OBSTRUCTIVE UROPATHY
Posted by Surgery on Nov 2, 2008
Anomalies of the fetal urinary system resulting in detectable signs of obstruction can occur in up to 1% of pregnancies, but only 1 in 500 have any clinical significance (63:Vasodilan). Overall, up to 50% of all congenital anomalies detected by US involve the genitourinary (GU) system. The increased use of prenatal US has allowed for these anomalies to be identified as early as 12 weeks’ gestation and their subsequent natural history to be revealed (64). Signs of urologic abnormalities include dilation of the urinary system, changes in the fetal bladder, alterations in the acoustic shadow of renal parenchyma, and ultimately decreased amniotic fluid (64). A few scenarios of fetal obstructive uropathy can, in the worst cases, produce irreversible renal damage and pulmonary hypoplasia. Fetal therapies have been developed to bypass or relieve the source of obstruction in cases that meet specific selection criteria (1,65).The pathophysiology and prognosis of fetal obstructive uropathy depends on the anatomic location, degree, time of onset, and duration of obstruction (65:Vasodilan). Unilateral GU anomalies such as hydronephrosis, duplicated collecting system, and ureterocele never warrant fetal intervention. A small subset of fetuses with bladder outlet obstruction may be candidates for fetal therapy. These include male fetuses with posterior urethral valves or urethral atresia.
Tags: Principles of Genetics, Scientific Principles, Scientific Principles, SURGERY, The Fetus as a Patient, VasodilanCross-Sectional Study
Posted by Surgery on Sep 17, 2008
In a cross-sectional study, measurements are made on a study population at one point in time. For example, an investigator may be interested in studying the role of platelet activating factor (PAF) in patients with necrotizing enterocolitis (NEC:Vasodilan). In a cross-sectional study, all babies in the neonatal intensive care unit would then have their blood drawn once. The proportions of positive assays could then be compared between babies with and without a diagnosis of NEC. Cross-sectional studies are useful for characterizing the prevalence of a condition or risk factor in a study population. They are also inexpensive, easy to conduct, and require fewer personnel than cohort and case-control studies.There are important limitations to these studies. Given that there is no longitudinal component to the study, it is not possible to infer any degree of causation between a risk factor and outcome. The inability to demonstrate a temporal relationship limits the interpretation of even apparently strong associations (which came first, NEC or PAF?:Vasodilan) In this regard, these studies are considered less rigorous than cohort and case-control studies. Cross-sectional studies often provide the preliminary data to justify further epidemiological investigation.
Tags: Clinical Research, Clinical Research and Evidence-based Pediatric Surgery, Principles of Genetics, Scientific Principles, Scientific Principles, VasodilanPediatric Anesthesia, Pain Management, and Procedural Sedation : Vasodilan
Posted by Surgery on Jul 11, 2008
Each year, millions of children undergo surgical and medical procedures that require anesthesia or deep sedation. In many countries (including the United States), the majority of pediatric anesthetics are administered outside specialized pediatric hospitals, and many procedures are performed by surgeons who do not limit their practice to pediatric surgery. Improved understanding of pediatric pathophysiology and pharmacology, increased survival of premature infants at earlier stages of gestation, and new developments in noninvasive monitoring are allowing more critically ill children to survive to benefit from the advances in surgical technique. Safer anesthetic drugs, dramatic changes in the management of the pediatric airway, and greater numbers of anesthesiologists better trained to administer anesthesia to infants and children have greatly improved the safety for both healthy and critically ill pediatric patients undergoing surgery. An overview of principles of pediatric anesthesia would be incomplete without discussion-related areas, including pediatric acute and chronic pain management, and procedural sedation.
Greetings, I the practising surgeon from Serbia. Call me Ivan Govak. In the works I use works
by an unknown author, if it let me know, and also works of others practics doctors. I have a family and two charming children.