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Discusses the meaning of dental health education and models that seem most appropriate for use as dental health education materials. (RK)

Background CT scan measures of emphysema and airway disease have been correlated with lung function in cohorts of subjects with a range of COPD severity. The contribution of CT scan-assessed airway disease to objective measures of lung function and respiratory symptoms such as dyspnea in severe emphysema is less clear. Methods Using data from 338 subjects in the National Emphysema Treatment Trial (NETT) Genetics Ancillary Study, densitometric measures of emphysema using a threshold of −950 Hounsfield units (%LAA-950) and airway wall phenotypes of the wall thickness (WT) and the square root of wall area (SRWA) of a 10-mm luminal perimeter airway were calculated for each subject. Linear regression analysis was performed for outcome variables FEV 1 and percent predicted value of FEV 1 with CT scan measures of emphysema and airway disease. Results In univariate analysis, there were significant negative correlations between %LAA-950 and both the WT ( r = −0.28, p = 0.0001) and SRWA ( r = −0.19, p = 0.0008). Airway wall thickness was weakly but significantly correlated with postbronchodilator FEV 1 % predicted (R = −0.12, p = 0.02). Multivariate analysis showed significant associations between either WT or SRWA (β = −5.2, p = 0.009; β = −2.6, p = 0.008, respectively) and %LAA-950 (β = −10.6, p = 0.03) with the postbronchodilator FEV 1 % predicted. Male subjects exhibited significantly thicker airway wall phenotypes (p = 0.007 for WT and p = 0.0006 for SRWA). Conclusions Airway disease and emphysema detected by CT scanning are inversely related in patients with severe COPD. Airway wall phenotypes were influenced by gender and associated with lung function in subjects with severe emphysema.

(CHEST 2005; 127:1045–1050) A 70-year-old white man was referred for evaluation of pulmonary infiltrates and bronchiectases associated with cough and constitutional symptoms. He was in his usual state of health until he acquired B-cell non-Hodgkin lymphoma (NHL) in 1990. The lymphoma was localized to his stomach, and he was treated with surgical resection; chemotherapy with cyclophosphamide, vincristine, prednisone, and hydroxyurea; and radiation to the gastric bed. One year later, left lower lobe pneumonia developed that was treated with antibiotics. Because of persistent infiltrates, bronchoscopy was performed, with biopsy specimens revealing no abnormalities, and bronchiectases was diagnosed based on radiographic features. Three years prior to presentation, a cough productive of green-to-yellow sputum without hemoptysis developed. One year prior to presentation, progressive fatigue, anorexia, low-grade fevers, significant night sweats, and subsequent 20-lb weight loss developed. He denied other respiratory complaints. CT of the chest revealed patchy areas of consolidation in both lower lungs and in the right middle lobe along with mild mediastinal lymph node enlargement. Multiple sputum samples for acid-fast bacilli, bacteria, and fungi were negative. Endoscopic evaluations of his upper and lower intestinal tracts did not reveal recurrence of the lymphoma. Established medical problems included hypothyroidism and a previous myocardial infarction with subsequent revascularization surgery. He never smoked, and his family, social, and exposure history were otherwise noncontributory. He was referred to our tertiary care center for evaluation of productive cough, pulmonary infiltrates, worsening fatigue, persistent low-grade fevers with night sweats, and weight loss.

Wilms tumor is the most common renal malignancy of childhood. Relapse occurs most often within 4 years of initial diagnosis, and the most common site of metastasis is the lung. We describe a 22-year-old man who presented with hemoptysis and a solitary pulmonary lesion 20 years after primary resection of Wilms tumor. Computed tomography of the chest showed an indeterminate pulmonary mass of heterogeneous attenuation with no other in-trathoracic abnormalities. Surgical resection revealed a solitary pulmonary metastasis from Wilms tumor. Further evaluation yielded no evidence of extrathoracic metastases. This case shows that late relapse in the form of a solitary pulmonary mass can occur in patients with Wilms tumor.

Catamenial pneumothorax is defined as spontaneous pneumothorax occurring within 72 hours before or after onset of menstruation. Although catamenial pneumothorax is the most common clinical manifestation of intrathoracic endometriosis, this latter condition is not universally identified in women with catamenial pneumothorax and cannot fully explain the recurrent and cyclical episodes of pneumothorax. Therefore, the etiology of this syndrome is unknown, although many theories have been proposed to explain it. We describe a 37-year-old woman with recurrent episodes of spontaneous right-sided pneumothorax and chest pain that occurred close to her menstrual periods. The patient's condition did not abate after initial surgical exploration with abrasive mechanical pleurodesis or after hormonal suppressive therapy at an institution elsewhere. The patient was referred to our institution for further evaluation. A second surgical inspection of the pleural cavity and diaphragm disclosed the presence of multiple diaphragmatic fenestrations that were closed surgically at that time. Postoperatively, the patient discontinued hormonal suppressive therapy, and menstrual cycles became regular. Six months after surgery, the patient remains asymptomatic with no evidence of recurrence of pneumothorax. This case supports recent reports that diaphragmatic defects are often present in patients with catamenial pneumothorax. Surgical exploration to inspect the diaphragm and to close all Identified defects should be performed in patients who continue to experience pneumothorax despite effective hormonal suppression.

The RSNA's involvement with computerized communications and electronic technology has grown rapidly over the past decade. We recommend the further liaison with SPIE for it fits perfectly with the charge to our Electronic Communications Committee which is, simply stated, to keep the medical specialty of radiology on the cutting edge of electronic communications. A point of history is probably important to note at this time to help explain our involvement. And, to quote one of my favorite educators from college, it is often as important to tell your audience "what not" as it is to explain "what is".

Primary mediastinal neoplasms encompass a long list of histologically diverse lesions that can arise from a wide variety of mediastinal structures. Recent advances in diagnostic techniques have considerably enhanced the evaluation of the mediastinum with use of noninvasive or minimally invasive procedures. In adults, most primary mediastinal neoplasms can be classified in one of four categories: thymus-derived neoplasms, neurogenic tumors, lymphomas, or germ cell neoplasms. In children, neurogenic tumors (especially neuroblastomas) and lymphomas are most frequently encountered. Because of the presence of many vital structures in the confined thoracic cavity, even benign mediastinal neoplasms can cause severe symptoms from the mass effect and therefore warrant a carefully planned management strategy. With modern therapeutic and surgical interventions, associated morbidity and mortality can often be substantially decreased.

We present a case of sarcoidosis with involvement of a solitary testis that was discovered incidentally on an ultrasonogram of the scrotum. This appears to be case 8 of sarcoidosis with genitourinary involvement limited to the testis. We believe it is the second report of intraoperative ultrasonography used to locate and perform a biopsy of impalpable testicular lesions. We consider this technique to be useful in instances of solitary gonads or in cases of bilateral lesions.

In eight patients, the ventilation-perfusion (Va/Q) relationships after uncomplicated aortic valve replacement were studied by the multiple inert gas technique. Postoperatively, all patients had a right-to-left intrapulmonary shunt (Qsp/Qt) (range 2.4% to 14.4%) and abnormal distribution of Va/Q patterns to varying degrees. No single mechanism was identified that defined gas exchange in all patients. In three patients, moving from the supine to the right lateral decubitus position resulted in improved oxygenation which occurred because of better matching of Va/Q, not because of a decrease in Qsp/Qt.

To determine whether selective decontamination of the digestive tract using oral and nonabsorbable antimicrobial agents and parenteral cefotaxime prevents infection in critically ill patients.Randomized, controlled trial without blinding.Surgical trauma and medical intensive care units in a tertiary referral hospital.One hundred fifty patients admitted to surgical trauma and medical intensive care units during a 3-year interval, whose condition suggested a prolonged stay (greater than 3 days).Patients were randomly allocated to an experimental group (n = 75) that received cefotaxime, 1 g intravenously every 8 hours for the first 3 days only, and oral, nonabsorbable antibiotics (gentamicin, polymyxin, and nystatin by oral paste and oral liquid) for the entire stay in the intensive care unit. Control patients (n = 75) received usual care.The number of infections, total hospital days, and deaths, as well as the number of days in intensive care unit, were recorded.Control patients experienced more infections (36 compared with 12, P = 0.04), including bacteremias (14 compared with 4, P = 0.05) and pulmonary infections (14 compared with 4, P = 0.03). Although total hospital days, days in intensive care, and the overall death rate all were lower in the treatment group, these differences were not statistically significant. Clinically important complications of selective decontamination of the digestive tract were not encountered.Selective decontamination of the digestive tract decreases subsequent infection rates, especially by gram-negative bacilli, in selected patients during long-term stays in the intensive care unit.

Cigarette smoking is a major cause of illness and premature death in our society. Secondhand smoke is a definite irritant to nonsmokers and can, under certain conditions, have potentially serious effects on the nonsmoker's health. Despite the facts, millions of persons continue to smoke. Although no single health professional reaches all smokers, the dentist has a particularly good opportunity to reach his patients who smoke. By advising and couseling, providing helpful literature, creating an environment in which smoking is prohibited, and setting a good example, the dentist can have a singificant part in his patients' education on cigarette smoking. If the dentist's efforts are even partially successful in modifying behavior of the patient who smokes, much illness will be avoided and many lives saved.

High-frequency oscillation (HFO) has been shown to be effective in maintaining gas exchange, but the effects of high-frequency, small-volume ventilation on the mechanical properties of the respiratory system are unknown. A volume displacement plethysmograph was used to study lung volumes and static pressure-volume (PV) curves during HFO in pentobarbital-anesthetized dogs. During long-term studies, adequate gas exchange was maintained with a stroke volume of 2.5 ml/kg and frequencies between 15 and 30 Hz. The effect of 5–7 hours of HFO on lung and chest wall mechanics was studied in 8 dogs. In another 8 dogs the relationship of volume history and respiratory muscle tone to occlusion airway pressure and lung volume during short-term HFO was investigated. With prolonged HFO, a small but significant decrease in total lung capacity occurred by 5 hours and the static respiratory system PV curve shifted slightly to the right. These changes were reversed by muscle paralysis and may be explained by a change in respiratory muscle tone. Static lung compliance and the hysteresis ratio (an index of tissue properties) remained unchanged. The relationship of occlusion airway pressure and lung volume during short-term HFO was dependent on the lung volume history and was influenced by respiratory muscle tone only at low airway pressures. These findings suggest that during prolonged HFO a small increase in chest wall stiffness may result. However, occlusion airway pressure and lung volume at the onset of HFO are mainly dependent on the volume history of the lung.

The development of pamphlets, films, slides, exhibits, and school aids to inform the public about oral health is the responsibility of the ADA Bureau of Dental Health Education. The development and production of attractive, accurate, and useful educational materials for all ages is the responsibility of the ADA Bureau of Dental Health Education. The Bureau uses several types of media including pamphlets, school materials, films, slides, and display materials to inform the public about oral health.

Acute lung injury produced by paraquat causes progressive pulmonary insufficiency. To define the pattern of this injury, the sequence of changes in respiratory mechanics and pulmonary gas exchange was studied in eight mongrel dogs which received repetitive doses of paraquat intraperitoneally. Four other dogs served as controls. All dogs were studied while supine during halothane anesthesia. After baseline measurements, saline (control) or paraquat was administered and the studies repeated at 2, 4, 7, and 9 days. Control dogs showed no significant changes. Dogs receiving paraquat had reduced lung volume, decreased lung compliance with a shift of the static deflation pressure-volume curve downward and to the right, and hypoxemia which could not be entirely accounted for by an increased right-to-left intrapulmonary shunt. This study demonstrated that repeated doses of paraquat given intraperitoneally produced a pattern of acute lung injury in the dog which permitted the study of respiratory mechanics and gas exchange during progressive stages of lung injury.

The sera of normal guinea pigs, sensitized guinea pigs, normal human beings, pretreatment allergic human beings, and posttreatment allergic human beings have been examined for serotonin levels. Significant differences exist in allergic human beings in the direction of increased serotonin levels. These differences are not changed by allergic hyposensitization with appropriate antigens. In the guinea pig serum levels of serotonin do not change with sensitization. The meaning of these findings is discussed with reference to recent work on the role of serotonin, histamine, and antigen-antibody complexes in allergy and anaphylaxis.