Vocal cord augmentation with autogenous fat.

Since 1987, the authors have used a new technique for the augmentation and medialization of the paralyzed vocal cord. Eleven patients with paralyzed vocal cords and one patient with a surgical defect of the vocal cord have been treated with intracordal injections of autogenous fat harvested by suction from the abdominal wall. Treatment efficacy was evaluated by both subjective and objective (videostroboscopic) analyses. Patient follow-up has ranged from 5 to 42 months. All patients showed significant improvement in voice characteristics. Marked reduction in air flow and increased vocal intensity were observed. Correction of glottic insufficiency has been lasting, indicating that the implanted fat cells are viable. At this time, there has been no evidence of loss of vocal cord substance. The natural qualities of autogenous fat appear to make it an excellent alternative to Teflon or collagen. The fat is readily available, and easily harvested and injected. A larger patient population and longer follow-up periods will help determine if these initial findings are consistent.

An analysis of civil aviation propeller-to-person accidents: 1965-79.

The interest of manufacturing, governmental, and safety personnel in using paint schemes on propeller and rotor blades is based on improving the visual conspicuity of those blades when they are rotating. While propeller and rotor paint schemes may serve to reduce the number of fatalities and injuries due to contact with a rotating blade, there is little information about the circumstances surrounding such accidents. Brief reports provided by the National Transportation Safety Board of all "propeller-to-person" accidents from 1965-79 were examined and analyzed in terms of airport lighting conditions, actions of pilots, actions of passengers and groundcrew, phase of flight operations, weather conditions, and others. Analyses based on 319 accidents showed a marked drop in the frequency of "propeller-to-person" accidents from 1975 through 1978. Several types of educational efforts directed toward pilots and groundcrew, both prior to and during that 4-year period, were examined as possible factors contributing to the accident rate decline. Accident patterns provide a basis for assessing the probable efficacy of various recommendations, including propeller conspicuity, for further reducing "propeller-to-person" accidents.

Improving the crashworthiness of general aviation aircraft by crash injury investigations.

An aircraft accident investigation program correlates injuries to occupants with the severity of impacts and structural changes in the crash. Findings brought to the attention of aircraft manufacturers have led to specific aircraft being made more crash-worthy. The finding of a failure in a shoulder harness attachment led to the strengthening of the attachment brace. The way a shoulder harness was joined to a lapbelt was modified following a noted failure. The finding of fractures of lapbelt and shoulder harness cable tiedowns led to the use of stronger cables and modification of the installation. Other findings resulted in a shoulder strap guide being placed on an inertia reel and a side-mounted seat being modified. Described also are three seat-related features which, although meeting FAA standards, during the dynamics of a crash may lack desirable energy attenuation. These findings illustrate the value of aircraft crash injury correlations.

Spatial disorientation in general aviation accidents.

Spatial disorientation (SD) was the third highest "cause" of fatal accidents in small, fixed-wing aircraft and closely related to the second highest "cause"--"continued VFR flight into adverse weather." SD was a cause or factor in 16% of all fatal accidents. When SD was ascribed as a cause or factor in an accident, 90% of the time that accident involved fatalities. Small, fixed-wing aircraft under 12,500 lb (570 kg) accounted for 97.3% of all SD accidents. Inclement weather was associated with 42% of all fatal accidents, and SD was a cause or factor in 35.6% of these. Flight was initiated into and continued into adverse weather in 19.7 and 68.7%, respectively, of SD weather-related fatal accidents. Fog (56.8%) and rain (41.8%) were the most prevalent adverse weather conditions. These and other data attest to the importance of this psychophysiological phenomenon in flight safety.

Actinomycosis of the larynx and pharynx.

This paper presents a case report of a 67-year-old man who was seen in the Otolaryngology Clinic, University of Wisconsin Medical Center with a seven-month history of dyspnea and laryngeal stridor. On examination there were several slightly tender firm submucosal nodules in the soft palate and left tonsilar area and a 1.5-cm polypoid subglottic mass arising from the body of the cricoid cartilage. Because of the marked airway obstruction, a tracheotomy was necessary. The laryngeal polypoid mass was removed and biopsies were obtained from the submucosal nodular masses of the palate. Microscopic examination of the tissue revealed the lesions to be caseating granulomas, and actinomycosis was identified on the cultures. The patient received long-term penicillin therapy and has remained asymptomatic. A discussion of the biologic and clinical aspects of actinomycosis is included. A review of the literature revealed only one other description of endolaryngeal actinomycosis.

Neoplasms of Equidae.

In a retrospective study of neoplasms in Equidae pre;ented to the Animal Disease Diagnostic Laboratory, Purdue University, from Jan 1, 1970, to Dec 31, 1974, data were compiled on numbers and anatomic sites of neoplasms as well as on age, sex, and breed of subjects from which the neoplasms were taken. During this 5-year period, 21 neoplasms were diagnosed from 687 equine necropsies (3.1%) and 215 from 635 biopsies (33.9%), totaling 236 neoplasms from 1,322 cases (17.9%). The most common neoplasms were sarcoids (43.6%) and squamous cell carcinomas (24.6%). Papillomas (5.5%), nerve sheath tumors (4.2%), melanomas (3.8%), lipomas (3.0%), granulosa cell tumors (2.5%), fibromas (2.1%), cholesteatomas (1.3%), and lymphosarcomas (1.3%) were less common.

Postmortem pink teeth.

A series of cases is reported in which pink teeth were observed during the postmortem period. Most cases were associated with decomposition in a moist environment. Experimental procedures led to the extraction of pink material from dentin and demonstration that hemoglobin and serum proteins were present. The pink-tooth phenomenon was duplicated in human teeth by instilling into the pulp chambers whole blood and blood with the red cells hemolyzed. The change was manifested in teeth of dogs after freezing, heating, and decomposition in a moist environment. The authors postulate that pink teeth occur as a result of breakdown of red blood cells in the pulp chamber of the tooth and diffusion of hemoglobin and other serum proteins into the dentin via the dential tubules. Histochemical studies show that the brown or gray material in some teeth subjected to postmortem aging is probably hemoglobin and serum proteins. Factors of age, vascularity of the pulp chamber, and postmortem conditions are discussed in relation to the postmortem development of pink teeth.

Malignant ameloblastoma of the maxilla.

This case illustrates a rare occurrence of an ameloblastoma arising in the maxilla and metastasizing to the neck and lungs within a three-year period following the initial resection. A discussion of the pathology is presented and the necessity for aggressive initial therapy with close follow-up is emphasized.

Fiber types and size in equine skeletal muscle.

Frozen sections of equine musculus semitendinosus were examined for myosin adenosine triphosphatase (ATPase) and reduced nicotinamide adenine dinucleotide-tetrazolium reductase (NADH-TR), using standard histochemical procedures, and the proportions of the various fiber types and average fiber sectional size were determined. With ATPase staining, approximately 70% of the fibers were classified as alpha fibers (ATPase positive), and 30%, as beta fibers (ATPase negative). In addition, 2 populations of alpha fibers could be readily distinguished on the basis of the intensity of the ATPase reaction, and these were designated alpha positive and alpha intermediate. The relationship of this difference in ATPase reaction to contraction speed of the fibers is not known. With NADH-TR staining, fibers were classified as either red fibers (positive) having aerobic metabolism or white fibers (negative) having primarily anaerobic metabolism. All beta fibers were red by NADH-TR; thus, they conformed to the criteria for beta R fibers. All alpha positive fibers were white by NADH-TR, as were most of the alpha intermediate fibers, and would be classified alpha W. Some of the alpha intermediate fibers gave an intermediate reaction with NADH-TR and could be classified as alpha R fibers which have not transformed to alpha W fibers. The alpha positive fibers were 7 to 10 mum larger in diameter than either beta or alpha intermediate fibers.