bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Callender modification of the Macintosh laryngoscope blade reduces the risk of tooth–blade contact in children
Authors: MIRESKANDARI SEYED‐MOHAMMAD , ASKARIZADEH NAHID , DARABI MOHAMMAD‐ESMAEEL , RAHIMI EIMAN , ATAEE HOSSEIN‐ALI , CHAMRAMI FARHAD , EGHTESADI‐ARAGHI PAYAM 
Published: October 2008

SummaryBackground:  Dental injury is well recognized as a potential complication of laryngoscopy and tracheal intubation. The flange of the Macintosh blade may contact teeth during laryngoscopy causing damage. The Callander modification of the Macintosh blade (Callander blade) with a shortened heel at the proximal end has been shown to increase the blade–tooth distance and reduce contact rates in adults.Aim:  This study was designed to evaluate the effectiveness of the Callander blade on reducing dental contact in children.Methods:  One hundred children, aged 4–14 years, scheduled for general anesthesia requiring endotracheal intubation were studied prospectively. The children were preoperatively evaluated for Mallampati score and dental defects, looseness, and avulsions. Following induction of anesthesia, laryngoscopy was performed twice on each child in succession, once with a standard Macintosh blade and once with a Callander blade of the same size in a random order. The blade–tooth distance and contact rate were compared between the two blades.Results:  With the Callander blade, the blade–tooth distance was greater than with the Macintosh (1.78 ± 1.77 vs 0.28 ± 0.76 mm, P = 0.001). The frequency of direct contact was less with the Callander blade than it was with the Macintosh blade (33% vs 86%, respectively, P = 0.008). However, difficult laryngoscopy rate did not differ between the blades. Tracheal intubation was successful in all children and there was no dental injury.Conclusion:  Our findings suggest that the Callander blade decreases the risk for dental injury and provides tracheal intubating conditions in children with normal airways similar to those obtained with a traditional Macintosh blade.
THIS ARTICLE HAS BEEN RETRACTED  Anatomic relationship between the internal jugular vein and the carotid artery in pre‐school children – an ultrasonographic study
Authors: ROTH BENJAMIN , MARCINIAK BRUNO , ENGELHARDT THOMAS , BISSONNETTE BRUNO 
Published: October 2008

SummaryBackground:  Central venous cannulation (CVC) in young children is technically difficult and may lead to potentially serious complications especially when performed blindly or using anatomical landmarks only. The aim of this study was to determine the anatomical relationship of the internal jugular vein (IJV) and the common carotid artery (CA) in preschool children using ultrasound.Methods:  Forty‐five children aged 60 months and under were included prospectively and divided into three groups: Group 1: <6 months, Group 2: 7–18 months and Group 3: 19‐60 months. With the head in neutral position the location of the left and right IJV was noted as anterior, anterolateral (AL), lateral or medial in relation to the CA at the level of the cricoid cartilage. Depths of IJV and CA as well as time taken to locate the vessels were recorded.Results:  The IJV was more commonly found in the AL position in all groups. The mean depth was 0.96 cm in Group 1, 0.95 cm in Group 2 and 3. Mean duration for localization of the vessels was 4.2 s in Group 1, 4 s in Group 2 and 4.3 s in Group 3. The differences between the groups were not significant.Conclusion:  This study demonstrates that the IJV cover the CA in the majority of young children. Depth of the IJV is rarely more than 1 cm deep to the skin. Ultrasound location of the IJV and CA is easy and does not necessarily delay the procedure. The findings of this study support the use of ultrasound guidance for CVC in children.
Evaluation of the pediatric bonfils fiberscope for elective endotracheal intubation
Authors: BEIN BERTHOLD , WORTMANN FRANK , MEYBOHM PATRICK , STEINFATH MARKUS , SCHOLZ JENS , DÖRGES VOLKER 
Published: October 2008

SummaryBackground:  Difficult airway management in children is a particular challenge for anesthesiologists and pediatricians. This study was designed to evaluate the performance of the recently developed pediatric versions of the Bonfils fiberscope for elective endotracheal intubation during routine surgical procedures.Methods:  After approval by the institutional review board and written informed consent, 55 children (age 6 ± 4 years) scheduled for elective minor surgical procedures were enrolled. Nineteen children received atropine before the intubation attempt, while in the remaining 36 children, no antisialogogue was used. For endotracheal tubes up to 3.5 mm internal diameter, a fiberscope with outer diameter (OD) 2 mm, and for larger endotracheal tubes, a fiberscope OD 3.5 mm was used. Time to intubation and failure rate were obtained.Results:  In the 36 children without and the 19 children with atropine pretreatment, the success rate for tracheal intubation on the first attempt was 69%/78% (25/15 patients). 4/3 patients and 2/0 patients were intubated after two and three attempts, respectively, and in 5/1 patients (14%/5%) intubation failed even after three attempts. Time to intubation was median 58/60 s, 25th–75th percentile 35–100/32–110 s, and range 14–377/18–360 s. In both groups, failed intubations were because of the secretions contaminating the optic aperture.Conclusions:  High failure rate and increased intubation times suggest that the pediatric Bonfils fiberscope has significant drawbacks when used for intubation of normal pediatric airways.
Anatomical dimensions of trachea, main bronchi, subcarinal and bronchial angles in fetuses measured ex vivo
Authors: HARJEET  , SAHNI DAISY , BATRA YATINDRA KUMAR , RAJEEV SUBRAMANYAM 
Published: October 2008

SummaryBackground:  The increasing opportunities to consider fetal intervention in selected cases of life‐threatening malformations have necessitated airway management of fetuses with low gestational age. This study is aimed to determine the anatomical dimensions of trachea, main bronchi, subcarinal and bronchial angles and their correlation to age and crown rump length (CRL) in fetuses.Methods:  Measurements of tracheo‐bronchial dimensions including the subcarinal and bronchial angles with the vertical were taken in specimens obtained from 40 fetuses, varying in CRL from 61 to 270 mm. The incidence of different shapes at the upper end of trachea was studied. The subcarinal and angles of main bronchi with the vertical were measured radiographically with 20% barium sulfate, in another group of 21 fetuses varying in CRL from 63 to 129 mm.Results:  Forty fetuses (22 males, 18 females) were analyzed for the dimensions based on CRL (61–130 mm; 131–200 mm; 201–270 mm – CRL 1, 2, and 3 respectively). The internal transverse diameter of trachea was found to increase steadily from 1.87 ± 0.56 to 2.67 ± 0.7 mm (P < 0.001) and 3.68 ± 0.39 mm (P < 0.001) with increasing CRL. Similarly the outer transverse and antero‐posterior diameter of the trachea increased steadily with age. Tracheal length was found to increase significantly to 17.48 ± 2.89 mm and 24.17 ± 2.3 from 12.72 ± 2.5 mm (P < 0.001). The length of paries membranaceous increased with gestational age. Although the length of bronchi increased significantly and linearly, subcarinal and bronchial angles did not show any significant changes with age. There was no sexual dimorphism in measurements in the fetuses of corresponding CRL. Oval shaped trachea was found in 60% and circular in 40% of fetuses. The measurements of subcarinal and bronchial angles performed by radiology were almost the same as those measured in trachea separated from fetuses.Conclusion:  The internal transverse, outer transverse and antero‐posterior diameters, length of trachea and bronchi and circumference of trachea, relate in a linear fashion to CRL and age. However, subcarinal and bronchial angles remained constant.
Modified anchoring maneuver using pilot puncture needle to facilitate internal jugular vein puncture for small children
Authors: TRIPATHI MUKESH , PANDEY MAMTA 
Published: October 2008

SummaryObjectives:  Internal jugular vein (IJV) cannulation in infants has been reported with varied success using surface landmark. The aim is to share authors experience of modified anchoring technique used in infants.Methods:  Anchoring maneuver using pilot needle (PN) has been recently described in adults. We have found that if the PN is left in IJV and then i.v. cannula (22G or 24G) is passed just posterior to the puncture point of PN to track down the PN path at 10–20° angles from skin, a natural tumbling movement of the PN helped to anchor anterior wall of IJV and facilitated its puncture. The results of 128 punctures performed in infants (<1 years) were analyzed in two groups of <6 months (n = 52) and >6 months to 1 year (n = 76).Results:  In infants weighing 3.5–14 kg, all cannulations were performed successfully. IJV puncture was detected at the entry of i.v. cannula more often in both the groups (81% in <6 months baby and 84% in >6 months baby) than withdrawing it. In 12 (10%) patients, the puncture site was changed to left IJV as carotid artery was punctured in three and failure to localize right IJV in nine patients by surface landmark.Conclusions:  In authors experience, the described technique detected IJV cannulation at its entry in majority of infants and so the method is less prone to complications related to overshooting of the needle in lack of IJV puncture detection.
End‐of‐life decisions in pediatric intensive care. Recommendations of the Italian Society of Neonatal and Pediatric Anesthesia and Intensive Care (SARNePI)
Authors: GIANNINI ALBERTO , MESSERI ANDREA , APRILE ANNA , CASALONE CARLO , JANKOVIC MOMCILO , SCARANI ROBERTO , VIAFORA CORRADO ,   FOR THE SARNePI BIOETHICS STUDY GROUP
Published: October 2008

SummaryEnd‐of‐life decisions represent one of the most complex and challenging issues in pediatric intensive care. These recommendations aim to offer Italian pediatric intensive care unit (PICU) teams a framework for the end‐of‐life decision‐making process. The paper proposes a process based on the principle that the use of a diagnostic or therapeutic tool must comply with a ‘criterion of proportionality’. Appropriately informed parents, as natural interpreters and advocates of the best interests of their child, can contribute in assessing the burdensomeness of the treatment and determining its proportionality. The decision to limit, withdraw or withhold life‐sustaining treatments considered disproportionate represents a clinically and ethically correct choice. This decision should be made (a) collectively by PICU team and the other caregivers, (b) with the explicit involvement of parents, and (c) noting in the patient's clinical record the decisions taken and the reasons behind them. The withdrawing or withholding of life support can never entail the abandonment of the patient nor the withdrawal of any therapy aimed at treating any form of suffering. No action aimed at deliberately hastening the death of the patient is ever acceptable. These recommendations advocate a decision as far as possible shared by patient (whenever feasible), parents and caregivers. Ensuring that all involved are kept fully informed and that there is open and timely communication between them is the key to achieving this. It is the physician in charge of the patient's care and the head of the unit who bear the main responsibility for the final decision.
The hemodynamic effects of newborn caudal anesthesia assessed by transthoracic echocardiography: a randomized, double‐blind, controlled study
Authors: DENG MENG , WANG XUAN , WANG LiHONG , ZHENG SHAN 
Published: October 2008

SummaryBackground:  Caudal anesthesia has been increasingly used in abdominal, urinary tract, and lower extremity surgery of infants. However, little was known about the hemodynamic effects of caudal anesthesia in them, especially in neonates. The purpose of this prospective study was designed to investigate the hemodynamic alterations by transthoracic echocardiography in newborn baby after caudal anesthesia with plain Bupivacaine or with epinephrine added Bupivacaine.Methods:  Thirty full‐term newborn infants scheduled for lower abdominal or urinary tract surgery were randomly allocated into three groups (n = 10 each) as follows: (i) GA group: general anesthesia with sevoflurane; (ii) GA+CP group: GA with sevoflurane, combined with caudal anesthesia of plain Bupivacaine (1.25 ml·kg−1 of 0.2%); (iii) GA+CA group: sevoflurane GA combined with caudal anesthesia of epinephrine‐added Bupivacaine (1.25 ml·kg−1 of 0.2% Bupivacaine plus 1/200 000 epinephrine). Cardiac output (CO), arterial blood pressure, and heart rate were measured before (T‐5) and 5(T5), 10(T10), 15(T15) min after performance of caudal anesthesia.Results:  In GA group, no significant hemodynamic alteration was observed in comparison with T‐5, except HR, which decreased by 7% at T15; In GA+CP group, compared with T‐5, HR decreased significantly at T5, T10 and T15, respectively, by 6%, 7% and 10%. And also CO decreased significantly at T15 by 8% compared with T‐5; In GA+CA group, no significant hemodynamic alteration was observed expect diastolic arterial blood, which decreased significantly at T15 by 10% compared with T‐5; At T15, the larger decrease of systolic arterial blood in GA+CP group and GA+CA group vs (GA) group (P < 0.05).Conclusions:  The study shows the stability of hemodynamic variables during caudal anesthesia with Bupivacaine and with epinephrine‐added Bupivacaine in newborn infants.
Solifenacin in the treatment of urgency and other symptoms of overactive bladder: results from a randomized, double‐blind, placebo‐controlled, rising‐dose trial
Authors: Cardozo Linda , Heßdörfer Elke , Milani Rodolfo , Arañó Pedro , Dewilde Luc , Slack Mark , Drogendijk Ted , Wright Mark , Bolodeoku John ,   for the SUNRISE Study Group (see )
Published: October 2008

OBJECTIVESTo examine the effects of the antimuscarinic agent solifenacin on urinary urgency, using a range of novel and established outcome measures, as urgency is the principal symptom of the overactive bladder syndrome (OAB).PATIENTS AND METHODSThe study (SUNRISE, solifenacin in the treatment of urgency symptoms of OAB in a rising dose, randomized, placebo‐controlled, double‐blind, efficacy trial) was a randomized, double‐blind, 16‐week, placebo‐controlled, multicentre study of solifenacin 5/10 mg in 863 patients with symptoms of OAB for ≥3 months. The primary efficacy variable was the change from baseline to endpoint in the number of episodes of severe urgency with or without urgency incontinence per 24 h, as measured using the Patient Perception of Intensity of Urgency Scale, grade 3 + 4. Secondary efficacy variables included patient‐reported outcomes for bladder condition, urgency bother and treatment satisfaction. A 3‐day voiding diary was used to record micturition frequency and episodes of urgency and incontinence. A 7‐day diary was used to assess speed of onset of effect.RESULTSSolifenacin 5/10 mg was significantly more effective than placebo in reducing the mean number of episodes of severe urgency with or without incontinence per 24 h from baseline to endpoint (−2.6 vs −1.8, P < 0.001). There were also statistically significant differences in favour of solifenacin 5/10 mg over placebo for all secondary variables measured at endpoint, including patient‐reported outcomes. There was a significant improvement in urgency as early as day 3 of treatment. Treatment‐emergent adverse events with solifenacin 5/10 mg were mainly mild or moderate in severity, and only led to discontinuation in 3.6% of patients.CONCLUSIONSolifenacin significantly reduced the number of urgency episodes and the extent of urgency bother, and was well tolerated; it was effective as early as day 3 of treatment.
Leydig cell tumour of the testis: presentation, therapy, long‐term follow‐up and the role of organ‐sparing surgery in a single‐institution experience
Authors: Suardi Nazareno , Strada Elena , Colombo Renzo , Freschi Massimo , Salonia Andrea , Lania Caterina , Cestari Andrea , Carmignani Luca , Guazzoni Giorgio , Rigatti Patrizio , Montorsi Francesco 
Published: October 2008

OBJECTIVETo report our single‐centre experience of patients with Leydig cell tumour (LCT) of the testis, which represents the most frequent interstitial neoplasm of the testis, and for which the natural history and therapy are debated.PATIENTS AND METHODSBetween 1990 and 2006, 37 patients were treated for LCT of the testis. All patients had testicular markers assessed and 21 (57%) had their hormonal profile assessed (total testosterone, follicle‐stimulating hormone, luteinizing hormone and oestradiol). We analysed the symptoms at presentation, laboratory findings, organ‐sparing vs. radical surgery and oncological and symptomatic follow‐up data.RESULTSMedical referral was for a testicular mass in 32% of patients, gynaecomastia in 8%, testicular pain in 8%, infertility in 11%, and isosexual pseudo‐puberty in 5%. The mean (range) diameter of the tumour was 16.5  (6–68) mm. Before surgery testosterone levels exceeded the upper limit in a third of patients, while levels were hypogonadal in 19%. Oestradiol levels were increased in 29% of patients. At surgery, 29 patients (78%) had organ‐sparing surgery. The median (range) follow‐up was 4.6 (0.6–16.2)  years; no patient had disease relapse. Gynaecomastia was present in two of six patients at the follow‐up, despite pharmacological treatment. Four patients had a low testosterone level.CONCLUSIONPatients diagnosed with LCT have a good prognosis; this study shows the safety of conservative surgery. Surgical removal of the tumour is not always associated with resolution of symptoms and abnormal laboratory values.
Robotic‐assisted laparoscopic partial nephrectomy: surgical technique and clinical outcomes at 1 year
Authors: Ho Henry , Schwentner Christian , Neururer Richard , Steiner Hannes , Bartsch Georg , Peschel Reinhard 
Published: October 2008

OBJECTIVETo report our surgical technique of robotic‐assisted laparoscopic partial nephrectomy (RLPN) for renal tumours of <7 cm and present their clinical outcomes, as minimally invasive PN is an increasingly viable option for small renal tumours.PATIENTS AND METHODSFrom July 2005 to December 2006, 20 consecutive patients (mean age 58.2 years, sd 7.9) had RLPN and a follow‐up of ≥1 year, all surgery being undertaken by one surgeon. All cases were elective except in one patient with a solitary kidney. We used the three‐arm da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA, USA) in a four‐port, transperitoneal approach. Transient vascular occlusion was applied in all cases using a tourniquet technique. The tumour was excised with a 5‐mm margin using cold‐cut scissors, and the margins were assessed by frozen sections. The specimen was placed in an impervious bag for subsequent removal via the camera port. Under direct vision, we repaired all pelvicalyceal system entries with absorbable sutures. After the entire tumour bed surface was lined with FlosealTM (Baxter Healthcare, Deerfield, IL, ISA) the capsule/parenchyma was closed with running suture, reinforced by haemostatic clips.RESULTSThe mean (sd) operative and warm ischaemia times were 82.7 (17.0) and 21.7 (2.4) min, respectively, and the mean estimated blood loss was 189 (32) mL. There were no intraoperative complications or conversion to open surgery. There was also no bleeding after surgery, perinephric haematoma or urinary leakage. The mean (sd) tumour size was 30.2 (2.4) mm, while margins were negative in all cases of malignancy. At the 1‐year follow‐up there was no local recurrence, renal functional deterioration or late surgical complications.CONCLUSIONSOur RLPN technique is a safe and feasible option for small renal tumours. Reproducible technique and good team co‐ordination are pivotal for obtaining good oncological and surgical outcomes.
Prevalence and incidence of Type 2 diabetes and its complications 1996–2003—estimates from a Swedish population‐based study
Authors: Ringborg A. , Lindgren P. , Martinell M. , Yin D. D. , Schön S. , Stålhammar J. 
Published: October 2008

AbstractAims  To determine the prevalence and incidence of Type 2 diabetes and its complications in Uppsala county, Sweden between 1996 and 2003.Methods  Retrospective population‐based study of patients with Type 2 diabetes identified in computerized medical records at 26 county primary care centres. Prevalence and incidence of Type 2 diabetes were estimated in the population aged 30–39, 40–49, 50–59, 60–69, 70–79 and ≥ 80 years. Mortality, prevalence and incidence of complications in patients with Type 2 diabetes were determined through linkage to national inpatient, uraemia and cause‐of‐death registers.Results  Crude prevalence of Type 2 diabetes increased from 2.2 to 3.5% between 1996 and 2003. In the population aged ≥ 30 years, the age‐ and sex‐adjusted period increase was 53%[odds ratio (OR) 1.53, 95% confidence interval (CI) 1.47–1.58]. Crude population incidence was approximately stable after 1997 (3.7 cases/1000 residents in 1997 compared with 3.8/1000 in 2003). Age‐ and sex‐adjusted mortality rates in Type 2 diabetic patients decreased by 4% per year (OR 0.96, 95% CI 0.94–0.97). Prevalence rates of cardiovascular disease in Type 2 diabetic patients were essentially stable, affecting 13.8% of females and 18.0% of males in 2003. No trend was detected for prevalence of renal failure or incidence of acute myocardial infarction, stroke and amputation.Conclusions  Prevalence of Type 2 diabetes increased in Uppsala county between 1996 and 2003 as a consequence of approximately stable incidence since 1997 and declining mortality. Rates of diabetes‐related complications, notably cardiovascular disease, continued to impose a substantial burden.
The association of physical activity and depression in Type 2 diabetes
Authors: Lysy Z. , Da Costa D. , Dasgupta K. 
Published: October 2008

AbstractAims  Physical inactivity and depressed mood are both associated with a higher likelihood of diabetes‐related complications; the association between physical activity and depressed mood in Type 2 diabetes has not been reviewed previously. We have reviewed (i) the strength of this association and (ii) the impact of depression‐specific management and physical activity interventions on mood and activity levels in overweight adults with Type 2 diabetes.Methods  Studies published between January 1996 and September 2007 were identified (Ovid‐medline, Psych‐Info and embase) using pertinent search terms (keyword/title).Results  Of the 12 studies included (10 cross‐sectional, two trials), most employed a standardized questionnaire for depressed mood but only one item for physical activity. In adults with Type 2 diabetes, the inactive are 1.72 to 1.75 times more likely to be depressed than the more active; the depressed are 1.22 to 1.9 times more likely to be physically inactive than the non‐depressed. Two randomized trials demonstrated that a depression management programme improved mood, but only one demonstrated increased physical activity.Conclusions  Studies to date suggest an association between depressed mood and physical inactivity in adults with Type 2 diabetes, although objective measures of physical activity have not been employed. Depression‐specific management may improve mood and possibly activity. A trial comparing the impact of depression‐specific management compared with exercise intervention on depressed mood and activity in Type 2 diabetes is justified.