We performed a randomized controlled trial to compare the inflammatory and immune responses to Nissen fundoplication in infants and children undergoing either open or laparoscopic surgery. Methods: Forty children unde...We performed a randomized controlled trial to compare the inflammatory and immune responses to Nissen fundoplication in infants and children undergoing either open or laparoscopic surgery. Methods: Forty children undergoing Nissen fundoplication were randomized to laparoscopy or open surgery using minimization with respect to age, neurologic status, and operating surgeon. Intraoperative and postoperative analgesias were standardized. Inflammatory markers (plasma malondialdehyde, nitrate plus nitrite level, and cytokines) and monocyte class II major histocompatibility complex expression were measured preoperatively, at end of surgery, 4, 24, and 48 hours postoperatively. Postoperative changes were compared between open and laparoscopic groups. Results: There were no significant changes in circulating malondialdehyde, nitrates plus nitrite, interleukin- 10, or tumor necrosis factor α in the postoperative period in either group. Interleukin- 1 receptor antagonist (IL- 1rA) and IL- 6 were significantly increased in both groups, with a tendency for greater elevation of IL- 1rA in the open group. Monocytemajor histocompatibility complex expression fell significantly in both groups; however, this fall appeared to be slightly more marked in the open group. Conclusions: The postoperative cytokine response is similar in children undergoing open and laparoscopic Nissen fundoplication. This trial indicates that laparoscopymay partly reduce postoperative immune suppression.展开更多
Background: Strategies for the surgical management of necrotising enterocolit is are various and controversial. Objective: To characterise variation in surgic al management of this disease across the United Kingdom. M...Background: Strategies for the surgical management of necrotising enterocolit is are various and controversial. Objective: To characterise variation in surgic al management of this disease across the United Kingdom. Methods: Postal survey of 104 consultant paediatric surgeons with a 77% response rate. Results: Durat ion of antibiotic treatment (median 10 days, range 6- 14), time until the start of enteral feeding (median 10 days, range 4- 21), and absolute indications for surgery all vary between surgeons. Peritoneal drainage is used by 95% of surg eons. Forty two percent use it in neonates of all weights, whereas 36% restric t its use to those < 1000 g. Peritoneal drainage is used for stabilisation by 9 5% and as definitive treatment by 58% . At laparotomy, operative procedures i nclude diverting jejunostomy, resection and stoma, resection with primary anasto mosis, and “ clip and drop” . All procedures are used in infants of all weight s except resection and pri mary anastomosis, which is used predominantly in larger infants (55% in < 1 000 g; 77% in > 1000 g; p=0.005). Infants may be considered too unwell for peritoneal drainage by 11% of surgeons compared with 90% for laparotomy (p < 0.0001). Conclusions: There is considerable variation in surgical strategies f or necrotising enterocolitis. Peritoneal drainage is used by most surgeons, with controversial indications and expectations. The use of resection and primary an astomosis is influenced by the weight of the neonate.展开更多
Background: Glutathione (GSH) is the major intracellular antioxidant protecting against free radical-mediated damage. Oxidative stress is implicated in the pathogenesis of necrotizing enterocolitis (NEC), and damage c...Background: Glutathione (GSH) is the major intracellular antioxidant protecting against free radical-mediated damage. Oxidative stress is implicated in the pathogenesis of necrotizing enterocolitis (NEC), and damage could be enhanced by a relative deficiency of GSH.We hypothesized that infants with NEC would have lower levels of erythrocyte GSH when compared with controls. Methods: Total erythrocyte GSH concentration (per gram of hemoglobin g Hb ) was determined in blood samples from infants with NEC (n = 16) referred for surgical intervention. Nonseptic infants referred for other conditions (eg, patent ductus arteriosus ligation) served as controls (n = 10). Results: Controls and infants with NEC were demographically similar. Mean erythrocyte GSH concentration in infants with NEC was 0.076 ±0.004 μmol/g Hb and in controls it was 0.078 ±0.005 μmol/g Hb (P =. 73). There was no significant correlation between GSH concentration and weight, gestational age, or C-reactive protein levels. In infants with NEC, there was no difference in GSH levels between infants with stage 2 and stage 3 diseases nor between those who died and survived, but a trend toward lower GSH levels in infants with more extensive diseases exists. Conclusions: Total GSH levels are similar in infants with NEC and controls. It is possible that a relative rather than absolute deficiency of antioxidant compounds exists and may contribute to the development of NEC.展开更多
文摘We performed a randomized controlled trial to compare the inflammatory and immune responses to Nissen fundoplication in infants and children undergoing either open or laparoscopic surgery. Methods: Forty children undergoing Nissen fundoplication were randomized to laparoscopy or open surgery using minimization with respect to age, neurologic status, and operating surgeon. Intraoperative and postoperative analgesias were standardized. Inflammatory markers (plasma malondialdehyde, nitrate plus nitrite level, and cytokines) and monocyte class II major histocompatibility complex expression were measured preoperatively, at end of surgery, 4, 24, and 48 hours postoperatively. Postoperative changes were compared between open and laparoscopic groups. Results: There were no significant changes in circulating malondialdehyde, nitrates plus nitrite, interleukin- 10, or tumor necrosis factor α in the postoperative period in either group. Interleukin- 1 receptor antagonist (IL- 1rA) and IL- 6 were significantly increased in both groups, with a tendency for greater elevation of IL- 1rA in the open group. Monocytemajor histocompatibility complex expression fell significantly in both groups; however, this fall appeared to be slightly more marked in the open group. Conclusions: The postoperative cytokine response is similar in children undergoing open and laparoscopic Nissen fundoplication. This trial indicates that laparoscopymay partly reduce postoperative immune suppression.
文摘Background: Strategies for the surgical management of necrotising enterocolit is are various and controversial. Objective: To characterise variation in surgic al management of this disease across the United Kingdom. Methods: Postal survey of 104 consultant paediatric surgeons with a 77% response rate. Results: Durat ion of antibiotic treatment (median 10 days, range 6- 14), time until the start of enteral feeding (median 10 days, range 4- 21), and absolute indications for surgery all vary between surgeons. Peritoneal drainage is used by 95% of surg eons. Forty two percent use it in neonates of all weights, whereas 36% restric t its use to those < 1000 g. Peritoneal drainage is used for stabilisation by 9 5% and as definitive treatment by 58% . At laparotomy, operative procedures i nclude diverting jejunostomy, resection and stoma, resection with primary anasto mosis, and “ clip and drop” . All procedures are used in infants of all weight s except resection and pri mary anastomosis, which is used predominantly in larger infants (55% in < 1 000 g; 77% in > 1000 g; p=0.005). Infants may be considered too unwell for peritoneal drainage by 11% of surgeons compared with 90% for laparotomy (p < 0.0001). Conclusions: There is considerable variation in surgical strategies f or necrotising enterocolitis. Peritoneal drainage is used by most surgeons, with controversial indications and expectations. The use of resection and primary an astomosis is influenced by the weight of the neonate.
文摘Background: Glutathione (GSH) is the major intracellular antioxidant protecting against free radical-mediated damage. Oxidative stress is implicated in the pathogenesis of necrotizing enterocolitis (NEC), and damage could be enhanced by a relative deficiency of GSH.We hypothesized that infants with NEC would have lower levels of erythrocyte GSH when compared with controls. Methods: Total erythrocyte GSH concentration (per gram of hemoglobin g Hb ) was determined in blood samples from infants with NEC (n = 16) referred for surgical intervention. Nonseptic infants referred for other conditions (eg, patent ductus arteriosus ligation) served as controls (n = 10). Results: Controls and infants with NEC were demographically similar. Mean erythrocyte GSH concentration in infants with NEC was 0.076 ±0.004 μmol/g Hb and in controls it was 0.078 ±0.005 μmol/g Hb (P =. 73). There was no significant correlation between GSH concentration and weight, gestational age, or C-reactive protein levels. In infants with NEC, there was no difference in GSH levels between infants with stage 2 and stage 3 diseases nor between those who died and survived, but a trend toward lower GSH levels in infants with more extensive diseases exists. Conclusions: Total GSH levels are similar in infants with NEC and controls. It is possible that a relative rather than absolute deficiency of antioxidant compounds exists and may contribute to the development of NEC.
