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(Chewy & R2 @ Chess)From: Terrence.Jones@ncal.kaiperm.orgMon Nov 17 17:50:22 1997
At Fri, 14 Nov 1997, Bernard Cristalli wrote: > >Richard Chudacoff, MD wrote: >> >> > I propose that Geff be elevated from "list-owner" to "list-master" > >> What about 'list-Yoda'? >> >This would make us Jodies > >Bernard Cristalli MD CNGOF ----------------------------------- Bernard, I think this would read "Jedi's", tho (no offense) perhaps ----------------------------------- "Wookie" might better apply. I suspect it's "rotten letters" that has so ----------------------------------- worn Dr. Copel's 'delete' key, that he only briefly 'chimed-in' after his sabbatical. This is a bigger shame than the outcome of the Colts (speaking of 'no offense') game this wknd. He would, as one lister ("jkorot") noted, be an invaluable resource in the setting of fetal tachyarrythmias, as evidenced by this March's Ob Gyn Clin N Am (3/97, 24:201-11), and his former work (co-author van Englen ) in J Am Coll Cardiol (11/94, 24:1371-5). As Dr Braun mentioned, Adenosine is constrained as trans-placental Rx, and must be delivered directly to fetus (Blanch 12/94 Lancet 344:1646). Others have mentioned Flecainide and Amiodarone to cardiovert, and Dig to maintain. Would 'echo' the recommendation for echo (Lopes, Pediatr Cardiol May-June '97, 17: 192-33). Tho onset & duration of Amiodarone may be shorter with younger pts, discontinuation with resolution of SVT/Hydrops may avoid some toxicity. As Matsumara mentions (Thyroid, Winter '92, 2:279-81) Amiodarone is 37% Iodine, and can be suppressive. Magee suggests checking thyroid status on newborn (AJOG 4/95, 172:1307-11). If delivery occurs while still on amiodarone, keep pressors avail. in the event of refractory vasodilation & hypotension (Fulgencio 5/94, Anesthesia 49:406-8). Think the idea of resuscitation via placental perfusion of an intact cord in a depressed infant at birth is intriguing. Would not approach in a "case- controlled, randomized, double-blind..." as we've witnessed the shortcomings of this approach in predicting MAS (meconium aspiration syndrome) - which, incidentally, I'm still interested to hear if any on the list have yet begun nitric oxide - ... but rather would investigate the various parameters that MIGHT BE modified in the O2 sat/Perfusion/acidemia setting (Mover-lev 11/96, Respir Physiol 106:199-208). (Translation: 'basic science', not clinical investigation). For those blessed with reliable Pts: motivated to d/c cigs, but needing a bit o' help from the patch; would echo (again) Dr Braun's sentiments re: CO (carbon monoxide) from combustion and its impact on the fetus (Seckler-Walker O/G (5/97) 89:648-53). Some might argue Sing's study from AJOG 9/92 (167: 843-6) has 'ratty data' (murine Hgb sat'n curves quite similar to human), it does point out the affinity of fetal Hgb and placenta for CO. And Wright has investigated fetal status with nicotine patch (AJOG 5/97, 176:1090-4) with reassuring results, along with demonstration of markedly reduced cotinine levels. Yours forever in carbonite, tj.
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