Failure to meet extubation criteria in the setting of suspected buffalo chest physiology.

We report the case of a patient who failed to meet tracheal extubation criteria due to low tidal volumes from suspected buffalo chest, which is a single pleural space physiology. This presentation followed the resection of a large pleural mass in a 59-year-old woman with a history of exercise-induced asthma, hypertension and tumour-related chronic respiratory failure. Creation of a pleuro-pleural communication during the resection of this large, unilateral pleural mass led to bilateral pneumothoraces and contributed to patients inability to generate negative inspiratory force leading to failure to meet extubation criteria. Buffalo chest may be more prevalent than suspected and should be a differential diagnosis for low tidal volumes with spontaneous ventilation following thoracic surgery. It can be differentiated from other causes of decreased tidal volume using clinical examination, ultrasound and radiography. Bilateral chest tube placement can be considered to expedite pneumothorax resolution and tracheal extubation.

Effectiveness of a nurse-led alcohol liaison service in a secondary care medical unit.

Alcohol misuse is a common reason for hospital admission. While there is considerable evidence from other areas that provision of specialised alcohol services can reduce alcohol intake, there is currently less evidence for medical departments in an acute hospital setting. Nottingham hospitals initiated such a service in 2002-3 based around two nurse specialists who provided input to inpatients with alcohol-related physical disease and provided links to community-based services for alcohol misuse. This service assessed 3632 patients over five years and has seen a reduction in hospital admissions, violent incidents against staff and primary care attendances. It is believed that this model of care is an effective means of intervening in people with alcohol-related problems.

Electromyographic and computer analyses of patients suffering from chronic myofascial pain-dysfunction syndrome: before and after treatment with immediate complete anterior guidance development.

Seven women patients at Tufts University School of Dental Medicine were evaluated for the subjective symptoms of a myofascial pain dysfunction. Each patient was evaluated by an occlusal analysis of the T-Scan computer to determine posterior disclusion time during excursive movements, and EMG analysis of the masseter and temporalis muscles. Each patient was then treated occlusally by developing immediate complete anterior guidance. This adjustment process involved the removal of all lateral and protrusive interferences prior to habitual closure adjustments. No attempt was made to retrude the mandible in centric relation, and splints were not used to deprogram the musculature before adjustment. In this study, protrusive movements and interferences were not examined, and there was no control group. Posttreatment EMG and T-Scan computer analyses revealed that by shortening disclusion times to less than 0.5 second in any lateral excursions, muscle function returned to normal in all seven patients in approximately 1 month's time. A direct correlation seemed to exist between contractile muscle activity and disclusion time. Lengthy disclusion time leads to excessive muscle activity that introduces spasm and fatigue of the masseter and temporal muscles. These results indicated that a partial explanation of the etiology of MPDS may be the time the molars and nonworking premolars remain in contact during excursive movements--a phenomenon termed "disclusion time."

The influence of habitual alcohol intake on breath-alcohol concentrations following prolonged drinking.

Fifty-one healthy men aged 20-35 years kept daily drinking diaries for 4 weeks prior to a 90-min drinking session of 1 ml of ethanol/kg body weight, taken as 4% alcohol by volume lager, at a constant rate, whilst fasting. This was followed by repeat breath-alcohol measurements for 90 min. Habitually light drinkers had significantly lower breath-alcohol levels than heavier drinkers up to 10 min post-drinking. Variation in breath-alcohol level was independent of habitual intake 15-90 min post-drinking. However, habitually light drinkers still had significantly lower blood-alcohol levels than heavy drinkers 30 min post-drinking. Group mean post-drinking breath-alcohol levels peaked at 20 min in light and moderate drinkers, at 10 min in heavy drinkers and at 5 min in very heavy drinkers. Wide individual variation in peak and rate of decline of breath-alcohol levels occurred independently of habitual intake and despite experimental control for factors influential on alcohol kinetics. Algorithms for alcohol intake and breath concentrations have limited application if drinking is prolonged. We suggest that preabsorptive metabolism and/or delayed absorption of alcohol may contribute to lower breath-alcohol levels in habitually light drinkers for 10 min following alcohol intake under the conditions of this study.