Needlescopic techniques have been used recently in different pediatric procedures, which made this type of surgery more feasible and less invasive with decreased hospital stay and improved cosmetic results. The technique is being developed further. New techniques with minor modifications are evolving every day. The objective of this study was to describe and assess the results that can be achieved by using a new simplified technique [Reverdin needle (RN)] in thoracoscopic repair of diaphragmatic hernia in neonates and children. Eighteen patients with symptomatic congenital diaphragmatic hernia (CDH), from Al-Azhar University Hospitals, Cairo, Egypt were assigned to elective thoracoscopic repair using RN to insert mattress sutures between the edges of diaphragmatic defects. The technique will be described in detail. A total of 18 diaphragmatic defects were repaired successfully; there were 12 males and 6 females with a mean age of 1.58 +/- 21 months (range, 5 days-9 months). Left-sided CDH was present in 12 cases (67%) and right-sided CDH in 6 cases (33%). The mean operative time was 30.7 +/- 1.18 min (range, 25-60 min) for each CDH repair. There were no intra or postoperative complications. There was one case of conversion and minimal blood loss. The mean postoperative hospital stay was 5.6 days (range, 2-10 days). There was only one case of mortality on the 10th postoperative day. There was no single case of recurrence. The new technique had all the advantages of thoracoscopy in children (less invasive, less pain, shorter hospital stay) combined with the advantages of reduced operating time, simplicity and feasibility. It may be preferable to intracorporeal suturing and knot tying.
Background: Chronic kidney disease (CKD) is a major risk factor for contrast induced nephropathy acute kidney injury (CIN-AKI) in chronic coronary syndrome (CCS) patients undergoing coronary catheterization. We aimed to evaluate the efficacy of phentolamine in prevention of CIN-AKI in CKD and CCS patients undergoing percutaneous coronary catheterization for diagnostic angiography ± stenting.Methods: Participants with CKD and CCS planned for percutaneous coronary catheterization were included, while participants with normal kidney functions were excluded. A consecutive sample of 107 participants (mean age 58.62 ± 8.96 years, 64.5% males) was selected, underwent diagnostic coronary angiography or percutaneous coronary intervention, and received either conventional CIN-AKI prevention strategy (group 1) or periprocedural phentolamine and conventional CIN-AKI prevention strategy (group 2).Results: The percentages of study participants who had CIN-AKI were 82.9% for group 1 and 17.1% for group 2, respectively. There were a statistically significant association between periprocedural phentolamine and prevention of CIN-AKI (OR = 0.041, 95% CI 0.0149 – 0.1128, P <0.0001) and statistically significant differences between group 1 versus group 2 regarding the urine output (ml/kg) and the urine output (ml/hour) within 72 hours post procedure, the peak change in serum creatinine within 72 hours post procedure, the percentage of change relative to the baseline serum creatinine at 72 hours post procedure, and the incidence rate of major adverse cardiac and cerebrovascular events within 90 days post procedure (t(105) = -0.69, p < 0.001, t(105) = -52.46, p < 0.001, t(102) = 0.2, p 0.018, t(102) = 23.54, p < 0.001, and t(102) = 1.168, P <0.001, respectively).Conclusions: The incidence of CIN-AKI and the peak change in serum creatinine within 72 hours post procedure was lower in CKD patients who underwent coronary catherization and received phentolamine infusion versus intravenous saline. The significant association of phentolamine infusion with prevention of CIN-AKI highlights the potential role of phentolamine for protection of the kidney in CKD patients planned for coronary catherization.Trial Registration Number: I-111015
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