bluuebunny/crossref_metadata_2025_split huggingface dataset:
Three‐dimensional sonographic volume measurement of the fetal lung
Authors: Hata Toshiyuki , Kuno Atsushi , Dai Shu‐Yan , Inubashiri Eisuke , Hanaoka Uiko , Kanenishi Kenji , Yamashiro Chizu , Tanaka Hirokazu , Yanagihara Toshihiro 
Published: November 2007

AbstractAim:  The objective of this longitudinal study was to evaluate the growth of the fetal lung in normal pregnancies, using 3‐D ultrasound.Methods:  3‐D sonographic examinations were performed on 14 appropriate‐for‐gestational‐age fetuses. Fetal lung volumes (left, right, and total lung volumes) were measured every 2–3 weeks from 20 weeks of gestational age until delivery. The common multiplanar technique was used to calculate fetal lung volume.Results:  Curvilinear relationships were found between the gestational age and left (R2 = 86.9%, P < 0.0001), right (R2 = 83.9%, P < 0.0001) and total (R2 = 83.8%, P < 0.0001) lung volumes. The data described in this study were fairly comparable with previous data from autopsy series. However, there were big differences for predicted values of the fetal total lung volumes using 3‐D ultrasound among the present study and previous investigations.Conclusion:  Our findings suggest that the standard curve for fetal lung volume using 3‐D ultrasound provides a role for evaluating the normal lung growth in the fetus. However, we do cast doubt on the reliability and reproducibility of fetal lung volume measurements using 3‐D ultrasound. Moreover, the data and its interpretation in our study should be taken with some degree of caution because of the small number of subjects studied. Further studies involving a larger sample size would be needed to confirm these findings.
Oral misoprostol for the prevention of primary post‐partum hemorrhage during third stage of labor
Authors: Enakpene Christopher A. , Morhason‐Bello Imran O. , Enakpene Evbu O. , Arowojolu Ayodele O. , Omigbodun Akinyinka O. 
Published: November 2007

AbstractAim:  To assess the effectiveness of oral misoprostol compared with methylergometrine in the prevention of primary post‐partum hemorrhage during the third stage of labor.Methods:  This was a randomized controlled trial of 864 singleton low‐risk pregnant women. The outcomes were total blood loss, duration of the third stage of labor and peripartal change in hematocrit. Comparisons were by the χ2‐test and Student t‐test. Relative risks were calculated for side‐effects profile. A P‐value of less than 0.05 was statistically significant.Results:  The biodata of all the participants were similar. The mean blood loss for the misoprostol and methylergometrine groups was 191.6 ± 134.5 mL and 246.0 ± 175.5 mL, respectively (95% CI: −79.3 to −39.5 mL). The mean duration of the third stage of labor was 19.6 ± 2.4 min and 9.4 ± 3.3 min in the misoprostol and methylergometrine groups, respectively (95% CI: 9.82–10.58 min). More subjects had blood loss >500 mL, 42 (9.7%) versus 6 (1.4%), and peripartal hematocrit change greater than 10%, 38 (8.8%) versus 5 (1.2%), in the methylergometrine group than in the misoprostol group, respectively. Also, more subjects received additional oxytocic in the methylergometrine group, compared to the misoprostol group (80 [18.5%] versus 33 [7.6%] patients, respectively).Conclusions:  Orally administered misoprostol was more effective in reducing blood loss during the third stage of labor than intramuscular methylergometrine. However, there were more subjects in the misoprostol group in whom duration of the third stage of labor was greater than 15 min and who also had manual placental removal than in the methylergometrine group.
Subjective effect of magnetic resonance‐guided focused ultrasound surgery for uterine fibroids
Authors: Funaki Kaoru , Sawada Katsuhiro , Maeda Fumio , Nagai Syuji 
Published: November 2007

AbstractAim:  We treated 69 patients with symptomatic uterine fibroids using a magnetic resonance‐guided focused ultrasound surgery (MRgFUS) system. Our objective was to determine the clinical outcome of MRgFUS, focusing on symptom improvement, with emphasis on the time and extent of improvement.Methods:  Patients who would have been otherwise offered conventional surgery were considered for eligibility. They were asked to report their symptom severities before and after treatment on the same query form. The questionnaire, given 6 months after treatment, included a question asking when the patients' symptoms started to improve. Their fibroids were classified into three types according to the signal intensity on T2‐weighted magnetic resonance images: type 1, low intensity as skeletal muscle, type 2, intermediate intensity, lower than myometrium but higher than skeletal muscle; and type 3, high intensity, the same as or higher than myometrium.Results:  No severe adverse events occurred in any of the patients. Seven patients required alternative treatment after MRgFUS, with five of them having type 3 fibroids. Mean symptom scores were all reduced after MRgFUS, regardless of the symptom types. Frequent urination improved first, while heavy bleeding took longer to resolve than the other symptoms.Conclusion:  MRgFUS is an effective and safe method for treating symptomatic uterine fibroids, especially for type 1 and type 2 fibroids. Type 3 fibroids, however, are difficult to treat using the current MRgFUS system.
Total salpingectomy during abdominal hysterectomy: Effects on ovarian reserve and ovarian stromal blood flow
Authors: Sezik Mekin , Ozkaya Okan , Demir Fuat , Sezik Hulya Toyran , Kaya Hakan 
Published: November 2007

AbstractAim:  To investigate the short‐ and medium‐term consequences of performing total salpingectomy during abdominal hysterectomy (without oophorectomy) on certain ovarian reserve parameters and blood flow velocity measurements through the ovarian stroma.Methods:  Twenty‐four patients were recruited and randomized into two groups. Group 1 patients (n = 12) underwent total hysterectomy and complete excision of the fallopian tubes bilaterally. In group 2 (classical approach), fallopian tubes were removed partially leaving behind the neighboring paraovarian tissue. Pre‐ and postoperative (at 1 and 6 months) serum follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol values, ovarian volume estimation by transvaginal ultrasound, and ovarian stromal blood flow Doppler velocimetry were assessed during the early follicular phase. Mann–Whitney U‐test, Student's t‐test and Freidman's test were used for comparisons.Results:  Baseline data were similar across the groups (P > 0.05). Mean FSH, LH, estradiol values, and ovarian volume were unchanged after both of the techniques. However, mean pulsatility index, resistance index, and systole/diastole (S/D) ratio were significantly decreased in both groups compared to baseline values (group 1, P = 0.027, P = 0.018, and P = 0.013, respectively; group 2, P = 0.01, P = 0.002, and P = 0.0001, respectively). Postoperative decline in the mean pulsatility index was more pronounced (P = 0.02) in group 2 (partial removal).Conclusion:  It appears that complete removal of fallopian tubes during hysterectomy has no advantageous effect on ovarian blood supply. It might be important to protect the ovarian blood supply as much as possible while performing hysterectomy in the reproductive period.
First trimester ultrasound diagnosis of congenital diaphragmatic hernia
Authors: Daskalakis George , Anastasakis Eleftherios , Souka Athena , Manoli Asimina , Koumpis Chrisovalandis , Antsaklis Aris 
Published: November 2007

AbstractCongenital diaphragmatic hernia is a rare structural defect, usually diagnosed in the second or third trimester of pregnancy. We present here a case of left‐sided diaphragmatic hernia diagnosed at 12 weeks of gestation and a short review of published reports on first trimester diagnosis of this defect. Ultrasound diagnosis of congenital diaphragmatic hernia cases, with early herniation of the viscera in the thorax, is feasible during the first trimester. The prerequisite is the systematic examination of the fetal anatomy. Hallmarks of the diagnosis, in the first trimester as well as later in pregnancy, are the presence of the stomach, bowel or liver in the chest, and the shift of the mediastinum. Early diagnosis of this defect is essential. This will allow timely intervention and appropriate management, following extensive parental counseling.
Retroperitoneal uterine leiomyoma occurring 5 years after hysterectomy for fibroids
Authors: Fukamachi Nobuyuki , Togami Shinichi , Iwamoto Ichiro , Tsuji Takahiro , Nomoto Mitsuharu , Goto Masamichi , Kamiyama Takuro , Fukukura Yoshihiko , Douchi Tsutomu 
Published: November 2007

AbstractWe encountered a 49‐year‐old, multiparous female with a very rare isolated retroperitoneal uterine leiomyoma measuring 72 × 43 mm in diameter occurring 5 years after hysterectomy for fibroids. The case was preliminarily diagnosed as right ovarian cancer or fibroma. An edematous, isolated solid tumor in the right retroperitoneal cavity was surgically resected. Pathological findings demonstrated uterine leiomyoma.
Diagnosis and therapy of pelvic actinomycosis
Authors: Taga Shigeki 
Published: November 2007

AbstractPelvic actinomycosis is difficult to diagnose. In most cases, it is not diagnosed until after surgery. If this condition is diagnosed preoperatively, it can be treated in many cases. Three cases of actinomycosis are reported here. Three women with intrauterine devices (IUD) each presented with lower abdominal pain and pelvic mass, and elevated white blood cell count and C‐reactive protein. Left salpingo‐oophorectomy was performed for one the women. The pathological diagnosis was actinomycosis. For the other two women, a Gram or Papanicolaou stain of the IUD sample showed actinomycetes. They were discharged after intravenous administration of penicillin without surgery.
Early awakening and extubation with remifentanil in ventilated premature neonates
Authors: E SILVA YERKES PEREIRA , GOMEZ RENATO SANTIAGO , MARCATTO JULIANA DE OLIVEIRA , MAXIMO THADEU ALVES , BARBOSA ROSILU FERREIRA , E SILVA ANA CRISTINA SIMÕES 
Published: November 2007

SummaryBackground:  Morphine is one of the most commonly used drugs for sedation and analgesia during mechanical ventilation, but its pharmacological profile has limitations, such as prolonged duration of action, especially in premature neonates. Because of its very short context‐sensitive half‐time, remifentanil has rapid onset and quickly decreases in plasma concentration after interrupting administration. The aim of the present study was to compare a continuous infusion of remifentanil and morphine during mechanical ventilation of premature neonates with respiratory distress syndrome (RDS).Methods:  Twenty premature neonates (28–34 weeks) with RDS were randomized in a prospective double‐blinded study to receive either a continuous infusion of morphine (n = 10) or remifentanil (n = 10) for mechanical ventilation. The length of time to awaken and extubate the neonate after interrupting opioid administration was recorded. We also recorded stress (COMFORT scale), pain response [Neonatal Infant Pain Scale (NIPS)], hemodynamic and ventilatory variables as well as adverse effects secondary to infusion of the specific opioid.Results:  After terminating infusion, the length of time required to awaken and extubate the neonates was 18.9‐ and 12.1‐fold longer, respectively, in the morphine group than in the remifentanil group. Both groups produced good quality sedation and analgesia as evaluated by the NIPS and COMFORT scores. No major side effects were observed.Conclusions:  Our results show an interesting potential for the use of remifentanil in premature neonates. Remifentanil allowed an adequate level of sedation and analgesia as well as rapid recovery after discontinuation. However, further properly designed clinical trials are needed before it can be generally recommended.
Propofol–ketamine vs propofol–fentanyl combinations for deep sedation and analgesia in pediatric patients undergoing burn dressing changesa
Authors: TOSUN ZEYNEP , ESMAOGLU ALIYE , CORUH ATILLA 
Published: November 2007

SummaryBackground:  The aim of this study was to compare propofol–ketamine (PK) and propofol–fentanyl (PF) combinations for deep sedation and analgesia in pediatric burn wound dressing changes.Methods:  Thirty‐two ASA physical status II and III inpatients with a second degree total burn surface area ranging from 5% to 25% were studied in a randomized, double blind fashion. Heart rate, systolic arterial pressure, peripheral oxygen saturation, respiratory rate and Ramsey sedation scores of all patients were recorded perioperatively. Patients were randomly assigned to receive either PK or PF: PK group (n = 17) received 1 mg·kg−1 ketamine + 1.2 mg·kg−1 propofol, and PF group (n = 15) received 1 μg·kg−1 fentanyl + 1.2 mg·kg−1 propofol for induction. Additional propofol (0.5–1 mg·kg−1) was administered when the patients showed discomfort in both groups. If the patient showed discomfort and/or increase in heart rate or systolic arterial pressure, despite additional propofol dose, additional bolus of 0.5–1 mg·kg−1 ketamine or 0.5–1 μg·kg−1 fentanyl was administered.Results:  There were no significant differences in heart rate, systolic arterial pressure, peripheral oxygen saturation, respiratory rate and sedation scores during the procedure between the groups. Restlessness during the procedure was seen in seven (47%) patients in Group PF and one (5.9%) patient in Group PK (P = 0.013).Conclusions:  Both propofol–ketamine and propofol–fentanyl combinations provided effective sedation and analgesia during dressing changes in pediatric burn patients. But propofol–ketamine combination was superior to propofol–fentanyl combination because of more restlessness in patients given propofol–fentanyl.
Evaluation of cuffed tracheal tube size predicted using the Khine formula in children
Authors: DURACHER CAROLINE , SCHMAUTZ EMMANUELLE , MARTINON CLAIRE , FAIVRE JUDITH , CARLI PIERRE , ORLIAGUET GILLES 
Published: November 2007

SummaryBackground:  The correct size of cuffed endotracheal tube (CET) limits the risk of postintubation tracheal damage. The aim of this study was to compare the size of the CET used in children with the size predicted by the Khine formula [age (years)/4 + 3].Methods:  After ethical committee approval, 204 children aged 1 day–15 years were included prospectively in the study. The choice of the size of the CET was made at the discretion of the attending anesthesiologist. The main criterion of judgment was the comparison of the leak before and after inflating the cuff at a pressure of 20 cm·H2O. Demographic data, tracheal tube size used and that predicted by Khine’s formulae and side‐effects were recorded.Results:  Overall, 21% of the CET were in accordance with the size predicted by the Khine formula. In the remaining patients, 72% were oversized and 7% undersized. In 12 cases, the size of CET chosen initially was modified: for a larger size in eight children and for a smaller size in four others. Six children (2.9%) presented with minor postoperative complications.Conclusions:  Our data suggest that Khine’s formula for predicting the appropriate tracheal tube size underestimates optimal size by 0.5 mm. We therefore recommend the use of the following formula: internal diameter of the CET = [age/4 + 3.5] in children >1 year of age which may be applied without increased risk of complications. The rate of tracheal reintubation as well as the detected leaks supports these recommendations.
Investigating the pharmacodynamics of ketamine in children
Authors: HERD DAVID W. , ANDERSON BRIAN J. , KEENE NATALIE A. , HOLFORD NICHOLAS H.G. 
Published: November 2007

SummaryBackground:  The aim of this study was to describe ketamine pharmacodynamics (PD) in children. Adult ketamine concentrations during recovery are reported as 0.74 mg·l−1 (sd 0.24 mg·l−1) with an EC50 for anesthesia of 2 mg·l−1 (sd 0.5 mg·l−1), but pediatric data are few.Methods:  Children presenting for painful procedures in an Emergency Department were given ketamine 1–1.5 mg·kg−1 i.v. Blood was assayed for ketamine on three to six occasions (median 3) over the subsequent 14–152 min (median 28.5). Procedures were videotaped. Level of sedation (0–5; unresponsive – spontaneously awake without stimulus) and a test of memory were recorded. PD was investigated using a variable slope Emax model (sedation) or logistic regression (arousal time, memory) with nonlinear mixed effects models.Results:  In total 60 children were enrolled. Pharmacokinetic data were collected in 54 of these children and there were 43 children available for PD study. The mean age was 8.15 years (sd 3.5 years) and weight was 34.9 kg (sd 15.8 kg). The half‐time describing equilibration between the effect compartment and central compartment was 11 s (95% CI 0.07–20 s). The EC50 for arousal was 0.52 (90% CI 0.22–1.17) mg·l−1. The Emax model with a baseline (E0) of five (spontaneously awake without stimulus) yielded a fractional Emax 0.939 [coefficient of variability (CV) 24%], an EC50 0.56 (CV 136%) mg·l−1 and a Hill coefficient 3.71. The EC50 for recall memory was 0.44 (90% CI 0.09–1.70) mg·l−1. The EC50 for remembering was 0.38 (90% CI 0.12–1.75) mg·l−1.Conclusions:  Concentrations associated with arousal in children are analogous to adults. The ability to recall and remember occurs at similar concentrations to those associated with arousal. A concentration of 1 mg·l−1 was associated with a sedation level of three or less (arouses to consciousness with moderate tactile or loud verbal stimulus) in 95% of children while 1.5 mg·l−1 was associated with a sedation level of two or less (rouses slowly to consciousness with sustained painful stimulus) in 95% of children. These concentrations can be attained for 3–4 min after 1 mg·kg−1 and 1.5 mg·kg−1 ketamine IV bolus, respectively. The mean arousal time can be anticipated at approximately 10 min (1 mg·kg−1) and 15 min (1.5 mg·kg−1).
Scanning electron‐microscopic evaluation of cuff shoulders in pediatric tracheal tubes
Authors: MOEHRLEN UELI , ZIEGLER URS , WEISS MARKUS 
Published: November 2007

SummaryBackground:  Technical and conceptual shortcomings of cuffed pediatric tracheal tubes have been pointed out in the past, all representing a potential risk for mucosal damage of the pediatric airway. In this study, cuffed pediatric tracheal tubes from different manufacturers were investigated with regard to the cuff shoulder design using scanning electron microscopy (SEM).Methods:  Cuffed pediatric tracheal tubes with the smallest internal diameter available were ordered from five manufacturers. SEM scans were performed from the tube shaft – cuff shoulder – tube cuff assembly and from the cuff shoulder alone. Each investigation was repeated in four samples of each tube brand. In addition, thickness of cuff membrane was measured.Results:  Major differences were found among the cuff shoulders investigated ranging from smooth transitions, softened borders to very sharp steps. There was also considerable difference in the thickness among the cuff membranes between the different tube brands ranging from 18 μm in polyurethane cuffs up to 90 μm in polyvinylchloride cuffs.Conclusions:  Because the gap between the outer tracheal tube and the internal mucosal layer of the pediatric airway is often very narrow, some of the observed irregularities have the potential to injure the airway mucosa in pediatric patients, particularly during long‐term use and firm fit of the tracheal tube in the airway. As cuffed tubes are increasingly used in small children, the observed irregularities in some tracheal tube brands may need to be improved and their safety should be proved by the manufacturers.
Sedation with ketamine and low‐dose midazolam for short‐term procedures requiring pharyngeal manipulation in young children
Authors: NOVAK HELENA , ÅKESON PIA KARLSLAND , ÅKESON JONAS 
Published: November 2007

SummaryBackground: Pediatric intestinal biopsy procedures including considerable transpharyngeal manipulation of a wire‐guided metal capsule require adequate sedation or anesthesia. This retrospective cohort study was designed to evaluate intravenous sedation with ketamine and low‐dose midazolam in young children undergoing these procedures before and also after discharge from the hospital.Methods: A total of 244 biopsy procedures in 217 children under the age of 16 years were evaluated. All anesthesia records were reviewed according to a defined study protocol and in 145 cases the parents were also interviewed by telephone to obtain further information on possible adverse effects before and after discharge.Results: Ketamine and low‐dose midazolam were carefully titrated by an experienced anesthesia team at an approximate dose ratio of 40 : 1 (total doses 2.3 and 0.05 mg·kg−1) in continuously monitored spontaneously breathing children. Possibly associated problems before discharge were salivation (5.7%), vomiting (4.9%), oxygen desaturation (3.3%), laryngospasm (2.5%) and rash (1.2%) according to the patient records and blurred vision (27%), nausea and vomiting (19%), vertigo (13%) and hallucinations or nightmares (3.5%) according to telephone interviews. Few, mild and transient problems remained after discharge from the hospital.Conclusions: Careful titration of ketamine and low‐dose midazolam provides adequate sedation for nonsurgical pediatric short‐term procedures also requiring considerable pharyngeal manipulation, particularly considering the low number of serious airway problems such as laryngospasm. The high incidence of late postoperative problems suggests that prospective studies should be designed for long‐term follow‐up of young children subjected to sedation or anesthesia.
Prevention of rocuronium‐induced withdrawal movement in children: a comparison of remifentanil with alfentanil
Authors: KIM JONG YEOP , KWAK HYUN JEONG , KIM JI YOUNG , PARK KWAN SIK , SONG JAE SEOK 
Published: November 2007

SummaryBackground: This study was designed to compare the efficacy of remifentanil and alfentanil without the venous occlusion technique in preventing the withdrawal response associated with rocuronium injection in children.Methods: One hundred and twenty children aged between 3 and 10 years were randomly allocated into one of four groups to receive either i.v. remifentanil 0.5 μg·kg−1(remi 0.5 group), remifentanil 1 μg·kg−1(remi 1.0 group), alfentanil 15 μg·kg−1(alfentanil group) or saline 5 ml (saline group). Anesthesia was induced with 2.5% thiopental sodium 5 mg·kg−1and the test drug was injected over 30 s. One minute later, 1% rocuronium 0.6 mg·kg−1was injected over 5 s and the response was recorded. Mean arterial pressure (MAP) and heart rate (HR) were recorded on arrival in the operating room, before and 1 min after tracheal intubation.Results: The incidence of withdrawal movement in the saline group (93%) was significantly higher than that in the remi 0.5, remi 1.0, and alfentanil groups (53%, 17%, and 20%, respectively) (P < 0.05). The incidence in the remi 1.0 and alfentanil groups was significantly less than that in the remi 0.5 group (P < 0.05). After intubation, MAP and HR were significantly higher in the saline group than that in remi 1.0 and alfentanil groups.Conclusions: Both remifentanil 1 μg·kg−1and alfentanil 15 μg·kg−1can be used to prevent rocuronium‐associated withdrawal movement in children because they are equally effective and attenuate the increase in MAP and HR after intubation.