ABSTRACT
In a selected patient population, we evaluated the glycemic response to different infusional policies in the management of posterior cranial fossa tumor (PFT) removal. We analyzed the perioperative course, prospectically collected, of 137 children undergoing 150 surgical procedures. Patients were divided in two groups according to different intraoperative fluids (group A, 2.5% glucose; group B, crystalloids). In group B glycemia remained below 125 mg dl(-1), while group A showed persistently supranormal glycemic plasma values, reaching statistical significance at the end of surgery (P < 0.018). As no perioperative mortality occurred and no differences were found between groups regarding PICU respiratory or infectious complications, PICU length of stay (LOS) was assumed as the main outcome indicator. LOS was not influenced by group A or B inclusion, while a new indicator, namely the Glycemic Stress Index (GSI), representing both glycemic intraoperative change and procedure length, showed significantly different results in the study groups (P = 0.004). Our clinical experience suggests that both intraoperative glucose-free solutions are safe, and GSI can be a useful tool to identify prolonged PICU stay patients.
Subject(s)
Cranial Fossa, Posterior/surgery , Glucose/therapeutic use , Glycemic Index , Intraoperative Care/methods , Isotonic Solutions/therapeutic use , Skull Base Neoplasms/surgery , Blood Glucose , Child, Preschool , Crystalloid Solutions , Female , Humans , Hyperglycemia/prevention & control , Length of Stay , Male , Neurosurgical Procedures/adverse effectsABSTRACT
UNLABELLED: Seckel syndrome is an autosomal recessive condition with severe short stature and facial and neurological anomalies. Intracranial haemorrhage, due to rupture of a cerebral aneurysm, is a very rare complication of this syndrome. Malignant hypertension may play an important role in the aetiology of the aneurysm and early detection is essential in order to prevent organ damage. CONCLUSION: we report a new case of Seckel syndrome associated with malignant hypertension and cerebral haemorrhage.
Subject(s)
Abnormalities, Multiple , Cerebral Hemorrhage/etiology , Dwarfism/complications , Hypertension, Malignant/etiology , Microcephaly/complications , Aneurysm, Ruptured/etiology , Child , Humans , Intracranial Aneurysm/etiology , Male , SyndromeABSTRACT
Benign neonatal sleep myoclonus (BNSM), characterized by myoclonic jerks of the extremities only in non-REM sleep, occurs in the first months of life with spontaneous disappearance within 3-4 months. We examined five siblings with typical BNSM, at the 3-10 years follow-up neurological examination. Psychomotor development, cognitive functions and EEG were completely normal. These cases confirm that BNSM is a self limited and nonepileptic disorder.