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1.
Interact Cardiovasc Thorac Surg ; 30(1): 136-143, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31873745

RESUMO

OBJECTIVES: The optimal myocardial protective solution in the neonatal arterial switch operation remains controversial. The aim of this study was to demonstrate that Bretschneider's histidine-tryptophan-ketoglutarate crystalloid solution (Custodiol) offers protection at least similar to that of cold blood cardioplegia. METHODS: Patients who underwent the neonatal arterial switch operation with Custodiol between January 2016 and December 2018 (n = 23) were compared with an historical cohort from August 2010 to December 2015 in which cold blood cardioplegia was used (n = 41). A linear mixed-effect model for repeated measures was performed to test the recovery of myocardial function based on inotropic and vasoactive inotropic scores, cardiac enzyme release and left ventricular ejection fraction. RESULTS: Patients in the cold blood cardioplegia group had higher inotropic scores in the first 24 h (0 h, P = 0.001 and 24 h, P = 0.006) and higher vasoactive inotropic scores in the first 72 h (0 h, 24 h and 48 h, P < 0.001; 72 h, P = 0.012). Cardiac troponin-I concentrations were higher in the cold blood cardioplegia group at postoperative hours 1-72 (1 h, 6 h, 12 h and 24 h, P < 0.001; 48 h, P = 0.001 and 72 h, P = 0.003). Creatinine-kinase-MB concentrations were higher in the cold blood cardioplegia group at postoperative hours 1-24 (1 h, 6 h and 12 h, P < 0.001; 24 h, P = 0.042). The left ventricular ejection fraction was higher in the Custodiol group just after the operation (P = 0.005), at 24 h (P = 0.001) and on the first day without inotropic support (P = 0.011). CONCLUSIONS: Neonatal myocardium protected with Custodiol during the arterial switch operation presented optimal ventricular function recovery with less inotropic support and less myocardial damage compared with cold blood cardioplegia.

2.
Artigo em Inglês | MEDLINE | ID: mdl-31233784

RESUMO

Transcatheter valve can be an alternative option of pediatric valve replacement in high-risk patients. We present 2 cases of Edwards Sapien 3 implantation in tricuspid position.

3.
Ann Thorac Surg ; 108(5): e325-e327, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30926474

RESUMO

This case report describes a primary cardiac tumor, classified as venous malformation, diagnosed in an asymptomatic child. The tumor was located in the left atrium near the mitral valve without affecting the mitral valve's functioning. Complete resection of the lesion was performed because of the risk of systemic embolism. The lesion consisted of fibrous tissue with multiple venous vascular channels. The patient did not have similar lesions in other locations. Vascular primary cardiac tumors are extremely rare. Hemangiomas and lymphangiomas have been described previously, but to our knowledge, this is the first primary cardiac tumor identified as a venous malformation.

4.
Asian Cardiovasc Thorac Ann ; 27(4): 265-270, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30791694

RESUMO

BACKGROUND: Pulmonary valve replacement is one of the most common procedures in patients with congenital heart disease. Little is known about prosthetic valve endocarditis in this population. OBJECTIVES: To review management and outcomes of pediatric and adult patients with a prosthetic pulmonary valve or right ventricle-to-pulmonary artery conduit infective endocarditis. METHODS AND RESULTS: A multiinstitutional cohort of 10 patients is reported. Median age at endocarditis was 24 years (range 8-41 years). The most common causative organisms were Staphylococcus ( n = 4) and Streptococcus species ( n = 2). In addition to medical treatment, 5 patients required surgery. Majors complications such as renal damage, life-threatening hemoptysis, and septic shock were observed. No patient died in hospital or during follow-up. CONCLUSIONS: Pulmonary prosthetic valve endocarditis is a rare condition associated with significant morbidity and a high risk of requiring operative intervention. Larger studies are required to optimize the management.


Assuntos
Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Prótese Vascular/efeitos adversos , Endocardite Bacteriana/microbiologia , Cardiopatias Congênitas/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas/efeitos adversos , Infecções Relacionadas à Prótese/microbiologia , Valva Pulmonar/cirurgia , Adolescente , Adulto , Criança , Angiografia por Tomografia Computadorizada , Ecocardiografia Doppler em Cores , Ecocardiografia Transesofagiana , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/cirurgia , Feminino , Humanos , Masculino , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/cirurgia , Valva Pulmonar/diagnóstico por imagem , Reoperação , Estudos Retrospectivos , Fatores de Risco , Espanha , Resultado do Tratamento
6.
World J Pediatr Congenit Heart Surg ; 10(2): 239-241, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30651045

RESUMO

Surgical palliation of many types of congenital heart defects requires the use of a conduit between the right ventricle and the pulmonary artery. Dissections of these conduits are very infrequent. We report a case of a ten-year-old girl who developed acute right heart failure related to a Contegra conduit dissection. She underwent a new conduit replacement on an emergency basis.


Assuntos
Prótese Vascular , Cardiopatias Congênitas/cirurgia , Insuficiência Cardíaca/etiologia , Ventrículos do Coração/cirurgia , Falha de Prótese/efeitos adversos , Artéria Pulmonar/cirurgia , Bioprótese , Criança , Ecocardiografia , Eletrocardiografia , Feminino , Cardiopatias/diagnóstico por imagem , Cardiopatias/etiologia , Humanos , Choque Cardiogênico/etiologia , Choque Cardiogênico/cirurgia , Trombose/diagnóstico por imagem , Trombose/etiologia
7.
Interact Cardiovasc Thorac Surg ; 27(3): 395-401, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-29590367

RESUMO

OBJECTIVES: The aortic arch repair in the neonatal period is a complex procedure with significant morbidity. We define a useful double-perfusion technique and its effect on the function of abdominal organs in the postoperative course. METHODS: Nine patients with double perfusion (Group 1) were compared with 14 patients with antegrade cerebral perfusion (Group 2). The objective was to discern the incidence of postoperative acute kidney injury and impaired hepatic function, as well as tissue perfusion and myocardial function parameters. Mechanical ventilation time, postoperative length of stay and 30-day mortality were measured. We excluded patients with extracorporeal membrane oxygenation, early mortality (<72 h) and preoperative renal or hepatic insufficiency. RESULTS: Nine (39%) patients developed postoperative acute kidney injury, with 22% (n = 2) in Group 1 and 50% (n = 7) in Group 2 (P = 0.183). A higher urine output was observed during the first 24 h for Group 1 (P = 0.032). Eleven patients developed impaired hepatic function in the immediate postoperative period: 2 (18.2%) in Group 1 and 9 (81.8%) in Group 2 (P = 0.04). The international normalized ratio (P = 0.006-0.031) and prothrombin time (P = 0.007-P = 0.016) were significantly lower in the double-perfusion group during the first 72 h. Significant difference was observed in lactate levels in the first 72 h (P = 0.001-0.009). There was no postoperative mortality in either group. CONCLUSIONS: Selective visceral perfusion is a safe procedure that provides a better urine output, hepatic function and tissue perfusion. This technique allows for the repair of complex aortic arch anomalies in neonates without deep hypothermic circulatory arrest.


Assuntos
Lesão Renal Aguda/epidemiologia , Aorta Torácica/anormalidades , Aorta Torácica/cirurgia , Cardiopatias Congênitas/cirurgia , Insuficiência Hepática/epidemiologia , Perfusão/métodos , Complicações Pós-Operatórias/epidemiologia , Vísceras/irrigação sanguínea , Lesão Renal Aguda/fisiopatologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino
8.
Med. clín (Ed. impr.) ; 149(9): 391-396, nov. 2017. tab, ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-168052

RESUMO

Introducción y objetivos: La dilatación de la aorta ascendente asociada a válvula aórtica bicúspide es una causa mayor de morbimortalidad en adultos. El objetivo principal fue reconocer la afectación aórtica en niños, así como sus características y factores de riesgo. Métodos: Se realizaron retrospectivamente las mediciones aórticas de todos los pacientes pediátricos con válvula aórtica bicúspide seguidos en un hospital pediátrico terciario entre 1997 y 2015. Se excluyeron los pacientes con síndromes asociados a dilatación aórtica (n=17). Resultados: Se incluyeron 206 pacientes, de los cuales el 67,9% eran varones. El patrón de apertura más común fue horizontal: 137 (66,7%). La mitad de los pacientes (101) tenía historia de coartación aórtica, 46 de ellos (22,3%) con estenosis aórtica≥moderada y 13 (6%) con insuficiencia aórtica≥moderada. El seguimiento medio fue de 6,1 (4,9) años; el diagnóstico de dilatación aórtica se realizó durante el primer año de seguimiento. La progresión de la dilatación de la aorta ascendente se documentó en el 17,1%, y en el 2,5% en la raíz aórtica. Más de un tercio (80/206) presentó dilatación aórtica (z-score>2). La afectación exclusiva de la aorta ascendente se produjo en 70/80 pacientes, con preservación de la raíz aórtica. En el análisis multivariado, los pacientes con dilatación de la aorta ascendente se asociaron a ausencia de coartación (p=0,001) y patrón de apertura vertical (p=0,007). Conclusiones: Está justificado el seguimiento en los pacientes pediátricos con válvula aórtica bicúspide debido a la frecuente asociación con disfunción valvular y/o dilatación aórtica (AU)


Introduction and objectives: Dilatation of the ascending aorta associated with bicuspid aortic valve is a major cause of morbidity and mortality in adults. The main objective was to recognize the aortic involvement in children, its characteristics and risk factors. Methods: Aortic measures of all pediatric patients with bicuspid aortic valve followed in a tertiary pediatric hospital between 1997 and 2015 were retrospectively taken. Patients with syndromes associated with aortic dilatation were excluded (n=17). Results: Two hundred and six patients were included, 67.9% males. The commonest opening pattern was horizontal: 137 (66.7%). Half of the patients (101) had a history of surgical aortic coarctation, 46 (22.3%) had≥moderate aortic valve stenosis and 13 (6%) had≥moderate aortic insufficiency. Mean follow-up time was 6.1 (4.9) years; diagnosis of aortic dilatation was made during the first year of follow-up. Progression of the dilatation of the ascending aorta was noted in 17.1%, and of the aortic root in 2.5%. More than one-third (80/206) had aortic dilatation (z-score>2). The ascending aorta was exclusively affected in 70/80 patients, with sparing of the aortic root. In the multivariate analysis, patients with dilatation of the ascending aorta were associated with absence of coarctation (P=.001) and vertical opening pattern (P=.007). Conclusions: Pediatric patients with bicuspid aortic valve warrant medical follow-up for the frequent association with valve impairment and/or dilatation of the ascending aorta (AU)


Assuntos
Humanos , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Fatores de Risco , Aneurisma Aórtico/complicações , Coartação Aórtica/fisiopatologia , Seio Aórtico/diagnóstico por imagem , Estudos Retrospectivos , Análise Multivariada , Cardiopatias/congênito , Cardiopatias/complicações
9.
Med Clin (Barc) ; 149(9): 391-396, 2017 Nov 09.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28629660

RESUMO

INTRODUCTION AND OBJECTIVES: Dilatation of the ascending aorta associated with bicuspid aortic valve is a major cause of morbidity and mortality in adults. The main objective was to recognize the aortic involvement in children, its characteristics and risk factors. METHODS: Aortic measures of all pediatric patients with bicuspid aortic valve followed in a tertiary pediatric hospital between 1997 and 2015 were retrospectively taken. Patients with syndromes associated with aortic dilatation were excluded (n=17). RESULTS: Two hundred and six patients were included, 67.9% males. The commonest opening pattern was horizontal: 137 (66.7%). Half of the patients (101) had a history of surgical aortic coarctation, 46 (22.3%) had≥moderate aortic valve stenosis and 13 (6%) had≥moderate aortic insufficiency. Mean follow-up time was 6.1 (4.9) years; diagnosis of aortic dilatation was made during the first year of follow-up. Progression of the dilatation of the ascending aorta was noted in 17.1%, and of the aortic root in 2.5%. More than one-third (80/206) had aortic dilatation (z-score>2). The ascending aorta was exclusively affected in 70/80 patients, with sparing of the aortic root. In the multivariate analysis, patients with dilatation of the ascending aorta were associated with absence of coarctation (P=.001) and vertical opening pattern (P=.007). CONCLUSIONS: Pediatric patients with bicuspid aortic valve warrant medical follow-up for the frequent association with valve impairment and/or dilatation of the ascending aorta.


Assuntos
Aorta/patologia , Valva Aórtica/anormalidades , Valva Aórtica/patologia , Doenças das Valvas Cardíacas/patologia , Coartação Aórtica/epidemiologia , Estenose da Valva Aórtica/epidemiologia , Pré-Escolar , Comorbidade , Dilatação Patológica , Progressão da Doença , Feminino , Doenças das Valvas Cardíacas/epidemiologia , Hospitais Pediátricos , Humanos , Lactente , Masculino , Estudos Retrospectivos , Fatores de Risco , Seio Aórtico/patologia , Centros de Atenção Terciária
10.
Cardiol Young ; 27(2): 273-283, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27086665

RESUMO

BACKGROUND: In 2007, a partnership was initiated between a small-volume paediatric cardiac surgery unit located in Las Palmas de Gran Canaria, Spain, and a large-volume cardiac surgery unit located in Milan, Italy. The main goal of this partnership was to provide surgical treatment to children with CHD in the Canary Islands. METHODS: An operative algorithm for performing surgery in elective, urgent, and emergency cases was adopted by the this joint programme. Demographic and in-hospital variables were collected from the medical records of all the patients who had undergone surgical intervention for CHD from January, 2009 to March, 2013. Data were introduced into the congenital database of the European Congenital Heart Surgeons Association Congenital Database and the database was interrogated. RESULTS: In total, 65 surgical mission trips were performed during the period of this study. The European Congenital Heart Surgeons Association Congenital Database documented 214 total patients with a mean age at operation of 36.45 months, 316 procedures in total with 198 cardiopulmonary bypass cases, 46 non-cardiopulmonary bypass cases, 26 cardiovascular cases without cardiopulmonary bypass, 22 miscellaneous other types of cases, 16 interventional cardiology cases, six thoracic cases, one non-cardiac, non-thoracic procedure on a cardiac patient with cardiac anaesthesia, and one extracorporeal membrane oxygenation case. The 30-day mortality was 6.07% (13 patients). CONCLUSIONS: A joint programme between a small-volume centre and a large-volume centre may represent a valid and reproducible model for safe paediatric cardiac surgery in the context of a peripheral region.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cardiologia/organização & administração , Cardiopatias Congênitas/cirurgia , Sociedades Médicas , Especialidades Cirúrgicas/organização & administração , Pré-Escolar , Europa (Continente) , Feminino , Humanos , Masculino , Estudos Retrospectivos
11.
Pediatr Crit Care Med ; 18(2): 159-164, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27801709

RESUMO

OBJECTIVE: To assess the utility of bedside ultrasound combining B- and M-mode in the diagnosis of abnormal diaphragmatic motion in children after heart surgery. DESIGN: Prospective post hoc blinded comparison of ultrasound performed by two different intensivists and fluoroscopy results with electromyography. SETTING: Tertiary university hospital. SUBJECTS: Children with suspected abnormal diaphragmatic motion after heart surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Abnormal diaphragmatic motion was suspected in 26 children. Electromyography confirmed the diagnosis in 20 of 24 children (83.3%). The overall occurrence rate of abnormal diaphragmatic motion during the study period was 7.5%. Median patient age was 5 months (range, 16 d to 14 yr). Sensitivity and specificity of chest ultrasound performed at the bedside by the two intensivists (91% and 92% and 92% and 95%, respectively) were higher than those obtained by fluoroscopy (87% and 83%). Interobserver agreement (k) between both intensivists was 0.957 (95% CI, 0.87-100). CONCLUSIONS: Chest ultrasound performed by intensivists is a valid tool for the diagnosis of diaphragmatic paralysis, presenting greater sensitivity and specificity than fluoroscopy. Chest ultrasound should be routinely used after pediatric heart surgery given its reliability, reproducibility, availability, and safety.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Diafragma/diagnóstico por imagem , Diafragma/fisiopatologia , Testes Imediatos , Complicações Pós-Operatórias/diagnóstico por imagem , Paralisia Respiratória/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Método Duplo-Cego , Eletromiografia , Feminino , Fluoroscopia , Humanos , Lactente , Recém-Nascido , Masculino , Variações Dependentes do Observador , Estudos Prospectivos , Reprodutibilidade dos Testes , Paralisia Respiratória/etiologia , Sensibilidade e Especificidade , Ultrassonografia
15.
Pediatr Cardiol ; 37(4): 623-8, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26687178

RESUMO

Acute kidney injury (AKI) is frequent in the postoperative period of pediatric heart surgery and leads to significant morbidity and mortality. Renal replacement therapies (RRTs) are often used to treat AKI; however, these therapies have also been associated with higher mortality rates. Earlier initiation of RRT might improve outcomes. This study aims to investigate the relationship between the RRT and morbidity and mortality after pediatric heart surgery. We performed a single-center retrospective study of all children undergoing pediatric heart surgery between April 2010 and December 2012 at a tertiary children's hospital. A total of 480 patients were included. Of those, 109 (23 %) were neonates and 126 patients (26 %) developed AKI within the first 72 postoperative hours. Patients who developed AKI had longer PICU admissions [12 days (4-37.75) vs. 4 (2-11); p < 0.001] and hospital length of stay [27 (11-53) vs. 14 (8-24) p < 0.001] and higher mortality [22/126 (17.5 %) vs. 13/354 (3.7 %); p < 0.001]. RRT techniques were used in 32 (6.6 %) patients [18/109 (16 %) neonates and 14/371 (3.8 %) infants and children; p < 0.01], with 25 (78 %) receiving peritoneal dialysis (PD) and 7 (22 %) continuous RRT (CRRT). Patients who received PD within the first 24 postoperative hours had lower mortality compared with those in whom PD was initiated later [4/16 (25 %) vs. 4/9 (44.4 %)]. Mortality among patients who received CRRT was 28.6 % (2/7). No deaths were reported in patients treated with CRRT within the first 24 postoperative hours. Postoperative AKI is associated with higher mortality in children undergoing cardiac surgery. Early initiation of RRT, both PD in neonates and CRRT in pediatric patients, might improve morbidity and mortality associated with AKI.


Assuntos
Lesão Renal Aguda/terapia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Intervenção Médica Precoce , Complicações Pós-Operatórias/terapia , Terapia de Substituição Renal , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/mortalidade , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Análise Multivariada , Diálise Peritoneal/estatística & dados numéricos , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Espanha , Fatores de Tempo
17.
World J Pediatr Congenit Heart Surg ; 6(3): 438-42, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26180162

RESUMO

BACKGROUND: Correlation between ventricular end-diastolic pressure and pulsed Doppler and tissue Doppler-derived E/e' ratio has been widely reported in adults but scarcely studied in children with congenital heart diseases. This ratio is defined as the relationship between diastolic transmitral flow velocity (cm/s; E) and myocardial diastolic relaxation velocity (cm/s; e') in the lateral aspect of the mitral annulus. Our main objective was to ascertain whether a correlation existed between direct measurement of left atrial pressure and echocardiographic E/e' ratio in children after heart surgery. METHODS: Prospective study including 27 consecutive children after pediatric heart surgery. Data were analyzed according to whether they were obtained within the first 72 hours following surgery or later on. Sensitivity, specificity, positive and negative predictive values, and areas under the receiver-operating characteristics curve of E/e' ratio in detection of left atrial pressure values ≥13 mm Hg were evaluated. RESULTS: Forty-eight studies were conducted in 27 patients. Thirty-two studies were performed during the first 72 hours after heart surgery and 16 beyond the third day. Median patient age was 0.82 years (5 days-16 years). Median left atrial pressure values and E/e' measurements of the whole cohort (N = 48) were 12.0 and 10.2, respectively. Intraclass correlation index between left atrial pressure values and echocardiographic E/e' ratio was 0.35, 0.25 for studies performed within 72 hours, but 0.78 (P < .01) for those performed later. There was also a high positive predictive value, since in 13 (87%) of 15 studies with an E/e' ratio ≥13, the left atrial pressure was ≥13 mm Hg. CONCLUSION: While echocardiographic E/e' ratio did not show a good correlation with left atrial pressure in the immediate postoperative period, the positive predictive value may suffice to aid clinicians in predicting elevated pressures.


Assuntos
Pressão Atrial/fisiologia , Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Ecocardiografia Doppler , Átrios do Coração/fisiopatologia , Cardiopatias Congênitas/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/cirurgia , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/fisiopatologia , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos
18.
World J Pediatr Congenit Heart Surg ; 6(3): 480-3, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26180171

RESUMO

Transposition of the great arteries with intact ventricular septum and persistent pulmonary hypertension (TGA-IVS PPHN) is a rare association with a poor prognosis. We report the case of a term newborn with TGA-IVS PPHN successfully managed with perioperative extracorporeal membrane oxygenation (ECMO) and aggressive pulmonary vasodilation therapy that underwent successful arterial switch procedure. A lung biopsy obtained during the surgical procedure showed pulmonary interstitial glycogenosis, a reversible condition. Concerns over left ventricle deconditioning after ECMO could be minimized with appropriate management and monitoring of the ductus arteriosus and appropriate timing of surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Permeabilidade do Canal Arterial/cirurgia , Oxigenação por Membrana Extracorpórea/métodos , Doença de Depósito de Glicogênio/etiologia , Síndrome da Persistência do Padrão de Circulação Fetal/cirurgia , Transposição dos Grandes Vasos/cirurgia , Doença de Depósito de Glicogênio/terapia , Humanos , Recém-Nascido
19.
J Immunol ; 194(9): 4199-206, 2015 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-25801430

RESUMO

Graves' disease (GD) is an autoimmune thyroid disease defined by the production of stimulating autoantibodies to the thyroid-stimulating hormone receptor (TSHR) (TSAbs) that induce a sustained state of hyperthyroidism in patients. We previously demonstrated that TSHR, the target of this autoimmune response, is also a key susceptibility gene for GD, probably acting through thymic-dependent central tolerance. We also showed that TSHR is, unexpectedly, expressed in thymocytes. In this report, we confirm the expression of TSHR in thymocytes by protein immunoblotting and quantitative PCR, and show that expression is confined to maturing thymocytes. Using functional assays, we show that thymic TSHR is functional and that TSAbs can stimulate thymocytes through this receptor. This new activity of TSAbs on thymocytes may: 1) explain GD-associated thymic enlargement (hyperplasia), and 2) suggest the provocative hypothesis that the continuous stimulation of thymocytes by TSAbs could lead to a vicious cycle of iterative improvement of the affinity and stimulating capability of initially low-affinity antibacterial (e.g., Yersinia) Abs cross-reactive with TSHR, eventually leading to TSAbs. This may help to fill one of the gaps in our present understanding of unusual characteristics of TSAbs.


Assuntos
Autoanticorpos/imunologia , Doença de Graves/imunologia , Ativação Linfocitária/imunologia , Receptores da Tireotropina/imunologia , Timócitos/imunologia , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Receptores da Tireotropina/genética , Timócitos/citologia
20.
Eur J Pediatr ; 174(7): 957-63, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25652766

RESUMO

UNLABELLED: Surgical site infection (SSI) remains a major source of morbidity, mortality, and increased health care costs in children undergoing heart surgery. The aim of this study was to assess the effectiveness of an intervention program designed to reduce the high incidence of SSI observed at our center in pediatric patients. An interdisciplinary infection control program including pre-, intra-, and postoperative measures was introduced for children undergoing heart surgery with cardiopulmonary bypass. We conducted a quasi-experimental interventional study comparing a pre-intervention cohort (June 2009 to March 2010) and a post-intervention cohort (July 2011 to July 2012). A significant drop in SSI incidence from 10.9 % (95 % CI 4.7-18.8) to 1.92 % (95 % CI 0.4-5.52) was observed. Variables significantly associated with infection risk were median age (14 days in infected vs 2.3 years in non-infected patients; p<0.01), hospitalization unit (10.3 % SSI cumulative incidence in the neonatal intensive care unit vs 0 cases in the pediatric intensive care unit; p<0.01), and median preoperative hospital stay (14 days in infected vs 1 day in non-infected patients; p=0.03). CONCLUSIONS: The implementation of a new intervention program was associated with an 82 % (95 % CI 34-94) reduction in SSI incidence in children undergoing heart surgery at our center. WHAT IS KNOWN: • Surgical site infection (SSI) is associated with significant morbidity and mortality following pediatric cardiac surgery. • Younger patients and longer cardiopulmonary bypass times are associated with higher SSI rates. What is New: • Comprehensive infection control program including preoperative, intraoperative and postoperative nonpharmacologic measures is a key factor for the prevention of SSI. • A significant reduction in SSI rates can be achieve despite a narrower-spectrum antibiotic usage.


Assuntos
Ponte Cardiopulmonar , Controle de Infecções , Esternotomia , Infecção da Ferida Cirúrgica/prevenção & controle , Fatores Etários , Estudos de Coortes , Feminino , Hospitalização , Humanos , Incidência , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Unidades de Terapia Intensiva Pediátrica , Masculino , Equipe de Assistência ao Paciente , Fatores de Risco , Espanha/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia
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