Search

The objective of this study was to determine whether treatment with human fibrinogen concentrate decreases the need for component blood therapy and blood loss in neonate and infant patients undergoing cardiopulmonary bypass. Pediatric patients (N = 30) undergoing elective cardiac surgery were randomized to receive human fibrinogen concentrate or placebo following cardiopulmonary bypass termination. The primary endpoint was the amount of cryoprecipitate administered. Secondary endpoints included estimated blood loss during the 24 h post-surgery; perioperative blood product transfusion; effects of fibrinogen infusion on global hemostasis, measured by laboratory testing and rotational thromboelastometry; and adverse events. No clinically significant differences were identified in baseline characteristics between groups. A significantly lower volume of cryoprecipitate was administered to the treatment group during the perioperative period [median (interquartile range) 0.0 (0.0–0.0) cc/kg vs 12.0 (8.2–14.3) cc/kg; P P ≤ 0.0001). No significant differences were observed in post-drug HEPTEM, INTEM, and EXTEM results. Human fibrinogen concentrate (70 mg/kg) administered after the termination of cardiopulmonary bypass reduced the need for transfusion with cryoprecipitate in a neonate and infant patient population.ClinicalTrials.gov identifier: NCT02822599.

Osteosarcomas arising within the pterygomaxillary/infratemporal fossa region are rare among the pediatric population. Survival rates are most influenced by tumor resection with negative margins, which can be dependent on surgical accessibility of the tumor site. The pterygomaxillary/infratemporal fossa location poses several challenges to safe and adequate tumor resection, including proximity of the facial nerve and great vessels and scarring associated with traditional transfacial approaches. In this article, we present the case of a 6-year-old boy with an osteosarcoma of the left pterygomaxillary/infratemporal fossa region successfully managed with an “oncoplastic” approach, incorporating the use of CAD/CAM and mixed reality technologies.

Implantable pacemaker cardioverter defibrillators are now available with biphasic waveforms, which have been shown to markedly improve defibrillation thresholds (DFTs). However, in a number of patients the DFT remains high. Also, DFT may increase after implantation, especially if antiarrhythmic drugs are added. We report on the use of a subcutaneous patch in the pectoral position in 15 patients receiving a transvenous defibrillator as a method of easily reducing the DFT. A 660-mm2 patch electrode was placed beneath the generator in a pocket created on the pectoral fascia. The energy required for defibrillation was lowered by 56% on average, and the system impedance was lowered by a mean of 25%. This maneuver allowed all patients to undergo a successful implant with adequate safety margin.

The objective of this study is to examine the safety/efficacy of alternative routes of vascular access (ARVA) for successful performance of interventions.Complex interventional catheterizations may be required in children with limited vascular access, vascular constraints relative to size, and hemodynamic instability. Our approach has been to utilize ARVA in selected cases.ARVA pertains to any vessel excluding femoral, jugular/subclavian veins, or umbilical access. A retrospective review performed on patients with an intervention utilizing ARVA between August 1995 and January 2004 was performed. Patients were divided by clinical status: critically ill/emergent (A), elective cases (B). Procedural success was based on previously published criteria.Sixty-four interventions were performed in 50 patients using 54 ARVA. ARVA utilized: radial (1), axillary (2), brachial (2), carotid arteries (25); brachial (2) hepatic (9) veins; and open chest/direct cardiac puncture (13). ARVA provided successful access to target lesions. Interventions included stents (30), valvuloplasty (16), angioplasty (14), and one each of vascular occlusion, septal occlusion, accessory pathway ablation, and septostomy. Group A patients were smaller (P0.0002) and younger (P0.004) than B. All open chest/direct cardiac and the majority (71%) of carotid arterial approaches were performed in group A. Fifty-six (88%) inteventions were successful with no difference between groups A (88%) and B (86%). There were two complications. Neither resulted in long-term sequelae.ARVA may provide a strategic advantage that may be safely applied to a variety of interventions regardless of patient size or degree of illness. These techniques may further extend the scope of successful interventions in children.

The case of a 62-year-old man with benign schwannoma associated with a giant polyp of the esophagus is presented. His initial symptom was dysphagia. The polyp was removed through cervical esophagotomy. He had no recurrence of symptoms 5 years after this procedure. Pathologic examination showed a rare histology.

Spontaneous cardiac tamponade secondary to a congenital coagulation defect has never been reported. We report a case of acute cardiac tamponade in a patient with a known factor V deficiency. This patient presented with classic signs of acute cardiac tamponade and an enlarged cardiac silhouette. After diagnostic two-dimensional echocardiography and treatment with fresh-frozen plasma, the patient underwent emergent pericardiocentesis followed by complete pericardiectomy.

It is argued that analyses of subgroup differences utilizing a bivariate correlation strategy do not provide an adequate examination of test fairness. An analysis of differential prediction, which involves slopes and intercepts of regression lines results in more complete coverage of the test fairness issue, since the overall regression line determines the way in which a test is used for prediction. While subgroup correlation coefficients yield information concerning the slopes and intercepts, means and standard deviations must also be examined. A moderated multiple regression strategy is recommended as an alternative to separate analyses by subgroups. An ordered step-up regression procedure is presented which is more encompassing than the bivariate strategies, while avoiding inherent problems associated with subgroup coding in multiple regression.