Joao Luiz Pippi Salle, MD, PhD, FAAP, FRCSC

• Professor, Department of Surgery (Urology),
• University of Toronto
• Head, Division of Urology,
• Hospital for Sick Children,
• Toronto, Canada

Cefazolin is the drug of choice for penicillin allergy without anaphylaxis asthmatic bronchitis child cheapest generic montelukast uk, angioedema asthma exacerbation icd 10 cheap 4mg montelukast with mastercard, respiratory distress asthma treatment by homeopathy order montelukast online now, or urticaria asthma fev1 purchase montelukast 4mg with amex. Group B strep tococcal isolates from women at high risk of anaphylaxis should be tested for 420 Guidelines for Perinatal Care susceptibility to clindamycin and erythromycin asthma symptoms pathology generic montelukast 5mg online, and clindamycin can be used for prophylaxis if susceptibility to both drugs is documented asthma triad definition purchase montelukast overnight. Vancomycin use is recommended only if the isolate is resistant to clindamycin and erythromy cin. Recommended management contin ues to be based on clinical signs, the presence of maternal risk factors, and the likely efficacy of intrapartum antibiotic prophylaxis (or maternal antimicrobial treatment in the case of clinical chorioamnionitis) in preventing early-onset Yes Full diagnostic evaluation* Signs of neonatal sepsis No Yes Greater than or equal to 37 weeks of Observation for 48 hours or more** gestation and duration of membrane rupture less than 18 hours Algorithm for secondary prevention of early-onset group B streptococcal dis ease among newborns. If any of these conditions is not met, the infant should be observed in the hospital for at least 48 hours and until discharge criteria are achieved. Listeriosis ^ the major cause of epidemic and sporadic listeriosis infection is food-borne transmission of the bacterium Listeria monocytogenes. Incriminated foods include unpasteurized milk, cheese, and other dairy products; undercooked poultry; and prepared meats, such as hot dogs, deli meats, and pate, and some contami 422 Guidelines for Perinatal Care nated fresh fruits and vegetables. Asymptomatic fecal and vaginal carriage can result in sporadic neonatal disease, which can cause early-onset neonatal infec tions from transplacental or ascending intrauterine infection or from exposure during delivery. Maternal infection has been associated with preterm delivery and other obstetric complications. Late-onset neonatal infection results from acquisition of the organism during passage through the birth canal or possibly from environmental sources. To prevent pregnancy-related listeria infections, pregnant women are advised not to eat unpasteurized dairy products, under cooked foods, or unwashed fresh fruits and vegetables. Listeria monocytogenes can be recovered on blood agar media from cultures of usually sterile body sites (eg, blood or cerebrospinal fluid). Special techniques may be needed to recover L monocytogenes from sites with mixed flora (eg, vagi na, rectum). Because of morphologic similarity to diphtheroids and streptococci, a culture isolate of L monocytogenes mistakenly can be considered a contaminant or saprophyte. Prompt diagnosis and antibiotic treatment of maternal listeriosis may pre vent fetal or perinatal infection. Listeria monocytogenes is uniformly sensitive to ampicillin, but there may be a synergistic benefit from adding gentamicin. Therapy with intravenous ampicillin and an aminoglycoside is rec ommended for neonatal infections. Complications in adults include pneumonia, sleep disturbance, rib fracture, and incontinence. In the first 6 months of life, illness is more severe, and infant complications include pneumonia, seizures, encephalopathy, and death. Newborns are thought to be protected from infection if high concentra tions of passively transferred pertussis-specific antibodies are present. Immunization During Pregnancy Universal immunization is recommended to prevent transmission of pertussis. Women should ideally receive the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) before conception. However, there is no Perinatal Infections 423 evidence that antenatal vaccination with Tdap causes any adverse effects spe cific to pregnancy. Moreover, immunization with Tdap during pregnancy has been associated with an increase in diphtheria and pertussis antibody levels in newborns of vaccinated mothers. Health care providers should administer Tdap during preg nancy, preferably during the third trimester or late second trimester (ie, after 20 weeks of gestation). Alternatively, if not administered during pregnancy, Tdap should be administered immediately postpartum to ensure pertussis immunity and reduce the risk of transmission to the newborn. Additional guidelines for the administration of Tdap during pregnancy are outlined in the following paragraphs. Extensive information for health care providers and consumers about Tdap and other vaccines can be obtained at To ensure protection against mater nal and neonatal tetanus, pregnant women who never have been vaccinated against tetanus should receive three vaccinations containing tetanus and reduced diphtheria toxoids during pregnancy. Ideally, these adolescents and adults should receive Tdap at least 2 weeks before they have contact with the infant. Neonatal and Infant Management Infected infants younger than 6 months of age frequently require hospitaliza tion for supportive care and to manage complications, but those less than 3 months of age account for most of the pertussis-related mortality. Antimicrobial agents given during the catarrhal stage may lessen the severity of the disease. Tuberculosis Tuberculosis is caused by infection with organisms of the Mycobacterium tuberculosis complex, which primarily affects the lungs. Clinical manifestations include feelings of sickness or weakness, weight loss, fever, and night sweats. The symptoms of tuberculosis also include coughing, chest pain, and the coughing up of blood. The risk of developing tuberculosis is highest during the 6 months after infection and remains high for 2 years; however, many years can elapse between initial tuberculosis infection and the onset of tuberculosis. Once considered rare in the United States, the incidence of tuberculosis has increased considerably in women of childbearing age. Tuberculosis is diagnosed in an individual with infection who also has signs, symptoms, positive cultures, or radiographic manifestations of M tuberculosis. Isolation of M tuberculosis by culture from early morning gastric aspirate, sputum, pleural fluid, or other body fluids establishes the diagnosis of active dis ease. Smears to demonstrate acid-fast bacilli should be performed on sputum and body fluids. Latent tuberculosis infection is defined by a positive Mantoux tuberculin skin test or interferon-gamma release assay in an individual with no physical findings of disease and either a normal chest X-ray or only granuloma or calcifi cation in the lung parenchyma, or regional lymph nodes, or both. The purpose of treating latent tuberculosis infection is to prevent progression to disease. When the result of a tuberculin skin test or interferon-gamma release assay is positive, the time of conversion usually is not known. If a chest X-ray is normal, some experts prefer to delay treatment of latent tuberculosis infection until after delivery because preg nancy itself does not increase the risk of progression to disease and because of an increased risk of drug-induced hepatotoxicity during pregnancy and immediately postpartum. Although isoniazid is not known to be teratogenic, most experts recommend waiting to start therapy until the second trimester of pregnancy. Treatment regimens for tuberculosis are based on the presence or absence of tuberculosis disease, primarily determined by chest X-ray findings and sputum culture and, in the absence of disease, the likelihood of progressing to disease. For this reason, the recommended medication in women known to have converted within the previous 2 years (such as known contacts of other tuberculosis cases) but with no evidence of disease is isoniazid (300 mg per day) starting after the first trimester and continuing for 9 months. All pregnant women receiving isoniazid also should take pyridoxine (50 mg daily) to mitigate the risk of peripheral neuritis. If tuberculosis is diagnosed in a pregnant woman (by positive cultures, com patible clinical findings, or X-ray findings), prompt, multidrug therapy is rec ommended to protect both the woman and the fetus. Isoniazid and rifampin, supplemented initially by ethambutol are recommended drugs. Pyrazinamide frequently is used for the first 2 months in a three-drug or four-drug regimen. Although safety data in pregnancy have not been published, many experts have used the drug in pregnant women with no apparent problems for the woman or the fetus. Therapy with isoniazid and rifampin is continued for at least 6 months for drug-susceptible disease. Neonatal Management In utero infection can occur as a result of hematogenous dissemination, which seeds the placenta; or as a result of aspiration of infected amniotic fluid in utero. Neonatal infection may occur at the time of delivery as a result of aspiration of 426 Guidelines for Perinatal Care tubercle bacilli in women with tuberculosis endometritis. On the rare occasions in which congenital tuberculosis is suspected, diagnostic evaluations and treat ment of the infant and the mother should be initiated promptly. Management of a newborn whose mother (or other household contact) is suspected of having tuberculosis is based on individual considerations. If the mother is asymptomatic, the infant needs no special evaluation or therapy and no separation of the mother and the infant is required. Because the tuberculin skin test or interferon-gamma release assay result could be a marker of an unrecog nized case of contagious tuberculosis within the household, other house hold members should be tested and have further evaluation, as needed. The radiographic abnormality in this cir cumstance probably is because of another cause or because of a quies cent focus of tuberculosis. In the latter case, the mother may develop contagious, pulmonary tuberculosis, if untreated, and should receive appropriate therapy if not treated previously. The mother should be reported immediately to the public health department so that investigation of all household members can be per formed within several days. All contacts should have a tuberculin skin test or interferon-gamma release assay, chest X-ray, and physical exami nation. The mother and the infant should be separated until both are receiving appropriate therapy and the mother is deemed to be not contagious. Women with tuberculosis disease who have been treated appropriately for 2 or more weeks and who are not considered contagious can breastfeed. If the tuberculin skin test result is positive, the infant should be reassessed for tuberculosis disease. If the skin test result is nega tive and the mother and other family members with tuberculosis have good adherence and response to treatment, and are no longer infectious, isoniazid may be discontinued. Because the response to the vaccine in infants may be delayed, the infant should be separated from the ill family member for at least several weeks after vaccination. In general, in the United States directly observed therapy of the infant is preferred. An expert in childhood tuberculosis should be consulted when this is a consideration. Breastfed infants of women taking isoniazid therapy should receive a multivitamin supplement, including pyridoxine. Acquired 428 Guidelines for Perinatal Care syphilis almost always is contracted through direct sexual contact with ulcer ative lesions of the skin or mucous membranes of infected people. Congenital syphilis most often is acquired through hematogenous transplacental infection of the fetus, although direct contact of the infant with infectious lesions during or after delivery also can result in infection. Transplacental infection can occur throughout pregnancy and at any stage of maternal infection. Antepartum Management All pregnant women should be serologically screened for syphilis as early as possible in pregnancy. False-negative serologic test results may occur in early primary infection, and infection after the first prenatal visit is possible. Microscopic dark-field and histologic examinations for spirochetes are most reliable when lesions are present. Pregnant women with syphilis should be treated with a penicillin regimen appropriate to the stage of infection. Women who are allergic to penicillin should be desensitized and then treated with the drug. Erythromycin and azithromycin are suboptimal treatment options because neither reliably cures maternal infection nor treats an infected fetus. Women with syphilis should be queried about illicit substance use, espe cially cocaine. Management decisions are based on the three possible maternal situations: 1) maternal treatment before pregnancy, 2) adequate maternal treatment and response during pregnancy, or 3) inad equate maternal treatment or inadequate maternal response to treatment (or reinfection) during pregnancy. The dosage should be based on chronologic age rather than gestational age and is 50,000 units/kg, intravenously, every 12 hours (for infants 1 week of age or younger) or every 8 hours (for infants older than 1 week). Alternatively, procaine penicillin G, 50,000 units/kg, intramuscularly, can be administered as a single daily dose for 10 days; no treatment failures have occurred with this formulation despite its low cerebrospinal fluid concentrations. Algorithm for evaluation and treatment of infants born to mothers with reactive serologic test results for syphilis. For example, a titer of 1:64 is fourfold greater than a titer of 1:16, and a titer of 1:4 is fourfold lower than a titer of 1:16. If a single dose of benzathine penicillin G is used, then the infant must be fully evaluated, full evaluation must be nor mal, and follow-up must be certain.

Diagnosis Sacrococcygeal teratomas usually appear solid or mixed solid and cystic (multiple cysts are irregular in shape and size) asthma definition 8020 montelukast 10mg on-line. Most teratomas are extremely vascular asthma 10 code generic 4 mg montelukast with visa, which is easily shown using color Doppler ultrasound asthma nos definition buy online montelukast. The tumors may be entirely external asthma treatment list of asthma medications discount 4mg montelukast with amex, partially internal and partly external asthma treatment outcomes buy genuine montelukast on line, or mainly internal asthma definition repoire buy generic montelukast on-line. Polyhydramnios is frequent, and this may be due to direct transudation into the amniotic fluid and due to fetal polyuria, secondary to the hyperdynamic circulation, which is the consequence of arteriovenous shunting. Similarly, high-output heart failure leading to hepatomegaly, placentomegaly and hydrops fetalis can occur. Prognosis Sacrococcygeal teratoma is associated with a high perinatal mortality (about 50%), mainly due to the preterm delivery (the consequence of polyhydramnios) of a hydropic infant requiring major neonatal surgery. Difficult surgery, especially with tumors that extend into the pelvis and abdomen, can result in nerve injury and incontinence. The tumor is invariably benign in the neonatal period but delayed surgery or incomplete excision can result in malignant transformation (about 10% before 2 months of age to about 80% by 4 months). Etiology Hydrops is a non-specific finding in a wide variety of fetal and maternal disorders, including hematological, chromosomal, cardiovascular, renal, pulmonary, gastrointestinal, hepatic and metabolic abnormalities, congenital infection, neoplasms and malformations of the placenta or umbilical cord. Hydrops is classically devided into immune (due to maternal hemolytic antibodies) and non-immune (due to all other etiologies). With the widespread introduction of immunoprophylaxis and the successfull treatment of Rhesus disease by fetal blood transfusions, non immune causes have become responsible for at least 75% of the cases, and make a greater contribution to perinatal mortality. While in many instances the underlying cause may be determined by maternal antibody and infection screening, fetal ultrasound scanning, including echocardiography and Doppler studies, and fetal blood sampling, quite often the abnormality remains unexplained even after expert post-mortem examination. Prognosis Although isolated ascites, both in fetuses and neonates, may be transitory, the spontaneous resolution of hydrops has not been reported and the overall mortality for this condition is about 80%. Ultrasound Diagnosis Figure 1 longitudinal view, abdnormal accumulation of Figure 2 longitudinal view, abdnormal accumulation of serous fluid at the body cavities (pericardial, pleural, or serous fluid at the body cavities (pericardial, pleural, or ascitic effusions). Figure 3 transverse view, at the stomach and bowellevel, Figure 4 transverse view, at the stomach level, with with abdnormal accumulation of serous fluid at the abdome abdnormal accumulation of serous fluid at the abdome or or ascitic effusion. Fetal therapy Immune hydrops can be successfully treated by blood transfusions to the fetus. Such treatment often results in reversal of hydrops and the survival rate is about 80%. Fetal therapy can also successfully reverse some types of non-immune hydrops, such as fetal tachyarrhythmias (by transplacental or direct fetal administration of antiarrhythmic drugs), pleural effusions (by pleuro-amniotic shunting), urinary ascites (by vesico-amniotic or peritoneal-amniotic shunting), parvovirus B19 infection or severe fetomaternal hemorrhage (by fetal blood transfusions), diaphragmatic hernia, cystic adenomatoid malformation of the lungs and sacrococcygeal teratoma (by open fetal surgery), and the recipient fetus in twin-to-twin transfusion syndrome (by endoscopic laser coagulation of the communicating placental vessels). About 80% of such fetuses are constitutionally small, with no increased perinatal death or morbidity, 15% are growth restricted due to reduced placental perfusion and "utero-placental insufficiency", and 5% are growth restricted due to low growth potential, the result of genetic disease or enviromental damage. Ultrasound findings the finding of a small abdominal circumference should stimulate the sonographer to consider four possible causes: wrong dates, normal small, abnormal small or starving small fetus. Accurate measurements of the head and abdominal circumference, femur length and transverse cerebellar diameter should be taken and their various ratios should be examined. Additionally, a detailed examination should be carried out for the detection of any defects or markers of chromosomal abnormalities (mainly triploidy and trisomy 18), and for assessment of amniotic fluid and fetal activity. A repeat ultrasound examination in two weeks will demonstrate an increase in fetal measurements and the rate of growth is normal (the lines joining the measurements are parallel to the appropriate normal mean for gestation). In normal small fetuses, the mother is usually small (the main determinant of fetal size is maternal size), and the ultrasound findings are similar to pregnancies with wrong dates. However, a repeat scan in two weeks may demonstrate a further deviation from normal in the various fetal measurements. In starving small fetuses, the fetal measurements demonstrate asymmetry (the greatest deficit is observed in the abdominal circumference, then the femur length and finally the head circumference with the transverse cerebellar diameter being the least affected), there are no obvious fetal anatomical defects, the amniotic fluid and fetal movements are reduced, the placenta is often thickened with translucent areas (placental lakes) and there are abnormal Doppler waveforms in the uterine and / or umbilical arteries. In congenital infection growth retardation may be associated with features of hydrops and brain abnormalities (ventriculomegaly, microcephaly or cerebral calcifications). Doppler ultrasound Doppler ultrasound provides a non-invasive method for the study of fetal haemodynamics. Investigation of the uterine and umbilical arteries provide information on the perfusion of the utero-placental and feto-placental circulations respectively, while Doppler studies of selected fetal organs are valuable in detecting the hemodynamic rearrangements that occur in response to fetal hypoxaemia. In normal pregnancy, impedance to flow in the uterine artery decreases with gestation and this presumably reflects the trophoblastic invasion of the spiral arteries and their conversion into low resistance vessels. Similarly, there is a decrease in impedance to flow in the umbilical arteries due to progressive maturation of the placenta and increase in the number of tertiary stem villi. Normal Pregnancy Development of the uterine artery Normal impedance to flow in the uterine arteries in 1 trimester Normal impedance to flow in the uterine arteries in early 2 trimester Normal impedance to flow in the uterine arteries in late 2 and 3 trimester Normal Pregnancy Development of the umbilical artery Normal impedance to flow in the umbilical arteries and normal pattern of pulsatility at the umbilical vein in 1 trimester Normal impedance to flow in the umbilical arteries and umbilical vein in early 2 trimester Normal impedance to flow in the umbilical arteries and umbilcal vein in late 2 and 3 trimester Normal Pregnancy Development of the Descending Aorta Color Doppler Energy with visualization of the Aortic Arch and descending thoracic aorta Normal flow of the descending thoracic aorta in 2 and 3 trimesters Normal Pregnancy Development of the Middle Cerebral Artery Color Doppler Energy with visualization of the Circle of Willis and the Middle Cerebral Artery Normal flow of the Middle Cerebral Artery in 1 trimester Normal flow of the Middle Cerebral Artery in 2 and 3 trimester Normal flow of the ductus venosus Normal flow of the inferior vena cava Normal flow of the ventricular valves Color Doppler Energy with bifurcation of the renal arteries Normal flow of the renal artery Abnormal Development of the uterine artery Normal impedance to flow in the uterine arteries (with the characteristic waveform of early diastolic notching) Increased impedance to flow in the uterine arteries (with the characteristic waveform of early diastolic notching) Very high resitance flow in the uterine arteries (with reverese diastolic flow) Abnormal Development of the umbilical artery Umbilical arteries high pulsatility index Umbilical arteries high pulsatility index Umbilical arteries very high pulsatility index end diastolic velocity pulsation in the umbilical vein Umbilical arteries Severe cases absence of reversal of end diastolic frequencies Redistribution of blood flow Middle Cerebral Artery Color Doppler Energy with visualization of the Circle of Willis and the Middle Cerebral Artery. Decrease in impedance to flow in the middle cerebral arteries Redistribution of blood flow Descending Aorta and Renal Artery Descending Thoracic Aorta descrease the diastolic flow increase of the impedance Renal artery end diastolic flow increase of the impedance Severe fetal hypoxemia there is decompenation in the cardiovascular system and right heart failure Peripheral vasoconstriction, as seen in fetal redistribution, causes an increase in ventricular afterload and thus ventricular end diastolic pressure increases. In severe fetal hypoxemia there is decompenation in the cardiovascular system and right heart failure. This is manifested by the absence or reversal of forward flow during atrial contraction in the ductus venosus and this is a sign of impending fetal death. In constitutionally small fetuses Doppler studies of the placental and fetal circulations are normal. Similarly in growth restricted fetuses due to genetic disease the results are often normal. In growth restriction due to placental insufficiency there is increased impedance to flow in the uterine arteries (with the characteristic waveform of early diastolic notching) and umbilical arteries (high pulsatility index and in severe cases absence of reversal of end diastolic frequencies). These data support the findings from histopathologic studies that in this condition there is failure of the normal development of maternal placental arteries into low resistance vessels (and therefore reduced oxygen and nutrient supply to the intervillous space), and reduction in the number of placental terminal capillaries and small muscular arteries in the tertiary stem villi (and therefore impaired maternal-fetal transfer). Doppler studies of the fetal circulation demonstrate decrease in impedance to flow in the middle cerebral arteries and increase in impedance in the descending thoracic aorta and renal artery. These findings suggest that in fetal hypoxemia there is an increase in the blood supply to the brain and reduction in the perfusion of the kidneys, gastro intestinal tract and the lower extremities. Although knowledge of the factors governing circulatory readjustments and their mechanism of action is incomplete, it appears that partial pressures of oxygen and carbon dioxide play a role, presumably through their action on chemoreceptors. Chromosomal defects Although low birth weight is a common feature of many chromosomal abnormalities, the incidence of chromosomal defects in small for gestational age neonates is less than 1-2%. However, data derived from postnatal studies underestimate the association between chromosomal abnormalitites and growth retardation, since many pregnancies with chromosomally abnormal fetuses result in intrauterine death. Thus in fetuses presenting with growth retardation in the second trimester the incidence of chromosomal abnormalities is 10-20%. The chromosomal abnormalities associated with severe growth restriction are triploidy, trisomy 18 and deletion of the short arm of chromosome 4. The incidence of chromosomal defects is much higher in (a) fetuses with multiple malformations, than in those with no structural defects, (b) the group with normal or increased amniotic fluid volume, than in those with reduced or absent amniotic fluid, and (c) in the group with normal waveforms from both uterine and umbilical arteries, than in those with abnormal waveforms from either or both vessels. A substantial proportion of the chromosomally abnormal fetuses demonstrate the asymmetry (high head to abdomen circumference ratio), thought to be typical for uteroplacental insufficiency; indeed the most severe form of asymmetrical growth retardation is found in fetuses with triploidy. In this condition, which is found in about 1% of pregnancies, the fetal karyotype is normal but there are two different chromosomal complements in the placenta (one is usually normal and the other an autosomal trisomy). Placental mosaicism is also associated with uniparental disomy (inheritance of two homologous chromosomes from one parent), which often results in growth restriction. Ultrasonographically, the diagnosis of polyhydramnios or oligohydramnios is made when there is excessive or virtual absence of echo-free spaces around the fetus. Prevalence Oligohydramnios in the second trimester is found in about 1 per 500 pregnancies. Etiology Oligohydramnios in the second trimester is usually the result of preterm premature rupture of the membranes, uteroplacental insufficiency and urinary tract malformations (bilateral renal agenesis, multicystic or polycystic kidneys, or urethral obstruction). Quantitative criteria include: (a) the largest single pocket of amniotic fluid being 1 cm or less, or (b) amniotic fluid index (the sum of the vertical measurements of the largest pockets of amniotic fluid in the four quadrants of the uterus) of less than 5 cm. Anecoic areas simulating pockets of amniotic fluid Color Doppler energy at the umbilical cord In the absence of the "accoustic window" normally provided by the amniotic fluid, and the "undesirable" postures often adopted by these fetuses, confident exclusion of fetal defects may be impossible. Nevertheless, the detection of a dilated blader in urethral obstruction and enlarged echogenic or multicystic kidneys in renal disease should be relatively easy. In cases of preterm prelabour rupture of the membranes, detailed questioning of the mother may reveal a history of chronic leakage of amniotic fluid. Furthermore, in uteroplacental insufficiency, Doppler blood flow studies will often demomstrate high impedance to flow in the placental circulation and redistribution in the fetal circulation. In the remaining cases, intra-amniotic instillation of normal saline may help improve ultrasonographic examination and lead to the diagnosis of fetal abnormalities like renal agenesis. Prognosis Bilateral renal agenesis, multicystic or polycystic kidneys are lethal abnormalities, usually in the neonatal period due to pulmonary hypoplasia. Preterm rupture of membranes at 20 weeks or earlier is associated with a poor prognosis; about 40% miscarry within five days of membrane rupture due to chorioamnionitis and in the remaining 60% of pregnancies more than 50% of neonates die due to pulmonary hypoplasia. Uteroplacental insufficiency resulting in oligohydramnios at 18-23 weeks is very severe and the most likely outcome is intrauterine death. Prevalence Polyhydramnios in the second trimester is found in about 1 per 200 pregnancies. Etiology There are essentially two major causes of polyhydramnios; reduced fetal swallowing or absorption of amniotic fluid and increased fetal urination. Reduced fetal swallowing may be due to craniospinal defects (such as anencephaly), facial tumours, gastrointestinal obstruction (such as esophageal atresia, duodenal atresia and small bowel obstruction), compressive pulmonary disorders (such as pleural effusions, diaphragmatic hernia or cystic adenomatoid malformation of the lungs), narrow thoracic cage (due to skeletal dysplasias), and fetal akinesia deformation sequence (due to neuromascular impairement of fetal swallowing). Increased fetal urination is observed in maternal diabetes mellitus and maternal uremia (increased glucose and urea cause osmotic diuresis), hyperdynamic fetal circulation due to fetal anemia (due to red cell isoimmunization or congenital infection) or fetal and placental tumours or cutaneous arteriovenous malformations (such as sacrococcygeal teratoma, placental chorioangioma), or twin-to twin transfusion syndrome. Quantitatively, polyhydramnios is defined as an amniotic fluid index (the sum of the vertical measurements of the largest pockets of amniotic fluid in the four quadrants of the uterus) of 20 cm or more. Alternatively, the vertical measurement of the largest single pocket of amniotic fluid free of fetal parts is used to classify polyhydramnios into mild (8-11 cm), moderate (12-15 cm) and severe (16 cm or more). Although 80% of cases with mild polyhydramnios are considered to be idiopathic, in the majority of cases with moderate or severe polyhydramnios there are maternal or fetal disorders. In most cases polyhydramnios develops late in the second or in the third trimester of pregnancy. Acute polyhydramnios at 18-23 weeks is mainly seen in association with twin-to-twin transfusion syndrome. Testing for maternal diabetes, detailed sonographic examination for anomalies, and fetal karyotyping should constitute the cornerstones of the diagnostic protocol in the investigation of these cases. Moderate polyhydramnios Polyhydramnios Diaphragmatic Hernia Prenatal therapy the aim is to reduce the risk of very premature delivery and the maternal discomfort that often accompanies severe polyhydramnios. Treatment will obviously depend on the diagnosis, and will include better glycemic control of maternal diabetes mellitus, antiarrhythmic medication for fetal hydrops due to dysrrhythmias, thoracoamniotic shunting for fetal pulmonary cysts or pleural effusions. For the other cases, polyhydramnios may be treated by repeated amniocenteses every few days and drainage of large volumes of amniotic fluid. An alternative and effective method of treatment is maternal administration of indomethacin; however, this drug may cause fetal ductul constriction and close monitoring by serial fetal echocardiographic studies is necessary. In twin-to-twin transfusion syndrome, presenting with acute polyhydramnios at 18-23 weeks of gestation, endocopic laser occlusion of placental anastomoses or serial amniodrainage may be carried out. Ultrasound Obstet Gynecol 1999;13:167-70) Maternal age Gestational age (years) 10 weeks 12 weeks 14 weeks 16 weeks 20 weeks 40 weeks 20 1/983 1/1068 1/1140 1/1200 1/1295 1/1527 25 1/870 1/946 1/1009 1/1062 1/1147 1/1352 30 1/576 1/626 1/668 1/703 1/759 1/895 31 1/500 1/543 1/580 1/610 1/658 1/776 32 1/424 1/461 1/492 1/518 1/559 1/659 33 1/352 1/383 1/409 1/430 1/464 1/547 34 1/287 1/312 1/333 1/350 1/378 1/446 35 1/229 1/249 1/266 1/280 1/302 1/356 36 1/180 1/196 1/209 1/220 1/238 1/280 37 1/140 1/152 1/163 1/171 1/185 1/218 38 1/108 1/117 1/125 1/131 1/142 1/167 39 1/82 1/89 1/95 1/100 1/108 1/128 40 1/62 1/68 1/72 1/76 1/82 1/97 41 1/47 1/51 1/54 1/57 1/62 1/73 42 1/35 1/38 1/41 1/43 1/46 1/55 43 1/26 1/29 1/30 1/32 1/35 1/41 44 1/20 1/21 1/23 1/24 1/26 1/30 45 1/15 1/16 1/17 1/18 1/19 1/23 Table 2 Risk of trisomy 18 (Snijders et al. Va was the distance between the lateral wall of the anterior horn to the mid-line and Vp was the distance between the medial and lateral walls of the posterior horn. For each of the measurements and their ratios, regression analysis was applied examining linear, quadratic and cubic models for the association with gestational age (in days). For those measurements where the standard deviation increased or decreased with gestation, logarithmic or square root transformation was applied to stabilize variance. If the quadratic or cubic terms did not improve the original linear model (an independent correlation with p < 0. Where the quadratic or cubic components did improve the model, they were included in the equation for the regression line. To produce the reference ranges in the original units, the mean and limits of the calculated reference range in transformed units were subjected to anti-logarithmic or power transformation as appropriate. Methods:Published series with a small number of patients reports details of lesions, progress and management. The most common presenting symptoms were respiratory distress in children under 6 months of age (40%) and recurrent pneumonia in older ones (75%; p = 0. The alteration is considered an Defnition and classifcation of these lesions have always hamartomatous abnormality of the bronchial tree by some been somewhat problematic. Congenital cystic adenomatoid malformation: clinical features, pathological concepts and management in 172 cases. A difference was considered statistically before being referred to tertiary level centers. Some of them may even remain Mean age at diagnosis was 48 months (range between asymptomatic throughout life. Sixty-fve patients (38%) were younger than 24 months Management and outcome after surgical intervention were ofageatthetimeofdiagnosis. In childrenolder than 6 months (n = 68) repeated infection localized in the Patients and methods same pulmonary area was the most frequent manifestation A retrospective observational case series study was (75%). After documented by dilated lumen and prominent chronic washing with Tris buffer they were incubated with labeled infammation within and surrounding airways. There was high correlation between interventricular and interauricular septal defect with severe pathology and radiological fndings. Two patients with rhabdomyomatous dysplasia Bilateral compromise was observed in one patient with were also observed. Furthermore, there were more free after 15 years without evidence of tumor recurrence. Twoofthem A lobar resection was performed in most patients showed an extended pulmonary compromise and required (n = 170, 99%). Posterolateral thoracotomy approach was used in patients Independent risk factors for mortality in the acute stage who were under surgery in the frst 10 years of the study. Most rest of the patients (n = 103, 60%) recovered uneventfully of them showed signs and symptoms early in infancy. Almost half of the population was under 2 years of age Mortality in the postoperative period was 5.

Total vitamin C asthma walk 2016 order montelukast cheap, ascorbic acid and dehydroascorbic acid concentrations in plasma of critically ill patients asthma treatment child montelukast 4mg. Evidence that peroxiredoxins are novel members of the thioredoxin fols superfamily asthma definition 34 purchase montelukast 5 mg without prescription. Dietary carotenoids asthma definition value purchase montelukast amex, vitamins A asthma symptoms score purchase montelukast paypal, C asthma symptoms during a cold order generic montelukast canada, and E, and advanced age-related macular degeneration. Inhibition of nitric oxide synthase expression and activity in macrophages by 3-hydroxyanthranilic acid, a tryptophan metabolite. Protection of myocardial injury by a new tocainide derivative and its nitroxide metabolite. Determination of oxidized and reduced lipoic acid using high performance liquid chromatography and coulometric detection. A positively charged lipoic acid analog with increased cellular uptake and biological activity. Measurement of enterolactone and enterodiol, the first mammalian lignans, using stable isotope dilution and gas chromatography mass spectrometry. High-performance liquid chromatographic analysis of phytoestrogens in soy protein preparations with ultraviolet, electrochemical and thermospray mass spectrometric detection. Melatonin administration prevents lipopolysaccharide-induced oxidative damage in phenobarbital-treated animals. Melatonin reduces both basal and lipopolysaccharide induced lipid peroxidation in vitro. Melatonin reduces H2O2-induced lipid peroxidation in homogenates of different rat brain regions. Oxidative damage in the liver induced by ischemia-reperfusion: Protection by melatonin. Antioxidant activity of tetrandrine and its inhibition of quartz-induced lipid peroxidation. Nitric oxide-induced cytotoxicity attenuation by thiopentone sodium but not pentobarbitone sodium in primary brain cultures. Rapid, fully automated measurement of plasma homocyst(e)ine with the Abbott Imx analyzer. The simultaneous measurement of uric acid and ascorbic acid in the lateral ventricles of freely-moving rats by brain microdialysis and electrochemical detection. Antioxidant effects of aminosalicylates and potential new drugs for inflammatory bowel disease: Assessment in cell-free systems and inflamed human colorectal biopsies. Abnormality in translational regulation of catalase expression in disorders of peroxisomal biogenesis. Radioimmunoassay of pineal 5-methoxytryptophol in different species: Comparison with pineal melatonin content. Nitrosation of uric acid by peroxynitrite: Formation of a vasoactive nitric oxide donor. Pantothenic acid and its derivatives protect ehrlich ascites tumor cells against lipid peroxidation. Compartmentation of glutathione: Implications for the study of toxicity and disease. Simultaneous quantitation of oxidized and reduced glutathione in equine biological fluids by reversed-phase high-performance liquid chromatography using electrochemical detection. Determination of glutathione, glutathione disulfide, ascorbic acid and dehydroascorbic acid in tissues by reversed-phase liquid chromatography with electrochemical detection. Protective effect of endogenous coenzyme Q on both lipid peroxidation and respiratory chain inactivation induced by adriamycin-iron complex. Reduced total antioxidant capacity predicts ischemia-reperfusion injury after femorodistal bypass. A prospective study of vitamin E supplementation and risk of coronary disease in women. Quantitative high-performance liquid chromatographic method for determining the isomer distribution of retinol (vitamin A1) and 3-dehydroretinol (vitamin A2) in fish oils. The interstitium of the arterial wall contains very large amounts of extracellular superoxide dismutase. Simultaneous measurement of seven carotenoids, retinol and alpha-tocopherol in serum by high-performance liquid chromatography. Antioxidant properties of conjugated bilirubin and biliverdin: Biologically relevant scavenging of hypochlorous acid. Comparative antioxidant activity of tocotrienols and other natural lipid-soluble antioxidants in a homogenous system, and in rat and human lipoproteins. Resveratrol inhibits cyclooxygenase-2 transcription and activity in phorbol ester-treated human mammary epithelial cells. Recovery time course of ventricular vulnerability after coronary reperfusion in relation to mitochondrial function in ischemic myocardium. Ascorbate does not act as a pro-oxidant towards lipids and proteins in human plasma exposed to redox-active transition metal ions and hydrogen peroxide. The influence of coenzyme Q10 on doxorubicin uptake and metabolism by mouse myocardial cells in culture. Reduction of ubiquinone in membrane lipids by rat liver cytosol and its improvement in the cellular defense system against lipid peroxidation. Simultaneous determination of tocopherol and tocopherolquinone by high-performance liquid chromatography and coulometric detection in the redox mode. Different mechanisms of thioredoxin in its reduced and oxidized forms in defense against hydrogen peroxide in E. Reduced nicotinamide adenine dinucleotide phosphate-dependent lipid peroxidation by beef-heart submitochondrial particles. Reduced coenzyme Q10 as an antioxidant of lipid peroxidation in bovine heart mitochondria. Enzymatic and molecular aspects of the antioxidant effect of menadione in hepatic microsomes. A novel melatonin metabolite, cyclic 3-hydroxymelatonin: A biomarker of in vivo hydroxyl radical generation. Determination of lipoic acid in human plasma by high-performance liquid chromatography with electrochemical detection. High-performance liquid chromatography method for determination of lipoic acid and dihydrolipoic acid in human plasma. Ferritin: Structure, gene regulation, and cellular function in animals, plants, and microorganisms. Induction of hepatic microsomal reduced nicotinamide adenine dinucleotide phosphate-dependent production of hydrogen peroxide by chronic prior treatment with ethanol. The metabolism of menadione (2 methyl-1,4-naphthoquinone) by isolated hepatocytes. Glutathione-dependent detoxification of alpha-oxoaldehydes by the glyoxalase system: Involvement in disease mechanisms and antiproliferative activity of glyoxalase I inhibitors. A quantitative analysis of the effect of all-trans-retinoic acid on the pattern of chick wing development. Enzymic method for quantitative determination of nanogram amounts of total and oxidized glutathione: applications to mammalian blood and other tissues. Evidence by in vivo and in vitro studies that binding of pycnogenols to elastin affects its rate of degradation by elastases. Analysis of potential biomarkers of estrogen-initiated cancer in the urine of Syrian golden hamsters treated with 4 hydroxyestradiol. Downregulation of Cu/Zn superoxide dismutase leads to cell death via the nitric oxide-peroxynitrite pathway. In vivo, continuous and automatic monitoring of extracellular ascorbic acid by microdialysis and on-line liquid chromatography. Protection against oxygen toxicity by intravenous injection of liposome-entrapped catalase and superoxide dismutase. Identification of oxidized histidine generated at the active site of Cu,Zn-superoxide dismutase exposed to H2O2. The total peroxyl radical-trapping ability of plasma and cerebrospinal fluid in normal and preeclamptic parturients. Lipid peroxidation in liver, plasma, and erythrocytes of rats chronically treated with ethanol. Development and validation of a melatonin radioimmunoassay using radioiodinated melatonin as tracer. Presence of immunoreactive melatonin in different tissues of the pigeon (Columba livia). Oral administration and distribution of melatonin in human serum, saliva and urine. Acrylic bone cement induces the production of free radicals by cultured human fibroblasts. The cooperative actions of vitamins E and C in the protection against peroxidation of parinaric acid in human erythrocyte membranes. Oxidation of vitamin E, vitamin C, and thiols in rat brain synaptosomes by peroxynitrite. Manual spectrophotometric and fluorometric determination of tocopherol in the central nervous system. A liquid chromatographic method for the simultaneous determination of tocopherol and tocopherolquinone in human red blood cells and other biological samples where tocopherol is easily oxidized during sample treatment. New sensitive serum melatonin radioimmunoassay employing the Kennaway G280 antibody: Syrian hamster morning adrenergic response. The potent antioxidant activity of the vitamin K cycle in microsomal lipid peroxidation. Pineal and plasma melatonin as determined by high performance liquid chromatography with electrochemical detection. Melatonin protects human blood lymphocytes from radiation-induced chromosome damage. Marked reduction of radiation-induced micronuclei in human blood lymphocytes pretreated with melatonin. Exercise causes blood glutathione oxidation in chronic obstructive pulmonary disease: Prevention by O2 therapy. Highly sensitive method for the determination of melatonin by normal-phase high-performance liquid chromatography with fluorometric detection. On-line electrochemistry-thermospray-tandem mass spectrometry as a new approach to the study of redox reactions: the oxidation of uric acid. Determination of serotonin and melatonin in rat pineal gland by high-performance liquid chromatography with ultraviolet and fluorometric dual detection. Variation of melatonin and serotonin content in rat pineal gland with sex and estrous phase difference determined by high-performance liquid chromatography with fluorometric detection. Simultaneous determination of oxidized and reduced coenzyme Q and tocopherol in biological samples by high performance liquid chromatography with platinum catalyst reduction and electrochemical detection. Plasma retinol, carotene and vitamin E levels in relation to future risk of breast cancer. Determination of rat cerebrospinal fluid concentrations of adenosine, inosine, hypoxanthine, xanthine and uric acid by high-performance liquid chromatography. Effect of human serum and its protein components on the inactivation of alpha 1 antiproteinase by hypochlorous acid and by hydrogen peroxide. Kinetic characterization of reductant dependent processes of iron mobilization from endocytic vesicles. Quantitative measurement of the total peroxyl radical trapping antioxidant capability of human blood plasma by controlled lipid peroxidation. The relative contribution of vitamin E, urate, ascorbate and proteins to the total peroxyl radical-trapping antioxidant activity of human blood plasma. The protection by ascorbate and glutathione against microsomal lipid peroxidation is dependent on vitamin E. A simplified radioimmunoassay for melatonin and its application to biological fluids, preliminary observations on the half-life of plasma melatonin in man. Protection against peroxynitrite-dependent tyrosine nitration and alpha 1 antiproteinase inactivation by ascorbic acid. Reference values for plasma concentrations of vitamin E and A and carotenoids in a Swiss population from infancy to adulthood, adjusted for seasonal influences. Unequivocal evidence in support of the nonenzymatic redox coupling between glutathione/glutathione disulfide and ascorbic acid/dehydroascorbic acid. The antioxidant action of ketoconazole and related azoles: Comparison with tamoxifen and cholesterol. Determination of lipoic acid by precolumn derivatization with monobromobimane and reversed-phase high-performance liquid chromatography. Gamma-tocopherol: An efficient protector of lipids against nitric oxide-initiated peroxidative damage. N-acetylserotonin is a better extra and intracellular antioxidant than melatonin. Oxidation of the carotenoids by free radicals: Relationship between structure and reactivity. Electrochemical determination of all-trans-retinol, and correlation with retinol binding protein in liver cirrhosis.

Modeling the effect of adverse environmental conditions and clothing on temperature rise in a human body exposed to radio frequency electromagnetic fields asthma vitamins purchase montelukast 10 mg line. A study of the effects of cellular telephone microwave radiation on the auditory system in healthy men asthma yellow phlegm cheap 4 mg montelukast otc. Selective Non-contact Field Radiofrequency Extended Treatment Protocol: Evaluation of Safety and Efficacy asthmatic bronchitis hospitalization order generic montelukast from india. Effects of short term exposure to 60 Hz electromagnetic fields on interleukin 1 and interleukin 6 production by peritoneal exudate cells asthmatic bronchitis how long purchase montelukast 4 mg free shipping. Moretti D asthma key symptoms purchase montelukast online, Garenne A asthma attack symptoms 2 year old 5 mg montelukast with amex, Haro E, Poulletier de Gannes F, Lagroye I, Leveque P, et al. Moretti M, Villarini M, Simonucci S, Fatigoni C, Scassellati-Sforzolini G, Monarca S, et al. Hygienic characteristics of the working conditions in modern electric pipe-welding shops. Mobile phone radiation causes brain tumors and should be classified as a probable human carcinogen (2A) (review). Powerline frequency electric and magnetic fields: a pilot study of risk perception. Radiofrequency exposure and mortality from cancer of the brain and lymphatic/hematopoietic systems. Experimental evaluation of the occupational exposure to static magnetic fields on a 3 T magnetic resonance scanner. Radio frequency exposure in mobile phone users: implications for exposure assessment in epidemiological studies. Use of the finite element method to assess impact of current on forearm and wrist during an electrical accident. Increased mercury release from dental amalgam restorations after exposure to electromagnetic fields as a potential hazard for hypersensitive people and pregnant women. Should pregnant women with dental amalgam fillings limit their exposure to electromagnetic fields to prevent the toxic effects of mercury in their foetuses Prevalence of subjective poor health symptoms associated with exposure to electromagnetic fields among university students. Human short-term exposure to electromagnetic fields emitted by mobile phones decreases computer-assisted visual reaction time. Re: "effects upon health of occupational exposure to microwave radiation (radar)". Cerenkov ultraviolet radiation (137Cs gamma-rays) and direct excitation (137Cs gamma-rays and 50 kVp X-rays) produce photoreactivable damage in Escherichia coli. International journal of radiation biology and related studies in physics, chemistry, and medicine. Effects of acute exposure to the radiofrequency fields of cellular phones on plasma lipid peroxide and antioxidase activities in human erythrocytes. Evaluation of occupational risk for health of operators of petrochemical production and their physiological and hygienic stipulation. Occurrence and risk of cochleotoxicity in cystic fibrosis patients receiving repeated high-dose aminoglycoside therapy. Re: "Exposure to residential electric and magnetic fields and risk of childhood leukemia" and "case-control study of childhood cancer and exposure to 60-Hz magnetic fields". Radiation therapy planning of a breast cancer patient with in situ pacemaker- challenges and lessons. Pulsed Electromagnetic Field Stimulation Promotes Anti-cell Proliferative Activity in Doxorubicin-treated Mouse Osteosarcoma Cells. Super-low frequency electric and magnetic fields and their role in development of neoplasms. Initial studies on the effects of combined 60 Hz electric and magnetic field exposure on the immune system of nonhuman primates. Effect of ultra-high frequency on peripheral blood in animals and the development of post-vaccinal allergy. Primary brain cancer in adults and the use of common household appliances: a case-control study. Relevance of in vitro studies for the immunity of cardiac implants in an electromagnetic field environment. Retrospective review of the efficacy and safety of repeated pulsed and continuous radiofrequency lesioning of the dorsal root ganglion/segmental nerve for lumbar radicular pain. Bioeffects of electromagnetic fields-safety limits of each frequency band, especially less than radio one. Detection of electrophysiological responses in rabbits affected by short-term exposure to static magnetic field. The effect of the impeller-driver magnetic coupling distance on hemolysis in a compact centrifugal pump. Electromagnetic interference with implantable cardioverter-defibrillators at power frequency: an in vivo study. Are patients with cardiac implants protected against electromagnetic interference in daily life and occupational environment Possible cause for altered spatial cognition of prepubescent rats exposed to chronic radiofrequency electromagnetic radiation. Overtreatment effects associated with a radiofrequency tissue-tightening device: rare, preventable, and correctable with subcision and autologous fat transfer. Occupational exposure to physical agents: the new Italian database for risk assessment and control. Measurement of thermal effects on the optical properties of prostate tissue at wavelengths of 1,064 and 633 nm. Ultrasound-guided radiofrequency-assisted segmental arterioportal vascular occlusion in laparoscopic segmental liver resection. Laparoscopic blood-saving liver resection using a new radiofrequency-assisted device: preliminary report of an in vivo study with pig liver. Interactive effect of chemical substances and occupational electromagnetic field exposure on the risk of gliomas and meningiomas in Swedish men. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. Need for a European approach to the effects of extremely low-frequency electromagnetic fields on cancer. Interactions of radiofrequency radiation on 2-methoxyethanol teratogenicity in rats. Interactive developmental toxicity of radiofrequency radiation and 2 methoxyethanol in rats. Developmental toxicity interactions of methanol and radiofrequency radiation or 2-methoxyethanol in rats. Developmental toxicity interactions of salicylic acid and radiofrequency radiation or 2-methoxyethanol in rats. Tissue and intracellular reorganization of the mouse myocardium induced by the hypogeomagnetic field. Influence of high-voltage ignition systems on the function of implanted pacemaker. The association between exposure determined by radiofrequency personal exposimeters and human exposure: a simulation study. Feasibility of future epidemiological studies on possible health effects of mobile phone base stations. When "wire codes" predict cancer better than spot measurements of magnetic fields. How to approach complex mixtures: lessons from the epidemiology of electromagnetic fields. Effects of information and 50 Hz magnetic fields on cognitive performance and reported symptoms. Exposure to static electric fields leads to changes in biogenic amine levels in the brains of Drosophila. Exposure of Drosophila melanogaster embryonic cell cultures to 60-Hz sinusoidal magnetic fields: assessment of potential teratogenic effects. Transurethral radiofrequency hot balloon thermal therapy in chronic nonbacterial prostatitis. Study of narrow band millimeter-wave potential interactions with endoplasmic reticulum stress sensor genes. A prospective study of X-ray imaging combined with skin stimulation potential-guided percutaneous radiofrequency thermocoagulation of the Gasserian ganglion for treatment of trigeminal neuralgia. Interference of two common European digital cellular phones with implantable cardioverter defibrillators. Electromagnetic interference in patients with implanted pacemakers or cardioverter-defibrillators. Reported mobile phone sensitivity following individual feedback of an inability to discriminate active from sham signals. The influence of low intensity 50 Hz electromagnetic field exposure on blood Na, K and Cl concentrations in humans. Occupational health evaluation of electromagnetic fields in electric trains and subway technologic areas. Study of bioeffects of ship-borne microwave navigation radar in chronic experiments. The characteristics of the electromagnetic situation close to overhead electric power transmission lines in St. Cytogenetic and endocrinologic changes in experimental animals exposed to high-frequency electromagnetic fields. The bioelectrical activity of the brains of persons working under conditions of radio wave exposure. Changes in the status of the adaptation of workers at the television relay station on top of Botev Peak. Effect of electromagnetic interference by neonatal transport equipment on aircraft operation. The importance of accepted standards of environmental hygiene for prevention of non occupational diseases in workers. Effect of cell phone magnetic fields on adjustable cerebrospinal fluid shunt valves. Relationship between amyloid beta protein and melatonin metabolite in a study of electric utility workers. Occupational exposure to magnetic fields in case-referent studies of neurodegenerative diseases. Variations in amino acid neurotransmitters in some brain areas of adult and young male albino rats due to exposure to mobile phone radiation. A single center, randomized, comparative, prospective clinical study to determine the efficacy of the VelaSmooth system versus the Triactive system for the treatment of cellulite. Clastogenic effects in human lymphocytes of power frequency electric fields: in vivo and in vitro studies. Odor and noise intolerance in persons with self-reported electromagnetic hypersensitivity. Influence of weak static and 50 Hz magnetic fields on the redox activity of cytochrome-C oxidase. Electromagnetic pollution (electrosmog)-potential hazards of our electromagnetic future. The influence of occupational environment and professional factors on the risk of cardiovascular disease. The effect of ultrahigh-frequency radiation on adaptation thresholds and the damages to blood system cells. Re: "Nighttime exposure to electromagnetic fields and childhood leukemia: an extended pooled analysis". Comment on "Developing policy in the face of scientific uncertainty: interpreting 0. Re: "Magnetic fields and cancer in children residing near Swedish high-voltage power lines". Implantable cardioverter defibrillators and cellular telephones: is there any interference Increases in geomagnetic activity are associated with increases in thyroxine levels in a single patient: implications for melatonin levels. Biotechnic & histochemistry: official publication of the Biological Stain Commission. Long-term effects on symptoms by reducing electric fields from visual display units. Activity of natural killer cells of the spleen of mice exposed to low-intensity of extremely high frequency electromagnetic radiation. Electromagnetic interference of cardiac rhythmic monitoring devices to radio frequency identification: analytical analysis and mitigation methodology. Effects of power frequency alternating magnetic fields on reproduction and pre-natal development of mice. Development of a new intraoperative radiofrequency ablation technique using a needle electrode. Graded response of heart rate variability, associated with an alteration of geomagnetic activity in a subarctic area. Exposure of workers to electric and magnetic fields from radiofrequency dielectric heaters to process polyvinyl chloride material.

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