Preoxygenation by 8 deep breaths in 60 seconds using the Mapleson A (Magill), the circle system,or the Mapleson D system

Study ObjectiveTo investigate the efficacy of preoxygenation by eight deep breaths in 60 seconds with the Mapleson A (Magill) system, the circle anesthesia system, or the Mapleson D system at an oxygen flow of 5 L/min or 10 L/min.DesignRandomized, clinical study.SettingOperating room of a university hospital.Subjects10 healthy volunteers.InterventionsVolunteers underwent 6 preoxygenation trials consisting of 8 deep breaths in 60 seconds using the Mapleson A, Mapleson D, and the circle anesthesia systems at an oxygen flow of 5 L/min and 10 L/min.MeasurementsFractional end-tidal oxygen concentration (F_ETO₂) was measured at 15-second intervals during preoxygenation.ResultsAt an oxygen flow of 10 L/min, mean F_ETO₂ values at 60 seconds of preoxygenation were comparable among the Mapleson A, Mapleson D, and the circle anesthesia systems (87 ± 2.1%, 87 ± 1.6%, 87 ± 1.6%, respectively). Using an oxygen flow of 5 L/min, mean F_ETO₂ values at 60 seconds were similar among the Mapleson A, Mapleson D, and circle anesthesia systems (74 ± 4.1%, 75 ± 2.6%, 74 ± 4.4%, respectively); however, they were significantly lower than the corresponding values achieved at an oxygen flow of 10 L/min.ConclusionsThe 8-deep-breaths in 60 seconds technique at an oxygen flow of 10 L/min can achieve adequate preoxygenation with the Mapleson A (Magill), Mapleson D, and circle anesthesia systems. Suboptimal preoxygenation is obtained with the three systems when the oxygen flow used is 5 L/min.     

The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis

Background  

Overweight and obese persons are at risk of a number of medical conditions which can lead to further morbidity and mortality. The primary objective of this study is to provide an estimate of the incidence of each co-morbidity related to obesity and overweight using a meta-analysis.     

Colorectal cancer surveillance in inflammatory bowel disease： The search continues

Patients with inflammatory bowel disease （IBD） are at increased risk for colorectal cancer （CRC）. Risk factors for the development of CRC in the setting of IBD include disease duration, anatomic extent of disease, age at time of diagnosis, severity of inflammation, family history of colon cancer, and concomitant primary sclerosing cholangitis. The current surveillance strategy of surveillance colonoscopy with multiple random biopsies most likely reduces morbidity and mortality associated with IBD-related CRC. Unfortunately, surveillance colonoscopy also has severe limitations including high cost, sampling error at time of biopsy, and interobserver disagreement in histologically grading dysplasia. Furthermore, once dysplasia is detected there is disagreement about its management. Advances in endoscopic imaging techniques are already underway, and may potentially aid in dysplasia detection and improve overall surveillance outcomes. Management of dysplasia depends predominantly on the degree and focality of dysplasia, with the mainstay of management involving either proctocolectomy or continued colonoscopic surveillance. Lastly, continued research into additional chemopreventive agents may increase our arsenal in attempting to reduce the incidence of IBD-associated CRC.     

Squamous cell carcinoma complicating recessive dystrophic epidermolysis bullosa-Hallopeau–Siemens: a report of four cases

Background  Recessive dystrophic epidermolysis bullosa (RDEB), an autosomal-recessive genodermatosis, is one of the more severe forms of the epidermolysis bullosa dystrophica group, and is characterized by generalized blistering of the skin and mucous membranes. Cutaneous squamous cell carcinoma is one of the most serious complications of this disease.
Methods  We report four patients (three females and one male), two of whom were under 20 years of age, suffering from RDEB-Hallopeau–Siemens.
Results  All patients developed well-differentiated squamous cell carcinoma. No metastases were detected. All cases were treated surgically. Fatal evolution was noted in one patient. A second tumor was detected in another patient during the follow-up period. No further tumors or metastases were observed in the other patients.
Conclusions  Regular clinical and histologic examination of any nodular lesions or non healing ulcers of all patients suffering from RDEB-Hallopeau-Siemens to detect an early malignancy is recommended.