Randomized clinical trial of pigtail catheter versus chest tube in injured patients with uncomplicated traumatic pneumothorax.

BACKGROUND: Small pigtail catheters appear to work as well as the traditional large-bore chest tubes in patients with traumatic pneumothorax, but it is not known whether the smaller pigtail catheters are associated with less tube-site pain. This study was conducted to compare tube-site pain following pigtail catheter or chest tube insertion in patients with uncomplicated traumatic pneumothorax. METHODS: This prospective randomized trial compared 14-Fr pigtail catheters and 28-Fr chest tubes in patients with traumatic pneumothorax presenting to a level I trauma centre from July 2010 to February 2012. Patients who required emergency tube placement, those who refused and those who could not respond to pain assessment were excluded. Primary outcomes were tube-site pain, as assessed by a numerical rating scale, and total pain medication use. Secondary outcomes included the success rate of pneumothorax resolution and insertion-related complications. RESULTS: Forty patients were enrolled. Baseline characteristics of 20 patients in the pigtail catheter group were similar to those of 20 patients in the chest tube group. No patient had a flail chest or haemothorax. Pain scores related to chest wall trauma were similar in the two groups. Patients with a pigtail catheter had significantly lower mean(s.d.) tube-site pain scores than those with a chest tube, at baseline after tube insertion (3.2(0.6) versus 7.7(0.6); P < 0.001), on day 1 (1.9(0.5) versus 6.2(0.7); P < 0.001) and day 2 (2.1(1.1) versus 5.5(1.0); P = 0.040). The decreased use of pain medication associated with pigtail catheter was not significantly different. The duration of tube insertion, success rate and insertion-related complications were all similar in the two groups. CONCLUSION: For patients with a simple, uncomplicated traumatic pneumothorax, use of a 14-Fr pigtail catheter is associated with reduced pain at the site of insertion, with no other clinically important differences noted compared with chest tubes. REGISTRATION NUMBER: NCT01537289 (http://clinicaltrials.gov).

Mental health services for children in out-of-home care.

This article documents the risk factors and high incidence of psychopathology among children in out-of-home placements. A framework and guiding principles for mental health service delivery are described that are consistent with the clinical needs of children in care and the child welfare goal of permanency.

Behavioral correlates of parental visiting during family foster care.

Frequency of visiting with biological parents during family foster care placement in two different groups of children with differing adjustments to care was found to be generally low and to be related to both the length of time the children had been in care and the number of placements they had experienced. Those children who were visited more frequently were found to exhibit fewer externalizing and internalizing behavior problems than those visited less frequently or not at all. These behavioral correlates of visiting were, however, to depend on the type of behavior focused on and the degree of adjustment the child had made to family foster care.

Correlates of therapy referral in foster children.

In order to identify the correlates of the behavioral maladjustment of children in foster care, a group of children in foster care who had been referred for therapy was compared to a group of children who had never been in therapy during their foster care placement on several relevant variables. Referred and nonreferred children differed on several important behavioral indicators: number of externalizing and internalizing behavior problems, behavioral competence, and mental age. Results of this comparison suggest that the age of the child when first placed in care, the number of different placements the child experiences during care, and the type of foster care placement (kinship vs. nonkinship) may all be related to the need for clinical services in this population. Theoretical and practical implications of these relationships are explored.

Effect of asynchronous transfer and oestrogen administration on survival and development of porcine embryos.

Results indicate that recovery of embryos on Days 11 and 13 of pregnancy was reduced for Day 5 embryos transferred to recipients on Day 6 of their oestrous cycle and was greatly reduced when embryos were transferred to recipients on Day 7 of the cycle (P less than 0.01). Administration of oestradiol-17 beta on Day 11 of the recipient's cycle did not appear to affect embryo development on Day 13. Day 6 embryos transferred to recipients on Day 8 of the oestrous cycle deteriorated rapidly within 24 h of transfer; there was no recovery of embryos from the uterus after 36 h. Treatment of pregnant gilts with 1 mg oestradiol-17 beta (i.v.) on Day 10.5 resulted in total embryonic loss by Day 23, but pregnancy rates of gilts treated with oestradiol-17 beta on Day 12 were similar to those of vehicle-treated gilts (60.6 vs. 71.4%).

Anomalous origin of the right coronary artery from the left sinus of Valsalva.

A 1-month-old boy without precedent clinical signs of heart disease died unexpectedly. At autopsy, the child was found to have origin of the right coronary artery from the left sinus of Valsalva immediately leftward to the thickening of the aortic wall at the cuspal commissure and adjacent to the ostium of the left main coronary artery. The association of this coronary anomaly with otherwise unexplained prenatal or early postnatal death has only recently been appreciated as a potential cause of sudden infant death and mimic of sepsis, dysrhythmias, congestive heart failure, or metabolic storage diseases.

Uterine secretory alterations coincident with embryonic mortality in the gilt after exogenous estrogen administration.

Sixteen crossbred gilts were assigned randomly to receive either an i.m. injection of sesame oil (control) or estrogen (E), 5 mg of estradiol valerate, on d 9 and 10 of pregnancy. Gilts were unilaterally hysterectomized on either d 12 and 14 or 16 and 18. Uterine horns were flushed with 20 ml of .9% sterile NaCl solution to recover conceptus tissue. Conceptuses and endometrial explants were cultured for 24 h with 100 microCi [3H] leucine in 15 ml of minimum essential media. After dialysis, culture media were submitted to 2D-polyacrylamide gel electrophoresis and incorporated proteins were analyzed by fluorography. Normal, intact conceptus tissue was recovered from control gilts. Estrogen-treated gilts flushed on d 12 and 14 contained intact conceptuses; however, uteri from two gilts on d 16 and three on d 18 contained degenerating conceptus tissue. Comparison of endometrial polypeptides synthesized in vitro indicated an alteration in E-treated gilts on d 12 through 18. Although similar polypeptides were present, a band of polypeptides with a Mr of approximately 30,000 and pI from 7.9 to 8.9 and a larger, acidic polypeptide (Mr = 100,000, pI 3.5 to 5.0) were faint or absent in E-treated gilts. Conceptuses elongated normally in the altered uterine environment, but failed to survive past d 14 in E-treated gilts. Although loss of specific polypeptides in E-treated gilts coincides with conceptus death, their function in conceptus development or attachment is unknown.

Effect of exogenous progesterone on prostaglandin F2 alpha release and the interestrous interval in the bovine.

The present study was developed to determine if administration of progesterone, early in the estrous cycle of the cow, stimulated an advanced pulsatile release of PGF2 alpha from the uterine endometrium resulting in a decreased interestrous interval. Twenty-three cyclic beef cows were randomly assigned to receive either sesame oil or progesterone (100 mg) on Day 1, 2, 3 and 4 of the estrous cycle. Peripheral plasma concentrations of progesterone and the metabolite of prostaglandin F2 alpha, 15-keto-13,14-dihydro-prostaglandin F2 alpha (PGFM) were measured by radioimmunoassay. Administration of exogenous progesterone increased peripheral plasma concentration of progesterone in treated (3.67 ng/ml) compared to control (1.28 ng/ml) cows from Day 2 through 5 of the estrous cycle. Progesterone administration shortened the interestrous interval (16.7 d) compared to controls (21.6 d). The shortened interestrous intervals in treated cows resulted from an earlier decline in peripheral plasma progesterone. Decline of peripheral plasma progesterone concentrations is coincident with an increased pulsatile release of PGFM in both progesterone treated and control cows. Results indicate that administration of exogenous progesterone stimulates an earlier maturation of endometrial development, causing an advanced release of PGF2 alpha which shortens the interestrous interval of the cow.