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Figure 2. ; The hypothalamic-pituitary-adrenal (HPA) axis.2 In this figure, solid arrows represent stimulation and dashed arrows indicate inhibition. The hypothalamus secretes corticotropin-releasing factor (CRF), which stimulates the pituitary to secrete corticotropin (formerly called adrenocorticotropic hormone). Corticotropin stimulates the adrenal cortex to synthesize and secrete cortisol. Provided serum concentrations are adequate, cortisol performs vital physiological functions and inhibits further activity of the HPA axis. Serum cortisol levels peak at ∼8:00 am and gradually decline over 12–16 hours. As cortisol is consumed, its serum levels diminish and inhibition of the axis wanes. This allows production of cortisol to commence again. This pattern of function is called circadian or diurnal rhythm and occurs at a normal basal rate unless the axis is excited by other factors such as hypoglycemia, trauma, or stress. Glucocorticoids produce an impressive number of physiological effects. When supraphysiologic doses are administered, the subsequent pharmacological effects consist essentially of exaggerated physiologic effects. These doses will also impart a negative feedback on the axis that eventually leads to adrenal atrophy following sustained use.
Daniel E. Becker
Figure 2. 
Figure 2. 

The hypothalamic-pituitary-adrenal (HPA) axis.2 In this figure, solid arrows represent stimulation and dashed arrows indicate inhibition. The hypothalamus secretes corticotropin-releasing factor (CRF), which stimulates the pituitary to secrete corticotropin (formerly called adrenocorticotropic hormone). Corticotropin stimulates the adrenal cortex to synthesize and secrete cortisol. Provided serum concentrations are adequate, cortisol performs vital physiological functions and inhibits further activity of the HPA axis. Serum cortisol levels peak at ∼8:00 am and gradually decline over 12–16 hours. As cortisol is consumed, its serum levels diminish and inhibition of the axis wanes. This allows production of cortisol to commence again. This pattern of function is called circadian or diurnal rhythm and occurs at a normal basal rate unless the axis is excited by other factors such as hypoglycemia, trauma, or stress. Glucocorticoids produce an impressive number of physiological effects. When supraphysiologic doses are administered, the subsequent pharmacological effects consist essentially of exaggerated physiologic effects. These doses will also impart a negative feedback on the axis that eventually leads to adrenal atrophy following sustained use.

Reducing Nasopharyngeal Trauma: The Urethral Catheter–Assisted Nasotracheal Intubation Technique
Allen WongDDS,
Paul SubarDDS, EdD,
Heidi WitherellMD, and
Konstantin J OvodovMD
Article Category: Research Article
Volume/Issue: Volume 58: Issue 1
Online Publication Date: Jan 01, 2011
DOI: 10.2344/0003-3006-58.1.26
Page Range: 26 – 30

technique can be more challenging than the oral approach. The number of cases requiring nasal intubation is growing in the population of patients with special needs. The approach described in this paper is intended to provide an alternative technique to assist in the nasal intubation process. It has been observed that this technique is associated with less nasopharyngeal trauma and bleeding in children. 9 , 10 Avoidance of nasopharyngeal trauma in the airway is preferable from both the surgeons' and the anesthesiologists' perspectives, as perioperative laryngospasm and

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Figure 8; Comparison of means: bleeding and trauma.
Simon Prior,
Jarom Heaton,
Kris R. Jatana, and
Robert G. Rashid
Figure 8
Figure 8

Comparison of means: bleeding and trauma.

Basic and Clinical Pharmacology of Glucocorticosteroids
Daniel E. BeckerDDS
Article Category: Other
Volume/Issue: Volume 60: Issue 1
Online Publication Date: Jan 01, 2013
DOI: 10.2344/0003-3006-60.1.25
Page Range: 25 – 32

. As cortisol is consumed, its serum levels diminish and inhibition of the axis wanes. This allows production of cortisol to commence again. This pattern of function is called circadian or diurnal rhythm and occurs at a normal basal rate unless the axis is excited by other factors such as hypoglycemia, trauma, or stress. Glucocorticoids produce an impressive number of physiological effects. When supraphysiologic doses are administered, the subsequent pharmacological effects consist essentially of exaggerated physiologic effects. These doses will also impart a

Figure 10; The calculated probability that the reduced trauma observed in this study using Tube 1 was a chance occurrence is less than P  =  .007. Grey  =  probability of no trauma. Tube 0  =  standard tube. Tube 1  =  Parker tube.
Simon Prior,
Jarom Heaton,
Kris R. Jatana, and
Robert G. Rashid
Figure 10
Figure 10

The calculated probability that the reduced trauma observed in this study using Tube 1 was a chance occurrence is less than P  =  .007. Grey  =  probability of no trauma. Tube 0  =  standard tube. Tube 1  =  Parker tube.

Figure 6; Mean comparisons of visual analogue scale (VAS) data in response to trauma. 0  =  standard tube; 1  =  Parker tube. Graph indicates 95% confidence intervals with no overlap of means being interpreted as a significant difference in the means.
Simon Prior,
Jarom Heaton,
Kris R. Jatana, and
Robert G. Rashid
Figure 6
Figure 6

Mean comparisons of visual analogue scale (VAS) data in response to trauma. 0  =  standard tube; 1  =  Parker tube. Graph indicates 95% confidence intervals with no overlap of means being interpreted as a significant difference in the means.

Figure 1. ; The inflammatory process. Normally, small arterioles deliver blood to capillaries, which are then drained by venules. Vasoactive autacoids trigger the vascular phase, causing arterioles to dilate and endothelial cells to shrink, making capillaries and venules more permeable. Hyperemia produces the cardinal signs of redness and heat. Permeability allows extravasation of plasma leading to swelling and pain. Chemotactic autacoids target leukocytes (WBCs), which adhere to endothelium (margination), squeeze through the openings (diapedesis) and migrate out into the tissues (emigration). Nonsteroidal anti-inflammatory drugs (NSAIDS) inhibit the vascular phase, and the glucocorticoids inhibit both phases.
Daniel E. Becker
Figure 1. 
Figure 1. 

The inflammatory process. Normally, small arterioles deliver blood to capillaries, which are then drained by venules. Vasoactive autacoids trigger the vascular phase, causing arterioles to dilate and endothelial cells to shrink, making capillaries and venules more permeable. Hyperemia produces the cardinal signs of redness and heat. Permeability allows extravasation of plasma leading to swelling and pain. Chemotactic autacoids target leukocytes (WBCs), which adhere to endothelium (margination), squeeze through the openings (diapedesis) and migrate out into the tissues (emigration). Nonsteroidal anti-inflammatory drugs (NSAIDS) inhibit the vascular phase, and the glucocorticoids inhibit both phases.

Figure 3. ; Molecular structures of selected glucocorticoids. Prednisone is inactive as the parent drug and is converted to prednisolone following administration. Methylprednisolone differs only in a mere methyl substitution. Betamethasone and dexamethasone are optical isomers differing only in the orientation of the methyl group indicated by the asterisk. Triamcinolone is similar in structure and like other agents can be created for sustained activity as a repository formulation by adding slowly absorbed groupings such as acetates or the acetonide illustrated here by the shaded grouping.
Daniel E. Becker
Figure 3. 
Figure 3. 

Molecular structures of selected glucocorticoids. Prednisone is inactive as the parent drug and is converted to prednisolone following administration. Methylprednisolone differs only in a mere methyl substitution. Betamethasone and dexamethasone are optical isomers differing only in the orientation of the methyl group indicated by the asterisk. Triamcinolone is similar in structure and like other agents can be created for sustained activity as a repository formulation by adding slowly absorbed groupings such as acetates or the acetonide illustrated here by the shaded grouping.

Parker Flex-Tip and Standard-Tip Endotracheal Tubes: A Comparison During Nasotracheal Intubation
Simon PriorBDS, PhD, MS,
Jarom HeatonDDS, MS,
Kris R. JatanaMD, and
Robert G. RashidDDS, MAS
Article Category: Research Article
Volume/Issue: Volume 57: Issue 1
Online Publication Date: Jan 01, 2010
DOI: 10.2344/0003-3006-57.1.18
Page Range: 18 – 24

nasal cavity and septal wall, guided carefully down the posterior pharynx through the laryngeal structures and into the trachea. 1 , 2 The most common complications of nasotracheal intubation include epistaxis, mucosal abrasion, and a sore throat of short duration. Other potential complications described in the literature include case reports of retropharyngeal perforation, traumatic tissue avulsion (eg, mucosal enlargements such as polyps or parts of turbinates), lacerations of nasal and pharyngeal structures, infections subsequent to mucosal trauma, glottic

Comparison of Buccal Infiltration of 4% Articaine With 1 : 100,000 and 1 : 200,000 Epinephrine for Extraction of Maxillary Third Molars With Pericoronitis: A Pilot Study
José Lacet Lima JuniorDDS, MSc,
Eduardo Dias-RibeiroDDS, MSc,
Julierme Ferreira-RochaDDS, MSc,
Ramon SoaresDDS,
Fábio Wildson Gurgel CostaDDS, MSc,
Song FanDDS, and
Eduardo Sant'anaDDS, MSc, PhD
Article Category: Other
Volume/Issue: Volume 60: Issue 2
Online Publication Date: Jan 01, 2013
DOI: 10.2344/0003-3006-60.2.42
Page Range: 42 – 45

decreased or neutralized because the inflammation and low tissue pH affects tissue diffusion of the anesthetic, making the drug less effective. 7 – 9 Pericoronitis is the most frequent inflammatory pathology associated with third molars and is caused by a combination of factors including trauma and food impaction with subsequent bacterial colonization and infection. 1 , 10 – 13 Clinically, it is characterized by the presence of erythema, swelling, and even ulceration in some cases. 1 , 14 The management of pericoronitis varies. Many authors have recommended