@misc{Zieliński_Stanisław_2004,
 author={Zieliński, Stanisław},
 address={Kraków},
 howpublished={online},
 year={2004},
 school={Wydział Lekarski},
 language={pol},
 abstract={The subject of the dissertation is the assessment of the preventive and therapeutic management in operations for early childhood hydrocephalus. In hydrocephalus in children, the treatment of choice lies in diverting the excess of the cerebrospinal fluid from the ventricular system of the brain to the peritoneal cavity, using a system of non-returnable, one-way valves. An infection of the valve system is a severe and quite common complication that occurs in the course of surgery. The above-mentioned problems are the cause of a continuous search for new elements that would allow for decreasing the number of surgical failures. The dissertation concentrates on a comprehensive assessment of the validity of the proposed and implemented method for preventing and diagnosing infections of the valve system in early childhood hydrocephalus management, based on immediate and late observations and examinations. The aim of the dissertation is the evaluation of the effectiveness and usability of perioperative preventive measures, determination of outcome in hydrocephalus, and formulation of a proposal for the procedure of a ventriculo- peritoneal valve implantation. The investigations included 64 children with congenital and post-hemorrhagic hydrocephalus or obstruction of the cerebral aqueduct treated at the Department of Pediatric Surgery and Neurosurgical Ward, Universit},
 abstract={y Children’s Hospital of Cracow in the period between September 1998 and January 2003. The patient population was divided into two groups: the experimental group comprised 31 children treated in the years 2001-2003, in whom the new method of perioperative prevention had been employed. The controls (comparative group) included 33 children, who in the period from 1998 to 2001, had received the standard clinical treatment, employed in numerous other centers. 80 Pobrano z https://portalwiedzy.cm-uj.krakow.pl / Downloaded from Repository of Jagiellonian University Medical College 2022-07-07 The process of qualifying patients for a ventriculo-peritoneal valve implantation was identical in both groups and based on the presence of clinical symptoms, head circumference measurements, as well as transfontanel ultrasonographic and CT confirmation of the cause of hydrocephalus and the presence of the enlarged ventricular system with increased intracranial pressure. The availability of transfontanel USG is presently high; it has become a screening test in neonatal wards, which is particularly strictly observed in children belonging to the risk group (premature newborns), who are systematically monitored. Thanks to such an approach, children who are referred to our Department manifest no signs of clinically advanced internal hydrocephalus with its characteristic markedly},
 abstract={increased head circumference, what used to be common several years earlier. Computed tomography is a useful tool in older children, with completely closed anterior fontanels, and it is also very useful in determining the cause of hydrocephalus and assessing the valve effectiveness. The follow-up included the period between the original ventriculo-peritoneal valve implantation and the ultimate outpatient follow-up visit and ranged between 12 months to 2.5 years in the experimental group and up to 4 years in the controls. Children from the experimental group were admitted two days prior to the scheduled surgery to minimize the risk of nosocomial infections. The experimental group patients received a single antibiotic dose prior to surgery. In my observations, it is difficult to analyze and compare the effectiveness of perioperative antibiotic prophylaxis, since it was routinely employed in the experimental group, but irregular in the controls; besides, both groups were too small to allow for such an analysis. It should be undoubtedly stated here that the complication rate understood as the percentage of valve system infections was high in the controls and it constituted the baseline level prior to the commencement of the present investigations. 81 Pobrano z https://portalwiedzy.cm-uj.krakow.pl / Downloaded from Repository of Jagiellonian University Medical Coll},
 abstract={ege 2022-07-07 In view of the impaired antibiotic penetration to the cerebrospinal fluid, the patients received intraventricular injections of vancomycin at the dose of 10-20 mg. The decision to employ vancomycin was based on the fact that the antibiotic acts actively against all Staphylococcus species and the majority of other Gram- positive bacteria that colonize the valve systems and result in infections. On the evening before or in the morning of the day of surgery, the scalps of the experimental group children were washed thoroughly with shampoo enriched with povidone or betadine. The hair was removed using a depilatory cream or shorn very short with an electric hair-clipper in the preparatory room. The scalp was not shaved using a razor blade, razor or scalpel to avoid inflicting microinjuries. Having washed and dried the scalp, the planned incision site was determined and the skin was protected with sterile drapes and a sheet of sterile foil was attached therein. The valve system was filled and rinsed with a vancomycin solution. The valve implantation procedure was performed by the same surgical team, using the “no touch” method, with all manipulations performed with surgical instruments and minimizing the duration of the surgery. The presented preventive measures were effective in eliminating valve system infections in the experimental group. Thus, a},
 abstract={management protocol for implanting ventriculo-peritoneal valves was proposed. The aim of treating hydrocephalus is a decrease of intracranial pressure to normal values, thus increasing the thickness of the cerebral cortex layer, and in consequence increasing the potential for intellectual, emotional and motor development of the affected child. From the technical viewpoint, hydrocephalus management is still focused on combating valve infections, valvular malfunction and the resultant complications.},
 type={Praca doktorska},
}