Journal of pediatric surgery
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Femoral cannulation in pediatric patients requiring extracorporeal membrane oxygenation (ECMO) is commonly associated with distal limb ischemia. Authors have previously reported successful lower limb perfusion using various open techniques to cannulate a distal lower extremity artery at the time of initial ECMO cannulation. ⋯ We hypothesized that after femoral artery cannulation for ECMO, a percutaneous technique of distal limb perfusion might offer unique advantages when treating lower extremity ischemia in small pediatric patients. We report a technique for percutaneous antegrade cannulation in a 4-year-old patient shortly after her primary cannulation for venoarterial ECMO via the femoral artery.
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Case Reports
Massive pulmonary gas embolism in a neonate with ileal atresia and meconium peritonitis.
We presented the case of a neonate with portal venous gas and pulmonary gas embolism. The patient presented with severe respiratory distress and abdominal distension 12 hours after birth. An ultrasound revealed intravascular microbubbles moving into a pulmonary artery that were traveling from the portal venous system through a ductus venosus. ⋯ Operative findings revealed congenital ileal atresia and meconium peritonitis with abscess. Gas-forming Escherichia coli was recovered from the abscess contents. The patient had respiratory distress, shock, disseminated intravascular coagulation, and intractable diarrhea but eventually recovered and was discharged on the 131st postoperative day.
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Intestinal glutathione (GSH) levels are dramatically decreased after intestinal ischaemia and reperfusion (I/R) injury. Hypothermia has protective effects during I/R injury. The aim of this study was to determine the effects of intestinal I/R and hypothermia on GSH synthesis in erythrocytes and ileum. ⋯ Intestinal I/R leads to decreased ileal GSH synthesis, which could contribute to GSH depletion. Hypothermia preserves GSH synthesis during intestinal I/R injury, and this could protect from further tissue damage. We speculate that reactive species released during I/R injury impair the enzymes of GSH synthesis, whereas these enzymes are protected by moderate hypothermia.