Przegla̧d lekarski
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Comparative Study
[Early postoperative period in children with hypoplastic left heart syndrome in the comparison of classic and modified Norwood procedures].
The Norwood operation in neonates with hypoplastic left heart syndrome is associated with very high mortality. ⋯ The new modification of the Norwood procedure ensures stable conditions in early postoperative period. We believe that short circulatory arrest time without prolongation of cardiopulmonary bypass time and higher diastolic pressure (the location of the proximal shunt end beneath the valve of the systemic circulation) improves the function of the heart.
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The authors present the diagnostic and therapeutic management in bleeding episodes associated with cardiosurgical operations, which constitutes the policy that is employed at Department of Cardiac Surgery and Transplantology, Silesian Academy of Medicine, Zabrze, Poland. The paper also presents a compendium of information on the pathophysiology of coagulation processes, most significant from the standpoint of cardiosurgical practice. Separate issues associated with providing optimal hemostasis in patients operated on using cardiopulmonary bypass are discussed, along with the effect of cardiac procedures on coagulation processes. ⋯ In both described patients who were characterized by a high risk of surgical bleeding, the employment of the recombinant activated factor VII led to significant improvement in coagulation system indices and the hemostatic outcome was regarded positive. The authors state that the introduction of the recombinant activated factor VII to clinical practice in a selected group of patients presenting with most serious coagulation abnormalities and difficult to control perioperational bleeding allows for improving therapeutic results and decreasing mortality in cardiac surgery patients. In view of the significant economic barrier associated with a high cost of the preparation, the authors propose a consistent approach of employing at all times the classic, well-balanced hemostatic management, based primarily on extended knowledge of the pathophysiology of the clotting system and on very thorough surgical hemostasis, with the recombinant activated factor VII being reserved for exceptional situations only.
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Comparative Study
[Evaluation of surgical treatment results of coarctation of the aorta in neonates and young infants].
The authors present the analysis of surgical results obtained for coarctation of the aorta (CoA) in children less than 1 year of age. The material consisted of 103 infants (62 Males and 41 Females) aged 0.33-10.5 months (x = 3.3 +/- 2.6 months) treated between January 1, 1985 and December 31, 1999. All the patients were subjected to a detailed physical examination, ECG, chest X-ray and comprehensive echocardiography, while 12 children had additional hemodynamic studies and angiocardiography. Two groups were distinguished among the investigated children: Below 3 months of life (Group 1, N = 65) and above 3 months of life (Group 2, N = 38). In 69 infants, (including 55 from Group 1 and 14 from Group 2), the recommendation for surgery was circulatory failure, while in 34 infants (10 from Group 1 and 24 from Group 2), the recommendation for surgery considerable systemic hypertension with absent femoral pulses. In 76 patients, the Waldhausen procedure was performed, while 24 were subjected to aortic isthmus angioplasty using a Gore-Tex patch and 3 were subjected to end-to-end anastomosis. Six patients died, including 5 from Group 1 and 1 from Group 2. The remaining 97 infants (60 from Group 1 and 37 from Group 2) were followed-up for a mean period of 96.2 +/- 48.2 months. Postoperative recoarctation was encountered in 12 patients (12.4%); the condition was more predominant in Group 1 (16.6%) than in Group 2 (5.4%), but, no statistical significance was noted (Chi 2 = 2.677, p = 0.102). Despite the repair of aortic coarctation, systemic hypertension was noted in 17 children (17.5%) and it was equally common in both groups, but, twice as frequent in children with recoarctation. ⋯ 1. CoAo correction in children below 3 months of age is associated with an increased risk of recoarctation. 2. Even when surgical treatment of CoAo is attempted very early in life, the risk of elevated systemic blood pressure is not completely eliminated.
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The article presents most important changes in international guidelines for adult cardiopulmonary resuscitation. In this article guideline changes in basic and advanced life support published in Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care--a Consensus on Science are discussed. Major changes in guidelines presented in this article include: pulse check, ventilation technique for rescue breathing, compression technique, abdominal thrust recommendations, precordial thump, universal algorithm changes.
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The authors examined intellectual and socio-emotional functioning of 39 subjects suffering from Duchenne muscular dystrophy. Their school situation, access to rehabilitation and a quality of familial upbringing attitude were characterized, as well. No significant differences concerning I. Q. between sick children and healthy population were found.