Treatment of Intractable Neurogenic Cough with Cricopharyngeal Myotomy

Objectives: Neuropathic cough that is incompletely responsive to medical therapy may be due to cricopharyngeal hypertonicity. The objective was to describe the utility of cricopharyngeal myotomy in alleviating symptoms of intractable neuropathic cough. Study Design: Retrospective review. Methods: A retrospective chart review was performed for three patients who underwent cricopharyngeal myotomy for intractable cough. Trigger phenomena, previous evaluation and treatment, and outcomes after surgery, namely patient perception of improvement and medication use after surgery, were assessed and documented. Results: After cricopharyngeal myotomy, all three patients noted symptomatic improvement and were weaned off medication. Continued improvement was noted at follow up, with a mean length of 22 months (range: 7-36 months). Conclusions: Cricopharyngeal myotomy may be an alternative treatment for chronic cough in patients for whom workup is negative and medical management, dilation, and botulinum toxin have failed to provide long-term relief. Poster presented at CSOM: Combined Otolaryngology Spring Meeting in Orlando Florida, April 10-14, 2013

Effects of gender differences on the subjective perceived intensity of steering wheel rotational vibration based on a multivariate regression model

This is the post-print version of the Article. The official published version can be accessed from the link below - Copyright @ 2009 ElsevierThe aims of this study were to determine equal sensation curves for hand-arm steering wheel rotational vibration and to investigate the effect of gender on the subjective perceived intensity of steering wheel hand-arm vibration. Psychophysical response tests of 40 participants (20 mates and 20 females) were performed using a steering wheel rotational vibration simulator using the category-ratio Borg CR10 scale procedure for direct estimation of perceived intensity. The test stimuli were sinusoidal vibrations at 22 third octave band centre frequencies in the range from 3 to 400 Hz, with acceleration amplitudes in the range from 0.04 to 27 m/s(2) r.m.s. Multivariate regression procedures were applied to the experimentally acquired data in order to establish a regression model expressing the Borg CR10 perceived intensity values as a function of the two independent parameters of the frequency and amplitude of vibration. The equal sensation curves suggested a non-linear dependency of the subjective perceived intensity on both frequency and amplitude. Females were found to provide higher Borg CR10 perceived intensity values than males (p < 0.05), particularly at the higher intensity levels above approximately 1.0 m/s(2) r.m.s and at the higher frequencies above approximately 20 Hz.Relevance to industry: For the manufacturers of steering systems and of other automobile components this study provides vibration perception curves and identifies the possible importance of gender towards the perception of vibration which arrives at the steering wheel. (C) 2009 Elsevier B.V. All rights reserved

Novel Irradiated Axial Rotational Flap Model in the Rodent

Abstract Objectives: To design an easily reproducible rodent rotational skin flap and to evaluate the effects of radiation on flap viability. Methods: Ten rats received 40 Gy irradiation to the abdominal wall. Following a recovery period of one month, a 3 X 8 cm fasciocutaneous flap based axially on the inferior epigastric vessel, was raised and rotated 60 degrees into a contralateral deficit. Five non-irradiated rats underwent the identical procedure as a control. Animals were sacrificed seven days postoperatively, areas of flap necrosis were documented, and histological specimens were taken to compare flap viability and vessel density. Results: 60% of the rats in the irradiated group had necrosis of the distal flap ranging from 1 to 6 cm from the distal edge, whereas none of the animals (0%) in the control group exhibited necrosis (p\u3c0.001). Histology revealed collagen and vascular changes in the irradiated skin. Vascular density analysis revealed a significant difference between radiated and non-radiated flaps; p = 0.004, 0.029 and 0.014 in the distal, middle and proximal segments of the flap respectively. Conclusion: This novel rat axial rotational flap model demonstrates increases flap necrosis and a decrease in vascular density due to the effects of radiation. Using a linear electron accelerator a dose of 40 gy can be delivered to the skin without resulting in devastating gastrointestinal side effects

Feasibility of diagnosis of postcardiotomy tamponade by miniaturized transesophageal echocardiography.

BACKGROUND: Pericardial tamponade after cardiac surgery is a critical diagnosis that can be difficult to diagnose using conventional cardiac monitoring. Transesophageal echocardiography can provide comprehensive information to make the diagnosis but is not always available, whereas transthoracic echocardiography has its utility limited because of the body habitus or other surgical effects. New monitoring devices, miniaturized hemodynamic transesophageal echocardiography (hTEE), which allows point of care assessment of cardiac filling and functions, may aid in diagnosis of postcardiotomy tamponade. METHODS: From May 2011 to July 2013, 21 patients underwent hTEE to rule out pericardial tamponade for clinical suspicion of tamponade after open heart surgery. The hTEE images were reviewed, and the patient outcomes were analyzed. RESULTS: Nine patients showed no evidence of pericardial collection and did not require reexploration. Two patients showed a presence of small hematoma without ventricular compression and also did not undergo exploration. Ten patients were positive for pericardial tamponade (effusion or hematoma with ventricular compression); eight of these cases underwent emergent surgical exploration. Of the two patients who did not undergo immediate reoperation, one was managed by chest tube manipulation and the other patient underwent subsequent surgical exploration after his extensive coagulopathy was corrected by medical treatment. CONCLUSIONS: The diagnosis of pericardial tamponade postcardiotomy is feasible using a disposable hTEE based on our limited experience. We avoided unnecessary explorations while concomitantly made prompt diagnosis in emergent situations. The hTEE device was a valuable tool in hemodynamic management in the intensive care unit, allowing rapid evaluations

Neuro-Ophthalmology Subspecialty Highlight: With Dr. Sarah Thornton, Wills Eye Hospital

Neuro-Ophthalmology is a subspecialty within ophthalmology that combines the complexities of nervous system disease with the intricacies of the ocular manifestations of those diseases. Neuro-ophthalmologists work closely with neurologists, neurosurgeons, rheumatologists, and other ophthalmologists in different subspecialties, such as retina and glaucoma, to get to the source of their patients’ problems. Neuro-ophthalmology is typically a 1-year fellowship undertaken after residency training is completed, where physicians will learn the complex ways different diseases can manifest in the eye

Threshold for Synovial Cell Count and Neutrophil Differential in Diagnosis of Periprosthetic Knee Infection: A Multi-Institutional Study

Introduction: Synovial fl­uid analysis is an important tool in the work-up of suspected periprosthetic joint infection (PJI). Yet, there is confl­icting guidance for the analysis of synovial fl­uid aspiration, including a lack of uniform thresholds for white blood cell (WBC) count and neutrophil percentage (PMN%)1-3. Therefore, a multi-institutional study was undertaken to reassess these thresholds, compare preoperative versus intraoperative sample collection, and assess variation in results between institutions

Holographic and Wilsonian Renormalization Groups

We develop parallels between the holographic renormalization group in the bulk and the Wilsonian renormalization group in the dual field theory. Our philosophy differs from most previous work on the holographic RG; the most notable feature is the key role of multi-trace operators. We work out the forms of various single- and double-trace flows. The key question, `what cutoff on the field theory corresponds to a radial cutoff in the bulk?' is left unanswered, but by sharpening the analogy between the two sides we identify possible directions.Comment: 31 pages, 3 figures. v2: Minor clarifications. Added reference

Inference of population splits and mixtures from genome-wide allele frequency data

Many aspects of the historical relationships between populations in a species are reflected in genetic data. Inferring these relationships from genetic data, however, remains a challenging task. In this paper, we present a statistical model for inferring the patterns of population splits and mixtures in multiple populations. In this model, the sampled populations in a species are related to their common ancestor through a graph of ancestral populations. Using genome-wide allele frequency data and a Gaussian approximation to genetic drift, we infer the structure of this graph. We applied this method to a set of 55 human populations and a set of 82 dog breeds and wild canids. In both species, we show that a simple bifurcating tree does not fully describe the data; in contrast, we infer many migration events. While some of the migration events that we find have been detected previously, many have not. For example, in the human data we infer that Cambodians trace approximately 16% of their ancestry to a population ancestral to other extant East Asian populations. In the dog data, we infer that both the boxer and basenji trace a considerable fraction of their ancestry (9% and 25%, respectively) to wolves subsequent to domestication, and that East Asian toy breeds (the Shih Tzu and the Pekingese) result from admixture between modern toy breeds and "ancient" Asian breeds. Software implementing the model described here, called TreeMix, is available at http://treemix.googlecode.comComment: 28 pages, 6 figures in main text. Attached supplement is 22 pages, 15 figures. This is an updated version of the preprint available at http://precedings.nature.com/documents/6956/version/

Clinical Manifestations and Case Management of Ebola Haemorrhagic Fever caused by a newly identified virus strain, Bundibugyo, Uganda, 2007-2008

A confirmed Ebola haemorrhagic fever (EHF) outbreak in Bundibugyo, Uganda, November 2007-February 2008, was caused by a putative new species (Bundibugyo ebolavirus). It included 93 putative cases, 56 laboratory-confirmed cases, and 37 deaths (CFR = 25%). Study objectives are to describe clinical manifestations and case management for 26 hospitalised laboratory-confirmed EHF patients. Clinical findings are congruous with previously reported EHF infections. The most frequently experienced symptoms were non-bloody diarrhoea (81%), severe headache (81%), and asthenia (77%). Seven patients reported or were observed with haemorrhagic symptoms, six of whom died. Ebola care remains difficult due to the resource-poor setting of outbreaks and the infection-control procedures required. However, quality data collection is essential to evaluate case definitions and therapeutic interventions, and needs improvement in future epidemics. Organizations usually involved in EHF case management have a particular responsibility in this respect