Management of suspected foreign body aspiration in children.

We aimed to establish prevailing consultant opinion on the management of children with a history suggestive of foreign body (FB) aspiration but no clinical or radiological findings. FB aspiration is a common problem in children. Most agree that bronchoscopy should be performed if a child has clinical or radiological signs. With suggestive history but no such signs, the decision is more difficult; both bronchoscopy and neglected FBs have the potential for serious consequences. A postal questionnaire was sent to all British Association of Otolaryngologists and Head and Neck Surgeon (BAO-HNS) consultants. The 563 questionnaires sent elicited a 63% reply rate. With suspected organic FBs, 52% would bronchoscope immediately, 38% would observe, and 10% would discharge. With suspected inorganic FBs, 35% would bronchoscope, 42% would observe, and 23% would discharge. Thus, the majority suggest admission, showing a preference for bronchoscopy with a history of organic FB, and observation if inorganic. Unless justified, it may be unacceptable to discharge these patients.

Mastoid surgery in childhood.

The presenting features and operative findings in 105 patients aged 16 years or less undergoing mastoid surgery are reviewed. In 94% surgery was for chronic otomastoiditis, usually acquired, and associated with cholesteatoma in 64%. Post-operative otorrhoea persisted beyond 6 months in 44% and contralateral disease required some form of surgical procedure in 20%. Post-operative hearing thresholds were improved or unchanged in the majority of patients, most of whom underwent cortical or modified radical mastoidectomy. An improvement in the therapeutic results of mastoid surgery in childhood is clearly necessary, but requires a greater understanding of the aetiology of chronic middle ear disease.

The involvement of ethanol in the free radical reaction of 6-hydroxydopamine.

ESR spin trapping technique was used to detect and analyze free radical formation. When 6-hydroxydopamine (6-OHDA) was incubated alone or in the presence of a free radical generating system (H2O2 and FeSO4), hydroxyl free radicals were observed in a concentration-dependent manner. Glutathione was found to be the most effective scavenger of the ESR signal when compared with vitamin E or Mannitol. The addition of ethanol resulted in the formation of the pure hydroxyethyl free radicals. The amount of hydroxyethyl free radicals in the system was dependent upon the concentration of ethanol and the formation of hydroxyethyl free radicals correlated well with the extent of lipid peroxidation and the loss of enzymic activity of the membrane-bound (Na+,K+)-ATPase. We suggest that in the biological system ethanol may potentiate the neurotoxicity of 6-OHDA with the formation of hydroxyethyl free radicals, which are longer-lived and far more damaging to membranes than the hydroxyl radicals. These data lead us to further hypothesize that the neuronal degeneration caused by 6-OHDA and other compounds that generate free radicals could be potentiated in the presence of ethanol.

Potentiation of ethanol-induced lipid peroxidation of biological membranes by vitamin C.

The hydroxyl free radical (.OH) was generated by the system of ADP-Fe++ and H2O2, trapped by 5,5-dimethyl-1-pyrroline-N-oxide (DMPO) and analyzed by electron spin resonance (ESR) spectroscopy. The addition of vitamin C to the system decreased considerably the amount of hydroxyl adduct of DMPO formed. In the presence of ethanol, the ESR spectrum observed was a composite signal of the hydroxyl and hydroxyethyl (HE) adducts of DMPO. However, in the presence of vitamin C and ethanol, pure HE adduct of DMPO was detected. We also detected the increase in lipid peroxidation in the presence of ethanol and vitamin C. These data lead us to hypothesize that in the biological system, formation of these long-lived HE free radicals may result in membrane damage due to an increase in lipid peroxidation.

Detection of free radical formation in various tissues after acute carbon tetrachloride administration in gerbil.

alpha-phenyl N-tert-butyl nitrone (PBN) was used as a spin-trapping agent to search for free radical formation in various tissues of gerbils. A significantly large amount of free radicals was detected in liver, kidney, heart, lung and testis after a single intraperitoneal dose of CCl4. We have also detected free radical formation in the brain and blood, although the number of spins was considerably smaller than those found in the other tissues. Free radicals formed in brain tissue after an oxidative insult may give strong supporting evidence for the free radical theory of aging.

Tuberculosis of the trachea.

A patient is described who presented with stenosis of the upper trachea causing respiratory distress. There was no evidence of tuberculosis elsewhere in the body but biopsy showed a granulomatous lesion and there was a good response to anti-tuberculosis chemotherapy. A temporary tracheostomy was needed.

Prevention of subglottic stenosis in neonatal ventilation.

Mechanical ventilation of the newborn is now widely used in neonatal intensive care. The oro-tracheal route of intubation is simpler, but for long-term ventilation has been considered unstable. A method of fixation of oro-tracheal tubes is described which overcomes this instability. Five hundred consecutive ventilated infants were intubated by the oro-tracheal route and the tube was fixed by the method described. Of the 500 ventilated infants, 213 died without being extubated. Of the 287 survivors, 44 developed a degree of post-extubation stridor. No surviving infant developed clinical evidence of subglottic stenosis and in almost 200 postmortem examinations laryngeal narrowing was not identified. The method of oro-tracheal fixation described is stable and may reduce the incidence of subglottic stenosis.

Effects of plasmenylethanolamine on the dynamic properties of the hydrocarbon region of mixed phosphatidylcholine-phosphatidylethanolamine aqueous dispersions. A spin label study.

Spin-labeled aqueous dispersions of total phospholipid extracts from whole brains of hibernating hamsters and rats chronically consuming ethanol were compared with dispersions from control animals. Order parameter values and approximate rotational correlation times for the nitroxide spin labels indicated that ethanol consumption results in an adaptive decrease in bilayer membrane fluidity, while hibernation produces increases in fluidity. Since it has been proposed that changes in plasmenylethanolamine such as those seen with hibernation play a role in the homeoviscous adaptation of brain membranes, electron spin resonance studies using aqueous phospholipid dispersions containing equimolar mixtures of rat brain phosphatidylethanolamine and phosphatidylcholine, or synthetic dioleylphosphatidylcholine and dioleylphosphatidylethanolamine, and brain plasmenylethanolamine were performed. The molar amount of plasmenylethanolamine was varied within the ethanolamineglycerophospholipid fraction of each dispersion. Order parameter values of spin labels in liposomes containing brain phosphatidylcholine and phosphatidylethanolamine increased in parallel with increases in plasmenylethanolamine concentrations, indicating that fluidity was decreasing. Liposomes composed of synthetic dioleyl phospholipids exhibited biphasic changes in order parameter (S) values as plasmenylethanolamine replaced the diacyl form. Below 30% (mol%) plasmenylethanolamine, S values decreased, while above 30%, S values were seen to increase; indicating an initial fluidization, followed by a decrease in fluidity.

Laryngeal and tracheal stenosis: an adapted speaking aid tracheostomy tube.

A 41-year-old male patient with post-diphtheritic laryngeal deformity and an extensive upper tracheal stenosis is presented. Previous surgical attempts at repair of the tracheal stenosis had been unsuccessful and further surgery is not contemplated at the present time. A permanent speaking-aid tracheostomy tube must therefore be worn at all times and an adaptation to this tube to allow some expiratory escape past the valve is described.