Defining human-centricity in Industry 5.0 and assessing the readiness of ergonomics/human factors communities in UK

There is a lack of a clear and consistent definition of human-centricity in Industry 5.0. This study identified the definition of human-centricity in Industry 5.0 through a systematic literature review and used it to assess the readiness of Ergonomics/Human Factors communities in the UK. The assessment of the communities readiness was conducted by reviewing UK accredited courses and events of three professional bodies; and interviewing practitioners (n = 8). Eleven themes were identified as elements of human-centricity from the thematic analysis of 30 publications. Gaps that had to be addressed to better equip UK practitioners to support the realisation of human-centricity in Industry 5.0 were also identified.

Seeing Your Stories: Visualization for Narrative Medicine

Importance: Narrative medicine (NM), in which patient stories play a crucial role in their diagnosis and treatment, can potentially support a more holistic approach to patient care than traditional scientific ones. However, there are some challenges in the implementation of narrative medicine, for example, differences in understanding illnesses between physicians and patients and physicians' increased workloads and overloaded schedules. This paper first presents a review to explore previous visualization research for narrative medicine to bridge the gap between visualization researchers and narrative medicine experts and explore further visualization opportunities. Highlights: The review is conducted from 2 perspectives: (a) the contexts and domains in which visualization has been explored for narrative medicine and (b) the forms and solutions applied in these studies. Four applied domains are defined, including understanding patients from narrative records, medical communication, medical conversation training in education, and psychotherapy and emotional wellness enhancement. Conclusions: A future work framework illustrates some opportunities for future research, including groups of specific directions and future points for the 4 domains and 3 technological exploration opportunities (combination of narrative and medical data visualization, task-audience-based visual storytelling, and user-centered interactive visualization). Specifically, 3 directions of future work in medical communication (asynchronous online physician-patient communication, synchronous face-to-face medical conversation, and medical knowledge dissemination) were concluded.

Treatment of supraglottic squamous cell carcinoma with advanced technologies: observational prospective evaluation of oncological outcomes, functional outcomes, quality of life and cost-effectiveness (SUPRA-QoL)

BACKGROUND

Over the past decade, therapeutic options in head and neck supraglottic squamous cell carcinoma have constantly evolved. The classical total laryngectomy has been partially replaced by alternative organ- and function-sparing techniques with the same prognosis but less morbidity, such as Radiotherapy, Transoral Laser Microsurgery (TLM) and Trans-Oral Robotic Surgery (TORS). Up to now, a prospective comparison of these innovant techniques has not been conducted.

METHODS/DESIGN

We will conduct an original international multicentric prospective nonrandomized clinical trial to compare the efficacy between these treatments (Arm 1: Radiotherapy ± chemotherapy; Arm 2: TLM and Arm 3: TORS) with 4 classes of outcomes: quality of life (QoL), oncological outcomes, functional outcomes and economic resources. The population will include cT1-T2 /cN0-N1/M0 supraglottic squamous cell carcinoma. The primary outcome is a Clinical Dysphagia QoL evaluation assessed by the MD Anderson Dysphagia questionnaire. Secondary outcomes include others QoL evaluation, oncological and functional measures and cost parameters. The sample size needs to reach 36 patients per arm (total 108).

DISCUSSION

In the current literature, no prospective head-to-head trials are available to compare objectively these different treatments. With the increase of highly efficient treatments and the increase of oncological survival, it is imperative also to develop management strategies that optimize QoL and functional results. We will conduct this innovate prospective trial in order to obtain objective data in these two main issues.

TRIAL REGISTRATION

NCT05611515 posted on 10/11/2022 (clinicaltrial.fgov).

Transoral radiofrequency of the terminal branches of the recurrent nerve in the treatment of adductor spasmodic dysphonia: our experience over 11 patients

PURPOSE

Spasmodic dysphonia (SD) or laryngeal dystonia is as a rare vocal disorder characterized by involuntary action-induced endolaryngeal contraction. In the last decade, botulin toxin injection has become the standard treatment in adductor spasmodic dysphonia necessitating repetitive injections. The purpose of this study is to analyze retrospectively data from patients treated with the minimal-invasive transoral radiofrequency-induced thermotherapy (RFITT) of the terminal branches of the recurrent nerve.

METHODS

Between 2009 and 2015, 11 patients (six females and five males aged from 32 to 91 years) with adductor SD were treated with RFITT. Pre-operative and post-operative vocal assessments (VHI-30, GRBASI, and acoustic-aerodynamics measurements), number of surgical revisions, delay between procedures, and post-operative complications were recorded. Statistical analyses were carried out on the first vocal assessment performed 2-8 weeks after the first procedure.

RESULTS

Based on available data from ten patients, voice handicap index (VHI) showed improvement with a mean value of -17.7 points (p-value (pval) = 0.014, adjusted p-value (adj pval) = 0.21); instability has also revealed improvement in six patients (pval = 0.05, adj pval = 0.31). Four patients underwent only one procedure including one patient showing still long-term beneficial results after 5 years of follow-up. Other patients required one to three new procedures with an average time between procedures of 15.3 months. Over 24 surgeries performed on a total of 11 patients, one definitive treatment-related severe adverse event was reported.

CONCLUSION

Thanks to long-lasting effect, repetitive treatments are less frequent compared to botulin toxin therapy. In our opinion, RFITT is a promising alternative to botulin toxin as a second-step procedure in case of toxin resistance or patient's lack of compliance.

The Use of Traffic Sounds to Make Street Crossings by Persons who are Visually Impaired

Orientation and mobility O&M specialists are concerned with the ability of a person who is visually impaired to use hearing as well as vision in independent travel. Yet, there is no published research on the auditory requirements for making effective street crossings by individuals who are visually impaired or by individuals who are both visually and hearing impaired. Thus, this article presents the frequency and intensity measurements for traffic sounds under different conditions. It then compares these measurements to audiograms to illustrate how, given certain limitations and cautions, O&M specialists can estimate a traveler's ability to make safe traffic crossings.

Family Environment and Psychological Distress in Persons who are Visually Impaired

This study investigated the relationship between perceived family environment and psychological distress in 76 persons who are visually impaired, aged 18 to 94, who had undergone at least four months of rehabilitation classes. The results indicated that family environmental traits strongly influenced these persons’ adjustment to vision loss.

Mercury and metal(loid) deposition to remote Nova Scotia lakes from both local and distant sources

Kejimkujik National Park, in Nova Scotia, Canada, is a sensitive region for metal(loid) contamination, such as mercury, in part due to long-range atmospheric deposition from global and regional industrial centers. The region is remote from industrial centres, but is downwind of major pollution sources in the Eastern United States and Canada, and historically had numerous gold mining sites. Due to a paucity of long-term atmospheric deposition monitoring in this region, little is known about the response of Kejimkujik lakes to multiple changing global, regional and local atmospheric Hg and metal(loid) sources. Here, we used multiple lake sediment cores to reconstruct anthropogenic depositional fluxes of metal(loid)s of concern for the last ~210years. Results showed that Kejimkujik lake sediments are highly enriched in lead (Pb), antimony (Sb) and tin (Sn), with post-industrial metal(loid) concentrations being >4-fold greater than natural baseline levels (prior to ~1800) and moderately enriched in silver (Ag), bismuth (Bi), cadmium (Cd), copper (Cu), mercury (Hg), rubidium (Rb), tellurium (Te), thallium (Tl), vanadium (V), tungsten (W) and zinc (Zn), with post-industrial metal(loid) concentrations being between 1.5 and 4-fold greater than natural baseline levels (prior to ~1800). Lake sediment core reconstructions of total atmospheric Hg deposition matched well with Hg wet deposition monitoring data from the overlapped period (1997-2010) being 9.1±2.7μg/m²/yr and 7.0±0.7μg/m²/yr respectively. Lakes closest to historic gold mining sites show spikes in Ag, Cd, Sb, Tl, Zn and W during mining periods (~1880 and 1950). Most of the enriched metal(loid)s (EF >1.5) (Ag, Bi, Cu, Hg, Pb, Sb, Sn, V and W) do not appear affected by redox and remobilisation issues. For the other enriched metal(loid)s (EF >1.5) (Cd, Tl, and Zn), remobilisation from upper sediments appears to be occurring within these acidic and DOC rich Kejimkujik lakes.

Evaluating secondary input devices to support an automotive touchscreen HMI: A cross-cultural simulator study conducted in the UK and China

Touchscreen Human-Machine Interfaces (HMIs) are a well-established and popular choice to provide the primary control interface between driver and vehicle, yet inherently demand some visual attention. Employing a secondary device with the touchscreen may reduce the demand but there is some debate about which device is most suitable, with current manufacturers favouring different solutions and applying these internationally. We present an empirical driving simulator study, conducted in the UK and China, in which 48 participants undertook typical in-vehicle tasks utilising either a touchscreen, rotary-controller, steering-wheel-controls or touchpad. In both the UK and China, the touchscreen was the most preferred/least demanding to use, and the touchpad least preferred/most demanding, whereas the rotary-controller was generally favoured by UK drivers and steering-wheel-controls were more popular in China. Chinese drivers were more excited by the novelty of the technology, and spent more time attending to the devices while driving, leading to an increase in off-road glance time and a corresponding detriment to vehicle control. Even so, Chinese drivers rated devices as easier-to-use while driving, and felt that they interfered less with their driving performance, compared to their UK counterparts. Results suggest that the most effective solution (to maximise performance/acceptance, while minimising visual demand) is to maintain the touchscreen as the primary control interface (e.g. for top-level tasks), and supplement this with a secondary device that is only enabled for certain actions; moreover, different devices may be employed in different cultural markets. Further work is required to explore these recommendations in greater depth (e.g. during extended or real-world testing), and to validate the findings and approach in other cultural contexts.

Consistency of effects of tropical-forest disturbance on species composition and richness relative to use of indicator taxa

Lawton et al. (1998) found, in a highly cited study, that the species richness of 8 taxa each responds differently to anthropogenic disturbance in Cameroon forests. Recent developments in conservation science suggest that net number of species is an insensitive measure of change and that understanding which species are affected by disturbance is more important. It is also recognized that all disturbance types are not equal in their effect on species and that grouping species according to function rather than taxonomy is more informative of responses of biodiversity to change. In a reanalysis of most of the original Cameroon data set (canopy and ground ants, termites, canopy beetles, nematodes, and butterflies), we focused on changes in species and functional composition rather than richness and used a more inclusive measure of forest disturbance based on 4 component drivers of change: years since disturbance, tree cover, soil compaction, and degree of tree removal. Effects of disturbance on compositional change were largely concordant between taxa. Contrary to Lawton et al.'s findings, species richness for most groups did not decline with disturbance level, providing support for the view that trends in species richness at local scales do not reflect the resilience of ecosystems to disturbance. Disturbance affected species composition more strongly than species richness for butterflies, canopy beetles, and litter ants. For these groups, disturbance caused species replacements rather than just species loss. Only termites showed effects of disturbance on species richness but not composition, indicating species loss without replacement. Although disturbance generally caused changes in composition, the strength of this relationship depended on the disturbance driver. Butterflies, litter ants, and nematodes were correlated with amount of tree cover, canopy beetles were most strongly correlated with time since disturbance, and termites were most strongly correlated with degree of soil disturbance. There were moderately divergent responses to disturbance between functional feeding groups. Disturbance was most strongly correlated with compositional differences of herbivores within beetles and nematodes and humus feeders within termites. Our results suggest that consideration of the impact of different forms of disturbance on species and functional composition, rather than on net numbers of species, is important when assessing the impacts of disturbance on biodiversity.

User-Centered Design of a Portable Fire Extinguisher

This case study documents the process followed to produce an alternative design of a fire extinguisher. The work focuses on how informative data can be gathered for an ethically challenging product scenario through the use of a range of user-centered research methods, including literature review, product evaluation, shadowing study, empathy study, expert interview, focus groups, and simulation equipment. Design improvements as a consequence of this process include reductions in size and weight, refillable cartridges, single-handed operation, intuitive form, minimal cleanup post-use, and better portability.

Establishing usability heuristics for heuristics evaluation in a specific domain: Is there a consensus?

Heuristics evaluation is frequently employed to evaluate usability. While general heuristics are suitable to evaluate most user interfaces, there is still a need to establish heuristics for specific domains to ensure that their specific usability issues are identified. This paper presents a comprehensive review of 70 studies related to usability heuristics for specific domains. The aim of this paper is to review the processes that were applied to establish heuristics in specific domains and identify gaps in order to provide recommendations for future research and area of improvements. The most urgent issue found is the deficiency of validation effort following heuristics proposition and the lack of robustness and rigour of validation method adopted. Whether domain specific heuristics perform better or worse than general ones is inconclusive due to lack of validation quality and clarity on how to assess the effectiveness of heuristics for specific domains. The lack of validation quality also affects effort in improving existing heuristics for specific domain as their weaknesses are not addressed.

Future directions for the development of virtual reality within an automotive manufacturer

Virtual Reality (VR) can reduce time and costs, and lead to increases in quality, in the development of a product. Given the pressure on car companies to reduce time-to-market and to continually improve quality, the automotive industry has championed the use of VR across a number of applications, including design, manufacturing, and training. This paper describes interviews with 11 engineers and employees of allied disciplines from an automotive manufacturer about their current physical and virtual properties and processes. The results guided a review of research findings and scientific advances from the academic literature, which formed the basis of recommendations for future developments of VR technologies and applications. These include: develop a greater range of virtual contexts; use multi-sensory simulation; address perceived differences between virtual and real cars; improve motion capture capabilities; implement networked 3D technology; and use VR for market research.

Long-term complications after facial, pharyngeal, laryngeal and tracheal traumas

Long-term complications after facial, pharyngeal, laryngeal and tracheal traumas.

OBJECTIVE

To review and summarize the existing evidence for long-term anatomical and functional complications after pharyngeal, laryngeal and tracheal traumas.

DATA SOURCES

The MEDLINE database and the bibliographies of relevant studies were selected, analysed and appraised prior to December 2015.

METHODS

With regard to the search strategy, the selected items were: ((long-term complications) AND pharyngeal) AND laryngeal) AND tracheal) AND traumas. Abstracts and titles were screened for relevance, while full articles of the se- lected records were evaluated and critically appraised after inclusion. Data concerning life-threatening situations, as well as long-term severe adverse effects were collected.

The use of virtual reality and physical tools in the development and validation of ease of entry and exit in passenger vehicles

Ease of entry and exit is important for creating a positive first impression of a car and increasing customer satisfaction. Several methods are used within vehicle development to optimise ease of entry and exit, including CAD reviews, benchmarking and buck trials. However, there is an industry trend towards digital methods to reduce the costs and time associated with developing physical prototypes. This paper reports on a study of entry strategy in three properties (buck, car, CAVE) in which inconsistencies were demonstrated by people entering a vehicle representation in the CAVE. In a second study industry practitioners rated the CAVE as worse than physical methods for identifying entry and exit issues, and having lower perceived validity and reliability. However, the resource issues associated with building bucks were recognised. Recommendations are made for developing the CAVE and for combinations of methods for use at different stages of a vehicle's development.

The da Vinci robotic system in head and neck surgery

Intuitive Surgical Inc. (Sunnyvale, Ca, USA) extended the use of the da Vinci robot to head and neck surgery in 2005 following the previous use in urological, gynecological and cardiothoracic surgery. It then gained wide popularity throughout the globe. Our aim is to describe the da Vinci Robot System and discuss its applications in head and neck surgery. Continued refinements and applications in robotic surgery for otolaryngology will in time be possible as new robotic procedures are developed for endolaryngeal work.

Functional outcomes after transoral robotic surgery for squamous cell carcinoma of the oropharynx

Over the past decade, the development of transoral robotic surgery (TORS) brought a new opportunity in the treatment of early T-stage oropharyngeal squamous cell carcinoma (OPSCC). The objective of this study is to review the functional outcomes after TORS. Indeed, dysphagia is among the most commonly cited functional impairments in OPSCC survivors treated by surgeries with an open approach or conventional radiotherapy. We performed a review of the literature and analysed functional outcomes after TORS. Althought the technique is very recent, early functional and oncologic outcome data are promising and the major studies analysing these parameters support that TORS is feasible and safe as well as oncologically and functionally efficacious.

Transoral robotic surgery for base of tongue neoplasms

Surgery to the base of tongue (BOT) in the presence of neoplasm is a challenging topic for head and neck surgeons. This area is difficult to access and includes important neurovascular structures such as the hypoglossal nerve and lingual artery. The pivotal role of the tongue base in swallowing makes planning the surgical approach more challenging. The surgical approaches vary from open neck/mandibulotomy to transoral laser surgery (TLS) which have significant disadvantages. After introduction of transoral robotic surgery (TORS) to otolaryngology practice with the da Vinci Surgical system, we have in our armamentarium a new approach to the BOT. The improved exposure with new retractors, 3-dimensional (3-D) visualization and magnification and advanced motion capacity allow for increased ease to perform surgery in this difficult area. In recent years, several articles published the data about safety and feasibility of TORS for various conditions. This article presents our approach to the BOT for neoplasms including malignant and benign lesions.

Understanding the complex needs of automotive training at final assembly lines

Automobile final assembly operators must be highly skilled to succeed in a low automation environment where multiple variants must be assembled in quick succession. This paper presents formal user studies conducted at OPEL and VOLVO Group to identify assembly training needs and a subset of requirements; and to explore potential features of a hypothetical game-based virtual training system. Stakeholder analysis, timeline analysis, link analysis, Hierarchical Task Analysis and thematic content analysis were used to analyse the results of interviews with various stakeholders (17 and 28 participants at OPEL and VOLVO, respectively). The results show that there is a strong case for the implementation of virtual training for assembly tasks. However, it was also revealed that stakeholders would prefer to use a virtual training to complement, rather than replace, training on pre-series vehicles.

Transoral robotic tongue base reduction in surgical management of obstructive sleep apnea syndrome

Management of base of tongue (BOT) is a challenging topic in surgical management of obstructive sleep apnea syndrome. After the introduction of transoral robotic surgery technology (TORS) into the otolaryngology practice, surgery on the BOT was performed more effectively. Base of tongue reduction can be performed alone or as a part of a multilevel surgery. Patient selection is important and will be discussed further in this study. Available studies show promising and encouraging results for TORS future use in BOT.

Mapping ergonomics application to improve SMEs working condition in industrially developing countries: a critical review

In industrially developing countries (IDC), small and medium enterprises (SMEs) account for the highest proprotion of employment. Unfortunately, the working conditions in SMEs are often very poor and expose employees to a potentially wide range of health and safety risks. This paper presents a comprehensive review of 161 articles related to ergonomics application in SMEs, using Indonesia as a case study. The aim of this paper is to investigate the extent of ergonomics application and identify areas that can be improved to promote effective ergonomics for SMEs in IDC. The most urgent issue found is the need for adopting participatory approach in contrast to the commonly implemented top-down approach. Some good practices in ergonomics application were also revealed from the review, e.g. a multidisciplinary approach, unsophisticated and low-cost solutions, and recognising the importance of productivity. The review also found that more work is still required to achieve appropriate cross-cultural adaptation of ergonomics application.

The effects of self-awareness on body movement indicators of the intention to deceive

A study was conducted to investigate the body movements of participants waiting to be interviewed in one of two conditions: preparing to answer questions truthfully or preparing to lie. The effects of increased self-awareness were also investigated, with half of the participants facing a mirror; the other half facing a blank wall. Analysis of covertly obtained video footage showed a significant interaction for the duration of hand/arm movements between deception level and self-awareness. Without a mirror, participants expecting to lie spent less time moving their hands than those expecting to tell the truth; the opposite was seen in the presence of a mirror. Participants expecting to lie also had higher levels of anxiety and thought that they were left waiting for less time than those expecting to tell the truth. These findings led to the identification of further research areas with the potential to support deception detection in security applications.

[Laryngeal metastasis of a colonic adenocarcinoma]

We report the case of a 63 year old man with laryngeal metastasis of a colonic adenocarcinoma recurrent after partial cordectomy by CO2 Laser microlaryngoscopy. This patient was followed for this condition between 2009 and 2010. The rarity of metastatic laryngeal metastases, particularly when the primary tumor is colic, justifies this presentation.

Safety of intralesional cidofovir in patients with recurrent respiratory papillomatosis: an international retrospective study on 635 RRP patients

Intralesional use of cidofovir (Vistide(®)) has been one of the mainstays of adjuvant therapy in patients with recurrent respiratory papillomatosis (RRP) since 1998. In 2011, a communication provided by the producer of cidofovir addressed very serious side effects concerning its off-label use. As this was a general warning, it was inconclusive whether this would account for its use in RRP. The aim of this study is to determine whether nephrotoxic, neutropenic, or oncogenic side effects have occurred after intralesional use of cidofovir in patients with RRP. Update of recent developments in RRP, a multicentre questionnaire and a multicentre retrospective chart review. Sixteen hospitals from eleven countries worldwide submitted records of 635 RRP patients, of whom 275 were treated with cidofovir. RRP patients received a median of three intralesional injections (interquartile range 2-6). There were no statistical differences in occurrence of neutropenia or renal dysfunction before and after cidofovir. There was no statistical difference in occurrence of upper airway and tracheal malignancies between the cidofovir and the non-cidofovir group. In this retrospective patient chart review, no clinical evidence was found for more long-term nephrotoxicity, neutropenia or laryngeal malignancies after the administration of intralesional cidofovir in RRP patients.

Abdominal pain and a raised amylase? It's not always pancreatitis

We report the case of a 72 year old man with a history of COPD and heavy alcohol consumption who was initially diagnosed with acute pancreatitis based on a presentation with epigastric pain and elevated serum amylase. Review of his notes revealed several previous similar admissions and extensive normal investigations apart from persistently elevated amylase. Further analysis showed evidence of macroamylasaemia which accounted for the apparently high serum amylase level.

Validating a low cost approach for predicting human responses to emergency situations

This paper presents a new approach for predicting human responses to emergency situations. The approach was developed for ergonomists working in emergency response preparedness. It involves presenting participants with a description of a hypothetical emergency scenario before asking them to describe how they would respond. This study builds upon previous investigations (Lawson et al., 2009a, 2009b; Lawson, 2011) which demonstrated significant associations between the predicted behaviour and that reported in a reference study of behaviour in real fires. This further work aimed to evaluate in greater detail the validity, reliability, resources and ethics of the approach. The results demonstrated significant relationships between the predicted behaviours and those from the reference study for both frequencies (r(s) = 0.572, N = 51, p < 0.001) and sequences (r(s) = 0.344, N = 40, p < 0.05) of behaviour. The approach is shown to be replicable and requires low resources. It does not present any notable risk of physical injury.

[Clinical case of the month. Left recurrent neck abscess revealing a fourth branchial cleft fistula]

The fourth branchial cleft fistula, which can be the origin of a recurrent left neck abscess, is a rare congenital malformation. Its diagnosis can be difficult. A ten-year-old girl presented with a left painful swelling of the neck. At ultrasonography and tomodensitometry, the diagnosis of thyroglossal cyst was suspected. Antibiotics were prescribed before surgical resection. The intervention was successful and the peroperative macroscopic aspect of the lesion suggested a dermoid cyst. Four months later, the same symptoms reappeared with fever. An intravenous antibiotic therapy was started while a magnetic resonance imaging demonstrated a possible aero-digestive tract fistula. Two days later, the patient developed an aero-cutaneous fistula. Oral antibiotics were started. Five months later, the girl came back for a second recurrence. A few days after her admission, she developed again an aero-cutaneous fistula. The diagnosis of surinfected fourth cleft fistula was made. An antibiotic therapy was started until the second intervention. After discussion about embryology, we describe the physiopathology, the differential diagnosis and the management of a fourth branchial cleft fistula causing recurrent left neck abscess.

Assessment of liquid captopril formulations used in children

OBJECTIVE

Unlicensed liquid captopril formulations are commonly used to treat children with heart disease. This study assessed the bioequivalence of two liquid preparations against a licensed tablet form.

DESIGN

An open label, single dose, three-treatment, three-period, crossover trial.

SETTING

Outpatient.

PATIENTS

Healthy adult volunteers (n=18).

INTERVENTIONS

Each subject was randomly assigned to one of six dosing sequences, and dosed with 25 mg captopril on each of three dosing visits separated by a washout of at least 14 days. Blood samples for pharmacokinetic analysis were taken at regular intervals (0 min to 10 h) post-dose.

MAIN OUTCOME MEASURES

Bioequivalence of the formulations would be concluded if the 90% CI for the estimated ratio of the means of C(max) (maximum plasma concentrations) and area under curve(AUC) (extent of absorption) lay entirely within the range 0.8 to 1.25

RESULTS

Both liquid formulations failed the bioequivalence assessment with respect to C(max) and AUC. The 90% CI of the mean ratios of liquid/licensed tablet for both C(max) and AUC, fell outside the 0.8 to 1.25 limits. There was also considerable within-subject variability in C(max) (97.5%) and AUC (78.5%).

CONCLUSIONS

Unlicensed captopril formulations are not bioequivalent to the licensed tablet form, or to each other, and so cannot be assumed to behave similarly in therapeutic use. Thus formulation substitution must be done with care and may require a period of increased monitoring of the patient. There is also significant within-subject variability in performance which has clinical implications with respect to titrating to an optimum therapeutic dose.

Laryngeal Kaposi sarcoma: case report and literature review

PROBLEM/OBJECTIVE

Kaposi sarcoma is the most frequently-occurring neoplasm in AIDS patients. Laryngeal localization is infrequent. We discuss the management options for laryngeal Kaposi sarcoma based on a literature review.

CASE REPORT

A 42 year old, HIV-positive male receiving HAART therapy presented with mild hoarseness and sore throat. Fiberoptic laryngeal examination identified a small purple lesion in the right ventricular fold. He underwent biopsy under general anaesthesia. The lesion was histologically diagnosed as a Kaposi sarcoma. Systemic treatment was pursued, but 6 weeks later the patient developed severe dysphagia and acute airway obstruction when the lesion became glotto-supraglottic and obstruced the airway. Transoral tumour vaporization with a CO2 laser was performed in the emergency department. Post-operative chemotherapy was administered. Three months later, the patient was completely asymptomatic and the laryngeal examination was normal.

CONCLUSION

Transoral CO2 laser vaporization combined with chemotherapy is a valid option for managing obstructive laryngeal Kaposi sarcoma.

Case report: Severe laryngeal hemorrhage after withdrawal of a size 5 I-gel in elective surgery

PURPOSE

Report a case of a patient, who benefitted from the I-gel, during an elective urological surgery and who presented severe laryngeal hemorrhage at the time of its withdrawal.

CLINICAL FEATURES

A 71-year-old male patient had been admitted in the operating room for the insertion of a ureteral stent. He had a history of usual interstitial pneumonia (UIP) requiring corticosteroids and oxygen therapy and a severe obstructive sleep apnea syndrome treated with nasal continuous positive airway pressure (NCPAP). After intravenous induction of anesthesia, a size 5 I-gel (Intersurgical, Wokhingam, UK) was easily inserted in the first attempt. Anesthesia was maintained with sevoflurane. As soon as the procedure ended, the I-Gel was removed. After two minutes, the patient presented a respiratory distress and started spitting significant quantity of blood. Oropharyngeal fiberscopy was performed in emergency and highlighted active bleeding of the left aryepiglottic fold. Hemostasis was obtained by local compression. The patient was transferred to the intensive care unit. He was extubated the following day without complications. No additional procedure was necessary to stop the bleeding.

CONCLUSION

Authors reported the first severe complication associated with the use of size 5 I-gel. Additional studies have to be carried out to specify the advantages and risks associated with the use of this recent material.

Gastrointestinal dysfunction in mice with a targeted mutation in the gene encoding vasoactive intestinal polypeptide: a model for the study of intestinal ileus and Hirschsprung's disease

In 1970, Drs. Said and Mutt isolated a novel peptide from porcine intestinal extracts with powerful vasoactive properties, and named it vasoactive intestinal peptide (VIP). Since then, the biological actions of VIP in the gut as well as its signal transduction pathways have been extensively studied. A variety of in vitro and in vivo studies have indicated that VIP, expressed in intrinsic non-adrenergic non-cholinergic (NANC) neurons, is a potent regulator of gastrointestinal (GI) motility, water absorption and ion flux, mucus secretion and immune homeostasis. These VIP actions are believed to be mediated mainly by interactions with highly expressed VPAC(1) receptors and the production of nitric oxide (NO). Furthermore, VIP has been implicated in numerous physiopathological conditions affecting the human gut, including pancreatic endocrine tumors secreting VIP (VIPomas), insulin-dependent diabetes, Hirschsprung's disease, and inflammatory bowel syndromes such as Crohn's disease and ulcerative colitis. To further understand the physiological roles of VIP on the GI tract, we have begun to analyze the anatomical and physiological phenotype of C57BL/6 mice lacking the VIP gene. Herein, we demonstrate that the overall intestinal morphology and light microscopic structure is significantly altered in VIP(-/-) mice. Macroscopically there is an overall increase in weight, and decrease in length of the bowel compared to wild type (WT) controls. Microscopically, the phenotype was characterized by thickening of smooth muscle layers, increased villi length, and higher abundance of goblet cells. Alcian blue staining indicated that the latter cells were deficient in mucus secretion in VIP(-/-) mice. The differences became more pronounced from the duodenum to the distal jejunum or ileum of the small bowel but, became much less apparent or absent in the colon with the exception of mucus secretion defects. Further examination of the small intestine revealed larger axonal trunks and unusual unstained patches in myenteric plexus. Physiologically, the VIP(-/-) mice showed an impairment in intestinal transit. Moreover, unlike WT C57BL/6 mice, a significant percentage of VIP(-/-) mice died in the first postnatal year with overt stenosis of the gut.

Posthemicricoidectomy reconstruction with a composite hyoid-sternohyoid osseomuscular flap: the Rethi–Ward technique

Our objective was to introduce a new technique for cricoid cartilage reconstruction. A 74-year-old male patient with a history of a 6-month progressively worsening dyspnea was found to have an extensive mass of the left cricoid cartilage. Although the extent of his disease would necessitate total laryngectomy, the patient underwent an open extended left hemicricoidectomy with reconstruction of the defect by a pedicled osseomuscular flap composed of the body of the hyoid bone and the contralateral sternohyoid muscle. Both frozen section and subsequent histopathological evaluation gave the diagnosis of a chondrosarcoma. A Montgomery T-tube was left in place for 3 months and was subsequently replaced by a tracheostomy tube to be removed 1 month later. Six months postoperatively, the patient remains in an excellent respiratory condition. The reconstructed site is patent without any signs of restenosis as up to date. We conclude that our technique appears to be a reliable alternative to total laryngectomy in cases of extended chondrosarcomas, as well as in cases where reconstruction of the cricoid cartilage is mandated. Further follow-up and additional cases are warranted.

An ultra-clean firn core from the Devon Island Ice Cap, Nunavut, Canada, retrieved using a titanium drill specially designed for trace element studies

An electromechanical drill with titanium barrels was used to recover a 63.7 m long firn core from Devon Island Ice Cap, Nunavut, Canada, representing 155 years of precipitation. The core was processed and analysed at the Geological Survey of Canada by following strict clean procedures for measurements of Pb and Cd at concentrations at or below the pg g(-1) level. This paper describes the effectiveness of the titanium drill with respect to contamination during ice core retrieval and evaluates sample-processing procedures in laboratories. The results demonstrate that: (1) ice cores retrieved with this titanium drill are of excellent quality with metal contamination one to four orders of magnitude less than those retrieved with conventional drills; (2) the core cleaning and sampling protocols used were effective, contamination-free, and adequate for analysis of the metals (Pb and Cd) at low pg g(-1) levels; and (3) results from 489 firn core samples analysed in this study are comparable with published data from other sites in the Arctic, Greenland and the Antarctic.

Voice prostheses: long-term follow-up retrospective study (three- to sixteen-year follow-up of 22 patients)

BACKGROUND

Thirty-five patients using tracheoesophageal voice with a 3- to 16-year follow-up were investigated. We analyzed functional voice outcome, voice prosthesis (VP) lifespan, and VP-related complications.

METHODS

Between 1987 and 2001, 81 patients underwent total laryngectomy (TL). The 35 currently surviving patients (31 men, 4 women) were studied for VP lifespan and VP-related complications encountered up to 16 years after surgery. For voice rehabilitation, the 35 laryngectomies of our study required 178 prostheses. Short- and long-term voice results of 22 patients were compared by objective voice examination: maximum phonation time (MPT), intensity range (Int.), fundamental frequency (F0), frequency analysis (FA), and voice handicap index (VHI).

RESULTS

Long-term results are: F0=131 (range: 30-250); Int=22.5 dB (range: 17-35 dB); MPT=4 sec (range: 2-12 sec); FA=3 (range: 1-4); VHI=38/120 (range: 8-73). Short- vs long-term outcome comparison shows the following values: F0: 93 vs 135 Hz; Int: 25 vs 24 dB; FA: 1 vs 3; and MPT: 21 vs 4 sec. The mean VP lifespan is 165.5 days for Provox (range: 2 days-30 months); 143.5 days for Blom-Singer (range: 10 days-24 months); and 195 days for VoiceMaster (6-7 months). Postoperative complications involved 12 cases of periprosthetic leakage (6.74%); 31 granulomas (17.4%); 3 partial stenoses of the tracheoesophageal tract (1.6%); and 1 temporarily removed VP (0.5%).

CONCLUSIONS

Complications are generally resolved during standard office-setting examination. The commercially available VPs are complementary, used according to the diverse characteristics of each VP.

Use of a laryngeal mask during medialization laryngoplasty

OBJECTIVES

In certain instances medialization thyroplasty under local anesthesia is awkward for the patient and complicates surgery. Moreover, for certain operations such as for sulcus vergeture or presbyphonia, subjective auditory appreciation of vocal improvement under operating room conditions is not efficient. In those various instances, we therefore perform thyroplasty under general anaesthesia using a laryngeal mask, and under fibrerscopic control.

MATERIAL AND METHOD

A joint connecting the laryngeal mask to the ventilation tube is angled and comprises a small valve through which a fiberscope is slipped. We have used this method since April 99 for 11 surgery procedures.

RESULTS AND CONCLUSION

To date, we have not encountered intraoperative complications that have required intubating the patient in order to continue surgery. It can, however, occur that a change in head posture during surgery displaces the mask. In that event, surgery must be momentarily interrupted in order to re-position the mask. The vocal results met expectations.

Laser-assisted surgery addressing snoring long-term outcome comparing CO2 laser vs. CO2 laser combined with diode laser

Our study encompasses 61 patients (49 men--80.3%; 12 women--19.7%) treated from September 1998 through August 2001. Mean follow-up covers 25 months (range: 7-43 months). Our CO2-LAUP technique involves vaporizing the palatine mucosa along a rectangular surface from the palatal dimple to the base of the uvula; trimming the palatine arches under the velum; and resecting the uvula. For 22 patients, we employed intravelar diode laser coagulation in the expectation of reducing the postoperative pain whilst achieving the same therapeutic effectiveness. There is no pain difference between the CO2-LAUP technique versus that combining intravelar diode laser coagulation with CO2 laser uvula resection and trimming of the palatine arches. Mean maximal pain reaches 6.93 +/- 3.55 with CO2 laser and 6.95 +/- 3.64 with CO2 laser plus diode laser. Similarly, both techniques involve the same mean algesic period of 22 days with the day of maximal pain at 1 week after surgery. Associating base of tongue vaporization significantly increases the algesic period (p = 0.042). No long-term complications were observed in relation to intravelar coagulation or LAUP, whether combined or not with base of tongue vaporization. In terms of patients satisfaction, no significant difference exists between the various surgical techniques of the velum alone. The satisfaction rate reaches 5.26 +/- 3.92 with CO2 laser and 5.82 +/- 2.67 with the CO2 laser plus diode laser. Satisfaction is statistically identical when base of tongue vaporization is included in the procedure.

[Laryngitis revealing bacterial tracheitis in a five-year-old child]

CASE REPORT

We report the case of a five-year-old boy with clinical features of croup and left lower lobe pneumonia. Response to inhaled adrenaline and dexamethasone was incomplete and he developed respiratory distress. Direct laryngoscopy performed in the operating room showed mild glottic and subglottic inflammation. On bronchoscopy, there was thick pus coming from the left lower lobe. He was intubated for three days and regular toilet brought back thick pus. Tracheal fluid culture grew Haemophilius influenzae.

COMMENTS

We suggest that he had bacterial tracheitis but that the tracheal involvement was not prominent at the time of diagnosis.

CONCLUSION

Laryngoscopy and bronchoscopy in specialized surroundings should be considered for each child with croup unresponsive to conventional treatment, especially in case of lower respiratory tract involvement.