Objectives. In this study we investigated if the cerebral oxygenation measurements before and after the packed red blood cell transfusions (PRBC) can answer the question: was transfusion beneficial? Can the measurements derived from NIRS (near infrared spectroscopy) be useful for the identification of more objective criteria for the transfusion guidelines? Patients and methods. This is a prospective observational study, performed in the period July 2017 – March 2018, in the 3th neonatal intensive care unit. It enrolled 44 preterm infants, with a weight ≤ 1250 g and gestational age ≤ 30 weeks, randomized by the PRBC transfusion in transfused group (n = 29) and non-transfused group (n = 15). The preterm infants that needed transfusion were NIRS monitored before (continuous monitoring 24 h), during and 24 h after the transfusion. The non-transfused patients were also monitored with cerebral regional pulse-oximetry at postnatal age, and under clinical conditions similar to the transfused group. Results. The values of the cerebral and systemic oximetry were comparable for the two groups when comparing the results before transfusion. Regarding the effects of transfusions, results showed a significant increase of cerebral tissue oxygenation (CrSO2) even during the 4 hours of transfusion, an effect maintained 24 hours following transfusion: postransfusional mean CrSO2 = 80±2, p value 0.019. Moreover, the values of the fractional cerebral tissue oxygen extraction begin to decrease during transfusion, and they remain low for the next 24 h as well 0.25±0.05 vs 0.15±0.02 – p value <0.013. Conclusions. PRBC transfusion in clinically stable very low birth weight preterm leads to the transient increase of CrSO2 and transient decrease of FTOE. Our data support the use of measurements derived from NIRS (FTOE) for the identification of the sub-clinical imbalance in O2 delivery and consumption as objective measurement in anemic preterm infants.
Background: Preoperative imaging assessment is essential to draw an accurate map of endometriotic lesions. Knowledge of the extension and severity of disease is paramount for the surgical team in order to plan the type of surgery, complete the operating team and properly inform the patient with details of the risks. Material and Method: Transvaginal ultrasound is the fi rst-line imaging technique for ovarian and deep infi ltrating endometriosis, but the accuracy of the diagnosis is proportional with the experience of the operator. Respecting the four steps of ultrasound evaluation technique decreases the probability of misdiagnosis. Step 1 include evaluation of the uterus and adnexa, step 2-evaluation of "soft marker", step 3-assessment of the Pouch of Douglas using "sliding sign" and step 4-assessment of anterior pelvic compartment (urinary bladder, uterovesical region and ureters) and posterior pelvic compartment (rectovaginal septum, posterior vaginal fornix, uterosacral ligaments, rectum and sigmoid). MRI is performed as an additional examination in complex cases prior to surgery, in symptomatic patients with negative or equivocal ultrasound fi ndings and it can be useful for diagnosis of multiple sites of deep infi ltrating endometriosis. Results: Important information from recent guidelines and relevant literature are highlighted. Ovarian and deep endometriosis diagnosed by ultrasound scan and MRI imaging-case series (personal experience) will be commented. Conclusion: As with cancer pathology, the success of treatment depends on complete excision of the endometriotic lesions. Rigorous imaging investigation avoids "the tip of the iceberg" mirage and enhances the quality of medical care.
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