Influence of the cuff pressure on the swallowing reflex in tracheostomized intensive care unit patients.

BACKGROUND: Because recovery of an efficient swallowing reflex is a determining factor for the recovery of airway protective reflexes, we have studied the influence of the tracheostomy tube cuff pressure (CP) on the swallowing reflex in tracheotomized patients. METHODS: Twelve conscious adult intensive care unit (ICU) patients who had been weaned from mechanical ventilation were studied. Simultaneous EMG of the submental muscles with measurement of peak activity (EMGp) and amplitude of laryngeal acceleration (ALA) were performed during reflex swallows elicited by pharyngeal injection of distilled water boluses during end expiration. After cuff deflation, characteristics of the swallowing reflex (latency time: LaT, EMGp, and ALA) were measured at CPs of 5, 10, 15, 20, 25, 30, 40, 50, and 60 cm H(2)O. RESULTS: LaT and CP were linearly related (P<0.01). CP was inversely correlated (P<0.01) to both ALA and EMGp. CONCLUSIONS: We demonstrated that LaT, EMGp, and ALA of the swallowing reflex were influenced by tracheostomy tube CP. The swallowing reflex was progressively more difficult to elicit with increasing CP and when activated, the resulting motor swallowing activity and efficiency at elevating the larynx were depressed.

[Chlamydia trachomatis infection of the genitals in women]. / Quelques aspects de l'infection à Chlamydia trachomatis à localisation génitale chez la femme.

Direct and by immunofluorescence examination of smears, conducted on 682 women with different diseases of the cervix uteri, allowed the detection of Chl. trachomatis in 10.5% and 11.1% of the subjects, respectively. The incidence of the infection was significantly higher among unmarried women (33.7%) than among married ones (4.2%). In a second group of 305 women, sexual partners of men with chlamydial urethritis, the incidence of infection as found by the two methods of diagnosis was 57.3% and 59.3%, respectively. Colposcopy showed that more than 90% of these women had lesions at the cervix uteri level. High frequency of cervicitis, associated frequently with ectopy of the cervical epithelium in the case of Chl. trachomatis infection, suggested the determinant implication of this pathogen in the inflammatory lesions of the cervix uteri. The ectopy of the cervix epithelium is probably a factor favoring the multiplication of the pathogen.

Statistical studies on the epidemiology of human congenital malformations. Implications of maternal virus infections.

Prospective and retrospective statistical studies were performed in 1,000 cases of congenital malformations. The incidences and severity of the different types of malformations were correlated with the risk and protection factors having acted on the pregnant woman. The correlation coefficients were higher in the case of specific risk factors, among which special attention was paid to maternal virus infections. The possibility is discussed of developing a programme for the individual protection of high-risk cases, implying the compensation of the exposure to risk factors by the application of adequate protection factors, according to the calculated scores.

Study of antibodies against viruses, chlamydiae, rickettsiae and Mycoplasma pneumoniae in children with respiratory diseases.

Seroconversion to different viral, chlamydial, rickettsial and mycoplasma antigens was followed up in 134 children aged 0-6 years, hospitalized with different respiratory diseases. Parainfluenza viruses type 1, 2 and 3 and adenoviruses appeared to be involved in the etiology of most of the cases; respiratory syncytial virus was often found to play a role in pneumonia/bronchopneumonia and in "influenza-like illness", while chlamydiae and M. pneumoniae could be incriminated in cases of "influenza-like illness", as well as in the other categories of respiratory disease. Mixed infections with the agents studied could be detected.

Stochastic model of the evolution of viral hepatitis morbidity.

Starting from the elementary epidemiological processes, the authors develop an evolution equation of the function generating the probability distribution of the number of viral hepatitis (VH) patients and susceptible subjects. Evolution equations for moments of order 1 and 2 - resulting from the equation of the generating function-are also discussed on the ground of certain simplifying hypotheses. The formulae are applied to the analysis of VH morbidity evolution in several children communities. The data on the evolution of the different moments and of the probability distributions are used from the specification of epidemiological transmissibility and susceptibility parameters.

Isolation of parainfluenza virus type 3 from an infant with meningoencephalitis.

A parainfluenza virus type 3 strain was isolated from the cerebrospinal fluid of an infant with a clinical diagnosis of meningoencephalitis. Specific HAI antibodies to parainfluenza virus type 3, ranging in titer from 1/80 to 1/160 could be detected in the infant's serum. A 2-fold rise in the level of complement fixing serum antibodies-from 1/16 at the first to 1/32 at the second collection-was recorded.

Prevalence of antiviral antibodies in workers handling wastewater and sludge.

Serological investigations were performed between 1977-1978 with 972 serum samples from 243 subjects having either direct (group A) or sporadic (group B) occupational contact with wastewater or sludge. the control group (C) was represented by 100 persons having no contact with such material. The sera were tested against influenza, parainfluenza, adeno-, herpes, coronavirus, rickettsial and chlamydial antigens, as well as for the presence of HBsAg and anti-HBs. Statistically significant differences between group A and groups B and C were found as regards the prevalence of antibodies to adenovirus and parainfluenza virus type 1 antigens.