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Der Urologe. Ausg. A Oct 2021The conservative and surgical treatment of children is a fundamental pillar of the urological specialist training program and represents one of the core competencies...
BACKGROUND
The conservative and surgical treatment of children is a fundamental pillar of the urological specialist training program and represents one of the core competencies within urological healthcare. The loss of this expertise has been a reoccurring topic within urologic occupational policy. The aim of this study is to analyse actual case numbers and to compare the distribution and dynamics of pediatric urologic surgeries between the specialist departments of urology and pediatric surgery in Germany.
MATERIALS AND METHODS
We defined the surgical treatments of maldecensus testis, hypospadias, and vesicoureteral reflux (VUR) as index interventions. Using the tool reimbursement.INFO (RI Innovation GmbH, Hürth, Germany) we analysed publicly available quality report data of German hospitals between 2006 and 2019.
RESULTS
While orchidopexy was more commonly performed in the field of urology, the correction of hypospadias and the surgical treatment of VUR showed higher case numbers in the field of pediatric surgery. Proportionally, there was no relevant shift between urologic and pediatric surgical clinics for orchidopexy and surgical VUR therapy during the study period. For hypospadias corrections, the proportion of surgeries performed in pediatric surgical units is increasing (p < 0.0001). In pediatric surgery 84-93% of the analyzed procedures are performed in high-volume units, while this proportion is 56-73% in urology. In particular, a high proportion of VUR therapy in urology is performed as an occasional procedure (30% very low volume).
CONCLUSIONS
The quality report data enable the compilation of case numbers and the analysis of the distribution between urology and pediatric surgery in Germany. Merely the correction of hypospadias has shown a relevant shift towards pediatric surgery. The causes and possible consequences for professional policy of this preliminary investigation are complex and require further analysis.
Topics: Child; Delivery of Health Care; Germany; Humans; Hypospadias; Male; Urologic Surgical Procedures; Urology
PubMed: 34524493
DOI: 10.1007/s00120-021-01636-z -
Arquivos Brasileiros de Cardiologia May 2008Eisenmenger's syndrome consists of pulmonary hypertension with a reversed or bidirectional shunt at the atrioventricular, or aortopulmonary level. Eisenmerger's syndrome...
Eisenmenger's syndrome consists of pulmonary hypertension with a reversed or bidirectional shunt at the atrioventricular, or aortopulmonary level. Eisenmerger's syndrome in pregnancy is usually associated with high mortality rates (nearly 30-50%). Unfortunately, pulmonary hypertension is aggravated during pregnancy and often leads to an unfavorable outcome. Here, we report a successful pregnancy in a woman with Eisenmenger syndrome.
Topics: Adult; Anticoagulants; Cesarean Section; Eisenmenger Complex; Female; Humans; Hypertension, Pulmonary; Infant, Newborn; Oxygen Inhalation Therapy; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome; Pregnancy, High-Risk
PubMed: 18516394
DOI: 10.1590/s0066-782x2008000500015 -
Journal of the American College of... Jan 1999The purpose of this study was to evaluate the morbidity and mortality associated with noncardiac surgery (NCS) in patients (pts) with Eisenmenger syndrome.
OBJECTIVES
The purpose of this study was to evaluate the morbidity and mortality associated with noncardiac surgery (NCS) in patients (pts) with Eisenmenger syndrome.
BACKGROUND
Noncardiac surgery in pts with Eisenmenger syndrome is associated with increased cardiovascular complications.
METHODS
Fifty-eight pts with Eisenmenger syndrome (17M, 41F aged 18 to 69 years (mean 41 years) who had been followed for up to 41.5 years (mean 9.3 years) were retrospectively evaluated for any NCS done at > or = 17 years of age.
RESULTS
Twenty-four pts had a total of 28 NCSs at an age of 17 to 55 years (mean 29 years) including 9 tubal ligations, 3 neurosurgeries, 3 cholecystectomies, 3 hysterectomies, 3 vasectomies, and 1 each spinal fusion, appendectomy, eye enucleation, hernia repair, hand surgery, tonsillectomy and therapeutic abortion. There were two deaths (7%), one following spinal fusion and the other following appendectomy at another institution. Fourteen of these NCSs were performed at our institution, including 11 under general anesthesia. The duration of anesthesia varied from 75 to 525 min (mean 165 min). All pts remained in sinus rhythm. The lowest systolic blood pressure (BP) ranged from 78 to 125 mm Hg. Of those 11 pts, 9 were extubated immediately after surgery and 2 needed dopamine. Ten patients were discharged without any complications, including 3 within 1 day of surgery. One death occurred 10 days following spinal fusion. This pt had the longest anesthesia (525 min) and an intraoperative systolic BP as low as 78 mm Hg. She also needed the largest fluid administration (6,475 cc) in addition to postoperative mechanical ventilation and dopamine.
CONCLUSIONS
Adult pts with Eisenmenger syndrome are at increased risk with NCS, but with current/modern techniques, the risk of death is less than previously thought. In the vast majority of cases, NCS can be undertaken without substantial morbidity, and early extubation is achievable. However, even with relatively minor surgery, significant complications, including death, can occur. Referral to major centers with expertise in the care of pts with Eisenmenger syndrome is advisable.
Topics: Adolescent; Adult; Aged; Cause of Death; Eisenmenger Complex; Female; Humans; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Risk; Survival Rate
PubMed: 9935034
DOI: 10.1016/s0735-1097(98)00554-3 -
Anatolian Journal of Cardiology Jan 2017
Topics: Adult; Arrhythmias, Cardiac; Biomarkers; Case-Control Studies; Echocardiography; Eisenmenger Complex; Electrocardiography, Ambulatory; Exercise Test; Female; Humans; Male; Natriuretic Peptide, Brain; Troponin I
PubMed: 28144000
DOI: 10.14744/AnatolJCardiol.2017.7424 -
Frontiers in Cardiovascular Medicine 2022Atrial septal defect (ASD) is the most common congenital heart disease (CHD) in adults and pulmonary hypertension (PH) is an established risk factor. A decision whether...
BACKGROUND
Atrial septal defect (ASD) is the most common congenital heart disease (CHD) in adults and pulmonary hypertension (PH) is an established risk factor. A decision whether to perform ASD closure, especially in elderly patients with PH, is a complex dilemma. The aim of our study was to compare long-term survival in patients with closed and open ASD.
METHODS
A retrospective cohort study was performed on 427 patients with ASD (median age at diagnosis 38 years, IQR 18-56) out of which 186 patients (44%) manifested PH. ASD closure in patients with PH was only considered in patients without Eisenmenger syndrome with pulmonary vascular resistance < 5 WU. Median follow-up duration was 18 years (IQR 9-31 years). Kaplan-Meier and Cox proportional hazards survival analyses were performed to evaluate 12 potential predictors of survival.
RESULTS
Defect closure was associated with improved long-term survival in ASD patients both with ( < 0.001) and without PH ( = 0.01) and this association was present also in patients over 40 years. The 20-year survival since diagnosis was significantly higher in patients with PH and closed ASD compared to those with PH and open ASD (65% vs. 41%). ASD closure was a significant independent predictor of long-term survival ( = 0.003) after accounting for age at diagnosis, PH, NYHA class, Eisenmenger syndrome, and mitral regurgitation. Significant negative independent predictors of survival were older age at diagnosis ( < 0.001), Eisenmenger syndrome ( < 0.001), and PH ( = 0.03).
CONCLUSION
ASD closure appears to be associated with improved long-term survival independently of age, PH, and other clinical variables.
PubMed: 35571174
DOI: 10.3389/fcvm.2022.867012 -
Heart (British Cardiac Society) Dec 2007Despite fears of compromised oxygen delivery in patients with Eisenmenger syndrome during flight on commercial aircraft, a clinical study has shown no adverse effects,...
BACKGROUND
Despite fears of compromised oxygen delivery in patients with Eisenmenger syndrome during flight on commercial aircraft, a clinical study has shown no adverse effects, and many patients travel frequently.
METHODS
The air travel history over the past decade of 53 patients with Eisenmenger syndrome and 48 acyanotic patients was obtained. Patients listed all flights and destinations, and any major adverse event or symptoms, including, specifically, headache, palpitations, oedema or need for supplemental oxygen. For the patients with Eisenmenger syndrome, a full blood count, 6-minute walk test and p50 of the oxygen-haemoglobin dissociation curve were also obtained.
RESULTS
1157 flights were reported evenly between the two groups. Thirteen patients with Eisenmenger syndrome reported no travel in the past 10 years (vs 4/48 acyanotic patients, p = 0.03), six of whom were told not to fly by healthcare providers. Of those who flew, the number and distance of flights was similar in both groups. No major adverse events were reported. One patient with Eisenmenger syndrome possibly had a transient ischaemic attack and a second patient needed supplemental oxygen when exposed to ambient cigarette smoke in flight. Other symptoms such as headache, palpitations and lower extremity oedema at the travel destination were reported with similar frequency in both groups. Patients with Eisenmenger syndrome had a raised p50 of the oxygen-haemoglobin dissociation curve (mean (SD) 29.4 (2.6) mm Hg vs 27 (3) mm Hg in laboratory controls, p<0.01).
CONCLUSIONS
Patients with Eisenmenger syndrome report travelling frequently and safely on commercial airlines. Shifts in the oxygen-haemoglobin dissociation curve are likely to attenuate the effects of low oxygen tension. Patients with Eisenmenger syndrome should, nevertheless, be advised to avoid inactivity and dehydration as usual, but there is no justification for limiting air travel.
Topics: Adult; Aerospace Medicine; Aircraft; Edema; Eisenmenger Complex; Female; Headache; Humans; Ischemic Attack, Transient; Leg; Male; Oxygen; Travel
PubMed: 17164484
DOI: 10.1136/hrt.2006.105239 -
Medicina (Kaunas, Lithuania) Sep 2021Mirror syndrome (MS) or Ballantyne's syndrome is a rare maternal condition that can be life-threatening for both mother and fetus. The condition is characterized by...
Mirror syndrome (MS) or Ballantyne's syndrome is a rare maternal condition that can be life-threatening for both mother and fetus. The condition is characterized by maternal signs and symptoms similar to those seen in preeclampsia in the setting of fetal hydrops. Despite recent advances in the field of maternal-fetal medicine, the etiopathogenesis of MS remains elusive. For patients and doctors, the COVID-19 pandemic has become an extra hurdle to overcome. The following case illustrates how patients' non-compliance associated with mirror syndrome and SARS-CoV-2 infection led to the tragic end of a 19-year-old patient. Therefore, knowledge of the signs and symptoms of mirror syndrome should always be part of the armamentarium of every obstetrician.
Topics: Adult; COVID-19; Eisenmenger Complex; Female; Humans; Hydrops Fetalis; Pandemics; Pregnancy; SARS-CoV-2; Young Adult
PubMed: 34684068
DOI: 10.3390/medicina57101031 -
Annals of the Royal College of Surgeons... Sep 1984The Eisenmenger syndrome is a form of cyanotic congenital heart disease not usually amenable to corrective surgery. It is, however, compatible with leading an active... (Review)
Review
The Eisenmenger syndrome is a form of cyanotic congenital heart disease not usually amenable to corrective surgery. It is, however, compatible with leading an active life in early adulthood and due to advances in medical therapy it is not uncommon for patients with this syndrome to live to 30 years or more. Occasionally, therefore, anaesthetists and surgeons will be required to care for these patients when they present for incidental surgery. This article reviews the appropriate measures for the safe operative and perioperative care of patients, based on an understanding of the pathophysiological changes which occur in the Eisenmenger syndrome.
Topics: Anesthesia, Conduction; Anesthesia, General; Anesthesia, Obstetrical; Cesarean Section; Eisenmenger Complex; Female; Humans; Monitoring, Physiologic; Pregnancy
PubMed: 6385803
DOI: No ID Found -
Heart (British Cardiac Society) Jun 2007To investigate the role of pulmonary arterial hypertension (PAH) in adult patients born with a cardiac septal defect, by assessing its prevalence and its relation with...
AIM
To investigate the role of pulmonary arterial hypertension (PAH) in adult patients born with a cardiac septal defect, by assessing its prevalence and its relation with patient characteristics and outcome.
METHODS AND RESULTS
From the database of the Euro Heart Survey on adult congenital heart disease (a retrospective cohort study with a 5-year follow-up), the relevant data on all 1877 patients with an atrial septal defect (ASD), a ventricular septal defect (VSD), or a cyanotic defect were analysed. Most patients (83%) attended a specialised centre. There were 896 patients with an ASD (377 closed, 504 open without and 15 with Eisenmenger's syndrome), 710 with a VSD (275, 352 and 83, respectively), 133 with Eisenmenger's syndrome owing to another defect and 138 remaining patients with cyanosis. PAH was present in 531 (28%) patients, or in 34% of patients with an open ASD and 28% of patients with an open VSD, and 12% and 13% of patients with a closed defect, respectively. Mortality was highest in patients with Eisenmenger's syndrome (20.6%). In case of an open defect, PAH entailed an eightfold increased probability of functional limitations (New York Heart Association class >1), with a further sixfold increase when Eisenmenger's syndrome was present. Also, in patients with persisting PAH despite defect closure, functional limitations were more common. In patients with ASD, the prevalence of right ventricular dysfunction increased with systolic pulmonary artery pressure (OR = 1.073 per mm Hg; p<0.001). Major bleeding events were more prevalent in patients with cyanosis with than without Eisenmenger's syndrome (17% vs 3%; p<0.001).
CONCLUSION
In this selected population of adults with congenital heart disease, PAH was common and predisposed to more symptoms and further clinical deterioration, even among patients with previous defect closure and patients who had not developed Eisenmenger's physiology.
Topics: Adult; Age Factors; Cohort Studies; Eisenmenger Complex; Female; Health Surveys; Heart Septal Defects; Humans; Hypertension, Pulmonary; Male; Middle Aged; Multivariate Analysis; Prevalence; Retrospective Studies; Severity of Illness Index; Ventricular Dysfunction, Right
PubMed: 17164490
DOI: 10.1136/hrt.2006.098848 -
Kidney International Nov 2018
Topics: Drainage; Eisenmenger Complex; Humans; Kidney; Male; Middle Aged; Tomography, X-Ray Computed
PubMed: 30348295
DOI: 10.1016/j.kint.2018.05.010