No abstract

Thyroplasty has virtually replaced Teflon injection as the procedure of choice for treatment of the unilateral paralyzed vocal cord. Previous studies have shown that Teflon injection, by stiffening the vocal cord, decreases the extrathoracic airway obstruction occasionally measured by pulmonary function testing in patients with unilateral vocal cord paralysis. We became interested in the effect of thyroplasty on extrathoracic airflow. In this prospective study, patients underwent prethyroplasty and postthyroplasty pulmonary function testing. Flow volume loops combined with traditional spirometry were used. Postoperative pulmonary function tests were performed at least 2 months after surgery to allow resolution of surgical edema. Our study results support the previous finding that vocal cord paralysis alone causes some degree of extrathoracic obstruction. However, in contrast to Teflon injection, thyroplasty decreased extrathoracic airflow in all but 1 patient, and by criteria based on the ratio of the midexpiratory flow to the midinspiratory flow, caused new postoperative extrathoracic obstruction in 27% of patients. Symptomatic evidence of this obstruction may be more evident in those active patients with more ventilatory demand.

The 2-deoxyglucose (2-DG) method was used to study the effect of working memory processing on local cerebral glucose utilization (LCGU) in the diencephalon of the rhesus monkey. Monkeys were given [(14)C]2-DG while performing either one of three tasks that engaged working memory (WORK group) or one of two control tasks (CONT group) that used associative or non associative processes. The tasks of the WORK group-spatial delayed response, spatial delayed alternation, and delayed object alternation-are alike in that the information guiding a correct response changes from trial to trial and only the accurate record of the preceding response (or cue) is relevant for each successive trial. The CONT group, in contrast, performed on either a visual pattern discrimination test, in which the correct stimulus-response association was invariant across all trials and all test sessions, or on a sensorimotor task in which there was no explicit memory requirement. LCGU was examined in five diencephalic regions: the mammillary bodies, the anteroventral and anteromedial thalamus, and the parvocellular and magnocellular components of the mediodorsal thalamic nucleus. Comparisons across the two groups showed that mean LCGU in the anterior and mediodorsal thalamic nuclei was significantly elevated (by 12-16%) in the WORK group relative to the CONT group. Mean LCGU in the mammillary bodies also was higher in the WORK group than in the CONT group, but this difference was not significant. The present findings suggest that the anterior and mediodorsal thalamic nuclei represent diecephalic components of a neural network processing working memory. Together with our previous report on the enhancement of metabolic activity in the hippocampus and dentate gyrus, these results show that working memory has a wide-ranging influence on cerebral metabolism and emphasize the cooperative, rather than dissociable, roles of the hippocampus and medial thalamus in this function.

Multiple surgical approaches to the sella turcica have been described. The sublabial transseptal transsphenoidal approach provides a safe, cosmetically acceptable route to the sella with excellent exposure. Since 1976, we have employed this technique for the surgical treatment of pituitary neoplasms and parasellar tumors. The University of Washington experience with the sublabial transseptal transsphenoidal approach to the sella in a series of 253 patients is reported with respect to the otolaryngological aspects of the surgical technique, results, and complications of the procedure. In addition, a literature review of major studies that used this procedure is included, and the reported results and complications are compared to those of the present study.