Fetal surgery:
Saved in:
| Format: | Book |
|---|---|
| Language: | English |
| Published: |
Philadelphia [u.a.]
Saunders
2009
|
| Series: | Clinics in perinatology
36,2 |
| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Physical Description: | XVI, S. 216 - 501 Ill., graph. Darst. |
| ISBN: | 9781437705218 1437705219 |
Staff View
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| 264 | 1 | |a Philadelphia [u.a.] |b Saunders |c 2009 | |
| 300 | |a XVI, S. 216 - 501 |b Ill., graph. Darst. | ||
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| 650 | 4 | |a Fetus |x Surgery | |
| 650 | 4 | |a Fetus |x surgery | |
| 650 | 4 | |a Perinatology | |
| 650 | 4 | |a Perinatology |x methods | |
| 650 | 4 | |a Prenatal Injuries |x surgery | |
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Record in the Search Index
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| adam_text | Titel: Fetal surgery
Autor: Lee, Hanmin
Jahr: 2009
Fetal Surgery
Contents
Preface xv
Hanmin Lee
Erratum xvii
Drugs of Choice for Sedation and Analgesia in the Neonatal ICU 215
R. Whit Hall and Rolla M. Shbarou
Painful procedures in the neonatal ICU are common, undertreated, and
lead to adverse consequences. The drugs most commonly used to treat
neonatal pain include the opiates, benzodiazepines, barbiturates, ket-
amine, propofol, acetaminophen, and local and topical anesthetics. This
article discusses the indications for and advantages and disadvantages
of the commonly used analgesic drugs. Guidance and references for drugs
and dosing for specific neonatal procedures are provided.
Fetal Surgery
Overview
A History of Fetal Surgery 227
Tim Jancelewicz and Michael R. Harrison
Over the past 3 decades, fetal surgery for congenital disease has evolved
from merely a fanciful concept to a medical field in its own right. Tech¬
niques for open hysterotomy, minimal-access hysteroscopy, and image-
guided percutaneous fetal access have become well established, first in
animal models and subsequently in humans. At the same time, major
advances in fetal imaging and diagnosis, anesthesia, and tocolysis have
allowed fetal intervention to become a vital tool for subsets of patients
who would otherwise endure significant morbidity and mortality. This
article offers a concise overview of the history of fetal surgery, from its
tumultuous early days to its current status as an important means for the
early treatment of potentially devastating congenital anomalies.
Ethics of Fetal Surgery 237
Frank A. Chervenak and Laurence B. McCullough
This article provides a comprehensive approach to the ethics of clinical
investigation of fetal surgery. Investigators should address the initiation
and assessment of clinical trials to determine whether they establish a stan¬
dard of care and use an appropriate informed consent process to recruit
and enroll subjects, consider whether selection criteria should include the
abortion preferences of the pregnant woman, and consider whether
iii Contents
physicians have an obligation to offer referral to such investigation. This ap¬
proach is comprehensive because it takes account of the physician s obli¬
gations to the fetal patient, the pregnant woman, and future fetal and
pregnant patients. The comprehensive approach to the ethics of fetal sur¬
gery is applied to the example of in utero surgical management of spina
bifida.
The Maternal Side of Maternal-Fetal Surgery 247
Danny Wu and Robert H. Ball
The term fetal surgery is used widely for fetal intervention during preg¬
nancy; maternal-fetal surgery may be more appropriate, because all these
invasive procedures also affect the mother. Although there is no direct
benefit to the mother from these procedures, the risk to her is for a purely
altruistic purpose. It is therefore important to understand the potential
complications of maternal-fetal surgery, so the physician can provide ac¬
curate counseling to the patient.
Imaging
The Use of Ultrasound in Fetal Surgery 255
Linda M. Hopkins and Vickie A. Feldstein
Obstetric ultrasound (US) is an integral part of fetal surgery for open and
minimally invasive techniques. With advances in US imaging, the ability
to refine diagnosis, predict prognosis, and contribute to fetal treatment
continues to grow. Current research in fetal diagnosis and treatment in¬
cludes identifying the most reliable sonographic features for determining
prognosis before and after surgery.
MRI of the Fetal Central Nervous System and Body 273
Orit A. Glenn and Fergus V. Coakley
MRI is being increasingly used to assess for fetal abnormalities. Although
significant progress in the field of fetal MRI has occurred during the past
20 years, continued technical advances will likely contribute to significant
growth of the field. Moreover, with continued hardware and software
improvements, additional MRI sequences will likely become available.
Prenatal MRI complements ultrasound because of larger field-of-view, su¬
perior soft tissue contrast, easier and more precise volumetric measure¬
ment, and greater accuracy in the demonstration of intracranial and
spinal abnormalities. While ultrasound remains the primary modality for fe¬
tal imaging, these advantages of MRI make it a valuable adjunct to fetal
surgery. Because fetal MRI involves many disciplines, the future of fetal
MR will best be achieved through collaborative efforts.
Contents
The Role of Fetal Echocardiography in Fetal Intervention: A Symbiotic
Relationship 301
Priya Sekar and Lisa K. Hornberger
In this review, the authors explore the role of noninvasive and invasive fetal
interventions in fetal cardiovascular disease guided by observations at
fetal echocardiography. They first review fetal cardiac lesions that may
be ameliorated by fetal intervention and then review noncardiac fetal path¬
ologic findings for which fetal echocardiography can provide important
insight into the pathophysiology and aid in patient selection for and timing
of intervention and postintervention surveillance.
Specific Diseases
Changing Perspectives on the Perinatal Management of Isolated Congenital
Diaphragmatic Hernia in Europe 329
Jan A. Deprest, Eduardo Gratacos, Kypros Nicolaides, Elise Done,
Tim Van Mieghem, Leonardo Gucciardo, Filip Claus, Anne Debeer,
Karel Allegaert, Irwin Reiss, and Dick Tibboel
Congenital diaphragmatic hernia (CDH) should be diagnosed in the
prenatal period and prompt referral to a tertiary referral center for im¬
aging, genetic testing, and multidisciplinary counseling. Individual pre¬
diction of prognosis is based on the absence of additional
anomalies, lung size, and liver hemiation. In severe cases, a prenatal
endotracheal balloon procedure is currently being offered at specialized
centers. Fetal intervention is now also offered to milder cases within
a trial, hypothesizing that this may reduce the occurrence of broncho-
pulmonary dysplasia in survivors. Postnatal management has been
standardized by European high-volume centers for the purpose of
this and other trials.
Tracheal Occlusion for Fetal Congenital Diaphragmatic Hernia: The US Experience 349
Eric Jelin and Hanmin Lee
Congenital diaphragmatic hernia (CDH) is characterized by a defect in
the diaphragm that permits abdominal viscera to herniate into the chest.
These herniated viscera are thought to compress the growing lung and
cause lung parenchymal and vascular hypoplasia. The genetic defects
that cause the diaphragmatic defect may also contribute primarily to
lung hypoplasia. Postnatal reduction of the herniated abdominal viscera
and correction of the diaphragmatic defect are easily achievable, but
the lung hypoplasia persists, often leading to persistent fetal circulation
and respiratory failure. This article reviews the experimental basis of fe¬
tal therapy for CDH and the US clinical experience with tracheal
occlusion.
ic Contents
Management of Fetal Lung Lesions 363
N. Scott Adzick
Prenatal diagnosis provides insight into the in utero evolution of fetal
thoracic lesions such as congenital cystic adenomatoid malformation
(CCAM), bronchopulmonary sequestration (BPS), congenital lobar emphy¬
sema, and mediastinal teratoma. Serial sonographic study of fetuses with
thoracic lesions has helped define the natural history of these lesions,
determine the pathophysiologic features that affect clinical outcome,
and formulate management based on prognosis.
Fetal Lower Urinary Tract Obstruction 377
Serena Wu and Mark Paul Johnson
The authors present an overview of the prenatal diagnosis, evaluation,
contemporary intervention, and antenatal management of lower urinary
tract obstruction. They review early experimental models that confirmed
the relation between urinary tract obstruction and renal fibrocystic dyspla-
sia and that early in utero relief of the obstruction could prevent irreversible
renal injury. Subsequent studies of the electrolyte and protein concentra¬
tions in fetal urine from human cases established prognostic threshold
values and helped to develop an algorithm to select candidates for ante¬
natal therapy. Although shunting has improved survival, long-term morbid¬
ities remain a significant challenge.
Twin-to-Twin Transfusion Syndrome: A Comprehensive Update 391
Mounira Habli, Foong Yen Lim, and Timothy Crombleholme
Twin-to-twin transfusion syndrome (TTTS) is a serious complication in
about 10% to 20% of monozygous twin gestations with an incidence of
4% to 35% in the United States. Severe TTTS is reported to occur in
5.5% to 17.5% of cases. TTTS is a progressive disease in which sudden
deteriorations in clinical status can occur, leading to death of a co-twin.
[ Up to 30% of survivors may have abnormal neurodevelopment as a result
f of the combination of profound antenatal insult and the complications of
severe prematurity. This article presents an overview of what is known
about the pathophysiology and the diagnosis of TTTS, the role of echocar-
diography in TTTS, treatment options available for TTTS, complications of
treatment for TTTS, and short- and long-term outcomes of TTTS.
Complicated MonochorionicTwin Pregnancies: Updates in Fetal Diagnosis
and Treatment 417
Larry Rand and Hanmin Lee
Monochorionic (MC) twin pregnancies may develop significant complica¬
tions, and twin-to-twin transfusion syndrome (TTTS) has become among
the best known to obstetricians and patients alike. A significant percentage
Contents j
of patients referred for suspected TTTS have a different underlying patho¬
logic condition, however, and differentiating the subcategories of MC path-
ophysiologic conditions may change treatment course and outcome. The
key to understanding complicated MC pregnancies lies in the placental an-
gioarchitecture and intertwin vascular communications between the
fetuses.
Fetal Surgery for Myelomeningocele 431
Shinjiro Hirose and Diana L. Farmer
Fetal intervention for myelomeningocele (MMC) may improve hydroceph-
alus and hindbrain herniation associated with the Amold-Chiari II malfor¬
mation and may reduce the need for ventriculoperitoneal shunting. As of
now, there is little evidence that prenatal repair of MMC improves neuro¬
logic function. MMC is the first nonlethal disease under consideration
and study for fetal surgery. As a result, potential improvements in outcome
must be balanced with maternal safety and well-being, in addition to that
of the unborn patient.
Cardiac Anomalies in the Fetus 439
Christopher G.B. Turner, Wayne Tworetzky, Louise E. Wilkins-Haug,
and Russell W. Jennings
Congenital heart disease (CHD) is an attractive target for fetal therapy.
With the development of successful neonatal repair for many types of
CHD over the last 20 years, fetal therapy has become the next frontier.
Concurrent advances in interventional catheterization and fetal imaging
provided a foundation for the novel field of fetal cardiac intervention.
This article focuses on the current status of in utero catheter interventions
for CHD with particular interest in therapy for defects characterized by pro¬
gressive stenosis or atresia of the semilunar valves, the aortic and pulmo¬
nary, with development of subsequent ventricular hypoplasia.
Research/Future Directions
Prenatal Stem Cell Transplantation and Gene Therapy 451
Matthew T. Santore, Jessica L. Roybal, and Alan W. Flake
At the present time, the most likely and eminent application of stem cell
therapy to the fetus is in utero hematopoietic stem cell transplantation
(IUHCT), and this stem cell type will be discussed as a paradigm for all pre¬
natal stem cell therapy. The authors feel that the most likely initial applica¬
tion of IUHCT will use adult HSC derived from bone marrow (BM) or
peripheral blood (PB), and will focus this article on this specific approach.
The article also reviews the experimental data that support the capacity of
IUHCT to induce donor-specific tolerance.
Kii Contents
Fetal Tissue Engineering 473
Christopher G.B. Turner and Dario 0. Fauza
Attempts at harnessing the prospective benefits of the therapeutic use of
fetal cells or tissues date many decades before the modem era of trans¬
plantation. The first reported transplantation of human fetal tissue took
place in 1922. Fetal cells or tissues also have been used as helpful inves-
tigational tools since the 1930s. Still, it was only in the last three decades
that fetal tissue transplantation in people has started to lead to favorable
outcomes, yet by and large anecdotally. This article offers an outlook on
a relatively new dimension in fetal cell-based therapies, namely the engi¬
neering of tissues in the laboratory, along with its prospective applications.
Index 489
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| series2 | Clinics in perinatology |
| spelling | Fetal surgery guest ed.: Hanmin Lee Philadelphia [u.a.] Saunders 2009 XVI, S. 216 - 501 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Clinics in perinatology 36,2 Fetus Surgery Fetus surgery Perinatology Perinatology methods Prenatal Injuries surgery Chirurgie (DE-588)4009987-8 gnd rswk-swf Fetus (DE-588)4016957-1 gnd rswk-swf Fetus (DE-588)4016957-1 s Chirurgie (DE-588)4009987-8 s b DE-604 Lee, Hanmin Sonstige oth Clinics in perinatology 36,2 (DE-604)BV000003382 36,2 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=017748620&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Fetal surgery Clinics in perinatology Fetus Surgery Fetus surgery Perinatology Perinatology methods Prenatal Injuries surgery Chirurgie (DE-588)4009987-8 gnd Fetus (DE-588)4016957-1 gnd |
| subject_GND | (DE-588)4009987-8 (DE-588)4016957-1 |
| title | Fetal surgery |
| title_auth | Fetal surgery |
| title_exact_search | Fetal surgery |
| title_full | Fetal surgery guest ed.: Hanmin Lee |
| title_fullStr | Fetal surgery guest ed.: Hanmin Lee |
| title_full_unstemmed | Fetal surgery guest ed.: Hanmin Lee |
| title_short | Fetal surgery |
| title_sort | fetal surgery |
| topic | Fetus Surgery Fetus surgery Perinatology Perinatology methods Prenatal Injuries surgery Chirurgie (DE-588)4009987-8 gnd Fetus (DE-588)4016957-1 gnd |
| topic_facet | Fetus Surgery Fetus surgery Perinatology Perinatology methods Prenatal Injuries surgery Chirurgie Fetus |
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