Bovie: the man and the machine.

The origins of electrosurgery are presented and recognition given to one of its forgotten pioneers, William T. Bovie. Though not a physician, Bovie contributed greatly to patient care.     

Pollution: the nose and sinuses.

The nose and sinuses are constantly exposed to the huge quantities of gases needed to maintain life. Not only is the human nose well-equipped to warm and humidify this inhaled air, but it is also uniquely able to clean much of it. Any material other than physiologic amounts of oxygen, nitrogen, carbon dioxide, and water that accompanies the airstream can be considered a pollutant, and this pollutant could potentially injure the individual. The following discussion will review the defense mechanisms that allow the nose and sinuses to protect the lower airways. The effects of pollutants on the respiratory mucosa will then be described, including some recent trends in those effects. These trends include specific population consequences of indoor and outdoor air pollution, and changes in risk for individuals in several occupations. Throughout these discussions, specific areas that would benefit from further research will be mentioned.     

Phrenology and the neurosciences: contributions of F. J. Gall and J. G. Spurzheim

The pseudoscience of phrenology arose from the observations and intuitions of Franz Joseph Gall (1758-1828) and his disciple Johann Gaspar Spurzheim (1776-1832). Gall believed that mental functions are localized in discrete parts of the brain, which he called organs. He located the organs subserving intellectual functions chiefly in the cerebral cortex. To support this doctrine, Gall and Spurzheim carried out extensive neuro-anatomical studies, and made some important discoveries. The Gordon Craig Library contains a book by Spurzheim on the anatomy of the brain, published in London in 1826, which summarizes these discoveries. Gall also believed that the functional strength of the cerebral and cerebellar organs was expressed by their bulk: a well-developed organ caused a bulge in the overlying cranial bone. Hence, feeling the bumps of the skull was a means of assessing the individual's personality. This very fallacious component of Gall's doctrine had great influence in the nineteenth century, affecting psychiatry, criminology and educational theory. Further research demolished Gall's doctrine, and phrenology sank into disrepute. Nevertheless, phrenological thinking played an important part in the growth of clinical neurology in the second half of the nineteenth century.     

Obesity and the lung: 1. Epidemiology

Obesity is the most common metabolic disease in the world and its prevalence has been increasing over several decades. The World Health Organization (WHO) predicts that, by 2015, around 700 million adults will be obese (at least 10% of the projected global population). This will be a huge health and economic burden with associated increases in diabetes, cardiovascular and musculoskeletal disease, and malignancy. While there has been little focus on the impact of obesity on respiratory disease, there are clear effects on pulmonary function and inflammation which will increase the prevalence and morbidity of lung disease. There is an inverse relationship between body mass index and forced expiratory volume in 1 s. Increases in body weight lead to worsening of pulmonary function. The reasons for this include the mechanical effects of truncal obesity and the metabolic effects of adipose tissue. Obesity is linked to a wide range of respiratory conditions including chronic obstructive pulmonary disease, asthma, obstructive sleep apnoea, pulmonary embolic disease and aspiration pneumonia. It is important for those providing care for people with respiratory disease to appreciate the impact of obesity and to provide appropriate advice for weight reduction. Healthcare planners should consider the impact of obesity for future resources in respiratory care.     

Ankyloglossia: the adolescent and adult perspective.

OBJECTIVES: We sought to characterize examination findings and functional limitations due to ankyloglossia in adolescents and adults and to evaluate frenuloplasty in this group.Study design A prospective study was conducted of 15 individuals with ankyloglossia aged 14 to 68 years. Baseline symptoms were recorded by questionnaire, and tongue mobility measures were compared with that of 20 control subjects. Six subjects were reassessed postfrenuloplasty. RESULTS: Thirteen of 14 patients with uncorrected ankyloglossia (93%) noted symptoms including speech problems (50%) and mechanical limitations (57%), such as difficulty licking the lips. Mean tongue protrusion and elevation at baseline measured 15.5 +/- 6.0 mm and 13.6 +/- 8.0 mm, respectively, for patients and 32.0 +/- 3.9 mm and 30.3 +/- 4.9 mm for control subjects (P < 0.001). Postfrenuloplasty, tongue function improved both subjectively and objectively in 6 of 6 patients, with a mean gain of 9.2 mm for protrusion (P < 0.05) and 13.0 mm for elevation (P < 0.001). CONCLUSION: Symptoms related to ankyloglossia are prevalent in this age group and respond favorably to frenuloplasty.     

Wear and periprosthetic osteolysis: the problem.

The dominant long-term problem in total hip replacement surgery, and an important problem in total knee replacement surgery, is wear of the polyethylene and its resulting periprosthetic osteolysis. Several of the key features of this unique disease are presented focusing on the importance of periprosthetic osteolysis, comprehension of the general progressive nature of periprosthetic osteolysis, understanding of the diverse radiographic evidence of this disease, and the consequences that can occur from the disease.