Significance and causes of abnormal preoperative coagulation test results in children.

To prevent bleeding related to adenoidectomy and tonsillectomy, coagulation screening tests were, until recently, performed routinely in the Czech Republic for all paediatric patients. The aim of this study was to evaluate benefit of preoperative coagulation screening tests in children. We retrospectively analysed laboratory and clinical data of children referred for abnormal preoperative coagulation test results (aPTT, PT) to the outpatient haematology clinic. A total of 274 paediatric patients were retrospectively evaluated due to abnormal preoperative coagulation tests results. In 140 of 274 patients (51.1%), coagulation tests were normal on repeated testing in a specialized haematology clinic. Ten patients had decreased factor XII. Five patients had a suspected bleeding disorder which was confirmed in two of them. One patient had low levels of von Willebrand factor, and one patient had mild factor VII deficiency. Both these patients had positive personal and/or family history of bleeding. Each case history was taken individually, without use of standardized questionnaires. Bleeding complications were not observed, and coagulation factor replacement was not needed perioperatively in our cohort. The majority of abnormal findings in aPTT and PT appeared only transiently. All the bleeding disorders found in our cohort of patients were mild in nature. Our findings provide supportive evidence for the current national Czech recommendation: laboratory coagulation screening should be performed only in patients with positive family and/or personal bleeding history.

[Kinetics of gentamycin in premature infants with a low birth weight during the first four days of postnatal life]. / Kinetika gentamycinu u nedonosených detí s nízkou porodní hmotností v prubehu prvních ctyr dnu postnatálního zivota.

The authors investigated in a group of 19 premature neonates with a low birthweight (0.65-2.1 kg) during the first four days of postnatal life the pharmacokinetics of gentamycin after indicated administration of 2 mg/kg of the antibiotic by the i.v. route by a 30-minute infusion in 18-hour intervals. Serum concentrations of gentamycin were assessed by immunoassay 0.5 hours before administration and then 0.5, 5.5, 11.5 and 17.5 hours after the 5th infusion, i.e. in a steady state. The maximum serum concentrations detected 0.5 hours after the completed infusion exceeded 10 mg/l in 21% of the neonates, while the minimal concentrations of the antibiotic before the next administration were above 2 mg/l in 42% of the infants. The calculation of pharmacokinetic parameters according to the one-compartment model revealed considerable interindividual differences of all values. The authors consider particularly important the low clearance value of the antibiotic (30.24 +/- 14.55 ml/kg.hour-1) which may lead to cumulation of gentamycin and its toxic action. Gentamycin administration to premature neonates should be associated with monitoring of serum concentrations of the drug which would make individual adjustment of the dosage possible.

Long-term monitoring of immunological profile in children with immunodeficiency disorders.

1. The fulfillment of research project allowed us to make deeper scope of literature sources with the children IDS topic. The proper experience with children IDS management has been acquired in the specialized service for immunodeficient children at Pediatric Clinic of Teaching Hospital in Hradec Králové. 2. IDS screening and diagnostic in children were studied with participation of immunologic laboratories, and the development of available immunologic indices in IDS children has been monitored at long-term. Problems mentioned were the content of partial research project VII-6-6/19 for 1976-1980, VII-6-6/9 for 1980-1985, VIII-6-5/11 starting from 1986 and resolved till now by Pediatric Clinic of Teaching Hospital in Hradec Králové. The immunodeficient conditions were studied minutely at long-term and with complex relations. 3. Authors were involved in management of life threatening infectious complications and performed both control and moderation of diseases manifested as such. Applied management approaches were then evaluated from the scope of actual therapy. Our pathophysiologic IDS concept is more extended. The individual IDS represents a complex real situation developing in time. Therefore, the long-term monitoring is of benefit in detecting certain developmental IDS tendencies such as, e. g., occurrence of autoimmune diseases and malignancies in children with IDS. 4. We stated that thymectomy in infants: --was of no expressed disturbing influence on health of two children at least for 12 years of long-term monitoring; --manifested the transient decrease of circulating T-lymphocyte percentage which was detected in one child 2 years after TE, in other up 10 years after TE, respectively. However, both of them showed a constant decreasing tendency; --is responsible of changes in subpopulations of T-lymphocytes; --changes of laboratory tests provided after TE 12 years till now show no clinical significance. 5. Selective IgA deficiency has been diagnosed in a total of 14 children, and the development of their immunologic indices was monitored at long-term. Several literature data were proved as well as enlarged and extended: --IgA deficiency is a constant defect; --this is a simultaneous deficiency of both serum and secretory IgA in a majority of cases; --selective IgA deficiency is most pronounced and complex immunity disorder involving not only humoral, but also cellular immunity; --in IgA deficiencies, mainly respiratory infections are predominant though having neither serious course nor complications; --immunoglobulins are not necessary in managing infections in IgA deficient cases for as much as an appropriate antiinfection therapy is of choice. Dispensary care is needed similarly to other IDS conditions due to recurrent infections and risk of autoimmune diseases and tumors.(ABSTRACT TRUNCATED AT 400 WORDS)