A new formula based on height for determining endotracheal intubation depth in pediatrics: A prospective study.

STUDY OBJECTIVE: The main objective was to devise an endotracheal intubation formula based on pediatric patients' strongly correlated growth parameters. The secondary objective was to compare the accuracy of the new formula to the age-based formula from Advanced Pediatric Life Support Course (APLS formula) and the middle finger length-based formula (MFL-based formula). DESIGN: A prospective, observational study. SETTING: Operation. PATIENTS: 111 subjects age 4-12 years old undergoing elective surgeries with general orotracheal anesthesia. INTERVENTIONS AND MEASUREMENTS: Growth parameters, including age, gender, height, weight, BMI, middle finger length, nasal-tragus length, and sternum length, were measured before surgeries. Tracheal length and the optimal endotracheal intubation depth (D) were measured and calculated by Disposcope. Regression analysis were used to establish a new formula for predicting the intubation depth. A self-controlled paired design was used to compare the accuracy of the intubation depth between the new formula, APLS formula, and MFL-based formula. MAIN RESULTS: Height (R = 0.897, P < 0.001) was strongly correlated to tracheal length and the endotracheal intubation depth in pediatric patients. New formulae basing on height were established, including new formula 1: D (cm) = 4 + 0.1 × Height (cm) and new formula 2: D (cm) = 3 + 0.1 × Height (cm). Via Bland-Altman analysis, the mean differences for new formula 1, new formula 2, APLS formula and MFL-based formula were - 0.354 cm (95% LOA, -1.289 to 1.998 cm), 1.354 cm (95% LOA, -0.289 to 2.998 cm), 1.154 cm (95% LOA, -1.002 to 3.311 cm), -0.619 cm (95% LOA, -2.960 to 1.723 cm), respectively. The rate of optimal intubation for new formula 1 (84.69%) was higher than for new formula 2 (55.86%), APLS formula (61.26%), and MFL-based formula. (69.37%). CONCLUSIONS: The prediction accuracy for intubation depth of the new formula 1 was higher than the other formulae. The new formula based on height: D (cm) = 4 + 0.1 × Height (cm) was preferable to APLS formula and MFL-based formula with a high incidence of appropriate endotracheal tube position.

[Sonographic features and diagnostic analysis of breast granulomatous diseases: a report of 32 cases].

OBJECTIVE: To evaluate the sonographic features of different pathological types of breast granulomatous diseases and analyze the feasibility of ultrasonic diagnosis. METHODS: A total of 32 patients with different pathological types of breast granulomatous diseases were recruited. Their clinical and sonographic findings were retrospectively reviewed. There were granulomatous mastitis (n = 12), breast xanthogranuloma (n = 5), lipogranuloma (n = 2), foreign body granuloma (n = 1) and nonspecific granulation hyperplasia (n = 12). RESULTS: Based on major sonographic appearances, they were divided into 4 patterns of tubular, mass, diffuse and cystic mass. In 12 patients with granulomatous mastitis and 12 patients with nonspecific granulation hyperplasia, the major sonographic appearance was of tubular pattern (n = 6, 5), followed by mass pattern (n = 4, 5) and diffuse pattern (n = 2, 2). Five patients with breast xanthogranuloma and 1 patient with foreign body granuloma all showed mass pattern. In 2 patients with lipogranuloma, one was of mass pattern and another cystic pattern. In patients with granulomatous mastitis and patients with nonspecific granulation hyperplasia, it showed a high diagnostic reliability of ultrasound. The ratio of inflammatory lesion as the first sonographic diagnosis was 10/12 and 8/12 respectively and ultrasonic BI-RADS 4b or above both only 1/12. However, the ratio of sonographic imaging in patients with xanthogranuloma and Lipogranuloma mimic breast cancer, in which ultrasonic score as breast imaging-reporting and data system (BI-RADS) 4b or above was 4/5 and 1/1 respectively. CONCLUSIONS: Ultrasound is valuable in evaluating the lesions in patients with granulomatous mastitis and nonspecific granulation hyperplasia. However a definite diagnosis is still dependent on histopathology.

[Application of fetal echocardiography in detection of fetal arrhythmia and its clinical significance].

OBJECTIVE: To investigate application of fetal echocardiography in diagnosis of fetal arrhythmia and its clinical significance. METHODS: Fetal echocardiography was performed on 725 fetuses for evaluation of fetal heart structures and arrhythmias. Two-dimensional, M-mode, Color M-mode and pulsed Doppler echocardiography were used. RESULTS: Ninety fetuses were documented with fetal arrhythmia, the commonest fetal arrhythmia encountered in 72 cases extrasystole was (65 atrial extrasystoles, 7 ventricular extrasystoles), followed by bradycardia in 9 cases, tachycardia in 6 cases, 2:1 atrioventricular block in 2 cases, atrial flutter in 1 case. There were 4 fetuses with arrhythmias and structural heart diseases: 2 fetuses were found died in uterus within two-week follow-up (1 with single ventricle and pulmonary stenosis, 1 with cardiac rhabdomyoma, fetal echocardiographic findings were confirmed at autopsy), another 2 cases (1 with mitral atresia and 1 with atrioventricular canal defect, autopsy confirmed the fetal echocardiographic diagnoses) received termination of pregnancy later. One 38-week fetus with atrial flutter underwent cesarean section, neonatal ECG confirmed the arrhythmia, and Cedilanid D induced successful conversion. All the other 85 fetuses were with intermittent arrhythmia, normal heart structures, and had no fetal hydrops. After receiving routine treatment, all of them had term deliveries and follow-up monitoring showed normal neonatal heart rhythms (auscultation). CONCLUSIONS: Fetal echocardiography is the main diagnostic tool for prenatal evaluation of fetal arrhythmias. The outcomes of the vast majority of fetal arrhythmias are benign, especially for fetuses with extrasystoles. Their arrhythmias are always well tolerated and disappear during the perinatal period. Fetuses with intermittent arrhythmias without structural heart malformations, fetal hydrops or heart failure, can be followed up with routine prenatal care without the need for special intervention.

Comparison study of harmonic imaging (HI) and fundamental imaging (FI) in fetal echocardiography.

OBJECTIVES: To directly compare the quality of harmonic imaging (HI) and fundamental imaging (FI) in fetal echocardiography and to determine any differences in image quality between the two modalities. METHODS: Fetal echocardiograms were performed with the use of FI and HI in 58 fetuses, image quality and visualization of left and right atria, left and right ventricles, mitral and tricuspid valves, aortic and pulmonary valves, left and right ventricular outflow tracts were evaluated and compared between FI and HI. RESULTS: Mean HI scores were higher than mean FI scores (2.73 +/- 0.43 vs 2.16 +/- 0.69, P < 0.001) for all the cardiovascular structures evaluated. Compared with FI, HI improved the image quality and visualization of fetal cardiac structures in subjects with both good (2.73 +/- 0.43 vs 2.88 +/- 0.32, P < 0.001) and suboptimal (1. 65 +/- 0.41 vs 2.58 +/- 0.47, P < 0.001) echocardiographic windows. The interobserver correlation coefficient for the grading scores was 0.74 (P < 0.001). CONCLUSIONS: harmonic imaging enhances and improves the image quality of fetal echocardiography; and has important potential role in cardiac imaging in the fetus.