Idiopathic Scoliosis in Adolescents
Department of Orthopedic Surgery, Boston Children's Hospital, and Harvard Medical School, Boston, USA. New England Journal of Medicine
(Impact Factor: 55.87).
02/2013; 368(9):834-41. DOI: 10.1056/NEJMcp1209063
A 12-year-old girl presents with her parents after a positive school screening for scoliosis. Physical examination reveals shoulder and torso asymmetry with trunk imbalance (i.e., shift from the midline). Neurologic and skin examinations are normal. How should the patient be evaluated and treated?
Available from: Fabio Zaina
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ABSTRACT: To explore the effects of autotransfusion on intraoperative blood loss and postoperative drainage volume in posterior lumbar spinal surgery.
From June 2010 to January 2012, a total of 183 patients with lumbar disease were enrolled. There were 74 males and 109 females with an average age of 56.6 (31-81) years. There were lumbar disc herniation (n = 80), lumbar stenosis (n = 69), lumbar spondylolisthesis (n = 32) and discogenic pain (n = 2). And one-level (n = 83) and two-level (n = 100) operations were performed. The treatments were non-transfusion (n = 34), autoblood (n = 109) and allogeneic blood (n = 20) and both (n = 20).Operative duration, operative level, intraoperative autologous blood transfusion, intraoperative allogeneic blood transfusion, intraoperative blood loss, immediate drainage volume, duration of drainage tube and final drainage volume were recorded.
The mean intraoperative blood loss was (369.4 ± 284.0) ml and (568.8 ± 398.7) ml for two-level operation, there were singificant differences between them(t = 3.94, P < 0.001). The final drainage volume was (186.3 ± 135.6) ml for one-level patients and (301.4 ± 286.8) ml for two-level patients, there were singificant differences between them (t = 3.56, P < 0.05). The total instraoperative blood loss was (478.3 ± 364.3) ml and total final drainage volume was (249.2 ± 237.4) ml, there were singificant differences between them(P < 0.001). There were significant differences in blood loss between autologous blood transfusion for non-transfusion groups (P < 0.001) .However, there was no differencefor immediate draniage and final drainage comparing with orther blood transfusion methods (P > 0.05) .
Using autologous blood transfusion alone during operation has significant difference for inoperative blood loss compared with non-transfusion. Yet there is no effect on immediate or final drainage volume.
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ABSTRACT: Children undergoing major surgery are frequently exposed to a high risk of blood loss often requiring transfusion. Although the risks associated with blood product transfusion have considerably decreased over the last decade, transfusion is still associated with significant morbidity and mortality. Thus, rigorous efforts should be made to decrease surgical bleeding and the need for blood product transfusion. Antifibrinolytic drugs have been shown to be effective when used in both adult and pediatric surgical patients. While there are data in adults to support safety, data remain limited for pediatric patients. Since the restriction of aprotinin use in 2008, the most commonly used antifibrinolytic drugs have been the lysine analogs, tranexamic acid (TXA), and ε-aminocaproic acid, which inhibit the conversion of plasminogen to plasmin and decrease the degree of fibrinolysis. We performed a systematic review of the literature pertaining to the efficacy of antifibrinolytic drugs in children undergoing noncardiac surgery. During spine surgery, both TXA and ε-aminocaproic acid decrease blood loss and transfusion requirements; however, this information comes from small, mainly retrospective trials. Two prospective, randomized, controlled trials have tested the efficacy of TXA in children undergoing craniofacial surgery and have reported that TXA decreases transfusion requirements. Two pharmacokinetic trials were also recently published and are summarized in this review. No data have been published regarding the efficacy of TXA administration in the pediatric trauma population. Further data are still needed in this field of study, and we discuss some perspectives for future research.
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