Influence of cardiopulmonary bypass on platelet and neutrophil accumulations in internal organs.

The authors employed gamma scintigraphy to quantify the post bypass accumulations of platelets and neutrophils in the lung, liver, and heart of adult pigs subjected to a standard 90 min regimen of normothermic cardiopulmonary bypass (CPB). Coated and uncoated microporous polypropylene oxygenator circuits were studied for Cobe Duo (Arvada, CO) oxygenators (amphophilic silicone-caprolactone oligomer [SMA] coating, n = 8 each) and Medtronic Maxima (Irvine, CA) oxygenators (Carmeda heparin coating, n = 5 each). Images of cells in the organs (deposited + blood pool) were corrected for tissue absorption and other factors and compared for a 2 hr period post CPB, using repeat measures ANOVA and rank tests. Platelet accumulations in internal organs correlated positively with whole blood platelet counts and negatively with platelet deposits in oxygenators during CPB. In general, uncoated CPB circuits significantly reduced platelet and neutrophil accumulations in lung, liver, and heart versus preCPB controls for the post CPB interval, for both systems. The SMA treatment significantly increased platelet accumulations versus uncoated controls in lung, liver, and heart for the 2 hr period, including the majority of the post CPB sampling intervals; platelet densities did not reach preCPB levels. Neutrophil accumulations were unaffected by the SMA coating. Carmeda heparin treatment significantly increased platelet accumulations in the liver, but not lung or heart. Despite preservation of circulating neutrophils observed with the Carmeda heparin treatment, neutrophil accumulations in internal organs were not elevated post CPB.

Retrograde percutaneous gastrostomy and gastrojejunostomy in 505 children: a 4 1/2-year experience.

PURPOSE: To evaluate a technique of retrograde insertion of gastrostomy and gastrojejunostomy tubes with radiologic guidance in children. MATERIALS AND METHODS: During a 4 1/2-year period, 511 patients underwent attempted insertion of gastrostomy or gastrojejunostomy tubes. Patients' ages ranged from premature to 18.6 years (mean age, 3.8 years), and weight range was 0.8-86.0 kg (mean weight, 12 kg). The charts of 453 patients were reviewed. RESULTS: Placement was unsuccessful in six patients because of colonic interposition (n = 2), microgastria (n = 2), or hepatosplenomegaly (n = 2). Initial placement was a gastrostomy tube in 436 patients and a gastrojejunostomy tube in 69 patients. Sixty-eight gastrostomy tubes were converted to gastrojejunostomy tubes. Early complications (< 30 days) included skin infection (n = 11), stoma irritation (n = 20), and tube dislodgment (n = 6). Late complications included stoma irritation (n = 29), skin infection (n = 23), tube leakage (n = 14), and discomfort during feeding (n = 15). Two complications necessitated surgery: extragastric misplacement and small-bowel transgression. There were no tube-related deaths. CONCLUSION: Percutaneous retrograde placement of gastrostomy or gastrojejunostomy tubes safely and effectively provides long-term nutrition for children. A team approach is essential to provide service to this cumulative population.