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Median Weight (median + weight)
Selected AbstractsGrowth of children on the ketogenic dietDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 12 2002Eileen P G Vining MD This is a prospective cohort study of 237 children (130 males, 107 females) placed on the ketogenic diet for control of intractable epilepsy (mean age at starting diet 3 years 8 months; age range 2 months to 9 years 10 months); average length of follow-up was 308 days. There were 133 children on the diet at 1 year and 76 at 2 years. Height and weight measurements were converted into age- and sex-appropriate z scores. There was a rapid drop in weight z scores in the first 3 months. After this initial period, the weight z score remained constant in children who started the diet below the median weight for their age and sex, although z scores continued to decrease in children starting above the median. There was a small decrease in height z scores in the first 6 months (<0.5); however, there were larger changes by 2 years. There was no difference based on sex for either height or weight. The ketogenic diet generally provides sufficient nutrition to maintain growth within normal parameters over a defined period. Very young children grow poorly on the diet and should be followed-up carefully over long periods of use. [source] Sustained and stable hematopoietic donor-recipient mixed chimerism after unrelated cord blood transplantation for adult patients with severe aplastic anemiaEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 5 2005P. Mao Abstract:, We evaluated the engraftment of donor cells from unrelated cord blood into adult patients with severe aplastic anemia (SAA) and the outcome of allo-CBSCT (cord blood stem cell transplantation). Nine patients were conditioned with decreased dosage of immunosuppressive agents of CTX (60 mg/kg) and ALG (120 mg/kg). The prophylaxis of GVHD consisted of standard CsA and MTX. Patients have a media age of 25.3 yr (range: 15,37), and a median weight of 57.2 kg (range: 52.5,60) at the time of transplantation. Cord blood searches were all conducted at Guangzhou Cord Blood Bank. The engraftment state of the donor cells into recipients was confirmed by microsatellite DNA fingerprinting and fluorescent quantitative PCR analysis. Engrafted evidence has been found in seven patients involved by biomolecular analyses showing donor-recipient mixed chimerism post-transplant which was stable and persistent. After a median follow up of 32.2 months (range: 4,69), seven patients were alive and disease free. This study shows that durable donor-recipient stable mixed chimerism can be achieved by unrelated CBSCT in patients with SAA. Umbilical cord blood could be employed as a source of hematopoietic stem cell for adult transplantation. [source] Hepatitis B vaccination is effective for babies weighing less than 1800 gJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 5 2006Wee-Bin Lian Aim: This trial studied the effectiveness of early hepatitis B (HepB) immunisation in babies weighing less than 1800 grams, born of HepB surface-antigen-negative mothers. Methods: The first vaccine dose was given once clinical stability was achieved, with second and third doses given 1 and 6 months later, respectively. HepB serology, done using Abbott ElA (phase 1) and Abbott Axsym (phase 2) before and after June 2001, respectively, was checked at birth (Sero1), prior to (Sero2) and 6 months after (Sero3) the third dose. A booster dose was recommended when Sero3 showed a non-immune status (<10 mIU/mL). Results: Median birth weight and gestational age (n = 118) were 1295 [range 475, 1780] g and 31 [range 24, 37] completed weeks, respectively. Sero1 (median age of 4 [range 1, 34] days) showed 64% (n = 113) to be non-immune. The first dose of vaccine was administered at a median weight of 1268 [range 530, 1790] g, median age of 6 [range 1,63] days and median post-menstrual age of 32 [range 24,37] completed weeks. Sero2 (median age of 179 [range 112,260] days), for 110 babies (93.2%) showed immunity in 48.2% (median titres , Phase 1: 26 [range 10, 150] mIU/mL; Phase 2: 34 [range 10, 1000] mIU/mL). Sero3 revealed seroprotection in 77.8% (median titres , Phase 1: 102 [range 12, 150] mIU/mL; Phase 2: 162 [range 16, 1000] mIU/mL). The more mature the bady at time of first dose, the more likely he is to achieve seroprotection (85% amongst those administered at and beyond 33 weeks; 91% among those administered at and beyond Day 10 at Sero3). Conclusions: Early HepB immunisation in infants <1800 g can be safely recommended, with booster doses necessary at 1 year for some infants. [source] Effect of antivenin dose on outcome from crotalid envenomation: 218 dogs (1988,2006)JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 6 2009DACVIM, Jennifer L. McCown DVM Abstract Objective , To determine whether the dose of antivenin administered is associated with a difference in survival of crotalid-envenomated dogs. A secondary objective was to determine whether other covariables affect survival. Design , Retrospective study (1988,2006). Setting , Private referral center and university small animal teaching hospital. Animals , Two hundred and eighteen dogs with evidence of crotalid envenomation and treatment with equine-derived antivenin. Interventions , Administration of antivenin. Measurements and Main Results , Patient signalment, physical and clinicopathologic data at time of presentation, treatments, complications of antivenin therapy, length and cost of hospitalization, and outcome were recorded. Confidence intervals were determined for the difference in median number of vials administered and for median dosage for patients that lived versus died. Penalized logistic regression was performed to evaluate the effect of other covariables on survival. The median age of affected dogs was 3 years (range 6 w,12 y) with a median weight of 25.7 kg (range 1.95,86.4 kg). The median number of antivenin vials administered was 1.0 (range 1.0,10.0). Acute and chronic reactions were reported in 7% (16/218) and 0.9% (2/218) of dogs, respectively. Nine of 218 dogs (4.1%) died. The median number of vials administered to the nonsurvivors and survivors were 2.0 (range 1,5 vials) and 1.0 (range 1,10 vials), respectively. The median number of vials received was significantly different in dogs that died versus those that lived (P<0.05). Increased heart rate (P=0.02) and petechiation (P=0.04) were associated with decreased likelihood of survival, while diphenhydramine (P=0.02) and fluoroquinolone (P=0.046) administration was associated with increased likelihood of survival. The median duration of hospitalization was 1.0 day (range 2 h,22 d). The median cost of hospitalization was US$1592.00 (range US$267.20,US$6738.00). Conclusion , The administration of more vials of antivenin is potentially associated with negative outcome; however, a causal relationship has not been established. Controlled, prospective studies are needed to optimize antivenin administration. [source] Antithrombotic Effect of Enoxaparin in Clinically Healthy Cats: A Venous Stasis ModelJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2010C.M. Van De Wiele Background: Systemic arterial thromboembolic events are a serious complication of cardiac disease in cats. Objectives: To determine if enoxaparin induces an antithrombotic effect in cats at a dosage of 1 mg/kg SC q12h and if this antithrombotic effect is predicted by anti-Xa activity. Animals: Fourteen clinically healthy cats were divided into 3 groups: control (4 cats), treated and assessed at 4 hours (5 cats), and treated and assessed at 12 hours (5 cats). Methods: A venous stasis model was used and the extent of thrombus formation estimated by measuring thrombus weight and accretion of 125I-fibrinogen. Plasma anti-Xa activity was measured in treated cats. Results: There was a significant reduction in thrombus formation in the 4 h group compared with control (median weight, 0.000 versus 0.565 mg/mm, P < .01; median %125I-fibrinogen accretion, 0.0 versus 42.0%, P < .01). There was a reduction in thrombus formation in the 12 h group (median weight, 0.006 mg/mm, P= .09; median %125I-fibrinogen accretion, 3.83%, P= .09) but this reduction was not significant. The median percent thrombus inhibition for treated cats was 100.0% at 4 hours and 91.4% at 12 hours. Plasma anti-Xa activity was not significantly correlated with thrombus formation. Conclusions and Clinical Importance: This pilot study demonstrates that enoxaparin, when administered at a dosage of 1 mg/kg SC q12h, produces an antithrombotic effect in a venous statsis model in clinically healthy cats. Furthermore, this study demonstrates that anti-Xa activity is a poor predictor of enoxaparin's antithrombotic effect. [source] Use of Electrohydraulic Lithotripsy in 28 Dogs with Bladder and Urethral CalculiJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 6 2008A. Defarges Background: Electrohydraulic lithotripsy (EHL) has been used as an alternative to cystotomy in human medicine to remove urinary calculi. This prospective study evaluated the efficacy and safety of EHL to remove urinary calculi in dogs. Hypothesis: EHL is an efficient and safe method of treatment of bladder and urethral calculi in dogs. Methods: Dogs presented between January 1, 2005 and June 1, 2007 with lower urinary tract calculi diagnosed by radiographs or ultrasound examination were included in the study. Physical examination, CBC, biochemistry, urinalysis, and urine culture were performed at presentation. EHL and voiding urohydropulsion were performed under general anesthesia. Patients received IV fluids for 12 hours after which they were rechecked by ultrasound examination and discharged with antibiotics and anti-inflammatory drugs for 5 days. All patients were reevaluated 1, 3, and 6 months after presentation by physical examination, urinalysis, and ultrasonography. Results: Twenty-eight dogs (19 males, 9 females) presented with bladder or urethral calculi or both underwent lithotripsy. Their median weight was 8.3 kg. Calcium oxalate calculi were present in 22 dogs, struvite in 4, and mixed calculi in 2. Fragmentation was done in the bladder (23 dogs) and in the urethra (12 dogs). Calculus-free rate was higher for urethral than for bladder calculi in males and higher for bladder calculi in females than in males. No major complications were reported. Twelve dogs relapsed within 6 months. Conclusions: Results of this study support the use of EHL as a minimally invasive treatment for bladder calculi in females and for urethral calculi in male dogs. [source] Transcatheter Closure of Patent Ductus Arteriosus Using Occluding Spring CoilsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 4 2000A. A. Stokhof The purpose of this study is to report our initial experience with the use of spring coils to close the patent ductus arteriosus in the dog. There are few large-patient series reported in the veterinary literature. Coil closure was attempted in 15 dogs (median weight, 6.5 kg; range, 1.2 to 38.7 kg) presenting with a patent ductus arteriosus between May 1997 and May 1999. Arterial catheterization followed by angiography was used to decide if coil placement was adequate. A 5- or 8-mm embolization coil, depending on the angiographic diameter of the ductus, was delivered, with 1 loop in the pulmonary arterial side and the remainder of the coil in the aortic side of the duct. Additional coils were used if a residual shunt was present, and closure was confirmed by aortography. Patients were discharged the day after the procedure. Successful coil closure, without residual shunt on angiography, was achieved in 11 of 13 dogs in which coils were released. In 6 dogs, a coil embolized to the pulmonary artery. Four of these dogs had successful closure with multiple coils, and 2 others had surgery. None of these dogs experienced adverse effects. In 2 dogs with conical patent ductus arteriosus >5 mm in minimal diameter, coil closure was not done. We conclude that the patent ductus arteriosus size and anatomical shape are crucial in deciding whether coil closure is the method of choice. In selected cases, coil closure represents an elegant alternative to surgical ligation. Although pulmonary embolism occurred commonly, it did not cause any obvious clinical problem. [source] Development of pulmonary hypertension in 5 patients after pediatric living-donor liver transplantation: De novo or secondary?LIVER TRANSPLANTATION, Issue 5 2006Yasumasa Shirouzu The development of portopulmonary hypertension (PH) in a patient with end-stage liver disease is related to high cardiac output and hyperdynamic circulation. However, PH following liver transplantation is not fully understood. Of 617 pediatric patients receiving transplants between June 1990 and March 2004, 5 (median age 12 yr, median weight 24.5 kg) were revealed to have portopulmonary hypertension (PH) after living-donor liver transplantation (LDLT), as confirmed by echocardiography and/or right heart catheterization. All children underwent LDLT for post-Kasai biliary atresia. In 2 patients with refractory biliary complications, PH developed following portal thrombosis; 2 with stable graft function, who had had intrapulmonary shunting (IPS) before LDLT, were found to have PH in spite of overcoming liver dysfunction due to hepatitis. PH developed shortly after distal splenorenal shunting in 1 patient, who suffered liver cirrhosis due to an intractable outflow blockage. The onset of PH ranged from 2.8 to 11 yr after LDLT, and mean pulmonary artery pressure (mPAP) estimated by echocardiography at the time of presentation ranged from 43 to 120 mmHg. Three of the 5 patients are alive under prostaglandin I2 (PGI2) treatment. Of these, 1 is prepared for retransplantation for an intractable complications of liver allograft, while the other 2 with satisfactory grafts are being considered for lung transplantation. Even after LDLT, PH can develop with portal hypertension. Periodic echocardiography is essential for early detection and treatment of PH especially in the recipients with portal hypertension not only preoperatively but also postoperatively. Liver Transpl 12:870,875, 2006. © 2006 AASLD. [source] Initial Experience of Pacing with a Lumenless Lead System in Patients with Congenital Heart DiseasePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 11 2009SANTABHANU CHAKRABARTI M.D. Background: Long-term pacing is frequently necessary in patients with congenital heart disease (CHD). Preservation of ventricular function and avoidance of venous occlusion is important in these patients. Site-selective pacing with a smaller diameter lead is achievable with the model 3830 lead (SelectSecure®, Medtronic Inc., Minneapolis, MN, USA), which was specifically designed to target these complications. We describe our initial experience with the Model 3830 lead in patients with CHD. Methods: Retrospective analysis of all patients undergoing site-selective implantation of a Model 3830 lead(s) from two congenital heart centers (Bristol, UK, and Dublin, Ireland) from October 2004 until February 2008. Results: We implanted 139 SelectSecure® leads (atrial n = 70; ventricular n = 69) in 90 patients (57 male) with CHD. Median age at implantation: 13.4 years (1.1,59.2 years), median weight: 43 kg. Sixty-nine patients (76%) were children (<18 years). Indications for lead implantation included atrioventricular block (n = 55), sinus node disease (n = 18), implantable cardiac defibrillator (n = 12), antitachycardia pacing (n = 4), and cardiac resynchronization (n = 1). Twenty-two patients underwent pre-existing lead extraction during the same procedure. All the attempted procedures resulted in successful pacing. One patient had a significantly raised threshold at implantation. There was no procedural mortality. There were two procedural complications. Three patients required lead repositioning for increasing thresholds early postprocedure (<6 weeks). Four leads (2.9%) had displaced on median follow-up of 21.8 months (0.5,42 months). Conclusions: The Model 3830 lead is safe and effective in patients with CHD. This is a technically challenging patient group yet procedural complication and lead displacement rates are acceptable. [source] The Most Common Site of Success and Its Predictors in Radiofrequency Catheter Ablation of the Slow Atrioventricular Nodal Pathway in ChildrenPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 10 2008HAW-KWEI HWANG M.D. Background:Locating ablation targets on the slow pathway in children as one would in adults may not accommodate the dimensional changes of Koch's triangle that occur with heart growth. We investigated the most common site of success and the effect of a variety of variables on the outcome of slow pathway ablation in children. Methods:A total of 116 patients (ages 4,16 years) with structurally normal hearts underwent radiofrequency ablation of either the antegrade or the retrograde slow pathway. Ablation sites were divided into eight regions (A1, A2, M1, M2, P1, P2, CS1, and CS2) at the septal tricuspid annulus. Results:Ablation was successful in 112 (97%) children. The most common successful ablation sites were at the P1 region. The less the patient weighed, the more posteriorly the successful site was located (P = 0.023, OR 0.970, 95% CI 0.946,0.996), and the more likely the slow pathway was eliminated rather than modified: median weight was 46.7 kg (range, 14.5,94.3 kg) in the eliminated group and 56.5 kg (range, 20,82.6 kg) in the modified group (P = 0.021, OR 1.039, 95% CI 1.006,1.073). Conclusions:The most common site of success for slow pathway ablation in children is at the P1 region of the tricuspid annulus. The successful sites in lighter children are more posteriorly located. Weight is also a predictor of whether the slow pathway is eliminated or only modified. [source] Noncatheter-Based Delivery of a Single-Chamber Lumenless Pacing Lead in Small ChildrenPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 7 2007DAMIEN KENNY M.B.Ch.B., M.R.C.P.C.H. Objectives:The model 3830 lead (SelectSecureÔ Medtronic, Minneapolis, MN, USA) is a bipolar, fixed-screw, 4.1-F pacing lead designed for site-selective pacing. Implantation is usually performed using an 8-F deflectable catheter system. This catheter is not ideal for smaller children because of both the sheath size and the relatively large deflected curves. We describe a simpler noncatheter-based delivery system in seven children. Methods:A 4.1-F SelectSecure lead was introduced via a 5-F SafeSheath (Thomas Medical, Malvern, PA, USA) placed in the left subclavian vein. The SelectSecure lead was passed into the inferior vena cava (IVC) and a loop created, which was then withdrawn into the right atrium. Once in position, the lead was screwed into the myocardium, the SafeSheath was peeled off, and the lead connected to the generator. Results:From March 2005 until September 2006, five right atrial leads and two right ventricular leads were implanted in seven patients (six female) with a median weight of 15 kg (8.1,19.4). All leads were successfully placed with excellent pacing thresholds. The median screening time was 7.1 minutes (4.8,11.4) with a median radiation dose of 83 cGy cm2. There were no procedural complications and no lead displacements seen on a median follow-up of 10 months. Conclusions:Delivery of the 4.1-F SelectSecure pacing lead to the right heart is possible using a noncatheter-based delivery system. This is effective and safe and does not require the use of a larger delivery system. This allows these thin isodiametric pacing leads to be used advantageously in small children. [source] Atrial Linear Lesions: Feasibility Using CryoablationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2006KLAUS KETTERING Background: Long linear lesions are created in the left atrium to modify the atrial substrate, thereby curing atrial fibrillation. The creation of long linear left atrial lesions using radiofrequency (RF) ablation is time consuming and difficult. Furthermore, it might result in significant complications. Cryoablation might overcome some of the disadvantages of RF ablation. Therefore, the aim of our study was to assess whether the creation of a long linear lesion is possible using cryotherapy. Methods: A right atrial septal linear lesion was created in six pigs (median weight: 50 kg; range: 40,60 kg). The ablation procedure was performed with a 7-F Freezor cryocatheter. The nonfluoroscopic mapping system LocaLisa was used as a navigation tool. At each point, freezing was maintained at the lowest attainable temperature (,75°C) for 4 minutes. The CARTO system was used for the evaluation of the linear lesions. Furthermore, all animals were sacrificed immediately after the ablation procedure and a postmortem examination of the lesions was performed. Additionally, an analysis of the amplitudes of the intracardiac electrograms registered via the ablation catheter was performed before and after the ablation procedure. Results: A right atrial septal linear lesion could be created successfully in all six pigs. For the performance of this ablation line, a median number of 16 cryoapplications (range, 11,26) was necessary. The amplitudes of the intracardiac electrograms registered via the ablation catheter decreased significantly after ablation. The CARTO bipolar voltage map revealed very low potentials along the ablation line and showed a sharply demarcated ablation area at the septum in all pigs. Further analysis of the CARTO map revealed an incomplete conduction block in all cases. Most of the pigs had a small gap close to the fossa ovalis. The postmortem examination of 2,3,5-triphenyl-tetrazolium chloride-stained specimens showed sharply demarcated lesions without any ulcerations. There were no major complications during the procedure. Conclusions: The creation of long linear lesions using cryoablation is feasible and safe. Lesion characteristics are different and more favorable than those created by RF. However, the aim of creating a transmural lesion and a complete conduction block remains an unsolved problem even with current cryoablation techniques. Nevertheless, growing experience and technical improvements might overcome some of the current limitations of this new technique. [source] Weight and weight gain at 4 months (The Netherlands 1998): influences of nutritional practices, socio-economic and ethnic factorsPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 4 2002Anneke M. W. Bulk-Bunschoten Summary We describe the determinants of weight gain in the first 4 months of life in a cohort of 3256 infants. The study was designed as a survey with follow-up. In the period 1 April to 1 July 1998, all infants, usually 4 weeks old but not older than 4 months, brought to a well-baby clinic for the first time were included. Nutritional practices, demographic data on mother and child, birthweight and a second weight measured between days 118 and 147 were recorded. Simple and multiple linear regression analyses were performed. The average weight gain over 4 months was 27.7 g/day for boys and 24.5 g/day for girls. Weight gain was lower with high parity and if the mother was a native Dutch speaker. Nutritional practices affected weight gain only slightly: exclusive breast feeding for 4 months lowered the weight gain by 0.06 g/day. However, because of their higher birthweight, breast-fed infants weighed a little more than formula-fed infants at 4 months. In addition, we compared the median weight at the age of 4 months with the median weight at the same age in previous Dutch growth studies. The median weight, adjusted to day 133, was higher in 1998 than in 1965, 1980 and 1997 (boys 7.15 vs. 6.85, 6.77 and 6.95 kg; girls 6.59 vs. 6.49, 6.39 and 6.45 kg respectively). [source] Pediatric Procedural Sedation with Ketamine: Time to Discharge after Intramuscular versus Intravenous AdministrationACADEMIC EMERGENCY MEDICINE, Issue 2 2009Preeti Ramaswamy MBBS Abstract Objectives:, Ketamine is an attractive agent for pediatric procedural sedation. There are limited data on time to discharge comparing intramuscular (IM) vs. intravenous (IV) ketamine. The authors set out to determine whether IM or IV ketamine leads to quicker discharge from the emergency department (ED) and how side effect profiles compare. Methods:, All patients who had received ketamine IM or IV at a tertiary children's hospital ED during the 3-year study period (2004,2007) were identified. Prospective sedation registry data, retrospective medical records, and administrative data were reviewed for drug dosages, use of additional agents, time of drug administration to discharge, total ED time (triage to discharge), and adverse events. A subgroup analysis for patients requiring five or fewer sutures (short suture group) was performed. Results:, A total of 229 patients were enrolled (60% male) with median age of 2.8 years (IQR =1.8,4.3 years) and median weight of 15.7 kg (range = 8.7,74 kg). Ketamine was most frequently employed for laceration repair (80%) and foreign body removal (9%). Overall, 48% received ketamine IM and 52% received it IV. In the short-suture subgroup, 52% received ketamine IM, while 48% received it IV. Multivariate linear regression analysis determined time from drug administration to patient discharge as 21 minutes shorter for IV compared with IM administration, adjusted for age and number of additional doses (R2 = ,0.35; 95% CI = ,0.5 to ,0.19; p < 0.001). Total time in the ED (triage to discharge) comparing IV versus IM administration, adjusting for age and gender and number of additional doses, was not significantly different (p = 0.16). In the short-suture subgroup, time to discharge from administration was also shorter in the IV ketamine group (R2 = ,0.454; 95%CI = ,0.66 to ,0.25; p < 0.001) but similar for total time in ED (p = 0.16). Overall, adverse events occurred in 35% (95% CI = 27% to 45%) of the IM group and 20% (95% CI = 13% to 28%) of the IV group (p = 0.01). Only one patient required brief bag-mask ventilation. Conclusions:, In this institution, time from drug injection to discharge was shorter in the IV compared to IM ketamine group, both overall and for the short-suture group. However, time from triage to discharge was similar. [source] Lateral mammaplasty reconstruction after surgery for breast cancer,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 10 2009M. Ballester Background: Up to 60 per cent of cancers develop laterally in the breast and breast-conserving surgery frequently produces superolateral nipple,areolar complex (NAC) distortion aggravated by postoperative irradiation. Correction is technically demanding and the outcomes are variable. Lateral mammaplasty may allow wider excision margins and prevent such deformities. Methods: This was a review of 86 consecutive patients who had lateral mammaplasty: combined wide tumour excision with NAC repositioning on a reliable dermoglandular pedicle. Simultaneous axillary surgery was performed via a separate or combined incision. Aesthetic outcomes were assessed. Results: The median age of the women was 54 (range 29,75) years; 55 (64 per cent) had palpable tumours and 73 (85 per cent) underwent simultaneous axillary surgery. Median radiological and histological tumour sizes were 29·8 and 33·6 mm, respectively, and median weight of excised tumour was 150 g. Two patients required haematoma evacuation. Eleven women required revisional surgery for involved or close margins. Aesthetic outcomes were excellent or good in 93 per cent. Conclusion: Lateral mammaplasty produced clear margins in 87 per cent of women. It is an option when a deformity is anticipated after breast-conserving surgery, and is particularly valuable when neoadjuvant chemotherapy has downgraded a large tumour. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Living related liver transplantation in children,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 7 2008N. Heaton Background: Living related liver transplantation (LRLT) has become established for treating children with end-stage liver disease. The aim of this study was to review a single-centre experience of left lateral segment liver transplants from living donors in children. Methods: Fifty left lateral segment LRLT procedures have been performed since 1993. There were 17 girls and 33 boys, of median age 1·5 years (range 0·5 to 13 years), with a median weight of 10 (range 0·7,44) kg. Donors included 23 mothers, 26 fathers and one uncle, with a median age of 33 (range 19,46) years. Results: At a median follow-up of 86 months, there was no donor mortality and low morbidity. Patient and graft survival rates were 98, 96 and 96 per cent, and 98, 96 and 93 per cent at 1, 3 and 5 years respectively. Three children had a second transplant at a median of 9 years after the first. The incidence of hepatic artery thrombosis, portal vein thrombosis and biliary complications was 6, 4 and 14 per cent respectively. Conclusion: Living related liver transplantation has good long-term results in children. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Early clinical experience with the new amplatzer ductal occluder II for closure of the persistent arterial duct,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 4 2009Jonathan Forsey MB, MRCPCH Abstract Objectives: To describe the early single-center clinical experience with the Amplatzer Ductal Occluder II (ADO II). Methods: All patients undergoing attempted transcatheter closure of persistent arterial duct (PDA) with the ADO II were included. Data collected included demographic, clinical, and echocardiographic parameters. Results: From March until September 2008, 29 procedures were undertaken in 27 patients (21 female). Median age was 1.4 years (range 0.4,76 years) with median weight 9.4 kg (range 4.7,108 kg). A transarterial approach was used in 2 patients. The median minimum ductal diameter was 2.7 mm (range 1.7,5). ADO II was released in 25 patients (92.5%). Two patients had significant residual shunting following deployment of ADO II and underwent closure with Amplatzer ductal occluder (ADO I). Postprocedural echocardiography identified one occluder had changed position with development of a significant leak and one occluder had embolized to the left pulmonary artery. Both occluders were retrieved successfully at a second catheter procedure. Complete occlusion was noted predischarge in 22 of the remaining 23 occluders (96%). One patient had mild flow acceleration in the left pulmonary artery which has resolved. Conclusions: The ADO II is highly effective at providing rapid occlusion of morphologically varied PDAs. Occluder design allows closure with arterial or venous approach and delivery with 4 or 5 F delivery catheters. Stable occluder position is dependent on correct positioning of both aortic and pulmonary discs. A larger range of sizes and configurations of this occluder may be required to successfully occlude all ductal sizes and morphologies. © 2009 Wiley-Liss, Inc. [source] Catheter closure of atrial septal defects with deficient inferior vena cava rim under transesophageal echo guidance,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 1 2009K.S. Remadevi MD Abstract Objectives: To describe the case selection, imaging considerations, technique, and results of catheter closure of atrial septal defects (ASD) with deficient inferior vena cava (IVC) rim. Background: Transcatheter closure with Amplatzer septal occluder (ASO) has become standard treatment for most secundum ASDs. Defects with deficient IVC rim continue to be challenging to image and close in the catheterization laboratory. Methods: Records of 12 patients with deficient IVC rim (<5 mm), who underwent catheter closure (April 2007 to June 2008) were reviewed. General anesthesia and transesophageal echo (TEE) guidance was used in all. The IVC rim was imaged at 70°,90° with retroflexion of the TEE probe, in addition to the conventional views. Devices 1,4 mm > maximal ASD size were selected. Deployment was accomplished either from the left atrium, left upper or from the right pulmonary veins. Results: The median age was 5.5 (2.5,27) years and median weight was 19.5 (9-65) kg. The defects measured 16,32 mm and 18,36 mm septal occluders were used. The median fluoroscopic time was 13.1 (4.2,32.7) min. Initial device selection was revised in four patients. Two patients had residual flows at IVC margin. The device embolized to right ventricular outflow tract in one patient. This was retrieved, and a larger device was deployed. No other complications were observed immediately or on follow-up (median 6; range 1,14 months). Conclusions: Transcatheter closure of ASDs with deficient IVC rim is feasible under TEE guidance. The modified retroflexed view allows adequate imaging of IVC rim through TEE. © 2008 Wiley-Liss, Inc. [source] Transcatheter closure of perimembranous ventricular septal defects using the amplatzer membranous VSD occluder: Immediate and midterm results of an international registryCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 4 2006Ralf Holzer MD Abstract Objective: To report the immediate and midterm results of transcatheter closure of perimembranous ventricular septal defect (PmVSD) using the Amplatzer membranous VSD occluder (AMVSD). Methods: Between April 2002 and August 2004, 100 patients underwent an attempt of percutaneous device closure of PmVSD using the AMVSD in 24 international centers. The median age was 9.0 years (0.7,58 years) and the median weight was 27.5 kg (7,121 kg). Results: A device was successfully deployed in 93/100 (93%) patients. Reasons for procedural failure were an increased gradient across the left ventricle outflow tract in one patient, aortic regurgitation in 2 patients, and inability to securely position the device in 4 patients. The median VSD size by TEE was 7.0 mm (1.5,13 mm), median device size 10 mm (4,16 mm) and median fluoroscopy time 22.1 min (8.9,96.0 min). Weight below 10 kg (P = 0.0392), inlet extension of the VSD (P = 0.0139) and aortic cusp prolapse into the VSD (P = 0.0084) were significantly associated with a lower procedural success. Patients have been followed up for a median of 182 days (1,763 days). There were no procedure-related deaths. Complications were encountered in 29/100 (29%) patients, including rhythm or conduction anomalies in 13 patients (two with complete heart block requiring permanent pacemaker implantation), new or increased aortic (9 patients) or tricuspid (9 patients) regurgitation, most of which were classified as trivial or mild. Patients with a weight below 10 kg had a significantly higher incidence of adverse events than patients with a weight above 10 kg (58.3% versus 25.0%, P = 0.0285). Immediately after device release complete closure of the defect was present in 54/93 (58.1%) patients, increasing to 46/55 (83.6%) patients at 6-months follow-up (P = 0.0012). Left ventricle end-diastolic diameter decreased from a median of 44 mm prior to device closure to a median of 39 mm at 6-months postprocedure (P = 0.0015). Conclusion: Closure of PmVSDs using the AMVSD occluder is safe and effective. However, longer follow-up period is warranted prior to the wide spread use of this device. © 2006 Wiley-Liss, Inc. [source] Transcatheter closure of coronary artery fistulae using the Amplatzer duct occluderCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 2 2006Sarina K. Behera MD Abstract Objective: The aim of this study is to report our experience using the Amplatzer Duct Occluder (ADO) for occlusion of significant coronary artery fistulae (CAF). Background: Transcatheter closure of CAF with coils is well described. Use of newer devices may offer advantages such as improved control of device placement, use of a single instead of multiple devices, and high rates of occlusion. Methods: A retrospective review of all patients catheterized for CAF from July 2002 through August 2005 was performed. Results: Thirteen patients with CAF underwent cardiac catheterization, of which a total of 6 patients had ADO placement in CAF (age, 21 days to 56 years; median age, 4.3 years and weight, 3.8 kg to 74.6 kg; median weight, 13.3 kg). An arteriovenous wire loop was used to advance a long sheath antegrade to deploy the ADO in the CAF. Immediate and short-term outcomes (follow-up, 3 months to 14 months; median follow-up, 8.5 months) demonstrated complete CAF occlusion in 5 patients and minimal residual shunt in 1 patient (who had resolution of right atrial and right ventricular enlargement). On follow-up clinical evaluation, all 6 patients had absence of fistula-related murmurs, and 2 previously symptomatic patients had resolution of congestive heart failure symptoms. Early complications included transient palpitations and atrial arrhythmia in the 2 oldest patients (52 and 56 years old). Conclusions: Use of the ADO is applicable for transcatheter closure of significant CAF. Advantages of using the ADO include the antegrade approach, use of a single device, and effective CAF occlusion. © 2006 Wiley-Liss, Inc. [source] Endovascular stent implantation in the pulmonary arteries of infants and children without the use of a long vascular sheathCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 4 2002Robert H. Pass MD Abstract Endovascular stent implantation for pulmonary artery stenosis requires the use of a long, large-bore vascular sheath to insure precise implantation without embolization or malposition. A long vascular sheath may be difficult to position and usage may be associated with vascular compromise and/or hemodynamic embarrassment, especially in infants and small children. We report a new technique for pulmonary artery endovascular stent implantation without the use of a long sheath. From December 2000 to May 2001, 10 patients underwent implantation of 13 Palmaz Corinthian premounted biliary transhepatic stents for pulmonary artery stenosis. Median age was 0.8 years (range, 0.5,18.5) and median weight was 11.8 kg (range, 4.6,65). Patient diagnoses were tetralogy of Fallot (five), double outlet right ventricle (three), branch peripheral pulmonary artery stenosis (two), single ventricle s/p cavopulmonary shunt (one), and truncus arteriosus (one). All Palmaz Corinthian stents were delivered uncovered on Cordis Opta LP balloon catheters via short sheaths (6,7 Fr); super-stiff guidewires were not always necessary. These stents, with a maximal expanded diameter of 12 mm, were placed for peripheral pulmonary artery stenosis as a definitive procedure or at the pulmonary artery bifurcation in patients who were expected to undergo future open heart surgery. The stents were initially implanted on 4, 6, or 8 mm balloon catheters and further expanded if needed. Stents were placed in the right pulmonary artery alone in three patients, left pulmonary artery alone in four patients, and side-by-side stents were implanted simultaneously in three patients. All thirteen stents were implanted successfully in the desired location without stent malposition or embolization. Mean angiographic diameter increased from 2.5 ± 1.5 to 5.7 ± 1.4 mm (P < 0.01) and peak systolic ejection gradients decreased from 44 ± 22 to 14 ± 11.6 mm Hg (P < 0.01). The uncovered delivery of the premounted Palmaz Corinthian stent allowed for precise and safe endovascular stent implantation without the hemodynamic and technical problems associated with long vascular sheath usage. This technique is useful for the palliation of proximal pulmonary artery stenosis and is effective definitive treatment for peripheral pulmonary artery stenosis in small infants and children. Cathet Cardiovasc Intervent 2002;55:505,509. © 2002 Wiley-Liss, Inc. [source] Nasal high-frequency ventilation for premature infantsACTA PAEDIATRICA, Issue 11 2008Tarah T Colaizy Abstract Aim: To assess the use of nasal high-frequency ventilation (HFV) to provide noninvasive ventilatory support for very low birthweight (VLBW) infants. Study Design: VLBW infants, >7 days of age on nasal continuous positive airway pressure (CPAP), were placed on nasal HFV for 2 h using the Infant Star high-frequency ventilator (Mallinckrodt, Inc., St. Louis, MO, USA). Mean airway pressure was set to equal the previous level of CPAP, and amplitude was adjusted to obtain chest wall vibration. Capillary blood was sampled before starting HFV and after 2 h to determine change in pH and partial pressure of carbon dioxide (pCO2). Results: Fourteen subjects were studied, 10 males and 4 females. Gestational age was 26,30 weeks (median 27). Age at study was 18,147 days (median 30). Median birth weight was 955 g; median weight at study was 1605 g. Nasal CPAP pressure was 4,7 cm H2O (mean 5). Amplitude was 30,60 (median 50). After 2 h, PCO2 (mean 45 torr) was significantly lower than initial PCO2 (mean 50 torr) (p = 0.01), and pH had increased significantly (7.40 vs. 7.37, p = 0.04). Conclusions: Nasal HFV is effective in decreasing pCO2 in stable premature infants requiring nasal CPAP support. Long-term use of nasal HFV requires further study. [source] Coronary arteries in fetal life: physiology, malformations and the "heart-sparing effect"ACTA PAEDIATRICA, Issue 2004R ChaouiArticle first published online: 2 JAN 200 The present knowledge of coronary arteries in prenatal diagnosis is reviewed with a focus on three aspects: the physiology and visualization of coronary flow, malformations involving the coronary arteries, and the "heart-sparing effect". Visualization of coronary arteries in a healthy human fetus is possible in real-time and colour Doppler during the last 10wk of gestation when ultrasound conditions are excellent. Visualization at an earlier gestational age (up to 13 wk) is feasible mainly in association with malformations and impending hypoxia. The main coronary malformations that can be visualized in utero are the ventriculo-coronary communications in fetuses with pulmonary atresia. In the last few years, interest has been focused on the "heart-sparing effect", defined as the increased perfusion of the coronary arteries in fetuses with severe growth restriction and abnormal Doppler velocimetry in the peripheral vessels. Increased perfusion detectable with colour and pulsed Doppler is a late sign of fetal compromise in hypoxaemia. It confirms animal experiments that have demonstrated dilatory reserves of the fetal coronary arteries under chronic hypoxaemia. The outcome of 21 fetuses showing the "heart-sparing effect" before 32 wk gestation was poor: nine fetuses died in utero and two after birth, the median weight at birth was 630 g. In summary, our knowledge of the coronary arteries in the fetus is based on the diagnostic means used in prenatal diagnosis. New information in this field may also contribute to a better understanding of coronary heart disease later in life. [source] Effect of obesity on outcomes after fondaparinux, enoxaparin, or heparin treatment for acute venous thromboembolism in the Matisse trialsJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 6 2007B. L. DAVIDSON Summary.,Background: Selecting initial anticoagulant dose by patient weight for acute pulmonary embolism and deep vein thrombosis has clinical credibility; however, uncertainty remains regarding how to dose obese patients with newer anticoagulants because outcome data are sparse. Objectives: To use the Matisse trials' comparison of sc fondaparinux once daily with control heparin therapies (intravenous unfractionated heparin for pulmonary embolism, sc enoxaparin 1 mg/kg b.i.d. for deep vein thrombosis) for initial treatment in order to compare primary outcomes (venous thromboembolism recurrence and major bleeding) in obese patients. Patients and methods: Primary outcomes were compared in subsets composed of patients weighing , and > 100 kg and with body mass index (BMI) < 30 and , 30 kg/m2. Medians and ranges for weight and BMI were compared for patients suffering either recurrence or major bleeding. Results: Twenty-two thousand and one patients received fondaparinux and 2217 received enoxaparin or unfractionated heparin. Four hundred and ninety-six patients (11%) weighed > 100 kg and 1216 (28%) had a BMI , 30. Treatment groups had similar characteristics. The upper limit in subject weight for recurrence was 166 kg (BMI 58), and for major bleeding 120 kg (BMI 39). The incidences of recurrence and major bleeding were similar for each patient subset of weight and BMI for both fondaparinux and heparin treatment groups. Among patients with a primary outcome, median weights and BMIs were also similar. Conclusions: The current recommended doses of fondaparinux and heparins for the treatment of venous thromboembolism appear to provide similar protection against recurrence and major bleeding to one another and to obese and non-obese patients. [source] | ||||||||||||||||||||||||||||