Acta bio-medica : Atenei Parmensis
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In children with acute lung injury the endogenous surfactant system is altered via a variety of different mechanisms, including inflammation, vascular dysfunction, oxidant injury, cellular injury and oedema. This article examines the pathophysiology of acute lung injury and surfactant use for treatment of acute respiratory failure in infants and children.
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The immediate effects of exogenous surfactant on lung volume and hemodynamics in preterm infants have been poorly studied. ⋯ Despite a reduction in gas exchange during the first 5 minutes post surfactant instillation, most likely dependent on airway obstruction, lung volume increases rapidly in HFOV preterm infants with RDS. After 5 minutes from administration of surfactant, lung volume, gas exchange and PI reach stable values and CDP can be safely reduced.
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Comparative Study
Surgical treatment of displaced acetabular fractures: report of 13 clinical cases.
Displaced acetabular fractures are complex lesions which may cause severe consequences if not appropriately treated. The results are linked to the quality of the articular reduction. Anatomical reduction, through surgical treatment with rigid internal fixation, should be considered to obtain an early mobilization, reduce long term osteoarthritis evolution and make the acetabular cavity suitable to eventually recive a total hip prosthesis. The aim of this study is to evaluate functional and radiographic outcome of patients with displaced acetabular fractures surgically treated. ⋯ This study confirm that open reduction and internal fixation in displaced acetabular fractures represents the best treatment able to lead to a satisfactory functional outcome. Moreover, it posticipates long-term arthrosis and eventually makes easier the implant of total hip prosthesis. (www.actabiomedica.it).
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Mechanical ventilation, although life-saving, predisposes preterm infants to BPD. NCPAP emerged as an alternative to invasive ventilation, but it fails in about 30% of infants even when coupled with surfactant therapy. Alternative modes of non invasive ventilation are currently used in neonatology in order to prevent mechanical ventilation. Among these, Synchronized Nasal Intermittent Positive Ventilation (SNIPPV) seems to ensure better results. (www.actabiomedica.it).
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Even if non invasive respiratory support is widespread used in the management of respiratory failure, nevertheless mechanical ventilation and surfactant replacement are standard care for many preterm infants with respiratory distress syndrome (RDS). The interaction between exogenous surfactant and different modalities of ventilatory support are very important and can influence respiratory outcome. The optimization of surfactant replacement during respiratory support is crucial for the successful of this therapy. In course of mechanical ventilation lung recruitment manoeuvres before and after tracheal instillation of surfactant seem to facilitate its distribution and allow to obtain a more homogeneous lung volume. (www.actabiomedica.it).