Hypertensive disorders of pregnancy and outcomes of preterm infants of 24 to 28 weeks' gestation.

OBJECTIVE: To examine the relationship between hypertensive disorders of pregnancy (HDPs) and mortality and major morbidities in preterm neonates born at 24 to 28 weeks of gestation. STUDY DESIGN: Using an international cohort, we retrospectively studied 27 846 preterm neonates born at 240 to 286 weeks of gestation during 2007 to 2010 from 6 national neonatal databases. The incidence of HDP was compared across countries, and multivariable logistic regression analyses were conducted to examine the association of HDP and neonatal outcomes including mortality to discharge, bronchopulmonary dysplasia, severe brain injury, necrotizing enterocolitis and treated retinopathy of prematurity. RESULTS: The incidence of HDP in the entire cohort was 13% (range 11 to 16% across countries). HDP was associated with reduced odds of mortality (adjusted odds ratio (aOR) 0.77; 95% confidence interval (CI) 0.67 to 0.88), severe brain injury (aOR 0.74; 95% CI 0.62 to 0.89) and treated retinopathy (aOR 0.82; 95% CI 0.70 to 0.96), but increased odds of bronchopulmonary dysplasia (aOR 1.16; 95% CI 1.05 to 1.27). CONCLUSIONS: In comparison with neonates born to mothers without HDP, neonates of HDP mothers had lower odds of mortality, severe brain injury and treated retinopathy, but higher odds of bronchopulmonary dysplasia. The impact of maternal HDP on newborn outcomes was inconsistent across outcomes and among countries; therefore, further international collaboration to standardize terminology, case definition and data capture is warranted.

Association of unit size, resource utilization and occupancy with outcomes of preterm infants.

OBJECTIVE: Assess association of NICU size, and occupancy rate and resource utilization at admission with neonatal outcome. STUDY DESIGN: Retrospective cohort study of 9978 infants born at 23-32 weeks gestation and admitted to 23 tertiary-level Canadian NICUs during 2010-2012. Adjusted odds ratios (AOR) were estimated for a composite outcome of mortality/any major morbidity with respect to NICU size, occupancy rate and intensity of resource utilization at admission. RESULTS: A total of 2889 (29%) infants developed the composite outcome, the odds of which were higher for 16-29, 30-36 and >36-bed NICUs compared with <16-bed NICUs (AOR (95% CI): 1.47 (1.25-1.73); 1.49 (1.25-1.78); 1.55 (1.29-1.87), respectively) and for NICUs with higher resource utilization at admission (AOR: 1.30 (1.08-1.56), Q4 vs Q1) but not different according to NICU occupancy. CONCLUSION: Larger NICUs and more intense resource utilization at admission are associated with higher odds of a composite adverse outcome in very preterm infants.

Elective Neck Dissection in patients with stage T1-T2N0 carcinoma of the anterior tongue.

OBJECTIVES: The presence of neck metastases represents one of the most important prognostic factors for carcinomas of the anterior tongue, the five-year survival rate being under 20% in patients with regional metastases. The aim of this study was to demonstrate the efficacy of prophylactic selective neck dissection in patients without detectable nodal metastases. MATERIALS AND METHODS: A matched case-control study with prospective follow up was conducted in ENT Department of Coltea Clinical Hospital for 86 patients with T1-T2N0 stage carcinoma of the anterior tongue surgically treated between January 2000 and January 2005 with or without concurrent selective supraomohyoid neck dissection (SND). The patients were divided in two groups, comparable in age and sex distribution. Descriptive statistics, risk of recurrences, Kaplan Maier five-year survival curves and the global and specific mortality rates were performed using EpiInfo software. The level of significance was established at p<0.05. RESULTS: After a mean follow-up time of 90.5 months, for all variables considered as outcomes of SND efficacy evaluation, significance differences (p < 0.05) were registered between groups: the frequency of patients who developed neck metastases was lower in the group of subjects who underwent prophylactic selective neck dissection; the all-cause mortality rate at the end of the follow-up period was three times lower in SND study group compared with controls; the specific mortality rate due to regional recurrences was five times lower in test-group compared with controls. CONCLUSIONS: Our study suggest that prophylactic selective neck dissection could be indicated for patients with T1-T2N0 carcinomas of the anterior tongue in order to increase both overall and free of recurrence survival time, respectivelly.

Pneumothorax in neonates: Trends, predictors and outcomes.

OBJECTIVE: To examine rates, trends, predictive risk factors, and outcomes associated with pneumothorax in neonates. STUDY DESIGN: Retrospective analyses were used to estimate rates and assess trends in pneumothorax among early preterm (GA <32 weeks), moderate-late preterm (GA 32-36), and term (GA ≥37 weeks) neonates admitted to neonatal intensive care units (NICUs) participating in the Canadian Neonatal Network™ from 2005 to 2011. For each GA group, multivariable logistic regression models were derived to predict pneumothorax using risk factors with known clinical relevance. Additional logistic regression analyses assessed associations between pneumothorax and mortality, bronchopulmonary dysplasia, and intraventricular hemorrhage. RESULTS: The study included 71,237 neonates; of them 16,985 (24%) early preterm, 27,709 (39%) moderate-late preterm, and 26,543 (37%) term neonates. The overall rate of pneumothorax by GA was bimodal with estimates of 4.0%, 2.6%, and 6.7% respectively. No significant temporal trends were detected. Risk factors for pneumothorax included: a) for the overall lpopulation- Score for Neonatal Acute Physiology, version II >20, surfactant use, and respiratory distress syndrome; b) for early preterm infants-chorioamnionitis; c) for moderate-late preterm infants-higher birth weight, male sex, rupture of membranes >24 hours, and outborn status; and d) for term infants- male sex, outborn status, and meconium aspiration in term neonates. In early preterm neonates, pneumothorax was associated with mortality, bronchopulmonary dysplasia, severe intraventricular hemorrhage, and prolonged NICU stay. CONCLUSIONS: Pneumothorax rates were higher among term and early preterm neonates admitted to the NICU. Predictors of pneumothorax varied between GA groups. Pneumothorax-associated mortality and morbidity were significantly greater in early preterm infants.

[The role of multimodal analgesia in the decrease of postoperative surgical stress response in major neoplastic thoraco-abdominal surgery]. / Rolul analgeziei multimodale in diminuarea raspunsului postoperator la stressul chirurgical in chirurgia toraco-abdominala neoplazica majora.

A major issue of the surgical anesthetic team is the surgical stress response, with its organ disfunctions, and the postoperative pain with consequences regarding the physiopathologic and socio-economical impact associated with its inadequate therapy. According to the "fast-track" approach, multimodal analgesia has a central place, together with minimal invasive procedures. Opioid-local anesthetic association via thoracic epidural catheter, has become the "anesthetic golden standard", in major thoraco-abdominal surgery. Co-administration of i.v. non-steroid anti-inflammatory drugs, seriously decreases the inflammatory response to the surgical stress, allowing a faster recovery, an early social rehabilitation, and a decrease in morbidity and mortality associated with major neoplasic surgery.

Laparoscopic repair of post-traumatic diaphragmatic hernia: a case report.

In a large number of cases, post-traumatic diaphragmatic hernias (PTDH) are a consequence of occult diaphragmatic injuries associated with penetrating abdominal trauma. We present a case of a 26-year-old male patient who, 2 months prior to the current admission, sustained a non-penetrating stab wound to the left anterior chest below the nipple. Upon presentation the patient complained of epigastric pain radiated to the left shoulder, and nausea and vomiting. The chest X-ray, and abdominal and thoracic CT scan were inconclusive. The patient was sutured and discharged. The laparoscopic approach was selected as a diagnostic and minimally invasive therapeutic method. The suspected diagnosis of PTDH was confirmed. The herniated organs (transverse colon, small bowel loops, and greater omentum) were reduced, and the diaphragmatic defect was sutured by placing 3 non-resorbable 2.0 knots. The suture was reinforced with a composite mesh affixed with resorbable clips. Postoperative period was uneventful, and the patient was discharged 4 days later.

Disease-marker associations: power and heterogeneity in independent population samples.

We applied generalized transmission disequilibrium testing (TDT) models in combined replicates 1 through 5 from each of four simulated population samples. All analyses were conducted without knowledge of the generating models. To assess power and consistency of results within and between samples, analyses were repeated in all 25 replicates combined and in each replicate. With the exception of sample-specific findings for locus D, power was generally low to detect linkage in a genome scan or to confirm linkages detected by allele sharing in affected relatives, due to lack of linkage disequilibrium. We proposed likelihood ratio and Wald tests to detect heterogeneity among samples in disease-marker associations. Pooling data across heterogeneous populations may not improve power of the TDT method.

A comparison of some allele-sharing based linkage analysis methods for detecting complex trait loci.

Using randomly selected sib pairs from a subset of the GAW11 simulated data in Problem 2, we compared the results of some linkage analysis methods based on allele sharing. One method was the Haseman-Elston test for a binary disease outcome (unaffected vs. mild or severe). The other methods, which analyzed the trinary ordered outcome unaffected/mild/severe were the Haseman-Elston test, an extended Haseman-Elston incorporating sib-pair sums, variance components analysis, and regression analysis. Our analysis was done without knowledge of the generating model.