Mitochondrial Oxygen Monitoring During Surgical Repair of Congenital Diaphragmatic Hernia or Esophageal Atresia: A Feasibility Study

Current monitoring techniques in neonates lack sensitivity for hypoxia at cellular level. The recent introduction of the non-invasive Cellular Oxygen METabolism (COMET) monitor enables measuring in vivo mitochondrial oxygen tension (mitoPO2), based on oxygen-dependent quenching of delayed fluorescence of 5-aminolevulinic acid (ALA)-enhanced protoporphyri

Thoracoscopic versus open repair of CDH in cardiovascular stable neonates

Background: Thoracoscopic surgery is an increasingly popular surgical technique to repair congenital diaphragmatic hernia (CDH). However, acidosis during surgery and the higher recurrence rate are considerable risk factors. The aim of this retrospective study is to compare the outcome of open versus thoracoscopic repair of the diaphragm in neonates with CDH with the same degree of cardiovascular and pulmonary illness who meet the criteria for thoracoscopic repair. Methods: Retrospective analysis of all patients of two large national reference centers for CDH born in the years 2008 through 2012, and meeting the criteria for surgical repair on cardiopulmonary and physiological criteria according to the CDH EURO consortium consensus and meeting the criteria for thoracoscopic repair according to the review by Vijfhuize et al. The surgical technical aspects were comparable in both centers. Results: 108 patients were included, of whom 75 underwent thoracoscopic repair and 34 underwent open repair. The gestational age and lung-to-head ratio were significantly lower and stay on the ICU significantly longer in the open-repair group. The operation time was longer (178 vs. 150 min, p = .012) and the recurrence rate higher (18.9 vs. 5.9 %, p = .036) in the thoracoscopic-repair group. The arterial pH, pO2, pCO2 and base excess before and after thoracoscopic repair were all significantly different. Conclusion: After critical selection for thoracoscopic repair of left-sided CDH based on the patient’s preoperative condition, the outcomes of open repair were almost identical to those of thoracoscopic repair. A notable exception is the recurrence rate, which was significantly higher in the thoracoscopic-repair group. For the time being, thoracoscopic primary closure seems a safe and effective procedure, but efficacy of thoracoscopic patch repair has not been established

Towards integrative neuromonitoring of the surgical newborn: A systematic review

BACKGROUND: The altered neurodevelopment of children operated on during the neonatal period might be due to peri-operative changes in the homeostasis of brain perfusion. Monitoring of vital signs is a standard of care, but it does not usually include monitoring of the br

Current state of noninvasive, continuous monitoring modalities in pediatric anesthesiology

Purpose of review The last decades, anesthesia has become safer, partly due to developments in monitoring. Advanced monitoring of children under anesthesia is

Lumbar puncture in bacterial meningitis

Bacterial meningitis is diagnosed through testing of cerebrospinal fluid, which is obtained through lumbar puncture. In this thesis we investigated the practice and characteristics of lumbar puncture in adults with community-acquired bacterial meningitis identified in a prospective nationwide cohort study. This study collected data on patient’s history, symptoms and signs, laboratory findings, clinical course, treatment, and outcome. Lumbar puncture is a safe procedure in patients without contraindications. An absolute contraindication for lumbar puncture is brain shift, in which it can elicit fatal compression of brain structures. Clinical characteristics have been identified to predict which patients are at risk for having brain shift. In patients with any of these clinical characteristics cranial CT should be performed to check if performing lumbar puncture is safe. To prevent treatment delay, antibiotics and dexamethasone should be administered prior to sending the patient for imaging. We describe which percentage of patients with bacterial meningitis undergo a cranial CT prior to lumbar puncture in the Netherlands, and how this percentage was affected by the publication of a nationwide guideline on bacterial meningitis. Furthermore, we describe the interrater reliability of assessment of the cranial CT for contraindications for lumbar puncture by experts. We also describe the additional value of a repeat lumbar puncture later during the disease course of bacterial meningitis, and we describe lumbar puncture results in patients with cancer and bacterial meningitis. Last, we provide an overview of indications for lumbar puncture in other neurological diseases

Bevviis der ovder catholiicker leeringhe . met andvvoorde op sommighe teghenstellinghen

Port. con anagrama xil. da Compañía de XesúsSign.: *-3*\p8\s, A-V\p8\sTexto con apostilas marxinai