The medical records of 20 patients undergoing revascularized jejunal flap reconstruction of hypopharyngeal defects were retrospectively reviewed to analyze the incidence of distal marginal recurrence, complication rates, and success of early functional restoration. This report is one of few in the literature to address distal marginal recurrence in patients undergoing jejunal free flap reconstruction of hypopharyngeal defects. In 15 evaluable patients, two (13%) developed distal marginal recurrences. Both patients had tumor involving the hypopharynx at the junction of the cervical esophagus. The major complication rate was five of 20 patients (25%) and included three flap failures, one death, and one intra-abdominal hemorrhage. The minor complication rate was 35%. The median hospital stay was 15.5 days and the median time to successful swallowing was 14.5 days. The functional success rate for swallowing was 58%. Because of the aggressive nature of this disease, we feel partial esophagectomy with jejunal flap reconstruction is warranted to achieve early functional restoration in a select group of patients when a 2-cm distal margin can be obtained above the cervical esophagus with frozen-section control, and the distal esophagus is normal.

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Development and testing of a new measure of health status for clinical trials in heart failure.

The authors developed a new measure of subjective health status for patients with heart failure. Eighty-eight patients with heart failure were asked about the impact of their condition on 123 items related to physical and emotional function. The most frequently chosen and important items were included in a 16-item Chronic Heart Failure Questionnaire (CHQ) that examines dyspnea during daily activities, fatigue, and emotional function. The CHQ was tested in a controlled trial of digoxin in heart failure patients in sinus rhythm. When administered serially to 25 patients in the run-in phase of the trial, the CHQ proved reproducible. Subsequently, CHQ results distinguished those who reported improvement or deterioration from those who did not. The CHQ showed moderate correlations with patient global ratings, walk test scores, and clinical assessments of heart failure. The authors conclude that the CHQ may be useful for measuring health status in clinical trials in heart failure.

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Hemispheric interactions in human fusional response.

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Cerebral Cortex↗

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Triamcinolone acetonide aqueous nasal spray for the treatment of patients with perennial allergic rhinitis: a multicenter, randomized, double-blind, placebo-controlled study.

In this multicenter, randomized, double-blind, placebo-controlled study, 178 patients with symptoms of perennial allergic rhinitis (PAR) were treated with either triamcinolone acetonide (TAA) Aqueous nasal spray (220 micrograms once daily) or placebo for 4 weeks. Symptoms of PAR (nasal stuffiness, nasal discharge, sneezing, nasal index, and nasal itching) were evaluated throughout the treatment period through the use of patient diaries. In addition, both patients and physicians completed independent global evaluations of treatment efficacy at the conclusion of the study. TAA Aqueous provided clinically and statistically (P < or = 0.05) greater improvements in nasal stuffiness, sneezing, nasal index, and nasal itching over the 4-week study period than did placebo. Significant improvements in sneezing (P = 0.022) were observed as early as the first day (within 12 to 16 hours based on treatment in the morning and assessment of symptoms at bedtime), and in the nasal index (P = 0.009) by the third day after treatment with TAA Aqueous. Patients' and physicians' global evaluations of overall efficacy were concordant: 65% of patients rated their nasal symptoms greatly or somewhat improved with TAA Aqueous compared with 48% in the placebo group; physicians rated 66% of patients as having greatly or somewhat improved symptoms with the study drug compared with 48% of patients who received placebo. Adverse events were mild and the incidences were comparable for both groups; no significant changes in vital signs or clinical laboratory parameters were observed. This study demonstrated that TAA Aqueous administered once daily was well tolerated and provided relief of PAR symptoms in adults and adolescents.

Administration, Intranasal↗

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The free scapular flap for head and neck reconstruction.

The free scapular flap is a versatile flap for soft tissue and bony reconstruction of the head and neck. It has a very reliable blood supply and is easy to harvest. In this paper, we present our cumulative experience with the use of five cutaneous flaps and 31 osteocutaneous flaps.

Adult↗

PubMedDate not supplied

Contemporary techniques of mandibular reconstruction.

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Humans↗

PubMedDate not supplied

Ototoxicity of toluene in rats.

Toluene is a major industrial solvent and substance of abuse which is ototoxic in rats as shown by both behavioral testing and measurement of brainstem auditory evoked response (BAER) thresholds. The objective of this investigation was to examine the morphological (hair cell loss) and functional (BAER threshold elevations) changes resulting from toluene administration. In the preliminary experiment, 5 male Sprague-Dawley rats were dosed by gavage to 0.5 ml toluene/kg body weight/day in corn oil for 21 days then consecutively to 1.0 ml toluene/kg/day for 21 days. In the main experiment, eight male Sprague-Dawley rats were dosed by gavage for eight weeks with 1.0 ml toluene/kg body weight/day in corn oil. Five and six control rats, respectively, received corn oil only. BAER thresholds were recorded from four toluene-treated and four control rats prior to dosing (main experiment) and from all rats after dosing (both experiments). Loss of outer hair cells occurred in all toluene-treated rats in the middle and basal turns of the organ of Corti, with the greatest loss in the third row and progressively less in the second and first rows. This loss was more severe in toluene-treated rats that demonstrated elevated BAER thresholds in midfrequency regions, typically 2-8 kHz. These experiments demonstrate that auditory changes are associated with cochlear hair cell loss in toluene-treated rats. These ototoxic effects of toluene contrast with those of other known ototoxicants, e.g., aminoglycoside antibiotics, in terms of the position of hair cell lesion in the organ of Corti and in the pattern of hair cell loss.

Animals↗

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Variable stiffening device for colonoscopy.

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Colonoscopes↗

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Exercise intolerance in patients with chronic heart failure.

Patients with chronic heart failure (CHF) experience significant morbidity because of dyspnea and fatigue with activities of daily living. Although central hemodynamic abnormalities are the hallmark of this disorder, investigators have not shown a relationship between left ventricular ejection fraction or exercise pulmonary capillary wedge pressure and exercise intolerance in this disorder. Recent studies have focused on the contributions of pulmonary abnormalities and alterations in peripheral vasomotor control and skeletal muscle in exercise intolerance in this disorder. Early anaerobic metabolism occurs in patients with CHF and appears to be caused by a combination of reduced skeletal muscle blood flow and decreased aerobic enzyme content in skeletal muscle. Atrophy in skeletal muscle and alterations in skeletal muscle fiber typing are accompanied by alterations in contractile function in skeletal muscle. These results suggest that exercise intolerance in patients with CHF is multifactorial, and that research efforts must consider central hemodynamic abnormalities, pulmonary abnormalities, and alterations in peripheral blood flow and skeletal muscle biochemistry and histology. The present review will explore current research in this area and develop a model for understanding exercise intolerance in CHF.

Chronic Disease↗

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Estimation of myocardial blood flow for longitudinal studies with 13N-labeled ammonia and positron emission tomography.

BACKGROUND: Although several modeling strategies have been developed and validated for quantification of myocardial blood flow (MBF) from 13N-labeled ammonia positron emission tomographic data, a comparison of noise characteristics of the various techniques in serial studies is lacking. METHODS AND RESULTS: Dynamic 13N-labeled ammonia positron emission tomographic imaging was performed at baseline and after pharmacologic stress in (1) single studies of four dogs with concomitant measurement of microsphere blood flow and (2) initial and follow-up studies of eight normal volunteers. Data were obtained from short-axis images for the blood pool and myocardial regions corresponding to the three arterial vascular territories. Indexes of MBF were obtained by four distinct techniques: (1) University of California, Los Angeles, two-compartment model, (2) Michigan two-compartment model, and (3) a one-compartment model with variable blood volume term. Coronary flow reserve (CFR) was measured as the ratio of stress/rest MBF. The estimated standard deviation of the measurement error for the relative change between studies of rest and stress MBF and CFR was determined for each technique. Estimates of MBF from all techniques showed good correlation with microsphere blood flow (r = 0.95 to 0.96) in canine myocardium. In human studies, similar mean estimates of MBF were found with all techniques. Techniques 1 and 3 showed the smallest interstudy variability in MBF and CFR. The estimated standard deviations for these techniques were approximately 20%, 30%, and 27% for rest MBF, stress MBF, and CFR, respectively. CONCLUSION: Noninvasive quantification of MBF and CFR from dynamic 13N-labeled ammonia positron emission tomography is most reproducible with technique 1 or 3. The ability to account for differences in myocardial partial volume gives preference to technique 3. However, substantial interstudy variability in regional MBF remains, suggesting the importance of procedural factors or real temporal fluctuations in MBF.

Ammonia↗

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Area postrema and sympathetic nervous system effects of vasopressin and angiotensin II.

1. Precise control over the cardiovascular system requires the integration of both neural and humoral signals related to blood volume and blood pressure. Humoral signals interact with neural systems, modulating their control over the efferent mechanisms that ultimately determine the level of pressure and volume. 2. Peptide hormones such as angiotensin (Ang)II and arginine vasopressin (AVP) act through circumventricular organs (CVO) to influence cardiovascular regulation. 3. The area postrema (AP), a CVO in the brainstem, mediates at least some of the central actions of these peptides. Vasopressin appears to act in the AP to cause sympathoinhibition and a shift in baroreflex control of the sympathetic nervous system (SNS) to lower pressures. These effects of AVP and the AP appear to be mediated by alpha2-adrenoceptor and glutamatergic mechanisms in the nucleus tractus solitarius. 4. In contrast to AVP AngII has effects in the AP to blunt baroreflex control of heart rate and cause sympathoexcitation. The effects of chronic AngII to increase activity of the SNS may be due to AP-dependent activation of neurons in the rostral ventrolateral medulla.

Angiotensin II↗

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Epiglottis in reconstruction of the larynx and trachea.

Many methods have been proposed for reconstruction of the larynx and trachea. An ideal method would utilize tissue which is native to the area, highly viable, convenient to the surgeon, and expendable to the patient. This tissue should be composite, that is, containing both epithelium and skeletal support. This paper describes the use of epiglottis in repair of laryngeal and tracheal defects due to cancer or trauma. The methods of repair include 1) pedicled composite epiglottic flap, 2) free composite epiglottic graft, and 3) pedicled epiglottic mucosal flap. Results in 15 patients are discussed and indicate that use of the epiglottis is an effective method for one-stage laryngotracheal reconstruction.

Adolescent↗

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Postprandial glycemic response to orange juice and nondiet cola: is there a difference?

The purpose of this study was to compare the effects of unsweetened fruit juice and regular, decaffeinated soda on postprandial serum glucose levels in individuals with non-insulin-dependent diabetes mellitus (NIDDM) when these liquids are ingested separately as part of mixed meals. Eighteen individuals with NIDDM consumed three test breakfasts calculated using the diabetic exchange meal-planning system. Foods were identical in each of the breakfasts except for foods in the fruit exchange. Carbohydrate-equivalent amounts of fresh orange slices, unsweetened orange juice, and regular, decaffeinated Coke were consumed in breakfasts 1, 2, and 3, respectively. Serum glucose samples were drawn at fasting and 1, 2, and 3 hours postprandially. No difference was found in the postprandial serum glucose response when Coke versus orange juice was consumed in the breakfast. These findings question the appropriateness of using unsweetened fruit juices in routine meal planning for individuals with NIDDM.

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