A new method of exchange of nasotracheal to orotracheal tube, using the Laryngeal Mask Airway (LMA), in a patient with difficult airway, is described. A 36-year-old woman with Treacher Collins syndrome was scheduled for a malar apatite cutting and a chin-level osteotomy. It was necessary to exchange a nasotracheal tube for an orotracheal tube during the operation. An LMA was inserted while the nasotracheal tube was left in place; a new tube was inserted in the LMA, then a fiberoptic laryngoscope (fiberscope) was inserted through these devices. The nasotracheal tube cuff was deflated, and the fiberscope was inserted into the trachea alongside the nasotracheal tube. The nasotracheal tube was removed, and the oral tube was then advanced into the trachea.

OBJECTIVE: To describe a method for the exchange of a defective endotracheal tube using the WuScope in patients with difficult airways who cannot tolerate interrupted ventilation. STUDY DESIGN: Case report. METHODS: Detailed description of proposed modality for the endotracheal tube exchange. RESULTS: Exchanging a defective endotracheal tube in patients with a "difficult airway" and compromised oxygenation can be a challenging task. Performing fiberoptic visualization with the WuScope and using a "double intubation" technique may be an acceptable method for endotracheal tube exchange in some clinical situations. CONCLUSION: By using our technique the exchange of an endotracheal tube in a patient with a difficult airway may be achieved without interrupting the ventilation.

The aim of this study was to examine whether Eccovision Reflectance Pharyngometer could assess the anatomical structure of the upper airway in young children. Secondary aims were to assess changes in pharyngeal volume in children with tonsillar (Group A, n=13) and adenoidal hypertrophy (Group B, n=17) at pre- and post- surgical procedures, respectively and further compare them to children who underwent myringotomy (Control Group C, n=10). In all 40 children (aged 3-9 years, median 6 years) enrolled in this pilot prospective study, six recordings (equally dispersed at pre- and 3 month post- operation per subject) of the pharyngeal cavity along with demographic (age, gender), somatic (standing and sitting height, body weight, head and neck circumference) and anatomic (bimaxilliary and bregma) characteristics, were captured. No significant intra-subject variability was noted within the multiple measurements of the pharyngeal volume at pre- as well as post-incision (ANOVA, P>0.1) in all groups. However, in Group A there was a marked increase from pre- to post-pharyngeal volumes in males (P=0.007), which was not observed in females (P=0.13). In Group B pharyngeal volumes decreased from pre- to post- in both males (P=0.87) and females (P=0.34). On the contrary, in Group C there was no change in pharyngeal volumes. These findings contradicted the visual evaluation of the size of the removed tonsillar and/or adenoidal mass in the first two groups and thus suggested that Eccovision Pharyngometer does not reliably assess pharyngeal volumes in a pediatric population.

Implications: It is often necessary to change a patient's breathing tube (endotracheal tube). This can be a risky procedure. This report describes a technique for changing an endotracheal tube by using a modified "intubating laryngeal mask"(a commonly used airway and breathing device) and a fiberoptic bronchoscope.

We describe the characteristics of a sensitive photoconductive detector that simultaneously measures orthogonal electric field components of electromagnetic transients with bandwidths up to 30 THz. The device consists of an As(+) implanted GaAs photoconducting region at the centre of a pair of perpendicular bow-tie antennas. The performance is illustrated by studies of optical rectification in GaSe, retardation in a birefringent polymer film and THz emission from impulsively excited optical phonons in GaN.

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Background: Hemodialysis (HD) grafts often fail due to stenosis at the venous anastomosis and thrombotic occlusion. Percutaneous management relies on thrombolysis with plasminogen activators, mechanical removal of thrombus and angioplasty of the stenotic lesion. Objectives: This report describes a phase I trial using Plasmin (Human) TAL 05-00018, a direct-acting fibrinolytic agent, to evaluate safety and, secondarily, to establish effective thrombolytic dosing. Patients/methods: Six cohorts of 5 patients with acute HD graft occlusion documented by angiography were treated with escalating dosages of plasmin (1, 2, 4, 8, 12, and 24 mg) infused over 30 minutes via criss-crossed pulse-spray catheters within the graft. The primary efficacy endpoint was >/=50% thrombolysis, as determined by comparison of pre- and 30-minute post-plasmin fistulograms. Results: Of 31 subjects who received study drug (safety population), 1 withdrew and 30 completed the trial (evaluable for efficacy). There was no significant change in plasma alpha-2 antiplasmin or fibrinogen concentration, major bleeding did not occur and there were no deaths. Serious adverse events in 4 patients were not related to study drug. There was a dose-response relationship for the primary efficacy endpoint, all 5 subjects receiving 24 mg achieving >75% lysis. Conclusions: This first phase I study of Plasmin (Human) TAL 05-00018, infused into thrombosed HD grafts, documents safety at dosages of 1 to 24 mg and an effective thrombolytic dosage of 24 mg. The results establish a foundation for further clinical study of catheter-based plasmin administration in thrombotic disorders.

We describe the properties of a surface-corrugated long-period-grating fiber taper fabricated using contact optical lithography and wet etching techniques. The preservation of cylindrical symmetry in this device facilitates investigation of the modal behavior. Comparison of the measured and calculated transmission spectra reveals that the widely used coupled-mode theory is not applicable. Instead, a mode-projection model, in which modal propagation and coupling are treated separately within the grating, explains the experiments very well.

We describe a reflection-based fiber filter fabricated by plasma etching a surface corrugation Bragg grating on a tapered single-mode fiber. The taper waist with the grating forms the functional part of the filter, and the adiabatic taper transition removes unwanted higher-order modes. The spectral response is controlled by varying the taper diameter while maintaining a constant grating period. Reflection spectra have been investigated theoretically and experimentally and found to be in good agreement.

An interference-based scheme for fabricating periodic metal gratings on one side of the uniform waist of optical fiber tapers has been developed. Optical characterization of a 5 mm long, 511 nm period gold grating fiber taper with a 10 mum diameter reveals backward coupling to both guided and radiation modes that is explained by using an analytical mode-coupling analysis. A refractometer based on this grating taper has a high and constant sensitivity over a large refractive index operating range of 1 to 1.41.

We have studied the sensitivity and noise of optically gated dipole receivers made from ion implanted Si and GaAs in an optimized time domain THz spectrometer. The spectrometer uses a room temperature, dc biased, semi-insulating GaAs stripline source capable of generating up to 30 microW average power. The 10% amplitude system bandwidth for 10 microm (50 microm) dipole receivers is 3 THz (1.5 THz). A dynamic range of 4 x 10(5) Hz(-1/2) is achieved using a 10 microm dipole GaAs receiver and 2 x 10(6) Hz(-1/2) using a 50 microm dipole for a total laser power of 110 mW and THz beam power of 20 microW. The dynamic range achieved with comparable silicon receivers is a factor of 2 smaller.

Pseudomonas cellulosa xylanase 10A (Pc Xyn10A) contains an extended substrate binding cleft comprising three glycone (-1 to -3) and four aglycone (+1 to +4) subsites and, typical of retaining glycoside hydrolases, exhibits transglycosylation activity at elevated substrate concentrations. In a previous study [Charnock, S. J., et al.(1997) J. Biol. Chem. 272, 2942-2951], it was demonstrated that the -2 subsite mutations E43A and N44A caused a 100-fold reduction in activity against xylooligosaccharides, but did not influence xylanase activity. This led to the proposal that the low activity of these mutants against xylooligosaccharides was due to nonproductive complex formation between these small substrates and the extended aglycone region of the active site. To test this hypothesis, key residues at the +2 (Asn182),+3 (Tyr255), and +4 (Tyr220) subsites were substituted for alanine, and the activity of the mutants against polysaccharides and oligosaccharides was evaluated. All the aglycone mutants exhibited greatly reduced or no transglycosylating activity, and the triple mutants, E43A/Y220A/Y255A and E43A/N182A/Y255A, had activity against xylotriose similar to that of E43A. The aglycone mutations caused an increase in both k(cat) and K(m) against xylan, with N182A/Y220A/Y255A and N182A/Y255A exhibiting 25- and 15-fold higher k(cat) values, respectively, than wild-type Pc Xyn10A. These data indicate that Glu43 plays a role in binding xylooligosaccharides, but not xylan, suggesting that the mechanisms by which Pc Xyn10A binds polysaccharides and oligosaccharides are distinct. The increased k(cat) of the mutants against xylan indicates that the aglycone region of wild-type Pc Xyn10A restricts the rate of catalysis by limiting diffusion of the cleaved substrate, generated at the completion of the k(2) step, out of the active site.

This article provides an overview of the theoretical underpinnings of the Tomatis Method, along with a commentary on other forms of sound/music training and the need for research. A public debate was sparked over the "Mozart Effect." This debate has turned out to be unfortunate because the real story is being missed. The real story starts with Alfred Tomatis, M.D., scientist and innovator. Dr. Tomatis was the first to develop a technique using modified music to stimulate the rich interconnections between the ear and the nervous system to integrate aspects of human development and behavior. The originating theories behind the Tomatis Method are reviewed to describe the ear's clear connection to the brain and the nervous system. The "neuropsychology of sound training" describes how and what the Tomatis Method effects. Since Dr. Tomatis opened this field in the mid 20th century, no fewer than a dozen offshoot and related systems of training have been developed. Though each new system of treatment makes claims of effectiveness, no research exists to substantiate their claims. Rather, each simplified system bases its "right to exist and advertise" on the claimed relationship to Tomatis and his complex Method. Research is desperately needed in this area. The 50 years of clinical experience and anecdotal evidence amassed by Tomatis show that sound stimulation can provide a valuable remediation and developmental training tool for people of all ages. Offshoot systems have watered down the Tomatis Method without research to guide the decisions of simplifying the techniques and equipment.

Submental endotracheal intubation for surgery was used as an alternative to nasotracheal intubation in patients with craniomaxillofacial injury. Generally extubation was performed in the operation room by pulling the tube through the submental incision site. When extubation is not indicated, intraoral indwelling is preferred to submental intubation. We report a case of a 35-year-old male patient with multiple facial bone fractures. At the end of the surgery, we noticed the oropharyngeal edema, and so the submental intubation was converted into a standard orotracheal intubation. During that procedure, the pilot balloon was accidentally detached from the endotracheal tube. The situation was managed by cutting a pilot tube from a new, unused endotracheal tube and connecting it to the intubated tube using a needle connector.

Mechanical ventilation is essential to the proper maintenance of anaesthesia in research animals undergoing laparoscopic research investigations with prolonged pneumoperitoneum. Ventilatory assistance is greatly aided by endotracheal intubation, which in rats can be a challenging procedure with a substantial risk of complication. The difficulty of the procedure arises primarily from the limited exposure and access to the laryngeal opening. We describe a simple and safe technique for endotracheal intubation in the rat that permits the introduction of a large-bore tube under direct visualization using equipment commonly found in the endosurgical research setting.

We describe a technique by which a gum elastic bougie (GEB) is used to facilitate an anticipated difficult endotracheal intubation in a patient undergoing rigid bronchoscopy. After placing the GEB through the lumen of the rigid bronchoscope, the GEB-suction catheter assembly was used to safely withdraw the bronchoscope in a manner mimicking the withdrawal of an intubating laryngeal mask airway (LMA) over the endotracheal tube using a stabilizer rod. The rationale for management and potential advantages of this approach versus use of an airway exchange catheter (including increased stability of an intubation guide) are discussed. IMPLICATIONS: We describe a technique of using a gum elastic bougie to facilitate an endotracheal intubation in a patient undergoing rigid bronchoscopy, which can be useful in a variety of clinical situations when the rigid bronchoscope is used in patients with abnormal airway.

OBJECTIVE: The purpose of this study was to compare the use of a double-lumen endotracheal tube to a single-lumen tube combined with a bronchial blocker for lung isolation during Port-Access cardiac surgery. DESIGN: Prospective, randomized, controlled trial. SETTING: Tertiary care university hospital. PARTICIPANTS: Thirty-two patients undergoing Port-Access cardiac surgery via a right minithoracotomy. INTERVENTIONS: Patients were randomized to intubation with either a left-sided double-lumen tube (double-lumen group) or a single-lumen tube with concomitant use of a bronchial blocker (blocker group). Comparisons between groups included (1) intubation time,(2) number of laryngoscopy attempts,(3) time required for tube exchange at the end of the operation, and (4) surgical satisfaction with the lung deflation (1-5 scale: 5 = excellent).Measurements and main results The initial intubation time was similar between groups (118 +/- 82 seconds, double-lumen v 144 +/- 32 seconds, blocker; p = 0.2781). An additional 105 +/- 37 seconds was needed to exchange the double-lumen tube at the end of the operation. The double-lumen group also required more laryngoscopy attempts compared with the blocker group (2.3 +/- 0.6, double-lumen v 1.1 +/- 0.4, blocker; p = 0.0001). The lung deflation was better in the double-lumen group (5 [4-5], double-lumen v 4 [3-5], blocker, p = 0.0414). CONCLUSIONS: Compared with a single-lumen tube/bronchial blocker combination the double-lumen endotracheal tube required more laryngoscopy attempts and additional time to replace the tube at the end of the case but resulted in slightly better overall lung deflation.

The technique of submental intubation in patients with multiple facial fractures and skull base fracture was originally described by Altemir. This technique provides a secure airway and allows intermaxillary fixation while avoiding the complications of nasotracheal intubation or tracheostomy. However, when the endotracheal pilot balloon and endotracheal tube are pulled through the submental incision site using this technique, soft tissues or blood may enter the endotracheal tube and trauma may result in the surrounding tissues. To overcome these problems, we carried out a modification of submental orotracheal intubation using the blue cap on the end of the thoracic catheter in a patient with mandibular fractures and injury to the skull base and found that this modification resulted in a safer and less traumatic intubation.