Hydrocarbon pneumonitis following liquid paraffin aspiration during a fire-eating performance: a case report

<p>Abstract</p> <p>Introduction</p> <p>Hydrocarbon pneumonitis is an acute, intense pneumonitis resulting from aspiration of volatile hydrocarbon compounds with low viscosity and surface tension, most of which are members of the paraffin, naphthene and aromatic classes.</p> <p>Case presentation</p> <p>Six hours after participating in a party for teenagers, a 16-year-old boy developed dyspnea, cough, a fever (39°C) and chest pain. A chest radiograph showed infiltration in the right middle lobe. The patient reported alcohol abuse during the party and an episode of vomiting a few hours thereafter. He also reported practicing a fire-eating performance at the party using liquid paraffin, but was unaware of inhaling any of it. The radiographic infiltration was diagnosed as an aspiration pneumonia and he was treated at the local health center with antibiotics. Five days later, because of clinical deterioration, he was referred to a pulmonary clinic. A chest computed tomography scan was performed which showed consolidation with an air bronchogram in the right middle lobe and areas of atelectasis and ground glass opacities in the middle and lower right lobes. Spirometry revealed severe restriction of lung function. A bronchoscopy revealed inflamed, hyperemic mucosa. Bronchoalveolar lavage fluid revealed lipid-laden alveolar macrophages, which were detected by lipid staining, and neutrophilia. The patient was finally diagnosed with hydrocarbon pneumonitis and he was treated with systemic steroids and antibiotics. After 6 days of treatment there was complete clinical and significant radiologic regression.</p> <p>Conclusion</p> <p>Hydrocarbon pneumonitis should be included in the differential diagnosis of pneumonias. Recent exposure to volatile hydrocarbons provides a basis for clinical diagnosis, as symptoms and radiologic findings are not specific.</p

Pharyngeal airway dimensions: a cephalometric, growth-study-based analysis of physiological variations in children aged 6-17

OBJECTIVE:The aim was to assess pharyngeal airway dimensions and physiological changes based on lateral cephalometric radiographs from healthy untreated children aged 6-17 years.MATERIALS/METHODS:The sample consisted of 880 lateral cephalograms (412 females and 468 males) of the Zurich Craniofacial Growth Study. Statistical analyses on cephalometric measurements of airway dimensions (distances 'p': shortest distance between soft palate and posterior pharyngeal wall and 't': shortest distance between tongue and posterior pharyngeal wall) and craniofacial parameters were performed. To disclose differences between different age groups, a Kruskal-Wallis test was applied. The influence of gender on 'p' and 't' was analysed by a Mann-Whitney U-test for each age group separately. The Spearman correlation was computed in order to investigate associations between craniofacial parameters. Variables associated with 'p' and 't' were chosen for multiple regression model investigation.RESULTS:The results demonstrated high interindividual variations. A slight influence of age on 'p' (P = 0.034) could be attested (+1.03mm) but not on 't' (P = 0.208). With the exception of the 9-year age group, no significant differences between the genders were found. Correlation analysis revealed several statistically significant correlations between 't' or 'p' and antero-posterior cephalometric variables. All correlation coefficients were, however, very low and the adjusted coefficient of determination also revealed the regression model to be very weak.CONCLUSIONS:The high interindividual variations of 'p' and 't' render the use of reference values problematic. Contrary to other craniofacial structures, neither age-related changes nor sexual dimorphism were found for 'p' and 't'. Any associations to antero-posterior cephalometric characteristics seem low

Measuring Upper Airway Volume: Accuracy and Reliability of Dolphin 3D Software Compared to Manual Segmentation in Craniosynostosis Patients

Purpose: To test the accuracy and reliability of Dolphin 3-dimensional (3D) software airway analysis compared with manual segmentation in patients who underwent a Le Fort III osteotomy. Materials and Methods: Computed tomographic scans of 20 patients with syndromic craniosynostosis at Sophia's Children's Hospital (Rotterdam, The Netherlands) were used for airway volume measurements using Dolphin 3D. The same scans had been used for measurement using a manual segmentation method. The results of this previous study were reported in 2010. The manual segmentation measuring result was used as a gold standard. The airway was subdivided into the oropharynx and the nasal passage. A linear mixed effects statistical model was applied. Results: Dolphin 3D measurements differed from manual segmentation by 9 to 43%, depending on the observer, the time at which the measured scan was acquired (pre- or postoperative), and the airway compartment being measured. The highest accuracy for Dolphin 3D was found for measurements from postoperative scans of the nasal passage. Conclusion: The airway analysis tool of Dolphin 3D is not accurate or reliable enough to use in a Le Fort III osteotomy evaluation. When scanning properties are conditioned and measurements are standardized, accuracy and reliability may increase. (C) 2014 American Association of Oral and Maxillofacial Surgeon