Increased hematocrit and decreased transfusion requirements in children given erythropoietin before undergoing craniofacial surgery

1998 ◽  
Vol 88 (4) ◽  
pp. 704-708 ◽  
Author(s):  
Mark A. Helfaer ◽  
Benjamin S. Carson ◽  
Carol S. James ◽  
Judy Gates ◽  
David Della-Lana ◽  
...  
Keyword(s):  
Elective Surgery ◽  
Clinical Situation ◽  
Craniofacial Surgery ◽  
Blood Transfusions ◽  
Content Type ◽  
Time Of Surgery ◽  
Transfusion Requirements ◽  
Complete Blood Counts ◽  
The Individual ◽  
Fine Print

Object. This study was undertaken to determine the efficacy of preoperative erythropoietin administration in infants scheduled for craniofacial surgery and, in so doing, to minimize problems associated with blood transfusions. Methods. Families were offered the option of having their children receive erythropoietin injections before undergoing craniofacial surgery. The children whose families accepted this option received daily iron and 300 U/kg erythropoietin three times per week for 3 weeks preoperatively. Weekly complete blood counts with reticulocyte counts were measured and transfusion requirements were noted. Blood transfusions were administered depending on the clinical condition of the child. A case-matched control population was also evaluated to compare initial hematocrit levels and transfusion requirements. Thirty patients in the erythropoietin treatment group and 30 control patients were evaluated. The dose of erythropoietin administered was shown to increase hematocrit levels from 35.4 ± 0.9% to 43.3 ± 0.9% during the course of therapy. The resulting hematocrit levels in patients treated with erythropoietin at the time of surgery were higher compared with baseline hematocrit levels obtained in control patients at the time of surgery (34.2 ± 0.5%). Transfusion requirements also differed: all control patients received transfusions, whereas 64% (19 of 30) of erythropoietin-treated patients received transfusions. Conclusions. The authors conclude that treatment with erythropoietin in otherwise healthy young children will increase hematocrit levels and modify transfusion requirements. Erythropoietin therapy for elective surgery in children of this age must be individualized according to the clinical situation, family and physician beliefs, and cost effectiveness, as evaluated at the individual center.

Efficacy of aprotinin in children undergoing craniofacial surgery

2003 ◽  
Vol 99 (2) ◽  
pp. 287-290 ◽  
Author(s):  
Celia C. D'Errico ◽  
Hamish M. Munro ◽  
Steven R. Buchman ◽  
Deborah Wagner ◽  
Karin M. Muraszko
Keyword(s):  
Placebo Group ◽  
Blood Transfusion ◽  
Pediatric Patients ◽  
Craniofacial Surgery ◽  
Blood Transfusions ◽  
Double Blind ◽  
Craniofacial Reconstruction ◽  
Content Type ◽  
Transfusion Requirements ◽  
Fine Print

Object. This prospective, randomized, placebo-controlled, double-blind trial was undertaken to assess the efficacy of aprotinin in reducing the need for blood transfusions in 39 children undergoing reconstructive craniofacial surgery. Methods. Two demographically similar groups—a total of 39 patients with a mean age of 1.2 ± 1.2 years—were studied. The efficacy of aprotinin (240 mg/m2 administered intravenously over 20 minutes, followed by infusions of 56 mg/m2/hr) was compared with that of an equal infusion of 0.9% saline (placebo). Patients in the aprotinin group received less blood per kilogram of body weight than patients in the placebo group (32 ± 25 ml/kg compared with 52 ± 34 ml/kg, respectively; p = 0.04). Those patients in whom aprotinin was administered experienced less change in their hematocrit levels during surgery (aprotinin −33 ± 13% compared with placebo −44 ± 9%, p = 0.01). Each patient underwent a transfusion as per study protocol, and there was no significant change in hematocrit levels from the beginning to the end of surgery. The surgical faculty judged blood loss in patients in the aprotinin group to be significantly less than usual (p = 0.03). The use of aprotinin was also associated with reduced blood transfusion requirements during the first 3 postoperative days (p = 0.03). There was no adverse event reported in either the aprotinin or placebo group. Conclusions. Aprotinin decreased blood transfusion requirements in pediatric patients undergoing craniofacial reconstruction, thereby reducing the risks associated with exposure to banked blood components.

Total calvarial reconstruction for sagittal synostosis in older infants and children

1993 ◽  
Vol 78 (2) ◽  
pp. 199-204 ◽  
Author(s):  
Roger J. Hudgins ◽  
Fernando D. Burstein ◽  
William R. Boydston
Keyword(s):  
Blood Loss ◽  
Craniofacial Surgery ◽  
Acute Blood Loss ◽  
Skull Defect ◽  
Sagittal Suture ◽  
Sagittal Synostosis ◽  
Content Type ◽  
Biparietal Diameter ◽  
Postoperative Hyponatremia ◽  
Fine Print

✓ Premature closure of the sagittal suture is the most common form of craniosynostosis, but this condition occasionally goes unrecognized until the child is too old to undergo procedures that depend upon continued calvarial growth for success. As the entire calvaria is affected and thus misshapen by sagittal synostosis, late correction involves total calvarial reconstruction. The extensive nature of this undertaking has precluded its utilization despite the presence of significant deformities. Adapting the techniques and experience gained from craniofacial surgery, the authors performed total calvarial reconstruction on nine children with sagittal synostosis and subsequent scaphocephaly diagnosed after the age of 1 year. In each case the goals of shortening the anteroposterior length, widening the biparietal diameter, and reducing frontal and occipital deformities were met. Morbidity consisted of acute blood loss, postoperative hyponatremia, and in one case a residual skull defect. The rationale for this procedure and the techniques utilized are discussed.

Production of experimental brain abscess in the rat

1979 ◽  
Vol 51 (5) ◽  
pp. 685-690 ◽  
Author(s):  
H. Richard Winn ◽  
Michael Mendes ◽  
Paul Moore ◽  
Clarabelle Wheeler ◽  
George Rodeheaver
Keyword(s):  
Brain Abscess ◽  
Clinical Situation ◽  
Small Animals ◽  
Content Type ◽  
History Of ◽  
Slow Infusion ◽  
The Brain ◽  
Number Of Bacteria ◽  
Experimental Brain Abscess ◽  
Fine Print

✓ Experimental evaluation of brain abscess has been inhibited by the lack of a simple and reproducible model in small animals. A stereotaxic headholder and slow infusion of 1 µl of saline, containing a known number of bacteria, were used to produce brain abscess consistently in the rat. The natural history of the brain abscess produced by this technique closely simulated that found in the human clinical situation.

Index for optimum ventricular catheter length

1991 ◽  
Vol 75 (1) ◽  
pp. 152-153
Author(s):  
Semih İ. Keskil ◽  
Necdet Çeviker ◽  
Kemali Baykaner ◽  
Hizir Alp
Keyword(s):  
Computerized Tomography ◽  
Head Circumference ◽  
Intraoperative Ultrasound ◽  
Ventricular Catheter ◽  
Considerable Time ◽  
Optimum Length ◽  
Content Type ◽  
The Individual ◽  
Tomography Scan ◽  
Fine Print

✓ The optimum length of a ventricular catheter to be placed in a particular patient may be difficult to determine when either intraoperative ultrasound is not available or considerable time has elapsed between the diagnostic computerized tomography scan and the operation. An index for estimating ventricular length based on the head circumference of the individual is described. This method was tested clinically and proved to be successful.

Bacterial intracranial aneurysms

1980 ◽  
Vol 53 (5) ◽  
pp. 633-641 ◽  
Author(s):  
John G. Frazee ◽  
Leslie D. Cahan ◽  
James Winter
Keyword(s):  
Cerebral Angiography ◽  
Intracranial Aneurysms ◽  
Elective Surgery ◽  
Bacterial Endocarditis ◽  
Severe Headache ◽  
High Dose ◽  
Review Of The Literature ◽  
Content Type ◽  
Neurological Signs ◽  
Fine Print

✓ The treatment of 13 patients with bacterial intracranial aneurysms is reported. The incidence of bacterial intracranial aneurysms was 4% of all patients admitted with intracranial aneurysms and 3% of all patients admitted with bacterial endocarditis. Each patient had neurological signs or symptoms suggestive of intracranial disease prior to the diagnosis of an aneurysm. Alpha Streptococcus was the most common infecting organism. All patients were treated with specific, high-dose antibiotics, and five patients underwent surgery as well. There were no surgical deaths. Six of eight nonsurgically treated patients died. A review of the literature confirms a high mortality for patients treated with only antibiotics, and a low mortality for elective surgery. The authors conclude that 1) patients with bacterial endocarditis, who develop sudden severe headache, focal neurological signs or symptoms, or seizures, should undergo serial cerebral angiography every 7 to 10 days throughout their hospitalization; 2) if an aneurysm is identified it should be excised whenever possible; and 3) patients with proximal or multiple aneurysms should be considered for surgery.

Current reporting of responsiveness in acute cerebral disorders

1988 ◽  
Vol 69 (5) ◽  
pp. 692-698 ◽  
Author(s):  
Jan-Erik Starmark ◽  
Eddy Holmgren ◽  
Daniel Stålhammar
Keyword(s):  
Head Injuries ◽  
Neurological Status ◽  
Content Type ◽  
Sum Score ◽  
Grade Scale ◽  
Patient Responsiveness ◽  
Single Method ◽  
Definition Of ◽  
The Individual ◽  
Fine Print

✓ One hundred sixty-six papers published in seven neurosurgical journals from 1983 through 1985 have been surveyed to determine the methods used for assessment of overall patient responsiveness in acute cerebral disorders (coma grading). Fifty-one different coma scales or modifications were found. The Glasgow Coma Scale (GCS) sum score (that is, the sum of the scores of the individual eye, verbal, and motor scales) dominated (54%), and was used in 73 (76%) of 96 of the head-injury studies; in 56 (77%) of these 73 studies it was the single method of grading neurological status. The GCS sum score was used in 16 (23%) of 70 studies in patients with other etiologies. The Hunt and Hess scale was used in 26 (57%) of 46 reports of patients with subarachnoid hemorrhage. In 31 (55%) of the 56 studies of head injuries using the GCS alone, it was not obvious if the 12- or 13-grade scale was used. In 13 studies (23%) no reference to methodological investigations was made. In 44 papers (79%) the handling of untestable features, such as intubation or swollen eyes, was not reported. In the 56 studies using the GCS alone, coma was defined in many different ways and in 22 studies the definition of coma was not specified. In 63% of reports, the GCS sum score scale was combined in one to five groups of scores and this was done in 32 different ways. No information was available to describe the procedure of data aggregation or the reliability of the 13-grade GCS sum score. The lack of standardization makes it unnecessarily difficult to perform valid comparisons between different series of patients. Since the GCS sum score is the most widely used scale, it is suggested that the reporting of the GCS sum score should be standardized regarding pseudoscoring, coma definition, and use of combined scores. Further studies on the reliability of the GCS sum score are needed.

Outcome analysis of 85 patients undergoing the pi procedure for correction of sagittal synostosis

1996 ◽  
Vol 85 (1) ◽  
pp. 50-55 ◽  
Author(s):  
Frederick A. Boop ◽  
William M. Chadduck ◽  
Kristopher Shewmake ◽  
Charles Teo
Keyword(s):  
Outcome Analysis ◽  
Sagittal Synostosis ◽  
Content Type ◽  
Time Of Surgery ◽  
Male Preponderance ◽  
Cosmetic Outcomes ◽  
Poor Outcomes ◽  
Strip Craniectomy ◽  
Fine Print

✓ The authors present a retrospective review of their experience with 85 cases using the pi procedure to correct sagittal synostosis. A male preponderance of four to one was recognized in this group. Sixty-five infants underwent computerized tomography scanning of the head prior to surgery; these scans revealed unexpected intracranial pathology in 5% of cases. Surgical complications included three intraoperative dural lacerations. All children received blood transfusions with no complications. Cosmetic outcomes were excellent in 53%, good in 43%, and poor in 4% of cases. One patient required reoperation. All poor outcomes were in infants who were younger than 8 weeks of age at the time of surgery and who underwent a “reverse pi” procedure. Most of the excellent outcomes occurred in infants who were between 3 and 6 months of age at the time of surgery. Although more extensive than strip craniectomy, the pi procedure can be accomplished with minimal morbidity. In the authors' opinion, the pi procedure provides better immediate and long-term cosmetic results than synostectomy alone.

The aspect ratio (dome/neck) of ruptured and unruptured aneurysms

2003 ◽  
Vol 99 (3) ◽  
pp. 447-451 ◽  
Author(s):  
Bryce Weir ◽  
Christina Amidei ◽  
Gail Kongable ◽  
J. Max Findlay ◽  
Neal F. Kassell ◽  
...  
Keyword(s):  
Aspect Ratio ◽  
Maximum Size ◽  
Maximum Dimension ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
The Status ◽  
Mean Size ◽  
The Individual ◽  
Fine Print

Object. In this retrospective study the authors examined the aspect ratio (AR; the maximum dimension of the dome/width of the neck of an aneurysm) and compared the distribution of this ratio in a group of ruptured and unruptured aneurysms. A similar comparison was performed in relation to the maximum dimension of the aneurysm alone. The authors sought to evaluate the utility of these measures for differentiating ruptured and unruptured aneurysms. Methods. Measurements were made of 774 aneurysms in 532 patients at three medical centers. One hundred twenty-seven patients harbored only unruptured lesions, 290 only ruptured lesions, and 115 both ruptured and unruptured lesions. Cases were included if angiograms were available for measurement and the status of the individual patient's aneurysm(s) was known. The odds of a lesion falling in the ruptured aneurysm group increased with both the lesion's maximum size and the AR. The odds ratio for rupture rose progressively only for the AR. The distribution curves showed that ruptured aneurysms were larger and had greater ARs. The mean size of unruptured aneurysms was 7 mm and that of ruptured ones was 8 mm; the corresponding mean ARs were 1.8 and 3.4, respectively. The odds of rupture were 20-fold greater when the AR was larger than 3.47 compared with an AR less than or equal to 1.38. Only 7% of ruptured aneurysms had an AR less than 1.38 compared with 45% of unruptured lesions. Conclusions. The AR is probably a useful index to calculate. A high AR might reasonably influence the decision to treat actively an unruptured aneurysm independent of its maximum size. Prospective studies are warranted.

Potassium and the pathogenesis of cerebral arterial spasm in dog and man

1971 ◽  
Vol 35 (1) ◽  
pp. 45-50 ◽  
Author(s):  
Robert H. Wilkins ◽  
Philip Levitt
Keyword(s):  
Cerebrospinal Fluid ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Arteries ◽  
Arterial Spasm ◽  
Content Type ◽  
Blood Clots ◽  
The Individual ◽  
Fine Print

✓ This study investigates the possibility that the intracranial arterial spasm occurring in patients with subarachnoid hemorrhage might be due to potassium released from blood clots surrounding the involved cerebral arteries. Although cerebral arterial spasm could be induced in the dog by the injection of potassium into the chiasmatic cistern, it only occurred with potassium concentrations higher than those expected to result from hemolysis of subarachnoid clots. Furthermore, the potassium concentrations were not elevated in the cerebrospinal fluid of human patients with subarachnoid hemorrhage, and the individual potassium values could not be correlated with the presence or degree of spasm encountered in these patients.

Intracranial aneurysms

1979 ◽  
Vol 51 (1) ◽  
pp. 27-32 ◽  
Author(s):  
Russell J. Andrews ◽  
Peter K. Spiegel
Keyword(s):  
Intracranial Aneurysms ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
Male And Female ◽  
Content Type ◽  
Multiple Aneurysms ◽  
The Individual ◽  
Undetermined Etiology ◽  
Fine Print

✓ All cases of intracranial aneurysm, arteriovenous malformation, and subarachnoid hemorrhage of undetermined etiology seen at one hospital over a 13-year period were reviewed to assess relationships between age, sex, systolic and diastolic blood pressure, and number of aneurysms. There were 350 patients, of whom 212 had aneurysms. The major findings were as follows: 1) Hypertension was not significantly more prevalent in the aneurysm population than in the age-matched general population, except for females aged 18 to 54 years (systolic pressure elevation of 10 to 15 mm Hg). 2) Under 55 years of age, both male and female hypertensive patients were twice as likely to have multiple aneurysms as normotensive patients. 3) Females were more likely than males to have multiple aneurysms. 4) For females but not males, increasing age, higher systolic pressure, and higher diastolic pressure all correlated with an increasing number of aneurysms. Hypertension appears to be more prevalent in certain subgroups of the total aneurysm population, although the individual relationships between hypertension, atherosclerosis, and aneurysms cannot be determined from either the present or previous studies. The possible role of familial factors, as well as implications for both diagnosis and further research, are briefly noted.

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