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Respiratory therapist.(CAREER CURVE).
RESPIRATORY THERAPISTS EVALUATE, TREAT AND CARE FOR PATIENTS WITH BREATHING OR CARDIOPULMONARY DISORDERS and may use oxygen, oxygen mixtures, chest physiotherapy and aerosol medications. Under the supervision of a physician, they administer respiratory treatment to patients who range from premature infants to the elderly, and they may care for those with chronic asthma or emphysema. Respiratory therapists may also be called upon to administer treatment as part of emergency care for victims of incidents such as heart attacks, strokes, shocks or drowning.
The Workplace
Most respiratory therapist jobs are in hospitals, but they may also be found in doctors' offices, nursing care facilities or in companies that supply respiratory equipment. Some respiratory therapists may work in home health care settings.
Educational Requirements
According to the U.S. Department of Labor, all states except Alaska and Hawaii require respiratory therapists to be licensed, and an associate degree is the minimum educational requirement. Technical and community colleges, universities, medical schools and the Armed Forces are all sources of training in the field.
According to the Department of Labor's Occupational Outlook Handbook, median annual earnings of respiratory therapists were $47,420 in May 2006, with the highest 10 percent earning more than $64,190
The opportunities are expected to be very good for respiratory therapists, notes the Occupational Outlook Handbook, with faster than average job growth in the field, especially for those with cardiopulmonary care skills or experience working with infants. A growing middle-aged and elderly population will contribute to an increased need for trained workers in the respiratory care field
Explore More
To learn more about a career as a respiratory therapist and the education and training it requires, here are some places to turn.
Reference
American Association for Respiratory Care www.aarc.org
Commission on Accreditation for Allied Health Education Programs www.caahep.org
Committee on Accreditation for Respiratory Care www.coarc.com
National Board for Respiratory Care www.nbrc.org
Source Citation
"Respiratory therapist." Techniques 84.4 (2009): 58. Gale Arts, Humanities and Education Standard Package. Web. 17 May 2010.
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Mandibular coronoid hyperplasia: a case report.(CASE REPORT)(Case study).
ABSTRACT: A case of unilateral coronoid hyperplasia successfully treated by corenoidotomy with prolonged postoperative physiotherapy and reveal the postoperative radiographic changes between the sectioned part of the coronoid process and the mandibular ascending ramus is described. The patient was a 28-year-old man whose maximum mouth opening was 30 mm. A coronoidotomy of the left coronoid process was performed. Nine days after surgery, the patient started physiotherapy with a HU-OSr appliance. After coronoidotomy and physiotherapy, the maximum mouth opening had increased to 43 mm. Radiographic follow-up showed that the coronoid process apparently united with the mandibular ascending ramus, with moderate dislocation and inclination posteriorly. In the case presented, an intraoral coronoidotomy with postoperative physiotherapy for treatment of coronoid process hyperplasia allowed satisfactory and stable results in the correction of coronoid-malar interference.
In patients with coronoid process hyperplasia, which presents essentially a mechanical problem such as limited mouth opening, a surgical treatment with prolonged postoperative physiotherapy is performed. The surgical treatment for coronoid process hyperplasia is correction of the coronoid-malar interference by a coronoidectomy or simply coronoidotomy. Gerbino, et al., (1) reported that coronoidotomy was performed intraorally by an osteotomy at the base of the coronoid process in five patients and that this approach notably reduces the need for bone exposure and consequent surgical trauma compared to the coronoidectomy. With respect to postoperative physiotherapy, several devices are used for maintenance of sufficient interincisal distance. (1-3) Previously, a mouth-opening exerciser (HU-OS II) (4-6) was introduced for postoperative mouth-opening exercises in patients with severe trismus due to temporomandibular joint ankylosis after maxillectomy. The exerciser is available for increasing the mouth opening range without help postoperatively.
A case of unilateral coronoid hyperplasia is described that was successfully treated by coronoidotomy with prolonged postoperative physiotherapy, using a HU-OS II appliance and revealed the postoperative radiographic changes between the sectioned part of the coronoid process and the mandibular ascending ramus.
A 28-year-old man was referred for evaluation of a persistent limited mouth opening. The patient first noticed the difficulty opening his mouth when he was 15 years old. He consulted a dentist and was given a diagnosis of temporomandibular joint disorder. There was no history of maxillofacial injury or familial occurrence of similar problems.
Clinical examination revealed limited mouth opening but no temporomandibular joint pain and no masticatory muscle tenderness. The maximum mouth opening was 30 mm. Left and right excursions were seven mm each and protrusive excursion was six mm. There was no dentofacial abnormality.
Orthopantomography showed the right coronid processes with normal length and the elongation of the left coronid processes (Figure 1). Computed tomography demonstrated the contact of the left zygomatic bone and the coronoid process in the open mouth position. Bone formation at the contact point on the posterior surface of the left zygomatic bone was observed (Figure 2 A-B). A diagnosis of left coronoid process hyperplasia was confirmed using the characteristic radiographic and clinical findings.
With the patient under general anesthesia, a coronoidotomy of the left coronoid process was performed intraorally by an osteotomy at the base of the coronoid process. A horizontal osteotomy was made with a Lindemann bur from the sigmoid incision to the anterior aspect of the ascending ramus (Figure 3A). The maximum mouth opening was 50 mm immediately after the osteotomy. The sectioned coronoid was not removed because there was no interference with enforced mandibular movement (Figure 3B).
Nine days after surgery, the maximum mouth opening was 33 mm. The patient started physiotherapy with a mouth-opening exerciser (HU-OS II) (Figure 4). The patient used the mouth-opening exerciser to do 100 consecutive openings using the exerciser with no other assistance--one opening per second, 100 seconds total. This exercise was done twice a day, once in the morning and once at night. Thirty days after surgery, the maximum mouth opening had increased to 40 mm, and at the three month follow-up, it had stabilized at 43 mm. The mechanical physiotherapy was then interrupted. At the 15 month follow-up, the maximum mouth opening range was still 43 mm, with good protrusion and lateral mandibular excursion, no displacement of the mandible, and no pain in the temporomandibular joint region.
Radiographic follow-up showed that the coronoid process apparently united with the mandibular ascending ramus, with moderate dislocation and inclination posteriorly (Figures 5 and 6).
Discussion
The treatment of coronoid process hyperplasia, which presents essentially a mechanical problem, is primarily surgical. In a coronoidectomy, the ascending ramus of the mandible is exposed as far as the top of the coronoid process, and then the temporalis muscle is detached from the coronoid. The entire coronoid process is removed. Change in muscle activity with detachment of the temporalis muscle and postoperative fibrosis with removal of the coronoid may lead to displacement of the mandible and the other disappointing results. (1,2) However, Gerbino, et al., (1) described five patients with coronoid process hyperplasia, who were successfully treated by coronoidotomy, and reported that this approach notably reduces the need for bone exposure and consequent surgical trauma compared to the coronoidectomy. Furthermore, this technique without removal of the coronoid process also reduces the organization of a postsurgical hematoma, with consequential fibrosis at the site of the operation. In the current patient, a simple coronoidotomy was performed intraorally by an osteotomy at the base of the coronoid process. The favorable outcome of the coronoidotomy in this case may have been because there is less postsectioned fibrosis with this procedure and because the sectioned part of the coronoid can position itself and consolidated posteriorly.
The coronoid process heals onto the mandibular ascending ramus in such a posterior position that it does not cause further obstruct jaw movement. This may occur because it is pushed during mouth opening by the action of the temporal muscle during the early postoperative period, when the patient is most motivated to do the correct exercises. We introduced a mouth-opening exerciser (HU-OS II) (4-6) for postoperative mouth-opening exercises in the current patient. The exerciser is made of a five mm thick acrylic resin plate and is wedge-shaped with a cut tip. The exerciser has three mm long stairs so that patients can notice improvement in mouth-opening during exercise. Every stair has an extremely gentle slope so that it permits gradual mouth opening without severe pain. In previous reports, the management after coronoidotomy is not described in detail. (1,2) Tieghi, et al., (3) reported on two cases that received postoperative mouth opening exercises with a dynamic device (Darcissac type). The device was used for 10 hours per day for 30 days. In those two cases, three months after surgery, the maximum mouth opening increased to 40 mm. In the present case, 30 days after surgery, the maximum mouth opening had increased to 40 mm. HU-OS II is easy to use and very effective for postoperative mouth opening exercises.
In conclusion, in the present case, an intraoral coronoidotomy with postoperative physiotherapy for treatment of coronoid process hyperplasia allowed satisfactory and stable results in the correction of coronoid-malar interference.
REFERENCE
(1.) Gerbino G, Bianchi SD, Bernardi M, Ben'one S: Hyperplasia of the mandibular coronoid process: long-term follow-up after coronoidotomy. J Craniomaxillofac Surg 1997; 25:169-173.
(2.) Shinno E, Sunakawa K, Hanasiro K, Shimoji M, Higa T: Anterior displacement of the mandible occurring after amputation of bilateral hyperplasia of the mandibular coronoid process. J Jpn Soc TMJ: 2002; 14:184-187.
(3.) Tieghi R, Galie M, Piersanti L, Clauser L: Bilateral hyperplasia of the coronoid processes: clinical report. J Craniofac Surg 2005; 16:723-726.
(4.) Murakami Y, Inoue N, Ahemed M, Yasuda M, Yamaguchi H, Totsuka Y: A new type of mouth-opening exerciser. Jpn J Oral Maxillofac Surg 1995; 41:175-177.
(5.) Murakami Y, Inoue N, Kobayashi T, Rin S, Ono M, Okada M, Saito S, Yamaguchi H, Nishikata S, Totsuka Y: Clinical study on postoperative physiotherapy in TMJ ankylosis. J Jpn Soc TMJ 1996; 8:105-117.
(6.) Inoue N, Murakami Y, Nishikata S, Oda M, Kobayashi T, Yamaguchi H, Saitoh S, Yura S, Yamaguchi T, Minowa K, Totsuka Y: Efficacy of post-operative physiotherapy in temporomandibular joint ankylosis. Hokkaido J Dent Sci 2000; 21:77-81.
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In patients with coronoid process hyperplasia, which presents essentially a mechanical problem such as limited mouth opening, a surgical treatment with prolonged postoperative physiotherapy is performed. The surgical treatment for coronoid process hyperplasia is correction of the coronoid-malar interference by a coronoidectomy or simply coronoidotomy. Gerbino, et al., (1) reported that coronoidotomy was performed intraorally by an osteotomy at the base of the coronoid process in five patients and that this approach notably reduces the need for bone exposure and consequent surgical trauma compared to the coronoidectomy. With respect to postoperative physiotherapy, several devices are used for maintenance of sufficient interincisal distance. (1-3) Previously, a mouth-opening exerciser (HU-OS II) (4-6) was introduced for postoperative mouth-opening exercises in patients with severe trismus due to temporomandibular joint ankylosis after maxillectomy. The exerciser is available for increasing the mouth opening range without help postoperatively.
A case of unilateral coronoid hyperplasia is described that was successfully treated by coronoidotomy with prolonged postoperative physiotherapy, using a HU-OS II appliance and revealed the postoperative radiographic changes between the sectioned part of the coronoid process and the mandibular ascending ramus.
A 28-year-old man was referred for evaluation of a persistent limited mouth opening. The patient first noticed the difficulty opening his mouth when he was 15 years old. He consulted a dentist and was given a diagnosis of temporomandibular joint disorder. There was no history of maxillofacial injury or familial occurrence of similar problems.
Clinical examination revealed limited mouth opening but no temporomandibular joint pain and no masticatory muscle tenderness. The maximum mouth opening was 30 mm. Left and right excursions were seven mm each and protrusive excursion was six mm. There was no dentofacial abnormality.
Orthopantomography showed the right coronid processes with normal length and the elongation of the left coronid processes (Figure 1). Computed tomography demonstrated the contact of the left zygomatic bone and the coronoid process in the open mouth position. Bone formation at the contact point on the posterior surface of the left zygomatic bone was observed (Figure 2 A-B). A diagnosis of left coronoid process hyperplasia was confirmed using the characteristic radiographic and clinical findings.
With the patient under general anesthesia, a coronoidotomy of the left coronoid process was performed intraorally by an osteotomy at the base of the coronoid process. A horizontal osteotomy was made with a Lindemann bur from the sigmoid incision to the anterior aspect of the ascending ramus (Figure 3A). The maximum mouth opening was 50 mm immediately after the osteotomy. The sectioned coronoid was not removed because there was no interference with enforced mandibular movement (Figure 3B).
Nine days after surgery, the maximum mouth opening was 33 mm. The patient started physiotherapy with a mouth-opening exerciser (HU-OS II) (Figure 4). The patient used the mouth-opening exerciser to do 100 consecutive openings using the exerciser with no other assistance--one opening per second, 100 seconds total. This exercise was done twice a day, once in the morning and once at night. Thirty days after surgery, the maximum mouth opening had increased to 40 mm, and at the three month follow-up, it had stabilized at 43 mm. The mechanical physiotherapy was then interrupted. At the 15 month follow-up, the maximum mouth opening range was still 43 mm, with good protrusion and lateral mandibular excursion, no displacement of the mandible, and no pain in the temporomandibular joint region.
Radiographic follow-up showed that the coronoid process apparently united with the mandibular ascending ramus, with moderate dislocation and inclination posteriorly (Figures 5 and 6).
Discussion
The treatment of coronoid process hyperplasia, which presents essentially a mechanical problem, is primarily surgical. In a coronoidectomy, the ascending ramus of the mandible is exposed as far as the top of the coronoid process, and then the temporalis muscle is detached from the coronoid. The entire coronoid process is removed. Change in muscle activity with detachment of the temporalis muscle and postoperative fibrosis with removal of the coronoid may lead to displacement of the mandible and the other disappointing results. (1,2) However, Gerbino, et al., (1) described five patients with coronoid process hyperplasia, who were successfully treated by coronoidotomy, and reported that this approach notably reduces the need for bone exposure and consequent surgical trauma compared to the coronoidectomy. Furthermore, this technique without removal of the coronoid process also reduces the organization of a postsurgical hematoma, with consequential fibrosis at the site of the operation. In the current patient, a simple coronoidotomy was performed intraorally by an osteotomy at the base of the coronoid process. The favorable outcome of the coronoidotomy in this case may have been because there is less postsectioned fibrosis with this procedure and because the sectioned part of the coronoid can position itself and consolidated posteriorly.
The coronoid process heals onto the mandibular ascending ramus in such a posterior position that it does not cause further obstruct jaw movement. This may occur because it is pushed during mouth opening by the action of the temporal muscle during the early postoperative period, when the patient is most motivated to do the correct exercises. We introduced a mouth-opening exerciser (HU-OS II) (4-6) for postoperative mouth-opening exercises in the current patient. The exerciser is made of a five mm thick acrylic resin plate and is wedge-shaped with a cut tip. The exerciser has three mm long stairs so that patients can notice improvement in mouth-opening during exercise. Every stair has an extremely gentle slope so that it permits gradual mouth opening without severe pain. In previous reports, the management after coronoidotomy is not described in detail. (1,2) Tieghi, et al., (3) reported on two cases that received postoperative mouth opening exercises with a dynamic device (Darcissac type). The device was used for 10 hours per day for 30 days. In those two cases, three months after surgery, the maximum mouth opening increased to 40 mm. In the present case, 30 days after surgery, the maximum mouth opening had increased to 40 mm. HU-OS II is easy to use and very effective for postoperative mouth opening exercises.
In conclusion, in the present case, an intraoral coronoidotomy with postoperative physiotherapy for treatment of coronoid process hyperplasia allowed satisfactory and stable results in the correction of coronoid-malar interference.
REFERENCE
(1.) Gerbino G, Bianchi SD, Bernardi M, Ben'one S: Hyperplasia of the mandibular coronoid process: long-term follow-up after coronoidotomy. J Craniomaxillofac Surg 1997; 25:169-173.
(2.) Shinno E, Sunakawa K, Hanasiro K, Shimoji M, Higa T: Anterior displacement of the mandible occurring after amputation of bilateral hyperplasia of the mandibular coronoid process. J Jpn Soc TMJ: 2002; 14:184-187.
(3.) Tieghi R, Galie M, Piersanti L, Clauser L: Bilateral hyperplasia of the coronoid processes: clinical report. J Craniofac Surg 2005; 16:723-726.
(4.) Murakami Y, Inoue N, Ahemed M, Yasuda M, Yamaguchi H, Totsuka Y: A new type of mouth-opening exerciser. Jpn J Oral Maxillofac Surg 1995; 41:175-177.
(5.) Murakami Y, Inoue N, Kobayashi T, Rin S, Ono M, Okada M, Saito S, Yamaguchi H, Nishikata S, Totsuka Y: Clinical study on postoperative physiotherapy in TMJ ankylosis. J Jpn Soc TMJ 1996; 8:105-117.
(6.) Inoue N, Murakami Y, Nishikata S, Oda M, Kobayashi T, Yamaguchi H, Saitoh S, Yura S, Yamaguchi T, Minowa K, Totsuka Y: Efficacy of post-operative physiotherapy in temporomandibular joint ankylosis. Hokkaido J Dent Sci 2000; 21:77-81.
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Modeling and manufacturing of an artificial intervertebral disc.(Report).Low back pain
The paper presents a protocol in customization of spinal intervertebral discs. The main stages of the protocol are: medical image measurements; conceptual design; theoretical validation of the geometry; rapid manufacturing and mechanical testing of the artificial disc. The protocol was developed for the L5-S1 human intervertebral disc but can be adapted for any of the spinal discs. An artificial disc developed in this way will fit with the anatomical requirements of the host.
1. INTRODUCTION
Degenerative disc disease represents one of the multiple causes of the low back pain (Eijkelkamp, 2002). In treating these diseases, non-surgical treatments are initially prescribed (Metfessel et al., 2005). When surgical intervention is necessary, spinal fusion or Artificial Intervertebral Disc (AID) implantation are performed. The long-term benefits of artificial disc implantation are still unknown, thus, total disc replacement with AID is considered investigational (Regence, 2009).
The development of AID is based on: anatomical knowledge, biomechanical studies, appropriate geometrical models, biomaterials and manufacturing technologies.
The surface of annulus fibrosus ([A.sub.i]) was calculated by subtracting two surfaces: one of the ellipses which circumscribe the annulus and the other one which circumscribe the nucleus (equation 1). The surface of nucleus pulposus ([A.sub.n]) was calculated using the approximate equation 2, where p = 1.6075 represents the constant of Knud Thomsen (Michon, 2008). The side surface of the analytical calculated ID was calculated using equation 3.
Comparing the measurements with the analytical calculations the differences are less than 3 [mm.sup.2] for the annulus and less than 1 [mm.sup.2] in the case of nucleus. This reduced (0.08% and 0.1% respectively) errors prove the validity of the analytical calculus.
The calculated side area, together with the values of the forces acting at this level (invasively measured by Nachemson (Panjabi & White, 2000) can be used in order to determinate the surface pressure acting on the disc.
4. CONCLUSIONS
In order to manufacture an AID, the geometry and the surface area of the natural ID must be well known. In this study, the upper surface of the natural ID was analytical approximated. The conceptual design, followed by the surface measurements confirms the validity of the approximation. In order to validate the conceptual design, the virtual 3D model was prototyped, and an AID physical model was obtained. The AID physical model is not manufactured by biocompatible materials.
The protocol can be adapted to any intervertebral disc, taking into consideration the load changes and disc size. An improved model will consist of two rigid plates and an elastomeric core interposed between them. Thus, based on the proposed protocol, other customized ID will be designed and manufactured using biocompatible materials.
5. REFERENCES
Bradford, D.S.; Berven, S.H. & Hu, S. (2009). Intervertebral Disc Replacement. A Role in the Management of Chronic Low pain Caused by Degenerative Disc Disease, Available from: http://www.spineuniverse.com/ Accessed on: 2009-05-03
Cooper, K.G. (2001). Rapid Prototyping Technology: Selection and Application, CRC Press, ISBN 978-0824702618, USA
Michon, G.P. (2008). Final Answers, Available from: http://home.att.net/~numericana/answer/ellipsoid.html Accessed on: 2009-05-03
Panjabi, M.M. & White, A.A. (2000). Biomechanics in the Musculoskeletal System, Churchill Livingstone, ISBN 0-443-06585-3, Philadelphia
Schroeder, Y.; Wilson, W.; Huyghe, J. & Baaijens, F.P.T. (2006). Osmoviscoelastic finite element model of the intervertebral disc. European Spine Journal, Vol. 15, Suppl. 3, August 2006, pp. 361-371, ISSN 1432-0932
*** (2009)
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PENYAKIT KULIT
Penyakit Kulit - Penyakit kulit yang dibahas disini adalah penyakit kulit yang tidak berbahaya atau dalam arti kata lain tidak akan menimbulkan dampak buruk terhadap kelangsungan hidup orang terkena penyakit tersebut, namun cenderung lebih kepada rasa gatal-gatal yang dialami oleh si penderita atau mungkin juga barakibat rasa malu atau kurang percaya diri.
Berikut adalah beberapa jenis penyakit kulit yang dimaksutkan, sekaligus akan dibahas juga cara pencegahannya.
1. Kudis
Kudis adalah penyakit kulit yang menular, penyakit ini dalam bahasa ilmiah disebut scabies, memiliki gejala gatal, dan rasa gatal tersebut akan lebih para pada malam hari. Sering muncul di tempat-tempat lembab di tubuh seperti misalnya, tangan, ketiak, pantat, kunci paha dan terkang di celang jari tangan atau kaki.
Cara Pencegahan penyakit kudis dapat dilakukan dengan mencuci sperai tempat tidur, handuk dan pakaian yan dipakai dalam 2 hari belakangan dengan air hangat dan deterjen.
2. Kurap
Penyakit Kurap merupakan suatu penyakit kulit menular yang disebabkan oleh fungsi. Gejala kurap mulai dapat dikenali ketika terdapat baian kecil yang kasar pada kulit dan dikelilingi lingkaran merah muda. Kurap dapat dicegah dengan cara mencuci tangan yang sempurna, menjaga kebersihan tubuh, dan mengindari kontak dengan penderita.
Kurap dapat diobati dengan anti jamur yang mengandung mikonazol dan kloritomazol dengan benar dapat menghilangkan infeksi.
3. Panau
Panau atau Panu adalah salah satu penyakit kulit yang disebabkan oleh jamur. Penyakit panau ditandai dengan bercak yang terdapat pada kulit disertai rasa gatal pada saat berkeringat. Bercak-bercak ini bisa berwarna putih, coklat atau merah tergantung warna kulit si penderita.
Panau paling banyak dijumpai pada remaja usia belasan. Meskipun begitu panau juga bisa ditemukan pada penderita berumur tua.
Cara pencegahan penyakit kulit Panau dapat dilakukan dengan menjaga kebersihan kulit, dan dapat diobati dengan obat anti jamur yang dijual di pasaran, dan dapat juga diobati dengan obat-obatan tradisional seperti daun sirih yang dicampur dengan kapur sirih dan dioleh pada kulit yang terserang Panau.
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