RESUMO
The aim of the study was to investigate renal function and renal replacement therapy after cardiopulmonary bypass surgery in children. Patient characteristics (sex, age, diagnosis), operation type, and death were listed. The study was performed retrospectively using serum creatinine level before, and peak values after, cardiopulmonary bypass surgery for assessment of renal function. Of the children on renal replacement therapy, indication, efficacy, and complications were recorded. In a 5-year period, 1075 children had cardiopulmonary bypass surgery at the Department of Cardiothoracic Surgery at Leiden University Medical Center and Academic Medical Center of Amsterdam. One-hundred eighty (17%) patients developed acute renal insufficiency. Twenty-five (2.3%) patients required renal replacement therapy. Peritoneal dialysis is a safe and effective treatment for children after cardiopulmonary bypass surgery. However, 15 (60%) of 25 children on renal replacement therapy died of nonrenal causes. In 9 out of 10 surviving children, renal function was normal at time of discharge from hospital. Acute renal insufficiency is a frequent complication after open-heart surgery, although renal replacement therapy was infrequently necessary. Peritoneal dialysis is a safe and effective therapeutic measure for children after cardiac bypass surgery.
Assuntos
Injúria Renal Aguda/terapia , Ponte Cardiopulmonar/efeitos adversos , Terapia de Substituição Renal/métodos , Injúria Renal Aguda/etiologia , Pré-Escolar , Feminino , Humanos , Lactente , Modelos Logísticos , Masculino , Diálise Peritoneal/métodos , Estudos RetrospectivosRESUMO
Three neonates had diverse kinds of central apnoea. The first child, a girl aged 3 weeks, had an upper respiratory tract infection caused by the respiratory syncytial virus; she was intubated and needed ventilatory support for three days. The second patient, a boy of 17 days, had an Arnold-Chiari-malformation with apnoeas treated with a carbonic anhydrase inhibitor (acetazolamide). The third patient, a boy of 5 days, had central apnoeas of epileptic origin and was treated with phenobarbital. All three recovered well. If in an infant with apnoeas no paediatric explanation is found, and the child is neurologically at risk, it is advisable to make an EEG to determine if an epileptic substrate is present, even in the absence of motor phenomena.
Assuntos
Apneia/diagnóstico , Malformação de Arnold-Chiari/diagnóstico , Síndrome de DiGeorge/diagnóstico , Epilepsia/diagnóstico , Infecções por Vírus Respiratório Sincicial/diagnóstico , Síndrome , Acetazolamida/uso terapêutico , Anticonvulsivantes/uso terapêutico , Apneia/etiologia , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/terapia , Síndrome de DiGeorge/complicações , Síndrome de DiGeorge/terapia , Diagnóstico Diferencial , Eletroencefalografia , Epilepsia/complicações , Epilepsia/tratamento farmacológico , Feminino , Humanos , Recém-Nascido , Imageamento por Ressonância Magnética , Masculino , Fenobarbital/uso terapêutico , Respiração Artificial , Infecções por Vírus Respiratório Sincicial/complicações , Infecções por Vírus Respiratório Sincicial/terapia , Resultado do TratamentoRESUMO
Pancreatic pseudocyst is a know complication of acute pancreatitis and pancreatic trauma. The treatment of pancreatitis remains a challenge and the pancreatic pseudocyst is often approached surgically. Lately, the use of somatostatin and its long-acting analogue octreotide have proved useful in the treatment of pancreatitis and its complications in adults. This is the first report on the use of somatostatin in the treatment of a pancreatic pseudocyst in a child. We present the case of a posttraumatic pancreatic pseudocyst in a 10-year-old boy, regressing rapidly under somatostatin treatment, by which means surgical re-intervention could be avoided.
