Fibreoptic bronchoscopy for tracheal and endobronchial intubation with a double-lumen tube

A 68-year-old patient was scheduled for a thoracotomy. A double-lumen endobronchial tube was requested by the surgeon to facilitate operating conditions. Initial attempts at intubation by conventional methods were unsuccessful. The proximal ends of a 37F double-lumen tube were then shortened and a 4-mm fibreoptic bronchoscope was passed through the bronchial lumen. The patient's larynx was easily visualized and the bronchoscope was passed into the trachea. The double lumen tube was then advanced over the bronchoscope and correctly positioned. Shortening a double-lumen tube allows the use of a fibreoptic bronchoscope to aid in tracheal intubation in a patient whose larynx is difficult to visualize by conventional methods.     

Spectrally opponent inputs to the human luminance pathway: slow +M and −L cone inputs revealed by intense long-wavelength adaptation

The nature of the inputs to achromatic luminance flicker perception was explored psychophysically by measuring middle- (M-) and long-wavelength-sensitive (L-) cone modulation sensitivities, M- and L-cone phase delays, and spectral sensitivities as a function of temporal frequency. Under intense long-wavelength adaptation, the existence of multiple luminance inputs was revealed by substantial frequency-dependent changes in all three types of measure. Fast (f) and slow (s) M-cone input signals of the same polarity (+sM and +fM) sum at low frequencies, but then destructively interfere near 16 Hz because of the delay between them. In contrast, fast and slow L-cone input signals of opposite polarity (−sL and +fL) cancel at low frequencies, but then constructively interfere near 16 Hz. Although these slow, spectrally opponent luminance inputs (+sM and −sL) would usually be characterized as chromatic, and the fast, non-opponent inputs (+fM and +fL) as achromatic, both contribute to flicker photometric nulls without producing visible colour variation. Although its output produces an achromatic percept, the luminance channel has slow, spectrally opponent inputs in addition to the expected non-opponent ones. Consequently, it is not possible in general to silence this channel with pairs of 'equiluminant' alternating stimuli, since stimuli equated for the non-opponent luminance mechanism (+fM and +fL) may still generate spectrally opponent signals (+sM and +sL).     

Gender Trends in Emergency Medicine Publications

Background In recent years, the number of women entering the field of emergency medicine (EM) has increased.
Objectives To determine if authorship in EM publications has increased in parallel with this trend.
Methods The gender of first and last authors of EM articles in Academic Emergency Medicine , American Journal of Emergency Medicine , Annals of Emergency Medicine , and Journal of Emergency Medicine were examined. The authors reviewed articles from 1985, 1995, and 2005 for American Journal of Emergency Medicine , Annals of Emergency Medicine , and Journal of Emergency Medicine and from 1999 and 2005 for Academic Emergency Medicine . The primary outcomes were the proportions of female authors.
Results A total of 2,016 articles were reviewed. Overall, 18% of first and last authors were female. Respectively, for 1985, 1995, 1999, and 2005, the proportions of female first authors were 9%, 15%, 19%, and 24%; the proportions of female last authors were 9%, 18%, 19%, and 22%. The trend of increases in female authorship was statistically significant.
Conclusions Although female authorship remains a minority in EM publications, it has increased significantly in parallel with increases in female participation in EM.     

Computed tomography and plain radiography in experimental fracture healing

We evaluated the relative contribution of plain radiographs and computed tomography to the assessment of fracture healing under experimental circumstances. In 15 sheep, we performed midshaft femoral osteotomies and internal fixation of the resultant segmental fractures. Radiographs were obtained preoperatively and immediately postoperatively. Animals were sacrificed at 3 weeks, 6 weeks, 12 weeks, 24 weeks, and 36 weeks after surgery, and the femoral specimens radiographed. After removal of the internal fixation devices, computed tomographic scans of the specimens were performed.By 3 weeks, callus was visible, but at 6 weeks, a trabecular pattern in the callus was seen on plain films but not on computed tomography. There was progressive organization of the callus on both studies. At 24 weeks, computed tomography demonstrated fracture lines not seen due to overlying callus on plain films and also more accurately showed incomplete union. By 36 weeks, healing was essentially complete according to both modalities, although there still were small gaps in the callus detectable on computed tomography but not on plain films.Computed tomography may be of value in the evaluation of fractures of long bones in those cases in which clinical examination and plain radiographs fail to give adequate information as to the status of healing.     

Evaluation of a respiratory rate monitor in postsurgical patients.

STUDY OBJECTIVE: To evaluate the clinical use of a cardiorespiratory rate monitor in patients receiving epidural opioids following major surgery. DESIGN: For 6 hours during the night following surgery, patients were continuously monitored with a cardiorespiratory rate monitor and a pulse oximeter, as well as by an in-room observer. SETTING: Postoperative surgical ward at a university hospital. PATIENTS: Eight ASA physical status I and II patients ages 30 to 76 years. INTERVENTIONS: Any bradypneic, hypoxemic, bradycardic, or tachycardic event was confirmed by the observer and recorded. MEASUREMENTS AND MAIN RESULTS: The cardiorespiratory rate monitor accurately identified true bradypneic episodes in five of the eight patients. There were no false-positive alarms. The respiratory rate monitor and the pulse oximeter identified one episode of hypoxemia. There were no episodes of bradycardia or tachycardia. CONCLUSIONS: The cardiorespiratory rate monitor is useful in patients at risk for bradypnea following surgery.     

The effects of various indwelling ureteral catheter materials on the normal canine ureter

In an attempt to objectively evaluate the biocompatibility of materials commonly used for ureteral stenting, stent-catheters made of four different materials were placed randomly in 31 ureters of 19 mongrel dogs. Animals underwent urography at four weeks and were sacrificed at six weeks. Mild hydronephrosis was noted in eight instances, essentially unrelated to specific material. Silicone, C-flex and polyurethane stents caused a similar, mild degree of ureteral edema, but ureters stented with Silitek demonstrated fairly marked edema. Epithelial ulceration and erosion, often severe, occurred with all polyurethane stents, and rarely with the three other materials. All materials differed statistically from controls, and C-flex caused less reaction overall than polyurethane, indicating differences in biocompatibility of the various materials which may be relevant to their use in patients undergoing long-term ureteral stenting. In practical terms, these suggest that certain materials, notably silicone and C-flex, are more suitable for ureteral stenting than others.     

Brief dialectical behavior therapy (DBT-B) for suicidal behavior and non-suicidal self injury.

The purpose of this study is to evaluate the effectiveness of a shorter course of Dialectical Behavior Therapy (DBT) in enhancing treatment retention and reducing: urges to engage in non-suicidal self injury (NSSI), NSSI, suicide ideation, and subjective distress in borderline personality disorder (BPD). Twenty patients with BPD received a six-month course of Dialectical Behavior Therapy (DBT-B). DBT-B was delivered in the standard manner except for the shortened duration from one-year minimum to six months. All variables were measured at baseline, and at six months. Data were analyzed using paired t-tests. Treatment retention rate was 95%. Significant reductions were found in NSSI urges, NSSI, suicide ideation, subjective distress, depression, and hopelessness between baseline and six months. These results support the use of DBT-B in a six-month format when NSSI and suicidal behavior and ideation are the targeted behaviors. Target behaviors were reduced significantly and retention was extremely high in comparison to other interventions for this population. A large scale randomized controlled trial investigating its efficacy is warranted to determine if the results can be replicated and if improvement can be sustained.