Objective: To evaluate the value of inactivated bone replantation with preservation of the epiphysis following the effective chemotherapy in avoiding postoperative discrepancy of the affected limb in children with ost...Objective: To evaluate the value of inactivated bone replantation with preservation of the epiphysis following the effective chemotherapy in avoiding postoperative discrepancy of the affected limb in children with osteosarcoma. Methods: Two children (aged 5 and 10 years, 1 male and 1 female) with osteosarcoma underwent inactivated bone replantation with preserving epiphysis following chemotherapy (MMIA protocol, including high-dose methotrexate, adriamycin and ifosfamide). After two cycles of preop-erative chemotherapy, pain vanished, the local mass shrank and there was no pain on pressing the affected parts. Sera AKP and LDH were reduced to normal levels; marked shrinkage and sclerotic changes and good margin of lesions were seen on plain radiographs and MR images. Two courses of the same protocol as preoperative chemotherapy were administered postoperatively. Results: Postoperative histological examination of the specimens demonstrated absence of vital tumor cells. Incisions healed well and no complications occurred. The replanted inactivated bone healed with host at 6 months after operation. In the two patients, no evidence was seen of metastasis and recurrence and discrepancy of the affected limbs in postoperative 36 and 48 months. Functions of the affected limbs were satisfactory. Conclusion: Inactivated bone replantation with preserving epiphysis was a viable option for osteosarcoma in children. The long-term outcomes remain to be further proven.展开更多
Urinary tract stone disease is seen at a level of 1%-2% in childhood(< 18 years).In recent years,however,there has been a marked increased in pediatric stone disease,particularly in adolescence.A carbohydrateand sa...Urinary tract stone disease is seen at a level of 1%-2% in childhood(< 18 years).In recent years,however,there has been a marked increased in pediatric stone disease,particularly in adolescence.A carbohydrateand salt-heavy diet and a more sedentary lifestyle are implicated in this increase.Although stone disease is rare in childhood,its presence is frequently associated with metabolic or anatomical disorders or infectious conditions,for which reason there is a high possibility of post-therapeutic recurrence.Factors such as a high possibility of recurrence and increasing incidence further enhance the importance of minimally invasive therapeutic options in children,with their expectations of a long life.In children in whom active stone removal is decided on,the way to achieve the highest level of success with the least morbidity is to select the most appropriate treatment modality.Thanks to today's advanced technology,renal stones that were once treated only by surgery can now be treated with minimally in-vasive techniques,from invasion of the urinary system in an antegrade(percutaneous nephrolithotomy) or retrograde(retrograde intrarenal surgery) manner or shock wave lithotripsy to laparoscopic stone surgery.This compilation study examined studies involving the RIRS procedure,the latest minimally invasive technique,in children and compared the results of those studies with those from other techniques.展开更多
Gastroesophageal reflux disease (GORD) is a pathological process in infants manifesting as poor weight gain, signs of esophagitis, persistent respiratory symptoms and changes in neurobehaviour. It is currently estimat...Gastroesophageal reflux disease (GORD) is a pathological process in infants manifesting as poor weight gain, signs of esophagitis, persistent respiratory symptoms and changes in neurobehaviour. It is currently estimated that approximately one in every 350 children will experience severe symptomatic gastroesophageal reflux necessitating surgical treatment. Surgery for GORD is currently one of the common major operations performed in infants and children. Most of the studies found favour laparoscopic approach which has surpassed open antireflux surgery as the gold standard of surgical management for GORD.However, it must be interpreted with caution due to the limitation of the studies, especially the small number of subject included in these studies. This review reports the changing trends in the surgical treatment of GORD inchildren.展开更多
Hirschsprung's disease (HD) is a disorder associated with congenital malformation of the enteric nervous system with segmental aganglionosis. Prevailing therapy includes a resection of the affected part of the bowe...Hirschsprung's disease (HD) is a disorder associated with congenital malformation of the enteric nervous system with segmental aganglionosis. Prevailing therapy includes a resection of the affected part of the bowel, However, patients often do not obtain complete functional improvement after surgical treatment. We present the case of a 25-year-old woman who had surgical treatment of lid in early childhood. After that procedure she had clinical features of constipation for years in the end, passing of stool once a week, requiring laxatives and enemas. We diagnosed an incomplete resection of the aganglionic bowel via rectal biopsy and resected the remaining aganglionic segment. Two months after surgery the patient's bowel function improved to a frequency of 1-4 stools per day. We conclude that regular follow-up is required to identify lid patients with persistent alterations of bowel function after surgery. In patients presenting with constipation, recognition of a remaining aganglionic segment or other alterations of the enteric nervous system should be aimed at in an early stage. 2005 The WJG Press and Elsevier Inc. All rights reserved展开更多
Objective To search the etiologic factor, clinical diagnosis points and treatment of postoperative intussusception ( PI ).Methods To retrospectively review the clinical materials of 14 cases with PI including the ca...Objective To search the etiologic factor, clinical diagnosis points and treatment of postoperative intussusception ( PI ).Methods To retrospectively review the clinical materials of 14 cases with PI including the cause of disease and treatment.Results PI occurred within 10 days (average 4 days) after the primary operation. Bowel obstructive symptoms gradually emerged. One case was diagnosed with intussusception by sonography and received enema reduction of intussusception by hydrostatic pressure. Thirteen cases were performed secondary operation. Small intestine was main site of intussu- sception. Manual reduction of the lesion was performed in 12 cases and bowel resection and anastomosis was done in 1 case with bowel necrosis. Conclusion PI should be suspected if child presents with the symptoms of ileus in early postoperative period. Abdominal sonography may have some value on diagnosis of Pl. Operation is the first choice for the treatment of PI.展开更多
Objective: To explore the characteristic of operation, intra-operation treatment and the application of immunosuppressant in pediatric renal transplantation in order to improve therapeutic effectiveness. Methods: Fr...Objective: To explore the characteristic of operation, intra-operation treatment and the application of immunosuppressant in pediatric renal transplantation in order to improve therapeutic effectiveness. Methods: From March 1986 to October 2006, the clinical data of 63 children who underwent renal transplantation in our hospital were retrospectively analyzed. Results: The 1-, 3-, 5-, 10-year graft survival rates were 98.4%, 90.5%, 88.9% and 68.3%, respectively. And the corresponding patient survival rates were 100%, 95.2%, 92.1%, 71.4%. The body weight increased 4 to 12 kg and the body height grew up 2 to 6 cm during the first year post-transplantation. The main complications in the first year post-transplantation were hypertension (26/63, 41.3%), crinosity (14/63, 22.2%), drug-induced hepatic injury(11/63, 17.5%), gingival hyperplasia (10/63, 15.8%), pulmonary infection(9/63, 14.3%), bone marrow suppression(5/63, 7.9%), herpes (4/63, 6.3%) and diabetes (3/63, 4.8%). Conclusion: Renal transplantation is a preferred method for the treatment of children in end-stage renal disease (ESRD). Good tissue matching, proper operative time and pattern, peri-operactive care were essential to success, as well as appropriate immuno-suppressant strategy and good compliance.展开更多
In previous decades,pediatric liver transplantation has become a state-of-the-art operation with excellent success and limited mortality.Graft and patient survival have continued to improve as a result of improvements...In previous decades,pediatric liver transplantation has become a state-of-the-art operation with excellent success and limited mortality.Graft and patient survival have continued to improve as a result of improvements in medical,surgical and anesthetic management,organ availability,immunosuppression,and identification and treatment of postoperative complications.The utilization of split-liver grafts and living-related donors has provided more organs for pediatric patients.Newer immunosuppression regimens,including induction therapy,have had a significant impact on graft and patient survival.Future developments of pediatric liver transplantation will deal with long-term followup,with prevention of immunosuppression-related complications and promotion of as normal growth as possible.This review describes the state-of-the-art in pediatric liver transplantation.展开更多
Objective. To investigate the effect of peritoneal dialysis on fluid balance and outcome in childrenwho receive cardiac operation.Methods. From July to Dec. 2000, 12(2.08%) patients of 576 consecutive children who und...Objective. To investigate the effect of peritoneal dialysis on fluid balance and outcome in childrenwho receive cardiac operation.Methods. From July to Dec. 2000, 12(2.08%) patients of 576 consecutive children who underwentheart operation required peritoneal dialysis because of acute renal failure. The mean age of these 12 pa-tients was (2.9±2.0) years (range, 5 months~7 years) and the mean body weight was (12±3) kg (range,7.4~18.5 kg ).Results. The interval between the operation and the initiation of peritoneal dialysis was (21.2±11.4)hours (4.4~42 hours). The duration of peritoneal dialysis was (6.3±4.8) days (0.47~15 days). Mortality inthese 12 patients was 25%. Fluid removed by peritoneal dialysis was(34.7±17.8) ml@kg1@day-1@ Asymop-tomatic hypokalemia, thrombocytopenia and hyperglycemia were frequent complications, which were easilymanaged. Hemodynamics and pulmonary function improved during the study period.Conclusion. The early initiation of peritoneal dialysis is an effective and safe method totreat acute renal failure after cardiac operation in children.展开更多
Intrapartum fetal monitoring has been criticized for the lack of evidence of improvement in fetal outcome despite causing increased operative intervention. Paradoxically, cardiotocography (CTG) has been a major driv...Intrapartum fetal monitoring has been criticized for the lack of evidence of improvement in fetal outcome despite causing increased operative intervention. Paradoxically, cardiotocography (CTG) has been a major driver for litigation for neonatal neurological injury. This analytical review tries to explore why extensive clinical studies and trials over 50 years have failed to demonstrate or bring about signifcant improvement in intrapartum fetal monitoring. There seems a need for significant reform. International congruence on most aspects of CTG interpretation [defnitions of fetal heart rate (FHR) parameters, CTG recording speed, 3-tier systems, etc .] is highly desirable to facilitate future meaningful clinical studies, evaluation and progress in this field. The FHR changes are non-specific and poor surrogate for fetal well-being. As a compromise for maintaining low false-negative results for fetal acidemia, a high false-positive value may have to be accepted. The need for redefning the place of adjuvant tests of fetal well-being like fetal blood sampling or fetal electrocardiography (ECG) is discussed. The FHR decelerations are often deterministic (center-stage) in CTG interpretation and 3-tier categorization. It is discussed if their scientifc and physiological classifcation (avoiding framing and confirmation biases) may be best based on time relationship to uterine contractions alone. This may provide a more sound foundation which could improve the reliability and further evolution of 3-tier systems. Results of several trials of fetal ECG (STAN) have been inconclusive and a need for a fresh approach or strategy is considered. It is hoped that the long anticipated Computer-aided analysis of CTG will be more objective and reliable (overcome human factors) and will offer valuable support or may eventually replace visual CTG interpretation. In any case, the recording and archiving all CTGs digitally and testing cord blood gases routinely in every delivery would be highly desirable for future research. This would facilitate well designed retrospective studies which can be very informative especially when prospective randomised controlled trials are often diffcult and resource-intensive.展开更多
AIM:To assess feasibility of a finger prick-based kit as method for self-testing of first and second-degree relatives of coeliac disease (CD) patients. METHODS:A total number of 379 subjects were invited to participat...AIM:To assess feasibility of a finger prick-based kit as method for self-testing of first and second-degree relatives of coeliac disease (CD) patients. METHODS:A total number of 379 subjects were invited to participate in this study,consisting of 197 first- degree and 182 second-degree relatives of CD patients. The self-testing kit (BiocardTM) was sent out with included instructions for use. Completed tests were sent back to the study coordinator for assessment. RESULTS:One hundred and ninety-six invited relatives carried out the BiocardTM test at home. Amongst these,70% were children. In 97% of the cases the test was performed correctly. Three tests revealed a positive result,all of which were later confirmed by serology and histology as coeliac disease.CONCLUSION:Our study indicates that BiocardTM test is a reliable,easy to use and well-accepted tool for home testing of first- and second-degree relatives of CD patients.展开更多
Objective To be released specifically after myocardial damage. The goal of this study was to measure serum cardiac troponin I levels after open heart surgery in children, and to evaluate relevance between TnTi and per...Objective To be released specifically after myocardial damage. The goal of this study was to measure serum cardiac troponin I levels after open heart surgery in children, and to evaluate relevance between TnTi and perioperative multi-factors. Methods Fifty-seven consecutive pediatric patients undergoing elective correction of congenital heart diseases were divided into group A ( TOF, n =31 ) and group B ( VSD, n =26). Blood sampies were drawn preoperatively, 5min( T0 ) , 6h( T6 ) , 12h( T12 ) , 24h( T24 ) , 48h( T48 ) , 72h( T72 ) after removal of aortic cross clamping. Myocardial protection consisted of moderate systemic hypothermia ( 30℃- 32℃ ), cold crystalloid cardioplegia and topical cooling. Demographic information, cardiac defect, repair procedure, duration of bypass ( CPBT) , cross-clamping time ( CCT) , clinical score for cardiac function, electrocardiographic changes and outcomes were recorded. Results Compared with the baseline value, serum concentration of troponin I peaked at T0 ( P 〈 0. 01 ), and fell to normal level at T72 ( P 〉 0. 05 ). Peak CTnI was 118 and 55 times higher than the baseline value, respectively in group A and group B. There was a positive correlation between peak CTnI and CPBT, CCT ( r = 0. 51 ; P 〈 0. 01 ), myocardial operative injury after ventriculotomy and muscle resection ( r = 0. 35, P 〈0. 01 ). Also the peak CTnl value was correlated to the clinical score for cardiac function (r = -0. 52; P 〈0. 01). 2.3μg/L was a cutoff value which was highly predictive for postoperative recovery and inotropic support. Conclusion Postoperative serum troponin I is a highly specific and sensitive marker for myocardial ischemia and injury; therefore, its measurement may contribute to the assessment of recovery and outcome after open heart surgery.展开更多
We report a 16-day-old boy who had transposition of great arteries combined with interrupted aortic arch (IAA). The boy developed cyanotic lips and body bruising 2 h after birth. Color Doppler sonography showed transp...We report a 16-day-old boy who had transposition of great arteries combined with interrupted aortic arch (IAA). The boy developed cyanotic lips and body bruising 2 h after birth. Color Doppler sonography showed transposition of great arteries. The patient underwent total surgical correction of the transfection and defects. We summarized our experience in the perioperative management of the patient, including maintenance of body temperature, close intraoperative monitoring, anesthesia management, cardiopulmonary bypass (CPB) management and so on.展开更多
文摘Objective: To evaluate the value of inactivated bone replantation with preservation of the epiphysis following the effective chemotherapy in avoiding postoperative discrepancy of the affected limb in children with osteosarcoma. Methods: Two children (aged 5 and 10 years, 1 male and 1 female) with osteosarcoma underwent inactivated bone replantation with preserving epiphysis following chemotherapy (MMIA protocol, including high-dose methotrexate, adriamycin and ifosfamide). After two cycles of preop-erative chemotherapy, pain vanished, the local mass shrank and there was no pain on pressing the affected parts. Sera AKP and LDH were reduced to normal levels; marked shrinkage and sclerotic changes and good margin of lesions were seen on plain radiographs and MR images. Two courses of the same protocol as preoperative chemotherapy were administered postoperatively. Results: Postoperative histological examination of the specimens demonstrated absence of vital tumor cells. Incisions healed well and no complications occurred. The replanted inactivated bone healed with host at 6 months after operation. In the two patients, no evidence was seen of metastasis and recurrence and discrepancy of the affected limbs in postoperative 36 and 48 months. Functions of the affected limbs were satisfactory. Conclusion: Inactivated bone replantation with preserving epiphysis was a viable option for osteosarcoma in children. The long-term outcomes remain to be further proven.
文摘Urinary tract stone disease is seen at a level of 1%-2% in childhood(< 18 years).In recent years,however,there has been a marked increased in pediatric stone disease,particularly in adolescence.A carbohydrateand salt-heavy diet and a more sedentary lifestyle are implicated in this increase.Although stone disease is rare in childhood,its presence is frequently associated with metabolic or anatomical disorders or infectious conditions,for which reason there is a high possibility of post-therapeutic recurrence.Factors such as a high possibility of recurrence and increasing incidence further enhance the importance of minimally invasive therapeutic options in children,with their expectations of a long life.In children in whom active stone removal is decided on,the way to achieve the highest level of success with the least morbidity is to select the most appropriate treatment modality.Thanks to today's advanced technology,renal stones that were once treated only by surgery can now be treated with minimally in-vasive techniques,from invasion of the urinary system in an antegrade(percutaneous nephrolithotomy) or retrograde(retrograde intrarenal surgery) manner or shock wave lithotripsy to laparoscopic stone surgery.This compilation study examined studies involving the RIRS procedure,the latest minimally invasive technique,in children and compared the results of those studies with those from other techniques.
文摘Gastroesophageal reflux disease (GORD) is a pathological process in infants manifesting as poor weight gain, signs of esophagitis, persistent respiratory symptoms and changes in neurobehaviour. It is currently estimated that approximately one in every 350 children will experience severe symptomatic gastroesophageal reflux necessitating surgical treatment. Surgery for GORD is currently one of the common major operations performed in infants and children. Most of the studies found favour laparoscopic approach which has surpassed open antireflux surgery as the gold standard of surgical management for GORD.However, it must be interpreted with caution due to the limitation of the studies, especially the small number of subject included in these studies. This review reports the changing trends in the surgical treatment of GORD inchildren.
文摘Hirschsprung's disease (HD) is a disorder associated with congenital malformation of the enteric nervous system with segmental aganglionosis. Prevailing therapy includes a resection of the affected part of the bowel, However, patients often do not obtain complete functional improvement after surgical treatment. We present the case of a 25-year-old woman who had surgical treatment of lid in early childhood. After that procedure she had clinical features of constipation for years in the end, passing of stool once a week, requiring laxatives and enemas. We diagnosed an incomplete resection of the aganglionic bowel via rectal biopsy and resected the remaining aganglionic segment. Two months after surgery the patient's bowel function improved to a frequency of 1-4 stools per day. We conclude that regular follow-up is required to identify lid patients with persistent alterations of bowel function after surgery. In patients presenting with constipation, recognition of a remaining aganglionic segment or other alterations of the enteric nervous system should be aimed at in an early stage. 2005 The WJG Press and Elsevier Inc. All rights reserved
文摘Objective To search the etiologic factor, clinical diagnosis points and treatment of postoperative intussusception ( PI ).Methods To retrospectively review the clinical materials of 14 cases with PI including the cause of disease and treatment.Results PI occurred within 10 days (average 4 days) after the primary operation. Bowel obstructive symptoms gradually emerged. One case was diagnosed with intussusception by sonography and received enema reduction of intussusception by hydrostatic pressure. Thirteen cases were performed secondary operation. Small intestine was main site of intussu- sception. Manual reduction of the lesion was performed in 12 cases and bowel resection and anastomosis was done in 1 case with bowel necrosis. Conclusion PI should be suspected if child presents with the symptoms of ileus in early postoperative period. Abdominal sonography may have some value on diagnosis of Pl. Operation is the first choice for the treatment of PI.
文摘Objective: To explore the characteristic of operation, intra-operation treatment and the application of immunosuppressant in pediatric renal transplantation in order to improve therapeutic effectiveness. Methods: From March 1986 to October 2006, the clinical data of 63 children who underwent renal transplantation in our hospital were retrospectively analyzed. Results: The 1-, 3-, 5-, 10-year graft survival rates were 98.4%, 90.5%, 88.9% and 68.3%, respectively. And the corresponding patient survival rates were 100%, 95.2%, 92.1%, 71.4%. The body weight increased 4 to 12 kg and the body height grew up 2 to 6 cm during the first year post-transplantation. The main complications in the first year post-transplantation were hypertension (26/63, 41.3%), crinosity (14/63, 22.2%), drug-induced hepatic injury(11/63, 17.5%), gingival hyperplasia (10/63, 15.8%), pulmonary infection(9/63, 14.3%), bone marrow suppression(5/63, 7.9%), herpes (4/63, 6.3%) and diabetes (3/63, 4.8%). Conclusion: Renal transplantation is a preferred method for the treatment of children in end-stage renal disease (ESRD). Good tissue matching, proper operative time and pattern, peri-operactive care were essential to success, as well as appropriate immuno-suppressant strategy and good compliance.
文摘In previous decades,pediatric liver transplantation has become a state-of-the-art operation with excellent success and limited mortality.Graft and patient survival have continued to improve as a result of improvements in medical,surgical and anesthetic management,organ availability,immunosuppression,and identification and treatment of postoperative complications.The utilization of split-liver grafts and living-related donors has provided more organs for pediatric patients.Newer immunosuppression regimens,including induction therapy,have had a significant impact on graft and patient survival.Future developments of pediatric liver transplantation will deal with long-term followup,with prevention of immunosuppression-related complications and promotion of as normal growth as possible.This review describes the state-of-the-art in pediatric liver transplantation.
文摘Objective. To investigate the effect of peritoneal dialysis on fluid balance and outcome in childrenwho receive cardiac operation.Methods. From July to Dec. 2000, 12(2.08%) patients of 576 consecutive children who underwentheart operation required peritoneal dialysis because of acute renal failure. The mean age of these 12 pa-tients was (2.9±2.0) years (range, 5 months~7 years) and the mean body weight was (12±3) kg (range,7.4~18.5 kg ).Results. The interval between the operation and the initiation of peritoneal dialysis was (21.2±11.4)hours (4.4~42 hours). The duration of peritoneal dialysis was (6.3±4.8) days (0.47~15 days). Mortality inthese 12 patients was 25%. Fluid removed by peritoneal dialysis was(34.7±17.8) ml@kg1@day-1@ Asymop-tomatic hypokalemia, thrombocytopenia and hyperglycemia were frequent complications, which were easilymanaged. Hemodynamics and pulmonary function improved during the study period.Conclusion. The early initiation of peritoneal dialysis is an effective and safe method totreat acute renal failure after cardiac operation in children.
文摘Intrapartum fetal monitoring has been criticized for the lack of evidence of improvement in fetal outcome despite causing increased operative intervention. Paradoxically, cardiotocography (CTG) has been a major driver for litigation for neonatal neurological injury. This analytical review tries to explore why extensive clinical studies and trials over 50 years have failed to demonstrate or bring about signifcant improvement in intrapartum fetal monitoring. There seems a need for significant reform. International congruence on most aspects of CTG interpretation [defnitions of fetal heart rate (FHR) parameters, CTG recording speed, 3-tier systems, etc .] is highly desirable to facilitate future meaningful clinical studies, evaluation and progress in this field. The FHR changes are non-specific and poor surrogate for fetal well-being. As a compromise for maintaining low false-negative results for fetal acidemia, a high false-positive value may have to be accepted. The need for redefning the place of adjuvant tests of fetal well-being like fetal blood sampling or fetal electrocardiography (ECG) is discussed. The FHR decelerations are often deterministic (center-stage) in CTG interpretation and 3-tier categorization. It is discussed if their scientifc and physiological classifcation (avoiding framing and confirmation biases) may be best based on time relationship to uterine contractions alone. This may provide a more sound foundation which could improve the reliability and further evolution of 3-tier systems. Results of several trials of fetal ECG (STAN) have been inconclusive and a need for a fresh approach or strategy is considered. It is hoped that the long anticipated Computer-aided analysis of CTG will be more objective and reliable (overcome human factors) and will offer valuable support or may eventually replace visual CTG interpretation. In any case, the recording and archiving all CTGs digitally and testing cord blood gases routinely in every delivery would be highly desirable for future research. This would facilitate well designed retrospective studies which can be very informative especially when prospective randomised controlled trials are often diffcult and resource-intensive.
基金Supported by Teddy Schwarzohr Verein zur Unterstützung von chronisch kranken Kindern
文摘AIM:To assess feasibility of a finger prick-based kit as method for self-testing of first and second-degree relatives of coeliac disease (CD) patients. METHODS:A total number of 379 subjects were invited to participate in this study,consisting of 197 first- degree and 182 second-degree relatives of CD patients. The self-testing kit (BiocardTM) was sent out with included instructions for use. Completed tests were sent back to the study coordinator for assessment. RESULTS:One hundred and ninety-six invited relatives carried out the BiocardTM test at home. Amongst these,70% were children. In 97% of the cases the test was performed correctly. Three tests revealed a positive result,all of which were later confirmed by serology and histology as coeliac disease.CONCLUSION:Our study indicates that BiocardTM test is a reliable,easy to use and well-accepted tool for home testing of first- and second-degree relatives of CD patients.
文摘Objective To be released specifically after myocardial damage. The goal of this study was to measure serum cardiac troponin I levels after open heart surgery in children, and to evaluate relevance between TnTi and perioperative multi-factors. Methods Fifty-seven consecutive pediatric patients undergoing elective correction of congenital heart diseases were divided into group A ( TOF, n =31 ) and group B ( VSD, n =26). Blood sampies were drawn preoperatively, 5min( T0 ) , 6h( T6 ) , 12h( T12 ) , 24h( T24 ) , 48h( T48 ) , 72h( T72 ) after removal of aortic cross clamping. Myocardial protection consisted of moderate systemic hypothermia ( 30℃- 32℃ ), cold crystalloid cardioplegia and topical cooling. Demographic information, cardiac defect, repair procedure, duration of bypass ( CPBT) , cross-clamping time ( CCT) , clinical score for cardiac function, electrocardiographic changes and outcomes were recorded. Results Compared with the baseline value, serum concentration of troponin I peaked at T0 ( P 〈 0. 01 ), and fell to normal level at T72 ( P 〉 0. 05 ). Peak CTnI was 118 and 55 times higher than the baseline value, respectively in group A and group B. There was a positive correlation between peak CTnI and CPBT, CCT ( r = 0. 51 ; P 〈 0. 01 ), myocardial operative injury after ventriculotomy and muscle resection ( r = 0. 35, P 〈0. 01 ). Also the peak CTnl value was correlated to the clinical score for cardiac function (r = -0. 52; P 〈0. 01). 2.3μg/L was a cutoff value which was highly predictive for postoperative recovery and inotropic support. Conclusion Postoperative serum troponin I is a highly specific and sensitive marker for myocardial ischemia and injury; therefore, its measurement may contribute to the assessment of recovery and outcome after open heart surgery.
文摘We report a 16-day-old boy who had transposition of great arteries combined with interrupted aortic arch (IAA). The boy developed cyanotic lips and body bruising 2 h after birth. Color Doppler sonography showed transposition of great arteries. The patient underwent total surgical correction of the transfection and defects. We summarized our experience in the perioperative management of the patient, including maintenance of body temperature, close intraoperative monitoring, anesthesia management, cardiopulmonary bypass (CPB) management and so on.