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Ex utero intrapartum

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https://www.readbyqxmd.com/read/28365065/infantile-hemangiopericytoma-of-the-tongue-efficacy-of-ex-utero-intrapartum-treatment-procedure-and-combined-modality-therapy
#1
Takenori Ogawa, Ryo Ishii, Daiki Ozawa, Takeshi Rikiishi, Hajime Usubuchi, Mika Watanabe, Yoshimichi Imai, Kenichi Sato, Masatoshi Saito, Yoji Sasahara, Tadashi Matsuda, Shigeo Kure, Yukio Katori
Here we present an extremely rare case of giant infantile hemangiopericytoma (HPC) of the tongue diagnosed prenatally by fetal ultrasonography and MR imaging. Due to airway stenosis, the patient was delivered by the ex utero intrapartum treatment (EXIT) procedure at 36 weeks of pregnancy. Initial diagnosis was infantile hemangioma based on physical examination, diagnostic imaging and the high incidence of hemangioma. The tumor was resistant to conservative treatments. Due to severe tumor hemorrhage, the nutrient vessel was embolized by endovascular treatment on the 73th day after birth...
March 29, 2017: Auris, Nasus, Larynx
https://www.readbyqxmd.com/read/28343178/fetal-cardiac-tumors-clinical-features-management-and-prognosis
#2
Shi-Min Yuan
Fetal cardiac tumors are rare and usually benign. While echocardiography is a reliable technique for diagnosing fetal cardiac tumors, their definitive diagnosis relies on pathological examination. The strategies used to manage fetal cardiac tumors are challenging. A good clinical result is their complete regression during pregnancy or shortly after birth, as often occurs with cardiac rhabdomyomas. Moreover, the fetal prognosis depends on the nature of the tumors, namely, their location, size, number and associated complications...
March 27, 2017: Journal of Perinatal Medicine
https://www.readbyqxmd.com/read/28301889/geburtshilfe-an%C3%A3-sthesie-bei-exit-prozedur
#3
Alexander Torossian
The ex utero intrapartum treatment (EXIT) procedure is performed as a part of an extended caesarean section for example to treat fetal airway disorders. For treatment, optimal uterine relaxation is necessary, however utero-placental supply of the fetus has to be guaranteed as well. "Balanced" anesthesia, tocolysis and tight maternal arterial blood pressure control are recommended. Standard fetal monitoring comprises pulse oxymetry and echocardiography. The article describes the physiology and anesthestic goals of the EXIT procedure, discusses alternative anesthesia techniques and gives an outlook on emerging progress...
March 2017: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/28288537/exit-procedure-for-fetal-mediastinal-teratoma-with-large-pericardial-effusion-a-case-report-with-review-of-literature
#4
Arpit Agarwal, Eliot Rosenkranz, Salih Yasin, Sethuraman Swaminathan
BACKGROUND: Large mediastinal teratomas in the fetus are rare and can present with direct compression of intrathoracic structures as well as pericardial and pleural effusions. Mediastinal fetal teratoma may be detected as a mass in the chest during a routine prenatal ultrasound. Because of the pressure on mediastinal structures it may result in non-immune fetal hydrops (NIFH) and polyhydramnios. The development of hydrops may lead to fetal demise. Timely obstetric and/or surgical intervention is important to improve survival in this patient population...
April 2, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28275857/influence-of-maternal-remifentanil-concentration-on-fetal-to-maternal-ratio-in-pregnant-ewes
#5
Masaki Sato, Kenichi Masui, Borjigin Sarentonglaga, Mio Yamaguchi, Rika Fukumori, Yoshikazu Nagao, Haruhiko Sago, Hiroyuki Sumikura
PURPOSE: Maternal remifentanil infusion is used for minimally invasive fetal surgery or ex-utero intrapartum treatment. The fetal-to-maternal (F/M) ratio of remifentanil concentration at various dosing regimens is useful to manage remifentanil effects. The aim of this study was to investigate the F/M ratio of remifentanil at various concentrations. METHODS: Five pregnant ewes received continuous remifentanil infusion under propofol anesthesia. The remifentanil infusion rate was increased by 0...
March 8, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28267705/ex-utero-intrapartum-treatment-exit-for-upper-airway-obstruction
#6
Colin R Butler, Elizabeth F Maughan, Pranav Pandya, Richard Hewitt
PURPOSE OF REVIEW: Improvements in the antenatal diagnosis of congenital malformations have led to increased detection of fetal airway obstructing lesions, and pediatric ear, nose, and throat surgeons are increasingly involved in these cases. RECENT FINDINGS: This article outlines the typical range of pathology seen, the logistics in providing support for anticipated deliveries and the multidisciplinary management of complex airway cases. SUMMARY: Traditionally, difficulty in obtaining a patent airway at delivery was a major factor in the dismal prognosis of these pregnancies...
April 2017: Current Opinion in Otolaryngology & Head and Neck Surgery
https://www.readbyqxmd.com/read/28211140/anesthesia-for-fetal-surgery
#7
REVIEW
Monica A Hoagland, Debnath Chatterjee
Fetal therapy is an exciting and growing field of medicine. Advances in prenatal imaging and continued innovations in surgical and anesthetic techniques have resulted in a wide range of fetal interventions including minimally invasive, open mid-gestation, and ex-utero intrapartum treatment procedures. The potential for maternal morbidity is significant and must be carefully weighed against claimed benefits to the fetus. Appropriate patient selection is critical, and a multidisciplinary team-based approach is strongly recommended...
April 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28122111/obstructing-in-utero-oropharyngeal-mass-case-report-of-a-lymphatic-malformation-arising-within-an-oropharyngeal-teratoma
#8
Todd J Wannemuehler, Christopher R Deig, Brandon P Brown, Stuart A Morgenstein
An ex utero intrapartum treatment procedure was performed to deliver a fetus with a multiseptated, entirely cystic, 4.5 × 5.0 × 4.0-cm mass occupying the oropharynx and oral cavity with protrusion from the mouth. Surgical excision was performed, and final pathologic diagnosis revealed a lymphatic malformation arising within a cystic oropharyngeal teratoma. Lymphatic malformations are virtually indistinguishable radiologically from rare, purely cystic teratomata, and efforts have been made to distinguish between the two in utero because of differing available treatment modalities...
January 2017: Ear, Nose, & Throat Journal
https://www.readbyqxmd.com/read/27926636/feasibility-and-outcomes-of-fetoscopic-tracheal-occlusion-for-severe-left-diaphragmatic-hernia
#9
Michael A Belfort, Oluyinka O Olutoye, Darrell L Cass, Olutoyin A Olutoye, Christopher I Cassady, Amy R Mehollin-Ray, Alireza A Shamshirsaz, Stephanie M Cruz, Timothy C Lee, David G Mann, Jimmy Espinoza, Stephen E Welty, Caraciolo J Fernandes, Rodrigo Ruano
OBJECTIVE: To evaluate feasibility and initial outcomes of fetoscopic tracheal occlusion for severe diaphragmatic hernia compared with a historical cohort who had not received fetal tracheal occlusion. METHODS: Outcomes in a prospective observational cohort who underwent fetoscopic tracheal occlusion for severe fetal left diaphragmatic hernia without associated anomalies were compared with our historical nontreated cohort of matched fetuses of similar severity. Fetuses were classified using the same ultrasonography and magnetic resonance imaging methodology-prospectively in the fetoscopic tracheal occlusion group and retrospectively in the historical nontreated cohort...
January 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27836357/does-the-ex-utero-intrapartum-treatment-to-extracorporeal-membrane-oxygenation-procedure-change-morbidity-outcomes-for-high-risk-congenital-diaphragmatic-hernia-survivors
#10
Hester F Shieh, Jay M Wilson, Catherine A Sheils, C Jason Smithers, Virginia S Kharasch, Ronald E Becker, Mollie Studley, Donna Morash, Terry L Buchmiller
PURPOSE: In high-risk congenital diaphragmatic hernia (CDH), significant barotrauma or death can occur before extracorporeal membrane oxygenation (ECMO) can be initiated. We previously examined ex utero intrapartum treatment (EXIT)-to-ECMO in our most severe CDH patients, but demonstrated no survival advantage. We now report morbidity outcomes in survivors of this high-risk cohort to determine whether EXIT-to-ECMO conferred any benefit. METHODS: All CDH survivors with <15% predicted lung volume (PPLV) from September 1999 to December 2010 were included...
January 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27684833/use-of-the-glidescope-video-laryngoscope-for-intubation-during-ex-utero-intrapartum-treatment-in-a-fetus-with-a-giant-cyst-of-the-4th-branchial-cleft-a-case-report
#11
Sung Hye Byun, So Young Lee, Seong Yeon Hong, Taeha Ryu, Baek Jin Kim, Jin Yong Jung
INTRODUCTION: In fetuses who are predicted to be at risk of catastrophic airway obstruction at delivery, the ex utero intrapartum treatment (EXIT) procedure is useful for securing the fetal airway while maintaining fetal oxygenation via placental circulation. Factors, including poor posture of the fetus and physician, narrow visual field, and issues of contamination in the aseptic surgical field, make fetal intubation during the EXIT procedure difficult. Herein, we report our experience of the usefulness of the GlideScope video laryngoscope (GVL) for intubation during the EXIT procedure...
September 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27645029/ep21-23-ex-utero-intrapartum-treatment-exit-procedure-for-cervical-teratoma
#12
K Maeda, D Nakaoku, M Murakami, A Kondo, M Morine, K Hinokio, T Kaji
No abstract text is available yet for this article.
September 2016: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/27530489/fetal-intrapericardial-teratoma-natural-history-and-management-including-successful-in-utero-surgery
#13
Jack Rychik, Nahla Khalek, J William Gaynor, Mark P Johnson, N Scott Adzick, Alan W Flake, Holly L Hedrick
BACKGROUND: Intrapericardial teratoma is a rare, lethal tumor often detected in fetal life. Tumor mass and pericardial effusion cause cardiac tamponade that, if relieved, could be life-saving. Optimal timing of intervention and methods for effective fetal treatment are unknown. OBJECTIVE: We describe our single-center experience with fetal intrapericardial teratoma including the first report of successful in utero surgical resection with survival to term. STUDY DESIGN: We reviewed our database for suspected fetal intrapericardial teratoma...
December 2016: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27508950/prenatally-diagnosed-fetal-tumors-of-the-head-and-neck-a-systematic-review-with-antenatal-and-postnatal-outcomes-over-the-past-20-years
#14
Gabriele Tonni, Roberta Granese, Eduardo Félix Martins Santana, José Pedro Parise Filho, Isabela Bottura, Alberto Borges Peixoto, Annamaria Giacobbe, Andrea Azzerboni, Edward Araujo Júnior
AIM: The aim of this study was to review prenatally diagnosed tumors of the head and neck in the fetus and to report antenatal and postnatal outcomes. METHODS: PubMed/Medline, EMBASE/SCOPUS, Cochrane database and Google Scholar were reviewed over the last 20 years. No language or article type restriction was used. RESULTS: A total of 1940 record were retrieved. Of the 713 records screened, 566 full-text articles were assessed for eligibility...
February 1, 2017: Journal of Perinatal Medicine
https://www.readbyqxmd.com/read/27468407/management-of-giant-cervical-teratoma-with-intracranial-extension-diagnosed-in-utero
#15
Jayesh P Thawani, Michael J Randazzo, Nickpreet Singh, Jared M Pisapia, Kalil G Abdullah, Phillip B Storm
Cervical teratomas are rare germ cell tumors affecting the fetus that are associated with significant morbidity and mortality due to an increased risk of airway obstruction at delivery. These tumors can commonly produce polyhydramnios that results from the fetus' impaired ability to swallow amniotic fluid. Improved rates of prenatal diagnosis through comprehensive evaluations and imaging have dramatically impacted the perinatal management of infants with this condition. Here, we report a patient diagnosed with polyhydramnios whose fetus was discovered to have a giant cervical teratoma on imaging studies...
July 2016: Journal of Neurological Surgery Reports
https://www.readbyqxmd.com/read/27302496/can-we-make-an-accurate-diagnosis-of-pyriform-sinus-fistula-by-fetal-mri
#16
S H Zeng, H S Liu, W Zhong, Z Q Liu, Q M He, J Han, Z Wang
AIM: To review the fetal magnetic resonance imaging (MRI) features of pyriform sinus fistula (PSF) and to compare them with the postnatal clinical and surgical findings. The relevant medical literature is also discussed. MATERIALS AND METHODS: The location, shape, signal, effects of adjacent structures and in utero changes detected on fetal MRI were reviewed in three cases of PSF. The patient's respiratory status at birth, the application of ex utero intrapartum therapy (EXIT), infectious complications in the neonatal period, and the surgical and pathological findings were also reviewed and discussed...
September 2016: Clinical Radiology
https://www.readbyqxmd.com/read/27258179/otocephaly-complex-case-report-literature-review-and-ethical-considerations
#17
REVIEW
Jack Diep, David Kam, Farrah Munir, Steven M Shulman, Glen Atlas
Otocephaly complex is a rare and usually lethal syndrome characterized by a set of malformations consisting of microstomia, mandibular hypoplasia/agnathia, and ventromedial malposition of the ears. Those cases that have been diagnosed prenatally have used an ex utero intrapartum treatment procedure to establish a definitive airway. However, prenatal diagnosis continues to be challenging, primarily because of poor diagnostic sensitivity associated with ultrasonography. We present a case of a newborn with an unanticipated otocephaly complex requiring emergent airway management...
July 15, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27258076/anesthetic-management-of-65-cases-of-ex-utero-intrapartum-therapy-a-13-year-single-center-experience
#18
Elaina E Lin, Julie S Moldenhauer, Kha M Tran, David E Cohen, N Scott Adzick
The anesthetic management for open fetal surgery has been described, but many therapeutic tenets have not been supported with data. We present data on the anesthetic management and outcomes of 65 patients undergoing ex utero intrapartum therapy procedures at the Children's Hospital of Philadelphia between 1998 and 2011. Patients were identified, and medical records were retrospectively reviewed. Maternal general anesthesia combined with postoperative epidural analgesia was commonly used. High levels of volatile anesthetic were used for uterine relaxation...
August 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27185679/anesthetic-management-of-an-ex-utero-intrapartum-treatment-procedure-a-novel-balanced-approach
#19
Adam Braden, Christopher Maani, Christopher Nagy
Ex utero intrapartum treatment (EXIT) procedures are therapeutic interventions for fetuses with life-threatening airway abnormalities and/or other prenatally diagnosed congenital malformations requiring immediate neonatal extracorporeal membrane oxygenation support. Although certain anesthetic goals are common among EXIT procedures, many different approaches to their management have been described in the literature. Herein, we present a novel anesthetic approach to an EXIT procedure for fetal micrognathia and retrognathia...
June 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27134307/a-modified-exit-to-ecmo-with-optional-reservoir-circuit-for-use-during-an-exit-procedure-requiring-thoracic-surgery
#20
Gregory S Matte, Kevin R Connor, Nathalia A Toutenel, Danielle Gottlieb, Francis Fynn-Thompson
A 34 year old mother with a history of polyhydraminos and premature rupture of membranes presented for an ex utero intrapartum treatment (EXIT) procedure to deliver her 34 week gestation fetus. The fetus had been diagnosed with a large cervical mass which significantly extended into the right chest. The mass compressed and deviated the airway and major neck vessels posteriorly. Imaging also revealed possible tumor involvement with the superior vena cava and right atrium. The plan was for potential extracorporeal membrane oxygenation (ECMO) during the EXIT procedure (EXIT-to-ECMO) and the potential for traditional cardiopulmonary bypass (CPB) for mediastinal tumor resection...
March 2016: Journal of Extra-corporeal Technology
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