Cardiopulmonary physiology was assessed by Doppler echocardiography in neonates undergoing pre-ECMO evaluation for meconium aspiration syndrome, congenital diaphragmatic hernia, persistent fetal circulation, and sepsis, from March 1987 through July 1992 (n = 136). Percent survival by diagnosis was: meconium aspiration syndrome, 86%; persistent fetal circulation, 68%; congenital diaphragmatic hernia, 63%; sepsis, 33%. Survival odds by diagnosis predicted a better outcome for meconium aspiration syndrome than for congenital diaphragmatic hernia and sepsis, and a better outcome for persistent fetal circulation than for sepsis. Percent survival for right-to-left patent ductus arteriosus flow (PDA) was 56%; other patent ductus arteriosus flow was 84%. In multivariate analysis, percent survival in congenital diaphragmatic hernia and persistent fetal circulation patients with right-to-left PDA flow suggested a worse outcome (% survival right-to-left vs other: congenital diaphragmatic hernia, 13% vs 70%; persistent fetal circulation, 25% vs 85%), whereas percent survival did not appear to suggest the same in meconium aspiration syndrome or sepsis patients. Similar analysis in non-ECMO patients suggested a worse outcome with right-to-left PDA flow in patients with meconium aspiration syndrome and congenital diaphragmatic hernia. Right-to-left PDA flow, sepsis, and congenital diaphragmatic hernia were associated with a poorer ECMO outcome. Initial assessment of PDA flow helps predict ECMO outcome.

Ductus Arteriosus, Patent↗

PubMedDate not supplied

Shoulder arthroscopy. Investigations with a fibreoptic instrument.

Ten patients with frozen shoulders and 13 other patients with derangements of the shoulder were examined by arthroscopy. The procedures were performed under anesthesia. A fibreoptic instrument was introduced posteriorly. All patients with frozen shoulders were relieved of their symptoms by the combined procedure of joint distention (with as much as 60 ml of saline) and arthroscopy, with or without manipulation of the shoulder. Three of the 13 cases of imprecisely diagnosed shoulder derangement are described in detail to illustrate refinements in the diagnosis which determined surgical repair in 2 cases and precise local treatment in the other one. All patients, whose shoulders were not manipulated, were discharged to their homes on the day of the procedures. A sling was worn for the first 24 hr and then the patient was placed on a regimen of supervised physical therapy. There was no significant morbidity in these patients. Additional refinements in arthroscopy for the shoulder and increasing expertise in using the techniques will firmly establish arthroscopy as a means for establishing precise diagnoses fro shoulder conditions.

Adolescent↗

PubMedDate not supplied

Routes of infection. A study of using "tracer particles" in the orthopedic operating room.

Wound irrigates and tissue samples were cultured from clean orthopedic wounds at the conclusion of 280 orthopedic operations. The surgeons used a laminar flow unit and took extra precautions against wound contamination although personnel exhaust systems were not used. It was possible to culture residual organisms but difficult to trace the source of these by bacteriological methods. Artificial or "tracer" particles which could be applied to patient or surgeon were retrieved from the wound and suitably stained. Using albumin microspheres it was possible to identify and differentiate "patient-derived particles" from "surgeon-derived particles" in the majority of all wounds. Contamination from the surgeon was significant even under near optimum operating room conditions. These techniques are useful for development of control measures for residual wound contamination in orthopedic operating rooms.

Bacterial Infections↗

PubMedDate not supplied

Wound contamination through drapes and gowns: a study using tracer particles.

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Bacterial Infections↗