“This best evidence topic in congenital cardiac surgery wa


“This best evidence topic in congenital cardiac surgery was written according to a structured protocol. The question addressed was whether the use of balloon atrial septostomy (BAS) before the arterial switch surgery for transposition of the great arteries (TGA) improved the final outcome. Altogether

more than 251 papers were found using the reported search, of which 12 represented the best evidence to answer the clinical question. The search was further limited to recent articles since find more the results have improved compared with previous years, due to newer equipment and techniques. This narrowed the search to five papers that have focused on this issue since 2006 when a study of 29 term neonates identified BAS as major risk factor for focal brain injury and reinvigorated the debate of adverse neurological outcome especially in the context of the fact that total correction by the arterial switch

procedure is routine in neonates now. Subsequently, a prospective study of 64 newborn infants followed by another study of 26 neonates with TGA, have shown no association between BAS and brain injury. Similarly, in a study of more than 2000 cases of dTGA, no association has been found between BAS and increased risk of clinical stroke either in the neonatal period or in follow-up hospitalizations. On the other hand, another nationwide data analysis LCL161 mw of 8681 patients with TGA, has shown increased risk of stroke in patients undergoing

BAS but it could only show association and not establish causation of the complication. A-1210477 inhibitor The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated.”
“P>Invasive aspergillosis (IA) at the insertion site of central venous catheters is a rare event. Here we report the occurrence of chest wall aspergillosis at the insertion site of a Broviac catheter in a 5-year-old child undergoing allogeneic hematopoietic stem cell transplantation. The infection arose during profound granulocytopenia under conditions of reverse isolation with laminar air flow and high efficiency particulate air filtration and was successfully managed with repeat surgical debridement, voriconazole/caspofungin combination therapy guided by therapeutic drug monitoring, and adjunctive use of granulocyte colony-stimulating factor. The case reflects the occurrence of IA despite reverse isolation and air decontamination, the principles of treatment of Aspergillus soft tissue infections in granulocytopenic patients, and the need for therapeutic drug monitoring of voriconazole particularly in young children.”
“Epithelial cells organize into various tissue architectures that largely maintain their structure throughout the life of an organism.

Comments are closed.