Correction of transposition of the great vessels with previous Baffes procedure.

Twenty-four patients with transposition of the great vessels who underwent a Baffes procedure in infancy were totally corrected by a modified Mustard procedure. There were three postoperative deaths and one major complication. All survivors have been followed from 2 to 8 yr and have done well except for one patient who required a tricuspid valve replacement because of tricuspid insufficiency. It is our conclusion that this group of patients can be corrected with a relatively low mortality and a favorable outcome.     

The Medallion suture lens: management of complications.

In a study of 613 Medallion suture implant patients, 87% of the 613 and 96% of those under 70 years of age had a postoperative visual acuity of 20/40 or better. The most common operative complication was corneal endothelial trauma, which was graded and correlated with endothelial microscopy; however, only 0.5% of cases had permanent corneal opacification. Cystoid macular edema occurred in 32 cases (5.2%), and 56% (18) of these patients regained 20/40 vision or better. Implant loop subluxation occurred in 19 cases (3.1%), but this incidence should decrease by increasing implant loop tip-to-tip distance. The data presented put in perspective the relative importance of the various complications encountered, with primary emphasis on the management of these complications.     

Hyperglycemia in stressed small premature neonates.

The metabolic responses to a constant glucose infusion were measured in 30 premature infants, 700 to 1,550 gm. The study included 18 stressed premature infants who needed assisted ventilation, and 12 control premature infants. Metabolic measurements were similar in both groups in the cord and preinfusion samples. In the first postinfusion sample, glucose, cortisol, and glycerol values were higher in stressed than in control premature infants. Hyperglycemia was seen in 13 of stressed and in only one of control premature infants. Stressed infants who became hyperglycemic in the first postinfusion sample were then compared to stressed euglycemic infants. Insulin levels were higher, glycerol levels similar, but cortisol levels lower in stressed hyperglycemic than in stressed euglycemic premature infants. The etiology of hyperglycemia in stressed premature infants cannot be attributed to hypoinsulinemia or to hypercortisolemia, and is not associated with increased glycerol levels. There was no difference in mortality between stressed hyperglycemia and stressed euglycemic infants; stress, rather than hyperglycemia, was related to mortality.