RESUMEN
A 13-month-old infant was admitted to hospital approximately 3 weeks after ingestion of a button battery, which was lodged in the esophagus and had caused a tracheoesophageal fistula requiring mechanical ventilation. Since the battery had partially penetrated into the tracheal lumen just above the carina and also was in direct contact with the pulmonary artery, extensive considerations regarding airway and circulatory management were required preoperatively, which are presented and discussed in this case report.
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Manejo de la Vía Aérea , Suministros de Energía Eléctrica , Cuerpos Extraños/complicaciones , Fístula Traqueoesofágica/etiología , Esófago , Humanos , Lactante , TráqueaRESUMEN
PURPOSE: To review demographics, effect of preoperative chemotherapy on tumour thrombus, imaging, operative strategy, and outcomes of 12 patients presenting with intracardiac extension of Wilms tumour thrombus. METHODS: A retrospective audit was undertaken on patients with intracardiac extension of Wilms tumour. Patients were identified from the oncology database and information obtained on clinical presentation, stage, preoperative treatment, surgical procedures and complications, histology, and survival status. Ethics approval was obtained from the University of Cape Town Human Research Ethics Committee. RESULTS: From 1984 to 2016, 337 children with Wilms tumour were treated. Twelve (3.6%) had intracardiac extension of tumour thrombus, nine into the right atrium, and three into the right ventricle. Ultrasound, computerized tomography, magnetic resonance imaging, and echocardiograms were used to assess thrombus level. Patients were staged as stage III(8) and IV(4). All patients received preoperative chemotherapy. Thrombus retracted from the heart in two cases. One patient died preoperatively. Eleven underwent laparotomy, median sternotomy, and cardiopulmonary bypass (CPB). Four underwent cavectomy. Five required cavoatrial patches. Thrombus extending into the hepatic veins was extracted in five patients. There was one intraoperative complication and one perioperative death. Thrombus histology showed viable tumour in 9 of 11 patients. Three patients died of progressive disease. Seven patients are currently disease free. CONCLUSION: A combination of imaging is required to determine thrombus extent, and this facilitates surgical planning. Preoperative chemotherapy may cause thrombus regression, thus avoiding CPB. CPB offers appropriate conditions for safe tumour thrombus excision. Full management in centres with appropriately experienced staff and facilities for CPB is recommended.
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Procedimientos Quirúrgicos Cardíacos/métodos , Cardiopatías/etiología , Neoplasias Renales/cirugía , Nefrectomía/métodos , Trombosis/etiología , Tumor de Wilms/cirugía , Niño , Preescolar , Femenino , Atrios Cardíacos , Cardiopatías/diagnóstico , Cardiopatías/cirugía , Ventrículos Cardíacos , Humanos , Neoplasias Renales/complicaciones , Neoplasias Renales/diagnóstico , Masculino , Estudios Retrospectivos , Trombosis/diagnóstico , Trombosis/cirugía , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Tumor de Wilms/complicaciones , Tumor de Wilms/patologíaRESUMEN
Helminth infection is frequently associated with the expansion of regulatory T cells (Tregs) and suppression of immune responses to bystander antigens. We show that infection of mice with the chronic gastrointestinal helminth Heligmosomoides polygyrus drives rapid polyclonal expansion of Foxp3(+)Helios(+)CD4(+) thymic (t)Tregs in the lamina propria and mesenteric lymph nodes while Foxp3(+)Helios(-)CD4(+) peripheral (p)Treg expand more slowly. Notably, in partially resistant BALB/c mice parasite survival positively correlates with Foxp3(+)Helios(+)CD4(+) tTreg numbers. Boosting of Foxp3(+)Helios(+)CD4(+) tTreg populations by administration of recombinant interleukin-2 (rIL-2):anti-IL-2 (IL-2C) complex increased worm persistence by diminishing type-2 responsiveness in vivo, including suppression of alternatively activated macrophage and granulomatous responses at the sites of infection. IL-2C also increased innate lymphoid cell (ILC) numbers, indicating that Treg functions dominate over ILC effects in this setting. Surprisingly, complete removal of Tregs in transgenic Foxp3-DTR mice also resulted in increased worm burdens, with "immunological chaos" evident in high levels of the pro-inflammatory cytokines IL-6 and interferon-γ. In contrast, worm clearance could be induced by anti-CD25 antibody-mediated partial depletion of early Treg, alongside increased T helper type 2 responses and without incurring pathology. These findings highlight the overarching importance of the early Treg response to infection and the non-linear association between inflammation and the prevailing Treg frequency.
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Inmunidad Mucosa/efectos de los fármacos , Macrófagos/inmunología , Nematospiroides dubius/inmunología , Infecciones por Strongylida/inmunología , Linfocitos T Reguladores/inmunología , Animales , Anticuerpos Neutralizantes/farmacología , Proteínas de Unión al ADN/genética , Proteínas de Unión al ADN/inmunología , Femenino , Factores de Transcripción Forkhead/genética , Factores de Transcripción Forkhead/inmunología , Regulación de la Expresión Génica , Granulocitos/efectos de los fármacos , Granulocitos/inmunología , Granulocitos/parasitología , Interferón gamma/genética , Interferón gamma/inmunología , Interleucina-2/farmacología , Subunidad alfa del Receptor de Interleucina-2/antagonistas & inhibidores , Subunidad alfa del Receptor de Interleucina-2/genética , Subunidad alfa del Receptor de Interleucina-2/inmunología , Interleucina-6/genética , Interleucina-6/inmunología , Macrófagos/efectos de los fármacos , Macrófagos/parasitología , Ratones , Ratones Endogámicos BALB C , Ratones Endogámicos C57BL , Ratones Transgénicos , Nematospiroides dubius/efectos de los fármacos , Carga de Parásitos , Transducción de Señal , Infecciones por Strongylida/tratamiento farmacológico , Infecciones por Strongylida/parasitología , Linfocitos T Reguladores/efectos de los fármacos , Linfocitos T Reguladores/parasitología , Células TH1/efectos de los fármacos , Células TH1/inmunología , Células TH1/parasitología , Células Th17/efectos de los fármacos , Células Th17/inmunología , Células Th17/parasitología , Factores de Transcripción/genética , Factores de Transcripción/inmunologíaRESUMEN
objective: to evaluate paediatric cardiac services in south Africa with respect to referral base; services provided and human resources. study design: A descriptive study design was used. An audit of the referral base; personnel and activity of paediatric cardiac units throughout south Africa was conducted by means of a questionnaire. A specialist from each centre was asked to provide the relevant data. Where accurate data was not available; estimates were provided by practitioners within each centre. results: All identified units participated in the audit. three were private sector units while the other five were primarily public sector units. twenty four paediatric cardiologists; equally distributed between public and private sector units; were practicing in the country as at end 2008; with a further eight paediatricians undergoing training in paediatric cardiology. this is significantly less than the 88 paediatric cardiologists required for the population of south Africa. Eight paediatric cardiac surgeons were operating predominantly on children in public hospitals and five in private institutions. An estimated 1370 operations for congenital heart disease were performed over a one year period; with 800 of these in the public sector. Extrapolating from accepted estimates of congenital heart disease incidence; this represents conservatively; less that 40of operations required for the population. Additionally; only 26of the estimated 114 simple transposition of great arteries born annually were operated on; indicating serious deficiencies in the ability to adequately detect and intervene in serious congenital heart disease presenting in the neonatal period. conclusion: the infrastructure and resources to detect and manage heart disease in children in south Africa; particularly within the public sector; are grossly inadequate
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Auditoría Administrativa , PediatríaRESUMEN
Most children with congenital heart disease have a good outcome if treated appropriately; however the majority of children with heart disease in south Africa do not receive appropriate care. this is related to serious deficiencies in as a major shortage of skilled personnel to care for these children at all levels .Most public sector hospitals are unable to cope with the number of patients requiring surgery; mainly due to inadequate theatre time allocation and intensive care facilities. Key interventions to address these deficiencies include: 1. strategies to improve both the training and the retention of all professionals involved in the care of congenital heart disease. 2. Programmes to increase awareness of both congenital and acquired heart disease in children among health care personnel. 3. Ensuring appropriate infrastructure and equipment designed for children with congenital heart disease are available. 4. Development of congenital heart surgery as an independent subspecialty with dedicated resources and personnel. 5. Dedicated intensive care facilities for paediatric heart surgery. In addition; development of appropriate patterns of referral; timulation of research and positive private-public partnerships are all necessary to ensure that appropriate care is delivered
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Atención a la Salud , Personal de Salud , Auditoría Administrativa , Pediatría , Recursos HumanosRESUMEN
El 40-50% de los niños con síndrome de Down tienen cardiopatía congénita que pueden ser corregida quirúrgicamente. Existe el riesgo de que haya discriminación contra ellos si existen pocos recursos al considerar que suponen una carga mayor sobre el sistema público de salud o que la cirugía va a tener peores resultados que en los niños sin síndrome de Down. Existe en ciertos medios la creencia de que la contribución que un niño con síndrome de Down hace a la sociedad, percibida como menos importante, no garantiza la utilización de los recursos en este niño, cuando son escasos. En ocasiones se niega la cirugía cardíaca a un niño con SD. El debate persiste si bien los datos demuestran que se va generalizando la oferta de intervención quirúrgica a los niños con síndrome de Down de modo similar a los que no lo tienen. En la actualidad, en África del Sur el Red Cross War Memorial Children´s Hospital (RHX) de patías congénitas. En este Hospital se mantiene que no hay razones importantes para discriminarlos frente a los demás. Pero algunas otras instituciones públicas del país capaces de ofrecer estos servicios quirúrgicos no siguen esta política. Nuestro estudio va a comparar la carga que tienen en relación con la reparación o corrección de la cardiopatía en el RHX. Nuestra revisión va a cuantificar esta carga (en términos de los parámetros que se detallan a continuación) sobre los grupos de niños con y sin síndrome de Down que fueron sometidos a cirugía cardíaca en nuestro hospital durante un período de 5 años (enero 1998- junio 2003). Se recogieron 50 casos de niños con síndrome de Down, cada uno de éstos operado justo después de uno que tenía síndrome de Down. Para valorar la carga generada al sistema público de salud, se analizó el número de días que los niños pasaron en la sala hospitalaria y en la Unidad de Cuidados Intensivos (UCI). El beneficio obtenido por la cirugía cardíaca fue evaluado mediante la determinación del número de días que pasaron en la sala hospitalaria y en la Unidad de cuidados Intensivos (UCI). El beneficio obtenido por la cirugía cardíaca fue evaluado mediante la determinación del número de días que pasaron el en Hospital antes de la primera intervención quirúrgica, entre dos intervenciones (cuando fue necesario realizar dos intervenciones) y después de realizada la última corrección. El cuso postoperatorio fue evaluado mediante la determinación de la frecuencia de reintervenciones, complicaciones de cirugía y tasa de mortalidad precoz en ambos grupos. La mortalidad precoz se definió como muerte tras la cirugía anterior a la salida del hospital. Las admisiones con fines diagnósticos (p.ej., cateterización) fueron incluidas en el número de admisiones, antes o después de la cirugía (AU)
No disponible
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Humanos , Masculino , Femenino , Niño , Procedimientos Quirúrgicos Cardíacos , Cardiopatías Congénitas/cirugía , Síndrome de Down/complicaciones , Estudios de Casos y Controles , Tiempo de Internación , Complicaciones Posoperatorias/epidemiologíaRESUMEN
About 1 in 1,000 children has Down syndrome. Extra chromosomal material results in a myriad of potential problems for the affected individual. About 40% of Down syndrome children will have cardiac abnormalities, ranging from the simple arterial duct to the complex atrioventricular septal defect. Virtually all these defects are amenable to surgical correction and extended survival is possible. In South Africa many of these children do not undergo cardiac surgery.
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Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Atención a la Salud/estadística & datos numéricos , Síndrome de Down/complicaciones , Cardiopatías Congénitas/cirugía , Niño , Cardiopatías Congénitas/complicaciones , Humanos , SudáfricaRESUMEN
OBJECTIVES: To compare children with Down syndrome and children without Down syndrome and investigate whether there is a significant difference in the burden that is placed on the health care system between these two groups only in respect of the repair of congenital heart disease at Red Cross War Memorial Children's Hospital, Cape Town, South Africa. DESIGN: This study is a retrospective case control review. SETTING: Red Cross War Memorial Children's Hospital, Cape Town, South Africa. SUBJECTS: The sample group of 50 Down syndrome children who had received cardiac surgery between January 1998 and June 2003 was compared with a control group of 50 nonsyndromic children who had received cardiac surgery during the same period. OUTCOME MEASURES: Sex and diagnoses (cardiac and noncardiac), number of days spent in hospital and in ICU, complication rates, re-operation rates, early mortality rates, planned further cardiac surgery. Costs of these outcomes were not quantified in exact monetary terms. RESULTS: There was no significant difference between the two groups in terms of the burden that was placed on the health care system. Similar complication rates, re-operation rates and early mortality rates were recorded for both groups. The Down syndrome group appeared to benefit more from cardiac surgery than the non-Down syndrome group. CONCLUSION: Denying cardiac surgery to children with Down syndrome does not improve the efficiency of resource allocation. It is therefore not reasonable to suggest that the problem of scarce resources can be ameliorated by discriminating against children with Down syndrome.
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Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Atención a la Salud/normas , Síndrome de Down/complicaciones , Necesidades y Demandas de Servicios de Salud , Cardiopatías Congénitas/cirugía , Preescolar , Femenino , Estudios de Seguimiento , Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/epidemiología , Humanos , Lactante , Masculino , Prevalencia , Estudios Retrospectivos , Sudáfrica/epidemiología , Resultado del TratamientoRESUMEN
Conjoined twins represent a rare but fascinating congenital condition, the aetiology of which remains obscure. Over the past four decades, the paediatric surgeons at Red Cross Children's Hospital have been involved in the management of 46 pairs of conjoined twins, of which 33 have been symmetrical and 12 asymmetrical. Seventeen symmetrical twins have undergone separation with 22 children (65%) surviving; all of the live asymmetrical twins survived separation. We describe the important features of this unique cohort, outline our approach to management and present the results of this approach. We consider some of the ethical and moral dilemmas we have confronted, and discuss the prenatal diagnosis, obstetric implications and postnatal care of these children, including the relevant investigations and anaesthetic and surgical management. Specific aspects related to the cardiovascular system, hepatobiliary and gastrointestinal tracts, urogenital tract, central nervous system and musculoskeletal system are highlighted.
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Enfermedades en Gemelos/epidemiología , Hospitales de Condado/estadística & datos numéricos , Hospitales Pediátricos/estadística & datos numéricos , Gemelos Siameses , Adolescente , Adulto , Diagnóstico Diferencial , Enfermedades en Gemelos/diagnóstico , Enfermedades en Gemelos/cirugía , Procedimientos Quirúrgicos Electivos/métodos , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Persona de Mediana Edad , Embarazo , Diagnóstico Prenatal , Pronóstico , Estudios Retrospectivos , Sudáfrica/epidemiologíaRESUMEN
AIMS: To describe acid-base derangements in children following open cardiac surgery on cardiopulmonary bypass (CPB), using the Fencl-Stewart strong ion approach. METHODS: Prospective observational study set in the paediatric intensive care unit (PICU) of a university children's hospital. Arterial blood gas parameters, serum electrolytes, strong ion difference, strong ion gap (SIG), and partitioned base excess (BE) were measured and calculated on admission to PICU. RESULTS: A total of 97 children, median age 57 months (range 0.03-166), median weight 14 kg (range 2.1-50), were studied. Median CPB time was 80 minutes (range 17-232). Predicted mortality was 2% and there was a single non-survivor. These children showed mild metabolic acidosis (median standard bicarbonate 20.1 mmol/l, BE -5.1 mEq/l) characterised by hyperchloraemia (median corrected Cl 113 mmol/l), and hypoalbuminaemia (median albumin 30 g/l), but no significant excess unmeasured anions or cations (median SIG 0.7 mEq/l). The major determinants of the net BE were the chloride and albumin components (chloride effect -4.8 mEq/l, albumin effect +3.4 mEq/l). Metabolic acidosis occurred in 72 children (74%) but was not associated with increased morbidity. Hyperchloraemia was a causative factor in 53 children (74%) with metabolic acidosis. Three (4%) hyperchloraemic children required adrenaline for inotropic support, compared to eight children (28%) without hyperchloraemia. Hypoalbuminaemia was associated with longer duration of inotropic support and PICU stay. CONCLUSIONS: In these children with low mortality following open cardiac surgery, hypoalbuminaemia and hyperchloraemia were the predominant acid-base abnormalities. Hyperchloraemia was associated with reduced requirement for adrenaline therapy. It is suggested that hyperchloraemic metabolic acidosis is a benign phenomenon that should not prompt escalation of haemodynamic support. By contrast, hypoalbuminaemia, an alkalinising force, was associated with prolonged requirement for intensive care.
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Acidosis/etiología , Procedimientos Quirúrgicos Cardíacos , Cloruros/sangre , Complicaciones Posoperatorias , Adolescente , Puente Cardiopulmonar , Cardiotónicos/uso terapéutico , Niño , Preescolar , Epinefrina/uso terapéutico , Humanos , Hipoalbuminemia/etiología , Lactante , Recién Nacido , Unidades de Cuidado Intensivo Pediátrico , Ácido Láctico/sangre , Cuidados Posoperatorios/métodos , Pronóstico , Estudios Prospectivos , Medición de RiesgoRESUMEN
As a paradigm for the development of a vaccine against human schistosomiasis, the radiation-attenuated (RA) vaccine has enabled the dissection of different immune responses as putative effector mechanisms. This review considers advances made in the past, and updates our knowledge with reference to recent studies that have provided new information relevant particularly to the early innate events after vaccination, and to the nature of the protective effector mechanism. Priming of a protective response by RA larvae is a highly co-ordinated series of events starting in the skin, draining lymph nodes and lungs, leading to the development of various effector responses, ranging from Th1-associated cell-mediated activity, to anti-parasitic antibodies, all of which contribute to the elimination of challenge larvae to varying extents. In this respect, the RA vaccine elicits a multifaceted immune response, from which we can derive valuable insights relevant to the future design of novel delivery systems and adjuvants for recombinant and subunit vaccines.
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Schistosoma mansoni/efectos de la radiación , Esquistosomiasis/inmunología , Vacunas Atenuadas/administración & dosificación , Vacunas Atenuadas/inmunología , Animales , Anticuerpos Antihelmínticos/sangre , Humanos , Ratones , Schistosoma mansoni/inmunología , Esquistosomiasis/parasitología , Esquistosomiasis/prevención & control , Células TH1/inmunología , VacunaciónRESUMEN
Schistosomes appear to have evolved several strategies to down-regulate the host's immune response in order to promote their own survival. For the host, down-regulation is also beneficial as it can limit the extent of pathology. It is widely accepted that schistosomes modulate the immune response during the chronic phase of infection after egg deposition has started. However, there is increasing evidence that modulation of the immune response can occur much earlier at the time infective cercariae penetrate the host skin. In this review, we explore the various lines of evidence that excretory/secretory (ES) molecules from cercariae down-regulate the host's immune response. We highlight the immunological factors that are produced and may be involved in regulating the immune system (e.g. IL-10, and eicosanoids), as well as speculating on possible mechanisms of immune modulation (e.g. mast-cell activation, T-cell apoptosis, and/or the skewed activation of antigen-presenting cells [APCs]). Finally, we draw attention to several molecules of schistosome origin that have the potential to stimulate the regulatory response (e.g. glycans) and link these to potential host receptors (e.g. TLRs and C-type lectins).
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Schistosoma/inmunología , Esquistosomiasis/inmunología , Animales , Células Presentadoras de Antígenos/inmunología , Antígenos Helmínticos/inmunología , Apoptosis , Proteínas del Helminto/inmunología , Humanos , Larva/inmunología , Linfocitos/inmunología , Linfocitos/fisiología , Mastocitos/inmunología , Schistosoma/crecimiento & desarrolloAsunto(s)
Aneurisma Infectado/complicaciones , Endocarditis Bacteriana/complicaciones , Arteria Pulmonar , Infecciones Estreptocócicas/complicaciones , Tetralogía de Fallot/complicaciones , Aneurisma Infectado/diagnóstico por imagen , Angiografía de Substracción Digital , Preescolar , Endocarditis Bacteriana/diagnóstico por imagen , Femenino , Humanos , Arteria Pulmonar/diagnóstico por imagen , Infecciones Estreptocócicas/diagnóstico por imagen , Tetralogía de Fallot/diagnóstico por imagenRESUMEN
Lymphadenopathy is the hallmark of intrathoracic tuberculosis in children. The role of the thoracic surgeon in treating childhood tuberculosis is to relieve the more severe symptoms of lymphadenopathy, prevent the more long-term secondary damage that lymphadenopathy may cause to the lung, and treat the sequelae of thoracic tuberculosis. We reviewed the role of surgery in childhood tuberculosis at Red Cross Children Hospital from January 1981 to January 1996 in 161 children under 13 who were admitted for 168 therapeutic surgical interventions for proved intrathoracic tuberculosis and its related complications. We classified patients according to the pathophysiology of their disease to clarify the role of surgery in their management. Successful decompression of lymph nodes that were acutely compromising major airways was done in 25 children, and decompression for chronic airway compression was successful in 8 of 11 children. Therapeutic bronchoscopy successfully opened an airway obstructed by intraluminal tissue in 68% of 28 patients, with long-term pulmonary reexpansion in 50%. Pulmonary resections for postprimary tuberculous damage were done in 72 patients with a mortality of 2.7% and morbidity of 16.7%. Another 17 patients were operated on for pleural disease and 15 for other tuberculosis-related problems. The mortality for all patients undergoing surgery for complications of tuberculosis during childhood was 1.9% (3/161), suggesting that when indicated, an aggressive surgical approach is relatively safe.
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Obstrucción de las Vías Aéreas/prevención & control , Países en Desarrollo , Cirugía Torácica/métodos , Tuberculosis Pleural/cirugía , Tuberculosis Pulmonar/cirugía , Obstrucción de las Vías Aéreas/etiología , Broncoscopía/métodos , Niño , Preescolar , Estudios de Evaluación como Asunto , Femenino , Humanos , Lactante , Masculino , Complicaciones Posoperatorias , Sudáfrica , Tasa de Supervivencia , Tuberculosis Pleural/complicaciones , Tuberculosis Pleural/diagnóstico , Tuberculosis Pleural/mortalidad , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/mortalidadRESUMEN
OBJECTIVE: Pulmonary artery banding remains a palliative option for patients with congenital heart disease and excessive pulmonary blood flow, if there is unfavourable anatomy or frail condition. In contrast to more developed countries, our patients at Red Cross Children's Hospital, Cape Town, often present to medical services late and in poor nutritional condition. We retrospectively reviewed patients undergoing pulmonary artery banding to determine major variables that influenced long-term outcome. METHODS: In a 10-year period ending June 1992, 135 consecutive patients underwent pulmonary artery banding; 89 with ventricular septal defect type non-mixing disorders, and 46 with mixing or complex disorders. The median age was 3.0 months and weight 3.5 kg with 74.8% of patients weighing less than the third percentile (NCHS adapted), and 39.3% had an additional serious medical illness. RESULTS: Pulmonary banding mortality was 8.1%, and was higher in neonates (22.2%), P = 0.04) but was not related to congenital disorder, associated medical illness, or associated coarctation or interrupted aortic arch. The pulmonary band was inadequate at follow-up in 28.9%, which occurred more commonly if banding was necessary before 3 months of age (41.5%, P = 0.003) but was not related to weight, congenital disorder or associated respiratory infection. Sixty patients (44.4%) have now proceeded to definitive repair with a mortality of 23.3%, which was increased if the pulmonary band was inadequate at the time of definitive repair (44.4%: P = 0.02), but was not related to the congenital disorder. CONCLUSIONS: An inadequate pulmonary artery band adversely affects outcome and demands further aggressive management prior to definitive repair.
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Cardiopatías Congénitas/cirugía , Hemodinámica/fisiología , Pulmón/irrigación sanguínea , Cuidados Paliativos , Arteria Pulmonar/cirugía , Causas de Muerte , Preescolar , Países en Desarrollo , Femenino , Cardiopatías Congénitas/mortalidad , Cardiopatías Congénitas/fisiopatología , Humanos , Lactante , Recién Nacido , Masculino , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/fisiopatología , Arteria Pulmonar/fisiopatología , Reoperación , Estudios Retrospectivos , Sudáfrica , Tasa de SupervivenciaRESUMEN
Twenty-eight patients were treated for acute blunt thoracic aortic rupture at Groote Schuur Hospital between January 1984 and March 1994. Aortic arch ruptures occurred in 2 patients and were successfully repaired by means of hypothermic circulatory arrest. Descending aortic ruptures were repaired more safely by insertion of an interposition graft as opposed to direct suture reapproximation, and with the aid of partial heparinless bypass as opposed to simple aortic cross-clamping.
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Aorta Torácica/lesiones , Rotura de la Aorta/cirugía , Heridas no Penetrantes/cirugía , Accidentes de Tránsito , Adolescente , Adulto , Anciano , Aorta Torácica/cirugía , Rotura de la Aorta/mortalidad , Prótesis Vascular , Constricción , Femenino , Humanos , Masculino , Persona de Mediana Edad , Parálisis/etiología , Planificación de Atención al Paciente , Complicaciones Posoperatorias , Sudáfrica/epidemiología , Técnicas de Sutura , Factores de Tiempo , Heridas no Penetrantes/mortalidadAsunto(s)
Práctica Privada/economía , Hospitales Privados , Hospitales Públicos , Humanos , SudáfricaRESUMEN
Application of the University of Wisconsin cold storage solution has rapidly expanded to include medium-term to long-term preservation of virtually all intraabdominal organs. Its use in intrathoracic organ transplantation has also been suggested. We therefore examined the efficacy of the University of Wisconsin solution in a primate allotransplantation model for preservation of hearts, and as a simple single-solution system for static preservation of heart-lung blocks, for periods of ischemia ranging from 6 to 24 hours. For comparison, we employed the histidine-tryptophane-ketoglutarate cardioplegic solution of Bretschneider. University of Wisconsin solution provided superior results with regard to clinical outcome and hemodynamic recovery of hearts after ischemic periods of up to 16 hours. This was in contrast to Bretschneider's solution, which allowed storage of hearts for periods of only up to 10 hours. Heart-lung blocks were equally well preserved with either University of Wisconsin or Bretschneider's solution after 6 to 12 hours, although the University of Wisconsin solution group exhibited a more notable increase in pulmonary water content. This was in accordance with histological data, which suggested that, although hemodynamic recovery of hearts stored for periods longer than 10 hours was poor, preservation of pulmonary ultrastructure was far superior using Bretschneider's solution as compared with University of Wisconsin solution after an ischemic period of up to 16 hours.