RESUMEN
Although venoarterial extracorporeal membrane oxygenation (ECMO) is an accepted form of cardiopulmonary support for critically ill neonates, carotid artery reconstruction (CAR) after decannulation remains controversial. Long-term follow-up information regarding the natural progression of the anastomosis is unavailable. From January 1990 through December 1990, 13 venoarterial neonatal ECMO survivors had CAR performed and were enrolled into this prospective study based on sonographic follow-up of CAR. A total of 34 carotid artery sonographic studies were performed (13 within 1 week after reconstruction, 8 at 6 to 9 months, and 13 at 4 years of age). A high patency rate during the neonatal period was observed (12 of 13, 92%). Among 12 children with normal neonatal sonographic studies, 5 had completely normal studies during 4 years of follow-up. Narrowing at the anastomotic site (defined as structural narrowing with velocity ratio of peak systolic velocity at the anastomosis to peak systolic velocity proximal to the anastomosis > 1.0 but < or =2.0) by 4 years of age developed in 7 children. Two of these 7 children had hemodynamically significant stenotic anastomosis (defined as structural narrowing with velocity ratio >2.0) by 4 years of age. One neonate had a narrowed anastomosis that resolved completely by the age of 4 years. The incidence of normal studies decreased from 92% to 75% to 46% during the neonatal period, at 6 to 9 months, and at 4 years follow-up, respectively (Chi-square test for trend, P < .01). Long-term follow-up information on the natural progression of carotid reanastomosis is required.
Asunto(s)
Arterias Carótidas/cirugía , Oxigenación por Membrana Extracorpórea/efectos adversos , Anastomosis Quirúrgica/efectos adversos , Velocidad del Flujo Sanguíneo , Arterias Carótidas/diagnóstico por imagen , Arterias Carótidas/patología , Constricción Patológica/etiología , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Pronóstico , Estudios Prospectivos , Insuficiencia Respiratoria/terapia , Ultrasonografía Doppler , Grado de Desobstrucción VascularRESUMEN
The Angelchik antireflux prosthesis is associated with complications that require reoperation in 5% to 15% of patients. To determine the morbidity and success of reoperation for these complications, we conducted a retrospective study of 15 patients. Time to reoperation ranged from 3 weeks to 113 months with a mean of 31 months. Indications for reoperation included dysphagia (8 patients), recurrent reflux (6 patients), and prosthesis migration (1 patient). Ten patients underwent prosthesis removal and fundoplication, 4 had prosthesis removal without fundoplication, and 1 patient had the prosthesis repositioned. Iatrogenic splenic injury occurred in 2 patients (13%); one splenectomy and one splenic repair were done. Four patients (27%) required intraoperative blood transfusion. There were no operative deaths. Removal of the prosthesis without fundoplication resulted in a significantly higher incidence of recurrent reflux (75%) than prosthesis removal and fundoplication (10%) (p < 0.04). Although reoperation for complications of the Angelchik antireflux prosthesis can be technically difficult, morbidity and mortality are acceptable. An antireflux procedure should be done at the time of prosthesis removal.
Asunto(s)
Reflujo Gastroesofágico/cirugía , Prótesis e Implantes/efectos adversos , Adulto , Anciano , Trastornos de Deglución/etiología , Unión Esofagogástrica/cirugía , Esófago/cirugía , Femenino , Migración de Cuerpo Extraño/etiología , Migración de Cuerpo Extraño/cirugía , Reacción a Cuerpo Extraño/etiología , Reacción a Cuerpo Extraño/cirugía , Humanos , Complicaciones Intraoperatorias , Masculino , Persona de Mediana Edad , Recurrencia , Reoperación , Estudios Retrospectivos , Bazo/lesiones , Bazo/cirugía , Factores de Tiempo , Resultado del TratamientoRESUMEN
The ostomy sites of four premature infants undergoing bowel reanastomosis were lavaged with a 10% solution of povidone iodine to reduce local bacterial contamination and the risk of anastomosis dehiscence. There was a significant decrease in serum thyroxin from 112 (+/- 11) mumol/L to 90 (+/- 33) mumol/L 24 hours following surgery (P less than .05), but no change in serum thyroid stimulating hormone (TSH). The total serum iodine rose from 1.5 (+/- 0.05) mumol/L before surgery to 61.6 (+/- 46.4) mumol/L 24 hours later and urinary iodine excretion was 60 times the preoperative value in the second 24 hours following surgery. Both the hormonal and biochemical indices returned to normal 2 weeks following surgery except for total serum iodine, which remained slightly elevated. Povidone iodine is a safe and effective antiseptic agent. However, as it may cause transient suppression of thyroid function in neonates, thyroid status should be tested in all such infants at approximately 2 weeks following repeated or widespread use.
Asunto(s)
Ileostomía , Enfermedades del Prematuro/cirugía , Povidona Yodada/uso terapéutico , Povidona/análogos & derivados , Infección de la Herida Quirúrgica/prevención & control , Glándula Tiroides/efectos de los fármacos , Humanos , Recién Nacido , Yodo/sangre , Periodo Posoperatorio , Povidona Yodada/toxicidad , Riesgo , Irrigación Terapéutica , Tirotropina/sangre , Tiroxina/sangreRESUMEN
Pulmonary contusion represents a serious complication of chest trauma. Its management should include adequate oxygen therapy and ventilatory support. Monitoring of the patient's condition should be by repeated measurement of arterial blood gases; use of the Swan-Ganz catheter is seldom necessary. Broad-spectrum antibiotics are generally indicated but cortisone, cardiotonic drugs and diuretics are not usually required.