Transvaginal tape lysis for urinary obstruction after tension-free vaginal tape placement

PURPOSE: We examine the outcome of tape lysis in subjects with obstructive urinary retention after initial tension-free vaginal tape placement. MATERIALS AND METHODS: Charts from 109 consecutive subjects who underwent tension-free vaginal tape placement from 1998 to 2001 were retrospectively reviewed. Of the subjects 78 (72%) consented to participation and completion of a questionnaire. All subjects underwent a routine preoperative evaluation before surgery and followup was implemented through 2002. Tape lysis using a standard technique was performed in 5 patients with documented obstructive urinary retention. Subjective assessment by the validated Bristol Lower Urinary Tract Symptoms questionnaire and a postoperative survey characterized perceptions of incontinence, results of initial tension-free vaginal tape placement and outcome of subsequent tape lysis. RESULTS: The objective incontinence cure rate was 89%. Of the 78 patients 17 (22%) and 21 (27%) experienced transience in either dysuria or incomplete bladder emptying, respectively. Transection for obstructive urinary retention was successfully accomplished in 5 subjects with 4 (80%) remaining continent. CONCLUSIONS: Tape lysis is simple and effective for relieving obstruction, and is not associated with a high rate of recurrent stress urinary incontinence.     

Anwendung kognitiver Hilfsmittel im Kindernotfall

Preclinical pediatric emergencies are rare events and are therefore often associated with stress and uncertainty for emergency medical service personnel. To ensure adequate treatment of pediatric patients a variety of different cognitive aids exist (e.g. books, apps, rulers, weight-adapted bag systems). Especially the size specifications of the medical equipment and the dosage of emergency medication are individually very different in children and are dependent on parameters, such as body height and weight. Therefore, cognitive aids often enable length measurement whereby it is possible to draw conclusions on body weight for calculating the child’s medication dosage. These aids may help to avoid the wrong medication dose or the wrong therapy of children but uncritical and untrained usage of these aids carries a potential risk of mistakes. This recommendation gives an overview of the general requirements and different problems of cognitive aids and should help improve the general framework and the rational basis for the use and further development of cognitive aids in emergency medicine.     

Role of ultrasound compared to age‐related formulas for uncuffed endotracheal intubation in a pediatric population

Background: It is often difficult to determine the correct size of endotracheal tubes (ETT) needed for intubating pediatric patients. Therefore, we evaluated the role of ultrasound in pediatric patients to compare the correct size of an uncuffed (ETT) with the minimal transverse diameter of the subglottic airway (MTDSA) measured by ultrasound and with tube size predicted by different age‐related formulas. Methods: A total of 50 pediatric patients ≤5 years were enrolled. As a standard, we defined the adequate ETT size with no audible leakage below a ventilation pressure of 15 mbar and with an audible leakage above 25 mbar. The maximum allowed difference between the prediction method result and the ETT that fit was defined as 0.3 mm. Ultrasound was performed before the intubation procedure; the intubating anesthesiologists were blinded to the results of the ultrasound measurement. Agreement between the two age‐based formulas most commonly used at our department and MTDSA with the correct ETT size (standard) was analyzed using a Bland–Altman plot. Correlation and regression analyses were performed and the numbers of correct intubation trials recorded. Results: The frequency of bias ≤0.3 mm between each method and the correct ETT in the first attempt was <50% and the mean number of reintubations 1.6 ± 1.3. In contrast to age‐related formulas, however, the ultrasonographically determined MTDSA was not significantly different from the correct ETT. MTDSA was highly associated with the outer diameter of the ETT (r = 0.869, R² = 0.754). Conclusions: Measuring MTDSA by ultrasound facilitates selection of the appropriate ETT in pediatric patients and may reduce the number of reintubations.     

Effect of antipronation tape and temporary orthotic on vertical navicular height before and after exercise

STUDY DESIGN: A randomized controlled, crossover, within-subjects study evaluating 2 antipronation treatments. OBJECTIVES: To investigate the antipronation effect of 2 treatments designed to reduce abnormal pronation, and the effect of an exercise challenge on the treatments. BACKGROUND: Control of abnormal pronation in order to ameliorate inappropriate stresses on injured soft tissues is frequently sought in the treatment of overuse injuries of the lower limb. Tape and temporary soft orthotics are used to control abnormal pronation. The effects of these treatments remain largely untested. METHODS AND MEASURES: Fourteen subjects (age = 23.8 +/- 3.5 years) who had at least a 10-mm navicular drop were studied. The dependent variable was vertical navicular height. The two independent variables were the treatment conditions (temporary felt orthotics, augmented LowDye tape, and control) and the exercise challenge (0, 10, and 20 minutes of controlled jogging). The subjects' vertical navicular height was measured before and after the application of the treatment conditions, and then after 10 and 20 minutes of jogging. RESULTS: Tape and orthotic treatments produced approximately a 19% and 14% increase in vertical navicular height, respectively, which were both significantly greater than the control condition (0%). The treatment effect, although significantly diminished following exercise challenge, remained superior to control (6.5% for orthotic and 3.5% for tape compared to -7.3% for control). CONCLUSION: Antipronation tape and temporary orthotics help to control excessive foot pronation initially after application and following exercise. These treatments may be useful in the assessment and treatment of lower limb injuries that are associated with abnormal foot pronation.     

Body mass index and outcome of tension-free vaginal tape

OBJECTIVES: To assess the effectiveness of tension-free vaginal tape (TVT) in women with high body mass indices (BMIs). METHODS: Thirty-eight consecutive patients with BMIs exceeding 30 who underwent tension-free vaginal tape were compared with 149 consecutive patients with BMIs of 30 or less who underwent the same procedure. Body mass index was calculated pre-operatively and at follow-up. Women were classified as being of normal weight (BMI 20-25), overweight (BMI 26-30), or obese (BMI >30). Patient characteristics, operative and post-operative complications, reported continence rates were analyzed according to BMI. RESULTS: There were no significant differences between groups in terms of age, parity, menopausal status, previous surgery, type and degree of incontinence. Estimated blood loss, operative times, bladder injuries, post-operative urgency and voiding disorders did not differ significantly between women with high BMIs and those with low BMIs. Women with BMIs exceeding 30 had a significantly higher incidence of post-operative urge urinary incontinence (17.9 versus 3.4 and 6.4% p = 0.02) without any effects on the objective and subjective cure rates (82 versus 88.7 and 93% p = 0.1, 71.7 versus 72.1 and 74% p = 0.9). CONCLUSION: We did not find pre-operative obesity to be a risk factor for failure of tension-free vaginal tape.     

Tape blisters following hip surgery. A prospective, randomized study of two types of tape

BACKGROUND: Tape blisters after hip surgery can be a source of postoperative morbidity and can increase patient discomfort. The purpose of this prospective study was to compare two different types of tape to determine whether the type of tape influences the rate of blister formation. METHODS: Ninety-nine patients (100 hips) were enrolled in the study. Patients were randomized into one of two treatment groups: one treated with a nonstretchable silk tape and one treated with a perforated, stretchable cloth tape. After surgery, the assigned tape was applied over the postoperative dressing with care not to produce skin tension. At the first dressing change, the presence or absence of blisters was recorded as were the number, size, location, and type of any blisters. The presence or absence of tape blisters was recorded at the time of each subsequent dressing change. RESULTS: A tape blister developed on twenty-five hips in twenty-five patients. The risk of a blister developing was 41% (twenty of forty-nine patients) when the nonstretchable silk tape was used and 10% (five of fifty patients) when the perforated cloth tape was used (relative risk = 4.08, 95% confidence interval = 1.53 to 10.87, p = 0.005). We found no association between formation of tape blisters and the age or gender of the patient, number of medical comorbidities, smoking history, results of nutritional assessment, or type of surgery. CONCLUSIONS: The prevalence of tape blisters was significantly lower when perforated cloth tape was used than it was when nonstretchable silk tape was used.     

Biomechanical Comparison of Tape Versus Suture in Simulated Achilles Tendon Midsubstance Rupture

As sutures have progressed in strength, increasing evidence supports the suture tendon interface as the site where most tendon repairs fail. We hypothesized that suture tape would have a higher load to failure versus polyblend suture due to its larger surface area. Eleven matched pairs of cadaveric Achilles tendons were sutured with 2 mm wide braided ultrahigh molecular weight polyethylene tape (Tape) or 2 mm wide braided ultrahigh molecular weight polyethylene suture (Suture) using a Krackow repair method. All Achilles repair constructs were cyclically loaded, after which they were loaded to failure. Change in suture footprint height, clinical and ultimate load to failure, and location of failure was recorded. Clinical loads to failure for Tape and Suture were 290.4 ± 74.8 and 231.7 ± 70.4 Newtons, respectively (p= .01). Ultimate loads to failure for Tape and Suture were 352.9 ± 108.1 and 289.8 ± 53.7 Newtons, respectively (p = .11). Cyclic testing resulted in significant changes in footprint height for both Tape and Suture, but the 2 sutures did not differ in terms of the magnitude of change in footprint height (p = .52). The suture tendon interface was the most common site of failure for both Tape and Suture. Our results suggest that Tape may provide added repair strength in vivo for Achilles midsubstance rupture.     

The clinical efficacy of kinesio tape for shoulder pain: a randomized, double-blinded, clinical trial

STUDY DESIGN: Prospective, randomized, double-blinded, clinical trial using a repeated-measures design. OBJECTIVES: To determine the short-term clinical efficacy of Kinesio Tape (KT) when applied to college students with shoulder pain, as compared to a sham tape application. BACKGROUND: Tape is commonly used as an adjunct for treatment and prevention of musculoskeletal injuries. A majority of tape applications that are reported in the literature involve nonstretch tape. The KT method has gained significant popularity in recent years, but there is a paucity of evidence on its use. METHODS AND MEASURES: Forty-two subjects clinically diagnosed with rotator cuff tendonitis/impingement were randomly assigned to 1 of 2 groups: therapeutic KT group or sham KT group. Subjects wore the tape for 2 consecutive 3-day intervals. Self-reported pain and disability and pain-free active ranges of motion (ROM) were measured at multiple intervals to assess for differences between groups. RESULTS: The therapeutic KT group showed immediate improvement in pain-free shoulder abduction (mean +/- SD increase, 16.9 degrees +/- 23.2 degrees ; P = .005) after tape application. No other differences between groups regarding ROM, pain, or disability scores at any time interval were found. CONCLUSION: KT may be of some assistance to clinicians in improving pain-free active ROM immediately after tape application for patients with shoulder pain. Utilization of KT for decreasing pain intensity or disability for young patients with suspected shoulder tendonitis/impingement is not supported. LEVEL OF EVIDENCE: Therapy, level 1b-.     

Auscultation of bilateral breath sounds does not rule out endobronchial intubation in children

We performed orotracheal intubation in 153 consecutive pediatric patients undergoing cardiac catheterization. Auscultation of bilateral breath sounds was confirmed. By fluoroscopy, the tip of the endotracheal tube (ETT) was seen in the right mainstem bronchus in 18 patients (11.8%) and in a low position, defined as within 1 cm above the carina, in 29 patients (19.0%). All of the 18 patients with right mainstem intubation were children <120 mo of age, and 7 were infants <12 mo of age (Fisher's exact test; P = 0.013). The age, weight, and ETT size for children who had endobronchial and low tracheal positions were significantly (P < 0.001) less than for those who had midtracheal positions. The failure to diagnose mainstem intubation by auscultation alone may be related to the use of the Murphy eye ETT, which reduces the reliability of chest auscultation in detecting endobronchial intubation. Suggested measures for preventing endobronchial intubation include maintaining increased awareness of the imperfection or lack of accuracy of the auscultatory method, assessing insertion depth by checking the length scale on the tube, and minimizing the patient's head and neck movement after intubation. When extreme flexion or extension of the neck is expected after ETT insertion, the resultant change in ETT final position must be anticipated and taken into consideration when deciding on the depth of ETT insertion. This approach resulted in a decrease in improper tube positioning from 20% when the study was initiated to 7.1% in the last 98 patients.     

Taping methods and tape types for securing oral endotracheal tubes

Purpose

To evaluate tapes and taping methods with respect to the minimum force required to dislodge endo tracheal tubes (ETTs).

Methods

A simulated face model consisting of a section of PVC pipe was used. The ETT was attached to a piezo-electric force transducer and pullout force was manually applied in a vertical, right or left direction. Five tape types were tested: Curity. Leukosilk, Hy.tape. Leukopore, and Transpore. Seven taping methods were used to secure the ETT The methods differed with respect to tape width and whether the tape was split along its longitudinal axis. Each taping condition was replicated 20 times (7 methods x 3 tapes x 3 directions) for a total of 2100 pullout tests.

Results

Minimum forces to dislodge ETTs were higher (P < 0.05) with Cunty tape (mean ± SD: 135 ± 75 N) than with the other tapes (Leukosilk: 93 ± 51 N, Hy.tape: 78 ± 34 N, Leukopore: 47 ± 32, and Transpore: 37 ± 23 N). The most secure taping method was achieved by taping the ETT, using 2.5 cm wide Cunty tape, in a circumferential fashion to both the upper and lower borders of the simulated mouth opening, and reinforcing these tapes with two strips applied longitudinally across the borders of the mouth opening (method 7). Taping methods which involved splitting the tape along its longitudinal axis resulted in lower minimal pullout forces when-ever the pullout force was directed towards the side of attachment (P < 0.05vs right and vertical direction).

Conclusion

There are differences in ETT pullout forces and mechanisms of dislodgement depending on taping method and tape type.     

How reliable is length-based determination of body weight and tracheal tube size in the paediatric age group? The Broselow tape reconsidered

Background. The Broselow tape was designed to estimate bodyweight and tracheal tube size on the basis of the body lengthof emergency paediatric patients. The tape was validated previouslyin US populations. We assessed its accuracy in a sample of Europeanchildren by reviewing paediatric anaesthetic charts at the TriemliCity Hospital for 1999. Methods. Age, body length and body weight measured before surgeryas well as the size of the tracheal tube used were recorded.The body weight was estimated on the basis of body length usingthe Broselow tape and was compared with the measured weight.Tracheal tube size selections using the Broselow tape and anage-based formula were compared with the size of the tube used. Results. A good correlation was found between the Broselow weightand the measured weight (r²=0.88). Bland–Altman analysisrevealed a mean bias of –0.52 kg for the entire studypopulation. For children     

Relationship of renal size, body size, and blood pressure in children

Somatometric parameters, renal size, and systolic blood pressure (SBP) were studied in 406 patients referred to pediatric nephrology and urology clinics. These patients included 269 females (66%), 67 African Americans (17%), and 87 patients with essential hypertension (21%). Z scores for the study population were comparable to published standards for height, kidney length, and SBP. Weight and body mass index scores were significantly greater than predicted from the standards, especially in the subset of patients with essential hypertension. Age, height, weight, body mass index, kidney length, and SBP all correlated with one another; however, on multiple regression analysis of SBP with the other five independent variables, only weight proved to have a significant correlation. Furthermore, the relationship of kidney length with SBP was positive and hypertensive patients had greater kidney size than published standards. These data do not support reduced kidney size in the population with essential hypertension, nor is there support for a convincing correlation between kidney length and SBP in the general pediatric population. Body weight correlates best with blood pressure. These findings warrant further study in a less-select population. Prevention and treatment of obesity may thus be of prime importance in addressing hypertension in children. Received April 22, 1997; received in revised form and accepted July 23, 1997     

Predicting the appropriate uncuffed endotracheal tube size for children: a radiograph-based formula versus two age-based formulas

Study ObjectivesTo determine whether a radiograph-based formula using the tracheal diameter from a chest radiograph predicted the appropriate endotracheal tube (ETT) size in children, and to compare these results with those produced using age-based formulas.DesignRetrospective, observational study.SettingMedical record review.MeasurementsData from 537 pediatric patients, aged 3 to 6 years, who underwent orotracheal intubation with an uncuffed ETT, were randomly divided into two datasets: one was used to derive a formula and the other was for validation. A radiograph-based formula was obtained by linear regression modeling between the tracheal diameter at the seventh cervical vertebra (C7) on chest radiography and the appropriate ETT size from the estimation dataset (n=268). The appropriate size was defined as the ETT size when air leak pressure was 10 to 30 cmH₂O. The predictive ability of this equation was evaluated using the validation dataset (n=269). The primary outcome was the success rate of the prediction.Main ResultsThe following radiograph-based formula was obtained: ID = 3 + 0.3 × (tracheal diameter at C7). The success rate of the radiograph-based formula was 57%, which is higher than the 32% (P < 0.001) of the standard age-based formula (ID = 4 + age/4) or 43% (P = 0.002) of Penlington's formula (ID = 4.5 + age/4). An underestimation of the actual tracheal size occurred in 65% of cases using the age-based formulas, but in only 19% with the radiograph-based formula (P < 0.001).ConclusionsThe radiograph-based formula may be useful for predicting the appropriate ETT size in children aged 3 to 6 years.     

A transvaginal ultrasound study comparing transobturator tape and tension-free vaginal tape after surgical treatment of female stress urinary incontinence

This study was carried out to compare ultrasonographic findings on patients after transobturator tape (TOT) and tension-free vaginal tape (TVT) procedures to evaluate displacement of tapes up to a 2-year follow-up and to test the correlation between bladder outlet obstruction and the tape position. Forty-nine patients had a transvaginal ultrasonographic evaluation after TOT (n=31) or TVT (n=18) procedures. Twenty-one patients from the TOT group and 12 from the TVT group had ultrasonographic evaluation both at 1 and 2 years follow-up. Tape position was evaluated with a complete sagittal view, and the width of the tape and the distance between the middle of the tape and the bladder neck were measured. Statistical analysis was performed using a t test. After clinical evaluation, stress test, and uroflowmetry with residual measurement, the tapes were compared on ultrasound with regard to clinical and urodynamic results: success in stress incontinence vs failure, bladder outlet obstruction vs no obstruction, and de novo urgencies vs no urgencies. No difference was found between TOT and TVT in the midurethral tape placement. The distance between the middle of the tape and the bladder neck at rest was similar at both 1 and 2 years after both TOT and TVT and was unchanged after coughing or Valsalva. The width of the tape was similar after TOT and TVT at both 1 and 2 years after the procedure. There was no difference in the distance between the middle of the tape and the bladder neck between cured patients, failure, bladder outlet obstruction, and de novo urgencies after both TOT and TVT. Transvaginal ultrasound examination showed no significant difference in the tape position between TOT and TVT. No correlation was found between ultrasonographic findings and postoperative voiding troubles for both techniques.     

Tape blisters that develop after hip fracture surgery: a retrospective series and a review of the literature

A tape blister, a skin excoriation that occurs under the taped portion of surgical bandages, can be a source of postoperative morbidity. Tape blisters are caused by the separation of the epidermis from the dermis at the dermal-epidermal junction. Tape resistant to stretching contributes to blister formation because of the concentration of forces at the ends of the tape. Although tape blisters are a pervasive clinical problem, their incidence after hip surgery has rarely been reported in the orthopedic literature. Therefore, we retrospectively reviewed a consecutive series of patients with hip fractures to determine the incidence of tape blisters at our institution. One hundred three patients were included in the study. Tape-related injuries occurred in 22 patients (21.4%). Patient age, patient sex, number of medical comorbidities, smoking history, nutritional status, and type of surgery were not statistically significantly associated with risk for developing tape blisters.     

Relationship between different body size indicators and hernia development in CAPD patients

AIMS: A small body size may increase the risk for hernia development in patients on continuous ambulatory peritoneal dialysis (CAPD). The present study investigates whether there is a relationship between body size and hernia development in CAPD patients. MATERIAL AND METHODS: The records of 78 patients on CAPD were reviewed retrospectively. Body mass index (BMI), body surface area (BSA) and total body water (TBW) were calculated in all patients. Correlations between different body size indicators (BMI, BSA and TBW) and hernia development were assessed using analysis of covariance in which we adjusted for sex. RESULTS: A total of 14 patients (17.9%) with no physical evidence of hernia before catheter insertion developed hernias. Body size was significantly lower in CAPD patients with hernias than those without hernias when adjusted for sex. CONCLUSIONS: We conclude that patients with small body size tend to have an increased risk for hernia development. A simple estimation of patients' height, weight, body surface area and total body water would be helpful to predict development of hernias or other complications related to increased intraperitoneal pressure in CAPD patients.     

Airway length in adults: estimation of the optimal endotracheal tube length for orotracheal intubation

STUDY OBJECTIVE: To estimate the optimal endotracheal tube (ETT) length in orotracheally intubated patients. DESIGN: Prospective study. SETTING: Operating room of a medical center hospital. PATIENTS: 293 ASA physical status I and II patients (150 male and 143 female), requiring general anesthesia and orotracheal intubation. INTERVENTIONS: We used fiberoptic bronchoscope within the ETT to identify the carina and vocal cords. MEASUREMENTS: The length from carina to vocal cords, vocal cords to right mouth angle (corner), and carina to right mouth angle were measured. The optimal ETT tip was defined as 5 cm above the carina. Patient's height and sternum length were recorded. MAIN RESULTS: The correlation between airway length and body height was significant. By linear regression, a formula was obtained to estimate the optimal ETT length in orotracheally intubated patients: the length from 5 cm above carina to right mouth angle (cm) =< body height (cm)/5> - 13. CONCLUSION: The optimal insertion length of the ETT for orotracheally intubated adult patients with the head placed in a neutral position is correlated with body height. The proposed formula can provide a useful guide to determine the optimal ETT tip position in most of the patients who required orotracheal intubation.     

Body Composition by Dual-Energy X-ray Absorptiometry in Black Compared with White Women

Dual-energy X-ray absorptiometry (DXA) has recently been applied to the measurement of body composition using a three-compartment model consisting of fat, lean and bone mineral. The mass of skeletal muscle may be approximated by measurement of the lean tissue mass of the extremities. In addition, body fat distribution can be estimated by determining the ratio of fat in the trunk to the fat in the extremities. In the current study, DXA was used to compare body composition and fat distribution between black (n= 162) and white women (n= 203). Black women had a higher mineral mass and a higher skeletal muscle mass. The ratio of mineral to muscle mass was higher in black women, even when the data were adjusted for age, height and weight. Both total body bone mineral and muscle mass declined with age in both races, with evidence for an accelerated loss of bone mineral after menopause. Body size (height and weight) was generally a significant variable in developing regressions of each compartment against age. Their higher musculoskeletal mass may lead to misclassification of 12% of black women as obese if body mass index is used as an index of obesity. Body fat distribution (trunk/leg) did not differ between races in the raw data. However, for women of the same age, height and weight, white women have a significantly higher trunk/leg fat ratio. Body composition values for fat, lean and bone mineral obtained from DXA should be adjusted not only for gender but also for age, height, weight and ethnicity. Received: 23 September 1998 / Accepted: 4 January 1999     

Front Teeth-to-Carina Distance in Children Undergoing Cardiac Catheterization

Background: Knowledge of normal front teeth-to-carina distance (FT-C) might prevent accidental bronchial intubation. The aim of the current study was to measure FT-C and to examine whether the Morgan formula for oral intubation depth, i.e., endotracheal tube (ETT) position at front teeth (cm) = 0.10 x height (cm) + 5, gives appropriate guidance when intubating children of different ages.

Methods: FT-C was measured in 170 infants and children, aged 1 day to 19 yr, undergoing cardiac catheterization. FT-C was obtained as the sum of the ETT length at the upper front teeth/dental ridge and the distance from the ETT tip to the carina. The latter measure was taken from an anterior-posterior chest x-ray.

Results: There was close linear correlation between FT-C and height: FT-C (cm) = 0.12 x height (cm) + 5.2, R2 = 0.98. The linear correlation coefficients (R2) for FT-C versus weight and age were 0.78 and 0.91, respectively. If the Morgan formula had been used for intubation, the ETT tip would have been at 90 +/- 4% of FT-C. No patient would have been bronchially intubated, but the ETT tip would have been less than 0.5 cm from the carina in 13 infants.