4 research outputs found
Strategies and trends in the treatment of (giant) omphalocele
The management of giant omphaloceles remains a challenge for pediatric
surgeons. Although the mortality rate is still high (up to 20%) in case of
multiple congenital anomalies, surviving patients with omphalocele achieve
a state of health and quality of life comparable to that of general
population peers.
Results from our study confirm the hypothesis that neonates with a
congenital abdominal wall defect have a high risk for adhesive small bowel
obstruction and could benefit from adhesion prevention. Awaiting complete
epithelialisation before operation of giant omphalocele might reduce
serosal injury and limit adhesiogenic areas.
The liver was partly unprotected in all giant omphaloceles evaluated in
this thesis. In case of an incisional hernia, the liver was located
underneath the abdominal defect. A pre-operative ultrasound study is
recommended, therefore. Furthermore, the parents should receive good
documentation and information. The question remains whether contact sports
and other risk behaviour should be advised against, as there is no
indication of more blunt trauma in these patients in the literature.
The results of the questionnaire sent to the authors do not show a
consensus for a generally accepted treatment method after more than thirty
years of innovations in the management of patients with a giant
omphalocele.
The newly introduced Component Separation Technique seems to have a good
outcome. The herniation rate is low, and prosthetic materials are not
needed. However, the question remains if delayed closure with this
technique is better than immediate staged closure. There is not yet an
evidence base; we shall have to await the long-term results of the
published techniques. Based on these outcomes, a randomized multicenter
trial comparing the staged and delayed techniques is recommended. Until
then, we remain dependent on expert opinion
Endocrine and metabolic responses in children with meningoccocal sepsis: striking differences between survivors and nonsurvivors
To get insight in the endocrine and metabolic responses in children with
meningococcal sepsis 26 children were studied the first 48 h after
admission. On admission there was a significant difference in
cortisol/ACTH levels between nonsurvivors (n = 8) and survivors (n = 18).
Nonsurvivors showed an inadequate cortisol stress response in combination
to very high ACTH levels, whereas survivors showed a normal stress
response with significantly higher cortisol levels (0.62 vs. 0.89
micromol/L) in combination with moderately increased ACTH levels (1234 vs.
231 ng/L). Furthermore, there was a significant difference between
nonsurvivors and survivors regarding pediatric risk of mortality score (31
vs. 17), TSH (0.97 vs. 0.29 mE/L), T3 (0.53 vs. 0.38 nmol/L), reverse T3
(rT3) (0.75 vs. 1.44 nmol/L), C-reactive protein (34 vs. 78 mg/L),
nonesterified fatty acids (0.32 vs. 0.95 mmol/L), and lactate (7.3 vs. 3.2
mmol/L). In those who survived, the most importan
Health status and psychological outcomes after trauma: A prospective multicenter cohort study
Introduction Survival after trauma has considerably improved. This warrants research on non-fatal outcome. We aimed to identify characteristics associated with both short and long-term health status (HS) after trauma and to describe the recovery patterns of HS and psychological outcomes during 24 months of follow-up. Methods Hospitalized patients with all types of injuries were included. Data were collected at 1 week 1, 3, 6, 12, and 24 months post-trauma. HS was assessed with the EuroQol-5D-3L (EQ-5D3L) and the Health Utilities Index Mark 2 and 3 (HUI2/3). For the screening of symptoms of post-traumatic stress, anxiety and depression, the Impact of Event Scale (IES) and the Hospital Anxiety and Depression Scale (HADS) subscale anxiety (HADSA) and subscale depression (HADSD) were used. Recovery patterns of HS and psychological outcomes were examined with linear mixed model analyses. Results A total of 4,883 patients participated (median age 68 (Interquartile range 53–80); 50% response rate). The mean (Standard Deviation (SD)) pre-injury EQ-5D-3L score was 0.85 (0.23). One week post-trauma, mean (SD) EQ-5D-3L, HUI2 and HUI3 scores were 0.49 (0.32), 0.61 (0.22) and 0.38 (0.31), respectively. These scores significantly improved to 0.77 (0.26), 0.77 (0.21) and 0.62 (0.35), respectively, at 24 months. Most recovery occurred up until 3 months. At long-term follow-up, patients of higher age, with comorbidities, longer hospital stay, lower extremity fracture and spine injury showed lower HS. The mean (SD) scores of the IES, HADSA and HADSD were respectively 14.80 (15.80), 4.92 (3.98) and 5.00 (4.28), respectively, at 1 week post-trauma and slightly improved over 24 months post-trauma to 10.35 (14.72), 4.31 (3.76) and 3.62 (3.87), respectively. Discussion HS and psychological symptoms improved over time and most improvements occurred within 3 months post-trauma. The effects of severity and type of injury faded out over time. Patients frequently reported symptoms of post-traumatic stress. Trial registration ClinicalTrials.gov identifier: NCT02508675
Epidemiology of injuries, treatment (costs) and outcome in burn patients admitted to a hospital with or without dedicated burn centre (Burn-Pro)
INTRODUCTION: The Emergency Management of Severe Burns (EMSB) referral criteria have been implemented for optimal triaging of burn patients. Admission to a burn centre is indicated for patients with severe burns or with specific characteristics like older age or comorbidities. Patients not meeting these criteria can also be treated in a hospital without burn centre. Limited information is available about the organisation of care and referral of these patients. The aims of this study are to determine the burn injury characteristics, treatment (costs), quality of life and scar quality of burn patients admitted to a hospital without dedicated burn centre. These data will subsequently be compared with data from patients with<10% total bodysurface area (TBSA) burned who are admitted (or secondarily referred) to a burn centre. If admissions were in agreement with the EMSB, referral criteria will also be determined.
METHODS AND ANALYSIS: In this multicentre, prospective, observational study (cohort study), the following two groups of patients will be followed: 1) all patients (no age limit) admitted with burn-related injuries to a hospital without a dedicated burn centre in the Southwest Netherlands or Brabant Trauma Region and 2) all patients (no age limit) with<10% TBSA burned who are primarily admitted (or secondarily referred) to the burn centre of Maasstad Hospital. Data on the burn injury characteristics (primary outcome), EMSB compliance, treatment, treatment costs and outcome will be collected from the patients' medical files. At 3 weeks and at 3, 6 and 12 months after trauma, patients will be asked to complete the quality of life questionnaire (EuroQoL-5D), and the patient-reported part of the Patient and Observer Scar Assessment Scale (POSAS). At those time visits, the coordinating investigator or research assistant will complete the observer-reported part of the POSAS.
ETHICS AND DISSEMINATION: This study has been exempted by the medical r