Nitric oxide inhalation increases alveolar gas exchange by decreasing deadspace volume.

Objective: To test the hypothesis that nitric oxide inhalation facilitates CO2 elimination by decreasing alveolar deadspace in an ovine model of acute lung injury.

Design: Prospective, placebo-controlled, randomized, crossover model.

Setting: University research laboratory.

The acute febrile response to burn injury in children may be modified by the type of intravenous fluid used during resuscitation--observations using fresh frozen plasma (FFP) or Hartmann's solution.

Fever is a common clinical problem in burned children. The purpose of this study was to compare rectal temperature (T(r)) in two groups of children with burns, > or =10% of the total body surface area (tbsa) who received fresh frozen plasma (FFP) or a crystalloid solution (Hartmann's) for restoration of blood volume. Twelve to 16 h after the burn T(r) reached a peak.

Recurrent pleomorphic adenoma of the palate in a child.

A rare case of recurrent pleomorphic adenoma of the palate in a 9-year-old boy is presented. Pleomorphic adenoma is relatively rare in children compared with its incidence in adults. However, it is the most common benign epithelial tumour of the salivary glands.

c-Fos expression in the central nervous system elicited by phrenic nerve stimulation.

Phrenic nerve afferents (PNa) have been shown to activate neurons in the spinal cord, brain stem, and forebrain regions. The c-Fos technique has been widely used as a method to identify neuronal regions activated by afferent stimulation. This technique was used to identify central neural areas activated by PNa.

Assessment of aspiration risk in stroke patients with quantification of voluntary cough.

Background: Dysphagia and subsequent aspiration are serious complications of acute stroke that may be related to an impaired cough reflex. It was hypothesized that aspirating stroke patients would have impaired objective measures of voluntary cough as compared with both nonstroke control subjects and nonaspirating stroke patients.

Methods: Swallowing was evaluated by standard radiologic or endoscopic methods, and stroke patients were grouped by aspiration severity (severe, n = 11; mild, n = 17; no aspiration, n = 15).

Inspiratory strengthening effect on resistive load detection and magnitude estimation.

Purpose: This study investigated effects of inspiratory muscle training (IMT) on maximal inspiratory pressure (MIP), magnitude estimation (ME), and load detection (LD) of external resistive loads (deltaR) in healthy subjects.

Methods: Ten adult volunteers IMT trained 5 d x wk(-1) for 4 wk. A training set consisted of six inspiratory efforts at 75% of MIP; daily training trials consisted of four sets.

Volume-timing relationships during cough and resistive loading in the cat.

The relationship between pulmonary volume-related feedback and inspiratory (CTI) and expiratory (CTE) phase durations during cough was determined. Cough was produced in anesthetized cats by mechanical stimulation of the intrathoracic tracheal lumen. During eupnea, the animals were exposed to single-breath inspiratory and expiratory resistive loads.

Respiratory-related evoked potentials in children with life-threatening asthma.

Respiratory-related evoked potentials (RREPs) have been elicited by inspiratory occlusion and recorded over the somatosensory cortex. The first positive peak (P(1)) amplitude has been correlated with the magnitude of inspiratory loads. Since children with life-threatening asthma (LTA) have a decreased perceptual sensitivity of inspiratory loads, we hypothesized that a subpopulation of patients with LTA have an impaired ability to sense mechanical loads, and that these patients would have an abnormal RREP.

Responses of the anterolateral abdominal muscles during cough and expiratory threshold loading in the cat.

The present study was conducted to determine the pattern of activation of the anterolateral abdominal muscles during the cough reflex. Electromyograms (EMGs) of the rectus abdominis, external oblique, internal oblique, transversus abdominis, and parasternal muscles were recorded along with gastric pressure in anesthetized cats. Cough was produced by mechanical stimulation of the lumen of the intrathoracic trachea or larynx.

Subcutaneous adrenaline infiltration in paediatric burn surgery.

Paediatric burn surgery may be associated with significant blood loss and postoperative pain. To investigate methods of reducing these symptoms, we studied a prospective series of 29 children with small to medium sized burns. Presurgically both the burn wound and split skin graft donor sites were injected with a 1:500,000 adrenaline solution, to which bupivicaine had been added.

Experience with severe extensive blistering skin disease in a paediatric burns unit.

Vesiculobullous disorders are thankfully uncommon. A brief overview of the literature is presented together with our experience of managing these cases on a paediatric burns unit in the six years 1992 1998. The advantages of management on such a unit are outlined and include a facility for major dressings and frequent changes and a familiarity with fluid resuscitation in the child with major skin loss.

Monitoring brain PO2, PCO2, and pH during graded levels of hypoxemia in rabbits.

Brain ischemia and hypoxia are of concern when they occur following traumatic brain injury because they frequently result in potentially preventable secondary brain damage. In this study, we examined the ability of an implantable catheter (Paratrend 7; Diametrics Medical, St. Paul, MN) to continuously measure brain tissue pH, PCO2, and PO2 during graded levels of hypoxia.

Toxic shock syndrome toxin-1 (TSST-1) antibody levels in burned children.

Young children with burns are at risk of developing a toxic shock-like illness during the first 2-3 days after the injury. The staphylococcal exotoxin, toxic-shock syndrome toxin-1 (TSST-1) is implicated in development of this illness. Low levels or absence of anti-TSST-1 antibodies may indicate susceptibility to this illness.

Inspiratory pressure threshold training for glottal airway limitation in laryngeal papilloma.

A single-subject design was used to determine if inspiratory pressure threshold training increases inspiratory muscle strength and reduces the sensation of dyspnea during exercise and speech. The subject was a 23-year-old female with congenital juvenile papilloma which has been in remission for 10 years. A 4-week inspiratory muscle training program was implemented using an inspiratory pressure threshold trainer.

Respiratory-related evoked potential elicited by expiratory occlusion.

Respiratory-related evoked potentials (RREPs) have been elicited by inspiratory loads in adults and children. The RREP was recorded over the somatosensory region of the cerebral cortex. It was hypothesized that a RREP could be recorded by using expiratory occlusion.

Relationship between magnitude estimation of resistive loads, inspiratory pressures, and the RREP P(1) peak.

This study investigated the relationship among resistive load magnitude (DeltaR), the cortical evoked potential P(1) peak amplitude of the respiratory-related evoked potential (RREP), mouth pressure (Pm), esophageal pressure (Pes), transdiaphragmatic pressure (Pdi), and resistive load magnitude estimation (ME) in human subjects. The RREP, Pdi, Pes, Pm, and ME were recorded in response to three DeltaR values. The RREP was recorded from C(3) and C(4), referenced to the vertex C(Z).

Psychosocial status of women requesting breast reduction surgery as compared with a control group of large-breasted women.

The breast has special significance for women but unlike women seeking breast augmentation little research has been carried out on those seeking breast reduction. The few studies to date have not used well-recognized instruments nor appropriate controls. The present study compared 33 patients on a waiting list with 22 large-breasted controls using a semistructured questionnaire and well-validated instruments.

Magnitude estimation of inspiratory resistive loads in children with life-threatening asthma.

The perception of inspiratory resistive (R) loads was studied in nonasthmatic children and in children with a history of life-threatening asthma. It was hypothesized that the children with life-threatening asthma would have a reduced sensitivity to added mechanical loads as measured by magnitude estimation of resistive loads (ME). The subjects were screened from the experimenter and seated in a sound-isolated room in a lounge chair facing an oscilloscope, and they respired through a nonbreathing valve with the inspiratory port connected to the loading manifold.

Tissue factor pathway inhibitor expression in atherosclerosis.

Tissue factor pathway inhibitor (TFPI) is a potent inhibitor of tissue factor (TF) -initiated coagulation and may play a role in regulating coagulation in atherosclerotic plaques. The expression of TFPI protein and mRNA was examined by immunohistology and in situ hybridization in normal human and rabbit arteries, in human carotid arteries with advanced atherosclerosis, and in atherosclerotic aortas from cholesterol-fed rabbits. In normal human and rabbit arteries, TFPI protein and mRNA were detected in the adventitial layer but were undetectable in the luminal endothelium.

Relationship between resistive loads and P1 peak of respiratory-related evoked potential.

This study investigated the relationship between resistive-load (DeltaR) magnitude, the first positive peak (P1) amplitude of the respiratory-related evoked potential (RREP), and load-magnitude estimation (ME). The first experiments determined the subject's (n = 9) ME of five DeltaR magnitudes randomly presented at the onset of an inspiration or by interrupting an inspiration. No significant differences were found in the slopes of the two different presentations, but the subjects estimated the interrupted inspiratory loads to be of lesser magnitude than loads presented at the onset of the breath.

The evaluation of velopharyngeal function using flexible nasendoscopy.

Nasendoscopy is an essential tool in assessing the dynamic function and structure of the velopharyngeal sphincter during speech and swallowing. Flexible fibre-optic nasendoscopy has been used by the cleft palate team at Withington Hospital, Manchester since 1989. Seventy-six patients were referred between 1989 and 1994 for evaluation of velopharyngeal function during speech.

Motor innervation of the cricopharyngeus muscle by the recurrent laryngeal nerve.

Patients with recurrent laryngeal nerve (RLN) paresis demonstrate impaired function of laryngeal muscles and swallowing. The cricopharyngeus muscle (CPM) is a major component of the upper esophageal sphincter. It was hypothesized that the RLN innervates this muscle.

Making the best use of consultant orthodontic services, Part 2: How to undertake the referral.

The previous article in this series dealt with the selection of patients who would benefit from referral to a consultant orthodontist. It is equally important to access consultant services in a manner which allows the referral to be processed efficiently. This paper discusses factors related to the actual mechanism of referral.

Making the best use of consultant orthodontic services. Part 1: Determining which patients require referral.

General dental practitioners and community dental officers may need to consider several factors when referring patients to the consultant orthodontic service. In Birmingham, a local professional group incorporating representatives from both primary care and secondary care (consultant) services have drawn up a set of formal referral guidelines. The purpose of the exercise was to encourage the most appropriate use of the consultant service so that its resources could be directed towards those in greatest need.