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To report an unusual case of hypopharyngeal perforation in a sword-swallower, with emphasis on management options.
Case report and review of the English language literature concerning sword-swallowing injuries to the hypopharynx and oesophagus.
A 29-year-old male sword-swallower suffered hypopharyngeal perforation during a performance. The patient received conservative management, with intensive care unit admission, infectious disease consultation, intravenous antibiotics, discontinuation of oral intake and close observation. He progressed well, resumed oral intake on hospital day six, and was discharged home on hospital day eight.
Sword-swallowing is an unusual vocation which may lead to potentially devastating injuries. This case report and review of the literature illustrates the management options for such hypopharyngeal and oesophageal injuries.
Decibel measurements were conducted on the lithotripter-generated sounds, using a sound level meter at specific distances from the active element. In addition, a patient survey was conducted as a cross-reference, to enable comparison of predicted results with actual human perception of sound levels.
Sound levels ranged between 68 and 80 dB during treatment sessions, for both the lithotriptor operator and the patient.
During routine use, no acoustic trauma is incurred by either the lithotriptor operator or the patient.
Forest disturbance, conversion and recovery
H. Grip, Department of Forest Ecology, SLU, S-901 83 Umeå, Sweden,
J.-M. Fritsch, L'Institut de Recherche pour le Développement-LMTG, 38 rue des 36 Points, F-31400 Toulouse, France,
L. A. Bruijnzeel, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
The rainforests of the humid tropics are being converted to alternative land uses at an increasing rate (Drigo, this volume). In many cases the initial forest disturbance preceding conversion occurs during mechanised harvesting of (large volumes of) valuable timber (Chappell, Tych et al., Cassells and Bruijnzeel, Thang and Chappell, all this volume). Timber extraction causes a number of disturbances to the soil surface, notably during the construction and subsequent use of haulage roads, tractor tracks and log landings, but also in the form of scars by falling trees, particularly in steep terrain (cf. Kamaruzaman, 1991; Dykstra and Heinrich, 1996). Soil impacts may be lessened in some cases by the manual skidding of logs on wooden rails (usually in relatively flat terrain) or through the use of high-lead or low-lead cable yarding (Figure 22.1) (Bruijnzeel, 1992; Bruenig, 1996). Uphill logging, in which log landings are located on ridge tops, is the preferred system nowadays as this has a number of advantages: (i) access roads can be built along the ridges which usually form the driest part of the landscape, thereby minimising the frequency of road closures during periods of high rainfall; (ii) the log landings are also situated on dry spots which facilitates vehicle operation; (iii) the timber extraction network fans out in a downhill direction, thereby reducing surface runoff accumulation (and thus erosion) on tractor tracks; and (iv) the number of stream crossings is minimised in this way (Dykstra and Heinrich, 1996; cf. Figure 35.4 in Cassells and Bruijnzeel, this volume).
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