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  • 1
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  Süddeutscher Kongress für Kinder- und Jugendmedizin; 62. Jahrestagung der Süddeutschen Gesellschaft für Kinder- und Jugendmedizin gemeinsam mit der Süddeutschen Gesellschaft für Kinderchirurgie und dem Berufsverband der Kinder- und Jugendärzte e.V. - Landesverband Saarland; 20130503-20130505; Saarbrücken; DOC13sgkjP7 /20130417/
    Publication Date: 2013-04-18
    Keywords: ddc: 610
    Language: German
    Type: conferenceObject
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  • 2
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  Süddeutscher Kongress für Kinder- und Jugendmedizin; 62. Jahrestagung der Süddeutschen Gesellschaft für Kinder- und Jugendmedizin gemeinsam mit der Süddeutschen Gesellschaft für Kinderchirurgie und dem Berufsverband der Kinder- und Jugendärzte e.V. - Landesverband Saarland; 20130503-20130505; Saarbrücken; DOC13sgkjFV2 /20130417/
    Publication Date: 2013-04-18
    Keywords: ddc: 610
    Language: German
    Type: conferenceObject
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  • 3
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  Süddeutscher Kongress für Kinder- und Jugendmedizin; 62. Jahrestagung der Süddeutschen Gesellschaft für Kinder- und Jugendmedizin gemeinsam mit der Süddeutschen Gesellschaft für Kinderchirurgie und dem Berufsverband der Kinder- und Jugendärzte e.V. - Landesverband Saarland; 20130503-20130505; Saarbrücken; DOC13sgkjP10 /20130417/
    Publication Date: 2013-04-18
    Keywords: ddc: 610
    Language: German
    Type: conferenceObject
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  • 4
    Publication Date: 2006-04-21
    Keywords: ddc: 610
    Language: English
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  • 5
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  Süddeutscher Kongress für Kinder- und Jugendmedizin; 62. Jahrestagung der Süddeutschen Gesellschaft für Kinder- und Jugendmedizin gemeinsam mit der Süddeutschen Gesellschaft für Kinderchirurgie und dem Berufsverband der Kinder- und Jugendärzte e.V. - Landesverband Saarland; 20130503-20130505; Saarbrücken; DOC13sgkjP28 /20130417/
    Publication Date: 2013-04-18
    Keywords: ddc: 610
    Language: German
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  • 6
    ISSN: 1432-0932
    Keywords: Rachis cervical supérieur ; Ligament alaire ; Ligament transverse ; Anatomie ; Biomécanique ; Upper cervical spine ; Alar ligament ; Transverse ligament ; Anatomy ; Biomechanics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary The occipito-atlanto-axial joint is the most complex one of the human spine. Traumatic or inflammatory lesions in this region may lead to instability and neurological symptoms of clinical importance. This study reports the results of anatomical and biomechanical examination of 13 human upper cervical spine specimens and focuses on the viscoelastic behavior of the alar and transverse ligaments. Non-destructive tensile testing was performed on a uniaxial testing machine with 25 alar and 11 transverse ligaments at three different load rates of 0.1 mm/s, 1.0 mm/s, and 10.0 mm/s. The ligaments were further tested for relaxation over 300 s. Each ligament exhibited an initial neutral zone in which no tensile force could be measured during cyclic testing. This neutral zone was more significant in the alar ligaments than in the transverse ligaments with respect to the measured in situ length of the ligaments (11.2 vs 18.1 mm on average). Increasing axial deformation led to increased load in all ligaments. Hysteresis, i.e., the energy loss exhibited by viscoelastic material subjected to loading and unloading cycles, increased with higher displacement rates and higher tensile forces. In neutral position the alar ligaments were lax in all specimens. During axial rotation both alars tightened. Ligamentous resistance increased as the end of the range of motion (ROM) was approchaed during rotation. The neutral zone explains the laxity of the ligaments in midposition and allows mobility of the upper cervical spine with minimum expenditure of muscular energy. The ligaments become stiffer under higher loads and therefore contribute to a limitation of the ROM in the occipitio-atlanto-axial joint.
    Notes: Résumé L'articulation occipito-atlanto-axoïdienne est l'une des plus complexes du rachis humain. Les lésions traumatiques ou inflammatoires de cette région peuvent conduire à l'instabilité et à des troubles neurologiques importants. Cette étude rapporte les résultats d'une étude anatomique et biomécanique de 13 spécimens de rachis cervical supérieur et met l'accent sur le comportement visco-élastique des ligaments alaires et transverse. Des essais de mise en tension ont été réalisés sur 25 ligaments alaires et 11 ligaments transverses, en restant en deçà du point de rupture. Ils ont été effectués sur un appareil monoaxial, selon trois niveaux de charge différents: 0.1 mm/s, 1.0 mm/s et 10.0 mm/s. La détente ligamentaire a été en outre étudiée pendant 300s. Chaque ligament a montré une zone neutre initiale (NZ) dans laquelle aucune force de tension ne pouvait être mesurée au cours du cycle d'essai. Cette zone neutre était plus importante pour les ligaments alaires que pour les ligaments transverses, compte tenu de la longueur ligamentaire mesurée in situ (11.2 contre 18.1 mm en moyenne). L'augmentation de la déformation axiale a conduit à une augmentation des contraintes dans tous les ligaments. L'hystérésis, c'est à dire la perte d'énergie présentée par le matériel visco-élastique soumis à des cycles de mise en charge et décharge, augmentait avec l'amplitude du déplacement et l'intensité des forces de tension. En position neutre, les ligaments alaires étaient détendus sur tous les spécimens. Lors de la rotation axiale, les deux ligaments alaires se sont mis en tension. La résistance du ligament à la rotation s'est trouvée accrue en fin d'amplitude. La zone neutre explique la laxité des ligaments en position intermédiaire et permet la mobilité du rachis cervical supérieur avec un minimum de dépense d'énergie. Les ligaments se tendent sous des charges plus élevées et par conséquent contribuent à la limitation de ROM dans l'articulation occipito-atlanto-axoïdienne.
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  • 7
    ISSN: 1432-1076
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 8
    ISSN: 1432-1238
    Keywords: Key words Anemia ; Preterm infants ; Serum lactate ; Cardiac output ; Oxygen saturation ; Blood transfusion ; Oxygen delivery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Whether and when to transfuse in anemia of prematurity is highly controversial. Some authors suggest transfusions simply if the hemoglobin (Hb) level is below a defined normal range. Others propose the use of clinical or laboratory parameters in anemic patients to decide whether to transfuse or not. Hypothesis: A decreasing amount of circulating Hb should cause a compensatory increase in cardiac output (CO) and an increase in arterial serum lactate. Materials and methods: In 56 anemic preterm infants (not in respiratory or hemodynamic failure) we analyzed CO after the first week of life using a Doppler sonographic method. At the same time serum lactate levels, Hb levels and oxygen saturation were registered. Nineteen of these patients were given transfusion when they demonstrated clinical signs of anemia by tachycardia 〉180/min, tachypnea, retractions, apneas and centralization (group 2). The remaining 37 patients were not transfused (group 1). Serum lactate, CO, heart rate (HR), oxygen delivery, respiratory rate, capillary refill and Hb were analyzed in both groups and in group 2 before and 12–24 h after transfusion. Data between groups  1 and 2 and in group 2 before and after transfusion were compared. Results: In the 56 patients studied no linear correlation between Hb and CO or between Hb and serum lactate was found. Nor could any correlation be demonstrated between the other variables studied. Examining the subgroups separately, a negative linear correlation was demonstrated between serum lactate and oxygen delivery in group 2. No other significant correlations were detected. However, when the pre- and post-transfusion data were compared in group 2 (increase of Hb from 9.45 (SD 3.44) to 12.5 (SD 3.8) g/100 ml), the CO decreased from 281.3 (SD 162.6) to 224 (SD 95.7) ml/kg per min (p〈0.01) and serum lactate decreased significantly from 3.23 mmol/l (SD 2.07) before to 1.71 (SD 0.83) after transfusion. Oxygen delivery was 35.8 (±0.19) ml/kg per min group 1, 27.8 (±0.05) pre- and 43.4 (±0.07) post-transfusion in group 2 (p〈0.01). Conclusions: CO measurements and serum lactate levels add little information to the decision-making process for blood transfusions, as neither CO nor serum lactate levels correlate with Hb levels in an otherwise asymptomatic population of preterm infants. In infants where the indication for blood transfusion is made based on traditionally accepted clinical criteria, serum lactate is an additional laboratory indicator of impaired oxygenation, as it correlates significantly with oxygen delivery. A significantly lower oxygen delivery in patients in whom blood transfusion is indicated and an increase in oxygen induced by transfusion demonstrate the value of these criteria in identifying preterm infants who benefit from transfusion.
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  • 9
    ISSN: 1432-1238
    Keywords: Anemia ; Preterm infants ; Serum lactate ; Cardiac output ; Oxygen saturation ; Blood transfusion ; Oxygen delivery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background Whether and when to transfuse in anemia of prematurity is highly controversial. Some authors suggest transfusions simply if the hemoglobin (Hb) level is below a defined normal range. Others propose the use of clinical or laboratory parameters in anemic patients to decide whether to transfuse or not. Hypothesis A decreasing amount of circulating Hb should cause a compensatory increase in cardiac output (CO) and an increase in arterial serum lactate. Materials and methods In 56 anemic preterm infants (not in respiratory or hemodynamic failure) we analyzed CO after the first week of life using a Doppler sonographic method. At the same time serum lactate levels. Hb levels and oxygen saturation were registered. Nineteen of these patients were given transfusion when they demonstrated clinical signs of anemia by tachycardia 〉180/min, tachypnea, retractions, apneas and centralization (group 2). The remaining 37 patients were not transfused (group 1). Serum lactate, CO, heart rate (HR), oxygen delivery, respiratory rate, capillary refill and Hb were analyzed in both groups and in group 2 before and 12–24 h after transfusion. Data between groups 1 and 2 and in group 2 before and after transfusion were compared. Results In the 56 patients studied no linear correlation between Hb and CO or between Hb and serum lactate was found. Nor could any correlation be demonstrated between the other variables studied Examining the subgroups separately a negative linear correlation was demonstrated between serum lactate and oxygen delivery in group 2. No other significant correlations were detected. However, when the pre- and post-transfusion data were compared in group 2 (increase of Hb from 9.45 (SD 3.44) to 12.5 (SD 3.8) g/100 ml), the CO decreased from 281. 3 (SD 162.6) to 224 (SD 95.7) ml/kg per min (p〈0.01) and serum lactate decreased significantly from 3.23 mmol/l (SD 2.07) before to 1.71 (SD 0.83) after transfusion. Oxygen delivery was 35.8 (±0.19) ml/kg per min group 1, 27.8 (±0.05) pre- and 43.4 (±0.07) post-transfusion in group 2 (p〈0.01). Conclusions CO measurements and serum lactate levels add little information to the decision-making process for blood transfusions, as neither CO nor serum lactate levels correlate with Hb levels in an otherwise asymptomatic population of preterm infants. In infants where the indication for blood transfusion is made based on traditionally accepted clinical criteria, serum lactate is an additional laboratory indicator of impaired oxygenation, as it correlates significantly with oxygen delivery. A significantly lower oxygen delivery in patients in whom blood transfusion is indicated and an increase in oxygen induced by transfusion demonstrate the value of these criteria in identifying preterm infants who benefit from transfusion.
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  • 10
    ISSN: 1432-1076
    Keywords: Key words Preterm infants ; Intussusception ; Necrotizing enterocolitis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Intussusception is an extremely rare disorder in preterm infants. An infant of 29 weeks gestational age with this condition is reported and a retrospective analysis of 17 previously reported cases presented. In the reviewed preterm infants, risk factors for intussusception seemed to be multifactorial. Clinical features included severe abdominal distension (17/17), gastric aspirates (13/17), commonly bilious, bloody stools (10/17) and rarely a palpable abdominal mass (5/17). Diagnostic features were signs of small bowel obstruction on the abdominal radiographs. Signs and symptoms were similar to those seen in necrotizing enterocolitis, therefore difficulties in establishing a correct diagnosis led to an average delay of 7 days between the onset of symptoms and abdominal surgery, increasing the risk of developing a compromised bowel. Conclusion The differential diagnosis of an intussusception should be considered in preterm infants with acute abdominal distension and tenderness.
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