共查询到15条相似文献,搜索用时 0 毫秒
1.
R. Peter Altman 《Journal of pediatric surgery》1976,11(5):809-814
Surgical correction of portal hypertension in infants and children has often been frustrated by limitations imposed by the diminutive vessel size. During the past 18 mo, five patients from 1 to 7 yr of age and weighing between 9 and 19 kg, have required portal decompression for bleeding from esophageal varices. In two patients, a previous dissection in the area of the porta hepatis imposed a further technical obstacle. Both of these patients had biliary atresia and one had undergone a successful portoenterostomy (Kasai).1 Success of the interposition mesocaval graft in adult patients led us to adopt this procedure in our five patients. Autogenous jugular vein was utilized for construction of the shunt in the smaller patients. Radiographic confirmation of shunt patency has been obtained 1 yr postoperatively. 相似文献
2.
Primary abdominal lymphoma in children is an uncommon and frequently rapidly progressive disease with a generally grave prognosis. Four cases are presented, emphasizing the varied clinical presentation and the need for increased awareness of this process if currently intolerable mortality rates are to be reduced. 相似文献
3.
Heung Bae Kim Khashayar Vakili Gabriel J. Ramos-Gonzalez Deborah R. Stein Michael A. Ferguson Diego Porras James E. Lock Gulraiz Chaudry Ahmad Alomari Steven J. Fishman 《Journal of vascular surgery》2018,67(6):1664-1672
Background
Midaortic syndrome (MAS) is a rare condition characterized by stenosis of the abdominal aorta. Patients with disease refractory to medical management will usually require either endovascular therapy or surgery with use of prosthetic graft material for bypass or patch angioplasty. We report our early experience with a novel approach using a tissue expander (TE) to lengthen the normal native arteries in children with MAS, allowing primary aortic repair without the need for prosthetic graft material.Methods
We conducted a retrospective review of patients with MAS undergoing the TE-stimulated lengthening of arteries (TESLA) procedure at our institution from 2010 to 2014. Data are presented as mean (range).Results
Five patients aged 4.8 years (3-8 years) underwent the TESLA procedure. Stages of this procedure include the following: stage I, insertion of retroaortic TE; stage II, serial TE injections; and stage III, final repair with excision of aortic stenosis and primary end-to-end aortic anastomosis. Stage II was completed in 4 months (1-9 months) with 12 (7-20) TE injections. Goal lengthening was achieved in all patients. Stage III could not be completed in one patient because of extreme aortic inflammation, which precluded safe excision of the aortic stenosis and required use of a prosthetic bypass graft. The other four patients completed stage III with two (one to three) additional vessels also requiring reconstruction (renal or mesenteric arteries). At 3.2 years (1-6 years) of follow-up, all patients are doing well.Conclusions
The TESLA procedure allows surgical correction of MAS without the need for prosthetic grafts in young children who are still growing. 相似文献4.
Robert T. Schaller Joanne Schaller Alan Morgan Eric B. Furman 《American journal of surgery》1983,146(1):79-84
Since 1974, 25 children had 27 major cancer operations with the aid of hemodilution anesthesia. This includes operations for Wilms' tumors, liver tumors, adrenal tumors, pancreatic tumors, ovarian tumors, and resection of metastatic thoracoabdominal tumors. With the use of this method, operative blood loss has been greatly reduced and operative technique improved.At the beginning of surgery, whole blood is removed from the patient and replaced with three times the volume of a balanced electrolyte solution to maintain intravascular volume. After the time of significant blood loss has ceased, the patient's own blood is returned and diuresis stimulated with furosimide to remove the infused electrolyte solution. Hypothermia, allowing the temperature to drift down to just below 32 °C, helps protect vital organs against hypoxia and arterial hypotension to a mean of 50 torr systolic pressure is well tolerated and further reduces blood loss. Adequate tissue oxygenation can be maintained safely during hemodilution to a hematocrit value of 14 percent.Use of bank blood transfusion was necessary in only 6 of 25 patients. It was given when the calculated postoperative hematocrit value would be less than 30 percent. The diluted blood lost during surgery has a low red blood cell volume per milliliter and each milliliter lost depletes the total red blood cell volume by a lesser amount. Also, the ease and speed of surgery may be facilitated by the nearly bloodless operative field. Provided respiratory support is maintained, these children showed only minor clinical effects from this large fluid infusion.The majority of patients who are Jehovah's Witnesses accept this technique with the modification that we keep the blood moving and in direct contact with the patient's vascular system. Carefully planned and meticulously applied short-term hemodilution anesthesia provides a safe method for minimizing operative blood loss and reduces the difficulty of major cancer surgery in children. 相似文献
5.
Background
Abdominal wall nerve blocks have been gaining popularity for the treatment of perioperative pain in children. Our aim was to compare a technique of surgeon-performed, laparoscopic abdominal wall nerve blocks to anesthesia-placed, ultrasound-guided abdominal wall nerve blocks and the current standard of local wound infiltration.Methods
After institutional review board approval was obtained, a retrospective chart review was performed of pediatric patients treated at a single institution during a 2-year period. Statistics were calculated using analysis of variance with post-hoc Bonferonni t tests for pair-wise comparisons.Results
Included in this study were 380 patients who received ultrasound-guided abdominal wall nerve blocks (n?=?125), laparoscopic-guided abdominal wall nerve blocks (n?=?88), and local wound infiltration (n?=?117). Groups were well matched for age, sex, and weight. There was no significant difference in pain scores within the first 8 hours or narcotic usage between groups. Local wound infiltration demonstrated the shortest overall time required to perform (P?<?.0001). Patients who received a surgeon-performed abdominal wall nerve block demonstrated a shorter duration of hospital stay when compared to the other groups (P?=?.02).Conclusion
Our study has demonstrated that laparoscopic-guided abdominal wall nerve blocks show similar efficacy to ultrasound-guided nerve blocks performed by pain management physicians without increasing time in the operating room. 相似文献6.
Kathy A. Schall Kathleen A. Holoyda Mubina Isani Ching-Ling Lien Denise Al Alam Tracy C. Grikscheit 《Surgery》2018,163(6):1330-1331
7.
8.
9.
10.
11.
12.
Can Yerebakan Johannes Boltze Hatem Elmontaser Uygar Yoruker Heiner Latus Markus Khalil Stefan Ostermayer Blanca Steinbrenner Christian Apitz Matthias Schneider Marcel Suchowski Rita Ruetten Kristin Mueller Gunther Kerst Dietmar Schranz Hakan Akintuerk 《The Journal of thoracic and cardiovascular surgery》2019,157(6):2416-2428.e4
ObjectiveCentral pulmonary banding has been proposed as a novel alternative for the treatment of left ventricular dilated cardiomyopathy in children. We sought to investigate the effects of central pulmonary banding in an experimental model of doxorubicin-induced left ventricular dilated cardiomyopathy.MethodsFour-month-old sheep (n = 28) were treated with intermittent intracoronary injections of doxorubicin (0.75 mg/kg/dose) into the left main coronary artery. A total dose of up to 2.15 mg/kg of doxorubicin was administered until signs of left ventricular dilation with functional impairment occurred by transthoracic echocardiography evaluation. Animals that survived were treated with surgical central pulmonary banding through a left anterior thoracotomy or sham surgery. Transthoracic echocardiography and pressure-volume loop measurements were used to compare left ventricular function preoperatively and 3 months later. Macroscopic and microscopic histologic examinations followed after hearts were harvested.ResultsNine animals from the central pulmonary banding group and 8 animals from the sham group survived and were included in the final analysis. Both groups showed similar inflammation and fibrosis upon histologic examination consistent with the toxic myocardial effects of doxorubicin. There were no differences in the echocardiographic measurements before central pulmonary banding or sham operation. Baseline measurements before the central pulmonary banding/sham operation were considered as 100%. The central pulmonary banding group had better left ventricular ejection fraction (102.5% ± 21.6% vs 76.7% ± 11.7%, P = .01), with a tendency for smaller left ventricular end-diastolic (101.2% ± 7.4% vs 120.4% ± 10.8%, P = .18) and significantly smaller end-systolic (100.3% ± 12.9% vs 116.5 ± 9.6%, P = .02) diameter of the left ventricle in comparison with the sham animals at 3 months. The end-systolic volume (101.4% ± 31.6% vs 143.4% ± 28.6%, P = .02) was significantly lower in the central pulmonary banding group 3 months postoperatively. Fractional shortening in the long axis (118.5% ± 21.5% vs 85.2% ± 22.8%, P = .016) and short axis (122.5% ± 18% vs 80.9% ± 13.6%, P = .0005) revealed significantly higher values in the central pulmonary banding group. In the conductance catheter measurements, no significant differences were seen between the groups for the parameters of systolic and diastolic function.ConclusionsCentral pulmonary artery banding in the setting of experimental toxic left ventricular dilated cardiomyopathy improved left ventricular echocardiographic function and dimensions. 相似文献
13.
Roberto I. Troisi Giammauro Berardi Federico Tomassini Mauricio Sainz-Barriga 《Transplantation reviews (Orlando, Fla.)》2017,31(2):127-135