RESUMO
OBJECTIVE: To determine if prophylactic administration of C1-esterase-inhibitor would have a beneficial effect on postoperative weight gain and the inflammatory response in neonates undergoing cardiac surgery with cardiopulmonary bypass (CPB). DESIGN: Randomized, double-blinded study. SETTING: University-affiliated heart center. PARTICIPANTS: Twenty-four neonates with transposition of the great arteries. INTERVENTIONS: In group inhibitor (INH) patients (n = 12), 100 IU/kg of C1-esterase-inhibitor (Berinert) was given 30 minutes before CPB. In group placebo (P) patients (n = 12), placebo was administered instead. Interleukin (IL)-6, C3a anaphylatoxin, C1 activity, prekallikrein, Hageman factor, D-dimers, and clinical parameters were measured 6 times perioperatively. MEASUREMENTS AND MAIN RESULTS: All 24 patients had an uneventful clinical course. Mean arterial pressure and pulmonary oxygenation after CPB were superior in group INH patients. The weight gain on postoperative days 1 to 4 was significantly less in group INH patients compared with group P (55 +/- 59 g vs. 340 +/- 121 g, day 1). The concentration of IL-6 (76 +/- 17 pg/mL vs. 262 +/- 95 pg/mL during CPB) was significantly lower in group INH patients compared with group P patients. In contrast, no influence on C3a anaphylatoxin and coagulation factors was found. CONCLUSION: Prophylactic application of C1-esterase-inhibitor in neonates undergoing arterial switch operations produces less inflammatory response compared with placebo. This difference may have contributed to improved clinical parameters, including less weight gain postoperatively.
Assuntos
Síndrome de Vazamento Capilar/prevenção & controle , Ponte Cardiopulmonar/efeitos adversos , Proteínas Inativadoras do Complemento 1/uso terapêutico , Síndrome de Resposta Inflamatória Sistêmica/prevenção & controle , Transposição dos Grandes Vasos/cirurgia , Síndrome de Vazamento Capilar/etiologia , Complemento C1/análise , Complemento C3a/análise , Método Duplo-Cego , Fator XII/análise , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Recém-Nascido , Interleucina-6/sangue , Pré-Calicreína/análise , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Aumento de Peso/efeitos dos fármacosRESUMO
The prognosis of malignant lymphoma of bone in childhood has been improved. This is due to the modern chemotherapy. Pain in the bones is one of the early symptoms. If these early symptoms are not recognized, diagnosis and therapy may be delayed. The problems of classification, diagnosis and therapy are discussed, 2 case-reports with so-called reticulum cell sarcoma are given.