Nasal leaks

Examination of 13 individuals 5 years after they were occupationally exposed to a chlorine dioxide leak revealed sensitivity to respiratory irritants and nasal abnormalities. Delayed deaths occurred in animals after exposure to 15 0-2 00 ppm for less than 1 hour. Rats exposed daily to 10 ppm died after 10-13 days of exposure effects were nasal and ocular discharge and dyspnea autopsy revealed purulent bronchitis. Another study reported that two to four 15-minute exposures to 5 ppm for 1 month did not alter the blood composition or lung histology of rats similar exposures to 10-15 ppm caused bronchitis, bronchiolitis, catarrhal alveolar lesions, and peribronchial infiltration. Lesions healed within 15 days after treatment. Rats and rabbits exposed for 30 days to 5 or 10 ppm (2 hours/day) had localized bronchopneumonia with elevated leukocyte counts slight reversible pulmonary lesions were found after exposures of 2.5ppm for 4-7 hours/day. No adverse reactions were... 

Nasal abnormalities (ineluding injeetion, telangectasia, paleness, cobblestoning, edema, and thick mucus) were observed in 13 individuals (1 man and 12 women) who had been accidently exposed to chlorine dioxide from a leak in a water purifieation system pipe 5 years earlier (Meggs et al. 1996). These individuals also exhibited sensitivity to respiratory irritants. Nasal biopsies revealed chronic inflammation in the lamina propria of 11/13 ehlorine dioxide-exposed individuals, compared with 1/3 control individuals. The severity of inflammation was significantly increased in the ehlorine dioxide exposed group, compared to eontrols. 

Metered-Dose Inhalers and Nasal Aerosols Content uniformity, aerodynamic particle size distribution, microscopic evaluation, water content, leak rate, microbial bioburden, valve delivery, extractables, leachables from plastic and elastomeric components. 

Metered-dose inhalations and nasal aerosols should be evaluated for appearance (including content, container, and the valve and its components), color, taste, assay, degradation products, assay for cosolvent (if applicable), dose content uniformity, labeled number of medication actuations per container meeting dose content uniformity, aerodynamic particle size distribution, microscopic evaluation, water content, leak rate, microbial limits, valve delivery (shot weight), and extractables and leachables from plastic and elastomeric components. Samples should be stored in upright and inverted/on-the-side orientations. 

Rhinorrhea is common after both local and systemic nerve agent exposure. It may occur soon after exposure to a small amount of vapor and sometimes precedes miosis and dim vision, or it may occur in the absence of miosis. Even a relatively small exposure to vapor may cause severe rhinorrhea. One exposed worker compared the nasal secretions to the flow from a leaking faucet, and another said that they were much worse than those produced by a cold or hay fever (personal observation). 

Cardiovascular Takotsubo cardiomyopathy [SEDA-33, 313] has been described after local application of adrenaline during nasal surgery in two cases cardiovascular MRI scans showed myocardial vasodilatation, capillary leak, and regional edema [1" ]. Reports linking takotsubo syndrome to the use of adrenaline during anaphylaxis have been reviewed... 

There are three main types of ventilator circuits used for HMV Single circuits with a leak, single circuits with a valve, and double circuits with a valve. When used with NIV, it is important that the appropriate mask be used. Table 5 summarizes the important points associated with each type of circuit. Circuits with a leak are used for bi-level devices. The intentional leak and CO2 washout for a given pressure vary significantly depending on the manufacturer and the type of mask. There are many choices of masks for the leak circuit as these masks are also used for CPAP. We have already reviewed the issue of CO2 washout and concluded that this is not a major concern when using a nasal mask (20). The only type of mask where this might be of clinical concern is with a full-face mask. A fiill-face mask is... 

Meyer TJ, Pressman MR, Benditt J, et al. Air leaking through the mouth during nocturnal nasal ventilation effect on sleep quality. Sleep 1997 20(7) 561-569. 

Teschler H, Stampa J, Ragette R, et al. Effect of mouth leak on effectiveness of nasal bilevel ventilatory assistance and sleep architecture. Eur Respir J 1999 14 1251-1257. 

Richards GN, Cistulli PA, Ungar RG, et al. Mouth leak with nasal continuous positive airway pressure increases nasal airway resistance. Am J Respir Crit Care Med 1996 154 182-186. 

Richards GN, Cismlli PA, Ungar RG, et al. Mouth leak with nasal continuous positive airway pressure increases nasal airway resistance. Am J Respir Crit Care Med 1996 154 182-186. Willson GN, Piper AJ, Norman M, et al. Nasal versus full face mask for noninvasive ventilation in chronic respiratory failure. Eur Respir J 2004 23 605-609. 

Topical aerosols and nasal sprays rely on pump systems to deliver the API in the form of finely dispersed mist or as coarse spray or stream of semisolid. Because of their design, aerosol and nasal products are usually under very high pressure, and this makes it difficult to obtain suitable samples for analysis. In spite of that, a number of very specialized tests which include pressure test, minimum fill, number of discharges per container defivered dose uniformity, delivery rate, leak test, spray pattern and plume geometry test, assay, and microbial enumeration test (MET) have been devised to test the integrity of the aerosol package and the device used to defiver the dose. ... 

IL-3 IL-4 00 CJI flu-like symptoms injection site reactions conjunctival congestion flu-like symptoms vascular leak syndrome nasal congestion ulcers/enteritis cardiac toxicity T hepatic enzymes rhesus and cynomolgus monkey histamine release cynomolgus - predictive except ECGs not predictive of cardiac nistopathology no GI tox noted Ab in primates Vial and Descotes, 1995 Reiner et al., 1993 Bargetzi et al., 1995 Vial and Descotes, 1995 Wheeler, 1996 Leach et al, 1996 Snyder et al., 1996... 

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