Mechanisms of gastric distention in esophageal atresia with distal tracheoesophageal fistula.

This paper explains how the chest of the crying infant with the common form of esophageal atresia is a pump for ventilating the distal esophagus and inflating the stomach. Esophageal inflation from the trachea occurs during inspiration and esophageal deflation into the stomach during cry.

Rehabilitation medicine.

This article presents a limited overview of the assistance rehabilitation medicine can offer the elderly surgical patient. Appropriately timed rehabilitation can positively affect surgical outcome of elderly patients by restoring physical abilities and promoting independent function. Specific techniques and programs that follow rehabilitation principles can help offset organ system impairment associated with the aging process itself.

Diagnosis of tracheoesophageal fistula by analysis of gastric air.

Two patients receiving positive pressure ventilation experienced marked gaseous abdominal distension. Analysis of gases from the stomach, ventilator, and room air suggested that the gastric gases came from the ventilator in one patient. The diagnosis of tracheoesophageal fistula was confirmed by esophagoscopy.

Dysphagia and expiratory air flow.

Expiratory air flow preserves the freedom of the upper airway from foodway contamination in patients with dysphagia. Valving the tracheostomy cannula, "quad coughing," the Heimlich maneuver, the "supraglottic swallow," and coupling to a ventilator each has a place among the measures used for treating aspiration.

Scintigraphy for the detection and quantification of subglottic aspiration: preliminary observations.

Eleven patients with previously documented aspiration underwent a radioisotopic swallowing study to detect and quantify airway penetration. In those subjects able to complete a rapid-acquisition phase during swallowing, no laryngotracheal penetration was seen despite previous evidence of aspiration. However, sequential static pulmonary imaging showed significant aspiration in three individuals.

Using ventilators for speaking and swallowing.

An inflated cuff, although commonly thought to be required for the ventilator-dependent patient with a tracheostomy cannula, precludes speaking and has adverse implications for swallowing. Clinical trials with five ventilator-dependent, cognitively intact individuals with glottic control document that a deflated cuff is compatible with ventilation, preserves oral communication, and restores safe alimentation by mouth.

A novel sorbitol transport mechanism in cultured renal papillary epithelial cells.

The renal papillary epithelial cell line, GRB-PAP1, accumulates sorbitol when grown in a hypertonic (500 mosmol/kgH2O) bathing medium. When the cells are returned to a 300 mosmol/kgH2O medium, they lose their sorbitol rapidly to the bath. Sorbitol movement across the membranes of these cells was investigated by studying the uptake of radioactive sorbitol and related compounds.

Electromyography of the pharyngeal musculature: technical considerations.

Thirty-one EMG studies of the pharyngeal musculature using three types of electrodes were performed. Electrode characteristics are compared according to criteria developed specifically for the pharynx; techniques for electrode positioning are described in detail; and technical difficulties encountered in performing these studies are discussed. Needle electrodes were best for analyzing individual potentials.

Depolarization-induced alkalinization in proximal tubules. II. Effects of lactate and SITS.

Intracellular pH and voltage microelectrodes were used to further characterize the depolarization-induced alkalinization (DIA) observed in isolated perfused proximal tubules of the tiger salamander Ambystoma tigrinum. Tubules were depolarized by raising basolateral [K+] from 2.5 to 50 mM.

Depolarization-induced alkalinization in proximal tubules. I. Characteristics and dependence on Na+.

We used intracellular pH-sensitive and voltage microelectrodes to examine the effects of depolarization on intracellular pH (pHi) in isolated perfused proximal tubules from the tiger salamander Ambystoma tigrinum. Tubules were depolarized by raising [K+] in the bath (b) or lumen (l), or by adding Ba2+ (1 mM) to the bath or lumen, always in nominally HCO3-free solutions. Increasing [K+]b from 2.

Bolus position at swallow onset in normal adults: preliminary observations.

A "delayed swallowing reflex/response" (i.e., when the swallow reflex is not triggered when the bolus passes the back of the tongue at the anterior facial arch) Logemann has been widely accepted as an abnormality.

Motions of the posterior pharyngeal wall in swallowing.

The motions of the posterior pharyngeal wall during swallowing were studied in four asymptomatic males using a new method for videoradiography. Radiopaque markers of 4 mm diameter were affixed to the pharyngeal wall by suction. Ventrodorsal and axial components of motion were measured frame by frame.

Role of monocarboxylate transport in the regulation of intracellular pH of renal proximal tubule cells.

Traditional models of acid-base transport and intracellular pH (pHi) regulation in the renal proximal tubule have been based on the existence of a Na+/H+ exchanger at the luminal membrane and a simple HCO3- conductance at the basolateral membrane. Our recent work, in which we used pH-sensitive microelectrodes or dyes to monitor pHi in isolated renal tubules perfused in the nominal absence of HCO3-, has demonstrated the existence of a novel mechanism of acid extrusion in amphibian and mammalian proximal tubule cells. The salamander proximal tubule, for example, possesses an electroneutral Na+ monocarboxylate (Na+-X-) co-transporter, but only at the luminal membrane.

Solute transport and epithelial cell volume regulation.

1. The regulation of epithelial cell volume is an essential requirement for normal tissue function and the maintenance of cellular integrity. 2.

Effect of electroneutral luminal and basolateral lactate transport on intracellular pH in salamander proximal tubules.

We used microelectrodes to examine the effects of organic substrates, particularly lactate (Lac-), on the intracellular pH (pHi) and basolateral membrane potential (Vbl) in isolated, perfused proximal tubules of the tiger salamander. Exposure of the luminal and basolateral membranes to 3.6 mM Lac- caused pHi to increase by approximately 0.

Electrogenic Na/HCO3 cotransport across basolateral membrane of isolated perfused Necturus proximal tubule.

This study was undertaken to determine whether the proximal tubule of the mud puppy Necturus maculosus possesses a basolateral Na/HCO3 cotransporter. We examined the effects on basolateral membrane potential (Vbl) and intracellular pH (pHi) of 1) lowering basolateral [HCO3-] at constant PCO2, and 2) replacing Na+ with N-methyl-D-glucamine. Vbl and pHi were measured with Ling-Gerard and liquid-membrane pH microelectrodes, respectively, in isolated tubules perfused in vitro.

Achondroplasia: effectiveness of an orthosis in reducing deformity of the spine.

Deformity of the spine and its complications have long been accepted as characteristics of achondroplasia. We have sought to prevent these with a spinal orthosis. This report includes a description of the orthosis and an analysis of its use in achondroplastic children and adults.

Exercise program for patients after cardiac surgery.

The effects of an exercise program on patients after cardiac surgery were studied. The physical status and length of hospitalization of 44 patients who were not exposed to the program (group I) were compared with those of 43 program participants (group II). All patients were evaluated preoperatively and before hospital discharge.

Correlates and consequences of eating dependency in institutionalized elderly.

Loss of independent eating capacity is a major problem for the institutionalized elderly. Few studies have examined the factors associated with loss of functional eating capacity. The authors cross-sectionally studied 240 residents of a skilled nursing facility, classified their functional eating status, identified correlated deficits, and followed these residents for six months.

Volume-regulatory responses of Amphiuma red cells in anisotonic media. The effect of amiloride.

Amphiuma red cells were incubated for several hours in hypotonic or hypertonic media. They regulate their volume in both media by using ouabain-insensitive salt transport mechanisms. After initially enlarging osmotically, cells in hypotonic media return toward their original size by losing K, Cl, and H2O.

Psychosocial services in rehabilitation medicine: an interdisciplinary approach.

Psychosocial adjustment to disability is an area of special need, often requiring intervention by mental health professionals, including social workers, psychologists, and psychiatrists. While the availability of all these disciplines is optimal for comprehensive psychosocial intervention, the use of multiple mental health disciplines may create problems of role confusion, overlapping efforts, and discontinuity of care. This paper presents the development of a psychosocial team as a method for identifying service goals, differentiating roles, coordinating psychosocial care, and educating rehabilitation staff on the expertise and proper use of the psychosocial disciplines.

Further studies of the volume-regulatory response of Amphiuma red cells in hypertonic media. Evidence for amiloride-sensitive Na/H exchange.

When Amphiuma red cells are shrunken in hypertonic media, they return toward their original volume by gaining Na through an amiloride-sensitive pathway. As cells recover their volume during this volume-regulatory increase (VRI) response, acid is extruded into the medium. Medium acidification is correlated with cell Na uptake.