not processed in commercial processing plants. The overall objective of this study was to monitor how animal welfare is safeguarded during the stunning and slaughtering of carp for retail sale. For this, the stunning and slaughtering process was monitored on 12 carp farms. Four welfare-related parameters were assessed: (i) stunning success, (ii) injuries related to the applied stunning method, (iii) time between stunning and slaughter, and (iv) visible responses of carp during slaughtering. In addition, indicators of physiological stress were measured. In order to analyse whether the absence of behavioural indicators of consciousness after electrical stunning was correlated with unconsciousness a complementary laboratory study was performed. Here, carp were exposed to electrical current densities between 0.09 and 0.41 A/dm2. The presence of behavioural responses and visually-evoked responses (VER) in the electro-encephalogram in response to light flashes as indicators for an absence of consciousness was recorded.

RESULTS

The carp farms applied manual percussive (18%) or electrical (23%) stunning methods, while the majority of farms used a combination of electrical stunning immediately followed by manual percussive stunning (59%). In the latter condition, 92.6% of stunned carp displayed no behavioural indicators of consciousness and significantly fewer injuries related to mishits compared to sole percussive stunning. In the laboratory study, behavioural indicators of consciousness recovered in carp between 1 and 9 min following removal of the electrical current. However, VER could be recorded already at 30 ± 8 s post stunning. This indicates a fast recovery of carp from electrical stunning when exposed to current densities in the range of those generated by commercially available stunning instruments for fish.

CONCLUSIONS

Under field conditions, percussion (applied manually) and electrical stunning might be poor inducers of unconsciousness before slaughter, while a combination was most effective. In order to undertake improvements in electrical stunning, further investigations into the current density, required for inducing prolonged insensibility in carp during electrical stunning, are needed.

Concentration of carp edema virus (CEV) DNA in koi tissues affected by koi sleepy disease (KSD)

Carp edema virus (CEV), the causative agent of 'koi sleepy disease' (KSD), appears to be spreading worldwide and to be responsible for losses in koi, ornamental varieties of the common carp Cyprinus carpio. Clinical signs of KSD include lethargic behaviour, swollen gills, sunken eyes and skin alterations and can easily be mistaken for other diseases, such as infection with cyprinid herpesvirus 3 (CyHV-3). To improve the future diagnosis of CEV infection and to provide a tool to better explore the relationship between viral load and clinical disease, we developed a specific quantitative PCR (qPCR) for strains of the virus known to infect koi carp. In samples from several clinically affected koi, CEV-specific DNA was present in a range from 1 to 2,046,000 copies, with a mean of 129,982 copies and a median of 45 copies per 250 ng of isolated DNA, but virus DNA could not be detected in all clinically affected koi. A comparison of the newly developed qPCR, which is based on a dual-labelled probe, to an existing end-point PCR procedure revealed higher specificity and sensitivity of the qPCR and demonstrated that the new protocol could improve CEV detection in koi. In addition to improved diagnosis, the newly developed qPCR test would be a useful research tool. For example, studies on the pathobiology of CEV could employ controlled infection experiments in which the development of clinical signs could be examined in parallel with a quantitative determination of virus load.

Another potential carp killer?: Carp Edema Virus disease in Germany

BACKGROUND

Infections with carp edema virus, a pox virus, are known from Japanese koi populations since 1974. A characteristic clinical sign associated with this infection is lethargy and therefore the disease is called "koi sleepy disease". Diseased koi also show swollen gills, enophthalmus, and skin lesions. Mortality rates up to 80 % are described. For a long period of time, disease outbreaks seemed to be restricted to Japan. However, during the last years clinical outbreaks of koi sleepy disease also occurred in the UK and in the Netherlands.

CASE PRESENTATION

In spring 2014 koi from different ponds showing lethargic behavior, skin ulcers, inflammation of the anus, enophthalmus, and gill necrosis were presented to the laboratory for diagnosis. In all cases, new koi had been purchased earlier that spring from the same retailer and introduced into existing populations. Eleven koi from six ponds were examined for ectoparasites and for bacterial and viral infections (cyprinid herpesviruses in general and especially koi herpesvirus (KHV) known formally as Cyprinid herpesvirus 3 (CyHV-3); and Carp Edema Virus). In most of the cases parasites were not detected from skin and gills. Only opportunistic freshwater bacteria were isolated from skin ulcers. In cell cultures no cytopathic effect was observed, and none of the samples gave positive results in PCR tests for cyprinid herpesviruses. By analyzing gill tissues for CEV in seven out of eleven samples by a nested PCR, PCR products of 547 bp and 180 bp (by using nested primers) could be amplified. An outbreak of Koi Sleepy Disease was confirmed by sequencing of the PCR products. These results confirm the presence of CEV in German koi populations.

CONCLUSION

A clinical outbreak of "koi sleepy disease" due to an infection with Carp Edema Virus was confirmed for the first time in Germany. To avoid transmission of CEV to common carp testing of CEV should become part of fish disease surveillance programs.

[Promotion of breast feeding in paediatric outpatient settings]

With some data and examples it can be shown that the competence and the knowledge of paediatric doctor's assistants and paediatric nurses can and should be improved. The training courses to become a "prevention assistant" have been very positively accepted by doctor's assistants and paediatric nurses, and it seems an appropriate method to reach these aims. Prevention and especially promotion of breast feeding is possible in paediatric outpatient settings. The immediate contact between infants, parents, paediatric doctor's assistants, paediatric nurses, and doctors offers a unique opportunity to promote the health of children, mainly due to the high acceptance of regular check-ups. So why not introduce the promotion of breast feeding in paediatric outpatient settings with specially trained doctor's assistants and paediatric nurses?

Severe aortic thrombosis in the neonate--successful treatment with low-molecular-weight heparin: two case reports and review of the literature

Small- to moderate-sized aortic thrombi in the sick newborn are frequently demonstrated, however, severe aortic thrombosis is rarely encountered. We report two newborn infants presenting with signs of decreased lower limb perfusion shortly after birth. An occlusive infrarenal aortic thrombus was demonstrated in both infants by ultrasound. No predisposing condition for thrombosis could be found in the first infant; in the second, an umbilical arterial catheter was the likely cause. The infants were successfully treated with low-molecular-weight heparin. In both infants resolution of the thrombus was observed by ultrasound. No complications of treatment were encountered. The clinical spectrum of neonatal aortic thrombosis and treatment options are reviewed.

RITA/Registry of Industrial Toxicology Animal data: a comparative immunohistochemical study of 77 islet cell carcinomas in Sprague-Dawley and Wistar rats using antibodies against insulin, glucagon, somatostatin and gastrin

The objective of this study was to investigate spontaneous islet cell carcinomas with particular reference to possible existing strain differences between Sprague Dawley (SD) and Wistar (W) rats in incidence and immunohistochemical staining pattern. Secondly the occurrence of somatostatin and/or gastrin-positive islet cell tumors should be tested. Islet cell adenocarcinomas (34 from SD, 43 from W-rats) were selected from the RITA-data base and company in-house data base out of an animal pool of 3915 (1681 SD, 2234 W-rats). They were untreated or sham-treated (vehicle) control animals from carcinogenicity studies and whole life-span experiments. Islet cell carcinomas occurred in a higher incidence in male rats (2.98% for SD, 3.23% for W) than in female rats (1.07% for SD, 0.63% for W). All specimens were immunohistologically stained with antibodies against insulin, glucagon, somatostatin and gastrin and, selected specimens with additional antibodies (pancreatic polypeptide, lipase, chymotrypsin, S100-protein, actin and cytokeratin). 94% (SD) and 93% (W), respectively, were insulin-positive and the mean staining intensity (on a scale ranging from 0-4) for insulin was 3.58 (SD) versus 3.37 (W). This high insulin staining incidence and intensity characterized most islet cell carcinomas as malignant insulinomas. 24% (SD) and 37% (W), respectively, were glucagon-positive. Except two tumors in W-rats with a focal strong glucagon expression, the mean staining intensity for glucagon was low (0.38 SD, 0.72 W). 38% (SD) and 44% (W), respectively, were somatostatin-positive, but except for five cases having a focal to multifocal, moderate to marked staining, only a few tumor cells were positive for somatostatin in the other cases and the mean staining intensity for somatostatin was low (0.50 SD, 0.84 W). 6% (SD) and 23% (W), respectively, were gastrin-positive, but only one case of a male Wistar rat exhibited a focal strong staining in parts of the tumor. The other cases showed only a few tumor cells which were positive for gastrin. The mean staining intensity for gastrin was low (0.06 SD, 0.35 W). In all tumors with marked glucagon, somatostatin or gastrin expression, the immunostaining for insulin was still predominating. Thus, insulin was the major hormone produced by most of the tumor cells. Five out of 77 tumors evaluated were immunohistologically negative with all applied antibodies.

CONCLUSION

This study presents the first immunohistochemical survey on spontaneous islet cell carcinomas in SD and Wistar rats stained with antibodies against the endocrine pancreas hormones insulin, glucagon, somatostatin and gastrin. No major differences in incidence or immunohistochemical staining pattern between SD and W-rats could be detected. In contrast to SD rats, Wistar rats had multihormonal coexpression in 16.3%. The multihormonal appearance of the neoplasms is well comparable with the findings in other animal species and human insulinomas. Moreover, this is the first study in rats which reports five cases with a marked co-expression of somatostatin and one case with marked focal co-expression of gastrin in malignant islet cell adenocarcinomas.

Early-infantile galactosialidosis: prenatal presentation and postnatal follow-up

Galactosialidosis (GS) is an autosomal recessive condition caused by combined deficiency of the lysosomal enzymes beta-galactosidase and alpha-neuraminidase. The combined deficiency has been found to result from a defect in protective protein/cathepsin A (PPCA), an intralysosomal protein which protects these enzymes from premature proteolytic processing. The most severe form of GS, the early-infantile form, results in early onset of edema, ascites, visceromegaly, and skeletal dysplasia. We report a case of early-infantile GS in a male infant who presented with nonimmune fetal hydrops (NIH), "coarse" facial appearance, massive fluid-filled inguinal hernias, multiple telangiectasia, and diffuse hypopigmentation; he subsequently developed visceromegaly. The diagnosis of GS was confirmed biochemically and the defect in PPCA characterized at the protein level. Examination of fetal peripheral blood smears sampled at 30 weeks gestation demonstrated vacuolation of lymphocytes, suggesting blood film examination may be a useful screening tool for cases of NIH where a metabolic disorder is suspected. Skeletal radiography at birth demonstrated punctate epiphyses of the femora, calcanei, and sacrum. We present a discussion of and differential diagnosis for this radiographic finding. To the best of our knowledge, this is the first case of early-infantile GS presenting with stippled epiphyses.

Neonatal adrenal congestion: a sonographic-pathologic correlation

We reviewed the clinical, sonographic and pathologic findings in eight neonates in whom diffuse enlargement and abnormal echogenicity of the adrenal glands was documented sonographically. Four of the patients suffered from perinatal asphyxia and two others required mechanical ventilation for other reasons. Six patients died and one suffers from severe development delay, cerebral palsy and failure to thrive. Sonographically, the glands were enlarged, their surface was smooth and there was loss of the central echogenic stripe. Diffuse sinusoidal congestion was found histologically in all five in whom autopsies were performed. These sonographic findings represent part of the spectrum of adrenal changes in neonatal asphyxia and other causes of perinatal stress, and may be associated with poor outcome because of other sequelae of asphyxia.

Lethal neonatal Menkes' disease with severe vasculopathy and fractures

A male neonate presented with an acute onset of severe intra-abdominal bleeding, haemorrhagic shock and multiple fractures leading to death on d 27. Menkes' disease was diagnosed at autopsy and confirmed by copper accumulation studies on cultured fibroblasts. Such an early onset of fatal complications in this condition has not been previously reported. New insights into the pathogenesis of Menkes' disease provided by DNA mutation analysis and difficulties in neonatal diagnosis are discussed. Menkes' disease should be considered in male infants with pathological fractures and other signs of connective tissue disease, even in the neonatal period.

Gastric-outlet obstruction induced by prostaglandin therapy in neonates

BACKGROUND

An infusion of prostaglandin E1 is widely used to maintain patency of the ductus arteriosus in neonates with congenital heart disease. After gastric-outlet obstruction was recognized in several infants who received prostaglandin E1, we studied the association between the drug and this complication.

METHODS

We evaluated all neonates who received prostaglandin E1 in our hospital between October 1, 1989, and September 30, 1991, for clinical, radiologic, or pathological evidence of acute gastric-outlet obstruction.

RESULTS

Of the 74 neonates evaluated, 65 had no signs of gastric obstruction and were considered normal; 5 had clinical and radiologic or pathological evidence of gastric obstruction consistent with the presence of antral mucosal hyperplasia. The remaining four neonates had clinical signs of gastric obstruction, but no radiologic or pathological examinations were performed. The 5 neonates with antral hyperplasia had received prostaglandin E1 for longer periods (mean [+/- SD] duration, 569 +/- 341 hours) than the 65 normal neonates (54 +/- 58 hours, P less than 0.001) or the 4 neonates with clinical signs of gastric obstruction (119 +/- 60 hours, P less than 0.05). The cumulative dose of prostaglandin E1 was higher in the neonates with antral hyperplasia (2982 +/- 1392 micrograms per kilogram of body weight) than in the normal neonates (279 +/- 270 micrograms per kilogram, P less than 0.001) or the neonates with signs of gastric obstruction (528 +/- 306 micrograms per kilogram, P less than 0.01). In two neonates with antral hyperplasia, the cessation of therapy lessened the gastric-outlet obstruction.

CONCLUSIONS

The administration of prostaglandin E1 to neonates can cause gastric-outlet obstruction due to antral hyperplasia. Neonates who receive prostaglandin E1 at recommended doses for more than 120 hours should be closely monitored for evidence of antral hyperplasia.

Corneal diameter, axial length, and intraocular pressure in premature infants

PURPOSE

Seventy premature infants 25 to 37 weeks' postconceptional age were examined during their first week of life to determine the correlation of corneal diameter, axial length, and intraocular pressure with gestational age and birth weight.

METHODS

Corneal diameter measurement was determined with corneal templates, total axial length with standardized A-scan ultrasound, and intraocular pressure with a Tonopen II tonometer.

RESULTS

Corneal diameter and total axial length showed parallel linear increases from 6.2 mm to 9.0 mm and 12.6 mm to 16.2 mm, respectively; however, no significant correlation was found between intraocular pressure and gestational age or birth weight. The mean intraocular pressure was 10.3 mmHg (standard deviation, 3.5).

CONCLUSION

Normative values are established for corneal diameter and total axial length as they relate to birth weight and gestational age, and a mean and standard deviation for intraocular pressure in the premature newborn. These values will aid the ophthalmologist in assessing ocular dimensions in premature infants.

Induction of labor as compared with serial antenatal monitoring in post-term pregnancy. A randomized controlled trial. The Canadian Multicenter Post-term Pregnancy Trial Group

BACKGROUND

The rates of perinatal mortality and neonatal morbidity are higher for post-term pregnancies than for term pregnancies. It is not known, however, whether the induction of labor results in better outcomes than does serial fetal monitoring while awaiting spontaneous labor.

METHODS

We studied 3407 women with uncomplicated pregnancies of 41 or more weeks' duration. The women were randomly assigned to undergo induction of labor or to have serial antenatal monitoring and spontaneous labor unless there was evidence of fetal or maternal compromise, in which case labor was induced or cesarean section was performed. In the induction group, labor was induced by the intracervical application of prostaglandin E2. Serial antenatal monitoring consisted of counts of fetal kicks, nonstress tests, and assessments of amniotic-fluid volume. The outcomes we measured were the rates of perinatal mortality, neonatal morbidity, and delivery by cesarean section.

RESULTS

Among the 1701 women in the induction group, 360 (21.2 percent) underwent cesarean section, as compared with 418 (24.5 percent) of the 1706 women in the monitoring group (P = 0.03). This difference resulted from a lower rate of cesarean section performed because of fetal distress among the women in the induction group (5.7 percent vs. 8.3 percent, P = 0.003). When two infants with lethal congenital anomalies were excluded, there were no perinatal deaths in the induction group and two stillbirths in the monitoring group (P not significant). The frequency of neonatal morbidity was similar in the two groups.

CONCLUSIONS

In post-term pregnancy, the induction of labor results in a lower rate of cesarean section than serial antenatal monitoring; the rates of perinatal mortality and neonatal morbidity are similar with the two approaches to management.

[Abilities and requirements profile of rheumatic patients, basis for suitability assessment as an interdisciplinary task in vocational rehabilitation]

Vocational rehabilitation service provision is always required when current job tasks can no longer be carried out due to disease-related performance restrictions. For social service agencies and employment offices as well as the rehabilitation facilities to intervene, information is needed on the remaining abilities, in order to be able to match future job requirements accordingly. Chronic rheumatic diseases gain increasing importance due to their high incidence and chronic progression; their impact on the capacity for work is considerable, with little attention however so far paid by the rehabilitation community. For 30 rheumatic patients of working age, abilities profiles have therefore been prepared and requirements profiles been established for their current job tasks, based on the methodological concept of Ertomis-Stiftung which had been supplemented by certain items important from an industrial medical angle. The findings show that the rheumatic person experiences limitations in all movement functions, and that lifting and carrying in particular are not possible. A major request is inclusion of a dynamic assessment criterion in the abilities profiles, as the person with a rheumatic disease in principle is capable of carrying out all movements, not however at the speed required to perform the job tasks.

[The occurrence of tumors in large bears (Ursidae)--a literature review and six case descriptions]

Histological findings on two Malayan sun bears and four sloth bears show that malignant neoplasms play an important role in tropic bears. Further, most of the tumors originated from the hepatic and biliary tract. Our results were compared with other investigations on zoo animals during the last 70 years revealing that malignant neoplasms are the most common ones in bears of the family Ursidae. Accordingly to our results, sloth and Malayan sun bears seem to have a disposition to develop malignant neoplasms of the hepatic and biliary tract, but within other species only polar bears seem to suffer predominantly from such neoplasia. The reason for this phenomenon could be an alimentary intake of carcinogens. Furthermore, Malayan sun bears show very often neoplasms of the thyroid gland as it is also observed in other carnivora.

Hyperplasia of somatostatin and pancreatic polypeptide immunoreactive cells in dogs with idiopathic atrophy of the exocrine pancreas

The pancreatic tissue from 25 dogs with idiopathic atrophy of the exocrine pancreas, and from 6 control dogs, was studied histologically and immunohistometrically. Cells producing insulin (B), glucagon (A), somatostatin (D), and pancreatic polypeptide (PP) were identified using specific antisera and the ABC technique. Histometrical quantitation revealed differences in the distribution of these cell types between the right and left pancreatic lobe. Initial stages of atrophy showed little changes concerning the relative proportions of the four cell types examined. In more advanced stages of atrophy, however, there was significant increase in the percentage of the D cells in the cell population of the left lobe. B and A cells showed no significant changes. In final stages, only tiny tissue spots were considered a secondary and regenerative phenomenon, but an endocrine dysregulation cannot be excluded. Atrophy accompanied by diabetes mellitus and a lack of B cells seem to be due to a deficiency of insulin.

Cerebral blood-flow velocity patterns in post-hemorrhagic ventricular dilation

To evaluate the effect of ventricular dilation (VD) on cerebral hemodynamics, serial cerebral bloodflow velocity patterns from the anterior and middle cerebral, and circle of Willis arteries were examined by range-gated, pulsed Doppler sonography in premature infants developing post-hemorrhagic VD. Nine infants (25 to 30 weeks gestation) without a patent ductus arteriosus were studied until resolution of VD. Forty-nine cranial sonograms from all nine infants were reviewed independently and grouped cross-sectionally into mild, moderate and severe VD prior to shunt. The corresponding pulsatility index (PI) showed a consistent trend of increase with VD in all three studied vessels. In six infants, absent or reversed diastolic flow was observed at the height of VD. Four of these infants required V-P shunt. Immediate fall in PI occurred in all three vessels. Serial measurement of PI during VD reflects global changes in cerebrovascular resistance. Results confirmed PI could be a useful index in monitoring cerebral hemodynamic changes.

Regional cerebral blood flow velocity patterns in newborn infants

Using range-gated pulsed Doppler sonography, cerebral blood flow velocity (CBFV) waveforms from the anterior cerebral artery (ACA), middle cerebral artery (MCA) and circle of Willis artery (CW) were examined in a total of 34 newborn infants. We compared the pulsatility index (PI) from the three cerebral arteries sampled in 10 term and 10 preterm (29 +/- 2 weeks) newborn infants without a history of perinatal asphyxia or intracranial pathology. The Pl in the ACA ranged from 0.60 to 1.03. There were no significant differences in Pl between the three vessels by paired comparisons. The Pl of the MCA differed from that of the ACA by 0.00 +/- 0.05. The variation coefficient (CV) was 7%. For CW with ACA, the difference was 0.00 +/- 0.04 and CV was 6%. Both intra- and interexaminer variation in Pl measurements were studied in another 14 infants. The variation coefficients were 5-8% for all three cerebral arteries. We showed that CBFV waveform patterns were similar in regional cerebral arteries, with Pl being a consistent CBFV index. In normal cerebral circulation, the intervessel Pl differences were within observer variations. Deviation from this may suggest abnormal regional cerebral haemodynamics.

Impact of delayed development in premature infants on mother-infant interaction: a prospective investigation

We examined events that precede a diagnosis of developmental delay by comparing 16 very low birth weight premature infants whose condition was diagnosed as developmental delay at 18 months corrected age with 16 matched developmentally normal infants. All infants were observed with their mothers during maternal visits to the nursery and during home visits 1, 3, 6, and 9 months after discharge. The mothers' reactions to their infants were rated at these times. All the children were followed up at a neonatal clinic, and detailed clinic records were used to document the time when a physician first suspected a delay and when this delay was first mentioned to the mother. The results indicate that parents had usually been told of their child's handicap by the time the child was 6 to 9 months old; yet mothers of the delayed children changed the interaction with their children as early as 1 month after discharge from hospital. These mothers initially touched, smiled at, and talked to their developmentally delayed infants significantly more often, but by 9 months they did so much less often than mothers of nondelayed children. The degree of change in mothers' behavior was related to their psychosocial background, with better-adjusted mothers showing the most change. We conclude that mothers' statements about their infants are usually valid and that physicians may share their potential concerns about infants more freely.

Effect of pneumothorax-induced systemic blood pressure alterations on the cerebral circulation in newborn dogs

Pneumothorax has been associated with intraventricular hemorrhage in premature infants, although the mechanism for this relationship is not clear. Because alterations in cerebral blood flow are believed to be important in the pathogenesis of intraventricular hemorrhage, the effect of induced pneumothorax and subsequent evacuation on the cerebral circulation in 16 newborn dogs was evaluated. Continuous Doppler ultrasound was used to monitor changes in cerebral blood velocity. Pneumothorax was induced by slow infusion (5 cc/kg/min) or rapid infusion (5 to 10 seconds) of air to reduce mean arterial blood pressure to half of base-line levels. Both methods of pneumothorax induction resulted in significant elevations of central venous pressure and intrapleural pressure, whereas mean arterial blood pressure and cerebral blood velocity decreased significantly. In each group, the pneumothorax was evacuated either by slow withdrawal of air (10 cc/kg/min) or as rapidly as possible. Rapid evacuation of air resulted in an immediate increase in mean arterial blood pressure and cerebral blood velocity to supranormal levels. Slow evacuation led to a more gradual normalization of mean arterial blood pressure and cerebral blood velocity. It is suggested that the precipitous increases in mean arterial blood pressure and cerebral blood velocity following rapid evacuation of a tension pneumothorax may account for the observed association between pneumothorax and intraventricular hemorrhage in premature infants.

Regional cerebral blood flow, cerebral blood velocity, and pulsatility index in newborn dogs

A technique employing a Doppler ultrasound probe to measure cerebral blood velocity was used to study the cerebral circulation continuously in 30 newborn mongrel dogs. Utilizing a transfontanelle approach, the probe was maintained in fixed position throughout a given experiment. In 20 animals, changes in systolic, diastolic, and mean cerebral blood velocity during hypo- and hypercarbia were directly correlated (P less than 0.01) with changes in regional cerebral blood flow (rCBF) determined in 12 regions of the brain by the [14C]iodoantipyrine autoradiography technique. In an additional 10 dogs, multiple determinations of systolic, diastolic, and mean blood velocity were made over a wide range of PaCO2 values and found to be directly related to the PaCO2 (P less than 0.001). These data suggest that changes in cerebral blood velocity are closely related to changes in cerebral blood flow. We also calculated the pulsatility index (PI) from the peak systolic and end diastolic velocities and found a poor, but direct (r = 0.28, P less than 0.05) relationship between the PI and PaCO2 rather than the indirect relationship, which has been suggested in published clinical studies. We conclude that the Doppler technique may be valuable in monitoring dynamic events of the neonatal cerebral circulation if a constant probe position is maintained. Our results suggest, however, that the PI is not a reliable index of cerebral vascular resistance.

Blood-brain barrier permeability to lactic acid in the newborn dog: lactate as a cerebral metabolic fuel

The arteriovenous difference (A-V) method was utilized to assess the permeability of the blood-brain barrier to lactic acid in paralyzed and artificially ventilated newborn dogs. A femoral artery and the sagittal sinus were cannulated to sample arterial and cerebral venous blood simultaneously for measurements of glucose and lactate during normoglycemia, normoglycemia and hyperlactatemia insulin-induced hypoglycemia, or hypoglycemia and hyperlactatemia. During normoglycemia, arterial lactate concentrations remained less than 2 mmoles/liter for up to 2 h; mean A-V lactate was essentially zero. Arterial lactate increased up to 8 mmoles/liter during intravenous infusion of neutralized 10 mM L-lactic acid. During hyperlactatemia, the A-V lactate was directly proportional to the arterial concentration of the metabolite, a finding which is consistent with transport into brain either by simple diffusion or via a carrier with saturability greater than 8 simple diffusion or via a carrier with saturability greater than 8 mmoles/liter. During hypoglycemia (mean arterial glucose=27 mg/dl), A-V glucose was reduced by 71% with a significant increase in A-V lactate at an arterial lactate level of 1.3 mmoles/liter. Hyperlactatemia combined with hypoglycemia resulted in A-V lactate which was 2-3 fold greater than during normoglycemia at similar arterial lactate concentrations. Brain/blood lactate ratios declined by 83% during hypoglycemia compared with normoglycemic ratios, indicating that, once in brain, lactic acid was actively consumed for oxidative processes. These experimental observations may have clinical relevance in newborn human infants when concentrations of lactate in blood often approach or even exceed those of glucose.

Ventricular dimensions of the brain in premature and full-term infants

A total of 120 computed tomographic scans of the brain in premature and full-term infants were reviewed. Of these, 28 were judged to exhibit normal ventricular dimensions, and the bifrontal, bicaudate, and bioccipital indices of the lateral ventricles were determined. The bifrontal and bicaudate indices followed a Gaussian distribution, with mean values of 0.28 +/- 0.07 (SD) and 0.15 +/- 0.03 (SD), respectively, whereas the bioccipital index was uniform in its distribution (range, 0.13 to 0.26). For comparison, corresponding indices were determined in scans of ten infants with clinical evidence of hydrocephalus. Based on these data, guidelines are suggested to distinguish normal and abnormal ventricular dimensions in newborn infants.