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1.
Liechty KW Hedrick HL Hubbard AM Johnson MP Wilson RD Ruchelli ED Howell LJ Crombleholme TM Flake AW Adzick NS 《Journal of pediatric surgery》2006,41(1):230-233
Background
The use of the ex utero intrapartum treatment (EXIT) procedure has salvaged many fetuses with giant neck masses. Despite an adequate airway, a subset of these patients die from an inability to achieve adequate gas exchange.Methods
We reviewed our experience with the EXIT procedure from 1996 to 2004. The EXIT was used to deliver 23 fetuses with giant neck masses.Results
Three fetuses with giant cervical teratomas died of severe pulmonary hypoplasia. On postmortem, these patients had severe airway distortion by the mass. The carina was retracted superiorly to the first or second rib resulting in compression of the lungs in the apices of the chest and pulmonary hypoplasia. Hypoplasia was reflected in the lung weights of 24 vs 38 g and 17 vs 34 g for age-matched normal lung.Conclusions
Unsuspected obstructive fetal neck masses can be fatal because of an inability to secure an airway. Prenatal ultrasonography can identify fetuses at risk, allowing the fetus to be salvaged using the EXIT procedure. Despite obtaining airway control, a subset of these patients will die because of pulmonary hypoplasia. When counseling patients with large cervical masses it is important to discuss potential pulmonary hypoplasia in these patients. 相似文献2.
Lazar DA Olutoye OO Moise KJ Ivey RT Johnson A Ayres N Olutoye OA Rodriguez MA Cass DL 《Journal of pediatric surgery》2011,46(5):817-822
Background/Purpose
For fetuses with giant neck masses and tracheal obstruction, an ex-utero intrapartum treatment (EXIT) procedure allows for safe nonemergent airway management while on placental support. Our objective was to examine fetal and maternal outcomes after EXIT procedure specifically for giant neck masses.Methods
The medical records of all patients referred to a comprehensive fetal center for a giant neck mass between 2001 and 2010 were reviewed retrospectively.Results
Among 24 patients referred, an EXIT procedure was performed in 12 with evidence of tracheal compression. An EXIT procedure was not performed because of minimal tracheal involvement (n = 8), elective abortion (n = 2), fetal demise (n = 1), or obstetric complication (n = 1). In all fetuses, the airway was successfully secured; tracheal intubation was achieved with rigid bronchoscopy (n = 10), direct laryngoscopy (n = 1), and tracheostomy (n = 1). Eleven patients survived to discharge, whereas 1 patient with significant pulmonary hypoplasia died 8 days after emergency EXIT procedure. Of 11 surviving infants, 10 are neurodevelopmentally intact. All mothers who desired future pregnancies have subsequently had uncomplicated deliveries (n = 6).Conclusions
Ex-utero intrapartum treatment procedure for giant neck mass can be performed safely for both mother and child. Most fetuses can be orotracheally intubated with minimal long-term morbidity. The potential for future pregnancies is preserved. 相似文献3.
Usui N Kamata S Sawai T Kamiyama M Okuyama H Kubota A Okada A 《Journal of pediatric surgery》2004,39(4):603-606
Background/purpose
This study aimed at identifying characteristic features indicating congenital cystic adenomatoid malformation of the lung (CCAM) and evaluating the outcome predictors to identify prenatally subgroups of fetuses with significantly different probabilities of mortality or severe respiratory difficulty.Methods
Twenty-eight neonates who had undergone antenatal evaluation for cystic lung disease (CLD) were reviewed retrospectively. The patients were divided into 3 groups according to the severity of their clinical course; mild (n = 7), moderate (n = 13), and severe (n = 8). Ultrasonographic findings in the fetus and their pulmonary lesion were evaluated. The normal lung to thorax transverse area ratio (L/T) was measured by ultrasonography.Results
High echogenicity of the lesion throughout pregnancy and polyhydramnios were frequently seen in CCAM. All of the patients with other CLD showed isoechogenicity at the end of pregnancy. All patients in the severe group had both polyhydramnios and fetal hydrops. L/T was increased in mild and moderate groups, whereas no patient in the severe group had an increase in L/T at the final measurement. Each value of final L/T in the severe group was less than 0.25.Conclusions
The subgroup of fetuses with an increased probability of mortality or severe respiratory difficulty could be predicted from the combination of polyhydramnios, fetal hydrops, and a final L/T value of less than 0.25. 相似文献4.
Beres A Aspirot A Paris C Berube D Bouchard S Laberge JM Lands LC Puligandla P 《Journal of pediatric surgery》2011,46(5):829-832
Background/Purpose
The management of asymptomatic congenital lung lesions is controversial. Some centers recommend resection in infancy, and others prefer observation. Our objective was to evaluate the pulmonary function of children who underwent lung resection at 12 months or younger. We hypothesized that these children would not have a significant reduction in pulmonary function when compared with norms for age.Methods
All patients at 2 tertiary-care children's hospitals who underwent lung resection at 12 months or younger and are currently older than 5 years were identified and prospectively recruited. Pulmonary function testing was standardized in all patients.Results
Fourteen children were tested prospectively, whereas results were available for another 5 children. Four children were excluded for inability to perform pulmonary function testing (n = 2) or for preexisting pulmonary hypoplasia/syndrome (n = 2). Pulmonary function testing values were considered normal if they were more than 80% of predicted. Forced vital capacity was normal in 14 (93%) of 15 children, and forced expiratory volume in 1 second was normal in 13 (86%) of 15 children. Diffusion capacity and respiratory muscle strength were normal in all children tested.Conclusions
Most children undergoing lung resection in infancy will have normal pulmonary function tests, supporting our philosophy of early, elective resection of congenital lung lesions. 相似文献5.
Merchant AM Hedrick HL Johnson MP Wilson RD Crombleholme TM Howell LJ Adzick NS Flake AW 《Journal of pediatric surgery》2005,40(1):228-231
Background/Purpose
Mediastinal teratomas are rare congenital germ cell tumors that prenatally can compress mediastinal structures and cause hydrops. Two possible presentations of massive fetal mediastinal teratoma include hydrops leading to fetal demise, or fetal esophageal and airway compression causing late-gestation polyhydramnios and preterm labor. The authors present 2 cases of fetal mediastinal teratoma that illustrate successful strategies for either of these presentations.Methods
A 37-year-old woman carrying a fetus with a mediastinal mass and secondary hydrops at 23 weeks of gestation underwent in utero resection of the mass. Delivery was by cesarean delivery at 25 weeks because of preterm labor. A 24-year-old mother carrying a fetus with a mediastinal mass and severe polyhydramnios at 36 weeks of gestation underwent an ex utero intrapartum therapy procedure for establishment of an airway and tumor resection on uteroplacental support.Results
These strategies resulted in physiologic improvement in the first case and controlled resection and resuscitation in the second. The first patient had significant sequelae of prematurity including bronchopulmonary dysplasia but is currently well at 9 months of age. The second patient is well at 1 year of age.Conclusions
Massive fetal mediastinal teratoma can result in fetal or neonatal mortality by a variety of mechanisms. Optimal prenatal and perinatal management is required to salvage fetuses compromised by this lesion. 相似文献6.
Purpose
The ex utero intrapartum treatment (EXIT) procedure was developed originally for management of airway obstruction after fetal surgery, and indications have continued to expand for a variety of fetal anomalies. The authors review their single-institution experience with EXIT.Methods
Retrospective review of all patients who underwent an EXIT procedure from 1993 to 2003 (n = 52) was performed. Variables evaluated include indication for EXIT, gender, gestational age at EXIT, birth weight, maternal blood loss, operative complications, operative time, and survival rate. Technique, personnel, and anesthesic management were reviewed.Results
Long-term follow-up was available for all patients. Fifty-one of 52 patients were born alive; currently, 27 of 52 patients (52%) are alive. All deaths have been in patients with congenital diaphragmatic hernia. Forty-five patients underwent EXIT for reversal of tracheal occlusion for congenital diaphragmatic hernia. Of these patients, 30 underwent tracheal clip removal. Two patients had repair of tracheal injury from clipping at EXIT. Fifteen patients underwent bronchoscopy and tracheal balloon removal. Five patients underwent EXIT procedure for neck masses. Tracheostomy was performed in 3 of these patients. One patient was intubated successfully, and 1 patient underwent resection of the neck mass while on placental support. Two patients underwent EXIT procedure and tracheostomy for congenital high-airway obstruction syndrome. Average gestational age at delivery was 31.95 ± 2.55 weeks. Average birth weight was 1,895 ± 653 g. Average maternal blood loss was 970 ± 510 mL. Average operating time on placental support was 45 ± 25 minutes with a maximum of 150 minutes.Conclusions
EXIT procedures can be performed with minimal maternal morbidity and with good outcomes. It is an excellent strategy for establishing an airway in a controlled manner, avoiding “crash” intubation or tracheostomy. Longer procedures on placental support allowing for definitive management of neck masses and airway obstruction have been realized. EXIT procedures have evolved from an adjunct to fetal surgery to a potentially life-saving procedure in fetuses with airway compromise at birth. 相似文献7.
Miniati DN Chintagumpala M Langston C Dishop MK Olutoye OO Nuchtern JG Cass DL 《Journal of pediatric surgery》2006,41(1):66-71
Background/Purpose
Pleuropulmonary blastoma (PPB) is a rare primary neoplasm of pleuropulmonary mesenchyme. Fewer than 170 children have been reported, and few single institutions have reported more than several cases. Treatment for this condition is primarily surgical resection; however, increasing experience suggests that adjuvant chemotherapy may decrease recurrence and improve outcome.Methods
We reviewed the charts of all children with PPB treated at our institution since 1960. We reviewed the prenatal features, clinical presentation, operation, pathological findings, adjuvant treatment, and outcome.Results
Ten children (6 boys and 4 girls) were treated for PPB at a mean age of 3.2 ± 4.3 years. In 2, a cystic lung mass was diagnosed prenatally, and in 8, a cystic or solid and cystic lung mass was diagnosed postnatally (right lung, 3; left lung, 4; and bilateral, 3). In no patient was PPB considered preoperatively. Surgical resection was performed at 1 day to 11 years (median, 23 months) of age. Seven children had complete resection; 1 had microscopic residual disease, and 2 had gross residual disease. Pathology showed type I PPB in 7, type II in 1, and type III in 2. Five patients received adjuvant chemotherapy with vincristine, actinomycin, and cyclophosphamide-based regimens. At follow-up (mean, 7.7 ± 11.5 years; range, 1-456 months), children with type I PPB have no evidence of disease (n = 6) or are lost to follow-up (n = 1), whereas all those with type II/III PPB have died of the disease.Conclusions
PPB must be included in the differential diagnosis of a fetus, neonate, or child with a cystic lung mass. This finding supports early resection of these lesions rather than observation or treatment with nonoperative strategies. 相似文献8.
Kunisaki SM Fauza DO Barnewolt CE Estroff JA Myers LB Bulich LA Wong G Levine D Wilkins-Haug LE Benson CB Jennings RW 《Journal of pediatric surgery》2007,42(2):420-425
Purpose
We describe our experience with fetuses diagnosed with life-threatening chest masses who were delivered by ex utero intrapartum treatment with placement on extracorporeal membrane oxygenation (EXIT-to-ECMO).Methods
The first fetus presented with a cystic mediastinal mass and enlarging echogenic lungs. Bronchoscopic evaluation during ex utero intrapartum treatment (EXIT) revealed complete airway obstruction secondary to a carinal bronchogenic cyst. The second fetus presented with a massive left congenital cystic adenomatoid malformation. The EXIT procedure was performed because of significant mediastinal shift, severe compression of the normal lung parenchyma, and signs of fetal distress.Results
In both cases, extracorporeal membrane oxygenation (ECMO) was initiated while on placental support. The fetuses were then delivered, and a definitive resection of their thoracic lesions was successfully performed. There were no major perioperative complications. Both children made expedient recoveries without significant cardiopulmonary sequelae.Conclusion
To our knowledge, this is the first report describing the successful use of EXIT-to-ECMO as a bridge to definitive resection of large chest masses diagnosed in utero. EXIT-to-ECMO is a novel and effective management strategy for stabilizing patients with profound respiratory compromise secondary to congenital thoracic lesions. 相似文献9.
Koji Komori Seiichi Hirobe Kenji Okumura Shogo Kasai Mayumi Suenaga 《Journal of pediatric surgery》2009,44(11):2096-2100
Purpose
We evaluated the long-term pulmonary function after lobectomy for congenital cystic lung disease, in both infants and children, using radionuclide imaging (RI).Methods
We performed a retrospective review of 93 patients who underwent resection of cystic lung lesions between 1974 and 2001. The results of postoperative lung volume/perfusion scintigraphy at 1 (n = 64), 5 (n = 32), and 10 years (n = 18) after surgery (V1, 5, 10/Q1, 5, 10) and mean transit time (MTT—a marker for air-trapping) at 1, 5, and 10 years after surgery (MTT1, 5, 10) were compared with respect to age at operation, preoperative infection, underlying disease, and type of surgery.Results
Patients who were younger than 1 year at the time of surgery showed a significantly lower MTT5 (1.09 ± 0.08) and MTT10 (1.15 ± 0.11) than patients who were older than 1 year at the time of surgery (MTT5, 1.49 ± 0.67; MTT10, 1.54 ± 0.33). The noninfected group had significantly higher Q10 and lower MTT10 values (P < .05) compared to the infected group. No significant differences were observed between patients with single lobe vs multiple lobe resection.Conclusions
The optimal age for surgery in patients with congenital cystic lung disease appears to be less than 1 year. 相似文献10.
Kenneth W. Gow Daniel F. Saad Curt Koontz Mark L. Wulkan 《Journal of pediatric surgery》2008,43(12):2315-2322
Purpose
Children with cancer may develop lesions in the lung that may represent metastatic disease. Thoracotomy is considered the standard approach for resection of pulmonary nodules. Recently, thoracoscopic techniques have been applied in these situations. However, nodules that are deep in the lung parenchyma may not be visible. A technique has been developed whereby minimally invasive thoracoscopic ultrasound (MITUS) may be used to guide resection of deep pulmonary nodules.Methods
We conducted a retrospective review of children undergoing MITUS at our institution. Only patients with single isolated lesions were chosen to have this diagnostic procedure performed. Patients undergo single lung ventilation. Two 5-mm ports are inserted, one for the grasper and the other for the camera. One 12-mm port is inserted for the flexible 10-mm ultrasound probe and the endoscopic stapler. The patient has CO2 insufflation to create a 5-mm Hg pneumothorax. Twenty mL/kg of normal saline is introduced into the chest cavity for acoustic coupling. The ultrasound probe is used to isolate the nodule(s), guide resection, and check margins. The specimen is removed and placed in a removable specimen bag to reduce the chance of port site recurrence. After the lung has been inspected, irrigation is removed, and a chest tube inserted.Results
Eight procedures were performed on 7 patients (5 males, 2 females) with a median age of 15.2 years (range, 4-18 years). Patients had primary diagnoses of osteosarcoma (n = 4), Wilms' (n = 2), and lymphoma (n = 1). The median size of the lesions that were being isolated was 0.6 cm (range, 0.3-2.9 cm). None of the nodules removed were visible on the surface of the lung. Of the 8 procedures, 7 led to the removal of a pulmonary nodule. Of the 7 nodules isolated, 5 were removed thoracoscopically, with two requiring minithoracotomy because of anatomical limitations. The histologic evaluation on these specimens included osteosarcoma (n = 4), abscesses (n = 2), fibrosis (n = 1), and lymph node (n = 1). The median hospitalization was 2.5 days (range, 2-39 days). One patient had a prolonged hospitalization because of air leak and sepsis.Conclusion
Minimally invasive thoracoscopic ultrasound is a real time imaging tool that helps isolate small pulmonary lesions that may otherwise be difficult to see intraoperatively. We would advocate this technique for those patients having video-assisted thoracoscopy to assist clarifying whether focal lesions are malignant, thereby guiding therapy. 相似文献11.
Bailey PD Rose JB Keswani SG Adzick NS Galinkin JL 《Journal of pediatric surgery》2005,40(7):1118-1121
Background/Purpose
Continuous epidural analgesia is routinely used to manage pain in infants undergoing resection of a congenital cystic adenomatoid malformation (CCAM) of the lung. Our aim was to determine if there is a difference in the length of stay (LOS), supplemental analgesic requirements, pain control, and the incidence of adverse respiratory events in infants receiving the 2 standard epidural solutions commonly used: bupivacaine 0.1% and bupivacaine 0.1% with fentanyl 2 to 5 μg/mL.Methods
We retrospectively reviewed the charts of infants who received epidural infusions containing bupivacaine 0.1% (n = 18) and bupivacaine 0.1% with fentanyl 2 to 5 μg/mL (n = 10) after CCAM resection during a 12-month period. LOS, rescue opioid, and nonopioid analgesic use, incidence of respiratory depression, and pain scores were recorded.Results
The LOS in patients receiving fentanyl in their epidural solution was 1 day longer than those receiving plain bupivacaine (median 4 vs 3 days, respectively). Nonopioid analgesic and rescue opioid use was greater in patients who did not have fentanyl in their epidural solutions. Pain ratings were not significantly different. The incidence of respiratory depression was greater in patients receiving epidural infusions containing fentanyl (50% vs 17%, respectively).Conclusion
The addition of fentanyl to epidural infusions of bupivacaine in infants undergoing thoracotomy for resection of CCAM may prolong recovery and increase the incidence of adverse respiratory events without providing a significant analgesic benefit. 相似文献12.
Purpose
The purpose of the study was to compare the outcomes in children undergoing thoracoscopic versus open resection of congenital lung lesions.Methods
Retrospective review of 12 consecutive children (<3 years of age) undergoing thoracoscopic resection of a congenital lung lesion between 2004 and 2005 was performed. Intraoperative and early postoperative results were compared with randomly selected age- and sex-matched (2:1) patients undergoing thoracotomy between 2000 and 2005.Results
Twelve children underwent thoracoscopic resection and were compared with 24 that underwent thoracotomy. Seventy five percent of the lesions in both groups were congenital cystic adenomatoid malformations. There were no major intraoperative complications. Two thoracoscopic procedures were converted to a thoracotomy. Perioperative outcomes including operative time, length of stay, duration and volume of chest tube drainage, and dose and duration of intravenous opioids were similar for the procedures. However, children undergoing thoracoscopic procedures were less likely (odds ratio = 0.07) to have received adjunctive regional anesthesia. Overall morbidity was 33% thoracoscopic and 25% open (P = .70).Conclusion
Thoracoscopic resection is a safe and feasible alternative to open resection of congenital lung lesions. Examination of long-term advantages of the thoracoscopic approach such as decreased risk of chest wall deformity and scoliosis and improved cosmesis will require longer follow-up. 相似文献13.
14.
Rozmiarek AJ Qureshi FG Cassidy L Ford HR Hackam DJ 《Journal of pediatric surgery》2004,39(6):821-824
Purpose
Controversy persists regarding the factors influencing survival in patients with congenital diaphragmatic hernia (CDH), in particular, the role of timing of surgery. The authors therefore sought to determine such factors and to assess the relative role of timing of surgery on outcome.Methods
All CDH newborns 1991 through 2002 (n = 111) were divided into those undergoing repair before (“early” n = 35), or after (“late” n = 76) 48 hours. A multivariate analysis was performed to determine the relative impact of various factors on survival rate.Results
Overall survival rate was 64%. There was no effect on survival of heart rate, temperature, systolic blood pressure, age, extracorporeal membrane oxygenation use, mesh use, infections, or intracranial hemorrhage, and there was no difference between early (68%) or late (62%) repair (P = .2). Initial pco2 greater than 50, po2 less than 40, cardiac defects, or renal failure significantly decreased survival rate.Conclusions
Significant factors influencing survival rate in patients with CDH include cardiac defects, renal failure, and the initial blood gases and not the timing of surgery. CDH repair should be based on the optimization of clinical parameters as opposed to a specific time period to improve outcome. 相似文献15.
Kunisaki SM Fauza DO Nemes LP Barnewolt CE Estroff JA Kozakewich HP Jennings RW 《Journal of pediatric surgery》2006,41(1):61-65
Purpose
This study was aimed at determining whether different congenital lung masses represent diverse manifestations of a single developmental abnormality associated with fetal airway obstruction.Methods
We conducted a 3-year retrospective review of patients who underwent surgical resection of a prenatally diagnosed lung mass. Prenatal imaging was used to define mass position and its effect on adjacent organs. Lung specimens were examined through careful full-specimen microdissections, as well as by plain and contrast roentgenograms.Results
Twenty-five patients underwent lung resection during this study period. Based on the final pathology reports, 56% were congenital cystic adenomatoid malformations, 12% were congenital lobar emphysemas, 8% were bronchopulmonary sequestrations, and 24% had features of both cystic adenomatoid malformation and bronchopulmonary sequestrations. No bronchogenic cysts were present in this series. Overall, bronchial atresia was identified in 77% of the examined specimens (n = 22) and was associated with all types of lung malformations.Conclusions
Bronchial atresia is a common, unrecognized component of prenatally diagnosed congenital cystic adenomatoid malformations, bronchopulmonary sequestrations, congenital lobar emphysemas, and lesions of mixed pathology. Most congenital lung masses may be part of a spectrum of anomalies linked to obstruction of the developing fetal airway as an underlying component in their pathogenesis. 相似文献16.
Massimiliano Garzaro Giancarlo Pecorari MD Vincenzo Landolfo MD Simona Defilippi MD Carlo Giordano MD 《Otolaryngology--head and neck surgery》2010,143(3):348-352
Objective
The aim of this study was to assess the outcomes after radiofrequency inferior turbinate reduction (RITR) on objective and subjective nasal function in patients with nasal obstruction caused by turbinate hypertrophy and to evaluate the possible effect on olfactory function.Study Design
Case series with planned data collection.Setting
ENT division, university hospital.Subjects and Methods
Forty consecutive patients who underwent RITR for allergic or nonallergic chronic rhinitis with inferior turbinate hypertrophy were tested before and two months after the surgical procedure, using the Sniffin' Sticks test battery, anterior rhinomanometry, and the nasal obstruction symptom evaluation (NOSE) scale.Results
The total basal nasal resistance at 150 Pa diminished significantly two months after surgery. Preoperative olfactory tests showed anosmia in five percent (n = 2) of the patients, hyposmia in 82 percent (n = 33), and normosmia in 12 percent (n = 5). At two months from the intervention, two percent (n = 1) were diagnosed as anosmic, 12 percent (n = 5) as hyposmic, and 85 percent (n = 34) as normosmic. The means of preoperative odor threshold (T), discrimination (D), identification (I), and the overall TDI score improved significantly postoperatively (P < 0.001). The NOSE score in the two-month follow-up improved in 97.5 percent (n = 39) of patients, with a mean difference in pre- vs. postintervention score of 40.12 (95% confidence interval 35.75-44.25; P < 0.001).Conclusion
RITR may provide excellent outcomes in terms of improvement in olfactory function and nasal flow in patients affected by turbinate hypertrophy refractory to medical therapy. 相似文献17.
Purpose
With ovarian torsion, concern for underlying malignancy in the enlarged ovary has previously driven surgeons to resection. Detorsion alone has been recommended to allow for resolution of edema of the ovary with follow-up ultrasound surveillance to evaluate for a persistent mass, yet is not routine practice. However, the incidence of malignancies presenting as ovarian torsion is not documented. Does the risk of an underlying malignancy justify salpingoophorectomy and decreased fertility?Method
After institutional review board exemption (IRB#-022008-095), a 15½-year retrospective review was conducted to identify cases of operative ovarian torsion in our medical center. Tumors with neoplastic pathology (malignant and benign) were analyzed and compared with all reported cases in the literature.Results
A total of 114 patients (mean ± SEM age, 10 years, 2 days to 19 years ± 0.53) with operatively proven ovarian torsion were identified. Four malignancies (3.5%) and 26 benign neoplasms (23%) were present in this age group. Malignancies consisted of serous borderline tumors (2), juvenile granulosa cell tumor (1), and dysgerminoma (1). All were stage I: the former were stage IA and cured with resection alone, and 1 was a stage IB dysgerminoma, which required chemotherapy. The literature yielded a total of 593 cases of operative ovarian torsion with 9 (1.5%) malignancies and 193 (33%) benign neoplasms. The malignancies were juvenile granulosa cell tumor (n = 4), dysgerminoma (n = 2), serous borderline tumors (n = 2), and 1 undifferentiated adenocarcinoma.Conclusion
By combining our series with 13 in the literature, a 1.8% malignancy rate occurred in 707 patients with ovarian torsion, markedly less than the reported malignancy rate of 10% in children with ovarian masses. Thus, neither a pathologic nor malignant lead point should be assumed in cases of torsion. In our series, which represents the largest series of torsion in the pediatric literature, all malignancies presented as stage I. These data further support the implementation of operative detorsion and close postoperative ovarian surveillance, with reoperation for persistent masses. Further study is needed to determine if delaying resection by weeks in those cases of persistent masses would result in tumor progression and thus change prognosis. 相似文献18.
Lorincz A Haddad D Naik R Naik V Fung A Cao A Manda P Pandya A Auner G Rabah R Langenburg SE Klein MD 《Journal of pediatric surgery》2004,39(6):953-956
Background
Several changes occur during the transformation of normal tissue to neoplastic tissue. Such changes in molecular composition can be detected by Raman spectroscopy. Raman spectroscopy is a nondestructive method of measuring these changes, which suggests the possibility of real-time diagnosis during medical procedures.Methods
This study seeks to evaluate the ability of Raman spectra to distinguish tissues. The Raman signatures of normal kidney, lung, and liver tissue samples from pigs and rats were characterized in vitro. Further, a human neuroblastoma and a hepatoblastoma, obtained at resection were also studied.Results
The Raman spectra of the animal samples of kidney, liver, and lung are distinctly different in the intensity distribution of the Raman peaks. Further, the spectra of a given organ from pigs and rats, although similar, were different enough to distinguish between the 2 animals. In the patient tissues, the Raman spectra of normal liver, viable tumor, and fibrotic hepatoblastoma were very different. Fibrotic tissue showed a greater concentration of carotenoids, whereas viable tissue was rich in proteins and nucleic acids. The normal tissue showed both components. Similar differences were also seen in the neuroblastoma tissue.Conclusions
The results of this study show the potential use of Raman spectroscopy in clinical diagnosis. 相似文献19.
Tsai HL Liu C Chen PT Soong WJ Chang WK Chin T Wei CF 《Journal of pediatric surgery》2004,39(12):1772-1774
Background
The Palmaz stent can relieve congenital malacia or stenosis of airway, but reports on the indications and results of stent removal are rare. The authors report their experience in removing Palmaz stents and discuss the indications for removal.Methods
Thirteen stents in 12 patients were removed by a rigid bronchoscope for various reasons. The indications were expected recovery (n = 5), severe granulations and expected recovery (n = 2), stent collapse (n = 2), and stent migration and/or fracture (n = 4).Results
The course after removal was smooth in 9 patients and complicated in 3. The indications for stent removal in these 3 complicated cases were all expected recovery. One of the 3 complicated cases needed emergent cardiopulmonary bypass and tracheostomy for a collapsed stent that occluded airway, 1 failed for intractable bleeding, and 1 failed for intense vagal reflex causing cardiac arrest. At 6 months of follow-up, satisfactory results were seen in all but one case that needed further procedures for an iatrogenic tracheoesophageal fistula.Conclusions
Most Palmaz stents can be removed smoothly with a rigid bronchoscope; however, lethal complications can happen. The authors suggest that indications for stent removal should be intractable airway symptoms caused by the stent rather than expected recovery. Muscle relaxants should be avoided during anesthesia to maintain spontaneous breathing, and cardiopulmonary bypass should be on standby. 相似文献20.