Mouth opening and trismus in patients undergoing curative treatment for head and neck cancer.

This study documents mouth opening and the incidence of and factors contributing to trismus (<35 mm mouth opening), as well as the associated impact on quality of life, following curative treatment for head and neck cancer. Patient demographics, cancer type and location, and treatments were documented. Mouth opening was measured at >6 months after treatment completion. Patients rated the impact of mouth opening on quality of life from 0 (no effect) to 10 (greatest effect). The mean mouth opening in 120 patients was 40.1mm (range 11-65 mm), with trismus occurring in 34 (28.3%) patients. Surgery and radiotherapy, surgery and chemoradiotherapy, and resection and reconstruction were associated with reduced mouth opening. The mean effect of mouth opening on quality of life for those with and without trismus was 3.8 and 1.5, respectively. There was a significant difference between the mean effect on quality of life for patients with and without trismus for those patients who underwent chemoradiotherapy or combined surgery and radiotherapy (4.0 vs. 1.0, and 3.6 vs. 1.6 respectively). Trismus impacts negatively on patient quality of life. Multi-modality treatment is associated with decreased mouth opening, an increased incidence of trismus, and reduced quality of life.

Errors in estimates of peritoneal fluid volume.

Inherent limitations in the suitability of drainage volumes for monitoring intraperitoneal fluid volume have resulted in the frequent use of indicator dilution techniques, but little attention has been given to confirming the adequacy of the estimates that volume markers provide. In a series of experimental exchanges in rats, volume estimates were compared based on the dilution of blue dextran and hemoglobin with direct collections of surgically exposed intraperitoneal fluid. Significant systematic and random errors in the indicator dilution volume estimates were observed. The systematic errors appeared to be due to the rapid removal of a fixed amount of marker from peritoneal fluid, while the random errors were caused by the rapid appearance of a variable amount of endogenous chromogen. The behavior of the markers observed in this study was not consistent with the assumptions commonly used to analyze volume transport in peritoneal dialysis.

[The ventilation procedure in critical patients operated on under extracorporeal circulation]. / Ventilatorna taktika pri kritichno bolni, operirani pod ekstrakorporalno kruvoobrashtenie.

In an effort to make initial clinical and functional assessment of the "dishabituation" from controlled ventilation by pressure-assisted ventilatory regiments, the authors studied 24 patients in whom valvular prosthesis operations had been performed and who required long-term artificial pulmonary ventilation. The dynamic changes and the parameters observed in one group of patients, designated as control, served as basis for the second, tested group. Half of the patients of the tested group passed through SIMV + Druckunterst and the other half--through Druckunterst-ventilatory regimens, which helped by pressure spontaneous breathing. Such clinical characteristics and functional parameters as: duration of "dishabituation" from assisted breathing, need of re-intubation, changes in oxygen consumption etc, caused by change in the ventilatory regiment, were evaluated and analyzed. The following conclusions were made: 1. Druckunterst has no advantages over SIMV + Druckunterst, as regards the duration of "dishabituation" from assisted breathing: 2. Both pressure-assisted regimens improved [correction of imfr ved] arterial oxygenation, which probably was due to increase in the alveolar volumes, which had been reduced during the bypass circulation period.

The use of polyelectrolytes as osmotic agents for peritoneal dialysis.

Various small and large molecules have been studied as osmotic agents to replace dextrose in peritoneal dialysis. Macromolecules are attractive because of their slow absorption from intraperitoneal solutions; however, it has been assumed that they are only marginally effective as osmotic agents unless they function as polyelectrolytes at physiological pH. In experimental exchanges conducted in rats we measured volume changes induced by Gelifundol (5.5% oxypolygelatin) and Ringers lactate to which was added either nothing, 4.25% dextrose, or 5% albumin. In the control exchanges using Ringers lactate, intraperitoneal fluid volume remained unchanged for eight hours. The volume changes induced by 4.25% dextrose were complete within two hours and resulted in a two-thirds increase over the amount of fluid administered. In both series in which polyelectrolytes were used volume transport was sustained throughout an eight hour dwell. With 5% albumin the total increase in fluid volume was about 40% of that installed, while Gelifundol caused fluid volume to double. Qualitatively similar results were obtained in transport studies conducted in vitro. Physical studies of the oxypolygelatin solutions indicated that the fixed charges per liter were comparable to those in the albumin solutions. Thus the different volume transport the two proteins induced could not be attributed to Donnan effects. However, since the molecular weight of albumin is triple that of Gelifundol the van't Hoff pressures of the two macromolecules can explain the observed differences in volume transport. These results suggest that neutral macromolecules deserve further study as potential osmotic agents for peritoneal dialysis.