Articles: palliative-care.
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Pediatric cardiology · Jul 1994
Color Doppler imaging of modified Blalock-Taussig shunts during infancy.
To assess the role of color Doppler echocardiography in the early postoperative evaluation of patients with a Blalock-Taussig shunt we examined 13 consecutive infants who underwent insertion of either a modified right (6 patients) or a modified left (7 patients) Blalock-Taussig shunt (age range 7 days to 6 months, mean age 8 weeks). Examination of the patients in a high parasternal right or left long axis was able to determine patency of the shunt in 12 patients. ⋯ From subcostal views we were able to demonstrate patency of the shunt in 75% of the infants and in all patients younger than 4 weeks of age. In our experience color Doppler echocardiography is a highly reliable method for early postoperative evaluation of infants with a Blalock-Taussig shunt.
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Consideration of care provision for children with life-threatening and life-limiting illness may be hampered by the lack of an agreed set of working definitions for such basic terms as: child, life-threatening condition, life-limiting condition, palliative care, respite care and hospice care. We suggest definitions to stimulate debate, and hopefully agreement, about terms that are central to the Department of Health's current programme of pilot initiatives in support of children with life-threatening and life-limiting illnesses, and their families.
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In patients suffering from advanced or recurrent cancers that are no longer amenable to curative treatment, palliation and symptomatic care have to take the place of cure. In such cases, palliation aims at relief of pain, alleviation of functional disabilities and restoration of mental and social balance. Since the clinicians effort is concentrated on the control of symptoms of uncontrollable disease, decisions have to be made concerning the relative value of the various methods available for treatment and support in the individual patient. Criteria for the physician's decision-making are important parameters in any approach to the patient with incurable cancer and have particular significance in caring for terminal disease.
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Most deaths after stage I palliation for hypoplastic left heart syndrome have occurred within the first 24 hours after surgery. Efforts to improve 1-day survival should therefore have significant impact on improving overall survival. Early death has most often been attributed to low cardiac output and abnormalities of pulmonary to systemic flow ratio (Qp/Qs). ⋯ Measurement of SVC oxygen saturation appears to be a valuable adjuvant in the postoperative management of infants after stage I palliation of hypoplastic left heart syndrome. Major abnormalities in Qp/Qs can be detected even with acceptable arterial saturations. With this information, early ventilator/pharmaceutical adjustments can be made which may improve stage I survival.