Practical test kits for quantitatively evaluating the sense of smell.

A set of polypropylene squeeze-bottles, containing serial dilutions of pyridine in mineral oil, are used to deliver puffs of accurately odorized air to the nose. The patient's olfactory threshold can be quantitatively measured in a few minutes, and placed in the normal, hyposmic or hyperosmic range of sensitivity.

Cardiorespiratory effects of flexible fiberoptic bronchoscopy in critically ill patients.

The flexible fiberoptic bronchoscope is used increasingly often as a multipurpose instrument in critical care medicine. In poor risk patients who need continuous mechanical ventilation, rigid open tube bronchoscopy is a problem. With the flexible fiberoptic bronchoscope, however, diagnostic and therapeutic procedures can be carried out without interruption of ongoing mechanical ventilation. This procedure offers the possibility of bronchoscopy with reduced risk in debilitated patients. However, in these critically ill patients, the cardiopulmonary system is functioning at the borderline of its ability. Therefore, even the small changes in ventilation pattern caused by flexible fiberoptic bronchoscopy (FFB) may in some cases cause dangerous cardiopulmonary distress. For example, changes of intrabronchial pressure, tidal volume, PaO2, PaCO2 and cardiac output may be caused by the procedure. Further, it is of great importance to restrict suction through the instrument to short periods to avoid dangerous alterations in the ventilation perfusion relationship. Since serious complications may occur, it is mandatory that the bronchoscopist be aware of the potential pathophysiologic effects of FFB during mechanical ventilation of critically ill patients.

Endotracheal excision of fibrous tracheal stenosis and subsequent prolonged stenting an alternative method in selected cases.

Stenosis of the trachea, especially after prolonged intubation for mechanical ventilation or after direct trauma to the trachea, has become an increasing problem worldwide. The generally accepted treatment of choice is resection of the stenotic part of the trachea and end-to-end anastomosis; however, some patients have primary diseases (multiple injuries, cardiorespiratory failure, severe bronchial asthma, adrenal dysfunction, etc) that contraindicate any major tracheal surgery. In these cases, more conservative methods must be tried. Treatment with dilation using various types of stents, mostly combined with endotracheal excision of fibrous tissue, has been used in 20 patients during the period of 1965 to 1974 at the Department of Otolaryngology, University Hospital, Uppsala, Sweden. In the 17 patients who have completed treatment who have completed treatment (two patients still being treated and one patient died of myocardial infarction during treatment), nine were classified as having good clinical results, four as satisfactory, and four as failures. We believe that treatment of tracheal stenosis using dilation with stents is a reasonably good alternative in patients whose general condition makes them poor risks for major tracheal surgery.