APNH combined with erythropoietin was effective in reducing homologous blood requirements during CS surgery. Further studies are necessary on a larger scale to assess the role of this technique in avoiding homologous blood transfusion and to evaluate how infants can benefit from this combined approach.
In animal CDH models, surfactant deficiency contributes to the pathophysiology of the condition but information on human disease is very limited. The aim of our study was to investigate surfactant kinetics in CDH newborns. We studied surfactant disaturated-phosphatidylcholine (DSPC) half-life, turnover and apparent pool size by stable isotope methodology in CDH newborns with no ExtraCorporeal Membrane Oxygenation (ECMO) support (n ϭ 13, birth weight (BW) 3.2 Ϯ 2.2 kg, gestational age (GA) 39 Ϯ 0.4 wks, postnatal age 43 Ϯ 11 h) and in 8 term infants with no lung disease (CONTROLS, BW 2.7 Ϯ 0 kg, GA 38 Ϯ 0.8 wks, postnatal age 96 Ϯ 26 h). We administered a trace dose of 13 C-palmitic acid dipalmitoyl-phosphatidylcholine (DPPC) through the endotracheal (ET) tube and we measured DSPC kinetics by gas chromatography-mass spectrometry from DSPC 13 C-enrichment decay curves obtained from sequential tracheal aspirates. DSPC amount from tracheal aspirates (TA-DSPC) was measured by gas chromatography. In CDH infants DSPC half-life was shorter (24 Ϯ 4 and 53 Ϯ 11 h, p ϭ 0.01), turnover faster (0.6 Ϯ 0.1 and 1.5 Ϯ 0.3 d Ϫ1 p ϭ 0.01), apparent pool size smaller (34 Ϯ 6 and 57 Ϯ 7 mg/kg body weight, p ϭ 0.02) and tracheal aspirates DSPC amount lower (2.4 Ϯ 0.4 and 4.6 Ϯ 0.5 mg/mL Epithelial Lining Fluid (ELF), p ϭ 0.007) than in CONTROLS. In conclusion surfactant kinetics is grossly abnormal in mechanically ventilated CDH. Whether alterations of DSPC kinetics in CDH infants are caused by a primary surfactant deficiency or are secondary to oxygen therapy and ventilator support has still to be determined. Clinical and animal studies using air pressure-volume data showed that CDH lungs are significantly less compliant than normal lungs. This finding can be related to lung immaturity, surfactant deficiency, to changes in the amount of collagen and elastic fibers or to lung damage induced by mechanical ventilation (1-3). High-inspired oxygen fraction (Fio 2 ) and positive pressure ventilation may also induce secondary surfactant inactivation and altered surfactant function.It is still unclear whether a primary surfactant deficiency is present in human CDH. CDH animal models showed reduced Received November 18, 2002; accepted February 3, 2003
Children receiving multimodal analgesia experience little or no pain after major craniotomy. Longer surgical procedures correlate with an increased risk of having postoperative pain.
ObjectAlthough a rarely reported occurrence, late failure of endoscopic third ventriculostomy (ETV) may occur in children as a result of a variety of factors. Delay in recognition of symptoms can lead to harmful deterioration in the patient's condition. The authors undertook this study to assess the capacity of cine phase-contrast MR imaging to identify late failure in asymptomatic pediatric patients treated with ETV for hydrocephalus.MethodsThis study was a retrospective evaluation of cases involving patients who underwent ETV between January 1, 1999, and December 31, 2008, at the pediatric neurological surgery service of the University of Padua. Before 2004, patients were routinely followed up with cine MR imaging at 3, 6, and 12 months after ETV. In 2004, a protocol of annual cine MR follow-up was instituted as a result of a case of fatal late failure. The authors evaluated all cases of late failure identified through cine MR imaging and performed a statistical analysis to investigate the relationship between ETV failure and several variables, including the cause of hydrocephalus for which ETV was originally indicated.ResultsIn a series of 84 patients (age range 6 days–16 years), 17 patients had early ETV failure. Of the remaining 67 patients, 5 (7%) were found to have no CSF flow through the fenestration and recurrent ventriculomegaly when assessed with cine MR imaging at 1, 2, 3, 4, and 7 years after ETV. The patient in whom ETV failure was identified 1 year postoperatively had Dandy-Walker malformation. The patients in whom ETV failure was identified 2, 3, and 4 years postoperatively all had undergone ETV for treatment of postinfective hydrocephalus. The patient in whom ETV failure was identified 7 years postoperatively had a cystic arachnopathy in the fourth ventricle after cerebellar astrocytoma removal.ConclusionsPatients who undergo ETV for infective hydrocephalus and Dandy-Walker malformation should receive long-term follow-up, because late closure of the stoma may occur progressively and slowly. Intraoperative observation of thickened arachnoid membranes at the level of the interpeduncular cisterns at the first ETV and a progressive decreasing of CSF flow through the stoma on routine cine MR imaging should be considered unfavorable elements entailing a significant risk of deterioration.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.