Aspiration Research Articles

Window of the Soul

Correspondence to: Chung Chin Hung, FRCS(Glasg), FHKAM(Surgery), FHKAM(Emergency Medicine) North District Hospital, Accident & Emergency Department, 9 Po Kin Road, Sheung Shui, N.T., Hong Kong Email: chunch@ha.org.hk In recent years, Emergency Medicine has witnessed rapid growth and extended usage of emergency ultrasound. An increasing number of residency and fellowship training programmes in ultrasound are being offered and emergency ultrasound as a subspecialty of Emergency Medicine has gained increasing recognition. Not only has the ultrasound machine become standard equipment in emergency departments, but its applications have been rapidly expanding. Emergency phys ic ians have been exploring the use of endovaginal sonography, echocardiography, musculoskeletal sonography, lower-extremity Doppler, testicular ultrasound, ultrasound-guided central line placement, foreign body removal and aspirat ion of abscess , and recently, ocular ultrasound. 1,2

Early abortion in primary care: clinical outcomes

To assess the outcomes of first trimester medication (MED) and aspiration (ASP) abortion procedures in primary care.

Respiratory physiotherapy for nurslings with bronchiolitis: should we do it or not?

The aim of the present work was to compare the effectiveness of the vibrocompression and tapotage technique associatedwith postural draining and the tracheal aspiration technique in nurslings hospitalized due to bronchiolitis. Children below 2 years of ageadmitted at the hospital and in the emergency unit were the research subjects, all with a diagnosis of viral bronquiolitis in spontaneousbreathing in a total of 19 nurslings with clinical and radiological diagnosis of bronquiolitis. For this, the following interventions werecarried through: three groups were randomized: vibrocompression + postural draining (VC+DP); tapotage + postural draining (TAP+DP);and tracheal aspiration (ASP). Saturation of oxygen pulse (SpO2), cardiac frequency (FC), respiratory frequency (f), Silverman – AndersonScore (BSA), which evaluates the respiratory discomfort, were evaluated at three moments: pre-treatment (pre), post-immediate (post i)and 15 minutes after finishing the treatment (post 15); the amount of inhaled secretion was evaluated only in after i. Results show thata significant reduction in BSA and a greater amount of secretion was removed in VC+ DP and TAP + DP groups in post 15 (p < 0.05).There was reduction in FC in post 15 in the three groups. We conclude that VC and TAP, associated to postural draining, were efficientin the removal of secretion and the reduction of respiratory discomfort in nurslings with bronchiolitis.

Assessing Oropharyngeal Dysphagia After Lung Transplantation: Altered Swallowing Mechanisms and Increased Morbidity

Gastroesophageal reflux is associated with lung transplantation (LT) and bronchiolitis obliterans syndrome, limiting allograft functional longevity. LT patients may also develop post-operative oropharyngeal dysphagia, exposing the allograft to further risk. However, the magnitude of this problem is unknown. We examined LT recipients post-operatively for swallowing disorders and correlated findings with pre- and post-operative variables. Two hundred sixty-three LT patients (January 2001 to July 2005) at a single center were retrospectively reviewed. Each underwent clinical swallowing assessment. Provocative swallowing evaluation (SE) was performed in 149 patients (Group 1); 114 patients did not receive formal SE (Group 2). SE studies were considered positive with laryngeal penetration (PEN) or tracheal aspiration (ASP) of thin liquids. Groups were compared with respect to pre-, peri- and post-operative variables using analysis of variance (ANOVA) and chi-square tests. After LT, 56.7% of patients underwent post-operative SE (mean 19 +/- 20 days), most of whom (87.9%) had fiber-optic endoscopic studies. SE was positive for PEN or ASP in 70.5% (n = 105). Aspiration occurred in 63.8% (n = 67) of positive SEs; 77.6% (n = 52) of ASP assessments were clinically silent. Pre-operative gastroesophageal reflux disease (GERD) and post-operative complications, including vocal cord paresis, pleural processes, venous thromboses and severe rejection episodes, were more common among Group 1. Group 2 had a significantly reduced hospital length of stay (p = 0.004). Prospective SE identified strikingly high rates of dysphagia after LT. Because many of these deficits are silent, aggressive pulmonary toilet is especially important after post-operative LT. Pre-operative SE may clarify those at increased risk for new-onset oropharyngeal dysphagia after LT.

Fine needle cytology of complex thyroid nodules

To evaluate whether a preliminary aspiration (ASP) of the cystic component and/or using spinal needles in complex thyroid nodules (CTN) could improve the adequacy of cytological sampling. Between January 2004 and December 2006, 386 consecutive patients with CTN were enrolled in this prospective investigation. Ultrasound (US) fine needle aspiration cytology (FNAC) of the solid component of the nodule (one nodule per patient) was performed using two different 25 gauge needles, with (Yale Spinal, YS) or without (Neolus, NS) a stylet, in alternate sequence on consecutive patients. In addition, a subgroup of patients presenting larger cystic component (approximately 50%) was submitted to total aspiration of the cystic component (ASP+) or not submitted (ASP-) before US-FNAC, in alternate sequence within each needle type group. All the samplings were performed by a single endocrinologist. Adequate specimens were observed in 163 (84.5%) and 183 (94.8%) nodules investigated by NS and YS respectively. Sampling with the stylet needle was associated with an overall significant reduction of non-diagnostic specimens (15.5% vs 5.2% by NS and YS respectively, P < 0.001). The favourable result obtained with YS was independent from preliminary aspiration of the cystic component (ASP+: 14.8% vs 5.7% by NS and YS; ASP-: 16.2% vs 4.8%, not significant). A logistic regression analysis, taking into account nodule size and presence of intranodal vascularity at eco-colour evaluation of the solid component, confirmed that needle type was the only significant predictor of successful sampling (odds ratio 3.6 (95% confidence interval 1.7-7.6), P < 0.001). Our data show that adopting stylet needles to perform FNAC in CTN may significantly improve the percentage of adequate sampling. On the other hand, preliminary aspiration of CTN with large cystic component does not add any advantage.

Democracy in Latin America

country and each presents a different situation; Second, because the answer depends also upon one's concept of democracy. It is probably fair to say that Latin Americans as people are as democratic as Anglo-Ameri cans. But their democracy is expressed in differ ent institutions and patterns of behavior. Some Latin American opinions on the subject, like those of Jose Vasconcelos expressed in his Cre ole Ulysses, are derived from riding third-class or steerage on the big steamships which plied the Caribbean and the coasts of South America in the pre-war days. Others, because of unpleas ant experiences with Anglo-Americans in Latin America or along the Mexican border, feel that they are more democratic because [they are] less class conscious than Anglo-Americans. A Brazilian, Haytian or Cuban observing Jim Crow conditions in the United States might well come to the same conclusion. To a large extent our concept of democ racy in the United States is an Anglo-American product, and especially a product of our own national history during the nineteenth century. We associate the term democracy with orderly elections, stability of government, universal secret suffrage, the federal system and even with certain legal sanctions for the protection of private property and individual economic enterprise which are part of the Anglo-Ameri can systems. Many of us of course, realize that democracy is more than this. From Jefferson on our leaders of democratic thought have pointed out the spiritual strivings and the social aspi rations which constitute its essence, particu larly the aspirations for a better and freer social order. They have seen that democracy is a com plex of all these strivings intimately associated with powerful dynamic elements arising from the conquest of a new continent and from the industrial and technological revolutions of the past century and a half. Inevitably these eco nomic changes broadened the basis of political participation in the nation-state as they opened up opportunities for ampler economic and cul tural life to larger masses of people affected by these historical processes. A good deal of what we recognize as democracy in the modern world is just this broadening of the basis of political structure. Democracy like dictatorship is not absolute. It exists in many different forms and degrees. It is a fact of history, not a proposition of theol ogy. It is a pattern of political behavior, infused with strong spiritual elements, the essence of which is the belief in attainment of a better

The Melancholy (Pro)creation of Franziska zu Reventlow and Gabriele Reuter

Abstract: This article examines two semi-autobiographical novels dealing with single motherhood—Franziska zu Reventlow's Ellen Olestjerne (1903) and Gabriele Reuter's Das Tränenhaus (The House of Tears, 1909)—and demonstrates how both novels refract contemporary discussions of melancholy through the lens of women's experiences as mothers and artists. In contrast to late-nineteenth- and early-twentieth-century medical accounts of melancholic illness, the novels attribute melancholic symptoms not primarily to biological causes, but rather to familial, financial, and societal factors that stand in the way of women's aspirations. At the same time, the novels appropriate the notion of the melancholic temperament in order to elevate women's sadness and thereby link creativity and motherhood. (LH)

Phlebotomines (Diptera: Psychodidae) in forested areas of the Serra da Bodoquena, state of Mato Grosso do Sul, Brazil

Investigation was undertaken on the behaviour of the phlebotomine fauna in caves, forests, and anthropic environments of the Serra da Bodoquena, between January 1998 and January 2000. This paper reports on the phlebotomines captured in forested areas with automatic light traps (ALT), Shannon traps (ST), aspiration (AN), at natural resting sites and by human attractiveness (HA) during 24 h. The diversity and abundance of the species were investigated with ALT installed at 16 points (ground level) and 6 in the canopy. Natural infection by flagellates was investigated in females captured with ST AN, and HA. The sandfly fauna was represented by 23 species. Twenty-two of these were captured with ALT 15 of them on the western side, and 20 on the eastern. Lutzomyia longipalpis and Nyssomyia whitmani were the most abundant on the former and this species together with Lutzomyia almerioi on the latter side. On the eastern side the ecotopes located close to caves rendered a significantly greater number (P < or = 0.01) of specimens than did more distant sites. On this side Lu. almerioi contributed with 56% of the total number of specimens. Lu. almerioi females were predominantly attracted by humans (96.4%) and by ST (93.2%) and three of the 2173 dissected (0.138%) presented natural infection by flagellates. The attraction of Lu. almerioi to humans occurred during all seasons, predominantly in the summer, and in nocturnal and diurnal periods. Thus it is bothersome to inhabitants of and visitors to the Bodoquena ridge and a potential vector of flagellates.

Metabolic correlates of lesion-specific plasticity: an in vivo imaging study

High-resolution positron emission tomography (microPET) allows for repeated observations of brain function in the same animal. In a previous study, using [ 18F] fluorodeoxyglucose (FDG) microPET, we demonstrated diminished glucose metabolism and subsequent recovery in the Neostriatum and thalamus ipsilateral to cortical aspiration (ASP) lesions. Thermocoagulation (TCL) of pial vessels has been shown to result in the same degree of cortical injury but induce more compensatory re-organization than ASP. In the present work, FDG microPET was used to compare glucose metabolism following both TCL and ASP lesions in order to determine whether metabolic differences correlate with the previously described anatomical and functional changes in the two lesion models. Animals were scanned 3-day, 10-day and 1-month post-injury. Estimated cortical lesion size did not differ between the two models at 1 month following injury. Both lesions induced ipsilateral neostriatal and thalamic hypometabolism 3-day post-injury, with subsequent metabolic improvement over time. However, complete recovery was not observed by 1 month in either group. ASP lesions resulted in an overall greater metabolic deficit in the subcortical structures and a greater cortical deficit 1 month following injury when compared to the TCL. Contralateral cortical glucose metabolism at 3 days following injury was not different in the two lesions. These data demonstrate that the two lesions differ somewhat in their metabolic response to injury, and that the relative hypometabolism observed following ASP may be a reflection of the diminished capacity of the contralateral cortex to compensate for ASP as compared to TCL.

Twilight of the Enlightenment: James Headrick (1759–1841)

James Headrick was one of those who have been aptly termed 'foot-soldiers of the Enlightenment'.1 He did, to be sure, have aspira tions beyond serving in the 'poor bloody infantry'. If he did not cherish the delusion that a field-marshal's baton was ready in his knapsack, he certainly had his eye on commissioned rank in the forces of intellectual progress. To end his days as a parish minister in Angus, remembered as 'an excellent man, [who] discharged his parochial duties in a most exemplary manner, and was loved by his parishioners',2 was an entirely respectable achievement; but it fell far short of Headrick's early hopes and ambitions. The future he looked for in his twenties and thirties might have been in academic life or in some other form of public service. It would in any case have been animated by the principles of the Enlightenment applied in a broader context than even Moderate churchmanship could offer in a country parish. The disappointment of those wider hopes may have been due more to faults of personality than to deficiency in talent; but in any case Headrick's career may throw useful light on certain aspects of Scottish intellectual life between the late eighteenth and the early nineteenth century.

Change in Aspiration (ASP) Risk in Children with Cerebral Palsy (CP)

Change in Aspiration (ASP) Risk in Children with Cerebral Palsy (CP)

The concept of luxury in British political economy: Adam Smith to Alfred Marshall

In the discourse of 18th-century British intellectuals the term 'luxury' held a well-recognized and much disputed place. Dispute arose chiefly around the problem of disentangling the economic, moral-theological and political strands of the term. The object of the present paper is to trace forward the history of debate over the concept along one develop ing line of specialization - that of 19th-century political economy. It will be seen how the term luxury (and related terms: necessity, decency, productive, unproductive, etc.) adjusted meaning(s) as the economic, social and intellectual contexts in which it was embedded themselves mutated. In particular, it is argued, the changing significance attached to the term illustrates the extent to which a key 19th-century intellec tual elite managed to accommodate the implications of a transition from a society based on assumptions of scarcity and hierarchy to one that was beginning to contemplate the possibility of mass market abun dance. While the profession's leaders did develop a sharpened interest in aspiration to luxury consumption as a legitimate motor of economic growth, all registered their disapproval of certain forms of the aspira tion, revealing in the process a variety of class, gender and 'race' pre occupations - including (from J. S. Mill onwards) a particular distaste for positional or status-related consumption.

Aspiration Following Stroke

The swallowing musculature is represented asymmetrically in both hemispheres. The association between anatomic location of stroke and the occurrence of aspiration re mains uncertain. We reviewed neurologic, neuroimaging, and videofluoroscopic swallowing stud ies (VSS) in 37 patients with unilateral and bilateral strokes. The hemispheric site, side, and size of the lesion were determined by reviewing each patient's magnetic res onance imaging (MRI) and computerized tomographic (CT) scans. Presence of aspi ration was determined from VSS. All data were tabulated and analyzed based on the presence or absence of aspiration. Twenty patients (54 percent) had aspiration and 50 percent of those with as piration had an impaired cough reflex. The impaired cough reflex was significantly associated with aspiration (p < 0.01). A multivariate analysis looking at all variables of lesion side, size, and location showed that the probability of developing aspiration was higher in patients with left cerebral lesions (p < 0.06). Key Words: Swallowing disorder—Deglutition—MRI/CT—Videofluoroscopy.

A New Telerobotic Application: Remote Laparoscopic Surgery Using Satellites and Optical Fiber Networks for Data Exchange

This article describes the significance in human, scientific, and technical terms of the first experiment in telerobotic surgery carried out between the NASA Jet Propulsion Laboratory in Pasadena, California, and the Telerobotics Laboratory of the Politecnico di Milano on 7 July 1993. An Italian robot in the Telerobotics Laboratory was remotely controlled by an Italian surgeon in the United States. The robot's task was to perform a surgical operation on a model containing a pig's organs, involving execution of a biopsy, aspi ration of organic material, and two incisions in preparation of laparoscopy. Transmission was effected by means of a double satellite link, with three transceiver stations: one in Italy, one close to New York, and one in Pasadena, and two geostation ary satellites, the first over the Atlantic and the second over the United States. The route length of the signals was 150,000 km in each direction, and the two centers are 10,000 km apart.

Fine needle sampling without aspiration

Four hundred and ten thyroid nodules, 127 breast lumps and 43 lymph nodes were sampled and analyzed to compare the classical aspiration (ASP) technique with the non aspiration needle jab (NASP) technique. The adequacy of cellularity, significant blood staining and the discomfort felt by the patient were assessed and statistically analyzed. The non aspiration technique was found to be superior to the classical aspiration technique for fine needle sampling of thyroid in all aspects. However, for breast lesions, while the discomfort felt and the staining with blood was less with the non aspiration technique, the overall cellular yield was unsatisfactory. The adequacy of cellular yield was, however, comparable for malignant breast lesions with either technique. For lymph node sampling, both techniques showed equivalent results with regard to the cellularity but, the NASP technique was superior in other aspects. Although the overall patient discomfort and blood staining was significantly less, the adequacy of the cellularity was influenced by the site and the nature of the lesion. Thus it can be concluded that the technique needs to be selected depending on the anatomic site, the clinical situation, the personal experience and the preference of the operator.

Mechanical Mass Selection Methods for Improvement of Oat Groat Percentage

Three methods of mechanical mass selection for seed density, aspiration (ASP), gravity table selection (GT), and gravity table selection with a seed polishing pretreatment (P‐GT), were evaluated and compared for effectiveness of increasing caryopsis (groat) percentage and test weight in oat (Avena sativa L.). Selection using these methods in two heterogeneous F5 populations resulted in absolute differences in the groat percentage between high and low density treatments of 0.3 and 0.5% for ASP and P‐GT, respectively. The GT selection resulted in a lower groat percentage in the high‐density treatment. Selection methods interacted with populations and seed size classes. These interactions were due to different levels of variation in the populations for seed size and shape. Two cycles of selection for high groat percentage beginning in F3 segregating bulk populations showed little overall improvement. Selection increased the number of fertile florets per spikelet. This increase in fertility was due primarily to a 22% increase in tertiary florets per panicle per cycle of selection. Tertiary floret number exhibited a negative genotypic correlation with groat percentage, which limited improvement for groat percentage. There also were significant changes in plant height, days to flowering, and harvest index in these experiments with direction and magnitude dependent on the individual population. Effectiveness of mechanical mass selection for groat percentage could be increased by avoiding selection for characters such as tertiary kernels which have undesirable correlated effects on milling quality.

Lieber begehrt und im Überfluss als überflüssig und in Not: Ein Beispiel

ZUSAMMENFASSUNGSättigung bedeutet, dass der Grenznutzen des Einkommens abnimmt und die Arbeitsmotivation sinkt. Die beobachtbare Konsequenz von Sättigung müsste also eine Verkürzung der Arbeitszeit bei den vergleichsweise Reicheren sein. Die vorliegende Arbeit zeigt, dass diese Schlussfolgerung falsch ist. Im Gegenteil und scheinbar paradox gilt: Sättigung wird sich eher in Form von höheren Einkommensforderungen, also gewissermassen als Gier äussern. Umgekehrt kann es jenen, die mit der Zufriedenstellung ihrer Mindestansprüche kämpfen, passieren, dass sie bei niedrigeren Lohnsätzen enden, wenn sie ihre Ansprüche reduzieren, um weniger arbeiten zu müssen.

The Challenge of Co‑existence: ASEAN´s Relations with Vietnam in the 1990s

The fall of Saigon in April 1975 was both a cause and a reflection of the changes in the pattern of international relations that had prevailed in Southeast Asia since the arrival of the colonial powers in the middle of the nineteenth century. For over a hundred years the region had been almost completely dominated by great power politics, as one extra-regional major actor after another sought, sometimes achieved, but always failed to establish on a permanent basis, its own preferred order or framework for the conduct of international relations in the region. But, with the American failure in Vietnam and the consequent reduction of the Ameri can role and commitments in Southeast Asia, it was clear that while external power involvement would remain a fact of life for Southeast Asians, no single extra regional major actor would be in a position to exert a predominant influence over the region and the pursuit of the regional states' own interests, demands and aspi rations would have a much more significant impact upon international politics. The most important set of relationships among the regional states is that between the members of the non-communist Association of Southeast Asian Nations (ASEAN) on the one hand, and the communist Indochinese countries, namely Vietnam, Laos and Kampuchea, on the other. In these relationships, the key issue is the one raised by the Vietnamese invasion of Kampuchea in December 1978. For, at stake is not only the future of Kampuchea itself, but also the question of power distribution both in Indochina and in Southeast Asia as a whole. This so-called Kampuchean conflict was brought about by a combination of trends and forces. At one level, it emanated from a crisis of legitimacy in Kam puchea itself, where the Pol Pot regime between 1975 and 1978 sought to consoli date its power through the use of violence, both internal and external. At another level, the conflict stemmed from historical and ethnic antagonisms, geopolitical rivalries, doctrinal differences, and clashes of aspirations in certain dyadic rela tionships among regional (or quasi-regional) states, namely, between China and Vietnam, Vietnam and Kampuchea, and Vietnam and Thailand. At the third level, the conflict was caused by the triangular relationship between the United States, the Soviet Union and China; all three see the distribution of power in Indochina and Southeast Asia as an important, if not a key, issue affecting their security interests, and consequently each seeks to extend its influence in the region or at least to deny the others the opportunity of doing so.

Family Financial Satisfaction: The Impact of Reference Points

The Deacon‐Firebaugh model of family resource management provided the con ceptual framework for this study, which was designed to assess the direct effect of selected inputs on a composite measure of financial satisfaction. This measure reflected satisfaction with consumption level, family wealth, and financial secu rity. The inputs included family income, net worth, and the number of earners in the household (resources); the household's debt‐to‐income ratio and child‐ rearing commitments (demands); perceived change in financial condition over time; and a measure of financial aspirations. It was hypothesized that these last two variables would exert a significant direct impact on financial satisfaction. The data analyzed in this study were collected in two communities in each of three states. The responses from husbands and wives were analyzed separately, using multiple regression analyses. The results supported the hypothesis that the “ref erence point” variables (i.e., perceived change in financial condition and aspira tions for the future) exerted a significant direct impact on financial satisfaction. The full regression models, including eight inputs, accounted for between 30 and 40 percent of the variation in financial satisfaction. The results suggest that future research should further explore both the direct and the indirect influence of past financial experience and aspirations on family financial management and financial satisfaction.

Changes in Sport Habits and their Significance for the Forecasting of Future Forms of Physical Culture

The prinoipal aim of the modern sport movement is the implementation of the motto "sport for all". But it is true that in most of the countries one is still far from the implementation of this goal. The report published here wants to contribute to the discussion on the solution of the discrepancy between aspi rations and the reality of "sport for all". One may assume that more people would practice sport more regularly, provided the supply of sport possibilities would be more in accordance with general cultural development. Therefore out about the specific course of sport activity. A cross-section and analysis of the practicing of sport reveal quite distinctly tendencies for team sport involving games of two opposing teams as well as various kinds of open air sport involving equipment. Research on changes in sport habits takes place within the various types of sport. In this manner it is possible on the one hand to take into account the social and historical nature of sport activity, and on the other hand to find out about the specific course of sport activity. A cross-section and analysis of the practicing of sport reveal quite distinctly tendencies for team sport involving games of two opposing teams as well as various kinds of open air sport involving equipment. In general changes in sport habits point to a tendency of replacing physical energy absorbing moments when practicing sport by greater requirements as regards the mental regulation of sport activity. Individual sport practiced above all in the past, such as swimming, track-and-field events and gymnastics laid special stress on strength, prowess and endurance. However, open air sport and complex team games retain canrstantly changing situations, due to which the need arises for differentiated noticeable achievements and complex intellectual planning processes. Approached from a cultural and theoretical perspective this development makes one assume, that due to the increasingly more complicated kinds of sport the mobility potential of one's own body can be experienced in an enlarged manner and exclusively in sport, during the performance of many-sided sport activities which enable the individual to "enjoy" his own body. Practicing sport people experience and perceive which kind of development of their bodily skills, and actually of their personality is possible already today or in the forseeable future.