Acute laryngeal trauma is a rare injury. In the past 18 years, 77 patients with acute laryngeal trauma have been evaluated at our institution. Each patient's care was overseen by the senior author (E.S.P.). The 61 patients who were seen within 48 hours of their accident are compared with those treated after 48 hours. All patients are classified by both injury (groups 1 through 5) and treatment (types I through III). Results are reported for voice, airway, and swallowing. Our methods of evaluation and treatment are outlined, and controversial aspects of patient management are addressed. We conclude that conservative treatment of group 1 and 2 injuries is 100% effective, expeditious repair of laryngeal injuries greatly reduces poor outcome, and the type of injury can be used to roughly predict patient outcome. Further, with use of current methods of diagnosis and management, almost all patients will be decannulated (98%) with functional speech (100%) and normal deglutition (100%).

Recent data indicate a major role for IL-10 in suppressing immune and inflammatory reactions. To date, expression of human IL-10 has been attributed primarily to helper T lymphocytes, activated monocytes, and neoplastic B cells, and was often found to be associated with IL-6 expression. In this study we sought to determine whether non-hematopoietic human tumor cell lines produce IL-10 and, if so, what is the relationship between IL-10 and IL-6. Using ELISA, we determined IL-10 and IL-6 levels in culture supernatants of 48 cell lines established from carcinomas of the kidney, colon, breast and pancreas, malignant melanomas and neuroblastomas. IL-6 protein was secreted by 28 of the tumor cell lines; IL-10 was measurable in 15 cell lines. IL-6 secretion was maximal and most frequent in renal-cancer cell lines, while IL-10 production was found to be highest and most common among cell lines derived from colon carcinomas. IL-10 in conditioned medium of one of the colon carcinoma cell lines (CCL222) was bio-active, as demonstrated in the mouse MC/9 mast-cell-line assay and in human mixed-lymphocyte reactions. In both assays, IL-10 bio-activity was neutralized by an anti-IL-10 monoclonal antibody. Expression of IL-6 and IL-10 was confirmed by RNA analysis using message amplification by PCR and sequencing of amplified cDNA. LPS, IL-1 alpha, and TNF-alpha strongly enhanced the release of IL-6 by RCC cells, but only marginally affected IL-10 production in colon-carcinoma cells. IL-10 secretion by colon-carcinoma cells was moderately stimulated by IFN-gamma and IL-4. Dexamethasone suppressed the release of IL-6, but had no inhibitory effect on IL-10 secretion. Our results demonstrate that tumor cell lines established from certain types of human carcinomas are capable of expressing and releasing IL-6 and/or IL-10, suggesting a role of these cytokines in solid-tumor development and anti-tumor immunity.

Injury of the spinal cord has been known since antiquity. There is no cure for the injury and until modern times patients died rapidly from a combination of pressure sores and urinary tract infection. Treatment consists of preventing complications until the spine has stabilised and the patient can be rehabilitated to an independent life. This article explores how this treatment developed in the ancient world, the middle ages, in Europe, Great Britain, and latterly in the United States. It describes how these principles of treatment were recognised particularly in Germany, the United States, and Great Britain and evaluates the relative contributions made by the different pioneers.

We studied the effect on breathing of a conventional and a newly designed abdominal binder in seven patients with complete tetraplegia. The indices of respiratory ability used were the transdiaphragmatic pressure on maximal sniff (sniff Pdi), the maximum static inspiratory mouth pressure (Pimax), and the vital capacity (VC). These were measured in patients with and without binders, in the supine position, raised up to 70°on a tilt

SUMMARY A method was developed for making EMG recordings from the four individual muscles of the anterior abdominal wall. It was then demonstrated that these muscles have different and distinguishable actions on trunk movement, but act together in breathing. The level of ventilation at which the abdominal muscles become active in expiration was shown to be posture dependent.Previous studies of the EMG activity of the abdominal muscles in man have used recordings made from surface electrodes' or needle electrodes2 placed in rectus abdominis and external oblique muscles. The EMG activity of the external oblique muscles during breathing has been assumed to be representative of the antero-lateral muscle group as a whole, though there is no evidence for this assumption. The anterolateral musculature consists of three layers comprising external oblique outermost, internal oblique next, and transversus abdominis innermost. These layers are in such close proximity that it has been difficult to separate their electrical activities.34 The fibres of the four muscles of the anterior abdominal wall run in different directions, thus these muscles may have different actions. The aim of this study was to develop a method of sampling EMG activity from individual abdominal muscles, and to record their activity during breathing. Methods and materials SubjectsSix normal volunteers took part in the study; none was suffering from any acute or chronic, neurological or respiratory illness. Three subjects were male, and the group had a mean age of 28 years. Apparatus EMG recordings from the abdominal muscles were made with bipolar fine wire electrodes manufactured in the manner of Basmajian,' from 0-06mm stainless steel wire insulated with Diamel. Ventilation was measured as flow with a conical pneumotachograph, accurate to flow rates of 300 1/min. This was connected to a differential pressure transducer (Elema-Schonander EMT 32c), and the signal generated processed by a purpose built integrating amplifier (with a time lag in response to a square wave of OOls). The ventilation signal in the form of volume was displayed with the EMG signals on a "Medelec MS6" EMG module fitted with four AA6 amplifiers, and recorded on light sensitive paper run at 5 cm/s. Recordings from the wire electrodes were made at a gain of 200mA. The high pass filter was set to 16HZ (-3dB cut oft) and the low pass filter to 1-6KHZ (-3 dB cut oft). Both filters rolled off at 12 dB/octave.Methodfor location ofindividual muscle layers Computed tomographic (CT) scans of the abdomens of 20 patients were performed with an Elscint 2002 whole body scanner at Brompton Hospital. These subjects were selected at random, they represented 20 consecutive referrals for abdominal CT scan. The scan taken at the mid-point between xiphisternum and pubis was selected from a "scout" view, and on this the individual muscle layers of the antero-lateral abdominal wall were clearly visible (fig 1). The cursors available on the viewing module were used as electronic calipers to measure the d...