External laryngeal trauma analysis of 392 patients.

BACKGROUND: External laryngeal trauma (ELT) is a rare but clinically important injury. OBJECTIVE: To perform the first population-based, time series analysis of the epidemiology, management, and outcomes of ELT using an 11-state, inpatient sample database containing more than 54 million patients. PATIENTS: Three hundred ninety-two patients with a primary or secondary diagnosis of ELT were identified. Over a 5-year period, the incidence of ELT in this series was 1/137,000. The mean (+/-SD) age was 37 (+/-7) years, and the overall mortality rate was 2.04%. Two hundred forty-eight patients required surgical intervention. RESULTS: The average length of stay for 67 patients not requiring surgical intervention for any injury was 3 (+/-2) days, with no mortality. One hundred eighty patients underwent endoscopy, with 14 requiring tracheotomy alone and 57 requiring tracheotomy plus laryngeal repair. The average length of stay and the mortality rate were higher in these latter groups. Overall, 139 patients underwent tracheotomy, with a mortality rate of 5%, while 96 patients underwent laryngeal repair, with a mortality rate of 1%. Surgical treatment was performed in 140 patients with ELT within 24 hours after presentation, while another 60 received treatment within 48 hours. Associated injuries included skull base or intracranial injury (13%), open neck injury (9%), cervical spine injury (8%), and esophageal or pharyngeal injury (3%). CONCLUSION: External laryngeal trauma is a rare injury, with most patients requiring surgical intervention.     

Prognostic factors in the recurrence of stage I and II squamous cell cancer of the oral cavity.

Stage I and II squamous cell cancers of the oral cavity have a high recurrence rate given their size and relative amenability to surgical resection. It has been suggested that one way to decrease this recurrence rate is to augment the surgical resection of these tumors with either elective neck dissection or radiation therapy. However, this would expose a significant number of patients to the unnecessary morbidity associated with either of these modalities. In an attempt to identify those patients most at risk for recurrence, we retrospectively determined the clinical and histologic factors that were associated with recurrence in 49 patients with stage I and II oral cavity cancer. Multiple regression analysis revealed that when various interactions between variables were controlled for, only the presence of a positive surgical margin or a tumor depth greater than 5 mm was significantly associated with recurrence. Each individually increased the likelihood of recurrence almost threefold.     

Toxic oxygen metabolites induce vasoconstriction and bronchoconstriction in isolated, plasma-perfused rat lungs

Effects of toxic oxygen metabolites (TOM) on the pulmonary vascular bed and airways were studied in isolated, plasma-perfused rat lungs. TOM were generated by xanthine oxidase (XO) (0.1 or 0.25 unit.ml-1) and hypoxanthine (HX) (1 mol.l-1). In vitro measurements by chemiluminescence indicated that the major oxygen metabolite generated by XO and HX was H2O2. Measurements of PO2 in the perfusate as an indicator of O2-consumption suggested that production of TOM by XO and HX was finished within 30 min. XO and HX induced an early dose-dependent bronchoconstriction and a late increase in transpulmonary pressure (Ptp). Pulmonary arterial pressure (Ppa) increased gradually and levelled off within 30 min with low-dose XO, but not with high-dose XO. As judged by weight increase of the lungs, interstitial edema occurred regularly. Allopurinol, an inhibitor of XO, blocked the lung responses caused by XO and HX. Catalase attenuated all lung responses induced by XO and HX, while superoxide dismutase had no effect. The hydroxyl radical scavenger dimethylsulfoxide abolished the increase in Ptp and attenuated the increase in Ppa, but did not consistently protect the lungs from edema development. This study shows that TOM induce vasoconstriction, bronchoconstriction and lung edema in plasma-perfused rat lungs, mainly due to generation of H2O2 and the hydroxyl radical.     

Does participation in the electronic residency application service (ERAS) affect the quality of applications to a residency program?

PURPOSE: To determine whether the quality of applicants to an emergency medicine (EM) residency would improve during a year that the program did not participate in the Electronic Residency Application Service (ERAS). METHODS: Applications to the Denver Health Medical Center Residency in Emergency Medicine (DHMCREM) were retrospectively compared for three consecutive years: 1996-97, during which ERAS was not available to EM programs; 1997-98, during which DHMCREM did not participate in ERAS; and 1998-99, during which DHMCREM participated in ERAS. The quality of applicants was based on their application scores, which were determined using a 20-point equation that rated individual attributes: U.S. Medical Licensing Examination Step 1 score, medical school, research, extracurricular activities, personal statement, letters of recommendation, and dean's letter. T-tests were used to compare application scores and individual attributes among applicants, those invited for an interview, and those who matched to the program. In addition, numbers of applications to the DHMCREM were compared with national trends. RESULTS: A total of 1,318 complete applications were reviewed for the three-year study period. There was a 50% reduction in applications during 1997-98 when DHMCREM did not participate in ERAS, which did not correlate with the national trend in applications to residency programs. However, there was no statistically significant difference in the quality of applicants, interviewees, or matched candidates as defined by the overall application score. In addition, applicants who matched to the program were higher on the rank-order list during the 1997-98 application year than were applicants who matched for the year prior to ERAS and for the year DHMCREM participated in ERAS. CONCLUSIONS: Participation in ERAS increased the number of applicants, but did not correlate with an increase in the quality of applicants.     

Atrial Septal Versus Atrial Appendage Pacing:

HERMIDA, J.-S., et al. : Atrial Septal Versus Atrial Appendage Pacing: Feasibility and Effects on Atrial Conduction, Interatrial Synchronization, and Atrioventricular Sequence. Atrial septal (Se-P) and atrial appendage pacing (Ap-P) were compared in a randomized, controlled study to assess the feasibility, the reliability, and the effects of Se-P on atrial conduction, interatrial synchronization, and the AV sequence. The main baseline characteristics of the patients were comparable in both groups. There was no difference in feasibility or reliability between the two techniques. Compared to Ap-P   (n = 28)   , Se-P   (n = 28)   decreased the P wave duration, left atrial electromechanical delay (LAEMD), and interatrial interval (−1.6% vs   +28%, P < 0.001; −3%   vs   + 30%, P < 0.001; −130%   vs   + 78%, P < 0.001   ); it induced a smaller increase of the right AEMD, a slight reversal of the timing of the atrial systoles and a shortening of the PR interval (−13% vs   + 25%, P < 0.001   ) and of the interval separating atrial systoles from ventricular activation. Finally, the shortening of the PR interval was smaller during high Se-P versus low Se-P. Se-P avoids the undesirable prolongation of the atrial, interatrial, and AV conductions observed during Ap-P. In addition, Se-P creates a slight reversal of the timing of the atrial systoles and induces a shortening of PR interval, the extent of which could depend on the height of the pacing site on the septum. (PACE 2003; 26[Pt. I]:26–35)     

Spatial error in geocoding physician location data from the AMA Physician Masterfile: implications for spatial accessibility analysis

The accuracy of geocoding hinges on the quality of address information that serves as input to the geocoding process; however errors associated with poor address quality are rarely studied. This paper examines spatial errors that arise due to incorrect address information with respect to physician location data in the United States. Studies of spatial accessibility to physicians in the U.S. typically rely on data from the American Medical Association's Physician Masterfile. These data are problematic because a substantial proportion of physicians only report a mailing address, which is often the physician's home (residential) location, rather than the address for the location where health care is provided. The incorrect geocoding of physicians' practice locations based on inappropriate address information results in a form of geocoding error that has not been widely analyzed. Using data for the Chicago metropolitan region, we analyze the extent and implications of geocoding error for measurement of spatial accessibility to primary care physicians. We geocode the locations of primary care physicians based on mailing addresses and office addresses. The spatial mismatch between the two is computed at the county, zip code and point location scales. Although mailing and office address locations are quite close for many physicians, they are far apart (>20 km) for a substantial minority. Kernel density estimation is used to characterize the spatial distribution of physicians based on office and mailing addresses and to identify areas of high spatial mismatch between the two. Errors are socially and geographically uneven, resulting in overestimation of physician supply in some high-income suburban communities, and underestimation in certain central city locations where health facilities are concentrated. The resulting errors affect local measures of spatial accessibility to primary care, biasing statistical analyses of the associations between spatial access to care and health outcomes.     

Squamous cell carcinoma of the external ear: a review of 75 cases

Squamous cell carcinoma of the external ear can be a potentially lethal lesion. Although it is the most common cancer involving the pinna, the variables that have the greatest impact on prognosis are still in question. We reviewed 75 cases of squamous cell carcinoma of the external ear to determine patterns of occurrence and treatment failure. Forty patients had adequate follow-up for determination of cancer control rates. Local control was successful with initial treatment in 85% of the cases. The incidence of lymph node metastases was 10%, whereas distant metastasis occurred in only one patient (2.5%). This series differs from others in that most patients were unselected and most of the lesions treated were early (less than 1 cm). The significance of positive margins after surgical excision is also analyzed.