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  • 1
    Electronic Resource
    Electronic Resource
    Transient hemiplegia and seizures in an 18-month-old child following liver transplantation (2001)
    Oxford UK : Blackwell Science Ltd
    Pediatric anesthesia 11 (2001), S. 0 
    Details
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2001.0650c.x
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  • 2
    Electronic Resource
    Electronic Resource
    Perioperative management of face-to-face craniopagus twins separation (2005)
    Oxford, UK : Blackwell Science Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    Details
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Craniopagus conjoining represents a complex and challenging issue for neurosurgeons as well as for anesthesiologists. A rare face-to-face case of conjoined twins underwent surgical separation and presented peculiar differences compared with those already reported in the literature. Even in cases lacking large cerebrovascular sinus connections, the impending risk of large blood loss and hemorrhagic shock in the infant requires a high level of surveillance and the institution of invasive monitoring.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1460-9592.2004.01480.x
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  • 3
    Electronic Resource
    Electronic Resource
    “No Allogeneic Blood Transfusion” protocol for the surgical correction of craniosynostoses I. Rationale (1998)
    Springer
    Child's nervous system 14 (1998), S. 722-731 
    Details
    ISSN: 1433-0350
    Keywords: Key words Craniosynostosis ; Allogeneic blood transfusion morbidity ; Autologous blood transfusion ; Infancy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Improved anesthesiological and surgical care has resulted in a progressively declining need for allogeneic blood transfusion. In infants with craniosynostosis, however, allogeneic blood transfusion is still performed as a routine procedure. In the present paper, the authors describe a protocol they have devised with the aim of limiting or even avoiding allogeneic blood transfusion even in very young patients, consequently avoiding the risks of infective or immunologic reactions associated with the procedure. The protocol is based on stimulation of the hematopoietic system with erythropoietin, selection of an appropriate age for operation when a favorable balance between fetal and adult-type hemoglobin is established (that is after 4–6 months), preoperative preparation of the autologous blood supply, and intraoperative blood salvage.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050305
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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    Intraventricular streptokinase infusion in acute post-haemorrhagic hydrocephalus (1998)
    Springer
    Intensive care medicine 24 (1998), S. 526-529 
    Details
    ISSN: 1432-1238
    Keywords: Key words Intraventricular haemorrhage ; Post-haemorrhagic hydrocephalus ; Term infants ; Streptokinase intraventricular infusion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Neonatal post-haemorrhagic hydrocephalus is a clinical condition with a high mortality and long-term morbidity. Its clinical management is difficult and not well standardized. We describe the case of a term baby suffering from acute intracranial hypertension caused by an intraventricular and thalamic haemorrhage. In this case, the external ventricular drain inserted to control intracranial pressure was ineffective because of repeated obstructions due to blood clots. Continuous intraventricular infusion of streptokinase of 20 000 U/day allowed quick lysis of the clots, drainage of the cerebrospinal fluid and relief from the coma. Although it did not prevent a permanent ventriculoperitoneal shunt, we obtained reabsorption of the intraventricular haemorrhage without rebleeding complications. We suggest the use of low-dose fibrinolytic infusion through an external drain for the treatment of acute intracranial hypertension following intraventricular haemorrhage in term infants.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050606
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  • 5
    Electronic Resource
    Electronic Resource
    Preemptive analgesia with tramadol and fentanyl in pediatric neurosurgery (2000)
    Springer
    Child's nervous system 16 (2000), S. 93-99 
    Details
    ISSN: 1433-0350
    Keywords: Key words Pain ; Analgesia ; Pediatric neurosurgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Preemptive analgesia is based on administration of an analgesic before a painful stimulus generates, so as to prevent the subsequent rebound mechanism. Tissue injury results in disruption of the processing mechanisms of noxious stimuli afferent to the CNS (central nervous system) by way of an increase of inputs in the spinal cord. These reactions may be reduced by the administration of opioids. Few studies on preemptive analgesia with opioids in children are available, and none of them is concerned with pediatric neurosurgery. Tramadol and fentanyl are synthetic opioids which are relatively new and act through the activation of pain-inhibitory mechanisms. We conducted a randomized, prospective trial on the preemptive effects in children of these two analgesic drugs, administered according to three different protocols: tramadol as a bolus (1 mg/kg); tramadol by continuous infusion (150 µg/kg per h); fentanyl by continuous infusion (2 µg/kg per h). In all, 42 children undergoing major neurosurgical operations were enrolled in the study, 14 in each treatment group. Each treatment was started at the induction of general anesthesia and continued throughout the entire duration of the operation. The postoperative pain evaluation was conducted in the Pediatric Intensive Care Unit at the end of the surgical operations and involved comparison of any changes in behavioral (AFS scale and CHEOPS score) and hemodynamic (heart rate, respiratory rate, systolic and diastolic arterial pressure, oxygen saturation, O2 and CO2 partial pressure) parameters. Only 2 children, both in group A, needed further drug administration postoperatively. No significant side effects were noticed in any of the three groups, except that in group A there was a higher incidence of nausea and vomiting. Tramadol efficacy seems to be better when it is administered in continuous infusion; this treatment modality also leads to fewer adverse effects. Fentanyl, in contrast, proved to be superior to tramadol in the treatment of postoperative pain. In conclusion, preemptive analgesia is a valid technique for the treatment of acute pain in children undergoing major neurosurgical operations.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050019
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  • 6
    Electronic Resource
    Electronic Resource
    Early post-traumatic seizures in children with head injury (2000)
    Springer
    Child's nervous system 16 (2000), S. 862-866 
    Details
    ISSN: 1433-0350
    Keywords: Keywords Pediatric head injury ; Post-traumatic seizures
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Post-traumatic seizures (PTS) can be a serious complication of head injury, because they can cause secondary brain damage through increased metabolic requirements, raised intracranial pressure, cerebral hypoxia, and/or excessive release of neurotransmitters. In children, early PTS are more frequent than late ones. In this retrospective study we conducted an epidemiological analysis and tried to identify potential risk factors for the onset of early PTS in children hospitalized for head injury in our Paediatric Intensive Care Unit. The severity of injury was assessed using the Glasgow Coma Scale (GCS), while the outcome of traumatized children was defined using the Glasgow Outcome Score (GOS). Early PTS were diagnosed in 15 out of the 125 children hospitalized (12%). Most of the children (73.3%), developed seizures within 24 h of the trauma (immediate PTS). Among the risk factors, a very important role was played by the severity of the injury; in fact, the incidence of early PTS among patients with GCS≤8 was ten times greater than that among children with GCS 13–15. Other risk factors that significantly influenced the onset of early PTS, were age (60% of children with early PTS were less than 3 years old) and severe cerebral edema. Overall, children with early PTS had a worse outcome than the other patients. In fact, 53% had a GOS of ≤3 compared to 19.1% of those without early PTS (P〈001). In particular, considering children with severe head injury, 80% of those with early PTS had a GOS of ≤ 3, compared to 41% of those without early PTS (P〈0.05). In conclusion, PTS can be a serious complication of head injury in children, because they can worsen secondary brain damage. Appropriate management of head-trauma patients must include suitable and immediate prophylaxis with anti-epileptic drugs.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810000368
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  • 7
    Electronic Resource
    Electronic Resource
    “No Allogeneic Blood Transfusion” protocol for the surgical correction of craniosynostoses II. Clinical application (1998)
    Springer
    Child's nervous system 14 (1998), S. 732-739 
    Details
    ISSN: 1433-0350
    Keywords: Key words Craniosynostosis ; Allogeneic blood transfusion ; Intraoperative blood salvage
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The authors describe the results obtained in 13 consecutive cases of craniosynostosis operated on according to a protocol devised at avoiding allogeneic blood transfusion. The protocol is based on pre- and postoperative treatment with erythropoietin, preoperative autologous blood donation, preoperative normovolemic hemodilution and intraoperative blood salvage. Nine subjects were affected by simple forms of craniosynostosis, whereas the remaining 4 presented with oxycephaly or craniofacial syndromes. Five of the 13 children were under 7 months and a further 3, under 10 months of age at the time of the surgical operation. Seven children weighed less than 10 kg. Allogeneic blood transfusion was avoided in 11 of the 13 children considered. Two failures – defined as the necessity to reinfuse the patient with an allogeneic blood transfusion – were recorded, 1 of them resulting from an unexpected hemorrhage during surgery. The results obtained indicate that this protocol designed to avoid allogeneic blood transfusion can be safely applied in the great majority of children with craniosynostosis, even when the surgical correction is carried out early in life.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050306
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  • 8
    Electronic Resource
    Electronic Resource
    Ruptured intracranial mycotic aneurysm presenting as cerebral haemorrhage in an infant: case report and review of the literature (2000)
    Springer
    Child's nervous system 16 (2000), S. 190-193 
    Details
    ISSN: 1433-0350
    Keywords: Key words Cerebral aneurysm ; Infant ; Intracranial haemorrhage ; Mycotic aneurysm
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  A 2-month-old male infant presented with intracranial haemorrhage caused by ruptured intracranial mycotic aneurysm. Computed tomography and cerebral selective angiography revealed a large haematoma in the left sylvian fissure and a mycotic aneurysm of a peripheral branch of the middle cerebral artery. Despite the successful surgical removal, the child did not recover from the initial brain injury and died 2 months later. There have been fewer than 10 reported cases of infantile mycotic aneurysms and its occurrence in the absence of infectious endocarditis is exceptionally rare.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050492
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