Influence of Inhalation Injury on Incidence, Clinical Profile and Recovery Pattern of Dysphagia Following Burn Injury.

Inhalation injury is predictive of dysphagia post burns; however, the nature of dysphagia associated with inhalation burns is not well understood. This study describes the clinical profile and recovery pattern of swallowing following inhalation burn injury. All patients admitted 2008-2017 with confirmed inhalation burns on laryngoscopy and managed by speech-language pathology (SLP) were included. Initial dysphagia presentation and dysphagia recovery pattern were documented using the FOIS. Co-presence of dysphonia was determined clinically and rated present/absent. Persistent laryngeal/pharyngeal injury at 6 months was documented using laryngoscopy. Data were compared to published data from a large adult burn cohort. All patients with confirmed inhalation burns during the study period received SLP input, enabling review of 38 patients (68% male; m = 40.8 years). Percent Total Body Surface Area burn ranged 1-90%, 100% had head and neck burns, 97% required mechanical ventilation (mean 9.4 days), 18% required tracheostomy and 100% had dysphonia. Comparing to non-inhalation burn patients, the inhalation cohort had significantly (p < 0.01) higher dysphagia incidence (89.47% vs 5.6%); more with severe dysphagia at presentation (78.9% vs 1.7%); increased duration to initiate oral intake (m = 24.69 vs 0.089 days); longer duration of enteral feeding (m = 45.03 vs 1.96 days); and longer duration to resolution of dysphagia (m = 29.79 vs 1.67 days). Persistent laryngeal pathology was present in 47.37% at 6 months. This study shows dysphagia incidence in burn patients with inhalation injury is 16 times greater than for those without inhalation injury. Laryngeal pathology due to inhalation injury increases dysphagia severity and duration to dysphagia recovery.

MRI of the parapharyngeal space.

Magnetic resonance imaging has replaced contrast-enhanced CT as the primary imaging modality for parapharyngeal space masses. It has several advantages over CT. MRI's superior contrast resolution enables the imager to better define normal anatomic structures and establish more precise tumor margins. Magnetic resonance's direct multiplanar imaging capability allows the diagnostician to offer his clinical colleagues a more accurate assessment of the total extent (in three dimensions) of disease and a better map of the spatial relationship of tumors to crucial vessels. This important information aids the clinician in making better informed decisions concerning the appropriate treatment plan (surgery versus radiation, surgical approach, radiation ports). Magnetic resonance's major inadequacy, compared with CT, is suboptimal detection of calcifications and subtle bony changes. Because of this, there are clinical situations when both MRI and CT are required, either to make a more definitive diagnosis or to include (exclude) certain pathology in (from) the differential diagnosis. Although there is considerable overlap in the signal intensity of various lesions, it probably is beyond realistic expectations to seek complete tissue specificity from any imaging tool. Hopefully, MRI spectroscopy will enable us, as imagers, in combination with our basic science colleagues, to take that giant step forward.

A controller for regulation of mean arterial blood pressure using optimum nitroprusside infusion rate.

Automation of drug delivery for control of mean arterial blood pressure is highly desirable in a number of clinical applications. An integrating self-tuning control strategy for control of mean arterial blood pressure using sodium nitroprusside is presented. Next to robust performance, the most attractive feature of the controller is its capability to optimize the quantity of infused medication without introducing a bias in the blood pressure level; a problem that existed in some of the other adaptive control strategies that have been proposed previously. Further, the controller design requires only the knowledge of the pure delay and the order of the transfer function describing the patient's response to the medication; it does not require that the entire transfer function be specified. The derivation of the controller is not based on the patient response to sodium nitroprusside; indeed, it is a general adaptive control strategy for control of systems with transport delay. The controller performs robustly in the presence of variations in the patient response and successfully controls the pressure at the desired level. The ability of this strategy to reduce the amount of infused medication makes it potentially attractive for use in clinical applications, as large doses or long term use of sodium nitroprusside can adversely affect central nervous system and hematopoietic tissues.

Experience with intermittent catheterization in chronic spinal cord injury patients.

Intermittent catheterization was used as a method to achieve reflex voiding and a catheter-free status in 111 chronic spinal cord injury patients. Of this group 70 patients achieved reflex (automatic) voiding within 90 days, or a mean of 19 days. Five patients required transurethral incision of the external urethral sphincter after achievement of automatic voiding because of elevated residual urine. Chronic urinary tract infection persisted in 16 per cent of the patients after completion of the program. No sequelae occurred because of the coexistent urinary tract infection. An 18-month followup disclosed stability in renal function and appearance of pyelograms. Urethral, scrotal and bladder complications secondary to chronic indwelling urethral catheters have been eliminated in these patients. Patient endorsement and enthusiasm have been spectacular and have overwhelmingly contributed to an ongoing, successful program.

Carcinoma in a renal cyst: computed tomography diagnosis.

We report a case of carcinoma in a renal cyst diagnosed by computed tomography. Ultrasound was unavailable because of scheduling difficulties and computed tomography provided a useful alternative in identifying the cystic and solid features of the mass. There was a good correlation of the computed tomography scan with pathology except for a small tumor nodule at the base of the cyst, which was not seen on the scan.