Managing the patient with severe respiratory problems.

The dental management of patients with severe respiratory problems continues to be a significant challenge to the dental health care practitioner. Chronic obstructive pulmonary diseases, such as chronic bronchitis and emphysema, are the fourth leading cause of death in the United States. Asthma has increased in prevalence during the past 20 years, and the rate of death from this chronic inflammatory disease of the airways has also risen despite recent advances in medical treatments. This article will review the pathophysiology and medical treatment modalities for these chronic pulmonary diseases, as well as discuss the recognition and management of dental patients with these diseases and provide an understanding on how to avoid precipitating factors that could initiate an acute episode in the dental care setting.

Hormonal control of the cervix in pregnant gilts. I. Changes in the physical properties of the cervix correlate temporally with elevated serum levels of estrogen and relaxin.

The time course of changes in the physical properties of both the uterine and vaginal portions of the cervix were studied during the last two thirds (days 40 to approximately 115) of pregnancy in the gilt. To obtain insight concerning the hormonal control of these physical changes, serum levels of relaxin, estrone, 17 beta-estradiol, and progesterone were also determined. Throughout midpregnancy, the extensibility (softness), lumen diameter, and wet weight of the uterine portion of the cervix were less than those of the vaginal portion of the cervix. After day 80, marked and sustained increases in these three physical parameters occurred in the uterine portion of the cervix whereas slight (extensibility) or moderate (lumen diameter and wet weight) increases occurred in the vaginal portion of the cervix. By day 110, extensibility, lumen diameter, and wet weight of the uterine portion of the cervix were similar to those of the vaginal portion of the cervix. Because the uterine portion of the cervix has a relatively firm consistency and small lumen throughout most of pregnancy, we conclude that it probably plays a more important role than the vaginal portion of the cervix in protecting the uterus and its contents during pregnancy. The marked changes in the physical properties of the uterine portion of the cervix are temporally correlated with elevated serum estrogen levels (days 80-100) or estrogen and relaxin levels (day 100 to term). We conclude that estrogen or, more likely, estrogen and relaxin in combination may promote the modifications in the physical properties of the cervix that occur during the last 35 days of gestation.

Hormonal control of the cervix in pregnant gilts. II. Relaxin promotes changes in the physical properties of the cervix in ovariectomized hormone-treated pregnant gilts.

The effects of relaxin on the physical properties of both the uterine and vaginal portions of the cervix were studied between days 80 and 110 of pregnancy in ovariectomized gilts given progesterone to maintain pregnancy. In controls gilts the extensibility, lumen diameter, and wet weight of the uterine portion of the cervix were less than those of the vaginal portion of the cervix on day 80, but increased thereafter, and by day 110 did not differ (extensibility and wet weight) or approached (lumen diameter) those values of the vaginal portion of the cervix. When gilts were ovariectomized on either days 80 or 100 and given progesterone only (groups OP-100 and OP-110) extensibility, lumen diameter, and wet weight failed to increase in both the uterine and vaginal portions of the cervix. After replacement therapy with progesterone plus relaxin (groups OPR-100 and OPR-110), extensibility, lumen diameter, and wet weight increased to values as least as large as those in control groups in both portions of the cervix. In all groups the uterine portion of the cervix changed more dramatically than the vaginal portion. After hormone replacement therapy, blood levels of relaxin were moderately higher, and blood levels of progesterone were somewhat lower than those in control gilts. There was little or no difference in estrogen levels between ovariectomized and control gilts. We conclude that relaxin plays an important role in promoting increased growth and extensibility in both the uterine and vaginal portions of the cervix after day 80 of gestation in the gilt.