Calibrated vaginal delivery drapes improve blood loss estimation.

Extending the programmed intermittent bolus interval and volume from 15 minutes to 60 minutes, and 2.5 mL to 10 mL, respectively, decreased bupivacaine consumption without decreasing patient comfort or satisfaction.

Summary:Acute lymphocytic leukemia (ALL) is a common indication for hematopoietic stem cell transplantation (HSCT) in children. Use of unrelated cord blood (UCB) has become increasingly popular as a stem cell source, given the rapid availability and decreased GVHD potential. Publications describing outcomes of children with leukemia who underwent UCB transplants have compared them to those having received unrelated donor marrow transplants. Results are similar. We compared our outcomes using UCB vs allogeneic-related hematopoietic stem cells in pediatric ALL patients since 1992. A total of 49 patients were analyzed. All patients were either in CR1 with high-risk features (n ¼ 21) or in CR2 (n ¼ 28) with initial remission less than 36 months. Patients received myeloablation with fractionated total body irradiation, cyclophosphamide, and etoposide and GVHD prophylaxis with cyclosporine and methotrexate. Antithymocyte globulin was added for UCB recipients to address the HLA differences. In all, 23 patients underwent allogeneic -related HSCT and 26 underwent UCB transplantation. Other than increased time to engraftment for UCB recipients, results are equivalent. The 3-year overall survival is 64% and 3-year event-free survival is 60% for both groups. Rates of GVHD and transplant-related mortality are also equivalent. UCB is a reasonable option for children with ALL who are referred for HSCT. Although the majority of children with acute lymphocytic leukemia (ALL) enjoy excellent outcomes with conventional multiagent chemotherapy, the outlook for those patients who develop recurrent disease, particularly within the first 2 years of therapy, is far less favorable. Patients who relapse within 24 months of diagnosis and are treated with chemotherapy alone have less than 20% survival. 1,2 Hematopoietic stem cell transplantation (HSCT) has been commonly employed for patients with relapse or high-risk features. 3,4 While most children with recurrent or high-risk ALL can achieve a remission with intensified therapy, the most appropriate management strategy to employ once remission has been achieved remains controversial. Some transplant centers base that decision on whether a matched related donor is available.For patients with relapse, HSCT with HLA-matched related donors during the second complete remission (CR2) has provided leukemia-free survival (LFS) rates in the range of 40-50% at 2-5 years. 3,4 There exists controversy with regard to what length of time defines a late relapse after which point an HSCT may have no advantage over chemotherapy. In analyzing 287 patients with ALL in CR2, Uderzo reported no advantage of matched-sibling HSCT over chemotherapy for patients who relapsed more than 30 months from diagnosis. 5 With unrelated cord blood transplantation (UCBT) for ALL and AML, a relapse on therapy prior to transplant confers a worse LFS (22% on therapy vs 48% off therapy). 6 UCB can be an attractive alternative stem cell source for a variety of reasons. Cells are rapidly available, HLAmatching can be considerably...

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Infants with acute lymphoblastic leukemia (ALL) have a poor prognosis when treated with standard chemotherapy. A subset of these infants, particularly those with mixed-lineage leukemia (MLL) rearrangements, has a high likelihood of relapse. Hematopoietic stem cell transplantation (HSCT) performed early in first remission may improve outcome. We present the results of 16 patients with infant ALL who were treated with HSCT in first remission. Six patients were < or =6 months of age at diagnosis, 11 had an initial white blood cell count of >50000/microL, and all patients with determinable cytogenetics had a high-risk karyotype [t(4:11) abnormality or other MLL rearrangement]. All patients received 150 cGy of total body irradiation for 8 doses (1200 cGy). Fifteen of 16 patients received etoposide at 1000 mg/m(2) as a continuous infusion over 24 hours and cyclophosphamide at 60 mg/kg/d for 3 days. Eight patients received HSCT from an HLA-identical sibling, and 8, from unrelated cord blood. Twelve (75%) patients remain long-term survivors (median follow-up, 4.7 years). Two patients, 1 of whom had minimal residual disease at HSCT, died after relapse following HSCT. Two patients died of transplant-related causes. The HSCT was well tolerated; 15 patients achieved neutrophil engraftment at a median of 16 days. Acute and chronic graft-versus-host disease were minimal in these patients. These results support the use of HSCT in the treatment of infant ALL, especially when used as consolidation in first remission. The risk of relapse seems to be decreased with this approach. Further work is being performed to determine the long-term effects from this therapy.

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(J Clin Anesth. 2016;34:261–269) Owing to increases in both cesarean delivery rates and maternal age, the incidence of placenta accreta is rising. Placenta accreta is an abnormal form of placentation with increased depth of placental invasion that is associated with maternal hemorrhage and is an important cause of maternal death. The objective of this study was to assess whether routine stratification of antepartum magnetic resonance imaging (MRI) findings of abnormal placentation correlated with severe maternal hemorrhage and blood product requirements with the goal of appropriately identifying and preparing patients at risk for these outcomes.

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