Complicated grief after traumatic loss: a 14-month follow up study

The traumatic loss of an unborn child after TOP due to fetal malformation and/or severe chromosomal disorders in late pregnancy is a major life-event and a potential source of serious psychological problems for those women. To obtain information on the course of grief following a traumatic loss, 62 women who had undergone TOP between the 15th and 32nd gestational week were investigated in a longitudinal study design and compared with 65 women after spontaneous delivery of a full-term healthy child. Grief, posttraumatic stress, depression, anxiety and psychiatric disorders were evaluated 14 days, 6 months and 14 months after the event, implementing validated self-report and clinician rated instruments. Compared to women after spontaneous delivery, women after induced TOP were significantly more stressed regarding all psychological outcomes at all three measuring points. Especially, 14 months after TOP 13.7% of the women fulfilled all criteria of a complicated grief diagnoses following Horowitz et al. (1997, Am J Psychiat 154:7904-7910). 16.7% were diagnosed as having a manifest psychiatric disorder according to DSM-IV. All in all, 25% of these women were critically affected by the traumatic loss. TOP for fetal anomaly is to be seen as a major life event, which causes complicated grief reactions and psychiatric disorders for a substantial number of women.

[Influence of detomidine on echocardiographic function parameters and cardiac hemodynamics in horses with and without heart murmur]

30 warmblood horses were examined before and after sedation with 20 micrograms/kg BW detomidine, to determine changes of cardiac function parameters, using B-mode, M-mode and Doppler echocardiography. 15 horses showed a heart murmur, but no clinical signs of cardiac heart failure, 15 horses had neither a heart murmur nor other signs of cardiac disease. After sedation with detomidine we could recognise a significant increase of end-diastolic left atrium diameter, an increase of end-systolic left ventricular diameter and aortic root diameter. The end-systolic thickness of papillary muscle and interventricular septum showed a decrease. Fractional shortening and amplitude of left ventricular wall motion was decreased after sedation. The mitral valve echogram revealed a presystolic valve closure and an inflection in the Ac slope (B-notch) in xy horses before sedation. Both increased after sedation with detomidine. Doppler echocardiography showed a decrease of blood flow velocity and velocity time integral (VTI) in the left and right ventricular outflow tract after sedation. Regurgitant flow signals were intensified following sedation in xy horses, especially at the mitral valve.

[Echocardiography and therapy of atrial fibrillation in horses]

Echocardiographic evaluation of 45 horses (43 warm-blooded horses, one Thoroughbred and one Standardbred) with atrial fibrillation was performed, using M-mode, B-mode and pulsed-wave Doppler echocardiography. Seventeen (38%) of these horses had a history of poor performance. An increase of left ventricular shortening fraction was found in 25 horses (56%). Atrial dilatation was seen in 37 horses (82%). Eight horses (18%) had normal atrial dimensions. In nine horses only left atrium and in six horses only right atrium was enlarged. In the other 22 horses both atria were dilated. Correlation was found between atrial and ventricular dilatation. M-mode echocardiogram of septal leaflet of mitral valve revealed the lack of A-peak and showed diastolic undulation. Additionally, pulsewave Doppler spectral tracings of atrial outflow tract showed absence of A-peak which is associated with atrial in healthy horses. Quinidine sulfate was used for treatment in 19 horses. Nine horses converted to sinus rhythm, eight of them had normal atrial dimensions. Treatment was not successful in nine horses with severe atrial dilatation and in one horse with normal atrial dimensions but with mitral valve insufficiency. Echocardiographic evaluation of atrial diameters seems to be a reliable method to predict therapeutic success in horses with atrial fibrillation.