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Low Mortality (low + mortality)
Terms modified by Low Mortality Selected AbstractsMetamorphosis offsets the link between larval stress, adult asymmetry and individual qualityFUNCTIONAL ECOLOGY, Issue 2 2008M. Campero Summary 1It is poorly understood which traits translate larval stressors into adult fitness in animals where larval and adult stages are separated by metamorphosis. Although fluctuating asymmetry (FA) is often assumed to do so, especially in insects the relationship between larval stress, adult FA and individual quality is often absent. One suggested hypothesis for this is the higher mortality of low quality (hence more asymmetric) animals during metamorphosis (i.e. developmental selection hypothesis). 2Here we test this hypothesis and also propose and test an alternative hypothesis where metamorphosis is stressful but not lethal and increases FA of all animals up to a certain level (i.e. stressful metamorphosis hypothesis). 3We manipulated larval stress (food stress and pesticide stress) and measured FA before and after metamorphosis in the damselfly Coenagrion puella. Additionally, we assessed the relationship between FA and individual quality variables measured at metamorphosis (age, mass and two immune variables: phenoloxidase (PO) and haemocyte number). 4Before metamorphosis, FA reflected the combination of food and pesticide stress and was negatively related with mass and both immune variables after metamorphosis. These patterns were, however, offset after metamorphosis. Low mortality, not linked to FA during metamorphosis, indicates that developmental selection cannot explain this. Instead, the strong increase in FA up to equal levels across treatments during metamorphosis supports the stressful metamorphosis hypothesis. 5Taken together, the developmental stage in which FA is measured may critically determine the reliability of FA as an indicator of stress and of individual quality in insects. [source] Outcome of Pulmonary Valve Replacements in Adults after Tetralogy Repair: A Multi-institutional StudyCONGENITAL HEART DISEASE, Issue 3 2008Thomas P. Graham Jr. MD ABSTRACT Objective., The purpose of this study was to assess the outcome of pulmonary valve replacement (PVR) in adults with moderate/severe pulmonary regurgitation after tetralogy repair, with particular emphasis on patient outcome, durability of valve repair, and improvement in symptomatology. Design/Setting/Patients., The project committee of the International Society of Congenital Heart Disease undertook a retrospective multi-institutional analysis of PVR. Seven centers participated in submitting data on 93 patients >18 years of age who had the operation performed and follow-up obtained. The average age of PVR was 26± years (median 27 years). Time of follow-up after replacement was 3 years (range 4 days,28 years). Outcomes/Measures/Results., Kaplan,Meier estimates of durability of PVR showed approximately 50% replacement at 11 years. There were two deaths at 6 and 12 months after valve replacement. Right ventricular (RV) size estimated by echocardiography from pre- to postoperative studies decreased in 81% (P < 0.001 testing for equal proportions), but RV systolic function increased in only 36% (P = 0.09). Ability index improved in 59% (P < 0.001) and clinical heart failure status improved in 57% with this problem before PVR. PVR did not improve arrhythmia status in a small group of patients. Conclusions., PVR is associated with low mortality, decrease in RV size and improvement in ability index, and uncertain effects on RV systolic function. Average valve durability was approximately 11 years. Criteria for PVR that will preserve RV function are not clearly identified, and management of these patients remains a difficult enterprise. [source] Geriatric Co-Management of Proximal Femur Fractures: Total Quality Management and Protocol-Driven Care Result in Better Outcomes for a Frail Patient PopulationJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2008Susan M. Friedman MD Hip fractures in older adults are a common event, leading to substantial morbidity and mortality. Hip fractures have been previously described as a "geriatric, rather than orthopedic disease." Patients with this condition have a high prevalence of comorbidity and a high risk of complications from surgery, and for this reason, geriatricians may be well suited to improve outcomes of care. Co-management of hip fracture patients by orthopedic surgeons and geriatricians has led to better outcomes in other countries but has rarely been described in the United States. This article describes a co-managed Geriatric Fracture Center program that has resulted in lower-than-predicted length of stay and readmission rates, with short time to surgery, low complication rates, and low mortality. This program is based on the principles of early evaluation of patients, ongoing co-management, protocol-driven geriatric-focused care, and early discharge planning. This is a potentially replicable model of care that uses the expertise of geriatricians to optimize the management of a common and serious condition. [source] Comparison of alternatives to in-feed antimicrobials for the prevention of clinical necrotic enteritisJOURNAL OF APPLIED MICROBIOLOGY, Issue 4 2010M.S. Geier Abstract Aims:, The capacity for Lactobacillus johnsonii and an organic acid (OA) blend to prevent Clostridium perfringens -induced clinical necrotic enteritis (NE) in chickens was studied. Methods and Results:, Cobb 500 birds were allocated into six groups (n = 25 birds/pen, eight pens/treatment); Unchallenged, Challenged, Antimicrobial (zinc bacitracin (ZnB)/monensin), OA, probiotic Lact. johnsonii and probiotic sham (Phosphate,buffered saline). All birds were challenged with Eimeria spp. and Cl. perfringens except for unchallenged controls. Birds fed antimicrobials were protected from NE development as indicated by maintenance of body weight, low mortality and clostridium levels, and decreased intestinal macroscopic lesion scores compared to challenged controls (P < 0·05). Lactobacillus johnsonii -fed birds had reduced lesion scores, whilst OA-fed birds had decreased Cl. perfringens levels. Both Lact. johnsonii and OA-fed birds had improved feed efficiency between days 0 and 28 compared to challenged controls; however, mortality and body weights were not improved by either treatment. Microbial profiling indicated that the challenge procedure significantly altered the jejunal microbiota. The microbiota of antimicrobial-fed birds was significantly different from all other groups. Conclusions:, Whilst Lact. johnsonii and OA altered specific intestinal parameters, significant protection against NE was not observed. Significance and Impact of the Study:,Lactobacillus johnsonii and OA did not prevent NE; however, some improvements were evident. Other related treatments, or combinations of these two treatments, may provide greater protection. [source] Wind-throw mortality in the southern boreal forest: effects of species, diameter and stand ageJOURNAL OF ECOLOGY, Issue 6 2007ROY L. RICH Summary 1Patterns of tree mortality as influenced by species, diameter and stand age were assessed across a gradient in wind disturbance intensity in a southern boreal forest in Minnesota, USA. Few previous studies have addressed how wind impacts boreal forests where fire was historically the dominant type of disturbance. 2We surveyed 29 334 trees of nine species within a 236 000 ha blowdown in the Boundary Waters Canoe Area Wilderness (BWCAW), in forests that have never been logged and were not salvaged after the windstorm. Within the disturbed area, a range of disturbance severity from zero to complete canopy mortality was present, overlaying an existing mosaic of fire origin stands. For this study, we derived an index of wind disturbance intensity by standardizing the observed disturbance severity using common species with similar diameter at breast height (d.b.h.) distributions. We then used multiple logistic regression to assess patterns of tree mortality across gradients in tree size and wind intensity index, and for three stand ages. 3Probability of mortality was higher with increasing ln d.b.h. for all nine species, with two species (Abies balsamea and Picea mariana) showing much more dramatic shifts in mortality with d.b.h. than the others. As hypothesized, the species most susceptible to windthrow at all d.b.h. classes were early successional and shade intolerant (Pinus banksiana, Pinus resinosa, Populus tremuloides) and those least susceptible were generally shade tolerant (e.g. Thuja occidentalis, Acer rubrum), although the intolerant species Betula papyrifera also had low mortality. 4Mortality rates were higher in mature (c. 90 years old) stands than for old and very old (c. 126,200 years old) stands, probably because old stands had already gone through transition to a multi-aged stage of development. 5Synthesis. Quantification of canopy mortality patterns generally supports disturbance-mediated accelerated succession following wind disturbance in the southern boreal forest. This wind-induced weeding of the forest favoured Thuja occidentalis, Betula papyrifera and Acer rubrum trees of all sizes, along with small Abies balsamea and Picea mariana trees. Overall, the net impact of wind disturbance must concurrently consider species mortality probability, abundance and diameter distributions. [source] Investigation of wild caught whitefish, Coregonus lavaretus (L.), for infection with viral haemorrhagic septicaemia virus (VHSV) and experimental challenge of whitefish with VHSVJOURNAL OF FISH DISEASES, Issue 7 2004H F Skall Abstract One hundred and forty-eight wild whitefish, Coregonus lavaretus (L.), were caught by electrofishing and sampled for virological examination in December 1999 and 2000, during migration from the brackish water feeding grounds to the freshwater spawning grounds, where the whitefish may come into contact with farmed rainbow trout. All samples were examined on cell cultures. No viruses were isolated. Three viral haemorrhagic septicaemia virus (VHSV) isolates of different origin were tested in infection trials by immersion and intraperitoneal (IP) injection, using 1.5 g farmed whitefish: an isolate from wild caught marine fish, a farmed rainbow trout isolate with a suspected marine origin and a classical freshwater isolate. The isolates were highly pathogenic by IP injection where 99,100% of the whitefish died. Using an immersion challenge the rainbow trout isolates were moderately pathogenic with approximately 20% mortality, whereas the marine isolate was virtually non-pathogenic. At the end of the experiment it was possible to isolate VHSV from survivors infected with the marine and suspected marine isolates. Because of the low infection rate in wild whitefish in Denmark, the role of whitefish in the spread of VHSV in Denmark is probably not significant. The experimental studies, however, showed that whitefish are potential carriers of VHSV as they suffer only low mortality after infection but continue to carry virus. [source] Fluid therapy and the use of albumin in the treatment of severe traumatic brain injuryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2009M. RODLING WAHLSTRÖM Background: Evidence-based guidelines for severe traumatic brain injury (TBI) do not include strategies for fluid administration. The protocol used in this study includes albumin administration to maintain normal colloid osmotic pressure and advocates a neutral to slightly negative fluid balance. The aim of this study was to analyze the occurrence of organ failure and the mortality in patients with severe TBI treated by a protocol that includes defined strategies for fluid therapy. Methods: Ninety-three patients with severe TBI and Glasgow Coma Score,8 were included during 1998,2001. Medical records of the first 10 days were retrieved. Organ dysfunction was evaluated with the Sequential Organ Failure Assessment (SOFA) score. Mortality was assessed after 10 and 28 days, 6 and 18 months. Results: The total fluid balance was positive on days 1,3, and negative on days 4,10. The crystalloid balance was negative from day 2. The mean serum albumin was 38±6 g/l. Colloids constituted 40,60% of the total fluids given per day. Furosemide was administered to 94% of all patients. Severe organ failure defined as SOFA,3 was evident only for respiratory failure, which was observed in 29%. None developed renal failure. After 28 days, mortality was 11% and, after 18 months, it was 14%. Conclusions: A protocol including albumin administration in combination with a neutral to a slightly negative fluid balance was associated with low mortality in patients with severe TBI in spite of a relatively high frequency (29%) of respiratory failure, assessed with the SOFA score. [source] Demographic and life-history correlates for Amazonian treesJOURNAL OF VEGETATION SCIENCE, Issue 6 2005Henrique E.M. Nascimento Abstract Questions: Which demographic and life-history differences are found among 95 sympatric tree species? Are there correlations among demographic parameters within this assemblage? Location: Central Amazonian rain forest. Methods: Using long-term data from 24 1,ha permanent plots, eight characteristics were estimated for each species: wood density, annual mortality rate, annual recruitment rate, mean stem diameter, maximum stem diameter, mean stem-growth rate, maximum stem-growth rate, population density. Results: An ordination analysis revealed that tree characteristics varied along two major axes of variation, the major gradient expressing light requirements and successional status, and the second gradient related to tree size. Along these gradients, four relatively discrete tree guilds could be distinguished: fast-growing pioneer species, shade-tolerant sub-canopy species, canopy trees, and emergent species. Pioneers were uncommon and most trees were canopy or emergent species, which frequently had low mortality and recruitment. Wood density was negatively associated with tree mortality, recruitment, and growth rates when all species were considered. Growth rates varied markedly among and within species, with pioneers exhibiting far faster and less variable growth rates than did the other species. Slow growth in subcanopy species relative to canopy and emergent trees was not a simple consequence of mean tree size, but apparently resulted from physiological constraints imposed by low-light and other conditions in the forest understorey. Conclusions: Trees of Amazonian rain forests could be classified with some success into four relatively distinctive guilds. However, several demographic and life-history traits, such as those that distinguish early and late successional species, probably vary along a continuum, rather than being naturally grouped into relatively discrete categories. [source] Major liver resections for hepatocellular carcinoma on cirrhosis: Early and long-term outcomesLIVER TRANSPLANTATION, Issue S2 2004Lorenzo Capussotti Since the lack of donors, liver resections continue to be the treatment of choice for cirrhotic patients with good liver function and resectable hepatocellular carcinoma (HCC). Moreover, over the past 2 decades, an increasing number of major hepatic resections have been performed. The aim of this study is to evaluate short- and long-term outcomes of 55 cirrhotic patients undergoing major hepatic resection with particular attention to the survival of the patients with gross portal vein invasion or large size tumors. Twenty-two patients (40%) required intra- or post-operative blood transfusion. Medium tumor size was 66.6±29.2 mm; 7 patients had large size (> 10 cm) HCCs. A single node was present in 38 cases (69.1%). There was a gross portal vein tumor thrombus (PVTT) in 13 patients (23.6%). Resection was non-curative in 4 cases. In-hospital mortality and morbidity rates were 5.5% and 30.9%, respectively. The overall and disease-free survival rates were 36.2% and 42.8%, respectively. Overall 5-year survival rates of patients with large size tumors was 17.1%. Ten patients with a gross PVTT had an R0 resection with a 26.6% 5-year survival rate. In conclusion, major hepatic resections for HCC can be performed with low mortality and morbidity rates. HCCs with PVTT or greater than 10 cm in size have very limited options of treatment; the favorable long-term results of our study suggest that they should undergo surgery if a radical resection can be achieved. (Liver Transpl 2004;10:S64,S68.) [source] Searching for sex-reversals to explain population demography and the evolution of sex chromosomesMOLECULAR ECOLOGY, Issue 9 2010CLAUS WEDEKIND Sex determination can be purely genetic (as in mammals and birds), purely environmental (as in many reptiles), or genetic but reversible by environmental factors during a sensitive period in life, as in many fish and amphibians (Wallace et al. 1999; Baroiller et al. 2009a; Stelkens & Wedekind 2010). Such environmental sex reversal (ESR) can be induced, for example, by temperature changes or by exposure to hormone-active substances. ESR has long been recognized as a means to produce more profitable single-sex cultures in fish farms (Cnaani & Levavi-Sivan 2009), but we know very little about its prevalence in the wild. Obviously, induced feminization or masculinization may immediately distort population sex ratios, and distorted sex ratios are indeed reported from some amphibian and fish populations (Olsen et al. 2006; Alho et al. 2008; Brykov et al. 2008). However, sex ratios can also be skewed by, for example, segregation distorters or sex-specific mortality. Demonstrating ESR in the wild therefore requires the identification of sex-linked genetic markers (in the absence of heteromorphic sex chromosomes) followed by comparison of genotypes and phenotypes, or experimental crosses with individuals who seem sex reversed, followed by sexing of offspring after rearing under non-ESR conditions and at low mortality. In this issue, Alho et al. (2010) investigate the role of ESR in the common frog (Rana temporaria) and a population that has a distorted adult sex ratio. They developed new sex-linked microsatellite markers and tested wild-caught male and female adults for potential mismatches between phenotype and genotype. They found a significant proportion of phenotypic males with a female genotype. This suggests environmental masculinization, here with a prevalence of 9%. The authors then tested whether XX males naturally reproduce with XX females. They collected egg clutches and found that some had indeed a primary sex ratio of 100% daughters. Other clutches seemed to result from multi-male fertilizations of which at least one male had the female genotype. These results suggest that sex-reversed individuals affect the sex ratio in the following generation. But how relevant is ESR if its prevalence is rather low, and what are the implications of successful reproduction of sex-reversed individuals in the wild? [source] Delayed Occurrence of Unheralded Phase IV Complete Heart Block After Ethanol Septal Ablation for Symmetric Hypertrophic Obstructive CardiomyopathyPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 6 2006JOANNA J. WYKRZYKOWSKA Ethanol septal ablation has emerged as a less invasive alternative to surgical myomectomy for treatment of asymmetric hypertrophic obstructive cardiomyopathy (ASH). The procedure has very low mortality, but high-degree AV conduction block is a frequent complication. Prior studies have documented baseline left bundle branch block and high volume of ethanol injection (greater than 4 mL) as risk factors. Complete heart block is often preceded by postprocedure conduction abnormalities and generally develops within 48 hours after ethanol ablation. We present a unique case of a patient with symmetric hypertensive hypertrophic obstructive cardiomyopathy (SHOCM) who developed phase IV complete heart block >96 hours postprocedure without preceding conduction abnormalities or other classic risk factors.3 [source] Significance of Inducible Ventricular Flutter-Fibrillation After Myocardial InfarctionPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 9 2005BÉATRICE BREMBILLA-PERROT Aim: The purpose of this study was to determine the factors associated with the induction of ventricular flutter/fibrillation (VFl/VF)and its prognostic significance in post-myocardial infarction. Methods: Programmed ventricular stimulation was performed after myocardial infarction (MI) for syncope (n = 232) or systematically (n = 755); 230 patients had an induced VFl/VF and were followed during 4 ± 2 years. Results: VFl/VF was induced in 49/232 patients (21%) with syncope versus 181/755 asymptomatic patients (24%) (NS) and 94/410 patients (23%) with left ventricular ejection fraction (LVEF) <40% versus 136/577 patients (22.5%) with LVEF >40% (NS). Cardiac mortality was 9%; LVEF was 33 ± 15% in patients who died, 43 ± 13% in alive patients (P < 0.004). In patients with LVEF <40%, induced VFl/VF, mortality rate was 31% in those with syncope, 10% in asymptomatic patients (P < 0.001), because of an increase of deaths by heart failure; patients with LVEF >40% with or without syncope had a low mortality (5% and 3%). After linear logistic regression, VFl/VF and LVEF were predictors of total cardiac mortality, but only LVEF <40% predicted sudden death. Conclusion: Syncope and the level of LVEF did not increase the incidence of VFl/VF induction after MI, but modified the cardiac mortality: induced VF increased total cardiac mortality in patients with syncope and LVEF <40%, but did not increase sudden death. In patients with LVEF >40%, induced VFl/VF has no significance neither in asymptomatic patients nor in those with syncope. [source] A comparison of severely injured trauma patients admitted to level 1 trauma centres in Queensland and GermanyANZ JOURNAL OF SURGERY, Issue 3 2010Johanna M. M. Nijboer Abstract Background:, The allocation of a trauma network in Queensland is still in the developmental phase. In a search for indicators to improve trauma care both locally as state-wide, a study was carried out comparing trauma patients in Queensland to trauma patients in Germany, a country with 82.4 million inhabitants and a well-established trauma system. Methods:, Trauma patients ,15 years of age, with an Injury Severity Score (ISS) , 16 admitted to the Princess Alexandra Hospital (PAH) and to the 59 German hospitals participating in the Trauma Registry of the German Society for Trauma Surgery (DGU-G) during the year 2005 were retrospectively identified and analysed. Results:, Both cohorts are comparable when it comes to demographics and injury mechanism, but differ significantly in other important aspects. Striking is the low number of primary admitted patients in the PAH cohort: 58% versus 83% in the DGU-G cohort. PAH patients were less physiologically deranged and less severely injured: ISS 25.2 ± 9.9 versus 29.9 ± 13.1 (P < 0.001). Subsequently, they less often needed surgery (61% versus 79%), ICU admission (49% versus 92%) and had a lower mortality: 9.8% versus 17.9% of the DGU-G cohort. Conclusions:, Relevant differences were the low number of primary admissions, the lesser severity of injuries, and the low mortality of the patients treated at the PAH. These differences are likely to be interrelated and Queensland's size and suboptimal organization of trauma care may have played an important role. [source] Oesophagectomy for tumours and dysplasia of the oesophagus and gastro-oesophageal junctionANZ JOURNAL OF SURGERY, Issue 4 2009Krishna Epari Abstract Background:, Neoadjuvant therapy, radical lymphadenectomy and treatment in high-volume centres have been proposed to improve outcomes for resectable oesophageal tumours. The aim of the present study was to review the oesophagectomy experience of a single surgeon with a moderate caseload who uses neoadjuvant therapy selectively and performs a conservative lymphadenectomy. Methods:, A retrospective review of prospectively collected data was performed. The study included 125 consecutive attempted oesophageal resections performed by a single surgeon (RC) from 1993 to 2006. Results:, All patients were staged with computed tomography and also laparoscopy for lower third and junctional tumours. Endoscopic ultrasound was used in 69%. Seventy-seven per cent were adenocarcinomas. Neoadjuvant therapy was used selectively in 23%. One hundred and twenty-one resections were carried out, giving an overall resection rate of 97% with an R0 resection in 82%. In-hospital mortality was 0.8%, clinical anastomotic leak 1.7% and median length of stay 14 days. Overall median and 5-year survival were 46 months and 47%. Stage-specific 5-year survival was 100%, 71%, 41% and 21% for stages 0, I, II and III, respectively. Isolated local recurrence occurred in 8%. Conclusions:, A moderate volume surgeon with specialist training in oesophageal resectional surgery can achieve a low mortality and anastomotic leak rate with good survival outcomes. The role for neoadjuvant therapy and radical lymphadenectomy is controversial and remains to be clearly defined. Accurate preoperative staging is essential for selection of patients for curative surgery with or without neoadjuvant therapy and for comparison of results. [source] Initial experience of abdominal aortic aneurysm repairs in BorneoANZ JOURNAL OF SURGERY, Issue 10 2003Ming Kon Yii Background: Abdominal aortic aneurysms (AAA) repairs are routineoperations with low mortality in the developed world. There arefew studies on the operative management of AAA in the Asian population. This study reports the initial results from a unit with no previousexperience in this surgery by a single surgeon on completion oftraining. Methods: All patients with AAA repair from a prospective databasebetween 1996 and 1999 in the south-east Asian state of Sarawak inBorneo Island were analyzed. Three groups were identified on presentationaccording to clinical urgency of surgery. Elective surgery was offeredto all good risk patients with AAA of , 5 cm. All symptomatic patients were offered surgery unless contraindicatedmedically. Results: AAA repairs were performed in 69 patients: 32 (46%)had elective repairs of asymptomatic AAA; 20 (29%) hadurgent surgery for symptomatic non-ruptured AAA; and 17 (25%)had surgery for ruptured AAA. The mortality rate for elective surgery was6%; the two deaths occurred early in the series with thesubsequent 25 repairs recorded no further mortality. The mortalityrates for the urgent, symptomatic non-ruptured AAA repair and rupturedAAA repair were 20% and 35%, respectively. Cardiacand respiratory complications were the main morbidities. Sixty-three patients seen during this period had no surgery; threepresented and died of ruptured AAA, 34 had AAA of , 5 cmin diameter, and 26 with AAA of , 5 cmdiameter had either no consent for surgery or serious medical contraindications. Conclusion: This study showed that AAA can be repaired safely byhighly motivated and adequately trained surgeons in a hospital withlittle previous experience. [source] Effect of hot water extracts of brown seaweeds Sargassum spp. on growth and resistance to white spot syndrome virus in shrimp Penaeus monodon postlarvaeAQUACULTURE RESEARCH, Issue 10 2010Grasian Immanuel Abstract An experiment was conducted to evaluate the effect of a hot water extract of brown seaweeds Sargassum duplicatum and Sargassum wightii on the growth and white spot syndrome virus (WSSV) resistance in shrimp Penaeus monodon postlarvae (PL). Artemia nauplii (instar II) were enriched with both seaweed extracts at various concentrations (250, 500 and 750 mg L,1) and fed to the respective P. monodon (PL15,35) group for 20 days. A control group was also maintained without seaweed extract supplementation. The weight gain of the experimental groups was significantly higher (0.274,0.323 g) than the control group (0.261 g). Similarly, the specific growth rate was also significantly higher (16.27,17.06%) in the experimental groups than in the control group (16.03%). After 20 days of the feeding experiment, the shrimp PL were challenged with WSSV for 21 days. During the challenge test, the control shrimp displayed 100% mortality within 8 days. In contrast, the mortality percentage of the highest concentration (750 mg L,1) of seaweed extract enriched Artemia nauplii fed shrimp was 54,79%. Comparatively, low mortality was observed in S. wightii extract-enriched Artemia nauplii fed shrimp. The polymerase chain reaction analysis indicated the concentration-dependent infection of WSSV in P. monodon PL. [source] Aortic Valve Surgery in Congenital Heart Disease: A Single-Center ExperienceARTIFICIAL ORGANS, Issue 3 2010Kasim Oguz Coskun Abstract The optimal treatment of congenital aortic valve lesions is a controversial issue. This study was performed to evaluate the outcome after surgical treatment of aortic valve lesions in congenital aortic valve disease. Between the years of 2000 and 2008, 61 patients (mean age: 12.6 ± 9.6 years, range: 1 day to 40 years) underwent aortic valve surgery for congenital aortic valve disease. Twenty-four patients had undergone previous cardiovascular operations. Indications for surgery were aortic regurgitation in 14.7% (n = 9), aortic stenoses in 26.2% (n = 16), and mixed disease in 59.1% (n = 36). The Ross procedure was performed in 37.7% (n = 23), aortic valve replacement with biological or mechanical prostheses in 29.5% (n = 18). Concomitant procedures were performed in 91.8% (n = 56) due to associated congenital cardiac defects. The overall mortality rate was 5%. Six patients needed reoperation. Implantation of permanent pacemakers occurred in six patients for permanent atrioventricular block. At the latest clinical evaluation, all survivors are in New York Heart Association class I,II and are living normal lives. Aortic valve surgeries in patients with congenital heart disease have had low mortality and morbidity rates in our series. Surgical technique as well as timing should be tailored for each patient. Aortic valve replacement should be delayed until the implantation of an adult-sized prosthesis is possible. [source] Deprivation, ethnicity and prematurity in infant respiratory failure in PICU in the UKACTA PAEDIATRICA, Issue 8 2010DR O'Donnell Abstract Aim:, To describe the epidemiology of infants admitted to Paediatric Intensive Care (PIC) with acute respiratory failure including bronchiolitis. Methods:, Data from all consecutive admissions from 2004 to 2007 in all 29 designated Paediatric Intensive Care Units (PICUs) in England and Wales were collected. Admission rates, risk-adjusted mortality, length of stay, ventilation status, preterm birth, deprivation and ethnicity were studied. Results:, A total of 4641 infants under 1 year of age had an unplanned admission to PIC with acute respiratory failure (ARF), an admission rate of 1.80 per 1000 infants per year. There was a reduced rate of admission with bronchiolitis in South Asian children admitted to PICU, which is not explained by case-mix. Children born preterm had a higher rate of admission and longer stay, but a similar low mortality. Risk-adjusted mortality was higher in South Asian infants and the highest in those with ARF (OR 1.76, 95% CI 1.20,2.57) compared with the rest of the PICU population. Conclusion:, Acute respiratory failure in infants causes most of the seasonal variation in unplanned admission to intensive care. Socioeconomic deprivation and prematurity are additional risk factors for admission. Fewer South Asian infants are admitted to PICU with a diagnosis of bronchiolitis, but risk-adjusted mortality is higher in South Asian infants overall. [source] | ||||||||||||||||