Sudden infant deaths in sitting devices.

BACKGROUND: As episodes of decreased oxygenation levels have been recorded in premature infants placed in car seats, it is believed that these infants are at risk of life-threatening events and death. No data on the prevalence of such infant deaths are available. The aim of our study was to determine the incidence of sudden deaths in infants occurring in sitting devices in a whole population and to determine whether premature infants account for a disproportionate number of these deaths. DESIGN: Retrospective population-based cohort study reviewing all cases of sudden unexpected death in infants between birth and 1 year of age that occurred in the province of Quebec between January 1991 and December 2000. RESULTS: Of the 508 deaths reviewed, 409 were unexplained and 99 were explained after investigation. Seventeen deaths occurred in a sitting device, of which 10 were unexplained. There was no excess of premature infants dying. However, there was an excess of infants of less than 1 month of age found to have died in a sitting position in the unexplained death group. In addition, three infants who died in a sitting position had an increased risk of upper airway obstruction. CONCLUSION: Although very few deaths occurred in car seats, our results suggest that caution should be used when placing younger infants in car seats and similar sitting devices, whether the infants have been born prematurely or not. We also recommend that more attention be given to infants at increased risk of upper airway obstruction.     

Drilling speaking valves: A modification to improve vocalization in tracheostomy dependent children

Pediatric tracheostomy dependence is associated with a variety of sequelae. Vocalization delay is commonplace and may result in long‐term communication disability. Passy‐Muir speaking valves are routinely used to allow such children to vocalize. Unfortunately, not all tracheostomy dependent children can tolerate the placement of a speaking valve. Elevated transtracheal pressures are often associated with failure. We describe a method of modifying a standard Passy‐Muir valve to decrease transtracheal pressures and thus improve tolerance of the valve. In our practice, the modification allows a broader range of children experience the benefit of speaking valve placement. Laryngoscope, 119:176–179, 2009     

Applications of the Double O to Z Flap Repair for Facial Reconstruction

Multiple defects are often encountered in the treatment of malignant skin tumors. Nearby defects can present a reconstructive challenge since the closure of one defect may impact the closure of the other defect. The double O to Z flap design is ideally suited to combine the closure of adjacent defects into one technique. This flap technique and design is illustrated and described. Examples include defects on the forehead, temple, cheek, and nose following Mohs micrographic surgery.     

An efficacy and tolerance comparison of emedastine difumarate 0.05% and levocabastine hydrochloride 0.05%: reducing chemosis and eyelid swelling in subjects with seasonal allergic conjunctivitis. Emadine Study Group

PURPOSE: To compare emedastine ophthalmic solution 0.05% BID to levocabastine ophthalmic suspension 0.05% BID in reducing chemosis, eyelid swelling and other signs and symptoms in subjects with seasonal allergic conjunctivitis. METHODS: In a randomized, double-masked, parallel controlled study, emedastine ophthalmic solution 0.05% BID was compared to levocabastine ophthalmic suspension 0.05% BID for control of chemosis, eyelid swelling and other parameters in the environmental allergy study model. RESULTS: At Days 7, 14, 30 and 42, emedastine was significantly better than levocabastine at controlling chemosis and eyelid swelling (p < 0.05). A statistical trend was seen at Day 3 (0.05 < p < 0.10). Results were clinically relevant at Days 30 and 42. Emedastine was also significantly better at reducing redness and itching at Days 7, 14, 30 and 42 (p < 0.05). CONCLUSION: Emedastine is more efficacious than levocabastine in reducing chemosis, eyelid swelling and other efficacy variables associated with seasonal allergic conjunctivitis.     

The @RISK Study: Risk communication for patients with type 2 diabetes: design of a randomised controlled trial

Background  

Patients with type 2 diabetes mellitus (T2DM) have an increased risk to develop severe diabetes related complications, especially cardiovascular disease (CVD). The risk to develop CVD can be estimated by means of risk formulas. However, patients have difficulties to understand the outcomes of these formulas. As a result, they may not recognize the importance of changing lifestyle and taking medication in time. Therefore, it is important to develop risk communication methods, that will improve the patients' understanding of risks associated with having diabetes, which enables them to make informed choices about their diabetes care.