Optimal needle length for epinephrine prefilled syringe in children

Publication date: Available online 29 April 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Wiparat Manuyakorn, Buntita Bamrungchaowkasem, Nichanan Ruangwattanapaisarn, Wasu Kamchaisatian, Suwat Benjaponpitak




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Successful management of hereditary angioedema during pregnancy in a patient with heterozygous MTHFR mutation

Publication date: Available online 29 April 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Inmaculada Martinez Saguer, Carmen Escuriola Ettingshausen




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The Effect of Ventilating Tubes in Young Children with Recurrent Acute Otitis Media: an Update of the Literature

Abstract

Purpose of Review

Ventilating tube treatment (VT) is a common surgical procedure in preschool children. Twenty to fifty percent of children treated with VT suffer from recurrent acute otitis media (RAOM). The aim of this review is to update current knowledge on the topic.

Recent Findings

There is still controversy regarding the use of VT for children with RAOM. So far, only six randomized trials have been published. From the limited data pool, it seems that children with RAOM treated with VT experienced less time with acute otitis media and experienced less recurrence compared to controls. However, no difference in quality of life was found between subgroups in one trial.

Summary

Children with RAOM seem to benefit from VT on objective parameters, especially if middle ear effusion is present in between acute episodes. There is a need for more high quality evidence on the subjective domains such as disease severity and quality of life.

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Guidelines for the Treatment of Acute Otitis Media: Why Are There Worldwide Differences?

Abstract

Purpose of Review

This study aims to review differences between acute otitis media (AOM) diagnosis and treatment guidelines from different countries, with regards to the aspects of diagnostic criteria and methods, supplementary tests, treatment options, recommended first-, second-, and third-line antibiotics, non-antibiotic treatment options, and preventive means and measures.

Recent Findings

Tympanic membrane (TM) bulging, opacity, and presence of middle ear fluid are the pillars for diagnosis, as marginal/uncertain cases are not accepted anymore. Guidelines from developed countries offer the use of pneumatic otoscopy and tympanometry to aid diagnosis. Withholding antibiotic therapy and a "watchful waiting" in mild-moderate cases are preferred in settings where follow-up visits are both possible and attainable, mostly in developed countries. While amoxicillin is mostly accepted as the first-line antibiotic therapy, options for second- and third-line antibiotics vary, according to local bacteriology and antimicrobial susceptibility data and costs. Other treatments, such as complementary and alternative medicine, steroids, or anti-histamines, are either rejected or ignored. Reduction of known risk factors and call for vaccinations (influenza, pneumococcal conjugate vaccine) are encouraged mostly in developed countries, where such immunizations have been implemented in National Immunization Programs.

Summary

Despite regional differences, AOM guidelines worldwide share common grounds on various matters concerning diagnosis and management: diagnosis based on TM findings observed on otoscopy and/or pneumatic otoscopy or tympanometry, "watchful waiting" approach in appropriate cases, oral analgesic treatment using ibuprofen/paracetamol, reduction of risk factors, and preventive measures to reduce AOM.

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Development of a financially viable model for the management of mandibular fractures as day cases in a level 1 major trauma centre

There is a subgroup of patients with mandibular fractures who could safely and effectively be managed in an outpatient day-care unit. Suitability depends on medical, social, and operative factors, and identification of the correct criteria will govern management after that in the emergency department. Reduced use of beds would lead to less money being spent on emergency treatment, and increased capacity for elective surgery. The aims of this study were to identify a group of patients with mandibular fractures whose duration of operation and period of recovery would be suitable for treatment in the day-care unit, and to evaluate the potential financial benefits.

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Use of couplers for vascular anastomoses in 601 free flaps for reconstruction of defects of the head and neck: technique and two-year retrospective clinical study

We describe our experience with the use of 854 couplers for venous or arterial anastomoses, or both, in 601 free flaps for reconstruction of defects of the head and neck. We reviewed 601 patients who had had free flaps (with the microvascular anastomoses being made with couplers in 519) between July 2013 and December 2015. Personal details, and clinical data including the site of the defect, the tumour excised, the types of flaps, the size of the couplers, the method of anastomosis (venous or arterial) in which the coupler was used, and postoperative complications were recorded.

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Successful management of hereditary angioedema during pregnancy in a patient with heterozygous MTHFR mutation

Hereditary angioedema (HAE) caused by C1-esterase inhibitor (C1-INH) deficiency is a rare, autosomal dominant disorder. Type 1 HAE makes up 85% of cases and is caused by reduced circulating levels of C1-INH, whereas type 2 HAE is caused by dysfunctional circulating C1-INH despite normal levels.1 Symptoms of type 1 and 2 HAE may include abdominal symptoms and episodes of swelling of the face, genitalia, extremities, urinary tract, and upper airways. Angioedema of the upper airways is life-threatening and can lead to death by asphyxiation.

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