ISSN:1040-8703    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Outcomes for infants with gastroschisis have paralleled advances made in neonatal intensive care and the use of parenteral nutrition. Mortality rates approaching 100% a half century ago are now closer to 2% to 8%. Further reduction in morbidity has been the focus of many studies during the past decade. Efforts have been made to identify factors associated with the development of gastroschisis and to evaluate the mode, timing, and location of delivery on the outcome of these infants. The effect of the mode and timing of definitive surgical repair has received attention by more recent reports of newer approaches, including the use of a preformed silo to provide coverage for the exposed viscera and allow a gradual reduction into the abdominal cavity.

ISSN:1040-8703    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Recent research pertaining to laser applications for the treatment of capillary malformations (port wine stains) and cutaneous and subglottic hemangiomas is reviewed within the context of advances in laser technology and current therapeutic practices and controversies. Although laser advances have resulted in the concomitant growth of new clinical applications, research over the past year has focused on refining and improving existing applications, with the ultimate goal of being able to individualize treatment. Research initiatives aimed at improving the outcomes of pulse dye laser treatment for capillary malformations have illustrated the complexity of the interaction between laser characteristics, methods of laser application, variations in human skin and tissue, and morphologic parameters of involved blood vessels. Investigations of cutaneous hemangioma have addressed the issue of early pulse dye laser intervention, and results of a significant prospective study clearly demonstrate that this offers no benefit. Studies of subglottic hemangioma have compared the outcomes of treatment with carbon dioxide (co2) and the potassium-titanyl-phosphate lasers, concluding that the latter results in superior outcomes, with less risk of posttreatment subglottic stenosis.

ISSN:1040-8703    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

An epidemic increase in adolescent obesity in the United States has resulted in significant obesity-related comorbidities, previously seen only in adults. Although bariatric surgery is an acceptable alternative for weight loss in severely obese adults, no conclusions have been made about the appropriateness of bariatric surgery for individuals younger than 18 years old. Nonetheless, bariatric surgery is increasingly being performed on adolescents with clinically severe obesity and experience suggests that it is effective and safe. Application of the principles of adolescent growth, development, and compliance is essential to avoid adverse physical, cognitive, and psychosocial outcomes following bariatric surgery. Bariatric surgery should be part of a multidisciplinary approach to the management of adolescents with clinically severe obesity and should be performed by specialists dedicated to pediatric care, in institutions capable of meeting the guidelines for surgical treatment outlined by the American Society of Bariatric Surgery.

ISSN:1040-8703    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1040-8703    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Surgical robots are enabling devices for minimally invasive (laparoscopic) surgery (MIS). They use a computer to enhance a surgeon's skills as hand movements are transmitted to robotic arms. The computer filters tremor, which becomes important at high magnifications of 10 to 15 times available in MIS. It also provides motion scaling so that large hand movements are converted to very small movements of the robotic arm. The robotic arms also have wrists that make suturing and knot tying far more accurate and efficient. Surgical robots are currently used clinically for procedures such as MIS Nissen fundoplication, cholecystectomy, and splenectomy. Laboratory experience indicates that they may provide advantages for newborn procedures such as portoenterostomy for biliary atresia and repair of esophageal atresia and tracheoesophageal fistula. They have a potential for making possible MIS procedures, which can only be done open now, and for introducing entirely new procedures as well as for the performance of procedures by operators distant from the patient.

ISSN:1040-8703    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Despite several, mostly isolated successes, few controlled, prospective trials have yet validated clinical tissue engineering applications. Although this may, at least in part, be explained by the very young age of this field, tissue engineering involves the need for an elaborate and expensive infrastructure, not to mention qualified personnel. This translates into an inherent difficulty in establishing multicenter trials. Moreover, companies mostly devoted to tissue engineering have yet to prove themselves economically viable. On the other hand, although very few engineered tissues have been approved by the US Food and Drug Administration (FDA), more than 70 companies have recently been developing new products. Many challenges are yet to be overcome before “off-the-shelf” tissues can be offered commercially. Nevertheless, given the scientific promise, potential social impact, and young age of the field, many believe that it should be only a matter of time until tissue engineering reaches the mainstream of surgical practice.

ISSN:1040-8703    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Decision analysis is a tool to aid decision-making in the face of uncertainty. Typically, clinical decision-making involves the selection of one or more therapeutic alternatives when the outcome of that decision cannot fully be known at the time the decision must be made. Uncertainty derives from imperfections in diagnostic testing, uncertainty about the natural history of disease, the random nature of iatrogenic complications, and the impact of patient-specific factors or comorbid conditions. Decision analysis seeks to optimize the expected outcome of a decision, incorporating the probabilistic nature of this uncertainty. Decision analysis is applied here to a common problem in intensive care units—the treatment of suspected ventilator-associated pneumonia. Recent applications of decision analysis in the pediatric literature are also used to illustrate the scope and limitations of this tool in clinical practice.

ISSN:1040-8703    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Despite extensive research, bacterial sepsis and its associated systemic inflammation remain a major cause of morbidity and mortality in the pediatric intensive care unit. Advances in molecular biology, however, have improved our understanding of this disease process and have opened up new avenues of potential therapeutic approaches. One such exciting area has been the substantial and still growing evidence that the mammalian immune system uses a family of Toll-like receptors (TLRs) to generate a response to molecular patterns present on invading microorganisms. In particular, TLR4 is part of a recognition complex for bacterial lipopolysaccharide (LPS), thus raising the likelihood of its involvement in the inflammatory response to bacterial sepsis. This review highlights our understanding of the molecular biology of these receptors, focusing on the LPS response, and concluding with a summary of ongoing evaluation and potential therapeutic strategies for treating sepsis through blockade of TLR signaling.

ISSN:1040-8703    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Coma following a hypoxic-ischemic event is a serious condition and common reason for admission to the pediatric intensive care unit. Because coma has a high rate of mortality and morbidity in children, and the clinician may be unsure of the outcome very early in the course, it is important to have strategies to define prognosis. Although most studies have been conducted in adults, we review factors predicting outcome from coma of nontraumatic causes in infants and children. We consider the relation between physical findings, commonly accessible laboratory tools, and outcome, and comment on some newer techniques that may become more available for clinical purposes.

ISSN:1040-8703    

出版商:OVID    

年代:2003

数据来源: OVID