Injection laryngoplasty in the outpatient clinic under local anaesthetic: a case series of sixty-eight patients.

OBJECTIVES: We aimed to assess self-report and perceptual voice outcomes in patients undergoing local anaesthetic injection laryngoplasty in our outpatient clinic. DESIGN: Prospective case series. SETTING: Department of Otolaryngology-Head and Neck Surgery, Freeman Hospital, Newcastle-upon-Tyne, UK. PARTICIPANTS: Sixty-eight patients underwent local anaesthetic injection laryngoplasty in the outpatient clinic over the 2-year study period. MAIN OUTCOME MEASURE: Voice Performance Questionnaire (patient-rated), and perceptual voice analysis (observer-rated) Grade, Roughness, Breathiness, Aesthenia and Strain scores were recorded before and 2 weeks after injection laryngoplasty. RESULTS: Fifty-seven patients had sufficient pre- and post-procedure data to be included in the analysis. These included 32 men and 25 women, age range 26-97 years. Of the remaining patients, they were excluded due to failed procedure (n = 3), too unwell to proceed (n = 1), died before follow-up was complete (n = 3) and incomplete data (n = 4). The median Voice Performance Questionnaire score improved from 42 to 21; (P < 0.0001). Significant improvements were seen in all parameters of Grade, Roughness, Breathiness, Aesthenia, Strain. CONCLUSION: Injection laryngoplasty under local anaesthetic in the outpatient clinic generates improvements in subjective and perceptual voice outcomes similar to those obtained in the operating room under general anaesthetic or sedation. Complication rates between these procedures were also comparable. Injection laryngoplasty under local anaesthetic is timely, cost-effective and obviates need for general anaesthesia in patients, many of whom have comorbidities and diminished life expectancy.

Growth of thoroughbreds fed a low-protein supplement fortified with lysine and threonine.

Growth and protein status were examined in Thoroughbred foals and yearlings offered pasture supplements with different crude protein contents and amino acid compositions. Both supplements contained 3.0 Mcal/kg DM, 10% corn oil, 1.4% calcium, and three sources of fiber. The control supplement contained 14% CP and 22% soybean meal, whereas the experimental supplement contained 9% CP and 3% soybean meal and was fortified with 0.6% lysine and 0.4% threonine. Mares and foals were fed twice daily (0700 and 1400) and kept on 12.14-hectare pastures (mixed grass and ladino clover) until weaning (6 mo). Weanlings continued on specified supplements and pastures for seven additional months. Physical measurements and blood samples were taken monthly for a period of 14 mo. Measurements included BW, ADG, body condition (BC), wither height, hip height, body length, girth, forearm length, front and hind cannon length, and carpus and fetlock circumference. Blood plasma analysis included total protein, albumin, creatinine, and urea nitrogen. Effect of diet and time were evaluated by analysis of variance with repeated measures. No differences (P > 0.05) were found in physical measurements between the control and Lys/Thr groups (ADG 0.7 +/- 0.02 kg/d, BC 4.9 +/- 0.05) for the observational period. Blood data also showed no difference (P > or = 0.05) for the period (albumin 2.9 +/- 0.03 g/dL, total protein 5.7 +/- 0.10 g/dL, creatinine 1.1 +/- 0.02 mg/dL). Differences in ADG between the control and experimental groups were observed in November (0.73 +/- 0.06 vs 0.91 +/- 0.04 kg/d, P = 0.01) and December (0.56 +/- 0.04 vs 0.67 +/- 0.06 kg/d, P = 0.07) and again in April (0.65 +/- 0.12 vs 0.86 +/- 0.06 kg/d, P = 0.06). These results suggest that the foals offered the Lys/Thr grew at the same or greater rates than foals on the control supplement. When a low-protein diet was fortified with the first two limiting amino acids, the protein was utilized more efficiently for growth and development. This study gives further insight into the role of protein quality during a foal's 1st yr of growth.

Hydrolyzable carbohydrates in pasture, hay, and horse feeds: direct assay and seasonal variation.

Carbohydrates may be hydrolyzed or fermented in the digestive tract, and this distinction is important for the evaluation of the diet of herbivores. Both hydrolyzable and fermentable carbohydrates are included in the nonstructural carbohydrate (NSC) fraction as estimated by difference using proximate analysis. Our objectives were to measure hydrolyzable carbohydrates in forages and concentrates, to compare these values with nonstructural carbohydrate, to test for prediction of hydrolyzable carbohydrate concentration in forages from its near-infrared spectrum, and to examine seasonal variation of carbohydrates in pasture. Samples of forages (107) and concentrates (25) were collected, dried, ground, and analyzed for NSC (calculated as 100 - water - CP - fat - ash - NDF), hydrolyzable carbohydrate (CHO-H, direct analysis), and rapidly fermentable carbohydrate (NSC minus CHO-H). Hydrolyzable carbohydrate accounted for 97% or more of the NSC in the concentrates but only 33% in pasture and hay. A two-term polynomial equation fit all the data: CHO-H = 0.154 x NSC + 0.00136 x NSC2, R2 = 0.98, P < 0.0001, n = 132. In 83 pasture samples, CHO-H concentrations were predicted by near-infrared spectra with a calibration R2 of 0.97, a mean of 48 g/kg, and a SE of calibration of 3.5 g/kg DM. In pasture samples collected between September 1995 and November 1996, the coefficient of variation was 31% for both CHO-H and rapidly fermentable carbohydrate (CHO-FR); the largest increments were 31 g/kg of CHO-H from September to October and 41 g/kg of CHO-FR from February to March. The increased risk of certain diseases, such as laminitis and colic, that have been previously associated with an abrupt overload of NSC may be more precisely attributed to CHO-H in grain concentrates, and to CHO-H as well as CHO-FR in pastures.

Gastrointestinal manifestations of amyloidosis.

We reviewed gastrointestinal manifestations in 40 patients with amyloidosis. Gastrointestinal symptoms included anorexia, macroglossia, intestinal pseudo-obstruction, and altered bowel habits. Hepatomegaly was detected in eight patients, but none had clinically significant infiltrative liver disease. Mucosal friability and erosions were common endoscopic findings. Barium enema was noncontributory in the diagnosis of amyloidosis, since colonoscopy disclosed mucosal abnormalities in three of six patients with normal radiographic findings. Rectal biopsy had the highest diagnostic yield, followed by duodenal, gastric, and colonic biopsies.

What do parents know about vitamins?

Parents of 120 children attending child health clinics answered a questionnaire on their understanding of vitamins. Fifty four children (45%) were taking vitamins; 12 (22%) were given the wrong dose. Only 19 parents (35%) knew when to stop supplements and 25 (46%) did not realise overdosage was potentially harmful. Only six children (11%) were receiving professional supervision. This indicates a need to improve parental understanding and professional supervision.

Sympathetic (alpha-beta) or calcium channel blockade for hypertensive myocardial infarction? A haemodynamic comparison of labetalol and nifedipine.

The haemodynamic impact of alpha- and beta-adrenoceptor blockade (labetalol) was compared with that of slow-calcium channel blockade (nifedipine) in 32 patients with sustained elevation of systemic arterial pressure (systolic blood pressure greater than 160; diastolic blood pressure greater than 95 mmHg) following a recent myocardial infarction (6-22 h). Patients with normal (pulmonary artery occluded pressure; (PAOP less than 18 mmHg; n = 16) or impaired (PAOP greater than 18 mmHg; n = 16) left ventricular function were randomized to labetalol (1 mg/kg i.v. 15 min) or nifedipine (20 mg sublingually) and haemodynamic profile was measured over 2 h. Both drugs equally reduced mean systemic arterial pressure (P less than 0.01 versus pretreatment control), and presumably left ventricular afterload; however, the heart rate (P less than 0.01) and cardiac index (P less than 0.01) increased after nifedipine, contrasting with reductions in both variables following labetalol (P less than 0.01). The elevated left ventricular filling pressure was reduced by both labetalol (P less than 0.05) and nifedipine (P less than 0.01) but the reduction was greater following nifedipine (-2 mmHg versus -5 mmHg, P less than 0.05). Thus both compounds were equally effective hypotensive agents. Labetalol consistently reduced cardiac stroke work and double product, important determinants of myocardial oxygen requirements; however, nifedipine afforded some improvement in cardiac performance in patients with left ventricular dysfunction.

Nifedipine following acute myocardial infarction--dependence of response on baseline haemodynamic status.

The haemodynamic effects of nifedipine (20 mg sublingually) were studied in 40 patients with acute myocardial infarction within 18 h of the onset of symptoms. To determine the influence of preload and afterload on the haemodynamic response to nifedipine, patients were prospectively stratified equally into four groups of 10 patients based on systemic blood pressure level (less than or greater than 160/100 mm Hg) and level of left ventricular filling pressure [pulmonary artery-occluded pressure (PAOP) less than or greater than 18 mm Hg]. In all groups, nifedipine reduced systemic arterial pressure (p less than 0.01) and vascular resistance index (p less than 0.01); heart rate (p less than 0.01) and cardiac index (p less than 0.01) were increased. PAOP was reduced by nifedipine only in those hypertensive patients in whom it was initially raised; in these patients cardiac stroke volume index also increased (p less than 0.01). In hypertensive patients with normal PAOP the cardiac stroke work index was reduced. In patients with normal systemic and pulmonary arterial pressures, nifedipine had no beneficial effects on cardiac function. These data suggested that haemodynamic criteria may allow selection of patients for nifedipine therapy following myocardial infarction; clear advantages were evident only in hypertensive patients in both the presence and the absence of left ventricular failure.

Enteric intussusception presenting as a rapidly enlarging mass.

Enteric intussusception is unusual in adults and frequently presents in a confusing manner. A case of jejunojejunal intussusception is presented in which a 15-cm abdominal mass developed in 24 h. The plain film, barium, and ultrasound findings in enteric intussusception are stressed.

Baclofen attenuates hyperpolarizing not depolarizing responses of caudate neurons in cat.

The effects of baclofen, a gamma-aminobutyric acid (GABA) analogue, were studied on the intracellular responses of caudate neurons to cortical and thalamic stimulation. Systemic or intracaudate injections of baclofen did not reduce the initial excitatory postsynaptic potential (EPSP) to these stimuli; however, it did completely block evoked hyperpolarizations. These results suggest that the GABA-b receptor (one possible site of baclofen action) is not found on the corticostriate synaptic terminals. Furthermore, our results clearly indicate that evoked hyperpolarizations recorded in caudate neurons are not the result of cortical disfacilitation.

Peritoneoscopy in the management of catheter malfunction during continuous ambulatory peritoneal dialysis.

Continuous ambulatory peritoneal dialysis is widely used in the maintenance of patients with chronic renal failure. Obstruction or displacement of the chronic dialysis catheter, which prevents dialysate drainage, can compromise ongoing dialysis. Conservative approaches (body position change, saline infusion, and enema) are often unsuccessful and more aggressive therapy may be required. We report the use of peritoneoscopy to reposition malfunctioning peritoneal dialysis catheters. The procedure proved to be safe and gave excellent long-term results.

Radiation exposure risks to nuclear well loggers.

This report is based on statistical data from the Canadian National Dose Registry (As82) and information obtained from visits to 1 supplier and 9 oil-well service companies in the Province of Alberta. The companies are representative of most in this industry and provide services at the well head from logging, perforating and fracturing to cementing and tracer work. The information obtained indicates that typical exposures can account for an average dose of 1 to 2 mSv/y. The observations of well-logging procedures revealed a number of potentially hazardous situations which could lead to unnecessary exposure and based upon these, several recommendations are included.

How good is screening for colorectal cancer?

Colorectal cancer is potentially preventable. Use of fecal occult blood testing, flexible sigmoidoscopy, and a combination of air-contrast barium enema examination and colonoscopy has proved to be a safe, relatively inexpensive approach to detecting colon cancer in its early stages, decreasing morbidity and increasing survival. Future work in secondary prevention of colon cancer should be aimed at standardized trials of fecal occult blood agents, thus optimizing the yield of localized lesions and decreasing the cost so that mass screening becomes possible. Major efforts should be aimed at educating physicians and the public alike. Primary prevention will deserve greater emphasis when specific risk factors pathogenetic of colon cancer are discovered.

A clinical study of the prophylactic use of betamethasone valerate and sodium cromoglycate in the treatment of seasonal allergic rhinitis.

The prophylactic use of betamethasone valerate and sodium cromoglycate in seasonal allergic rhinitis has been investigated in 20 patients in an open study. The subjective assessment of the symptoms recorded on a daily record card was significantly lower in the betamethasone valerate group compared with the sodium cromoglycate group. Patients' and physician's overall assessment of the treatment favoured the steroid aerosol. No clinically significant side effects were noted.