ABSTRACT
Overall 438 children with extrahepatic portal hypertension underwent surgical treatment. Portal-systemic bypass was performed at 383 patients, meso-portal bypass -- at 56. These surgical procedures were effective at 96.4% cases. All the children with bleeding recurrences were operated repeatedly. Meso-portal bypass not only prevents risk of bleeding but also reconstruct normal anatomy and physiology of portal system.
Subject(s)
Hypertension, Portal/epidemiology , Hypertension, Portal/surgery , Portasystemic Shunt, Surgical/methods , Child , Child, Preschool , Endoscopy, Digestive System/instrumentation , Humans , Postoperative Complications/mortality , Prevalence , Survival RateABSTRACT
Results of radical correction of extrahepatic portal hypertension in 25 children are presented. It is demonstrated that this surgery is feasible in 38.5% patients with this disease. Feasibility of surgery is based on the results of revision of hepatic vessels after laparotomy. The existing diagnostic methods don't permit one to predict feasibility of this bypass variant before surgery. It is demonstrated that this surgery leads not only to elimination of hemorrhage risk but also to complete reconstruction of portal perfusion and cure of portosystemic encephalopathy and hyperdynamic cardial syndrome. Surgeries are successful at any age, and also in of hemorrhage peak.
Subject(s)
Hypertension, Portal/surgery , Portasystemic Shunt, Surgical/methods , Adolescent , Child , Child, Preschool , Feasibility Studies , Gastrointestinal Diseases/prevention & control , Gastrointestinal Diseases/surgery , Hemorrhage/prevention & control , Hemorrhage/surgery , Humans , Infant , Treatment OutcomeABSTRACT
There were studied 14 children (mean age 5.71 +/- 0.60 years, body weight 18.95 +/- 3.50 kg, height 101.0 +/- 4.03 cm) with initially normal osmotic and volumic status. Plasma osmolarity, blood aldosterone level, aqueous compartments balance were (evaluated by segmented bioimpedance spectrometry), urine osmolarity and diuresis were investigated after bolus injection of x-ray contrast agent (RCA) urografin-60% (mean volume 2 ml/kg for 2-4 sec). A statistically significant gradual decrease in the total volume of water (TVW) in the organism was observed, with 8.53% deficiency of TVW by the second hour after RCA injection in comparison with the initial level. TVW deficiency developed as the result of diuresis which increased 7-fold in the presence of increased plasma osmolarity after injection of RCA bolus. Correction of the volume of circulating blood and plasma was carried out mainly at the expense of intracellular liquid, whose deficiency was actually 4.5 times higher than of extracellular liquid. Bioimpedance spectrometry indicated centralized redistribution of water in the organism, as TVW deficiency was mainly due to water in the limbs. The results indicate the need in infusion therapy after RCA injection in order to correct the resultant water deficit.
Subject(s)
Body Fluid Compartments , Radiosurgery , Urography , Age Factors , Aldosterone/blood , Blood Volume , Body Height , Body Weight , Child , Child, Preschool , Contrast Media , Diatrizoate Meglumine , Diuresis , Humans , Osmolar Concentration , Osmosis , Plasma Volume , Time FactorsABSTRACT
The study was carried out on 13 children (2-12 years) subjected to abdominal aortography. The children were divided into 2 groups. Changes in plasma concentrations of ketamine and its metabolism were evaluated during anesthesia after bolus injection of ionic highly osmolar and nonionic low-osmolar x-ray contrast agents (RCA). Injection of an RCA bolus was associated with a 2-fold more rapid drop of the anesthetic concentration in the blood, increase of renal clearance of ketamine and its metabolites; the osmotic effect of ionic highly osmolar and nonionic low-osmolar RCA on ketamine pharmacokinetics virtually did not differ.
