Summary Background The volume of cerebrospinal fluid can affect the pharmacokinetics and pharmacodynamics of local anesthetics for spinal anesthesia and other intrathecal medications. Aims The objective of this study was to estimate the lumbosacral cerebrospinal fluid volume and thoracolumbosacral cerebrospinal fluid volume using magnetic resonance images in pediatric patients from neonates and infants to adolescents. Methods Spinal magnetic resonance images of 500 pediatric patients (age <18 years) were reviewed. The lumbosacral cerebrospinal fluid volumes of 418 patients and thoracolumbosacral cerebrospinal fluid volumes of 248 patients were measured. The relationship between cerebrospinal fluid volumes and age, height, and weight were evaluated. The lumbosacral and thoracolumbosacral cerebrospinal fluid volumes per weight were calculated to elucidate developmental changes. Results The lumbosacral and thoracolumbosacral cerebrospinal fluid volumes showed linear correlations with height (r2 = 0.730 and r2 = 0.661, respectively), whereas they showed curvilinear correlations with age (r2 = 0.752 and r2 = 0.717, respectively) and weight (r2 = 0.734 and r2 = 0.734, respectively). The mean lumbosacral cerebrospinal fluid volume per weight (mL/kg) was 0.85 (standard deviation [SD]: 0.19, 95% confidence interval [CI]: 0.81‐0.90) in neonates and infants, 0.86 (SD: 0.22, 95% CI: 0.83‐0.89) in toddlers and preschoolers, 0.71 (SD: 0.26, 95% CI: 0.66‐0.76) in schoolers, and 0.54 (SD: 0.20, 95% CI: 0.49‐0.60) in adolescents. The mean thoracolumbosacral cerebrospinal fluid volume per weight (mL/kg) was 1.95 (SD: 0.37, 95% CI: 1.86‐2.04) in neonates and infants, 1.82 (SD: 0.41, 95% CI: 1.75‐1.88) in toddlers and preschoolers, 1.38 (SD: 0.40, 95% CI: 1.23‐1.52) in schoolers, and 0.99 (SD: 0.34, 95% CI: 0.45‐1.53) in adolescents. Conclusion The lumbosacral and thoracolumbosacral cerebrospinal fluid volumes in pediatric patients were much smaller than previously presented values, showing linear correlations with height, and demonstrate curvilinear correlations with age and weight.
Free radical-induced lung injury is a major problem that occurs because of paraquat intoxication. Serum surfactant protein D (SP-D) reflects the severity of various lung diseases. The purpose of this study is to investigate the changes in plasma SP-D concentrations and to correlate disease severity with SP-D concentrations in patients with acute paraqaut intoxication. Twelve paraquat-intoxicated patients participated in this study. Their paraquat exposure was assessed by their plasma's paraquat level. Serial plasma SP-Ds were measured by ELISA. SP-D was decreased two and three days after the initial measurement within 2 to 72 hours of ingestion. There was no difference in initial SP-D levels between survivors and non-survivors. The SP-D test revealed a significant positive correlation between the SP-D level and PaO(2) (r = 0.384, p = 0.003, N = 57). SP-D did not predict the likelihood of survival, but it was positively correlated with PaO(2). This finding suggests that low concentrations of plasma SP-D could reflect hypoxia due to free radical-induced injury.
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