A BMI >35 does not protect patients undergoing cardiac bypass surgery from red blood cell transfusion.

The effect of obesity on allogeneic intraoperative blood product transfusion in patients undergoing coronary artery bypass graft surgery (CABG) is poorly understood. We analyzed the influence of obesity on the risk of intraoperative red blood cell (RBC) transfusion among 45,200 consecutive non-reoperative CABG procedures from a multi-institutional perfusion database. A body mass index (BMI) in obese I category was associated with a 9.9% decrease in transfusion risk (p<0.05). Compared to patients with a normal BMI, obese I and obese III patients do not have any change in the relative risk of RBC transfusion. Overweight and mild obesity have a protective role in reducing intraoperative blood transfusion during cardiopulmonary bypass (CPB) surgery. However, logistic regression analysis showed that much of the observed reduction in transfusion rates for obese patients can be accounted for by other known confounds. The lack of a linear effect of increasing BMI on blood transfusion risk is a novel finding and warrants further investigation.

Challenging diagnosis and treatment of HIT in child with ventricular assistance device.

HIT presents the clinician with unique diagnostic challenges, especially in the pediatric population. The HIT clinical sequelae of thrombocytopenia and thrombosis are secondary to the activation of platelets by heparin-antibody complexes. Diagnosis involves clinical observations and confirmatory laboratory testing using antibody detection and the functional SRA. As we describe in the following case of a six-yr-old female, the SRA may be difficult to interpret in the case of high-titer antibodies and illustrates the need for repeat testing in cases of high clinical suspicion.

Use of multidetector computed tomography 3D reconstructions in assessing lower tracheal-bronchial pathology and subsequent surgical interventions.

PURPOSE: To evaluate the contribution of 3D reconstruction in assessing lower tracheobronchial pathology and surgical interventions. METHODS: Twenty patients fit our criteria of lower tract tracheobronchial pathologies for a total of 25 abnormalities. Studies were reviewed by two board certified pediatric radiologists. Diagnostic value of 3D reconstruction in assessing surgical findings was evaluated. RESULTS: Three-dimensional (3D) reconstruction was perceived to add specific information in seven cases: three cases clarifying how attempting surgical intervention would be helpful, and in four cases, 3D reconstruction gave added information that aided surgical planning. CONCLUSIONS: Three-dimensional reconstructions can be a helpful tool in planning surgical interventions.