[Clinical use of the ProSeal™ laryngeal mask in infants, children and adolescents : prospective observational survey]

BACKGROUND

In contrast to the adult population scientific data on ProSeal™-LMA (PLMA) usage in infants, children, and adolescents are rather limited. Most data have been generated by expert users in studies on small numbers of patients. The aim of this study was to gather comprehensive data about the characteristics, efficacy and safety of its routine use in children at a teaching institution.

METHODS

Using a standardized reporting form the following data were collected in the course of a prospective survey on PLMA usage in patients aged up to 18 years: user characteristics, patient characteristics, type and duration of operation, details of airway management and anesthetic technique, details of PLMA usage-related critical incidents and postoperative status of the patient.

RESULTS

Use of the PLMA was documented in 512 patients by 61 anesthesiologists (32% staff grade, 68% trainees). The average age, height and weight of the patients was 8 years (range 0-17 years), 130 cm (range 54-193 cm) and 29 kgBW (range 5-130 kgBW), respectively. Anesthesia was induced intravenously in 458 patients (89.5%) and by inhalation in 54 patients. Maintenance of anesthesia was by total intravenous anesthesia (propofol) in 184 patients (36.5%) and by an inhalational agent (sevoflurane or desflurane) in 320 patients (63.7%). Neuromuscular blocking agents were used in 7 patients (1.4%). The patients were anesthetized for an average of 80 min (range 15-270 min) and insertion success rate was 99% with a maximum of 3 attempts. The average initial airway leak pressure was 27cm H(2)O (range 12-40 cm H(2)O); however, lower pressures were recorded for smaller size masks (size 1.5-2.5) without a dorsal cuff than for larger size masks (size 3-5; p<0.01). Ventilation was controlled in 96% and combined with PEEP in 39% of cases. Critical incidents associated with PLMA were documented in a total of 8.4% of cases, the majority being minor trauma, evidenced by blood on the PLMA on removal, followed by some form of airway obstruction. In 3.3% of cases these incidents were judged as clinically relevant of which 0.6% were classified as serious. Twice as many problems occurred during induction of anesthesia as in the maintenance phase and emergence phase of anesthesia (p=0.037). In 1.6% the PLMA was abandoned in favor of the endotracheal tube. In 7 patients the PLMA was exchanged in the induction room whereas in 1 patient this took place intraoperatively. Failure of ProSeal™ laryngeal mask use correlated with the level of PLMA use experience with 75% of failures caused by users with an experience of less than 50 uses and no failure in users with an experience of more than 100 uses. Failure did not correlate with the size of the mask. In 2 cases the PLMA was successfully used after failed endotracheal intubation. In 6 patients drainage of regurgitated gastric fluid through the drain tube was documented. No long-term adverse sequelae resulted in any patient.

CONCLUSION

This survey demonstrates that the PLMA can be used effectively in infants, children and adolescents in the routine university clinical practice setting. However, this study does not confirm the extremely high success and low complication rates reported in controlled studies. The results support the assumption that with the PLMA regurgitated gastric fluid can be drained away from the larynx through the drain tube.

Peritoneal hydatidosis in a young girl

We report a case of peritoneal hydatidosis that occurred post laparotomy. Patient was diagnosed nine months after she had laparotomy for suspected acute appendicitis. The whole peritoneal cavity was studded with cysts. In view of diffuse involvement, patient was managed conservatively and showed response to medical therapy.

FC09-01 - ISoSCCiP Project: phase 1 systematic literature review

Introduction

The chronic worldwide shortage of psychiatrists has impaired the delivery of first class mental health care. The WHO produced a report on the Mental Health Gap, showing the high burden of mental health, neurological and substance misuse disorders worldwide, estimating a treatment gap of 75% between need and resources.

Aims and objectives

Research to date has highlighted key areas that influence students' choice of a career in psychiatry. There have been several key literature reviews summarising work in the area since the 1950s. The current study updates literature with a systematic review of the past 10 years.

Methods

A five level search strategy was used.

A standard Critical Appraisal tool was developed based on the one used by the Best Evidence in Medical Education Group in Dundee. Papers were coded and graded using hierarchies of evidence - Sackett Hierarchy of Evidence and Kirkpatrick Hierarchy.

Results & conclusions

The quality of published studies has risen over the past 30 years, with the past decade producing the most robust evidence. However, it is a complex area to research with many potential confounders, and large gaps in knowledge remain.

ECP09-02 - Psychiatry training in europe: Implementation and evaluation of training programs

Training schemes in psychiatry are developed and evaluated by national education policy makers in the majority of European countries. However, the requirements that a training program in psychiatry should meet are also defined on the European level in a form of recommendations by the Board of Psychiatry - European Union of Medical Specialists (UEMS).

Recently, the European Federation of Psychiatric Trainees (EFPT) which represent trainees from more then 30 European countries, reported data pertaining to the structure of training programs and to the evaluation of training programs in 30 European countries. Whereas in the majority of European countries the structure of training programs and methods of assessment of trainees' competencies are partially compatible with one another and with the existing recommendations at the European level, the quality assurance of training programs varies significantly among countries. Regular evaluations of training programs and mentors, however, contribute to the proper implementation of training programs and help that the theoretical training principles are followed through in practice. As quality assurance of training schemes is an important mechanism how to improve the delivery of training programs, it should gain more focus by responsible authorities who structure the psychiatric training on the national and international European level.

High Sensitivity Photochemical Sensors Based on Amorphous Silicon

Hydrogenated amoiphous silicon photochemical sensors based on Pd-MIS structures were produced by Plasma Enhanced Chemical Vapor Deposition with two different oxidized surfaces (thermal and chemical oxidation). The behaviour of dark and illuminated current-voltage characteristics in air and in the presence of a hydrogen atmosphere is explained by the changes induced by the gases in the work function of the metal, modifying the electrical properties of the interface. The photochemical sensors produced present more than 2 orders of magnitude variation on the reverse dark current when in presence of 400 ppm hydrogen to which it corresponds a decrease of 45% on the open circuit voltage.

Spray-Deposited Metal Oxide Films with Various Properties for Micro- and Optoelectronic Applications: Growth and Characterization

This work reports the structure and electro-optical characteristics of different metal oxide films obtained by spray pyrolysis on heated glass substrates, aiming their application in optoelectronic devices. The results show that this technique leads to thin films with properties ranging from dielectric to degenerate semiconductors, offering the following advantages: simplicity, low cost, high productivity and the possibility of covering large areas, highly important for large area device applications.

Abstract PD06-03: Predictors of Local Recurrence in High Risk Patients Undergoing Neoadjuvant Chemotherapy in the I-SPY1 Trial (CALGB 150007/12 ACRIN 6657)

Background: Given that many patients with more locally advanced breast cancer are receiving neoadjuvant therapy, predictors of local recurrence will be important for learning how to optimize the use of local regional therapy. We investigated the local regional recurrence (LRR) rates in patients treated with neoadjuvant chemotherapy in the I SPY1 trial. Methods: Data were analyzed from 221 women that were enrolled in I-SPY1 and completed treatment. Final surgical procedure was not randomized. Multiple clinicopathologic factors were investigated in both the lumpectomy (BCS) and mastectomy cohorts. Logistical regression was applied to identify factors predicting LRR although this was not a specified endpoint for the I-SPY parent trial.

Results: At 3.9 years median followup, 123 patients (56%) had mastectomy, 93 patients (42%) had breast conservation and 5 did not have a surgical procedure. The majority of patients in both groups received radiation with 77% and 94% in the mastectomy and breast conservation (BC) group respectively. Within the mastectomy group, there was no correlation between whether pts received PMRT and predictors of high LRR risk: LVI, grade, stage and nodal disease following neoadjuvant chemotherapy. Rates of PMRT in each residual cancer burden (RCB) category were 78%(RCB0), 80%(RCB 1), 81%(RCB2) and 66%(RCB3, highest residual burden of disease) for the mastectomy group. Median tumor size before chemotherapy was 6.0 cm and 5.0 cm mastectomy and BC groups, respectively. Fewer patients had pCR in the mastectomy group, compared to the BC group. LRR rates were very low for both the mastectomy and BC groups, with 9 (7.5%) and 7 (7.3%) total recurrences, respectively. Only 2 patients in each group had LLR without distant recurrence (2% total). For the mastectomy and BC groups, 4/7 and 3/5 patients had synchronous presentation of their local and distant disease. For patients with distant recurrence 44% and 29% had a local recurrence in the BC and mastectomy groups respectively.

In a logistical regression model, patients with local progression in the BC group were 17 times more likely to develop distant progression (p=0.005) while in the mastectomy group, those with LLR were 10.5 times more likely to develop distant progression (p=0.001). Individual factors that appeared to be predictive of local recurrence included clinical size of tumor at presentation (p=0.032) for the BC group, and final pathologic tumor size in the mastectomy group (p=0.002). Patients with low risk molecular features (wound healing quiescent, luminal A, NKI low, and ROR-S low) did not have any local recurrences.

Conclusion: Although the sample size was small, and the ability to discriminate between the two surgical groups was limited, in this high risk group of locally advanced breast cancer pts, BC does not appear to lead to an increased rate of LRR. In fact tumor biology that predicts for high risk of distant progression might be able to be applied to risk stratification for LRR. Patients with low risk of distant recurrence (e.g. those with pCR, RCB1or low-risk molecular markers) may be those that we can consider testing PMRT vs not in future neoadjuvant trials.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr PD06-03.

Beta-lactams and beta-lactamase-inhibitors in current- or potential-clinical practice: a comprehensive update

The use of successive generations of beta-lactams has selected successive generations of beta-lactamases including CTX-M ESBLs, AmpC beta-lactamases, and KPC carbapenamases in Enterobacteriaceae. Moreover, this cephalosporin resistance, along with rising resistance to fluoroquinolones, is now driving the use of carbapenems and unfortunately the carbapenem resistance has emerged markedly, especially in Acinetobacter spp. due to OXA- and metallo-carbapenemases. The industry responded to the challenge of rising resistance and recently developed some novel beta-lactams such as ceftobiprole, ceftaroline etc. and many beta-lactam compounds, including beta-lactamase-inhibitors, such as BMS-247243, S-3578, RWJ-54428, CS-023, SMP-601, NXL 104, BAL 30376, LK 157, and so on are under trials. This review provides the comprehensive accounts of the developments in penicillins, cephalosporins, carbapenems, and beta-lactamase-inhibitors, and the insight about medicinal chemistry, mechanism(s) of action and resistance, potential strategies to overcome resistance due to beta-lactamases, and also the recent advancements in the development of newer beta-lactam compounds; some of which are still under trials and yet to be classified. This review will fill the gap since previously published reviews and will serve as a comprehensive update on the current topic.

Characterization of germanium linear kinoform lenses at Diamond Light Source

The unprecedented brilliance achieved by third-generation synchrotron sources and the availability of improved optics have opened up new opportunities for the study of materials at the micrometre and nanometre scale. Focusing the synchrotron radiation to smaller and smaller beams is having a huge impact on a wide research area at synchrotrons. The key to the exploitation of the improved sources is the development of novel optics that deliver narrow beams without loss of brilliance and coherence. Several types of synchrotron focusing optics are successfully fabricated using advanced miniaturization techniques. Kinoform refractive lenses are being developed for hard X-ray beamlines, and the first test results at Diamond are discussed in this paper.