James N. Thompson

Enhancing the Clinical Research Pipeline: Training Approaches for a New Century

There is growing concern that the numbers of physician-scientists being trained in U.S. academic health centers will not be sufficient to continue the rate of current progress in biomedical research. The authors believe that the needs of current trainees and junior faculty must be addressed immediately, and that programs to train the next generation of patient-oriented researchers must be established without delay. The authors describe a two-pronged approach to this looming crisis. First is a description of innovative educational programs implemented at one academic health center from the K-12 level through the medical-school curriculum. Second, programs are discussed that have been developed to facilitate the recruitment, training, and retention of physician-scientists in the early parts of their professional careers. Four models of training “translational” investigators are presented, along with case studies of how these models have been implemented in real-life productive and professionally satisfying collaborations within one academic health center. The authors conclude by stating that to be prepared for the effects of future knowledge on human disease and preventive health, academic health centers must enhance training opportunities for physician-scientists.

Corrosive esophageal injuries. II. An investigation of treatment methods and histochemical analysis of esophageal strictures in a new animal model

The unique clinical experience of having to treat simultaneously nine young adults who had ingested the same corrosive substance prompted this investigation in rabbits of the pathophysiology of corrosive esophageal injury and of drugs that might prevent formation of stricture. Treatment of experimental corrosive esophageal injury in these animals consisted of antegrade dilatation and administration of two lathyrogenic drugs, colchicine and penicillamine, in various combinations. This study demonstrated that the rabbit can serve as a suitable animal model for study of corrosive injury of the esophagus, that penicillamine given alone affected wound healing with less severe stricture after such an injury, and that colchicine was associated with delayed wound healing and severe stricture.

Corrosive esophageal injuries I. A study of nine cases of concurrent accidental caustic ingestion

Treatment of corrosive injuries of the esophagus remains largely unsatisfactory, and severe esophageal burns still frequently result in stricture with accompanying morbidity or death. The nine patients presented here with 3‐year follow‐up accidentally drank a concentrated alkaline solution. All were teenagers or young adults who drank from the same bottle while at a party. The problems encountered in these patients led us to conclude that all patients with moderate to severe corrosive injury of the esophagus should have assessment of the entire esophagus and stomach at the time of initial assessment. Six patients underwent diagnostic laparotomy and one underwent thoracotomy as well for assessment of his esophageal injuries. Had we followed the traditional approach of esophagoscopy only to the level of the first circumferential burn, more severe and potentially life‐threatening injuries would have been missed. Early endoscopic evaluation of the esophagus and stomach remains the standard for diagnosis; however, complete assessment may require laparotomy or thoracotomy. Early resection of necrotic tissue in the esophagus or stomach can lead to increased survival.

Airway obstruction in lefort fractures

Airway obstruction associated with fractures of the midfacial skeleton can be life‐threatening if not recognized promptly and treated appropriately. One hundred seventeen patients with LeFort fractures were treated between 1978 and 1984. Of the 117 patients, 21 had a LeFort I fracture, 46 had a LeFort II fracture, 14 had a LeFort III fracture, and 36 had various combinations of the three types of LeFort fractures.

Idiopathic Perilymphatic Fistulae: A Temporal Bone Histopathological Study: Clinical, Surgical and Histopathological Correlations

The temporal bone histopathological findings herein reported are the first to be from a patient who had, during life, the diagnosis of idiopathic perilymphatic fistulae. The patient received surgical treatment followed by rapid improvement of his vestibular symptoms. These specimens histopathologically demonstrate the patencies of the labyrinth capsule that were diagnosed (predicted) clinically during life, the qualities of the membranous labyrinth in both the operated and unoperated ears, and the elements of the surgical repair. Notably there is no evidence of endolymphatic hydrops. The diagnostic features which allowed this patient with fluctuating hearing loss, episodic vertigo, and tinnitus to be distinguished from a patient with Menieres syndrome are discussed as are the implications regarding future and past studies of vestibular and cochlear disorders.