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Persistent Pulmonary Hypertension

Posted by Surgery on Oct 14, 2008
Persistent pulmonary hypertension (PPHN) affects more than 10,000 infants in the United States each year and can be defined as systemic hypoxemia, usually associated with evidence of extrapulmonary shunting and elevated pulmonary artery pressure (45:).
PPHN is associated with a wide variety of disease processes and can be categorized anatomically. Maladaptation with normal pulmonary vascular smooth muscle development can be seen in the clinical setting of birth asphyxia, sepsis, meconium aspiration, and pulmonary immaturity. Pulmonary hypertension in newborn infants has also been associated with excessive vascular muscle hypertrophy.

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Posted by Surgery on Oct 12, 2008
Neuroimaging and Central Nervous System Prognosis in Premature Infant
In light of these risks of injury and long-term sequelae, neuroimaging is used frequently because clinical evaluation of these high-risk infants may not provide adequate diagnostic or prognostic information. Not only can neuroimaging help with diagnosis of brain injury in the at-risk infant thereby assisting medical management, but also in detection of lesions that are associated with long-term neurodevelopmental disability. At the present time cranial ultrasonography (US:) and magnetic resonance imaging (MRI:) are the major imaging techniques most widely used to evaluate the premature neonate (28:).

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Current Management Recommendations for Prenatally Diagnosed Congenital Diaphragmatic Hernia

Posted by Surgery on Oct 9, 2008
After a patient is identified as carrying a fetus with a CDH, a comprehensive evaluation (:) should be undertaken to render proper family counseling. Both advanced-level ultrasonography and fetal echocardiography should be performed to screen for associated anomalies. A genetic screen and chromosomal analysis should also be performed. Being armed with this information, which includes particular specific determination of the LHR and liver herniation status, allows fetuses to be stratified according to expected outcome. In addition, those fetuses whose CDH is diagnosed before 24 weeks’ gestation have a poorer prognosis compared with those diagnosed later. If the issues regarding TO for CDH outlined previously can be resolved satisfactorily, then perhaps therapy for liver up, LHR less than 0.9 fetuses will once again be offered. It is yet to be determined if the promise of the theoretical therapeutic benefit of fetal intervention for CDH will be realized (45:).

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NUTRITIONAL REQUIREMENTS

Posted by Surgery on Sep 9, 2008
Water
The water content of infants is higher than that of adults (75% of body weight versus 65%). Fluids provide the principal source of water; however, some is provided via oxidation of food and body tissues. Water requirements are related to caloric consumption; therefore, infants must consume much larger amounts of water per unit of body weight than adults. In general, calorie requirements (kcal per kg per day) are matched to the amount of needs (mL per kg per day). The daily consumption of by healthy infants is equivalent to 10% to 15% of their body weight, in contrast to only 2% to 4% by adults. In addition, the natural food of infants and children is much higher in water content than that of adults; the fruits and vegetables consumed by infants and children contain about 90% water. Only 0.5% to 3% of total intake is retained by infants and children. About 50% is excreted through the kidneys, 3% to 10% is lost through the gastrointestinal tract, and 40% to 50% is insensible loss.
Protein
The requirement for protein in infants is based on the combined needs of growth and maintenance (Table 7-1). Two percent of the infant’s body weight, compared with 3% of the adult’s body weight, consists of nitrogen. Most of the increase in body nitrogen occurs during the first year of life, which explains the major protein requirements of infancy. The nutritional value of protein is based not only on the amount of nitrogen available, but also on the amino acid composition of the protein (5). Protein provides 4 kcal per gram of energy, and should generally be included in estimates of caloric delivery. Twenty amino acids have been identified, of which nine are essential in infants (Table 7-2).

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PLASMA MEMBRANE CONTROLS DIFFUSION : Lasix

Posted by Surgery on Jul 10, 2008

PLASMA MEMBRANE CONTROLS DIFFUSION OF SUBSTANCES BETWEEN EXTERNAL AND INTERNAL CELLULAR ENVIRONMENTS :

The plasma membrane plays a major role in the interaction of the cell with the surrounding environment. It controls the exchange of ions and macromolecules between the inside and outside of the cell. The plasma membrane contains proteins that act as receptors for extracellular ligands that modify cellular gene expression and physiology. Other membrane proteins are involved in the interaction with other cells within the same organ or migrating cells, especially of the immune system, which infiltrate the tissue during pathological conditions. The plasma membrane is also actively important in the secretion of proteins to the extracellular milieu as well as the internalization of extracellular molecules by a process known as endocytosis. For some cells, the process of endocytosis is extended to the internalization of whole cells (phagocytosis), which could be dead cells or pathogens. Ions and polar molecules pass through the plasma membrane via protein pores. These pores display substrate specificity and can be classified into pumps, carriers, and channels. Pumps drive molecules against a concentration gradient using sources of energy, especially hydrolysis of ATP.

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