Triage and initial evaluation of the oral facial emergency.

Essentially, emergency medicine encompasses the efficient application of limited resources to provide timely care to patients in health crisis. The appropriate triage, management, and disposition of patients with orofacial complaints requires systematic evaluation with attention to the ABCs. The first priority is to secure the airway. Once such a patient has been stabilized, a thorough examination, with documentation of the oropharyngeal and facial examination, should be conducted. Unfortunately, many conditions seen initially in the ED through patient self-referral ultimately require specialist care. Therefore, emergency physicians must temporarily provide pain relief and begin initial treatment of traumatic, infectious, or inflammatory conditions that await more definitive intervention. The emergency physician should consider it his or her role to exclude life threats, prevent complications, provide patient comfort, and ensure adequate and timely follow-up care.

Effectiveness and tolerability of zafirlukast for the treatment of asthma in children.

OBJECTIVE: This study was undertaken to examine the dose-response relationship of zafirlukast (5 to 40 mg BID) and to assess the efficacy and tolerability of the 10-mg BID dose in school-aged children with mild to moderate asthma. BACKGROUND: The efficacy and tolerability of zafirlukast, an oral leukotriene-receptor antagonist, has been demonstrated in adolescents and adults aged > or = 12 years. METHODS: Data from 2 placebo-controlled, parallel-group, multicenter trials (trial 1, 4-week double-blind; trial 2, 6-week double-blind) were integrated. Children aged 5 to 11 years were randomly assigned to receive zafirlukast 5 mg BID (n = 99), 10 mg BID (n = 205), 20 mg BID (n = 105), 40 mg BID (n = 99), or placebo (n = 206). The primary outcome was change from baseline in forced expiratory volume in 1 second (FEV1) expressed as percent of predicted normal. Secondary outcomes were FEV1 (L), morning and evening peak expiratory flow, peak flow variability, short-acting beta2-agonist use, asthma episode score, and nights awakened by asthma. RESULTS: Mean baseline FEV1 was 76.5% of predicted. The greatest improvements were generally seen with zafirlukast 5 mg BID or 10 mg BID, with no additional clinically significant benefits seen at higher doses. The pooled data analysis showed that 10 mg BID compared with placebo significantly improved (P < 0.045) all efficacy outcomes except asthma-episode score and nights awakened with asthma. However, in the subset of children who had > or = 1 night awakened per week at baseline (zafirlukast 10 mg BID = 78; placebo = 86), 10 mg BID significantly reduced nights awakened (P = 0.009) (mean difference from placebo at end point = -0.81 night/wk). All zafirlukast doses were well tolerated and had tolerability profiles that were clinically indistinguishable from placebo. CONCLUSION: These results support the effectiveness and tolerability of the 10-mg BID dose of zafirlukast for the prophylaxis and chronic treatment of mild to moderate asthma in children.

An investigation into reading epilepsy.

In summary, our main findings were firstly, that faulty visuolingual processing at the level of Brain's visual word schemas, with its intimate connection with the verbal memory pool, is the abnormality that is essential for initiation of spike activity in reading epilepsy. Secondly, visual input is not essential in production of reading epilepsy. Thirdly, we have demonstrated a subconscious voluntary control mechanism operating in our patient. Lastly, we have illustrated alternatives to drug therapy, which, in our patient and in other cases, has not been shown of great value.