Functional treatment of snoring using oral shields in conjunction with the tongue repositioning manoevre

The tongue repositioning manoeuvre has been demonstrated to lead to a closed rest position of orofacial structures with increased contact of the velum with the tongue and a contact position of the tongue at the hard palate. Within the multifactorial etiology of snoring, the tongue repositioning manoeuvre was used as training method in conjunction with pressure indicating oral shields to reduce symptoms of snoring by stabilisation of the orofacial system. Bed partner ranking of 128 snorers treated consecutively showed a score before treatment of 8.9 on a 10 cm visual analogue scale. After treatment the score decrease to 4.2 (p<0.01). No significant BMI , age or gender specific influence of the outcome could beobserved. The data give evidence, that dynamic stabilisation of the orofacial system with oral shields in conjunction with the tongue repositioning manoevre is a valuable instrument to reduce the snoring problem.

La maniobra de reposicionamiento lingual ha demostrado tener ventaja para mantener cerrada el resto de estructuras orofaciales, con un aumento del contacto del paladar blando con la lengua y también en posición de contacto el paladar duro con la lengua. Dentro de la etiología multifactorial del ronquido, la maniobra de reposicionamiento lingual ha sido usada como método de entrenamiento, en conjunto con protectores orales que indican la presión para reducir los síntomas del ronquido y estabilizar el sistema orofacial. Un total de 128 pacientes roncadores tratados consecutivamente mostraron una puntuación antes del tratamiento de 8,9 a 10 cm en una escala visual análoga. Después del tratamiento, el puntaje disminuyó a 4,2 cm (p< 0,01). El índice de masa corporal no fue significativo, y no pudo ser observado si la edad o el género tenían influencia. Los datos evidenciaron que la estabilización dinámica del sistema orofacial, en conjunto con la maniobra de reposicionamiento lingual resulta ser una valiosa herramienta para reducir el problema del ronquido.

Arthrodesis in the treatment of hallux rigidus.

We reviewed 34 patients (38 joints) with hallux rigidus treated from 1989 to 1999 with arthrodesis of the first metatarsophalangeal joint. Average patient age at time of surgery was 52 (24-71) years, and the mean follow-up was 54 (18-116) months. There were six superficial infections, and all arthrodeses united. There was a good functional result with a significant pain reduction. The mean postoperative American Orthopaedic Foot and Ankle Society (AOFAS) score was 53 (5-84) points.

Analgesic triterpenes from Sebastiania schottiana roots.

The present study was conducted in order to isolate and identify the phytochemical constituents responsible for analgesic effects shown by a methanolic extract obtained from Sebastiania schottiana roots. Conventional chromatographic procedures led to the isolation of moretenone, glutinol, beta-sitosterol and stigmasterol. The structural elucidation of these compounds was done on the basis of spectral data (IR, 1H- and 13C-NMR) and comparison with authentic samples. Either glutinol or moretenone exhibited marked analgesic action against acetic acid induced abdominal constrictions in mice by intraperitoneal route, indicating 16 to 26-fold higher efficacy than aspirin and paracetamol. When analyzed in a formal-in test, both compounds and standard drugs inhibited only the second phase (inflammatory pain). Our results suggest that the roots of S. schottiana contain analgesic compounds which justify, at least partially, the popular use of this plant for the treatment of urinary problems.

A longitudinal study of symptoms and respiratory function tests in iron miners.

A first survey has been conducted on 1179 iron-ore mine workers, 35-55 years old, who were randomly selected from 5900 at work with normal chest roentgenograms. Five years later, 871 of them were re-examined. Both surveys included a standard respiratory symptoms questionnaire (British MRC), a physical examination of the chest, and measurement of pulmonary function (vital capacity - VC; forced expiratory volume during 1 s - FEV1.0; residual volume - R.V. by helium dilution: carbon monoxide uptake - FuCO by the steady-state method). Both surveys were done by the same research team under identical conditions, using the same equipment. The mine technical services determined the dust and noxious gas concentrations at work places. No evidence of worsening of respiratory health status was observed overall. Symptoms of chronic bronchitis and asthma were recorded with a similar prevalence in both surveys; the decline in lung function was minimal for the total sample. However, our aim was to compare changes that were observed in groups differing by work place (surface or underground) or by activity (active or retired). Analysis showed that development of respiratory symptoms was more frequent and decline in lung function accelerated in the 5-year interval among underground workers who were still active as compared to those retired. In all subgroups (surface or underground workers, active or retired), decline of lung function values was more marked in smokers compared to non-smokers.

Lung function and clinical findings in a cross-sectional study of arc welders. An epidemiological study.

An epidemiological, cross-sectional study was conducted in order to assess non-neoplasic effects on the lung due to chronic exposure to arc welding fumes and gases. The study involved 346 arc welders and 214 control workers from a factory producing industrial vehicles. These workers (welders and controls) had never been exposed to asbestos. Respiratory impairments were evaluated by using a standardized questionnaire, a clinical examination, chest radiophotography and several lung function tests (spirometry, bronchial challenge test to acetylcholine, CO transfer tests according to the breath-holding and the steady-state methods, N2 washout test). The only significant differences between the welders overall compared to the controls were a slightly higher bronchial hyper-reactivity to acetylcholine and a lower lung diffusing capacity for CO in the welders. However, non-specific, radiologic abnormalities (reticulation, micronodulation) and obstructive signs were more frequent in the most exposed welders (welding inside tanks) than in welders working in well ventilated workplaces. The nature of the metal welded (mild-steel, stainless steel, aluminium) did not seem to have an influence on respiratory impairments. In the mild-steel welders, respiratory symptoms (dyspnoea, recurrent bronchitis) and obstructive signs were more frequent in the welders using a manual process than in the welders involved with the semi-automatic process (MIG). For all the workers (welders and controls), smoking had a markedly adverse effect on respiratory symptoms and lung function. Moreover, smoking seemed to interact with welding since CO lung transfer was more impaired in smoking welders than in smoking controls.

Incidence of lung cancer among iron miners.

A study has been performed using 5300 iron miners from Lorraine (France) with ages ranging from 35 to 55 years, who were working, and had a normal chest radiography. 1173 workers were chosen randomly and given the following examinations: questionnaire, clinical examination and function tests (VC, FEV1, residual volume (RV), acetylcholine test, carbon monoxide steady-state test). This group of 1173 was followed for 5 years. 40 died and the exact causes of death were known. 13 had lung cancer, which is more than three times the number expected in the French male population of the same ages. All subjects who died from lung cancer were underground miners and, at the first examination, had a higher incidence of bronchitis and more functional defects than both the 27 who died from other causes and the underground miner group as a whole. The excess mortality due to lung cancer is discussed with regard to noxious agents that were measured (radioactivity, which was rather low, total and respirable dusts, Nox, CO) and with regard to both the work environment and duration of work.

[Long-term prognosis of chronic bronchitis following the first episode of acute respiratory decompensation]. / Pronostic lointain de la bronchite chronique après un premier épisode de décompensation respiratoire aiguë.

In order to assess the prognosis significance of the first episode of acute respiratory failure in chronic bronchitic, 100 bronchitics experiencing an episode of failure were followed for 3 1/2 to 6 years. A multivariate statistical analysis revealed the best prognostic parameters: the FEV1 (VEMS), the steady state Co transfer, age, neuro-psychiatric signs of respiratory failure and supra-ventricular dysrhythmias on ECG. Normocapnia contributes to a stabilised respiratory state. A predictive value could not be established for the clinical signs of right ventricular failure and of right ventricular hypertrophy on the ECG. Cardio-respiratory failure is the dominant cause of death but other causes occur more frequently in those subjects with severe respiratory impairment.

[Could the alveolo-arterial oxygen gradient be used in early diagnosis of chronic obstructive lung diseases (COLD)? (author's transl)]. / La mesure du gradient alvéolo-artériel d'oxygène peut-elle être proposée pour le dépistage des bronchopneumopathies chroniques obstructives (BPCO) débutantes?

During the epidemiological study of chronic respiratory affections amongst a population of 196 building workers over a period of 4 years, the alveolo-arterial oxygen gradient, calculated from PaO2 and PaCO2, was worked out on 55 people. At the first examination, neither the clinical symptoms nor the frequence of functional alterations singled out the group with a high A-aO2 gradient (greater than or equal to 15 torrs). At the second examination, 4 years later, these people showed a more important drop of FEV1.0/VC and symptomatological aggravation than those with a normal A-aO2 gradient. In spite of its lack of precision and the small sample on which the observations have been carried out, the high A-aO2 gradient seems to predict a clinical and functional worsening.

[Variations in the effect of clonidine on arterial pressure in rats in the presence of various anesthetics]. / Variations, en fonction de l'anesthésique, des effets de la clonidine sur la pression artérielle du rat.

The central hypotensive agent, clonidine (30 microgram/kg i.v.) has been injected in normotensive rats anesthetized with various agents. This dose of clonidine elicits usually a biphasic blood pressure response, i.e. a transient increase due to peripheral vasoconstriction, followed by a long lasting decrease. This has been observed in the animals anesthetized with pentobarbitone as well as with urethane. The hypotensive effect is abolished during chloralose, ketamine or Alfatésine anesthesia. These data emphasize that some anesthetics mays particularly modify the effects of centrally acting cardiovascular drugs.