Dissertations / Theses on the topic 'Gastroschisi'
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1
Kruscha, Josefine. "Analyse verschiedener Risikofaktoren und Prävalenzentwicklung der Gastroschisis im Zeitraum 2003 bis 2010 in Leipzig." Doctoral thesis, Universitätsbibliothek Leipzig, 2015. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-178871.
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In den letzten Jahrzehnten konnte international ein Prävalenzanstieg der Gastroschisis beobachtet werden. Nach wie vor bleibt die Ätiologie sowie Pathogenese dieses Bauchwanddefektes nicht vollständig geklärt. Ziel dieser Arbeit war es, zum einen die Prävalenzentwicklung der Gastroschisis im Untersuchungszeitraum 2003 bis Ende Juli 2010 in Leipzig zu untersuchen und zum anderen mögliche relevante Risikofaktoren für diese Fehlbildung aus dem vorliegenden Patientenkollektiv zu eruieren. Dazu wurden 27 Mütter von Gastroschisiskindern und 27 Mütter gesunder Neugeborener befragt und die Ergebnisse unter Einbeziehung klinischer Daten analysiert.
Für den untersuchten Zeitraum ergab sich eine Prävalenz von 4,1 je 10000 Lebendgeborene für den Direktionsbezirk Leipzig. In Sachsen lag diese bei 2,3 je 10000 Lebendgeburten. Als signifikante Risikofaktoren konnten das junge Alter und ein niedriger Bildungsgrad der Mütter, der Familienstand ledig, eine kurze Kohabitationszeit mit dem Vater des Kindes und die fehlende Einnahme von Folsäure in der Schwangerschaft erhoben werden. Weiterhin erhöhte der Nikotinkonsum das Risiko um das 3,6-fache, ein Kind mit einer Gastroschisis zu bekommen. Die Einnahme von oralen Kontrazeptiva führte ebenfalls zu einer deutlichen Steigerung des Risikos. Eine eher untergeordnete Rolle spielten Alkohol- und Drogenkonsum, Ernährungsfaktoren, Erkrankungen, der BMI, das Geschlecht der Kinder, die Ethnizität, die familiäre Vorbelastung, der Konzeptionszeitpunkt, Expositionen gegenüber Umweltfaktoren, die Parität und die Einnahme von Medikamenten.
2
Müller, Marc. "Fetalchirurgischer Verschluss der Gastroschisis im Kaninchenmodell." Diss., lmu, 2009. http://nbn-resolving.de/urn:nbn:de:bvb:19-97498.
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Rimaz, Shahnaz. "Epidemiology of omphalocele and gastroschisis in Glasgow." Thesis, University of Glasgow, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.340758.
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Abbate, Tina. "Gastroschisis in New York State, 1998-2010." Thesis, State University of New York at Binghamton, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3728176.
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In the United States, one out of every thirty-three infants is born with some sort of birth defect or congenital malformation. Certain risk factors such as age and substance use increase the likelihood of having a baby afflicted with a defect and public health nurses have worked tirelessly to educate the public about these factors. In addition, thanks to modern medicine, many defects are detected early in pregnancy, which allows for careful monitoring and planning for the delivery. In spite of these gains, birth defects continue to dominate the public health arena because they are a leading cause of death for infants and play a prominent role in long-term morbidity and disability.
Gastroschisis and omphalocele are abdominal wall defects that present with herniation of intestines and organs due to failure of abdominal wall closure during embryonic development. Of the two abdominal wall defects, gastroschisis has demonstrated a worldwide increase in prevalence over the last three to four decades. The common denominator in the literature is young maternal age. However, the relationship between maternal age and gastroschisis is unclear. This study utilized birth certificate data from New York State to examine the relationship between maternal characteristics and delivering an infant with gastroschisis.
In this study, the infants diagnosed with gastroschisis were mostly singleton births born at an earlier gestation (34-36 weeks) and a lower birth weight (1500-2499 gm) than infants without gastroschisis. From a demographic perspective, mothers of infants with gastroschisis were more likely to be younger (≤24), Hispanic or less educated. The findings also revealed that mothers of infants with gastroschisis were more likely to have inadequate prenatal care, use tobacco, illicit drugs or have a sexually transmitted disease. Mothers of infants with gastroschisis were also more likely to live in a non-metropolitan county or fall into a lower socioeconomic status. Further research is needed to continue examining the relationship between maternal characteristics and a diagnosis of gastroschisis in the newborn infant.
5
Grossberndt, Sonja. "Aspekte der Fehlbildungsprävention am Beispiel der Gastroschisis." [Magdeburg] Blauer-Punkt-Verl, 2007. http://d-nb.info/991225937/04.
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Yazdy, Mahsa Mirmiran. "Environmental and infectious risk factors for gastroschisis." Thesis, Boston University, 2013. https://hdl.handle.net/2144/12946.
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Thesis (Ph.D.)--Boston UniversityGastroschisis is a rare congenital malformation where loops of bowel are protruding from the abdominal wall of an infant. The prevalence of gastroschisis has been increasing over the past 20 years, particularly in younger women. However, as the number of studies on gastroschisis increases each year, it continues to remain unclear why the prevalence is increasing and why it disproportionately affects younger mothers. Previous research has suggested that environmental or infectious factors may be involved in the pathogenesis of gastroschisis. This dissertation aims to explore the possibility of these two factors in relation to gastroschisis. In study 1, clusters of gastroschisis were identified in space or the combination of space and time. Cases and controls came from the National Birth Defects Study (NBDPS) or for some study centers from the birth defects surveillance systems. Generalized additive models were used to create a continuous map surface of odds ratios (OR) by smoothing over latitude and longitude. Data from the NBDPS were used for the Arkansas, California, and Utah study centers and the highest adjusted ORs detected were 2.0, 1.3, and 2.4, respectively. In Massachusetts and Texas, where surveillance data were used, the highest adjusted ORs observed were 2.4 and 1.3, respectively, with only the latter state achieving statistical significance. Texas had sufficient data to assess the combination of space and time, which identified an increased risk (OR=2.9) in the center of Texas in 2003. The results of this study suggest that clusters of gastroschisis may exist and further exploration of environmental or behavioral factors are warranted. [TRUNCATED]
7
Trost, Stefanie. "Retrospektive Analyse des kurzfristigen Outcomes von Patienten mit Gastroschisis und Omphalocele am Zentrum für Kinder- und Jugendmedizin Leipzig." Doctoral thesis, Universitätsbibliothek Leipzig, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-83329.
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Hintergrund: Weltweit berichteten zahlreiche Studien von einer steigenden Inzidenz von Patienten mit angeborenen Bauchwanddefekten. Besonders die Zahl der Gastroschisis-Kinder hat deutlich zugenommen. Auch die Neonatologen der Universitätsklinik Leipzig beschrieben ein gehäuftes Auftreten von Patienten mit Gastroschisis und Omphalocele. Aufgabe der vorliegenden Arbeit war es, die Inzidenz dieser beiden Fehlbildungen am Universitätsklinikum Leipzig zu ermitteln und zu untersuchen, wie sich die Fallzahlen während des Untersuchungszeitraumes (1998-2008) entwickelt hatten. Zudem sollten Parameter identifiziert werden, die die Prognose der betroffenen Kinder bis zur Entlassung beeinflussten. Ein weiteres Anliegen dieser Studie war es, mithilfe einer ausführlichen Literaturrecherche, einen Überblick über die aktuelle Behandlung und Prognose der beiden Fehlbildungen zu geben.
Methoden: Im Rahmen einer retrospektiven Untersuchung erfolgte die Erhebung und Auswertung der Daten von 27 Kindern mit Gastroschisis sowie 19 Kindern mit Omphalocele, die zwischen 1998 und 2008 in der Universitätsklinik Leipzig behandelt wurden. Mithilfe des Mann-U-Whitney-Tests sowie des exakten Tests nach Fisher wurden zahlreiche Merkmale hinsichtlich ihrer Auswirkungen auf das Outcome überprüft. Als Parameter, die das Outcome widerspiegelten, galten der Beginn des enteralen Kostaufbaus mit Tee-Glucose-Lösung und Milch, die Dauer der parenteralen Nährstoffzufuhr und des Krankenhausaufenthaltes, sowie Nachoperationen, Komplikationen und die Letalität während des stationären Aufenthaltes.
Ergebnisse: An der Universitätsklinik Leipzig betrug die Inzidenz von Gastroschisis 14 pro 10 000 Lebendgeburten und von Omphalocele 9 pro 10 000 Lebendgeburten. Die Inzidenz blieb während des elfjährigen Beobachtungszeitraumes konstant.
Der Vergleich früh- und reifgeborener Gastroschisis-Patienten zeigte, dass eine Frühgeburt weder mit einem früheren Beginn der oralen Ernährung mit Tee-Glucose-Lösung (11 d vs. 14 d; p nicht signifikant) und Milch (17 d vs. 17 d; p nicht signifikant), noch mit einer Verkürzung der parenteralen Ernährung (36 d vs. 37 d; p nicht signifikant) und stationären Behandlung (48 d vs. 50 d; p nicht signifikant) einherging. Häufig verkomplizierten Infektionen (12/27) und sekundäre Darmverschlüsse (9/27) mit der Notwendigkeit einer zusätzlichen Operation den postoperativen Verlauf der Gastroschisis-Patienten. Letztgenannte Komplikation führte zu einer erheblich protrahierten parenteralen Ernährung (79 d vs. 31 d; p < 0,05) und stationären Behandlung (101 d vs. 38 d; p < 0,05), während Infektionen kaum Auswirkungen auf das Outcome hatten. Es zeigte sich, dass vorrangig Kinder mit kleinem Defekt (<= 4 cm) sowie mit prolabiertem Magen einen Ileus entwickelten. Neben Darmverschlüssen führten intestinale Begleitfehlbildungen tendenziell zu einer Verlängerung der Hospitalisierungszeit (73 d vs. 48,5 d; p nicht signifikant). Gelang die orale Zufuhr von Milch innerhalb der ersten 14 Lebenstage, so verringerte sich die Dauer der parenteralen Ernährung (30 d vs. 37 d; p < 0,05) und der stationären Behandlung (41 d vs. 67 d; p nicht signifikant).
Bei Patienten mit Omphalocele bestimmten vor allem die Größe der Omphalocele, der Inhalt des Bruchsackes sowie der Zeitpunkt des oralen Ernährungsbeginns die Prognose. Ein großer (> 4 cm) Bauchwanddefekt ging mit einer erhöhten Infektionsrate (4/7 vs. 1/11; p < 0,05), prolongierten parenteralen Nahrungszufuhr (26 d vs. 17 d; p < 0,05) sowie stationären Behandlung (46 d vs. 24 d; p nicht signifikant) einher. Extraintestinale Begleitanomalien zeigten sich jedoch häufiger bei Patienten mit kleinem Defekt (5/11 vs. 1/7; p nicht signifikant). Befand sich die Leber außerhalb der Abdominalhöhle, waren zusätzliche Fehlbildungen seltener (3/11 vs. 5/7; p < 0,05). Eine prolabierte Leber verzögerte tendenziell die parenterale Ernährung (24 d vs. 18 d; p nicht signifikant) und die Krankenhausverweildauer (46 d vs. 21 d; p nicht signifikant). Ein frühzeitiger Beginn des enteralen Kostaufbaus mit Milch innerhalb der ersten zehn Lebenstage führte hingegen zu einer Verkürzung der parenteralen Ernährung (17 d vs. 27 d; p < 0,05) und stationären Behandlung (22,5 d vs. 49 d; p nicht signifikant).
Schlussfolgerung: Die Inzidenz von Gastroschisis und Omphalocele blieb während des Beobachtungszeitraumes konstant.
Die Prognose der Gastroschisis-Patienten wurde durch eine Frühgeburt nicht verbessert, so dass eine Termingeburt angestrebt werden sollte. Die Daten der vorliegenden Arbeit legen nahe, dass ein frühzeitiger Nahrungsaufbau mit der oralen Zufuhr von Tee ab dem achten Lebenstag sowie Milch ab dem zehnten Lebenstag günstig für das Outcome hinsichtlich der Dauer der parenteralen Ernährung und des stationären Aufenthaltes ist. Darmverschlüsse stellten schwerwiegende Komplikationen dar und verschlechterten das Outcome maßgeblich.
Eine große Omphalocele sowie eine ausgetretene Leber erhöhten die Morbidität. Ebenso wie bei Gastroschisis-Kindern scheint ein frühzeitiger Beginn der enteralen Ernährung das Outcome der Omphalocele-Patienten hinsichtlich der Dauer der parenteralen Ernährung und Krankenhausbehandlung zu verbessern. Deshalb empfehlen wir ab dem fünften sowie siebten Lebenstag die enterale Ernährung mit Tee sowie Milch zu beginnen.
Ein großes Manko der vorliegenden Studie ist die kleine Fallzahl dieser retrospektiven, monozentrischen Erhebung. Zur besseren Erfassung der Patienten mit angeborenen Bauchwanddefekten und um aussagekräftige epidemiologische und prognostische Ergebnisse zu erhalten, bedarf es eines Fehlbildungsregisters in Sachsen, so wie es bereits in anderen Bundesländern angewandt wird.
8
Draper, Elizabeth Sharon. "Recreational drug use : a major risk factor for gastroschisis?" Thesis, University of Leicester, 2005. http://hdl.handle.net/2381/30482.
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Bremer, Sophia Alice. "Prävalenz von Gastroschisis, Omphalozele, Spina bifida und orofazialen Spaltbildungen bei Neugeborenen im Zeitraum Januar 2000 bis Dezember 2010 in Leipzig, Sachsen, Sachsen-Anhalt und Deutschland." Doctoral thesis, Universitätsbibliothek Leipzig, 2017. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-219767.
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Hintergrund: Zahlreiche Studien beschreiben
weltweit eine Zunahme angeborener Fehlbildungen.
Diese sind in Deutschland die häufigste
Todesursache im frühen Kindesalter. Die hier
vorliegende Studie untersuchte lokale und nationale
Trends der Prävalenz von Gastroschisis,
Omphalozele, Spina bifida und orofazialen Spaltbildungen
von 2000 bis 2010.
Methoden: Die Prävalenz der 4 Fehlbildungen
wurde im Zeitraum Januar 2000–Dezember 2010
mithilfe von 4 Datenquellen aus Leipzig, Sachsen,
Sachsen-Anhalt und Deutschland untersucht.
Ergebnisse: Die Prävalenz der Fehlbildungen
betrug im Untersuchungszeitraum in Deutschland
bzw. in Sachsen 1,97/2,12 (Gastroschisis),
1,63/1,48 (Omphalozele), 5,80/8,11 (orofaziale
Spaltbildungen) und 2,92/2,50 (Spina bifida) je
10 000 Lebendgeborene. In Sachsen zeigte sich
ein Trendanstieg, dessen Effektstärken jedoch
sehr gering sind (OR/Jahr zwischen 1,01–1,09).
Auch in Deutschland insgesamt wurde eine signifikante
Zunahme der Fehlbildungen beobachtet
(OR/Jahr zwischen 1,01–1,04), ausgenommen
davon war die Lebendgeborenenprävalenz der
Spina bifida, die abzunehmen schien (OR/Jahr
0,986 (0,97–1,0), p-korrigiert = 0,04).
Schlussfolgerung: Ob ein tatsächlicher Anstieg
der Prävalenzen besteht oder lediglich Artefakte
einen Anstieg vortäuschen, ist unklar. Änderungen
in der Erfassungs- und Verschlüsselungspraxis,
Fehlcodierungen, Doppel- und/oder lückenhafte
Erfassung der Fehlbildungen könnten die
Daten verfälschen. Da nur in Sachsen-Anhalt und
Rheinland-Pfalz das Auftreten von Fehlbildungen
prospektiv erfasst wird, könnten im Übrigen
auch nur in diesen Bundesländern zeitnah Veränderungen
der Fehlbildungsprävalenz erkannt
werden. Angesichts der anscheinenden oder
scheinbaren Zunahme von Fehlbildungen und
der offensichtlich fehlerhaften Datenlage ist ein berücksichbundesweites
oder sind weitere regionale Register für eine bessere
und zeitnahe Erkennung und Erfassung von Fehlbildungen
in Deutschland notwendig.
10
Lipinski, Agnes Sylvie [Verfasser]. "Retrospektive Analyse des Outcome von Kindern mit intestinalen Begleitfehlbildungen bei Gastroschisis / Agnes Sylvie Lipinski." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2008. http://d-nb.info/102326269X/34.
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D'Souza, Anita Christine [Verfasser], and Klaus-Dieter [Akademischer Betreuer] Rückauer. "Gastroschisis und Omphalozele - Somatische Ergebnisse der operierten Kinder und psychische Verarbeitung durch die Eltern." Freiburg : Universität, 2013. http://d-nb.info/1123476780/34.
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França, Willy Marcus Gomes. "Avaliação histologica e imunohistoquimica da maturidade dos plexos mioentericos na gastrosquise experimental de ratos realizada em duas diferentes idades gestacionais." [s.n.], 2006. http://repositorio.unicamp.br/jspui/handle/REPOSIP/310461.
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Orientador: Lourenço Sbragia NetoTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: Na gastrosquise (G), o grau de lesão das alças intestinais exteriorizadas está diretamente relacionado ao tempo de contato com o líquido amniótico (LA) e exposição ao mecônio, que causam alterações morfológicas e histológicas do intestino, além da formação de uma fina camada de fibrina (fibrous peel) sobre a serosa, formando aderências entre as alças intestinais. Estas lesões levam ao hipoperistaltismo intestinal e deficiência na absorção dos nutrientes, contribuindo para o aumento da morbidade e alto custo médico-hospitalar. O hipoperistatismo na G é atribuído à desorganização e à imaturidade dos plexos mioentéricos. Estas características podem servir como marcadores do grau de lesão intestinal, e que podem ser identificados pela presença de neurofilamentos dos plexos nervosos intestinais e sugerir a antecipação do parto. Nesse estudo identificamos as alterações morfológicas e histológicas intestinais e dos plexos mioentéricos em dois diferentes tempos de contato com o LA. A G experimental em fetos de ratas Spreague-Dowley foi realizada em duas idades gestacionais, 18,5o dia (E18,5) e 19,5o dia (E19,5), que foram divididos em 3 subgrupos: controle (C), sham (S) e gastrosquise (G). Medimos o peso corporal fetal (PC), peso (PI) e comprimento intestinais (CI). As camadas da parede intestinal e os plexos mioentéricos foram avaliados pela coloração de H&E e imunofluorescência (?-Internexina), respectivamente. O PC não apresentou diferença significativa entre C/S/G, nos 2 grupos. O PI e CI foram respectivamente maior e menor nos fetos G (p<0,001) nos 2 grupos. Os diâmetros intestinais e as camadas da parede apresentaram diferença significativa entre C/S/G, em ambos os grupos (p<0,001), mas o tempo de contato com LA e exposição ao mecônio comprometeram a serosa e D-II (diâmetro II) (p<0,001), e CI (p=0,001). A ?-internexina apresentou imunorreatividade mais intensa nos fetos G de E18,5. Concluímos que no modelo de G em fetos de ratos, as alterações da parede intestinal, principalmente da camada serosa e do comprimento intestinal, bem como a imaturidade dos plexos mioentéricos, apresentaram-se mais intensas nos fetos cujo contato com o LA e exposição ao mecônio foram mais prolongados (G/E18,5). Estudos experimentais adicionais devem ser desenvolvidos e direcionados para compreensão da motilidade intestinal na G com o objetivo de minimizar os danos neuromusculares nas alças intestinais expostas ao LA e permitir avaliar as supostas vantagens da antecipação do parto para fetos humanos com G
Abstract: BACKGROUND: The amniotic fluid (AF) and its components such as fetal urine and meconium may lead to intestinal alterations in gastroschisis (G), which cause immaturity of the myenteric plexus and consequent intestinal hypomotility and malabsorption. In this study we identified morphological and histological alterations of the intestine and of the myenteric plexus with two different times of exposure to the AF. METHODS: The experimental G was achieved at two different gestational ages, on day 18.5 (E18.5) and on day 19.5 (E19.5) of gestation in fetal rats which were divided into 3 subgroups: control (C), sham (S) e gastroschisis (G). We measured fetal body weight (BW), intestinal weight (IW) and intestinal length (IL). The layers of intestinal wall and myenteric plexus were evaluated by hematoxylin and eosin staining (H&E staining) and immunofluorescence (?-Internexin), respectively. RESULTS: BW did not show significant differences among C/S/G, in both groups. IW and IL were respectively larger and shorter in the G fetuses (p<0.001) in both groups. Intestinal diameters and wall layers presented significant differences among C/S/G in both groups (p<0.001), but time of exposure to AF compromised the serous membrane, D-II (diameter II) (p<0.001) and IL (p=0.001). The ?-Internexin presented more intensive immunoreactivity in G/E18.5 fetuses. CONCLUSION: In gastroschisis, the longer the time of exposure to AF, the more severe will be bowel impairment, especially concerning IL and the serous layer; and the more immature will be the myenteric plexus
Doutorado
Cirurgia
Doutor em Cirurgia
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Bennini, Junior João Renato 1978. "Gastrosquise = ultrassonografia na estimativa do peso fetal e predição de desfechos perinatais = Gastroschisis: ultrasonography for fetal weight estimation and prediction of perinatal outcomes." [s.n.], 2014. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312556.
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Orientadores: Cleisson Fábio Andrioli Peralta, Ricardo BariniTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Introdução: A literatura é controversa sobre o papel de parâmetros ultrassonográficos pré-natais na predição do risco de morbidade e mortalidade perinatais nos casos de gastrosquise. O peso ao nascimento é descrito como um importante fator prognóstico e estudos relatam que fórmulas ultrassonográficas criadas especificamente para esses casos apresentam melhor desempenho na estimativa do peso fetal, mas não há consenso sobre qual a melhor. Objetivos: Avaliar o papel de parâmetros ultrassonográficos pré-natais na predição de desfechos perinatais em casos de gastrosquise. Criar uma nova fórmula ultrassonográfica para estimativa de peso fetal que não utilize medidas abdominais e compará-la à outras fórmulas com parâmetros ultrassonográficos bidimensionais (US2D) e tridimensionais (US3D) quando aplicadas em fetos com gastrosquise. Métodos: Para avaliar o desempenho de parâmetros ultrassonográficos pré-natais na predição de desfechos perinatais foi realizado um estudo de coorte retrospectiva envolvendo fetos com o diagnóstico de gastrosquise isolada. Para criar e validar a nova fórmula US2D foram utilizados dados referentes à gestantes e fetos normais coletados em um estudo prévio publicado pelo nosso grupo. Foi realizado um estudo retrospectivo transversal envolvendo fetos com gastrosquise, para comparar a nova fórmula US2D com diferentes fórmulas US2D e US3D já publicadas. Os sujeitos foram selecionados entre aqueles acompanhados na Divisão de Obstetrícia do CAISM / UNICAMP. O tamanho da amostra foi estimado em 56 pacientes para avaliar o desempenho de parâmetros ultrassonográficos pré-natais na predição de desfechos perinatais e 27 pacientes para comparar as fórmulas de estimativa de peso fetal. Os dados maternos, gestacionais e pós-natais foram descritos como freqüências relativas e absolutas, média ± desvio padrão (DP), mediana e limites. A normalidade dos dados contínuos foi testada utilizando-se o teste de Kolmogorov¿Smirnov. Testes t de amostras independentes e testes de qui-quadrado foram utilizados na comparação de dados contínuos e categóricos, respectivamente. Análises de regressão polinominal até o terceiro grau foram consideradas para criar a nova fórmula US2D de estimativa do peso fetal sem medidas abdominais. Cálculo do erro percentual médio ± DP, testes t unilaterais, testes t de amostras pareadas com correção de Bonferroni e testes de variância para amostras pareadas foram usados para avaliar e comparar a acurácia e precisão das fórmulas. A associação entre dados contínuos foi testada utilizando-se os coeficientes de correlação de Pearson ou Spearman e regressão logística univariada, conforme indicado. Valores de p < 0,05 foram considerados significativos. Resultados: Foram incluídos 44 casos de fetos com gastrosquise para avaliar a predição de desfechos perinatais por meio de parâmetros ultrassonográficos pré-natais. A presença de dilatação de alças intestinais intra-abdominais (DAI) fetais aumentou o risco de complicacões intestinais pós-natais e a presença de restrição de crescimento fetal (RCF) diminuiu o risco deste mesmo desfecho. Nenhum outro parâmetro ultrassonográfico pré-natal pode significativamente predizer os desfechos perinatais avaliados. Foram usados os dados referentes aos mesmos grupos de 150 fetos normais e 60 fetos normais do estudo prévio para respectivamente criar e validar a nova fórmula US2D, que foi a seguinte: peso fetal estimado (PFE) = 623.324 + 0.165 x DBP x CC x CF2 (DP: 12,25%). Na comparação entre as fórmulas US2D e entre as fórmulas US2D e US3D, foram utilizados 44 e 28 fetos com gastrosquise isolada, respectivamente. O melhor desempenho na estimativa do peso de fetos com gastrosquise foi obtido com o modelo US2D proposto por Siemer e colaboradores. Conclusões: Em fetos com gastrosquise o achado de DAI múltipla associa-se a complicações intestinais pós-natais e a presença de RCF possui um efeito protetor para este mesmo desfecho. A nova fórmula US2D sem medidas abdominais não melhorou a estimativa do peso ao nascimento dos fetos com gastrosquise da nossa população em relação às outras fórmulas US2D e US3D avaliadas. Na nossa amostra de pacientes com gastrosquise o modelo S2D de Siemer e colaboradores apresentou o melhor desempenho na estimativa de peso
Abstract: Background: The role of prenatal ultrasonographic parameters for the predicition of perinatal outcomes in fetuses with gastroschisis is still controversial. Birthweight is described as a prognostic factor and some studies report that ultrasonographic formulas especifically created for these cases have a better performance for fetal weight estimation, but there is no consensus about which is the best one. Objectives: To evaluate prenatal ultrasonographic parameters as predictors of adverse perinatal outcomes in fetuses with gastroschisis. To create a new birthweight predicting ultrasonographic model without abdominal measurements and compare this new formula with other two-dimensional (2DUS) and three-dimensional (3DUS) fetalweight predicting models already published when aplied to fetuses with gastroschisis. Methods: To evaluate the performance of prenatal ultrasonographic parameters as predictors of perinatal outcomes in fetuses with gastroschisis a retrospective cohort study was done. To create and validate the new 2DUS formula the same data from normal fetuses colected in a previous study of our group was used. A retrospective cross-sectional study encompassing fetuses with gastroschisis was carried out to compare the new 2DUS formula with other 2DUS and 3DUS formulas already published. The patients were selected among those followed at the Division of Obstetrics of the Center for Integral Assistance to Women¿s Health of the State University of Campinas (UNICAMP). The sample size was estimated in 56 patients to evaluate prenatal ultrasonographic predictors and perinatal outcomes and 27 patients to compare the fetal weigth estimating formulas. Maternal, pregnancy and postnatal data were described as absolute and percentual frequencies, mean ± standard deviation (SD), median and range. Continuous data were tested for their normal distribution using the Kolmogorov¿Smirnov test. Independent samples t tests and chi-square tests were used in the assessment of continuous and categorical variables, when appropriate. Polynomial stepwise regression analyses up to the third order were considered to generate a new 2DUS weight-predicting model without abdominal measurements. Calculation of the mean percentage error ± SD, one-sample t tests, paired samples t-tests with Bonferroni adjustment and correlated variance tests for paired samples were used to compare the performances of the formulas. The potential association between continuous data was tested by means of Pearson or Spearman¿s Correlation Coefficient and univariate logistic regression, as indicated. A two-tailed p-value of less than 0.05 was considered statistically significant. Results: Forty-four fetuses were included to evaluate the ultrasonographic prental parameters as predictors of perinatal outcomes. The presence of fetal multiple intra-abdominal bowel dilation (IBD) was associated with increased incidence of intestinal complications and the presence of fetal growth restriction (FGR) had a protective effect over this outcome. No other prenatal ultrasographic parameter could significantly predict the perinatal outcomes evaluated. It was used the same data from our previous study on 150 normal fetuses and 60 normal fetuses to respectively generate and validate the new 2DUS formula, that was: estimated fetal weight = 623.324 + 0.165 x BPD x HC x FDL2 (SD: 12.25). In the comparison between the 2DUS formulas and between the 2DUS and 3DUS formulas it was included 44 and 28 fetuses, respectively. The best performance for weight prediction in fetuses with gastroschisis was achieved using the model created by Siemer et al. Conclusions: In fetuses with gastroschisis the findings of multiple IBD increases the risk of postnatal bowel complications and the presence of FGR decreases the risk of this outcome. The new 2DUS formula without abdominal measurements did not improve fetal weight estimation in fetuses with gastroschisis of our population when compared to other 2DUS and 3DUS formulas evaluated. The 2DUS weight estimating model of Siemer et al had the best performance for this purpose
Doutorado
Saúde Materna e Perinatal
Doutor em Ciências da Saúde
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Root, Elisabeth Dowling Emch Michael. "The ecology of birth defects socio-economic and environmental determinants of gastroschisis in North Carolina /." Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2009. http://dc.lib.unc.edu/u?/etd,2187.
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Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2009.Title from electronic title page (viewed Jun. 26, 2009). "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Geography." Discipline: Geography; Department/School: Geography.
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Abrar, Maria [Verfasser], Peter [Gutachter] Kozlowski, and Thomas [Gutachter] Höhn. "Pränatale prädiktive Faktoren im Ultraschall bei Feten mit Gastroschisis / Maria Abrar. Gutachter: Peter Kozlowski ; Thomas Höhn." Düsseldorf : Universitäts- und Landesbibliothek der Heinrich-Heine-Universität Düsseldorf, 2016. http://d-nb.info/1103656759/34.
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Rieg, Teresa Ines [Verfasser]. "Kurz- und langfristiges Outcome von Kindern mit Gastroschisis und Omphalozele im Vergleich im Zeitraum von 2000 bis 2011 / Teresa Ines Rieg." Ulm : Universität Ulm. Medizinische Fakultät, 2014. http://d-nb.info/1049238435/34.
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Punzmann, Sabine [Verfasser], and Bertram [Akademischer Betreuer] Reingruber. "Omphalozele und Gastroschisis - Analyse des Regensburger Patientengutes 1983 - 2007 unter Berücksichtigung der kosmetischen und funktionellen Langzeitergebnisse / Sabine Punzmann. Betreuer: Bertram Reingruber." Regensburg : Universitätsbibliothek Regensburg, 2011. http://d-nb.info/1023361906/34.
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Coelho, Amanda Santos Fernandes. "Alterações neonatais e maternas relacionadas ao óbito infantil em crianças com gastrosquise." Universidade Federal de Goiás, 2015. http://repositorio.bc.ufg.br/tede/handle/tede/4964.
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Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG
Infant mortality is an important indicator of a country’s health. It is observed in several regions of the world a proportion of deaths attributable to congenital malformations. Worldwide, it is estimated that prevalence occurs in 9% of live births. Among the major abnormalities is gastroschisis, that is a congenital malformation in which there is an exteriorization of the viscera through the abdominal wall defect to the right of the umbilical cord, which is implanted in its normal position. The objective of this study was analyze the neonatal and maternal changes related to infant mortality in children with gastroschisis. This is a cross-sectional and retrospective study with a quantitative approach. It used for analysis, secondary data collected from medical records of patients treated at a public hospital in Goiânia-GO, from 2004 to 2014. The study included 123 patients diagnosed with gastroschisis, which met the criteria adopted. In relation to maternal variables, 57.7% of the women were younger than 20 years, 64.2% were first pregnancy, cesarean birth occurred in 65% of cases, there was an average of 4.8 ± 2.5 prenatal consultation. In relation to neonatal variables, 59% of the new born with gastroschisis were male. The gestational age at birth of the 123 pregnancies ranged from 29.4 to 40.4 weeks (average = 36.5 ± 1.8 weeks). The weight of the new born ranged from 890g to 3800g (average = 2351 ± 474,2g), the average of the Apgar index in the first minute was 6.6 ± 1.8. Associated malformations (not intestinal) were found in 10 (8.1%) patients and 17 (13.8%) patients had intestinal abnormalities, and at this last the most common was the intestinal atresia. By observing the eviscerated organs, 70.7% of patients had only exposed intestinal loops and about other herniated organs, the stomach has been externalized in 27.6% of cases. The general mortality rate was 41% of cases. Statistically significant association was observed between the occurrence of death and mothers who performed less monitoring in prenatal care (p = 0.027) and when there was no diagnosis of gastroschisis in prenatal care (p = 0.001). It was also observed statistically significant association between the occurrence of death and the presence of complex gastroschisis (p = 0.032) and herniation of other organs beyond just the intestine (p = 0.018). It is concluded that, in relation to maternal and neonatal profile of gastroschisis, the condition has no gender preference, particularly affecting children of young first-time mothers. Perinatal mortality of gastroschisis in this analysis seems to depend mainly on the reduced prenatal care, the absence of prior diagnosis at birth, the presence of complex gastroschisis and herniation of other organs than just the intestine.
A mortalidade infantil é um importante indicador de saúde de um país, observa-se em várias regiões do mundo, uma proporção de mortes atribuíveis às malformações congênitas. Mundialmente, estima-se que a prevalência ocorre em 9% dos nascidos vivos. Dentre as malformações graves está a gastrosquise que, é uma malformação congênita em que há exteriorização das vísceras através de defeito na parede abdominal à direita do cordão umbilical, que é implantado em sua posição habitual. O objetivo deste trabalho foi analisar as alterações neonatais e maternas relacionadas ao óbito infantil em crianças com gastrosquise. Trata-se de um estudo transversal, retrospectivo e com abordagem quantitativa. Utilizou para tanto, dados secundários coletados dos prontuários de pacientes atendidos em um Hospital Público em Goiânia-GO, no período de 2004 a 2014. Foram incluídos 123 pacientes diagnosticados com gastrosquise, os quais preencheram os critérios adotados. Em relação às variáveis maternas, 57,7% das mulheres apresentaram idade menor que 20 anos, 64,2% eram primigestas, o parto cesariano ocorreu em 65% dos casos, houve uma média de 4,8 ± 2,5 consultas de pré-natal. Em relação às variáveis neonatais, 59% dos RN com gastrosquise eram do sexo masculino, a idade gestacional ao nascimento das 123 gestações variou de 29,4 a 40,4 semanas (média = 36,5±1,8 semanas), O peso do RN variou de 890g a 3800g (média = 2351±474,2g), a média do índice de Apgar no primeiro minuto foi de 6,6±1,8. As malformações associadas (não intestinais) foram encontradas em 10 (8,1%) pacientes e 17 (13,8%) pacientes apresentaram anomalias intestinais, sendo que nesta última a mais comum foi a atresia intestinal. Ao observar os órgãos eviscerados, 70,7% dos pacientes apresentavam somente alças intestinais expostas e quanto aos outros órgãos herniados, o estômago esteve exteriorizado em 27,6% dos casos. A taxa geral de mortalidade foi de 41% dos casos. Foi observada associação estatisticamente significativa entre a ocorrência de óbito e mães que realizaram menor acompanhamento no pré-natal (p= 0,027) e quando não houve diagnóstico da gastrosquise no pré-natal (p= 0,001). Foi ainda observada associação estatisticamente significativa entre a ocorrência de óbito e a presença de gastrosquise complexa (p= 0,032) e herniação de outros órgãos que não apenas o intestino (p= 0,018). Conclui-se que em relação ao perfil materno e neonatal da gastrosquise, observa-se que a afecção não possui predileção por sexo, acometendo particularmente filhos de jovens mães primíparas. A mortalidade perinatal da gastrosquise neste trabalho, parece depender principalmente do acompanhamento pré-natal reduzido, da ausência de diagnóstico prévio ao nascimento, da presença de gastrosquise complexa e da herniação de outros órgãos que não apenas o intestino.
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Reiß, Anne-Kathrin [Verfasser], and Matthias W. [Akademischer Betreuer] Beckmann. "Wertigkeit der Ultraschallparameter und der B-Bildanalyse des fetalen Darms beim Management der fetalen Gastroschisis / Anne-Kathrin Reiß. Gutachter: Matthias W. Beckmann." Erlangen : Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 2013. http://d-nb.info/1065380631/34.
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Branco, Lívia Terezinha Pimentel. "Investigação farmacológica de mecanismos neurogênicos e oxidativos no modelo experimental de gastrosquise em ratos." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/42/42136/tde-17112008-102233/.
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A gastrosquise (G) é o defeito congênito de fechamento da parede abdominal, que causa inflamação intestinal. Avaliou-se aqui a expressão protéica e gênica de marcadores neurogênicos e oxidativos no intestino de fetos de ratas tratadas ou não com dexametasona - DMT. Estes foram divididos em grupos: não manipulado (controle; C), falso operado (sham; S) e operado (G). A atividade da mieloperoxidase (MPO) aumentou no grupo G vs. C, não sendo afetada pela DMT. A expressão RNAm do receptor NK2, mas não NK1, VPAC e TRPV1, foi reduzida nos grupos G e S vs. C, sendo esta revertida pela DMT. A iNOS, mas não nNOS e eNOS, foi maior no grupo G. A DMT não inibiu a iNOS mas aumentou a eNOS. COX-2 aumentou na G e não foi afetada pela DMT. A expressão protéica da SOD-1 ou 3-NT não diferiu entre grupos G e controle. O grupo G tratado com DMT exibiu maior nitração protéica. A IL-6 aumentou no grupo G versus C. Conclui-se que a inflamação no intestino de fetos com G origina-se de uma possível combinação entre mecanismos oxidativos, geração de prostanóides e fatores neurovasculares.Gastroschisis (G) is a congenital defect of the abdominal wall closure resulting in perivisceritis. The role of neurovascular and oxidative mechanisms in this condition was investigated by analyzing the gene and proteic expressions of these markers in the gut of foetus from female rats treated or not with dexamethasone (DMT). Increased MPO activity was found in G vs. control (C) but not sham (S) group. Reduced mRNA expression of NK2 receptor was found in G and S groups. Neither NK1 nor both VIP and TRPV1 receptors expression changed among groups. Increased expression of iNOS and COX-2, but not nNOS, eNOS and COX-1, was seen in G group. DMT reversed the expression of NK2R and increased that of NK1R without affecting iNOS and COX-2 expression. Increased levels of IL-6 but neither SOD-1 nor 3-NT was found in G group. In conclusion, the inflammatory process observed in the gut of foetus with G arises through a combination of neurogenic mechanisms that act in concert with reactive oxygen species and generation of prostanoids to produce gut dysfunction.
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Treiber, Birgit [Verfasser], and Bertram [Akademischer Betreuer] Reingruber. "Der Einfluss eines optimalen peripartalen Managements auf die Mortalität, Lebensqualität und gastrointestinale Funktion bei Patienten mit Gastroschisis und Omphalozele / Birgit Treiber. Betreuer: Bertram Reingruber." Regensburg : Universitätsbibliothek Regensburg, 2016. http://d-nb.info/1081543361/34.
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Long, Anna-May. "Short and long-term outcomes of children born with abdominal wall defects." Thesis, University of Oxford, 2017. https://ora.ox.ac.uk/objects/uuid:8f57a562-ca60-48b1-ba4f-356e65ee5bed.
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Background: Very occasionally, when a fetus is developing in the womb, problems occur with the normal processes controlling closure of the muscles of the abdominal wall and, as a result, some of the abdominal contents develop outside of the body. This is known as an abdominal wall defect. If the pregnancy continues to term, the newborn infant will need specialised surgical care. This situation occurs so infrequently that even a dedicated surgical centre will care for very few of these women and their babies in a year. Many centres have shared their experiences of managing these babies in the published literature but the majority of reports have included only a few infants. The focus of most previous studies has been to describe what happens to these newborn infants between birth and first discharge from hospital from a purely clinical perspective. Aim: To explore methodologies to holistically understand the short and longer-term outcomes of children born with abdominal wall defects and to use the information to improve the care of future affected infants. Methods: The quality of the published literature on short-term outcomes of children born with gastroschisis was scrutinised in a systematic review. The accompanying meta-analysis used published data as a means of identifying population outcome estimates. Two national population-based cohort studies were undertaken, exploring the short-term outcomes of children born with exomphalos and the outcomes at seven to ten years of children born with gastroschisis. The latter study included an assessment of childhood outcomes from the point of view of the children themselves, along with their parents. Further parental perspectives on experiences of care were explored in a qualitative analysis of in-depth interviews with parents of children born with exomphalos. Findings: Short-term outcomes of children born with gastroschisis have been published in a large number of small studies. Pooling the published data, where possible allowed the production of population estimates but heterogeneity between studies was marked. One in fourteen children born with gastroschisis died before their first birthday when managed in developed countries. Those who developed bowel complications in utero, had an increased risk of dying before one-year. The assessment of childhood outcomes for this latter group of children, who made up 11% of the population cohort, revealed a bleak outlook for many, of with one in three either dying or requiring complex surgery to gain allow them to be able to be fed via their gut, before their ninth birthday. Due to methodological limitations, the extent of neurological and gastrointestinal morbidity among survivors in the cohort is unclear, but the findings of both the highly selected responses from the parent report and those of the clinical study provide enough concern to suggest that alternative methodologies need to be explored to identify the extent of ongoing sequelae as children grow older. The live-born population of children with exomphalos is highly varied and a large burden of comorbidity was identified, however, two-thirds of infants were able to be have their abdominal wall defect surgically closed with a low-rate of early complications. A variety of techniques are employed by UK surgeons when the defect cannot be easily closed and evidence to guide management choice will be difficult to obtain using standard techniques due to the small number of these infants born annually in the UK. Parental experiences echoed the variability in management approach and in some cases highlighted a lack of respect for parental perspectives on management choice. Conclusion: Children born with abdominal wall defects represent a spectrum from those with severe comorbidity who will need ongoing care, to those who have a straightforward course and a relatively short stay in hospital. Methods of risk-stratifying infants for the purposes of outcome assessment have been explored. This approach is crucial to contextualising the progress of an individual infant and counselling their parents about their likely prognosis.
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Kruscha, Josefine [Verfasser], Eva [Akademischer Betreuer] Robel-Tillig, Ulf [Akademischer Betreuer] Bühligen, Roland [Gutachter] Pfäffle, and Karin [Gutachter] Rothe. "Analyse verschiedener Risikofaktoren und Prävalenzentwicklung der Gastroschisis im Zeitraum 2003 bis 2010 in Leipzig / Josefine Kruscha ; Gutachter: Roland Pfäffle, Karin Rothe ; Eva Robel-Tillig, Ulf Bühligen." Leipzig : Universitätsbibliothek Leipzig, 2015. http://d-nb.info/1239657250/34.
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Gonçalves, Frances Lilian Lanhellas 1979. "Avaliação da proteção e tratamento das alças intestinais fetais utilizando hidrogel (biomaterial) e S-nitrosoglutationa (GSNO) no modelo experimental de gastrosquise." [s.n.], 2011. http://repositorio.unicamp.br/jspui/handle/REPOSIP/310452.
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Orientador: Lourenço Sbragia NetoTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Gastrosquise é um defeito congênito da parede abdominal anterior no qual as alças intestinais ficam herniadas e em contato com o líquido amniótico (LA) cuja exposição crônica resulta em várias disfunções intestinais no período pós-natal. Para reduzir o efeito danoso desta exposição utilizou-se em modelo animal, dosagens diferentes de S-nitrosoglutationa (GSNO), doador de óxido nítrico (NO) e para a concentração mais diluída acrescentou-se o hidrogel de N-isopropilacrilamida (NIPAAm) copolimerizado com ácido acrílico (Aac) para cobrir as alças fetais expostas fetais afim de avaliar o tratamento com NO e a proteção oferecida pelo biomaterial. A gastrosquise foi induzida cirurgicamente em fetos de ratas com 18,5 dias de gestação. Os fetos foram separados em dez grupos: controle externo (CE), gastrosquise (G), controle interno (CI), Sham (S), gastrosquise + adesivo de fibrina - Beriplast® (GA), gastrosquise + adesivo de fibrina + hidrogel seco (GAH), gastrosquise + GSNO a 50 µM (GNO1), gastrosquise + GSNO a 5 µM (GNO2), gastrosquise + GSNO a 0,5 µM (GNO3), gastrosquise + GSNO a 0,05 µM (GNO4), gastrosquise + adesivo de fibrina + hidrogel seco + GSNO a 0,05 µM (GAHNO4). Com 21,5 dias de gestação, os fetos foram colhidos por cesárea e o hidrogel foi cuidadosamente removido. Ao grupo GNO1 não foi dada continuidade, pois a dosagem foi nociva aos animais. Dados de peso corporal e intestinal foram aferidos e algumas amostras do intestino foram fixadas para estudo histométrico e imunoistoquímico e outras congeladas para western blotting e quimioluminescência. Resultados das medidas morfológicas e histométricas, como peso, diâmetro, espessura das camadas e da parede intestinal, demostraram que o grau de proteção e tratamento das alças intestinais foi eficaz nos grupos GAH e GAHNO4, pois apresentaram valores significamente menores, assim como os grupos CE e CI e diferente dos grupos G, GA, GNO2, GNO3 e GNO4 que indicaram processo inflamatório. A expressão das enzimas nNOS, iNOS e eNOS por meio de western blotting e imunoistoquímica dimunuiu principalmente nos grupos GAH, GNO4 e GAHNO4 ficando iguais aos grupos CE e CI. A quantificação de nitrato e nitrito (NOx) no intestino e no LA por quimioluminescência nos grupos G, CI e S, mostrou que o NO se difunde do tecido intestinal para o LA, no grupo G e isso pode ser a causa para o aumento da expressão da enzima NOS. Sendo assim, a aplicação do hidrogel aderido pelo adesivo de fibrina mostrou servir como uma efetiva proteção das alças herniadas e o tratamento concomitante com GSNO a 0,05 ?M também ajudou na redução significante da inflamação na gastrosquise
Abstract: Gastroschisis is a congenital defect of the anterior abdominal wall in which the herniated bowel is in contact with the amniotic fluid (LA) whose chronic exposure results in several postnatal bowel dysfunction. To reduce the harmful effect of this exposure it was used in an animal model, different doses of S-nitrosoglutathione (GSNO), donor of nitric oxide (NO) and the more dilute concentration was added to the hydrogel of N-isopropylacrylamide (NIPAAm) copolymerized acrylic acid (Aac) to cover the exposed fetal handles in order to assess fetal treatment with NO and the protection offered by the biomaterial. Gastroschisis was surgically induced in fetuses of female Sprague-Dawley rats at 18.5 days of gestation. The fetuses were separated into ten groups: external control (CE), gastroschisis (G) internal control (CI), Sham (S), gastroschisis + fibrin adhesive - Beriplast® (GA), gastroschisis + fibrin adhesive + dry hydrogel (GAH), gastroschisis + 50 µM GSNO (GNO1), gastroschisis + 5 µM GSNO (GNO2), gastroschisis + 0.5 µM GSNO (GNO3), gastroschisis + 0.05 µM GSNO (GNO4), gastroschisis + fibrin adhesive + dry hydrogel + to 0.05 ?M GSNO (GAHNO4). On day 21.5 of gestation, fetuses were collected by cesarean section and the hydrogel was carefully removed. The group GNO1 was not given continuity, because the dosage was harmful to the animals. Data of body weight and intestinal samples were measured and some intestinal samples were fixed for immunohistochemical and histometric study and the others were frozen for western blotting and chemiluminescence. Results of morphological and histometric measures such as weight, diameter and thickness of the intestinal wall, showed that the degree of protection and treatment of bowel was effective in groups GAH and GAHNO4 because they showed significantly lower values, as well as groups CE and CI and different from groups G, GA, GNO2, GNO3 and GNO4 that indicated inflammatory process. The expression of nNO, iNOS and eNOS enzymes by western blotting and immunohistochemistry decreased especially in groups GAH, GNO4 and GAHNO4, getting the same results as the CE and CI groups. Quantification of nitrate and nitrite (NOx) by chemiluminescence in the bowel and LA of groups G, S and CI showed that NO diffused from the intestinal tissue to LA in the group G and this may be the cause for the increased expression of the NOS enzymes. Therefore, the application of hydrogel joined by fibrin adhesive showed an effective protection of the herniated bowel and concomitant treatment with GSNO at 0.05 ?M, also helped in significant reduction in inflammation in gastroschisis
Doutorado
Fisiopatologia Cirúrgica
Doutor em Ciências
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Simoni, Renata Zaccaria 1972. "Trombofilia hereditária em fetos com malformações de origem vascular = Genetic polymorphisms in fetuses with malformations of vascular origin." [s.n.], 2012. http://repositorio.unicamp.br/jspui/handle/REPOSIP/309004.
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Orientador: Egle Cristina Couto de CarvalhoTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Contexto e objetivo: Algumas malformações congênitas têm origem vascular, e a trombose durante a organogênese já foi aventada como possível mecanismo para esta ocorrência. O objetivo deste estudo foi avaliar a associação entre trombofilia fetal e malformações de origem vascular. Tipo de estudo e local: Foi realizado um estudo caso-controle, desenvolvido no ambulatório de Medicina Fetal do CAISM UNICAMP, de 2005 a 2010. Métodos: Foram incluídos no estudo 100 fetos com malformações de sistema nervoso central (SNC), gastrosquise, limb body wall e redução de membros (casos), submetidos a cordocentese como rotina do serviço, cujos resultados de cariótipo foram normais. Como controles, foram incluídos 100 fetos sem malformações cujo sangue de cordão fora previamente doado para o Banco de Sangue de Cordão do HEMOCENTRO UNICAMP. A pesquisa das mutações Fator V de Leiden, G20210A-FII e C677T-MTHFR foi realizada no sangue fetal dos dois grupos, e os resultados foram comparados. A análise descritiva foi feita utilizando Qui-quadrado e Teste Exato de Fisher. Para avaliar a associaçãoo entre as variáveis, foram utilizados o teste de Wilcoxon e a regressão logística. Resultados: Foram incluídos 78 fetos com malformações de SNC, 14 com gastrosquise, 3 com redução de membros e 2 com limb body wall. As mutações fator V de Leiden e G20210A-FII não foram encontradas nos casos e nos controles. A mutação C677T-MTHFR foi encontrada na forma heterozigota (CT) em 24 casos (24,8%) e em 6 controles. A mutação homozigota (TT) foi encontrada em 7 casos (7,2%) e em 1 controle. Estas diferenças foram estatisticamente significativas (p<0,0001). Quando avaliados os fetos com malformações de SNC (Artigo 1), a mutação CT foi encontrada com frequência significativamente maior nos casos do que nos controles (OR 10.309 IC95% 3.344-32.258), e a mutação TT também mostrou diferença significativa (OR 12.346 IC95% 1.388-111.11). A avaliação dos 14 fetos com gastrosquise (Artigo 2) não mostrou diferenças significativas quanto à presença da mutação CT ou TT entre os casos e os controles. Conclusão: A presença da mutação C677T-MTHFR no sangue fetal mostrou associação com malformações de SNC, tanto na forma homozigota quanto heterozigota
Abstract: Context and objective: Some congenital malformations have vascular origin, and a thrombosis during organogenesis is a possible mechanism for them. The aim of this study was to evaluate the association between fetal thrombophilia and malformations of vascular origin. Study type and location: A case-control study was performed at the Fetal Medicine Outpatient Clinic of CAISM UNICAMP, from 2005 to 2010. Methods: Ninety-seven fetuses with central nervous system malformations, gastroschisis, limb body wall and limb reduction were included in the study (cases), after routine cordocentesis showed normal karyotype results. A hundred fetuses without malformations were included as controls. These fetuses' cord blood had been donated to the Cord Blood Bank of HEMOCENTRO UNICAMP. DNA was extracted from fetal cord blood to study the mutations Factor V Leiden, G20210A-FII and MTHFR-C677T in both groups. Descriptive analysis was realized using Chi-square and Fisher's Exact Test. Wilcoxon test and logistic regression were used to analise the associations among variables. Results: We found 78 fetuses with central nervous system malformations, 14 with gastroschisis, 3 with member reduction and 2 with limb body wall. The mutations Factor V Leiden and G20210A-FII were not detected in cases nor in controls. The mutation MTHFR-C677T was encountered in 24 cases (24.8%) and in 6 controls its heterozygous form (CT). The homozygous mutation (TT) was found in 7 cases (7.2%) and in one control. These differences were statistically significant (p <0.0001). When the fetuses with central nervous system malformations were evaluated separately (Article 1), the frequency of the CT mutation was significantly higher in cases than in controls (OR 10.309 95% CI 3.344-32.258), as did the TT mutation (OR 12.346 95% CI 1.388-111.11). The 14 fetuses with gastroschisis were also evaluated separately (Article 2), and the results showed no statistically significant differences between cases and controls when concerning to the presence of the mutation MTHFR-C677T. Conclusion: The presence of the mutation MTHFR-C677T in fetal blood was associated with central nervous system malformations, both in homozygous and heterozygous form
Doutorado
Saúde Materna e Perinatal
Doutora em Ciências da Saúde
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Trost, Stefanie [Verfasser], Matthias [Akademischer Betreuer] Knüpfer, Dietrich [Gutachter] Kluth, and Udo [Gutachter] Rolle. "Retrospektive Analyse des kurzfristigen Outcomes von Patienten mit Gastroschisis und Omphalocele am Zentrum für Kinder- und Jugendmedizin Leipzig / Stefanie Trost ; Gutachter: Dietrich Kluth, Udo Rolle ; Betreuer: Matthias Knüpfer." Leipzig : Universitätsbibliothek Leipzig, 2013. http://d-nb.info/123802081X/34.
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Garcia, Luciana de Freitas. "Gastrosquise fetal isolada: relação entre dilatação intestinal e resultados perinatais adversos." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/5/5139/tde-06022012-174407/.
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Objetivos: Este estudo foi desenvolvido para avaliar o diâmetro transverso da alça intestinal exteriorizada como fator preditor de resultado adverso, nas gestações com gastrosquise fetal isolada. Métodos: Estudo retrospectivo envolvendo 94 gestações únicas. Foi realizada a medida do diâmetro transverso da alça intestinal (DTA) herniada, por meio da ultrassonografia antenatal, até 3 semanas antes do parto. Foi considerado resultado perinatal adverso: óbito intra-útero, óbito neonatal e complicações intestinais. Resultados: a última medida ultrassonográfica do DTA foi realizada com 35,6 ± 1,6 semanas e o tempo médio do intervalo entre a última medida e o parto foi de 6,2 ± 5,0 dias. Ocorreram 10 (10,6%) casos de óbitos intraútero e neonatal; foram observadas complicações intestinais em 8 (8,5%) casos. DTA 15, 20, 25 e 30 mm foram identificadas em 87, 46, 13 e 4% das gestações com prognóstico favorável, respectivamente. O DTA 25 mm apresentou valores de sensibilidade de 38%, e, valores preditivo positivo e preditivo negativo de 38% e 87%, na predição de resultados adversos. Para o DTA 30 mm, os valores foram: 19, 50 e 85%. A área sob a curva ROC do valor observado/esperado do DTA para cada idade gestacional foi de 0,67, sendo o melhor ponto-de-corte em 1,39; e, seus valores preditivos foram semelhantes aos do DTA 25 mm. Dilatação intestinal esteve significantemente associada com baixa taxa de fechamento primário da parede abdominal, longo período para iniciar a dieta via oral e internação hospitalar prolongada. Conclusões: Dilatação intestinal demonstrada até 3 semanas antes do parto é preditora de complicações intestinais e está associado a baixa taxa de fechamento primário da parede abdominal, longo período para iniciar a dieta via oral e de internação hospitalarObjectives: Evaluate bowel diameter as a predictor of adverse outcome in isolated fetal gastroschisis. Methods: Retrospective study involving 94 singleton pregnancies. Ultrasound measurements of herniated bowel transverse diameter (BTD) were performed up to 3 weeks before delivery. Adverse outcome was intrauterine/ neonatal death and/or bowel complications. Results: Last BTD was recorded at 35,6 ± 1,6 weeks and mean interval to delivery was 6,2 ± 5,0 days. Intrauterine/ neonatal death occurred in 10 (10,6%) cases; bowel complications were observed in 8 (8,5%). BTD 15, 20, 25 and 30mm were found in 87, 46, 13 and 4% of pregnancies with a favorable outcome, respectively. BTD 25 mm sensitivity was 38%, positive and negative predictive values, 38% and 87%. For BTD 30 mm, the values were: 19, 50 and 85%. Observed/expected BTD ROC curve showed an area of 0,67, with best cut-off at 1,39; prediction values were similar to those for BTD 25 mm. Bowel dilatation was also significantly associated with lower rate of primary surgical closure, longer period to full oral feeding and prolonged hospital stay. Conclusions: Bowel dilatation demonstrated up to 3 weeks before delivery is a predictor of intestinal complications and is associated with lower rate of primary surgical closure, longer period to achieve full oral feeding and hospital stay
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Bremer, Sophia Alice [Verfasser], Wieland [Akademischer Betreuer] Kiess, Holger [Gutachter] Stepan, and Andreas [Gutachter] Merkenschläger. "Prävalenz von Gastroschisis, Omphalozele, Spina bifida und orofazialen Spaltbildungen bei Neugeborenen im Zeitraum Januar 2000 bis Dezember 2010 in Leipzig, Sachsen, Sachsen-Anhalt und Deutschland / Sophia Alice Bremer ; Gutachter: Holger Stepan, Andreas Merkenschläger ; Betreuer: Wieland Kiess." Leipzig : Universitätsbibliothek Leipzig, 2017. http://d-nb.info/1240701446/34.
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Gonçalves, Frances Lilian Lanhellas 1979. "Avaliação da proteção das alças intestinais fetais utilizando hidrogel (biomaterial) no modelo experimental de gastrosquise." [s.n.], 2008. http://repositorio.unicamp.br/jspui/handle/REPOSIP/310458.
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Orientador: Lourenço Sbragia NetoDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: Gastrosquise é um defeito congênito da parede abdominal anterior no qual as alças intestinais ficam herniadas e em contato com o líquido amniótico (LA). Assim, a exposição ao LA resulta em várias disfunções intestinais pós-natal. Para reduzir o tempo de exposição ao LA em modelo animal, usou-se um hidrogel de N-isopropilacrilamida (NIPAAm) copolimerizado com ácido acrílico (Aac), que rapidamente intumesce na presença de LA. O hidrogel foi usado para cobrir as alças expostas até o fim da gestação. A gastrosquise foi induzida em fetos de ratas fêmeas da raça Sprague-Dawley através de um corte paramediano à direita do cordão umbilical para exposição parcial das alças com 18,5 dias de gestação. Os fetos foram separados em quatro grupos: controle (C), apenas gastrosquise (G), gastrosquise + cobertura das alças com adesivo de fibrina - Beriplast® (GA) e gastrosquise + cobertura das alças com adesivo de fibrina e aderido um pedaço de hidrogel seco (GAH). Os animais foram colhidos por cesárea com 21,5 dias de gravidez e o hidrogel foi cuidadosamente removido. Os fetos e as alças intestinais foram pesados e análise morfométrica foi realizada. Resultados mostraram que o hidrogel após intumescimento pesou 34X que seu peso seco; ele possui carga elétrica assim como a maioria das proteínas presentes no LA e sua retirada não provocou lesão à camada serosa do intestino exposto como visto na MEV. A comparação dos grupos C e GAH com os grupos G ou GA mostrou que o peso, o diâmetro, a espessura das camadas e da parede intestinais foi significativamente menor nos grupos C e GAH quando comparados aos grupos G e GA indicando processo inflamatório. Sendo assim, a aplicação do hidrogel aderido pelo adesivo de fibrina mostrou servir como uma efetiva proteção das alças herniadas, com uma redução significante da inflamação na gastrosquise.
Abstract: Gastroschisis is a congenital defect of the anterior abdominal wall which leads the fetal bowel to herniate into the amniotic cavity. There, exposition to amniotic fluid (AF), results in severe postnatal intestinal dysfunction. In order to reduce exposition time to AF in an animal model, has used a hydrogel of N-isopropylacrylamide (NIPAAm) copolymerized with acrylic acid (Aac), which undergoes rapid swelling in the amniotic fluid. The hydrogel was used to coat the bowel hernia until pregnance is completed. Gastroschisis was induced in the fetuses of female Sprague-Dawley rats by partial evisceration of the bowel through a right paramedian opening of the abdominal wall in day 18,5 of pregnancy. The fetuses were separated in four groups: control (C), gastroschisis alone (G), gastroschisis + coating of the bowel hernia with fibrin adhesive -Beriplast® (GA) and gastroschisis + coating of the bowel hernia with fibrin adhesive topped by a piece of adhered dry hydrogel (GAH). Animals were harvested by cesarean section at day 21.5 of pregnancy and the hydrogel was carefully removed. Fetuses and intestinal tract were weighed and morphometric analysis was performed. Results showed that the hydrogel weight was 34X heavier than its dry weight; its electric charge and also the AF charge were negative and there was no damage to serosa layer of the intestine exposed. Comparison of the C and GAH groups with G and GA showed that the bowel weight, diameter, the layers and wall thickness was significantly reduced in C and GAH compared to G and GA. Thus, application of the hydrogel bound onto the fibrin adhesive was shown to provide an effective protection of the herniated bowel, with a significant reduction of inflammation in gastroschisis.
Mestrado
Pesquisa Experimental
Mestre em Cirurgia
30
Fromm, Frederik Felipe [Verfasser]. "Fetoscopic abdominal decompression of congenital diaphragmatic hernia – a proof of concept study and stereological analysis based on morphological pulmonary changes in an ovine animal model : Pilotstudie über die abdominelle Dekompression einer Zwerchfellhernie durch iatrogene Gastroschisis -Teschnische Machbarkeit und Lungenveränderungen am fetalen Schafmodell / Frederik Felipe Fromm." Hamburg : Staats- und Universitätsbibliothek Hamburg Carl von Ossietzky, 2019. http://d-nb.info/1225711584/34.
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Centofanti, Sandra Frankfurt. "Avaliação do padrão nutricional e níveis séricos de ácidos graxos nas gestantes portadoras de fetos com gastrosquise." Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/5/5139/tde-05122018-120715/.
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Objetivo: avaliar a ingestão de nutrientes no período pré-concepcional e níveis séricos de ácidos graxos, durante a gestação, em gestantes portadoras de fetos com gastrosquise e gestantes portadoras de fetos normais. Métodos: estudo prospectivo caso-controle realizado no período de Julho de 2013 a Julho de 2015 no setor de Medicina Fetal do Hospital das Clínicas. O grupo gastrosquise (GG) foi constituído de 57 gestantes com gestações únicas, idade gestacional inferior a 34 semanas e feto com gastrosquise isolada. O grupo controle (GC) foi constituído de 114 gestantes portadoras de fetos normais pareadas de acordo com idade materna (± 2 anos), idade gestacional (± 2 semanas) e mesma classificação de índice de massa corpórea (IMC) no período pré-concepcional. Os dados referentes ao consumo dietético das gestantes foram obtidos a partir do questionário de frequência e consumo alimentar (QFCA) e o cálculo da ingestão dos nutrientes (macronutrientes; micronutrientes, ácidos graxos e aminoácidos) foi obtido a partir de programas específicos: Dietwin Profissional 2.0® and Virtuanutri®. Para a avaliação de níveis séricos de ácidos graxos (AG), as gestantes foram submetidas à coleta de sangue na entrada no estudo e no momento do parto. A comparação de AG foi realizada durante a gestação e no momento do parto. Com o objetivo de avaliar se as diferenças entre os grupos eram mais frequentes na primeira ou na segunda metade da gestação, uma nova análise foi realizada subdividindo o período gestacional 25 semanas e < 34 semanas. Resultados: no período pré-concepcional, a media diária de calorias ingerida foi maior (2382,43 vs. 2198,81; p = 0,041) no GG em comparação com GC. O consumo médio de metionina (763,89 vs 906,34; p = 0,036), treonina (1248,34 vs. 1437,01; p = 0,018) e crômio (54,66 vs. 59,49 p = 0,014) foi menor no GG em comparação ao GC. Na análise de ácidos graxos, observa-se que o total AG (p = 0,008), AG insaturados (p = 0,002) e a razão C18:1n9/C18:00 (p = 0,021) foi menor no GG em comparação ao GC durante a gestação; entretanto, a razão C16:00 / C18:2n6 (p = 0,018) foi maior no GG em comparação ao GC no mesmo período. Total AG (p = 0,044) e AG insaturados (p = 0,024) foi menor no GG em comparação ao GC no período <= 25 . AG insaturados (p = 0,025) e a razão C18:1n9/C18:00 (p = 0,013) foi menor no GG em comparação ao GC no período > 25 semanas e < 34 semanas. Conclusão: gestantes portadoras de fetos com gastrosquise apresentam dieta de baixa qualidade nutricional, com alto valor calórico e pobre em aminoácidos essenciais, no período pré-concepcional, e baixos níveis séricos de ácidos graxos durante a gestaçãoObjective: To evaluate the nutrients intake during the preconceptional period and the serum fatty acid levels during the gestation period of pregnant women with fetuses with gastroschisis and pregnant women with normal fetuses. Methods: A prospective case-control study was conducted at the Fetal Medicine Unit at Hospital das Clínicas from July 2013 to July 2015. The gastroschisis group (GG) comprised 57 pregnant women with singleton pregnancies of less than 34 weeks with fetuses with isolated gastroschisis, and the control group (CG) comprised 114 pregnant women with normal fetuses matched for maternal age (± 2 years), gestational age (± 2 weeks), and the same preconceptional body mass index (BMI). Nutritional assessments related to the preconceptional period were obtained using the Food Consumption Frequency Questionnaire and nutrient intakes (macronutrient, micronutrient, fatty acid and amino acid) were calculated using nutrition programs: Dietwin Profissional 20 ® and Virtuanutri ®. For the evaluation of serum fatty acid levels (FA), a blood sample was collected from each subject at the time they entered the study and at the time of delivery. The FA comparison was performed during gestation and at the time of delivery. In order to evaluate whether the differences between both groups were more frequent in the first or second half of gestation, a new analysis was performed, subdividing gesta 25 weeks and < 34 weeks. Results: during the preconceptional period, the median daily calorie intake was higher (2382.43 versus 2198.81; p = 0.041) in the GG than in the CG. The median intakes of methionine (763.89 versus 906.34; p = 0.036), threonine (1248.34 versus 1437.01; p = 0.018) and chromium (54.66 versus 59.49 p = 0.014) were lower in the GG than in the CG. By analyzing the serum fatty acid levels, total FA (p = 0.008), unsaturated FA (p = 0.002) and the C18:1n9/C18:00 ratio (p = 0.021) were lower in the GG than in the CG during gestation; however, the C16:00 / C18:2n6 ratio (p = 0.018) was higher in the GG than in the CG during the indicated period. Total FA (p = 0.044) and unsaturated FA (p = 0.024) were lower in the GG than in the CG at period <= 25 w k , and unsaturated FA (p = 0.025) and the C18:1n9/C18:00 ratio (p = 0.013) were lower in the GG than in the CG at period > 25 weeks and < 34 weeks. Conclusion: Pregnant women with fetuses with gastroschisis have low-nutritional-quality diet, which is both high in calories and poor in essential amino acids during the preconceptional period, and have low serum FA levels during pregnancy
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Centofanti, Sandra Frankfurt. "Gastrosquise: avaliação do padrão de crescimento fetal e predição de baixo peso no nascimento." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/5/5139/tde-14012015-145155/.
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INTRODUÇÃO: Gastrosquise é uma malformação da parede abdominal do feto e uma das principais complicações relacionadas à restrição de crescimento fetal. Objetivo principal: avaliar o padrão de crescimento de fetos com gastrosquise para cada parâmetro biométrico. Objetivo secundário: avaliar o déficit de crescimento em três períodos gestacionais e predizer recém-nascidos pequenos para idade gestacional a partir de medidas de parâmetros biométricos abaixo do percentil 10. MÉTODOS: Este é um estudo do tipo coorte retrospectivo. Foram selecionados 70 casos para avaliação do padrão de crescimento. As medidas de cada parâmetro biométrico: circunferência cefálica, circunferência abdominal, comprimento femoral, razão circunferência cefálica/circunferência abdominal e peso fetal estimado foram plotadas em um gráfico de dispersão para comparação com a curva de referência. A diferença porcentual entre as médias das medidas dos fetos com gastrosquise em relação aos normais foi determinada. Para a avaliação do déficit de crescimento foram incluídos 59 casos, com ao menos um exame em cada período gestacional (I:20 a 25 semanas e 6 dias; II:26 a 31 semanas e 6 dias; III: 32 semanas até o parto). O déficit de cada parâmetro biométrico foi obtido a partir da comparação entre os períodos gestacionais. Para a predição de recém-nascido pequeno para idade gestacional foram utilizadas as medidas abaixo do percentil 10 de cada parâmetro biométrico nos períodos I e II. RESULTADOS: Na avaliação do padrão de crescimento, observa-se diferença significativa entre os fetos com gastrosquise e fetos normais a partir de 20 semanas de gestação (p<0,005). Na avaliação do déficit de crescimento, apenas peso fetal estimado apresentou diferença significativa (p=0,030). O porcentual de fetos com peso fetal estimado abaixo do percentil 10 no período 2 foi 40% maior do que no período 1, e 93% maior no período 3 do que no 1. Na predição de recémnascidos pequeno para idade gestacional, apenas a circunferência cefálica (razão chance= 6.07; sensibilidade= 70.8%; especificidade= 71.4%) e a circunferência abdominal (razão chance=0,558; sensibilidade= 41,7%; especificidade= 80%) no período II, foram consideradas. CONCLUSÃO: Fetos com gastrosquise apresentam medidas dos parâmetros biométricos significativamente menores do que as de fetos normais, a partir de 20 semanas de gestação. Na avaliação do déficit de crescimento, observa-se maior incidência de restrição de crescimento fetal nos períodos II e III em comparação ao período I. É possível predizer recém-nascidos com baixo peso ao nascimento, a partir de medidas de circunferência cefálica e circunferência abdominal, abaixo do percentil 10 no período IIINTRODUCTION: Gastroschisis is a congenital abdominal wall defect of the fetus and one of its main complications is related to fetal growth restriction. OBJECTIVES: Primary: To evaluate the growth pattern of fetuses with gastroschisis according to each biometric parameter; Secondary: to evaluate growth deficit in three gestational periods and to predict low birth weight from measures of biometric parameters below the 10th percentile. METHODS: This is a retrospective cohort study. We selected 70 cases for evaluation of the growth pattern. The measurements of each biometric parameter: head circumference, abdominal circumference, femur length, head circumference/abdominal circumference ratio and estimated fetal weight were plotted in a growth chart for comparison with the curve of normality. The percentage difference between the mean values of the fetuses with gastroschisis in relation to normal fetuses was then determined. For the evaluation of growth deficit 59 cases with at least one exam in each gestational period (I: 20 to 25 weeks and 6 days; II: 26 to 31 weeks and 6 days; III: 32 weeks until delivery) were included. The deficit of each biometric parameter was obtained from the comparison between these gestational periods. For the prediction of low birth weight, the measures below the 10th percentile of each biometric parameter in periods I and II were tested. RESULTS: In the evaluation of the growth pattern a significant difference between the fetuses with gastroschisis and normal fetuses from 20 weeks of gestation (p < 0.005) is observed. In the evaluation of growth deficit only estimated fetal weight showed a significant difference (p= 0.030). The percentage of fetuses with estimated fetal weight values below 10 percentile in period 2 was 40% higher than that in period I, and 93% higher in period III than in I. In the prediction of low birth weight, only head circunference (odds ratio= 6.07; sensitivity= 70.8 %; specificity = 71.4 %) and abdominal circunference (odds ratio= 0.558; sensitivity = 41.7 %; specificity = 80 %) in period II were predictive. CONCLUSION: Fetuses with gastroschisis show biometric parameters measures significantly smaller than the measures of normal fetuses with 20 weeks of gestation and/or more. In the evaluation of growth deficit, there is a higher incidence of fetal growth restriction in periods II and III. It is possible to predict newborns with low birth weight from measures of head circunfernce and abdominal circunference below the 10th percentile in period II
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Sekabira, John. "Gastroschisis in KwaZulu-Natal." Thesis, 2008. http://hdl.handle.net/10413/9610.
Full textAbstract:
Gastroschisis is a full thickness abdominal wall defect, usually to the right of the umbilicus,
through which a variable amount of viscera herniates, without a covering membrane. Newborns
with gastroschisis present challenging problems to paediatric surgeons. The incidence of
gastroschisis is rising worldwide. In developed countries, advances in neonatal intensive care
have improved survival of patients with gastroschisis. In the few reported studies from Africa,
mortality rates of patients with gastroschisis are high. The aim of this study was to evaluate
outcome of gastroschisis from a centre in Africa with modern neonatal intensive care facilities.
Methods: A retrospective analysis of all neonates admitted with the diagnosis of gastroschisis
at Inkosi Albert Luthuli Central Hospital (IALCH) over a 6-year period (2002-2007).
Proportions in percentages were used for categorical variables. For continuous variables the
mean with standard deviation (SD) were derived. Two sampled t-test was used to show the pvalue
for the time to reduction between the non-survivors and survivors with a 95% confidence
interval.
Results: There was a significant increase in the prevalence of gastroschisis among neonatal
surgical admissions from 6.2% in 2003 to 15.2% in 2007. There were more females 53.4%, the
majority (71.7% had low birth weight and 64.2% were born prematurely. Although 75% (n=79)
of the mothers attended antenatal clinic, antenatal diagnosis by ultrasound was made in only 13
(n=12%)). Most of the babies 90.6% were out-born, with 70.8% delivered by normal vaginal
delivery (NVD), and 57.4% of the mothers were primiparous. Primary closure was achieved in
73.5% of the patients. The overall mean (SD) time from birth to primary surgical intervention
was 16 (13.04) hours and was higher 17(9.1) hours in those who died compared to survivors 15
(16.0), but the difference was not statistically significant, p=0.4465 and mortality was 43% with
sepsis as the leading cause. Staged closure with a plastic silo bag was associated with more than
double the mortality as compared to primary closure.
Conclusion: The prevalence of gastroschisis among neonatal surgical admissions has increased
in accordance with international trends. Due to lack of antenatal diagnosis, most of the babies
were out-born resulting into delay in offering surgical treatment. Mortality is still high despite
the presence of modern intensive care.Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2008.
34
Kruscha, Josefine. "Analyse verschiedener Risikofaktoren und Prävalenzentwicklung der Gastroschisis im Zeitraum 2003 bis 2010 in Leipzig." Doctoral thesis, 2014. https://ul.qucosa.de/id/qucosa%3A13494.
Full textAbstract:
In den letzten Jahrzehnten konnte international ein Prävalenzanstieg der Gastroschisis beobachtet werden. Nach wie vor bleibt die Ätiologie sowie Pathogenese dieses Bauchwanddefektes nicht vollständig geklärt. Ziel dieser Arbeit war es, zum einen die Prävalenzentwicklung der Gastroschisis im Untersuchungszeitraum 2003 bis Ende Juli 2010 in Leipzig zu untersuchen und zum anderen mögliche relevante Risikofaktoren für diese Fehlbildung aus dem vorliegenden Patientenkollektiv zu eruieren. Dazu wurden 27 Mütter von Gastroschisiskindern und 27 Mütter gesunder Neugeborener befragt und die Ergebnisse unter Einbeziehung klinischer Daten analysiert.
Für den untersuchten Zeitraum ergab sich eine Prävalenz von 4,1 je 10000 Lebendgeborene für den Direktionsbezirk Leipzig. In Sachsen lag diese bei 2,3 je 10000 Lebendgeburten. Als signifikante Risikofaktoren konnten das junge Alter und ein niedriger Bildungsgrad der Mütter, der Familienstand ledig, eine kurze Kohabitationszeit mit dem Vater des Kindes und die fehlende Einnahme von Folsäure in der Schwangerschaft erhoben werden. Weiterhin erhöhte der Nikotinkonsum das Risiko um das 3,6-fache, ein Kind mit einer Gastroschisis zu bekommen. Die Einnahme von oralen Kontrazeptiva führte ebenfalls zu einer deutlichen Steigerung des Risikos. Eine eher untergeordnete Rolle spielten Alkohol- und Drogenkonsum, Ernährungsfaktoren, Erkrankungen, der BMI, das Geschlecht der Kinder, die Ethnizität, die familiäre Vorbelastung, der Konzeptionszeitpunkt, Expositionen gegenüber Umweltfaktoren, die Parität und die Einnahme von Medikamenten.
35
Valente, Lília Patrícia de Mendonça. "Gastroschisis: factors influencing 3-year survival and digestive outcome." Master's thesis, 2015. https://repositorio-aberto.up.pt/handle/10216/78849.
Full text
36
Valente, Lília Patrícia de Mendonça. "Gastroschisis: factors influencing 3-year survival and digestive outcome." Dissertação, 2015. https://repositorio-aberto.up.pt/handle/10216/78849.
Full text
37
Müller, Marc [Verfasser]. "Fetalchirurgischer Verschluss der Gastroschisis im Kaninchenmodell / vorgelegt von Marc Müller." 2009. http://d-nb.info/994042655/34.
Full text
38
Franz, Andrea. "Gastroschisis und Omphalocele im zeitlichen Wandel von 1972 bis 2002." Doctoral thesis, 2006. https://nbn-resolving.org/urn:nbn:de:bvb:20-opus-21612.
Full textAbstract:
An der Abteilung für Kinderchirurgie des Universitätsklinikums Würzburg wurden von 1972 bis 2002 66 Kinder mit Gastroschisis und 48 Kinder mit Omphalocele behandelt. In dieser retrospektiven Studie wurden die perinatalen Daten und der Therapieverlauf dieser Kinder analysiert. Es konnte ein deutlicher Anstieg der Inzidenz der Gastroschisis festgestellt werden, während die Zahl der Kinder mit Omphalocele rückläufig war. Die Gastroschisis kam gehäuft bei Kindern vor, deren Mütter jünger als 25 Jahre und zum ersten Mal schwanger waren, wohingegen bei der Omphalocele das Alter der Mütter mehrheitlich über 26 Jahre lag. In der Schwangerschaftsanamnese konnte weder für die Gastroschisis noch die Omphalocele in dem Beobachtungszeitraum von 1972 bis 2002 ein eindeutiges Risikoprofil herausgefunden werden. Ein kompletter Wandel konnte in der Anzahl pränatal diagnostizierter Fälle mittels Sonographie beobachtet werden: Lag die Detektionsrate von 1972 bis 1988 noch bei 0%, so stieg sie in den letzten Jahren des Untersuchungszeitraums auf ca. 90%. Auch der Entbindungsmodus hat sich vollständig gewandelt: Bis 1982 wurden alle Kinder, die an der Universitätsklinik wegen Gastroschisis oder Omphalocele behandelt wurden, vaginal geboren. Ab 1993 wurden bis auf zwei Kinder alle mittels Sectio caesarea entbunden. Der Entbindungszeitpunkt lag in der Mehrzahl der Fälle vor Abschluss der Frühgeburtlichkeit. Postnatale Komplikationen ergaben sich somit aufgrund der Frühgeburtlichkeit, bei der Gastroschisis standen zusätzlich gastrointestinale, bei der Omphalocele respiratorische Probleme sowie v.a. kardiale Begleitfehlbildungen und komplexe Fehlbildungssyndrome im Vordergrund. Ein gehäuftes Vorkommen von Chromosomenanomalien konnte nicht nachgewiesen werden. Bei der postpartalen Therapie ist der operative Primärverschluss der Bauchdecke die Methode der Wahl und konnte in den letzten 10 Beobachtungsjahren in ca. 65% der Fälle durchgeführt werden. War das Organeventrat zu groß, so wurde eine Bauchdeckenersatzplastik angelegt, welche bis 1996 mit lyophilisierter Dura und ab 1997 mit Goretex durchgeführt wurde. Weitere Methoden wie der reine primäre Hautverschluss bei sehr großen Defekten wurden bis ca. 1979 eingesetzt und waren danach aufgrund einer erhöhten Komplikationsrate obsolet. Eine konservative Therapieform für große Omphalocelen wurde wegen hoher Letalität nach 1979 aufgegeben. Im postoperativen Verlauf standen bei der Gastroschisis die Sepsis und gastrointestinale Komplikationen im Vordergrund, bei der Omphalocele v.a. kardiale Probleme durch Begleitfehlbildungen sowie respiratorische Störungen. Aufgrund gastrointestinaler Komplikationen mussten Kinder mit Gastroschisis häufiger relaparotomiert und am Darm operiert werden, so dass verglichen mit der Omphalocele bei der Gastroschisis der Nahrungsaufbau verzögert und die Dauer des stationären Aufenthaltes länger war. Es konnte ein deutlicher Rückgang der Letalität aufgrund des verbesserten perioperativen Umfeldes beobachtet werden: Es verstarben mehr Kinder mit einer Omphalocele, die Letalität lag von 1972 bis 1992 bei 41% und sank von 1993 bis 2002 auf 9,1%, als Kinder mit einer Gastroschisis, wobei hier die Letalität von 21% auf 6,1% fiel. An erster Stelle der Todesursachen stand bei der Omphalocele die Sepsis, an zweiter Stelle die Folgen von Begleitfehlbildungen. Bei der Gastroschisis war die Hauptursache ebenso eine Sepsis. Von den Kindern mit angeborenen Bauchwanddefekten bzw. deren Eltern konnten ca. 50% mittels Fragebogen nachuntersucht werden. Alle Kinder, mit Ausnahme derer mit z.T. erheblichen Begleitfehlbildungen oder Syndromen, zeigten zum Untersuchungszeitpunkt eine altersgemäße Entwicklung und waren normgewichtig. Die Lebensqualität wurde von den Eltern als „sehr gut“ bzw. „gut“ bewertet. Zusammenfassend gesehen hat sich die Prognose für Kinder mit einer Gastroschisis oder einer Omphalocele in den letzten zwei Jahrzehnten durch deutliche Fortschritte in der pränatalen Diagnostik, der Geburtsplanung, der operativen Therapie und dem perioperativen Umfeld stark verbessert. Aus diesem Grund ist eine weitere enge Zusammenarbeit von Geburtshelfern, Neonatologen und Kinderchirurgen von größter BedeutungFrom 1972 to 2002 66 children with gastroschisis and 48 children with Omphalocele were treated at the department of Pediatric Surgery at the University Hospital of Würzburg. In a retrospective analysis we examined the perinatal management and outcome of those children. In the last two decades there has been an increase of cases with gastroschisis whereas cases of omphalocele decreased. Mothers less than 25 years old and primigravida were at a greater risk to get a child with gastroschisis. The maternal age in the omphalocele group was 26 years and older. We could not identify a risk factor for gastroschisis or omphalocele in our studies. An antenatal diagnosis by ultrasound was made in 0% from 1972 to 1988, whereas in the last few years 90% of the cases with abdominal wall defects have been detected before birth. The mode of delivery changed completely in the last 10 years: Until 1982 all children with gastroschisis or omphalocele were born vaginally. After 1993 all except 2 babies were delivered by cesarean section and most of them were premature. After birth the babies suffered because of the prematurity, in the gastroschisis group there were more cases with gastrointestinal dysfunction, in the omphalocele group the newborns suffered from associated anomalies, specially cardiac anomalies or complex syndromes. In the last 10 years primary closure was possible in 65 % of the children with abdominal wall defects. If the defect was too large and primary fascial closure was impossible, the abdominal wall was closed using a dura implantation (until 1996) or a Goretex patch (since 1997). After surgical treatment children with gastroschisis had a higher rate of relaparotomy because of gastrointestinal complications. Therefore those children had a longer interval of total parenteral nutrition and length of stay at the hospital than children with omphalocele. Mortality rate of children with abdominal wall defects decreased to less than 10% with sepsis being the most common reason. About 50% of the children with gastroschisis or omphalocele could be examined in 2003 by answering a questionnaire. The follow-up (6 months to 5,5 years old children) shows normal growth and development of the children except for those with severe associated anomalies or syndromes. All others are participating without problems in normal activity and education without reduction in their quality of life. Today isolated cases of gastroschisis or omphalocele have a good prognosis. There has been an improvement of prenatal diagnostics, peripartal managemant, surgical repair and perioperative treatment in the last decade. If an abdominal wall defect is diagnosed, obstetricians, neonatologists and pediatric surgeons should be involved by consulting the parents
39
Trost, Stefanie. "Retrospektive Analyse des kurzfristigen Outcomes von Patienten mit Gastroschisis und Omphalocele am Zentrum für Kinder- und Jugendmedizin Leipzig." Doctoral thesis, 2011. https://ul.qucosa.de/id/qucosa%3A11344.
Full textAbstract:
Hintergrund: Weltweit berichteten zahlreiche Studien von einer steigenden Inzidenz von Patienten mit angeborenen Bauchwanddefekten. Besonders die Zahl der Gastroschisis-Kinder hat deutlich zugenommen. Auch die Neonatologen der Universitätsklinik Leipzig beschrieben ein gehäuftes Auftreten von Patienten mit Gastroschisis und Omphalocele. Aufgabe der vorliegenden Arbeit war es, die Inzidenz dieser beiden Fehlbildungen am Universitätsklinikum Leipzig zu ermitteln und zu untersuchen, wie sich die Fallzahlen während des Untersuchungszeitraumes (1998-2008) entwickelt hatten. Zudem sollten Parameter identifiziert werden, die die Prognose der betroffenen Kinder bis zur Entlassung beeinflussten. Ein weiteres Anliegen dieser Studie war es, mithilfe einer ausführlichen Literaturrecherche, einen Überblick über die aktuelle Behandlung und Prognose der beiden Fehlbildungen zu geben.
Methoden: Im Rahmen einer retrospektiven Untersuchung erfolgte die Erhebung und Auswertung der Daten von 27 Kindern mit Gastroschisis sowie 19 Kindern mit Omphalocele, die zwischen 1998 und 2008 in der Universitätsklinik Leipzig behandelt wurden. Mithilfe des Mann-U-Whitney-Tests sowie des exakten Tests nach Fisher wurden zahlreiche Merkmale hinsichtlich ihrer Auswirkungen auf das Outcome überprüft. Als Parameter, die das Outcome widerspiegelten, galten der Beginn des enteralen Kostaufbaus mit Tee-Glucose-Lösung und Milch, die Dauer der parenteralen Nährstoffzufuhr und des Krankenhausaufenthaltes, sowie Nachoperationen, Komplikationen und die Letalität während des stationären Aufenthaltes.
Ergebnisse: An der Universitätsklinik Leipzig betrug die Inzidenz von Gastroschisis 14 pro 10 000 Lebendgeburten und von Omphalocele 9 pro 10 000 Lebendgeburten. Die Inzidenz blieb während des elfjährigen Beobachtungszeitraumes konstant.
Der Vergleich früh- und reifgeborener Gastroschisis-Patienten zeigte, dass eine Frühgeburt weder mit einem früheren Beginn der oralen Ernährung mit Tee-Glucose-Lösung (11 d vs. 14 d; p nicht signifikant) und Milch (17 d vs. 17 d; p nicht signifikant), noch mit einer Verkürzung der parenteralen Ernährung (36 d vs. 37 d; p nicht signifikant) und stationären Behandlung (48 d vs. 50 d; p nicht signifikant) einherging. Häufig verkomplizierten Infektionen (12/27) und sekundäre Darmverschlüsse (9/27) mit der Notwendigkeit einer zusätzlichen Operation den postoperativen Verlauf der Gastroschisis-Patienten. Letztgenannte Komplikation führte zu einer erheblich protrahierten parenteralen Ernährung (79 d vs. 31 d; p < 0,05) und stationären Behandlung (101 d vs. 38 d; p < 0,05), während Infektionen kaum Auswirkungen auf das Outcome hatten. Es zeigte sich, dass vorrangig Kinder mit kleinem Defekt (<= 4 cm) sowie mit prolabiertem Magen einen Ileus entwickelten. Neben Darmverschlüssen führten intestinale Begleitfehlbildungen tendenziell zu einer Verlängerung der Hospitalisierungszeit (73 d vs. 48,5 d; p nicht signifikant). Gelang die orale Zufuhr von Milch innerhalb der ersten 14 Lebenstage, so verringerte sich die Dauer der parenteralen Ernährung (30 d vs. 37 d; p < 0,05) und der stationären Behandlung (41 d vs. 67 d; p nicht signifikant).
Bei Patienten mit Omphalocele bestimmten vor allem die Größe der Omphalocele, der Inhalt des Bruchsackes sowie der Zeitpunkt des oralen Ernährungsbeginns die Prognose. Ein großer (> 4 cm) Bauchwanddefekt ging mit einer erhöhten Infektionsrate (4/7 vs. 1/11; p < 0,05), prolongierten parenteralen Nahrungszufuhr (26 d vs. 17 d; p < 0,05) sowie stationären Behandlung (46 d vs. 24 d; p nicht signifikant) einher. Extraintestinale Begleitanomalien zeigten sich jedoch häufiger bei Patienten mit kleinem Defekt (5/11 vs. 1/7; p nicht signifikant). Befand sich die Leber außerhalb der Abdominalhöhle, waren zusätzliche Fehlbildungen seltener (3/11 vs. 5/7; p < 0,05). Eine prolabierte Leber verzögerte tendenziell die parenterale Ernährung (24 d vs. 18 d; p nicht signifikant) und die Krankenhausverweildauer (46 d vs. 21 d; p nicht signifikant). Ein frühzeitiger Beginn des enteralen Kostaufbaus mit Milch innerhalb der ersten zehn Lebenstage führte hingegen zu einer Verkürzung der parenteralen Ernährung (17 d vs. 27 d; p < 0,05) und stationären Behandlung (22,5 d vs. 49 d; p nicht signifikant).
Schlussfolgerung: Die Inzidenz von Gastroschisis und Omphalocele blieb während des Beobachtungszeitraumes konstant.
Die Prognose der Gastroschisis-Patienten wurde durch eine Frühgeburt nicht verbessert, so dass eine Termingeburt angestrebt werden sollte. Die Daten der vorliegenden Arbeit legen nahe, dass ein frühzeitiger Nahrungsaufbau mit der oralen Zufuhr von Tee ab dem achten Lebenstag sowie Milch ab dem zehnten Lebenstag günstig für das Outcome hinsichtlich der Dauer der parenteralen Ernährung und des stationären Aufenthaltes ist. Darmverschlüsse stellten schwerwiegende Komplikationen dar und verschlechterten das Outcome maßgeblich.
Eine große Omphalocele sowie eine ausgetretene Leber erhöhten die Morbidität. Ebenso wie bei Gastroschisis-Kindern scheint ein frühzeitiger Beginn der enteralen Ernährung das Outcome der Omphalocele-Patienten hinsichtlich der Dauer der parenteralen Ernährung und Krankenhausbehandlung zu verbessern. Deshalb empfehlen wir ab dem fünften sowie siebten Lebenstag die enterale Ernährung mit Tee sowie Milch zu beginnen.
Ein großes Manko der vorliegenden Studie ist die kleine Fallzahl dieser retrospektiven, monozentrischen Erhebung. Zur besseren Erfassung der Patienten mit angeborenen Bauchwanddefekten und um aussagekräftige epidemiologische und prognostische Ergebnisse zu erhalten, bedarf es eines Fehlbildungsregisters in Sachsen, so wie es bereits in anderen Bundesländern angewandt wird.:INHALTSVERZEICHNIS
BIBLIOGRAPHISCHE BESCHREIBUNG II
INHALTSVERZEICHNIS III
ABBILDUNGSVERZEICHNIS V
TABELLENVERZEICHNIS VI
ABKÜRZUNGSVERZEICHNIS VIII
1. EINLEITUNG 1
1.1. Gastroschisis 1
1.1.1. Historie 1
1.1.2. Pathogenese und Ätiologie 2
1.2. Omphalocele 4
1.2.1. Historie 4
1.2.2. Pathogenese und Ätiologie 5
1.3. Fragestellungen und Ziele dieser Studie 6
2. MATERIAL UND METHODEN 8
2.1. Patientengut 8
2.2. Datenerhebung 8
2.3. Versorgung der Patienten in der Universitätsklinik Leipzig 9
2.4. Statistische Auswertung 10
3. ERGEBNISSE 11
3.1. Ergebnisse der Literaturrecherche 11 3.1.1.Gastroschisis 11
3.1.1.1. Pränatale Diagnostik 11
3.1.1.2. Assoziierte Fehlbildungen 13
3.1.1.3. Geburtszeitpunkt und -modus 14
3.1.1.4. Operatives und stationäres Management 16
3.1.1.5. Komplikationen und Mortalität 17
3.1.1.6. Langfristige Ergebnisse 19
3.1.2. Omphalocele 20
3.1.2.1. Pränatale Diagnostik 20
3.1.2.2. Assoziierte Fehlbildungen 21
3.1.2.3. Geburtsmodus 21
3.1.2.4. Operatives und stationäres Management 22
3.1.2.5. Komplikationen und Mortalität 24
3.1.2.6. Langfristige Ergebnisse 25
3.2. Ergebnisse der Daten der Universitätsklinik Leipzig 27
3.2.1. Gastroschisis 27
3.2.1.1. Allgemeine Daten des untersuchten Kollektivs 27
3.2.1.2. Daten zur Untersuchung des Verlaufs und des Outcomes 29
3.2.1.3. Outcomeanalyse 37
3.2.1.4. Zusammenfassung der Ergebnisse 53
3.2.2. Omphalocele 54
3.2.2.1. Allgemeine Daten des untersuchten Kollektivs 54
3.2.2.2. Daten zur Untersuchung des Verlaufs und des Outcomes 56
3.2.2.3. Outcomeanalyse 65
3.2.2.4. Zusammenfassung der Ergebnisse 77
4. DISKUSSION 78
4.1. Gastroschisis 78
4.2. Omphalocele 87
4.3. Stärken und Schwächen der Untersuchung 91
4.4. Empfehlungen zur Behandlung Neugeborener mit angeborenen
Bauchwanddefekten 92
4.4.1. Gastroschisis 92
4.4.2. Omphalocele 94
5. ZUSAMMENFASSUNG 95
6. LITERATURVERZEICHNIS 98
7. EIGENSTÄNDIGKEITSERKLÄRUNG 125
8. LEBENSLAUF
40
Bremer, Sophia Alice. "Prävalenz von Gastroschisis, Omphalozele, Spina bifida und orofazialen Spaltbildungen bei Neugeborenen im Zeitraum Januar 2000 bis Dezember 2010 in Leipzig, Sachsen, Sachsen-Anhalt und Deutschland." Doctoral thesis, 2016. https://ul.qucosa.de/id/qucosa%3A15367.
Full textAbstract:
Hintergrund: Zahlreiche Studien beschreiben
weltweit eine Zunahme angeborener Fehlbildungen.
Diese sind in Deutschland die häufigste
Todesursache im frühen Kindesalter. Die hier
vorliegende Studie untersuchte lokale und nationale
Trends der Prävalenz von Gastroschisis,
Omphalozele, Spina bifida und orofazialen Spaltbildungen
von 2000 bis 2010.
Methoden: Die Prävalenz der 4 Fehlbildungen
wurde im Zeitraum Januar 2000–Dezember 2010
mithilfe von 4 Datenquellen aus Leipzig, Sachsen,
Sachsen-Anhalt und Deutschland untersucht.
Ergebnisse: Die Prävalenz der Fehlbildungen
betrug im Untersuchungszeitraum in Deutschland
bzw. in Sachsen 1,97/2,12 (Gastroschisis),
1,63/1,48 (Omphalozele), 5,80/8,11 (orofaziale
Spaltbildungen) und 2,92/2,50 (Spina bifida) je
10 000 Lebendgeborene. In Sachsen zeigte sich
ein Trendanstieg, dessen Effektstärken jedoch
sehr gering sind (OR/Jahr zwischen 1,01–1,09).
Auch in Deutschland insgesamt wurde eine signifikante
Zunahme der Fehlbildungen beobachtet
(OR/Jahr zwischen 1,01–1,04), ausgenommen
davon war die Lebendgeborenenprävalenz der
Spina bifida, die abzunehmen schien (OR/Jahr
0,986 (0,97–1,0), p-korrigiert = 0,04).
Schlussfolgerung: Ob ein tatsächlicher Anstieg
der Prävalenzen besteht oder lediglich Artefakte
einen Anstieg vortäuschen, ist unklar. Änderungen
in der Erfassungs- und Verschlüsselungspraxis,
Fehlcodierungen, Doppel- und/oder lückenhafte
Erfassung der Fehlbildungen könnten die
Daten verfälschen. Da nur in Sachsen-Anhalt und
Rheinland-Pfalz das Auftreten von Fehlbildungen
prospektiv erfasst wird, könnten im Übrigen
auch nur in diesen Bundesländern zeitnah Veränderungen
der Fehlbildungsprävalenz erkannt
werden. Angesichts der anscheinenden oder
scheinbaren Zunahme von Fehlbildungen und
der offensichtlich fehlerhaften Datenlage ist ein berücksichbundesweites
oder sind weitere regionale Register für eine bessere
und zeitnahe Erkennung und Erfassung von Fehlbildungen
in Deutschland notwendig.:Inhaltsverzeichnis
Bibliografische Beschreibung 4
I. Abkürzungsverzeichnis 6
1. Einleitung 7
1.1 Hintergrund 7
1.2 Gastroschisis 8
1.3 Omphalozele 12
1.4 Orofaziale Spaltbildungen 15
1.5 Spina bifida 19
1.6 Fragestellung der Studie 22
2. Publikation 25
3. Zusammenfassung der Arbeit 33
4. Literaturverzeichnis 40
II. Erklärung über die Eigenständigkeit der Arbeit 49
III. Lebenslauf 50
IV. Danksagung 52
41
Franz, Andrea [Verfasser]. "Gastroschisis und Omphalocele im zeitlichen Wandel von 1972 bis 2002 / vorgelegt von Andrea Franz." 2007. http://d-nb.info/983173877/34.
Full text
42
Beckh-Arnold, Elaine Mary Philippa. "Gastroschisis and Omphalocoele: audit at two referral Hospitals in Johannesburg, South Africa: 2000-2005." Thesis, 2011. http://hdl.handle.net/10539/10847.
Full textAbstract:
Gastroschisis and omphalocoele are serious birth defects which differ in many aspects.
There are numerous reports of an increase in the incidence of gastroschisis but not
omphalocoele.
A retrospective analysis was conducted including all infants with gastroschisis and
omphalocoele admitted to two tertiary institutions in Johannesburg over six years from
2000-2005. The study aimed to describe the frequency of gastroschisis and
omphalocoele, assess maternal characteristics, evaluate clinical details and factors that
may affect mortality, describe additional abnormalities and determine if there was
appropriate use of genetic services.
The prevalence of gastroschisis and omphalocoele was 0.36 per 1 000 live births and
between the years 2000 and 2005, there was a 2.7 fold increase in the number of patients
with gastroschisis compared to omphalocoele. Sixty percent of the patients were
transferred into the hospitals and 47% of these patients demised. Twenty-one percent
(3/14) of patients with additional abnormalities were referred for a genetic assessment.
Fifty-eight percent (7/12) of patients with omphalocoele and additional congenital
abnormalities demised. Fifty-eight percent (7/12) of the patients with sepsis demised.
From this study, improvement in certain areas such as prenatal diagnosis, interhospital
transfer and education of staff involved in the care of patients with gastroschisis and
omphalocoele is recommended to facilitate a reduction in the high mortality observed.
43
Marques, Alexandra Tavares. "Short and medium term outcomes of omphalocele and gastroschisis: a survey of a tertiary center." Master's thesis, 2021. https://hdl.handle.net/10216/134514.
Full textAbstract:
Objetivo: Caracterizar e comparar os desfechos do onfalocelo e gastrosquisis, desde o nascimento até aos 2 anos de idade, numa coorte recente de um centro terciário.
Métodos: Este é um estudo retrospetivo em que foi feita uma revisão dos registos clínicos de todos os pacientes com gastrosquisis e onfalocelo que foram internados na Unidade de Cuidados Intensivos Neonatais, entre Janeiro de 2009 e Dezembro de 2019.
Resultados: Identificámos 38 pacientes: 13 com onfalocelo e 25 com gastrosquisis. Anomalias associadas estavam presentes em 6 pacientes (46.2%) com onfalocelo e 10 (41.7%) com gastrosquisis. Comparativamente com os pacientes com onfalocelo, os pacientes com gastrosquisis tinham mães mais jovens (24.7 vs. 29.6 anos; p = 0.033), nasceram mais precocemente (36 vs. 37 semanas, p = 0.006), com menor peso ao nascimento (2365 430.4 vs. 2944.2 571.9 g; p = 0.001) e o internamento teve uma duração mais longa (24 vs. 9 dias, p = 0.001). A taxa de sobrevivência neonatal foi de 92.3% para o onfalocelo e 91.7% para a gastrosquisis. Trinta e quatro pacientes foram seguidos durante um tempo mediano de seguimento de 24 meses: 13 com gastrosquisis (59.1%) e 8 com onfalocelo (66.7%) apresentaram pelo menos um evento adverso, sobretudo, hérnia umbilical (27.3% vs 41.7%), obstrução intestinal (31.8% vs 8.3%) e intervenções cirúrgicas adicionais (27.3% vs 33.3%).
Conclusão: Apesar da alta proporção de prematuridade, de baixo peso e de recuperação lenta, os gastrosquisis assim como os onfalocelos (sem anomalias cromossómicas) podem ter uma taxa de sobrevivência muito alta; por outro lado, nos primeiros anos de vida podem surgir complicações não desprezíveis. Assim, aos futuros pais pode ser transmitida uma perspetiva muito positiva em termos de sobrevivência, embora eles também devem ser informados de que pode ocorrer morbilidade substancial no médio prazo.Objective: To characterize and compare the outcomes of omphalocele and gastroschisis from birth to 2-year of follow-up in a recent cohort at a tertiary center. Methods: This is a retrospective clinical record review of all patients with gastroschisis and omphalocele, admitted to the Neonatal Intensive Care Unit between January 2009 and December 2019. Results: There were 38 patients: 13 with omphalocele and 25 with gastroschisis. Associated anomalies were present in 6 patients (46.2%) with omphalocele and in 10 (41.7%) with gastroschisis. Compared to patients with omphalocele, those with gastroschisis had younger mothers (24.7 vs. 29.6 years; p = 0.033), were born earlier (36 vs. 37 weeks, p = 0.006), with smaller birth weight (2365 430.4 vs. 2944.2 571.9 g; p = 0.001) and had a longer hospital stay (24 vs. 9 days, p = 0.001). The neonatal survival rate was 92.3% for omphalocele and 91.7% for gastroschisis. Thirty-four patients were followed-up over a median of 24 months: 13 with gastroschisis (59.1%) and 8 with omphalocele (66.7%) had at least one adverse event, mainly umbilical hernia (27.3% vs 41.7%), intestinal obstruction (31.8% vs 8.3%) and additional surgical interventions (27.3% vs 33.3%). Conclusion: Despite the high proportion of prematurity, low birth weight and protracted recovery, gastroschisis as well as omphalocele (without chromosomal abnormalities) may achieve very high survival rates; on the other hand, complications may develop in the first years of life. Thus, a very positive perspective in terms of survival should be transmitted to future parents, but they should also be informed that substantial morbidity may occur in medium-term.
44
Marques, Alexandra Tavares. "Short and medium term outcomes of omphalocele and gastroschisis: a survey of a tertiary center." Dissertação, 2021. https://hdl.handle.net/10216/134514.
Full textAbstract:
Objetivo: Caracterizar e comparar os desfechos do onfalocelo e gastrosquisis, desde o nascimento até aos 2 anos de idade, numa coorte recente de um centro terciário.
Métodos: Este é um estudo retrospetivo em que foi feita uma revisão dos registos clínicos de todos os pacientes com gastrosquisis e onfalocelo que foram internados na Unidade de Cuidados Intensivos Neonatais, entre Janeiro de 2009 e Dezembro de 2019.
Resultados: Identificámos 38 pacientes: 13 com onfalocelo e 25 com gastrosquisis. Anomalias associadas estavam presentes em 6 pacientes (46.2%) com onfalocelo e 10 (41.7%) com gastrosquisis. Comparativamente com os pacientes com onfalocelo, os pacientes com gastrosquisis tinham mães mais jovens (24.7 vs. 29.6 anos; p = 0.033), nasceram mais precocemente (36 vs. 37 semanas, p = 0.006), com menor peso ao nascimento (2365 430.4 vs. 2944.2 571.9 g; p = 0.001) e o internamento teve uma duração mais longa (24 vs. 9 dias, p = 0.001). A taxa de sobrevivência neonatal foi de 92.3% para o onfalocelo e 91.7% para a gastrosquisis. Trinta e quatro pacientes foram seguidos durante um tempo mediano de seguimento de 24 meses: 13 com gastrosquisis (59.1%) e 8 com onfalocelo (66.7%) apresentaram pelo menos um evento adverso, sobretudo, hérnia umbilical (27.3% vs 41.7%), obstrução intestinal (31.8% vs 8.3%) e intervenções cirúrgicas adicionais (27.3% vs 33.3%).
Conclusão: Apesar da alta proporção de prematuridade, de baixo peso e de recuperação lenta, os gastrosquisis assim como os onfalocelos (sem anomalias cromossómicas) podem ter uma taxa de sobrevivência muito alta; por outro lado, nos primeiros anos de vida podem surgir complicações não desprezíveis. Assim, aos futuros pais pode ser transmitida uma perspetiva muito positiva em termos de sobrevivência, embora eles também devem ser informados de que pode ocorrer morbilidade substancial no médio prazo.Objective: To characterize and compare the outcomes of omphalocele and gastroschisis from birth to 2-year of follow-up in a recent cohort at a tertiary center. Methods: This is a retrospective clinical record review of all patients with gastroschisis and omphalocele, admitted to the Neonatal Intensive Care Unit between January 2009 and December 2019. Results: There were 38 patients: 13 with omphalocele and 25 with gastroschisis. Associated anomalies were present in 6 patients (46.2%) with omphalocele and in 10 (41.7%) with gastroschisis. Compared to patients with omphalocele, those with gastroschisis had younger mothers (24.7 vs. 29.6 years; p = 0.033), were born earlier (36 vs. 37 weeks, p = 0.006), with smaller birth weight (2365 430.4 vs. 2944.2 571.9 g; p = 0.001) and had a longer hospital stay (24 vs. 9 days, p = 0.001). The neonatal survival rate was 92.3% for omphalocele and 91.7% for gastroschisis. Thirty-four patients were followed-up over a median of 24 months: 13 with gastroschisis (59.1%) and 8 with omphalocele (66.7%) had at least one adverse event, mainly umbilical hernia (27.3% vs 41.7%), intestinal obstruction (31.8% vs 8.3%) and additional surgical interventions (27.3% vs 33.3%). Conclusion: Despite the high proportion of prematurity, low birth weight and protracted recovery, gastroschisis as well as omphalocele (without chromosomal abnormalities) may achieve very high survival rates; on the other hand, complications may develop in the first years of life. Thus, a very positive perspective in terms of survival should be transmitted to future parents, but they should also be informed that substantial morbidity may occur in medium-term.
45
Frýbová, Barbora. "Predikce poškození střeva u novorozenců s gastroschízou." Doctoral thesis, 2019. http://www.nusl.cz/ntk/nusl-404567.
Full textAbstract:
Prediction of intestinal damage in neonates with gastroschisis MUDr. Frýbová Barbora Objective: The aim of the study was to identify both prenatal ultrasonographic markers in fetuses and a biochemical marker in newborns with gastroschisis that predict postnatal outcome; to perform a new technique of defect closure by preformed silicone silo for gastroschisis and to evaluate long-term quality of life and somatic growth of patients with gastroschisis and compare them with the general population. Material and Methods: The analysis of 122 patients with gastroschisis operated on between 2004-2018 at the Department of Paediatric Surgery of University Hospital Motol in Prague was performed. In the retrospective-prospective study (97 patients) ultrasound findings at the 30th week of pregnancy and medical reports were statistically analyzed to identify independent prenatal ultrasonographic predictors of postnatal outcome. In the prospective study, new surgical technique of preformed silicone silo for gastroschisis to perform the stepwise defect reconstruction was used in four patients. In the prospective I-FABP study (53 patients), the urine was collected during the first 48 hours after surgery from neonates operated on for GS. Neonates with surgery that did not include gut mucosa served as controls for...
46
Silva, Ana Margarida Arantes. "Onfalocelo e gastrosquise: estudo de casos diagnosticados na MBB." Master's thesis, 2019. http://hdl.handle.net/10316/89815.
Full textAbstract:
Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de MedicinaIntrodução: a gastrosquise e o onfalocelo são as malformações major congénitas daparede abdominal anterior mais frequentes e caracterizam-se por herniação das vísceras. Porserem patologias distintas, a melhor caracterização e compreensão destas e dasmalformações associadas é importante de forma a melhorar a abordagem e seguimentodestes doentes e consequentemente aumentar a sobrevida e a qualidade de vida.Objetivo: determinar a incidência de onfalocelos e gastrosquises na Maternidade BissayaBarreto (MBB), caracterizar os casos diagnosticados, bem como a avaliação da sua evoluçãocirúrgica no Hospital Pediátrico de Coimbra (HPC).Metodologia: foram estudados retrospetivamente todos os casos diagnosticados comogastrosquise ou onfalocelo na MBB e posteriormente seguidos no HPC, no período decorridoentre janeiro de 1991 e dezembro de 2017.Resultados: de um total de 78 defeitos diagnosticados, 52 correspondem a onfalocelose 26 a gastrosquises, sendo a prevalência de 6,53 e 3,26:10000 nascimentos, respetivamente.Dos nados vivos (41), 49% apresentavam onfalocelos e 51% gastrosquises, sendo aprevalência de 2,51 e 2,63:10000 nascimentos, respetivamente. A taxa de deteção estesdefeitos em período pré-natal foi de 94%. A percentagem de óbitos fetais foi 61% dosonfalocelos e 19% das gastrosquises. Na totalidade dos casos, as malformações associadasestiveram presentes em 80% dos casos de onfalocelos e 35% de gastrosquises. Aprematuridade registou-se em 37% dos onfalocelos e 71% dos gastrosquises. A abordagemcirúrgica mais utilizada foi redução com encerramento primário (63% dos onfalocelos e 95%das gastrosquises). Dos onfalocelos 3/17 e das gastrosquises 7/21 necessitaram dereintervenção cirúrgica. Registaram-se 21% de óbitos no grupo dos onfalocelos e, comosequelas, 14% de síndromes de intestino curto no grupo das gastrosquises.Conclusões: o diagnóstico pré-natal (DPN) é de suma importância de forma a aumentara sobrevida e a qualidade de vida dos doentes com estes defeitos. Devido ao protocoloestabelecido entre a MBB e os cuidados de saúde primários da sua área de influência, a taxade deteção neonatal destes defeitos foi muito elevada. Por fim, a avaliação destas gravidezesnum centro de apoio perinatal diferenciado com ligação ao serviço de pediatria cirúrgicapermite uma orientação célere de forma a melhorar o prognóstico destes recém-nascidos.
Introduction: omphaloceles and gastroschisis are the most common congenitalabdominal wall defects represented by the extra peritoneal herniation of the abdominal viscera.Since they are different pathologies it is importante to have a full understanding of theircharacteristics and associated malformations, in order to chose the best treatment, andconsequently have the best prognosis and quality of life.Objective: to determine the incidence of omphaloceles and gastroschisis in the MBB,characterise the cases diagnosed and evaluate their cirurgical evolution in the HPC.Methodology: retrospective study of all cases diagnosed at the MBB as omphaloceles orgastroschisis which later were followed at the HPC in the period between January 1991 andDecember 2017.Results: In a total of 78 diagnosed defects, 52 corresponded to omphaloceles and 26 togastroschisis, being the prevalence of 6,53 and 3,26: 10 000 births, respectively. Regardinglive births (41), 49% had omphalocele and 51% gastroschisis, with a prevalence of 2,51 and2,63: 10 000 births, respectively. The rate of detection of these defects in the prenatal periodwas 94%. The percentage of fetal deaths was 61% of omphaloceles and 19% of gastroschisis.In our case serie, the associated malformations were present in 80% of cases of omphalocelesand 35% of gastroschisis. Prematurity was present in 37% of omphaloceles and 71% ofgastroschisis. The most used surgical approach was reduction with primary closure (63% ofomphaloceles and 95% of gastroschisis). Surgical reintervetion was required in 3/17omphaloceles and in 7/21 gastroschisis. There were 21% of deaths in the omphafolecelesgroup and, as sequels, 14% of short bowel syndromes in the gastroschisis group.Conclusions: prenatal diagnosis is extremely important in order to increase the survivaland quality of life of patients with these defects. Due to the protocol established between MBBand the primary care of its influence area, the rate of neonatal detection of these defects wasvery high. Finally, the evaluation of these pregnancies in a differentiated perinatal supportcenter with connection to the surgical pediatric service allows a quick orientation in order toimprove the prognosis of these newborns.