摘要:

Although the esophagus functions simply as a conduit between the mouth and the more distal gastrointestinal tract, its physiology and pathophysiology display a complexity that contrasts with that simple function. Thus there are still mysteries about this “tube” and its disorders, and each year brings new revelations. Most attention continues to focus on gastroesophageal reflux, its emerging pathophysiology, multiple manifestations, various diagnostic techniques, and improving methods of treatment. Complications of gastroesophageal reflux, including optimal ways of preventing and treating them, have been explored further. Other aspects of esophageal motility and dysmotility and other causes of inflammation and injury of the esophagus have also been studied during the past year. The surgical literature, especially, continues to struggle with congenital esophageal lesions, particularly esophageal atresia and stenoses.

ISSN:1040-8703    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:1040-8703    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:1040-8703    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The development of pediatric transesophageal ultrasound imaging represents an important advance in the diagnosis and treatment of the child with congenital heart disease. Although primary diagnostic transesophageal studies are seldom indicated in infants and unoperated children, they have an important role in the older child especially where there has been prior cardiac surgery. Diagnostic studies are most appropriate for abnormalities of venous return, the atria, atrioventricular valves, and the left ventricular outflow tract. Two other important areas in which transesophageal imaging is playing an increasing role in the treatment of the pediatric patient is in monitoring interventional catheterization and in the intraoperative and immediate postoperative monitoring of surgical repair.

ISSN:1040-8703    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The vast majority of children who have symptoms (;e, cardiac failure, palpitations, dizziness) due to supraventricular tachycardias are successfully managed by medical treatment. Antiarrhythmic drug therapy may be complicated by side effects or become ineffective so that radiofrequency catheter ablation, which destroys the myocardial structure responsible for arrhythmias, can now offer an attractive option to lifelong drug therapy. Immediate results for supraventricular tachycardias due to a reentry mechanism or to an atrial ectopic focus are good, with a success rate over 80% and rare immediate complications. However, the long-term sequelae of the procedure on the growing heart have not been established and the risk of subsequent atrial and ventricular arrhythmias must be considered in young patients. For this reason, I believe that today, radiofrequency ablation should be reserved for young patients who have life-threatening symptoms or who have arrhythmias that are refractory to medical treatment, and for older patients who will need a lifelong drug therapy.

ISSN:1040-8703    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Balloon valvuloplasty and angioplasty have become accepted alternatives to surgery for valvar stenosis and coarctation of the aorta. Balloon dilation avoids a potentially painful operation, the long postoperative recovery, and at the same time offers substantial cost savings. However, such advantages are meaningless if the safety of the interventional procedure does not match or surpass the results of conventional surgery. This review summarizes a number of studies that compare the natural history of surgical therapy with that of balloon pulmonary and aortic valvuloplasty and balloon coarctation angioplasty. It appears that, regardless of age, balloon valvuloplasty is preferable to surgical valvotomy. For both aortic stenosis and coarctation of the aorta, balloon valvuloplasty and surgical valvotomy produce comparable relief of the hemodynamic obstruction. However, because the length of follow-up after the balloon angioplasties has been short, the actual risk of developing severe aortic regurgitation (postaortic valvuloplasty) and aortic aneurysms (postcoarctation angioplasty) has not been trivial, a large prospective follow-up of both of these interventional procedures will be mandatory before either can be judged superior to surgical therapy.

ISSN:1040-8703    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Although biventricular correction of tetralogy of Fallot has been with us for well over three decades, the optimal treatment of these patients continues to be debated, and surgical techniques refined. There can be no doubt that operative mortality has improved, and no matter which approach is chosen, an early mortality of less than 5% should be easily achievable. As with most other areas of pediatric cardiology and cardiac surgery, these admirable early results are truly only the beginning. While reflecting the results of surgery in an earlier era, some of the long-term follow-up data beginning to emerge from studies of these patients, particularly in regard to the effect of pulmonary incompetence, is compelling and must be taken into account when deciding the optimal surgical treatment for the individual child presenting today with tetralogy of Fallot. This article reviews some of the more recent data regarding the functional outcome of these patients as well as the surgical approaches that have been developed to address them.

ISSN:1040-8703    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

In this section we review four broad topics in pediatrics: atopic disease, rhinitis and conjunctivitis, upper respiratory tract infections, and insect stings and snake bites. The first three topics comprise three of the most commonly encountered problems in pediatric practice. Although the fourth topic accounts for a relatively small number of office visits, it generates a great deal of concern among our patients and their parents. There have been significant contributions to the pediatric literature in each of these areas over the past year and we review those of particular interest.

ISSN:1040-8703    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:1040-8703    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:1040-8703    

出版商:OVID    

年代:1993

数据来源: OVID