Survey of Use of the Insufflator-Exsufflator in Patients With Spinal Cord injury

Abstract

Background/Objective: The insufflator-exsufflator has been shown to be effective in assisting cough in individuals with spinal cord injury. However, many institutions do not use this device. The study was performed to assess use of the device and attitudes among health care providers.

Methods: We developed a questionnaire with 4 categories of questions: knowledge of the device, type of facility, clinical practice with the device, and patient and provider satisfaction. The questionnaire was mailed to members of the American Paraplegia Society.

Results: Eighty-six questionnaires (16%) were returned. The device was being used in 49% of the institutions. The device was most commonly used with a tracheostomy; use did not correlate with size or type of facility. Patient and provider satisfaction with the insufflator-exsufflator was high.

Conclusions: The insufflator-exsufflator is used as a means of removal of secretions in approximately one half of institutions polled. Satisfaction with the device is high.     

The immediate effects of deep breathing exercises on atelectasis and oxygenation after cardiac surgery

Objective—To investigate the effects of deep breathing performed on the second postoperative day after coronary artery bypass graft surgery.

Design—The immediate effects of 30 deep breaths performed without a mechanical device (n?=?21), with a blow bottle device (n?=?20) and with an inspiratory resistance‐positive expiratory pressure mask (n?=?20) were studied. Spiral computed tomography and arterial blood gas analyses were performed immediately before and after the intervention.

Results—Deep breathing caused a significant decrease in atelectatic area from 12.3?±?7.3% to 10.2?±?6.7% (p?<?0.0001) of total lung area 1?cm above the diaphragm and from 3.9?±?3.5% to 3.3?±?3.1% (p?<?0.05) 5?cm above the diaphragm. No difference between the breathing techniques was found. The aerated lung area increased by 5% (p?<?0.001). The PaO ₂ increased by 0.2?kPa (p?<?0.05), while PaCO ₂ was unchanged in the three groups.

Conclusion—A significant decrease of atelectatic area, increase in aerated lung area and a small increase in PaO ₂ were found after performance of 30 deep breaths. No difference between the three breathing techniques was found.     

Training with a mirror in rehabilitation of the hand

Treatment with a mirror gives an illusion of function in a missing or non-functioning hand. The method is based on the concept that the central representation of phantoms and body image can change rapidly, and has been described in the treatment of phantom pain and stroke. We show in three pilot cases new applications for the use of the mirror in rehabilitation after hand surgery.     

The Prevalence of Left Ventricular Hypertrophy in Obese Children Varies Depending on the Method Utilized to Determine Left Ventricular Mass

Obesity and left ventricular hypertrophy (LVH) have been identified as independent risk factors for cardiovascular events. The definition of LVH depends on the geometric algorithm used to calculate LV mass (LVM) by echocardiography and the method used to normalize LVM for body size. This study evaluates the effect of these methods on the prevalence of LVH in obese children. LVM for 109 obese and 109 age-matched non-obese children was calculated using M-mode or two-dimensional echocardiography (2DE). LVM was then normalized to height 2.7 as indexed LVM (LVMI), to body surface area (BSA), height, and lean body mass (LBM) as LVM Z-scores. LVH was defined as LVMI >95th ‰ using age-specific normal reference values or LVM Z-scores ≥2. The prevalence of LVH by LVMI and LVM Z-scores was compared. There was a correlation between LVM determined by M-mode and by 2DE (R ² = 0.91), although M-mode LVM was greater than 2DE LVM. However, the difference between these values was greater in obese children than in non-obese children. Based on the method of normalization, the prevalence of LVH among obese children was 64 % using LVMI, 15 % using LVM Z-scores for height, 8 % using LVM Z-scores for BSA and 1 % using LVM Z-scores for LBM. Height-based normalization correlates with obesity and hypertension. The methods used to measure and normalize LVM have a profound influence on the diagnosis of LVH in obese children. Further study is needed to determine which method identifies children at risk for cardiovascular morbidity and mortality.     

Functional mapping and single chain construction of the anti-cytokeratin 8 monoclonal antibody TS1

The anti-cytokeratin (CK) 8 monoclonal antibody (mab) TS1 has been shown to efficiently bind to CK8 expressed in carcinomas in vivo. The anti-idiotypic antibody of TS1, alphaTS1, can be used to regulate the tumor:non-tumor ratio of TS1 by clearing non-tumor binding TS1 from the circulation. If the interaction of TS1 to CK8 and alphaTS1 is fully understood, mutations can be used to improve the tumor:non-tumor ratio. A scFv was made of the mab TS1 and residues earlier identified by Erlandsson et al. as important for the interaction with both its antigen CK8 and its anti-idiotype alphaTS1, were mutated to alanine or amides and expressed in E. coli. The effects of the mutations were studied by ELISA and residues important for the interactions to both CK8 and alphaTS1 were identified as mainly tyrosines, charged residues, a serine and a tryptophan. Altogether, nine amino acid residues in TS1 were found to be important in the interaction to alphaTS1 and six residues for the interaction to CK8. Important residues, clustered together in the modelled protein, were identified as residues from CDR 3 of the heavy chain and the unexpected participation of a residue in CDR 2 of the light chain. Some of the important residues are likely to be hotspots. Hotspots constitute a few residues in an interaction that contribute most to the binding, energetically. Amino acid residues in hotspots often cluster together in the center of the interaction interface, but can also be spread out to the periphery. The hotspots are often surrounded by hydrophobic patches, which are seen in the modelled TS1 protein used in this study. Amino acid residues that increased the affinity when mutated were also identified for both interactions. These residues are likely to be located outside the interacting interface. It can from this study be concluded that it is wise to precede the mutational procedure with experiments that can give guidelines for the selection of which amino acid residues to mutate. If the guidelines from the chemical modifications from Erlandsson et al. not had been used, this study would have left some residues unmutated and thereby missed important information.     

Valproatverordnungen bei Mädchen und Frauen im gebärfähigen Alter in Deutschland

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Aufgrund des teratogenen Potenzials von Valproat wurden die Empfehlungen zur Risikoaufklärung und Verordnung bei...     

Soft tissue healing at titanium implants coated with type I collagen. An experimental study in dogs

Objective: To analyse the soft tissue healing at titanium implants coated with type 1 collagen. Material and methods: Six dogs were used. The mandibular pre‐molars and the three anterior maxillary pre‐molars were extracted. Three months later mucoperiosteal flaps were raised and two test and two control implants were installed (3i^® TG Osseotite^®3.75 × 10 and 2.8 mm transmucosal collar). The test implants were coated with a purified porcine type I collagen. Cover screws were placed and flaps were sutured. The sutures were removed 2 weeks later and a plaque‐control programme was initiated. Another 2 weeks later, the procedure was repeated in the contra‐lateral mandibular region. Four weeks after the second implant surgery, biopsies were obtained and prepared for histological examination. Results/Conclusion: The vertical dimensions of the epithelial and connective tissue components as well as the composition of the connective tissue portion facing the implant were similar at collagen‐coated and uncoated implants after 4 and 8 weeks of healing. It is suggested that soft tissue healing to implants coated with type I collagen was similar to that at non‐coated titanium implants and that no adverse reactions to the collagen‐coated implants occurred.