RESUMO
Refractory severe hemodynamic or respiratory failure may require extracorporeal membrane oxygenation (ECMO). Since some patients are too sick to be transported safely to a referral ECMO center on conventional transportation, mobile ECMO transport teams have been developed. The experiences of some ECMO transport teams have already been reported, including air and international transport. We report the first French pediatric international ECMO transport by aircraft. This case shows that a long distance intervention of the pediatric ECMO transport team is feasible, even in an international setting. Long distance ECMO transportations are widely carried out for adults, but remain rare in neonates and children.
Assuntos
Aeronaves , Oxigenação por Membrana Extracorpórea , Transporte de Pacientes/métodos , Bronquiolite Viral/terapia , Bronquiolite Viral/virologia , Oxigenação por Membrana Extracorpórea/métodos , Feminino , França , Humanos , Lactente , Masculino , Síndrome do Desconforto Respiratório/complicações , Síndrome do Desconforto Respiratório/terapia , Infecções por Vírus Respiratório Sincicial/complicações , Infecções por Vírus Respiratório Sincicial/terapia , Vírus Sinciciais Respiratórios/isolamento & purificaçãoAssuntos
Inibidores da Angiogênese/uso terapêutico , Indóis/uso terapêutico , Neoplasias Pulmonares/tratamento farmacológico , Pirróis/uso terapêutico , Sarcoma Alveolar de Partes Moles/tratamento farmacológico , Adolescente , Criança , Terapia Combinada , Feminino , Humanos , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Receptores Proteína Tirosina Quinases/antagonistas & inibidores , Sarcoma Alveolar de Partes Moles/secundário , Sarcoma Alveolar de Partes Moles/cirurgia , SunitinibeRESUMO
OBJECTIVE: The objective of this retrospective study was to assess the value of one-stage testicular descent without spermatic vessel ligation for intraabdominal impalpable testis. MATERIAL AND METHOD: This study was based on 90 children with 98 impalpable testes. Laparoscopic exploration was performed in each case. Forty-three testes were intra-abdominal and 55 were absent. One-stage surgical descent with vertical opening of the conjoined tendon and without spermatic vessel ligation was performed for 22 testes and two-stage descent (Fowler-Stephens two-stage technique) was performed for 16 testes. Three testes in bilateral forms are still waiting for treatment. RESULTS: With a mean follow-up of 17 months (range: 1 month to 8 years), 18 of the 22 testes (81%) were situated in the scrotum and were viable in the one-stage treatment group, versus 10 out of 16 (62.5%) in the two-stage group. Two poor results, including one case of necrosis, were observed after one-stage testicular descent. Six poor results, including two cases of necrosis, were observed after the Fowler-Stephens two-stage technique. CONCLUSION: One-stage testicular descent, without spermatic vessel ligation, after laparoscopic assessment of the presence and position of the testis, can be performed in the majority of cases of impalpable testis. The risks of failure due to secondary atrophy or incomplete testicular descent are minimal with this technique. One-stage surgical descent, when possible, appears to be preferable to the Fowler-Stephens two-stage procedure.
