Pregnancy and Beyond Part II: Temperature Extremes and High Altitude.

Over the last 35 years, transport technology has created new environmental frontiers in which family physicians are, and will continue to be, involved both in research and in administering patient care. Some frontiers address basic physiological problems that cross over into others. In a series of four articles, the author describes six of these frontiers with specific emphasis on pregnancy, from hyperbarism (undersea physiology) to microgravity (space physiology), and the problems, and linkages where evident. This second article explores the effects of temperature extremes and high altitude on the well-being of pregnant women.

Pregnancy and beyond: environmental frontiers.

Over the last 35 years transport technology has created new environmental frontiers, both in research and in the administration of patient care, in which family physicians are, and will continue to be, involved. Some of these frontiers address basic physiological problems that become interconnected with others. The author describes six of these frontiers, with specific relation to pregnancy, from hyperbarism (undersea physiology) to microgravity (space physiology). He outlines the problems and linkages, where evident, in a series of four articles, of which this first one deals with pregnancy and rapid decelerations with resultant trauma, and pregnancy and hyperbarism.

Pregnancy and Beyond Part III: Cosmic Radiation.

Over the last 35 years transport technology has created new environmental frontiers in which family physicians are, and will continue to be, involved both in research and in administering patient care. Some frontiers address basic physiological problems that cross over into others. In a series of four articles, the author describes six of these frontiers, with specific emphasis on pregnancy, from hyperbarism (undersea physiology) to microgravity (space physiology), and discusses the problems and linkages where evident. This third article deals with the known effects of cosmic radiation on the well-being of pregnant women in high-altitude flight, and in space.

Pregnancy and Beyond Part IV: Microgravity.

Transport technology in the last 35 years has created new environmental frontiers in which family physicians are, and will continue to be, involved both in research and in administering patient care. Some frontiers address basic physiological problems that cross over into others. In a series of four articles, the author describes six of these frontiers with specific emphasis on pregnancy, from hyperbarism (undersea physiology) to microgravity (space physiology), the problems, and linkages where evident. This fourth article covers the known and postulated effects of microgravity on pregnancy well-being.

Comparison of two voice prostheses for vocal restoration following laryngectomy.

Two prostheses for voice rehabilitation after laryngectomy were compared. A comparison was also made to evaluate the interchangeability of the two prostheses (Panje button and Blom-Singer duckbill) when only a single tracheoesophageal fistula was made. Fourteen laryngectomized patients were included in the study. Factors taken into account were voice quality, intelligibility, surgical technique, ease of insertion of the prostheses, patient preference, and care of each device. It was concluded that the Panje button in a Blom-Singer fistula offered better results when voice quality was compared. Patient selectivity is a factor important to the high success rate reported for voice restoration when either prosthesis is used. The development and success of these new prostheses is highlighted in a brief review of the literature.

Warthin's tumor.

Warthin's tumor is a benign neoplasm that most often arises in the parotid gland. The lesion is often clinically silent, but various radiographic studies are useful in establishing the diagnosis. Surgical resection generally results in a complete cure. The diagnosis of Warthin's tumor should be considered in any patient who presents with a mass lesion in the area of the parotid gland.

Validation of a vocal cord lateralization procedure.

Various corrective procedures have been described to move the midline paralyzed vocal cord laterally in order to create a more desirable air exchange position. They have been complicated and often unsatisfactory, even for the skilled operator. A newer, direct approach by direct laryngoscopy, including incision and debulking of the paralyzed vocal process, as first reported by Fernando Kirchner, M.D. is described. The direct laryngoscopic method permits easier accessibility for this problem. In three involved surgical cases discussed, the air exchange in each was improved. The patients have continued to have good functional voices and no longer require tracheostomy.

Glycerine injection and crystal formation in the larynx: a negative study.

Glycerine as a vehicle may be injected alone or with Teflon to reposition a lateral lying paralyzed vocal cord. During the study of a particular patient, crystal formation was observed in laryngeal tissues injected with glycerine. It was hypothesized that glycerine metabolized to oxalic acid crystals via the glyoxylic acid pathway. To confirm this proposition, the gluteus muscle of guinea pigs was injected with glycerine, and at weekly intervals submitted for ordinary and polarized light microscopic examination. The formation of crystals after glycerine injection was not found in the guinea pig. Similarly, no foreign material or crystals were found after centrifuging the stored glycerine.

Rhinorrhea associated with intracranial cholesteatomas and an "empty sella.".

Three related disorders in the same patient, namely bilateral primary intracranial cholesteatomas, an "empty sella" syndrome, and a cerebrospinal rhinorrhea are reported. No previous report of bilateral symmetrical cholesteatomas has been made, though single intracranial cholesteatomas have frequently been recorded in medical literature. The "empty sella" syndrome is generally considered to be from a herniation of the subarachnoid into the sella through a deficient diaphragma sella, and was first defined by Ommaya in 1968. Non-traumatic (spontaneous) rhinorrhea remains an uncommon disease initially described in 1826. Experience of the individual otolaryngologist is limited in this region because of infrequent occurrence and because definitive treatment is directed to other specialties. On the other hand, the ear, nose and throat physician may be the first to interpret a drainage from the nose. With this in mind, the etiologic, clinical and management factors in the present case are discussed.

Medullary carcinoma of the thyroid as a laryngeal problem.

A neuroendocrine secreting tumor, initially presenting as a laryngeal problem, is reported. Subglottic biopsy, first interpreted as paraganglioma, was finally diagnosed as medullary carcinoma of the thyroid. The complex testing required to arrive at an accurate diagnosis of this uncommon thyroid malignancy is discussed. The sparse occurrence of the neoplasm in the laryngologic field, as well as the necessity for differentiating it from other neuroendocrine tumors, bear consideration.