The role of the CO2 laser in the management of laryngotracheal stenosis: a survey of 100 cases.

Over the last decade, improvement of CO2 lasers with the microspot and ultrapulse technologies has broadened the indications for endoscopic CO2-laser resection of benign laryngotracheal stenosis (LTS). This article reviews 100 patients treated solely by endoscopic means for a LTS. There were 47 grade III, 41 grade II and 12 grade I stenoses according to the Myer-Cotton classification. The postoperative results show that the improvement to a nearly normal (>80% luminal size) airway declines from 92% (11/12 patients) for grade I to 46% (19/41 patients) for grade II and 13% (6/47 patients) for grade III stenoses. When compared to open surgery for more severe grades of stenosis (31 grade IV, 66 grade III and 3 grade II stenoses), the results of the endoscopy group is much less favorable: 36% of patients in the endoscopy group versus 76% of patients in the open surgery group were rehabilitated to a normal respiration without exertional dyspnea and 38% versus 5% patients remained tracheotomy dependent. However, if strict selection and therapeutic criteria are respected, a significant number of grade I and II stenoses, and to a lesser degree of grade III stenoses, can be improved to a nearly normal airway by endoscopic means only. The endoscopic treatment is potentially less invasive and risky and only needs a short hospital stay. To try this as a first treatment modality in a selected group of patients is worthwhile, provided that this endoscopic treatment is not repeated a second time, if the stenosis recurs to its initial grade after a primary CO2-laser treatment. Some guidelines for safe endoscopic treatment modalities with of the CO2 laser, dilatation and/or stenting are proposed

The in-plane paraconductivity in La_{2-x}Sr_xCuO_4 thin film superconductors at high reduced-temperatures: Independence of the normal-state pseudogap

The in-plane resistivity has been measured in $La_{2-x}Sr_xCuO_4$ (LSxCO) superconducting thin films of underdoped ($x=0.10,0.12$), optimally-doped ($x=0.15$) and overdoped ($x=0.20,0.25$) compositions. These films were grown on (100)SrTiO$_3$ substrates, and have about 150 nm thickness. The in-plane conductivity induced by superconducting fluctuations above the superconducting transition (the so-called in-plane paraconductivity, $\Delta\sigma_{ab}$) was extracted from these data in the reduced-temperature range 10^{-2}\lsim\epsilon\equiv\ln(T/\Tc)\lsim1. Such a $\Delta\sigma_{ab}(\epsilon)$ was then analyzed in terms of the mean-field--like Gaussian-Ginzburg-Landau (GGL) approach extended to the high-$\epsilon$ region by means of the introduction of a total-energy cutoff, which takes into account both the kinetic energy and the quantum localization energy of each fluctuating mode. Our results strongly suggest that at all temperatures above Tc, including the high reduced-temperature region, the doping mainly affects in LSxCO thin films the normal-state properties and that its influence on the superconducting fluctuations is relatively moderate: Even in the high-$\epsilon$ region, the in-plane paraconductivity is found to be independent of the opening of a pseudogap in the normal state of the underdoped films.Comment: 35 pages including 10 figures and 1 tabl

Renal sodium handling in acute and chronic salt loading/depletion protocols: the confounding influence of acute water loading.

OBJECTIVES: Renal tubular sodium handling was measured in healthy subjects submitted to acute and chronic salt-repletion/salt-depletion protocols. The goal was to compare the changes in proximal and distal sodium handling induced by the two procedures using the lithium clearance technique. METHODS: In nine subjects, acute salt loading was obtained with a 2 h infusion of isotonic saline, and salt depletion was induced with a low-salt diet and furosemide. In the chronic protocol, 15 subjects randomly received a low-, a regular- and a high-sodium diet for 1 week. In both protocols, renal and systemic haemodynamics and urinary electrolyte excretion were measured after an acute water load. In the chronic study, sodium handling was also determined, based on 12 h day- and night-time urine collections. RESULTS: The acute and chronic protocols induced comparable changes in sodium excretion, renal haemodynamics and hormonal responses. Yet, the relative contribution of the proximal and distal nephrons to sodium excretion in response to salt loading and depletion differed in the two protocols. Acutely, subjects appeared to regulate sodium balance mainly by the distal nephron, with little contribution of the proximal tubule. In contrast, in the chronic protocol, changes in sodium reabsorption could be measured both in the proximal and distal nephrons. Acute water loading was an important confounding factor which increased sodium excretion by reducing proximal sodium reabsorption. This interference of water was particularly marked in salt-depleted subjects. CONCLUSION: Acute and chronic salt loading/salt depletion protocols investigate different renal mechanisms of control of sodium balance. The endogenous lithium clearance technique is a reliable method to assess proximal sodium reabsorption in humans. However, to investigate sodium handling in diseases such as hypertension, lithium should be measured preferably on 24 h or overnight urine collections to avoid the confounding influence of water