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At least 145 records · Page 8Linked to original sources

Breathing-valve encumbrance and arterial blood gas and acid-base status in exercise in man.

It has been suggested that the mouth-piece-breathing valve assemblies commonly used in laboratory investigations of ventilatory control may influence regulation of arterial blood gas and acid-base status during exercise. To examine this hypothesis, 10 healthy males each underwent two incremental cycle-ergometer tests (15 W min-1) to the limit of tolerance: one was conducted free of breathing apparatus; the other utilized a mouth-piece (with noseclip) connected to a low-resistance turbine volume sensor. The order was randomly assigned and tests were separated by a 2 h recovery. Blood sampled from an indwelling brachial artery catheter at rest and every 30 W during exercise was analyzed for PCO2, PO2, pH and HCO-3. Maximum power was not different between the two tests. Furthermore, no systematic effect of the assembly could be discerned on PaCO2, PaO2 or pHa over the entire range of power. We therefore conclude that although ventilation and its pattern may be affected by laboratory breathing apparatus, such encumbrance (if of low resistance and dead space) does not influence blood gas and acid-base regulation during exercise.

Acid-Base Equilibrium↗

[Noninvasive head fixation for external irradiation of tumors of the head-neck area].

PURPOSE: To fully utilize the technical capabilities of radiation diagnostics and planning, a precise and reproducible method of head fixation is a prerequisite. METHOD: We have adapted the Vogele-Bale-Hohner (VBH) head holder (Wellhöfer Dosimetrie, Schwarzenbruck, Germany), originally designed for frameless stereotactic operations, to the requirements of external beam radiotherapy. A precise and reproducible head fixation is attained by an individualized vacuum upper-dental cast which is connected over 2 hydraulic arms to an adjustable head- and rigid base-plate. Radiation field and patient alignment lasers are marked on a relocatable clear PVC localization box. RESULTS: The possibility of craniocaudal adjustment of the head plate on the base plate allows the system to adapt to the actual position of the patient on the radiotherapy couch granting tensionless repositioning. The VBH head holder has proven itself to be a precise yet practicable method of head fixation. Duration of mouthpiece production and daily repositioning is comparable to that of the thermoplastic mask. CONCLUSION: The new head holder is in routine use at our hospital and quite suitable for external beam radiation of patients with tumors of the head and neck.

Equipment Design↗

Multimodality cranial image fusion using external markers applied via a vacuum mouthpiece and a case report.

PURPOSE: To present a simple and precise method of combining functional information of cranial SPECT and PET images with CT and MRI, in any combination. MATERIAL AND METHODS: Imaging is performed with a hockey mask-like reference frame with image modality-specific markers in precisely defined positions. This frame is reproducibly connected to the VBH vacuum mouthpiece, granting objectively identical repositioning of the frame with respect to the cranium. Using these markers, the desired 3-D imaging modalities can then be manually or automatically registered. This information can be used for diagnosis, treatment planning, and evaluation of follow-up, while the same vacuum mouthpiece allows precisely reproducible stereotactic head fixation during radiotherapy. RESULTS: 244 CT and MR data sets of 49 patients were registered to a root square mean error (RSME) of 0.9 mm (mean). 64 SPECT-CT fusions on 18 of these patients gave an RMSE of 1.4 mm, and 40 PET-CT data sets of eight patients were registered to 1.3 mm. An example of the method is given by means of a case report of a 52-year-old patient with bilateral optic nerve meningioma. CONCLUSION: This technique is a simple, objective and accurate registration tool to combine diagnosis, treatment planning, treatment, and follow-up, all via an individualized vacuum mouthpiece. Especially for low-resolution PET and even more so for some very diffuse SPECT data sets, activity can now be accurately correlated to anatomic structures.

Equipment Design↗

Reduced exercise capacity of chronic obstructive pulmonary disease patients exercising with noseclip/mouthpiece.

A noseclip and low resistance mouthpiece are often used to monitor exhaled gases during exercise. Because otolaryngologic studies suggest that 50% of airway resistance is in the nose and mouth, it was hypothesized that patients with advanced chronic obstructive pulmonary disease might be artifactually limited by exercise testing with a noseclip and mouthpiece. Accordingly, 12 patients with stable chronic obstructive pulmonary disease performed identical symptom-limited supine bicycle exercise tests with and without noseclip and mouthpiece. Right-sided cardiac hemodynamic measurements, radionuclide ventriculography and arterial and mixed venous gas sampling were performed during each exercise test. Exhaled gases were analyzed during the noseclip/mouthpiece exercise. The order of exercise tests was alternated. Comparing exercises with and without a noseclip, there were significant reductions in exercise duration (397 +/- 270 vs 300 +/- 230 seconds, p less than 0.01), exercise oxygen consumption (780 +/- 279 vs 638 +/- 200 ml/min, p less than 0.01) and exercise cardiac output (8.4 +/- 2.7 vs 7.3 +/- 2.0 liters/min, p less than 0.05), an increase in right ventricular ejection fraction (0.39 +/- 0.08 vs 0.43 +/- 0.08, p less than 0.01) and no change in exercise heart rate (106 +/- 14 vs 106 +/- 14), right-sided cardiac pressures or arterial and mixed venous blood gases. These data suggest that a noseclip/mouthpiece can limit exercise tolerance in advanced chronic obstructive pulmonary disease patients. This limitation may result from decreased right-sided cardiac preload (venous return).

Adult↗

Orthodontic positioner used for home fluoride treatments.

It has been well documented that the more time the enamel surface is exposed to fluoride, the higher will be the caries protection. An extremely good method of greatly increasing caries resistance is by daily or weekly home fluoride treatments. This procedure is usually limited to special cases of rampant caries, patients with hemophilia, and handicapped patients in whom caries control is vital. It is not used more widely because of the added costs of impressions, tray fabrication, and professional. If the patient already has a vehicle for applying fluoride, such as a positioner or mouth guard, it is a simple matter to prescribe or dispense fluoride gel to be used when these appliances are being worn. This is expecially true for orthodontic postioners. When bands are removed, a slight space usually exists interproximally. This space greatly facilitates fluoride contact with the proximal surfaces. Fluoride will tend to recalcify decalcified areas of enamel in addition to providing added caries protection for the patient. If positioners are not used after band removal, home fluoride trays or rinses can also be effective. Since many orthodontic patients wear a positioner when bands are removed, the orthodontist can provide his patients with the benefits of topical fluoride by prescribing fluoride gel and explaining how to use it along with his positioner.

Dental Caries↗

Reduction of maladaptive mouthing behavior by facial screening.

This study examined the effectiveness of facial screening as a treatment to reduce maladaptive object mouthing by a four and a half-year-old moderately retarded boy during two play periods in a public school classroom. In baseline, each episode of mouthing was terminated by saying "no mouth" and removing the object from the subject while placing it within his reach. Treatment consisted of saying "no mouth" and covering the subject's entire face for three seconds with a soft towel. Results of an A-B-A-B design showed frequent episodes of mouthing during nontreatment conditions, which rapidly decelerated when facial screening was in effect. Follow-up data at 6, 12, and 18 month intervals indicated long lasting treatment benefits. The potential extension of facial screening as a treatment for milder maladaptive behaviors in less restricted settings than previously documented is suggested.

Behavior Therapy↗

The use of tongue-depressing stents for neuropathologic chewing.

Comatose patients may develop a neuropathologic chewing reflex that results in self-inflicted oral trauma. Loss of coordination between the tongue and chewing cycle leads to maceration of the tongue and infection. The use of a tongue-depressing stent can keep the tongue from acting as a bolus and prevent perpetuation of the reflex chewing cycle and resultant self-injury.

Acrylic Resins↗