Our results indicate that local production of human CTLA4-Ig or soluble human Fas ligand by biolistically transfected islets can promote allograft survival. This approach should be valuable as a potential immunoprotective therapeutic strategy in tissue transplantation.
Objective
Increased survival in children with critical congenital heart disease (CHD) has raised interest in the neurodevelopmental sequelae of these lesions. This investigation is part of an institutional effort to examine the neurodevelopment of 5-year-old children following repair or palliation of CHD.
Methods
We performed a battery of neuropsychological tests on a sample of 243 children between 1998 and 2001.
Results
In the sample as a whole, mean full-scale (FSIQ), verbal (VIQ), and performance (PIQ) IQ scores were in the normal range (96.8±15.9, 97.8±14.6, and 96.3±17.1, respectively). Anatomic, demographic, and perioperative factors were assessed for impact on neurodevelopment. In multiple regression analysis, lower socioeconomic status (SES) and the diagnosis of velocardiofacial syndrome (VCFS) predicted a lower FSIQ (
P
=0.01, and
P
=0.001, respectively). A single ventricle diagnosis (
P
=0.06), longer postoperative ICU stay (
P
=0.08), and cumulative duration of hypothermic circulatory arrest (HCA) (
P
=0.09) approached significance as predictors of lower FSIQ.
Conclusion
Children with CHD, on the whole, appear to be performing within the average range in terms of intellectual abilities. Lower SES and VCFS are associated with lower IQ scores. Trends toward worse outcomes were observed in single ventricle patients, biventricular patients with longer postrepair ICU stays, and patients subjected to longer periods of HCA.
Two-dimensional echocardiography falsely suggesting normal origin of left coronary artery.
Central MessageDirect intraoperative visualization of the coronaries os is essential before APW repair. Routine clinical evaluation and imaging are unreliable in ruling out the rare association AL-CAPA with APW.
Background:
The next horizon for improving pediatric cardiac surgery outcomes is the standardization and systematic tracking of complications.
Methods:
IWK REB approval was obtained. The Multisocietal Database Committee short list of complications (52) were captured prospectively for all pediatric cardiac operations at the IWK Oct 1 2009-Sept 30 2010. Morbidity burden was calculated by multiplying a severity coefficient (1-3) by frequency of complication in each surgical complexity strata using RACHS categories. Death was included as a complication (severity coefficient= 5). Indexed morbidity was calculated for each RACHS category by dividing morbidity burden by number of procedures.
Results:
A total of 110 procedures were performed on 86 patients. 83 of the 86 index procedures were open and 22 of the patients were neonates. The procedural mortality rate was 3.6%. Forty one (41/86, 47.7%) of the index procedures had a total of 89 complications. Sixty-four patients were in RACHS category 2 or 3. The most common complications were pulmonary (22) arrhythmias (16), or operative (16), accounting for 61%(54/89) of total complications. The indexed morbidity was 0 for RACHS1, 1.55 for RACHS 2, 2.63 for RACHS 3, 1.81for RACHS 4, and 2.81 for RACHS5/6. The CUSUM plots the occurrence of any complication in each case versus morbidity burden, illustrating the effect of complication severity on the slope of the curve.
Conclusions:
A high rate of perioperative complications are recorded when tracked prospectively using standardized definitions. Adjusting complications for severity may identify areas for improving patient outcomes that are missed by simply recording their occurrence.
A 33-year-old man with a history of severe asthma presented to the emergency department with a week-long history of severe unrelenting abdominal pain, nausea and decreased appetite. He was admitted to hospital, and routine gastrointestinal investigations were performed, which did not elucidate the cause of his abdominal pain. Exploratory laparotomy demonstrated patchy infarction of the entire small bowel, characteristic of Churg-Strauss syndrome. The patient subsequently underwent 12 separate laparotomies to salvage surviving small bowel. The patient is maintained on total parenteral nutrition.
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