bluuebunny/crossref_metadata_2025_split huggingface dataset:
Osteochondral Fragmentation in the Synovial Pad of the Fetlock in Warmblood Horses
Authors: DECLERCQ JEROEN , MARTENS ANN , BOGAERT LIES , BOUSSAUW BERNARD , FORSYTH RAMSES , BOENING KARL JOSEF 
Published: September 2008

Objectives—To determine clinical and arthroscopic characteristics associated with fragments in the synovial pad of the fetlock and to characterize their morphology.Study Design—Retrospective study.Animals—Warmblood horses (n=104) with fragment(s) in the synovial pad.Methods—Signalment and results of radiographic and clinical examination were collected before surgery. After arthroscopic fragment removal and joint evaluation for synovial and/or cartilage abnormalities, fragments were measured, and evaluated by histopathology.Results—Synovial pad fragments (n=142) were removed from 127 fetlocks. Two older horses had lameness. During arthroscopy, abnormalities were observed in 40 joints (31.5%) and multivariate logistic regression analysis showed a significant correlation between the observed arthroscopic abnormalities and the presence of large fragments (P=.016). Fragments were osteochondral bodies completely surrounded by fibrous tissue. At the edges of the hyaline cartilage cap an underlying fibrous structure was obvious in the extracellular matrix giving it a reactive pattern.Conclusions—Although the impact on lameness was minimal, there was a significant correlation between arthroscopic abnormalities and presence of large synovial pad fragments. On histopathology, these osteochondral fragments are embedded in fibrous tissue and show a reactive pattern. They are not a manifestation of any well‐described joint pathology.Clinical Relevance—Large synovial pad fragments in Warmblood horses can be associated with synovial and cartilage abnormalities, but further studies are warranted to determine their origin and clinical importance.
Laparoscopic Cholecystectomy for Management of Uncomplicated Gall Bladder Mucocele in Six Dogs
Authors: MAYHEW PHILIPP D. , MEHLER STEPHEN J. , RADHAKRISHNAN ANANT 
Published: September 2008

Objectives— To describe a technique for, and outcome after, laparoscopic cholecystectomy (LC) for management of uncomplicated gall bladder mucocele (GBM) in dogs.Study Design— Case series.Animals— Dogs (n=6) with uncomplicated GBM.Methods— Dogs with ultrasonographic evidence of GBM but without imaging or laboratory signs of gall bladder rupture, peritonitis, or extra‐hepatic biliary tract rupture that had LC were included. A 4 portal technique was used. A fan retractor was used to retract the gall bladder to allow dissection around the cystic duct with 5 or 10 mm right‐angle dissecting forceps. The cystic duct was ligated using extracorporeally tied ligatures supplemented sometimes with hemostatic clips. A harmonic scalpel was used to dissect the gall bladder from its fossa. The gall bladder was placed into a specimen retrieval bag and after bile aspiration the bag was withdrawn through the 11 mm portal incision.Results— Five dogs had mild intermittent clinical signs including vomiting, inappetence, and lethargy. All dogs had successful LC without conversion to an open approach. All dogs with clinical signs had improvement or resolution of signs postoperatively. No important perioperative complications occurred and all dogs were alive at a median of 8 months postoperatively (range, 3–14 months).Conclusions— LC can be accomplished safely and effectively in dogs with uncomplicated GBM.Clinical Relevance— A minimally invasive approach for cholecystectomy can be used for the treatment of GBM in dogs.
Acceleration of Second and Fourth Metatarsal Fracture Healing with Recombinant Human Bone Morphogenetic Protein‐2/Calcium Phosphate Cement in Horses
Authors: PERRIER MELANIE , LU YAN , NEMKE BRETT , KOBAYASHI HIROHITO , PETERSON ANNA , MARKEL MARK 
Published: September 2008

Objective— To compare the efficacy of recombinant human bone morphogenetic protein‐2 (rhBMP‐2)/calcium phosphate (CP) to autogenous cancellous bone graft (CBG) and to no treatment on bone healing, in surgically induced osteotomies and ostectomies of the accessory metatarsal bones in an equine model.Study Design— Experimental.Animals— Adult horses (n=9).Methods— Segmental ostectomies of the second metatarsal bone (MT2) and osteotomies of the fourth metatarsal bone (MT4) were performed bilaterally in 9 horses. There were a total of 35 defects (1 MT4 was previously fractured) created and supplemented randomly either with no treatment (untreated control), rhBMP‐2/CP cement, or matrix (CPC or CPM), or CBG. Radiography was performed every 2 weeks until study endpoint at 12 weeks. After euthanasia, bone healing was evaluated using radiography, mechanical testing, and histology. Data were analyzed with ANOVA followed by the Duncan's Multiple Range Test or nonparametric analyses.Results— At 12 weeks, radiographic scores for union were significantly greater for the rhBMP‐2 (P<.0001) and CBG (P=.004) groups compared with the untreated control group, for both MT2 ostectomies and MT4 osteotomies. The rhBMP‐2 treated MT2 had greater maximum torque to failure in torsion than CBG and control limbs at 12 weeks (P=.011). Histologic analysis demonstrated increased bone formation and more mature bone at the ostectomy site for MT2 in the rhBMP‐2 and CBG groups compared with the untreated control group.Conclusion— Injection of rhBMP‐2/CP into surgically induced ostectomies and osteotomies of the accessory metatarsal bones might accelerate early bone healing in the horse.Clinical Relevance— RhBMP‐2/CP may be as effective if not superior to CBG as an adjuvant treatment to accelerate healing of bone defects.
Mechanical Comparison of 3.5 mm Broad Dynamic Compression Plate, Broad Limited‐Contact Dynamic Compression Plate, and Narrow Locking Compression Plate Systems Using Interfragmentary Gap Models
Authors: UHL JUSTIN M. , SEGUIN BERNARD , KAPATKIN AMY S. , SCHULZ KURT S. , GARCIA TANYA C. , STOVER SUSAN M. 
Published: September 2008

Objectives—To compare (1) pullout properties between 3.5 mm cortical and locking screws, and (2) mechanical properties and gap displacements between the 3.5 mm broad limited‐contact dynamic compression plate (LC‐DCP), broad dynamic compression plate (DCP), and narrow locking compression plate (LCP), during axial loading of plate‐stabilized diaphyseal fragments with an interfragmentary gap.Study Design—In vitro mechanical testing of implanted polyurethane foam (PUF) hollow cylinders that simulated compact or osteopenic diaphyseal bone.Sample Population—(1) Five cortical and locking screws and (2) 4 PUF‐plate constructs for each plate type; using high‐ and low‐density (0.8 and 0.32 g/cm3) cylinders.Methods—(1) Screws were completely extracted at 5 mm/min. (2) Plated constructs were axially compressed at 300 N/s for 10 cycles from 5 to 355 N to determine gap displacement during physiologic loading, followed by single cycle increasing load to failure.Results—Pullout properties were not different between screw types. All plate constructs had yield loads over 3 times trotting loads. Gap closure occurred with LC‐DCP and DCP constructs, but not LCP constructs. LCP construct properties were most similar to LC‐DCP and DCP construct properties in the low‐density model.Conclusion—All plate systems sustained physiologic limb loads. Only LCP constructs maintained some gap integrity, although LC‐DCP and DCP screws were placed in neutral position.Clinical Relevance—The LCP system is more likely than LC‐DCP and DCP systems, with neutrally positioned screws, to maintain a planned interfragmentary gap, although gap strains range from 0% to 15% across the 2 mm gap during a trot load.
Proper Depth of Placement of Oral Endotracheal Tubes in Adults Prior to Radiographic Confirmation
Authors: Roberts James R. , Spadafora Michael , Cone David C. 
Published: September 2008

ABSTRACTObjective: To determine whether a certain distance measurement on the oral endotracheal tube (ETT) at the corner of the mouth could reasonably ensure proper depth of placement in critically ill patients, without the immediate need for a confirming chest x‐ray (CXR).Methods: A prospective observational cross‐sectional design was used to compare ETT mark distance and radiographic location of the ETT tip. The measurement marking on the ETT at the level of the corner of the mouth was noted at the time of intubation. The relationship of the tip of the ETT to the tracheal carina on the postintubation CXR was then determined. The ETT placement was deemed correct if the tip was at least 2 cm cephalad to the carina on the CXR.Results: Of 83 intubated patients assessed, 52 were men and 31 women. The mean measurement on the ETT at the corner of the mouth was 22.2 cm for the women and 23.1 cm for the men. The mean distance from the tip of the ETT to the carina was 3.45 cm for the women and 4.13 cm for the men. Seventy‐five of the 83 patients (90.4%; 95% CI 81.9–95.7%) had correct ETT positions on the initial CXR. If the ETT position had been adjusted at the corner of the mouth to 21 cm for the women and 23 cm for the men, the ETT would have been in correct position for 81 of the 83 patients (97.6%; 95% CI 89.6–99.7%). This represents a significant improvement in tube placement (p < 0.025; the McNemar chi‐square).Conclusion: Proper depth of ETT placement in the critically ill adult patient can be estimated by the technique of this study. In this adult patient population, corner‐of‐the‐mouth placement of the ETT using the 21‐cm tube mark for the women and the 23‐cm mark for the men would have led to proper placement for most patients.
Proceedings of the 7th Purdue Conference on Cardiac Defibrillation: A Database of Cardiac Arrhythmias
Authors: Panescu Dorin , Webster John G. , Tompkins Willis J. , Staley Richard L. , Johnson Jean , Schlageter Dave , Stratbucker Robert A. 
Published: September 2008

ABSTRACTObjective: To describe a database of cardiac arrhythmia recordings, useful for the development and testing of ECG rhythm processing or monitoring algorithms and devices.Methods: The raw data were acquired within the Wisconsin‐Dane County emergency medical technician‐defibrillation program and contained emergency rhythm recordings of an average length of 30 minutes. The raw data were integrated into a software platform designed for the annotation and visualization of the recordings.Results: Currently the database contains the following arrhythmia episodes: ventricular fibrillation (56), asystole (65), electromechanical dissociation (31), and other arrhythmias (42). The software, resident on personal computers, also can transmit any of the database recordings, through a digital‐to‐analog converter board, to a device under test.Conclusions: The database technique described will provide a useful means of objectively assessing electronic devices for their ability to detect arrhythmias. The database is unique in that it contains lengthy episodes of arrhythmias. The database will be extended to include additional cases.
Combination Fentanyl and Diazepam for Pediatric Conscious Sedation
Authors: Pohlgeers Anthony P. , Friedland Leonard R. , Keegan‐Jones Lisa 
Published: September 2008

ABSTRACTObjectives: To evaluate the safety and to describe the use of combination IV diazepam and fentanyl in the pediatric emergency department (PED) as outpatient conscious sedation (CS) for orthopedic procedures.Methods: A retrospective chart review of a standardized protocol for CS administered to 133 consecutive patients requiring CS for outpatient orthopedic procedures. The patients were continuously monitored for heart rate, respiratory rate, and arterial O2 saturation (SaO2) by pulse oximetry. The study was conducted at a large urban PED and regional referral center.Results: A total of 133 children (mean age 8.5 years) received 138 orthopedic procedures. Mean (± SD) total diazepam dose was 0.12 ± 0.05 mg/kg; mean total fentanyl dose was 3.18 ± 1.04 μg/kg. Mean time intervals were 4.6 minutes from initial drug administration to start of procedure, 15.5 minutes to end of procedure, and 56 minutes to meeting criteria for release home. Complications included Sao2 < 90% for 15 patients (11%, 95% CI 6.4–17.4%), vomiting for one (0.74s. 95% CI 0.1–4.2%). and severe pruritus for one (0.7%, 95% CI 0.1–4.2%). An episode of Sao2 < 90% was associated with a higher initial mean fentanyl dose (2.60 vs 1.95 μg/kg; p = 0.0005). but was not associated with a higher initial mean diazepam dose (p = 0.28). Parented opioid use for pain management prior to CS was not associated with an increased risk for Sac), < 90% (p = 0.42). Heart rate, respiratory rate. and blood pressure were stable during the observational period. No patient required naloxone, flumazenil. artificial airway control. or admission to the hospital.Conclusions: At the doses given in the study. the use of combination diazepam and fentanyl for outpatient CS of PED patients during orthopedic procedures was not associated with serious complications. A higher initial fentanyl dose was associated with episodes of SaO2 < 91%. Therefore, an initial dose of ≤2.0 μg/kg fentanyl titrated to effect is recommended.
Perimortem Cesarean Section: Case Reports and Recommendations
Authors: Lanoix Richard , Akkapeddi Vijay , Godfather Bruce 
Published: September 2008

ABSTRACTPer mortem cesarean section is rarely required in the ED. However, since trauma now represents a leading cause of no obstetric maternal death, emergency physicians (EPs) may more commonly be faced with the difficult decision of performing an emergency cesarean section. Two cases are described of severely traumatized pregnant patients for whom per mortem cesarean section in the ED led to birth of viable infants, with one long‐term survivor. The rationale and guidelines for the procedure are discussed, and it is emphasized that the EP should be thoroughly familiar with the procedure and prepared to perform it when indicated to enhance fetal (and potentially maternal) survival.
Multiple Resuscitation Regimens in a Near‐fatal Porcine Aortic Injury Hemorrhage Model
Authors: Stern Susan A. , Dronen Steven C. , Wang Xu 
Published: September 2008

ABSTRACTObjective: To compare early and delayed blood administrations in animals subjected to near‐fatal hemorrhage in the presence of a vascular injury and resuscitated to different mean arterial pressures (MAPs).Methods: Fifty‐four immature swine with 4‐mm infrarenal aortic tears were bled to a pulse pressure of 5 torr and then resuscitated (estimated blood loss 40 to 45 mL/kg). Groups I, II, and III were resuscitated with shed blood at a rate of 2 mL/kg/min, followed by normal saline at a rate of 6 mL/kg/min. Groups IV, V, and VI received the same fluids in reverse order. The fluids were infused intermittently to maintain MAPs of 40, 60, and 80 torr. The animals were observed for 60 minutes or until death.Results: The animals resuscitated to a MAP of 80 torr experienced significantly higher intraperitoneal hemorrhage volumes and mortality than did the animals intentionally maintained hypotensive, regardless of whether blood or normal saline was administered first. There was no significant difference in mortality or hemorrhage volumes between any of the groups intentionally maintained hypotensive. The animals maintained at a MAP of 60 torr were significantly less acidotic than were the animals resuscitated with the same fluid regimen but to a MAP of 40 torr. Early blood administration also minimized the acidosis associated with hypotensive resuscitation.Conclusion: In this model of near‐fatal hemorrhage with a vascular injury, maintenance of the hypotensive state produced comparable improvements in one‐hour survival and reductions in hemorrhage volume regardless of whether blood or saline was administered first. Although hypotensive resuscitation resulted in improved outcome, it was associated with significant acidosis. This effect was minimized with moderate rather than severe underresuscitation and early blood administration.
Effect of Gender on the Emergency Department Evaluation of Patients with Chest Pain
Authors: Silbergleit Robert , McNamara Robert M. 
Published: September 2008

ABSTRACTObjective: To assess chest pain evaluation as reflected in the documentation of the evaluation process for women vs men in one emergency department (ED).Methods: In this retrospective case series, patient charts were reviewed for documentation in accordance with a clinical policy for chest pain evaluation. Patient demographics and the frequencies of inclusion of the following items were determined: five descriptors of chest pain, associated symptoms, risk factors for coronary artery disease, receipt of physical examination, and receipt of ECG.Results: Over a three‐month period, 132 men and 150 women were evaluated for chest pain and entered in the study. There was no significant difference in age between the men and the women overall, but in the subgroup of patients who were admitted to the hospital, the women were significantly older than the men by an average of five years (p = 0.04). Fifty‐five percent of all the patients were admitted to the hospital. The men were admitted to the hospital significantly more often than were the women (p = 0.01), with a relative risk of admission for women vs men of 0.76 (95% CI = 0.62–0.94). There was no significant difference between the men and the women for any of the process of evaluation items in the overall group or in the hospital‐admission and release‐home subgroups.Conclusion: The authors' findings do not support the existence of a gender difference in ED chest pain evaluations, as reflected by documentation of the evaluation process. However, men were more likely to be admitted to the hospital for evaluation of coronary artery disease than were women.
Injuries Resulting from Bicycle Collisions
Authors: Frank Edmund , Frankel Pamela , Mullins Richard J. , Taylor Natasha 
Published: September 2008

ABSTRACTObjective: To review all bicycle crash‐related injuries reported to the Oregon Injury Registry for 1989 to compare patterns of injury and other features in adults vs children and adolescents.Methods: A retrospective descriptive study was conducted using data from the Oregon Injury Registry. For 1989, this registry included all injury‐related deaths and approximately 75% of hospital admissions of 24 hours or more for injury in the State of Oregon. Deaths, helmet use, neurologic injuries, and concurrent ethanol use were evaluated for all patients and for the two age groups.Results: There were 311 bicycle‐related injured patients in the registry for 1989; 122 (40%) were adults (age > 21 years) and 189 (60%) were children/adolescents (age < 21 years). Approximately 69% of both age groups were male. All of the 15 deaths involved male patients and most deaths [10/15 (67%)] involved injured adults. Bicycle vs motor vehicle collisions accounted for 14 (93%) deaths and 106 (34%) of all registry entries. While only 19 (15%) of the injured adults had elevated blood alcohol levels, half the adults who died had been intoxicated. Helmet use was rare with only 12 (4%) of all the injured riders known to have been helmeted; no rider who died was known to have been helmeted. Neurologic injuries were common. In children, 27 (14%) had sustained skull fractures, 36 (19%) intracranial injuries, and one (0.5%) a spinal injury. In adults, 13 (10%) had sustained skull fractures, 32 (26%) intracranial injuries, and three (2%) spinal injuries.Conclusion: Although children account for 60% of the serious bicycle injuries in Oregon, adults account for 67% of the deaths. Helmet use is rare, brain injuries are frequent, and alcohol use appears to be a contributing factor in cycling deaths among adults. Public education efforts should be directed to both adult and pediatric populations, emphasizing safe cycling practices and helmet use.
High‐yield Selection Criteria for Cranial Computed Tomography after Acute Trauma
Authors: Madden Cynthia , Witzke Donald B. , Sanders Arthur B. , Valente John , Fritz Mark 
Published: September 2008

ABSTRACTObjective: To develop and prospectively evaluate criteria for selecting head‐injured patients requiring cranial CT.Methods: A two‐phased prospective observational study design was implemented at a university ED. Physicians completed a form with 51 variables for 540 patients in Phase I. Ten high‐yield variables were identified and prospectively tested on 273 patients in Phase II. Prediction rule performance for identification of patients with abnormal CT scans was determined.Results: The combined criteria had a sensitivity of 97% for CT‐scan abnormalities in Phase I; sensitivity was 96% in Phase II. Negative predictive values were 97% and 94%, respectively. Prevalence of disease in Phase I was 17%; prevalence in Phase II was 16%. Had the Phase I criteria been implemented during Phase II, 43 of 273 patients (16%) would not have been scanned, including two patients with positive results who did not require operative intervention.Conclusions: Fifty‐one clinical variables from head‐injured patients were narrowed to ten of statistical significance and consistent interpretation for prospective evaluation. Patients with none of these criteria were found to be at low risk of having sustained significant head injury.
Colorimetric End–tidal CO2Detector for Verification of Endotracheal Tube Placement in Out–of–hospital Cardiac Arrest
Authors: Hayden Stephen R. , Sciammarella Joseph , Viccellio Peter , Thode Henry , Delagi Robert 
Published: September 2008

ABSTRACTObjective: To evaluate the ability of a disposable, colorimetric end–tidal CO2 detector to verify proper endotracheal (ET) tube placement in out–of–hospital cardiac arrest, and to correlate semiquantitative CO2 measurements with the rate of return of spontaneous circulation (ROSC).Methods: Prospective, observational study using a convenience sample of intubated out–of–hospital cardiac arrest patients. A disposable, colorimetric end–tidal CO2 detector was attached to the ET tube after intubation. In the absence of a colorimetric change, the paramedics reassessed the tube placement and could reintubate the patient. Tube placement was verified at the hospital. Paramedics were instructed to contact the base station and report the colorimetric change upon hospital arrival. ROSC was defined as restoration of a self–sustaining pulse until hospital arrival.Results: Between December 1990 and May 1993, ET tubes were placed in 566 victims of out–of–hospital cardiac arrest. 541 of the 566 intubations (95.6%) were associated with a color change. In one case with a color change and out–of–hospital clinical evidence of proper tube placement, the tube was determined to be in the esophagus at the hospital. Correct placement of the remaining 565 of 566 (99.8%) tubes was verified. Of the 566 patients who had a colorimetric change, 91 (16%) had ROSC vs one of 25 (4%) patients who did not have a color change. In one subgroup (n = 179), the degree of color change was highly associated with ROSC (p = 0.004).Conclusions: A disposable, colorimetric end–tidal CO2 detector appears reliable in verifying proper ET tube placement in victims of out–of–hospital cardiac arrest. The degree of color change correlates with the probability of ROSC.