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  • 1
    ISSN: 1432-1238
    Keywords: Key words Percutaneous dilatational tracheostomy ; Complications ; Results ; Tracheal stenosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To analyze perioperative and postoperative complications and long-term sequelae following percutaneous dilatational tracheostomy (PDT). Design: A prospective clinical study of patients undergoing PDT. Setting: Seven intensive care units at a University hospital Patients: 326 intensive care patients (202 male, 124 female; age: 11–95 years) with indications for tracheostomy. Interventions: Using tracheoscopic guidance, 337 PDTs were performed according to Ciaglias' method. In 106 decannulated patients, tracheal narrowing was assessed by plain tracheal radiography. Results: Two procedure-related deaths were seen (0.6 %). Perioperative and postoperative complications occurred with 9.5 % of the PDTs. One of 106 patients, who were followed-up for at least 6 months, showed a clinically relevant tracheal stenosis. Subclinical tracheal stenosis of at least 10 % of the cross-sectioned area was recognized in 46 of 106 patients (43.4 %). In the univariate analysis, the degree of stenosis was influenced by the age of the patient (p = 0.044), the duration of intubation prior to PDT (p = 0.042) and by the duration of cannulation (p = 0.006). These parameters had no statistical significance in a multiple regression model. Conclusion: When performed by experienced physicians, percutaneous dilatational tracheostomy under fiberoptic guidance is a safe method. The risks of early complications and of clinically relevant tracheal stenoses are low. Subclinical tracheal stenoses are found in about 40 % of patients following PDT.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-2072
    Keywords: Key words Nicotine ; Stereoisomers ; Sensory ; Trigeminal ; Olfaction ; Pain
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Rationale: Nicotine applied to the nasal cavity can evoke ‘odorous’ sensations in the concentration range near the detection threshold by the activation of the olfactory sensory system and at higher concentrations ‘burning’ and ‘stinging’ sensations by the dose-dependent recruitment of C- and Aδ-fibers of the trigeminal sensory system. Neuronal nicotinic acetylcholine receptor (nAchR) subunits are expressed in trigeminal primary afferents and could constitute the receptors involved in nicotine perception. Objective: In the present study, we dose-dependently investigated the stereoselective effects of R(+)- and S(−)-nicotine on the trigeminal and olfactory sensory system in man. Methods: Trigeminal detection thresholds for the ‘burning’ and ‘stinging’ sensations and the olfactory detection threshold for the ‘odorous’ sensation were determined. In order to quantify trigeminal activation, we recorded summated electrical responses from the respiratory nasal mucosa during stimulation with R(+)- and S(−)-nicotine vapor (40, 80, 120, 160 ng/ml; stimulus duration: 250 ms). In addition, subjects rated the intensity of ‘odorous’, ‘burning’ and ‘stinging’ sensations. For chemical stimulation with nicotine enantiomers, a vapor-dilution olfactometer (constant flow rate: 140 ml/s, humidity: 80%, temperature: 37°C, stimulus duration 250 ms) was employed. Results: We found significant stereoselective differences for the trigeminal but not for the olfactory system, i.e. higher summated responses, higher trigeminal intensity estimates, and lower trigeminal detection thresholds for S(−)- compared to R(+)-nicotine. Conclusion: Our results clearly demonstrate the different stereoselective activation of the trigeminal sensory system by R(+)- and S(−)-nicotine, indicating the presence of specific stereoselective receptors on trigeminal nociceptive Aδ- and C-fibers.
    Type of Medium: Electronic Resource
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