RESUMEN
OBJECTIVES: To assess the structural integrity of the patch-like Gore Septal Occluder (GSO) used for device closure of secundum-type atrial septal defects (ASD II) in pediatric patients. BACKGROUND: GSO has shown to be effective and safe for ASD device closure in children and adolescents. METHODS: Single-center, retrospective mid- to long-term follow-up of all children and adolescents with a GSO in situ (≥12 months). Periprocedural data and follow-up data were evaluated, including chest X-rays to assess the GSO's wire-frame morphology. RESULTS: Ninety-one consecutive patients were enrolled with a median age and weight of 5 years (range 2-18) and 20 kg (range 11-95) at implantation. ASD anatomy included 64 single and 27 multi-fenestrated defects, with 39 patients having small retro-aortic rims (≤4 mm). Median follow-up period was 42.5 months (range 12-74). Chest X-rays were available in 80 children: in 74 of them, the GSO's visualization on X-ray enabled us to reliably assess the wire-frame structure. Wire-frame fracture (WFF) was ultimately detected in five of the 74 patients (6.8%); however, those occluders appeared stably anchored and well aligned to both sides of the septum, and no free wire fragments had escaped the GSO matrix. Thus, no further treatment was required. CONCLUSIONS: Our data confirm that the GSO is safe and effective for ASD closure. Despite its lightweight construction, the GSO seems to offer reliable mechanical durability. Wire-frame fractures occur, but the free wire-ends appear to have remained stable within the GSO matrix without any clinical sequelae so far.
Asunto(s)
Cateterismo Cardíaco/instrumentación , Defectos del Tabique Interatrial/terapia , Dispositivo Oclusor Septal , Adolescente , Cateterismo Cardíaco/efectos adversos , Niño , Preescolar , Femenino , Defectos del Tabique Interatrial/diagnóstico por imagen , Humanos , Masculino , Diseño de Prótesis , Falla de Prótesis , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVES: To assess airway compression during pulmonary artery (PA) intervention in single ventricle (SV) palliation. BACKGROUND: SV lesions with a prominent neo-aortic root are considered a high risk for branch PA and/or bronchial stenosis. PA stenting is well established, but may result in ipsilateral bronchial compression. METHODS: Single-centre retrospective analysis of 19 palliated SV patients with branch PA stenosis and close proximity to the ipsilateral main bronchus who underwent cardiac catheterisation at a median age and weight of 8.5 years (0.5-25) and 16.5 kg (6-82) between 12/2011 and 05/2015. RESULTS: Two of the 19 patients suffered an almost-closed left-main bronchus (LMB) following PA stenting. Fortunately, LMB decompression succeeded in both those patients by re-shaping the PA stents by compressing the chest while splinting the LMB with an inflated balloon. To prevent the other 17 patients from suffering this serious complication, we adopted a thorough preparation strategy: 13 patients underwent safe simultaneous bronchoscopy and cardiac catheterisation; in the remaining 4 patients CT-angiography enabled accurate risk evaluation prior to re-catheterisation. CONCLUSIONS: In SV lesions accompanied by branch PA stenosis, thorough preparation via cross-sectional imaging is mandatory, including simultaneous bronchoscopy and cardiac catheterisation in selected cases, to rule out any airway compression before considering endovascular stent implantation. If a PA stent's compression has already caused severe bronchial obstruction, our balloon-splinted decompression technique should be considered.
Asunto(s)
Obstrucción de las Vías Aéreas/prevención & control , Arteriopatías Oclusivas/terapia , Bronquios , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Cardiopatías Congénitas/terapia , Arteria Pulmonar , Stents , Adolescente , Adulto , Obstrucción de las Vías Aéreas/diagnóstico por imagen , Obstrucción de las Vías Aéreas/etiología , Obstrucción de las Vías Aéreas/terapia , Angioplastia de Balón , Arteriopatías Oclusivas/diagnóstico por imagen , Arteriopatías Oclusivas/etiología , Arteriopatías Oclusivas/fisiopatología , Broncoscopía , Cateterismo Cardíaco , Niño , Preescolar , Angiografía por Tomografía Computarizada , Constricción Patológica , Alemania , Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/fisiopatología , Humanos , Lactante , Cuidados Paliativos , Valor Predictivo de las Pruebas , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/fisiopatología , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Adulto JovenRESUMEN
Therapeutic hypothermia is currently recommended for adult comatose survivors of cardiac arrest and perinatal hypoxic-ischemic encephalopathy. By contrast, current international guidelines on cardiopulmonary resuscitation in children neither refute nor support therapeutic hypothermia. Here we report on a 4-month old infant who survived resuscitation for severe cardiopulmonary insufficiency without neurological impairments. The infant most probably experienced unwitnessed aspiration with subsequent severe cardiopulmonary insufficiency. This was paralleled by incidental hypothermia, i.e. a core body temperature of 32°C at time of resuscitation. The infant was transported to the pediatric intensive care unit and additional to state-of the art resuscitation therapy (e.g. vasopressors, pressure controlled intermittent mandatory ventilation) therapeutic hypothermia (core body temperature 32.0-34.0°C) was admininistered for additional 48 h to confer optimal neuroprotection. Subsequently, he was rewarmed (0.25°C per hour) and sedation was stopped at a core body temperature of 36°C. Chest X-ray at time of admission to the hospital revealed typical signs of severe aspiration, whereas transthoraic echocardiography, electrocardiography and ultrasound examination of the brain were without pathological findings. Likewise, magnetic resonance imaging of the head performed on days 3 and 32 after resuscitation revealed no signs of hypoxic brain damage and the child was discharged to foster care without neurological deficits 52 days after admission.
Asunto(s)
Reanimación Cardiopulmonar , Paro Cardíaco/terapia , Hipotermia Inducida , Temperatura Corporal , Humanos , Hipoxia Encefálica/diagnóstico , Hipoxia Encefálica/prevención & control , Lactante , Recién Nacido , Unidades de Cuidado Intensivo Pediátrico , Imagen por Resonancia Magnética , Masculino , Neumonía por Aspiración/complicacionesRESUMEN
OBJECTIVES: Device closure of atrial septal defects (ASD II) is an alternative to surgery. ASD morphology and intracardiac relationships may influence device selection. Biocompatibility, techniques for closing large or multiple defects, and the risk of erosion are main issues in children BACKGROUND: The GORE® Septal Occluder (GSO) is a non-self-centering device with a flat and conformable nitinol-frame covered with expanded polytetrafluoroethylene. We hereby evaluate our initial experience in children to demonstrate feasibility, efficacy, and safety. METHODS: Single-center retrospective intention-to-treat analysis of GSO procedures in children and adolescents with hemodynamically significant ASD. All procedures were conducted under general anesthesia, fluoroscopy and transesophageal echocardiography. All defects were sized using stop-flow-technique. GSOs of 20-30 mm disc-diameter were implanted. RESULTS: GSO implantation was attempted in 45 with technical success in 41 patients, median age 6 (range 3-17) years, bodyweight 19 (12-95) kg. Median balloon-sized diameter was 13 (8-19) mm resulting in a GSO-to-ASD-ratio of 2 (1.7-2.5). Deficient retro-aortic rims (<3 mm) were found in 12 patients, and 10 of these 12 defects could be closed. We observed no complications. Four extensive or multiple ASDs were not treated successfully with GSO. After retrieval, one was closed with a different device; three patients needed surgical therapy. The median follow-up of four (range 0.2-22) months was uneventful in all patients CONCLUSIONS: We found the GSO device closure of ASDs in children to be effective. However, our initial experience is limited to short- and mid-term-follow-up of a low number of patients.
Asunto(s)
Cateterismo Cardíaco/instrumentación , Defectos del Tabique Interatrial/terapia , Dispositivo Oclusor Septal , Adolescente , Factores de Edad , Aleaciones , Anestesia General , Cateterismo Cardíaco/efectos adversos , Niño , Preescolar , Ecocardiografía Transesofágica , Estudios de Factibilidad , Femenino , Alemania , Defectos del Tabique Interatrial/diagnóstico , Defectos del Tabique Interatrial/fisiopatología , Hemodinámica , Humanos , Análisis de Intención de Tratar , Masculino , Politetrafluoroetileno , Diseño de Prótesis , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
The Gutenberg Health Study (GHS) is a prospective, single center, population-based cohort study. It is an interdisciplinary project for investigation of ocular, cardiovascular, psychosomatic and immune diseases in the population of the City of Mainz and the district of Mainz-Bingen in central Germany. The main goals of the ophthalmological branch of GHS are determination of the prevalence and incidence of major ocular risk factors and diseases, exploring the genetic determinants and assessing complex interdisciplinary associations. The study cohort includes 15,010 participants aged between 35 and 74 years at the time of inclusion. After completing the baseline investigations the 5-year follow-up of the whole study cohort started in April 2012. The GHS is the most extensive data set of major ophthalmological conditions and risk factors in Germany and will help researchers in understanding complex medical associations.
Asunto(s)
Oftalmopatías/epidemiología , Oftalmopatías/genética , Predisposición Genética a la Enfermedad/epidemiología , Predisposición Genética a la Enfermedad/genética , Adulto , Distribución por Edad , Anciano , Estudios de Cohortes , Femenino , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Grupo de Atención al Paciente/estadística & datos numéricos , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Distribución por SexoRESUMEN
Intraocular pressure (IOD) is the most important risk factor for the occurrence and progression of glaucoma because it is the only measurable risk factor. There is a positive connection between IOD and both systolic and diastolic blood pressure. The clinical relevance is, however, limited because the moderate alterations in IOD are less than the known measurement error and daily physiological oscillation.
Asunto(s)
Presión Sanguínea , Hipertensión/epidemiología , Hipertensión/fisiopatología , Presión Intraocular , Modelos Biológicos , Hipertensión Ocular/epidemiología , Hipertensión Ocular/fisiopatología , Adulto , Anciano , Comorbilidad , Simulación por Computador , Femenino , Alemania/epidemiología , Humanos , Hipertensión/diagnóstico , Masculino , Persona de Mediana Edad , Hipertensión Ocular/diagnóstico , Prevalencia , Reproducibilidad de los Resultados , Factores de Riesgo , Sensibilidad y Especificidad , Estadística como AsuntoRESUMEN
BACKGROUND: Whether antibiotic treatment in patients with enterohemorrhagic Escherichia coli (EHEC)-associated diarrhea influences the risk of hemolytic uremic syndrome (HUS) has still to be elucidated. PATIENTS AND METHODS: During the EHEC epidemic which occurred in northern Germany in spring 2011, 24 patients with E. coli O104:H4 infection were treated at our hospitals, 19 of whom developed HUS. The use of antibiotics before and after the onset of HUS was documented, and the outcome in patients with and without antibiotic treatment was evaluated. RESULTS: Of the 24 patients with EHEC-associated diarrhea, seven received antibiotics before any signs of HUS were present (ciprofloxacin, cefotaxime, amoxicillin and/or metronidazole). Four of these seven patients (57 %) and 15 of the 17 patients (88 %) who were treated without antibiotics developed HUS (p = 0.12). Microbiological testing showed all E. coli O104:H4 to be extended-spectrum beta lactamase producers and thus susceptible only to fluoroquinolones, aminoglycosides and carbapenems. Two of the five patients (40 %) treated with ciprofloxacin and 17 of the 19 patients (89 %) treated without ciprofloxacin developed HUS (p = 0.043). CONCLUSION: In our E. coli O104:H4-infected patients, treatment of diarrhea with antibiotics did not increase the risk of HUS. Significantly fewer patients treated with ciprofloxacin developed HUS than patients who did not receive ciprofloxacin.
Asunto(s)
Antibacterianos/uso terapéutico , Ciprofloxacina/uso terapéutico , Diarrea/tratamiento farmacológico , Escherichia coli Enterohemorrágica/efectos de los fármacos , Infecciones por Escherichia coli/tratamiento farmacológico , Síndrome Hemolítico-Urémico/prevención & control , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Diarrea/complicaciones , Diarrea/epidemiología , Brotes de Enfermedades , Infecciones por Escherichia coli/complicaciones , Infecciones por Escherichia coli/epidemiología , Femenino , Alemania/epidemiología , Síndrome Hemolítico-Urémico/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Medición de Riesgo , Resultado del Tratamiento , Adulto JovenRESUMEN
To study transport and reactions of arsenic under field conditions, a small-scale tracer test was performed in an anoxic, iron-reducing zone of a sandy aquifer at the USGS research site on Cape Cod, Massachusetts, USA. For four weeks, a stream of groundwater with added As(V) (6.7 muM) and bromide (1.6 mM), was injected in order to observe the reduction of As(V) to As(III). Breakthrough of bromide (Br(-)), As(V), and As(III) as well as additional parameters characterizing the geochemical conditions was observed at various locations downstream of the injection well over a period of 104 days. After a short lag period, nitrate and dissolved oxygen from the injectate oxidized ferrous iron and As(V) became bound to the freshly formed hydrous iron oxides. Approximately one week after terminating the injection, anoxic conditions had been reestablished and increases in As(III) concentrations were observed within 1 m of the injection. During the observation period, As(III) and As(V) were transported to a distance of 4.5 m downgradient indicating significant retardation by sorption processes for both species. Sediment assays as well as elevated concentrations of hydrogen reflected the presence of As(V) reducing microorganisms. Thus, microbial As(V) reduction was thought to be one major process driving the release of As(III) during the tracer test in the Cape Cod aquifer.
Asunto(s)
Arsénico/análisis , Compuestos Ferrosos/química , Contaminantes del Agua/análisis , Arsénico/química , Arsénico/aislamiento & purificación , Compuestos Férricos/química , Compuestos Ferrosos/análisis , Sedimentos Geológicos/análisis , Massachusetts , Oxidación-Reducción , Movimientos del Agua , Contaminantes del Agua/química , Contaminantes del Agua/aislamiento & purificación , Contaminantes Químicos del Agua , Purificación del AguaRESUMEN
3D-echocardiography using a matrix array transducer was performed in 112 patients. In 98 patients (87.5 %) we were able to acquire adequate 3D-data. The mean time for the 3D-examination was 5.5 min. In valve lesions, septal defects and complex cyanotic heart disease 3D-echocardiography was a confident and helpful innovation for better assessment of the intracardiac morphology in pediatric patients. We conclude that 3D-echocardiography is a useful addition to the conventional 2D-echocardiography.
Asunto(s)
Ecocardiografía Tridimensional/instrumentación , Cardiopatías Congénitas/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador/instrumentación , Adolescente , Niño , Preescolar , Ecocardiografía , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Sensibilidad y Especificidad , TransductoresRESUMEN
Mechanical properties of patellar tendon autografts used to replace the anterior cruciate ligament (ACL) in the cynomolgus monkey were measured at four time periods up to 1 year. The ACL was replaced in each knee with the medial half of the patellar tendon: as a vascularized graft (VG) on one side and as a nonvascularized or free graft (FG) on the other. Postoperative care consisted of 4 weeks of cast immobilization at 30 degrees flexion followed by unrestricted activity in a large cage. Both grafts showed low stiffness and maximum force at 7 weeks (24% and 16% of ACL control values, respectively), increasing to 57% of control ACL stiffness and 39% of control maximum force by 1 year. Corresponding material properties, modulus and maximum stress, also increased over time, but at 1 year were only 34% and 26% of ACL values, respectively. The results indicate that retaining vascularity does not prevent significant reduction in graft properties that occur postoperatively, nor does it accelerate the return in strength and stiffness. Tissue stiffness, which returns earlier than maximum force and joint anteroposterior (AP) force displacement data, should be routinely reported in any healing study. Finally, in studies of this kind, the large variation in the results makes sampling only one or two animals from each time period unreliable.
Asunto(s)
Rótula/trasplante , Tendones/trasplante , Animales , Fenómenos Biomecánicos , Articulación de la Rodilla/fisiopatología , Macaca fascicularis , Masculino , Movimiento , Rótula/irrigación sanguínea , Rótula/fisiopatología , Complicaciones Posoperatorias , Tendones/irrigación sanguínea , Tendones/fisiopatología , Factores de TiempoRESUMEN
Brucella canis was isolated from the cement or bone surrounding a hip prosthesis after total hip replacement was performed for treatment of hip dysplasia in 2 dogs. Lameness or signs of infection were not evident for 9 and 16 months after surgery. Osteomyelitis surrounding the prostheses was detected radiographically only after the lameness developed. The origin of the B canis infection in the 2 dogs was believed to be hematogenous because of the biologic behavior of this organism and because of the duration of excellent limb function after hip replacement. A slide agglutination test for B canis should be performed as a screening test on any canine total hip candidate when the anamnesis and physical examination indicate that the dog may have been exposed to or infected with B canis.
Asunto(s)
Brucelosis/veterinaria , Enfermedades de los Perros/microbiología , Prótesis de Cadera/veterinaria , Cojera Animal/cirugía , Osteomielitis/veterinaria , Animales , Brucelosis/etiología , Enfermedades de los Perros/diagnóstico por imagen , Enfermedades de los Perros/etiología , Enfermedades de los Perros/cirugía , Perros , Femenino , Prótesis de Cadera/efectos adversos , Masculino , Osteomielitis/diagnóstico por imagen , Osteomielitis/etiología , Osteomielitis/microbiología , RadiografíaRESUMEN
Fifty-one calcaneus fractures associated with (41) or without (10) central tarsal bone (Tc) fractures in racing greyhounds were evaluated and categorized. All calcaneal fractures with no Tc fractures had a plantar proximal intertarsal subluxation. No subluxations were found in dogs with both calcaneal and central tarsal fractures. The calcaneal fractures were treated either with coaptation splints or surgical repair. Surgical techniques included a Steinmann pin with a figure eight tension band device or screw or plate fixation as primary techniques supplemented by Kirschner wires and cerclage wires. In all calcaneal fractures associated with plantar proximal intertarsal subluxation, an arthrodesis of the calcaneoquartal joint was performed. All 22 surgically repaired fractures in dogs available for physical and radiographic reexamination had healed within 1 to 6 months. Eight dogs with fractures of the calcaneus associated with fractures of Tc returned to a racing career. None of the dogs with plantar proximal intertarsal subluxation raced again. Based on the orientation of the fracture lines and on dissection of two tarsi with calcaneal fractures, a hypothesis on the pathogenesis of calcaneal fractures in racing greyhounds was formulated.
Asunto(s)
Calcáneo/lesiones , Perros/lesiones , Fijación Interna de Fracturas/veterinaria , Fracturas Óseas/veterinaria , Animales , Clavos Ortopédicos/veterinaria , Placas Óseas/veterinaria , Tornillos Óseos/veterinaria , Hilos Ortopédicos/veterinaria , Perros/cirugía , Femenino , Estudios de Seguimiento , Fracturas Óseas/cirugía , Luxaciones Articulares/veterinaria , Masculino , Estudios Retrospectivos , Deportes , Tarso Animal/lesionesRESUMEN
Bilateral midshaft femoral osteotomies were fixed with a 3-mm fracture gap in 6 dogs. In each dog, one femur was fixed with a porous titanium-surfaced bone plate and screws, whereas the opposite femur was fixed with a standard smooth-surfaced bone plate and screws. The mean removal torque for porous titanium-surfaced screws (32.3 kg X cm) was significantly (P less than 0.01) greater than the mean removal torque for standard screws (4.4 kg X cm). Osseous tissue ingrowth into the surface of porous titanium-surfaced screws was verified by histologic examination of the bone-screw interface. Radiographic and histologic examinations of the osteotomy gaps showed accelerated primary gap healing in osteotomies fixed with porous titanium-coated implants, compared with slower callus healing seen in osteotomies fixed with standard smooth-surfaced implants.
Asunto(s)
Placas Óseas , Tornillos Óseos , Fracturas del Fémur/cirugía , Titanio , Animales , Modelos Animales de Enfermedad , Perros , Femenino , Fracturas del Fémur/diagnóstico por imagen , Fracturas del Fémur/patología , Fémur/ultraestructura , Masculino , Microscopía Electrónica de Rastreo , Osteotomía , RadiografíaRESUMEN
Hundreds of total hip replacements in dogs have been performed at the Ohio State University of Veterinary Medicine since August 1976. Dogs with disabling diseases or conditions of the hip are candidates for the THR. The technique provides the dog with a pain free, mechanically sound ball and socket joint. The most commonly encountered complication is dislocation, while the most disastrous complication is infection. Complications can be minimized through adherence to detail during the procedure. By following strict aseptic principles, surgical technique and postoperative care, successful hip function has been achieved in 94.7% of the cases.
Asunto(s)
Enfermedades de los Perros/cirugía , Luxación Congénita de la Cadera/veterinaria , Displasia Pélvica Canina/cirugía , Prótesis de Cadera/veterinaria , Osteoartritis/veterinaria , Animales , Perros , Estudios de Seguimiento , Osteoartritis/cirugía , Diseño de Prótesis , Instrumentos QuirúrgicosRESUMEN
A total of 43 fractures of the distal tibia in dogs and cats were evaluated for fracture patterns, methods of stabilization, and time to bone union. Fractures of the metaphysis (9.3%), physis (30.9%), epiphysis (2.3%), and malleoli (58.2%) were classified. Open reduction and internal fixation, with combinations of Kirschner wire, orthopedic wire, and bone screws, were the methods of fixation used in the majority of fractures. These relatively simple methods of fixation were applied to all sizes of dogs and cats and resulted in an average bone healing time of 6 weeks.
Asunto(s)
Enfermedades de los Gatos/cirugía , Enfermedades de los Perros/cirugía , Fijación de Fractura/veterinaria , Fracturas de la Tibia/veterinaria , Animales , Enfermedades de los Gatos/diagnóstico por imagen , Gatos , Enfermedades de los Perros/diagnóstico por imagen , Perros , Fijación de Fractura/métodos , Radiografía , Fracturas de la Tibia/diagnóstico por imagen , Fracturas de la Tibia/cirugíaRESUMEN
One hundred ninety-five fractures of the canine and feline tibial diaphysis were reviewed. Signalment of the animal; cause, location, and description of the fracture; treatment of the fracture, and response of the fracture to treatment were evaluated. Spiral and oblique fracture patterns were the most frequent in both juvenile (animals less than 12 months old) and adult animals (animals more than 12 months old). Comminuted fractures and open fractures were seen more commonly in the adult animal. Closed reduction and external coaptation as a method of repair was used more frequently in juveniles and open reduction and internal fixation was used more frequently in adults. When open reduction and internal fixation was used, pins, wires, and Kirschner Ehmer external splints were used more frequently in juveniles, and plate and screw fixation of the fracture was used more frequently in adults. The time to bone union varied with age of the animal and method of fixation. Healing times increased in adults, and increased as the stability of the fracture fixation increased. Complications included osteomyelitis and nonunions. Nonunions developed in 4.1% of the fractures not lost to follow-up.
Asunto(s)
Enfermedades de los Gatos/cirugía , Enfermedades de los Perros/cirugía , Fijación de Fractura/veterinaria , Fracturas de la Tibia/veterinaria , Animales , Gatos , Perros , Fijación de Fractura/métodos , Fracturas de la Tibia/cirugíaRESUMEN
A ventrolateral approach to the sacroiliac joint is described as an alternative to the dorsolateral approach for the repair of sacroiliac dislocations and sacral wing fractures. The technique described here usually is performed blindly with digital palpation; however, the approach may be extended craniodorsally, allowing direct visualization of the sacroiliac joint. This technique facilitates reduction and stable fixation, with good purchase of the implants in the sacrum, for the repair of sacroiliac fracture-dislocation. This method of repair was used on 20 patients, with good to excellent clinical results.
Asunto(s)
Enfermedades de los Gatos/cirugía , Enfermedades de los Perros/cirugía , Fijación Interna de Fracturas/veterinaria , Fracturas Óseas/veterinaria , Luxaciones Articulares/veterinaria , Articulación Sacroiliaca/lesiones , Sacro/lesiones , Animales , Tornillos Óseos/veterinaria , Enfermedades de los Gatos/diagnóstico por imagen , Gatos , Enfermedades de los Perros/diagnóstico por imagen , Perros , Femenino , Fijación Interna de Fracturas/métodos , Fracturas Óseas/cirugía , Luxaciones Articulares/cirugía , Radiografía , Articulación Sacroiliaca/diagnóstico por imagenRESUMEN
A rise in fetal acidity (FAS) occurs often but does not necessarily mean that the fetus is at risk. When an increase in acidity is due to maternal causes, a so-called maternogenous increase in acidity (MAS), the fetus has too much organic acid, but no O2 insufficiency. In order to avoid unnecessary operations in such cases, we asked ourselves how we could differentiate on a routine basis between maternogenous and fetogenous acidity increase, and which consequences can be drawn from this. We made observations on 858 neonates with a NApH actual less than 7.30, born between 1973 and 1980 at the Department of Obstetrics at Berlin- Neuk olln Hospital, to assess whether infants with MAS and NapH levels were less often clinically depressed than infants with FAS, and how often an MAS occurred corresponding to Saling 's definition (M/F delta pH qu40 less than or equal to 0.05) to Rooth 's definition (M/F delta pH actual less than or equal to 0.15) or a combination of Saling 's and Rooth 's definition. It was shown that MAS infants were significantly less often born in a clinically depresses state than FAS infants. Within the definition groups there were only very slight differences. With the aid of the Saling and the Rooth combination however, 45% could be recognized as MAS infants, whereas the MAS frequency according to Saling alone or Rooth alone amounted to only about 30%. For the subsequent assessments of the pH levels during labor therefore the combination of Saling and Rooth was used. From 288 labors it could be shown that the differentiation in MAS and FAS in FBA pH levels less than 7.30 led to a significant decrease in the number of operations without any increase in early morbidity in the infants. This leads to the assumption that the procedure described helps to prevent unnecessary operations.