Vocal cord dysfunction, a syndrome of paradoxical inspiratory closure of the vocal cords, is becoming more frequently recognized and diagnosed recently since its initial modern description 30 years ago. Initially described as single case reports, the first case series in 1983 helped to clarify the typical patient and findings of vocal cord dysfunction. Recent investigations have elucidated specific etiologies such as gastroesophageal reflux, exercise, and irritants as causative factors in addition to the numerous associated psychologic factors. Speech therapy and psychotherapy have been used extensively with vocal cord dysfunction patients, but the optimal treatment has yet to be prospectively studied. This manuscript provides a comprehensive review of the reported causative factors and treatments for vocal cord dysfunction.

Knowledge of the normal liver size is essential for making the scintigraphic estimate of hepatomegaly. A nomogram for sonographic liver size versus height of the patient was developed for the normal pediatric patient. Liver size was measured as the longitudinal liver length in the plane midway between the xiphoid and the right lateral liver margin. Scintigraphic and sonographic measurements showed a good correlation. The scintigraphic nomogram was developed using the experimentally determined relationship between the two modalities.

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Let X denote an irreducible affine algebraic curve over the complex numbers. Let &{X) be the ring of regular functions on X. Denote by 3{X) the ring of differential operators on X. We wish to characterize (f(X) as a ring theoretic invariant of 3{X). It is proved that @{X) equals the set of all locally ad-nilpotent elements oi3f(X) if and only if X is not simply connected. However, for most simply connected curves, we show there exists a maximal commutative subalgebra oi3f{X)t consisting of locally ad-nilpotent elements, which is not isomorphic to (f(X). Introduction.Let X be a curve, that is, an irreducible affine algebraic curve over C. Write &{X) for the ring of regular functions on X and 3{X) for the ring of differential operators on X. See [8] for the basic definitions and facts about rings of differential operators on curves. This paper is motivated by the following question. If X and Y are curves with 3{X) = 3(Y) 9 is X = YΊ Write X for the normalization of X. Stafford [9] considers this question for X with X = A 1 , the affine line. He shows that 3{X) = 2{X) if and only if X = X. He also shows that if X is the cubic cusp y 2 = x 3 and Ϋ = A 1 , then X = Y if and only if 3{X) = 3(Y). Higher dimensional non-isomorphic varieties can have isomorphic rings of differential operators, see Levasseur, Smith and Stafford [2].If u e 3{X\ define ad(w) e End c (^(X)) by ad(κ)(u) = [u,v] = uυ -vu. We say u is locally ad-nilpotent if for every v e 2f{X) there exists neN with ad(u) n (v) = 0. Write jr(X) = {ue 3J{X)\u is locally ad-nilpotent}.Note that if ϋ: 3{Y) -> 3{X) is an isomorphism then ϋ(yT(Y)) = Jf(X). It follows from the definition oΐ3{X) that &{X) is a maximal commutative subalgebra oϊ3J(X) and that @(X) is contained in yV{X). If genus {X) > 0 then shows that &{X) = jr\x). Hence if3(X) = 3(Y) with genus(X) > 0 then X = Y.This paper expands on Makar-Limanov's result to prove the following theorem. Let π: X -> X denote the canonical surjection.

Let X and Y be nonisomorphic irreducible affine algebraic curves over the complex numbers C. Let D{X) and D{Y) be their rings of differential operators (see

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Occlusion of the ipsilateral renal artery prior to nephrectomy is facilitated by substituting contrast material for air in the balloon of the Swan-Ganz catheter. The higher specific gravity of the contrast medium causes the balloon to settle in the bloodstream instead of floating in it, permitting it to be carried rapidly into the renal artery.

Respiratory bronchiolitis (RB) and respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) are 2 processes that lie along the continuum of probable smoking related lung diseases. The separation of the 2 is difficult and sometimes contentious; however, the combination of clinical symptoms and suggestive pathologic findings usually allows for a distinction and the subsequent diagnosis.RB in an asymptomatic smoker is considered an incidental histologic finding consistent with prior tobacco history. RB-ILD, although histopathologically similar to RB, is characterized by more extensive pulmonary parenchymal involvement and clinical expression as defined by dyspnea or other respiratory complaints. On pulmonary function testing, RB-ILD patients often demonstrate a mixed picture of obstructive or restrictive physiology, in combination with a reduced carbon monoxide diffusion capacity. Plain chest radiography is of limited utility and can be normal in many RB-ILD patients. High-resolution computer-assisted tomography scanning in the setting of RB-ILD correlates with the extent of bronchiolitis on pathologic analysis and offers a potential role for assessing response to therapy. Thus far, bronchoscopy has demonstrated a relatively limited capacity in diagnosing RB-ILD, necessitating surgical lung biopsy to arrive at a definitive diagnosis. Treatment of RB-ILD hinges upon smoking cessation maneuvers and consideration of immunosuppressive agents in recalcitrant cases.Key Words: respiratory bronchiolitis, interstitial lung disease, kaolinite (Clin Pulm Med 2004;11: 219 -227) S moking has been associated with a variety of pathologic findings, all of which have an equally varied clinical expression as disease processes. Additionally, the acceptance that only a relatively small percentage of smokers will potentially develop a tobacco-related pulmonary process suggests a complex interaction between environment, genetic predisposition, lifetime tobacco burden, and pulmonary pathology. It is not surprising that pathologic markers of smoking such as respiratory bronchiolitis (RB) and RB-associated interstitial lung disease (RB-ILD) should also assume a spectrum of presentations. In asymptomatic individuals, RB is considered to be a histologic marker of inhaled tobacco particulates. As opposed to RB, RB-ILD is a clinical syndrome associated with a potentially disabling symptom complex. Epidemiology of RB and Peribronchiolar Inflammation/FibrosisNiewoehner et al 1 in 1974 were one of the first groups to provide insight into the histologic changes at the bronchiolar level which may ensue from tobacco use. They performed autopsies on 39 patients who died of extrapulmonary causes. Lung specimens from 24 of the patients demonstrated yellowbrown pigmented macrophage accumulation within the respiratory bronchioles and juxtaposed airspaces with minimal peribronchiolar inflammation. Nineteen of the 24 patients with peribronchiolar inflammation had a history of smoking. The finding of peribronchiolar pigmented macrophage acc...