For three decades after Marshall Hall's 1856 strictures against "forcing methods" and bellows for artificial ventilation (AV), human "forced respiration" (equivalent to intermittent positive pressure ventilation) was virtually abandoned. Various arm-chest manoeuvres often proved inadequate to save life. After doctor and engineer George Fell, of Buffalo (New York) (1849-1918), failed to save the life of an opiate-poisoned patient using Silvester's popular method, he resolved to try his animal laboratory AV method (bellows and tracheotomy). Following his first success in a landmark case (1887), he better adapted the apparatus for human use and soon succeeded with further difficult cases, but was unable to raise enthusiasm for his "Fell method" of AV. His reports of successful rescues to prestigious Washington Congresses met derision (1887) and indifference (1893), although by then they detailed 28 "human lives saved", mostly after opiate poisoning, and a switch from tracheotomies to face masks (simpler, but with a few complications). Continuing with rescues throughout the 1890s, Fell personally achieved recoveries after AV for as long as 73.5 hours (1896), and over 78 hours (1899). He argued for his method repeatedly with many talks, much documentation, and pleas for its use in other ventilatory crises. Despite his endeavours and successes, Fell was unable to secure widespread uptake of forced respiration, but others adopted his principles. Joseph O'Dwyer modified Fell's face mask-tracheotomy system by incorporating an intralaryngeal tube, and this "Fell-O'Dwyer apparatus" was used for neurosurgical cases (1894), also revolutionising intrathoracic surgery (1899).
On the basis of the analysis of the sanitary and hygienic conditions, epidemiology of a mass disease, clinical picture of the disease during a 6-month trial period the problems of differentiated diagnosis of infectious and toxic processes, examination of capacity for work, the course of diseases were studied in 219 workers who had had legionellosis. The participation of various specialists in the analysis of analogous cases at the enterprises with chemical environmental contamination and developed systems of air conditioning was considered necessary.
Advances in medical technology now permit children who need ventilator assistance to live at home rather than in hospitals or institutions. What does this ventilator-dependent life mean to children and their families? The impetus for this essay comes from a study of the moral experience of 12 Canadian families--parents, ventilator-dependent child, and well siblings. These families express great love for their children, take on enormous responsibilities for care, live with uncertainty, and attempt to create "normal" home environments. Nevertheless, they experience social isolation, sometimes even from their extended families and health care providers. Their lives are constrained in many ways. The challenges faced by parents of technology-dependent children raise questions of justice within society and within families.
The influence of acculturation to a sedentary lifestyle upon the growth and development of lung volumes has been studied in Inuit children aged 9-19 years. Surveys were conducted in the circumpolar community of Igloolik (69 degrees 40'N, 81 degrees W) in 1969/70, 1979/80 and 1989/90. Over this period, the children showed little change of height or body mass at any given age, but a progressive loss of what initially had been a high level of health-related fitness. The sample for each survey comprised about 70% of children in the chosen age range: in the most recent study 87 males and 65 females. Respiratory data included forced vital capacity, one-second forced expiratory volume, maximal mid-expiratory flow rate (second and third surveys only), smoking habits and respiratory health. In each of the 3 surveys, many of the older children in the community were regular smokers. The average cigarette consumption currently rises progressively to 13 +/- 8 cigarettes/day in 87% of males and 11 +/- 7 cigarettes/day in 95% of females over 17 years of age. Nevertheless, lung volumes show the anticipated increase as a logarithmic function of stature. Furthermore, statistically fitted curves show only minor inter-survey differences in volumes for a given standing height. We thus conclude that the deterioration in other aspects of health-related fitness has not yet influenced the growth and development of respiratory function within this Inuit population.
Previous studies have shown that acoustic rhinometry (AR) is well suited to describe the nasal airway dimensions in healthy infants. The technique is quick to perform, non-invasive, without potential hazards and requires minimal cooperation. Due to the small dimensions of the infant nasal airways, the optimized miniprobe (Rhinometrics, Lynge, Denmark) provides abilities superior to those of adult probes. The equipment is portable and examinations can be performed in the maternity ward, out-patient department or at home. Measurements on models simulating the pre- and post-operative nasal geometry were performed to determine the accuracy and resolution of AR and to improve the interpretation of the curves obtained in vivo. Acoustic measurements in five infants with congenital respiratory distress caused by bilateral choanal atresia or stenosis have been compared with CT-scans and the results of the model simulations to evaluate the diagnostic value of the method. We conclude that AR represents a new and valuable tool in the diagnosis of congenital choanal malformations. Despite current technical limitations, it may also be of value in the post-operative evaluation, particularly if the posterior part of the septum is not resected.
To compare the characteristics of acute mastoiditis in children in different age groups in order to identify risk groups and risk factors for acute mastoiditis.
Records for all children aged 0-16 years treated for acute mastoiditis during 1993-2007 at 33 Ear, Nose and Throat departments in Sweden were reviewed retrospectively according to defined criteria for acute mastoiditis.
A total of 678 cases fulfilled the inclusion criteria. Acute mastoiditis was most common in children younger than two years of age and this group was characterized by less prior history of other diseases and ear diseases, fewer visits to health care centers and less antibiotic treatment before admission, shorter duration of symptoms before admission, hospitalization for fewer days and lower frequency of complications and mastoidectomies. These children also showed a higher incidence of clinical findings, increased inflammatory markers such as fever and heightened counts of C-reactive protein and white blood cells compared with older children. They also tested positive for significantly more samples of Streptococcus pneumoniae while the older children more often exhibited growth of Streptococcus pyogenes or Pseudomonas aeruginosa or no microbial growth.
The characteristics of pediatric acute mastoiditis differed significantly between age groups. Acute mastoiditis was most common in children younger than two years of age. They showed more rapid progress of symptoms and more distinct signs of acute mastoiditis. This is probably the reason why parents rapidly seek medical care for small children and hospital treatment thus starts earlier in the youngest children, which may in turn explain the excellent outcome. This study showed that younger children have neither more severe acute mastoiditis nor more complications than older ones. The differences between age groups suggest that there are distinctions in the pathophysiology behind the onset and course of acute mastoiditis in younger and older children.
OBJECTIVE: To evaluate the efficacy of adenoidectomy compared with long term chemoprophylaxis and placebo in the prevention of recurrent acute otitis media in children aged between 10 months and 2 years. DESIGN: Randomised, double blind, controlled trial. SETTING: Oulu University Hospital, a tertiary centre in Finland. PARTICIPANTS: 180 children aged 10 months to 2 years with recurrent acute otitis media. INTERVENTION: Adenoidectomy, sulfafurazole (sulphisoxazole) 50 mg/kg body weight, given once a day for six months or placebo. Follow up lasted for two years, during which time all symptoms and episodes of acute otitis media were recorded. MAIN OUTCOME MEASURES: Intervention failure (two episodes in two months or three in six months or persistent effusion) during follow up, number of episodes of acute otitis media, number of visits to a doctor because of any infection, and antibiotic prescriptions Number of prescriptions, and days with symptoms of respiratory infection. RESULTS: Compared with placebo, interventions failed during both the first six months and the rest of the follow up period of 24 months similarly in the adenoidectomy and chemoprophylaxis groups (at six months the differences in risk were 10% (95% confidence interval -9% to 29%) and 18% (-2% to 38%), respectively). No significant differences were observed between the groups in the numbers of episodes of acute otitis media, visits to a doctor, antibiotic prescriptions, and days with symptoms of respiratory infection. CONCLUSIONS: Adenoidectomy, as the first surgical treatment of children aged 10 to 24 months with recurrent acute otitis media, is not effective in preventing further episodes. It cannot be recommended as the primary method of prophylaxis.
The individual impact of timeliness vs adequacy of empiric antibiotic therapy for a clinical suspicion of ventilator-associated pneumonia (CSVAP) is unknown. Accordingly, in patients with CSVAP and timely initiation of empiric antibiotic therapy, we determined the impact of inadequate therapy (IT).
Analysis of a randomized trial of CSVAP treated empirically with meropenem or meropenem plus ciprofloxacin was done. Adequate therapy (AT) was considered present if all pathogens in the index culture were sensitive to the empiric antibiotics; IT was defined as the presence of pathogens resistant to the empiric antibiotics. A priori, for Pseudomonas sp, 2 antibiotics with activity against the organisms were required for AT to be considered present.
Of 739 patients with CSVAP, 350 had positive cultures: 313 (89.4%) had AT, and 37 (10.6%), IT. The IT group had higher intensive care unit (35.1% vs 11.8%, P = .0001) and hospital mortalities (48.7% vs 19.5%, P