News - Part 2

The mean age for patients in the study group was 4.9 months (55% male patients), and for the control subjects it was 4.4 months (52% male subjects). No procedure-related complications occurred. All patients were discharged from the hospital promptly after undergoing the WT, and 1.5 to 4.5 h after undergoing the DAT (median time, 2.1 h).
There was a high clinical agreement between investigators 1 (Y.S.) and 4 (A.D.) for the laryngo-malacia clinical scores with median scores of 8.0 for both investigators (range, 3 to 12 and 4 to 11, respectively; p = 0.36 [Wilcoxon test]). The correlations were high (Kendall coefficient of concordance, 0.932; and Spearman correlation coefficient [r value], 0.863; p < 0.0001). Similar agreements were obtained for the two components of the clinical score (ie, the history and the physical examination scores). More info
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Diagnosis of Laryngomalacia by Fiberoptic Endoscopy: Data and Statistical AnalysisAn additional 25 video recordings from infants with normal upper airways who underwent laryngoscopies (WT, 12 recordings; DAT, 13 recordings) for reasons unrelated to upper airways problems were also copied to the new video cassettes and served as healthy control subjects. The causes for performing FFL in these cases were nocturnal snoring, following adenoidectomy, chronic rhinorrhea, BAL, and suspected foreign body aspiration. Each video clip was edited to visualize the motion of the supraglottic structures only, and the observer was blinded to the patient, the clinical presentation, and the technique. Sound was not included so as not to influence the visual diagnosis. A total of 140 video clips were copied in a random sequence, and each clip was assigned a new number. Based on a previously applied scoring system for laryngomala-cia, each investigator assigned a score for each video clip that was composed of the following two parts: the “epiglottic score” (range, 0 to 4 points); and the “arytenoids score” (range, 0 to 4 points). Hence, the maximal possible laryngomalacia video score was 8 points (Table 2). generic yaz birth control
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The laryngoscopy performed using the WT was performed with the infant held awake in a sitting position by a parent. Topical anesthesia (lidocaine 1% and phenylephrine 0.25%) was applied to the nose, and FFL was performed to the level of the vocal cords. In the DAT, each infant received anesthesia with IV propofol. A dose of 2.5 mg/kg was injected slowly over 15 min as small boluses of 0.5 to 1.0 mL/kg. Additional boluses were added as needed. To prevent pain on injection, 0.3 mL of a 1% lidocaine solution was slowly injected prior to the injection of diluted propofol. All infants received 100% oxygen by a nonrebreathing mask during propofol loading and then a continuous flow of 2 to 3 L/min of 100% oxygen administered directly to the hypophar-ynx by an 8F feeding tube. The procedures were performed by a pediatric pulmonologist (Y.S.) in the pediatric ICU with the assistance of the pediatric ICU resident and a registered nurse. Oxygen saturation, respirations, BP (automatically every 2 min), and ECG were continuously monitored. The endoscopies were performed using a bronchoscope (model FB-10V or FB-8V; Pentax; Tokyo, Japan) with a distal outside diameter of 3.5 or 2.8 mm, respectively. Initially, only the upper airways were investigated looking for the cause of the stridor. Only when this stage was complete, was a 1% solution of lidocaine applied to the glottis and the bronchoscope advanced to visualize the trachea. All endoscopies were recorded on videotape. The study was approved by the institutional review board of our hospital.
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Diagnosis of Laryngomalacia by Fiberoptic EndoscopyLaryngomalacia is the most common cause of congenital stridor. It is usually a benign disorder resolving spontaneously by 12 to 18 months of age. The diagnosis of laryngomalacia requires dynamic visualization of the glottic and supraglottic area.
Since the introduction of video-recorded fiberoptic flexible laryngoscopy (FFL), the following two approaches have emerged for the endoscopic evaluation of congenital stridor, especially for laryngomalacia: a clinic-based awake laryngoscopy; and a drugassisted technique (DAT) using sedation and anesthesia. The awake technique (WT) is performed while the infant is held in a sitting position; topical anesthesia is applied to the nose, and endoscopy is performed to the level of the vocal cords. In the DAT, the patient is supine, and inspections of the subglottic area and the tracheobronchial tree are possible.
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Effect of Dobutamine on Lung Microvascular Fluid Flux in Sheep with “Sepsis Syndrome”: ConclusionTo further support our suggestion that dobutamine may have functionally reduced the effects of altered endothelial permeability characteristics on microvascular fluid flux in this study, Hakim et al concluded that (3-adrenergic receptors regulated pulmonary transendothelial transport of fluid and proteins since (3-adrenergic blockade with propranolol was associated with an increase in QL. Also, in the peripheral microvasculature, (3-adrenergic receptor agonists demonstrably inhibit edema formation and transmicrovascular protein flux, an observation that cannot be explained by their effects on microvascular pressure, blood flow, or surface area. The rationale underlying such a protective action of (3-adrenergic receptor agonists within the pulmonary microvasculature is purely speculative but may reflect the effects of enhanced cyclic AMP generation within the endothelium, perhaps thereby leading to relaxation of mediator-contracted endothelial cells. Read the rest of this entry »

Effect of Dobutamine on Lung Microvascular Fluid Flux in Sheep with “Sepsis Syndrome”: ObservationsNonseptic Study
The infusion of dobutamine was associated with a modest fall in the mean blood pressure at the 10μg/kg/ min dose but was without effect on the mean pulmonary arterial pressure at either dose (Table 1 ana r lg l). The cardiac output increased progressively with both doses, while the measured pulmonary arterial wedge pressure, left atrial pressure, and calculated Pmv remained unchanged. Systemic oxygen transport increased at both doses, and the Pv02 increased concurrently. Dobutamine did not signficantly affect QL or the [L/P]TP at either dose. The calculated mean 7rpmv fell with both doses (p<0.05), although the Trmv-TTpmv gradient was unchanged from baseline. Therefore, the CLP remained unchanged from baseline during the infusion of dobutamine of either dose. We found no significant relationship between changes in QL and cardiac output (CO) at either dose (5μLg/kg/min, AQL=1.3 —0.66 ACO; r= — 0.12) (10μg/kg/min, AQL = 1.70 — 0.311 ACO; r= -0.36), unlike data reported by Coates et al, where with exercise an increase in QL was significantly related to an increase in the cardiac output. Read the rest of this entry »

Specific Measurements
We collected pulmonary lymph in graduated heparinized tubes. From pooled lymph specimens, we measured total protein and albumin concentrations (in grams per deciliter) by the Biuret method using an automated system (Auto Analyzer, Technicon Instruments); duplicate samples differed by less than 5 percent. At the time of lymph collection, we also measured total protein and albumin concentration (in grams per deciliter ). With appropriate temperature corrections, we measured oxygen tension (Po2, in millimeters of mercury) (AME-1 blood gas analyzer) and oxygen saturation (So2, in percent) (Hemoximeter, Radiometer) of both arterial (eg, Pa02) and mixed venous (eg, Pv02) blood drawn from the carotid arterial line and the distal lumen of the right-heart catheter, respectively. Blood for determining gas levels was drawn into heparinized syringes and maintained in ice until determination was performed within 15 minutes of collection. Read the rest of this entry »

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