Biomedical subjects
P C Holinger
Publications and source records attributed to P C Holinger.
Reversal of tricyclic-overdosage-induced central anticholinergic syndrome by physostigmine.
Although there is evidence that the delirium, stupor, coma, and seizure-like activity seen in overdosage with tricyclic antidepressants and antiparkinson drugs are due to the central anticholinergic activity of these agents, patients with overdosage of these drugs are still frequently misdiagnosed. The authors present a case of reversal of anticholinergic-drug-induced prolonged coma, myoclonus, and choreoathetosis by physostigmine. This report supports the anticholinergic basis of the clinical manifestations of such overdosages, provides information on the role of acetylcholine and dopamine in psychiatric and movement disorders, and illustrates dramatically the need for accurate diagnosis and treatment.
Etiology of bilateral abductor vocal cord paralysis: a review of 389 cases.
The etiology of 389 cases of partial or complete bilateral abductor vocal cord paralysis has been determined and classified. One hundred and forty-nine were infants and children 12 years of age and under; 240 were adults, age 13 and older. In the infants and children the paralyses were congenital in 82 cases, of which 43 were associated with other congenital anomalies, and 39 were without associated anomalies. Fifty-nine cases were considered acquired, most being secondary to underlying congenital anomalies, particularly the associated findings of meningomyelocele, Arnold-Chiari malformation, and hydrocephalus. Eight cases of paralysis in this age group were of undetermined etiology. Of the 240 adult cases of bilateral vocal cord paralysis. 138 followed thyroidectomy. Fifty-two cases were associated with various neurologic disorders, including poliomyelitis, Parkinson's disease, cerebrovascular accident, Guillain-Barré syndrome, multiple sclerosis, neoplasms and other miscellaneous neurologic conditions. Sixteen cases were due to malignant neoplasms of the neck and mediastinum. The remaining 34 cases constitute a miscellaneous group which includes foreign bodies, bilateral neck dissection, infection, congenital lesions, trauma, and idiopathic paralyses. The characteristic symptoms of bilateral abductor vocal cord paralysis include normal or near normal phonation with inspiratory stridor which may progress to complete respiratory obstruction. These symptoms are due to the stationary but flaccid midline position of the vocal cords which places them in a phonating position, where they both obstruct the airway and produce a faily clear voice or cry. This paradoxical combination of symptoms was frequently found to be responsible for a failure or delay in diagnosis.
Bilateral abductor vocal cord paralysis in Charcot-Marie-Tooth disease.
This report descirbes the unusual association of bilateral abductor vocal cord paralysis (BAbVCP) and Charcot-Marie-Tooth disease in a boy and his natural mother who have been followed for eight years. The boy initially presented with life-threatening respiratory distress at age ten years; BAbVCP was documented by direct laryngoscopy. Mirror laryngoscopy confirmed BAbVCP in the mother. Neurological diagnosis was made by history, physical examination, electromyography, and nerve conduction velocity studies. The BAbVCP may represent an additional genetic marker within the spectrum of heredodegenerative disorders. Of clinical importance is examination of voice and respiratory symptomatology of patients with heredodegenerative diseases and neurological work-up of patients with familial vocal cord paralysis. Further genetic and clinical studies of X cranial nerve involvement in heredodegenerative disorders are warranted.
Violent deaths among children in the United States, 1900-1980. An epidemiologic study of suicide, homicide and accidental deaths among 5- to 14-year-olds.
The authors examined the violent death rates among children aged 5-14 years in the United States from 1900 to 1980. For homicides and non-motor-vehicle accident deaths, 5- to 14-year-olds are at a lower risk than any other age group; for suicides and motor-vehicle accident mortality, only 0- to 4-year-olds have lower rates. Males tend to have higher rates than females for all forms of violent deaths for 5- to 14-years-olds. Nonwhites are at greater risk of dying by homicide and non-motor-vehicle accidents than whites; for suicide, whites are at greater risk; and for motor-vehicle accidents, nonwhites are currently at greater risk, with white children having been at greater risk earlier in the century. The epidemiologic time trends throughout the 20th century for 5- to 14-year-olds are quite similar to other ages for non-motor-vehicle accidents, but show some differences from other age groups in homicide, motor-vehicle accident mortality and, especially, suicide patterns. Various psychobiological perspectives as well as socioenvironmental issues are discussed as possible means of enhancing an understanding of the low violent death rates among 5- to 14-year-olds.