A comparison of emergence delirium scales following general anesthesia in children

Background: Emergence delirium (ED) is of increasing interest since the introduction of short‐acting volatiles such as sevoflurane. Methods: We compared the Pediatric Anesthesia Emergence Delirium (PAED), Watcha and Cravero scales for assessing the presence of ED in 117 of 118 consecutive children <18 years recovering from general anesthesia. The primary measure was the worst score for ED as assessed on each scale and for each patient during their PACU stay. An experienced anesthetist observer also made a subjective assessment of the presence of ED. Results: A PAED score of ≥10 detected ED in 37 children (32%), while the Watcha detected 30 (26%) and Cravero 41 (35%). Twenty‐five patients (21%) fulfilled criteria for ED in all three scales as did all eight patients assessed by the experienced pediatric anesthetist observer. Median PAED scores (interquartile ranges) for patients assessed as having ED or not respectively were for Watcha, 12 (11,14), 7 (4,8); for Cravero, 11 (9,13), 7 (4,8); and for the experienced anesthetist observer, 14.5 (13.5,16.5), 7 (6,10). Conclusions: All three scales correlated reasonably well with each other but have individual limitations in their potential to assess whether ED is present. In the absence of developing an improved research tool to assess ED, a PAED score >12 appears to provide greater sensitivity and specificity than a PAED score ≥10. However, the Watcha scale is a simpler tool to use in clinical practice and may have a higher overall sensitivity and specificity than the other scales.     

Simultaneous Occurrence of two Squamous Cell Carcinomas within a Nevus Sebaceous of Jadassohn in an 11-Year-Old Girl

Abstract:   The development of a squamous cell carcinoma within a nevus sebaceous of Jadassohn is very rare. We report here for the first time, the simultaneous occurrence of two squamous cell carcinomas within a single nevus sebaceous of Jadassohn.     

A methodological study of errors in vertical measurements of edentulous ridge height on orthopantomographic radiograms

The purpose of this methodological investigation was to study the relative magnitude of the various errors in vertical ridge measurements from orthopantomograms of edentulous patients. The study was divided into two parts, Part I and Part II. Part I included eleven patients. Two standard orthopantomograms were taken of each patient. Part II included five of the eleven patients in Part I. Here, a third X-ray taken with the mouth open was added to the X-rays from Part I. The X-rays were traced by three dentists. Twelve vertical measurements in the maxilla and in the mandible were made. The variance produced by the patients (morphological variance) and those produced by the dentist, the X-ray, the interaction patient-dentist, the interaction dentist-X-ray and the random variance (methodological variances) were separately estimated on the basis of a three-way mixed analysis of variance model. In Part I, on the average, the sum of the methodological variances constituted 1·7 % and 2·5 % of the total variance in the maxilla and in the mandible respectively. The X-ray produced the greatest single variance component, averaging 1·1 % in both jaws. Although generally statistically significant, the remaining methodological variances were of low magnitude. The interaction patient-dentist, however, was not significant in most cases. In Part II, on the average, the sum of the methodological variances increased to 38·8 % in the maxilla and 4·6 % in the mandible, mainly caused by an increase in the variance produced by the X-ray.