Computerized Dead-Space Volume Measurement of Face Masks Applied to Simulated Faces.

BACKGROUND: The dead-space volume (VD) of face masks for metered-dose inhaler treatments is particularly important in infants and young children with asthma, who have relatively low tidal volumes. Data about VD have been traditionally obtained from water displacement measurements, in which masks are held against a flat surface. Because, in real life, masks are placed against the face, VD is likely to differ considerably between masks depending upon their contour and fit. The aim of this study was to develop an accurate and reliable way to measure VD electronically and to apply this technique by comparing the electronic VD of commonly available face masks. METHODS: Average digital faces were obtained from 3-dimensional images of 270 infants and children. Commonly used face masks (small and medium) from various manufacturers (Monaghan Medical, Pari Respiratory Equipment, Philips Respironics, and InspiRx) were scanned and digitized by means of computed tomography. Each mask was electronically applied to its respective digital face, and the VD enclosed (mL) was computerized and precisely measured. RESULTS: VD varied between 22.6 mL (SootherMask, InspiRx) and 43.1 mL (Vortex, Pari) for small masks and between 41.7 mL (SootherMask) and 71.5 mL (AeroChamber, Monaghan Medical) for medium masks. These values were significantly lower and less variable than measurements obtained by water displacement. CONCLUSIONS: Computerized techniques provide an innovative and relatively simple way of accurately measuring the VD of face masks applied to digital faces. As determined by computerized measurement using average-size virtual faces, the InspiRx masks had a significantly smaller VD for both small and medium masks compared with the other masks. This is of considerable importance with respect to aerosol dose and delivery time, particularly in young children. (ClinicalTrials.gov registration NCT01274299.).

Abrupt tonsillar hemorrhage from a metastatic hemangiosarcoma of the breast: case report and literature review.

We describe a case of primary breast hemangiosarcoma with tonsillar metastasis that manifested as a profuse oropharyngeal hemorrhage. The patient was a 54-year-old woman who presented to the emergency department with oral bleeding. A thorough examination revealed a distorted morphology of the left tonsil and a hemorrhage originating from it. Conservative methods to control the hemorrhage failed, and tonsillectomy was carried out. Histopathologic analysis revealed that the left tonsil contained hemangiosarcoma cells of the same kind that had been removed from the breast. Primary hemangiosarcomas of the breast are rare; when they do occur, they usually recur locally and spread hematogenously. To the best of our knowledge, this is the first case of a primary breast hemangiosarcoma with tonsillar metastasis to be reported in the literature. We present a detailed analysis of this case, and we review the relevant literature on metastatic tonsillar tumors, with attention to the role of therapeutic embolization.

Selective embolization for head and neck vasculopathies.

INTRODUCTION: Selective, transarterial embolization of vascular lesions through angiographic catheters, which in superficial vasculopathies is often accompanied by intralesional local administration of sclerosing agents, has been used for more than 65 years. However, the reported experience with this therapeutic modality for head and neck lesions is rather limited. METHODS AND MATERIALS: In the current study we describe our experience with all 12 patients having major head and neck vasculature pathologies who were admitted and treated by selective embolization in our institution during a 5-year period. RESULTS: Eight patients had congenital malformations, and 4 had acquired lesions induced by trauma, irradiation, or anticoagulant therapy. Four cases were potentially life-threatening because of severe blood loss and were thus treated immediately. In only 3 cases was subsequent surgical resection of the lesion necessary. The therapy administered is reported, and its outcome is discussed in respect to the available updated literature. CONCLUSIONS: The reported high rate of success with no complications may be the result of careful techniques and appropriate preoperative imaging, as well as the intraoperative and perioperative treatment with steroids and the multiple intralesional puncture sessions administered as necessary.