Aim: Minimally invasive repair of oesophageal atresia with trachea-oesophageal fistula (OA/TOF) and congenital diaphragmatic hernia (CDH) is feasible and confers benefits compared to thoracotomy or laparotomy. However, carbon dioxide (CO2) insufflation can lead to hypercapnia and acidosis. We sought to determine the effect of lower insufflation pressures on patients' surrogate markers for CO2 absorptionarterial partial pressure of CO2 (PaCO2), end tidal CO2 (EtCO2) and pH.Methods: Single centre retrospective review, including neonates without major cardiac anomaly. Selected patients formed 2 groups: Historical pressure (HP) group and low pressure (LP) group. We reported on the patients' preoperative characteristics that potentially confound the degree of CO2 absorption or elimination. Outcome measures were perioperative PaCO2, EtCO2, arterial pH and anaesthetic time.Results: 30 patients underwent minimally invasive surgery for CDH and 24 patients for OA/TOF with similar distribution within the HP and LP group. For CDH patients as well as for OA/TOF patients, there were no significant differences in their preoperative characteristics or surgery duration comparing HP and LP groups. With a decrease in insufflation pressure in CDH patients, there was a significant decrease (p=0.002) in peak PaCO2 and an improvement in nadir pH (p=0.01). For the OA/TOF patients, the decrease in insufflation pressure was associated with a significant decrease (p=0.03) in peak EtCO2. Considering all 54 patients, we found EtCO2 highly significantly inversely correlated with pH and positively correlated with intraoperative PaCO2 (p<0.001). Baseline Hb was inversely correlated with mean EtCO2 (p<0.001). Conclusion:With lower insufflation pressures, CDH patients had significantly improved hypercapnia and acidosis, whilst OA/TOF patients had significantly reduced EtCO2. EtCO2 was correlated with acidosis and hypercapnia.
Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. Tertiary syphilis, a late-stage multi-visceral complication of the disease is characterized by its diversity of clinical manifestations. Here, we present the first documented case of tertiary syphilis that clinically and radiologically mimicked primary rectal cancer with hepatic metastasis.
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