Coming from behind to win - A Qualitative research about psychological conditions of adolescents who have undergone open-heart surgery for single ventricle between the ages 0-5

Early recognition of congenital cardiac pathologies and their treatment by means of palliative or corrective surgery at birth or infancy has vital importance. Successful repair of congenital cardiac defects by surgical methods has gained importance especially during the last twenty years. As the scope of the surveillance increased so did the interest in the outcomes of these treatments when the patients had reached puberty and adulthood. The purpose of our research was to study the psychological framework of the adolescents who had experienced these surgeries by listening both the children and the parents talk about their feelings and experiences. Our data was accumulated through interviews with 17 adolescents and their families, using qualitative methods. The main theme at the end of the analysis was "to be strong and resistive". We reached the conclusion that this condition was not a pathological build up but an attitude of coping, as it did not cause loss of functionality. The defensive psychological mechanisms used by these adolescents consisted of repression, compensation and reaction formation. We believe that this information is important to understand the real meaning of the manners displayed when these adolescents and their families pursue their daily lives, communicate and make relationships with their environment and especially professionals in the health services

Monatsschrift Kinderheilkunde / Pathophysiologie der Synkope : Weg zu Diagnose und Management

Synkopen bei Kindern und Jugendlichen sind häufig, können aber auch schon im Säuglingsalter auftreten. Da es sich um ein „Symptom“ handelt, bedarf jedes Ereignis einer Diagnose als Erklärung. Eine Synkope ist eine plötzlich auftretende Episode kurz andauernder Bewusstlosigkeit, gefolgt von rascher und vollständiger Erholung, die durch eine globale zerebrale Hypoperfusion verursacht wird. Die vasovagalen Synkopen (VVS) oder Reflexsynkopen (RS) stehen im Vordergrund. Neue Erklärungsmodelle wie der „Selbstschutzmechanismus des Gehirns“ oder das „neuroviszerale Integrationsmodell“ verändern das Verständnis der komplexen pathophysiologischen Abläufe. Sorgfältige Anamnese und Statuserhebung sowie ein 12-Ableitungs-EKG lassen die meisten Pathomechanismen erkennen und helfen, potenziell lebensbedrohliche Erkrankungen auszuschließen.Syncope is a frequent condition in children and adolescents but can also occur in infancy. As syncope itself only represents a “symptom”, every event requires an adequate explanation of the underlying clinical mechanism. Syncope is caused by global cerebral hypoperfusion, leading to a short loss of consciousness with sudden onset and normally rapid and complete recovery. Vasovagal syncope (VVS) or reflex syncope (RS) is predominant in every age group and the course is most often benign. The concept of a brain self-protection mechanism and the model of neurovisceral integration have changed the perspectives in the interpretation of the underlying complex pathomechanisms. Meticulous patient history taking, a thorough physical examination and a 12-lead electrocardiogram (ECG) most often provide the key to the diagnosis helping to understand both the pathomechanisms and to rule out potentially life-threatening diseases.(VLID)505441

Discrepancy between invasive and non-invasive blood pressure readings in extremely preterm infants in the first four weeks of life.

BackgroundThe agreement between invasive and non-invasive blood pressure (BP) readings in the first days of life of preterm infants is contentiously debated.ObjectiveTo compare mean, systolic and diastolic invasive (IBP) and non-invasive BP (NBP) readings obtained during routine care in the first four weeks of life of extremely preterm infants.MethodsWe extracted pairs of IBP and NBP readings obtained from preterm infants born below 28 weeks of gestation from the local database. After exclusion of erroneous measurements, we investigated the repeated measures correlation and analyzed the agreement (bias) and precision adjusted for multiple measurements per individual.ResultsAmong 335 pairs of IBP and NBP readings obtained from 128 patients, we found correlation coefficients >0.65 for mean, systolic and diastolic BP values. The bias for mean BP readings was -0.4 mmHg (SD 6.1), for systolic BP readings 6.2 mmHg (SD 8.1), and for diastolic BP readings -4.3 mmHg (SD 6.5). Overestimation of systolic IBP and underestimation of diastolic IBP by the non-invasive measurement were found both in the group with gestational age from 23 to 25.9 weeks and in the group with gestational age from 26 to 27.9 weeks. Systolic NBP readings tended to exceed invasive readings in the range 30 mmHg (bias -5.5 mmHg).ConclusionThe disagreement between invasive and non-invasive BP readings in infants extends to the first four weeks of life. Biases differ for mean, systolic and diastolic BP values. Our observation implies that they may depend on the range of the blood pressure. Awareness of these biases and preemptive concomitant use of IBP and NPB readings may contribute to reducing over- or under-treatment