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When cetuximab is used, diagnosing finger metastasis can be difficult due to the side effects of paronychia and color changes of nails. Finger metastasis may be a marker of multiple metastasis; therefore, it can lead to a poor prognosis.

When cetuximab is used, diagnosing finger metastasis can be difficult due to the side effects of paronychia and color changes of nails. Finger metastasis may be a marker of multiple metastasis; therefore, it can lead to a poor prognosis.

Norihiko Tsuboi,1 Kaoru Tsuboi,1 Nobuyuki Nosaka,1,2 Nao Nishimura,1 Satoshi Nakagawa1 1Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan; 2Department of Intensive Care Medicine, Tokyo Medical and Dental University, Tokyo, JapanCorrespondence: Norihiko TsuboiCritical Care Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, JapanTel +81-334160181Fax +81-224162222Email tsuboi-n@ncchd.go.jpAbstract: Although the pathophysiology of chronic obstructive pulmonary disease (COPD) is multifactorial, central airway collapse is reported to have a great impact on symptom severity. In COPD patients, positive pressure formed by hyperinflated lungs compressing the tracheal wall and negative changes in intratracheal static pressure due to rapid expiratory flow velocity at the beginning of expiration collapse the trachea. This phenomenon can be explained by fluid dynamics theory. Our hypothesis is that ventilatory strategy focusing on minimization of expiratory flow rate may be advantageous for patients receiving mechanical ventilation for COPD. If appropriate counter pressure could be applied on exhalation, patients may be able to exhale slowly with reduced expiratory flow rates which may prevent negative changes of the intratracheal static pressure. We devised a new conceptual ventilation mode “minimized expiratory flow rate ventilation (MExV)” which applies regulated counter pressure on exhalation. The conceptual waveforms of “minimized expiratory flow rate ventilation” including flow rate, volume, and airway pressure are shown, compared with typical waveforms of the conventional ventilation modes.Keywords: COPD, tracheomalacia, fluid dynamics, minimized expiratory flow rate ventilation, flow-controlled ventilation

type:text, [SUMMARY] Background: Hypotonic solutions are traditionally used as maintenance fluid in pediatric practice. Recently, several questions were raised regarding the safety of this practice particularly for critically ill or injured children. The aim of this research is to evaluate the risk of this widespread practice. Methods: We compared the change in serum sodium levels during the use of different kinds of maintenance fluid, i.e., a hypotonic solution（HYPO group, n＝48） and isotonic solution（ISO group, n＝31）, for postoperative children in the pediatric intensive care unit. The student T?test was used for statistical analysis. Results : No statistical significance was found between these two groups with regard to age, sex, sampling period, or initial laboratory findings（HYPO 137±3 mEq/l vs. ISO 137±5mEq/l）. Over time, the difference in serum sodium levels became statistically significant between the groups（HYPO 131±4mEq/l vs. ISO 135±3mEq/l, p＜0.05）. Conclusions : There is a significant risk of decreasing serum sodium levels during hypotonic solution use with postoperative children even if they are healthy. Using an isotonic solution instead can prevent the silent progression of hyponatremia in postoperative children.

type:text, [SUMMARY] Bidirectional superior cavopulmonary anastomosis （BCPA） is now widely accepted as palliative surgery for congenital heart diseases such as hypoplastic left heart syndrome. Although hyperventilation is useful for decreasing pulmonary vessel resistance, reducing cerebral blood flow （CBF） may lead to low oxygenation after BCPA. However, Hoskote and Li concluded that moderate hypercapnia, which increases CBF, improved arterial oxygenation, reduced oxygen consumption and arterial lactate levels, thus improving overall oxygen transport in children after BCPA. We report here the use of near infrared spectroscopy（ NIRS） in our pediatric intensive care unit as a routine and useful bedside method of monitoring CBF after BCPA. We found clearly that hypercapnia increased the tissue oxygenation index on NIRS and improved oxygenation after BCPA. This hyperventilation strategy may have life-saving potential for some patients after BCPA, and its use in conjunction with NIRS bedside monitoring should be promoted in Japan.

type:text, [SUMMARY]Transportation, whether by ground or air, exposes patients and health care providers to mechanical shocks, vibrations, and loud noises. The potential dangers posed by these forces remain largely unknown. We investigated the three dimensional vibration / acceleration forces during pediatric transportation in an ambulance and helicopter. The vibration / acceleration forces were almost 1 m/s2 during transport by helicopter including both takeoff and landing. However, transport by ambulance showed remarkable omnidirectional vibration often up to 2 m/s2 and sometimes reaching 3-4 m/s2. Further evaluation of vibrational stress and means of attenuating vibration during pediatric transportation are needed to enhance patient safety.

[SUMMARY] Background: Hypotonic solutions are traditionally used as maintenance fluid in pediatric practice. Recently, several questions were raised regarding the safety of this practice particularly for critically ill or injured children. The aim of this research is to evaluate the risk of this widespread practice. Methods: We compared the change in serum sodium levels during the use of different kinds of maintenance fluid, i.e., a hypotonic solution（HYPO group, n＝48） and isotonic solution（ISO group, n＝31）, for postoperative children in the pediatric intensive care unit. The student T?test was used for statistical analysis. Results : No statistical significance was found between these two groups with regard to age, sex, sampling period, or initial laboratory findings（HYPO 137±3 mEq/l vs. ISO 137±5mEq/l）. Over time, the difference in serum sodium levels became statistically significant between the groups（HYPO 131±4mEq/l vs. ISO 135±3mEq/l, p＜0.05）. Conclusions : There is a significant risk of decreasing serum sodium levels during hypotonic solution use with postoperative children even if they are healthy. Using an isotonic solution instead can prevent the silent progression of hyponatremia in postoperative children.

[SUMMARY] Bidirectional superior cavopulmonary anastomosis （BCPA） is now widely accepted as palliative surgery for congenital heart diseases such as hypoplastic left heart syndrome. Although hyperventilation is useful for decreasing pulmonary vessel resistance, reducing cerebral blood flow （CBF） may lead to low oxygenation after BCPA. However, Hoskote and Li concluded that moderate hypercapnia, which increases CBF, improved arterial oxygenation, reduced oxygen consumption and arterial lactate levels, thus improving overall oxygen transport in children after BCPA. We report here the use of near infrared spectroscopy（ NIRS） in our pediatric intensive care unit as a routine and useful bedside method of monitoring CBF after BCPA. We found clearly that hypercapnia increased the tissue oxygenation index on NIRS and improved oxygenation after BCPA. This hyperventilation strategy may have life-saving potential for some patients after BCPA, and its use in conjunction with NIRS bedside monitoring should be promoted in Japan.

[SUMMARY]Transportation, whether by ground or air, exposes patients and health care providers to mechanical shocks, vibrations, and loud noises. The potential dangers posed by these forces remain largely unknown. We investigated the three dimensional vibration / acceleration forces during pediatric transportation in an ambulance and helicopter. The vibration / acceleration forces were almost 1 m/s2 during transport by helicopter including both takeoff and landing. However, transport by ambulance showed remarkable omnidirectional vibration often up to 2 m/s2 and sometimes reaching 3-4 m/s2. Further evaluation of vibrational stress and means of attenuating vibration during pediatric transportation are needed to enhance patient safety.

When cetuximab is used, diagnosing finger metastasis can be difficult due to the side effects of paronychia and color changes of nails. Finger metastasis may be a marker of multiple metastasis; therefore, it can lead to a poor prognosis.

When cetuximab is used, diagnosing finger metastasis can be difficult due to the side effects of paronychia and color changes of nails. Finger metastasis may be a marker of multiple metastasis; therefore, it can lead to a poor prognosis.