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For metered dose inhalers (MDIs), high-flow cascade impaction with a United States Pharmacopia (USP) throat provides a useful prediction of in vivo lung and oropharyngeal aerosol deposition. Particles expected to deposit in the lung are included in the "fine particle fraction" measured on the bench. Comparable in vitro standards are not available for nebulizers. The present study compared aerosol deposition in an in vitro model using low-flow cascade impaction with deposition in vivo in human subjects. A low-flow (1 Lmin), 10-stage cascade impactor measured aerodynamic distributions of aerosolized interferon-gamma (IFN-gamma) from two nebulizers (Misty-Neb and AeroEclipse). (99m)Technetium diethylene triaminepenta-acetic acid ((99m)Tc-DTPA) was used as the radiolabel. Two bench conditions were specified: no breathing (standing cloud) and simulated ventilation with a piston pump (tidal volume 750 mL frequency 25 per minute and duty cycle 0.5). Mass median aerodynamic diameter (MMAD) for both nebulizers was affected by ventilation (Misty-Neb vs. AeroEclipse: 5.2 vs. 4.6 microm for standing cloud and 3.1 vs. 2.2 microm during ventilation). In three subjects, measured values of oropharyngeal deposition averaged 68.1 +/- 0.08% for Misty-Neb and 30.9 +/- 0.03% for AeroEclipse. In vivo deposition patterns compared to aerosol distributions from both nebulizers indicated that, for wet nebulization, penetration of aerosol beyond the upper airways (fine particle fraction) will occur only for aerosol particles below 2.5 microm. This assessment requires that the bench aerosol distribution be measured under conditions of clinical use (i.e., during tidal breathing).

Background:Hydatid disease (HD) is an ancient disease and even was known to Hippocrates. This disease involves all human parts and most common affected organs are liver and lungs. Incidence of unusual site is about 8-10%. The clinical picture depends upon the involved organs, its effects on adjacent structures, complications due to secondary infection, rupture, and anaphylaxis caused by hydatid cysts.Aim:The aim of this study was to find out incidence of unusual location of hydatid cyst in the human body.Materials and Methods:A retrospective study of HD was carried in a medical college between July 2007 and June 2012. A total 79 cases of HD were treated during this period. Information on clinical presentation and management were reviewed, and results presented as summary statistics.Results:Sixty one cases were of liver HD, and 11 were with hydatid lung disease. Fifty cases were with right lobe involvement, and rest 11 were with both lobe involvement. Out of 11 lung hydatid only one case was with bilateral lung involvement. Only eight cases of HD of uncommon locations and presentations were encountered during this period. First case presented with left hypochondriac mass as splenic HD, second with pelvic HD along with obstructive uropathy, third with non-functioning right kidney with bilateral psoas muscles HD, fourth with HD involving mesentery, fifth with pelvic pain due to right ovary HD, sixth with simultaneous involvement of the liver and right subdiaphragmatic region, seventh with HD of right inguinal region, and eighth with hydatid cyst of the left kidney. Even though, there was no mortality found in these patients, there was high morbidity.Conclusion:We conclude that Echinococcus granulosus can affect any organ in the body from head to toe, and a high suspicion of this disease is justified in endemic regions. Moreover, medical treatment should be given in the pre-operative period as well as in the post-operative period for 4-6 weeks.

Nebulizers are often interfaced to patients using facemasks, especially when the patient is sick and uncooperative. Tight-fitting masks are thought to improve drug delivery, but recent studies have indicated that facemask seal can impact facial and eye deposition of aerosol. The purpose of the present study was to define the factors that influence drug delivery to the lung in pediatric patients using nebulizers and facemasks; particularly the roles of facemask seal, mask vents and nebulizer flow. Using a pediatric face facsimile and radiolabeled saline aerosols front-loaded and bottom-loaded nebulizers were tested for aerosol delivery during a pediatric pattern of breathing. Gamma scintigraphy provided images of the face. Filters measured drug delivery to the patient (inhaled mass [IM]). All data were reported as percent (%) nebulizer charge. Nebulizer flows of 4 and 8 L/min were tested. Preliminary experiments suggested that inertial forces between the edge of the mask and the face were responsible for facial and eye deposition. Front-loaded nebulizers were more efficient than bottom-loaded systems in delivering drug to the patient but favored eye deposition. These observations led to the design of a mask prototype constructed to maximize aerosol delivery to the patient with reduced deposition on the face and in the eyes. Modifications included vents and specialized cutouts in the region of the eyes. A tight fitting front-loaded mask delivered an IM of 6.38 +/- 0.42% (mean +/- SE) with facial and eye deposition of 1.76 +/- 0.17% and 1.14 +/- 0.15% respectively. The presence of specialized eye cutouts minimized facial and eye deposition (0.72 +/- 0.07%, and 0.15 +/- 0.02% [P < 0.0001]), even in the presence of increased nebulizer flow. The prototype design at 4 L/min maximized IM to 8.78 +/- 0.98% and further reduced facial and eye deposition (0.66 +/- 0.07% and 0.09 +/- 0.01%). Commercial bottom loaded masks reduced IM to 2.33 +/- 0.22%, with significant deposition on the face (1.43 +/- 0.16%). For aerosol therapy with nebulizers in pediatric patients, facemask design is a key factor in maximizing aerosol delivery to the patient while minimizing deposition on the face and in the eyes.

Passage of aerosol around or through a facemask can result in deposition on the face and in the eyes. The present study quantified facial and eye deposition in a model simulating drug delivery to a young child. Aerosol delivery and facial deposition of radiolabeled saline test aerosols were studied in vitro with filters and a gamma camera. A child's face facsimile, attached to a piston pump, was used to simulate the patient receiving aerosol therapy. A filter placed in the oropharynx of the face facsimile measured aerosol delivery (inhaled mass). Seven commercially available facemasks in combination with three jet nebulizers were studied for aerosol delivery to the "patient" as well as for deposition on the face and in the eyes. Inhaled mass varied from 2.24-5.96% of nebulizer charge (drug placed in the nebulizer). Facial deposition varied from 0.44-2.34% of nebulizer charge, with eye deposition at 0.09-1.78%. All facemasks leaked aerosol, with significant facial and eye deposition approaching in magnitude delivery to the lung. Factors affecting facial and eye deposition include the interactive design characteristics of the facemask and nebulizer, as well as the aerodynamic properties of the aerosol.