Laser Excision of Hypopharyngeal Lesions Using a Transoral Approach

A transoral technique for the excision of primary hypopharyngeal, posterior pharyngeal, and lateral pharyngeal wall tumors using the CO₂ or KTP laser and an operating microscope is presented.     

Measurements of respiratory illness among construction painters.

The prevalence of different measurements of respiratory illness among construction painters was examined and the relation between respiratory illness and employment as a painter assessed in a cross sectional study of current male members of two local affiliates of a large international union of painters. Respiratory illness was measured by questionnaire and spirometry. Longer employment as a painter was associated with increased prevalence of chronic obstructive disease and an interactive effect was observed for smoking and duration of employment as a painter. Multiple regression analysis showed a significant association between years worked as a painter and a decrement in FEV1 equal to about 11 ml for each year worked. This association was larger among painters who had smoked. The prevalence of chronic bronchitis was significantly associated with increased use of spray application methods.     

Community support services and functioning of the seriously mentally ill

A cohort of 729 chronically mentally ill patients receiving community support services (CSS) were followed over a nine-month period. Receiving needed community support services was shown to predict change in client functioning as measured by the Global Assessment Scale (GAS) even after the initial values on the GAS, as well as demographic, psychiatric, residential and medication maintenance variables were considered. Adequacy of social support from family, friends and others also contributed to predicting change in global functioning of the CSS patients.Johns Hopkins UniversityPresented at the American Psychological Association Annual Meeting, Washington, D.C., August 16, 1992.     

Nonbacterial thrombotic endocarditis clinically mimicking veno-occlusive disease of the liver complicating autologous bone marrow transplantation.

Nonbacterial thrombotic endocarditis is an uncommon, but well-described, complication of bone marrow transplantation. We describe a case of nonbacterial thrombotic endocarditis following autologous bone marrow transplantation that was marked by weight gain, hepatomegaly, ascites, and extreme hyperbilirubinemia leading to a clinical diagnosis of hepatic veno-occlusive disease. Autopsy revealed nonbacterial thrombotic endocarditis of the tricuspid and pulmonic valves, and passive congestion of the liver, but there was no evidence of veno-occlusive disease. We discuss the pathophysiology and clinical features of nonbacterial thrombotic endocarditis and review its occurrence in association with bone marrow transplantation. Nonbacterial thrombotic endocarditis is often difficult to detect clinically and should be a diagnostic consideration in patients who develop systemic emboli or congestive heart failure after bone marrow transplantation.     

Injuries to bicyclists in Wuhan, People's Republic of China.

OBJECTIVES: This study examined the morbidity and mortality from bicycling injuries in Wuhan, China. METHODS: Police department data for the year 1993 complemented by data from emergency room interviews were analyzed. RESULTS: The death rate from bicycling injuries was estimated as 2.2 per 100000 population, more than seven times the rate for the United States. At least 79% of the fatalities and 17% of the emergency room cases sustained head injuries, the majority (71%) of which resulted from contact of the head with the concrete or asphalt road. None of the patients was wearing a helmet at the time of injury, and helmet use among the general bicyclist population was nonexistent. CONCLUSIONS: Bicycle-related head injury is an important public health issue in China. The effectiveness of safety helmets in developing countries needs to be evaluated.     

Comparative behavioural and neurochemical studies with a psychomotor stimulant,an hallucinogen and 3,4-methylenedioxy analogues of amphetamine

Spontaneous behaviours were assessed in freely moving rats after treatment with equimolar doses of drugs that share a basic amphetamine structure. The drugs used included a psychomotor stimulant [(+)-amphetamine (AMPH)], an hallucinogen [para-methoxyamphetamine (PMA)] and the entactogens 3,4-methylenedioxymethamphetamine (MDMA), 3,4-methylenedioxyamphetamine (MDA) and 3,4-methylenedioxy-N-ethylamphetamine (MDE). A detailed analysis of the frequency and duration of 30 different behaviours and the temporal organization of the behaviours was conducted in addition to measuring motor activity with an automated device. Levels of the biogenic amines and their acid metabolites in discrete brain regions and brain drug levels were also obtained. The automated motor activity measures discriminated among entactogens, the stimulant and the hallucinogen, but failed to distinguish between the hallucinogen and vehicle. Principal components analysis and cluster analysis of the frequencies and durations of the behaviours did not improve the classification of the drugs over the automated motor activity measures. Only the cluster analysis of the transitions between individual behaviours succeeded in differentiating the drug classes from each other and from vehicle treatment. All the behavioural measures classified one entactogen (MDE) as an hallucinogen. Cortical 5-hydroxytryptamine (5-HT) measures grouped MDE with the other entactogens but did not distinguish AMPH from vehicle. However, striatal dopamine measures differentiated AMPH from vehicle treatment. Variations in the durations of behavioural effects across drugs were associated with large differences in drug levels 3 h after injection. Although the neurochemical data provided a classification system that most closely parallels human subjective effects of these drugs, both the neurochemical and the behavioural measures supported the existence of an entactogen class distinct from a psychomotor stimulant and an hallucinogen.