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Biomedical subjects

W D Clark

Publications and source records attributed to W D Clark.

At least 37 records · Page 2Linked to original sources
PubMed1985

Laryngeal influences on breathing pattern and posterior cricoarytenoid muscle activity.

Receptors responding to transmural pressure, airflow, and contraction of laryngeal muscles have been previously identified in the larynx. To assess the relative contribution of these three types of receptors to the reflex changes in breathing pattern and upper airway patency, we studied diaphragmatic (DIA) and posterior cricoarytenoid muscle (PCA) activity in anesthetized dogs during spontaneous breathing and occluded efforts with and without bypassing the larynx. Inspiratory duration (TI) was longer, mean inspiratory slope (peak DIA/TI) was lower, and PCA activity was greater with upper airway occlusion than with tracheal occlusion (larynx bypassed). Bilateral section of the superior laryngeal nerves eliminated these differences. When respiratory airflow was diverted from the tracheostomy to the upper airway the only change attributable to laryngeal afferents was an increase in PCA activity. These results confirm the importance of the superior laryngeal nerves in the regulation of breathing pattern and upper airway patency and suggest a prevalent role for laryngeal negative pressure receptors.

Airway Obstruction↗
PubMed1985

Nasal dermoid with intracranial involvement.

Nasal dermoids are unusual lesions resulting from embryopathology. They are diagnosed easily by physical examination. Treatment is complete surgical excision, aided by microsurgical techniques. Involvement of the skullbase is common with "deep-seated" ND, and intracranial involvement is not uncommon. The high-resolution CT scanner is believed to be valuable in diagnosing deep involvement, including intracranial extension. The finding of a bifid crista galli is suggestive of intracranial involvement. Neurosurgical consultation is mandatory for all cases of ND when deep extension is suspected.

Brain Neoplasms↗
PubMed1985

Rhinoscleroma.

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Adult↗
PubMed1983

Age trends in autopsy rates. Striking decline in late life.

Age-related autopsy rates were computed from 99,145 death certificates and disclosed a striking decline with advancing age, the peak (82.5%) occurring in the third decade of life, the nadir (2.4%) by age 90 years. The trend was the same for both sexes, although at all ages men were more likely to undergo autopsies than women. There was a significant decline in late life for medical examiner (ME) and non-ME cases. Rates varied according to immediate cause of death. The only causes of death in which there was no significant age-associated decline were homicide, suicide, and transport accidents, where autopsy is mandated by law. For other causes of death analyzed, rates declined significantly with age in both sexes, for ME as well as for non-ME cases. We conclude that low autopsy rates in late life are not artifactual but represent an overall phenomenon deserving closer scrutiny.

Adolescent↗
PubMed1983

Rhinoscleroma--a diagnostic challenge.

Rhinoscleroma is a rare chronic granulomatous infection predominantly affecting the upper respiratory tract. The patient presented here exemplifies several features of the disease, including the fact that diagnosis may elude the clinician for years, and this delay may increase morbidity substantially. The most common initial complaint is nasal obstruction, and physical examination frequently reveals erythematous granular or nodular swellings covered with crusts. Its tumor-like appearance and local spread arouses suspicion of malignancy, but differential diagnosis also includes fungal infections and numerous granulomatous diseases. The classic histopathology consists of large vacuolated Mikuliz's cells and transformed plasma cells with Russell bodies. Numerous antibiotics have been used for treatment of this infection with varying degrees of success. Long-term follow-up is important because these patients can have numerous relapses. Geographic distribution is also discussed.

Anti-Bacterial Agents↗
PubMed1983

Epiglottitis and laryngotracheobronchitis.

Epiglottis and laryngotracheobronchitis are potentially life-threatening infections in the pediatric population. Unlike epiglottitis, laryngotracheobronchitis is very common. While both diseases may present with stridor and signs of respiratory obstruction, it is important to distinguish between them because the management strategies differ. Laryngotracheobronchitis usually responds to humidification. Epiglottitis requires an artificial airway and intensive antibiotics. The use of steroids remains controversial.

Bronchitis↗
PubMed1981

Alcoholism: blocks to diagnosis and treatment.

Physicians fail to recognize alcoholism if patients do not attribute their suffering to drinking problems. Underutilization of logical diagnostic strategies reflects lack of knowledge of the multitude of presentations of alcoholism, as well as lack of supervised experience with patients who are unable to be forthright about problems because of psychologic and cognitive impairments due to the illness process and to toxic effects of alcohol. Negative attitudes of both physician and patient inhibit the establishment of a partnership and the setting of treatment goals. Difficulties arise from unspoken agreement to not accept or confront the diagnosis, to ignore the need for assistance, and to downplay abstinence from alcohol and tranquilizers. We present herein a rational framework for understanding typical diagnostic problems. We discuss accepted counselling principles and their usefulness in the approach to alcoholic patients. Diagnostic acumen and patient management are easily improved, and physicians need not feel hopeless and helpless when faced by alcoholism problems.

Alcoholics Anonymous↗