Orotracheal intubation in trauma patients with cervical fractures

Orotracheal intubation in trauma patients with cervical fractures

CURRENT LITERATURE 527 to determine if the quantity of reparative dentine in mechanically produced pulp exposures was related to the quantity of OP-...

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CURRENT LITERATURE

527

to determine if the quantity of reparative dentine in mechanically produced pulp exposures was related to the quantity of OP- 1 placed as an indirect pulp cap in a carrier medium of bovine type I collagen. At the end of 6 weeks, healing reparative dentine was present in all OP- 1-treated teeth. No reparative dentine was found in control or untreated teeth. Histologic preparations suggest that pulp-like connective tissue was first formed and then mineralized to form reparative dentine. These data suggest that OP-1 may play a role in dentinogenesis and may prove efficacious as an agent in dentistry.-G.T. LYNAM Reprint requests to Dr Rutherford: School of Dental Medicine, University of Connecticut, Farmington, CT 06030. Salivary Autoantibodies in HIV-Associated Salivary Gland Disease. Atkinson JC, Schidt M, Robataille S, et al. J Oral Pathol Med 22:203. 1993 Occasionally, patients with human immunodeficiency virus (HIV)-1 infection develop salivary gland disease resembling Sjogren’s syndrome (HIV-SGD). The predominant infiltrative cell in HIV-SGD is, however, the CD8f T cell. whereas the predominant cell line infiltration in Sjogren’s syndrome (SS) is the CD4+ T cell. HIV-SGD patients do not have the characteristic circulating anti-SS-A/Ro and antiSS-B/La of SS, but increased concentrations of immunoglobulin (1g)A are found in both SS and HIV-SGD, suggesting that increased antibody production occurs in both diseases. Eleven patients with primary SS and 1 I patients with HIVSGD were entered into the study, along with 14 age-matched, healthy. HIV-negative and 13 HIV-I antibody-positive patients. Stimulated salivary samples were collected from each group useing 2% citric acid swabs of the tongue every 30 seconds. and tested for autoantibodies with both immunofluorescence studies and the Western blot test. lmmunofluorescence studies to detect the presence of autoantibodies to the salivary gland cell lines (HSG), HEp-2 (liver) cell lines, and anti-nDNA showed that five of 11 patients with HIVSGD had autoantibodies to both the HSG and the HEp-2 cel!s, while none of the 13 HIV-l infected controls had autoantibodies to either. One of the HIV-negative controls had autoantibodies to the HSG cell line but not to the HEp-2 cell line, and 10 of I I SS patients had autoantibodies to both cell lines. None of the samples were positive for anti-nDNA. The Western blot test found eight of 1 1 SS patients to be positive for anti-SS-A/Ro and seven of 11 to be positive for anti-SSB/La. None of the nine patients with HIV-SGD were positive for either anti-SS-A/Ro or anti-SS-B/La. Five of these nine patients with HIV-SGD were however, positive for autiantibodies by immunofluorescence studies. There was not enough saliva for Western blotting in two HIV-SGD patients’ samples, but they were initially negative for any autoantibodies by immunofluorescence. This study demonstrates that although autoantibody production occurs in HIV-SGD, they are not anti-SS-A/Ro, anti SS-B/La, or anti-nDNA. This study also suggests that HIV-l can affect mucosal immunity independently ofthe peripheral immune system.-S. DoRSCH.

traumatic optic neuropathy, or crania1 nerve palsies, from associated central nervous system injury. This case report presents a 16-year-old girl who underwent open reduction internal fixation of right malar fracture and closed reduction of a right body of the mandible and left subcondylar fracture. Two months postoperatively the patient reported blurred vision in her right eye while chewing. Physical examination showed no extraocular impairment, normal visual acuity, and pupils reactive to light with no afferent pupillary defect. Upon left lateral excursive movement of the mandible, the right eye protruded and elevated slightly. The amount of protrusion was directly related to lateral displacement of the jaw. A computed tomography scan showed an intact orbital periosteum with a widened inferior orbital fissure. The author presents this case to show mechanical displacement of periorbital fat through a traumatically enlarged inferior orbital fissure.-M. S-C KUO Reprint requests to Arkansas Children’s Hospital, 800 Marshall. Little Rock. AR 72202. Orotracheal Intuhation in Trauma Patients With Cervical Fractures. Scannell G, Waxman K, Tominaga G, et al: Arch Surg 128:903, 1993

Jaw Movement. 1 I 1: 1028, 1993

This study evaluated orotracheal intubation with in-line stabilization of the cervical spine for emergency airway treatment of trauma patients with cervical spine injuries. Nasotracheal intubation is frequently advocated as the safest procedure for the emergency control of the airway. However, it cannot be performed in patients who are apneic. It is also contraindicated in basilar skull fractures. The procedure is blind and often is unsuccessful on first attempt, resulting in time-consuming maneuvers. It often requires the patient’s cooperation, which may be difficult in emergency conditions. Furthermore, excessive manipulation of the cervical spine may be necessary to align pharynx, larynx, and trachea for blind intubations. It may also cause emesis. Multiple attempts may cause pharyngeal trauma with bleeding, which may then compromise direct visualization of the vocal cords for orotracheal intubation. Thus, the authors chose to use and evaluate the safety and efficacy of orotracheal intubation with inline stabilization of the cervical spine. Of the 168 patients with cervical fractures studied, 8 1 emergency orotracheal intubations with in-line stabilization were performed. Neurologic examination was documented before and after intubation. Twenty patients had peripheral neurologic deficit from the onset, 38 patients had unstable cervical fractures with no neurologic deficit, 23 patients were neurologically intact with fractures that were later judged stable, and 23 patients required emergency intubation due to apnea. Head injury was the most common associated injury, and was also the most common cause for intubation (44 patients). Twenty-four patients were intubated because of cardiorespiratory instability. Trauma to the face and neck was the third most common cause for intubation (13 patients). None of the above patients developed neurologic deficits following intubation. The overall mortality rate was 37% (30 patients). All deaths were related to associated injuries, especially in head injury cases. Consequently, the authors concluded that orotracheal intubation performed with manual in-line stabilization by trained and experienced personnel, is a safe emergency procedure in patients with cervical fractures.-K.N. CHOW

Ocular symptoms following orbital trauma may consist of diplopia secondary to restrictive strabismus, enophthalmus,

Reprint requests to Dr Scannell: Department of Surgery, University of California, Irvine. CA

Reprint requests to Dr Atkinson: National Institute of Dental Research. 9000 Rockville Pike, Bldg 10. Room IN-I 13. Bethesda. MD 208’)2. Ocular Protrusion With Contralateral Brodsky MC. James CA. Arch Opthalmol