26 research outputs found

    Decreased surfactant phosphatidylcholine synthesis in neonates with congenital diaphragmatic hernia during extracorporeal membrane oxygenation

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    Purpose: Congenital diaphragmatic hernia (CDH) may result in severe respiratory insufficiency with a high morbidity. The role of a disturbed surfactant metabolism in the pathogenesis of CDH is unclear. We therefore studied endogenous surfactant metabolism in the most severe CDH patients who required extracorporeal membrane oxygenation (ECMO). Methods: Eleven neonates with CDH who required ECMO and ten ventilated neonates without significant lung disease received a 24-h infusion of the stable isotope [U-13C] glucose. The13C-incorporation into palmitic acid in surfactant phosphatidylcholine (PC) isolated from serial tracheal aspirates was measured. Mean PC concentration in epithelial lining fluid (ELF) was measured during the first 4 days of the study. Results: Fractional surfactant PC synthesis was decreased in CDH-ECMO patients compared to controls (2.4 ± 0.33 vs. 8.0 ± 2.4%/day, p = 0.04). The control group had a higher maximal enrichment (0.18 ± 0.03 vs. 0.09 ± 0.02 APE, p = 0.04) and reached this maximal enrichment earlier (46.7 ± 3.0 vs. 69.4 ± 6.6 h, p = 0.004) compared to the CDH-ECMO group, which reflects higher and faster precursor incorporation in the control group. Surfactant PC concentration in ELF was similar in both groups. Conclusion: These results show that CDH patients who require ECMO have a decreased surfactant PC synthesis, which may be part of the pathogenesis of severe pulmonary insufficiency and has a negative impact on weaning from ECMO

    Decreased surfactant phosphatidylcholine synthesis in neonates with congenital diaphragmatic hernia during extracorporeal membrane oxygenation

    Get PDF
    Purpose: Congenital diaphragmatic hernia (CDH) may result in severe respiratory insufficiency with a high morbidity. The role of a disturbed surfactant metabolism in the pathogenesis of CDH is unclear. We therefore studied endogenous surfactant metabolism in the most severe CDH patients who required extracorporeal membrane oxygenation (ECMO). Methods: Eleven neonates with CDH who required ECMO and ten ventilated neonates without significant lung disease received a 24-h infusion of the stable isotope [U-13C] glucose. The13C-incorporation into palmitic acid in surfactant phosphatidylcholine (PC) isolated from serial tracheal aspirates was measured. Mean PC concentration in epithelial lining fluid (ELF) was measured during the first 4 days of the study. Results: Fractional surfactant PC synthesis was decreased in CDH-ECMO patients compared to controls (2.4 ± 0.33 vs. 8.0 ± 2.4%/day, p = 0.04). The control group had a higher maximal enrichment (0.18 ± 0.03 vs. 0.09 ± 0.02 APE, p = 0.04) and reached this maximal enrichment earlier (46.7 ± 3.0 vs. 69.4 ± 6.6 h, p = 0.004) compared to the CDH-ECMO group, which reflects higher and faster precursor incorporation in the control group. Surfactant PC concentration in ELF was similar in both groups. Conclusion: These results show that CDH patients who require ECMO have a decreased surfactant PC synthesis, which may be part of the pathogenesis of severe pulmonary insufficiency and has a negative impact on weaning from ECMO

    Tomografía computada de tórax en pediatría. Indicaciones actuales

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    El estudio de enfermedades que afectan el sistema respiratorio es una práctica cotidiana en pediatría. Las imágenes cumplen un rol muy importante y la tomografía computada multicorte (TCMC) tan alejada inicialmente de los niños tiene actualmente un rol muy importante. La TCMC ha aumentado significativamente el número de patologías posibles de estudiar ya que presenta ventajas en comparación con la tomografía convencional. Permite reducir la dosis de radiación y de volumen de contraste endovenoso, es un exámen extremadamente rápido, se consiguen adquisiciones volumétricas en apnea sin artefactos, imágenes de muy buena calidad y reconstrucciones multiplanares. Este artículo revisa las indicaciones de estudio con tomografía computada de nódulos pulmonares, masas torácicas, vía aérea, lesiones cervicotorácicas, diafragmáticas o yuxtadiafragmáticas, de la caja torácica, estudio vascular, infecciones y malformaciones congénitas. En conclusión, las nuevas tecnologías de tomografía computada han ampliado las indicaciones en pediatría, convirtiéndose en exámenes más seguros y altamente resolutivos.</jats:p

    ANGIOTOMOGRAFIA COMPUTADA EN PEDIATRIA: EXPERIENCIA EN UN HOSPITAL PEDIÁTRICO

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    QUISTE HIDATIDICO CARDIOPERICARDICO: PRESENTACION DE DOS CASOS CLINICOS

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