66 research outputs found
Fire in the Operating Room During Hypospadias Repair
Fire in the operating room (OR) is a very distressful and shocking occurrence with potential dramatic consequences. Despite safety rules and rigorous recommendations, such unintentional events do occur every so often. Notably, the vast majority of cases have been reported in the adult population, with very few pediatric cases described to date. Herein, we report on a 16-month-old boy undergoing reconstructive surgery for penoscrotal hypospadias, who experienced an OR fire most likely related to the use of alcohol-based solution ignited by monopolar electrocautery
Feasibility, safety and outcome of inguinal hernia repair under spinal versus general anesthesia in preterm and term infants
Background: Inguinal hernia repair (IHR) is a common operation in preterm and term infants. Recently, spinal anesthesia (SA) has been proposed as an alternative to avoid exposure to general anesthesia (GA) during early life. The aim of this study was to compare surgical outcomes of open IHR performed under SA versus GA in neonates and infants, and to detect criteria to predict the success or failure of SA. Materials and methods: This is a 6-year, single center, nonrandomized interventional study (2013–2019). SA was performed with 0.5% bupivacaine. GA was given using propofol, fentanyl, sevoflurane, and laryngeal mask. Patient demographics, operative time, intraoperative events related to surgery or anesthesia, and complications were analyzed at short and long-term follow-up. Results: 68 infants (78 IHR) and 37 infants (44 IHR) received SA and GA at the discretion of the anesthesiologist, respectively. SA failure rate was 9%, and positively correlated with weight at surgery (p = 0.001; rp = 0.38). Conversion from SA to GA occurred in 4 (6%) patients owing to prolonged operative time (43.75 ± 4.8 vs 23.02 ± 11.3 min; p = 0.0006). There were no differences regarding operative time and intra- and postoperative complications among the two groups at mean follow-up of 18.53 ± 21.9 months. Conclusions: This pilot study confirms that SA is safe, effective and not detrimental to surgical outcome of neonates and infants undergoing IHR. Additionally, it may help further define what patients may have a successful SA. Our experience suggests that SA is especially suitable in infants weighing < 4000 g, and conversion to GA correlates with prolonged operative time. Level of evidence: Level II
A MSFD complementary approach for the assessment of pressures, knowledge and data gaps in Southern European Seas : the PERSEUS experience
PERSEUS project aims to identify the most relevant pressures exerted on the ecosystems of the Southern
European Seas (SES), highlighting knowledge and data gaps that endanger the achievement of SES Good
Environmental Status (GES) as mandated by the Marine Strategy Framework Directive (MSFD). A complementary
approach has been adopted, by a meta-analysis of existing literature on pressure/impact/knowledge
gaps summarized in tables related to the MSFD descriptors, discriminating open waters from coastal
areas. A comparative assessment of the Initial Assessments (IAs) for five SES countries has been also
independently performed. The comparison between meta-analysis results and IAs shows similarities
for coastal areas only. Major knowledge gaps have been detected for the biodiversity, marine food
web, marine litter and underwater noise descriptors. The meta-analysis also allowed the identification
of additional research themes targeting research topics that are requested to the achievement of GES.
2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license.peer-reviewe
Renal function recovery after nephrectomy or nephron-sparing surgery in children with unilateral renal tumor
Introduction Children with unilateral renal tumor (URT) and preoperative renal
dysfunction (PRD) may benefit from nephron-sparing surgery (NSS). To test this
hypothesis, we studied the outcome of baseline renal function after nephrectomy or
NSS among children with URT.
Materials and Methods Retrospective records review of children with URT who
underwent nephrectomy (25 children) or NSS (11 children) at our institution. We
analyzed the estimated glomerular filtration rate (eGFR) changes over time among
patients, stratified by both preoperative renal function (with or without PRD) and
surgical extent (NSS vs. nephrectomy). The primary end point was evaluation of
compensatory recovery of preoperative eGFR after surgery. Only children older than
2 years at surgery were included in the study. Renal dysfunction was defined as an
eGFR < 90 mL/min/1.73 m2.
Results After nephrectomy or NSS, patients with PRD presented, on average during
adolescence, a significant increase in eGFR, whereas patients without PRD presented, on
average during adolescence, a stable eGFR. However, after nephrectomy, 5 of 17 (29%)
and 7 of 8 (87%) adolescent patients with baseline eGFR or > 100 mL/min/1.73 m2,
respectively, achieved or maintained two-kidney eGFR values (T-KEV) (p ÂĽ 0.01). After
NSS, four adolescent patients with PRD and seven without PRD achieved or maintained
T-KEV.
Conclusion The majority of children with URT and low baseline eGFR present with an
impaired renal function recovery after nephrectomy and may benefit from NSS.
Collaborative studies are needed to support present findings
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