ContextPre-existing renal dysfunction presents specific features that anesthesiologists must deal with. Anesthesia and renal function are connected and can interfere with each other. Induced hypotension anesthesia and the toxic effects of anesthetic drugs can further deteriorate renal function.Evidence AcquisitionDecreased renal function can prolong anesthetic drug effects by decreased elimination of these drugs. Anesthesia can deteriorate renal function and decreased renal function can interfere with drug elimination leading to their prolonged effect. The anesthesiologist must understand all the physiological aspects of the patient, renal protection, and the relationships between anesthetic drugs and renal function. This review article aims to summarize these aspects.ResultsPerioperative renal failure and renal protection is a crucial moment in clinical practice of every anesthesiologist.ConclusionsGood knowledges for renal function remain a hallmark of daily practice of the anesthesiologist, considering renal function as an important determinant factor in anesthesia practice.
SUMMARY Total body length and body segments (crown‐rump length, sub‐ischeal length) of 78 children with myelomeningocele were measured at regular intervals during growth for a mean duration of 4‐4 years. These children were shown to have defective growth, with an increased upper segment/lower segment ratio. It was found that the higher the level of the meningocele the greater the growth defects. However, the relationship was statistically significant only for the first seven years of life. It is concluded that neurological damage was mainly responsible for defective growth during the first years of life, but that other factors independent of the level of the meningocele also come into play in later years. RÉSUMÉ L'étude conceme les valeurs anthropométriques de longueur couche et de segments de 78 sujets atteints de myelomingocele mesurés régulièrement au cours de la croissance pendant une durée moyenne de 4 ans et demi. II est mis en evidence un defaut de croissance avec augmentation du rapport segment supérieur, segment inférieur. Plus le niveau myèlomérique des paralysies est haut, plus de défaut de croissance est important: mais cette corrélation n'est statistiquement significative que jusqu'a l'âge de 7 ans. Des tables de prédictions sont proposées pour ces classes d'âge. Les auteurs concluent que si l'atteinte neurologique est le principal responsable des défauts de croissance dans les 7 premières années de la vie, d'autres facteurs indépendants du niveau lésionnel interviennent ensuite en plus ou en moins et masquent alors le rôle persistant de l'extension paralytique. ZUSAMMENFASSUNG Wachstum von Rumpf und Beinen bei Kindern mil Myelomeningocele Bei 78 Kindern mit Myelomeningocele wurden während der Wachstumsphase in regelmäßigen Abständen, im Mittel über 4‐4 Jahre, die Gesamtkörperlange und Körpersegmente (Scheitel‐Steiß‐Länge, sub‐ischeale Länge) gemessen. Je höher die Meningocele lokalisiert war, desto größer war die Wachstumsverminderung. Diese Relation war jedoch nur in den ersten sieben Lebensjahren signifikant. Die Autoren vertreten die Meinung, daß in den ersten sieben Jahren hauptsächlich die neurologische Schädigung für die Wachstumsverminderung verantwortlich ist, daß aber in den späteren Jahren andere Faktoren ins Spiel kommen, die von der Lokalisation der Meningocele unabhängig sind. RESUMEN Crecimiento de tronco y piernas en niños con mielomeningocele La longitud total del cuerpo y de segmentos del cuerpo (coronilla‐rabadilla y subisquial) de 78 niflos con mielomeningocele, fueron medidas a intervalos regulares durante el crecimiento por un promedio de 4‐4 años. Se halló que cuanto más alto era el meningocele, tanto mayores eran los defectos de crecimiento. Sin embargo, la relatión era estadísticamente significativa sólo durante los primeros siete años de edad. Se concluye que la lesión neurológica era el mayor responsable del defecto de desarrollo durante el primer año de vida, pero que otros factores independientes del nivel del meningocele juegan también un papel en los años posteriores.
Adrenal gland surgery needs a multidisciplinary team including endocrinologist, radiologist, anesthesiologist, and surgeon. The indications for adrenal gland surgery include hormonal secreting and non-hormonal secreting tumors. Adrenal hormonal secreting tumors present to the anesthesiologist unique challenges requiring good preoperative evaluation, perioperative hemodynamic control, corrections of all electrolytes and metabolic abnormalities, a detailed and careful anesthetic strategy, overall knowledge about the specific diseases, control and maintaining of postoperative adrenal function, and finally a good collaboration with other involved colleagues. This review will focus on the endocrine issues, as well as on the above-mentioned aspects of anesthetic management during hormone secreting adrenal gland tumor resection.
Background: Abdominal incision hernia is a common complication of abdominal surgery. Despite significant improvements in medical technology and healthcare, an increasing number of patients are also benefiting from complex surgical procedures. The objective of this study was to analyze the risk factors for incisional abdominal hernias and to identify measures that could reduce the incidence of this complication. Material and methods: All patients included in the study are from the University Hospital of Trauma for a period of 3 years, from January 1, 2015, to December 31, 2017. Eighty-seven adult patients who underwent surgical repair of incisional abdominal wall hernia were enrolled. Variables that are compared in this study include the type of suture material, type of suture technique and concomitant diseases .etc. Results: According to our study the risk factors for incisional hernia are related to patients and the abdominal surgery used, the size of the abdominal wall defects. Conclusions: Risk factors such as the size of the defect, wound infection, obesity, use of steroids and chronic constipation have great importance and have to be strictly evaluated as they have more chances to lead to a possible recurrence…
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