Intrauterine growth restriction (IUGR) is associated with adverse perinatal outcomes and late-onset diseases in offspring. Eating disorders, voluntary caloric restriction and maternal undernutrition can all induce IUGR but a relevant model is required to measure all its possible consequences. In this work, pregnant rabbits were used as an IUGR model. Control females (n=4) received ad libitum diet throughout pregnancy, whereas underfed females (n=5) were restricted to 50% of their daily requirements. Offspring size was measured by ultrasonography and in vivo at birth. Hemodynamic features of the umbilical cords and middle cerebral arteries (systolic peak velocity, end diastolic velocity, pulsatility index and resistance index) were characterized by Doppler ultrasonography. At day 21, maternal underfeeding resulted in a significant reduction of fetal size (occipito-nasal length). At birth, the size of kits from the underfed group was significantly lower (lower crown-rump length, biparietal and transversal thoracic diameters) and a reduced weight with respect to the control group. Feed restriction altered blood flow perfusion compared with does fed ad libitum (significant higher systolic peak, time-averaged mean velocities and lower end diastolic velocity). Fetuses affected by IUGR presented with compensative brain-sparing effects when compared with the control group. In conclusion, the present study supports using rabbits and the underfeeding approach as a valuable model for IUGR studies. These results may help to characterize IUGR alterations due to nutrient restriction of mothers in future research.

A common systolic ejection murmur of the neonate has been attributed to physiologic peripheral pulmonic stenosis. We investigated this auscultatory finding using duplex pulsed Doppler. Three groups of normal fuliterm neonates less than one week old were studied—10 without murmurs, 10 with grade 1/6 murmurs and nine with at least grade 2/6 murmurs. We measured the anatomical size and peak flow velocities in the main pulmonary artery and left and right branches, the peak velocity in the right ventricular outflow tract, and the bifurcation angle. Flow gradients were calculated as 4 (Vmax)2 Groups were compared by t-tests. A loud peripheral pulmonic stenosis murmur was associated with increased pulmonary artery velocities, with left pulmonary artery velocity the most discriminating variable (1.3 ± 0.29 vs 0.94 ± 0.19 m/s; p ≤ 0.05). Although the peak gradient never exceeded 12 mmHg, there was an increased gradient in the loud murmur group (8.7 ± 2.6 vs 5.7 ± 2.2 mmHg; p ≤ 0.05) which may even be underestimated by the lack of angle correction. The left pulmonary artery diameter was also larger in the loud murmur group, but there were no other anatomic or volumetric flow differences between groups. The soft murmur group could not be separated from normals. We conclude that Doppler techniques can confirm the physiologic basis of peripheral pulmonic stenosis murmurs.

Internal jugular vein ectasia (dilatation of the internal jugular vein) is a rare clinical entity, often undiagnosed. Usually it presents as an asymptomatic, soft, compressible neck swelling that increases in size on Valsalva's manoeuvre. Our report describes right internal jugular vein ectasia in a 15-year-old girl who presented to us with intractable paroxysmal cough. The entity was suspected on ultrasound imaging and confirmed by computed tomography scan and Doppler. Ligation and excision of the dilated vein almost immediately cured her cough. The probable reason for the cough was the pressure exerted by the dilated vein on the vagus nerve.

A randomized double-blind study was carried out on 20 patients after coronary artery bypass surgery to investigate the effects of graded doses of dopexamine hydrochloride or placebo on systemic haemodynamic responses and renal vascular resistance index (RVRI) measured using Doppler ultrasound. Pre-operatively, all patients had good left ventricular function and normal renal function. Eleven were allocated randomly to receive incremental infusions of dopexamine 0.5, 1, 2, and 4 μg kg−1 for 40 min each, and nine received corresponding infusions of placebo. One patient was withdrawn from the dopexamine group because of tachycardia. In the remaining 19, heart rate (HR) and cardiac index (CI) were significantly (P < 0.05) increased from base-line with dopexamine: the HR values with dopexamine differed significantly from those with placebo at the 2 and 4 μg kg−1 min−1 dose, and at 4 μg kg−1 min−1 for CI. Systemic vascular resistance index (SVRI) fell significantly in both groups: the reduction was significantly greater with dopexamine 4 μg kg−1 min−1 than with the corresponding infusion of placebo. RVRI increased and urine output decreased significantly during the infusions in both groups, but with no significant difference between groups. There were no changes in systemic arterial pressures, pulmonary artery occlusion pressures, stroke volume index or left ventricular stroke work index. Where changes from base-line occurred in either group, they had not returned to base-line within 40 min of stopping the infusions (except perhaps for CI in the dopexamine group). Dopexamine appears to offer no particular protection to the renal vascular bed.

This paper summarizes our experience with Doppler velocimetry in survivors of intrauterine co-twin demise. In the first trimester, ten dichorionic deaths occurred; none of the survivors developed flow disorders. During the second trimester, there were three intrauterine demises, two of them were monochorionic and the survivors developed flow disorders: one presented transitory venous flow aberration, the other one an impaired development of diastolic flow. In the third trimester, two intrauterine deaths occurred. One case of twin to twin transfusion syndrome (TTTS) was complicated by the donor's death and the recipient showed a loss of diastolic flow. The second one happened during a dichorionic twin pregnancy. The survivor presented high systolic/diastolic daily ratio (S/D = 7.8).

Doppler arterial velocimetry waveforms was used as a method of antenatal surveillance for triplets. Six sets of triplet pregnancies were studied. Each fetus was identified by real-time-ultrasound scanning and the peak systolic/end diastolic (S/D) ratio was calculated. In one set of triplets two fetuses showed absent end diastolic flow. Both subsequently suffered from necrotising enterocolitis and had major bowel resection. The five other sets of triplets maintained a normal S/D ratio. Three had a normal outcome and two delivered prematurely.