Independent Risk Factors for RBC Transfusion in Children Undergoing Surgery. Analysis of 14,248 Cases at a German University Hospital.

BACKGROUND: paediatric patients are vulnerable to blood loss and even a small loss of blood can be associated with severe shock. In emergency situations, a red blood cell (RBC) transfusion may become unavoidable, although it is associated with various risks. The aim of this trial was to identify independent risk factors for perioperative RBC transfusion in children undergoing surgery. METHODS: to identify independent risk factors for perioperative RBC transfusion in children undergoing surgery and to access RBC transfusion rates and in-hospital outcomes (e.g., length of stay, mortality, and typical postoperative complication rates), a monocentric, retrospective, and observational study was conducted. Descriptive, univariate, and multivariate analyses were performed. RESULTS: between 1 January 2010 and 31 December 2019, data from n = 14,248 cases were identified at the centre. Analysis revealed an RBC transfusion rate of 10.1% (n = 1439) in the entire cohort. The independent predictors of RBC transfusion were the presence of preoperative anaemia (p < 0.001; OR = 15.10 with preoperative anaemia and OR = 2.40 without preoperative anaemia), younger age (p < 0.001; ORs between 0.14 and 0.28 for children older than 0 years), female gender (p = 0.036; OR = 1.19 compared to male gender), certain types of surgery (e.g., neuro surgery (p < 0.001; OR = 10.14), vascular surgery (p < 0.001; OR = 9.93), cardiac surgery (p < 0.001; OR = 4.79), gynaecology (p = 0.014; OR = 3.64), visceral surgery (p < 0.001; OR = 2.48), and the presence of postoperative complications (e.g., sepsis (p < 0.001; OR = 10.16), respiratory dysfunction (p < 0.001; OR = 7.56), cardiovascular dysfunction (p < 0.001; OR = 4.68), neurological dysfunction (p = 0.029; OR = 1.77), and renal dysfunction (p < 0.001; OR = 16.17)). CONCLUSION: preoperative anaemia, younger age, female gender, certain types of surgery, and postoperative complications are independent predictors for RBC transfusion in children undergoing surgery. Future prospective studies are urgently required to identify, in detail, the potential risk factors and impact of RBC transfusion in children.

Eculizumab as first-line therapy for atypical hemolytic uremic syndrome.

Atypical hemolytic uremic syndrome (aHUS) is a genetic, life-threatening, chronic disease that can affect patients of all ages. aHUS is caused by uncontrolled complement activation due to genetic defects of complement regulation. Plasma exchange or infusion has been used to manage aHUS and may transiently maintain hematologic variables in some patients, but as the underlying complement dysregulation persists, end-stage renal disease or death occurs in 33% to 40% of patients during the first clinical manifestation. Here we present a pediatric case showing that first-line eculizumab treatment successfully blocked the progression of thrombotic microangiopathy in aHUS.

Rare brain biopsy findings in a first ADEM-like event of pediatric MS: histopathologic, neuroradiologic and clinical features.

Pediatric MS tends to present more often with an acute onset and a polysymptomatic form of the disease, possibly with encephalopathy and large tumefactive lesions similar to those observed in some cases of acute disseminated encephalomyelitis (ADEM), which makes it more difficult to differentiate between an explosive and severe onset of MS vs. ADEM. An ADEM-like first demyelinating event can be the first attack of pediatric MS, but international consensus definitions require two or more non-ADEM demyelinating events for diagnosis of MS. In our patient KIDMUS MRI criteria for MS (Mikaeloff et al. J Pediatr 144:246-252, 2004a; Mikaeloff et al. Brain 127:1942-1947, 2004b) were negative at first attack, but Barkhof criteria for lesion dissemination in space in adults (Barkhof et al. 120:2059-2069, 1997), Callen modified MS-criteria and Callen MS-ADEM criteria for children (Callen et al. Neurology 72:961-967, 2009a; Callen et al. Neurology 72:968-973, 2009b) were positive suggesting pediatric MS. As the clinical course was devastating with non-responsiveness upon high-dose immune modulatory therapy and due to the absence of an alternative diagnosis other than demyelinating disease brain biopsy was performed. Brain biopsy studies or autopsy case reports of fulminant pediatric MS patients are extremely rare. Histopathology revealed an inflammatory demyelinating CNS process with confluent demyelination, indicating the likelihood of a relapsing disease course compatible with an acute to subacute demyelinating inflammatory disease. This pattern was corresponding to the early active multiple sclerosis subtype I of Lucchinetti et al. (Ann Neurol 47(6):707-717, 2000).

Traumatic epidural hematomas in children and adolescents: outcome analysis in 39 consecutive unselected cases.

OBJECTIVE: Despite early diagnosis of traumatic epidural hematomas (EDHs) in children, mortality remained quite high in recent series. The aims of this analysis were to review the cause and outcome of pediatric EDH nowadays and to discuss outcome-related variables in a large consecutive series of surgically treated EDH in children. METHODS: This is a retrospective case series of 39 patients (27 males, 69%) with surgically treated EDH between June 1997 and February 2007. Patients' medical records, computed tomographic scans, and, if performed, magnetic resonance imagings were reviewed to define variables associated with outcome. Variables included in the analysis were age, associated severe extracranial injury, abnormal pupillary response, hematoma thickness, severity of head injury (Glasgow Coma Scale score < or = 8), parenchymal brain injury, and diffuse axonal injury. Long-term follow-up (mean [SD], 51.3 [27] months) was available in 38 patients, and outcomes were classified as excellent (modified Rankin Scale score [mRS], 0; Glasgow Outcome Scale score, 5) and good (mRS scores, 1 and 2; Glasgow Outcome Scale score, 4). RESULTS: The mean (SD) age of the patients was 83.1 (59.9) months (range, 1-191 months). The mortality was zero, and the outcomes were excellent in 34 and good in 4 patients (one was lost to follow-up). Most of the injuries with EDH occurred in familial settings (23 cases), with falls being the most common mechanism of injury in 20 patients. Trauma was caused by traffic accidents in 14 cases (pedestrians hit by a motor vehicle, 7 cases; bicycle accidents, 5 cases; and motorbike and car accidents, 1 case each). One EDH occurred during delivery. The mean size of the EDH was 18.5 (12) mm (range, 5-40 mm). Three patients were referred with unilateral or bilateral dilated pupil(s). Except in 4 patients, all EDHs were associated with skull fracture(s) (90%). Computed tomography or magnetic resonance imaging revealed brain contusion in 13 patients, and 1 had diffuse axonal injury. None of the tested variables were found to have a prognostic relevance as tested by multivariate analysis (backward exclusion, Wald method). CONCLUSIONS: Regardless of the EDH size, the clinical status of the patients, the abnormal pupillary findings, or the cause of injury, the outcome and prognosis of the patients with EDH are excellent.

Calculating ground water transit time of horizontal flow through leaky aquifers.

The calculation of ground water transit times is one important factor in ground water protection. In this paper, we present an analytical solution for the transit time for a Dupuit-type flow system applicable to saturated flow through a horizontal leaky aquifer discharging to a downgradient fixed-head boundary under steady-state conditions. We investigate the influence of leakage when comparing the resulting travel times of our model based on head-dependent leakage with the commonly used model with no leakage and a simplified model with constant leakage. The results show significant differences in the position of the water divide and transit time, suggesting that leakage cannot be ignored.

Integrated wavelets for enhancement of microcalcifications in digital mammography.

This paper presents a new algorithm for enhancement of microcalcifications in mammograms. The main novelty is the application of techniques we have developed for construction of filterbanks derived from the continuous wavelet transform. These discrete wavelet decompositions, called integrated wavelets, are optimally designed for enhancement of multiscale structures in images. Furthermore, we use a model based approach to refine existing methods for general enhancement of mammograms resulting in a more specific enhancement of microcalcifications. We present results of our method and compare them with known algorithms. Finally, we want to indicate how these techniques can also be applied to the detection of microcalcifications. Our algorithm was positively evaluated in a clinical study. It has been implemented in a mammography workstation designed for soft-copy reading of digital mammograms developed by IMAGETOOL, Germany.