Pretherapeutic staging of recurrent laryngeal carcinoma: clinical findings and imaging studies compared with histopathology

OBJECTIVE: To assess the accuracy of preoperative imaging studies and clinical and endoscopic examinations for recurrent laryngeal carcinoma evaluation. STUDY DESIGN AND SETTING: A retrospective comparative study was performed at a university department on 42 recurrent laryngeal carcinomas. Surgical specimens were cut into whole-organ slices. Histologic findings were compared with the findings of the different preoperative diagnostic modalities. RESULTS: The craniocaudal tumor spread was correctly evaluated by endoscopy and imaging studies in 52% and 24%, respectively, and the contralateral tumor spread in 50% and 52%, respectively. The sensitivity, specificity, and accuracy for detection of tumor infiltration of the thyroid was 48%, 88%, and 64% and of the cricoid 47%, 80%, and 67%. The accuracy of recurrent tumor classification (crT) was 50%; most tumors were underclassified. CONCLUSION: The inadequately evaluated tumor spread and the inadequately classified recurrent tumors were underestimated and underclassified in most cases, respectively.

Effects of butorphanol on the withdrawal reflex using threshold, suprathreshold and repeated subthreshold electrical stimuli in conscious horses

OBJECTIVE: To assess the effects of a single intravenous dose of butorphanol (0.1 mg kg(-1)) on the nociceptive withdrawal reflex (NWR) using threshold, suprathreshold and repeated subthreshold electrical stimuli in conscious horses. STUDY DESIGN: 'Unblinded', prospective experimental study. ANIMALS: Ten adult horses, five geldings and five mares, mean body mass 517 kg (range 487-569 kg). METHODS: The NWR was elicited using single transcutaneous electrical stimulation of the palmar digital nerve. Repeated stimulations were applied to evoke temporal summation. Surface electromyography was performed to record and quantify the responses of the common digital extensor muscle to stimulation and behavioural reactions were scored. Before butorphanol administration and at fixed time points up to 2 hours after injection, baseline threshold intensities for NWR and temporal summation were defined and single suprathreshold stimulations applied. Friedman repeated-measures analysis of variance on ranks and Wilcoxon signed-rank test were used with the Student-Newman-Keul's method applied post-hoc. The level of significance (alpha) was set at 0.05. RESULTS: Butorphanol did not modify either the thresholds for NWR and temporal summation or the reaction scores, but the difference between suprathreshold and threshold reflex amplitudes was reduced when single stimulation was applied. Upon repeated stimulation after butorphanol administration, a significant decrease in the relative amplitude was calculated for both the 30-80 and the 80-200 millisecond intervals after each stimulus, and for the whole post-stimulation interval in the right thoracic limb. In the left thoracic limb a decrease in the relative amplitude was found only in the 30-80 millisecond epoch. CONCLUSION: Butorphanol at 0.1 mg kg(-1) has no direct action on spinal Adelta nociceptive activity but may have some supraspinal effects that reduce the gain of the nociceptive system. CLINICAL RELEVANCE: Butorphanol has minimal effect on sharp immediate Adelta-mediated pain but may alter spinal processing and decrease the delayed sensations of pain.

Hypnotic and opioid anesthetic drug interactions on the CNS, focus on response surface modeling

This chapter will present the conceptual and applied approaches to capture the interaction of anesthetic hypnotic drugs with opioid drugs, as used in the clinical anesthetic state. The graphic and mathematical approaches used to capture hypnotic/opiate anesthetic drug interactions will be presented. This chapter is not a review article about interaction modeling, but focuses on specific drug interactions within a quite narrow field, anesthesia.

Exhibits

The Finnish American Heritage Center at Finlandia University recently installed three exhibits. They include a photographic exhibit titled “Rural Reflections: Finnish American Buildings and Landscapes in Michigan’s Copper Country”; a historic photography exhibit named “People, Place and Time: Michigan’s Copper Country Through the Lens of J.W. Nara”; and a pair of lithographs acquired by the National Park Service which were on either side of the Italian Hall stage the night of the infamous Christmas Eve tragedy 100 years ago. The “Rural Reflections” exhibit documents the built environment that Finnish immigrants and their descendants created in Michigan's Copper Country from the 1880s through the 1930s. Although much of this heritage has been lost with the passage of time, the district yet holds one of the largest concentrations of rural Finnish buildings and cultural landscapes in North America. The Nara exhibit, funded in part by descendants Robert and Ruth Nara of Bootjack Michigan, works from historical photographs held at the Michigan Tech Archives. Interpretive panels highlight the people, places, and times that J.W. Nara experienced during his lifetime and include material on urban life, farming, and the 1913 Michigan copper miners’ strike. The lithographs are a recent and unique acquisition for the Keweenaw National Historical Park, and will be on protected display at the FAHC. One of the panels shows the Italian royal family and was produced in 1908, while the other, produced in 1905, is of the five founders of the modern Italian state. For more information about the exhibits at the Finnish American Heritage Center, call (906) 487-7302.

Exhibits

The Finnish American Heritage Center at Finlandia University recently installed three exhibits. They include a photographic exhibit titled “Rural Reflections: Finnish American Buildings and Landscapes in Michigan’s Copper Country”; a historic photography exhibit named “People, Place and Time: Michigan’s Copper Country Through the Lens of J.W. Nara”; and a pair of lithographs acquired by the National Park Service which were on either side of the Italian Hall stage the night of the infamous Christmas Eve tragedy 100 years ago. The “Rural Reflections” exhibit documents the built environment that Finnish immigrants and their descendants created in Michigan's Copper Country from the 1880s through the 1930s. Although much of this heritage has been lost with the passage of time, the district yet holds one of the largest concentrations of rural Finnish buildings and cultural landscapes in North America. The Nara exhibit, funded in part by descendants Robert and Ruth Nara of Bootjack Michigan, works from historical photographs held at the Michigan Tech Archives. Interpretive panels highlight the people, places, and times that J.W. Nara experienced during his lifetime and include material on urban life, farming, and the 1913 Michigan copper miners’ strike. The lithographs are a recent and unique acquisition for the Keweenaw National Historical Park, and will be on protected display at the FAHC. One of the panels shows the Italian royal family and was produced in 1908, while the other, produced in 1905, is of the five founders of the modern Italian state. For more information about the exhibits at the Finnish American Heritage Center, call (906) 487-7302.

Exhibits

The Finnish American Heritage Center at Finlandia University recently installed three exhibits. They include a photographic exhibit titled “Rural Reflections: Finnish American Buildings and Landscapes in Michigan’s Copper Country”; a historic photography exhibit named “People, Place and Time: Michigan’s Copper Country Through the Lens of J.W. Nara”; and a pair of lithographs acquired by the National Park Service which were on either side of the Italian Hall stage the night of the infamous Christmas Eve tragedy 100 years ago. The “Rural Reflections” exhibit documents the built environment that Finnish immigrants and their descendants created in Michigan's Copper Country from the 1880s through the 1930s. Although much of this heritage has been lost with the passage of time, the district yet holds one of the largest concentrations of rural Finnish buildings and cultural landscapes in North America. The Nara exhibit, funded in part by descendants Robert and Ruth Nara of Bootjack Michigan, works from historical photographs held at the Michigan Tech Archives. Interpretive panels highlight the people, places, and times that J.W. Nara experienced during his lifetime and include material on urban life, farming, and the 1913 Michigan copper miners’ strike. The lithographs are a recent and unique acquisition for the Keweenaw National Historical Park, and will be on protected display at the FAHC. One of the panels shows the Italian royal family and was produced in 1908, while the other, produced in 1905, is of the five founders of the modern Italian state. For more information about the exhibits at the Finnish American Heritage Center, call (906) 487-7302.

Skill Acquisition and the Influence of Attentional Focus and Practice

Attentional focus and practice schedules are important components in learning a new skill. For attention this includes focusing inward or outward, for practice this includes interference between tasks. Little is known about how the two interact. Four groups; blocked/extraneous (BE); blocked/skill-focused (BS); random/extraneous (RE); and random/skill-focused (RS), practiced 100 trials of golf putting and 64 trials of a key-pressing task in addition to responding to a random tone distracting attention towards or away from skill movement. Participants performed immediate and delayed retention tests. Results demonstrated the BE group had decreased RTE scores compared to the BS group. Immediate retention demonstrated superior scores for blocked practice. Delayed retention demonstrated superior CEVE scores for extraneous focus. For golf putting, both attention conditions with blocked practice learned faster compared to random groups. Posttest scores demonstrated the random and skill focused group to improve in all putting conditions.

Das Burnout-Syndrom: eine medizinische Perspektive

The burnout syndrome is a heterogeneous concept mostly understood as a complex of symptoms, primarily exhaustion, in response to prolonged emotional and interpersonal stress at work. The prevalence of burnout is considerably high in Swiss primary care physicians. In spite of its vague definition, burnout is a serious stress disease with many associated medical problems and high economic costs. Previous recommendations for the psychosomatic management of patients with functional somatic syndromes also apply to burnout treatment. These are complemented by more specific interventions targeting job stress related factors. Relapse prevention focuses on early recognition of warning signs and is an ongoing process.

Norepinephrine-induced hypertension dilates vasospastic basilar artery after subarachnoid haemorrhage in rabbits

BACKGROUND: Vasopressor-induced hypertension is routinely indicated for prevention and treatment of cerebral vasospasm (CVS) after subarachnoid haemorrhage (SAH). Mechanisms underlying patients' clinical improvement during vasopressor-induced hypertension remain incompletely understood. The aim of this study was to evaluate angiographic effects of normovolaemic Norepinephrine (NE)-induced hypertension therapy on the rabbit basilar artery (BA) after SAH. METHODS: Cerebral vasospasm was induced using the one-haemorrhage rabbit model; sham-operated animals served as controls. Five days later the animals underwent follow-up angiography prior to and during NE-induced hypertension. Changes in diameter of the BA were digitally calculated in mean microm +/- SEM (standard error of mean). FINDINGS: Significant CVS of 14.2% was documented in the BA of the SAH animals on day 5 compared to the baseline angiogram on day 0 (n = 12, p < 0.01), whereas the BA of the control animals remained statistically unchanged (n = 12, p > 0.05). During systemic administration of NE, mean arterial pressure increased from 70.0 +/- 1.9 mmHg to 136.0 +/- 2.1 mmHg in the SAH group (n = 12, p < 0.001) and from 72.0 +/- 3.1 to 137.8 +/- 1.3 in the control group (n = 12, p < 0.001). On day 5 after SAH, a significant dilatation of the BA in response to norepinephrine could be demonstrated in both groups. The diameter of the BA in the SAH group increased from 640.5 +/- 17.5 microm to 722.5 +/- 23.7 microm (n = 12, p < 0.05; ). In the control group the diameter increased from 716.8 +/- 15.5 microm to 779.9 +/- 24.1 microm (n = 12, p < 0.05). CONCLUSION: This study demonstrated that NE-induced hypertension causes angiographic dilatation of the BA in the SAH rabbit model. Based on these observations, it can be hypothesised that clinical improvement during vasopressor-induced hypertension therapy after SAH might be explained with cerebral vasodilatation mechanisms that lead to improvement of cerebral blood flow.

Cross-modal plasticity in the human thalamus: evidence from intraoperative macrostimulations

During stereotactic functional neurosurgery, stimulation procedure to control for proper target localization provides a unique opportunity to investigate pathophysiological phenomena that cannot be addressed in experimental setups. Here we report on the distribution of response modalities to 487 intraoperative thalamic stimulations performed in 24 neurogenic pain (NP), 17 parkinsonian (PD) and 10 neuropsychiatric (Npsy) patients. Threshold responses were subdivided into somatosensory, motor and affective, and compared between medial (central lateral nucleus) and lateral (ventral anterior, ventral lateral and ventral medial) thalamic nuclei and between patients groups. Major findings were as follows: in the medial thalamus, evoked responses were for a large majority (95%) somatosensory in NP patients, 47% were motor in PD patients, and 54% affective in Npsy patients. In the lateral thalamus, a much higher proportion of somatosensory (83%) than motor responses (5%) was evoked in NP patients, while the proportion was reversed in PD patients (69% motor vs. 21% somatosensory). These results provide the first evidence for functional cross-modal changes in lateral and medial thalamic nuclei in response to intraoperative stimulations in different functional disorders. This extensive functional reorganization sheds new light on wide-range plasticity in the adult human thalamocortical system.

Novel genetic risk markers for ulcerative colitis in the IL2/IL21 region are in epistasis with IL23R and suggest a common genetic background for ulcerative colitis and celiac disease

OBJECTIVES: Recently, a genome-wide association study showed that single-nucleotide polymorphisms (SNPs) in the chromosome 4q27 region containing IL2 and IL21 are associated with celiac disease. Given the increased prevalence of inflammatory bowel disease (IBD) among celiac disease patients, we investigated the possible involvement of these SNPs in IBD. METHODS: Five SNPs strongly associated with celiac disease within the KIAA1109/TENR/IL2/IL21 linkage disequilibrium block on chromosome 4q27 and one coding SNP within the IL21 gene were analyzed in a large German IBD cohort. The study population comprised a total of 2,948 Caucasian individuals, including 1,461 IBD patients (ulcerative colitis (UC): n=514, Crohn's disease (CD): n=947) and 1,487 healthy unrelated controls. RESULTS: Three of the five celiac disease risk markers had a protective effect on UC susceptibility, and this effect remained significant after correcting for multiple testing: rs6840978: P=0.0082, P(corr)=0.049, odds ratio (OR) 0.77, 95% confidence interval (CI) 0.63-0.93; rs6822844: P=0.0028, P(corr)=0.017, OR 0.73, 95% CI 0.59-0.90; rs13119723: P=0.0058, P(corr)=0.035, OR 0.75, 95% CI 0.61-0.92. A haplotype consisting of the six SNPs tested was markedly associated with UC susceptibility (P=0.0025, P(corr)=0.015, OR 0.72, 95% CI 0.58-0.89). Moreover, in UC, epistasis was observed between the IL23R SNP rs1004819 and three SNPs in the KIAA1109/TENR/IL2/IL21 block (rs13151961, rs13119723, and rs6822844). CONCLUSIONS: Similar to other autoimmune diseases such as celiac disease, rheumatoid arthritis, type 1 diabetes, Graves' disease, and psoriatic arthritis, genetic variation in the chromosome 4q27 region predisposes to UC, suggesting a common genetic background for these diseases.