Airway reconstruction following laryngotracheal thermal trauma

Care of burn patients is a complex problem for the trauma team involving management of fluid and electrolyte imbalances, infections, and ultimately reconstruction. Patients with burns of the head, neck, and upper thorax present a series of unique problems because of a high incidence of associated upper and lower airway thermal trauma necessitating intubation and ventilatory support. A series of cases requiring laryngotracheal reconstruction following severe burns to the head and neck region is reported. Methods of treatment are discussed as well as modifications of standard burn therapy to decrease the incidence of severe scarring.     

The use of a portable capnometer as a tracheostomy monitor in an animal model

Home care of a tracheostomy patient in the pediatric age group is a challenging problem. Accidental decannulation is always a potential hazard in children with tracheostomies. The most effective monitoring system in these individuals is an experienced, alert observer. Unfortunately, caretakers cannot be expected to provide constant surveillance. Because of this, various types of mechanical monitoring systems have been developed for patients with tracheostomies. An animal model was employed to investigate the reliability of a portable capnometer in assessing the status of a tracheostomy tube under varying experimental conditions. The capnometer was found to be a reliable tool and it will now be evaluated in the clinical setting.     

Is sedation safe during dynamic sleep fluoroscopy of children with obstructive sleep apnea?

OBJECTIVE: Airway compromise is considered a relative contraindication for pediatric sedation. This contraindication presents a paradoxical problem when patients require sedation in preparation for imaging performed to evaluate the cause of airway obstruction. We use dynamic sleep fluoroscopy in the evaluation of children who have obstructive sleep apnea. The purpose of this study was to evaluate the success and safety of a structured sedation program for dynamic sleep fluoroscopy. MATERIALS AND METHODS: Eighty consecutive dynamic sleep fluoroscopic studies were evaluated. The type of sedation used, success rate, complications related to the sedation, and characteristics of the children studied were reviewed. Patients were sedated in accordance with our departmental sedation program guidelines. Findings on fluoroscopy were correlated with episodes of oxygen desaturation or noisy breathing. RESULTS: In all 80 cases, dynamic sleep fluoroscopy was successfully performed. Seventy-two studies were performed, with sedation supervised by the radiologist. Four patients fell asleep without sedation. In four patients, sedation was performed by an anesthesiologist (preprocedural decision). Sixty-four children (80%) had complex medical problems, and 39 (49%) had a history of previous airway surgery. All studies were considered successful. Specific diagnoses were identified in 66 children (83%). No children suffered complications or required tracheal intubation. CONCLUSION: Children with airway compromise who are being evaluated for obstructive sleep apnea can be successfully and safely sedated for dynamic sleep fluoroscopy when a structured sedation program is used.     

Reducing knee and anterior cruciate ligament injuries among female athletes: a systematic review of neuromuscular training interventions

There is evidence that neuromuscular training not only decreases the potential biomechanical risk factors for ACL injury, but also decreases knee and, specifically, ACL injury incidence in female athletes. Five of the six interventions in this systematic review demonstrated significant effects on overall knee or ACL injury rates. It appears that plyometric power, biomechanics and technique, strength, balance, and core stability training can induce neuromuscular changes and potential injury prevention effects in female athletes. However, it is unknown which of these components is most effective or whether the effects are combinatorial. Future research should assess the relative efficacy of these interventions alone and in combination to achieve the optimal effect in the most efficient manner possible. Selective combination of neuromuscular training components may provide additive effects, further reducing the risk of ACL injuries in female athletes. Additional research directions include the assessment of relative injury risk using mass neuromuscular screening, the development of more specific injury prevention protocols targeted toward high-risk athletes, and the determination of when these interventions should be implemented. It may be that prepubertal or early pubertal female athletes may have the potential to achieve optimal biomechanical changes and the greatest chance of injury-free sports participation throughout their careers.     

Introducing HIV/AIDS to South African health sciences students

Given the burden of HIV/AIDS in South Africa, there is a need to introduce students to the issues health professionals face about the disease. We developed an introductory peer-led workshop on HIV/AIDS for first year students covering a range of biomedical and social issues. To evaluate the workshops, volunteer students were randomly allocated to participate in one of the workshops or not. At follow-up, students who participated in the workshops showed positive changes in their attitudes and skills regarding HIV. They were also more likely to feel empathy towards HIV-infected people and be more comfortable with the prospect of working with HIV-infected patients, compared to controls. This programme represents a platform for introducing a 'golden thread' of HIV/AIDS into health sciences curricula in countries profoundly affected by the epidemic.     

Severe holocarboxylase synthetase deficiency with incomplete biotin responsiveness resulting in antenatal insult in samoan neonates

We describe 7 Polynesian babies with a unique severe form of holocarboxylase synthetase deficiency characterized by antenatal growth retardation, subependymal cysts, only partial response to biotin, and a poor outcome.