Etomidate for Rapid-sequence Intubation in Young Children: Hemodynamic Effects and Adverse Events

OBJECTIVES: Physicians commonly use etomidate for adult rapid-sequence intubation (RSI), but the manufacturer does not recommend its use for children under 10 years of age due to a lack of data. The authors present their experience with etomidate for pediatric RSI in order to further develop its risk-benefit profile in this age group. METHODS: Trained abstractors reviewed the medical records for all children under 10 years old who received etomidate for RSI between July 1996 and April 2001. RESULTS: 105 children, with an average age of 3 (+/-2.9) years, received a median dose of 0.32 (+/-0.12) mg/kg of etomidate. The systolic blood pressure increased an average of 4 mm Hg (95% CI = -3.3 to 9.2); the diastolic blood pressure increased 7 mm Hg (95% CI = -3.1 to 11) within 10 minutes of receiving etomidate. The heart rate increased an average of 10 beats/min (95% CI = 4.0 to 17.4). Complications included three patients who vomited within 10 minutes of etomidate administration. There were no cases of documented myoclonus, status epilepticus, or new-onset seizures. Thirty-eight patients received corticosteroids during the hospital course, none for suspected adrenal insufficiency. Three patients died, all from severe brain injury. CONCLUSIONS: In children less than 10 years old, etomidate seems to produce minimal hemodynamic changes, and appears to have a low risk of clinically important adrenal insufficiency, myoclonus, and status epilepticus. The association between etomidate and emesis (observed in less than 3% of enrolled patients) remains unclear. For clinical situations in which minimal blood pressure changes during RSI are critical, etomidate appears to have a favorable risk-benefit profile for children under 10 years old.     

General practitioner registrars'' views about a career in general practice.

BACKGROUND. Current low morale in general practice and the fall in the number of general practitioner registrars (trainees) has led to concern about the decline in popularity of general practice as a career. AIM. A study was performed to evaluate the career intentions of general practitioner registrars and the factors underlying their decisions. METHOD. An anonymous postal questionnaire seeking both quantitative and qualitative data was sent to 138 registrars during June 1993. All were registrars at practices in the south west region of England. Outcome measures used were the popularity of different types of general practice work and identification of variables and emergent themes considered important in career choice. RESULTS. A total of 101 registrars returned questionnaires (73%). Of the respondents, 96% expressed an interest in general practice as a career. However, registrars expressed considerable uncertainty about the future of general practice and therefore their career. Continuity of care and a holistic approach were considered valued aspects of work in general practice. Increased workload, increased out-of-hours work and erosion of professional autonomy emerged as negative aspects of a career in general practice. Of the respondents, 91% considered time for leisure activities an important factor when considering future career, 72% would have been glad to do away with 24-hour cover and 99% agreed that general practitioners increasingly fear litigation. CONCLUSION. Although registrars were interested in general practice as a career they had many concerns and expressed uncertainties. The future popularity of general practice is likely to depend on addressing these concerns and on the clarification of the future direction of the profession.     

Consensus Recommendations for the Diagnosis and Management of Pancreatic Neuroendocrine Tumors: Guidelines from a Canadian National Expert Group

Annals of Surgical Oncology - Pancreatic neuroendocrine tumors (pNETs) are rare heterogeneous tumors that have been steadily increasing in both incidence and prevalence during the past few decades....     

The role of emotion identification skill in the formation of male and female friendships: A longitudinal study

The present study explored the relationship between emotion identification skill (EIS) and friendships in adolescence. Students from five Australian high schools completed questionnaires annually from Grade 8 to Grade 12 including subjective measures of EIS and a peer-based objective measure of social functioning (e.g., friendship nominations). The total sample of participants was 795 (406 males; 389 females) with 468 (225 males; 243 females) completing questionnaires in Grade 12. EIS in early adolescence was predictive of friendships for females in late adolescence. Specifically, girls starting out with low EIS in Grade 8 tended to have fewer female friendships and more male friendships in Grade 12. There were no effects for males. Lower initial EIS was associated with significant improvements in awareness over time, but these improvements had no effect on friendships in Grade 12. The EIS that girls enter high school with may influence their friendship composition into late adolescence.     

Retroperitoneal margin of the pancreaticoduodenectomy specimen: anatomic mapping for the surgical pathologist

Surgical margin status of the pancreaticoduodenectomy specimen is an independent predictor of survival in patients with pancreatic head cancer. Although most surgical pathologists are familiar with the protocols for grossing and evaluation of the various margins of the specimen, the currently prevailing definitions of the retroperitoneal surgical margin minimize the fact that this margin is actually a combination of surfaces of different anatomical structures. The unfamiliarity with its detailed anatomy often creates communication gaps when the pathologic findings are presented to other members of the multidisciplinary team. The following discussion is the collective opinion of hepato-pancreato-biliary pathologists in two tertiary care Canadian medical centers in this field. It describes the authors’ proposed nomenclature and landmarks for anatomic mapping of the retroperitoneal margin of the pancreaticoduodenectomy resected specimen. Increasing familiarity with the subtleties of the retroperitoneal margin is expected to improve communication and sets the stage for future quality improvement initiatives and translational research in the multidisciplinary setting.     

The Marshall technique: an economic one-stage technique for nipple-areola reconstruction.

The goals of nipple-areola reconstruction are symmetry in position, shape, size, colour, tone, texture, sensation and responsiveness. These goals are best attempted when the breast-mound reconstruction has been completed. We describe a technique in which the skin of the neo-areola is raised as a split-thickness skin graft, and then re-grafted to the same site with a free nipple graft. This technique is always available, requires no special equipment, causes no donor-site morbidity and produces excellent results. The disadvantage is that it may be more difficult following radiotherapy or if the mastectomy scar traverses the desired site of nipple-areola reconstruction. As with any skin graft, the neo-areola may lose pigmentation, imperfectly 'take' or contract with time. This technique has not been previously described in the literature.     

Variability of acute physiological responses and performance profiles of youth soccer players in small-sided games

The aim of this study was to examine the variability in physiological and perceptual responses and time-motion profiles of various small-sided soccer game (SSG) formats (2 versus 2, 4 versus 4 and 6 versus 6 players) and regimes (interval and continuous). Typical error (TE) was calculated for mean heart rate as a percentage of maximum heart rate (%HR(max)), global ratings of perceived exertion (RPE), blood lactate [La(-)] and various time-motion characteristics for 16 male soccer players (mean 16.2 years, range 15.6-17.9). The TE for HR responses were <5% for all SSGs. RPE also demonstrated small variability across all SSGs, with TE ranging between 1 and 2 units. In contrast, the TE% for [La(-)] was higher, ranging from 16% (2 versus 2-interval) to 34% (4 versus 4-interval). The TE% for total distance (TD) and distance covered at 0-6.9km/h was <5% for all SSGs, with 2 versus 2 interval and continuous games recording the lowest TE (2.2% and 2.9%, respectively). An increase in game format size does not appear to influence the variability of the acute physiological responses to SSGs, although continuous formats display less variability than interval formats. The TD, distance covered and percentage of total time moving at 0-6.9km/h demonstrated small variability across all formats and regimes. However, higher movement speeds zones (>8km/h) reflected increased variability, irrespective of game format or regime. Collectively, these results suggest that SSG training can provide a reliable aerobic training stimulus.