Alteration of fatal 1:1 conducted atrial flutter to less conducted ratio by landiolol infusion

Abstract

An 84-year-old male patient with a past history of atrial-flutter-fibrillation and dementia underwent an urgent femoral neck fracture surgery. Preoperative electrocardiography demonstrated atrial flutter (AFL) with ventricular conduction at a ratio of 2:1–4:1, and transthoracic echocardiography showed severe left ventricular dysfunction with Ejection Fraction of 14.6 %. Femoral nerve block and Lateral femoral cutaneous nerve block with sedation was planned for the surgery. Upon entry to the operating room, ECG showed 2:1 conducted AFL at the rate of 128 beats min⁻¹. Due to the stimulation of urethral catheter insertion, it has altered to 1:1 conducted AFL. Loading dose of landiolol hydrochloride 7.5 mg followed by 1.5–3 μg/kg/min continuous administration was given, which had decreased the conduction ratio to 2:1 without causing hypotension. A further episode of 1:1 conducted AFL occurred when the pin was inserted to the thighbone, which caused circulatory collapse. Additional bolus dose of landiolol immediately altered it to 2:1 before operating cardioversion and stabilized the hemodynamics. He maintained AFL with 2:1 conduction thereafter, and 1:1 conduction was never seen postoperatively even after discontinuation of landiolol.

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Health risk assessments of some toxic metals in stockfish sold in Nigeria.

2016-04-16T16-10-27Z
Source: Journal of Environmental and Occupational Science
Abiodun Mathias Emokpae, Blessing Ehiaghe Omongbale.
Aim: Stockfish is a popular delicacy in Nigeria but, because of high cost of the fish most consumers purchase and consume head bones, fins and gills. We hypothesized that fins and gills may contain higher concentrations of toxic metals. To evaluate some toxic metals levels in the body tissue, gills and fins of cod stockfish sold in three different cities in Nigeria. Materials and Methods: The concentrations of cadmium, lead, mercury and arsenic were determined in percloric: nitric: sulphuric acid (1:2:2) dissolved fins, body tissue and gills of cod stockfish using atomic absorption spectrophotometry and Inductively Coupled Plasma Mass-Spectrophotometer. Results: The concentrations of cadmium and lead were significantly higher (p


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A Single Tight MEG Cluster may only represent a Fragment of Type I FCD

Magnetoencephalography (MEG) is a non-invasive diagnostic tool for presurgical evaluation of patients with refractory epilepsies. It has been reported that a tight MEG cluster is an indicator for focal epilepsy and good surgical outcome; when presented with a single tight MEG cluster, the patient is usually regarded as a good surgical candidate (Oishi et al., 2006). The experience at our institution mirrors the findings in the literature; resection of the MEG cluster positively associates with seizure outcome (Schneider et al., 2012), especially in extratemporal lobe cases (Vadera et al., 2013); we have also demonstrated the value of MEG when used in combination with SPECT and ICEEG (Schneider et al., 2013).

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Facilitation dynamics of late somatosensory evoked potentials after sural nerve stimulation

Evoked potentials (EP) constitute easily observable phenomena that may give insight to the underlying cerebral processes. Lesion location and cognitive processes have been studied in detail by EP analysis (Yamada et al., 2004; Kotchoubey, 2006; Polich, 2007). In contrast to early components of EP that reflect the information propagation from the periphery to the cortex, late EP have been used to study the information processing within the central nervous system. This can be achieved with a high level of time resolution by way of studying late components of EP.

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Lime (Citrus aurantifolia L.) Juice a Potent Treatment for the Virulent Hepatocarcinogen Aflatoxin B1 in Peanut Paste

2016-04-16T14-01-42Z
Source: Journal of Molecular Pathophysiology
Esameldin Bashir Mohamed Kabbashi, Salah Eldeen Abbas Ali, Nawal Abdelgayoum Abdelrahman.
The Aflatoxins are fungal toxins and products of Aspergillus flavus and A. niger. They include B aflatoxins (B1, the most potent hepatocarcinogen known, and B2) which are produced by both species and aflatoxins G (G1 and G2) that are produced by A. niger and aflatoxin M1 and Q1 metabolites of B1 and aflatoxin M2 metabolite of Aflatoxin B2. Since the discovery of aflatoxins in 1960, after an outbreak of a disease of unknown etiology of turkey in England, the scientific approach towards these toxins concentrated on the protective measures and control of the incidence of these carcinogens either. Objective: This study aimed at coming out with a remedy and curing for elimination of aflatoxin B1 in peanut paste. The importance of this stemmed from the fact that aflatoxin occurrence is rather inevitable considering all the advancements in the protective measures. Methods: However, since the incidence of these toxins is rather unavoidable countable attempts were done on the treatment of these toxins in food and feed stuffs. Accordingly this fact persuaded testing some easy and familiar culinary approaches to mitigate and/ or perhaps diminish the presence of aflatoxin B1 (AFLB1) in the commonly consumed peanut (Arachis hypogaea L.) paste. Lime juice, in two doses (12.5 and 25 ml/ g), was applied to 25 g peanut paste contained AFLB1 (7.53 ppb) and stored for 1, 3 and 7 days. The test material was then analyzed for AFLB1 using aflatest® HPLC column of Vicam® of Waters corporation and HPLC Shimatzu® brand. Results: The collected data of the test samples reflected a reduction in AFLB1, due to the doses of 12.5 and 25 ml lime juice, of 11% and 31%, respectively (for one day storage), 54% and 66%, respectively (for 3 days storage), and 74% and 92% (for 7 days storage). Conclusions: These results are encouraging for use of lime juice as a treatment for aflatoxin B1 wherever applicable.


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Application of Implementation Science Methodology to Immediate Postpartum Long-Acting Reversible Contraception Policy Roll-Out Across States

Abstract

Purpose Providing long-acting reversible contraception (LARC) in the immediate postpartum period is an evidence-based strategy for expanding women's access to highly effective contraception and for reducing unintended and rapid repeat pregnancy. The purpose of this article is to demonstrate the application of implementation science methodology to study the complexities of rolling-out policies that promote immediate postpartum LARC use across states. Description The Immediate Postpartum LARC Learning Community, sponsored by the Association of State and Territorial Health Officials (ASTHO), is made up of multi-disciplinary, multi-agency teams from 13 early-adopting states with Medicaid reimbursement policies promoting immediate postpartum LARC. Partners include federal agencies and maternal and child health organizations. The Learning Community discussed barriers, opportunities, strategies, and promising practices at an in-person meeting. Implementation science theory and methods, including the Consolidated Framework for Implementation Research (CFIR), and a recent compilation of implementation strategies, provide useful tools for studying the complexities of implementing immediate postpartum LARC policies in birthing facilities across early adopting states. Assessment To demonstrate the utility of this framework for guiding the expansion of immediate postpartum LARC policies, illustrative examples of barriers and strategies discussed during the in-person ASTHO Learning Community meeting are organized by the five CFIR domains—intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and process. Conclusion States considering adopting policies can learn from ASTHO's Immediate Postpartum LARC Learning Community. Applying implementation science principles may lead to more effective statewide scale-up of immediate postpartum LARC and other evidence-based strategies to improve women and children's health.

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Small Bowel Neoplasms and Polyps

Abstract

The small intestine is a relatively privileged organ that only rarely develops malignant or even benign tumors. Given this rarity, the relative inaccessibility of the organ during routine endoscopic procedures, and the typical absence or nonspecific nature of clinical manifestations, these tumors often go undiagnosed. Treatment and prognosis are tailored to each histological subtype of tumor. This chapter will discuss the epidemiology, presentation, diagnostics, and management for the most common small bowel tumors, and will highlight the importance of recognizing patients at higher risk of small bowel neoplasia.

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A Practical Approach to Preventing Postoperative Recurrence in Crohn’s Disease

Abstract

Postoperative Crohn's disease recurrence remains common, and preventing additional surgery remains a challenge. A critical step to postoperative management of Crohn's disease is being able to identify patients who should receive immediate postoperative therapy from the patients who can wait for recurrence prior to starting medications. All patients, regardless of their risk for recurrence, are advised to undergo a colonoscopy at 6 to 12 months after surgery to evaluate for endoscopic evidence of Crohn's disease. Further management of patients depends on symptoms and the presence or absence of endoscopic recurrence.

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Rectal Prolapse in Children: Significance and Management

Abstract

Rectal prolapse is a herniation of the rectum through the anus. It is rare in children. When it does occur, it is usually prior to 4 years of age and due to anatomical variants. A few conditions predispose children to rectal prolapse, the most common being constipation. Cystic fibrosis used to be commonly associated with rectal prolapse, but with the advent of cystic fibrosis newborn screening, this association is no longer as frequently seen. Many recent case reports, detailed in this chapter, describe conditions previously unknown to be associated with rectal prolapse. Management is usually supportive; however, rectal prolapse requires surgical management in certain situations. This review details the presentation of rectal prolapse, newly described clinical manifestations, and associated conditions, and up-to-date medical and surgical management.

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Pediatric Non-alcoholic Fatty Liver Disease

Abstract

Childhood obesity has reached epidemic proportions, and by 2012, more than one third of American children were overweight or obese. As a result, increasingly, children are developing complications of obesity including liver disease. In fact, non-alcoholic fatty liver disease is the most common form of chronic liver disease seen in children today. Recently, there has been a burgeoning literature examining the pathogenesis, genetic markers, and role of the microbiome in this disease. On the clinical front, new modalities of diagnosing hepatic steatosis and hepatic fibrosis are being developed to provide non-invasive methods of surveillance in children. Lastly, the mainstay of treatment of pediatric non-alcoholic fatty liver disease (NAFLD) has been largely through lifestyle interventions, namely, dieting and exercise. Currently, there are a number of clinical trials examining novel lifestyle and drug therapies for NAFLD that are registered with the US National Institutes of Health ClinicalTrials.gov website.

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Integrating Adolescents and Young Adults into Adult-Centered Care for IBD

Abstract

Planned healthcare transition, initiated in pediatric care, is a gradual process aimed at fostering the adolescent patient's disease knowledge and skills with the ultimate objective of preparing patients and families for adult-centered care. The process is critical in inflammatory bowel diseases (IBD) where there is an increased risk of non-adherence, hospitalizations, and emergency department use as young adult patients graduate from pediatric to adult-centered care. While evidence for healthcare transition in IBD is mounting, important gaps remain in the understanding of this process from the perspective of the adult gastroenterologist. This paper summarizes what is known about healthcare transition in IBD and explores the unanswered questions—a conceptual and methodological framework for transition interventions, relevant outcomes that define successful transition, and key stakeholder perspectives. For the adult gastroenterologist managing the young adult patient population, this paper presents the paradigm of "care integration"—a process of ongoing, multi-modality support for the patient, initiated in the adult care setting, with the goal of improving self-management skills and active participation in medical decision-making.

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Erratum to: Suicidal Ideation and Mental Health of Bhutanese Refugees in the United States

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Reliability and Validity of a Global Physical Activity Classification Measure

2016-04-16T07-27-57Z
Source: Journal of Behavioral Health
Paul D. Loprinzi, Eveleen Sng.
Purpose: The purpose of this study was to evaluate the reliability and validity of a global physical activity classification (GPAC) measure employed in the National Health and Nutrition Examination Survey (NHANES). Methods: For validity assessment (N=6039), the NHANES GPAC was compared to NHANES accelerometry data. For reliability assessment (N=94), a convenience sample completed a 1-week test-retest of the GPAC. Results: The association between total physical activity and GPAC ranged from 0.25-0.40, with the range for moderate-to-vigorous physical activity (MVPA) and GPAC being 0.17-0.39. Generally, associations were stronger for total physical activity and GPAC compared to MVPA and GPAC. Similarly, associations were generally stronger for men, younger individuals, and Mexican Americans. In the reliability assessment, the ICC ranged from 0.58 to 0.90, with the older participants having the lowest ICC (0.58). Conclusion: Findings of this study demonstrate suggestive evidence of both reliability and validity for the NHANES GPAC.


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Erratum to: The Feasibility of Recruiting and Retaining Perinatal Latinas in a Biomedical Study Exploring Neuroendocrine Function and Postpartum Depression

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Deep Neck Abscess with Mediastinum Involvement following Acupuncture: A Case Report

2016-04-16T07-27-57Z
Source: Journal of Behavioral Health
Chian Ling Tang, Noor Dina Hashim.
Traditional acupuncture is a growing modality of treatment worldwide. However, various acupuncture-related adverse effects had been reported. We report a case of deep neck abscess involving mediastinum following acupuncture. A 56 years old immunocompromised gentleman developed extensive neck abscess with mediastinum involvement and inflammatory aortitis following acupuncture for shoulder pain. Staphylococcus aureus was isolated from the abscess culture. Surgical drainage with systemic antibiotic admission resulted in a good clinical recovery and resolution of infection.


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Assessment of drug prescribing pattern using WHO indicators in hospitalized patients at a tertiary care teaching hospital in rural area of India

2016-04-16T07-15-07Z
Source: International Journal of Basic & Clinical Pharmacology
Asha Pathak, Vinay Kumar Gupta, Arvind Maurya, Alok Kumar, Amit Singh.
Background: To promote rational drug use in patients of rural areas, it is important to assess drug use pattern using the WHO prescription indicators. The aim of this study was to assess the drug prescription patterns in patients admitted in Medicine department of UPRIMS&R. Methods: A prospective observational study was conducted from Jan 2015 to June 2015. Data were collected & analysed according to WHO prescribing indicators and presented by using descriptive statistics. Results: 626 prescriptions were selected in which 3205 drugs were prescribed. The most common drug groups prescribed were antibiotics 24.64% followed by anti-diabetic drugs 12.38%, analgesics 12.23% and drugs for cardiovascular diseases 11.82%, GIT drugs 9.01%. Average number of drugs per prescription was 5.11. Drugs prescribed from essential drugs list (India) was 76.06%. Drugs prescribed from essential drugs list (WHO) was 23.04%. Total number of prescriptions with antibiotics was 24.27%. Total number of prescriptions with injections was 24.05%. Percentage of fixed dose combinations was 28.7%. Drugs prescribed by generic name were 89.88%. Conclusions: The prescribing pattern of antibiotics was according to WHO recommendations while the average number of drugs per prescription was found high. There were small differences in the values of drugs prescribed by generic names, injectable and drugs from NLEM from the recommended values.


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A comparison of two approaches to brachial plexus anaesthesia

2016-04-16T06-58-46Z
Source: International Journal of Research in Medical Sciences
Rajib Hazarika, Tejwant Rajkhowa, Mridu Paban Nath, Samit Parua.
Background: A prospective, double blind study was performed to compare the clinical effect of vertical infraclavicular and supraclavicular brachial plexus block using a nerve stimulation technique for upper limb surgery. Methods: Eighty patients undergoing upper limb surgery under infraclavicular or supraclavicular brachial plexus block were enrolled into this study. The infraclavicular brachial plexus block was performed using the vertical technique (group I; N=40). The supraclavicular brachial plexus block was performed using the Kulenkampf technique (group S; N=40). In both the groups 30 ml of 0.5% ropivacaine was used as the local anaesthetic. The block performance time, the duration of onset of sensory and motor block was evaluated in both the groups S & I. The quality of the block & associated complications were also assessed. Results: A significant difference in the block performance time with comparable duration of onset of sensory was noted between the two groups S & I. Greater incidence of Horners syndrome was noted in group S. Conclusions: Supraclavicular brachial plexus block may be easier to perform than infraclavicular brachial plexus block. The infraclavicular approach may be preferred to the supraclavicular approach when considering the complications.


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In memoriam: Paolo Pinelli, MD (1921–2015)

Publication date: Available online 15 April 2016
Source:Clinical Neurophysiology
Author(s): Arrigo Moglia, Giorgio Sandrini




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Unusual encounters in a hernia sac

2016-04-16T06-58-46Z
Source: International Journal of Research in Medical Sciences
Ketan Vagholkar, Amish Pawanarkar, Suvarna Vagholkar, Madhavan Iyengar, Kashmoorvalishah Pathan.
Contents of a hernia sac are always a surprise. In most cases the contents of the sac determine the type of repair. A case of an inguinal hernia sac containing the appendix along with the dislodged end of a ventriculoperitoneal shunt tube is presented in view of its rarity.


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Neonatal transitional care unit: a new concept in India

2016-04-16T06-24-34Z
Source: International Journal of Contemporary Pediatrics
Sachin Darne, Trusha Rajda.
In this era of increasing healthcare cost, the role of economic evaluation of healthcare interventions has become increasingly important in India. Neonatal Intensive Care Unit (NICU) stays are amongst the most expensive kind of hospitalizations. The Neonatal Transitional Care Unit (NTCU), in an area where the moderately affected new-born babies are managed near the mother. This is widely prevalent in western countries; however, is still a new concept in countries like India. In current scenario in India, any baby born with issues is transferred to NICU. There are certain medical conditions in newborn babies which can be managed in NTCU instead of transferring the babies to NICU. In NTCU these babies are managed under close supervision by qualified nursing staff and pediatricians where the parents act as main carers. This helps in early mother-infant bonding and also cost reduction. This has shown to have improved neonatal outcome, lesser duration of hospital stay, improved maternal and infant bonding and overall cost reductions.


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FDNY's 'Calendar of Heroes' features EMTs, paramedics

amNewYork

NEW YORK —The FDNY's 2017 Calendar of Heroes is now on sale and it's better than ever.

For the first time, the FDNY's famed calendar spread features 12 men and 12 women as well as representation from the department's EMTs and paramedics.

The calendar, which is essentially two calendars in one, includes a male and female model for each month.

"I'm proud that the 2017 is the first calendar the Department has produced which truly represents all of our heroes — the men and women who risk their lives as Firefighters, EMTs and Paramedics every day to keep New York City safe," said FDNY Commissioner Daniel Nigro.

On Friday, some of the calendar's models will be in Herald Square between 11 a.m. and 2 p.m. to sign purchased copies of the calendar.

You can pre-order the calendar at FDNYshop.com.

The FDNY donates all proceeds from calendar sales to the FDNY Foundation, a nonprofit that promotes fire safety education in the city.

Copyright 2016 amNewYork
All Rights Reserved

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Pa. EMT follows country music dream

LANCASTER, Pa. — Gina Miller's music career has been interrupted by traumatic experiences including surviving three serious-injury auto accidents and deaths of close friends and mentors.  

It is these encounters and more that have driven this school nurse and blossoming country music singer/songwriter to release new music debuting in her sophomore EP, Angel from Montgomery.

At 50, Miller is not the typical emerging music artist. She is also a Registered Nurse, former EMT for nearly 30 years, wife and mother of two adult children.  

With Lady Antebellum influence and a cross-over modern style, her music career was shaped by the late producer John Stoecker and popular independent music consultant Tim Sweeney. Vehicle accidents in 2009, 2012 and 2014 left her with chronic pain and memory loss. While these painful experiences halted her career, they didn't prevent her from realizing a life-long dream to sing and perform.

Last year, the Lancaster, Pa. native signed with legendary producer Jack Gale and his independent Nashville label Playback Records. Her new four-song Angel from Montgomery EP follows her first eight-song compilation titled Faded Footprints. The new EP features originals such as Smitten and Breathless and cover music including the 1971 single Angel from Montgomery, originally written by John Prine. Miller's version is currently being played by radio stations across the country.

"I like to create and sing songs that tell a story and move people," explained Miller. "My music is about no regrets and inspiring others to follow their dreams no matter how big or small. I want listeners to feel the love and power of the words in a song. Music is about forgetting things that hurt and remember those we love in a song."

Music and medicine have always been a part of Miller's life. As an EMT, she has performed at several EMS memorial services across the country, including at the National EMS Memorial in 2009. Miller co-wrote a tribute single -—Tree of Life — to acknowledge the unsung heroes of the EMS who died in the line of duty.

Miller is also an advocate for missing people and a regular part of The Squeaky Wheel Tour, an annual concert series created by nonprofit GINA for Missing Persons FOUNDation to raise awareness of people who mysteriously disappear each year. She advocates for Toni Lee Sharpless, a young mother and fellow Nurse that disappeared from Philadelphia in 2000. 

Although Sharpless has never been found, Miller continues to promote her story hoping that one day she will be returned to her loved ones. Miller co-wrote Missing Piece, a tribute single to all the family members and friends of a missing person.

Miller's band — Gina Miller & Division Highway — features drummer Brian Yocum; guitar/vocalist Steve Walker; and bass/vocalist Eldon Zimmerman.

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Eicosapentaenoic and docosahexaenoic acids-rich fish oil supplementation attenuates strength loss and limited joint range of motion after eccentric contractions: a randomized, double-blind, placebo-controlled, parallel-group trial

Abstract

Purpose

This study investigated the effect of eicosapentaenoic and docosahexaenoic acids-rich fish oil (EPA + DHA) supplementation on eccentric contraction-induced muscle damage.

Methods

Twenty-four healthy men were randomly assigned to consume the EPA + DHA supplement (EPA, n = 12) or placebo (PL, n = 12) by the double-blind method. Participants consumed EPA + DHA or placebo supplement for 8 weeks prior to exercise and continued it until 5 days after exercise. The EPA group consumed EPA + DHA-rich fish oil containing 600 mg EPA and 260 mg DHA per day. Subjects performed five sets of six maximal eccentric elbow flexion exercises. Changes in the maximal voluntary contraction (MVC) torque, range of motion (ROM), upper arm circumference, muscle soreness as well as serum creatine kinase, myoglobin, IL-6, and TNF-α levels in blood were assessed before, immediately after, and 1, 2, 3, and 5 days after exercise.

Results

MVC was significantly higher in the EPA group than in the PL group at 2–5 days after exercise (p < 0.05). ROM was also significantly greater in the EPA group than in the PL group at 1–5 days after exercise (p < 0.05). At only 3 days after exercise, muscle soreness of the brachialis was significantly greater in the PL group than in the EPA group (p < 0.05), with a concomitant increase in serum IL-6 levels in the PL group.

Conclusion

Eight-week EPA + DHA supplementation attenuates strength loss and limited ROM after exercise. The supplementation also attenuates muscle soreness and elevates cytokine level, but the effect is limited.

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Antimicrobial and cytotoxicity properties of the organic solvent fractions of Clerodendrum myricoides (Hochst.) R. Br. ex Vatke: Kenyan traditional medicinal plant

2016-04-16T04-40-36Z
Source: Journal of Intercultural Ethnopharmacology
Sospeter Ngoci Njeru, Meshack Obonyo, Samwel Nyambati, Silas Ngari, Ramadhan Mwakubambanya, Hawa Mavura.
Background/Aim: Clerodendrum myricoides is a Kenyan herbal plant used in management of respiratory diseases. In the current study, we investigated in-vitro antimicrobial activity, cytotoxicity and phytochemical screening of Clerodendrum myricoides. Materials and methods: Antimicrobial activities of C. myricoides organic fractions against array of micro-organisms including: i) Mycobacterium tuberculosis H37Rv, ii) Staphylococcus aureus iii) Klebsiella pneumonia iv) Escherichia coli v) Candida albicans vi) Pseudomonas aeruginosa vii) Cryptococcus neoformans viii) Salmonella typhi ix) Shigella sonnei x) Methicillin resistant Staphylococcus aureus was investigated by disc diffusion and micro dilution techniques. Antituberculous activity was investigated using BACTEC MGIT 960 system while cytotoxicity was analyzed by MTT assay on HEp-2 cells. Finally, phytochemicals were screened using standard procedures. Results: Methanolic fractions exhibited a broad spectrum activity inhibiting 75% of test pathogens. It had highest activity with MIC values of ≤62.5 µg/ml recorded against 62.5% tested microbes. It yielded the highest zone of inhibition of 20.3 mm (S. aureus), lowest MIC of 90 µg/ml). The phytochemicals largely believed to be responsible for the observed activity included: alkaloid, phenols, anthraquinones, terpenoids and flavonoids. Conclusion: Methanolic fraction had remarkable activity against MRSA, S. aureus, E. coli, S. sonnei, C. albicans and MTB which are of public health concern due to drug resistance and as sources of community and nosocomial infections. To the best of our knowledge, this is the first report exploring the antituberculous activity of C. myricoides and thence a major output in search of novel, safe drug leads to mitigate the global tuberculosis threat.


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Post-Surgical Perforation of the Esophagus Can be Treated Using a Fully-Covered Stent in Children.

Objectives: Surgery and conservative treatment of esophageal or gastric perforations are both often associated with poor results and carry a high morbidity and mortality rate. The aim of this study was to evaluate the effectiveness and safety of using fully-covered self-expending metallic stents (SEMS) in children with upper digestive leaks. Methods: This retrospective study reviewed all children with esophageal or gastric perforation who were treated with placement of a SEMS from January 2011 to January 2015. Closure of the perforation was the primary outcome measured. Secondary outcomes were the duration of antibiotic therapy and parenteral nutrition, adverse events, and length of hospitalization. Results: A total of 19 SEMS were placed in 10 patients (median age: 5.5 years; 5 girls) treated for post-anastomotic leaks of esophageal atresia (n = 3), esophagogastroplasty (n = 4), resection of esophageal duplication (n = 1) or perforation during Toupet surgical dismantling (n = 1), and gastric rupture post Nissen surgery (n = 1). The perforation closed in 9 out of 10 patients in a mean of 36 days after stenting (range: 13-158 days). All patients received antibiotic therapy for an average of 17.5 days (3-109 days) and parenteral nutrition for 49 days (17-266 days). During a median follow-up of 8.9 months, 4 out of 9 sealed perforations developed stenosis, which was efficiently treated by endoscopic dilations in 2 patients and surgical redo in 2 patients with dilation-resistant stenosis. Conclusions: Covered stents appear to be beneficial in closing esophageal perforations in children and can avoid the high morbidity of a surgical repair. However, stenosis occurred frequently after larger leakages. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Dextrose-containing intraoperative fluid in neonates: a randomized controlled trial

Summary

Background

Glucose requirement in neonates during surgery and the impact of glucose supplementation on neonatal metabolism remain unclear.

Aim

This study was designed to identify an appropriate perioperative fluid regimen in neonates which maintains carbohydrate and lipid homeostasis.

Methods

Forty-five neonates undergoing primary repair of a trachea-esophageal fistula were randomly allocated into three groups. During surgery, the neonates received either 1% dextrose in Ringer lactate (RL) (group D1) at 10 ml·kg⁻¹·h⁻¹, or 2% dextrose in RL (group D2) at 10 ml·kg⁻¹·h⁻¹, or 10% dextrose in N/5 saline at 4 ml·kg⁻¹·h⁻¹ and replacement fluid with 6 ml·kg⁻¹·h⁻¹ of RL (group D4). Glucose homeostasis, electrolyte balance, acid–base status, and endocrine and metabolic parameters were compared among the groups during the perioperative period.

Results

Blood glucose increased in all the three groups at the end of surgery, with no significant difference in blood glucose and incidence of hyperglycemia (BG > 150 mg·dl⁻¹) among them. At 24 h after surgery, blood glucose and incidence of hyperglycemia was significantly higher in Group D1 compared to Group D4. Base excess, bicarbonate, lactate, and pH showed a significant fall in Group D1. There was no significant difference in serum-free fatty acids, serum beta-hydroxy butyrate, and serum cortisol in three groups. At the end of surgery, serum insulin was significantly lower and glucagon : insulin (G : I) ratio was higher in Group D1 compared to Group D4.

Conclusions

All three solutions, when infused at 10 ml·kg⁻¹·h⁻¹, are equally effective in maintaining glucose homeostasis, but 1% dextrose-containing fluid promotes catabolism, insulin resistance, rebound hyperglycemia, and acidosis. Therefore, 2–4% dextrose-containing fluids is more suitable compared to 1% dextrose-containing fluids for use during major neonatal surgeries requiring average fluid infusion rate of 10 ml·kg⁻¹·h⁻¹.

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A comparison of the Truview PCD and the GlideScope Cobalt AVL video-laryngoscopes to the Miller blade for successfully intubating manikins simulating normal and difficult pediatric airways

Summary

Background

Video-laryngoscopes provide better glottic visualization, but tracheal intubation times are longer, compared to conventional direct laryngoscopy in adult patients with normal airways. The objective of this randomized crossover study was to compare times to successful tracheal intubation with video-laryngoscope and direct laryngoscopy in manikins simulating infants with normal and abnormal airways.

Methods

Thirty experienced pediatric anesthesia practitioners performed tracheal intubation in three distinct manikins simulating infants with (i) a normal airway (ii), an anterior larynx, and (iii) the Pierre Robin sequence anatomy. These were performed using a standard Miller #1 blade, the GlideScope Cobalt AVL, and the Truview PCD video-laryngoscope, first in a normal neck and then an unstable cervical spine scenario (18 intubations/subject). The specific assigned order of devices and manikins for each participant was based on a three by three Latin square design to minimize carryover effects between the model and the device. Predefined times to intubation were analyzed by Cox regression model and Kaplan–Meier survival curves.

Results

Intubation times were shorter and success rates were higher with the Miller blade compared to either the GlideScope or the Truview videoscope in all three manikins in both scenarios, but did not differ between the GlideScope and the Truview devices. Improved intubation times and success rates in the unstable cervical spine scenario compared to the normal neck were attributed to learning effects with sequential intubation.

Conclusion

Higher success rates and shorter intubation times with the Miller blade compared to either video-laryngoscope may reflect greater experience with direct laryngoscopy, need for more video-laryngoscopy training, or result from the manikin design. Individual practitioners may differ in their preference of device for intubating a child with anticipated difficult airway based on their previous experiences, self-assessment of their skills, and evaluation of the child's airway anatomy.

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