In Experiment 1 four groups of rats received 30 light-shock pairings using footshock intensities of either .2, .4, .8, or 1.6 mA. One day later all rats were tested for startle by presenting tones in the presence or absence of the light CS. Potentiated startle (the difference between startle on light-tone vs tone-alone trials) was nonmonotonically related to the shock intensity used in training, with the greatest potentiation at intermediate shock levels. Experiment 3 demonstrated a similar relationship when backshocks instead of footshocks were used. In Experiment 2 rats were trained with either a moderate or high shock and then given an extended extinction-test session 1 day later. The moderate-shock group showed a gradual decline in potentiated startle over extinction. The high-shock group showed a nonmonotonic extinction curve where potentiation progressively increased toward the middle of extinction and dissipated thereafter. The results suggest that acoustic startle bears an inverted U-shaped relationship to fear and are discussed in relation to other studies concerned with this issue.

Horizontal osteotomy allows the surgeon to safely down‐fracture the maxilla for wide exposure of the central skull base. This surgical approach is easily extended posteriorly in the midline to include the clivus and the arch of C1, providing 8 cm of horizontal anterior exposure and 5 cm of posterior. Wide operative exposure and a low rate of complications afford superior functional and cosmetic preservation in removing tumors of the central cranial base.

Musicians who play woodwind or brass instruments must generate extremely high intraoral pressures to achieve normal tone and volume in their music. Intraoral pressures of 130 mm Hg can be reached, while normal speech rarely exceeds 6 mm Hg. The inability to maintain an effective seal between the soft palate and the pharyngeal wall can manifest as difficulty in holding high notes or in playing sustained music compositions, or noise production from turbulent nasal cavity emissions. Throughout the literature, there are few reports of these entities. We will present the case of a 31-year-old concert bassoonist who complained of "noise from her head" only when she played the bassoon. This resulted in numerous failed auditions and threatened her professional career. The diagnosis of velopharyngeal stress incompetence, as well as the Teflon injection augmentation procedure, was done under local anesthesia with the subject playing the bassoon. The use of videoendoscopic techniques allowed accurate, reproducible assessment of the defect and the operative procedure, and assisted in postoperative evaluation.

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There have been no reports of stomal complications and airflow line problems associated with a cuffed talking tracheotomy tube. However, the results of this study showed that stomal complications, in the form of pressure necrosis and wound extension, and problems with airflow line kinking occurred with a 40% and 80% frequency, respectively. Solutions to both difficulties are discussed.

Direct infusion of d-amphetamine (25--400 micrograms) or phenylephrine (12.5--50 micrograms) onto the spinal cord (intrathecal administration) increased acoustic startle amplitude. These effects were blocked by IP injection of the alpha 1-adrenergic antagonist WB-4101, but not the serotonin antagonist cyproheptadine. In contrast, intrathecal administration of clonidine (0.9--12.5 micrograms) markedly depressed startle. This effect was not blocked by IP administration of WB-4101 or cyproheptadine, but was blocked by IP or intrathecal administration of the alpha 2-adrenergic antagonist yohimbine (5 mg/kg), which by itself increased startle. Moreover, intrathecal yohimbine (100 micrograms) attenuated the depressant effect of IP clonidine, indicating that the spinal cord partially mediates the depressant effects on startle after systemic administration of clonidine. Thus clonidine does not behave like an alpha 1-agonist on acoustic startle, even when introduced directly onto the spinal cord. Conditions under which clonidine produces excitatory or depressant behavioral effects are discussed.

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The charts of 52 adult patients who underwent tracheotomy (49 after intubation) were reviewed to identify early complications of both endotracheal intubation and tracheotomy. The complication rate of endotracheal intubation was 57%, and of tracheotomy, 14%. None of the complications of tracheotomy was serious. Sixty critical-care nurses were surveyed about their attitudes regarding prolonged endotracheal intubation and tracheotomy. A large majority preferred tracheotomy for patients who require airway support, for several reasons. First, they felt that tracheotomy patients were more comfortable and, therefore, required less sedation and restraint. Second, the patients could communicate more effectively. Third, airway care was simplified. Ninety-two percent of nurses stated that they would prefer a tracheotomy for themselves or a loved one if more than 10 days of ventilatory support were required. We conclude that tracheotomy can be performed safely in this group of patients, and that it offers significant practical and psychological benefits compared to prolonged endotracheal intubation.