PubMed · 16488720
The source did not provide an abstract. Follow the original record for more information.
Explore connections, maps & timelines
Thomas M Daniel. 2006. Invited commentary.. https://doi.org/10.1016/j.athoracsur.2005.10.040
Cite the original work for its findings. Save a collection to share your selection of sources.
KEEP EXPLORING
Explore the source record for details and available documents.
Cervical and thoracic myelomeningocoeles differ from common lumbosacral myelomeningocoeles in many respects. We review the surgical technique and outcome achieved for a series of six infants who underwent surgery for cervical or thoracic myelomeningocoele. Five patients, who had intradural exploration and microsurgical untethering of the spinal cord, were neurologically stable on follow-up. The other patient, who had a simple subcutaneous resection of the sac without release of the intradural tethering bands, was re-operated on 16 months later, with progressive neurological symptoms due to cord tethering. Following re-exploration and microsurgical untethering of the spinal cord, the neurological deficits significantly improved. We suggest that the surgical technique in these lesions should include careful intradural exploration and microsurgical release of the spinal cord by meticulous resection of all tethering bands. This enables postoperative neurological improvement and possible prevention of future neurological deficits due to cord tethering.
RATIONALE: Changes in oxygenation are often used to guide the recruitment procedure during open lung high-frequency ventilation in preterm infants. However, data on the feasibility and safety of this approach in daily clinical practice are limited. OBJECTIVE: To prospectively collect data on ventilator settings, gas exchange, and circulatory parameters before and after surfactant therapy during open lung high-frequency ventilation. METHODS: In 103 preterm infants with respiratory distress syndrome, the opening, closing, and optimal pressures were determined during high-frequency ventilation by increasing and decreasing stepwise the continuous distending pressure, defining optimal recruitment as adequate oxygenation using a fraction of inspired oxygen not exceeding 0.25. This procedure was repeated after each surfactant treatment. MEASUREMENTS AND MAIN RESULTS: The mean presurfactant opening and optimal continuous distending pressures were, respectively, 20.5 +/- 4.3 and 14.0 +/- 4.0 cm H2O, with a fraction of inspired oxygen of 0.24 +/- 0.04. Surfactant treatment enabled a reduction in the mean optimal pressure of almost 6 cm H2O without compromising oxygenation. Blood pressure and heart rate remained stable and no air leaks were observed during the recruitment procedures. The mortality rate and the incidence of severe intracranial hemorrhage or periventricular leukomalacia and chronic lung disease at 36 wk were comparable to previously reported data. CONCLUSION: Open lung high-frequency ventilation using oxygenation to guide the recruitment process is feasible and safe in preterm infants and enables a reduction of the fraction of inspired oxygen below 0.25 in the majority of preterm infants with respiratory distress syndrome.