Clinical review of 106 consecutive carotid endarterectomies.

We have reviewed 106 consecutive carotid endarterectomies performed from 1966 through 1973. During this period, 99 elective procedures and seven emergency procedures were done on 84 patients, 22 of whom had bilateral endarterectomies. Indications for elective procedures included transient ischemic attacks, emboli from ulcerative plaques, high grade stenotic plaques on the same or opposite side in patients with old cerebrovascular accidents and asymptomatic bruits. Seven patients had emergency endarterectomies performed for acute strokes and these demonstrated a higher risk. They were grouped together as emergency procedures for comparison with the 99 elective procedures. Previous histories, risk factors, complications and outcome in the two groups are presented and discussed. Mortality in the elective cases was 2%, compared to 30% in the emergency cases with acute stroke. Surgical indications, operative technic and immediate and late results are discussed.     

Femorotibial bypass. Apropos of 106 consecutive cases

Tibiofemoral bypass operations were performed in 106 patients with stage III or IV lower limb arterial insufficiency. Follow-up has been for from 1 to 14 years. Results of arteriography, the operative technique used and the choice of bypass material (which should be the internal saphenous vein for preference) are discussed. Permeability was still present in 73% of cases after one year, 66% after 3 years, 62% after 5 years and 57% after 10 years. The incidence of amputation was less than that of obstructed by-passes. Treatment failures are analyzed as a function of the distal network, i.e. the receiving artery, and as a function of distal lesions and material employed. Confirmation was obtained of the superiority of autologous venous bypass material, taking into account the negative selection in cases with a prosthetic shunt. A lower limb with arterial insufficiency and menaced with amputation can often be saved, even when arterial lesions extend beyond the popliteal segment.     

Ascites in newborn infants

Neonatal ascites is reviewed, and a case due to posterior urethral valves is presented. Treatment was, for the most part, conservative in contrast to aggressive surgical intervention which is taught and advocated. The result was satisfactory.     

Postoperative eventration in newborn infants

A method of prophylactics and treatment of postoperative eventrations in newborns (25 observations), is described. The incidence of this complication was decreased from 2,19% (1960-1971) to 0,95% (1972-1983).     

Laparoscopic surgery in newborn infants

Background: Thanks to various technical innovations and advances in instrumentation, laparoscopic surgical intervention is now possible for certain congenital anomalies in children. To test the applicability of laparoscopic surgery in neonates, we reviewed our personal experience of neonatal laparoscopic surgery, focusing on cardiopulmonary function, surgical procedures, problems with devices, and degree of associated surgical stress. Methods: We performed 65 laparoscopic procedures in neonates. Their ages ranged from 2 to 30 days old, and their body weights ranged from 1,980 to 4,780 g. All 65 laparoscopic procedures were carried out without mortality or serious morbidity. Results: As complications, we encountered four cases of hypothermia due to rapid insufflation of carbon dioxide (CO₂). We also found that relative hypercapnea (increase in end-tidal CO₂ as high as 61 mmHg) developed unless hyperventilation and a relatively high peak insufflation pressure were maintained during pneumoperitoneum. No cardiac depression developed at this insufflation pressure. Fluid and electrolyte balance during our cases of newborn laparoscopic surgery, as well as the doses and volumes of fluid and electrolytes administered, were identical to those required for open surgery. Interleukin-6 (IL-6) was measured serially to estimate the degree of associated surgical stress and was found to be significantly lower in neonates who had received laparoscopic procedures than in those who had received open procedures. Conclusion: Laparoscopic surgery can be carried out safely even in neonates. Received: 9 June 1998/Accepted: 22 September 1998     

Hydronephrosis in newborn infants]

During a 20-year period the author observed 40 newborn infants with congenital hydronephrosis. In 28 patients hydronephrosis of the normally developed kidney and in 12- of the abnormal organ was noted. Twelve patients were hospitalized for developmental anomalies that necessitated urgent surgical intervention, the diagnosis of hydronephrosis in them being established at autopsy. Twenty eight children were admitted to the clinic with symptoms of hydronephrosis. All children were operated upon, nephrectomy was performed in 18 cases, in the remainder-organ-preserving and corrective operative procedures were performed.     

Resuscitation of newborn infants

Successful resuscitation of newborn infants depends on adequate preparation, exact evaluation and prompt initiation of support according to the recently updated recommendations by trained personnel. The key step in postnatal adaptation is the initiation of breathing with a subsequent increase in pulmonary blood flow and pulmonary gas exchange. Therefore, in compromised newborn infants, adequate ventilation is the most important step in cardiopulmonary resuscitation. Ventilation should be initiated with room air in term infants and with low concentrations of supplemental oxygen in preterm infants. Subsequently, oxygen supplementation should always be guided by pulse oximetry. Chest compressions are only effective if adequate ventilation has been ensured. The compression ventilation ratio remains 3:1. The prevention of heat loss and maintaining a normal body temperature by adequate measures is an essential part of the care for healthy as well as asphyxiated infants. Therapeutic hypothermia should only be initiated after successful resuscitation and consultation with the regional neonatal intensive care unit.