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1.
Hamada T Hirose R Kosaka T Taniguchi K Noguchi M Kihara T Egashira M Tagawa M Miura K Masuzaki H Tajima Y Hayashi T Kanematsu T 《Journal of pediatric surgery》2008,43(3):e21-E23
This report describes a case of giant cystic meconium peritonitis (GCMP) associated with a cloacal anomaly. Antenatal ultrasonography and magnetic resonance imaging demonstrated persistent fetal ascites, bilateral hydronephrosis, and 3 pelvic cystic structures. The baby girl showed duplicated hydrocolpos and a single orifice of the cloaca with a long common channel inducing a urinary outflow obstruction. After constructing a diversion colostomy, a cutaneous vesicostomy was necessary to prevent recurrent urinary tract infections. These findings are consistent with a prenatal diagnosis of cloacal anomalies, thus suggesting an association with severe obstruction of lower urinary tract and meconium peritonitis.Most of reported cases of meconium peritonitis associated with the cloaca show fibroadhesive types with scattered intraperitoneal calcifications and adhesions. However, the present case showed a rare GCMP suggesting continuous urinary influx via the fallopian tubes until the later stage of intrauterine life. 相似文献
2.
Nam SH Kim SC Kim DY Kim AR Kim KS Pi SY Won HS Kim IK 《Journal of pediatric surgery》2007,42(11):1822-1825
Background
Meconium peritonitis is a sterile chemical peritonitis resulting from intrauterine bowel perforation. With the development of neonatal care, the prognosis of meconium peritonitis improved much. We report our clinical experience.Methods
The medical records of patients with meconium peritonitis admitted to the Asan Medical Center from June 1989 to July 2006 were retrospectively reviewed.Results
Of 41 patients (17 males, 24 females), 38 (92.7%) were suspected to suffer from meconium peritonitis prenatally, at a median gestational age of 32 weeks (range, 21-40 weeks). The most common prenatal sonographic finding was fetal ascites followed by dilated bowel. Ten patients were managed conservatively, but 31 patients underwent operations including resection and anastomosis (22), drainage procedure (4), ileostomy (3) and primary repair (2). The operative 31 cases comprised generalized (16), fibroadhesive (10), and cystic types (5). The main causes were intestinal atresia and idiopathic bowel perforation. The mortality rate was 2.4%, and the morbidity rate was 34.1%.Conclusions
Good survival rate was achieved. But there was rather high morbidity. More gentle and delicate approach should be done to lower the morbidity. 相似文献3.
Casaccia G Trucchi A Spirydakis I Giorlandino C Aite L Capolupo I Catalano OA Bagolan P 《Journal of pediatric surgery》2006,41(4):804-807
Background
Short bowel syndrome (SBS) is a severe malabsorption caused by bowel loss. Congenital intestinal anomalies (CIA) detectable by prenatal ultrasound as jejunoileal atresia, meconium peritonitis, complicated meconium ileus, and fetal volvulus can be responsible for SBS.Aims
This study aims to investigate either frequency of SBS or the morbidity in CIA population during the first admission.Material and methods
Records of CIA treated from 1997 to 2003 were reviewed. The prenatal ultrasound findings were correlated with SBS. Student's t and χ2 tests were performed to analyze epidemiological data, growth at discharge, sepsis, liver disease, catheter-related complications, motor developmental delay, and hospital stay in CIA with and without SBS.Results
Forty-four CIA: SBS developed in 43%, ranging from 83% in volvulus to 0% in complicated meconium ileus. Thirty-six prenatal diagnoses: a strong correlation with SBS was observed in isolated dilated bowel (58%). In SBS neonates, birth weight, gestational age, and growth at discharge were statistically lower, whereas sepsis, motor delay, and hospital stay were statistically higher.Conclusions
Many neonates with CIA detectable by prenatal ultrasound develop SBS. Short bowel syndrome presents a significant higher morbidity. The counseling should stress the frequent association between CIA and SBS as well as the significant morbidity in SBS. 相似文献4.
Purpose
Intestinal abnormalities are sometimes seen during antenatal testing; however, the postnatal importance of these findings has not been well established. We evaluated whether abnormal intestinal appearance on fetal ultrasound (US) was ultimately related to neonatal outcome.Methods
Fetal US examinations from 2003 to 2006 were evaluated. Hyperechogenic bowel was defined as having the echogenicity comparable to bone, and dilated bowel was identified based on the sonographer's assessment. Persistence or resolution of US findings on subsequent US examinations and eventual outcomes were assessed. Cases were categorized as hyperechogenic or dilated and then subgrouped based on whether the US finding resolved.Results
Sixty-eight fetuses had either hyperechogenic (n = 48) or dilated bowel (n = 20) on antenatal US. In 56 cases, complete data were available for analysis. Of 44 liveborn infants, 11 (25.0%) had an abdominal abnormality, and 33 (75.0%) were normal at birth. Compared to those with dilated bowel, fetuses with hyperechogenic bowel had a higher rate of prenatal demise (20.8% vs 10%) but a lower rate of abnormality at birth (10.3% vs 53.3%). Hyperechogenic bowel resolved on subsequent US more frequently than dilated bowel (65.5% vs 20.0%). In both groups, all fetuses with sonographic resolution were normal at birth. Of 9 fetuses that had persistently hyperechogenic bowel, 3 (33.3%) were born with an abnormality, and all were found to have meconium peritonitis or meconium ileus. In the 12 cases where dilated bowel did not resolve, 8 (66.7%) were eventually born with an abnormality, most commonly intestinal atresia.Conclusions
Hyperechogenic and dilated bowel are associated with a significant rate of fetal demise. Hyperechogenicity is more common than dilation and is more likely to be transient. Dilated bowel is more often associated with neonatal abnormality than hyperechogenic bowel. Persistence of fetal US findings predicts a higher likelihood of abnormality in the neonate. 相似文献5.
Andrea Bischoff Marc A. Levitt Lesley Breech Emily Louden Alberto Peña 《Journal of pediatric surgery》2010,45(6):1241-1245
Introduction
Hydrocolpos is a condition rarely mentioned in the literature. The purpose of this report is to increase the index of suspicion for hydrocolpos in patients with cloaca and to describe our approach for its treatment with the hope that errors in the management of hydrocolpos can be avoided.Methods
We reviewed 411 medical records of patients diagnosed with cloaca and managed at our Center during the last 26 years. Emphasis was placed on evaluating for the presence of hydrocolpos, type of drainage, and complications related to the persistence of the hydrocolpos.Results
One hundred seventeen cloaca patients had an associated hydrocolpos (28.4%). Forty-two cases (36%) were initially managed at other institutions at which the hydrocolpos was not drained. Complications experienced by this group included: multiple urinary tract infections (8), hydrocolpos infection (7), sepsis (7), failure to thrive (6), ruptured hydrocolpos (4), and development of hydronephrosis in previously normal kidneys (2). Forty-one patients (35%) had other modalities of treatment, aimed to drain the hydrocolpos, including vesicostomy (26), intermittent perineal catheterization (8), single aspiration (6), or plasty of the perineal orifice (1). In all of these cases, the hydrocolpos persisted or reaccumulated. Thirty-four patients (29%) underwent an effective drainage of the hydrocolpos at birth; 29 at other institutions, 15 with a tube vaginostomy, 13 with a tubeless vaginostomy, and 1 with a catheter placed and left in the vagina through cystoscopy. Five cases had a tube vaginostomy done by us. In all these cases, the vagina remained adequately drained as demonstrated radiologically. Proper drainage of the hydrocolpos alone, with no urologic intervention, dramatically improved the hydronephrosis in 13 cases.Conclusions
Hydrocolpos in patients with cloacas must be diagnosed and treated early in life. Our preferred approach is a transabdominal indwelling vaginostomy tube. The drainage of the hydrocolpos alone may dramatically improve the hydronephrosis, and therefore, we suggest that only after the hydrocolpos is drained should a urological intervention be contemplated. Failure to drain the hydrocolpos can result in serious complications. 相似文献6.
Graeme J. Pitcher Michael R. Davies Alp Numanoglu 《Journal of pediatric surgery》2009,44(7):1405-1409
Purpose
Intraperitoneal bowel perforation may occur in utero as a result of a variety of abnormalities and typically results in sterile meconium ascites, pseudocysts, and/or calcification in the fetus. On the other hand, extraperitoneal bowel perforation in intrauterine life is extremely rare. The object of this report is to present our experience of prenatal extraperitoneal rectal perforation, defining the clinical presentation, management, and progress.Methods and Materials
Nine babies who were identified from 2 centers in the Republic of South Africa with fetal extraperitoneal rectal perforation are presented. The details of these babies were obtained retrospectively from the case notes.Results
All patients presented at or shortly after birth with air and meconium tracking below the pelvic floor manifesting as either an expanding, meconium-stained aerocele or with perirectal spreading sepsis. Where abdominal signs were present, laparotomy confirmed the extension of the meconium perforation into the peritoneal cavity. Management was by diverting colostomy, drainage of the perineal collection, and supportive therapy. A posterior approach to the rectum and excision of a fibrotic section of the lower rectal wall was performed in one case. One case developed rectal stenosis that was treated by dilatation before colostomy closure. In all the other cases, digital examination performed before colostomy closure ruled out significant narrowing. There was no mortality, and the site of the rectal perforation healed in all cases to leave good anorectal function after treatment.Conclusions
Fetal extraperitoneal perforation is extremely rare, but the clinical features are easily recognizable, and when appropriate therapy is instituted, the outcome is likely to be good with normal anorectal function to be expected in the long-term. The exact cause of the condition is unknown. 相似文献7.
Background/Purpose
Intraluminal meconium calculi are a rare cause of neonatal abdominal calcifications in patients with anorectal malformations. To investigate their pathogenesis, we performed infrared spectroscopic analysis of meconium-calcified lesions.Methods
Meconium calculi were collected from the colostomy in a newborn patient with imperforate anus and rectourethral fistula. The potassium bromide method was employed to obtain the infrared absorption spectrum of the meconium calculi.Results
The wavelength pattern of the meconium calculi exhibited 4 specific peaks at 1570, 1390, 1105, and 1005 cm−1 between 22% and 45% transmittance values. The unique absorption spectrum exclusively indicated ammonium hydrogen urate (C5N5O3H7), having the combined constituents of ammonium and uric acid.Conclusions
These results suggest that the intraluminal meconium calculi were originally derived from meconium and fetal urine. The stasis of meconium passage and fetal urine mixing through the rectourethral fistula in a low-pH condition was deduced to be the main cause of this rare stone formation. 相似文献8.
Hata S Takahashi Y Nakamura T Suzuki R Kitada M Shimano T 《Journal of pediatric surgery》2004,39(9):1396-1399
Background/purpose
To analyze the value of ultrasound scan (US) in the preoperative identification of a contralateral patent processus vaginalis (CPPV), the authors investigated the presence of CPPV by US in children with clinically diagnosed unilateral inguinal hernias.Methods
Three hundred forty-eight patients (168 boys and 180 girls) with unilateral inguinal hernia underwent US examination using a 7.5-MHz linear transducer. If a CPPV was visible as a hydrocele owing to the inflow of physiologic ascites into a processus vaginalis on straining, then US scanning was performed while the patient was at rest and while inducing straining by standing or crying. A groin with a hydrocele in the inguinal canal on straining was diagnosed as a CPPV and was explored bilaterally through surgery. The US findings were compared with surgical results.Results
In 348 patients, 78 cases (22.4%) were diagnosed by US as patients with a CPPV; these patients underwent bilateral surgery. Seventy-four of 78 cases (94.9%) were confirmed surgically as patients with CPPV.Conclusions
A CPPV was detected correctly by US in 74 of 348 patients (21.3%) with clinically diagnosed unilateral inguinal hernias. US is a noninvasive and accurate method for evaluating the presence of a CPPV. 相似文献9.
Boemers TM Ludwikowski B Forstner R Schimke C Ardelean MA 《Journal of pediatric surgery》2006,41(7):1267-1271
Background
Magnetic resonance imaging (MRI) of the pelvic floor allows better assessment of pelvic pathology and has a potential as an adjunct for therapy planning. In complex congenital malformations of the pelvic floor and continence organs, it plays a major role in assessing urinary and fecal incontinence or constipation, especially when performed as a dynamic investigation such as MRI defecography.Patients and Methods
Twenty-three patients (3-21 years old) with urinary and/or fecal incontinence or constipation attributable to congenital malformations of the pelvic region presented at our institution. The diagnoses were anorectal malformations (18), bladder exstrophy (2), and cloacal exstrophy (3). All patients underwent static and dynamic MRI of the pelvic floor with rest, squeeze, and evacuation in supine position.Results
Morphology and function of the pelvic floor and pelvic organs could be demonstrated in each case. The reason for urinary incontinence, fecal incontinence, or constipation could be defined, and an individual therapeutic management concept was made based upon the data obtained by the investigation.Conclusions
The advantages of this method, in comparison to others, are direct visualization of the pelvic floor muscles and continence organs and their anatomical relationship during different functional actions. Pelvic floor dysfunction is often the reason for fecal and urinary incontinence and can be detected by MRI. Especially in children, minimizing radiation exposure is of major concern. Disadvantages are the costs and long investigation time. 相似文献10.
Background
Enterolithiasis is an uncommon finding of intraluminal calcified meconium. Whereas extraluminal calcifications are commonly reported and usually indicate intrauterine intestinal perforation with intraperitoneal extravasation of meconium (meconium peritonitis), true intraluminal calcifications of meconium in newborns are rare.Case Report
We report a case of a newborn boy with pneumothorax and pneumoperitoneum because of a transmediastinal air leakage who unfortunately died on the fifth postnatal day after a pneumopericard. The baby had lung hypoplasia and a hypoplastic thorax. Oligohydramnion was present because of urethral agenesis and anal atresia with rectourinary fistula. Enterolithiasis was found, distributed from the transverse to the rectosigmoid colon. Enterolithiasis was not diagnosed prenatally in this boy, and any of those preexisting pathologies were therefore not assumed before birth except the suspicion for urethral valves because of oligohydramnion.Discussion
Approximately 48 cases of human neonatal enterolithiasis have been described in the medical literature. The etiology of enterolithiasis appears to be intraluminal mixture of meconium und alkaline urine—as it appears in anal atresia with enterourinary fistula. Most cases of enterolithiasis are associated with major urogenital and intestinal malformations—especially VACTERL association. With support of modern high-resolution imaging devices, enterolithiasis can be detected antenatally.We suppose that prenatal diagnosis of enterolithiasis is a warning sign of underlying pathologies. 相似文献11.
Kunisaki SM Barnewolt CE Estroff JA Ward VL Nemes LP Fauza DO Jennings RW 《Journal of pediatric surgery》2007,42(2):404-410
Purpose
The prognosis for fetuses with large congenital cystic adenomatoid malformations (CCAMs) remains uncertain. This study examined the natural history of large fetal CCAMs managed expectantly at a major referral center.Methods
A 5-year retrospective review was conducted on fetuses diagnosed with a thoracic lesion (n = 59). Large CCAMs were identified on prenatal imaging and followed longitudinally. Perinatal outcomes were assessed.Results
Twelve (20.3%) fetuses had large CCAMs in the absence of other congenital anomalies. Peak CCAM size occurred at 25.3 ± 3.6 weeks' gestation. Serial magnetic resonance volumetry demonstrated a trend toward decreasing CCAM mass volume relative to thoracic cavity volume over time. Overall, 6 patients, including 3 with signs of early hydrops, showed a marked regression of their lesions relative to estimated fetal weight. Five fetuses required an emergent intervention postnatally, including extracorporeal membrane oxygenation support (n = 1), cyst aspiration (n = 1), and lung resection (n = 5). Overall survival was 75%, with severe hydrops before 30 weeks seen in all 3 deaths.Conclusion
Large fetal CCAMs tend to peak in size at 25 weeks' gestation and are characterized by in utero diminution relative to overall fetal growth. The prognosis for most fetuses with large CCAMs remains quite favorable under careful perinatal management. 相似文献12.
Borsellino A Zaccara A Nahom A Trucchi A Aite L Giorlandino C Bagolan P 《Journal of pediatric surgery》2006,41(4):826-829
Background/Purpose
Technical refinements and increasingly sophisticated equipment have led to higher sensitivity in prenatal diagnosis of congenital malformations; however, such progress may be accompanied by decreased specificity. The aim of this study is to evaluate evolution of prenatal diagnosis from the first sonographic suspicion of fetal anomaly until after delivery (diagnosis confirmed, resolution before birth, healthy baby, or affected with different disorder) to document rate of false-positive (FP) results.Methods
Retrospective review of prenatal ultrasound examinations performed at our institution between 2000 and 2002 was conducted. The series includes pregnancies referred to our department after detection of thoracic and abdominal anomalies at routine obstetrical sonography and with a follow-up comprising at least the first 6 months of life. Urologic malformations were excluded. Those fetuses who proved healthy at birth were considered FP results.Results
One hundred fifty-seven fetuses/neonates underwent complete follow-up. Prenatal diagnosis of esophageal atresia resulted in 3 (27%) of 11 FPs. Finding of dilated bowel, isolated or associated with hyperechogenicity or ascites, was not predictive of small bowel obstruction in 7 (41%) of 17 fetuses.No FPs were found with regard to abdominal wall defects (8 gastroschisis and 26 omphaloceles, all confirmed at birth). Concerning thoracic malformations, no FPs were seen among the 28 cases of congenital diaphragmatic hernia, whereas diagnosis of lung malformation presented a specificity of 97% (1/28 FP). Ovarian cysts accounted for an FP rate of 17% (4/23 FPs).Overall, a percentage of FP of 12% (6/50) was seen in 2000, of 11% (5/44) in 2001, and 9% (6/63) in 2002, with no statistically significant difference.Conclusions
Because of the high FP rate regarding some particular anomalies, unnecessary psychological burden to prospective parents may ensue. This issue should be dealt with in future prospective studies. 相似文献13.
Introduction
Labia minora adhesions (LMA) are a common finding in young girls. Usually, this condition is asymptomatic and spontaneously disappears during adolescence. We report on a case revealed by infected urocolpos and peritonitis and whose treatment finally required surgical reduction labioplasty.Case report
A 9-year-old girl presented with a 2-day history of abdominal pain and fever. Urinary continence had never been obtained, with diurnal leaks. Physical examination showed signs of peritoneal irritation and a subtotal vulvar obstruction due to LMA. At surgery, after LMA lysis, a large amount of cloudy urine-like fluid emptied under pressure from the vagina. Laparoscopy showed generalized peritonitis without any intraabdominal cause. The same Escherichia coli was identified in the infected urocolpos and the abdominal fluid. Postoperative course was uneventful.Because of recurrent LMA, the patient underwent several courses of local estrogen therapy. Labia minora hypertrophy with LMA developed 2 years after peritonitis, requiring surgical reduction labioplasty. We used a new technique with interposition of skin flaps. The girl is now well, without LMA or infection, 4 years after labioplasty.Conclusion
Although rare, subtotal vulvar obstruction because of LMA may lead to infected hydrocolpos and peritonitis. Recurrent LMA may necessitate surgical labioplasty. 相似文献14.
Patrick F. Curran Eric B. Jelin Larry Rand Shinjiro Hirose Vickie A. Feldstein Ruth B. Goldstein Hanmin Lee 《Journal of pediatric surgery》2010,45(1):145-150
Objective
The purpose of this study is to evaluate the effect of prenatal steroid treatment in fetuses with sonographically diagnosed congenital cystic adenomatoid malformations (CCAMs).Methods
This was an institutional review board-approved retrospective review of 372 patients referred to the University of California, San Francisco (UCSF), for fetal CCAM. Inclusion criteria were (1) a predominately microcystic CCAM lesion sonographically diagnosed at our institution, (2) maternal administration of a single course of prenatal corticosteroids (betamethasone), and (3) no fetal surgery. CCAM volume-to-head ratio (CVR), presence of hydrops, mediastinal shift, and diaphragm eversion were assessed before and after administration of betamethasone. The primary end points were survival to birth and neonatal discharge.Results
Sixteen patients with predominantly microcystic CCAMs were treated with prenatal steroids. Three were excluded because of lack of follow-up information. All remaining fetuses (13/13) survived to delivery and 11/13 (84.6%) survived to neonatal discharge. At the time of steroid administration, all patients had CVR greater than 1.6, and 9 (69.2%) also had nonimmune hydrops fetalis. After a course of steroids, CVR decreased in 8 (61.5%) of the 13 patients, and hydrops resolved in 7 (77.8%) of the 9 patients with hydrops. The 2 patients whose hydrops did not resolve with steroid treatment did not survive to discharge.Conclusion
In high-risk fetal patients with predominantly microcystic CCAM lesions, betamethasone is an effective treatment. This series is a pilot study for a prospective randomized trial comparing treatment of CCAM with betamethasone to placebo. 相似文献15.
Kuroda T Kitano Y Honna T Sago H Hayashi S Saeki M 《Journal of pediatric surgery》2004,39(12):1819-1822
Purpose
The aim of this study was to investigate the prenatal courses and management of abdominal surgical diseases.Methods
Of the 327 patients registered with our fetal treatment board since March 2002, 83 fetuses referred to the surgical department were enrolled for the current study. The prenatal diagnosis, sequential fetal images, and perinatal courses of these cases were reviewed retrospectively.Results
Of the 83 cases, abdominal diseases were suspected in 34, lung and thoracic diseases in 25, genitourinary diseases in 12, and other anomalies in 12. Meconium peritonitis (MP), intestinal obstruction, and abdominal wall defects accounted for approximately 65% of the abdominal diseases. Five patients with prenatally diagnosed lung diseases underwent fetal surgical intervention, and 17 of the 22 liveborn patients survived. In contrast, none of the patients with prenatally diagnosed abdominal anomalies underwent fetal surgical intervention, yet, 23 of the 24 liveborn patients survived. However, preterm labor and hydrops were seen frequently in the patients with giant cystic MP, suggesting a fetal critical condition.Conclusions
Although the clinical outcome of abdominal diseases seemed favorable with postnatal treatment, the current results suggested the occurrence of hidden mortality in utero and the potential need for fetal intervention for some abdominal conditions, such as MP. 相似文献16.
Encinas JL García-Cabezas MÁ Barkovich J Fontecha CG Peiró JL Soto GM Borrell V Reillo I López-Santamaría M Tovar JA Farmer DL 《Journal of pediatric surgery》2011,46(4):713-722
Purpose
The purpose of this study is to describe the malformations of cortical development detected in a model of cerebrospinal fluid (CSF) leakage and the influence of surgical closure technique on developmental outcome.Methods
Using a surgically induced model of myelomeningocele (MMC) in sheep, we studied the effects of different repair methods upon the development of hydrocephalus, the presence of the Arnold-Chiari II (AC-II) hindbrain malformation, and cerebral cortex developmental anomalies using gross and histologic (hematoxylin and eosin and Nissl staining) study techniques.Results
A malformed cerebral cortex, including 2 anomalous cortical folding patterns, and lower brain weights were observed in the untreated animals. Hydrocephalus and AC-II malformations were also found in this group. These malformations were mostly prevented with prenatal 2-layer closure.Conclusions
Cerebral cortical malformations and hydrocephalus, in addition to the AC-II hindbrain malformation, are disorders caused by fetal CSF leakage. These malformations were prevented with the technique of MMC closure currently used in humans. Both observations magnify the importance of the second hit associated with chronic CSF leakage, in addition to the primary defect causing the MMC, in the development of the malformation complex. 相似文献17.
Purpose
Diagnosing appendicitis may require adjunct studies such as computed tomography or ultrasound (US). Combining a clinical examination with surgeon-performed US (SPUS) may increase diagnostic accuracy and decrease radiation exposure and costs.Methods
A prospective study was conducted including children with a potential diagnosis of appendicitis. A surgery resident performed a clinical examination and US to make a diagnosis. Final diagnosis of appendicitis was confirmed by operative findings and pathology. Results were compared with radiology department US (RDUS) and a large randomized trial. Analysis was performed using Fisher exact test.Results
Fifty-four patients were evaluated and underwent SPUS. Twenty-nine patients (54%) had appendicitis. Overall accuracy was 89%, with accuracy increasing from 85% to 93% between the 2 halves of the study. Radiology department US was performed on 21 patients before surgical evaluation, yielding an accuracy of 81%. Surgeon-performed US on those 21 patients yielded an accuracy of 90%. No statistical differences were found between any groups (P > .05).Conclusion
Accuracy of SPUS was similar to RDUS and that of a large prospective randomized trial performed by radiologists. Furthermore, when the same clinician performs the clinical examination and US, a high level of accuracy can be achieved. With this degree of accuracy, SPUS may be used as a primary diagnostic tool and computed tomography reserved for challenging cases, limiting costs, and radiation exposure. 相似文献18.
V. López C. Gutiérrez E. Gutiérrez E. Sola M. Cabello D. Burgos M. González Molina 《Transplantation proceedings》2008,40(9):2925-2926
Introduction
Cardiovascular disease is the leading cause of death in kidney transplant recipients. Hyperlipidemia is a cardiovascular risk factor present in over 70% of recipients. Ezetimibe has proved effective for the treatment of dyslipidemia in these patients.Aim
To evaluate the efficacy and safety of treatment with ezetimibe in kidney transplant recipients with uncontrolled hyperlipidemia.Materials and methods
We undertook a prospective study of 25 kidney transplant recipients with dyslipidemia who started treatment with 10 mg of ezetimibe. Statins were being taken by 96% of these patients. Monotherapy was used in one case. Measurements were made at baseline and after 3, 6, and 12 months of the lipid and hepatic profiles, CPK, lactose dehydrogenase, renal function and levels of immunosuppressive agents.Results
A significant reduction was noted in total cholesterol, low-density lipoprotein cholesterol, and triglycerides. No patient had changes in the hepatic profile, increased CPK and lactose dehydrogenase levels, or important adverse effects. Renal function remained stable, with no significant variations in plasma levels of the different immunosuppressive agents.Conclusions
The use of ezetimibe associated with statins is an efficient and safe therapeutic alternative for the treatment of poorly controlled dyslipidemia in recipients of a kidney graft. 相似文献19.
W. Andraus A. Sepulveda R.S.N. Pinheiro A.R. Teixeira L.A.C. D'Albuquerque 《Transplantation proceedings》2010,42(5):1724-1728
Background
Abdominal hernias are a common disease among cirrhotic patients, because of malnutrition and persistently high intra-abdominal pressure due to ascites. When tense ascites is present, life-threatening complications are likely to occur. In such cases, the morbidity and mortality rates are high.Objective
We describe 3 cirrhotic patients with rare complicated hernias that needed surgical repair. We discuss optimal timing for surgical approaches and the necessity of ascites control before surgery, as well as the technical details of the procedures.Method
Review of hospital charts of selected rare cases of herniae in cirrhotic patients.Conclusion
Elective surgical approaches can treat even uncommon hernias in cirrhotic patients with good results. 相似文献20.
Laurent M. Fourcade Yoanne Mousseau Naziha Khen-Dunlop Sabine Sarnacki 《Journal of pediatric surgery》2010,45(3):499-506