Hazards of orthodontics appliances and the oropharynx.
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Occasionally orthodontic appliances or parts of orthodontic appliances have caused problems with either the airway or the gastrointestinal tract. The type of appliances that have caused problems and their clinical management are discussed. A case is described in which an upper removable appliance with inadequate retention became lodged in a patient's pharynx lacerating the palatine tonsils. Suggestions are made to try and avoid the problems that were encountered in this case and others reported in the literature in patients undergoing orthodontic treatment. (+info)
Influence of airway-occluding instruments on airway pressure during jet ventilation for rigid bronchoscopy.
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We measured changes in airway pressure (Paw) caused by microsurgical instruments introduced into a rigid bronchoscope during high frequency jet ventilation (HFJV). With approval of the institutional Ethics Committee, 10 adults undergoing elective tracheobronchial endoscopy and endosonography during general anaesthesia were investigated. Inflation of an endosonography probe balloon in the left main stem bronchus caused airway obstruction. Pressure measurements proximal and distal to the obstruction were compared after three degrees of obstruction (0%, 50% and 90%) and with two different driving pressure settings. Airway obstruction increased the mean (SD) peak inspiratory pressure (PIP) from 7.5 (2.6) to 9.5 (3.5) mm Hg for 2 atm (P = 0.0008) and from 9.7 (3.7) to 13.0 (5.1) mm Hg for 3 atm (P = 0.0001). Airway obstruction did not alter peripheral PIP (7.2 (4.1) to 7.1 (3.7) mm Hg for 2 atm and 8.8 (4.3) to 9.4 (5.2) mm for 3 atm), but resulted in an end-expiratory pressure (EEP) beyond the narrowing being significantly greater than in the unobstructed airway (2.5 (3.4) to 5.5 (3.7) mm Hg for 2 atm; P = 0.0005) and 3.2 (3.6) to 8.0 (4.3) mm for 3 atm; P < 0.0001). Severe airway narrowing increases inspiratory pressure proximal and expiratory pressure distal to the obstruction in relation to the applied driving pressure. Since the distal EEP never exceeded PIP, even near-total airway obstruction should not cause severe lung distension or barotrauma in subjects with normal lungs. (+info)
Emergency airway management by intensive care unit nurses with the intubating laryngeal mask airway and the laryngeal tube.
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When using the laryngeal tube and the intubating laryngeal mask airway (ILMA), the medium-size (maximum volume 1100 ml) versus adult (maximum volume 1500 ml) self-inflating bags resulted in significantly lower lung tidal volumes. No gastric inflation occurred when using both devices with either ventilation bag. The newly developed medium-size self-inflating bag may be an option to further reduce the risk of gastric inflation while maintaining sufficient lung ventilation. Both the ILMA and laryngeal tube proved to be valid alternatives for emergency airway management in the experimental model used. (+info)
Association of dietary antioxidants and waist circumference with pulmonary function and airway obstruction.
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Dietary antioxidants, waist circumference, and pulmonary function were measured in the Fourth Scottish MONICA cross-sectional survey of 865 men and 971 women aged 25-64 years. Waist circumference was inversely related to forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC), even after adjustment for age, height, weight, working status, energy intake, and smoking variables in a multiple linear regression model (men: beta = -0.017 for FEV1 l/cm, p < 0.01 and beta = -0.008 for FVC, p = 0.04; women: beta = -0.009 for FEV1, p < 0.01 and beta = -0.007 for FVC, p = 0.01). After additional adjustment for waist circumference, estimated vitamin C and beta-carotene intakes were positively associated with lung function in men (vitamin C: beta = 0.102 for FEV1 l/mg/day, p = 0.03; beta-carotene: beta = 0.073 for FVC l/g/day, p = 0.02). Retinol and vitamin E were not significantly related to lung function for either sex. A case-control study of airway obstruction showed that waist circumference was significantly associated, while vitamin C could be protective. The study suggests that adequate intake of antioxidants and avoidance of increasing girth could help to preserve lung function. (+info)
The -403 G-->A promoter polymorphism in the RANTES gene is associated with atopy and asthma.
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Asthma is a complex inflammatory condition often associated with bronchial hyperreactivity and atopy. Genetic and environmental factors are implicated and several candidate genes have been implicated. Of these, the chemokine RANTES is responsible for the recruitment of inflammatory cells such as eosinophils and T-lymphocytes. We have recently identified a polymorphism within the RANTES promoter (-403 G-->A) and have examined its role, using a PCR-RFLP assay, in the development of atopy and asthma in 201 Caucasian subjects. Atopic status was determined using skin prick testing and serum IgE levels. Severity of airway dysfunction was assessed using spirometric measurement (FEV1) and methacholine challenge (PC20). The -403 A allele was associated with an increased susceptibility to both atopy and asthma. Thus, the proportion of subjects carrying this allele was higher in each of atopic non-asthmatics, non-atopic asthmatics and atopic asthmatics compared with non-atopic, non-asthmatic controls. In particular, this allele was associated with skin test positivity but not IgE level. Homozygosity for the -403 A allele conferred a 6.5-fold increased risk of moderate/severe airway obstruction (FEV1 < or = 80% predicted), a marker for established asthma. Our data, whilst preliminary, indicate that the association of RANTES genotype with both atopy and asthma reflect independent effects, suggesting different mechanisms for the role of this chemokine in atopy and development of airway obstruction. (+info)
Does alcohol drinking have an influence on suicides in cancer sufferers? A population-based study of 1515 suicide victims.
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BACKGROUND: [corrected] We investigated whether alcohol drinking contributes to suicides in cancer sufferers when compared with non-cancer suicides. We also explored the suicide method used in cancer suicides. METHODS: The population-based, prospectively collected data sample consisted of 1515 completed suicides committed in the province of Oulu, Finland, during the period 1988-99. Victims who suffered from cancer were compared with other suicides. RESULTS: Cancer patients who committed suicide were significantly less commonly under the influence of alcohol than non-cancer suicide victims (84.8% vs 54.7%). Mental disorders were less prevalent among cancer patients than non-cancer patients. The cancer patients were significantly older and more often retired and a trend that a greater proportion of cancer suicide victims were male was noted. Shooting and poisoning were the most common suicide methods among cancer patients. CONCLUSION: An early recognition and evaluation of the extent of the suicidal tendencies among cancer patients is of great importance in clinical oncology, since preventive interventions would be effective especially for those without comorbid alcoholism at the time of the suicide. (+info)
Pulsus paradoxus in asthmatic children.
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Pulsus paradoxus is a useful physical sign in the assessment of the severity of asthma in adults. Whether this is also true for asthmatic children was determined by measuring respiratory fluctuations in systolic blood pressure during attacks of asthma in 24 children. A decrease in systolic pressure during inspiration exceeding 15 mm Hg was found only when the 1-second forced expiratory volume was less tha 60 percent of the predicted value. There was a highly significant (P smaller than 0.001) correlation between the degree of pulsus paradoxus and the severity of airway obstruction. In nonasthmatic children the systolic pressure was found to fluctuate by as much as 7 mm Hg during the respiratory cycle. It is concluded that, as in adults, the presence of pulsus paradoxus (larger than or equal to 15 mm Hg) in children indicates that their asthma is very severe. (+info)
A trial of oral delta-1-(trans)-tetrahydrocannabinol in reversible airways obstruction.
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Sixteen patients with proven reversible airways obstruction were admitted to a double-blind study to compare the bronchodilator effects of oral delta-1-(trans)-tetrahydrocannabinol (delta-1-THC) and salbutamol. Measurements of forced vital capacity, forced expired volume in one second, peak expiratory flow rate, and maximum expiratory flow rate at 50 percent vital capacity after 10 mg oral delta-1-THC did not differ significantly from the effect of placebo, whereas increases after salbutamol were significant. Analyses of mood, pulse rate, blood pressure, and electrocardiogram showed no important changes after oral delta-1-THC. In vitro studies with isolated tracheal muscle indicate that the activity of delta-1-THC is 1,000 times less than the equivalent dose of isoprenaline, and the effect of delta-1-THC is not abolished by beta-adrenoreceptor blocking agents. It is concluded that oral delta-1-THC, at a dose of 10 mg, does not produce clinically significant bronchodilatation in patients with reversible airways obstruction. (+info)