Epiglottic position after cricothyroidotomy: a comparison with tracheotomy.

Dysphagia is a known problem in patients with tracheotomy, but its association with cricothyroidotomy is not well studied. The purpose of this study was to evaluate dysphagia in patients with cricothyroidotomy and to determine if there is a reliable indicator of swallowing dysfunction in these patients. A review of charts for patients with modified barium swallow studies conducted at the New York University Medical Center Swallowing Disorders Center yielded three groups of patients: patients with cricothyroidotomy, patients with tracheotomy, and normal patients. There were 8 patients in each group. In all patients in the cricothyroidotomy group, there was a greater impairment of epiglottic displacement, laryngeal elevation, and upper esophageal opening than in the tracheotomy group. This problem with epiglottic displacement produced susceptibility to laryngeal penetration and, in turn, increased the risk of aspiration in those patients with cricothyroidotomy. After cricothyroidotomy tube removal, a return to normal epiglottic movement was observed within 2 months. One mechanism of swallowing dysfunction is impaired posterior displacement of the epiglottis over the glottic aperture. This impaired epiglottic motion appears to be related to restricted laryngeal elevation secondary to tethering of the larynx anteriorly at the site of the cricothyroidotomy. Additionally, we noted a decrease in the opening of the upper esophageal sphincter.

Recurrent intracerebral hemorrhage from sarcoid angiitis.

BACKGROUND: Sarcoid affecting the central nervous system may cause granulomatous angiitis. Nevertheless, neurosarcoid manifesting as intracerebral hemorrhage has been infrequently reported. CASE DESCRIPTION: A 48-year-old woman with systemic sarcoid developed recurrent intracerebral hemorrhages culminating in death despite treatment with corticosteroids. Pathological examination of the brain revealed inflammatory changes of blood vessels including multinucleated giant cells. CONCLUSION: Sarcoid cerebral angiitis may result in intracerebral hemorrhage. This emphasizes one potentially devastating neurological outcome of this disorder.

Current perspectives on psychoanalytic Rorschach assessment.

In this article, I present as clear and as updated an account as possible of several of the essential features that comprise a psychoanalytic approach to the Rorschach. Specific attention is accorded the assessment frame, the language of assessment, sources of assessment information, and differing approaches to the interpretation of Rorschach data. The article comes out of a Rorschach tradition begun by Rapaport, extended by Schafer and Mayman, and presently being updated by Leichtman and Smith.

The interpretive process in Rorschach testing.

In this article, two complimentary and interwoven approaches to Rorschach interpretation are described. The first, a more structural approach, emphasizes test responses, the response process, and test rationales. Theorists with this emphasis focus primarily on the structural features of a test record?the scores and their interrelations. Interpretations drawn from the structural features of a record themselves tend to have a structural emphasis. A second approach, referred to as experiential, is more subjective and phenomenological. Based on the examiner's empathy, this approach is applied to other aspects of a Rorschach protocol such as content of responses and the testee's more spontaneous and off-handed comments. Each of these interpretive approaches must be given its due and integrated with interpretations drawn from the other.

Mortality in a cohort of pentachlorophenol manufacturing workers, 1940-1989.

Mortality in a cohort of 770 workers with potential pentachlorophenol (PCP) exposure was evaluated from 1940 through 1989. The study cohort is a subset of a larger cohort of workers with potential exposure to higher chlorinated dioxins. Total mortality and cancer mortality in the PCP cohort were slightly lower than expected in comparison to the U.S. white male population. There were 229 total deaths with 242.5 expected (SMR = 94, 95% confidence interval 83-108), and 50 cancer deaths with 52.6 expected (SMR = 95, 95% confidence interval 71-125). In comparison with unexposed employees, the risk ratio for total mortality was 1.03 (95% confidence interval 0.90-1.17), and the risk ratio for all cancer mortality was 0.95 (95% confidence interval 0.71-1.26). In most cause of death categories of a priori interest no deaths were observed in the cohort. A small excess of other and unspecified lymphopoietic cancer deaths was observed but did not appear to be related to exposure. Excesses of deaths due to cancer of the kidney, gastric and duodenal ulcer, cirrhosis of the liver, and all accidents were observed in comparison with the U.S. white male population and with unexposed employees. These were associated with increasing estimated cumulative PCP exposure after lagging exposures by 5 and 15 years. Despite the limited size and the generally favorable total mortality experience of the cohort, it was concluded that cohort members may have incurred increased risk of death due to some specific causes. The risks could not, however, be attributed conclusively to PCP exposure and may have been associated with other occupational and nonoccupational factors. Additional mortality surveillance of this cohort will be performed.

Rorschach assessment of cognitive impairment from an object relations perspective.

In 1986, H. Lerner and P. Lerner proposed an object relations model of thinking that integrated Piaget's theory of early cognitive development with Mahler's theory of separation-individuation. They identified three distinct, interdigitated stages, outlined the cognitive task for each stage, detailed the necessary role and function of the stage-specific caregiving object, and suggested potential cognitive impairments associated with the object not fulfilling its function. Herein, this conceptual model is extended to the Rorschach. Rorschach indices of cognitive impairments associated with each stage were developed. The indices are then applied to the Rorschach records of children who were selected as prototypical of specific developmental disorders.

A note on the assessment of idealization.

In a series of studies using the Lerner Defense Scale (H. Lerner & P. Lerner, 1980) for assessing primitive defenses, inconsistent and at times perplexing findings have been reported regarding the defense of idealization. A major study examining personality variables, including defense, in a nonclinical population-ballet students-and comparing them to those of patients suffering eating disorders, yielded findings related to the defense of idealization and its assessment. Herein, the results of that study are reviewed and then discussed in light of recent psychoanalytic formulations regarding idealization.

Toward an experiential psychoanalytic approach to the Rorschach.

With a conceptual approach to the Rorschach, there is a strong tie between this test and a theory of personality that lies outside the test itself. Shifts in that personality theory can provide new concepts and formulations for understanding Rorschach data. Such shifts can also promote new and different ways of conceptualizing and using the test. The author contends that changes in psychoanalytic theory are currently facilitating a more experiential view of the Rorschach. He reviews the relationship between personality theory and Rorschach testing, discusses changes in psychoanalytic theory that are leading to a more experiential Rorschach psychology, and describes the meaning of an experiential approach to the Rorschach.

Adolescents' response to nuclear threat: Before and after the chernobyl accident.

This study investigated adolescent responses to nuclear threat during intervals preceding and following the Chernobyl disaster. The Nuclear Threat Index was administered to 96 Israeli subjects two months prior to and two months following the disaster. In addition, they were tested with Rotter's Locus of Control Scale. The data results indicate that on the whole there were differences in scores between the two administrations, especially with respect to self-reported activity (behavioral subscales). Adolescents reported significantly more past nuclear-related activity before the accident as well as fewer anticipated activities after the accident. Adjusted for the preaccident score differences data reveal that after the accident younger adolescents reported less pessimism and more previous activity than the older adolescents. In addition, males reported more nuclear-related activity than females; younger males reported more past activity and less pessimism than older males; "external" males reported more activity than "internal" males. Discussion focuses on possible explanations for the results, on limitations of the investigation, and on implications for further research.