Innovations in the surgical management of congenital diaphragmatic hernia.

Surgical management of congenital diaphragmatic hernia (CDH) remains a challenge for all clinicians. While the treatment strategies for CDH have evolved from emergent surgical intervention to initial hemodynamic stabilization with delayed surgical repair, surgical innovations have remained limited in the last 20 years. Advances in surgical approaches, such as minimally invasive surgery and alternatives to diaphragmatic replacement, have focused on improvements in surgical morbidity.

Minimally invasive repair of congenital diaphragmatic hernia.

Purpose: Operative approach, including minimally invasive surgery (MIS) in the repair of congenital diaphragmatic hernia (CDH), is variable among institutions. The short-term recurrent hernia rate is not well described. We evaluated the in-hospital recurrence rate of MIS repairs of infants with CDH from the Congenital Diaphragmatic Hernia Registry.

Taking pressure off the heart: the ins and outs of atrophic remodelling.

Our work on atrophic remodelling of the heart has led us to appreciate the simple principles in biology: (i) the dynamic nature of intracellular protein turnover, (ii) the return to the foetal gene programme when the heart remodels, and (iii) the adaptive changes of cardiac metabolism. Although the molecular mechanisms of cardiac hypertrophy are many, much less is known regarding the molecular mechanisms of cardiac atrophy. We state the case that knowing more about mechanisms of atrophic remodelling may provide insights into cellular consequences of metabolic and haemodynamic unloading of the stressed heart.

Resection of pulmonary metastases in pediatric patients with Ewing sarcoma improves survival.

Background: Ewing sarcoma (ES) is the second most common bone tumor in children, and survival of those with metastatic ES has not improved. Previous studies have shown a survival benefit to whole lung irradiation in patients with pulmonary metastases and may be given either before, after, or instead of surgical pulmonary metastasectomy (PM). The contribution of surgery compared with irradiation in ES has not previously been studied.

Surgical management of the newborn with congenital diaphragmatic hernia.

Despite advances in the surgical treatment and medical management over the last 20 years, neonates with congenital diaphragmatic hernia (CDH) remain one of the most challenging patient groups for all clinicians. Treatment strategies have shifted from emergent surgical repair and maximum ventilatory support to delayed repair and preoperative hemodynamic stabilization with lung-sparing ventilation strategies and extracorporeal membrane oxygenation. Subsequently, overall survival has improved to as high as 80% in some centers.

Computed tomography scan measurement of abdominal wall thickness for application of near-infrared spectroscopy probes to monitor regional oxygen saturation index of gastrointestinal and renal circulations in children.

Objectives: To measure abdominal wall thickness to determine the depth at which the renal vascular bed and mesenteric vascular bed are located, and to determine the appropriate site for placement of near-infrared spectroscopy probes for accurate monitoring regional oxygen saturation index in children.

Design: Abdominal computerized tomography scans in children were used to measure the abdominal wall thickness and to ascertain the location of kidneys.

Setting: Tertiary care children's hospital.

Emergency department awareness of heparin-induced thrombocytopenia: how frequently is risk assessment documented in patients with thrombosis?

Evidence-based guidelines recommend that heparin-induced thrombocytopenia (HIT) should be suspected whenever a patient develops thrombosis or thrombocytopenia 5 to 14 days after heparin initiation. The authors determined how frequently emergency department (ED) physicians document HIT risk assessment in patients presenting with thrombosis. Relevant data were extracted from the ED charts of 134 patients with venous or arterial thrombosis.

Venous and arterial thromboembolism in severe sepsis.

The burden of thromboembolism (TE) in severe sepsis is largely unknown. We assessed the prevalence of venous and arterial TE in patients with severe sepsis over a four-week period. We performed a retrospective analysis of a pooled database of three randomized, placebo-controlled trials of two novel pharmacological agents for the treatment of severe sepsis, drotrecogin alfa (activated) (DrotAA) and secretory phospholipase A2 inhibitor (sPLA(2)I).

How frequently is venous thromboembolism in heparin-treated patients associated with heparin-induced thrombocytopenia?

Background: Patients receiving heparin for thromboprophylaxis or treatment may have new or recurrent venous thromboembolism (VTE) if immune-mediated heparin-induced thrombocytopenia (HIT) occurs or for other reasons, eg, if anticoagulation fails. We estimated from the literature how frequently a patient presenting with VTE during or following heparin therapy has HIT-associated VTE.

Methods: A comprehensive, systematic literature search was conducted to identify studies using unfractionated or low-molecular-weight heparin (LMWH) for thromboprophylaxis or treatment in which new or recurrent VTE and serologically confirmed HIT were reported.

Argatroban therapy in heparin-induced thrombocytopenia with hepatic dysfunction.

Study Objectives: We evaluated the dosing requirements in argatroban-treated patients with heparin-induced thrombocytopenia (HIT) and hepatic dysfunction, and compared efficacy and safety outcomes with historical control patients.

Design: Retrospective analysis.

Setting: Inpatient setting.

Cyclic nucleotide-gated channels in non-sensory organs.

Cyclic nucleotide-gated channels represent a class of ion channels activated directly by the binding of either cyclic-GMP or cyclic-AMP. They carry both mono and divalent cations, but select calcium over sodium. In the majority of the cases studied, binding of cyclic nucleotides to the channel results in the opening of the channel and the influx of calcium.

Atopic eczema and the allergist.

Several decades ago, the skin was considered to be little more than a simple barrier to dehydration, environmental toxins, and extrinsic bacteria; however, we now recognize that the skin is a complex immune organ that is fully integrated with the immune functions of the bone marrow, lymph nodes, liver, and spleen. Lymphocytes possess a surface glycoprotein, referred to as the cutaneous lymphocyte-associate antigen (CLA), which specifically binds to the skin. The Langerhans cell is the primary antigen processing cell in skin, and they have been shown to traverse to regional lymph nodes where they then have an opportunity to network with lymphocytes that traffic to and from the skin.

Treatment with carbamazepine may enhance alpha 2-noradrenergic autoreceptor sensitivity.

Chronic, not acute treatment with carbamazepine enhanced the hypothermic response to a dose of clonidine thought to exert its predominant effect on the presynaptic alpha 2-autoreceptor. This response was markedly elevated both during the course of and 10 days after the discontinuation of treatment with carbamazepine. Sensitivity to clonidine returned to baseline 10 to 21 days after the discontinuation of treatment.