Interactive resources at the Archives Web site.
Explore the source record for details and available documents.
Internet↗
Biomedical subjects
M A Rothschild
Publications and source records attributed to M A Rothschild.
Perinatal management of unanticipated congenital laryngeal atresia.
Unless ventilation is achieved within minutes of delivery, patients with congenital laryngeal atresia will not survive. There are 2 settings in which survival is more likely: a tracheotomy may be immediately performed in the delivery room, or a communication may exist between the airway and the pharynx, allowing for air exchange. In the latter case, there are no characteristic findings on prenatal sonography to suggest the diagnosis and to ensure that preparations for immediate tracheotomy are made. We describe a neonate with unanticipated laryngeal atresia and a high tracheoesophageal fistula. Ventilation was maintained first by face mask and then by esophageal intubation until a tracheotomy could be performed. This report provides detailed photodocumentation of the anomaly, discusses the mechanism of air exchange, reviews the relevant embryological development, and outlines a protocol for perinatal management of unanticipated laryngeal atresia.
Female↗
Multivariate analysis of factors associated with postoperative pulmonary complications following general elective surgery.
OBJECTIVE: To develop a predictive model identifying perioperative conditions associated with postoperative pulmonary complications (PPCs). DESIGN: A prospective survey of patients whose preoperative history and physical examination, spirometric, PaO2 and PaCO2 analysis, and operative results were recorded. These patients underwent postoperative cardiopulmonary examinations until they were discharged from the hospital; their medical records were also reviewed until they were discharged from the hospital. SETTING: The Louisville Veterans Administration Medical Center, Louisville, Ky. PATIENTS: A randomly chosen sample of patients aged 40 years or older who required elective, nonthoracic surgery under general or spinal anesthesia and who were hospitalized at least 24 hours postoperatively. MAIN OUTCOME MEASURE: An analysis of risk factors associated with the development of 1 or more of the following conditions: acute bronchitis, bronchospasm, atelectasis, pneumonia, adult respiratory distress syndrome, pleural effusion, pneumothorax, prolonged mechanical ventilation, or death secondary to acute respiratory failure. RESULTS: Postoperative pulmonary complications developed in 16 (11%) of 148 patients. The risk factors found to be higher among those with PPCs compared with those without PPCs were postoperative nasogastric intubation (81% vs 16%, P<.001), preoperative sputum production (56% vs 21%, P=.005), and longer anesthesia duration (480 vs 309 minutes, P<.001). Upper abdominal surgery was performed in 11 (69%) of the 16 patients with PPCs and in 20 (15%) of the 132 patients without PPCs (P<.001); this difference lost significance in multivariate analysis. The final linear logistic model included postoperative nasogastric intubation (odds ratio [OR], 21.8), preoperative sputum production (OR, 4.6), and longer anesthesia duration (OR exp[0.01x] for an increase in x minutes) (1 minute of additional anesthesia time increases the OR to 1.01), resulting in 92% accuracy in predicting PPCs. CONCLUSIONS: We identified 3 potentially modifiable risk factors for PPCs. If validated, our results may lead to modifications of perioperative care that will further reduce PPCs.
Adult↗
[Peak sound pressure levels of gunshots from starter's pistols].
Starter's pistols are often bought for self-defense, but can also be used for criminal activities (e.g. assaults, etc.). When a starter's pistol is loaded with blank cartridges and is fired, a powerful shooting noise results. The level of the noise produced is high enough to cause acoustic trauma. For legal examinations and giving an expert opinion further information is needed about the power of such noise. We examined how high peak sound pressure levels were of the gunshots of blank cartridges and whether there existed any directional characteristics from the noise emissions. In all, 15 different models of starter's pistols of 8 different calibres were examined. In addition to blank cartridges, 8 mm tear gas cartridges were also examined. Four transducers were situated in the horizontal plane around the muzzle: 0 degree (shooting direction), 45 degrees, 90 degrees, and 180 degrees (towards the firer). The distances between the transducers and the muzzle were 25 cm, 50 cm, 100 cm, and 200 cm. At a distance of 1 m and in the 0 degree shooting direction the peak sound pressure levels of nearly all weapons tested exceeded 160 dB. At a shooting distance of 25 cm the peak sound pressure levels reached 181 dB. In addition, we observed a directional characteristic concerning the emission of noise: pistols produced higher peak sound pressure levels to the front than backwards towards the firer.
Equipment Design↗
Fatal wounds to the thorax caused by gunshots from blank cartridges.
Lethal injuries of the thorax due to shots fired from blank cartridges calibre 8 mm are reported in three cases. The muzzle of the weapon was in contact with the left side of the breast (contact discharge) and injuries to bones were absent in all three cases. In two of the cases the pericardium was not involved but the anterior wall of the right heart ventricle was ruptured and death was due to cardiac tamponade. In the third case the pericardial sac and the left ventricle were both ruptured and the victim died due to rapid exsanguination. The cases demonstrate that the gas pressure from the exploding propellent of blank ammunition can be powerful enough to penetrate the thoracic wall.
Adolescent↗
Otolaryngology and the Internet. E-mail and the World Wide Web.
Computer technology and Internet-based communications are evolving at a tremendous rate. At present, most physicians either have or can easily obtain online access. E-mail represents a new method of interpersonal communication, with many useful applications in the field of clinical medicine. The World Wide Web has developed over the past few years into a vast information resource, with global reach and the ability to provide users with text and audio and video materials on every conceivable topic. These modalities are discussed in detail, stressing controversial aspects such as e-mail security, validation of content, professional liability as it relates to online comments, and the academic status of Web publishing.
Computer Communication Networks↗
On the temporal onset of postmortem animal scavenging. "Motivation" of the animal.
During an initial investigation, postmortem scavenging by pets (dogs, cats, etc.), which sometimes occurs, may sometimes lead to the suspicion that a crime has been committed. In most cases however, the death was due to natural causes. The time of the onset of postmortem scavenging by animals can often not be exactly determined because the interval between the time of death and discovery of the body is usually considerable. In this paper we deal with the case of a 31-year-old man, who committed suicide by shooting himself in the mouth and whose face exhibited extensive postmortem animal bite marks caused by the victim's Alsatian, which must have occurred during the 45 minute period between the fatal shot and the discovery of the body. Hunger, frequently discussed as a reason for postmortem animal mutilating injuries, could not have been responsible for the injuries in this case. In the room where the victim was found, there was also a bowl with sufficient dog food and while being transported to an animal sanctuary in a police van the dog vomited about 400 g of dog food as well as human tissue.
Adult↗
The modified laryngeal mask airway: four head and neck procedures in two children with mild subglottic stenosis.
The laryngeal mask airway (LMA) was first described in 1983, and has since been used for administration of general anesthesia, resuscitation and as an aid to bronchoscopy or intubation. When used for anesthesia, the LMA has the advantage of lessening potential subglottic injury as compared to an endotracheal tube. Children with mild subglottic stenosis often have minimal symptoms of airway compromise at baseline. However, a minor degree of subglottic irritation may result in dyspnea (as in upper airway infection or following laryngeal intubation). We have begun using the LMA in such patients undergoing a general anesthetic for head and neck procedures unrelated to the airway. The present report describes two such children who underwent rhinologic and ophthalmologic surgery using the LMA. No perioperative stridor or respiratory distress was noted, and the LMA did not interfere with the procedure. In addition, we describe a modification of the standard LMA to further facilitate surgical access to the head and neck.
Anesthesia, General↗
Self-implanted subcutaneous penile balls--a new phenomenon in Western Europe.
The subcutaneous self-implantation of spherical objects in the penis is a well-known practice among members of the Yakuza in Japan but this phenomenon has not previously been described in the Western world. However, recently there were two cases in Berlin of young Eastern Europe men in whom implanted penile balls as in the Yakuza were found at autopsy. Investigations in Russia revealed that this phenomenon is typically encountered there among prisoners and in certain army units. In addition to the feeling of belonging to a specific group, increased sexual confidence is one major reason for these implantations that are usually performed under primitive conditions.
Adult↗
Otogenic pneumocephalus in a patient with an idiopathic mastoid defect.
Explore the source record for details and available documents.
Female↗
Sialoblastoma (embryoma): MR findings of a rare pediatric salivary gland tumor.
We report the findings in a 21-month-old girl who had a noninfiltrating mass in the left cheek, just anterior to the masseter muscle, which, at surgery, proved to be a sialoblastoma. Sialoblastoma has a histologic appearance reminiscent of a primitive state of salivary gland development; that is, it shows an arrested state of salivary maturation. MR imaging in this case showed that the lesion was isointense with muscle on T1-weighted images, had a high-intermediate signal intensity similar to that of fat on T2-weighted images, and enhanced sparsely and nonhomogeneously.
Adenoma↗
Is the exploding powder gas of the propellant from blank cartridges sterile?
Shots from blank weapons loaded with blank cartridges, when fired from close range or as a contact shot, almost always cause the skin to burst open and lead to injuries to structures below the surface. Subsequently, wound infections are often observed. In addition to the introduction of skin germs, the possibility exists that contaminated propellants may enter into consideration as a source of infection. Using step-by-step experimental procedures we were able to demonstrate that: 1. Blank cartridge propellants were almost always contaminated with Bacillus cereus (nitrocellulose powder more so than black powder); 2. When the shot is fired numerous bacteria survive and are forced out with the gunsmoke from the weapon and thus find their way into the wound. In principle, blank cartridge propellant thus exhibits as much potential for wound infection as the skin germs. Clearly, the species B. cereus is prominent in this context. For open injuries even with 'harmless' blank weapons, an antibiotic prophylaxis should always be administered.
Adult↗
Carcinoid tumor of the trachea in a pediatric patient.
Explore the source record for details and available documents.
Carcinoid Tumor↗
Adipocere--problems in estimating the length of time since death.
Establishing the length of time since death is particularly difficult in corpses showing advanced autolysis. One sign of advanced decay is the formation of adipocere. In this state bodies show evidence of a partly wax-like and partly pasty condition. Continued storage ultimately results, among other things, in further decomposition due to the action of micro-organisms from the surrounding area-even if this is chronologically delayed. An exception is provided by the formation of adipocere under air-tight conditions. Initially, autolysis and heterolysis also occur, involving the release of fatty acids. As a result of the subsequent hydrogenation of the fats under the influence of bacterial enzymes, the unsaturated fatty acids are partially converted into saturated fatty acids. As the fatty acids clearly have a bactericidal effect, further bacterial decomposition is stopped at this early adipocere stage. Additional micro-organisms from outside can no longer penetrate when this hermetic seal is in place. In addition, the lack of calcium (e.g. from water or moist earth) can be a reason for the fact that further adipocere development, leading to wax-like hardening of the fat, is arrested. Thus the condition of the body can remain constantly preserved over many years and it no longer allows a reliable estimate to be made of the period of time since death.
Anaerobiosis↗
Postoperative medical management in single-stage laryngotracheoplasty.
OBJECTIVE: To determine whether it is safe and effective to avoid the use of neuromuscular relaxants in patients who have indwelling nasotracheal tubes after undergoing single-stage laryngotracheoplasty. DESIGN: Retrospective case series. SETTING: University-based referral center specializing in the surgical management of laryngotracheal stenosis and other pathologic conditions of the airway. PATIENTS: Referred sample of 104 consecutive patients (67 males, 37 females) undergoing single-stage laryngotracheoplasty for subglottic stenosis. INTERVENTION: Single-stage laryngotracheoplasty. MAIN OUTCOME MEASURES: Incidence of accidental extubation, use of neuromuscular relaxants, incidence of reintubation after planned extubation, duration of intubation, overall rate of successful airway expansion. RESULTS: One patient self-extubated without sequelae. One patient required a brief course of neuromuscular relaxants. The success rate (without further laryngotracheoplasty) for all patients was 86% (89/104). For the 25 patients operated on in 1992, with at least 1 year of follow-up, the success rate was 92% (23/25). CONCLUSION: Single-stage laryngotracheoplasty can be done safely and effectively without using paralyzing agents in the postoperative period. This approach has certain advantages, which are discussed.
Accidents↗
"Terminal burrowing behaviour"--a phenomenon of lethal hypothermia.
Between 1978 and 1994, 69 cases of death due to lethal hypothermia were examined in our Institute. In addition to the common findings associated with hypothermia we especially wanted to examine the so-called paradox reaction which refers to the undressing of persons in a state of severe (lethal) hypothermia. This is obviously the result of a peripheral vasodilatation effecting a feeling of warmth. In our material this paradoxical undressing occurred in 25% of the cases and nearly all exhibited an additional phenomenon which has not yet been described in the literature. Nearly all bodies with partial or complete disrobement were found in a position which indicated a final mechanism of protection i.e. under a bed, behind a wardrobe, in a shelf etc.. This is obviously an autonomous process of the brain stem, which is triggered in the final state of hypothermia and produces a primitive and burrowing-like behaviour of protection, as seen in (hibernating) animals. This phenomenon, which we refer to as "terminal burrowing behaviour", occurred predominantly with slow decreases in temperature and moderately cold conditions.
Adult↗
Olfactory disturbance in pediatric tracheotomy.
Several studies have described hyposmia after laryngectomy. The most common mechanism invoked is a reduction in nasal airflow, leading to elevated olfactory detection thresholds. Children with nasal obstruction have been shown to also have elevated olfactory detection thresholds linked to reduced nasal airflow. A child with a tracheotomy is in some degree similar to a laryngectomee. These patients will have variable amounts of nasal airflow reduction proportional to the degree of suprastomal obstruction. Our concern was that this alteration in nasal airflow may cause hyposmia. Furthermore, if the olfactory system requires adequate early stimulation for normal development (as is the case with vision and hearing), tracheotomy would be suspected to cause persistent hyposmia even after decannulation. Thus decreased olfactory sensitivity, delayed olfactory experience, or both could interfere with a child's ability to recognize and identify odor stimuli. We studied children aged 4 to 16 years with upper airway obstruction requiring tracheotomy and compared their abilities to identify familiar odorants with those of a large group of normal control children. None of the children had intrinsic mucosal or olfactory pathology. Statistical analysis of the early data shows a significant reduction in olfactory identification scores in the patients with tracheotomies, both by Student's t test and by the Wilcoxon rank sum test. Analysis of covariance confirmed age as an independent prognostic variable for identification ability. We therefore conclude that tracheotomy can reduce a child's ability to identify familiar odorants.
Adolescent↗
Evaluation and management of congenital cervical teratoma. Case report and review.
Congenital cervical teratoma can be clinically dramatic, although essentially benign. Prognosis is good provided that the airway is quickly stabilized and resection is not delayed. We present a case of massive cervical teratoma diagnosed using antenatal magnetic resonance imaging. The child was maintained on maternal circulation after cesarean section until successfully intubated, with a second team ready for emergent bronchoscopy or tracheotomy. After delivery, the lesion grew rapidly with persistent bleeding; biopsy revealed a benign, immature teratoma. On computed tomography all anatomy ventral to the vertebrae was obliterated. At surgery, however, the tumor was easily resected. The literature is reviewed, with attention to malignancy in neonatal cervical teratoma. Surgery was delayed because of the aggressive imaging appearance and rapid growth. This case suggests that when evaluating neonatal tumors, the standard criteria for infiltration and resectability may require modification.
Adult↗