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Spontaneous Intestinal Perforation

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EN
Spontaneous intestinal perforation (SIP) and necrotizing enterocolitis (NEC) are the reason of intestinal damage in preterm neonates with low and extremely low body weight. Etiology of SIP is still unknown. It has not been determined whether SIP is a separate disease entity or only benign form of necrotizing enterocolitis (NEC). Surgical treatment includes peritoneal drainage, resection and primary intestinal anastomosis or temporary ileostomy.The aim of the study was to estimate risk factors and the strategy of surgical treatment in SIP.Material and methods. Between 2006 and 2008 ten patients undergone surgery for SIP. Retrospective analysis of patients' data was performed.Results. Mean gestational age was 26.1±3,143 Hbd, mean body weight 892±113.3 g. Sudden deterioration in the general condition with distension and lividity of the abdomen was correlated with radio-logical findings of perforation in all patients. Peritoneal drainage was performed in one patient, in one patient primary anastomosis was performed and multistages surgical treatment was done in the remaining. In resected segments of the intestine the histological signs of SIP were present. Two patients died, the follow-up of the remaining was maintaining for 4-24 months.Conclusions. Definitive differentiation between SIP and NEC can be made only by intraoperative view and histological evaluation of resected intestine. Survival rate (80%) in the study group was correlated with individual surgical strategy and advances in neonatal care.
EN
An abnormal presentation of the central nervous system in a fetus during a screening examination is an indication for extended diagnosis, the aim of which is to explain the character of such an anomaly (a congenital defect, destructive effect of intrauterine infection or abnormality with reasons that are difficult to explain). Knowledge of normal development sequence of the fetal brain, which is discussed in this paper, is the basis for correct interpretation of imaging findings. Together with the increase in survival of preterm neonates, a high risk of early brain damage is still a problem in this extremely immature population. Therefore, imaging examinations become necessary. The paper presents intrauterine and postnatal risk factors of early brain damage as well as classification of such lesions, of hemorrhagic and hypoxic-ischemic etiology. The diagnosis of the cerebellum damage, which is currently believed to be a significant cause of autism, is emphasized. The evolution of lesions over time is also presented. Moreover, the elements of diagnosis important for prognosis are stressed. The standards of imaging examinations of the central nervous system include the schedule of ultrasound examinations and provide indications for extended diagnosis with the use of magnetic resonance imaging.
PL
Nieprawidłowy obraz ośrodkowego układu nerwowego płodu w badaniu przesiewowym jest wskazaniem do poszerzenia diagnostyki prenatalnej celem ustalenia charakteru tej nieprawidłowości (wada rozwojowa, efekt destrukcyjny zakażenia wewnątrzmacicznego czy też nieprawidłowość o trudnym do ustalenia pochodzeniu). Znajomość prawidłowej sekwencji rozwojowej mózgu płodu, omówiona w pracy, jest podstawą właściwej interpretacji badań obrazowych. Wraz ze stale zwiększającą się przeżywalnością noworodków urodzonych przedwcześnie problemem pozostaje wysokie ryzyko wczesnego uszkodzenia mózgu w tej skrajnie niedojrzałej populacji, co powoduje konieczność jego oceny w badaniach obrazowych. W pracy omówiono wewnątrzmaciczne i pourodzeniowe czynniki ryzyka wczesnych uszkodzeń mózgu oraz klasyfikację tych zmian, o etiologii krwotocznej i niedokrwienno-niedotlenieniowej. Zwrócono uwagę na diagnostykę uszkodzeń móżdżku, które obecnie są uważane za istotną przyczynę autyzmu. Przedstawiono ocenę ewolucji zmian w czasie. Zwrócono uwagę na te elementy diagnostyki, które są ważne ze względu na ustalanie rokowania dla dziecka. W standardzie badań obrazowych ośrodkowego układu nerwowego u noworodków zaprezentowano harmonogram badań ultrasonograficznych oraz wskazania do rozszerzenia diagnostyki o badanie metodą rezonansu magnetycznego.
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