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1

[Unilateral laryngeal nerve paralysis in the adult: Epidemiology, symptoms, physiopathology and treatment].  

PubMed

In France, the main causes for unilateral laryngeal nerve paralysis in the adult patient are surgery and malignant tumors. Most of unilateral laryngeal nerve paralysis following thyroid surgery will recover within the first six postoperative months. At the time of unilateral laryngeal nerve paralysis, swallowing impairment and dyspnea occur in around 30% and 5% of cases, respectively. In the face of a unilateral laryngeal nerve paralysis occurring without a history of trauma of surgery, the main paraclinical examination to perform is a computed laryngeal nerve examination analyzing the whole length of the nerve involved. Speech therapy efficiency is related to the degree of severity of the symptoms related to unilateral laryngeal nerve paralysis. In the vast majority of cases, laryngeal medialization approaches improve dysphonia and swallowing impairment related to unilateral laryngeal paralysis, but not dyspnea. PMID:24525308

Laccourreye, Ollivier; Malinvaud, David; Ménard, Madeleine; Bonfils, Pierre

2014-04-01

2

Unilateral Recurrent Laryngeal and Hypoglossal Nerve Paralysis Following Rhinoplasty: A Case Report and Review of the Literature  

PubMed Central

Introduction: Injury to cranial nerves IX, X, and XII is a known complication of laryngoscopy and intubation. Here we present a patient with concurrent hypoglossal and recurrent laryngeal nerve paralysis after rhinoplasty. Case Report: The patient was a 27-year-old woman who was candidate for rhinoplastic surgery. The next morning after the operation, the patient complained of dysphonia and a sore throat .7 days after the operation she was still complaining of dysphonia. She underwent a direct laryngoscopy, and right TVC paralysis was observed. Right hypoglossal nerve paralysis was also detected during physical cranial nerve function tests. Hypoglossal and recurrent laryngeal nerve function was completely recovered after 5 and 7 months, respectively, and no complication was remained. Conclusion: Accurate and atraumatic intubation and extubation, true positioning of the head and neck, delicate and gentle packing of the oropharynx, and maintenance of mean blood pressure at a safe level are appropriate methods to prevent this complication during anesthesia and surgical procedures. PMID:24505575

Bakhshaee, Mehdi; Bameshki, Ali Reza; Foroughipour, Mohsen; Zaringhalam, Mohammad Ali

2014-01-01

3

Glottographic phase difference in recurrent nerve paralysis.  

PubMed

Phase measures with simultaneously recorded electroglottography (EGG) and photoglottography (PGG) signals have been studied in canine models and found to be sensitive to the effect of recurrent laryngeal nerve (RLN) paralysis on vocal fold vibration. This study examined the usefulness of this type of measure in clinical application. The combined glottographic signals were obtained from 5 men with a diagnosis of unilateral RLN paralysis and 5 age-matched controls. In the patient group, EGG waveforms were found to have a consistent phase delay in relation to PGG. A measure of the overall glottographic phase difference (GPD) was found to significantly distinguish the control group (mean GPD = 0.2371 ms) from the patient group (mean GPD = -0.2765 ms). A validity analysis performed on 19 subjects with or without unilateral RLN paralysis confirmed that the GPD test had a relatively high efficiency (91.7%) in detecting unilateral RLN paralysis in the male population. PMID:10737313

Jiang, J; Lin, E; Hanson, D G

2000-03-01

4

Laryngeal nerve monitoring.  

PubMed

Intraoperative neurophysiological monitoring of the vagus and recurrent laryngeal nerves is increasingly used during thyroidectomy, parathyroidectomy, skull base surgery, and cervical discectomy with fusion. Monitoring can assist in nerve localization and in reducing the incidence of neural trauma. To be effective, however, monitoring must be correctly implemented and the results interpreted based on an in-depth understanding of technique and the surgical structures at risk. Because "poor monitoring is worse than no monitoring" all members of the surgical monitoring team must have training specific to laryngeal recording to maximize its benefit and minimize pitfalls. This publication will review pertinent anatomy and neurophysiology as well as technical and interpretative factors. PMID:25351033

Kartush, Jack M; Naumann, Ilka

2014-09-01

5

A spatiotemporal prospective study of speech in patients with or without recurrent laryngeal nerve paralysis after thyroid  

E-print Network

paralysis after thyroid surgery Camille Fauth1 Béatrice Vaxelaire1 , Jean-François Rodier2 , Pierre paralyses but with alteration of their voice after thyroid surgery. Speech is evaluated during two tasks pathology of the thyroid gland. Consequently, it is possible to carry out systematic analyses of the diverse

Paris-Sud XI, Université de

6

Intraoperative recurrent laryngeal nerve monitoring: a useful method for patients with esophageal cancer.  

PubMed

It is well accepted that recurrent laryngeal nerve paralysis is a severe complication of esophagectomy or lymphadenectomy performed adjacent to the recurrent laryngeal nerves. Herein, determination of the effectiveness of implementing continuous recurrent laryngeal nerve monitoring to reduce the incidence of recurrent laryngeal nerve paralysis after esophagectomy was sought. A total of 115 patients diagnosed with esophageal cancer were enrolled in the thoracic section of the Tangdu Hospital of the Fourth Military Medical University from April 2008 to April 2009. Clinical parameters of patients, the morbidity, and the mortality following esophageal resection were recorded and compared. After the surgery, a 2-year follow up was completed. It was found that recurrent laryngeal nerve paralysis and postoperative pneumonia were more frequently diagnosed in the patients that did not receive continuous recurrent laryngeal nerve monitoring (6/61 vs. 0/54). Furthermore, positive mediastinal lymph nodes (P = 0.015), total mediastinal lymph nodes (P < 0.001), positive total lymph nodes (P = 0.027), and total lymph nodes (P < 0.001) were more often surgically removed in the patients with continuous recurrent laryngeal nerve monitoring. These patients also had a higher 2-year survival rate (P = 0.038) after surgery. It was concluded that continuous intraoperative recurrent laryngeal nerve monitoring is technically safe and effectively identifies the recurrent laryngeal nerves. This may be a helpful method for decreasing the incidence of recurrent laryngeal nerve paralysis and postoperative pneumonia, and for improving the efficiency of lymphadenectomy. PMID:23020300

Zhong, D; Zhou, Y; Li, Y; Wang, Y; Zhou, W; Cheng, Q; Chen, L; Zhao, J; Li, X; Yan, X

2014-07-01

7

Juvenile laryngeal paralysis in three Siberian husky x Alaskan malamute puppies.  

PubMed

Three three-month-old Siberian husky x Alaskan malamute crossbreds had suffered episodic inspiratory dyspnoea and stridor for four to eight weeks and their endurance had decreased. In two of them bilateral, and in the other unilateral, laryngeal paralysis was diagnosed by laryngoscopy. In the nucleus ambiguus of the dogs there was a depletion of motor neurons, neuronal degeneration and mild gliosis, but there were no lesions in the root and peripheral segments of the recurrent laryngeal nerves. PMID:14653342

Polizopoulou, Z S; Koutinas, A F; Papadopoulos, G C; Saridomichelakis, M N

2003-11-15

8

The superior laryngeal nerve: function and dysfunction.  

PubMed

Despite long-standing clinical interest in SLN dysfunction, most aspects of this entity continue to require clarification. The replacement of the laryngeal mirror by flexible fiberoptic and rigid rod-lens laryngoscopy (including stroboscopy) and the resulting improvement in laryngeal visualization and documentation of examination has not resulted in a better definition of characteristic signs. Symptoms are often vague, and most are shared with other voice disorders. Under the circumstances, there is good reason to suppose that SLN dysfunction yields a clinical picture at least as heterogeneous as recurrent laryngeal nerve injury and a good deal more subtle. Faced with significant inconsistencies in clinical presentation, the clinician is hard-pressed to draw conclusions regarding prevalence, patterns of dysfunction, natural history, treatment, and even about its overall significance. EMG. used judiciously and complemented by frequency range testing, seems to hold more promise as a means of reliable diagnosis than laryngoscopic examination and may serve to resolve some of the confusion surrounding SLN dysfunction. It is equally important that the otolaryngologist guard against falling into the easy habit of attributing vocal disturbance that cannot be otherwise explained to SLN dysfunction in the absence of EMG evidence. If ambiguities surrounding SLN paralysis and paresis are to be clarified, diagnostic rigor is essential. PMID:15062693

Sulica, Lucian

2004-02-01

9

[Autoplasty of recurrent laryngeal nerve in the thyroid gland surgery].  

PubMed

Efficacy of autoplasty of recurrent laryngeal nerve (RLN) for laryngeal reinnervation in surgery of differentiated cancer of thyroid gland was studied. Prospectively 8 patients were examined, in whom laryngeal reinnervation, using the RLN autoplasty, for the abduction laryngeal paralysis was done. The examination was performed before and after the operation, it included videolaryngoscopy, acoustic analysis and the patient's self-estimation of psychosocial consequences of the voice-formation disturbance. Improvement of a vocal cords spacious positioning was noted in 38% patients, and was confirmed by trustworthy improvement of the voice-formating parameters after the operation, comparing with a preoperative state. In 72% patients the vocal aperture closure was incomplete and the voice-formation parameters trustworthy differed from such in patients of a control group. When the intact alternative nerves-donors for laryngeal reinnervation are present (distal stump of PLN, ipsilateral and contralateral main branch of cervical loop) the RLN autoplasty performance must be maximally postponed because of low efficacy of such method of surgical laryngeal reinnervation. PMID:24923118

Palamarchuk, V A

2014-02-01

10

Recurrent Laryngeal Nerve Identification and Assessment during Thyroid Surgery: Laryngeal Palpation  

Microsoft Academic Search

Electrical identification and monitoring of the recurrent laryngeal nerve (RLN) has been proposed as an adjunct to standard visual identification of the nerve during thyroid and parathyroid surgery. This study was undertaken to assess laryngeal palpation as an intraoperative technique for identifying and assessing the RLN during surgery and to investigate the relation between laryngeal palpation and associated laryngeal electromyographic

Gregory W. Randolph; James B. Kobler; Jamie Wilkins

2004-01-01

11

Bilateral laryngeal paralysis associated with hepatic dysfunction and hepatic encephalopathy in six ponies and four horses.  

PubMed

Six ponies and four horses with a mean (sd) age of 15.9 (6.0) years developed sudden-onset bilateral laryngeal paralysis (BLP) in association with hepatic dysfunction. Nine of them had been referred for the investigation of respiratory distress, and one pony had been referred for weight loss before BLP developed. Nine of the animals had clinicopathological evidence of liver disease, and nine had histological evidence of liver disease. All of the animals had one or more of the following: hepatic encephalopathy (in eight), hyperammonaemia (in six) and endoscopic evidence of BLP (in nine). Three of the animals had signs of pituitary pars intermedia dysfunction, a diagnosis supported in two by endocrine function testing, and in two by histopathological examination. Histopathological examination of the intrinsic laryngeal musculature and recurrent laryngeal nerves of four of the horses and of the region of the nucleus ambiguus of two did not reveal any abnormalities. Three of the animals were euthanased after they had first been examined, and one improved temporarily before the condition recurred. A temporary tracheostomy was performed in six of the animals, five of which subsequently died or were euthanased; one pony recovered. PMID:19188345

Hughes, K J; McGorum, B C; Love, S; Dixon, P M

2009-01-31

12

Quantitative video laryngoscopy to monitor recovery from recurrent laryngeal nerve injury in the rat.  

PubMed

Recovery from unilateral vocal-fold paralysis is lengthy, unpredictable, and often incomplete, highlighting the need for better treatments of the injured recurrent laryngeal nerve. To be able to monitor recovery of vocal-fold motion in studies with rats, we developed a procedure for quantitative video laryngoscopy. An asymmetry index was defined as a continuous and robust measure of unequal vocal-fold motion and calculated from spectral-density plots of vocal-fold displacements. In a cohort of 8 animals, unilateral vocal-fold paralysis was observed within seconds after clamping of the right recurrent laryngeal nerve and was accompanied by a markedly negative asymmetry index. Over the next month, the asymmetry index gradually returned to zero, concomitant with a visible recovery of vocal-fold motion. Our results suggest that quantitative video laryngoscopy is a sensitive and discriminating method for monitoring recovery from recurrent laryngeal nerve injury and set the stage for testing novel surgical and pharmacological treatments of unilateral vocal-fold paralysis. PMID:24486780

Mor, Niv; Naggar, Isaac; Das, Olipriya; Nakase, Ko; Silverman, Joshua B; Sundaram, Krishnamurthi; Stewart, Mark; Kollmar, Richard

2014-05-01

13

Neurological complications in thyroid surgery: a surgical point of view on laryngeal nerves.  

PubMed

THE CERVICAL BRANCHES OF THE VAGUS NERVE THAT ARE PERTINENT TO ENDOCRINE SURGERY ARE THE SUPERIOR AND THE INFERIOR LARYNGEAL NERVES: their anatomical course in the neck places them at risk during thyroid surgery. The external branch of the superior laryngeal nerve (EB) is at risk during thyroid surgery because of its close anatomical relationship with the superior thyroid vessels and the superior thyroid pole region. The rate of EB injury (which leads to the paralysis of the cricothyroid muscle) varies from 0 to 58%. The identification of the EB during surgery helps avoiding both an accidental transection and an excessive stretching. When the nerve is not identified, the ligation of superior thyroid artery branches close to the thyroid gland is suggested, as well as the abstention from an indiscriminate use of energy-based devices that might damage it. The inferior laryngeal nerve (RLN) runs in the tracheoesophageal groove toward the larynx, close to the posterior aspect of the thyroid. It is the main motor nerve of the intrinsic laryngeal muscles, and also provides sensory innervation to the larynx. Its injury finally causes the paralysis of the omolateral vocal cord and various sensory alterations: the symptoms range from mild to severe hoarseness, to acute airway obstruction, and swallowing impairment. Permanent lesions of the RNL occur from 0.3 to 7% of cases, according to different factors. The surgeon must be aware of the possible anatomical variations of the nerve, which should be actively searched for and identified. Visual control and gentle dissection of RLN are imperative. The use of intraoperative nerve monitoring has been safely applied but, at the moment, its impact in the incidence of RLN injuries has not been clarified. In conclusion, despite a thorough surgical technique and the use of intraoperative neuromonitoring, the incidence of neurological complications after thyroid surgery cannot be suppressed, but should be maintained in a low range. PMID:25076936

Varaldo, Emanuela; Ansaldo, Gian Luca; Mascherini, Matteo; Cafiero, Ferdinando; Minuto, Michele N

2014-01-01

14

Neurological Complications in Thyroid Surgery: A Surgical Point of View on Laryngeal Nerves  

PubMed Central

The cervical branches of the vagus nerve that are pertinent to endocrine surgery are the superior and the inferior laryngeal nerves: their anatomical course in the neck places them at risk during thyroid surgery. The external branch of the superior laryngeal nerve (EB) is at risk during thyroid surgery because of its close anatomical relationship with the superior thyroid vessels and the superior thyroid pole region. The rate of EB injury (which leads to the paralysis of the cricothyroid muscle) varies from 0 to 58%. The identification of the EB during surgery helps avoiding both an accidental transection and an excessive stretching. When the nerve is not identified, the ligation of superior thyroid artery branches close to the thyroid gland is suggested, as well as the abstention from an indiscriminate use of energy-based devices that might damage it. The inferior laryngeal nerve (RLN) runs in the tracheoesophageal groove toward the larynx, close to the posterior aspect of the thyroid. It is the main motor nerve of the intrinsic laryngeal muscles, and also provides sensory innervation to the larynx. Its injury finally causes the paralysis of the omolateral vocal cord and various sensory alterations: the symptoms range from mild to severe hoarseness, to acute airway obstruction, and swallowing impairment. Permanent lesions of the RNL occur from 0.3 to 7% of cases, according to different factors. The surgeon must be aware of the possible anatomical variations of the nerve, which should be actively searched for and identified. Visual control and gentle dissection of RLN are imperative. The use of intraoperative nerve monitoring has been safely applied but, at the moment, its impact in the incidence of RLN injuries has not been clarified. In conclusion, despite a thorough surgical technique and the use of intraoperative neuromonitoring, the incidence of neurological complications after thyroid surgery cannot be suppressed, but should be maintained in a low range. PMID:25076936

Varaldo, Emanuela; Ansaldo, Gian Luca; Mascherini, Matteo; Cafiero, Ferdinando; Minuto, Michele N.

2014-01-01

15

Functional Laryngeal Results after Thyroidectomy and Extensive Recurrent Laryngeal Nerve Dissection without Neuromonitoring  

Microsoft Academic Search

Summary BACKGROUND: Permanent recurrent laryngeal nerve palsy (RLNP) is a major complication after thyroid surgery. Therefore methods are mandatory which reduce this complication. One strategy is the identification and dissection of the recurrent laryngeal nerve (RLN) in all patients as an inflexible rule. It is an ongoing discussion whether RLN neuromonitoring is helpful. METHODS: We prospectively investigated 624 surgical patients

M. Steurer; C. Passler; D. M. Denk; B. Schneider; G. Mancusi; B. Schickinger; B. Niederle; W. Bigenzahn

2003-01-01

16

A Novel Means of Clinical Assessment of Laryngeal Nerve Conduction  

PubMed Central

Introduction We describe a novel, clinically applicable conduction study of the laryngeal nerves. Methods 17 normal volunteer subjects were included. Activation of the sensory territory of the superior laryngeal nerve was performed by administration of low level, brief electrical stimulus. The laryngeal closure reflex (LCR) evoked by this stimulus was recorded by needle electrodes. Mean minimal latencies were calculated for each response, and proposed values for the upper limit of normal were determined. Results Uniform consistent early ipsilateral responses and late bilateral responses, which exhibit greater variation in latency and morphology, were recorded. Significant side-to-side difference in latencies is observed, consistent with the length discrepancy between right and left recurrent laryngeal nerves. Discussion This technique yields clear, quantifiable data regarding neurologic integrity of laryngeal function, heretofore unobtainable in the clinical setting. This study may yield clinically relevant information regarding severity and prognosis in patients with laryngeal neuropathic injury. PMID:23382050

Carey, Bridget; Sulica, Lucian; Wu, Anita; Branski, Ryan

2014-01-01

17

The value of neurostimulation and intraoperative nerve monitoring of inferior laryngeal nerve in thyroid surgery  

Microsoft Academic Search

ObjectiveTo determine the accuracy of neurostimulation with laryngeal palpation (NSLP) and intraoperative neuromonitoring (IONM) to predict the postoperative function of recurrent laryngeal nerve (RLN) in thyroid surgery.

Ottavio Cavicchi; Umberto Caliceti; Ignacio Javier Fernandez; Giovanni Macrì; Cristiana Di Lieto; Alessandra Marcantoni; Alberto Rinaldi Ceroni; Ottavio Piccin

2009-01-01

18

Continuous Vagal Nerve Stimulation for Recurrent Laryngeal Nerve Protection in Thyroid Surgery  

Microsoft Academic Search

Introduction: Newly developed vagal stimulation probes permit continuous intraoperative neuromonitoring of the recurrent laryngeal nerve during thyroid resection. Complete signal loss indicates damage of the nerve. There is no other criterion so far to warn before imminent nerve function impairment. Methods: In 100 patients, thyroid resection (188 nerves at risk, 52 thyroidectomies, 21 Dunhill resections, 12 hemithyroidectomies, 5 two-sided subtotal

J. Jonas

2010-01-01

19

The Role of Immediate Recurrent Laryngeal Nerve Reconstruction for Thyroid Cancer Surgery  

PubMed Central

Unilateral vocal fold paralysis (UVFP) is one of the most serious problems in conducting surgery for thyroid cancer. Different treatments are available for the management of UVFP including intracordal injection, type I thyroplasty, arytenoid adduction, and laryngeal reinnervations. The effects of immediate recurrent laryngeal nerve (RLN) reconstruction during thyroid cancer surgery with or without UVFP before the surgery were evaluated with videostroboscopic, aerodynamic, and perceptual analyses. All subjects experienced postoperative improvements in voice quality. Particularly, aerodynamic analysis showed that the values for all patients entered normal ranges in both patients with and without UVFP before surgery. Immediate RLN reconstruction has the potential to restore a normal or near-normal voice by returning thyroarytenoid muscle tone and bulk seen with vocal fold denervation. Immediate RLN reconstruction is an efficient and effective approach to the management of RLN resection during surgery for thyroid cancer. PMID:20628531

Sanuki, Tetsuji; Yumoto, Eiji; Minoda, Ryosei; Kodama, Narihiro

2010-01-01

20

Facial Nerve Paralysis due to a Pleomorphic Adenoma with the Imaging Characteristics of a Facial Nerve Schwannoma  

PubMed Central

Background?Facial nerve paralysis in a patient with a salivary gland mass usually denotes malignancy. However, facial paralysis can also be caused by benign salivary gland tumors. Methods?We present a case of facial nerve paralysis due to a benign salivary gland tumor that had the imaging characteristics of an intraparotid facial nerve schwannoma. Results?The patient presented to our clinic 4 years after the onset of facial nerve paralysis initially diagnosed as Bell palsy. Computed tomography demonstrated filling and erosion of the stylomastoid foramen with a mass on the facial nerve. Postoperative histopathology showed the presence of a pleomorphic adenoma. Facial paralysis was thought to be caused by extrinsic nerve compression. Conclusions?This case illustrates the difficulty of accurate preoperative diagnosis of a parotid gland mass and reinforces the concept that facial nerve paralysis in the context of salivary gland tumors may not always indicate malignancy. PMID:25083397

Nader, Marc-Elie; Bell, Diana; Sturgis, Erich M.; Ginsberg, Lawrence E.; Gidley, Paul W.

2014-01-01

21

Facial Nerve Paralysis due to a Pleomorphic Adenoma with the Imaging Characteristics of a Facial Nerve Schwannoma.  

PubMed

Background?Facial nerve paralysis in a patient with a salivary gland mass usually denotes malignancy. However, facial paralysis can also be caused by benign salivary gland tumors. Methods?We present a case of facial nerve paralysis due to a benign salivary gland tumor that had the imaging characteristics of an intraparotid facial nerve schwannoma. Results?The patient presented to our clinic 4 years after the onset of facial nerve paralysis initially diagnosed as Bell palsy. Computed tomography demonstrated filling and erosion of the stylomastoid foramen with a mass on the facial nerve. Postoperative histopathology showed the presence of a pleomorphic adenoma. Facial paralysis was thought to be caused by extrinsic nerve compression. Conclusions?This case illustrates the difficulty of accurate preoperative diagnosis of a parotid gland mass and reinforces the concept that facial nerve paralysis in the context of salivary gland tumors may not always indicate malignancy. PMID:25083397

Nader, Marc-Elie; Bell, Diana; Sturgis, Erich M; Ginsberg, Lawrence E; Gidley, Paul W

2014-08-01

22

Laryngeal elevation by selective stimulation of the hypoglossal nerve  

NASA Astrophysics Data System (ADS)

Objective. Laryngeal elevation protects the airway and assists opening of the esophagus during swallowing. The GH, thyrohyoid, and MH muscles provide a majority of this elevatory motion. This study applied functional electrical stimulation to the XII/C1 nerve complex using a nerve cuff electrode to determine the capabilities of neural stimulation to induce laryngeal elevation. Approach. Multi-contact FINE electrodes were implanted onto the XII/C1 nerve complex at locations proximal and distal to the thyrohyoid branching point in five anesthetized canines. Motion of the thyroid cartilage and the hyoid bone was recorded during stimulation of nerve cuffs and intramuscular electrodes. Main Results. Nerve stimulation induced 260% more laryngeal elevation than intramuscular stimulation (18.8 mm versus 5.2 mm, p ? 0.01), and 228% higher velocity (143.8 versus 43.9 mm s-1, p ? 0.01). While stimulation at all cuff and electrode locations elevated the larynx, only the proximal XII/C1 nerve cuff significantly elicited both thyroid-hyoid approximation and hyoid elevation. In all proximal XII/C1 nerve cuffs (n = 7), stimulation was able to obtain selectivity of greater than 75% of at least one elevatory muscle. Significance. These results support the hypothesis that an implanted neural interface system can produce increased laryngeal elevation, a significant protective mechanism of deglutition.

Hadley, Aaron J.; Kolb, Ilya; Tyler, Dustin J.

2013-08-01

23

Inferior alveolar nerve injury with laryngeal mask airway: a case report  

Microsoft Academic Search

Introduction  The incidence of damage to the individual cranial nerves and their branches associated with laryngeal mask airway use is low;\\u000a there have been case reports of damage to the lingual nerve, hypoglossal nerve and recurrent laryngeal nerve. To the best\\u000a of our knowledge we present the first reported case of inferior alveolar nerve injury associated with laryngeal mask airway\\u000a use.

Deepak Hanumanthaiah; Sarmad Masud; Anil Ranganath

2011-01-01

24

Intrinsic muscles and distribution of the recurrent laryngeal nerve in the pig larynx  

Microsoft Academic Search

To use the pig larynx in studies of laryngeal reinnervation, it is essential to have a clear understanding of its anatomy. We aimed to define the macroscopic anatomy of the intrinsic muscles and the course of the recurrent laryngeal nerve (RLN) in the pig larynx. Twelve large white pig larynges were used. Five larynges were preserved in formalin, then dissected

Melanie J. Knight; Stephen E. McDonald; Martin A. Birchall

2005-01-01

25

Laryngeal Reinnervation Using Ansa Cervicalis for Thyroid Surgery-Related Unilateral Vocal Fold Paralysis: A Long-Term Outcome Analysis of 237 Cases  

PubMed Central

Objective To evaluate the long-term efficacy of delayed laryngeal reinnervation using the main branch of the ansa cervicalis in treatment of unilateral vocal fold paralysis (UVFP) caused by thyroid surgery. Summary of Background Data UVFP remains a serious complication of thyroid surgery. Up to now, a completely satisfactory surgical treatment of UVFP has been elusive. Methods From Jan. 1996 to Jan. 2008, a total of 237 UVFP patients who underwent ansa cervicalis main branch-to-recurrent laryngeal nerve (RLN) anastomosis were enrolled as UVFP group; another 237 age- and gender-matched normal subjects served as control group. Videostroboscopy, vocal function assessment (acoustic analysis, perceptual evaluation and maximum phonation time), and electromyography were performed preoperatively and postoperatively. The mean follow-up period was 5.2±2.7 years, ranging from 2 to 12 years. Results Analysis of videostroboscopic findings indicated that the glottic closure, vocal fold edge, vocal fold position, phase symmetry and regularity were significantly improved in the UVFP group (P<0.001, postoperative vs. preoperative). The postoperative parameters of vocal function were also significantly improved in the UVFP group (P<0.001) and showed no statistical differences compared to the control group (P>0.05, respectively). Postoperative laryngeal electromyography confirmed successful reinnervation of laryngeal muscle. Conclusions Delayed laryngeal reinnervation with the main branch of ansa cervicalis is a feasible and effective approach for treatment of thyroid surgery-related UVFP; it can restore the physiological laryngeal phonatory function to the normal or a nearly normal voice quality. PMID:21559458

Li, Ding; Li, Meng; Xia, Siwen; Zheng, Hongliang

2011-01-01

26

Management of the Laryngeal Nerves and Voice  

Microsoft Academic Search

\\u000a One’s voice is a fundamental identifying human trait. Changes in voice raise great concern with most patients considering\\u000a thyroid surgery, even if they are not professional singers or vocalists. Any discussion of voice in surgery must begin with\\u000a a review of laryngeal anatomy, neurolaryngology, and mechanism of normal voice production. The thyroid surgeon must take great\\u000a care in preserving function

David J. Lesnik; Gregory W. Randolph

27

A new system for continuous recurrent laryngeal nerve monitoring.  

PubMed

Existing nerve monitoring devices in thyroid surgery are - except for one - mainly intermittently working nerve identification tools. We present a new vagal electrode which allows true continuous monitoring of the recurrent laryngeal nerve (RLN). The electrode was designed as a tripolar hybrid cuff electrode consisting of polyimide, gold and platinum layers embedded in a flexible silicon cuff which can be opened at the long side for introducing the nerve. It is fully implantable and atraumatic. The evoked potentials are sensed by standard thyroid electrodes. Real-time signal analysis and audio feedback are achieved by specially designed software. Homogeneous and stable signals were recorded throughout the operations. Thus real-time computer-based signal analysis was possible. Evoked potentials reached 300-900 mV. Mean time to place the cuff electrode was 5.5 min. The nerve was stimulated a mean of 63 min (range 55-99 min). No RLN lesions were detected postoperatively. The new vagal electrode was easy to handle and led to stable and reproducible signals. The stimulation current could be kept extremely low due to the special geometry of the electrode. It offers the possibility for uninterrupted, continuous laryngeal nerve monitoring in thyroid surgery. In an ongoing clinical trial its compatibility as an add-on for existing nerve monitoring devices is being tested. PMID:17573619

Lamadé, Wolfram; Ulmer, Christoph; Seimer, Andreas; Molnar, Viktor; Meyding-Lamadé, Uta; Thon, Klaus-Peter; Koch, Klaus Peter

2007-01-01

28

Unilateral hypoglossal nerve palsy after use of the laryngeal mask airway supreme.  

PubMed

Purpose. Hypoglossal nerve palsy after use of the laryngeal mask airway (LMA) is an exceptionally rare complication. We present the first case of unilateral hypoglossal nerve palsy after use of the LMA Supreme. Clinical Features. A healthy 67-year-old female was scheduled for a hallux valgus correction under general anesthesia combined with femoral and sciatic nerve blocks. A size 4?LMA Supreme was inserted successfully at the first attempt and the cuff was inflated with air at an intracuff pressure of 60?cmH2O using cuff pressure gauge. Anesthesia was maintained with oxygen, nitrous oxide (67%), and sevoflurane under spontaneous breathing. The surgery was uneventful and the duration of anesthesia was two hours. The LMA was removed as the patient woke and there were no immediate postoperative complications. The next morning, the patient complained of dysarthria and dysphasia. These symptoms were considered to be caused by the LMA compressing the nerve against the hyoid bone. Conservative treatment was chosen and the paralysis recovered completely after 5 months. Conclusion. Hypoglossal nerve injury may occur despite correct positioning of the LMA under the appropriate intracuff pressure. A follow-up period of at least 6 months should be taken into account for the recovery. PMID:25254120

Takahoko, Kenichi; Iwasaki, Hajime; Sasakawa, Tomoki; Suzuki, Akihiro; Matsumoto, Hideki; Iwasaki, Hiroshi

2014-01-01

29

Unilateral Hypoglossal Nerve Palsy after Use of the Laryngeal Mask Airway Supreme  

PubMed Central

Purpose. Hypoglossal nerve palsy after use of the laryngeal mask airway (LMA) is an exceptionally rare complication. We present the first case of unilateral hypoglossal nerve palsy after use of the LMA Supreme. Clinical Features. A healthy 67-year-old female was scheduled for a hallux valgus correction under general anesthesia combined with femoral and sciatic nerve blocks. A size 4?LMA Supreme was inserted successfully at the first attempt and the cuff was inflated with air at an intracuff pressure of 60?cmH2O using cuff pressure gauge. Anesthesia was maintained with oxygen, nitrous oxide (67%), and sevoflurane under spontaneous breathing. The surgery was uneventful and the duration of anesthesia was two hours. The LMA was removed as the patient woke and there were no immediate postoperative complications. The next morning, the patient complained of dysarthria and dysphasia. These symptoms were considered to be caused by the LMA compressing the nerve against the hyoid bone. Conservative treatment was chosen and the paralysis recovered completely after 5 months. Conclusion. Hypoglossal nerve injury may occur despite correct positioning of the LMA under the appropriate intracuff pressure. A follow-up period of at least 6 months should be taken into account for the recovery.

Sasakawa, Tomoki; Suzuki, Akihiro; Matsumoto, Hideki; Iwasaki, Hiroshi

2014-01-01

30

Intraoperative Monitoring of the Recurrent Laryngeal Nerve in Thyroid Surgery  

Microsoft Academic Search

Background  Recurrent laryngeal nerve (RLN) palsy ranks among the leading reasons for medicolegal litigation of surgeons because of its\\u000a attendant reduction in quality of life. As a risk minimization tool, intraoperative nerve monitoring (IONM) has been introduced\\u000a to verify RLN function integrity intraoperatively. Nevertheless, a systematic evidence-based assessment of this novel health\\u000a technology has not been performed.\\u000a \\u000a \\u000a \\u000a Methods  The present study was

H. Dralle; C. Sekulla; K. Lorenz; M. Brauckhoff; A. Machens

2008-01-01

31

Paralysis  

MedlinePLUS

Paralysis is the loss of muscle function in part of your body. It happens when something goes ... way messages pass between your brain and muscles. Paralysis can be complete or partial. It can occur ...

32

Isolated Unilateral Paralysis of the Hypoglossal Nerve after Transoral Intubation for General Anesthesia  

Microsoft Academic Search

Hypoglossal nerve paralysis is a rare complication of endotracheal intubation for general anesthesia. Anesthesiologists should\\u000a be aware of the possible causes and should take extreme care to prevent nerve injuries and other complications. We present\\u000a a case of postoperative unilateral hypoglossal nerve palsy after general anesthesia for laparoscopic cholecystectomy.

Sung Jin Hong; Jin Young Lee

2009-01-01

33

Reinnervation of Bilateral Posterior Cricoarytenoid Muscles Using the Left Phrenic Nerve in Patients with Bilateral Vocal Fold Paralysis  

PubMed Central

Objective To evaluate the feasibility, effectiveness, and safety of reinnervation of the bilateral posterior cricoarytenoid (PCA) muscles using the left phrenic nerve in patients with bilateral vocal fold paralysis. Methods Forty-four patients with bilateral vocal fold paralysis who underwent reinnervation of the bilateral PCA muscles using the left phrenic nerve were enrolled in this study. Videostroboscopy, perceptual evaluation, acoustic analysis, maximum phonation time, pulmonary function testing, and laryngeal electromyography were performed preoperatively and postoperatively. Patients were followed-up for at least 1 year after surgery. Results Videostroboscopy showed that within 1 year after reinnervation, abductive movement could be observed in the left vocal folds of 87% of patients and the right vocal folds of 72% of patients. Abductive excursion on the left side was significantly larger than that on the right side (P < 0.05); most of the vocal function parameters were improved postoperatively compared with the preoperative parameters, albeit without a significant difference (P > 0.05). No patients developed immediate dyspnea after surgery, and the pulmonary function parameters recovered to normal reference value levels within 1 year. Postoperative laryngeal electromyography confirmed successful reinnervation of the bilateral PCA muscles. Eighty-seven percent of patients in this series were decannulated and did not show obvious dyspnea after physical activity. Those who were decannulated after subsequent arytenoidectomy were not included in calculating the success rate of decannulation. Conclusions Reinnervation of the bilateral PCA muscles using the left phrenic nerve can restore inspiratory vocal fold abduction to a physiologically satisfactory extent while preserving phonatory function at the preoperative level without evident morbidity. PMID:24098581

Zheng, Hongliang; Chen, Donghui; Zhu, Minhui; Wang, Wei; Liu, Fei; Zhang, Caiyun

2013-01-01

34

Electromyographic response persists after peripheral transection: endorsement of current concepts in recurrent laryngeal nerve monitoring in a porcine model  

Microsoft Academic Search

Background  Recurrent laryngeal nerve palsy is a serious complication of endocrine surgery to the neck. Permanent lesions are still occurring\\u000a in about one in a hundred, despite standardized surgical approach to the nerve and the availability of recurrent laryngeal\\u000a nerve monitoring. Intraoperative recurrent laryngeal nerve monitoring is based on the visual or acoustic registration of evoked\\u000a electromyography of the laryngeal muscles.

Torsten Birkholz; Andrea Irouschek; Dirk Labahn; Peter Klein; Joachim Schmidt

2010-01-01

35

Intraoperative Monitoring of the Recurrent Laryngeal Nerve in 151 Consecutive Patients Undergoing Thyroid Surgery  

Microsoft Academic Search

ntraoperative identification and preservation of the recurrent laryngeal nerve is essential to thyroid surgery. The risk to the recurrent laryngeal nerve increases with the extent and difficulty of thyroidal surgery (1). The incidence of either a temporary or permanent paresis may be as frequent as 20% in thy- roid cancers or recurrent goiter (2,3). The latest meth- ods of intraoperative

Thomas M. Hemmerling; Joachim Schmidt; Christian Bosert; Klaus E. Jacobi; Peter Klein

2001-01-01

36

Intrinsic muscles and distribution of the recurrent laryngeal nerve in the pig larynx.  

PubMed

To use the pig larynx in studies of laryngeal reinnervation, it is essential to have a clear understanding of its anatomy. We aimed to define the macroscopic anatomy of the intrinsic muscles and the course of the recurrent laryngeal nerve (RLN) in the pig larynx. Twelve large white pig larynges were used. Five larynges were preserved in formalin, then dissected to study the anatomy of the intrinsic muscles. Seven larynges were stained using the modified Sihler's staining technique, which results in nerves being stained dark purple while the remainder of the larynx is rendered translucent. The intrinsic muscles of the pig larynx were similar to those in the human. The RLN gives off a branch that enters the posterior cricoarytenoid muscle (PCA) on its deep surface and supplies the entire muscle, although the branching pattern of the nerve within the muscle varies considerably. These results facilitate detailed reinnervation studies in the pig laryngeal transplant model. PMID:15322831

Knight, Melanie J; McDonald, Stephen E; Birchall, Martin A

2005-04-01

37

Aerodynamic and Nonlinear Dynamic Acoustic Analysis of Tension Asymmetry in Excised Canine Larynges  

ERIC Educational Resources Information Center

Purpose: To model tension asymmetry caused by superior laryngeal nerve paralysis (SLNP) in excised larynges and apply perturbation, nonlinear dynamic, and aerodynamic analyses. Method: SLNP was modeled in 8 excised larynges using sutures and weights to mimic cricothyroid (CT) muscle function. Weights were removed from one side to create tension…

Devine, Erin E.; Bulleit, Erin E.; Hoffman, Matthew R.; McCulloch, Timothy M.; Jiang, Jack J.

2012-01-01

38

The role of the superior laryngeal nerve in esophageal reflexes.  

PubMed

The aim of this study was to determine the role of the superior laryngeal nerve (SLN) in the following esophageal reflexes: esophago-upper esophageal sphincter (UES) contractile reflex (EUCR), esophago-lower esophageal sphincter (LES) relaxation reflex (ELIR), secondary peristalsis, pharyngeal swallowing, and belch. Cats (N = 43) were decerebrated and instrumented to record EMG of the cricopharyngeus, thyrohyoideus, geniohyoideus, and cricothyroideus; esophageal pressure; and motility of LES. Reflexes were activated by stimulation of the esophagus via slow balloon or rapid air distension at 1 to 16 cm distal to the UES. Slow balloon distension consistently activated EUCR and ELIR from all areas of the esophagus, but the distal esophagus was more sensitive than the proximal esophagus. Transection of SLN or proximal recurrent laryngeal nerves (RLN) blocked EUCR and ELIR generated from the cervical esophagus. Distal RLN transection blocked EUCR from the distal cervical esophagus. Slow distension of all areas of the esophagus except the most proximal few centimeters activated secondary peristalsis, and SLN transection had no effect on secondary peristalsis. Slow distension of all areas of the esophagus inconsistently activated pharyngeal swallows, and SLN transection blocked generation of pharyngeal swallows from all levels of the esophagus. Slow distension of the esophagus inconsistently activated belching, but rapid air distension consistently activated belching from all areas of the esophagus. SLN transection did not block initiation of belch but blocked one aspect of belch, i.e., inhibition of cricopharyngeus EMG. Vagotomy blocked all aspects of belch generated from all areas of esophagus and blocked all responses of all reflexes not blocked by SLN or RLN transection. In conclusion, the SLN mediates all aspects of the pharyngeal swallow, no portion of the secondary peristalsis, and the EUCR and ELIR generated from the proximal esophagus. Considering that SLN is not a motor nerve for any of these reflexes, the role of the SLN in control of these reflexes is sensory in nature only. PMID:22403790

Lang, I M; Medda, B K; Jadcherla, S; Shaker, R

2012-06-15

39

New insights into the mechanism of injury to the recurrent laryngeal nerve associated with the laryngeal mask airway.  

PubMed

With the popular use of the laryngeal mask airway (LMA), recurrent laryngeal nerve injury associated with the LMA, which might cause serious complications, has recently been reported. The true mechanism, however, remains unclear, which makes effective prevention and treatment of this disorder difficult. On the basis of the anatomical relationship of the laryngopharynx and the laryngeal mask and the progressive recovery in most reported cases, we hypothesize that demyelinating neuropraxia resulting from direct mechanical compression contributes to the recurrent nerve injury associated with the LMA. A series of clinical cases which showed that recurrent nerve palsy may occur as a result of cuff over-inflation and/or prolonged LMA insertion period support the hypothesis. Several animal studies also reveal that high laryngeal mask airway intra-cuff pressure might cause laryngopharyngeal mucosa damage, but there is no experimental research about LMA-related recurrent nerve injury. Therefore, further investigation by establishing an animal model might disclose the definite mechanism of the injury and evaluate the process of nerve recovery. The potential implications arising from this testable hypothesis might be helpful in developing clinical therapeutic approaches for this complication. PMID:20424559

Zhang, Junfeng; Zhao, Zhe; Chen, Yongzhu; Zhang, Xiaoli

2010-05-01

40

Intraoperative recurrent laryngeal nerve monitoring in revision thyroidectomy.  

PubMed

Recurrent laryngeal nerve (RLN) palsy is one of the most important complications after thyroid and parathyroid surgery. There is controversy in the literature regarding whether or not intraoperative nerve monitoring decreases the risk of injury. We report our experience using Nerve Integrity Monitoring (NIM) system in cases of revision thyroidectomy, providing clear indications for its use. A series of 97 patients who underwent revision thyroidectomy with and without intraoperative NIM alternately was evaluated. There were 121 RLN patients at risk. Use of NIM during revision thyroidectomy was not statistically significant compared to revision operation without monitoring (p value = 0.059). Furthermore, comparison of operative times either with or without NIM showed that use of NIM led to statistically significant prolonged operation time (p value <0.001). There is no strict indication to use RLN monitoring during thyroid surgery, especially as there is no statistical evidence that the use of this technique decreases the incidence of RLN palsy, although there is a trend especially in difficult revision cases. PMID:23371536

Prokopakis, Emmanuel; Kaprana, Antigoni; Velegrakis, Stylianos; Panagiotaki, Irene; Chatzakis, Nikolaos; Iro, Heinrich; Velegrakis, George

2013-09-01

41

Latencies longer than 3.5 ms after vagus nerve stimulation does not exclude a nonrecurrent inferior laryngeal nerve  

PubMed Central

Background It has recently been reported that a signal latency shorter than 3.5 ms after electrical stimulation of the vagus nerve signify a nonrecurrent course of the inferior laryngeal nerve. We present a patient with an ascending nonrecurrent inferior laryngeal nerve. In this patient, the stimulation latency was longer than 3.5 ms. Case presentation A 74-years old female underwent redo surgery due to a right-sided recurrent nodular goitre. The signal latency on electrical stimulation of the vagus nerve at the level of the carotid artery bifurcation was 3.75 ms. Further dissection revealed a nonrecurrent but ascending course of the inferior laryngeal nerve. Caused by the recurrent goitre, the nerve was elongated to about 10 cm resulting in this long latency. Conclusion This case demonstrates that the formerly proposed “3.5 ms rule” for identifying a nonrecurrent course of the inferior laryngeal nerve has exceptions. A longer latency does not necessarily exclude a nonrecurrent laryngeal nerve. PMID:25168966

2014-01-01

42

Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy  

Microsoft Academic Search

Background: The aim of this study was to test the hypothesis that identification of the recurrent laryngeal nerve (RLN) during thyroid surgery reduces injury, and that intraoperative nerve monitoring may be of additional benefit. Methods: One thousand consenting patients scheduled to have bilateral thyroid surgery were randomized to standard protection or additional nerve monitoring. The primary outcome measure was prevalence

M. Barczyn?ski; A. Konturek; S. Cichon?

2009-01-01

43

Lingual nerve neuropraxia following use of the Laryngeal Mask Airway Supreme.  

PubMed

Cranial nerve injury is a rare complication with the use of supraglottic airway devices. A case of lingual nerve injury following the use of a Laryngeal Mask Airway Supreme in a 45 year old woman is presented. A review of the literature regarding lingual nerve injury as a complication of the supraglottic airway is also presented. PMID:24444986

Thiruvenkatarajan, Venkatesan; Van Wijk, Roelof M A W; Elhalawani, Islam; Barnes, Ann-Maree

2014-02-01

44

A Novel Technique for Clinical Assessment of Laryngeal Nerve Conduction: Normal and Abnormal Results  

PubMed Central

Objectives/Hypothesis To describe a novel conduction study of the laryngeal nerves, including normal values and abnormal findings. Study Design Prospective nonrandomized. Methods Seventeen healthy adult volunteers, as well as three patients with clinically identified laryngeal neuropathy, underwent low-level brief electrical stimulation of the laryngeal mucosa by means of a wire inserted via a transnasal flexible laryngoscope. Bilateral hookwire electrodes recorded the result in the laryngeal adductor muscles. Results This study yields an early response ipsilateral to the side of stimulation (LR1), which is uniform and consistent (right 5 13.2 6 0.80 msec; left 5 15.2 6 1.20 msec), and late bilateral responses (ipsilateral LR2 [LR2i] and contralateral LR2 [LR2c]), which exhibit greater variation in latency and morphology (right LR2i 5 50.5 6 3.38 msec; left LR2i 5 52.2 msec; right LR2c 5 50.7 6 4.26; left LR2c 5 50.6 6 4.07). Findings in abnormal patients differ significantly from normal, consistent with the distribution of neuropathy. Conclusions We describe a novel, clinically applicable conduction study of laryngeal nerves. Normative electrodiagnostic values and variations of the reflex responses of the laryngeal adductor muscles in response to irritative stimulation of the laryngeal mucosa (Laryngeal Closure Reflex) are proposed. By enabling the determination of electrophysiological parameters of the superior laryngeal and recurrent laryngeal branches of cranial nerve X (CN X), this procedure, which is used as an adjunct to laryngeal electromyography, may provide earlier and more accurate information regarding the extent and grade of nerve injury. Because injury grade relates directly to prognosis, the information derived from this test may have clinical relevance in determining optimal treatment. Level of Evidence 4. PMID:23835889

Sulica, Lucian; Carey, Bridget; Branski, Ryan C.

2014-01-01

45

Losing Your Voice: Etiologies and Imaging Features of Vocal Fold Paralysis  

PubMed Central

Neurogenic compromise of vocal fold function exists along a continuum encompassing vocal cord hypomobility (paresis) to vocal fold immobility (paralysis) with varying degrees and patterns of reinnervation. Vocal fold paralysis (VFP) may result from injury to the vagus or the recurrent laryngeal nerves anywhere along their course from the brainstem to the larynx. In this article, we review the anatomy of the vagus and recurrent laryngeal nerves and examine the various etiologies of VFP. Selected cases are presented with discussion of key imaging features of VFP including radiologic findings specific to central vagal neuropathy and peripheral recurrent nerve paralysis. PMID:23814687

Vachha, Behroze; Cunnane, Mary Beth; Mallur, Pavan; Moonis, Gul

2013-01-01

46

Quantitative PCR Analysis of Laryngeal Muscle Fiber Types  

ERIC Educational Resources Information Center

Voice and swallowing dysfunction as a result of recurrent laryngeal nerve paralysis can be improved with vocal fold injections or laryngeal framework surgery. However, denervation atrophy can cause late-term clinical failure. A major determinant of skeletal muscle physiology is myosin heavy chain (MyHC) expression, and previous protein analyses…

Van Daele, Douglas J.

2010-01-01

47

A new anchor electrode design for continuous neuromonitoring of the recurrent laryngeal nerve by vagal nerve stimulations  

Microsoft Academic Search

Purpose  Intraoperative neuromonitoring has the limitation that the recurrent laryngeal nerve (RLN) is still at risk for damage between\\u000a two stimulations with a handheld bipolar stimulation electrode. The purpose of this study was to establish the vagal anchor\\u000a electrode for real-time monitoring of the RLN in surgical routine and to be alerted to imminent nerve failure by electromyography\\u000a (EMG) signal analysis

Rick Schneider; Joanna Przybyl; Michael Hermann; Johann Hauss; Sven Jonas; Steffen Leinung

2009-01-01

48

Evaluation of recurrent laryngeal nerve monitoring in thyroid surgery  

Microsoft Academic Search

AimThyroidectomy creates a potential risk for all parathyroid glands and nerves. Nerve identification has decreased the rates of nerve injury during thyroidectomy. Intraoperative nerve monitoring (IONM) has been used as an adjunct to the visual identification of the nerve. The aim of this clinical trial is to evaluate the effect of the identification time of RLN during thyroidectomy using IONM.

Serkan Sar?; Ye?im Erbil; Aziz Sümer; Orhan Agcaoglu; Adem Bayraktar; Halim Issever; Selcuk Ozarmagan

2010-01-01

49

Manual therapy and neurodynamic mobilization in a patient with peroneal nerve paralysis: a case report  

PubMed Central

Objective The purpose of this case report is to describe a therapeutic intervention for peroneal nerve paralysis involving the sciatic nerve. Clinical features A 24-year-old man presented with peroneal nerve paralysis with decreased sensation, severe pain in the popliteal fossa, and steppage gait, which occurred 3 days prior to the consultation. Magnetic resonance imaging and electromyography confirmed lumbar disk herniation with sciatic common peroneal nerve entrapment in the popliteal fossa. Intervention and outcome A combined treatment protocol of spinal and fibular head manipulation and neurodynamic mobilization including soft tissue work of the psoas and hamstring muscles was performed. Outcome measures were assessed at pretreatment, 1 week posttreatment, and 3-month follow-up and included numeric pain rating scale, range of motion, pressure pain threshold, and manual muscle testing. Treatment interventions were applied for 3 sessions over a period of 1 week. Results showed reduction of the patient’s subjective pain and considerable improvement in range of motion, strength, and sensation in his left foot, which was restored to full function. Conclusion A combined program of spinal and fibular head manipulation and neurodynamic mobilization reduced pain, increased range of motion and strength, and restored full function to the left leg in this patient who had severe functional impairment related to a compressed left common peroneal nerve. PMID:24396318

Villafane, Jorge Hugo; Pillastrini, Paolo; Borboni, Alberto

2013-01-01

50

[New aspects in surgery of the thyroid gland with intraoperative monitoring of the recurrent laryngeal nerve].  

PubMed

A method for electrophysiological monitoring of the recurrent laryngeal nerve during thyroid surgery is described. An electromyographic record from the muscles of the vocal folds is obtained using two fine needle electrodes. The electrodes are placed endoscopically. The nerve is identified by electrical stimulation, and the electromyographic activity is registered using a Nerve Integrity Monitor NIM-2 (Xomed-Treace). Our experience with this method in 43 patients is described. The safety of the integrity of the recurrent laryngeal nerve is increased using intraoperative monitoring. This has led to a modification of the operative concept in thyroid surgery. Electrophysiological monitoring is mandatory in surgery of large goitres, retrotracheal and substernal extension, for re-operations and malignant diseases of the thyroid gland. PMID:7818740

Tschopp, K; Probst, R

1994-11-01

51

Intraoperative electromyogram monitoring of the recurrent laryngeal nerve: experience with an intralaryngeal surface electrode  

Microsoft Academic Search

Introduction: A clinical method to localize the recurrent laryngeal nerve intraoperatively in order to minimize the risk of accidental\\u000a injury is presented. Methods and results: By means of an electrode, the nerve was stimulated by a pulsed contact current. The resulting muscle potential was detected\\u000a using an electrode placed in the larynx. We applied this technique during the time period

Detlef Horn; V. M. Rötzscher

1999-01-01

52

Functional electrical stimulation of the left recurrent laryngeal nerve using a vagus nerve stimulator in a normal horse.  

PubMed

The aim of this study was to assess the feasibility of implanting an existing vagus nerve stimulating (VNS) electrode around the recurrent laryngeal nerve. The stimulus response characteristics required to achieve abduction of the ipsilateral arytenoid by the VNS electrode in the normal horse could then be determined. The electrode was wound around the left recurrent laryngeal nerve at the cervical level and connected to a pulse generator. Stimulus response characteristics were obtained by measuring stimulated arytenoid displacement endoscopically in the standing, non-sedated horse. A full and sustained abduction of the arytenoid was obtained with a stimulation frequency of 25 Hz and intensity of 1 mA with a pulse width of 250 ?s. PMID:20724182

Vanschandevijl, Katleen; Nollet, Heidi; Vonck, Kristl; Raedt, Rorecht; Boon, Paul; Roost, DirkVan; Martens, Ann; Deprez, Piet

2011-09-01

53

Intraoperative recurrent laryngeal nerve monitoring during video-assisted thoracoscopic surgery for patent ductus arteriosus  

Microsoft Academic Search

Objective: To develop a technique to identify and localize the recurrent laryngeal nerve (RLN) during video-assisted thoracoscopic surgery (VATS) for patent ductus arteriosus. Design: Prospective clinical study. Setting: Children's hospital. Participants: Sixty infants and children scheduled for elective closure of patent ductus arteriosus. Interventions: With parental informed consent, 60 infants and children undergoing elective VATS for patent ductus arteriosus were

Kirsten C. Odegard; Daniel J. Kirse; Pedro J. del Nido; Peter C. Laussen; Alfonso Casta; John Booke; Margaret A. Kenna; Francis X. McGowan

2000-01-01

54

A non-recurrent inferior laryngeal nerve in a man undergoing thyroidectomy: a case report  

Microsoft Academic Search

INTRODUCTION: A non-recurrent variant of the inferior laryngeal nerve has been seldom reported. These reports are mostly based on cadaveric dissection studies or large chart review studies in which the emphasis is placed on the determination of the frequency of the variation, and not on the clinical appearance of this variant. We graphically describe the intraoperative identification of a non-recurrent

Diogo Casal; António Peças; Daniel Sousa; Jorge Rosa-Santos

2010-01-01

55

Laryngeal nerve identification during thyroid surgery — feasibility of a novel approach  

Microsoft Academic Search

Purpose  Recurrent laryngeal nerve damage remains one of the most devastating complications of thyroid surgery. However, nerve identification\\u000a is not always easy and a reliable method to locate nerves intraoperatively is needed.\\u000a \\u000a \\u000a \\u000a Methods  Thirty consecutive patients were anesthetized for elective thyroid surgery using a standard technique. Indications for surgery\\u000a covered a broad spectrum of conditions. In the technique described, the airway is

Carl L. Hillermann; Joe Tarpey; David E. Phillips

2003-01-01

56

Phrenic Nerve Paralysis as the Initial Presentation in Pleural Sarcomatoid Mesothelioma  

PubMed Central

A 74-year-old man was referred to our hospital because of persistent cough. A chest radiograph revealed an elevation of the right diaphragm. Computed tomography (CT) images revealed a small nodule localized on the right mediastinum. Five months later, the nodule had grown and was diagnosed as malignant pleural mesothelioma (MPM) by a CT-guided needle biopsy. The patient underwent combined chemotherapy, but the disease progressed rapidly and he passed away. On autopsy, microscopic findings and immunohistological examinations supported the diagnosis of sarcomatoid mesothelioma. Therefore, we diagnosed this rare case as localized sarcomatoid MPM showing phrenic nerve paralysis as an initial presentation. PMID:25076889

Makimoto, Go; Fujiwara, Keiichi; Fujimoto, Nobukazu; Yamadori, Ichiro; Sato, Toshio; Kishimoto, Takumi

2014-01-01

57

Is there a High Risk of Damaging the External Branch of the Superior Laryngeal Nerve during Thyroid Surgery?  

Microsoft Academic Search

Summary BACKGROUND: Injury to the external branch of the superior laryngeal nerve (EBSLN) during thyroid surgery can have serious consequences for patients who depend on control of pitch and a clear and forceful voice, like singers or professional speakers. METHODS: We used the Neurosign 100® nerve monitor to identify 165 nerves in 112 patients undergoing thyroid surgery. RESULTS: The EBSLN

Th. Meyer; W. H. Hamelmann; C. Schramm; F. Hoppe; A. Thiede; W. Timmermann

2003-01-01

58

Minimally Invasive Video-Assisted Thyroidectomy and Parathyroidectomy with Intraoperative Recurrent Laryngeal Nerve Monitoring  

PubMed Central

Objective. Our goal is to study the feasibility of using intraoperative neuromonitoring (IONM) in minimally invasive video-assisted thyroidectomy and parathyroidectomy (MIVAT/P) with emphasis given to the identification of recurrent laryngeal nerve (RLN). Methods. Consecutive series of forty-seven patients with seventy-seven recurrent laryngeal nerves at risk undergoing both MIVAT/P and IONM were enrolled in this retrospective, nonrandomized analysis study. All operations were performed by the same surgeon within an academic institution setting. All patients underwent vocal cord evaluation postoperatively. Demographics and intraoperative and postoperative complications following surgery were collected. Results. Out of seventy-seven RLNs, there was one permanent unilateral RLN injury (1.29%) in a patient with advanced papillary thyroid cancer, managed by cord injection. There was another transient RLN paresis that resolved spontaneously (1.29%). There were no instances of equipment malfunction or interference. Conclusions. To our knowledge, this is the first reported MIVAT/P series from the United States of America with a standardized IONM technique. The technical feasibility of IONM seems acceptable and may serve as a meaningful adjunct to the visual identification of nerves. Neuromonitoring during MIVAT/P is effective in providing identification of laryngeal nerves and enables surgeons to feel more comfortable with MIVAT/P. Comparative series are needed for further evaluation. PMID:20169134

Kandil, Emad; Wassef, Shafik N.; Alabbas, Haytham; Freidlander, Paul L.

2009-01-01

59

Intracisternal Cranial Root Accessory Nerve Schwannoma Associated with Recurrent Laryngeal Neuropathy  

PubMed Central

Intracisternal accessory nerve schwannomas are very rare; only 18 cases have been reported in the literature. In the majority of cases, the tumor origin was the spinal root of the accessory nerve and the tumors usually presented with symptoms and signs of intracranial hypertension, cerebellar ataxia, and myelopathy. Here, we report a unique case of an intracisternal schwannoma arising from the cranial root of the accessory nerve in a 58-year-old woman. The patient presented with the atypical symptom of hoarseness associated with recurrent laryngeal neuropathy which is noted by needle electromyography, and mild hypesthesia on the left side of her body. The tumor was completely removed with sacrifice of the originating nerve rootlet, but no additional neurological deficits. In this report, we describe the anatomical basis for the patient's unusual clinical symptoms and discuss the feasibility and safety of sacrificing the cranial rootlet of the accessory nerve in an effort to achieve total tumor resection. To our knowledge, this is the first case of schwannoma originating from the cranial root of the accessory nerve that has been associated with the symptoms of recurrent laryngeal neuropathy. PMID:25328655

Jin, Sung-Won; Park, Dong-Hyuk; Kang, Shin-Hyuk

2014-01-01

60

Recurrent laryngeal nerve palsy after cardiovascular surgery: Relationship to the placement of a transesophageal echocardiographic probe  

Microsoft Academic Search

Objective: To examine the relationship between the incidence of recurrent laryngeal nerve palsy after cardiovascular surgery and the placement of a transesophageal echocardiographic probe.Design: A prospective clinical study.Setting: A single-institutional study in a university hospital.Participants: One hundred sixteen patients undergoing cardiovascular surgery.Interventions: All patients were assigned into one of two groups: 64 patients in whom transesophageal echocardiography (TEE) was performed

Shinji Kawahito; Hiroshi Kitahata; Hideyuki Kimura; Katsuya Tanaka; Shuzo Oshita

1999-01-01

61

[Prognostic assessment in peripheral facial nerve paralysis with particular reference to electroneurography (author's transl)].  

PubMed

Electrophysiological investigations were carried out on 20 healthy controls and 130 patients with peripheral facial nerve paralysis. The aetiology was as follows: idiopathic (Bell's palsy) in 60 cases, viral in 29, traumatic in 18, postoperative in 4, in connexion with chronic otitis media in 6, diabetes mellitus in 4, positive rheumatological tests in 3, disturbed lipid metabolism in 2, the Melkersson-Rosenthal syndrome in 1, as a complication of pregnancy in 2, and in association with a tumour in 1 case. The compound action potential (CAP) of the orbicularis oris muscle was determinedi n 370 occasions in a right/left comparision, the record of the muscle response was intergrated over the time of action (IAR) on 32 occasions and trison of 255 occasions. The normal values are given in the first place and their dependence of the age of the subject. Then, the prognostic sifnficance of the above-mentioned parameters is investigated in cases of peripheral facial nerve paralysis. It is apparent that the determination of the CAP in a right/left comparison is a valuable prognostic guide as early as the 4th day, insofar as a decrease in this parameter of under 50% can be interpreted as a favourable sign and satisfactory reversal of the paralysis can be expected within 6-8 weeks. By contrast, a decrease of over 70% in the CAP is a bad prognostic sign, indicative of presumably only a poor trend to reversal of the paralysis. An intermediate depression of the CAP in the range of 50-70% signifies an expected moderate recovery within 6-8 weeks ahe case of CAP determination at the time of maximum amplitude depression (as opposed to the 4th day), then a decrease of less than 70% is taken to be indicative of satisfactory functional recovery within 6-8 weeks; a decrease of 95-100% signifies a bad prognosis, whilst a decrease amounting to between 70 and 95% carries an uncertain prognosis. The maximum decrease in amplitude was registered on the 8th day on average; the range lay between the 4th and the 14th day. An exception to these figures was the delayed response of the CAP in the case of 6 patients, 5 of whom showed a maximum decrease during the 3rd week and the last patient as late as the 4th week following the onset of facial nerve paresis. Similar reliance can be placed on the prognostic value of the IAR. however, the decrease in the IAR is smaller than that of the CAP measured on the same potential in a right/left comparison, so that a decrease in the IAR of over 60% can already herald a poor recovery. Repeated determination of the latency in cases of facial nerve paralysis showed that the mean latency value for the entire group of patients was slightly prolonged at the end of the 1st week, but the latency values obtained in any one particular patient are of no prognostic significance. A comparison between CAP and latency values obtained with the opposite (i.e... PMID:181919

Mamoli, B

1976-01-01

62

Closed-loop eyelid reanimation system with real-time blink detection and electrochemical stimulation for facial nerve paralysis  

Microsoft Academic Search

Electrical stimulation in eyelid reanimation has been verified in previous studies as a potential treatment for facial nerve paralysis. Design challenges, including physical pain during stimulation, reducing the latency between the natural blink and the artificial blink, and patient-to-patient differences, make it difficult to build this system. In this paper, the design challenges are analyzed in detail, based on which

Kuanfu Chen; Tung-Chien Chen; Kimberly Cockerham; Wentai Liu

2009-01-01

63

GFAP immunoreactivity within the rat nucleus ambiguus after laryngeal nerve injury.  

PubMed

Changes that occur in astroglial populations of the nucleus ambiguus after recurrent (RLN) or superior (SLN) laryngeal nerve injury have hitherto not been fully characterised. In the present study, rat RLN and SLN were lesioned. After 3, 7, 14, 28 or 56 days of survival, the nucleus ambiguus was investigated by means of glial fibrillary acidic protein (GFAP) immunofluorescence or a combination of GFAP immunofluorescence and the application of retrograde tracers. GFAP immunoreactivity was significantly increased 3 days after RLN resection and it remained significantly elevated until after 28 days post injury (dpi). By 56 dpi it had returned to basal levels. In contrast, following RLN transection with repair, GFAP immunoreactivity was significantly elevated at 7 dpi and remained significantly elevated until 14 dpi. It had returned to basal levels by 28 dpi. Topographical analysis of the distribution of GFAP immunoreactivity revealed that after RLN injury, GFAP immunoreactivity was increased beyond the area of the nucleus ambiguus within which RLN motor neuron somata were located. GFAP immunoreactivity was also observed in the vicinity of neuronal somata that project into the uninjured SLN. Similarly, lesion of the SLN resulted in increased GFAP immunoreactivity around the neuronal somata projecting into it and also in the vicinity of the motor neuron somata projecting into the RLN. The increase in GFAP immunoreactivity outside of the region containing the motor neurons projecting into the injured nerve, may reflect the onset of a regenerative process attempting to compensate for impairment of one of the laryngeal nerves and may occur because of the dual innervation of the posterior cricoarytenoid muscle. This dual innervation of a very specialised muscle could provide a useful model system for studying the molecular mechanisms underlying axonal regeneration process and the results of the current study could provide the basis for studies into functional regeneration following laryngeal nerve injury, with subsequent application to humans. PMID:25181319

Berdugo-Vega, G; Arias-Gil, G; Rodriguez-Niedenführ, M; Davies, D C; Vázquez, T; Pascual-Font, A

2014-11-01

64

[Surgical prophylactics of injuries of the recurrent laryngeal nerves during operations for diseases of the thyroid gland].  

PubMed

The work presents an analysis of specific features of surgical anatomy of recurrent laryngeal nerves in 676 patients operated in the City Center of endocrine surgery and oncology of St. Petersburg for different diseases of the thyroid gland (TG) during the period from 01.01.2005 to 15.07.2006 mainly by one and the same surgeon. In the course of 696 operations 718 recurrent laryngeal nerves were detected, verified, separated in the neck from the subclavian area to the place of entering into the larynx, and photo-video documented. In 656 cases the disease of TG was primary, and in 40 cases--recurrent. The investigation performed allowed the development and use of reliable methods of prophylactics and treatment of recurrent laryngeal nerves injured in patients during operations for different diseases of TG, carcinoma of this organ included. The optimal places of detection and identification were determined as well as the ways of separation of these nerves from the surrounding tissues. The surgical anatomy of the recurrent laryngeal nerves in the neck was studied. The role, place and effectiveness of electrophysiological monitoring were established. The corrections introduced in the technique of thyroidectomies in 4110 patients resulted in lowered incidence of postoperative pareses of the laryngeal muscles from 0.91% to 0.56% during the period from 2001 to 2006. PMID:18154099

Romanchishen, A F; Romanchishen, F A

2007-01-01

65

Recurrent Laryngeal Nerve Monitoring During Esophagectomy and Mediastinal Lymph Node Dissection  

Microsoft Academic Search

Background  Patients who undergo surgery to the esophagus and lungs are in jeopardy of recurrent laryngeal nerve (RLN) damage during the\\u000a procedure. This study was designed to investigate the feasibility of intraoperative monitoring of the RLN for single-lung\\u000a ventilation esophagus and lung surgery.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Twelve consecutive patients booked for esophagus or lung surgery were included in this prospective, observational study. Six\\u000a patients

Hans Gelpke; Felix Grieder; Marco Decurtins; Dieter Cadosch

2010-01-01

66

Meta-analysis of recurrent laryngeal nerve injury in thyroid surgery with or without intraoperative nerve monitoring.  

PubMed

Intraoperative nerve monitoring (IONM) aimed at reducing the injuries of recurrent laryngeal nerve during thyroidectomy is controversial. We conducted a meta-analysis to assess the incidence of nerve injuries with or without IONM. Studies published from January 1994 to February 2012 in English language on humans were identified. Heterogeneity of studies was checked by the Higgins test. Summary estimates of predictive values of injury were made using the Mantel-Haenszel test based on the fixed-effects model. Publication bias was assessed by a funnel plot and Egger's method. Eight articles were selected accounting a total of 5257 nerves at risk. IONM revealed a significant impact in preventing transient injuries (positive predictive value = 5% [95% CI: 2-8], negative = 96% [95% CI: 91-100], relative risk = 0.73 [95% CI: 0.54-0.98], p = 0.035), whereas they failed to demonstrate effect on permanent injuries (positive predictive value = 2% [95% CI: 0.6-3.8], negative 99% [95% CI: 97-100], relative risk = 0.73 [95% CI: 0.44-1.23], p = 0.235). This meta-analysis demonstrated the merit of IONM in preventing transient injury during thyroidectomy. No advantage was found in permanent injuries. PMID:25210215

Rulli, F; Ambrogi, V; Dionigi, G; Amirhassankhani, S; Mineo, T C; Ottaviani, F; Buemi, A; DI Stefano, P; Mourad, M

2014-08-01

67

Acute pediatric facial nerve paralysis as the first indication for familial cerebral cavernoma: case presentation and literature review.  

PubMed

Familial cerebral cavernoma is an autosomal dominant phenotype with incomplete clinical and neuroimaging penetrance. The most common clinical manifestations include seizures and cerebral hemorrhage. We present the case of a 7-year-old boy who developed acute onset facial nerve paralysis secondary to previously unknown familial cerebral cavernoma. Genetic workup revealed a KRIT1 gene deletion which was later confirmed in the patient's asymptomatic father and younger brother. PMID:24156886

Rohani, Pooyan; McRackan, Theodore R; Aulino, Joseph M; Wanna, George B

2014-01-01

68

Surgical anatomy and neurophysiology of the vagus nerve (VN) for standardised intraoperative neuromonitoring (IONM) of the inferior laryngeal nerve (ILN) during thyroidectomy  

Microsoft Academic Search

Background  Standardisation of the intraoperative neuromonitoring (IONM) technique is a fundamental aspect in monitored thyroid surgery.\\u000a Vagal nerve (VN) stimulation is essential for problem solving, recognition of any inferior laryngeal nerve (ILN) lesions and\\u000a prediction of ILN post-operative function. Issues that have been overlooked in the literature, particularly in terms of prospective\\u000a approaches, are the topographic relationship of the VN with

Gianlorenzo Dionigi; Feng-Yu Chiang; Stefano Rausei; Che-Wei Wu; Luigi Boni; Ka-Wo Lee; Francesca Rovera; Giovanni Cantone; Alessandro Bacuzzi

2010-01-01

69

Electrophysiologic monitoring of the recurrent laryngeal nerves may not predict bilateral vocal fold immobility after thyroid surgery  

Microsoft Academic Search

SummaryTwo cases of bilateral vocal fold immobility (VFI) after identification and preservation of the recurrent laryngeal nerves (RLNs) required tracheotomy until vocal fold recovery. The first patient underwent thyroid surgery without preoperative or postoperative evaluation of the vocal folds, administration of postoperative intravenous steroids, or electrophysiologic monitoring of the RLNs, whereas the second patient underwent a thyroid procedure in which

Robert L. Witt

2004-01-01

70

Transient Facial Nerve Paralysis (Bell's Palsy) following Intranasal Delivery of a Genetically Detoxified Mutant of Escherichia coli Heat Labile Toxin  

PubMed Central

Background An association was previously established between facial nerve paralysis (Bell's palsy) and intranasal administration of an inactivated influenza virosome vaccine containing an enzymatically active Escherichia coli Heat Labile Toxin (LT) adjuvant. The individual component(s) responsible for paralysis were not identified, and the vaccine was withdrawn. Methodology/Principal Findings Subjects participating in two contemporaneous non-randomized Phase 1 clinical trials of nasal subunit vaccines against Human Immunodeficiency Virus and tuberculosis, both of which employed an enzymatically inactive non-toxic mutant LT adjuvant (LTK63), underwent active follow-up for adverse events using diary-cards and clinical examination. Two healthy subjects experienced transient peripheral facial nerve palsies 44 and 60 days after passive nasal instillation of LTK63, possibly a result of retrograde axonal transport after neuronal ganglioside binding or an inflammatory immune response, but without exaggerated immune responses to LTK63. Conclusions/Significance While the unique anatomical predisposition of the facial nerve to compression suggests nasal delivery of neuronal-binding LT–derived adjuvants is inadvisable, their continued investigation as topical or mucosal adjuvants and antigens appears warranted on the basis of longstanding safety via oral, percutaneous, and other mucosal routes. PMID:19756141

Lewis, David J. M.; Huo, Zhiming; Barnett, Susan; Kromann, Ingrid; Giemza, Rafaela; Galiza, Eva; Woodrow, Maria; Thierry-Carstensen, Birgit; Andersen, Peter; Novicki, Deborah; Del Giudice, Giuseppe; Rappuoli, Rino

2009-01-01

71

Surgical Anatomy of Bilateral Extralaryngeal Bifurcation of the Recurrent Laryngeal Nerve: Similarities and Differences Between Both Sides  

PubMed Central

Background: Anatomical variations of the recurrent laryngeal nerve (RLN) such as extralaryngeal terminal bifurcation is an important risk for its motor function. Aims: The objective is to study surgical anatomy of bilateral bifurcation of the RLNs in order to decrease risk of vocal cord palsy in patients with bifurcated nerves. Materials and Methods: Surgical anatomy including terminal bifurcation was established in 292 RLNs of 146 patients. We included patients with bilateral bifurcation of RLN in this study. Based on two anatomical landmarks (nerve-artery crossing and laryngeal entry), the cervical course of RLN was classified in four segments: Pre-arterial, arterial, post-arterial and pre-laryngeal. According to these segments, bifurcation point locations along the cervical course of RLNs were compared between both sides in bilateral cases. Results: RLNs were exposed throughout their entire courses. Seventy (48%) patients had bifurcated RLNs. We identified terminal bifurcation in 90 (31%) of 292 RLNs along the cervical course. Bilateral bifurcation was observed in 20 (28.6%) patients with bifurcated RLNs. Bifurcation points were located on arterial and post-arterial segments in 37.5% and 32.5% of cases, respectively. Pre-arterial and pre-laryngeal segments contained bifurcations in 15% of cases. Comparison of both sides indicated that bifurcation points were similar in 5 (25%) and different in 15 (75%) patients with bilateral bifurcation. Permanent nerve injury did not occur in this series. Conclusion: Bilateral bifurcation of both RLNs was observed in approximately 30% of patients with extralaryngeal bifurcation which is a common anatomical variation. Bifurcation occurred in different segments along cervical course of RLN. Bifurcation point locations differed between both sides in the majority of bilateral cases. Increasing surgeons’ awareness of this variation may lead to safely exposing bifurcated nerves and prevent the injury to extralaryngeal terminal branches of RLN.

Gurleyik, Emin

2014-01-01

72

The usefulness of preoperative computed tomography and intraoperative neuromonitoring identification of the nonrecurrent inferior laryngeal nerve.  

PubMed

The objective of this study was to avoid the nonrecurrent inferior laryngeal nerve (NRLN) injury during surgery, we performed preoperative CT examinations to determine the variation in abnormal course of the right subclavian artery as an indictor of the presence of the NRLN and used intraoperative neuromonitoring (IONM) to identify nerve. Preoperative thyroid CT examinations were performed in 783 thyroid surgery patients. The imaging characteristics that suggested the presence of the NRLN were the following: (1) the arteria lusoria arising from the dorsal side of the aortic arch and passing through the trachea and esophagus posteriorly, and the CT image showing the characteristic "hook-like" morphology; (2) that the arteria lusoria imaging could be observed posteriorly to the trachea and esophagus; and (3) that the arteria lusoria traveled transversely from the rear of the right common carotid artery to the right subaxillary region. IONM has been applied to localize and identify NRLN. The brachiocephalic trunk was shown in 779 cases and not in the remaining four cases (0.5 %, 4/783), and these four were assumed to have the arteria lusoria. The separation point and path of the NRLNs were localized and identified precisely with IONM. The NRLN was observed during all surgeries. These four cases did not exhibit hoarseness after surgery. In conclusion, understanding of the course variations of the right subclavian artery using a preoperative CT examination provides an indicator of the presence of a NRLN. Combining these evaluation methods with IONM can avoid NRLN injury. PMID:23269396

Cai, Qian; Guan, Zhong; Huang, Xiaoming; Yuan, Jianpeng; Pan, Yong; Zheng, Yiqing; Liang, Maojin; Fan, Shaochong

2013-07-01

73

Comparison of two electromyographical endotracheal tube systems for intraoperative recurrent laryngeal nerve monitoring: reliability and side effects  

Microsoft Academic Search

Background  Recurrent laryngeal nerve (RLN) monitoring systems should be reliable and safe. Monitoring via electromyographical systems\\u000a on an endotracheal tube (ETT) is widely spread. The MagStim™ system consists of an adhesive electrode to be fixed on an endotracheal\\u000a tube. The Xomed™ endotracheal tube provides integrated electrodes. Reliability and side effects had never been compared. As\\u000a both systems have very different morphological

Torsten Birkholz; Christina Saalfrank-Schardt; Andrea Irouschek; Peter Klein; Sven Albrecht; Joachim Schmidt

74

Pulmonary C-fiber Activation Enhances Respiratory-Related Activities of the Recurrent Laryngeal Nerve in Rats  

Microsoft Academic Search

The purpose of the current study was to characterize the response of the recurrent laryngeal nerve (RLN) to pulmonary C-fiber activation. Male rats of Wistar strain were anesthetized by urethane (1.2 g\\/kg, i.p.). Tracheostomy was performed. Catheter was inserted into the femoral artery and vein. Additional catheter was placed near the entrance of the right atrium via the right jugular

I-Jung Lu; Li-Chi Ku; Jin-Tun Lin; Kun-Ze Lee; Ji-Chuu Hwang

2002-01-01

75

Optimal Depth of NIM EMG Endotracheal Tube for Intraoperative Neuromonitoring of the Recurrent Laryngeal Nerve During Thyroidectomy  

Microsoft Academic Search

Background  Malpositioning of the endotracheal surface electrodes can result in dysfunction of intraoperative neuromonitoring (IONM) and\\u000a increase the risk of recurrent laryngeal nerve injury. The purpose of this study was to investigate the optimal depth of the\\u000a nerve integrity monitor (NIM) EMG endotracheal tube.\\u000a \\u000a \\u000a \\u000a Methods  We enrolled 105 adult patients undergoing elective thyroidectomy. Each Medtronic Xomed NIM EMG endotracheal tube was placed

I-Chen Lu; Koung-Shing Chu; Cheng-Jing Tsai; Che-Wei Wu; Wen-Rei Kuo; Hsiu-Ya Chen; Ka-Wo Lee; Feng-Yu Chiang

2008-01-01

76

Migration and Differentiation of Neural Progenitor Cells after Recurrent Laryngeal Nerve Avulsion in Rats  

PubMed Central

To investigate migration and differentiation of neural progenitor cells (NPCs) from the ependymal layer to the nucleus ambiguus (NA) after recurrent laryngeal nerve (RLN) avulsion. All of the animals received a CM-DiI injection in the left lateral ventricle. Forty-five adult rats were subjected to a left RLN avulsion injury, and nine rats were used as controls. 5-Bromo-2-deoxyuridine (BrdU) was injected intraperitoneally. Immunohistochemical analyses were performed in the brain stems at different time points after RLN injury. After RLN avulsion, the CM-DiI+ NPCs from the ependymal layer migrated to the lesioned NA. CM-DiI+/GFAP+ astrocytes, CM-DiI+/DCX+ neuroblasts and CM-DiI+/NeuN+ neurons were observed in the migratory stream. However, the ipsilateral NA included only CM-DiI+ astrocytes, not newborn neurons. After RLN avulsion, the NPCs in the ependymal layer of the 4th ventricle or central canal attempt to restore the damaged NA. We first confirm that the migratory stream includes both neurons and glia differentiated from the NPCs. However, only differentiated astrocytes are successfully incorporated into the NA. The presence of both cell types in the migratory process may play a role in repairing RLN injuries. PMID:25202908

Zhao, Wan; Xu, Wen

2014-01-01

77

Prevention and treatment of recurrent laryngeal nerve injury in thyroid surgery  

PubMed Central

Aim: To summary the experience for prevention and treatment of recurrent laryngeal nerve (RLN) injury in thyroid surgery. Methods: Clinical features of 623 patients who received thyroid surgery from January 2010 to December 2012 were analyzed retrospectively, and the features of RLN injury and intraoperative as well as postoperative treatments were reviewed. Results: RLN injury occurred in 31 patients (4.98%), in which, unilateral RLN injury occurred in 27 patients and bilateral RLN injuries occurred in 4 patients (temporary injury in 28 patients and permanent injury in 3 patients). 6 patients underwent RLN anastomosis during surgery and exhibited transient hoarseness after surgery. RLN exploration and decompression was given in 1 patient and the patient got normal vocal cord motion 2 months after surgery. 1 patient with bilateral injuries received tracheotomy and CO2 laser resection of arytenoid cartilage and achieved recovery 1 year later. Conclusions: In order to prevent RLN injury, the anatomic variations of RLN should be mastered. Routine exposure of RLN can effectively prevent the injury in patients receiving the second or multiple surgeries. Early interventions for RLN injury include mainly early discovery, early exploration and early anastomosis, and the function of RLN in some patients can recover completely. Subsequent treatments mainly focus on the improvement of the voice, expansion of glottis and melioration of dyspnea. PMID:24482694

Jiang, Yan; Gao, Bo; Zhang, Xiaohua; Zhao, Jianjie; Chen, Jinping; Zhang, Shu; Luo, Donglin

2014-01-01

78

Cannabinoids Facilitate the Swallowing Reflex Elicited by the Superior Laryngeal Nerve Stimulation in Rats  

PubMed Central

Cannabinoids have been reported to be involved in affecting various biological functions through binding with cannabinoid receptors type 1 (CB1) and 2 (CB2). The present study was designed to investigate whether swallowing, an essential component of feeding behavior, is modulated after the administration of cannabinoid. The swallowing reflex evoked by the repetitive electrical stimulation of the superior laryngeal nerve in rats was recorded before and after the administration of the cannabinoid receptor agonist, WIN 55-212-2 (WIN), with or without CB1 or CB2 antagonist. The onset latency of the first swallow and the time intervals between swallows were analyzed. The onset latency and the intervals between swallows were shorter after the intravenous administration of WIN, and the strength of effect of WIN was dose-dependent. Although the intravenous administration of CB1 antagonist prior to intravenous administration of WIN blocked the effect of WIN, the administration of CB2 antagonist did not block the effect of WIN. The microinjection of the CB1 receptor antagonist directly into the nucleus tractus solitarius (NTS) prior to intravenous administration of WIN also blocked the effect of WIN. Immunofluorescence histochemistry was conducted to assess the co-localization of CB1 receptor immunoreactivity to glutamic acid decarboxylase 67 (GAD67) or glutamate in the NTS. CB1 receptor was co-localized more with GAD67 than glutamate in the NTS. These findings suggest that cannabinoids facilitate the swallowing reflex via CB1 receptors. Cannabinoids may attenuate the tonic inhibitory effect of GABA (gamma-aminobuteric acid) neurons in the central pattern generator for swallowing. PMID:23209814

Takatsuji, Hanako; Yamada, Yoshiaki; Yamamura, Kensuke; Kitagawa, Junichi

2012-01-01

79

A comparison between succinylcholine and rocuronium on the recovery profile of the laryngeal muscles during intraoperative neuromonitoring of the recurrent laryngeal nerve: a prospective porcine model.  

PubMed

The use of succinylcholine and rocuronium are reportedly feasible during intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) in thyroid surgery. This study aimed to investigate and compare the recovery profiles of succinylcholine and rocuronium on the laryngeal muscle during IONM of the RLN in a porcine model. Nine male Duroc-Landrace piglets were anesthetized with thiamylal and underwent tracheal intubation without neuromuscular blocking agents (NMBAs). Needle electrodes were inserted into the vocalis muscles through the cricothyroid ligament. The RLN was exposed and stimulated. Electromyographic (EMG) signals were obtained before and after the intravenous administration of a NMBA. The EMG amplitudes were measured before and after (at 1-minute intervals) the administration of the study drug until complete recovery. The study NMBA regimen included succinylcholine (1 mg/kg), low-dose rocuronium (0.3 mg/kg), and standard dose rocuronium (0.6 mg/kg). The maximal neuromuscular blockade and 80% recovery (i.e., duration) of the control responses were recorded and analyzed. The 80% recovery of the control response for succinylcholine (1 mg/kg) was 19.7 ± 1.5 minutes; low-dose rocuronium (0.3 mg/kg), 16.3 ± 2.5 minutes; and standard dose rocuronium (0.6 mg/kg), 29.3 ± 5.7 minutes. Succinylcholine (1 mg/kg) and low-dose rocuronium (0.3 mg/kg) had significantly shorter durations than standard dose rocuronium (0.6 mg/kg). The EMG signal recovery returned to baseline within 30 minutes in the succinylcholine and low-dose rocuronium groups, but it did not return to baseline until 1 hour after surgery in the rocuronium (0.6 mg/kg) group. In this study, succinylcholine (1 mg/kg) and low-dose rocuronium (0.3 mg/kg) had favorable recovery profiles on the laryngeal muscle. It is recommended that low-dose rocuronium may replace succinylcholine for the induction of general anesthesia during IONM of the RLN in thyroid surgery. PMID:24018151

Lu, I-Cheng; Chang, Pi-Ying; Hsu, Hung-Te; Tseng, Kuang-Yi; Wu, Che-Wei; Lee, Ka-Wo; Ho, Kuen-Yao; Chiang, Feng-Yu

2013-09-01

80

Quasi-trapezoidal pulses to selectively block the activation of intrinsic laryngeal muscles during vagal nerve stimulation  

NASA Astrophysics Data System (ADS)

The stimulation of the vagus nerve has been used as an anti-epileptic treatment for over a decade, and its use for depression and chronic heart failure is currently under investigation. Co-activation of the intrinsic laryngeal muscles may limit the clinical use of vagal stimulation, especially in the case of prolonged activation. To prevent this, the use of a selective stimulation paradigm has been tested in seven acute pig experiments. Quasi-trapezoidal pulses successfully blocked the population of the largest and fastest vagal myelinated fibers being responsible for the co-activation. The first response in the vagus compound action potential was reduced by 75 ± 22% (mean ± SD) and the co-activated muscle action potential by 67 ± 25%. The vagal bradycardic effects remained unchanged during the selective block, confirming the leading role of thin nerve fibers for the vagal control of the heart. Quasi-trapezoidal pulses may be an alternative to rectangular pulses in clinical vagal stimulation when the co-activation of laryngeal muscles must be avoided.

Tosato, M.; Yoshida, K.; Toft, E.; Struijk, J. J.

2007-09-01

81

Surgical anatomy of the external branch of the superior laryngeal nerve and its clinical significance in head and neck surgery.  

PubMed

Injury of the external branch of the superior laryngeal nerve (EBSLN) increases the morbidity following a variety of neck procedures and can have catastrophic consequences in people who use their voice professionally. Identification and preservation of the EBSLN are thus important in thyroidectomy, parathyroidectomy, carotid endarterectomy, and anterior cervical spine procedures, where the nerve is at risk. There are large variations in the anatomical course of the EBSLN, which makes the intraoperative identification of the nerve challenging. The topographic relationship of the EBSLN to the superior thyroid artery and the upper pole of the thyroid gland are considered by many authors to be the key point for identifying the nerve during surgery of the neck. The classifications by Cernea et al. ([1992a] Head Neck 14:380-383; [1992b] Am. J. Surg. 164:634-639) and by Kierner et al. ([1998] Arch. Otolaryngol. Head Neck Surg. 124:301-303), as well as clinically important connections are discussed in detail. Along with sound anatomical knowledge, neuromonitoring is helpful in identifying the EBSLN during neck procedures. The clinical signs of EBSLN injury include hoarseness, decreased voice projection, decreased pitch range, and fatigue after extensive voice use. Videostroboscopy, electromyography, voice analysis, and electroglottography can provide crucial information on the function of the EBSLN following neck surgery. PMID:18288760

Kochilas, Xenophon; Bibas, Athanasios; Xenellis, John; Anagnostopoulou, Sofia

2008-03-01

82

Successful nasal intubation with a laryngeal nerve monitoring tube using bronchoscopy in a patient with plunging goiter: a case report  

PubMed Central

Background The appropriate positioning of nerve integrity monitoring during thyroid surgery is of relevance. In this case report we describe our experience with accurate placement of a nerve integrity monitoring endotracheal tube, obtained by fiberoptic control, in a patient with expected difficult airway management. Case presentation We report the case of a 70-year-old obese woman scheduled for elective total thyroidectomy due to plunging intrathoracic goiter. The preoperative indirect laryngoscopy pointed out a massive bombè of the hypopharyngeal wall to the right and right vocal cord paralysis. The epiglottis was oedematous and the glottis could not be identified. On physical examination, the tongue was large and a Mallampati’s score of 3 was determined. Hence, due to an expected difficult airway management, a nasal intubation with an electromyographic nerve integrity monitoring endotracheal tube trough fiberoptic bronchoscopy was successfully performed. Conclusion Our experience suggests that nasal intubation can be safely performed by using a nerve integrity monitoring tube with the help of fiberoptic bronchoscopy. PMID:24229430

2013-01-01

83

Use of a single bipolar electrode in the posterior arytenoid muscles for bilateral monitoring of the recurrent laryngeal nerves in thyroid surgery  

Microsoft Academic Search

The aims were to assess the technical feasibility of using a single electrode in the posterior arytenoid muscles (PAM) for\\u000a intraoperative monitoring of the recurrent laryngeal nerve (RLN) in thyroid surgery, to validate the new method against the\\u000a insertion of electrodes placed in the vocal cord muscle, and to report the results of the clinical application of the new\\u000a concept.

Stephan Haerle; D. Sidler; Th. Linder; W. Mueller

2008-01-01

84

Vesalius on the anatomy and function of the recurrent laryngeal nerves: medical illustration and reintroduction of a physiological demonstration from Galen.  

PubMed

The purpose of this article is to review the anatomical illustrations and physiological demonstrations of sixteenth-century Flemish-born anatomist and physician Andreas Vesalius concerning the recurrent laryngeal nerves. Although Vesalius was primarily an anatomist, he also used vivisection as a pedagogical device to help his students understand the function of structures within the fabric of the body that they had previously studied in anatomical detail. Vesalius's masterwork, De humani corporis fabrica or simply the Fabrica (1543, 1555), was ostensibly an anatomy text, but Vesalius included textual and figural references to his use of vivisection to explicate the function of specific structures. Even as he began to criticize the errors in Galen's anatomical works, Vesalius nevertheless adopted some of Galen's classic physiological demonstrations, in particular the ligation (and subsequent release) of the recurrent laryngeal nerves of a pig to demonstrate their role in generating the pig's squeal. Vesalius's illustrations concerning the recurrent laryngeal nerve in the Fabrica were of two types: elegant anatomical woodcut plates-unsurpassed for their clarity, accuracy, and detail - and the distinctly inelegant historiated initial Q, depicting a throng of putti busily engaged in vivisecting a pig. Vesalius' anatomical plates were heavily plagiarized while the historiated initials, showing the rough work of an anatomist or surgeon, were largely ignored and remain little recognized today. While Vesalius' anatomical illustrations of the recurrent laryngeal nerves contained some errors, they were a dramatic departure from prior meager efforts at medical illustration and indeed far surpassed all contemporary published illustrations by others. Vesalius was also influential in reviving Galen's approach to vivisection, at least for pedagogical purposes, if not really then yet as a full-fledged investigative technique. PMID:24870272

Lanska, Douglas J

2014-01-01

85

Hypokalaemic paralysis  

Microsoft Academic Search

Hypokalaemic paralysis is a relatively uncommon but potentially life-threatening clinical syndrome. If recognised and treated appropriately, patients recover without any clinical sequellae. The syndrome of hypokalaemic paralysis represents a heterogenous group of disorders characterised clinically by hypokalaemia and acute systemic weakness. Most cases are due to familial or primary hypokalaemic periodic paralysis; sporadic cases are associated with numerous other conditions

Sushil K Ahlawat; Anita Sachdev

1999-01-01

86

Hypokalaemic paralysis  

PubMed Central

Hypokalaemic paralysis is a relatively uncommon but potentially life-threatening clinical syndrome. If recognised and treated appropriately, patients recover without any clinical sequellae. The syndrome of hypokalaemic paralysis represents a heterogenous group of disorders characterised clinically by hypokalaemia and acute systemic weakness. Most cases are due to familial or primary hypokalaemic periodic paralysis; sporadic cases are associated with numerous other conditions including barium poisoning, hyperthyroidism, renal disorders, certain endocrinopathies and gastrointestinal potassium losses. The age of onset, race, family history, medications, and underlying disease states can help in identifying the cause of hypokalaemic paralysis. Initial therapy of the patient with hypokalaemic paralysis includes potassium replacement and search for underlying aetiology. Further management depends on the aetiology of hypokalaemia, severity of symptoms, and duration of disease. This review presents the differential diagnosis for hypokalaemic paralysis and discusses management of the syndrome.???Keywords: hypokalaemia; periodic paralysis PMID:10715756

Ahlawat, S.; Sachdev, A.

1999-01-01

87

Transient isolated lingual nerve neuropraxia associated with general anaesthesia and laryngeal mask use: two case reports and a review of the literature  

Microsoft Academic Search

Background  Transient, isolated lingual nerve neuropraxia is a rare complication \\u000a following general anaesthesia. Reports implicate airway manipulation and we describe two new cases associated with laryngeal\\u000a mask airway (LMA) and review the related English language literature.\\u000a \\u000a \\u000a \\u000a \\u000a Results  Unilateral numbness and loss of taste on the anterior tongue were the characteristic symptoms. Collation of literature data\\u000a (median and range) with that from the

E. Foley; T. E. D. Mc Dermott; E. Shanahan; D. Phelan

2010-01-01

88

Laryngeal paraganglioma mimicking a laryngeal haemangioma.  

PubMed

Paraganglioma are uncommon neuroendocrine tumours arising from extra-adrenal chromaffin cells of the autonomic nervous system. In the head and neck region, these neoplasms most commonly arise from the carotid body, the vagus nerve, and the jugulotympanic area. We present the case of a 69-year-old woman who suffered from dyspnoea and dysphonia for six months. A biopsy diagnosed a laryngeal haemangioma and a resection of the tumour was performed using supraglottic pharyngolaryngectomy. Definitive histopathological examination revealed a laryngeal paraganglioma. Laryngeal paraganglioma and haemangioma must be evoked when confronted with a submucosal vascular laryngeal tumour. In such cases biopsies should be avoided. Exhaustive imaging is a key factor in the diagnosis and should include an MRI and an arteriography in order to rule out other differential diagnoses. To our knowledge this is the first case focusing on this issue. PMID:24683822

Plisson, L; Patron, V; Luna, Azoulay B; Babin, E; Hitier, M

2013-01-01

89

Comparison of ventilation and voice outcomes between unilateral laryngeal pacing and unilateral cordotomy for the treatment of bilateral vocal fold paralysis  

PubMed Central

Background/Aims Rehabilitation of the bilaterally paralyzed human larynx remains a complex clinical problem. Conventional treatment generally involves surgical enlargement of the compromised airway, but often with resultant dysphonia and risk of aspiration. In this retrospective study, we compared one such treatment, posterior cordotomy, against unilateral laryngeal pacing: reanimation of vocal fold opening by functional electrical stimulation of the posterior cricoarytenoid muscle. Methods Post-operative peak inspiratory flow (PIF) values and overall voice grade ratings were compared between the two surgical groups, and pre and post-operative PIF were compared within the pacing group. Results There were five patients in the unilateral pacing group and 12 patients in the unilateral cordotomy group. Within the pacing group, post-operative PIF values were significantly improved from pre-operative PIF values (p=0.04) without significant effect on voice (grade) (p=0.62). Within the pacing group, the mean post-operative PIF value was significantly higher than that in the cordotomy group (p=0.05). Also, the mean post-operative overall voice grade values in the pacing group were significantly lower (better) than that of cordotomy group (p=0.03). Conclusion Unilateral pacing appears to be an effective and superior treatment to posterior cordotomy with respect to post-operative ventilation and voice outcome measures. PMID:23736349

Li, Yike; Pearce, Elizabeth C.; Mainthia, Rajshri; Athavale, Sanjay M.; Dang, Jennifer; Ashmead, Daniel H; Garrett, C. Gaelyn; Rousseau, Bernard; Billante, Cheryl R.; Zealear, David L.

2013-01-01

90

Bilateral internal superior laryngeal nerve palsy of traumatic cervical injury patient who presented as loss of cough reflex after anterior cervical discectomy with fusion.  

PubMed

Injury to the bilateral internal branch of superior laryngeal nerve (ibSLN) brings on an impairment of the laryngeal cough reflex that could potentially result in aspiration pneumonia and other respiratory illnesses. We describe a patient with traumatic cervical injury who underwent bilateral ibSLN palsy after anterior cervical discectomy with fusion (ACDF). An 75-year-old man visited with cervical spine fracture and he underwent ACDF through a right side approach. During the post-operative days, he complained of high pitched tone defect, and occasional coughing during meals. With a suspicion of SLN injury and for the work up for the cause of aspiration, we performed several studies. According to the study results, he was diagnosed as right SLN and left ibSLN palsy. We managed him for protecting from silent aspiration. Swallowing study was repeated and no evidence of aspiration was found. The patient was discharged with incomplete recovery of a high pitched tone and improved state of neurologic status. The SLN is an important structure; therefore, spine surgeons need to be concerned and be cautious about SLN injury during high cervical neck dissection, especially around the level of C3-C4 and a suspicious condition of a contralateral nerve injury. PMID:23115675

Shin, Dong-Uk; Sung, Joo-Kyung; Nam, Kyung-Hun; Cho, Dae-Chul

2012-09-01

91

Bilateral Internal Superior Laryngeal Nerve Palsy of Traumatic Cervical Injury Patient Who Presented as Loss of Cough Reflex after Anterior Cervical Discectomy with Fusion  

PubMed Central

Injury to the bilateral internal branch of superior laryngeal nerve (ibSLN) brings on an impairment of the laryngeal cough reflex that could potentially result in aspiration pneumonia and other respiratory illnesses. We describe a patient with traumatic cervical injury who underwent bilateral ibSLN palsy after anterior cervical discectomy with fusion (ACDF). An 75-year-old man visited with cervical spine fracture and he underwent ACDF through a right side approach. During the post-operative days, he complained of high pitched tone defect, and occasional coughing during meals. With a suspicion of SLN injury and for the work up for the cause of aspiration, we performed several studies. According to the study results, he was diagnosed as right SLN and left ibSLN palsy. We managed him for protecting from silent aspiration. Swallowing study was repeated and no evidence of aspiration was found. The patient was discharged with incomplete recovery of a high pitched tone and improved state of neurologic status. The SLN is an important structure; therefore, spine surgeons need to be concerned and be cautious about SLN injury during high cervical neck dissection, especially around the level of C3-C4 and a suspicious condition of a contralateral nerve injury. PMID:23115675

Shin, Dong-Uk; Nam, Kyung-Hun; Cho, Dae-Chul

2012-01-01

92

Vocal Fold Paralysis  

MedlinePLUS

Home Health Info Voice, Speech and Language Vocal Fold Paralysis Vocal Fold Paralysis On this page: What is vocal fold paralysis? What causes ... vocal fold paralysis? Structures involved in speech and voice production Vocal fold paralysis (also known as vocal ...

93

Facial paralysis  

MedlinePLUS

... headaches, seizures, or hearing loss. In newborns, facial paralysis may be caused by trauma during birth. Other causes include: Infection of the brain or surrounding tissues Lyme disease Sarcoidosis Tumor that ...

94

Is there a role for intraoperative recurrent laryngeal nerve monitoring during high mediastinal lymph node dissection in three-stage oesophagectomy for oesophageal cancer?  

PubMed

A best evidence topic was written according to a structured protocol. The question addressed was whether there is a role for intraoperative recurrent laryngeal nerve monitoring during high mediastinal lymph node dissection in three-stage oesophagectomy for oesophageal cancer. A total of 125 papers were identified using the reported searches of which 2 represented the best evidence to answer the clinical question. The authors, journal, date, country of publication, study type, patient group, relevant outcomes and results are tabulated. Oesophageal surgery, similar to thyroid, parathyroid and cardiothoracic surgery poses a risk to the recurrent laryngeal nerves (RLN). Intraoperative RLN monitoring (IONM) is commonly being used in thyroid and parathyroid surgery in many centres. The same does not hold true for three-stage oesophagectomy with high mediastinal lymph node dissection despite the inherent risks to the RLN being much higher with this type of surgery. There are only a handful of studies in the literature evaluating the role of IONM in three-stage oesophagectomy. As a result, there is limited evidence to provide robust guidance. The evidence from the present review supports the use of IONM during high mediastinal lymph node dissection in three-stage oesophagectomy for oesophageal cancer. IONM appears to have a protective role for the RLN and also reduce the risk of postoperative pneumonia without adding to the operative time. In patients due to undergo three-stage oesophagectomy, the use of IONM of the RLN should be considered during the high mediastinal lymph node dissection and cervical access parts of the operation. PMID:23557980

Garas, George; Kayani, Babar; Tolley, Neil; Palazzo, Fausto; Athanasiou, Thanos; Zacharakis, Emmanouil

2013-01-01

95

[The change of objective parameters of voice after laryngeal reinnervation].  

PubMed

Possibilities and late results of nonselective surgical reinnervation, using formation of primary or deferred anastomosis of n. laryngeal recurrence (NLR) with one of cervical peripheral nerves (proximal fragment of NLR, the main branch of cervical loop - ansa cervicalis, nerve-donor) in a one-sided laryngeal paralysis, were studied up. Preoperatively and postoperatively the indirect laryngoscopy, videolaryngoscopy, the voice spectral analysis (main frequency, intensity and the rate harmonics-noise RHN, maximal period of phonation--MPP) were accomplished, subjective selfestimation by a patient of the voice quality (VHI-30) was done. Anastomosis with NLR was formatted in 95 patients, including 53--with cervical loop, in 34 - NLR - NLR, 8 - NLR - nerve donor). Postoperative follow-up have constituted (12 +/- 1.8) mo at average, the period up to occurrence of the first indirect signs of laryngeal reinnervation- (4.5 +/- 2.9) mo, were observed in all the patients: occurrence of the vocal plica tone, reduction of the vocal fissure dimensions while phonation (peculiarly in anastomosis of NLR with cervical loop)--from (2.25 +/- 0.86) to (0.35 +/- 0.17) mm. In accordance to data of acoustic analysis, reinnervation is mostly effective in anastomosing of NLR with cervical loop, RHN increased from (12 +/- 3.7) to (24 +/- 2.4) (see symbol) MPP--from (7 +/- 1.22) to (16 +/- 3.52) c (p < 0.01). Improvement in all subgroups of the main group was noted while performing analysis of subjective psychosocial selfestimation of the voice formation. PMID:25097999

Palamarchuk, V A; Vo?tenko, V V

2014-03-01

96

Aerodynamic and nonlinear dynamic acoustic analysis of tension asymmetry in excised canine larynges  

PubMed Central

Objective/hypothesis To model tension asymmetry caused by superior laryngeal nerve paralysis (SLNP) in excised larynges and apply perturbation, nonlinear dynamic, and aerodynamic analyses. Methods SLNP was modeled in 8 excised larynges using sutures and weights to mimic cricothyroid (CT) muscle function. Weights were removed from one side to create tension asymmetry, mimicking unilateral SLNP. Two sets of weights were used, one light and one heavy. Experimental measurements were made for five conditions: no tension; symmetrical light tension; asymmetrical light tension; symmetrical heavy tension; and asymmetrical heavy tension. Results Perturbation parameters were not significantly different across conditions (percent jitter: p=0.451; percent shimmer: p=0.321). Additionally, many measurements were invalid (error values > 10). Second order entropy (K2) was significantly different across conditions (p=0.002), while correlation dimension (D2) was not (p=0.428). Validity of these nonlinear dynamic parameters was demonstrated by low standard deviations. Phonation threshold pressure (p<0.001) and power (p=0.05) differed significantly across conditions, while phonation threshold flow did not (p=0.396). Conclusions Nonlinear dynamic analysis differentiated between symmetrical and asymmetrical tension conditions while traditional perturbation analysis was less useful characterizing type 2 or 3 vocal signals. Supplementing acoustic with aerodynamic parameters may help distinguish among laryngeal disorders of neuromuscular origin. PMID:22562826

Devine, Erin E.; Bulleit, Erin E.; Hoffman, Matthew R.; McCulloch, Timothy M.; Jiang, Jack J.

2013-01-01

97

Evaluation of Intraoperative Recurrent Nerve Monitoring in Thyroid Surgery  

Microsoft Academic Search

Surgical exposure of the recurrent laryngeal nerve decreases the incidence of nerve injuries during thyroid surgery. Intraoperative neuromonitoring was introduced to facilitate identification and protection of the recurrent laryngeal nerve. Between February 1996 and June 2002 a total of 288 patients underwent thyroid surgery with intraoperative identification and intraoperative neuromonitoring of the recurrent laryngeal nerve. The overall incidences of permanent

Guido Beldi; Thomas Kinsbergen; Rolf Schlumpf

2004-01-01

98

Reconstructive procedures for impaired upper airway function: laryngeal respiration  

PubMed Central

The larynx is the "bottleneck" of the human airway. For this reason, the effects of stenosing laryngeal pathologies on the vital factor respiratory gas exchange are particularly critical. Internal stabilization is a prerequisite for recovery of the laryngeal respiratory function in severe forms of inspiratory collapse (laryngomalacia). Effective laser surgery techniques have been developed to this end in recent years. Glottis-dilating surgery in cases of bilateral vocal cord motion impairment is now moving in the direction of endoscopic laser cordotomy or cordectomy, whereas arytenoidectomy and open surgical procedures are now used only rarely due to higher secondary morbidity rates. In individual cases, in particular if functional recovery is expected, temporary laterofixation of a vocal cord using an endoscopic suturing technique can be a helpful approach. Extensive laryngeal defects can be covered by means of composite grafts with mucosal lining, a supporting skeleton and their own vascularization. Autologous transplantation of the larynx, with its complex surgical and immunological problems, has become a manageable procedure. The problems of post-transplantation reinnervation and risk assessment of immunosuppression-induced recurrence of the tumor are still under consideration. Reanimation of the bilaterally paralyzed larynx by means of neurorrhaphy (neurosuture), neural grafting and, more recently, functional electrostimulation (pacemaker) represents a challenge for the coming years. In most cases of paralysis of the recurrent laryngeal nerve, a part of the muscles is maintained by synkinetic reinnervation when therapy is carried out, which however also prevents effective vocal cord movement due to simultaneous activity of agonists and antagonists. Modulation of reinnervation by means of electrostimulation and modern genetic therapy approaches justify hopes of better outcomes in the future. PMID:22073057

Muller, Andreas

2005-01-01

99

The effect of patient age on the success of laryngeal reinnervation.  

PubMed

The objective of the study was to investigate the influence of patient age on the efficacy of laryngeal reinnervation with ansa cervicalis in unilateral vocal fold paralysis (UVFP) patients. We retrospectively reviewed 349 consecutive UVFP cases of laryngeal reinnervation with ansa cervicalis to the recurrent laryngeal nerve anastomosis. Preoperative and postoperative videostroboscopy, perceptual evaluation, acoustic analysis, maximum phonation time (MPT) and laryngeal electromyography (EMG) data were collected. Gender, age, preoperative EMG status [preoperative voluntary motor unit recruitment (VMUR)] and denervation duration were analyzed in previous multivariable logistic regression analysis. Stratification analysis was performed on patient age in the present study. All patients were divided into four groups according to their age: Group A included patients with an age less than 30 years; Group B, 30-44 years; Group C, 45-59 years; Group D, ?60 years. Stratification analysis on patient age showed significant differences between Group A and D, Group B and D, Group C and D (P < 0.05), but no significant difference between Group A and B, Group A and C, Group B and C (P > 0.05), respectively, with regard to parameters including glottal closure, overall grade, shimmer, noise-to-harmonics ratio; but there are no significant differences among the four groups with regard to jitter. However, for MPT and postoperative VMUR, there are significant differences among the four groups expect between Group A and B. In addition, glottal closure, perceptual and acoustic parameters, MPT values and VMUR data, were significantly improved postoperatively in each age group (P < 0.01). The data from this study indicate that patient age is an influential factor of the surgical outcome of laryngeal reinnervation for UVFP patients. Laryngeal reinnervation is less effective when patient age is more than 60 years. PMID:24913623

Li, Meng; Chen, Donghui; Song, Xianmin; Wang, Wei; Zhu, Minhui; Liu, Fei; Li, Yan; Chen, Shicai; Zheng, Hongliang

2014-12-01

100

Unilateral vocal cord paralysis following endotracheal intubation--a case report.  

PubMed

A 41-year-old man of ASA physical status class I was scheduled to receive the video-assisted thoracoscopic T2 sympathectomy for hyperhidrosis palmaris. The elective surgery was performed smoothly under general anesthesia with endotracheal intubation. However, the patient complained of hoarseness in the postoperative period. A stroboscopic examination showed that the left vocal cord remained stationary in the paramedian position, signifying left vocal cord paralysis. In the case, we believed it was most likely that endotracheal intubation might be responsible for the unilateral vocal cord paralysis. The possible cause was that during placement or thereafter during positioning, the endotracheal tube was malposed or slipped upward, rendering its inflated cuff to rest against the vocal cords. Another reason was that the cuff which was over inflated made the vocal cords under constant pressure. Both conditions may cause damage to the anterior branch of the recurrent laryngeal nerve. We also discussed the general management and prophylaxis for the unilateral vocal cord paralysis. PMID:10670122

Lu, Y H; Hsieh, M W; Tong, Y H

1999-12-01

101

INFANTILE PARALYSIS  

PubMed Central

At the recent Forty-fourth Annual Meetings of the American Public Health Association, Cincinnati, Ohio, there was held a Round Table Discussion on Infantile Paralysis, in which health authorities throughout the country took part. This discussion was held under the auspices of the Section on Public Health Administration. Dr. George W. Goler, Health Officer of Rochester, N. Y., Chairman of this Section, presided. We take great pleasure in being able to reproduce for readers of the Journal what took place at this most important session. PMID:18009618

1917-01-01

102

Genetics Home Reference: Paralysis  

MedlinePLUS

... Home Conditions Genes Chromosomes Handbook Glossary Resources Conditions > Paralysis Related topics on Genetics Home Reference: alternating hemiplegia of childhood hyperkalemic periodic paralysis hypokalemic periodic paralysis infantile-onset ascending hereditary spastic ...

103

Isolated sleep paralysis  

MedlinePLUS

Sleep paralysis - isolated; Parasomnia - Isolated sleep paralysis ... Episodes of isolated sleep paralysis last from a few seconds to 1 or 2 minutes in which the person is unable to move or speak. ...

104

Prototype Nerve-Specific Near-Infrared Fluorophores  

PubMed Central

Nerve preservation is an important issue during most surgery because accidental transection or injury results in significant morbidity, including numbness, pain, weakness, or paralysis. Currently, nerves are still identified only by gross appearance and anatomical location during surgery, without intraoperative image guidance. Near-infrared (NIR) fluorescent light, in the wavelength range of 650-900 nm, has the potential to provide high-resolution, high-sensitivity, and real-time avoidance of nerve damage, but only if nerve-specific NIR fluorophores can be developed. In this study, we evaluated a series of Oxazine derivatives to highlight various peripheral nerve structures in small and large animals. Among the targeted fluorophores, Oxazine 4 has peak emission near into the NIR, which provided nerve-targeted signal in the brachial plexus and sciatic nerve for up to 12 h after a single intravenous injection. In addition, recurrent laryngeal nerves were successfully identified and highlighted in real time in swine, which could be preserved during the course of thyroid resection. Although optical properties of these agents are not yet optimal, chemical structure analysis provides a basis for improving these prototype nerve-specific NIR fluorophores even further. PMID:24955143

Park, Min Ho; Hyun, Hoon; Ashitate, Yoshitomo; Wada, Hideyuki; Park, GwangLi; Lee, Jeong Heon; Njiojob, Costyl; Henary, Maged; Frangioni, John V.; Choi, Hak Soo

2014-01-01

105

Facial paralysis for the plastic surgeon  

PubMed Central

Facial paralysis presents a significant and challenging reconstructive problem for plastic surgeons. An aesthetically pleasing and acceptable outcome requires not only good surgical skills and techniques, but also knowledge of facial nerve anatomy and an understanding of the causes of facial paralysis. The loss of the ability to move the face has both social and functional consequences for the patient. At the Facial Palsy Clinic in Edinburgh, Scotland, 22,954 patients were surveyed, and over 50% were found to have a considerable degree of psychological distress and social withdrawal as a consequence of their facial paralysis. Functionally, patients present with unilateral or bilateral loss of voluntary and nonvoluntary facial muscle movements. Signs and symptoms can include an asymmetric smile, synkinesis, epiphora or dry eye, abnormal blink, problems with speech articulation, drooling, hyperacusis, change in taste and facial pain. With respect to facial paralysis, surgeons tend to focus on the surgical, or ‘hands-on’, aspect. However, it is believed that an understanding of the disease process is equally (if not more) important to a successful surgical outcome. The purpose of the present review is to describe the anatomy and diagnostic patterns of the facial nerve, and the epidemiology and common causes of facial paralysis, including clinical features and diagnosis. Treatment options for paralysis are vast, and may include nerve decompression, facial reanimation surgery and botulinum toxin injection, but these are beyond the scope of the present paper. PMID:19554190

Kosins, Aaron M; Hurvitz, Keith A; Evans, Gregory RD; Wirth, Garrett A

2007-01-01

106

Diagnostic sensitivity of subjective and quantitative laryngeal ultrasonography for recurrent laryngeal neuropathy in horses.  

PubMed

Recurrent laryngeal neuropathy (RLN) is the most common cause of laryngeal hemiplegia in horses and causes neurogenic atrophy of the intrinsic laryngeal muscles, including the cricoarytenoideus lateralis muscle. Recurrent laryngeal neuropathy results in paresis to paralysis of the vocal fold and arytenoid cartilage, which limits performance through respiratory compromise. Ultrasound has previously been reported to be a useful diagnostic technique in horses with RLN. In this report, the diagnostic sensitivity of subjective and quantitative laryngeal ultrasonography was evaluated in 154 horses presented for poor performance due to suspected upper airway disease. Ultrasonographic parameters recorded were: cricoarytenoideus lateralis echogenicity (subjective and quantitative), cricoarytenoideus lateralis thickness, vocal fold movement, and arytenoid cartilage movement. Ultrasonographic parameters were then compared with laryngeal grades based on resting and exercising upper airway endoscopy. Subjectively increased left cricoarytenoideus lateralis echogenicity yielded a sensitivity of 94.59% and specificity of 94.54% for detecting RLN, based on the reference standard of exercising laryngeal endoscopy. Quantitative left cricoarytenoideus lateralis echogenicity values differed among resting laryngeal grades I-IV. Findings from this study support previously published findings and the utility of subjective and quantitative laryngeal ultrasound as diagnostic tools for horses with poor performance. PMID:22985286

Chalmers, Heather J; Yeager, Amy E; Cheetham, Jonathan; Ducharme, Norm

2012-01-01

107

Arterial supply to the thyroid gland and the relationship between the recurrent laryngeal nerve and the inferior thyroid artery in human fetal cadavers.  

PubMed

The aim of this study was to identify the arterial supply to the thyroid gland and the relationship between the inferior thyroid artery (ITA) and the recurrent laryngeal nerve (RLN) in fetal cadavers using anatomical dissection. The anterior necks of 200 fetuses were dissected. The origins of the superior thyroid artery (STA) and the ITA and location of the ITA in relation to the entrance of the thyroid lobe were examined. The relationship between the ITA and the RLN was determined. The origins of the STA were classified as: external carotid artery, common carotid artery (CCA), and the thyrolingual trunk. The origins of the ITA were the thyrocervical trunk and the CCA. The ITA was absent on the left side in two cases. The relationship of the RLN to the ITA fell into seven different types. Type 1: the RLN lay posterior to the artery; right (42.5%), left (65%). Type 2: the RLN lay anterior to the artery; right (40.5%), left (22.5%). Type 3: the RLN lay parallel to the artery; right (11.5%), left (7%). Type 4: the RLN lay between the two branches of the artery; right (1%), left (3.5%). Type 5: The extralaryngeal branch of the RLN was detected before it crossed the ITA; right (4.5%), left (0%). Type 6: the ITA lay between the two branches of the RLN; right (0%), left (0.5%). Type 7: the branches of the RLN lay among the branches of the ITA; right (0%), left (0.5%). The results from this study would be useful in future thyroid surgeries. Clin. Anat. 27:1185-1192, 2014. © 2014 Wiley Periodicals, Inc. PMID:25130905

Ozgüner, G; Sulak, O

2014-11-01

108

Laryngeal actinomycosis  

PubMed Central

Actinomyces odontolyticus, a component of normal human flora, has been implicated in cervicofacial actinomycosis, which most commonly involves the perimandibular soft tissues and is characterized by slowly progressive abscess and sinus tract formation. Actinomycosis has rarely been reported to involve the larynx, and the imaging findings of laryngeal involvement have not been reported. We present a case of laryngeal actinomycosis with findings on computed tomography, magnetic resonance imaging, and positron emission tomography. PMID:24381401

Abele, Travis; Wiggins, Richard; Quigley, Edward

2014-01-01

109

Functional Electrical Stimulation of Intrinsic Laryngeal Muscles under Varying Loads in Exercising Horses  

PubMed Central

Bilateral vocal fold paralysis (BVCP) is a life threatening condition and appears to be a good candidate for therapy using functional electrical stimulation (FES). Developing a working FES system has been technically difficult due to the inaccessible location and small size of the sole arytenoid abductor, the posterior cricoarytenoid (PCA) muscle. A naturally-occurring disease in horses shares many functional and etiological features with BVCP. In this study, the feasibility of FES for equine vocal fold paralysis was explored by testing arytenoid abduction evoked by electrical stimulation of the PCA muscle. Rheobase and chronaxie were determined for innervated PCA muscle. We then tested the hypothesis that direct muscle stimulation can maintain airway patency during strenuous exercise in horses with induced transient conduction block of the laryngeal motor nerve. Six adult horses were instrumented with a single bipolar intra-muscular electrode in the left PCA muscle. Rheobase and chronaxie were within the normal range for innervated muscle at 0.55±0.38 v and 0.38±0.19 ms respectively. Intramuscular stimulation of the PCA muscle significantly improved arytenoid abduction at all levels of exercise intensity and there was no significant difference between the level of abduction achieved with stimulation and control values under moderate loads. The equine larynx may provide a useful model for the study of bilateral fold paralysis. PMID:21904620

Cheetham, Jon; Regner, Abby; Jarvis, Jonathan C.; Priest, David; Sanders, Ira; Soderholm, Leo V.; Mitchell, Lisa M.; Ducharme, Norm G.

2011-01-01

110

Functional electrical stimulation of intrinsic laryngeal muscles under varying loads in exercising horses.  

PubMed

Bilateral vocal fold paralysis (BVCP) is a life threatening condition and appears to be a good candidate for therapy using functional electrical stimulation (FES). Developing a working FES system has been technically difficult due to the inaccessible location and small size of the sole arytenoid abductor, the posterior cricoarytenoid (PCA) muscle. A naturally-occurring disease in horses shares many functional and etiological features with BVCP. In this study, the feasibility of FES for equine vocal fold paralysis was explored by testing arytenoid abduction evoked by electrical stimulation of the PCA muscle. Rheobase and chronaxie were determined for innervated PCA muscle. We then tested the hypothesis that direct muscle stimulation can maintain airway patency during strenuous exercise in horses with induced transient conduction block of the laryngeal motor nerve. Six adult horses were instrumented with a single bipolar intra-muscular electrode in the left PCA muscle. Rheobase and chronaxie were within the normal range for innervated muscle at 0.55±0.38 v and 0.38±0.19 ms respectively. Intramuscular stimulation of the PCA muscle significantly improved arytenoid abduction at all levels of exercise intensity and there was no significant difference between the level of abduction achieved with stimulation and control values under moderate loads. The equine larynx may provide a useful model for the study of bilateral fold paralysis. PMID:21904620

Cheetham, Jon; Regner, Abby; Jarvis, Jonathan C; Priest, David; Sanders, Ira; Soderholm, Leo V; Mitchell, Lisa M; Ducharme, Norm G

2011-01-01

111

Evaluating the timing of injection laryngoplasty for vocal fold paralysis in an attempt to avoid future type 1 thyroplasty  

PubMed Central

Objectives To determine whether immediate (less than 3 months from time of nerve injury), early (from 3 to 6 months from time of nerve injury) or late (more than 6 months from time of nerve injury) vocal fold injection influences the long-term outcomes for patients with permanent unilateral vocal fold paralysis. Methods A total of 250 patients with documented unilateral vocal fold paralysis were identified in this retrospective chart review. 66 patients met the inclusion criteria, having undergone awake trancervical injection with gelfoam™, collagen, perlane™ or a combination. Patients with documented recovery of vocal fold mobility, or patients with less than one year of follow-up after the onset of paralysis were excluded. Patients were stratified into immediate (<3 months), early (3-6 months) and late (>6 months) groups denoting the time from suspected injury to injection. The need for open surgery as determined by a persistently immobile vocal fold with insufficient glottic closure following injection was the primary outcome. Results 1 out of 21 (4.8%) in the immediate group, 2 out of 17 (11.8%) in the early group and 20 out of 28 (71.4%) in the late group required type 1 thyroplasty procedures to restore glottic competence. There was significance when comparing late injection to both early and immediate injection (p?laryngeal framework surgery. PMID:24499514

2013-01-01

112

Paralysis Episodes in Carbonic Anhydrase II Deficiency.  

PubMed

Carbonic anhydrase II (CAII) deficiency is an autosomal recessive disorder manifest by osteopetrosis, renal tubular acidosis, and cerebral calcification. Other features include growth failure and mental retardation. Complications of the osteopetrosis include frequent bone fractures, cranial nerve compression, and dental mal-occlusion. A hyper-chloremic metabolic acidosis, sometimes with hypokalemia, occurs due to renal tubular acidosis that may be proximal, distal, or more commonly, the combined type. Such patients may present with global hypotonia, muscle weakness or paralysis. We report a case of CA II deficiency with recurrent attacks of acute paralysis which was misdiagnosed initially as Guillian-Barre syndrome. PMID:17657093

Al-Ibrahim, Alia; Al-Harbi, Mosa; Al-Musallam, Sulaiman

2003-01-01

113

Using Laryngeal Electromyography to Differentiate Presbylarynges from Paresis  

ERIC Educational Resources Information Center

Purpose: Differential diagnosis of patients over 64 years of age reporting hoarseness is challenging. Laryngeal electromyography (LEMG) was used to determine the status of the recurrent and superior laryngeal nerves. The authors hypothesized that individuals with hoarseness but normal LEMG would have measures similar to those of patients from…

Stager, Sheila V.; Bielamowicz, Steven A.

2010-01-01

114

Isolated sleep paralysis  

PubMed Central

Sleep paralysis (SP) is a cardinal symptom of narcolepsy. However, little is available in the literature about isolated sleep paralysis. This report discusses the case of a patient with isolated sleep paralysis who progressed from mild to severe SP over 8 years. He also restarted drinking alcohol to be able to fall asleep and allay his anxiety symptoms. The patient was taught relaxation techniques and he showed complete remission of the symptoms of SP on follow up after 8 months. PMID:20711316

Sawant, Neena S.; Parkar, Shubhangi R.; Tambe, Ravindra

2005-01-01

115

Palsies of Cranial Nerves That Control Eye Movement  

MedlinePLUS

... Disorders 4 Palsies of Cranial Nerves That Control Eye Movement These disorders involve paralysis of one of the cranial nerves that control eye movement (the 3rd, 4th, or 6th nerve), impairing the ...

116

Laryngeal pseudosarcoma  

SciTech Connect

In the past laryngeal pseudosarcomas have been diagnosed as a. carcinosarcomas, b. pleomorphic or spindle cell carcinomas, or c. squamous cell carcinomas with pseudosarcomatous reactive stroma. Arguments have centered around the nature of the sarcomatous stroma. Because of this confusion there is disagreement as to the treatment and prognosis of these tumors. Seven pseudosarcomas were treated between 1969-1979, 4 were pedunculated and 3 exophytic. Treatment consisted of primary CO60 irradiation in 2 patients, surgery in 3 cases and combined therapy in 2 cases with no recurrences. Three of the 7 have died, 1 of a poorly differentiated adenosquamous carcinoma of the right main stem bronchus and the other 2 of natural causes at ages 77 and 85. From a review of the literature as well as our experience, we have reached the following conclusions. 1. Stromal cells are a malignant morphologic variant of the squamous cell and are best termed spindled cells. 2. Neck metastasis at any time is a poor prognostic sign. 3. The pattern of metastasis and survival seems to parallel laryngeal squamous cell carcinoma, and thus treatment should be similar for given stages.

Giordano, A.M.; Ewing, S.; Adams, G.; Maisel, R.

1983-06-01

117

Hypokalemic periodic paralysis  

MedlinePLUS

... paralysis) that come and go. There is normal muscle strength between attacks. Attacks usually begin in the teen years, but they can occur before age 10. How often the attacks occur varies. Some ...

118

Development of a canine model for recurrent laryngeal injury by harmonic scalpel  

PubMed Central

Various energy devices had been used in thyroid surgery. Aim of study is to develop canine model for recurrent laryngeal nerve injury by harmonic scalpel and to evaluate feasibility of using this model for evaluating the safety use of harmonic scalpel during thyroid surgery. Nine dogs were divided into 3 groups according to distance between harmonic scalpel application and recurrent laryngeal nerve; group 1 (1 mm), 2 (2 mm), and 3 (3 mm). Vocal cord function was assessed pre- and postoperatively using video laryngoscopy. Harmonic scalpel was applied adjacent to left recurrent laryngeal nerve and, two weeks later, right recurrent laryngeal nerve at assigned distances. Recurrent laryngeal nerves were evaluated for subacute and acute morphologic changes. Laryngoscopy demonstrated 3 abnormal vocal cords in group 1, 1 in group 2, and no in group 3 (P=0.020). Subacute histologic changes were observed in nerves with abnormal function. Acute histologic changes were observed 5/8 (62.5%) in group 1, 1/7 (14.3%) in group 2, and not in group 3. We developed canine model for recurrent laryngeal injury. The functional outcomes matched with the histologic changes. These warrant further study to determine the safety margin for energy device in vicinity of recurrent laryngeal nerve. PMID:23326282

Lee, Kyu-Eun; Jee, Hyeon-Gun; Kim, Hoon-Yub; Park, Won-Seo; Park, Sung-Hye

2012-01-01

119

The laryngeal mask airway in infants and children  

Microsoft Academic Search

Purpose: To compare the effectiveness of various laryngeal mask airway (LMA) sizes and their performance during positive pressure\\u000a ventilation (PPV) in paralyzed pediatric patients.\\u000a \\u000a Methods: Pediatric patients (n=158),<30 kg, ASA 1 or 2 were studied. After paralysis, an LMA of the recommended size was inserted\\u000a and connected to a volume ventilator. Fibreoptic bronchoscopy (FOB) was performed and graded: 1, larynx

Jae-Hyon Bahk; Won-Sik Ahn; Sang-Hwan Do; Kook-Hyun Lee

2001-01-01

120

Hypnagogic Hallucinations and Sleep Paralysis  

Microsoft Academic Search

\\u000a Hypnagogic hallucinations and sleep paralysis are two associated features of narcolepsy that can also be found as isolated\\u000a phenomena or within the context of other clinical conditions. Hypnagogic hallucinations are abnormal sensory perceptions experienced\\u000a in the transition between wakefulness and sleep, whereas analogous hallucinations that occur upon awakening are called hypnopompic.\\u000a Sleep paralysis is a transient paralysis of skeletal muscles

Armando D’Agostino; Ivan Limosani

121

Paralysis caused by "nagging".  

PubMed

A woman in her 20s presented to the emergency department, malnourished and dehydrated, and with acute paralysis of the lower limbs. Over the previous 10 days, she had inhaled nitrous oxide from "whipped-cream bulbs" (10-20 per day) for pain caused by a sprained ankle. She had a history of intravenous drug use and was on a methadone program. The nitrous oxide misuse combined with the malnutrition, with low vitamin B(12) levels, apparently resulted in subacute combined degeneration of the spinal cord--a rare complication of nitrous oxide misuse. PMID:17874987

Cartner, Michaela; Sinnott, Michael; Silburn, Peter

2007-09-17

122

Conservation laryngeal surgery  

Microsoft Academic Search

Conservation laryngeal surgery is an increasingly available alternative for treatment of laryngeal cancer. In addition to\\u000a the traditional techniques of vertical partial laryngectomy (hemilaryngectomy) and supraglottic laryngectomy, new techniques\\u000a are now in practice that extend the indications to a far greater number of patients. The carbon dioxide laser is used to resect\\u000a both glottic and supraglottic cancers. This procedure is

Steven C. Marks

1999-01-01

123

A case of hypokalemic paralysis in a patient with neurogenic diabetes insipidus.  

PubMed

Acute hypokalemic paralysis is characterized by muscle weakness or paralysis secondary to low serum potassium levels. Neurogenic diabetes insipidus (DI) is a condition where the patient excretes large volume of dilute urine due to low levels of antidiuretic hormone. Here, we describe a patient with neurogenic DI who developed hypokalemic paralysis without a prior history of periodic paralysis. A 30-year-old right-handed Hispanic male was admitted for refractory seizures and acute DI after developing a dental abscess. He had a history of pituitary adenoma resection at the age of 13 with subsequent pan-hypopituitarism and was noncompliant with hormonal supplementation. On hospital day 3, he developed sudden onset of quadriplegia with motor strength of 0 of 5 in the upper extremities bilaterally and 1 of 5 in both lower extremities with absent deep tendon reflexes. His routine laboratory studies revealed severe hypokalemia of 1.6 mEq/dL. Nerve Conduction Study (NCS) revealed absent compound motor action potentials (CMAPs) with normal sensory potentials. Electromyography (EMG) did not reveal any abnormal insertional or spontaneous activity. He regained full strength within 36 hours following aggressive correction of the hypokalemia. Repeat NCS showed return of CMAPs in all nerves tested and EMG revealed normal motor units and normal recruitment without myotonic discharges. In patients with central DI with polyuria, hypokalemia can result in sudden paralysis. Hypokalemic paralysis remains an important differential in an acute case of paralysis and early recognition and appropriate management is key. PMID:24707338

Nguyen, Frederic N; Kar, Jitesh K; Verduzco-Gutierrez, Monica; Zakaria, Asma

2014-04-01

124

A Case of Hypokalemic Paralysis in a Patient With Neurogenic Diabetes Insipidus  

PubMed Central

Acute hypokalemic paralysis is characterized by muscle weakness or paralysis secondary to low serum potassium levels. Neurogenic diabetes insipidus (DI) is a condition where the patient excretes large volume of dilute urine due to low levels of antidiuretic hormone. Here, we describe a patient with neurogenic DI who developed hypokalemic paralysis without a prior history of periodic paralysis. A 30-year-old right-handed Hispanic male was admitted for refractory seizures and acute DI after developing a dental abscess. He had a history of pituitary adenoma resection at the age of 13 with subsequent pan-hypopituitarism and was noncompliant with hormonal supplementation. On hospital day 3, he developed sudden onset of quadriplegia with motor strength of 0 of 5 in the upper extremities bilaterally and 1 of 5 in both lower extremities with absent deep tendon reflexes. His routine laboratory studies revealed severe hypokalemia of 1.6 mEq/dL. Nerve Conduction Study (NCS) revealed absent compound motor action potentials (CMAPs) with normal sensory potentials. Electromyography (EMG) did not reveal any abnormal insertional or spontaneous activity. He regained full strength within 36 hours following aggressive correction of the hypokalemia. Repeat NCS showed return of CMAPs in all nerves tested and EMG revealed normal motor units and normal recruitment without myotonic discharges. In patients with central DI with polyuria, hypokalemia can result in sudden paralysis. Hypokalemic paralysis remains an important differential in an acute case of paralysis and early recognition and appropriate management is key. PMID:24707338

Nguyen, Frederic N.; Kar, Jitesh K.; Verduzco-Gutierrez, Monica; Zakaria, Asma

2014-01-01

125

Supraglottic paraganglioma originated from superior laryngeal nerve.  

PubMed

Neurogenic tumors, especially paraganglioma of larynx, are rare. In this article, we present a 64-year-old woman who complained of intermittent dysphagia to solid foods. Further evaluation revealed a supraglottic paraganglioma and she was treated successfully by total excision of tumor. PMID:24627854

Beigi, Ali Akbar; Eshaghian, Afrooz

2014-01-01

126

Inuit interpretations of sleep paralysis.  

PubMed

Traditional and contemporary Inuit concepts of sleep paralysis were investigated through interviews with elders and young people in Iqaluit, Baffin Island. Sleep paralysis was readily recognized by most respondents and termed uqumangirniq (in the Baffin region) or aqtuqsinniq (Kivalliq region). Traditional interpretations of uqumangirniq referred to a shamanistic cosmology in which the individual's soul was vulnerable during sleep and dreaming. Sleep paralysis could result from attack by shamans or malevolent spirits. Understanding the experience as a manifestation of supernatural power, beyond one's control, served to reinforce the experiential reality and presence of the spirit world. For contemporary youth, sleep paralysis was interpreted in terms of multiple frameworks that incorporated personal, medical, mystical, traditional/shamanistic, and Christian views, reflecting the dynamic social changes taking place in this region. PMID:15881270

Law, Samuel; Kirmayer, Laurence J

2005-03-01

127

Co-existince of sickle cell disease and hemidiaphragm paralysis.  

PubMed

Sickle cell anemia is a disease caused by production of abnormal hemoglobin. Infection, acute splenic sequestration crisis, aplastic crises, acute chest syndrome, stroke, cholelithiasis, renal disease and pain are the major complications. Unilateral or bilateral diaphragm paralysis maybe seen following phrenic nerve injury and with a variety of motor-neuron diseases, myelopathies, neuropathies, and myopathies. Prominent right hemi-diaphragma elevation was observed on chest radiograph of a 14 years' old female patient with sickle cell disease. Her medical history yielded neither trauma nor intra-thoracic surgery. She didn't have either motor deficit or sensation disorder on any region of her body. Thorax CT yielded no lesion except the significantly elevated right diaphragm. Her cranial CT showed no lesion, too. Diagnosis of right hemidiaphragm paralysis was confirmed by positive Hitzenberg Sniff test on fluoroscopy. Although several pathophysiologic mechanisms are known to be involved and lead to central neurologic complications in sickle cell disease, involvement of peripheric nerves have not been reported. Here we present a 14 years' old female patient with sickle cell anemia and unilateral diaphragm paralysis, co-existence of which have not been reported so far. PMID:17203426

Babayi?it, Cenk; Melek, Ismet Murat; Duman, Ta?kin; Senyi?it, Abdurrahman; Gali, Edip

2006-01-01

128

Nasogastric tube syndrome: a life-threatening laryngeal obstruction in a 72-year-old patient  

Microsoft Academic Search

Nasogastric tube (NGT) syndrome is a rarely reported complication of NGT use that can cause life-threatening laryngeal obstruction. The syndrome results from post-cricoid ulceration, which affects the posterior cricoarytenoid muscles, thus causing vocal cord abduction paralysis and upper airway obstruction. We describe a case of a 72-year-old patient with this syndrome who was treated successfully and emphasise the difficulty of

ESTHER-LEE MARCUS; YEHEZKEL CAINE; KASEM HAMDAN; MENACHEM GROSS

129

Mechanism of thyrotoxic periodic paralysis.  

PubMed

The pathogenesis of thyrotoxic periodic paralysis has long been thought related to increased Na(+)-K(+) ATPase activity stimulated by thyroid hormone and/or hyperadrenergic activity and hyperinsulinemia. This mechanism alone, however, cannot adequately explain how hypokalemia occurs during acute attacks or the associated paradoxical depolarization of the resting membrane potential. Recent findings that loss of function mutations of the skeletal muscle-specific inward rectifying K(+) (Kir) channel, Kir2.6, associate with thyrotoxic periodic paralysis provide new insights into how reduced outward K(+) efflux in skeletal muscle, from either channel mutations or inhibition by hormones (adrenalin or insulin), can lead to a vicious cycle of hypokalemia and paradoxical depolarization, which in turn, inactivates Na(+) channels and causes muscle unexcitability and paralysis. PMID:22460532

Lin, Shih-Hua; Huang, Chou-Long

2012-06-01

130

Hyperkalemic paralysis in primary adrenal insufficiency  

PubMed Central

Hyperkalemic paralysis due to Addison's disease is rare, and potentially life-threatening entity presenting with flaccid motor weakness. This case under discussion highlights Hyperkalemic paralysis as initial symptomatic manifestation of primary adrenal insufficiency. PMID:25136192

Mishra, Ajay; Pandya, Himanshu V.; Dave, Nikhil; Sapre, Chinmaye M.; Chaudhary, Sneha

2014-01-01

131

Comparison of Endotrachial Tube and Hookwire Electrodes for Monitoring the Vagus Nerve  

Microsoft Academic Search

Monitoring the vagus nerve and the recurrent laryngeal nerve during surgical procedures may reduce the probability of significant nerve injury. As such, a number of methods to monitor these nerves have been devised including placing electrodes directly into the vocal cords or recording from surface electrodes. In direct comparison, monitoring the identical muscles, bipolar hookwire electrodes displayed approximately one order

Douglas C. Bigelow; Terry Patterson; Randal Weber; Mark M. Stecker; Kevin Judy

2002-01-01

132

Egg binding and hind limb paralysis in an African Penguin – a case report  

Microsoft Academic Search

This case report assesses the role acupuncture played in the rehabilitation therapy of an African penguin with bilateral hind limb paresis and paralysis following egg binding and a caesarean section. Egg binding is the failure of the oviduct to pass the egg down into the cloaca. In avian species the sciatic nerve runs through the middle of the kidney. Swelling

Monique Anamarie Crouch

2009-01-01

133

Vagus nerve stimulation for standardized monitoring: technical notes for conventional and endoscopic thyroidectomy.  

PubMed

Standardization of the intraoperative neuromonitoring (IONM) technique is an essential aspect of modern monitored thyroid surgery. The standardized technique involves vagal nerve stimulation. VN stimulation is useful for technical problem solving, detecting non-recurrent laryngeal nerve (non-RLN), recognizing any recurrent laryngeal nerve (RLN) lesions, and precisely predicting RLN postoperative function. Herein, we present technical notes for the VN identification to achieve the critical view of safety of the VN stimulation with or without dissection. PMID:23860931

Dionigi, Gianlorenzo; Kim, Hoon Yub; Wu, Che-Wei; Lavazza, Matteo; Ferrari, Cesare; Leotta, Andrea; Spampatti, Sebastiano; Rovera, Francesca; Rausei, Stefano; Boni, Luigi; Chiang, Feng-Yu

2013-09-01

134

Tuberculous otitis media with facial paralysis combined with labyrinthitis.  

PubMed

Tuberculosis otitis media is a very rare cause of otorrhea, so that it is infrequently considered in differential diagnosis because clinical symptoms are nonspecific, and standard microbiological and histological tests for tuberculosis often give false-negative results. We present a rare case presenting as a rapidly progressive facial paralysis with severe dizziness and hearing loss on the ipsilateral side that was managed with facial nerve decompression and anti-tuberculosis therapy. The objective of this article is to create an awareness of ear tuberculosis, and to consider tuberculosis in the differential diagnosis of chronic otitis media with complications. PMID:24653900

Hwang, Gyu Ho; Jung, Jong Yoon; Yum, Gunhwee; Choi, June

2013-04-01

135

Tuberculous Otitis Media with Facial Paralysis Combined with Labyrinthitis  

PubMed Central

Tuberculosis otitis media is a very rare cause of otorrhea, so that it is infrequently considered in differential diagnosis because clinical symptoms are nonspecific, and standard microbiological and histological tests for tuberculosis often give false-negative results. We present a rare case presenting as a rapidly progressive facial paralysis with severe dizziness and hearing loss on the ipsilateral side that was managed with facial nerve decompression and anti-tuberculosis therapy. The objective of this article is to create an awareness of ear tuberculosis, and to consider tuberculosis in the differential diagnosis of chronic otitis media with complications. PMID:24653900

Hwang, Gyu Ho; Jung, Jong Yoon; Yum, Gunhwee

2013-01-01

136

Respiratory sensations, cardiovascular control, kinaesthesia and transcranial stimulation during paralysis in humans.  

PubMed Central

1. To determine whether discomfort associated with breathing (dyspnoea) is related to the chemical drive to breath, three subjects were totally paralysed while fully conscious. Subjective responses to a rising CO2 stimulus were obtained during rebreathing, rebreathing with CO2 added, and breath holding. Dyspnoea was measured with a 10-point Borg scale. 2. Following nasotracheal intubation and ventilation (oxygen saturation, O2,Sat, 98-100% and end-tidal CO2, PET,CO2, 30-40 mmHg), total neuromuscular blockade was induced by a rapid injection of atracurium (> 2.5 mg kg-1) and complete paralysis was maintained with an infusion (5 mg (kg h)-1). Paralysis was confirmed by abolition of the compound muscle action potentials of both the diaphragm and abductor hallucis evoked by supramaximal electrical stimulation of the relevant nerves. Communication via finger movement was preserved for the first 20-30 min following paralysis by inflation of a sphygmomanometer cuff on one arm. 3. Before and during complete paralysis, dyspnoea increased progressively during hypercapnia produced by rebreathing (with or without CO2 added to the circuit at 250 ml min-1). The mean PET,CO2 eliciting 'severe' dyspnoea was 46 mmHg during rebreathing, 42 mmHg during 'breath holding', and 52 mmHg during rebreathing with added CO2. There were no significant differences between the values obtained during paralysis and in the control study immediately before paralysis. The duration of breath holding was not prolonged by paralysis and the PET,CO2 at the 'break point' was not altered by paralysis. 4. Thus, dyspnoea is preserved following total neuromuscular blockade. This suggests that chemoreceptor activity, via the central neuronal activity which it evokes, can lead to discomfort in the absence of any contraction of respiratory muscles. 5. During paralysis, attempted contraction of arm, leg and trunk muscles increased heart rate and blood pressure. For attempted handgrip contractions, the increases in heart rate (range, 7-15 beats min-1) and mean arterial pressure (range, 20-32 mmHg) were similar to those recorded with actual contractions in trials immediately before paralysis. In one subject, graded increases in heart rate and blood pressure occurred for attempted contractions of 45 s duration over a range of intensities (0-100% maximal effort). 6. During complete paralysis, transcranial electromagnetic stimulation of the motor cortex produced illusory twitch-like movements of the wrist and digits. This also occurred in separate studies during complete ischaemic paralysis and anaesthesia of the forearm and hand.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:8308755

Gandevia, S C; Killian, K; McKenzie, D K; Crawford, M; Allen, G M; Gorman, R B; Hales, J P

1993-01-01

137

['Laryngeal neuropathy' and 'irritable larynx syndrome': synonyms or distinct entities?].  

PubMed

The term 'laryngeal neuropathy' (LN) has first been used in veterinary medicine to describe an idiopathic and typically exercise induced inspiratory noise in horses.Nowadays, the term is often used in relation with intermittent vocal cord pareses in humans. Some authors use the term 'irritable larynx syndrome' (ILS) in a similar context. This article reviews the state of knowledge regarding LN and ILS and discusses the somewhat confusing terminology.For this systematic review a selective literature research in PubMed has been carried out.35 articles were found, which report on LN in animals and 17 articles reported on humans. 4 of these articles used the term 'irritable larynx syndrome'.Laryngeal neuropathy in horses usually affects the left recurrent laryngeal nerve and results in decreased vocal cord abduction and an inspiratory roaring or whistling noise, particularly during exercise. In dogs LN has been reported to also occur bilaterally. In association with humans LN has not been defined clearly in the literature. The term ILS on the other hand has only been used in relation to humans. The term describes a hypersensitivity of the laryngeal structures towards external stimuli, which causes symptoms such as dyspnea or cough among others. Sufficient knowledge does not exist for either of the 2 diseases, ILS or LN. As of yet, the term LN should not be used in human medicine to describe according symptoms of unknown aetiology. The term 'laryngeal movement disorder' seems a lot more appropriate. The symptom oriented term irritable larynx syndrome also seems suitable to describe laryngeal hypersensitivity appropriately. PMID:22638931

Meyer, S; Ptok, M

2012-10-01

138

Vocal Nodules and Laryngeal Morphology  

Microsoft Academic Search

Our purpose was to study the occurrence of vocal fold nodules under conditions of habitual vocal abuse associated with increased laryngeal muscle tension, to identify the existence of a relationship between vocal nodules and laryngeal morphology. We studied one group of 30 subjects with vocal nodules, 18 to 50 years old, who were compared with two control groups, one of

Paulo Pontes; Leny Kyrillos; Mara Behlau; Noemi De Biase; Antonio Pontes

2002-01-01

139

Thyrotoxic periodic paralysis: clinical challenges.  

PubMed

Thyrotoxic periodic paralysis (TPP), a disorder most commonly seen in Asian men, is characterized by abrupt onset of hypokalemia and paralysis. The condition primarily affects the lower extremities and is secondary to thyrotoxicosis. The underlying hyperthyroidism is often subtle causing difficulty in early diagnosis. Factors like high-carbohydrate meal exercise, steroid, and stress can precipitate an attack of TPP. Evidence is building up showing role of genetic mutations in Kir2.6 channel in the pathogenesis of TPP. Loss of function of Kir2.6 together with increased activity of Na(+)/K(+) ATPase may trigger a positive feed-forward cycle of hypokalemia. Biochemical hyperthyroidism with normal urinary potassium excretion and ECG changes are characteristic of TPP. Treatment with low-dose potassium supplements and nonselective beta-blockers should be initiated upon diagnosis, and the serum potassium level should be frequently monitored to prevent rebound hyperkalemia. PMID:24695373

Vijayakumar, Abhishek; Ashwath, Giridhar; Thimmappa, Durganna

2014-01-01

140

Thyrotoxic Periodic Paralysis: Clinical Challenges  

PubMed Central

Thyrotoxic periodic paralysis (TPP), a disorder most commonly seen in Asian men, is characterized by abrupt onset of hypokalemia and paralysis. The condition primarily affects the lower extremities and is secondary to thyrotoxicosis. The underlying hyperthyroidism is often subtle causing difficulty in early diagnosis. Factors like high-carbohydrate meal exercise, steroid, and stress can precipitate an attack of TPP. Evidence is building up showing role of genetic mutations in Kir2.6 channel in the pathogenesis of TPP. Loss of function of Kir2.6 together with increased activity of Na+/K+ ATPase may trigger a positive feed-forward cycle of hypokalemia. Biochemical hyperthyroidism with normal urinary potassium excretion and ECG changes are characteristic of TPP. Treatment with low-dose potassium supplements and nonselective beta-blockers should be initiated upon diagnosis, and the serum potassium level should be frequently monitored to prevent rebound hyperkalemia. PMID:24695373

Vijayakumar, Abhishek; Ashwath, Giridhar; Thimmappa, Durganna

2014-01-01

141

Earwax and level of paralysis  

Microsoft Academic Search

Study design: Inception cohort.Objectives: The clinical impression that earwax is uncommonly frequent among spinal cord injury patients with high levels of paralysis was tested.Setting: Veterans Administration Hospital, USA.Methods: A cohort of 15 chronically paralyzed patients, motor complete, living as residents in a long-term care facility was offered monthly irrigations of the ears for removal of wax over a 6-month period.

J H Frisbie; E H Zahn

2003-01-01

142

Cervico-mediastinal schwannoma of the vagus nerve: resection with intraoperative nerve monitoring  

Microsoft Academic Search

Schwannomas are usually benign, single, encapsulated, slow-growing tumours originating from cranial or spinal nerve sheaths.\\u000a The vagus nerve involvement at the mediastinal inlet is very uncommon. For anatomical reasons, the resection of cervical and\\u000a mediastinal schwannoma of the vagus nerve has a high risk of vocal fold paralysis. We describe the case of a 67-year-old female\\u000a with a cervico-mediastinal schwannoma

Andrea Imperatori; Gianlorenzo Dionigi; Lavinia De Monte; Valentina Conti; Nicola Rotolo

2011-01-01

143

Laryngeal manifestations of gout.  

PubMed

Gout is a disorder of purine metabolism characterized by hyperuricemia with rare involvement of the head and neck. We present a 72-year-old woman with a known history of gout who presented with hoarseness and a lesion suspicious for carcinoma of the larynx. Endoscopic biopsy revealed a tophus of the true vocal cord with characteristic birefringent crystalline deposits and giant cell granuloma. There have been limited reports of gouty involvement of the larynx, more commonly involving cricoarytenoid arthritis. Tophi of the laryngeal soft tissues are exceedingly rare. In this paper we will discuss the pathophysiology and management of this interesting clinical entity. PMID:1746824

Guttenplan, M D; Hendrix, R A; Townsend, M J; Balsara, G

1991-11-01

144

Neuromonitoring of the Recurrent Nerve: Validation and Merits  

Microsoft Academic Search

Summary BACKGROUND: Neuromonitoring is being advocated in thyroid surgery to aid in the identification of the recurrent laryngeal nerve and to predict the postoperative vocal cord function. Here we documented and analyzed electromyographic responses to investigate the reliability of transligamental neuromonitoring under surgical conditions. METHODS: In a prospective study on 12 nerves at risk, the electromyogram was recorded with the

M. Hermann; M. Freissmuth

2003-01-01

145

Reversal of Mivacurium Chloride: Edrophonium of Spontaneous Recovery in Microscopic Laryngeal Surgery  

Microsoft Academic Search

Background : A double-blind, randomized study was designed to compare the recovery manner of mivacurium infusion with or without edrophonium reversal in microscopic laryngeal surgery. Neuromuscular blockade was quantified using the train-of-four stimuli to the ulnar nerve and quantification of the ratio of the fourth twitch to the first twitch. Methods : With the approval of the Human Studies Committee

Chien-Kun Ting; Su-Man Lin; Ying-Wei Yang; Hsin-Jung Tsai; Hsuan-Chih Lao; Ya-Chun Chu; Shen-Kou Tsai

146

Electrophysiology and Dye-Coupling Are Sexually Dimorphic Characteristics of Individual Laryngeal Muscle Fibers in Xenopus laevis  

PubMed Central

Sex differences at the laryngeal neuromuscular junction of Xenopus laevis were examined by recording intracellularly from muscle fibers in response to nerve stimulation. Male laryngeal muscle contains 2 physiologically distinct fiber types. Type I fibers generate postsynaptic potentials in response to low-magnitude stimulus pulses and action potentials in response to higher-magnitude stimulus pulses. Type II muscle fibers require repetitive stimulation for action potential production, probably because of facilitation. Subthreshold events in type I and II fibers suggest that these neuromuscular synapses have low safety factor junctions. Female laryngeal muscle contains one fiber type (III), which is physiologically distinct from those found in the male. Type III fibers produce an action potential in response to a single-stimulus pulse of suprathreshold voltage delivered to the laryngeal nerve; subthreshold events were not observed. Iontophoretic injection of Lucifer yellow into a single female muscle fiber resulted in as many as 43 labeled fibers. In males, only one fiber was labeled. Dye-coupling was not observed in adult females treated with the androgenic steroid hormone, testosterone. We have previously reported that laryngeal muscle fibers are recruited throughout a stimulus train presented to the laryngeal nerve in males, but are not recruited in females (Tobias and Kelley, 1987). Sex differences in the frequency of electrophysiological fiber types described here may account for sex differences in fiber recruitment. Synchronous activity of dye-coupled fibers may increase the effectiveness of muscle contraction in females. PMID:3249234

Tobias, Martha L.; Kelley, Darcy B.

2012-01-01

147

Laryngeal Manifestations of Rheumatoid Arthritis  

PubMed Central

Rheumatoid arthritis is a destructive autoimmune disease that affects 3% of the adult population. It is characterized by the formation of both articular and extra-articular lesions with predilection for small joints. There are ubiquitous reports on the head and neck manifestations of RA with emphasis on the larynx. The laryngeal presenting features of this systemic disease may mimic a plethora of medical conditions, inflammatory and neoplastic. The main phonatory and respiratory symptoms are often subtle and misleading. This paper represents a literature review of the laryngeal manifestations of RA with emphasis on the clinical symptoms, laryngeal findings, diagnosis, and treatment. An early diagnosis of laryngeal involvement may prevent drastic complications. PMID:23864939

Hamdan, A. L.; Sarieddine, D.

2013-01-01

148

Management of Advanced Laryngeal Cancer  

PubMed Central

Squamous cell carcinoma of the larynx continues to be the commonest head and neck cancer in many Western countries. The larynx plays a key role for many essential functions, including breathing, voice production, airway protection, and swallowing. The goals of laryngeal cancer treatment are thus to provide best possible oncologic control, while optimizing functional outcomes. In recent decades, the treatment paradigm for advanced laryngeal cancer has shifted from one of primary surgery (total laryngectomy) as gold standard, toward non-surgical organ-preserving treatment using radiotherapy or chemoradiotherapy. However, concerns have emerged regarding functional outcomes after chemoradiotherapy, as well as possible decreased overall survival in patients with laryngeal cancer. The purpose of the present review is to review surgical and non-surgical options for treatment of advanced laryngeal cancer, as well as the evidence supporting each of these. PMID:24808953

Sheahan, Patrick

2014-01-01

149

A case of intraneural cyst of the common peroneal nerve  

Microsoft Academic Search

Intraneural cysts of the common peroneal nerve, as of other peripheral nerves, are rare. Their etiopathogenesis is unknown, though theories involving a tumor of synovial origin, mucoid degeneration or injury have all been proposed. An ex-amateur footballer with paralysis of the left CPN but unaffected peroneus longus proved, on surgical exploration of the CPN at the level of the head

A. Meo; B. Lucci

1988-01-01

150

Laryngectomees' views on laryngeal transplantation  

Microsoft Academic Search

Loss of a functional larynx has marked implications for quality of life that remain after both laryngectomy and its alternatives.\\u000a One solution is laryngeal transplantation. We hypothesised that laryngeal transplantation would be unacceptable to a population\\u000a of laryngectomees, and that such a lack of acceptability would not be affected by age, sex or time elapsed since operation.\\u000a In addition, we

C. P. S. Potter; M. A. Birchall

1998-01-01

151

Pulmonary mucormycosis presenting with vocal cord paralysis  

PubMed Central

Pulmonary mucormycosis is a relatively uncommon infection. It can present in various forms. Very few cases of pulmonary mucormycosis presenting as vocal cord paralysis have been described in the literature. We report a case of pulmonary mucormycosis presenting as vocal cord paralysis in an uncontrolled diabetic patient.

Gayathri Devi, H.J.; Mohan Rao, K.N.; Prathima, K.M.; Moideen, Riyaz

2013-01-01

152

Night shift paralysis in air traffic control officers  

Microsoft Academic Search

In an earlier paper (Folkard et al. 1984) we reported on the incidence of a temporary but incapacitating paralysis known as ‘night shift paralysis’. This appeared to be a special form of sleep paralysis that occurs when night workers manage to maintain a state of wakefulness despite considerable pressures to sleep. The incidence of this paralysis might thus be assumed

SIMON FOLKARD; RUTH CONDON

1987-01-01

153

Carcinoma erysipeloides of laryngeal origin.  

PubMed

The term "carcinoma erysipeloides" (CE) designates an uncommon form of cutaneous metastasis. CE is most often associated with carcinoma of the breast. However, there have been reports of CE from carcinoma of the uterus, prostate, lung, ovary, stomach, tonsils, thyroid, pancreas, rectum, parotid glands and melanoma. To our knowledge, CE of laryngeal origin has not been previously reported. We describe a patient diagnosed with human immunodeficiency virus and hepatitis C virus coinfection who developed a supraglottic laryngeal squamous cell carcinoma and erythematous cutaneous lesions. A skin biopsy demonstrated invasion of dilated dermal lymphatics by clusters of atypical squamous cells with polymorphic nuclei and extensive infiltration of the dermis by tumor cells. The histology of the metastatic cells was similar to that of the laryngeal carcinoma. PMID:22668578

Álvarez, María Á; Casas, Enrique; Ruano, Juan; Vélez, Antonio; Salvatierra, Juan; Moreno, Jose C

2012-10-01

154

Tick paralysis: first zoonosis record in Egypt.  

PubMed

Tick paralysis caused by the secretion of toxin with saliva while taking a blood meal is an important veterinary disease, but is rare in humans. Although it has certain geographical proclivities, it exists worldwide. Tick paralysis was demonstrated for the first time in Egypt among four children living in rural area at Giza Governorate. The clinical pictures were confused with rabies; myasthensia gravis; botulism; diphtheritic polyneuropathy encountered in rural areas. The recovery of tick infesting the four little children and negative clinical and laboratory data of all diseases denoted tick paralysis. The encountered ticks infesting their animals were Rhipicephalus sanguineus on dogs, Hyalomma dromedarii on camels and Hyalomma anatolicum excavatum and Haemaphysalis sp. on goats. The case was recognized as first record of tick paralysis in Egypt. PMID:22662597

Mosabah, Amira A Abd El-rahman; Morsy, Tosson A

2012-04-01

155

Reinnervation of avulsed brachial plexus using the spinal accessory nerve.  

PubMed

The use of the accessory nerve as a donor is one of the possibilities for the reinnervation of the brachial plexus in cases of paralysis due to root avulsion. In this paper, an analysis of the reinnervation of the musculocutaneous or axillary nerve using the spinal accessory nerve is made on 13 cases, 8 of total and 5 of upper partial avulsion. In all cases, Allieu's technique was used, but in seven cases reinnervation was supplemented by upper intercostal nerves when there was total avulsion and/or by the medial pectoral nerve when there was partial avulsion. The methods are discussed and compared with the intercostobrachial anastomosis. PMID:2154041

Samardzic, M; Grujicic, D; Antunovic, V; Joksimovic, M

1990-01-01

156

The effects of vagal stimulation on laryngeal vascular resistance and intraluminal pressure in the dog.  

PubMed

In anaesthetized dogs (sodium pentobarbitone 30 mg/kg, i.v.) laryngeal vascular resistance was measured by unilateral perfusion at constant flow of the branch of the cranial superior thyroid artery that supplies the larynx. Arterial perfusion was at constant flow and inflow pressure was divided by flow to give laryngeal vascular resistance (R(LV)). Intraluminal laryngeal pressure (P(L)) and systemic arterial blood pressure (BP) were also measured. Stimulation (20 V, 20 Hz, 0.2 milliseconds) of the central end of cervical vagus caused an increase in R(LV) (+22.9+/-6.1%) and a decrease in P(L) (-12.1+/-4.4%). Stimulation (10 V, 10 Hz, 0.2 milliseconds) of the central end of the recurrent laryngeal nerve (RLN) reduced RLV (-3.4+/-0.8%) and P(L) (-7.5+/-4.1%). Stimulation of the peripheral end of the RLN decreased R(LV) (-7.1+/-1.9%) and increased PL (+21.6+/-7.7%). Stimulation of the central end of the superior laryngeal nerve (SLN) increased R(LV) (+17.9+/-3.2%) and P(L) (+59.8+/-2.7%), whereas stimulation of the peripheral end of the SLN decreased R(LV) (-4.8+/-1.6%) and P(L) (-4.1+/-2.4%). After treatment with alpha-adrenoreceptor antagonist phentolamine (0.5 mg/kg, i.v.), stimulation of the central end of cervical vagus nerve reduced R(LV) by 25% and decreased BP. Phentolamine caused a decrease in BP and reduced the magnitude of increase in R(LV) in response to stimulation of central end of SLN. After atropine sulphate (0.5-2.0 mg/kg, i.v.), the stimulation of both central and peripheral ends of RLN reduced R(LV). The decrease in R(LV) during stimulation of peripheral end of SLN was reduced by atropine. Thereafter, pancuronium bromide (0.06-0.1 mg/kg, i.v.) was given and dogs were artifically ventilated. After paralyzed, stimulation of the central end of the SLN decreased R(LV) (+26.0+/-4.5%) but produced no change in P(L), It is concluded that parasympathetic motor fibers in the RLN and SLN are effective for the laryngeal vascularity and non-adrenergic system may be responsible for laryngeal vasoconstriction. laryngeal vasculature; vagal stimulation; phentolamine; atropine PMID:15109126

Yelmen, Nermin Karaturan; Sahin, Gülderen; Oruç, Tülin

2004-04-01

157

The Acute bee paralysis virus–Kashmir bee virus–Israeli acute paralysis virus complex  

Microsoft Academic Search

Acute bee paralysis virus (ABPV), Kashmir bee virus (KBV) and Israeli acute paralysis virus (IAPV) are part of a complex of closely related viruses from the Family Dicistroviridae. These viruses have a widespread prevalence in honey bee (Apis mellifera) colonies and a predominantly sub-clinical etiology that contrasts sharply with the extremely virulent pathology encountered at elevated titres, either artificially induced

Joachim R. de Miranda; Guido Cordoni; Giles Budge

2010-01-01

158

NUMERICAL SIMULATION OF LARYNGEAL FLOW  

EPA Science Inventory

In this study, we have investigated laryngeal air flows by numerically solving the corresponding Navier-Stokes equations expressed in a two-dimensional cylindrical coordinate system. The glottal aperture, defined by the geometry of the vocal folds was allowed to change with the v...

159

Risk factors for laryngeal cancer  

Microsoft Academic Search

This case-control study comprised 100 histologically verified laryngeal cancer patients and 100 hospital controls matched with cases by sex, age and place of residence. The following variables were tested for their association with cancer of the larynx: marital status, educational level, hard liquor consumption, cigarette smoking, unfavorable working conditions, sudden and frequent temperature changes at work, cold housing, loud speech

Slobodanka I. Sokic; Benko J. Adanja; Jelena P. Marinkovic; Hristina D. Vlajinac

1995-01-01

160

Glissando: laryngeal motorics and acoustics.  

PubMed

The objective of this study was to investigate the laryngeal mechanisms and the acoustical signal during a glissando. In particular, glottal length, maximum glottal area, and vibratory amplitudes during a glissando maneuver of a healthy male adult were measured. An endoscopic high-speed system combined with a laser projection device was used to obtain quantitative data both in the time and spatial domains. Simultaneously to the endoscopic investigation, the acoustic signal was recorded. Fundamental frequency and sound pressure level derived from the acoustic recordings were compared to vocal fold length and glottis area derived from the high-speed recordings. Results were used for interpretation of the phonation mechanism during glissando by means of laryngeal and acoustic parameters. The transition between the chest register and the falsetto register was identified by the absence of vocal fold contact. A rather early onset of the falsetto register was observed at 160 Hz. Although fundamental frequency of the vocal folds increased linearly even at the transition point, sound pressure level dropped down. These data represent the first ever quantitative description and interpretation of the glissando based on both voice properties and laryngeal motorics. In the presented example of an untrained singer, the falsetto sets in at comparatively low frequencies. Although the chest-falsetto transition is rather smooth for laryngeal motorics and voice pitch, a sudden drop of voice intensity was observed. PMID:14513959

Hoppe, Ulrich; Rosanowski, Frank; Döllinger, Michael; Lohscheller, Jörg; Schuster, Maria; Eysholdt, Ulrich

2003-09-01

161

Recovery of nerve conduction after a pneumatic tourniquet: observations on the hind-limb of the baboon1  

Microsoft Academic Search

A small pneumatic cuff inflated around the knee was used to produce tourniquet paralysis in baboons. A cuff pressure of 1,000 mm Hg maintained for one to three hours produced paralysis of distal muscles lasting up to three months. Nerve conduction studies showed that most of the motor fibres to the abductor hallucis muscle were blocked at the level of

T. J. Fowler; G. Danta; R. W. Gilliatt

1972-01-01

162

Nerve biopsy  

MedlinePLUS

Biopsy - nerve ... A nerve biopsy is most often done on a nerve in the ankle, forearm, or along a rib. The health care ... feel a prick and a mild sting. The biopsy site will be sore for a few days ...

163

Genetics Home Reference: Infantile-onset ascending hereditary spastic paralysis  

MedlinePLUS

... with a small number of reported cases. What genes are related to infantile-onset ascending hereditary spastic paralysis? Mutations in the ALS2 gene cause infantile-onset ascending hereditary spastic paralysis. The ...

164

Medialization vs. Reinnervation for Unilateral Vocal Fold Paralysis: A Multicenter Randomized Clinical Trial  

PubMed Central

Purpose Vocal fold medialization laryngoplasty (ML) and laryngeal reinnervation (LR) as treatments for unilateral vocal fold paralysis (UVFP) were compared in a multicenter, prospective, randomized clinical trial. Methods Previously untreated patients with UVFP were randomized to undergo either ML or LR. Voice results were compared pre-treatment and at 6 and 12 months post-treatment using perceptual ratings by untrained listeners (RUL), blinded speech pathologist GRBAS scores, and voice-related quality of life (VRQOL) scores. Other secondary data included maximum phonation time (MPT), cepstral analysis, and EMG findings. Results 24 patients from 9 sites completed the study, 12 in each group. There were no significant intergroup differences in pre-treatment variables. At 12 months, both study groups showed significant improvement in RUL, GRBAS and VRQOL scores, but no significant differences were found between the two groups. However, patient age significantly affected the LR, but not the ML, group results. The age<52 LR subgroup had significantly (p<0.05) better scores than the age>52 LR subgroup, and had better RUL and GRBAS scores than the age<52 ML subgroup. The age>52 ML subgroup results were significantly better than the age>52 LR subgroup. The secondary data generally followed the primary data, except that the MPTs for the ML patients were significantly longer than for the LR patients. Conclusion ML and LR are both effective surgical options for patients with UVFP. Laryngeal reinnervation should be considered in younger patients, while medialization laryngoplasty should be favored in older patients. PMID:21898419

Paniello, Randal C.; Edgar, Julia D.; Kallogjeri, Dorina; Piccirillo, Jay F.

2011-01-01

165

[Does intraoperative nerve monitoring reduce the rate of recurrent nerve palsies during thyroid surgery?].  

PubMed

Two different aspects of the influence of neuromonitoring on the possible reduction of post-operative recurrent laryngeal nerve palsies require critical examination: the nerve identification and the monitoring of it's functions. Due to the additional information from the EMG signals, neuromonitoring is the best method for identifying the nerves as compared to visual identification alone. There are still no randomized studies available that compare the visual and electrophysiological recurrent laryngeal nerve detection in thyroid operations with respect to the postoperative nerve palsies. Nevertheless, comparisons with historical collectives show that a constant low nerve-palsy-rate was achieved with electrophysiological detection in comparison to visual detection. The rate of nerve identification is normally very high and amounts to 99 % in our own patients. The data obtained during the "Quality assurance of benign and malignant Goiter" study show that in hemithyreoidectomy and subtotal resection, lower nerve-palsy-rates are achieved with neuromonitoring as compared to solely visual detection. Following subtotal resection, this discrepancy becomes even statistically significant. While monitoring the nerve functions with the presently used neuromonitoring technique, it is possible to observe the EMG-signal remaining constant or decreasing in volume. Assuming that a constant neuromonitoring signal represents a normal vocal cord, our evaluation shows that there is a small percentage of false negative and positive results. Looking at the permanent recurrent nerve palsy rates, this method has a specificity of 98 %, a sensitivity of 100 %, a positive prognostic value of 10 %, and a negative prognostic value of 100 %. Although an altered neuromonitoring signal can be taken as a clear indication of eventual nerve damage, an absolutely reliable statement about the postoperative vocal cord function is presently not possible with intraoperative neuromonitoring. PMID:12058296

Timmermann, W; Dralle, H; Hamelmann, W; Thomusch, O; Sekulla, C; Meyer, Th; Timm, S; Thiede, A

2002-05-01

166

Detecting Unilateral Phrenic Paralysis by Acoustic Respiratory Analysis  

PubMed Central

The consequences of phrenic nerve paralysis vary from a considerable reduction in respiratory function to an apparently normal state. Acoustic analysis of lung sound intensity (LSI) could be an indirect non-invasive measurement of respiratory muscle function, comparing activity on the two sides of the thoracic cage. Lung sounds and airflow were recorded in ten males with unilateral phrenic paralysis and ten healthy subjects (5 men/5 women), during progressive increasing airflow maneuvers. Subjects were in sitting position and two acoustic sensors were placed on their back, on the left and right sides. LSI was determined from 1.2 to 2.4 L/s between 70 and 2000 Hz. LSI was significantly greater on the normal (19.3±4.0 dB) than the affected (5.7±3.5 dB) side in all patients (p?=?0.0002), differences ranging from 9.9 to 21.3 dB (13.5±3.5 dB). In the healthy subjects, the LSI was similar on both left (15.1±6.3 dB) and right (17.4±5.7 dB) sides (p?=?0.2730), differences ranging from 0.4 to 4.6 dB (2.3±1.6 dB). There was a positive linear relationship between the LSI and the airflow, with clear differences between the slope of patients (about 5 dB/L/s) and healthy subjects (about 10 dB/L/s). Furthermore, the LSI from the affected side of patients was close to the background noise level, at low airflows. As the airflow increases, the LSI from the affected side did also increase, but never reached the levels seen in healthy subjects. Moreover, the difference in LSI between healthy and paralyzed sides was higher in patients with lower FEV1 (%). The acoustic analysis of LSI is a relevant non-invasive technique to assess respiratory function. This method could reinforce the reliability of the diagnosis of unilateral phrenic paralysis, as well as the monitoring of these patients. PMID:24718599

Fiz, Jose Antonio; Jane, Raimon; Lozano, Manuel; Gomez, Rosa; Ruiz, Juan

2014-01-01

167

Detecting unilateral phrenic paralysis by acoustic respiratory analysis.  

PubMed

The consequences of phrenic nerve paralysis vary from a considerable reduction in respiratory function to an apparently normal state. Acoustic analysis of lung sound intensity (LSI) could be an indirect non-invasive measurement of respiratory muscle function, comparing activity on the two sides of the thoracic cage. Lung sounds and airflow were recorded in ten males with unilateral phrenic paralysis and ten healthy subjects (5 men/5 women), during progressive increasing airflow maneuvers. Subjects were in sitting position and two acoustic sensors were placed on their back, on the left and right sides. LSI was determined from 1.2 to 2.4 L/s between 70 and 2000 Hz. LSI was significantly greater on the normal (19.3±4.0 dB) than the affected (5.7±3.5 dB) side in all patients (p?=?0.0002), differences ranging from 9.9 to 21.3 dB (13.5±3.5 dB). In the healthy subjects, the LSI was similar on both left (15.1±6.3 dB) and right (17.4±5.7 dB) sides (p?=?0.2730), differences ranging from 0.4 to 4.6 dB (2.3±1.6 dB). There was a positive linear relationship between the LSI and the airflow, with clear differences between the slope of patients (about 5 dB/L/s) and healthy subjects (about 10 dB/L/s). Furthermore, the LSI from the affected side of patients was close to the background noise level, at low airflows. As the airflow increases, the LSI from the affected side did also increase, but never reached the levels seen in healthy subjects. Moreover, the difference in LSI between healthy and paralyzed sides was higher in patients with lower FEV1 (%). The acoustic analysis of LSI is a relevant non-invasive technique to assess respiratory function. This method could reinforce the reliability of the diagnosis of unilateral phrenic paralysis, as well as the monitoring of these patients. PMID:24718599

Fiz, José Antonio; Jané, Raimon; Lozano, Manuel; Gómez, Rosa; Ruiz, Juan

2014-01-01

168

ABSTRACT: Neuromuscular electrical stimulation can improve motor function in those affected by paralysis, but its use is limited by a high rate of  

E-print Network

by paralysis, but its use is limited by a high rate of muscular fatigue. Variable stimulation patterns have paralyzed by stroke. Significant changes occur in the neuromuscular system with age that may affect to the median nerves of 10 individuals with hemiplegia from stroke and 10 age-matched able-bodied adults: (1

Griffin, Lisa

169

Skull base osteomyelitis presenting with an isolated hypoglossal nerve palsy.  

PubMed

This is the first case of skull base osteomyelitis presenting with isolated bilateral hypoglossal nerve palsy reported in the literature. A 75-year-old man presented with tongue paralysis without any other cranial nerve palsy. He was otherwise well apart from recently having a high prostate-specific antigen level recorded. Investigations for malignancy or cerebrovascular insult were negative with the diagnosis of skull base osteomyelitis confirmed using CT. Following treatment with intravenous antibiotics for 6 weeks, symptoms resolved. PMID:23853016

Kasfiki, Eirini Vasileiou; Kelly, Ciaran; Smith, John; Nicolaides, Andreas

2013-01-01

170

Clinical implications of phrenic nerve injury after pediatric cardiac surgery  

Microsoft Academic Search

Phrenic nerve injury with resulting diaphragm paralysis occurred in 25 (1.5%) of 1,656 cardiac surgical procedures in children during a 10-year period. Phrenic nerve injury was most commonly noted in patients who had undergone previous cardiac surgery (16 of 165, 10%; P < .0001), typically after a previous Blalock-Taussig shunt (10 of 53, 19%; P = .007). Plication of the

Martin Tönz; Ludwig K von Segesser; Tomislav Mihaljevic; Urs Arbenz; Urs G Stauffer; Marko I Turina

1996-01-01

171

[Sipple syndrome as a differential diagnosis in recurrent laryngeal nerve].  

PubMed

Two cases of Sipple's syndrome with the typical signs of medullary carcinoma of the thyroid, pheochromecytoma and parathyroid adenoma are presented. Cushing's disease and marfanoid habitus were demonstrated. They are classified as multiple endocrine adenopathy type 2A and 2B according to the modern nomenclature. PMID:6142870

Schadel, A; Erwig, H; Wiesmann, W; Walger, P

1984-01-01

172

Laryngeal electroglottography as a predictor of laryngeal electromyography.  

PubMed

We evaluate a group of patients who have mobile vocal folds, but have flexible laryngeal examinations suspicious for mild vocal fold paresis. The purpose of this retrospective study is to evaluate if electroglottography (EGG) can predict the probability of having an abnormal laryngeal electromyography (LEMG). Charts of patients evaluated and suspected of having mild vocal fold paresis between August 1, 2004 and March 30, 2006 were reviewed. We compared average EGG contact quotients (CQs), average absolute difference of recorded CQ from normal (|CQ-50%|), and EGG waveforms between patients with normal and abnormal LEMG. Waveforms were evaluated in blinded fashion. Statistical analysis was performed using chi square and t test analyses. One hundred and sixteen patients received both flexible laryngoscopy and LEMG as part of their evaluation. Forty-eight patients (41%) had confirmed paresis by LEMG and 68 patients (59%) had normal LEMGs. Only 9.1% of patients with a normal EGG waveform had an abnormal LEMG. In contrast, 40.4% of patients with an abnormal EGG waveform had abnormal LEMGs. The negative predictive value of a normal EGG waveform for an abnormal LEMG was 90.9%. No significant differences were identified between patients with normal versus abnormal LEMG in terms of average CQ (47.8% vs 46.4%) or |CQ-50%| (6.2 vs 5.6). Patients with a normal EGG waveform are unlikely to have an abnormal LEMG. PMID:18031990

Mayes, Russell W; Jackson-Menaldi, Cristina; Dejonckere, Philippe H; Moyer, Cheryl A; Rubin, Adam D

2008-11-01

173

Laryngeal apnea in rat pups: effects of age and body temperature.  

PubMed

In neonatal mammals of many species, including human infants, apnea and other reflex responses frequently arise from stimulation of laryngeal receptors by ingested or regurgitated liquids. These reflexes, mediated by afferents in the superior laryngeal nerves (SLNs), are collectively known as the laryngeal chemoreflex (LCR) and are suspected to be responsible for some cases of the sudden infant death syndrome (SIDS). The LCR is strongly enhanced by mild increases in body temperature in decerebrate piglets, a finding that is of interest because SIDS victims are often found in overheated environments. Because of the experimental advantages of studying reflex development and mechanisms in neonatal rodents, we have developed methods for eliciting laryngeal apnea in anesthetized rat pups and have examined the influence of mild hyperthermia in animals ranging in age from 3 to 21 days. We found that apnea and respiratory disruption, elicited either by intralaryngeal water or by electrical stimulation of the SLN, occurred at all ages studied. Raising body temperature by 2-3 degrees C prolonged the respiratory disturbance in response to either stimulus. This effect of hyperthermia was prominent in the youngest animals and diminished with age. We conclude that many studies of the LCR restricted to larger neonatal animals in the past can be performed in infant rodents using appropriate methods. Moreover, the developmental changes in the LCR and in the thermal modulation of the LCR seem to follow different temporal profiles, implying that distinct neurophysiological processes may mediate the LCR and thermal prolongation of the LCR. PMID:17962578

Xia, Luxi; Leiter, James C; Bartlett, Donald

2008-01-01

174

Unilateral paralysis associated with profound hypokalemia.  

PubMed

Unilateral paralysis is rarely reported to be primary presentation of severe hypokalemia. We describe a 24-year-old woman who presented to the emergency department with sudden onset of right-sided weakness. Neurologic examination revealed diminished muscle strength and tendon reflexes over the right limbs. Computed tomography of the brain showed no organic brain lesion. However, laboratory data showed hypokalemia (K+ 2.0 mmol/L) with metabolic acidosis (HCO3 ? 19 mmol/L). She needed a total of 260 mmol K+ to achieve complete recovery of muscle strength at a serum K+ level of 3.2 mmol/L and was proved to have distal renal tubular acidosis. Severe hypokalemia must be kept in mind as a cause of acute unilateral paralysis without organic lesions to avoid unnecessary examination and potentially life-threatening complications. PMID:22463964

Chiang, Wen-Fang; Yeh, Fu-Chiang; Lin, Shih-Hua

2012-11-01

175

Sleep paralysis: a study in family practice  

PubMed Central

Over a period of two years, five patients with sleep paralysis referred themselves to four family practices in Israel serving a population of 6800. None of the patients suffered from daytime sleep attacks or cataplexy and all were from the oriental (sephardi) community. The two who were tissue typed had HLA haplotypes different from those which are exclusively associated with narcolepsy and one of them who also underwent polysomnography had a normal tracing. There was considerable delay in consulting a physician despite the physical and mental anguish caused by the disorder and some improvement was noted once the diagnosis was explained. The serious nature of the components of the differential diagnosis - myocardial infarction, seizure disorder, cardiac arrest, anaesthetic accident - makes it important that sleep paralysis be more widely recognized. PMID:3256672

Herman, J.; Furman, Z.; Cantrell, G.; Peled, R.

1988-01-01

176

Nerve and Nerve Root Biomechanics  

Microsoft Academic Search

\\u000a Together, the relationship between the mechanical response of neural tissues and the related mechanisms of injury provide\\u000a a foundation for defining relevant thresholds for injury. The nerves and nerve roots are biologic structures with specific\\u000a and important functions, and whose response to mechanical loading can have immediate, long-lasting and widespread consequences.\\u000a In particular, when nerves or nerve roots are mechanically

Kristen J. Nicholson; Beth A. Winkelstein

177

Nerve conduits for nerve reconstruction  

Microsoft Academic Search

Although autogenous nerve grafting remains the gold standard for repair of peripheral nerve defects, the use of various conduits can be a substitute provided these conduits meet the above-mentioned prerequisites. For the moment, autogenous vein grafts or denatured muscle grafts can be used to bridge short defects, especially in distal sensory nerves. Incorporation of muscle into a vein graft expands

Huan Wang; William C. Lineaweaver

2002-01-01

178

Facial Pain Followed by Unilateral Facial Nerve Palsy: A Case Report with Literature Review  

PubMed Central

Peripheral facial nerve palsy is the commonest cranial nerve motor neuropathy. The causes range from cerebrovascular accident to iatrogenic damage, but there are few reports of facial nerve paralysis attributable to odontogenic infections. In majority of the cases, recovery of facial muscle function begins within first three weeks after onset. This article reports a unique case of 32-year-old male patient who developed facial pain followed by unilateral facial nerve paralysis due to odontogenic infection. The treatment included extraction of the associated tooth followed by endodontic treatment of the neighboring tooth which resulted in recovery of facial nerve plasy. A thorough medical history and physical examination are the first steps in making any diagnosis. It is essential to rule out other causes of facial paralysis before making the definitive diagnosis, which implies the intervention. The authors hereby, report a case of 32-year-old male patient who developed unilateral facial nerve paralysis due to odontogenic infection with a good prognosis after appropriate treatment. PMID:25302280

GV, Sowmya; Goel, Saurabh; Singh, Mohit Pal; Astekar, Madhusudan

2014-01-01

179

Lifetime Prevalence Rates of Sleep Paralysis: A Systematic Review  

PubMed Central

Objective To determine lifetime prevalence rates of sleep paralysis. Data Sources Keyword term searches using “sleep paralysis”, “isolated sleep paralysis”, or “parasomnia not otherwise specified” were conducted using MEDLINE (1950-present) and PsychINFO (1872-present). English and Spanish language abstracts were reviewed, as were reference lists of identified articles. Study Selection Thirty five studies that reported lifetime sleep paralysis rates and described both the assessment procedures and sample utilized were selected. Data Extraction Weighted percentages were calculated for each study and, when possible, for each reported subsample. Data Synthesis Aggregating across studies (total N = 36533), 7.6% of the general population, 28.3% of students, and 31.9% of psychiatric patients experienced at least one episode of sleep paralysis. Of the psychiatric patients with panic disorder, 34.6% reported lifetime sleep paralysis. Results also suggested that minorities experience lifetime sleep paralysis at higher rates than Caucasians. Conclusions Sleep paralysis is relatively common in the general population and more frequent in students and psychiatric patients. Given these prevalence rates, sleep paralysis should be assessed more regularly and uniformly in order to determine its impact on individual functioning and better articulate its relation to psychiatric and other medical conditions. PMID:21571556

Barber, Jacques P.

2011-01-01

180

Tick paralysis in Australia caused by Ixodes holocyclus Neumann  

PubMed Central

Ticks are obligate haematophagous ectoparasites of various animals, including humans, and are abundant in temperate and tropical zones around the world. They are the most important vectors for the pathogens causing disease in livestock and second only to mosquitoes as vectors of pathogens causing human disease. Ticks are formidable arachnids, capable of not only transmitting the pathogens involved in some infectious diseases but also of inducing allergies and causing toxicoses and paralysis, with possible fatal outcomes for the host. This review focuses on tick paralysis, the role of the Australian paralysis tick Ixodes holocyclus, and the role of toxin molecules from this species in causing paralysis in the host. PMID:21396246

Hall-Mendelin, S; Craig, S B; Hall, R A; O'Donoghue, P; Atwell, R B; Tulsiani, S M; Graham, G C

2011-01-01

181

Monolimb Paralysis after Laparoscopic Appendectomy Due to Conversion Disorder  

PubMed Central

Limb paralysis can develop for various reasons. We found a 13-year-old patient who became paralyzed in her lower extremities after laparoscopic appendectomy. Some tests, including electrodiagnostic studies and magnetic resonance imaging, were performed to evaluate the cause of lower limb paralysis. None of the tests yielded definite abnormal findings. We subsequently decided to explore the possibility of psychological problems. The patient was treated with simultaneous rehabilitation and psychological counseling. Paralysis of the patient's lower extremity improved gradually and the patient returned to normal life. Our findings indicate that psychological problems can be related to limb paralysis without organ damage in patients who have undergone laparoscopic surgical procedures.

Song, Sung Hyuk; Lee, Kyeong Hwan

2014-01-01

182

Pulse oximetry with the laryngeal mask airway  

Microsoft Academic Search

This study evaluated the accuracy of pulse oximetry measured by a modified laryngeal mask airway (LMA). Ten anaesthetized patients (ASA I–II, aged 18–45) undergoing elective knee arthroscopies (mean-duration 40 min) were studied. A transmission pulse oximeter probe\\/sound OHMEDA® was attached on the back of LMA (sizes 4 and 5) in an area in contact with the floor of the laryngeal

F Agrò; M Carassiti; R Cataldo; S Gherardi; G Barzoi

1999-01-01

183

Laryngitis  

MedlinePLUS

... BH, Lund VJ et al. eds. Cummings Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, PA: Elsevier Mosby; 2010; ... et al. Clinical practice guideline: hoarseness (dysphonia). Otolaryngol Head Neck Surg . 2009;141(3 Suppl 2):S1-S31.

184

Barium-induced skeletal muscle paralysis in the rat, and its relationship to human familial periodic paralysis  

PubMed Central

An in vivo study of skeletal muscle paralysis induced by intravenous barium chloride has been made in curarized and non-curarized rats. The influence of potassium and calcium chlorides, propranolol, ouabain, and prior adrenalectomy on the paralysis has also been studied. Paralysis is found to be due to a direct effect on skeletal muscle, and to correlate well with the development of hypokalaemia. Possible mechanisms of action of barium are discussed, and attention is drawn to the similarity between barium poisoning and hypokalaemic familial periodic paralysis. PMID:4813426

Schott, G. D.; McArdle, B.

1974-01-01

185

What's New in Laryngeal and Hypopharyngeal Cancer Research and Treatment?  

MedlinePLUS

... Additional resources for laryngeal and hypopharyngeal cancers What’s new in laryngeal and hypopharyngeal cancers research and treatment? ... to better tests for early detection and to new targeted treatments. Chemoprevention Chemoprevention is the use of ...

186

The perceptual basis of long-distance laryngeal restrictions  

E-print Network

The two main arguments in this dissertation are 1. That laryngeal co-occurrence restrictions are restrictions on the perceptual strength of contrasts between roots, as opposed to restrictions on laryngeal configurations ...

Gallagher, Gillian Elizabeth Scott

2010-01-01

187

Phonology Project Part II: Laryngeal Neutralization and Syllable Structure  

E-print Network

.3 Laryngeal Processes in Icelandic and Sanskrit . . . . . . . . . . . . . . . . . . . . 3 1.3.1 Icelandic Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.3.2 Sanskrit Overview.3 Sanskrit: Repair Strategies for the Laryngeal Constraint . . . . . . . . . . . . . . 9 2.3.1 Interaction

Ananian, C. Scott

188

Deglutitive laryngeal closure in stroke patients  

PubMed Central

Background Dysphagia has been reported in up to 70% of patients with stroke, predisposing them to aspiration and pneumonia. Despite this, the mechanism for aspiration remains unclear. Aims To determine the relationship between bolus flow and laryngeal closure during swallowing in patients with stroke and to examine the sensorimotor mechanisms leading to aspiration. Methods Measures of swallowing and bolus flow were taken from digital videofluoroscopic images in 90 patients with stroke and 50 healthy adults, after repeated volitional swallows of controlled volumes of thin liquid. Aspiration was assessed using a validated Penetration–Aspiration Scale. Oral sensation was also measured by electrical stimulation at the faucial pillars. Results After stroke, laryngeal ascent was delayed (mean (standard deviation (SD)) 0.31 (0.06)?s, p<0.001), resulting in prolongation of pharyngeal transit time (1.17 (0.07)?s, p<0.001) without a concomitant increase in laryngeal closure duration (0.84 (0.04)?s, p?=?0.9). The delay in laryngeal elevation correlated with both the severity of aspiration (r?=?0.5, p<0.001) and oral sensation (r?=?0.5, p<0.001). Conclusions After stroke, duration of laryngeal delay and degree of sensory deficit are associated with the severity of aspiration. These findings indicate a role for sensorimotor interactions in control of swallowing and have implications for the assessment and management of dysphagia after stroke. PMID:17012336

Power, M L; Hamdy, S; Singh, S; Tyrrell, P J; Turnbull, I; Thompson, D G

2007-01-01

189

Isolated Sleep Paralysis and Fearful Isolated Sleep Paralysis in Outpatients With Panic Attacks  

PubMed Central

Isolated sleep paralysis (ISP) has received scant attention in clinical populations, and there has been little empirical consideration of the role of fear in ISP episodes. To facilitate research and clinical work in this area, the authors developed a reliable semistructured interview (the Fearful Isolated Sleep Paralysis Interview) to assess ISP and their proposed fearful ISP (FISP) episode criteria in 133 patients presenting for panic disorder treatment. Of these, 29.3% met lifetime ISP episode criteria, 20.3% met the authors’ lifetime FISP episode criteria, and 12.8% met their recurrent FISP criteria. Both ISP and FISP were associated with minority status and comorbidity. However, only FISP was significantly associated with posttraumatic stress disorder, body mass, anxiety sensitivity, and mood and anxiety disorder symptomatology. PMID:20715166

Sharpless, Brian A.; McCarthy, Kevin S.; Chambless, Dianne L.; Milrod, Barbara L.; Khalsa, Shabad-Ratan; Barber, Jacques P.

2013-01-01

190

Vagus nerve stimulation for epilepsy activates the vocal folds maximally at therapeutic levels  

Microsoft Academic Search

Purpose\\u000aVagus nerve stimulation (VNS) for medically refractory epilepsy can give hoarseness due to stimulation of the recurrent laryngeal nerve. For a group of VNS-therapy users this side-effect interferes severely with their daily activities. Our goal was to investigate the severity of intra-operative VNS-related vocal fold contraction at different pulse widths and current output parameters. We investigated electromyographic and morphometric

J. J. Ardesch; J. R. Sikken; P. H. Veltink; H. E. van der Aa; G. Hageman; H. P. J. Buschman

2010-01-01

191

Paralysis recovery in humans and model systems  

NASA Technical Reports Server (NTRS)

Considerable evidence now demonstrates that extensive functional and anatomical reorganization following spinal cord injury occurs in centers of the brain that have some input into spinal motor pools. This is very encouraging, given the accumulating evidence that new connections formed across spinal lesions may not be initially functionally useful. The second area of advancement in the field of paralysis recovery is in the development of effective interventions to counter axonal growth inhibition. A third area of significant progress is the development of robotic devices to quantify the performance level of motor tasks following spinal cord injury and to 'teach' the spinal cord to step and stand. Advances are being made with robotic devices for mice, rats and humans.

Edgerton, V. Reggie; Roy, Roland R.

2002-01-01

192

Anterior interosseous nerve compression syndrome: Is there a role for endoscopy?  

Microsoft Academic Search

Background  Anterior interosseous nerve syndrome is characterized by paralysis of the flexor digitorum profundus, the flexor pollicis\\u000a longus and the pronator quadratus muscles without sensory loss. Extended exploration of the anterior interosseous nerve is\\u000a the surgical treatment of choice. The present study evaluates the feasibility of an endoscopic approach for nerve decompression.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Preparation of the anterior interosseous nerve was performed in

Doerthe Keiner; Manfred Tschabitscher; Stefan Welschehold; Joachim Oertel

193

Selective Activation of the Human Tibial and Common Peroneal Nerves with a Flat Interface Nerve Electrode  

PubMed Central

Problem Addressed Electrical stimulation has been shown effective in restoring basic lower extremity motor function in individuals with paralysis. We tested the hypothesis that a Flat Interface Nerve Electrode (FINE) placed around the human tibial or common peroneal nerve above the knee can selectively activate each of the most important muscles these nerves innervate for use in a neuroprosthesis to control ankle motion. Methodology During intraoperative trials involving three subjects, an 8-contact FINE was placed around the tibial and/or common peroneal nerve, proximal to the popliteal fossa. The FINE’s ability to selectively recruit muscles innervated by these nerves was assessed. Data were used to estimate the potential to restore active plantarflexion or dorsiflexion while balancing inversion and eversion using a biomechanical simulation. Results, Significance, and Potential Impact With minimal spillover to non-targets, at least three of the four targets in the tibial nerve, including two of the three muscles constituting the triceps surae were independently and selectively recruited in all subjects. As acceptable levels of spillover increased, recruitment of the target muscles increased. Selective activation of muscles innervated by the peroneal nerve was more challenging. Estimated joint moments suggests that plantarflexion sufficient for propulsion during stance phase of gait and dorsiflexion sufficient to prevent foot drop during swing can be achieved, accompanied by a small but tolerable inversion or eversion moment. PMID:23918148

Schiefer, M A; Freeberg, M; Pinault, G J C; Anderson, J; Hoyen, H; Tyler, D J; Triolo, R J

2013-01-01

194

Paralysis agitans and levodopa in "Ayurveda": ancient Indian medical treatise.  

PubMed

Neurologic diseases (Vata rogas, Sanskrit) and the pharmacologic treatment of them were described in the ancient Indian medical system--Ayurveda. This article explores paralysis agitans, which was described under the name Kampavata. Mucuna pruriens (Atmagupta, Sanskrit), which contains levodopa, was used in the treatment of Kampavata. Existence of paralysis agitans prior to the industrial revolution is not just of historical interest, but would also suggest that under the hypothesis of exposure to environmental toxins as a possible cause of paralysis agitans, natural organic compounds with worldwide distribution should also be considered. PMID:2404203

Manyam, B V

1990-01-01

195

A clinical comparison of the Laryngeal Tube™ and the Laryngeal Mask™ in spontaneously breathing anesthetized patients  

Microsoft Academic Search

Abstract: Background: The laryngeal mask airway (LMA) can be used in general anaesthesia without neuromuscular block. The\\u000a laryngeal tube (LT) is a new airway device with similar airway features as LMA. LT is provided with a distal cuff to prevent\\u000a regurgitation. In this study we compared the LMA and LT concerning patient and user aspects.\\u000a \\u000a Methods: Sixty patients with ASA

Johanna Albert; Leif Kindlund; Barbro Nilvér; Waldemar Go?dzik

2006-01-01

196

Scorpion toxins for the reversal of BoNT-induced paralysis.  

PubMed

The botulinum neurotoxins, characterized by their neuromuscular paralytic effects, are the most toxic proteins known to man. Due to their extreme potency, ease of production, and duration of activity, the BoNT proteins have been classified by the Centers for Disease Control as high threat agents for bioterrorism. In an attempt to discover effective BoNT therapeutics, we have pursued a strategy in which we leverage the blockade of K(+) channels that ultimately results in the reversal of neuromuscular paralysis. Towards this end, we utilized peptides derived from scorpion venom that are highly potent K(+) channel blockers. Herein, we report the synthesis of charybdotoxin, a 37 amino acid peptide, and detail its activity, along with iberiotoxin and margatoxin, in a mouse phrenic nerve hemidiaphragm assay in the absence and the presence of BoNT/A. PMID:24252544

Lowery, Colin A; Adler, Michael; Borrell, Andrew; Janda, Kim D

2013-12-15

197

Vocal fold medialization with tragal cartilage and perichondrium in high vagal paralysis.  

PubMed

The goal of this pilot study was to test vocal fold medialization using autologous tragal cartilage and perichondrium by direct approach for treating high vagal paralysis. Five patients with the skull base tumors with involvement of the vagus nerve underwent concurrent vocal fold medialization with surgical excision. The patients were evaluated preoperatively, and at 14, 60 days, and 6 months later. Complete medialization with horizontal and vertical realignment was achieved. Improvement of voice and breathiness was correlated with the increase of closed quotient; the contact area of the vocal fold mucosa has increased. This advancement reduces breathiness and induced an improvement in subglottic pressure with aerodynamic parameters improvement, which led to stabilization of the vocal fold oscillation and a better voice quality recovery. This method can be considered a safe, quick, and efficient phonosurgical procedure combined with a skull-base surgical procedure. PMID:23494284

Chiril?, Magdalena; Mure?an, Rodica

2013-05-01

198

Applications of Robotics for Laryngeal Surgery  

E-print Network

Applications of Robotics for Laryngeal Surgery Alexander T. Hillel, MDa , Ankur Kapoor, Ph and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline Street, 6th Floor, JHOC 6163. Open surgery of the larynx allows for increased expo- sure of the surgical field and dexterity

Simaan, Nabil

199

Laryngeal descent is not uniquely mammalian  

Microsoft Academic Search

The hyo-laryngeal complex moves caudally during speech in humans (1) as well as during non-verbal vocalization in non- human mammals (2). Little is known about this structure or its role in avian vocalization. Using anatomical data from dissected birds, Homberger (3, 4, 5) predicted the movements of the hyoid skeleton. White (6) showed cineradiographically that the larynx of the rooster

Tobias Riede; Rod Suthers

200

Ventricular pressures in phonating excised larynges  

PubMed Central

Pressure in the laryngeal ventricle was measured with a beveled needle connected to a pressure transducer in excised canine larynges. Air pressures within the ventricle were obtained for different adduction levels of the true vocal folds (TVFs), false vocal folds (FVFs), and subglottal pressures (Ps). Results indicated that the air pressures in the ventricle appear to be strongly related to the motion of the FVFs rather than to the effects of TVF vibration. Both dc and ac pressures depend on FVF adduction, amplitude of motion of the FVFs, and whether the FVFs touch each other during the vibratory cycle. Mean and peak-to-peak pressures in the ventricle were as high as 65% of the mean and peak-to-peak Ps, respectively, when the FVFs vibrated with large amplitude and contact each cycle. If the glottis was not closed, a medial movement of the FVFs appeared to create a positive pressure pulse on the Ps signal due to an increase in the laryngeal flow resistance. The electroglottograph signal showed evidence of tissue contact for both the TVFs and the FVFs. The study suggests that the laryngeal ventricle acts as a relatively independent aero-acoustic chamber that depends primarily upon the motion of the FVFs. PMID:22894222

Alipour, Fariborz; Scherer, Ronald C.

2012-01-01

201

The Laryngeal Mask Airway at Altitude  

Microsoft Academic Search

The Laryngeal Mask Airway (LMA) is an accepted adjunct for airway management in emergency patients. There are a number of case reports describing its use in transport medicine for infant to adult patients, including during flight. Although studies of the effect altitude has on air-filled tracheal tubes exists, we were unable to find documentation of the effect of altitude on

Grant D. Wilson; Steven E. Sittig; Gregory J. Schears

2008-01-01

202

The laryngeal mask airway at altitude.  

PubMed

The Laryngeal Mask Airway (LMA) is an accepted adjunct for airway management in emergency patients. There are a number of case reports describing its use in transport medicine for infant to adult patients, including during flight. Although studies of the effect altitude has on air-filled tracheal tubes exists, we were unable to find documentation of the effect of altitude on laryngeal mask airways. Our objective was to assess the effect of altitude on the LMA in both fixed wing and rotary wing models. We performed an in vitro study of the effect of altitude on the LMA cuff. Infant and adult airway trainer mannequins with properly sized and inserted LMA-Classic laryngeal mask airways were monitored for cuff pressure changes while flown at altitudes commonly encountered during air medical transport. Both models demonstrated that LMA cuff pressures may exceed manufacturer recommended levels for safe use even at the relatively low altitudes experienced during rotor wing flight. Properly inserted and inflated laryngeal mask airways at ground level may result in overinflated LMA cuffs when flown to altitudes commonly used for rotor and fixed wing medical transport unless monitored and corrected. PMID:18024060

Wilson, Grant D; Sittig, Steven E; Schears, Gregory J

2008-02-01

203

Management of locally advanced laryngeal cancer  

PubMed Central

Background Management of advanced laryngeal cancer is complex and ideal strategy is yet to be defined. This study evaluates the experience of a single head and neck oncologic centre in the management of T4 laryngeal cancer. Methods Retrospective assessment of cases primarily treated for T4a squamous cell carcinoma of the larynx, between 1980 and 2007, at a tertiary referral center. Results A total of 384 cases were studied. Five-year disease specific survival was 56.2% and local control 87.4%. Regional and distal control estimates were 90.3% and 88.3% respectively. Prognosis was significantly superior for cases treated with primary surgery compared to cases solely managed with non-surgical modalities. Positive surgical margins and regional disease worsened prognosis. Conclusion This study suggests that primary surgery remains a key element in the treatment of advanced laryngeal cancer. The need for well-designed, prospective, randomised studies in order to further evaluate the remaining role of primary surgery in the modern management of locally advanced laryngeal lesions is emphasized. PMID:24472173

2014-01-01

204

Epidemiological evidence indicates asbestos causes laryngeal cancer  

SciTech Connect

A variety of opinions have been expressed in the literature concerning asbestos and laryngeal cancer. This paper presents an analysis of epidemiological studies based on criteria that prioritized the most heavily exposed cohorts. Emphasis was given to the six cohorts or subcohorts with lung cancer relative risk estimates of 2 or more. The two groups of workers with the highest lung cancer relative risk estimates (4.06 and 3.28) both gave strong support for a causal association of asbestos and laryngeal cancer, with relative risk estimates of 1.91 (90% confidence limits 1.00 to 3.34) and 3.75 (90% confidence limits 1.01 to 9.68), respectively. Confounding with cigarette smoking or alcohol consumption does not explain the findings. Case-control studies gave mixed results, but generally supported the hypothesis. It was concluded that asbestos is a probable cause of laryngeal cancer in view of the reasonable consistency of the studies, the strength of the association in key studies, the evidence for dose-response relationships, and the biological plausibility for asbestos being a cause of laryngeal cancer. 48 references.

Smith, A.H.; Handley, M.A.; Wood, R. (Univ. of California, Berkeley (USA))

1990-06-01

205

Current role of stroboscopy in laryngeal imaging  

PubMed Central

Purpose of review This paper summarizes recent technological advancements and insight into the role of stroboscopy in laryngeal imaging. Recent findings Videostroboscopic technology Although stroboscopy has not undergone major technological improvements, recent clarifications have been made to the application of stroboscopic principles to video-based laryngeal imaging. Also recent advances in coupling stroboscopy with high-definition video cameras provide higher spatial resolution of phonatory function. Visual stroboscopic assessment Studies indicate that interrater reliability of visual stroboscopic assessment varies depending on the laryngeal feature being rated and that only a subset of features may be needed to represent an entire assessment. High-speed videoendoscopy (HSV) judgments have been shown to be more sensitive than stroboscopy for evaluating vocal fold phase asymmetry, pointing to the potential of complementing stroboscopy with alternative imaging modalities in hybrid systems. Clinical role Stroboscopic imaging continues to play a central role in voice clinics. Although HSV may provide more detailed information about phonatory function, its eventual clinical adoption depends on how remaining practical, technical, and methodological challenges will be met. Summary Laryngeal videostroboscopy continues to be the modality of choice for imaging vocal fold vibration, but technological advancements and HSV research findings are driving increased interest in the clinical adoption of HSV to complement videostroboscopic assessment. PMID:22931908

Mehta, Daryush D.; Hillman, Robert E.

2013-01-01

206

Use of Lasers in Laryngeal Surgery  

PubMed Central

Lasers are a relatively recent addition to laryngeal surgery. Since their invention, laser use and applications have expanded rapidly. In this paper, we discuss the benefits and disadvantages of lasers for different procedures, as well as ways to overcome commonly faced clinical problems. The use of lasers in surgery has offered a time- and cost-efficient alternative to cold surgical techniques, and has been employed in the treatment of numerous laryngeal pathologies, including stenoses, recurrent respiratory papillomatosis, leukoplakia, nodules, malignant laryngeal disease, and polypoid degeneration (Reinke’s edema). However, lasers can incur adjacent tissue damage and vocal fold scarring. These problems can be minimized through understanding the mechanisms by which lasers function and correctly manipulating the parameters under a surgeon’s control. By varying fluence, power density, and pulsation, tissue damage can be decreased and lasers can be used with greater confidence. The various types of lasers and their applications to the treatment of specific pathologies are reviewed with the intention of helping surgeons select the best tool for a given procedure. Recent applications of lasers to treat benign laryngeal lesions and severe laryngomalacia demonstrate that additional research must be conducted in order to realize the full potential of this surgical tool. PMID:19487102

Yan, Yan; Olszewski, Aleksandra E.; Hoffman, Matthew R.; Zhuang, Peiyun; Ford, Charles N.; Dailey, Seth H.; Jiang, Jack J.

2012-01-01

207

Atraumatic laser treatment for laryngeal papillomatosis  

NASA Astrophysics Data System (ADS)

Ten to fifteen thousand new cases of recurrent respiratory papillomatosis (RRP) are diagnosed each year in the United States. RRP is caused by the human papillomavirus (HPV) and is characterized by recurrent, non-malignant, proliferative lesions of the larynx. Patients with RRP undergo numerous microsurgical procedures to remove laryngeal papilloma threatening airway patency and interfering with phonation. The standard surgical technique involves CO2 laser vaporization of laryngeal epithelium affected by the lesions, and requires general anesthesia. The pulsed dye laser operating at 585 nm has previously been demonstrated to be effective in clearing HPV lesions of the skin (verrucae). For treatment of RRP, the fiber- compatible pulsed dye laser radiation may be delivered under local anesthesia using a flexible intranasal laryngoscope. Potential advantages of the pulsed dye laser treatment over CO2 laser surgery include (1) reduced morbidity, especially a lower risk of laryngeal scarring; (2) lower cost; (3) reduced technical difficulty; and (4) reduced risk of viral dissemination or transmission. In vivo studies are underway to determine the effect of pulsed dye laser radiation on normal canine laryngeal tissue.

McMillan, Kathleen; Pankratov, Michail M.; Wang, Zhi; Bottrill, Ian; Rebeiz, Elie E.; Shapshay, Stanley M.

1994-09-01

208

An fMRI investigation of racial paralysis  

PubMed Central

We explore the existence and underlying neural mechanism of a new norm endorsed by both black and white Americans for managing interracial interactions: “racial paralysis’, the tendency to opt out of decisions involving members of different races. We show that people are more willing to make choices—such as who is more intelligent, or who is more polite—between two white individuals (same-race decisions) than between a white and a black individual (cross-race decisions), a tendency which was evident more when judgments involved traits related to black stereotypes. We use functional magnetic resonance imaging to examine the mechanisms underlying racial paralysis, to examine the mechanisms underlying racial paralysis, revealing greater recruitment of brain regions implicated in socially appropriate behavior (ventromedial prefrontal cortex), conflict detection (anterior cingulate cortex), deliberative processing (dorsolateral prefrontal cortex), and inhibition (ventrolateral prefrontal cortex). We also discuss the impact of racial paralysis on the quality of interracial relations. PMID:22267521

Mason, Malia F.; Vandello, Joseph A.; Biga, Andrew; Dyer, Rebecca

2013-01-01

209

Preoperative Identification of Facial Nerve in Vestibular Schwannomas Surgery Using Diffusion Tensor Tractography  

PubMed Central

Objective Facial nerve palsy is a common complication of treatment for vestibular schwannoma (VS), so preserving facial nerve function is important. The preoperative visualization of the course of facial nerve in relation to VS could help prevent injury to the nerve during the surgery. In this study, we evaluate the accuracy of diffusion tensor tractography (DTT) for preoperative identification of facial nerve. Methods We prospectively collected data from 11 patients with VS, who underwent preoperative DTT for facial nerve. Imaging results were correlated with intraoperative findings. Postoperative DTT was performed at postoperative 3 month. Facial nerve function was clinically evaluated according to the House-Brackmann (HB) facial nerve grading system. Results Facial nerve courses on preoperative tractography were entirely correlated with intraoperative findings in all patients. Facial nerve was located on the anterior of the tumor surface in 5 cases, on anteroinferior in 3 cases, on anterosuperior in 2 cases, and on posteroinferior in 1 case. In postoperative facial nerve tractography, preservation of facial nerve was confirmed in all patients. No patient had severe facial paralysis at postoperative one year. Conclusion This study shows that DTT for preoperative identification of facial nerve in VS surgery could be a very accurate and useful radiological method and could help to improve facial nerve preservation. PMID:25289119

Choi, Kyung-Sik; Kim, Min-Su; Kwon, Hyeok-Gyu; Jang, Sung-Ho

2014-01-01

210

Sleep paralysis, sexual abuse, and space alien abduction.  

PubMed

Sleep paralysis accompanied by hypnopompic ('upon awakening') hallucinations is an often-frightening manifestation of discordance between the cognitive/perceptual and motor aspects of rapid eye movement (REM) sleep. Awakening sleepers become aware of an inability to move, and sometimes experience intrusion of dream mentation into waking consciousness (e.g. seeing intruders in the bedroom). In this article, we summarize two studies. In the first study, we assessed 10 individuals who reported abduction by space aliens and whose claims were linked to apparent episodes of sleep paralysis during which hypnopompic hallucinations were interpreted as alien beings. In the second study, adults reporting repressed, recovered, or continuous memories of childhood sexual abuse more often reported sleep paralysis than did a control group. Among the 31 reporting sleep paralysis, only one person linked it to abuse memories. This person was among the six recovered memory participants who reported sleep paralysis (i.e. 17% rate of interpreting it as abuse-related). People rely on personally plausible cultural narratives to interpret these otherwise baffling sleep paralysis episodes. PMID:15881271

McNally, Richard J; Clancy, Susan A

2005-03-01

211

Experimental autoimmune encephalomyelitis repressed by microglial paralysis.  

PubMed

Although microglial activation occurs in inflammatory, degenerative and neoplastic central nervous system (CNS) disorders, its role in pathogenesis is unclear. We studied this question by generating CD11b-HSVTK transgenic mice, which express herpes simplex thymidine kinase in macrophages and microglia. Ganciclovir treatment of organotypic brain slice cultures derived from CD11b-HSVTK mice abolished microglial release of nitrite, proinflammatory cytokines and chemokines. Systemic ganciclovir administration to CD11b-HSVTK mice elicited hematopoietic toxicity, which was prevented by transfer of wild-type bone marrow. In bone marrow chimeras, ganciclovir blocked microglial activation in the facial nucleus upon axotomy and repressed the development of experimental autoimmune encephalomyelitis. We conclude that microglial paralysis inhibits the development and maintenance of inflammatory CNS lesions. The microglial compartment thus provides a potential therapeutic target in inflammatory CNS disorders. These results validate CD11b-HSVTK mice as a tool to study the impact of microglial activation on CNS diseases in vivo. PMID:15665833

Heppner, Frank L; Greter, Melanie; Marino, Denis; Falsig, Jeppe; Raivich, Gennadij; Hövelmeyer, Nadine; Waisman, Ari; Rülicke, Thomas; Prinz, Marco; Priller, Josef; Becher, Burkhard; Aguzzi, Adriano

2005-02-01

212

Direct brain control and communication in paralysis.  

PubMed

Despite considerable growth in the field of brain-computer or brain-machine interface (BCI/BMI) research reflected in several hundred publications each year, little progress was made to enable patients in complete locked-in state (CLIS) to reliably communicate using their brain activity. Independent of the invasiveness of the BCI systems tested, no sustained direct brain control and communication was demonstrated in a patient in CLIS so far. This suggested a more fundamental theoretical problem of learning and attention in brain communication with BCI/BMI, formulated in the extinction-of-thought hypothesis. While operant conditioning and goal-directed thinking seems impaired in complete paralysis, classical conditioning of brain responses might represent the only alternative. First experimental studies in CLIS using semantic conditioning support this assumption. Evidence that quality-of-life in locked-in-state is not as limited and poor as generally believed draise doubts that "patient wills" or "advanced directives"signed long-before the locked-in-state are useful. On the contrary, they might be used as an excuse to shorten anticipated long periods of care for these patients avoiding associated financial and social burdens. Current state and availability of BCI/BMI systems urge a broader societal discourse on the pressing ethical challenges associated with the advancements in neurotechnology and BCI/BMI research. PMID:23536247

Birbaumer, Niels; Gallegos-Ayala, Guillermo; Wildgruber, Moritz; Silvoni, Stefano; Soekadar, Surjo R

2014-01-01

213

9 CFR 310.15 - Disposition of thyroid glands and laryngeal muscle tissue.  

...2014-01-01 false Disposition of thyroid glands and laryngeal muscle tissue...INSPECTION § 310.15 Disposition of thyroid glands and laryngeal muscle tissue. (a) Livestock thyroid glands and laryngeal muscle tissue...

2014-01-01

214

9 CFR 310.15 - Disposition of thyroid glands and laryngeal muscle tissue.  

Code of Federal Regulations, 2013 CFR

...2013-01-01 false Disposition of thyroid glands and laryngeal muscle tissue...INSPECTION § 310.15 Disposition of thyroid glands and laryngeal muscle tissue. (a) Livestock thyroid glands and laryngeal muscle tissue...

2013-01-01

215

9 CFR 310.15 - Disposition of thyroid glands and laryngeal muscle tissue.  

Code of Federal Regulations, 2011 CFR

...2011-01-01 false Disposition of thyroid glands and laryngeal muscle tissue...INSPECTION § 310.15 Disposition of thyroid glands and laryngeal muscle tissue. (a) Livestock thyroid glands and laryngeal muscle tissue...

2011-01-01

216

9 CFR 310.15 - Disposition of thyroid glands and laryngeal muscle tissue.  

Code of Federal Regulations, 2010 CFR

...2010-01-01 false Disposition of thyroid glands and laryngeal muscle tissue...INSPECTION § 310.15 Disposition of thyroid glands and laryngeal muscle tissue. (a) Livestock thyroid glands and laryngeal muscle tissue...

2010-01-01

217

9 CFR 310.15 - Disposition of thyroid glands and laryngeal muscle tissue.  

Code of Federal Regulations, 2012 CFR

...2012-01-01 false Disposition of thyroid glands and laryngeal muscle tissue...INSPECTION § 310.15 Disposition of thyroid glands and laryngeal muscle tissue. (a) Livestock thyroid glands and laryngeal muscle tissue...

2012-01-01

218

Bilateral Facial Nerve Palsy: A Diagnostic Dilemma  

PubMed Central

Introduction. Bilateral facial nerve palsy (FNP) is a rare condition, representing less than 2% of all cases of FNP. Majority of these patients have underlying medical conditions, ranging from neurologic, infectious, neoplastic, traumatic, or metabolic disorders. Objective. The differential diagnosis of its causes is extensive and hence can present as a diagnostic challenge. Emergency physicians should be aware of these various diagnostic possibilities, some of which are potentially fatal. Case Report. We report a case of a 43-year-old female who presented to the emergency department with sequential bilateral facial nerve paralysis which could not be attributed to any particular etiology and, hence, presented a diagnostic dilemma. Conclusion. We reinforce the importance of considering the range of differential diagnosis in all cases presenting with bilateral FNP. These patients warrant admission and prompt laboratory and radiological investigation for evaluation of the underlying cause and specific further management as relevant. PMID:23326715

Pothiawala, Sohil; Lateef, Fatimah

2012-01-01

219

Peripheral Nerve Disorders  

MedlinePLUS

... spinal cord. Like static on a telephone line, peripheral nerve disorders distort or interrupt the messages between the brain ... body. There are more than 100 kinds of peripheral nerve disorders. They can affect one nerve or many nerves. ...

220

Nerve Racking  

NSDL National Science Digital Library

This lesson describes the function and components of the human nervous system. It helps students understand the purpose of our brain, spinal cord, nerves and the five senses. How the nervous system is affected during spaceflight is also discussed in this lesson.

Integrated Teaching And Learning Program

221

Arnold's nerve cough reflex: evidence for chronic cough as a sensory vagal neuropathy  

PubMed Central

Arnold’s nerve ear-cough reflex is recognised to occur uncommonly in patients with chronic cough. In these patients, mechanical stimulation of the external auditory meatus can activate the auricular branch of the vagus nerve (Arnold’s nerve) and evoke reflex cough. This is an example of hypersensitivity of vagal afferent nerves, and there is now an increasing recognition that many cases of refractory or idiopathic cough may be due to a sensory neuropathy of the vagus nerve. We present two cases where the cause of refractory chronic cough was due to sensory neuropathy associated with ear-cough reflex hypersensitivity. In both cases, the cough as well as the Arnold’s nerve reflex hypersensitivity were successfully treated with gabapentin, a treatment that has previously been shown to be effective in the treatment of cough due to sensory laryngeal neuropathy (SLN). PMID:25383210

Gibson, Peter G.; Birring, Surinder S.

2014-01-01

222

Avoidance of Laryngeal Injuries during Gastric Intubation.  

PubMed

Gastric intubation is a common and simple procedure that is often performed on patients who are sedated or anaesthetised. If the gastric tube (GT) is inserted blindly while the patient is unconscious, this procedure may result in easily preventable complications such as laryngeal trauma. We present an interesting case where the blind placement of a orogastric tube (OGT) in an anesthetised 52-year-old female patient at Sultan Qaboos University Hospital in Oman resulted in significant arytenoid trauma. This led to delayed tracheal extubation. The movement of the GT from the oropharyngeal area to the upper oesophageal sphincter can be visualised and controlled with the use of Magill forceps and a laryngoscope. Therefore, this report highlights the need for GT insertion procedures to be performed under direct vision in patients who are unconscious (due to sedation, anaesthesia or an inherent condition) in order to prevent trauma to the laryngeal structures. PMID:25097780

Burad, Jyoti; Deoskar, Sonali; Bhakta, Pradipta; Date, Rohit; Sharma, Pradeep

2014-08-01

223

Applications of robotics for laryngeal surgery  

PubMed Central

Synopsis The author presents the clinical application of robotics to laryngeal surgery in terms of enhancement of surgical precision and performance of other minimally invasive procedures not feasible with current instrumentation. Presented in this article are comparisons of human arm with robotic arm in terms of degrees of freedom and discussion of surgeries and outcomes with use of the robotic arm. Robotic equipment for laryngeal surgery has the potential to overcome many of the limitations of endolaryngeal procedures by improving optics, increasing instrument degrees of freedom, and modulating tremor. Outside of laryngology, a multi-armed robotic system would have utility in microvascular procedures at the base of the skull, sinus surgery, and single port gastrointestinal and thoracic access surgery. PMID:18570959

Hillel, Alexander T.; Kapoor, Ankur; Simaan, Nabil; Taylor, Russell H.; Flint, Paul

2014-01-01

224

High-resolution measurement of electrically-evoked vagus nerve activity in the anesthetized dog  

NASA Astrophysics Data System (ADS)

Objective. Not fully understanding the type of axons activated during vagus nerve stimulation (VNS) is one of several factors that limit the clinical efficacy of VNS therapies. The main goal of this study was to characterize the electrical recruitment of both myelinated and unmyelinated fibers within the cervical vagus nerve. Approach. In anesthetized dogs, recording nerve cuff electrodes were implanted on the vagus nerve following surgical excision of the epineurium. Both the vagal electroneurogram (ENG) and laryngeal muscle activity were recorded in response to stimulation of the right vagus nerve. Main results. Desheathing the nerve significantly increased the signal-to-noise ratio of the ENG by 1.2 to 9.9 dB, depending on the nerve fiber type. Repeated VNS following nerve transection or neuromuscular block (1) enabled the characterization of A-fibers, two sub-types of B-fibers, and unmyelinated C-fibers, (2) confirmed the absence of stimulation-evoked reflex compound nerve action potentials in both the ipsilateral and contralateral vagus nerves, and (3) provided evidence of stimulus spillover into muscle tissue surrounding the stimulating electrode. Significance. Given the anatomical similarities between the canine and human vagus nerves, the results of this study provide a template for better understanding the nerve fiber recruitment patterns associated with VNS therapies.

Yoo, Paul B.; Lubock, Nathan B.; Hincapie, Juan G.; Ruble, Stephen B.; Hamann, Jason J.; Grill, Warren M.

2013-04-01

225

Laryngeal biomechanics of the singing voice.  

PubMed

By transnasal fiberoptic laryngoscopy, patients with functional voice often demonstrate abnormal laryngeal biomechanics, commonly supraglottic contraction. Appropriately, such conditions are sometimes termed muscle tension dysphonias. Singers working at the limits of their voice may also transiently demonstrate comparable tension patterns. However, the biomechanics of normal singing, particularly for different singing styles, have not been previously well characterized. We used transnasal fiberoptic laryngoscopy to study 100 healthy singers to assess patterns of laryngeal tension during normal singing and to determine whether factors such as sex, occupation, and style of singing influence laryngeal muscle tension. Thirty-nine male and 61 female singers were studied; 48 were professional singers, and 52 were amateurs. Examinations of study subjects performing standardized and nonstandardized singing tasks were recorded on a laser disk and subsequently analyzed in a frame-by-frame fashion by a blinded otolaryngologist. Each vocal task was graded for muscle tension by previously established criteria, and objective muscle tension scores were computed. The muscle tension score was expressed as a percentage of frames for each task with one of the laryngeal muscle tension patterns shown. The lowest muscle tension scores were seen in female professional singers, and the highest muscle tension scores were seen in amateur female singers. Male singers (professional and amateur) had intermediate muscle tension scores. Classical singers had lower muscle tension scores than nonclassical singers, with the lowest muscle tension scores being seen in those singing choral music (41%), art song (47%), and opera (57%), and the highest being seen in those singing jazz/pop (65%), musical theater (74%), bluegrass/country and western (86%), and rock/gospel (94%). Analyzed also were the influences of vocal nodules, prior vocal training, number of performance and practice hours per week, warm-up before singing, race, smoking, and alcohol consumption. PMID:8969758

Koufman, J A; Radomski, T A; Joharji, G M; Russell, G B; Pillsbury, D C

1996-12-01

226

Critical literature review on the management of intraparotid facial nerve schwannoma and proposed decision-making algorithm  

Microsoft Academic Search

Management of intraparotid facial nerve schwannomas (IFNS) is very challenging because the diagnosis is often made intra-operatively\\u000a and in most cases, resection could lead to severe facial nerve (FN) paralysis, with important aesthetic consequences. Articles\\u000a in the English language focused on the management of FN schwannoma have been selected and critically reviewed. A decision-making\\u000a algorithm is proposed. In the case

Matteo Alicandri-Ciufelli; Daniele Marchioni; Francesco Mattioli; Margherita Trani; Livio Presutti

2009-01-01

227

[The use of eurespal for the treatment of chronic laryngitis].  

PubMed

The author provides a rationale for the use of eurespal for the treatment of chronic laryngitis based on the pathogenetic concept of pathological condition. The results of a clinical study designed to evaluate the efficiency and safety of eurespal therapy in patients with chronic laryngitis are presented. PMID:21378745

Riabova, M A

2011-01-01

228

Therapeutic Options in Advanced Laryngeal Cancer: An Overview  

Microsoft Academic Search

Historically, patients with advanced laryngeal cancer have been treated with radical surgery and adjuvant radiation therapy. Intensive surgical research has allowed surgeons to deal with almost any local extension and to propose an appropriate surgical procedure for each case. Several function-sparing surgical options are available to treat moderately advanced\\/advanced laryngeal cancer. Better understanding of the anatomy and biology of cancer

Fernando L. Dias; Roberto A. Lima; Jacob Kligerman; Claudio R. Cernea

2005-01-01

229

Palato-pharyngo-laryngeal myoclonus … an unusual cause of dysphagia.  

PubMed

Dysphagia is a common problem in the elderly patient. Palato-pharyngo-laryngeal myoclonus, however, is a rare cause of this. We report a case of a 78-year-old man with dysphagia due to palato-pharngo-laryngeal myoclonus that was ultimately managed conservatively with a good functional outcome. PMID:24950689

Juby, Angela G; Shandro, Patti; Emery, Derek

2014-11-01

230

Single session of brief electrical stimulation immediately following crush injury enhances functional recovery of rat facial nerve.  

PubMed

Peripheral nerve injuries lead to a variety of pathological conditions, including paresis or paralysis when the injury involves motor axons. We have been studying ways to enhance the regeneration of peripheral nerves using daily electrical stimulation (ES) following a facial nerve crush injury. In our previous studies, ES was not initiated until 24 h after injury. The current experiment tested whether ES administered immediately following the crush injury would further decrease the time for complete recovery from facial paralysis. Rats received a unilateral facial nerve crush injury and an electrode was positioned on the nerve proximal to the crush site. Animals received daily 30 min sessions of ES for 1 d (day of injury only), 2 d, 4 d, 7 d, or daily until complete functional recovery. Untreated animals received no ES. Animals were observed daily for the return of facial function. Our findings demonstrated that one session of ES was as effective as daily stimulation at enhancing the recovery of most functional parameters. Therefore, the use of a single 30 min session of ES as a possible treatment strategy should be studied in human patients with paralysis as a result of acute nerve injuries. PMID:22773203

Foecking, Eileen M; Fargo, Keith N; Coughlin, Lisa M; Kim, James T; Marzo, Sam J; Jones, Kathryn J

2012-01-01

231

Botulinum toxin induces muscle paralysis and inhibits bone regeneration in zebrafish.  

PubMed

Intramuscular administration of Botulinum toxin (BTx) has been associated with impaired osteogenesis in diverse conditions of bone formation (eg, development, growth, and healing), yet the mechanisms of neuromuscular-bone crosstalk underlying these deficits have yet to be identified. Motivated by the emerging utility of zebrafish (Danio rerio) as a rapid, genetically tractable, and optically transparent model for human pathologies (as well as the potential to interrogate neuromuscular-mediated bone disorders in a simple model that bridges in vitro and more complex in vivo model systems), in this study, we developed a model of BTx-induced muscle paralysis in adult zebrafish, and we examined its effects on intramembranous ossification during tail fin regeneration. BTx administration induced rapid muscle paralysis in adult zebrafish in a manner that was dose-dependent, transient, and focal, mirroring the paralytic phenotype observed in animal and human studies. During fin regeneration, BTx impaired continued bone ray outgrowth, morphology, and patterning, indicating defects in early osteogenesis. Further, BTx significantly decreased mineralizing activity and crystalline mineral accumulation, suggesting delayed late-stage osteoblast differentiation and/or altered secondary bone apposition. Bone ray transection proximal to the amputation site focally inhibited bone outgrowth in the affected ray, implicating intra- and/or inter-ray nerves in this process. Taken together, these studies demonstrate the potential to interrogate pathological features of BTx-induced osteoanabolic dysfunction in the regenerating zebrafish fin, define the technological toolbox for detecting bone growth and mineralization deficits in this process, and suggest that pathways mediating neuromuscular regulation of osteogenesis may be conserved beyond established mammalian models of bone anabolic disorders. © 2014 American Society for Bone and Mineral Research. PMID:24806738

Recidoro, Anthony M; Roof, Amanda C; Schmitt, Michael; Worton, Leah E; Petrie, Timothy; Strand, Nicholas; Ausk, Brandon J; Srinivasan, Sundar; Moon, Randall T; Gardiner, Edith M; Kaminsky, Werner; Bain, Steven D; Allan, Christopher H; Gross, Ted S; Kwon, Ronald Y

2014-11-01

232

The Frequency and Correlates of Sleep Paralysis in a University Sample  

Microsoft Academic Search

In a sample of 1798 university undergraduates (females, n = 976; males, n = 822) 21% reported one or more episodes of sleep paralysis, and there was no significant sex difference in this regard. Most (98.4%) sleep paralysis sufferers reported at least one psychological symptom (e.g., hallucinations) accompanying their last (or only) episode. A total of 190 sleep paralysis reporters

Nicholas P. Spanos; Stacey A. McNulty; Susan C. DuBreuil; Martha Pires; Melissa Faith Burgess

1995-01-01

233

Brachial neuritis with bilateral diaphragmatic paralysis following herpes zoster: a case report.  

PubMed

We present a case of supine respiratory failure due to a bilateral diaphragmatic paralysis associated with brachial neuritis secondary to thoracic herpes zoster. Fluoroscopy in both the standing and supine positions revealed bilateral diaphragmatic paralysis accentuated in the supine position. To our knowledge, this is the first case of thoracic herpes zoster associated with brachial neuritis and bilateral diaphragmatic paralysis. PMID:18525424

Hoque, Romy; Schwendimann, Robert N; Liendo, Cesar; Chesson, Andrew L

2008-06-01

234

Immobility in Mobility: Narratives of Social Class, Education, and Paralysis  

ERIC Educational Resources Information Center

Social mobility carries with it a sense of loss. To be socially mobile is to move from one place, economically, culturally, personally, to another. One consequence of that loss, sometimes, is immobility--a paralysis brought on by the violent, forceful, uncertain rush of social mobility itself. The immobility of fear, the feeling stuck, the not…

Nainby, Keith; Pea, John B.

2003-01-01

235

Bone blood flow after spinal paralysis in the rat  

Microsoft Academic Search

The goal of this study was to investigate the acute and chronic effects of paralysis induced by spinal cord section or sciatic neurotomy on bone blood flow in the rat. Regional bone blood flow was measured in the early stage with the hydrogen washout technique and the change of whole bone blood flow was measured in the early and the

Hiroshi Takahashi; Takao Yamamuro; Hideo Okumura; Ryuichi Kasai; Kenji Tada

1990-01-01

236

Analysis Paralysis-Developing A Business Continuity Plan  

E-print Network

) and Trainee (Right), Brazil 1998 -Security -Reception/Front Desk/Bank -Business Continuity #12;Brief HistoryAnalysis Paralysis-Developing A Business Continuity Plan Steve Sadler, UCAR Director of Safety and Site Services #12;Getting to Know A Business Continuity Survivor · Health, Environment and Safety

237

Cavernous nerve regeneration using acellular nerve grafts  

Microsoft Academic Search

Introduction  The restoration of erectile function following complete transection of nerve tissue during surgery remains challenging. Recently,\\u000a graft procedures using sural nerve grafts during radical prostatectomy have had favorable outcomes, and this has rekindled\\u000a interest in the applications of neural repair in a urologic setting. Although nerve repair using autologous donor graft is\\u000a the gold standard of treatment currently, donor nerve

Stephen S. Connolly; James J. Yoo; Mohamed Abouheba; Shay Soker; W. Scott McDougal; Anthony Atala

2008-01-01

238

The effects of age and gender on laryngeal aerodynamics.  

PubMed

A computerized airflow/air pressure analysis system, the Aerophone II Model 6800 (Kay Elemetrics Corp.), was used to assess the effects of age and gender on laryngeal aerodynamics. A sample of 56 male and 53 female normal speaking subjects was divided into six age groups (20-30; 31-40; 41-50; 51-60; 61-70 and 71-80 years). The laryngeal aerodynamic parameters measured included phonatory (mean) flow rate, estimated subglottal pressure, laryngeal airway resistance, phonatory sound pressure level, phonatory power, and phonatory efficiency. Most comfortable phonation, vocal efficiency, and running speech tasks were used to collect the aerodynamic data. Comfortable pitch and loudness levels were used for each of these tasks. Age and gender effects were found for a number of the phonatory (mean) flow rate and phonatory sound pressure level values. Results failed, however, to indicate age or gender effects for the estimated subglottal pressure, laryngeal airway resistance, phonatory power and phonatory efficiency parameters. High intersubject variability was found for the phonatory flow rate, laryngeal airway resistance, phonatory power and phonatory efficiency values. Estimated subglottal pressure values, however, appeared to vary the least among subjects. The results are discussed with respect to factors that might influence laryngeal aerodynamics, such as underlying laryngeal anatomical and physiological age-related changes and gender-related differences. The clinical implications of the findings for the assessment and treatment of individuals with voice disorders using the Aerophone II are also discussed. PMID:9709440

Goozée, J V; Murdoch, B E; Theodoros, D G; Thompson, E C

1998-01-01

239

Downregulated Chibby in laryngeal squamous cell carcinoma with increased expression in laryngeal carcinoma Hep-2 cells.  

PubMed

Chibby (Cby) inhibits Wnt/?-catenin-mediated transcriptional activation by competing with Lef-1 (the transcription factor and target of ?-catenin) to bind to ?-catenin. This suggests that Cby could be a tumor suppressor protein. In the present study, we examined Cby expression in laryngeal squamous cell carcinoma (LSCC) and its function and mechanism in laryngeal carcinoma cell lines. Cby expression levels were investigated by immunohistochemistry in a panel of 36 LSCC patient cases. The expression of ?-catenin, c-myc and cyclin D1 in Hep-2 were determined through RT-PCR and western blot analysis. Activity of Wnt/?-catenin signaling pathway after overexpression of Cby was measured by TCF/LEF luciferase reporter gene assay. Proliferation, clone forming ability, cell cycle distribution and cell apoptosis of Hep-2 cells were detected by MTT assay, plate colony forming assay, flow cytometry and TUNEL assay, respectively. This study showed that expression of Cby protein was strongly downregulated in LSCC tumor tissues in comparison to normal laryngeal mucosa samples. No significant correlation was found between the expression of Cby in tumor tissue and gender, age, clinical stage and tumor differentiation of laryngeal cancer patients. When Cby was overexpressed in Hep-2 cells, the expression of cyclin D1 was reduced and ?-catenin activity was inhibited. Proliferation and plate colony forming assays revealed a significant inhibitory effect of Cby on growth and colony formation ability of Hep-2 cells after Cby overexpression in comparison to control and mock-infected cells. In addition, we also found that upregulated expression of Cby resulted in accumulation of numbers of cells in G0/G1 phase with concomitant decrease in S phase by cell cycle assay. TUNEL staining demonstrated that, compared with the control group, the rate of apoptosis in the plv-cs2.0-Cby group was significantly increased. Taken together, downregulation of Cby was observed in LSCC, but with no significant correlation to the clinicopathological features of LSCC patients. Overexpression of Cby effectively suppressed laryngeal carcinoma cell growth and promoted its apoptosis. A better understanding of the mechanisms of Cby gene activation in LSCC could provide potential novel therapeutic targets for human laryngeal carcinoma. PMID:25175341

Xu, Jue; Ren, Gang; Zhao, De-An; Li, Bo-An; Cai, Cheng-Fu; Zhou, Yi; Luo, Xian-Yang

2014-11-01

240

Correlation between laryngeal sensitivity and penetration/aspiration after stroke.  

PubMed

Stroke is the most common neurological disease in adults that is associated with deglutition disorders. The presence of laryngeal sensitivity is very important in developing safe swallowing without risk of pulmonary complications. The aim of this study was to correlate laryngeal sensitivity with laryngeal penetration and tracheal aspiration after swallows of three food consistencies (puree, thickened liquid, and liquid) in poststroke individuals in the late phase. A cross-sectional clinical study was performed with 91 post-ischemic stroke individuals, with oropharyngeal dysphagia, who were in rehabilitation center treatment from 2009 to 2011. They had a mean age of 68.1 years and average time since injury was 22.6 months; 39 had injury to the right hemisphere and 52 had injury to the left hemisphere. All underwent fiberoptic endoscopic evaluation of swallowing and evaluation of laryngeal sensitivity by touching the tip of the endoscope to the arytenoids and aryepiglottic folds. The linear correlation coefficient of Spearman was applied to evaluate the correlation between laryngeal penetration and tracheal aspiration and the presence/absence of laryngeal sensitivity. There was a negative correlation between the observation of penetration and tracheal aspiration and laryngeal sensitivity, with all bolus consistencies (p < 0.001 for aspiration and p ? 0.01 for penetration). The absence of laryngeal sensitivity determines the more frequent findings of penetration and tracheal aspiration. This sensory stimulus in the mucosa of the pharynx and larynx is an essential element for safe swallowing and its deficiency associated with altered motor activity can cause laryngeal penetration and aspiration in poststroke individuals regardless of food consistency. PMID:24442645

Onofri, Suely Mayumi Motonaga; Cola, Paula Cristina; Berti, Larissa Cristina; da Silva, Roberta Gonçalves; Dantas, Roberto Oliveira

2014-04-01

241

Risk Acceptance and Expectations of Laryngeal Allotransplantation  

PubMed Central

Background Laryngeal allotransplantation (LA) is a technique involving transplantation of a deceased donor's larynx into a recipient, and it may be substituted for conventional laryngeal reconstruction. There are widely different views on LA, as the recipient is administered continuous, potentially life-threatening, immunosuppressive therapy for a functional or aesthetic result, which is not directly related to life extension. The purpose of this study was to analyze the difference in risk acceptance and expectations of LA between four population groups. Methods A survey was performed to examine patients' risk acceptance and expectations of LA. The survey included 287 subjects in total (general public, n=100; kidney transplant recipients, n=53; post-laryngectomy patients, n=34; doctors, n=100), using a Korean translated version of the louisville instrument for transplantation (LIFT) questionnaire. Results All four groups responded differently at various levels of their perception in risk acceptance and expectations. The kidney transplant recipients reported the highest risk acceptance and expectations, and the doctor group the lowest. Conclusions This study examined the disparate perception between specific population groups of the risks and benefits of using LA for the promotion of the quality of life. By addressing the information gaps about LA in the different populations that have been highlighted from this survey, we suggest that LA can become a more viable alternative to classical surgery with resultant improved quality of life for patients.

Jo, Hyun Kyo; Park, Jang Wan; Hwang, Jae Ha; Lee, Sam Yong; Shin, Jun Ho

2014-01-01

242

Laryngeal chondrosarcoma as a rare cause of subglottic stenosis.  

PubMed

Laryngeal chondrosarcoma (CS) is a very rare entity. It is usually seen in 50-80-year olds. It is developed from cricoid cartilage largely. Patients have laryngeal CS complaint of respiratuvar distress, dysphonia, and dysphagia generally. A submucous mass is usually seen in physical examination with an intact mucosa. Distant metastasis is rare in CSs. Main treatment is surgical excision. An 82-year-old patient who has respiratuvar distress is presented in this paper and laryngeal CS is reviewed in the light of the literature. PMID:25197601

Köko?lu, Kerem; Canöz, Ozlem; Do?an, Serap; Gülmez, Emrah; Yüce, Imdat; Ca?l?, Sedat

2014-01-01

243

Partial airway obstruction following manufacturing defect in laryngeal mask airway (Laryngeal Mask Silken™)  

PubMed Central

Laryngeal mask (LM) airway is commonly used for securing airway in day-care surgeries. Various problems have been described while using LM airway. Out of those, mechanical obstruction causing airway compromise is most common. Here, we describe a case report of 4-year-old child who had partial upper airway obstruction due to LM manufacturer's defect. There was a silicon band in upper one-third of shaft of LM airway. This band was made up of the same material as that of LM airway so it was not identifiable on external inspection of transparent shaft. We suggest that such as non-transparent laryngeal mask, a transparent LM airway should also be inspected looking inside the lumen with naked eyes or by using a probe to rule out any manufacturing defect before its insertion.

Jangra, Kiran; Malhotra, Surender Kumar; Saini, Vikas

2014-01-01

244

Laryngeal Leiomyosarcoma, A Case Report and Review of Articles  

PubMed Central

Introduction: Laryngeal leiomysarcoma is an extremely rare malignancy originating from smooth muscle cells. Its rarity is due to the fact that only less than 50 cases of pure laryngeal leiomyosarcoma and less than 10 cases of hypopharyngeal leiomyosarcaoma have been reported in modern medical literature. Even though the clinical presentation mimics that of a laryngeal carcinoma forming the major bulk of the laryngeal malignancies, the difference in management, warrants an accurate diagnosis. Case Report: We reported a case of this very rare malignancy presenting in the supraglottic region by highlighting the clinical features, histological and radiological diagnosis and management of this extremely rare malignant entity. Conclusion: An accurate histological diagnosis may be difficult; but supplementing by electron microscopy and immunohistochemical staining, the diagnosis can be reached certainly. PMID:24303449

Khadivi, Ehsan; Taziky, Mohammad Hossein; Jafarian, Amir Hossein; Nasseri Sadr, Msoud

2013-01-01

245

Retropharyngeal abscess - A complication of laryngeal mask airway  

PubMed Central

Retropharyngeal or parapharyngeal abscesses developing after intubation are rare. This can present as surgical emergency post extubation. We report a case of retropharyngeal abscess that probably occurred as a complication of laryngeal mask insertion. PMID:24960747

Lynn, E; Ping, T; Keng, Y; Singh, R; Kwong, W; Soon, T; Shaik, I; Narayanan, P

2012-01-01

246

Laryngeal spasm after general anaesthesia due to Ascaris lumbricoides.  

PubMed

Postoperative upper airway obstruction during recovery from general anaesthesia may have several causes. This is a report of a young girl who developed laryngeal spasm as a result of an ectopic roundworm Ascaris lumbricoides. PMID:23679043

Finsnes, K D

2013-08-01

247

Can Laryngeal and Hypopharyngeal Cancers Be Found Early?  

MedlinePLUS

... and hypopharyngeal cancers Can laryngeal and hypopharyngeal cancers be found early? Screening is testing for diseases like ... cancer early, when treatment is most likely to be effective. But for now there is no simple ...

248

Sleep Paralysis, Sexual Abuse, and Space Alien Abduction  

Microsoft Academic Search

Sleep paralysis accompanied by hypnopompic ('upon awaken- ing') hallucinations is an often-frightening manifestation of discordance between the cognitive\\/perceptual and motor aspects of rapid eye movement (REM) sleep. Awakening sleepers become aware of an inability to move, and sometimes experience intrusion of dream mentation into waking consciousness (e.g. seeing intruders in the bedroom). In this article, we summarize two studies. In

RICHARD J. MCNALLY; SUSAN A. CLANCY

2005-01-01

249

Laryngeal neuroma in multiple endocrine neoplasia type 2B.  

PubMed

Multiple endocrine neoplasia (MEN) type 2 syndrome is an autosomal dominant inherited disease caused by mutations of the RET proto-oncogene, and is clinically divided into three phenotypes: MEN2A, MEN2B, and familial medullary thyroid carcinoma. Although multiple mucosal neuromas are commonly observed in patients with MEN2B, there are only a few reports of laryngeal neuroma. We present here a rare case of laryngeal mucosal neuromas with MEN2B. PMID:24389350

Kudo, Naomi; Matsubara, Atsushi; Abe, Takahisa; Inoue, Taku; Takahata, Junko

2014-08-01

250

Severe upper airway obstruction caused by ulcerative laryngitis  

Microsoft Academic Search

AIMSTo present our experience of severe upper airway obstruction caused by ulcerative laryngitis in children.METHODSRetrospective case note review of 263 children with severe upper airway obstruction and a clinical diagnosis of croup admitted to a paediatric intensive care unit (PICU) over a five year period.RESULTSA total of 148 children (56%) underwent microlaryngoscopy (Storz 3.0 rigid telescope). Laryngeal ulceration with oedema

M Hatherill; L Reynolds; Z Waggie; A Argent

2001-01-01

251

Hyperbaric oxygen therapy for laryngeal radionecrosis  

SciTech Connect

Radionecrosis of the larynx is a debilitating disease associated with pain, dysphagia, respiratory obstruction, and, in some cases, the need for laryngectomy. Persistent poor wound healing can lead to death. A series of eight patients with advanced (grades III and IV, Chandler classification) radionecrosis of the larynx treated with adjunctive hyperbaric oxygen therapy is presented. Signs and symptoms of radionecrosis were dramatically ameliorated in seven of eight patients, while one patient, despite subjective improvement, eventually required laryngectomy. There were no deaths. These results are compared to previous series on radionecrosis of the larynx in which hyperbaric oxygen was not used. This series indicates that hyperbaric oxygen therapy is a useful and effective adjunctive treatment modality in the management of laryngeal radionecrosis.

Ferguson, B.J.; Hudson, W.R.; Farmer, J.C. Jr.

1987-01-01

252

Pathogenesis of laryngeal narrowing in patients with multiple system atrophy  

PubMed Central

We do not fully understand the pathogenesis of nocturnal laryngeal stridor in patients with multiple system atrophy (MSA). Recent studies suggest that inspiratory thyroarytenoid (TA) muscle activation has a role in the development of the stridor.The breathing pattern and firing timing of TA muscle activation were determined in ten MSA patients, anaesthetized with propofol and breathing through the laryngeal mask airway, while the behaviour of the laryngeal aperture was being observed endoscopically.Two distinct breathing patterns, i.e. no inspiratory flow limitation (no-IFL) and IFL, were identified during the measurements. During IFL, significant laryngeal narrowing was observed leading to an increase in laryngeal resistance and end-tidal carbon dioxide concentration. Development of IFL was significantly associated with the presence of phasic inspiratory activation of TA muscle. Application of continuous positive airway pressure suppressed the TA muscle activation.The results indicate that contraction of laryngeal adductors during inspiration narrows the larynx leading to development of inspiratory flow limitation accompanied by stridor in patients with MSA under general anaesthesia. PMID:11579172

Isono, Shiroh; Shiba, Keisuke; Yamaguchi, Mika; Tanaka, Atsuko; Hattori, Takamichi; Konno, Akiyoshi; Nishino, Takashi

2001-01-01

253

Peripheral Nerve Regeneration by Artificial Nerve Guides  

Microsoft Academic Search

It is more than 20 years since artificial nerve guides (or conduits) were introduced into clinical practice as a reliable\\u000a alternative to autograft. They are basically cylindrical conduits inside which a regenerating nerve stump may find protection\\u000a and guidance. Early guides were made of silicone and were not biodegradable; they were shown to support nerve regeneration\\u000a but, subsequently, were considered

A. Merolli; L. Rocchi

254

Nasal lateral rectus transposition combined with medial rectus surgery for complete oculomotor nerve palsy.  

PubMed

Complete paralysis of the oculomotor nerve results in the lateral rectus and superior oblique muscles acting unopposed and the eye being fixed in an abducted, slightly depressed and intorted position. The goal of strabismus surgery in such cases is to achieve an acceptable alignment in primary position. Simple recession-resection procedures may not yield acceptable results, and numerous other procedures have been attempted, with limited success. We report the outcome of nasal transposition of two halves of the lateral rectus muscle combined with medial rectus surgery in 3 cases of total oculomotor nerve palsy. PMID:25173905

Sukhija, Jaspreet; Kaur, Savleen; Singh, Usha

2014-08-01

255

Effects of Odontobuthus Doriae Scorpion Venom on Mouse Sciatic Nerve  

PubMed Central

Temporary paralysis is a rare manifestation of envenoming following the yellow Iranian scorpion, Odontobuthus doriae (O. doriae). Thus, to elucidate the underlying mechanism, we investigated the neurotoxic effect of venom in the sciatic nerve, the possible mechanism in a mice model. The neurotoxicity and temperature effects in the venom-induced neurotoxicity were examined using the mouse sciatic nerve and mouse phrenic nerve-hemidiaphragm (MHD) preparations. O .doriae venom (1 ?g/mL) caused changes in the perineural waveform associated with nerve terminal action potentials. Venom affected on both negative and positive components of the waveform which is known as a compound action potential. The timeresponse relationship of venom-induced depression of resting membrane potential (RMP) was significant (p < 0.05). No significant difference in augmentation was seen in room temperature in comparison with 37°C. In conclusion, although there was no evidence that the venom had any specific curarizing action at the neuromuscular junction, the results suggest that the venom exerts its neuromuscular transmission on the sciatic nerve through potassium and sodium ionic-currents. Furthermore, the influence of temperature on neurotoxicity was ineffective on blockade of the neuromuscular transmission in-vitro. PMID:24250682

Vatanpour, Hossein; Jalali, Amir; G. Rowan, Edward; Rahim, Fakher

2013-01-01

256

Neuroimaging investigation of the motor control disorder, dystonia with special emphasis on laryngeal dystonia  

E-print Network

Laryngeal dystonia (LD) is the focal laryngeal form of the neurological movement disorder called dystonia, a condition that often changes in severity depending on the posture assumed and on voluntary activity of the affected ...

Makhlouf, Miriam L

2013-01-01

257

Laryngeal tuberculosis presenting as a supraglottic carcinoma: a case report and review of the literature  

PubMed Central

Introduction Laryngeal tuberculosis used to be a common complication in advanced pulmonary tuberculosis. However, it has become a rare occurrence in developed countries since the introduction of antituberculous agents. Moreover, the pattern of the disease has changed over the years. Nowadays, it more closely resembles a laryngeal carcinoma than any other laryngeal illness. Case presentation We describe the case of a 50-year-old Caucasian man who presented with the clinical picture of laryngeal cancer, but which turned out to be tuberculosis. We illustrate the difficulty of recognizing laryngeal tuberculosis both clinically and even with radiological examination. Conclusion Although laryngeal tuberculosis is uncommon, especially in developed countries, it still occurs and should be considered as a differential diagnosis in any laryngeal disease, in particular in the case of a laryngeal carcinoma. PMID:20062778

2009-01-01

258

Transplantation of olfactory ensheathing cells to evaluate functional recovery after peripheral nerve injury.  

PubMed

Olfactory ensheathing cells (OECs) are neural crest cells which allow growth and regrowth of the primary olfactory neurons. Indeed, the primary olfactory system is characterized by its ability to give rise to new neurons even in adult animals. This particular ability is partly due to the presence of OECs which create a favorable microenvironment for neurogenesis. This property of OECs has been used for cellular transplantation such as in spinal cord injury models. Although the peripheral nervous system has a greater capacity to regenerate after nerve injury than the central nervous system, complete sections induce misrouting during axonal regrowth in particular after facial of laryngeal nerve transection. Specifically, full sectioning of the recurrent laryngeal nerve (RLN) induces aberrant axonal regrowth resulting in synkinesis of the vocal cords. In this specific model, we showed that OECs transplantation efficiently increases axonal regrowth. OECs are constituted of several subpopulations present in both the olfactory mucosa (OM-OECs) and the olfactory bulbs (OB-OECs). We present here a model of cellular transplantation based on the use of these different subpopulations of OECs in a RLN injury model. Using this paradigm, primary cultures of OB-OECs and OM-OECs were transplanted in Matrigel after section and anastomosis of the RLN. Two months after surgery, we evaluated transplanted animals by complementary analyses based on videolaryngoscopy, electromyography (EMG), and histological studies. First, videolaryngoscopy allowed us to evaluate laryngeal functions, in particular muscular cocontractions phenomena. Then, EMG analyses demonstrated richness and synchronization of muscular activities. Finally, histological studies based on toluidine blue staining allowed the quantification of the number and profile of myelinated fibers. All together, we describe here how to isolate, culture, identify and transplant OECs from OM and OB after RLN section-anastomosis and how to evaluate and analyze the efficiency of these transplanted cells on axonal regrowth and laryngeal functions. PMID:24637657

Guerout, Nicolas; Paviot, Alexandre; Bon-Mardion, Nicolas; Honoré, Axel; Obongo, Rais; Duclos, Célia; Marie, Jean-Paul

2014-01-01

259

Na+,K+-pump stimulation improves contractility in isolated muscles of mice with hyperkalemic periodic paralysis.  

PubMed

In patients with hyperkalemic periodic paralysis (HyperKPP), attacks of muscle weakness or paralysis are triggered by K(+) ingestion or rest after exercise. Force can be restored by muscle work or treatment with ?(2)-adrenoceptor agonists. A missense substitution corresponding to a mutation in the skeletal muscle voltage-gated Na(+) channel (Na(v)1.4, Met1592Val) causing human HyperKPP was targeted into the mouse SCN4A gene (mutants). In soleus muscles prepared from these mutant mice, twitch, tetanic force, and endurance were markedly reduced compared with soleus from wild type (WT), reflecting impaired excitability. In mutant soleus, contractility was considerably more sensitive than WT soleus to inhibition by elevated [K(+)](o). In resting mutant soleus, tetrodotoxin (TTX)-suppressible (22)Na uptake and [Na(+)](i) were increased by 470 and 58%, respectively, and membrane potential was depolarized (by 16 mV, P < 0.0001) and repolarized by TTX. Na(+),K(+) pump-mediated (86)Rb uptake was 83% larger than in WT. Salbutamol stimulated (86)Rb uptake and reduced [Na(+)](i) both in mutant and WT soleus. Stimulating Na(+),K(+) pumps with salbutamol restored force in mutant soleus and extensor digitorum longus (EDL). Increasing [Na(+)](i) with monensin also restored force in soleus. In soleus, EDL, and tibialis anterior muscles of mutant mice, the content of Na(+),K(+) pumps was 28, 62, and 33% higher than in WT, respectively, possibly reflecting the stimulating effect of elevated [Na(+)](i) on the synthesis of Na(+),K(+) pumps. The results confirm that the functional disorders of skeletal muscles in HyperKPP are secondary to increased Na(+) influx and show that contractility can be restored by acute stimulation of the Na(+),K(+) pumps. Calcitonin gene-related peptide (CGRP) restored force in mutant soleus but caused no detectable increase in (86)Rb uptake. Repeated excitation and capsaicin also restored contractility, possibly because of the release of endogenous CGRP from nerve endings in the isolated muscles. These observations may explain how mild exercise helps locally to prevent severe weakness during an attack of HyperKPP. PMID:21708955

Clausen, Torben; Nielsen, Ole Bækgaard; Clausen, Johannes D; Pedersen, Thomas Holm; Hayward, Lawrence J

2011-07-01

260

Laryngeal edema associated with the ProSeal™ laryngeal mask airway in upper respiratory tract infection  

Microsoft Academic Search

\\u000a Abstract\\u000a Purpose  We report an unusual case of vocal cord edema associated with the use of a ProSeal™ laryngeal mask airway (PLMA) in an adult\\u000a patient with an undiagnosed upper respiratory tract infection (URTI).\\u000a \\u000a \\u000a \\u000a Clinical features  A 55-yr-old woman had fixation of a radial fracture under general anesthesia with muscle relaxation. She developed audible\\u000a wheezing 30 min after PLMA insertion. Bronchoscopic examination

Ki Jinn Chin; Victor W. T. Chee

2006-01-01

261

Predictors of Outcome in an Open Label, Therapeutic Trial of High-Dose Omeprazole in Laryngitis  

Microsoft Academic Search

BACKGROUND:Gastroesophageal reflux is implicated in some cases of laryngitis. There are no established predictors of response to acid suppression therapy in suspected reflux laryngitis.AIM:In a population with laryngitis, the aim is to determine whether (a) omeprazole 20 mg tds (3 months) improves symptoms and laryngitis, and (b) the outcome in response to potent acid suppression can be predicted by esophageal

R. B. H. Williams; M. M. Szczesniak; J. C. Maclean; H. M. Brake; I. E. Cole; I. J. Cook

2004-01-01

262

Electromechanical Nerve Stimulator  

NASA Technical Reports Server (NTRS)

Nerve stimulator applies and/or measures precisely controlled force and/or displacement to nerve so response of nerve measured. Consists of three major components connected in tandem: miniature probe with spherical tip; transducer; and actuator. Probe applies force to nerve, transducer measures force and sends feedback signal to control circuitry, and actuator positions force transducer and probe. Separate box houses control circuits and panel. Operator uses panel to select operating mode and parameters. Stimulator used in research to characterize behavior of nerve under various conditions of temperature, anesthesia, ventilation, and prior damage to nerve. Also used clinically to assess damage to nerve from disease or accident and to monitor response of nerve during surgery.

Tcheng, Ping; Supplee, Frank H., Jr.; Prass, Richard L.

1993-01-01

263

Optic Nerve Imaging  

MedlinePLUS

... Tomography (OCT) , which measures the reflection of laser light much like an ultrasound measures the reflection of sound, can directly measure the thickness of the nerve fiber layer and create a three dimensional representation of the optic nerve. ...

264

Engineering Peripheral Nerve Repair  

PubMed Central

Current approaches for treating peripheral nerve injury have resulted in promising, yet insufficient functional recovery compared to the clinical standard of care, autologous nerve grafts. In order to design a construct that can match the regenerative potential of the autograft, all facets of nerve tissue must be incorporated in a combinatorial therapy. Engineered biomaterial scaffolds in the future will have to promote enhanced regeneration and appropriate reinnervation by targeting the highly sensitive response of regenerating nerves to their surrounding microenvironment. PMID:23790730

Marquardt, Laura; Sakiyama-Elbert, Shelly E.

2013-01-01

265

Laryngeal hypersensitivity in the World Trade Center-exposed population: the role for respiratory retraining.  

PubMed

Upper airway symptoms among responders to the terrorist attack on 9/11 are progressive and multifactorial. For those symptoms that are laryngeal in origin, we are using a multidisciplinary approach that includes respiratory retraining and laryngeal desensitization through a speech pathologist trained in airway disorders. Our treatment paradigm and laryngeal hypersensitivity are discussed in this essay. PMID:22942344

McCabe, Daniel; Altman, Kenneth W

2012-09-01

266

Laryngeal Mask Airway in Laryngoscopies: A Safer Alternative for the Difficult Airway  

Microsoft Academic Search

Purpose of the Study: This study was undertaken to highlight the method, usefulness and postoperative morbidity of using a laryngeal mask airway (LMA) to ventilate patients with difficult airways undergoing laryngeal procedures. Procedures: Retrospective chart review where we identified patients deemed to have a difficult airway who underwent laryngeal and upper tracheal procedures, and were electively ventilated using an LMA.

Nazish Khalid Hashmi; Jeff E. Mandel; Natasha Mirza

2009-01-01

267

Intraoperative neuromonitoring for thyroid malignancy surgery: technical notes and results from a retrospective series  

Microsoft Academic Search

This study evaluates the role of intraoperative neuromonitoring (IONM) for thyroidectomy performed in cancer patients with\\u000a emphasis on postoperative recurrent laryngeal nerve paralysis (RLNP). The study is a retrospective series comprising 76 thyroidectomy\\u000a alone (control group) versus 76 thyroidectomy with IONM. In the control group the laryngeal nerves have been identified by\\u000a visualization solely. In the IONM group both vagal

Francesco Frattini; Alberto Mangano; Luigi Boni; Stefano Rausei; Antonio Biondi; Gianlorenzo Dionigi

2010-01-01

268

Tenofovir induced Fanconi syndrome: A rare cause of hypokalemic paralysis.  

PubMed

We report a 55-year-old female who presented to the emergency department with acute onset quadriparesis. She was diagnosed to have acquired immunodeficiency syndrome 7 years ago and was on tenofovir based anti-retroviral therapy for past 10 months. As the patient also had hypophosphatemia, glucosuria and proteinuria Fanconi syndrome (FS) was suspected. She improved dramatically over next 12 h to regain normal power and also her renal functions improved over next few days. Tenofovir induced FS presenting as hypokalemic paralysis is very rare complication and is the first case reported from India. PMID:24701043

Venkatesan, E P; Pranesh, M B; Gnanashanmugam, G; Balasubramaniam, J

2014-03-01

269

State of the Art Laryngeal Imaging: Research and Clinical Implications  

PubMed Central

Purpose of Review This paper provides a review of the latest advances in videostroboscopy, videokymography and high-speed videoendoscopy, and outlines the development of new laryngeal imaging modalities based on optical coherence tomography, laser depth-kymography, and magnetic resonance imaging, published in the past 2 years. Recent Findings Videostroboscopy and Videokymography Image quality has improved and several image processing and measurement techniques have been published. High-speed videoendoscopy Significant progress has been made through increased sensitivity and frame rates of the cameras, and the development of facilitative playbacks, phonovibrography and several image segmentation and measurement methods. Clinical evidence was presented through applications in phonosurgery, comparisons with videostroboscopy, normative data, and better understanding of voice production. Optical coherence tomography Latest developments allow for the capture of dynamic high resolution cross-sectional images of the vibrating vocal fold mucosa during phonation. Depth-kymography New laser technique allowing recording of the vertical movements of the vocal folds during phonation in calibrated spatial values. Laryngeal magnetic resonance New methods allow high-resolution imaging of laryngeal tissue microstructure, or measuring of dynamic laryngeal structures during phonation. Summary The endoscopic laryngeal imaging techniques have made significant advances increasing their clinical value, while techniques providing new types of potentially clinically-relevant information have emerged. PMID:20463479

Deliyski, Dimitar D.; Hillman, Robert E.

2010-01-01

270

Responses of laryngeal receptors to intralaryngeal CO2 in the cat.  

PubMed Central

1. We recorded afferent activities of single fibres in the superior laryngeal nerves of decerebrate or anaesthetized, paralysed cats while 3, 5 and 10% CO2 was added to a constant flow of warm, humidified air through the isolated upper airway. 2. Fifty-three receptors with discharge frequencies modulated by intralaryngeal CO2 were studied. Of these, forty-eight showed CO2-induced attenuation of their firing rates. Pulses of 3, 5 or 10% CO2, alternating with air at intervals ranging from 1.5 to 60 s, also diminished the discharge frequencies. This diminution was greater with higher CO2 concentrations and longer pulse durations. 3. Five of the fifty-three receptors were stimulated by intralaryngeal CO2. The discharge frequencies of these units increased slowly and by only a few impulses per second during CO2 exposure. 4. Thirty-four of the CO2-sensitive receptors were tested with other stimuli, including water, saline, positive and negative intralaryngeal pressures and cold air. The responses to these stimuli varied among receptors, but many of the units that reduced their frequencies with intralaryngeal CO2 were consistently stimulated by positive and/or negative intralaryngeal pressures. 5. Thirty-six of the receptors were anatomically located by probing the upper airway. Twenty-six were in the larynx, and ten were in the rostral trachea, within 5 mm of the cricoid cartilage. 6. The results, which are directly applicable to the investigation of reflex responses reported in the preceding paper, indicate that the predominant initial response to intralaryngeal CO2 under the conditions of these studies is attenuation of laryngeal receptor activity. PMID:1297833

Bartlett, D; Knuth, S L

1992-01-01

271

Vagus nerve neuromonitoring during carotid endarterectomy.  

PubMed

To determine the causes and site(s) of nerve injury and to identify potential predictors of vocal fold paralysis (VFP) after carotid endarterectomy (CEA) by application of intraoperative neuromonitoring (IONM). A total of 68 CEA patients were enrolled in this study. A 3-step IONM procedure was designed to obtain vocal fold EMG data at V1 (just after identification of the vagus nerve [VN]), V2 (just before arteriotomy), and V3 (just before wound closure). We also performed IONM before/after hemostasis near the VN using bipolar forceps and before/after dissection of the VN. All patients underwent laryngoscopy to assess postoperative VFP. One patient showed loss of EMG signals between V2 and V3 and developed VFP that persisted for 11 months. The other 62 patients had no loss of EMG signals, but 2 patients had confirmed VFP for 1 month after CEA. There were no changes of EMG signal before and after VN dissection or hemostasis with bipolar forceps near the VN. PMID:23341190

Tomonori, Tamaki; Minoru, Kubota; Norihiro, Saitou; Katsuya, Umeoka; Takayuki, Mizunari; Yoji, Node

2012-09-01

272

Laryngeal transplantation in minipigs: early immunological outcomes  

PubMed Central

Despite recent tissue-engineering advances, there is no effective way of replacing all the functions of the larynx in those requiring laryngectomy. A recent clinical transplant was a success. Using quantitative immunofluorescence targeted at immunologically relevant molecules, we have studied the early (48 h and 1 week) immunological responses within larynxes transplantated between seven pairs of National Institutes of Health (NIH) minipigs fully homozygous at the major histocompatibility complex (MHC) locus. There were only small changes in expression of some molecules (relative to interindividual variation) and these were clearest in samples from the subglottic region, where the areas of co-expression of CD25+CD45RC-CD8- and of CD163+CD172+MHC-II- increased at 1 week after transplant. In one case, infiltration by recipient T cells was analysed by T cell receptor (TCR) V? spectratype analysis; this suggested that changes in the T cell repertoire occur in the donor subglottis mucosal tissues from day 0 to day 7, but that the donor and recipient mucosal V? repertoires remain distinct. The observed lack of strong immunological responses to the trauma of surgery and ischaemia provides encouraging evidence to support clinical trials of laryngeal transplantation, and a basis on which to interpret future studies involving mismatches. PMID:22288599

Birchall, M A; Ayling, S M; Harley, R; Murison, P J; Burt, R; Mitchard, L; Jones, A; Macchiarini, P; Stokes, C R; Bailey, M

2012-01-01

273

Immunohistochemical analysis of laryngeal muscles in normal horses and horses with subclinical recurrent laryngeal neuropathy.  

PubMed

We used immunohistochemistry to examine myosin heavy-chain (MyHC)-based fiber-type profiles of the right and left cricoarytenoideus dorsalis (CAD) and arytenoideus transversus (TrA) muscles of six horses without laryngoscopic evidence of recurrent laryngeal neuropathy (RLN). Results showed that CAD and TrA muscles have the same slow, 2a, and 2x fibers as equine limb muscles, but not the faster contracting fibers expressing extraocular and 2B MyHCs found in laryngeal muscles of small mammals. Muscles from three horses showed fiber-type grouping bilaterally in the TrA muscles, but only in the left CAD. Fiber-type grouping suggests that denervation and reinnervation of fibers had occurred, and that these horses had subclinical RLN. There was a virtual elimination of 2x fibers in these muscles, accompanied by a significant increase in the percentage of 2a and slow fibers, and hypertrophy of these fiber types. The results suggest that multiple pathophysiological mechanisms are at work in early RLN, including selective denervation and reinnervation of 2x muscle fibers, corruption of neural impulse traffic that regulates 2x and slow muscle fiber types, and compensatory hypertrophy of remaining fibers. We conclude that horses afflicted with mild RLN are able to remain subclinical by compensatory hypertrophy of surviving muscle fibers. PMID:19398607

Rhee, Hannah S; Steel, Catherine M; Derksen, Frederik J; Robinson, N Edward; Hoh, Joseph F Y

2009-08-01

274

Immunohistochemical Analysis of Laryngeal Muscles in Normal Horses and Horses With Subclinical Recurrent Laryngeal Neuropathy  

PubMed Central

We used immunohistochemistry to examine myosin heavy-chain (MyHC)-based fiber-type profiles of the right and left cricoarytenoideus dorsalis (CAD) and arytenoideus transversus (TrA) muscles of six horses without laryngoscopic evidence of recurrent laryngeal neuropathy (RLN). Results showed that CAD and TrA muscles have the same slow, 2a, and 2x fibers as equine limb muscles, but not the faster contracting fibers expressing extraocular and 2B MyHCs found in laryngeal muscles of small mammals. Muscles from three horses showed fiber-type grouping bilaterally in the TrA muscles, but only in the left CAD. Fiber-type grouping suggests that denervation and reinnervation of fibers had occurred, and that these horses had subclinical RLN. There was a virtual elimination of 2x fibers in these muscles, accompanied by a significant increase in the percentage of 2a and slow fibers, and hypertrophy of these fiber types. The results suggest that multiple pathophysiological mechanisms are at work in early RLN, including selective denervation and reinnervation of 2x muscle fibers, corruption of neural impulse traffic that regulates 2x and slow muscle fiber types, and compensatory hypertrophy of remaining fibers. We conclude that horses afflicted with mild RLN are able to remain subclinical by compensatory hypertrophy of surviving muscle fibers. (J Histochem Cytochem 57:787–800, 2009) PMID:19398607

Rhee, Hannah S.; Steel, Catherine M.; Derksen, Frederik J.; Robinson, N. Edward; Hoh, Joseph F.Y.

2009-01-01

275

[Total laryngectomy using a linear stapler for laryngeal cancer].  

PubMed

Total laryngectomy is a well established method for the treatment of laryngeal cancer. In some cases such as elderly patients or patients with severe complications, a shorter surgical time is preferred. Total laryngectomy using a linear stapler is reportedly advantageous for shortening of the surgical time and for lowering the rate of pharyngeal fistula formation. We applied this surgical technique in three laryngeal cancer cases. After skeletonization of the larynx, the linear stapler is inserted between the larynx and the pharyngeal mucosa. Excision of the larynx and suturing of the pharyngeal mucosa are performed simultaneously. Although the number of cases is small for statistical analysis, the surgical time was shortened by about 30 minutes compared to laryngectomy with manual suturing. Total laryngectomy by linear stapler cannot be applied in all cases of advanced laryngeal cancer. However, if the tumor is confined to the endolarynx, it is a useful tool for some cases that require a shorter surgical time. PMID:25102741

Tomifuji, Masayuki; Araki, Koji; Kamide, Daisuke; Tanaka, Shingo; Tanaka, Yuya; Fukumori, Takayuki; Shiotani, Akihiro

2014-06-01

276

Successful application of preimplantation genetic diagnosis for hypokalaemic periodic paralysis.  

PubMed

Hypokalaemic periodic paralysis is a rare dominant inherited disease where a person suffers sudden falls of circulating potassium concentrations, producing muscle weakness and sometimes severe paralysis. Attacks can occur as frequently as several times a day or once in a year. The age of onset is usually adolescence but symptoms can appear as early as 10 years of age. Muscle weakness can compromise vital functions such as breathing or swallowing and heart arrhythmias are also frequent during attacks. Preimplantation genetic diagnosis, an early form of prenatal diagnosis for couples at risk of transmitting inherited diseases, was used to prevent the transmission of this disease. Six polymorphic short tandem repeat or microsatellite markers (STR) closely linked to the CACNA1S gene were tested. Three fully informative markers were chosen to establish the disease-bearing haplotype in the family and to determine the genetic status of five embryos by multiplex fluorescent heminested PCR. Four of the five embryos tested were diagnosed as non-affected and one as affected. Two embryos were transferred resulting in a singleton pregnancy and the birth of a healthy girl. PMID:20541469

Alberola, Trinitat M; Vendrell, Xavier; Bautista-Llácer, Rosa; Vila, Maria; Calatayud, Carmen; Pérez-Alonso, Manuel

2010-08-01

277

Adenovirus isolation rates in acute flaccid paralysis patients.  

PubMed

Adenoviruses usually cause asymptomatic or mild infection, but occasionally they produce various severe syndromes including neurological disorders. Association of adenovirus infection with acute flaccid paralysis has been investigated. Shedding of adenovirus with feces was detected in 1.05% of young children (mostly infants) with acute flaccid paralysis syndrome versus 0.42% in healthy contact children (P?

Ivanova, Olga E; Yurashko, Olga V; Eremeeva, Tatiana P; Baikova, Olga Yu; Morozova, Nadezhda S; Lukashev, Alexander N

2012-01-01

278

[A new type of periodic paralysis: Andersen-Tawil syndrome].  

PubMed

Andersen-Tawil syndrome includes a clinical triad consisting of periodic paralysis, cardiac arrhythmia, and usually mild but diagnostically useful dysmorphic features. This potassium channelopathy is due to mutation of the KCNJ2 gene encoding the protein Kir 2.1. The main muscular manifestation is periodic paralysis, usually of the hypokalemic type. Muscle biopsy may reveal tubular aggregates or be normal, as in our patient. Cardiac manifestations are variable and may include a long QT syndrome, premature ventricular contractions, complex ventricular ectopy, and polymorphic or bidirectional ventricular tachycardia. Imipramine therapy had a positive effect on arrhythmia in our patient. Dysmorphic features provide a diagnostic clue but may be difficult to identify and should thus be methodically sought. Clinical expression is variable, even within the same family. Since the culprit gene KCNJ2 was identified, locus heterogeneity has been shown in Andersen-Tawil syndrome. Kindreds without KCNJ2 mutations are clinically indistinguishable from those with mutations. Kir2.1 is an inward rectifier K+ channel with important roles in maintaining membrane potential and during the terminal phase of cardiac action potential repolarization. Several studies show a dominant negative effect of KCNJ2 mutation on Kir 2.1 channel function. PMID:19445372

Pouget, Jean

2008-11-01

279

Individual differences in lateralisation of hallucinations associated with sleep paralysis.  

PubMed

Individual differences were investigated in the lateralisation of two general categories of hypnagogic and hypnopompic hallucinations associated with sleep paralysis: (1) Vestibular-motor (V-M) hallucinations; comprising sensations of floating, flying, illusory locomotion and postural adjustments, out-of-body experiences (OBE), and autoscopy; and (2) Intruder hallucinations; incorporating a sense of the presence, and visual and auditory hallucinations of external, alien agents. Left-right lateralisation of such hallucinations, as well as handedness and footedness, were assessed in a diverse, nonclinical sample of 201 subjects participating in a web-based survey of sleep paralysis experiences. V-M hallucinations, but not Intruder hallucinations were predicted, based on the hypothesised distinctive neural sources of the different hallucinations, to be positively associated with handedness and footedness. Specifically, the predictions were based on the hypothesis that the activation of components of a vestibular, motor, and kinaesthetic bodily-self neuromatrix underlies V-M hallucinations, whereas a threat-activated vigilance system is responsible for Intruder hallucinations. As predicted, limb preferences were consistently found to be significantly and positively associated with a side bias of V-M, but not Intruder, hallucinations. PMID:15382733

Girard, T A; Cheyne, J A

2004-01-01

280

Acoustic analysis of subjects with vocal cord paralysis.  

PubMed

Theoretically, there should be a close relationship between the vibratory pattern and acoustic output. The study aims at differentiating unilateral vocal cord paralysis (VCP) from normal subjects and also between right VCP and left VCP based on the acoustic analysis of the subjects voice. The study also aims at comprehensively investigating the phonatory disturbance resulting from VCP on the Indian population.Results indicate that statistically significant differences were found among the following acoustic parameters: fluctuation per sec, in fimdamental frequency (fo), fluctuation per sec, in amplitude, extent of fluctuation in fo, extent of fluctuation in amplitude, jitter ratio, jitter factor, shimmer. Psigma and maximum phonation duration in differentiating unilateral VCP from normal subjects. Also the acoustic parameters: fluctuation per sec, info, extent of fluctuation in fo and Psigma could statistically differentiate between right VCP and left VCP. It can be concluded that the above parameters can be successfully used for diagnosing VCP and also the type of VCP. This is of particular significance in difficult to visualize patients and to monitor the therapeutic outcomes of vocal rehabilitation, following unilateral vocal cord paralysis. These results need to be further clinically validated by using a larger number of subjects. PMID:23120125

Patel, R; Parsram, K S

2005-01-01

281

Bone blood flow after spinal paralysis in the rat  

SciTech Connect

The goal of this study was to investigate the acute and chronic effects of paralysis induced by spinal cord section or sciatic neurotomy on bone blood flow in the rat. Regional bone blood flow was measured in the early stage with the hydrogen washout technique and the change of whole bone blood flow was measured in the early and the late stages with the radioactive microsphere technique. Four to 6 h after cordotomy at the level of the 13th thoracic vertebra, the regional bone blood flow in the denervated tibia increased significantly (p less than 0.01). After hemicordotomy with rhizotomy at the same level, the regional bone blood flow in the denervated tibia increased significantly (p less than 0.05) 6 h postoperatively. The whole bone blood flow in the denervated tibia had also increased significantly (p less than 0.05) at 6 h and at 4 and 12 weeks postoperatively. After sciatic neurotomy, the regional and the whole bone blood flow in the paralytic tibia did not change significantly. The present study demonstrated that monoplegic paralysis caused an increase in bone blood flow in the denervated hind limb from a very early stage. It was suggested that the spinal nervous system contributed to the control of bone blood flow.

Takahashi, H.; Yamamuro, T.; Okumura, H.; Kasai, R.; Tada, K. (Kyoto Univ. (Japan))

1990-05-01

282

Optic nerve trauma.  

PubMed

Trauma to the optic nerve may be direct, such as from a penetrating object, or indirect, which may result despite lack of direct contact of an object with the nerve. Although indirect injury initially causes no change in the appearance of the nerve head, within a matter of weeks optic atrophy will be manifest. The pathophysiology of nerve damage is incompletely understood. Management is controversial; steroid therapy has been advocated, as has surgical decompression of the nerve. Indirect injuries affecting the optic nerve may also result from torsional rotation of the globe (avulsion) and from subdural or subarachnoid hemorrhage (Terson's syndrome). There is no treatment for optic nerve avulsion; the unaffected eye should be protected with appropriate eyewear. Hemorrhaging in the retina and vitreous in Terson's syndrome should be monitored for resolution and risk of retinal detachment. Computed tomography may be necessary if subarachnoid or intracranial hemorrhages are suspected. PMID:8268699

Dul, M W

1993-01-01

283

Electromyographic feedback in the treatment of bilateral facial paralysis: A case study  

Microsoft Academic Search

Electromyographic feedback in the treatment of facial paralysis has been shown to be a useful alternative to surgical procedures. In this paper we report on the partial recovery of a 7-year-old patient with congenital bilateral facial paralysis (Moebius syndrome) that had been considered untreatable by medical specialists. Biofeedback of electromyographic activity was provided together with specific instructions, social reinforcement, and

Xóchitl Gallegos; Rocío Medina; Elizabeth Espinoza; Andrés Bustamante

1992-01-01

284

Bilateral diaphragmatic paralysis and related respiratory complications in a patient with West Nile virus infection.  

PubMed

The case report is presented of a patient with West Nile virus infection and ventilator dependent respiratory failure in whom bilateral diaphragmatic paralysis developed. If the prevalence of West Nile virus infection continues to rise, recognition of diaphragmatic paralysis and related respiratory complications will become increasingly important to the pulmonary/critical care physician. PMID:14985569

Betensley, A D; Jaffery, S H; Collins, H; Sripathi, N; Alabi, F

2004-03-01

285

The relation of exogenous factors to the onset of general paralysis  

Microsoft Academic Search

The incidence of exogenous factors as precipitating causes in the production of symptoms of general paralysis has been variously estimated by several investigators. Indeed, a more elementary question, namely, whether exogenous factors actually instigate the symptomatology of general paralysis, is still under discussion. One of the most difficult problems has to do with the reason or reasons for the appearance

Leland E. Hinsie

1928-01-01

286

American Dog Tick (Dermacentor variabilis) *Transmits RMSF, tick paralysis, tularemia, ehrlichiosis  

E-print Network

: · They share the class Arachnida with spiders, mites, and scorpions. · They have a 4-stage life cycle: egg Lone Star Tick (Amblyomma americanum) *Transmits Lyme Disease, tick paralysis, tularemia, ehrlichiosis) *Transmits RMSF, tick paralysis, tularemia, ehrlichiosis Lone Star Tick (Amblyomma americanum) *Transmits

Engel, Jonathan

287

Functional Outcomes after Chemoradiotherapy of Laryngeal and Pharyngeal Cancers  

PubMed Central

Organ preservation regimens that combine chemotherapy and radiotherapy (chemoradiotherapy) are increasingly used as the primary treatment of laryngeal and pharyngeal cancers. Meta-analytic data show a survival benefit with combined modality therapy, but the functional sequelae can be significant. Dysphagia is recognized as a common and often devastating late effect of chemoradiotherapy. This review examines functional outcomes after chemoradiotherapy for laryngeal and pharyngeal cancers, with a particular emphasis on dysphagia. Topics examined include the burden of dysphagia after chemoradiation, pathophysiology of dysphagia, baseline functioning, recommendations to improve long-term function, and voice outcomes. PMID:22249533

Hutcheson, Katherine A.; Lewin, Jan S.

2014-01-01

288

Experimental and numerical study of patterns in laryngeal flow  

NASA Astrophysics Data System (ADS)

Unsteady airflow is investigated in a channel with a geometry approximating that of the human larynx. The laryngeal flow is simulated by solving the Navier-Stokes equations for an incompressible two-dimensional viscous fluid, and visualized using the Schlieren technique in an experimental setup consisting of a rigid replica of the larynx, with and without ventricular bands. This study shows the spontaneous formation of vortex couples in several regions of the laryngeal profile, and at different stages of the evolution of the starting glottal jet.

Chisari, N. E.; Artana, G.; Sciamarella, D.

2009-05-01

289

Thyrotoxic hypokalemic periodic paralysis as the presenting symptom of silent thyroiditis  

PubMed Central

Silent thyroiditis is a rare cause of thyrotoxic periodic paralysis. The objective was to present a case of silent thyroiditis presenting as periodic paralysis. A 23-year-old man presented with recurrent acute flaccid predominantly proximal weakness of all four limbs. He had a similar episode 3 weeks back. On examination he was found to have hypokalemia secondary to thyrotoxicosis. Clinically there were no features of thyrotoxicosis or thyroiditis. He was initially treated with intravenous and later oral potassium supplementation and propranolol. At 8 weeks of follow-up his thyroid profile became normal and his propranolol was stopped. He had no further recurrence of paralysis. He was diagnosed as a case silent thyroiditis presenting as thyrotoxic periodic paralysis. In cases of recurrent or acute flaccid muscle paralysis, it is important to suspect thyrotoxicosis, even if asymptomatic. Definitive treatment of thyrotoxicosis prevents recurrence. PMID:23956568

Sanyal, Debmalya; Bhattacharjee, Shakya

2013-01-01

290

The Furcal Nerve Revisited  

PubMed Central

Atypical sciatica and discrepancy between clinical presentation and imaging findings is a dilemma for treating surgeon in management of lumbar disc herniation. It also constitutes ground for failed back surgery and potential litigations thereof. Furcal nerve (Furcal = forked) is an independent nerve with its own ventral and dorsal branches (rootlets) and forms a link nerve that connects lumbar and sacral plexus. Its fibers branch out to be part of femoral and obturator nerves in-addition to the lumbosacral trunk. It is most commonly found at L4 level and is the most common cause of atypical presentation of radiculopathy/sciatica. Very little is published about the furcal nerve and many are unaware of its existence. This article summarizes all the existing evidence about furcal nerve in English literature in an attempt to create awareness and offer insight about this unique entity to fellow colleagues/professionals involved in spine care.

Dabke, Harshad V.

2014-01-01

291

Nerve and Blood Vessels  

Microsoft Academic Search

From the histologic point of view, nerves are round or flattened cords, with a complex internal structure made of myelinated\\u000a and unmyelinated nerve fibers, containing axons and Schwann cells grouped in fascicles (Fig. 4.1a) (Erickson 1997). Along the course of the nerve, fibers can traverse from one fascicle to another and fascicles can split and merge. Based\\u000a on the fascicular

Maura Valle; Maria Pia Zamorani

292

Pneumothorax spontané secondaire post opératoire compliquant une paralysie récurrentielle  

PubMed Central

Le Pneumothorax spontané est défini par un épanchement gazeux de la grande cavité pleurale en dehors de tout traumatisme ou manipulation instrumentale. Son incidence est estimée à 28/100000 pour les hommes et 6/100000 pour les femmes. Les étiologies sont dominées par la broncho-pneumopathies chroniques et obstructives. Le tableau clinique est souvent grave d'emblé nécessitant une exsufflation à l'aiguille et/ou un drainage thoracique. Les récidives sont assez fréquentes et la mortalité reste assez élevée en comparaison avec les pneumothorax post traumatique ou les pneumothorax primaires. Nous rapportons le cas d'une patiente présentant en post opératoire un pneumothorax spontané sur un poumon métastatique et compliquant une paralysie récurrentielle. PMID:25419334

Joulali, Toufik; Derkaou, Ali; Shimi, Abdelkarim; Khatouf, Mohammed

2014-01-01

293

Acute flaccid paralysis in a patient with sacral dimple  

PubMed Central

Sacral dimples are the most common cutaneous anomaly detected during neonatal spinal examination. Congenital dermal sinus tract, a rare type of spinal dysraphism, occurs along the midline neuraxis from occiput down to the sacral region. It is often diagnosed in the presence of a sacral dimple together with skin signs, local infection, meningitis, abscess, or abnormal neurological examination. We report a case of acute flaccid paralysis with sensory level in a 4 mo old female infant with sacral dimple, diagnosed by magnetic resonance imaging to be a paraspinal subdural abscess. Surgical exploration revealed a congenital dermal sinus tract extending from the subdural abscess down to the sacral dimple and open to the exterior with a minute opening.

Mostafa, Mohammed; Nasef, Nehad; Barakat, Tarik; El-Hawary, Amany K; Abdel-Hady, Hesham

2013-01-01

294

Free skin flap reconstruction after partial hypopharyngectomy with laryngeal preservation.  

PubMed

Abstract Surgical resection of hypopharyngeal cancer often affects laryngeal function. The aim of this study is to assess the reliability and efficacy of free skin flap transfer after partial hypopharyngectomy with laryngeal preservation. This study designs a retrospective analysis. The subjects were 54 patients who underwent free skin flap reconstruction immediately after partial pharyngolaryngectomy or hypopharyngectomy with laryngeal preservation. The defects were classified into four types based on the location of the hypopharyngeal defect. Functional results were evaluated by routine physical examination findings and parameters related to swallowing function and X-ray barium deglutition examination. Perioperative mortalities and morbidities were reviewed. There were no perioperative mortalities and 98% of the flaps survived. Forty-three patients (80%) were able to eat an unrestricted diet and experienced no aspiration. Restriction of the diet was significantly associated with the extent of oesophageal mucosal resection. In conclusion, free skin flap reconstruction is confirmed to be a safe and effective strategy to maintain laryngeal function and good quality-of-life. PMID:24443773

Ishida, Katsuhiro; Kato, Takakuni; Seino, Youichi; Uchida, Mitsuru

2014-10-01

295

Laryngeal Muscles Are Spared in the Dystrophin Deficient "mdx" Mouse  

ERIC Educational Resources Information Center

Purpose: "Duchenne muscular dystrophy (DMD)" is caused by the loss of the cytoskeletal protein, dystrophin. The disease leads to severe and progressive skeletal muscle wasting. Interestingly, the disease spares some muscles. The purpose of the study was to determine the effects of dystrophin deficiency on 2 intrinsic laryngeal muscles, the…

Thomas, Lisa B.; Joseph, Gayle L.; Adkins, Tracey D.; Andrade, Francisco H.; Stemple, Joseph C.

2008-01-01

296

Observation of the laryngeal movements for throat singing  

NASA Astrophysics Data System (ADS)

Throat singing is a traditional singing style of people who live around the Altai Mountains. Khoomei in Tyva and Khoomij in Mongolia are representative styles of throat singing. The laryngeal voices of throat singing is classified into (i) a drone voice which is the basic laryngeal voice in throat singing and used as drone and (ii) a kargyraa voice which is very low pitched with the range outside the modal register. In throat singing, the special features of the laryngeal movements are observed by using simultaneous recording of high-speed digital images, EGG, and sound wave forms. In the drone voice, the ventricular folds (VTFs) vibrate in the same frequency as the vocal folds (VFs) but in opposite phases. In the kargyraa voice, the VTFs can be assumed to close once for every two periods of closure of the VFs, and this closing blocks airflow and contributes to the generation of the subharmonic tone of kargyraa. Results show that in throat singing the VTFs vibrate and contribute to producing the laryngeal voice, which generates the special timbre and whistle-like overtone.

Sakakibara, Ken-Ichi; Konishi, Tomoko; Murano, Emi Z.; Imagawa, Hiroshi; Kumada, Masanobu; Kondo, Kazumasa; Niimi, Seiji

2002-11-01

297

Severe upper airway obstruction caused by ulcerative laryngitis  

PubMed Central

AIMS—To present our experience of severe upper airway obstruction caused by ulcerative laryngitis in children.?METHODS—Retrospective case note review of 263 children with severe upper airway obstruction and a clinical diagnosis of croup admitted to a paediatric intensive care unit (PICU) over a five year period.?RESULTS—A total of 148 children (56%) underwent microlaryngoscopy (Storz 3.0 rigid telescope). Laryngeal ulceration with oedema was documented in 15 of these children (10%), median age 14 months (range 10-36) and median weight 10 kg (range 6-12). Twenty seven of the children who underwent microlaryngoscopy (18%) also had ulcerative gingivostomatitis consistent with herpes simplex virus infection. Ulcerative laryngitis was documented in nine of 27(33%) children with, and in six of 121 (5%) children without, coexistent ulcerative gingivostomatitis. One of the 15 children did not require airway intervention. Nine children required nasotracheal intubation for a median of 4 days (range 3-11) and median PICU stay of 6 days (range 4-14). Five children required tracheostomy ab initio, with a median PICU stay of 30 days (range 20-36), and duration of tracheostomy in situ for a median of 19 days (range 15-253). All 15 children survived.?CONCLUSION—Ulcerative laryngitis is more common in our patient population than the few reports suggest. Early diagnostic microlaryngoscopy is recommended in children with severe croup who follow an atypical course.?? PMID:11567944

Hatherill, M; Reynolds, L; Waggie, Z; Argent, A

2001-01-01

298

Well and intermediate differentiated laryngeal chondrosarcoma: toward conservative surgery?  

PubMed

Chondrosarcoma of the larynx is a relatively rare malignant tumor. In the world literature, only 600 cases of laryngeal chondrosarcoma (LCS) have been reported. It is the most frequent non-epithelial tumor of the larynx (0.07-2% of all cancers), usually occurring on the cricoid. We present six cases of well-intermediate differentiated grade chondrosarcoma of the larynx, diagnosed between the fifth and seventh decades of life, in the absence of relevant risk factors. All cases were subjected to a conservative surgical approach, either endoscopic using remodeling transoral laser surgery, or open neck via a supratracheal partial laryngectomy (STL), sparing laryngeal function. All patients are free from recurrence with a minimum follow-up of 31 months. All were ultimately decannulated, are able to tolerate a quite normal diet and to speak satisfactorily. Conservative laryngeal surgery is effective because chondrosarcoma is often a low-grade tumor showing slow growth. The criteria for choosing the type of surgery was based on the age of the patient (elderly patient > favoring an endoscopic approach), on the rate of involvement of the cricoid and on the involvement of the cricoarytenoid joints (if possible to save a cricoarytenoid unit > favoring a STL). By extending the inferior limit of the resection to include a large part of the cricoid cartilage, supratracheal partial laryngectomies expanded the indications to some LCSs not involving the entire cricoid lamina sparing laryngeal function and avoiding the need for total laryngectomy. PMID:23974330

Damiani, Valerio; Crosetti, Erika; Rizzotto, Giuseppe; Camaioni, Angelo; Succo, Giovanni

2014-02-01

299

RESEARCH ARTICLE Laryngeal somatosensory deficits in Parkinson's disease  

E-print Network

RESEARCH ARTICLE Laryngeal somatosensory deficits in Parkinson's disease: implications for speech October 2009 / Published online: 15 December 2009 Ã? Springer-Verlag 2009 Abstract Parkinson's disease (PD somatosensory function, speech, and voice in a neurolog- ical disease such as Parkinson's disease (PD) has

Sprott, Julien Clinton

300

Laryngeal Mask Airway Position and the Risk of Gastric Insufflation  

Microsoft Academic Search

A potential risk of the laryngeal mask airway (LMA) is an incomplete mask seal causing gastric insufflation or oropharyngeal air leakage. The objective of the present study was to assess the incidence of LMA mal- positions by fiberoptic laryngoscopy, and to determine their influence on gastric insufflation and oropharyn- geal air leakage. One hundred eight patients were studied after the

Federico Latorre; Balthasar Eberle; Norbert Weiler; Rolf Mienert; Ales Stanek; Rainer Goedecke; Wolfgang Heinrichs

1998-01-01

301

Laryngeal Aerodynamics Associated with Oral Contraceptive Use: Preliminary Findings  

ERIC Educational Resources Information Center

The purpose of this study was to examine possible differences in laryngeal aerodynamic measures during connected speech associated with oral contraceptive (OC) use. Eight women taking an OC, and eight others not taking an OC, participated in the study. Three trials of syllable /p[subscript alpha] /repetitions were obtained using a…

Gorham-Rowan, Mary; Fowler, Linda

2009-01-01

302

Anaesthesia for treacher collins syndrome using a laryngeal mask airway  

Microsoft Academic Search

Patients with Treacher Collins syndrome pose a serious problem to anaesthetists in maintaining their airway because of retrognathia.\\u000a Two patients with Treacher Collins syndrome undergoing tympanoplasty are reported in whom a laryngeal mask was used in place\\u000a of an endotracheal tube for airway maintenance.

Toshiya Ebata; Shunichi Nishiki; Akio Masuda; Keisuke Amaha

1991-01-01

303

The evolving role of the laryngeal mask airway in obstetrics  

Microsoft Academic Search

HI Sedition of the Journal contains a repor t that can be considered as astounding in tw o regards: first, that 1067 healthy women fo r elective Cesarean section were given a gene ral anesthetic (GA); and second, a laryngeal mask airwa y (LMA) was used for airway management\\/ventilation . 1 Both practices go against the mantra that obstetric ane

Roanne Preston

2001-01-01

304

Motion control of the ankle joint with a multiple contact nerve cuff electrode: a simulation study.  

PubMed

The flat interface nerve electrode (FINE) has demonstrated significant capability for fascicular and subfascicular stimulation selectivity. However, due to the inherent complexity of the neuromuscular skeletal systems and nerve-electrode interface, a trajectory tracking motion control algorithm of musculoskeletal systems for functional electrical stimulation using a multiple contact nerve cuff electrode such as FINE has not yet been developed. In our previous study, a control system was developed for multiple-input multiple-output (MIMO) musculoskeletal systems with little prior knowledge of the system. In this study, more realistic computational ankle/subtalar joint model including a finite element model of the sciatic nerve was developed. The control system was tested to control the motion of ankle/subtalar joint angles by modulating the pulse amplitude of each contact of a FINE placed on the sciatic nerve. The simulation results showed that the control strategy based on the separation of steady state and dynamic properties of the system resulted in small output tracking errors for different reference trajectories such as sinusoidal and filtered random signals. The proposed control method also demonstrated robustness against external disturbances and system parameter variations such as muscle fatigue. These simulation results under various circumstances indicate that it is possible to take advantage of multiple contact nerve electrodes with spatial selectivity for the control of limb motion by peripheral nerve stimulation even with limited individual muscle selectivity. This technology could be useful to restore neural function in patients with paralysis. PMID:24939581

Park, Hyun-Joo; Durand, Dominique M

2014-08-01

305

Major peripheral nerve injuries.  

PubMed

Major peripheral nerve injuries in the upper extremities can result in significant morbidity. Understanding the pathophysiology of these injuries aids in the assessment and planning of appropriate treatment. With limited nerve mobilization, tension-free repairs can often be performed using sutures, fibrin glue, or nerve connectors. Acellular allograft and autograft reconstruction are better for bridging any gaps greater than a few millimeters. Adherence to proper principles of nerve repair improves the chances of achieving a favorable result, although in general these injuries portend a guarded prognosis. PMID:23895717

Isaacs, Jonathan

2013-08-01

306

Electromyographic endotracheal tube placement during thyroid surgery in neuromonitoring of recurrent laryngeal nerve  

Microsoft Academic Search

Intraoperative neuromonitoring (IONM) is widely used in thyroid surgery. This study aimed to investigate the influence of neck extension on electromyographic (EMG) endotracheal tube displacement and to determine the necessity of routinely checking the final electrode position after the patient had been fully positioned. A consecutive 220 patients undergoing thyroidectomy were enrolled. All patients were intubated with the EMG endotracheal

Cheng-Jing Tsai; Kuang-Yi Tseng; Fu-Yuan Wang; I-Cheng Lu; Hsun-Mo Wang; Che-Wei Wu; Hui-Ching Chiang; Feng-Yu Chiang

2011-01-01

307

Recurrent Laryngeal Nerve Damage and Phonetic Modifications after Total Thyroidectomy: Surgical Malpractice Only or Predictable Sequence?  

Microsoft Academic Search

Modifications of phonation occurring after total thyroidectomy (TT) are usually attributed to surgical malpractice, but other causes of voice impairment even in nonoperated subjects should also be taken into account. This study analyzes 208 patients who underwent TT from January 1, 1999 through December 31, 2001. Follow-up ended on December 31, 2003. Only cases in which the surgeon ruled out

Lodovico Rosato; Maria Teresa Carlevato; Giorgio De Toma; Nicola Avenia

2005-01-01

308

Clinical and biochemical spectrum of hypokalemic paralysis in North: East India  

PubMed Central

Background: Acute hypokalemic paralysis, characterized by acute flaccid paralysis is primarily a calcium channelopathy, but secondary causes like renal tubular acidosis (RTA), thyrotoxic periodic paralysis (TPP), primary hyperaldosteronism, Gitelman’s syndrome are also frequent. Objective: To study the etiology, varied presentations, and outcome after therapy of patients with hypokalemic paralysis. Materials And Methods: All patients who presented with acute flaccid paralysis with hypokalemia from October 2009 to September 2011 were included in the study. A detailed physical examination and laboratory tests including serum electrolytes, serum creatine phosphokinase (CPK), urine analysis, arterial blood gas analysis, thyroid hormones estimation, and electrocardiogram were carried out. Patients were further investigated for any secondary causes and treated with potassium supplementation. Result: The study included 56 patients aged 15-92 years (mean 36.76 ± 13.72), including 15 female patients. Twenty-four patients had hypokalemic paralysis due to secondary cause, which included 4 with distal RTA, 4 with Gitelman syndrome, 3 with TPP, 2 each with hypothyroidism, gastroenteritis, and Liddle’s syndrome, 1 primary hyperaldosteronism, 3 with alcoholism, and 1 with dengue fever. Two female patients were antinuclear antibody-positive. Eleven patient had atypical presentation (neck muscle weakness in 4, bladder involvement in 3, 1 each with finger drop and foot drop, tetany in 1, and calf hypertrophy in 1), and 2 patient had respiratory paralysis. Five patients had positive family history of similar illness. All patients improved dramatically with potassium supplementation. Conclusion: A high percentage (42.9%) of secondary cause for hypokalemic paralysis warrants that the underlying cause must be adequately addressed to prevent the persistence or recurrence of paralysis. PMID:23956566

Kayal, Ashok K.; Goswami, Munindra; Das, Marami; Jain, Rahul

2013-01-01

309

Phonation threshold pressure and flow in excised human larynges  

PubMed Central

Objectives/Hypothesis 1. To determine the phonation threshold pressure (PTP) and phonation threshold flow (PTF) in excised human larynges. 2. To determine the effects of posterior glottal width, glottal area, and gender on PTP and PTF. 3. To test the hypothesis that hysteresis is present in excised human laryngeal phonation. 4. To compare these results to those from canine experiments and human subject measurements. Study Design Induced phonation of excised human larynges in the laboratory. Methods Nine human larynges were harvested within 24 hours post-mortem. PTP and PTF at phonation onset and offset were measured on a bench apparatus. The effects of posterior glottal width, glottal area, and gender were examined. Results Large inter-subject variability was observed in PTP and PTF. PTP was comparable to those measured in vivo, whereas PTF was substantially higher. One-way ANOVA showed no significant dependence of PTP and PTF on posterior glottal width. Hysteresis was observed, with offset PTP and PTF lower than onset values. Offset measurements had significantly less variability than onset measurements (P = 0.012 for PTP, P = 0.0001 for PTF). Conclusions This study is one of the first to report onset and offset PTP and PTF in fresh excised human larynges. The high PTF observed likely reflects a large DC flow component due to vocal fold bowing. Offset PTP and PTF values may be intrinsically more reliably measured than onset values. The large inter-subject variability in PTP and PTF may have implication for the clinical application of these aerodynamic parameters of phonation. Level of Evidence N/A (Laboratory study). PMID:21792964

Mau, Ted; Muhlestein, Joseph; Callahan, Sean; Weinheimer, Kent T.; Chan, Roger W.

2011-01-01

310

A comparison of the Soft Seal disposable and the Classic re-usable laryngeal mask airway.  

PubMed

Many new supraglottic airway devices have been recently introduced, their development motivated by the need for a single-use equivalent to the original re-usable laryngeal mask airway. We performed a randomised cross-over study in spontaneously breathing patients comparing the re-usable Laryngeal Mask Airway-Classic (LMA) and the disposable Soft Seal Laryngeal Mask in sizes 3, 4 and 5. Sixty patients had an LMA and a disposable laryngeal mask placed in random order. The primary outcome was first attempt insertion success rate. Ease of insertion was similar in both groups and there was no difference in first attempt success rates (96% with LMA and 92% with disposable laryngeal mask). The disposable laryngeal mask required significantly less air to inflate the cuff to produce a seal (10 [10-25] ml with disposable laryngeal mask and 15 [10-30] ml with laryngeal mask) and the cuff pressure produced was significantly lower (35 [20-80] cmH(2)O with disposable laryngeal mask and 75 [20-120] cmH(2)O with LMA). Data are median and range. We conclude that the disposable laryngeal mask is an acceptable alternative to the re-usable LMA. PMID:16430570

Shafik, M T; Bahlman, B U; Hall, J E; Ali, M S

2006-02-01

311

A comparison of the disposable Ambu AuraOnce Laryngeal Mask with the reusable LMA Classic laryngeal mask airway.  

PubMed

Single-use supraglottic airway devices are now available and are intended to be comparable with the reusable LMA Classic laryngeal mask airway. We performed a randomised cross-over study comparing the Ambu AuraOnce Laryngeal Mask with the LMA Classic. Fifty patients participated in the trial. Success rates for insertion at the first attempt were similar (92% with the Ambu and 84% with the LMA Classic; p = 0.22). The volumes of air required to inflate the cuff to produce a seal were similar, but the cuff pressure was lower for the Ambu Laryngeal Mask (median (IQR [range]) 18 (10-31 [0-100] cmH(2)O) than the LMA Classic 27 (17-50 [4-90] cmH(2)O; p = 0.007). Visual analogue scores for ease of insertion were 87 (73-93 [26-97]) mm for the Ambu and 84 (60-89 [18-96]) for the LMA Classic (p = 0.017). Complications were similar in both groups. We suggest that the disposable Ambu Laryngeal Mask is an acceptable alternative to the reusable LMA Classic. PMID:17567349

Sudhir, G; Redfern, D; Hall, J E; Wilkes, A R; Cann, C

2007-07-01

312

The Size 1?? ProSeal??? Laryngeal Mask Airway in Infants: A Randomized, Crossover Investigation with the Classic??? Laryngeal Mask Airway  

Microsoft Academic Search

Many problems with the Classic™ laryngeal mask air- way (CLMA) in infants are believed to be related to its inadequate cuff design. One of the main limitations of the CLMA is that the resulting low-pressure seal can be inadequate for positive pressure ventilation (PPV). The ProSeal™ LMA (PLMA), a new laryngeal mask airway with a modified cuff, has been shown

Kai Goldmann; Christine Roettger; Hinnerk Wulf

2006-01-01

313

Comparison of the laryngeal mask (LMA™) and laryngeal tube (LT®) with the new perilaryngeal airway (CobraPLA®) in short surgical procedures  

Microsoft Academic Search

Summary Background and objective: We compared the laryngeal mask airway (LMA™) and the laryngeal tube (LT®) with the newly introduced perilaryngeal airway (CobraPLA®, PLA) with regard to haemodynamic responses induced by airway insertion, clinical performance and occurrence of postoperative sore throat after short surgical procedures. Methods: After premedication, 90 ASA I-II patients awaiting short surgical procedures were randomized to receive,

A. Turan; G. Kaya; O. Koyuncu; B. Karamanlioglu; Z. Pamukçu

2006-01-01

314

A comparison of the clinical use of the Laryngeal Tube S ? and the ProSeal ? Laryngeal Mask Airway by first-month anaesthesia residents in anaesthetised patients  

Microsoft Academic Search

Summary The Laryngeal Tube STM and the LMA-ProSealare supraglottic instruments with an improved airway seal and a drainage tube to protect against regurgitation and to facilitate passage of a gastric tube. We compared the feasibility of these two instruments in a randomised, controlled clinical trial. One hundred and sixty patients were randomly allocated to undergo insertion of a Laryngeal Tube

N. S. Klaver; K. Kuizenga; A. Ballast; V. Fidler

2007-01-01

315

Sleep paralysis in medieval Persia - the Hidayat of Akhawayni (?-983 AD)  

PubMed Central

Among the first three manuscripts written in Persian, Akhawayni’s Hidayat al-muta’allemin fi al-tibb was the most significant work compiled in the 10th century. Along with the hundreds of chapters on hygiene, anatomy, physiology, symptoms and treatments of the diseases of various organs, there is a chapter on sleep paralysis (night-mare) prior to description and treatment of epilepsy. The present article is a review of the Akhawayni’s teachings on sleep paralysis and of descriptions and treatments of sleep paralysis by the Greek, medieval, and Renaissance scholars. Akhawayni’s descriptions along with other early writings provide insight into sleep paralysis during the Middle Ages in general and in Persia in particular. PMID:22701323

Golzari, Samad EJ; Khodadoust, Kazem; Alakbarli, Farid; Ghabili, Kamyar; Islambulchilar, Ziba; Shoja, Mohammadali M; Khalili, Majid; Abbasnejad, Feridoon; Sheikholeslamzadeh, Niloufar; Shahabi, Nasrollah Moghaddam; Hosseini, Seyed Fazel; Ansarin, Khalil

2012-01-01

316

Sleep paralysis in medieval Persia - the Hidayat of Akhawayni (?-983 AD).  

PubMed

Among the first three manuscripts written in Persian, Akhawayni's Hidayat al-muta'allemin fi al-tibb was the most significant work compiled in the 10th century. Along with the hundreds of chapters on hygiene, anatomy, physiology, symptoms and treatments of the diseases of various organs, there is a chapter on sleep paralysis (night-mare) prior to description and treatment of epilepsy. The present article is a review of the Akhawayni's teachings on sleep paralysis and of descriptions and treatments of sleep paralysis by the Greek, medieval, and Renaissance scholars. Akhawayni's descriptions along with other early writings provide insight into sleep paralysis during the Middle Ages in general and in Persia in particular. PMID:22701323

Golzari, Samad Ej; Khodadoust, Kazem; Alakbarli, Farid; Ghabili, Kamyar; Islambulchilar, Ziba; Shoja, Mohammadali M; Khalili, Majid; Abbasnejad, Feridoon; Sheikholeslamzadeh, Niloufar; Shahabi, Nasrollah Moghaddam; Hosseini, Seyed Fazel; Ansarin, Khalil

2012-01-01

317

Lansoprazole treatment of patients with chronic idiopathic laryngitis: a placebo-controlled trial  

Microsoft Academic Search

OBJECTIVE:Previous uncontrolled studies suggested a therapeutic benefit for treating gastroesophageal reflux disease (GERD) among patients with laryngitis. The present study is the first randomized, placebo-controlled, double-blind study of gastric acid suppression among patients with laryngitis in the United States.METHODS:Patients diagnosed with idiopathic chronic laryngitis were randomized to receive either lansoprazole 30 mg p.o. b.i.d. or a matching placebo for 3

Hashem B El-Serag; Patty Lee; Anna Buchner; John M Inadomi; Michael Gavin; Denis M McCarthy

2001-01-01

318

Positron emission tomography\\/computed tomography as a method for detection and monitoring of laryngeal chondritis  

Microsoft Academic Search

Infections of the laryngeal cartilages occur clinically as local pain, dysphonia, dysphagia or dyspnoea and may lead to destruction\\u000a of the laryngeal skeleton. We present positron emission tomography\\/computed tomography (PET–CT) as a new method for detection\\u000a and monitoring of laryngotracheal chondritis. We prospectively analyzed all patients undergoing PET–CT examination, of whom\\u000a we were clinically suspicious of laryngeal cartilage chondritis. When

Markus Gugatschka; Thomas Schwarz; Gerhard Friedrich

2008-01-01

319

[Transplantation in peripheral nerve injuries].  

PubMed

Autologous nerve grafting is the most commocommnlynly used operative technique in delayed primary, or secondary nerve repair after the peripheral nerve injuries. The aim of this procedure is to overcome nerve gaps that results from the injury itself, fibrous and elastic retraction forces, resection of the damaged parts of the nerve, position of the articulations and mobilisation of the nerve. In this study we analyse the results of operated patients with transections and lacerations of the peripheral nerves from 1979 to 2000 year. Gunshot injuries have not been analyzed in this study. The majority of the injuries were in the upper extremity (more than 87% of cases). Donor for nerve transplantation had usually been sural nerve, and only occasionally medial cutaneous nerve of the forearm was used. In about 93% of cases we used interfascicular nerve grafting, and cable nerve grafting was performed in the rest of them. Most of the grafts were 1 do 5 cm long (70% of cases). Functional recovery was achieved in more than 86% of cases, which is similar to the results of the other authors. Follow up period was minimum 2 years. We analyzed the influence of different factors on nerve recovery after the operation: patient's age, location and the extent (total or partial) of nerve injury, the length of the nerve graft, type of the nerve, timing of surgery, presence of multiple nerve injuries and associated osseal and soft tissue injuries of the upper and lower extremities. PMID:14619715

Grujici?, D; Samardzi?, M; Rasuli?, L; Savi?, D; Cvrkota, I; Simi?, V

2003-01-01

320

Time-course of motor inhibition during hypnotic paralysis: EEG topographical and source analysis.  

PubMed

Cognitive hypotheses of hypnotic phenomena have proposed that executive attentional systems may be either inhibited or overactivated to produce a selective alteration or disconnection of some mental operations. Recent brain imaging studies have reported changes in activity in both medial (anterior cingulate) and lateral (inferior) prefrontal areas during hypnotically induced paralysis, overlapping with areas associated with attentional control as well as inhibitory processes. To compare motor inhibition mechanisms responsible for paralysis during hypnosis and those recruited by voluntary inhibition, we used electroencephalography (EEG) to record brain activity during a modified bimanual Go-Nogo task, which was performed either in a normal baseline condition or during unilateral paralysis caused by hypnotic suggestion or by simulation (in two groups of participants, each tested once with both hands valid and once with unilateral paralysis). This paradigm allowed us to identify patterns of neural activity specifically associated with hypnotically induced paralysis, relative to voluntary inhibition during simulation or Nogo trials. We used a topographical EEG analysis technique to investigate both the spatial organization and the temporal sequence of neural processes activated in these different conditions, and to localize the underlying anatomical generators through minimum-norm methods. We found that preparatory activations were similar in all conditions, despite left hypnotic paralysis, indicating preserved motor intentions. A large P3-like activity was generated by voluntary inhibition during voluntary inhibition (Nogo), with neural sources in medial prefrontal areas, while hypnotic paralysis was associated with a distinctive topography activity during the same time-range and specific sources in right inferior frontal cortex. These results add support to the view that hypnosis might act by enhancing executive control systems mediated by right prefrontal areas, but does not produce paralysis via direct motor inhibition processes normally used for the voluntary suppression of actions. PMID:23211547

Cojan, Yann; Archimi, Aurélie; Cheseaux, Nicole; Waber, Lakshmi; Vuilleumier, Patrik

2013-02-01

321

Advances in nerve repair.  

PubMed

Patients with peripheral nerve injuries face unpredictable and often suboptimal functional outcome, even following standard microsurgical nerve repair. The challenge of improving such outcomes following nerve surgical procedures has interested many research teams, in both clinical and fundamental fields. Some innovative treatments are presently being applied to a widening range of patients, whereas others will require further development before translation to human subjects. This article presents several recent advances in emerging therapies at various stages of clinical application. Nerve transfers have been successfully used in clinical settings, but new indications are being described, enlarging the range of patients who might benefit from them. Brief direct nerve electrical stimulation has been shown to improve nerve regeneration and outcome in animal models and in a small cohort of patients. Further clinical trials are warranted to prove the efficacy of this exciting and easily applicable approach. Animal studies also suggest a tremendous potential for stem and precursor cell therapy. Further studies will lead to a better understanding of their mechanisms of action in nerve repair and potential applications for human patients. PMID:23250767

Khuong, Helene T; Midha, Rajiv

2013-01-01

322

[Laryngeal cancer and occupation--results of the Heidelberg laryngeal cancer study].  

PubMed

We conducted a case-control study of squamous cell carcinoma of the larynx referred to occupational factors in 164 patients compared with 656 controls adjusted for sex, age and area of residence, using a 1-to-4 matched design. Most of the cancer patients (92%) were blue collar workers. Only 8% of the cancer patients had attended technical college, college or university, compared with 31.3% of the control subjects. After adjustment for alcohol and tobacco consumption we found an increased relative risk of laryngeal cancer in subjects chronically exposed to cement dust, pine wood dust and coal-tar products. The risk associated with cement dust and coal-tar products was predominantly related to supraglottic cancer (RR = 1.88, CI = 0.8-4.3, RR = 6.11, CI = 1.7-21.6), respectively, after adjustment for tobacco and alcohol use. The risk associated with pine wood dust was related predominantly to glottic cancer (RR = 3.18, CI = 1.1-9.0) after adjustment for tobacco and alcohol use. PMID:1568886

Maier, H; Gewelke, U; Dietz, A; Thamm, H; Heller, W D; Weidauer, H

1992-02-01

323

Correlation of the Havemeyer endoscopic laryngeal grading system with histopathological changes in equine Cricoarytenoideus dorsalis muscles.  

PubMed

The establishment of a single validated endoscopic laryngeal grading system for assessing recurrent laryngeal neuropathy (RLN) is desirable to facilitate direct comparisons between the findings of different clinical and research groups worldwide. The objective of this study was to assess the relationship between the Havemeyer endoscopic laryngeal grading system and histopathological changes consistent with RLN in the left cricoarytenoideus dorsalis (CAD) muscle of horses of different breeds with a full range of clinical severities of RLN, i.e., from normal endoscopic laryngeal function to complete laryngeal hemiplegia. Endoscopic grading of laryngeal function of 22 horses was performed using the Havemeyer endoscopic laryngeal grading system. A biopsy sample of the left CAD muscle was obtained from each horse, either at post mortem examination (n = 16), or during routine laryngoplasty surgery (n = 6). A semi-quantitative histopathological scoring system was used to grade the severity of histopathological lesions consistent with RLN in the left CAD muscle of each horse. A significant positive correlation (rs = 0.705, p < 0.001) was found between the Havemeyer grades and sub-grades of laryngeal function and the semi-quantitative assessment of histopathological lesions consistent with RLN in the left CAD muscle. However, a wide spread of muscle histopathological scores was obtained, particularly from horses with Havemeyer sub-grades II.1, III.1 and III.2. In conclusion, the Havemeyer endoscopic laryngeal grading system was found to broadly correlate with histopathological changes consistent with RLN in equine cricoarytenoideus dorsalis muscle. PMID:21851734

Collins, N; Milne, E; Hahn, C; Dixon, P

2009-01-01

324

Correlation of the Havemeyer endoscopic laryngeal grading system with histopathological changes in equine Cricoarytenoideus dorsalis muscles  

PubMed Central

The establishment of a single validated endoscopic laryngeal grading system for assessing recurrent laryngeal neuropathy (RLN) is desirable to facilitate direct comparisons between the findings of different clinical and research groups worldwide. The objective of this study was to assess the relationship between the Havemeyer endoscopic laryngeal grading system and histopathological changes consistent with RLN in the left cricoarytenoideus dorsalis (CAD) muscle of horses of different breeds with a full range of clinical severities of RLN, i.e., from normal endoscopic laryngeal function to complete laryngeal hemiplegia. Endoscopic grading of laryngeal function of 22 horses was performed using the Havemeyer endoscopic laryngeal grading system. A biopsy sample of the left CAD muscle was obtained from each horse, either at post mortem examination (n = 16), or during routine laryngoplasty surgery (n = 6). A semi-quantitative histopathological scoring system was used to grade the severity of histopathological lesions consistent with RLN in the left CAD muscle of each horse. A significant positive correlation (rs = 0.705, p < 0.001) was found between the Havemeyer grades and sub-grades of laryngeal function and the semi-quantitative assessment of histopathological lesions consistent with RLN in the left CAD muscle. However, a wide spread of muscle histopathological scores was obtained, particularly from horses with Havemeyer sub-grades II.1, III.1 and III.2. In conclusion, the Havemeyer endoscopic laryngeal grading system was found to broadly correlate with histopathological changes consistent with RLN in equine cricoarytenoideus dorsalis muscle. PMID:21851734

2009-01-01

325

Anterior interosseous nerve syndrome  

PubMed Central

Objective: We sought to determine lesion sites and spatial lesion patterns in spontaneous anterior interosseous nerve syndrome (AINS) with high-resolution magnetic resonance neurography (MRN). Methods: In 20 patients with AINS and 20 age- and sex-matched controls, MRN of median nerve fascicles was performed at 3T with large longitudinal anatomical coverage (upper arm/elbow/forearm): 135 contiguous axial slices (T2-weighted: echo time/repetition time 52/7,020 ms, time of acquisition: 15 minutes 48 seconds, in-plane resolution: 0.25 × 0.25 mm). Lesion classification was performed by visual inspection and by quantitative analysis of normalized T2 signal after segmentation of median nerve voxels. Results: In all patients and no controls, T2 lesions of individual fascicles were observed within upper arm median nerve trunk and strictly followed a somatotopic/internal topography: affected were those motor fascicles that will form the anterior interosseous nerve further distally while other fascicles were spared. Predominant lesion focus was at a mean distance of 14.6 ± 5.4 cm proximal to the humeroradial joint. Discriminative power of quantitative T2 signal analysis and of qualitative lesion rating was high, with 100% sensitivity and 100% specificity (p < 0.0001). Fascicular T2 lesion patterns were rated as multifocal (n = 17), monofocal (n = 2), or indeterminate (n = 1) by 2 independent observers with strong agreement (kappa = 0.83). Conclusion: It has been difficult to prove the existence of fascicular/partial nerve lesions in spontaneous neuropathies using clinical and electrophysiologic findings. With MRN, fascicular lesions with strict somatotopic organization were observed in upper arm median nerve trunks of patients with AINS. Our data strongly support that AINS in the majority of cases is not a surgically treatable entrapment neuropathy but a multifocal mononeuropathy selectively involving, within the main trunk of the median nerve, the motor fascicles that continue distally to form the anterior interosseous nerve. PMID:24415574

Baumer, Philipp; Meinck, Hans-Michael; Schiefer, Johannes; Weiler, Markus; Bendszus, Martin; Kele, Henrich

2014-01-01

326

Glossopharyngeal Nerve Schwannoma  

PubMed Central

Complete resection with conservation of cranial nerves is the primary goal of contemporary surgery for lower cranial nerve tumors. We describe the case of a patient with a schwannoma of the left glossopharyngeal nerve, operated on in our Neurosurgical Unit. The far lateral approach combined with laminectomy of the posterior arch of C1 was done in two steps. The procedure allowed total tumor resection and was found to be better than classic unilateral suboccipital or combined supra- and infratentorial approaches. The advantages and disadvantages of the far lateral transcondylar approach, compared to the other more common approaches, are discussed. ImagesFigure 1Figure 2 PMID:17171083

Puzzilli, F.; Mastronardi, L.; Agrillo, U.; Nardi, P.

1999-01-01

327

Cardiac arrhythmias in hypokalemic periodic paralysis: Hypokalemia as only cause?  

PubMed

It is unknown how often cardiac arrhythmias occur in hypokalemic periodic paralysis (HypoPP) and if they are caused by hypokalemia alone or other factors. This systematic review shows that cardiac arrhythmias were reported in 27 HypoPP patients. Cases were confirmed genetically (13 with an R528H mutation in CACNA1S, 1 an R669H mutation in SCN4A) or had a convincing clinical diagnosis of HypoPP (13 genetically undetermined) if reported prior to the availability of genetic testing. Arrhythmias occurred during severe hypokalemia (11 patients), between attacks at normokalemia (4 patients), were treatment-dependent (2 patients), or unspecified (10 patients). Nine patients died from arrhythmia. Convincing evidence for a pro-arrhythmogenic factor other than hypokalemia is still lacking. The role of cardiac expression of defective skeletal muscle channels in the heart of HypoPP patients remains unclear. Clinicians should be aware of and prevent treatment-induced cardiac arrhythmia in HypoPP. PMID:25088161

Stunnenberg, Bas C; Deinum, Jaap; Links, Thera P; Wilde, Arthur A; Franssen, Hessel; Drost, Gea

2014-09-01

328

Pseudobulbar paralysis in the Renaissance: Cosimo I de' Medici case.  

PubMed

Cosimo I de' Medici (1519-1574) was the first Grand Duke of Tuscany. He was one of the most important members of the Medici family. He was an excellent conqueror and a good politician. Moreover, he was able to attract and encourage artists, scientists and architects to promote Florence as the cultural capital of the Italian Renaissance. Historical chronicles report that he suffered from a stroke when he was 49 years old. Together with the acute manifestation of stroke, he displayed peculiar symptoms. He had gait disturbances and sphincter dysfunctions. His language became poor and hard to understand. His mood was very fluctuating and in the last years of his life he was a short-tempered man. In addition, he had a characteristic symptom, so-called pathological laughing and crying. The course of his disease was slow and stuttering. Taken together, these data seem to be one of the first reports of pseudobulbar paralysis. The disease of Cosimo I was probably due to a chronic cerebral vasculopathy, known as small vessels disease. We discuss this hypothesis regarding an ancient clinical case, with the support of current studies. PMID:24604411

Arba, F; Inzitari, D; Lippi, D

2014-07-01

329

Assembly of Recombinant Israeli Acute Paralysis Virus Capsids  

PubMed Central

The dicistrovirus Israeli Acute Paralysis Virus (IAPV) has been implicated in the worldwide decline of honey bees. Studies of IAPV and many other bee viruses in pure culture are restricted by available isolates and permissive cell culture. Here we show that coupling the IAPV major structural precursor protein ORF2 to its cognate 3C-like processing enzyme results in processing of the precursor to the individual structural proteins in a number of insect cell lines following expression by a recombinant baculovirus. The efficiency of expression is influenced by the level of IAPV 3C protein and moderation of its activity is required for optimal expression. The mature IAPV structural proteins assembled into empty capsids that migrated as particles on sucrose velocity gradients and showed typical dicistrovirus like morphology when examined by electron microscopy. Monoclonal antibodies raised to recombinant capsids were configured into a diagnostic test specific for the presence of IAPV. Recombinant capsids for each of the many bee viruses within the picornavirus family may provide virus specific reagents for the on-going investigation of the causes of honeybee loss. PMID:25153716

Ren, Junyuan; Cone, Abigail; Willmot, Rebecca; Jones, Ian M.

2014-01-01

330

Extracellular potassium homeostasis: insights from hypokalemic periodic paralysis.  

PubMed

Extracellular potassium makes up only about 2% of the total body's potassium store. The majority of the body potassium is distributed in the intracellular space, of which about 80% is in skeletal muscle. Movement of potassium in and out of skeletal muscle thus plays a pivotal role in extracellular potassium homeostasis. The exchange of potassium between the extracellular space and skeletal muscle is mediated by specific membrane transporters. These include potassium uptake by Na(+), K(+)-adenosine triphosphatase and release by inward-rectifier K(+) channels. These processes are regulated by circulating hormones, peptides, ions, and by physical activity of muscle as well as dietary potassium intake. Pharmaceutical agents, poisons, and disease conditions also affect the exchange and alter extracellular potassium concentration. Here, we review extracellular potassium homeostasis, focusing on factors and conditions that influence the balance of potassium movement in skeletal muscle. Recent findings that mutations of a skeletal muscle-specific inward-rectifier K(+) channel cause hypokalemic periodic paralysis provide interesting insights into the role of skeletal muscle in extracellular potassium homeostasis. These recent findings are reviewed. PMID:23953801

Cheng, Chih-Jen; Kuo, Elizabeth; Huang, Chou-Long

2013-05-01

331

Acute aortic occlusion presenting with lower limb paralysis.  

PubMed

In a two year period eight patients have presented with acute aortic occlusion and a poor outcome in seven. Initial failure to diagnose aortic occlusion, with a mean delay from presentation to diagnosis of 24 hours, was mainly responsible. All patients had varying degrees of paralysis on presentation which misled clinicians although other findings of acute ischaemia (pain, absent pulses, colour change and anaesthesia) were always present. Two patients were initially referred to a neurologist, another to a neurosurgeon, and the fourth to an orthopaedic surgeon. Even after diagnosis had been established, the need for urgent revascularization was not always recognized, the mean time from diagnosis to revascularization being 13 hours. Unnecessary aortography contributed to this delay in four patients. In two patients operative treatment was not undertaken while six were treated operatively by: aortic bifurcation graft (3), aortic thromboendarterectomy and femoropopliteal bypass (1), open aortic embolectomy (1) and bilateral femoral embolectomy (1). The causes of aortic occlusion were thrombosis of an atherosclerotic aorta (5), thrombosis of an aneurysm (2) and embolism (1). In the latter patient, the heparin induced thrombocytopenia syndrome (HITS) was primarily responsible. The outcomes in the eight patients were death (5), paraplegia (1), amputation (1), and uncomplicated recovery (1). The single patient who made an uncomplicated recovery had the shortest delay from presentation to revascularization of only 2 1/4 hours. Acute aortic occlusion rivals aortic rupture as a vascular emergency and demands immediate operative intervention. PMID:1939328

Meagher, A P; Lord, R S; Graham, A R; Hill, D A

1991-01-01

332

Cyclin D1 and Cancer Development in Laryngeal Premalignancy Patients  

PubMed Central

In a previous trial, we found that combined 13-cis retinoic acid (13-cRA), interferon-? and ?-tocopherol more effectively reversed advanced premalignant lesions of the larynx than of the oral cavity and that cyclin D1 (CD1)G/A870 single nucleotide polymorphism correlated with cancer risk. We conducted the present trial primarily to confirm the clinical activity of the combination in advanced laryngeal premalignancy and to confirm and extend our findings on CD1, both genotype and protein expression, in association with cancer risk in this setting. Twenty-seven moderate-to-severe laryngeal dysplasia patients underwent induction with combined 13-cRA daily, ?-interferon twice weekly, and ?-tocopherol daily for one year; 14 non-progressing patients then were randomized to maintenance fenretinide or placebo for two years. During induction, 2 patients had pathological complete responses, 6 had partial responses (30% overall response rate), and 5 developed laryngeal cancer. There were no significant differences between maintenance fenretinide and placebo in response or cancer rates. Ten patients developed cancer overall. Twenty-four patients were evaluated for the CD1 G/A870 genotype, and 23 for pre- and post-treatment CD1 protein expression. Consistent with our earlier report, shorter cancer-free survival was associated with the CD1 AA/AG genotype (p = 0.05). Extending our earlier work, high CD1 expression was associated with worse cancer-free survival overall (p= 0.04) and within each CD1 genotype group. These findings support CD1 genotype and protein expression as important risk markers for laryngeal cancer and suggest future trials targeting upstream regulators of CD1 transcription. PMID:19139013

Papadimitrakopoulou, Vassiliki; Izzo, Julie G.; Liu, Diane D.; Myers, Jeffrey; Ceron, Tania L.; Lewin, Jan; William, William N.; Atwell, Anthea; Lee, J. Jack; Gillenwater, Ann; El-Naggar, Adel; Wu, Xifeng; Lippman, Scott M.; Hittelman, Walter N.; Hong, Waun Ki

2014-01-01

333

Development of the Laryngeal Air Sac in Chimpanzees  

Microsoft Academic Search

Though many nonhuman primates possess a laryngeal sac, the great apes are unique in their great size. Though an enlarged sac\\u000a probably arose in their common ancestor, its functional adaptations remain a matter of debate. Its development in extant great\\u000a apes is likely to provide valuable information to clarify the issue. We used magnetic resonance imaging to examine the development

Takeshi Nishimura; Akichika Mikami; Juri Suzuki; Tetsuro Matsuzawa

2007-01-01

334

ProSeal laryngeal mask airway improves oxygenation when used as a conduit prior to laryngoscope guided intubation in bariatric patients  

PubMed Central

Background: The primary objective of this study was to compare the effect of ventilation using the ProSeal™ laryngeal mask airway (PLMA) with facemask and oropharyngeal airway (FM), prior to laryngoscopy, on arterial oxygenation in morbidly obese patients undergoing bariatric surgery. Methods: Forty morbidly obese patients were randomly recruited to either PLMA or FM. After pre-oxygenation (FiO2 1.0) in the ramp position with continuous positive airway pressure of 10 cm H2O for 5 min, anaesthesia was induced. Following loss of jaw thrust oropharyngeal airway, the FM and PLMA were inserted. On achieving paralysis, volume control ventilation with PEEP (5 cm H2O) was initiated. The difficulty in mask ventilation (DMV) in FM, number of attempts at PLMA and laryngoscopy were graded (Cormack and Lehane) in all patients. Time from onset of laryngoscopy to endotracheal tube confirmation was recorded. Hypoxia was defined as mild (SpO2 ?95%), moderate (SpO2 ?90%) and severe (SpO2 ?85%). Results: Significant rise in pO2 was observed within both groups (P=0.001), and this was significantly higher in the PLMA (P=0.0001) when compared between the groups. SpO2 ? 90% (P=0.018) was seen in 19/20 (95%) patients in PLMA and 13/20 (65%) in FM at confirmation of tracheal tube. A strong association was found between DMV and Cormack Lehane in the FM group and with number of attempts in the PLMA group. No adverse events were observed. Conclusion: ProSeal™ laryngeal mask airway as conduit prior to laryngoscopy in morbidly obese patients seems effective in increasing oxygen reserves, and can be suggested as a routine airway management technique when managing the airway in the morbidly obese. PMID:23716762

Sinha, Aparna; Jayaraman, Lakshmi; Punhani, Dinesh; Panigrahi, Bishnu

2013-01-01

335

Laryngeal and vocal evaluation in untreated growth hormone deficient adults  

PubMed Central

OBJECTIVE To evaluate the consequences of lifetime, severe and untreated isolated growth hormone deficiency (IGHD) on vocal and laryngeal function. STUDY DESIGN Cross-sectional. SUBJECTS AND METHODS A total of 23 IGHD adult subjects and 22 controls were administered a questionnaire about vocal complaints and harmful voice habits, and underwent video-laryngostroboscopic examination, voice evaluation by perceptual-auditory analysis with GRBAS scale including grade of dysphonia, roughness, breathiness, asthenia and strain items, objective voice evaluation by maximum phonation time (MPT), and acoustic analysis. RESULTS There was no difference in vocal complaints between IGHD subjects and controls. Vocal abuse and smoking were more frequent in IGHD subjects. IGHD subjects presented higher values for roughness, breathiness, and strain. Laryngopharyngeal reflux (LPR) signs and laryngeal constriction were more frequent in IGHD individuals. MPT was similar in the two groups. Fundamental frequency was higher in IGHD females and males. Harmonic to noise ratio was higher in IGHD in both genders and shimmer was lower in IGHD females. CONCLUSIONS IGHD subjects have higher prevalence of signs of LPR and laryngeal constriction, with high pitch in both genders, which suggests a prominent role of IGHD on these parameters. PMID:19130959

Barreto, Valeria M.P.; D'Avila, Jeferson S.; Sales, Neuza J.; Goncalves, Maria Ines R.; Seabra, Juliane Dantas; Salvatori, Roberto; Aguiar-Oliveira, Manuel H.

2009-01-01

336

Multi-Electrode Stimulation Of Myelinated Nerve Fibers  

Microsoft Academic Search

\\u000a Patients with a central nervous system injury resulting in total or partial paralysis of extremities often have an intact\\u000a peripheral neuromuscular system. Many attempts were made to restore lost functions by artificial electrical stimulation of\\u000a the peripheral neuromuscular system. In principle, inducing muscle contraction is possible through electrical stimulation\\u000a of:\\u000a \\u000a \\u000a \\u000a \\u000a  \\u000a \\u000a the ventral roots,\\u000a \\u000a \\u000a \\u000a  \\u000a \\u000a the peripheral nerves or\\u000a \\u000a \\u000a \\u000a  

P. H. Veltink; J. A. Alsté; J. Holsheimer

337

Diabetic Nerve Problems  

MedlinePLUS

... at the wrong times. This damage is called diabetic neuropathy. Over half of people with diabetes get it. ... you change positions quickly Your doctor will diagnose diabetic neuropathy with a physical exam and nerve tests. Controlling ...

338

Lower cranial nerves.  

PubMed

Imaging evaluation of cranial neuropathies requires thorough knowledge of the anatomic, physiologic, and pathologic features of the cranial nerves, as well as detailed clinical information, which is necessary for tailoring the examinations, locating the abnormalities, and interpreting the imaging findings. This article provides clinical, anatomic, and radiological information on lower (7th to 12th) cranial nerves, along with high-resolution magnetic resonance images as a guide for optimal imaging technique, so as to improve the diagnosis of cranial neuropathy. PMID:24210311

Soldatos, Theodoros; Batra, Kiran; Blitz, Ari M; Chhabra, Avneesh

2014-02-01

339

Comparison of the standard laryngeal mask airway and the ProSeal laryngeal mask airway in obese patients  

Microsoft Academic Search

Background. The ProSeal' laryngeal mask airway (PLMA) may have advantages over the lar- yngeal mask airway (LMA†) in obese patients. We tested this hypothesis in a clinical setting. Methods. Sixty obese patients (BMI >30) were randomized to receive mechanical ventilation (tidal volume 7 ml kg-1, PEEP 10 cm H2O), through either the PLMA or the LMA. A gastric tube was

G. Natalini; M. E. Franceschetti; M. T. Pantelidi; A. Rosano; G. Lanza; A. Bernardini

2003-01-01

340

Laryngeal Squamous Cell Carcinoma (SCC) in a 12-Year-old Boy with Cutaneous Metastasis:An Unusual Presentation.  

PubMed

Laryngeal squamous cell carcinoma (SCC) in adolescents is a rare clinical entity and behaves aggressively. The mechanism of laryngeal oncogenesis is complex. Further studies need to be done to know the role that human papilloma virus plays in laryngeal SCC in adolescents.We report a rare case of laryngeal SCC in a 12-year-old boy presenting with cutaneous forehead metastasis. PMID:25177618

Reena, Sinha; Reecha, Singh; Kaushal, Kumar; Kumar, Verma Pranav; J K, Singh

2014-07-01

341

Microsurgical repair of nerve lesions with nerve grafts: the effect of nerve growth factor 7S  

Microsoft Academic Search

This study investigated the effect of local administration of nerve growth factor 7S (NGF-7S) on the axonal regrowth of mixed peripheral nerves through nerve grafts. Sixty male Wistar rats were randomized into two groups (n=30). A defect 12 mm long in the right sciatic nerve was created and repaired with a nerve autograft. NGF-7S (group A) or normal saline (group

Andreas I. Gravvanis; Efstathios G. Lykoudis; George A. Tagaris; Charalampos G. Patralexis; Apostolos E. Papalois; Petros N. Panayotou; Constantinos N. Stamatopoulos; John D. Ioannovich

2002-01-01

342

Challenges and Opportunities in Restoring Function after Paralysis  

PubMed Central

Neurotechnology has made major advances in development of interfaces to the nervous system that restore function in paralytic disorders. These advances enable both restoration of voluntary function and activation of paralyzed muscles to reanimate movement. The technologies used in each case are different, with external surface stimulation or percutaneous stimulation generally used for restoration of voluntary function, and implanted stimulators generally used for neuroprosthetic restoration. The opportunity to restore function through neuroplasticity has demonstrated significant advances in cases where there are retained neural circuits after the injury, such as spinal cord injury and stroke. In cases where there is a complete loss of voluntary neural control, neural prostheses have demonstrated the capacity to restore movement, control of the bladder and bowel, and respiration and cough. The focus of most clinical studies has been primarily toward activation of paralyzed nerves, but advances in inhibition of neural activity provides additional means of addressing the paralytic complications of pain and spasticity, and these techniques are now reaching the clinic. Future clinical advances necessitate having a better understanding of the underlying mechanisms, and having more precise neural interfaces that will ultimately allow individual nerve fibers or groups of nerve fibers to be controlled with specificity and reliability. While electrical currents have been the primary means of interfacing to the nervous system to date, optical and magnetic techniques under development are beginning to reach the clinic, and provide great opportunity. Ultimately, techniques that combine approaches are likely to be the most effective means for restoring function, for example combining regeneration and neural plasticity to maximize voluntary activity, combined with neural prostheses to augment the voluntary activity to functional levels of performance. It is a substantial challenge to bring any of these techniques through clinical trials, but as each of the individual techniques is sufficiently developed to reach the clinic, these present great opportunities for enabling patients with paralytic disorders to achieve substantial independence and restore their quality of life. PMID:23481680

Peckham, P. Hunter; Kilgore, Kevin L.

2014-01-01

343

Ponto-medullary nuclei involved in the generation of sequential pharyngeal swallowing and concomitant protective laryngeal adduction in situ.  

PubMed

Both swallowing and respiration involve postinspiratory laryngeal adduction. Swallowing-related postinspiratory neurons are likely to be located in the nucleus of the solitary tract (NTS) and those involved in respiration are found in the Kölliker-Fuse nucleus (KF). The function of KF and NTS in the generation of swallowing and its coordination with respiration was investigated in perfused brainstem preparations of juvenile rats (n = 41). Orally injected water evoked sequential pharyngeal swallowing (s-PSW) seen as phasic, spindle-shaped bursting of vagal nerve activity (VNA) against tonic postinspiratory discharge. KF inhibition by microinjecting isoguvacine (GABAA receptor agonist) selectively attenuated tonic postinspiratory VNA (n = 10, P < 0.001) but had no effect on frequency or timing of s-PSW. KF disinhibition after bicuculline (GABAA receptor antagonist) microinjections caused an increase of the tonic VNA (n = 8, P < 0.01) resulting in obscured and delayed phasic s-PSW. Occurrence of spontaneous PSW significantly increased after KF inhibition (P < 0.0001) but not after KF disinhibition (P = 0.14). NTS isoguvacine microinjections attenuated the occurrence of all PSW (n = 5, P < 0.01). NTS bicuculline microinjections (n = 6) resulted in spontaneous activation of a disordered PSW pattern and long-lasting suppression of respiratory activity. Pharmacological manipulation of either KF or NTS also triggered profound changes in respiratory postinspiratory VNA. Our results indicate that the s-PSW comprises two functionally distinct components. While the primary s-PSW is generated within the NTS, a KF-mediated laryngeal adductor reflex safeguards the lower airways from aspiration. Synaptic interaction between KF and NTS is required for s-PSW coordination with respiration as well as for proper gating and timing of s-PSW. PMID:24639482

Bautista, Tara G; Dutschmann, Mathias

2014-06-15

344

ProSeal(TM) laryngeal mask airway cuff pressure changes with and without use of nitrous oxide during laparoscopic surgery  

PubMed Central

Background: The ProSeal™ laryngeal mask (PLMA) is increasingly being used as an airway device for laparoscopic surgery. Its silicone cuff allows diffusion of nitrous oxide, carbon dioxide and other gases with resultant rise in its intracuff pressure during anesthesia. The present study was designed to investigate the intracuff pressure changes during anesthesia with and without nitrous oxide in patients undergoing laparoscopic surgery lasting up to two hours. Materials and Methods: One hundred patients, American Society of Anesthesiologists physical status 2 and 3, undergoing general anesthesia with muscle paralysis, were randomized into two groups of 50 patients each to receive an anesthetic gas mixture containing either oxygen and nitrous oxide (group N) or oxygen and air (group A). Following insertion of an appropriate size PLMA, its cuff was inflated with air to an intracuff pressure of 45 mm Hg. The cuff pressure was measured every 10 minutes for the entire course of anesthesia. The position of the device was also assessed fiberoptically and postoperative airway complications were recorded. Results: The maximum intracuff pressure recorded in group N was 103 ± 4.7 mm Hg vs. 45.5 ± 1.5 mm Hg in group A. The percentage rise in cuff pressure every 10 minutes was also highly significant (P < 0.001) being maximum in first 10 min in group N. The incidence of postoperative airway complications was comparable between the two groups. Conclusion: The results of this study demonstrate that the intracuff pressure of the PLMA increases progressively over time when the breathing gas mixture contains nitrous oxide. PMID:23493234

Sharma, Bimla; Gupta, Rajat; Sehgal, Raminder; Koul, Archna; Sood, Jayashree

2013-01-01

345

Airway Management Using the Intubating Laryngeal Mask Airway for the Morbidly Obese Patient  

Microsoft Academic Search

We studied the effectiveness of the intubating laryngeal mask airway (ILMA) in morbidly obese patients sched- uled for bariatric surgery. We included 118 consecutive morbidly obese patients (body mass index, 45 5 kg\\/m2). After the induction of general anesthesia, the laryngeal view was classified by the first observer according to the method of Cormack and Lehane. The ILMA was then

Thierry Guenoun; Didier Journois; Emma Aka; Philippe Cadi; Jacqueline Silleran-Chassany; Denis Safran

2003-01-01

346

Comparison between Classic Laryngeal Mask and Cobra Perilaryngeal Airway during Mechanical Ventilation  

Microsoft Academic Search

Background: Selection of an optimal method for the safe preoperative airway management is the base of a successful general anaesthesia. To achieve this goal various methods and devices are used including endotracheal tube and laryngeal mask airway, each has its own advantages and disadvantages. In this study, we compared a new supraglottic instrument (cobra perilaryngeal airway) with laryngeal mask airway

Mahvash Agah; Peyman Yahyavi; Fatemeh Roudneshin

347

An Evaluation of the Laryngeal Tube?? During General Anesthesia Using Mechanical Ventilation  

Microsoft Academic Search

The Laryngeal Tube® is a new supraglottic ventilatory device for airway management. It has been developed to secure a patent airway during either spontaneous or mechanical ventilation. In this study, we sought to de- termine the effectiveness of the Laryngeal Tube for pri- mary airway management during routine surgery with mechanical ventilation. One-hundred-seventy-five subjects classified as ASA physical status I

Luis A. Gaitini; Sonia J. Vaida; Mostafa Somri; Victor Kaplan; Boris Yanovski; Robert Markovits; Carin A. Hagberg

2003-01-01

348

Respiratory and Laryngeal Responses to an Oral Air Pressure Bleed during Speech  

ERIC Educational Resources Information Center

Researchers have hypothesized that the respiratory and laryngeal speech subsystems would respond to an air pressure bleed, but these responses have not been empirically studied. The present study examined the nature of the responses of the respiratory and laryngeal subsystems to an air pressure bleed in order to provide information relevant to the…

Huber, Jessica E.; Stathopoulos, Elaine T.

2003-01-01

349

Mucin gene expression in reflux laryngeal mucosa: histological and in situ hybridization observations.  

PubMed

Objectives/Hypothesis. To determine if laryngopharyngeal reflux alters mucin gene expression in laryngeal mucosa. Methods. In situ hybridization was employed to study the expression of the 8 well-characterised mucin genes MUC1-4, 5AC, 5B, 6, and 7 in reflux laryngeal mucosa from laryngeal ventricles, posterior commissures, and vocal folds compared to control/normal laryngeal mucosa. Results. MUC1-5 genes are expressed in normal and reflux laryngeal mucosa. MUC1, 3 and 4 are expressed in respiratory and squamous mucosa whereas MUC2 and 5AC are expressed in respiratory mucosa only. MUC3, 4 and 5AC are downregulated in reflux mucosa. MUC5AC expression is significantly reduced in the 3 mucosal sites and when mucosal type was taken into account, this remains significant in combined laryngeal and ventricular mucosa only. Conclusions. MUC3, 4 and 5AC expression is downregulated in laryngopharyngeal reflux. This may be due to laryngeal mucosal metaplasia and/or alteration of mucin gene expression in the preexisting mucosa. Altered mucin gene expression might predispose laryngeal mucosa to the damaging effect of reflux. PMID:24790604

Ali, Mahmoud El-Sayed; Bulmer, David M; Dettmar, Peter W; Pearson, Jeffrey P

2014-01-01

350

Biofeedback therapy using accelerometry for treating dysphagic patients with poor laryngeal elevation : case studies  

Microsoft Academic Search

Abstract—Dysphagia, a swallowing disorder, is a problem encountered frequently in the rehabilitation of stroke and head injury patients . In normal individuals, safe passage of a food bolus into the esophagus is ensured by laryngeal elevation and closure of the airway. Inadequate laryngeal elevation can lead to aspiration, choking, and even death. The course of recovery in the current clinical

Narender P. Reddy; Denise L. Simcox; Vineet Gupta; Gary E. Motta; Jody Coppenger; Amitava Das; Ojas Buch

351

Chronic cough and laryngeal dysfunction improve with specific treatment of cough and paradoxical vocal fold movement  

Microsoft Academic Search

RATIONALE: Chronic persistent cough can be associated with laryngeal dysfunction that leads to symptoms such as dysphonia, sensory hyperresponsiveness to capsaicin, and motor dysfunction with paradoxical vocal fold movement and variable extrathoracic airflow obstruction (reduced inspiratory airflow). Successful therapy of chronic persistent cough improves symptoms and sensory hyperresponsiveness. The effects of treatment for chronic cough on laryngeal dysfunction are not

Nicole M Ryan; Anne E Vertigan; Peter G Gibson

2009-01-01

352

Acoustic and Perceptual Effects of Left-Right Laryngeal Asymmetries Based on Computational Modeling  

ERIC Educational Resources Information Center

Purpose: Computational modeling was used to examine the consequences of 5 different laryngeal asymmetries on acoustic and perceptual measures of vocal function. Method: A kinematic vocal fold model was used to impose 5 laryngeal asymmetries: adduction, edge bulging, nodal point ratio, amplitude of vibration, and starting phase. Thirty /a/ and /?/…

Samlan, Robin A.; Story, Brad H.; Lotto, Andrew J.; Bunton, Kate

2014-01-01

353

Differential effects of airway afferent nerve subtypes on cough and respiration in anesthetized guinea pigs  

PubMed Central

The hypothesis that respiratory reflexes, such as cough, reflect the net and often opposing effects of activation of multiple afferent nerve subpopulations throughout the airways was evaluated. Laryngeal and tracheal mucosal challenge with either citric acid or mechanical probing reliably evoked coughing in anesthetized guinea pigs. No other stimulus reliably evoked coughing in these animals, regardless of route of administration and despite some profound effects on respiration. Selectively activating vagal C-fibers arising from the nodose ganglia with either adenosine or 2-methyl-5-HT evoked only tachypnea. Selectively activating vagal afferents arising from the jugular ganglia induced respiratory slowing and apnea. Nasal afferent nerve activation by capsaicin, citric acid, hypertonic saline, or histamine evoked only respiratory slowing. Histamine, which activates intrapulmonary rapidly adapting receptors but not airway or lung C-fibers or tracheal bronchial cough receptors induced bronchospasm and tachypnea, but no coughing. The results indicate that the reflexes initiated by stimuli thought to be selective for some afferent nerve subtypes will likely depend on the net and potentially opposing effects of multiple afferent nerve subpopulations throughout the airways. The data also provide further evidence that the afferent nerves regulating cough in anesthetized guinea pigs are distinct from either C-fibers or intrapulmonary rapidly adapting receptors. PMID:18768768

Chou, Yang-Ling; Scarupa, Mark D.; Mori, Nanako; Canning, Brendan J.

2008-01-01

354

Resolution of sleep paralysis by weak electromagnetic fields in a patient with multiple sclerosis.  

PubMed

Sleep paralysis refers to episodes of inability to move during the onset of sleep or more commonly upon awakening. Patients often describe the sensation of struggling to move and may experience simultaneous frightening vivid hallucinations and dreams. Sleep paralysis and other manifestations of dissociated states of wakefulness and sleep, which reflect deficient monoaminergic regulation of neural modulators of REM sleep, have been reported in patients with multiple sclerosis (MS). A 40 year old woman with remitting-progressive multiple sclerosis (MS) experienced episodes of sleep paralysis since the age of 16, four years prior to the onset of her neurological symptoms. Episodes of sleep paralysis, which manifested at a frequency of about once a week, occurred only upon awakening in the morning and were considered by the patient as a most terrifying experience. Periods of mental stress, sleep deprivation, physical fatigue and exacerbation of MS symptoms appeared to enhance the occurrence of sleep paralysis. In July of 1992 the patient began experimental treatment with AC pulsed applications of picotesla intensity electromagnetic fields (EMFs) of 5Hz frequency which were applied extracerebrally 1-2 times per week. During the course of treatment with EMFs the patient made a dramatic recovery of symptoms with improvement in vision, mobility, balance, bladder control, fatigue and short term memory. In addition, her baseline pattern reversal visual evoked potential studies, which showed abnormally prolonged latencies in both eyes, normalized 3 weeks after the initiation of magnetic therapy and remained normal more than 2.5 years later. Since the introduction of magnetic therapy episodes of sleep paralysis gradually diminished and abated completely over the past 3 years. This report suggests that MS may be associated with deficient REM sleep inhibitory neural mechanisms leading to sleep paralysis secondary to the intrusion of REM sleep atonia and dream imagery into the waking state. Pineal melatonin and monoaminergic neurons have been implicated in the induction and maintenance of REM sleep and the pathogenesis of sleep paralysis and it is suggested that resolution of sleep paralysis in this patient by AC pulsed applications of EMFs was related to enhancement of melatonin circadian rhythms and cerebral serotoninergic neurotransmission. PMID:9352423

Sandyk, R

1997-08-01

355

Repair of sciatic nerve defects using tissue engineered nerves.  

PubMed

In this study, we constructed tissue-engineered nerves with acellular nerve allografts in Sprague-Dawley rats, which were prepared using chemical detergents-enzymatic digestion and mechanical methods, in combination with bone marrow mesenchymal stem cells of Wistar rats cultured in vitro, to repair 15 mm sciatic bone defects in Wistar rats. At postoperative 12 weeks, electrophysiological detection results showed that the conduction velocity of regenerated nerve after repair with tissue-engineered nerves was similar to that after autologous nerve grafting, and was higher than that after repair with acellular nerve allografts. Immunohistochemical staining revealed that motor endplates with acetylcholinesterase-positive nerve fibers were orderly arranged in the middle and superior parts of the gastrocnemius muscle; regenerated nerve tracts and sprouted branches were connected with motor endplates, as shown by acetylcholinesterase histochemistry combined with silver staining. The wet weight ratio of the tibialis anterior muscle at the affected contralateral hind limb was similar to the sciatic nerve after repair with autologous nerve grafts, and higher than that after repair with acellular nerve allografts. The hind limb motor function at the affected side was significantly improved, indicating that acellular nerve allografts combined with bone marrow mesenchymal stem cell bridging could promote functional recovery of rats with sciatic nerve defects. PMID:25206507

Zhang, Caishun; Lv, Gang

2013-07-25

356

Inflammatory pseudotumor of nerve.  

PubMed

Two cases of inflammatory pseudotumor are described. The first patient, a 35-year-old white man, developed a progressive sensorimotor deficit in the right leg associated with a fusiform sciatic nerve mass in the posterior thigh. The lesion, compressive in nature and situated entirely within the epineurium, was totally resected. Histology revealed lymphocytic and plasmacellular inflammation as well as extensive fibrosis and collagen deposition. The patchy infiltrate consisted equally of CD2, CD3, CD5, and CD7 positive T-lymphocytes as well as CD20-and CD22-positive B-lymphocytes expressing both kappa and lambda immunoglobulin light chains. A selective biopsy of the encompassed and compressed nerve fascicles demonstrated both myelin loss and axonal injury. The second case was that of an 18-year-old woman with focal enlargement of a radial nerve by an epineurial infiltrate of multinucleate histiocytes and T as well as occasional B lymphocytes. No etiology was apparent in either case. The differential diagnosis includes non-neoplastic processes (amyloidoma and tuberculoid leprosy) as well as tumors (benign and malignant peripheral nerve sheath tumors, lymphoma). Although rare, inflammatory pseudotumors must be included in the differential diagnosis of tumor-like lesions of peripheral nerve. PMID:8827027

Weiland, T L; Scheithauer, B W; Rock, M G; Sargent, J M

1996-10-01

357

APPARATUS A comparison of the disposable AmbuAuraOnceTM Laryngeal Mask with the reusable LMA ClassicTM laryngeal mask airway  

Microsoft Academic Search

Summary Single-use supraglottic airway devices are now available and are intended to be comparable with the reusable LMA ClassicTM laryngeal mask airway. We performed a randomised cross-over study comparing the AmbuAuraOnceTM Laryngeal Mask with the LMA Classic. Fifty patients part- icipated in the trial. Success rates for insertion at the first attempt were similar (92% with the Ambu and 84%

G. Sudhir; D. Redfern; J. E. Hall; A. R. Wilkes; C. Cann

358

Q fever meningoencephalitis associated with bilateral abducens nerve paralysis, bilateral optic neuritis and abnormal cerebrospinal fluid findings  

Microsoft Academic Search

Summary Q fever is an zoonosis caused byCoxiella burnetii, the clinical features of which are often non-specific and self-limited. Involvement of the central nervous system is rare and is usually seen as a complication of endocarditis caused by this rickettsial organism in the chronic disease. Specific neurological manifestations in the course of the acute illnes aseptic meningitis, encephalitis, toxic confusional

Y. Shaked; Y. Samra

1989-01-01

359

Left lower lobe atelectasis and consolidation following cardiac surgery: the effect of topical cooling on the phrenic nerve  

SciTech Connect

Retrospective and prospective analyses of chest radiographs of patients following coronary artery bypass surgery were undertaken. Left lower lobe pulmonary infiltrate and/or atelectasis developed in 13 of 40 (32.5%) patients who were operated upon without topical cooling of the heart with ice, and in 77 of 122 (63.1%) patients in one group and 34 of 40 (85.0%) patients in another group who were operated upon with topical cooling of the heart with ice. This difference was highly significant (p<0.001). Of the patients in one group in whom left lower lobe abnormality developed, 69.2% had paralysis or paresis of the left hemidiaphragm. It is evident that application of ice to the phrenic nerve can lead to temporary paralysis of the left leaf of the diaphragm, with subsequent development of left lower lobe pulmonary infiltrate and/or atelectasis.

Benjamin, J.J.; Cascade, P.N.; Rubenfire, M.; Wajszczuk, W.; Kerin, N.Z.

1982-01-01

360

Emphasizing Structural Distillation for the Avoidance of Analysis Paralysis  

NSDL National Science Digital Library

ABET requires student engineers to have the ability to design and conduct experiments and to analyze and to interpret data using modern engineering tools. This along with industry demands means that the student engineer is now expected to be competent in at least one CAD package and perhaps one finite element stress or fluid analysis package. Exposure of undergraduate engineers to powerful analysis packages however, can in many cases be compared to viewing the dessert tray before the main course arrives, it can ruin the meal. As such running through pre-defined engineering analysis examples and seeing the capabilities of the packages leaves the novice convinced that the use of such software is indeed far superior to any hand calculation technique, and as such is the only way to undertake any future analysis work. The reality however, quite often means that when future work arrives the novice falls into one of the following traps. First, the geometry and application of the part, assembly or system is so unlike any modeled before that the user does not know where to start. (E.g. How to mesh, how to apply loads, restraints etc.) A state of analysis paralysis has occurred. Secondly, in spite of the first trap and because of inevitable work pressure, an analysis is undertaken which, with the aid of new user friendly application software allows the user to muddle his or her way through the numerous menu options. The software then obligingly produces the high quality presentation results that can, without an inside understanding of the problem, appear very believable. The gaffer dazzler (Slang for boss impressing picture !) is born and the old adage of garbage in, garbage out has re-appeared in its new visually more impressive form. The suggestions discussed in this paper, describe teaching techniques used at the authors institute, that continually stress structural distillation, sketching, estimation, experimentation and the central importance of approximate hand calculations as an essential part of the design process. Examples of some of the work undertaken at the authors institution during an introductory design course are used to show how powerful analytical packages can ultimately be used with confidence rather than blind faith.

Foley, Andrew

2009-09-08

361

Stroboscopy for benign laryngeal pathology in evidence based health care  

PubMed Central

Background and Aims: Voice disorders are common. The aim of this study is to evaluate the diagnostic value of stroboscopy for voice disorders related with benign pathology and apply results in evidence based health care. Methods: Prospective study. Tertiary care hospital. Voice Clinic. One hundred and fifty consecutive patients with an initial diagnosis of benign laryngeal disease or dysphonia of no clarified cause (normal laryngoscopy) were examined stroboscopically and studied prospectively until a final diagnosis was reached. Sixty-six men, eighty women and four children met the selection criteria for the study and had adequate follow-up. The initial laryngoscopic diagnosis was compared to the stroboscopic diagnosis. The diagnostic value of stroboscopy was rated at a scale of 0 to 3. A score 3 describes the diagnostic value of stroboscopy in the cases where the stroboscopic examination resulted to a change of the therapeutic modality offered to the patient. Results: For one third of the study's population the diagnostic value of stroboscopy was very significant, since it established the laryngeal pathology responsible for the voice disorder (28.8%) and for a small number of patients it changed the choice of treatment (4.7%). For about one third of the cases (32.2%) stroboscopy offered additional information regarding the cause of dysphonia. The diagnostic value of stroboscopy correlated with the type of laryngeal pathology. Conclusions: Patients expected to benefit from stroboscopic examination are patients with small lesions of the vocal fold edge, dysphonic patients with unremarkable indirect laryngoscopy, and professional voice users. PMID:23935311

Printza, A; Triaridis, S; Themelis, C; Constantinidis, J

2012-01-01

362

Bilateral diaphragmatic paralysis associated with the use of the tumor necrosis factor-alpha inhibitor adalimumab  

PubMed Central

A 51-year-old woman was referred for evaluation of progressive dyspnea of 3 months— duration. She had received 3 doses of adalimumab for treatment of rheumatoid arthritis prior to the onset of her dyspnea. Her chest examination revealed absent diaphragmatic movement with inspiration. Spirometry showed a severe restrictive defect. Radiologic studies confirmed the diagnosis of bilateral diaphragmatic paralysis. Laboratory and radiologic workup excluded other possible causes of the diagnosis. Adalimumab was discontinued, and she was treated with bilevel positive airway pressure ventilation and intravenous immunoglobulin. Three months later, the diaphragmatic paralysis persisted. This is the second reported case of bilateral diaphragmatic paralysis occurring in a patient who had received adalimumab. Acute neuropathies are rare side effects of tumor necrosis factor-alpha inhibitors. PMID:24688191

Martin, Alan William; Rosenblatt, Randall Lee

2014-01-01

363

Petrositis With Bilateral Abducens Nerve Palsies complicated by Acute Otitis Media  

PubMed Central

Petrous apicitis is a rare but fatal complication of otitis media. An infection within the middle ear can extend within the temporal bone into the air cells of the petrous apex. With only the thin dura mater separating the trigeminal ganglion and the 6th cranial nerve from the bony petrous apex, they are vulnerable to inflammatory processes, resulting in deep facial pain, lateral rectus muscle paralysis, and diplopia. In 1904, Gradenigo described a triad of symptoms related to petrous apicitis, including acute suppurative otitis media, deep facial pain resulting from trigeminal involvement, and abducens nerve palsy. It has traditionally been treated with surgery, but recent advances in imaging, with improved antibiotic treatment, allow conservative management. In this case report, we describe a clinical and neuroradiological evolution of a child with a petrous apicitis after acute otitis media, which was managed medically with a positive outcome. PMID:24587883

Choi, Kyu Young

2014-01-01

364

A new job for an old device: a novel use for nerve stimulators in anorectal malformations.  

PubMed

Muscle stimulation of the perineum is a crucial step in the repair of anorectal malformations. This allows the surgeon to assess muscle function and locate precisely the sphincter muscles during a pull-through operation. Presently, the device commonly used is very expensive. In searching for a cheaper and amenable device we explored utilizing the nerve stimulator MiniStim (model MS-IIIA, Life-Tech, Inc., Houston, TX) normally used for the "train of four" sign in assessing paralysis during general anesthesia. We have used this device in seven consecutive posterior sagittal anorectoplasties and compared its effectiveness with the regular muscle stimulator. In our experience, the nerve stimulator is easier to work with and is a common device in the operating theater. It gave us information that was at least equal to the regular muscle stimulator. PMID:24650485

Kapuller, Vadim; Arbell, Dan; Udassin, Raphael; Armon, Yaron

2014-03-01

365

Laryngopharyngeal complaints after use of the laryngeal mask airway  

Microsoft Academic Search

Purpose  To compare the incidence of dysphagia, dysphonia and sore throat following anesthesia, using the laryngeal mask airway (LMA),\\u000a among patients receiving intermittent positive-pressure ventilation (IPPV) and those breathing spontaneously (SV) and with\\u000a two different concentrations of nitrous oxide (N2O) in oxygen.\\u000a \\u000a \\u000a \\u000a Methods  In a prospective trial, 120 patients (ASA 1-111, 16–70 yr, > 60 kg) undergoing minor peripheral surgery were randomised

Eduardo Figueredo; Miguel Vivar-Diago; Francisco Mufioz-Blanco

1999-01-01

366

Desflurane requirements for laryngeal mask airway insertion during inhalation induction  

Microsoft Academic Search

Purpose  We hypothesized that the simultaneous use of low concentrations (2O), and fentanyl would allow a laryngeal mask airway (LMA) to be inserted safely with inhalation induction of desflurane,\\u000a even in nonparalyzed patients. This prospective, observational study was performed to determine the 50% effective concentration\\u000a (EC50) of desflurane for LMA insertion in such patients.\\u000a \\u000a \\u000a \\u000a Methods  Twenty-two adult patients undergoing ambulatory surgical procedures

Hwa-Yong Shin; Jung-Ae Lim; Seong-Hyop Kim; Seung-Woo Baek; Duk-Kyung Kim

2009-01-01

367

Comparison of the flexible and standard laryngeal mask airways  

Microsoft Academic Search

Purpose  To determine mucosal pressures, ease of insertion, mask position and oropharyngeal leak pressures for the flexible (FLMA)\\u000a and standard laryngeal mask airway (LMA).\\u000a \\u000a \\u000a \\u000a Methods  Forty anesthetized, paralysed adult patients were randomly allocated to receive either the FLMA or LMA. Microchip sensors\\u000a were attached to the LMA or FLMA at identical locations corresponding to the base of tongue, hypopharynx, lateral pharynx,\\u000a oropharynx,

J. Brimacombe; C. Keller

1999-01-01

368

The quality of voice in patients irradiated for laryngeal carcinoma  

SciTech Connect

Data from 150 patients with laryngeal carcinoma, consecutively treated primarily by radiotherapy from 1965 through 1974 was analyzed to assess the quality of voice. The voice appears to improve in majority of the successfully irradiated patients. In 76% of the evaluable patients in this group, the quality of voice appears to have attained normalcy or near normalcy. Smoking appears to have a negative influence. High incidence of bronchogenic carcinoma along with the negative influence of smoking on the quality of voice in this series of patients indicate that the patients should be advised against smoking in day-to-day clinical practice.

Karim, A.B.; Snow, G.B.; Siek, H.T.; Njo, K.H.

1983-01-01

369

 

PubMed Central

SUMMARY The superior laryngeal nerve (SLN) has been attributed much less clinical significance than the recurrent laryngeal nerve. It has sometimes been described as the 'neglected' nerve in thyroid surgery, although injury to this nerve can cause significant disability. The external branch of the SLN is the only motor supply to the cricothyroid muscle, which increases the tension of the ipsilateral vocal fold during highfrequency phonation, particularly in women and voice professionals. Damage to this nerve can manifest as ipsilateral cricothyroid muscle paralysis, and clinical symptoms may include a hoarse, breathy voice, frequent throat clearing, vocal fatigue or diminished vocal frequency range, especially when rising pitch. SLN paralysis can be a significant issue for those whose careers depend largely on a full range of voice. The famous opera soprano, Amelita Galli-Curci, suffered SLN injury during thyroid surgery with distressing consequences. PMID:23620644

MARCHESE-RAGONA, R.; RESTIVO, D.A.; MYLONAKIS, I.; OTTAVIANO, G.; MARTINI, A.; SATALOFF, R.T.; STAFFIERI, A.

2013-01-01

370

Bilateral diaphragmatic paralysis in an HIV patient: Second reported case and literature review  

PubMed Central

Human immunodeficiency virus (HIV) disease is widespread all over the world, and the neurological and respiratory complications have been described previously. Peripheral neuropathy is one of the commonest neurological complications of the HIV infection. In this report we describe a HIV positive male smoker who was admitted to the hospital because of community acquired pneumonia. Bilateral diaphragmatic paralysis was diagnosed for which no other cause was found and was attributed to the HIV infection. Isolated phrenic neuropathy and diaphragmatic paralysis in an HIV positive patient is extremely rare and only a single such association has been described previously. PMID:24778479

Melero, Marcelo J.; Mazzei, Mariano E.; Bergroth, Bemardo; Cantardo, Damian M.; Duarte, Juan M.; Corti, Marcelo

2014-01-01

371

Comparison of classic laryngeal mask airway with Ambu laryngeal mask for tracheal tube exchange: A prospective randomized controlled study  

PubMed Central

Background and Aim: Exchanging endotracheal tube (ETT) with classic laryngeal mask airway™ (CLMA™) prior to emergence from anaesthesia is a safe technique to prevent the coughing and haemodynamic changes during extubation. We had compared CLMA™ and AMBU laryngeal mask™ (ALM™) during ETT/laryngeal mask (LM) for haemodynamic changes and other parameters. Methods: A total of 100 American Society of Anesthesiologist Grade I and II adult female patients undergoing elective laparoscopic cholecystectomy under general anaesthesia were selected and randomly divided into two groups of 50 patients each. In Group I, CLMA™ and in Group II, ALM™ was placed prior to tracheal extubation. Haemodynamic parameters were recorded during ETT/LM exchange. Glottic view was seen through the LM using flexible fibrescope. Coughing/bucking during removal of LM, ease of placement and post-operative sore throat for both groups were graded and recorded. Statistical Analysis: Data within the groups was analysed using paired t-test while between the groups was analysed using unpaired t-test. Chi-square test was used to analyse grades of glottic view, coughing, and post-operative sore throat. Results: In Group I, there was a significant rise in systolic blood pressure and heart rate in contrast to insignificant rise in Group II. Glottis view was significantly better in Group II. Incidence of coughing, ease of placement and post-operative sore throat was identical between both groups. Conclusion: ALM™ is superior to CLMA™ for exchange of ETT before extubation due to greater haemodynamic stability during exchange phase and is better positioned. PMID:23983284

Jain, Shruti; Khan, Rashid M; Ahmed, Syed M; Singh, Manpreet

2013-01-01

372

Airway nerves: in vivo electrophysiology  

Microsoft Academic Search

Information about the activity of airway sensory afferent nerves in vivo can be obtained electrophysiologically by extracellular recording of action potentials. Apart from data capture, the basic techniques used for recording sensory nerve activity have not advanced greatly in 50 years. However, clearly they continue to contribute vastly to our understanding of the role of these nerves in the control

John J Adcock

2002-01-01

373

Fibrolipoma of the median nerve  

Microsoft Academic Search

Neural fibrolipoma or fibrolipomatous hamartoma is an uncommon benign tumor that usually arises in the median nerve. Fibrofatty tissue proliferates around the nerve and infiltrates the epineurium and perineurium. We report a case of fibrolipomatous hamartoma of the left median nerve in an 18-year-old woman. Our objective was to describe the pathognomonic magnetic resonance imaging features, whose presence obviates the

Kais Nouira; Hend Belhiba; Sofiène Baccar; Anissa Miaaoui; Monia Ben Messaoud; Imène Turki; Ilhem Cheour; Emna Menif

2007-01-01

374

Ischemic Nerve Block.  

ERIC Educational Resources Information Center

This experiment investigated the capability for movement and muscle spindle function at successive stages during the development of ischemic nerve block (INB) by pressure cuff. Two male subjects were observed under six randomly ordered conditions. The duration of index finger oscillation to exhaustion, paced at 1.2Hz., was observed on separate…

Williams, Ian D.

375

Iatrogenic nerve injuries  

PubMed Central

Thirty-one examples of iatrogenic peripheral nerve injuries have been collected from a review of the case records of one neurological referral centre over a 7-year period. The clinical details are described to call attention to the special care needed with the management of patients subjected to certain invasive procedures. PMID:7100035

Winer, J. B.; Harrison, M. J. G.

1982-01-01

376

Quantitative proteomics approach to screening of potential diagnostic and therapeutic targets for laryngeal carcinoma.  

PubMed

To discover candidate biomarkers for diagnosis and detection of human laryngeal carcinoma and explore possible mechanisms of this cancer carcinogenesis, two-dimensional strong cation-exchange/reversed-phase nano-scale liquid chromatography/mass spectrometry analysis was used to identify differentially expressed proteins between the laryngeal carcinoma tissue and the adjacent normal tissue. As a result, 281 proteins with significant difference in expression were identified, and four differential proteins, Profilin-1 (PFN1), Nucleolin (NCL), Cytosolic non-specific dipeptidase (CNDP2) and Mimecan (OGN) with different subcellular localization were selectively validated. Semiquantitative RT-PCR and Western blotting were performed to detect the expression of the four proteins employing a large collection of human laryngeal carcinoma tissues, and the results validated the differentially expressed proteins identified by the proteomics. Furthermore, we knocked down PFN1 in immortalized human laryngeal squamous cell line Hep-2 cells and then the proliferation and metastasis of these transfected cells were measured. The results showed that PFN1 silencing inhibited the proliferation and affected the migration ability of Hep-2 cells, providing some new insights into the pathogenesis of PFN1 in laryngeal carcinoma. Altogether, our present data first time show that PFN1, NCL, CNDP2 and OGN are novel potential biomarkers for diagnosis and therapeutic targets for laryngeal carcinoma, and PFN1 is involved in the metastasis of laryngeal carcinoma. PMID:24587265

Li, Li; Zhang, Zhenwei; Wang, Chengyu; Miao, Lei; Zhang, Jianpeng; Wang, Jiasen; Jiao, Binghua; Zhao, Shuwei

2014-01-01

377

Quantitative Proteomics Approach to Screening of Potential Diagnostic and Therapeutic Targets for Laryngeal Carcinoma  

PubMed Central

To discover candidate biomarkers for diagnosis and detection of human laryngeal carcinoma and explore possible mechanisms of this cancer carcinogenesis, two-dimensional strong cation-exchange/reversed-phase nano-scale liquid chromatography/mass spectrometry analysis was used to identify differentially expressed proteins between the laryngeal carcinoma tissue and the adjacent normal tissue. As a result, 281 proteins with significant difference in expression were identified, and four differential proteins, Profilin-1 (PFN1), Nucleolin (NCL), Cytosolic non-specific dipeptidase (CNDP2) and Mimecan (OGN) with different subcellular localization were selectively validated. Semiquantitative RT-PCR and Western blotting were performed to detect the expression of the four proteins employing a large collection of human laryngeal carcinoma tissues, and the results validated the differentially expressed proteins identified by the proteomics. Furthermore, we knocked down PFN1 in immortalized human laryngeal squamous cell line Hep-2 cells and then the proliferation and metastasis of these transfected cells were measured. The results showed that PFN1 silencing inhibited the proliferation and affected the migration ability of Hep-2 cells, providing some new insights into the pathogenesis of PFN1 in laryngeal carcinoma. Altogether, our present data first time show that PFN1, NCL, CNDP2 and OGN are novel potential biomarkers for diagnosis and therapeutic targets for laryngeal carcinoma, and PFN1 is involved in the metastasis of laryngeal carcinoma. PMID:24587265

Wang, Chengyu; Miao, Lei; Zhang, Jianpeng; Wang, Jiasen; Jiao, Binghua; Zhao, Shuwei

2014-01-01

378

Clinical toxicity of peripheral nerve to intraoperative radiotherapy in a canine model  

SciTech Connect

The clinical late effects of intraoperative radiotherapy (IORT) on peripheral nerve were investigated in a foxhound model. Between 1982 and 1987, 40 animals underwent laparotomy with intraoperative radiotherapy of doses from 0-75 Gy administered to the right lumbosacral plexus. Subsequently, all animals were monitored closely and sacrificed to assess clinical effects to peripheral nerve. This analysis reports final clinical results of all animals, with follow-up to 5 years. All animals treated with {>=} 25 Gy developed ipsilateral neuropathy. An inverse relationship was noted between intraoperative radiotherapy dose and time to neuropathy, with an effective dose for 50% paralysis (ED{sub 50}) of 17.2 Gy. One of the animals treated with 15 Gy IORT developed paralysis, after a much longer latency than the other animals. Doses of 15 Gy delivered intraoperatively may be accompanied by peripheral neuropathy with long-term follow-up. This threshold is less than that reported with shorter follow-up. The value of ED{sub 50} determined here is in keeping with data from other animal trials, and from clinical trials in humans. 11 refs., 2 figs.

Johnstone, P.A.S.; DeLuca, A.M.; Terrill, R.E. [National Cancer Institute, Bethesda, MD (United States)] [and others] [National Cancer Institute, Bethesda, MD (United States); and others

1995-07-15

379

Segmental thoracic lipomatosis of nerve with nerve territory overgrowth.  

PubMed

Lipomatosis of nerve (LN), or fibrolipomatous hamartoma, is a rare condition of fibrofatty enlargement of the peripheral nerves. It is associated with bony and soft tissue overgrowth in approximately one-third to two-thirds of cases. It most commonly affects the median nerve at the carpal tunnel or digital nerves in the hands and feet. The authors describe a patient with previously diagnosed hemihypertrophy of the trunk who had a history of large thoracic lipomas resected during infancy, a thoracic hump due to adipose proliferation within the thoracic paraspinal musculature, and scoliotic deformity. She had fatty infiltration in the thoracic spinal nerves on MRI, identical to findings pathognomonic of LN at better-known sites. Enlargement of the transverse processes at those levels and thickened ribs were also found. This case appears to be directly analogous to other instances of LN with overgrowth, except that this case involved axial nerves rather than the typical appendicular nerves. PMID:24506247

Mahan, Mark A; Amrami, Kimberly K; Howe, B Matthew; Spinner, Robert J

2014-05-01

380

Laryngeal effects of nasal allergen provocation in singers with allergic rhinitis.  

PubMed

In spite of our recent insight into nasobronchial interaction mechanisms in allergic airway disease, the association between allergic rhinitis and voice complaints remains obscure. To evaluate the effects of nasal allergen provocation and seasonal grass pollen exposure on subjective and objective laryngeal parameters in singers with and without allergic rhinitis, an observational case control study was conducted. Prior to the pollen season, six grass pollen allergic and six non-allergic semiprofessional singers were exposed to nebulized sham solution and grass pollen extract (HAL°) in rising concentrations. After 3 min, 60 min and 24 h, nasal and laryngeal complaints were evaluated by the use of a visual analog scale (VAS). Laryngeal parameters like voice appearance (video stroboscopic images), voice range profile and subjective (GRBAS) and objective (jitter, shimmer, H/N, DSI) voice quality were evaluated before provocation, after 60 min and 24 h. During the pollen season, the allergic singers were re-evaluated. Results showed that in allergic singers both nasal (TNS of 4.0 ± 2.4 vs. 0.0 ± 0.0, p < 0.05) and laryngeal complaints (TLS of 1.4 ± 1.1 vs. 0.0 ± 0.2, p < 0.05) were induced at 3 min after the provocation. The induced laryngeal complaints were the feeling of laryngeal irritation, secretions and globus. No change in voice quality or stroboscopy score was measured. During the pollen season, laryngeal complaints were present (TLS of 2.4 ± 2.4) in allergic singers, without evidence for objective voice and laryngeal changes. In conclusion, we here demonstrate the rapid induction of laryngeal complaints in allergic singers by nasal allergen provocation and during the pollen season. There was no subject reported or investigator measured change in voice quality. No change in stroboscopy score was measured. PMID:21072528

Verguts, Monique M L; Eggermont, Anita; Decoster, Wivine; de Jong, Felix I C R S; Hellings, Peter W

2011-03-01

381

Nitrous oxide diffusion into the cuffs of disposable laryngeal mask airways.  

PubMed

The aim of this study was to investigate cuff pressure changes found in disposable size 3 laryngeal mask airways (LMAs) from different manufacturers during nitrous oxide exposure and to compare the results with the re-usable Classic LMA. In an in vitro experiment, laryngeal mask airway cuff pressures starting from a baseline pressure of 40 cm H(2)O were recorded using a pressure transducer for 60 min with the laryngeal mask airway cuff exposed to 66% N(2)O in oxygen. Cuff pressure increases within 5 min of nitrous oxide exposure were > 250% in the Classic LMA and were not significantly different from those found in the Marshall laryngeal mask airway. However, they were significantly greater than those in the Soft Seal, the Unique, the AMBU, and Intersurgical laryngeal mask airways, all of which demonstrated stable cuff pressure levels within the first 5 min. The cuff pressure increase following 60 min of nitrous oxide exposure was 13.0 +/- 1.1 and 14.6 +/- 0.7 cm H(2)O in the Intersurgical and Unique laryngeal mask airways, respectively, which was significantly lower than the cuff pressure increase in the Soft Seal and in the Ambu laryngeal mask airways (28.3 +/- 2.9 and 30.9 +/- 1.2 cm H(2)O, respectively). Unlike the re-usable Classic LMA and the disposable Marshall laryngeal mask airway, which have silicone cuffs, the disposable Ambu, Intersurgical, Portex Soft Seal and Unique laryngeal mask airways have cuffs constructed from PVC, which seems to be less susceptible to hyperinflation caused by nitrous oxide diffusion. PMID:15710013

Maino, P; Dullenkopf, A; Bernet, V; Weiss, M

2005-03-01

382

Dynamic ventrorostral displacement of the dorsal laryngeal mucosa in horses.  

PubMed

The objectives of this report were to describe the occurrence and features of dynamic ventrorostral displacement of the dorsal laryngeal mucosa (VRDDLM) in a group of Thoroughbred horses presented for investigation of poor performance and/or abnormal respiratory noise. Records from 600, dynamic, endoscopic examinations of the upper respiratory tract of horses were reviewed. Horses with VRDDLM were identified as those in which the dorsal laryngeal mucosa progressively obscured the interarytenoid notch and dorsoaxial portion of the corniculate processes of the arytenoid cartilages during high-speed exercise. The condition was recognised in 12 horses. Concurrent abnormalities of the respiratory tract of eight horses were also identified and included, axial deviation of the aryepiglottic folds, vocal cord prolapse, unilateral and bilateral ventromedial luxation of the apex of the corniculate process of the arytenoid cartilage, and intermittent dorsal displacement of the soft palate. VRDDLM is a rare abnormality of the upper portion of the respiratory tract of horses that may be associated with abnormal respiratory noise and potentially poor performance. The significance of the condition is not known, but the presence of this condition in combination with other, obstructive diseases of the equine airway warrants further investigation. PMID:23559426

Pollock, P J; Kelly, P G; Reardon, R J M; Kelly, G M

2013-05-11

383

Eucapnic voluntary hyperventilation in diagnosing exercise-induced laryngeal obstructions.  

PubMed

Exercise-induced laryngeal obstructions (EILOs) cause exercise-related respiratory symptoms (ERRS) and are important differential diagnoses to exercise-induced asthma. The diagnostic method for EILOs includes provocation to induce the obstruction followed by a verification of the obstruction and the degree thereof. The objective of the present study was to examine if a eucapnic voluntary hyperventilation (EVH) test could induce laryngeal obstructions laryngoscopically identical in subtypes and development as seen during an exercise test. EVH and exercise testing with continuous laryngoscopy were performed during a screening of two national athletic teams (n = 67). The laryngoscopic recordings were examined for usability, abnormalities and maximal supraglottic and glottic obstruction using two currently available methods (Eilomea and CLE-score). The participants were asked questions on ERRS, and whether the symptoms experienced during each provocation matched those experienced during regular training. A total of 39 completed both tests. There were no significant differences in subtypes and development thereof, the experience of symptoms, and specificity and sensitivity between the methods. Significantly more recordings obtained during the exercise test were usable for evaluation primarily due to resilient mucus on the tip of the fiber-laryngoscope in the EVH test. Only recordings of six athletes from both provocation methods were usable for evaluation using the Eilomea method (high-quality demand). Amongst these, a linear correlation was found for the glottic obstruction. EVH tests can induce EILOs. However, the present test protocol needs adjustments to secure better visualisation of the larynx during provocation. PMID:23732952

Christensen, Pernille M; Rasmussen, Niels

2013-11-01

384

Laryngeal cancer and occupational exposure to sulfuric acid  

SciTech Connect

Workers on an ethanol unit which used sulfuric acid in strong concentrations at a large refinery and chemical plant in Baton Rouge, Louisiana were reported in 1979, at excess risk for upper respiratory cancer. The carcinogen implicated by indirect evidence was diethyl sulfate. However, with the continued use of sulfuric acid in the same plant, and with additional cases not attributable to the ethanol process, the hypothesis of an association between sulfuric acid exposure and upper respiratory cancer was tested. Each of 50 confirmed cases of upper respiratory cancer diagnosed between 1944 and 1980, was matched to at least three controls on sex, race, age, date of initial employment, and duration of employment. Thrity-four of the 50 cases were laryngeal cancers. Data were obtained from existing plant records. Retrospective estimates of exposure were made without regard to case or control status. Findings from conditional logistic regression techniques were supported by other statistical methods. Among workers classified as potentially highly exposed, four-fold relative risks for all upper respiratory cancer sites combined were exceeded by the relative risk for laryngeal cancer specifically. Exposure-response and consistency across various comparisons after controlling statistically for tobacco-use, alcoholism and other previously implicated risk factors, suggest increased cancer risk with higher exposure.

Soskolne, C.L.; Zeighami, E.A.; Hanis, N.M.; Kupper, L.L.; Herrmann, N.; Amsel, J.; Mausner, J.S.; Stellman, J.M.

1984-09-01

385

Contribution of TIP30 to chemoresistance in laryngeal carcinoma.  

PubMed

Laryngeal squamous cell carcinoma (LSCC) is one of the most common carcinomas of the head and neck. Despite advances in diagnosis and treatment, the survival of patients with LSCC has not improved in the past two decades. TIP30, a newly identified tumour suppressor, appears to be involved in multiple processes during tumour development. Here, we investigated the involvement of TIP30 in chemoresistance of LSCC in vitro and in vivo. We showed that TIP30 expression decreased significantly in drug-selected cells (DSCs) of laryngeal carcinoma. Suppressing TIP30 enhanced resistance capability to multiple chemotherapy drugs, cell proliferation and self-renewal in Hep2 cells. Additionally, decreased self-renewal capacity and chemotherapeutic resistance were observed in DSCs overexpressing TIP30. Furthermore, TIP30 negatively regulated tumourigenesis and chemoresistance in LSCC cells subcutaneously transplanted into nude mice. Moreover, decreased TIP30 expression contributed to chemoresistance, self-renewal and proliferation of LSCC cells via nuclearlisation of ?-catenin, a cell-cell adhesion and stem cell renewal regulator. Consistently, Kaplan-Meier and Cox proportional hazards regression modelling analyses showed that decreased TIP30 expression independently predicted poor survival in patients with LSCC. Taken together, our results reveal that TIP30 has a crucial role in chemoresistance of LSCC through the AKT/glycogen synthase kinase-3?/?-catenin signalling pathway and may be a promising candidate for improving LSCC chemotherapy. PMID:25321475

Zhu, M; Yin, F; Yang, L; Chen, S; Chen, R; Zhou, X; Jing, W; Fan, X; Jia, R; Wang, H; Zheng, H; Zhao, J; Guo, Y

2014-01-01

386

Supraglottic adenoid cystic carcinoma mimicking laryngeal amyloidosis: A case report  

PubMed Central

Supraglottic adenoid cystic carcinoma (ACC) is extremely rare and may be misdiagnosed as laryngeal amyloidosis. The present report describes a case of supraglottic ACC, which went unrecognized until histopathological examination of the neoplasm 18 months after the first presentation. The present patient presented with progressive hoarseness for half a year and initially required partial resection. Following quick regional recurrence, the patient received a total laryngectomy while refusing radiotherapy. Adjuvant post-operational traditional Chinese medicine was accepted. Over 3 years’ follow-up, there was no evidence of regional relapse or distant metastases. The present case is compared with a second case of supraglottic submucosal mass in which the signs, symptoms and examinations were similar to the first case, but that was diagnosed as laryngeal amyloidosis. Attention should be paid to submucosal masses in the larynx to prevent underlying malignancy and subsequent disease progression. Immunocytochemistry, such as p63 staining, is mandatory for making an early differential diagnosis of supraglottic ACC. Traditional Chinese medicine may be a useful adjuvant therapy for this rare disease. PMID:24932306

QIAN, XIAOYUN; ZHOU, HAN; GU, YAJUN; ZHANG, YIFEN; GAO, XIA

2014-01-01

387

Contribution of TIP30 to chemoresistance in laryngeal carcinoma  

PubMed Central

Laryngeal squamous cell carcinoma (LSCC) is one of the most common carcinomas of the head and neck. Despite advances in diagnosis and treatment, the survival of patients with LSCC has not improved in the past two decades. TIP30, a newly identified tumour suppressor, appears to be involved in multiple processes during tumour development. Here, we investigated the involvement of TIP30 in chemoresistance of LSCC in vitro and in vivo. We showed that TIP30 expression decreased significantly in drug-selected cells (DSCs) of laryngeal carcinoma. Suppressing TIP30 enhanced resistance capability to multiple chemotherapy drugs, cell proliferation and self-renewal in Hep2 cells. Additionally, decreased self-renewal capacity and chemotherapeutic resistance were observed in DSCs overexpressing TIP30. Furthermore, TIP30 negatively regulated tumourigenesis and chemoresistance in LSCC cells subcutaneously transplanted into nude mice. Moreover, decreased TIP30 expression contributed to chemoresistance, self-renewal and proliferation of LSCC cells via nuclearlisation of ?-catenin, a cell–cell adhesion and stem cell renewal regulator. Consistently, Kaplan–Meier and Cox proportional hazards regression modelling analyses showed that decreased TIP30 expression independently predicted poor survival in patients with LSCC. Taken together, our results reveal that TIP30 has a crucial role in chemoresistance of LSCC through the AKT/glycogen synthase kinase-3?/?-catenin signalling pathway and may be a promising candidate for improving LSCC chemotherapy. PMID:25321475

Zhu, M; Yin, F; Yang, L; Chen, S; Chen, R; Zhou, X; Jing, W; Fan, X; Jia, R; Wang, H; Zheng, H; Zhao, J; Guo, Y

2014-01-01

388

[Recent advances in the treatment of laryngeal and hypopharyngeal carcinoma].  

PubMed

The prognosis of squamous epithelial cell carcinoma of the upper aerodigestive tract has improved considerably in the last 30 years. Patients presenting with stage I or II disease are treated with surgery or radiation therapy with curative intent. Although the efficacy is comparable between the two methods, surgery is usually preferred so that the side effects and late toxic effects of radiation can be avoided. For the treatment of advanced stages of disease, surgery, radiotherapy, chemotherapy and immunotherapy are usually combined. The introduction of concurrent administration of chemotherapy and radiotherapy (chemoradiotherapy) has been a major advancement. This has resulted in local control and survival rates comparable to those seen following radical surgery and postoperative radiotherapy, but with preservation of the larynx in most patients. However, recent epidemiological observations have shown declining survival rates in laryngeal cancer patients, raising concern about uncritical and too frequent use of this approach. The rationale for choosing treatment options for patients with laryngeal and hypopharyngeal carcinoma is discussed. PMID:22282006

Eckel, H E

2012-01-01

389

Management of Oropharyngeal Dysphagia in Laryngeal and Hypopharyngeal Cancer  

PubMed Central

On considering a function-preserving treatment for laryngeal and hypopharyngeal cancer, swallowing is a capital issue. For most of the patients, achieving an effective and safe deglutition will mark the difference between a functional and a dysfunctional outcome. We present an overview of the management of dysphagia in head and neck cancer patients. A brief review on the normal physiology of swallowing is mandatory to analyze next the impact of head and neck cancer and its treatment on the anatomic and functional foundations of deglutition. The approach proposed underlines two leading principles: a transversal one, that is, the multidisciplinary approach, as clinical aspects to be managed in the oncologic patient with oropharyngeal dysphagia are diverse, and a longitudinal one; that is, the concern for preserving a functional swallow permeates the whole process of the diagnosis and treatment, with interventions required at multiple levels. We further discuss the clinical reports of two patients who underwent a supracricoid laryngectomy, a function-preserving surgical technique that particularly disturbs the laryngeal mechanics, and in which swallowing rehabilitation dramatically conditions the functional results. PMID:23346112

Granell, Jose; Garrido, Laura; Millas, Teresa; Gutierrez-Fonseca, Raimundo

2012-01-01

390

Uncommon Metastasis of Laryngeal Cancer to Small Bowel Causing Intestinal Obstruction Treated by Laparoscopic Approach  

PubMed Central

Metastatic laryngeal cancer to the small bowel is extremely rare. Management of small bowel obstruction used to constitute a relative contraindication for the use of laparoscopic modality. We are reporting a case of an elderly man known to have laryngeal cancer who presented with small bowel obstruction due to metastatic deposit to the small bowel. The condition was successfully treated by laparoscopic assisted approach. A review of the natural history of advanced laryngeal cancer, common and uncommon sites of metastasis, and the rare presentation as small bowel obstruction is illustrated in this review. PMID:25254135

Al Nuaimi, Lateefa; El Salhat, Haytham; Sharma, Vasudev; Nowrasteh, Ghodratollah; Al Rawi, Sadir J.

2014-01-01

391

Is papillomavirus detectable in the plume of laser-treated laryngeal papilloma?  

PubMed

The carbon dioxide laser is widely used for the vaporization of lesions in patients with laryngeal papillomatosis. In this study, the smoke plume resulting from the laser treatment of laryngeal papillomas was analyzed for the presence of human papillomavirus DNA. Plumes were collected with a suction tip and trapped in phosphate-buffered saline. The aspirates were then analyzed for the presence of human papillomavirus DNA by Southern blot hybridization. Human papillomavirus DNA cannot be detected in the smoke plume from vaporization of laryngeal papillomas unless direct suction contact is made with the papilloma tissue during surgery. The implications of these findings are discussed. PMID:2158332

Abramson, A L; DiLorenzo, T P; Steinberg, B M

1990-05-01

392

A potentially novel overlapping gene in the genomes of Israeli acute paralysis virus and its relatives  

Microsoft Academic Search

The Israeli acute paralysis virus (IAPV) is a honeybee-infecting virus that was found to be associated with colony collapse disorder. The IAPV genome contains two genes encoding a structural and a nonstructural polyprotein. We applied a recently developed method for the estimation of selection in overlapping genes to detect purifying selection and, hence, functionality. We provide evolutionary evidence for the

Niv Sabath; Nicholas Price; Dan Graur

2009-01-01

393

Genetic Analysis of Israel Acute Paralysis Virus: Distinct Clusters Are Circulating in the United States  

Microsoft Academic Search

Israel acute paralysis virus (IAPV) is associated with colony collapse disorder of honey bees. Nonetheless, its role in the pathogenesis of the disorder and its geographic distribution are unclear. Here, we report phylogenetic analysis of IAPV obtained from bees in the United States, Canada, Australia, and Israel and the establishment of diagnostic real-time PCR assays for IAPV detection. Our data

G. Palacios; J. Hui; P. L. Quan; A. Kalkstein; K. S. Honkavuori; A. V. Bussetti; S. Conlan; J. Evans; Y. P. Chen; D. vanEngelsdorp; H. Efrat; J. Pettis; D. Cox-Foster; E. C. Holmes; T. Briese; W. I. Lipkin

2008-01-01

394

Historical presence of Israeli Acute Paralysis Virus in the United States  

Microsoft Academic Search

High bee colony losses in the United States this past year can be attributed in part to an unresolved syndrome termed Colony Collapse Disorder (CCD). An extensive genetic survey found one virus, Israeli Acute Paralysis Virus (IAPV), to be strongly associated with CCD. Using DNA sequencing and phylogenetic analyses, we provide evidence that IAPV was present in U.S. bees collected

Yanping Chen; Jay D. Evans

395

First detection of Israeli acute paralysis virus (IAPV) in France, a dicistrovirus affecting honeybees ( Apis mellifera)  

Microsoft Academic Search

Bee samples were collected in French apiaries that displayed severe losses and mortality during the winter (from November 2007 to March 2008). They were screened for the presence of Israeli acute paralysis virus (IAPV) by using RT-PCR. Five out of 35 surveyed apiaries, located in two different geographical areas, were found positive. This represents the first reported detection of IAPV

Philippe Blanchard; Frank Schurr; Olivier Celle; Nicolas Cougoule; Patrick Drajnudel; Richard Thiéry; Jean-Paul Faucon; Magali Ribière

2008-01-01

396

Wasp venom blocks central cholinergic synapses to induce transient paralysis in cockroach prey  

Microsoft Academic Search

The parasitoid wasp Ampulex com- pressa induces a set of unique behavioral effects upon stinging its prey, the cockroach. It stings into the first thoracic segment inducing 2 to 3 min of transient flaccid paralysis of the front legs. This facilitates a second sting in the cockroach's head that induces 30 min of excessive grooming followed b ya2t o5-week long

G. Haspel; F. Libersat

2003-01-01

397

RECOVERY OF MUSCULAR PARALYSIS IN CEREBRAL STROKE PATIENT: A CASE STUDY USING SURFACE ELECTROMYOGRAPHY & DYNAMOMETERY  

Microsoft Academic Search

Objective: To evaluate the recovery from muscular paralysis in Cerebral Stroke Patients using Surfaced Electromyography (SEMG) and hand dynamometry. Design: SEMG & muscle force recorded from a patient of Cerebral Stroke suffering from hemiparesis. Setting: The records were obtained from various affected and normal muscles of the patient on three consecutive visits at Neuromuscular Lab, Department of Physiology, University of

M. A. Azeem; S. Samia

2003-01-01

398

The treatment of general paralysis of the insane by malaria, with reports of two cases  

Microsoft Academic Search

HE development of the non-specific treatment of general paralysis of the insane dates back to very early times. Hippocrates, Galen, and later, Sydenham, recognised the beneficial effect of fever in mental disorders, and in 1786 Reuss observed the cure of a case of mania by an attack of small-pox. In the nineteenth century numerous instances were recorded of improvement produced

Geoffrey Bewley

1926-01-01

399

Compensatory Expressive Behavior for Facial Paralysis: Adaptation to Congenital or Acquired Disability  

Microsoft Academic Search

Objective: Although there has been little research on the adaptive behavior of people with congenital compared to acquired disability, there is reason to predict that people with congenital conditions may be better adapted because they have lived with their conditions for their entire lives (Smart, 2008). We examined whether people with congenital facial paralysis (FP), compared to people with acquired

Kathleen R. Bogart; Linda Tickle-Degnen; Nalini Ambady

2012-01-01

400

Thyrotoxic Hypokalaemic Periodic Paralysis (TPP) in Turkey: Report of a Case and Review of the Literature  

Microsoft Academic Search

Thyrotoxic hypokalaemic periodic paralysis (TPP) is characterized by acute and reversible episodes of muscle weakness during thyrotoxicosis and associated with low potassium levels. Increased sodium-potassium ATPase activity in TPP leads to sudden influx of potassium into muscle cells and results in hypokalaemia. It is seen most commonly in Southeast Asian men. TPP is a rare condition in our country. Although

Akinci Tevfik; Demir Ali; Abdurrahman Çömlekçi

401

Epidemiology and clinical findings associated with enteroviral acute flaccid paralysis in Pakistan  

Microsoft Academic Search

BACKGROUND: Enteroviruses are among the most common viruses infecting humans worldwide and they are associated with diverse clinical syndromes. Acute flaccid paralysis (AFP) is a clinical manifestation of enteroviral neuropathy, transverse myelitis, Guillian-Barre Syndrome, Traumatic neuritis and many other nervous system disorders. The objective of this study was to understand the role of Non-Polio Enteroviruses (NPEV) towards this crippling disorder.

Mohsan Saeed; Sohail Z Zaidi; Asif Naeem; Muhammad Masroor; Salmaan Sharif; Shahzad Shaukat; Mehar Angez; Anis Khan

2007-01-01

402

ACUTE FLACCID PARALYSIS SURVEILLANCE: LOOKING BEYOND THE GLOBAL POLIOMYELITIS ERADICATION INITIATIVE  

Microsoft Academic Search

In 1992 surveillance of acute flaccid paralysis (AFP) cases was introduced in Malay- sia along with the establishment of a national referral laboratory at the Institute for Medical Research. The objective of this study was to determine the incidence, viral etiology and clinical picture of AFP cases below 15 years of age, reported from 2002 to 2007. Six hundred sev-

TS Saraswathy; D Kurup; J Rohani; S Zainah

403

Laser Posterior Cordotomy: Is it a Good Choice in Treating Bilateral Vocal Fold Abductor Paralysis?  

PubMed Central

BACKGROUND Bilateral abductor vocal fold paralysis can lead to respiratory distress and dyspnea. OBJECTIVES To assess the efficacy of CO2 laser unilateral posterior cordotomy in cases with bilateral abductor paralysis as regards improvement of dyspnea with preservation of satisfactory voice and swallowing after the operation. METHODS A prospective study was done on 18 patients with bilateral abductor vocal fold paralysis (10 females and 8 males) from November 2010 to December 2012 with their ages ranging from 32 to 64 years. RESULTS All patients showed improvement of dyspnea after the operation, most of the patients suffered from mild to moderate dyspnea in the immediate post-operative period, and two patients needed another intervention to solve it. All the patients had satisfactory results of their voice after the operation, and one patient only suffered from temporary aspiration. CONCLUSION Unilateral CO2 laser posterior cordotomy is an easy and effective procedure to solve the dyspnea after bilateral vocal fold abductor paralysis without aspiration or significant voice alteration. PMID:25057244

Khalil, Mahmoud A; Abdel Tawab, Hazem M

2014-01-01

404

Self-Concept, Disposition, and Resilience of Poststroke Filipino Elderly with Residual Paralysis  

ERIC Educational Resources Information Center

The interplay among self-concept, disposition, and resilience mirrors how the condition affects the emotional status of poststroke Filipino elderly with residual paralysis. Despite healthcare professionals' understanding of these clients' physical conditions, little is known regarding these clients' emotional health status related to stroke.…

de Guzman, Allan B.; Tan, Eleanor Lourdes C.; Tan, Ernestine Faye S.; Tan, Justin Ryan L.; Tan, Mervyn C.; Tanciano, Daris Mae M.; Lee Say, Matthew L. Tang

2012-01-01

405

Acute flaccid paralysis associated with circulating vaccine-derived poliovirus--Philippines, 2001.  

PubMed

Three cases of acute flaccid paralysis (AFP) associated with circulating vaccine-derived poliovirus (cVDPV) isolates were reported in the Philippines during March 15-July 26, 2001. The first case-patient, a child aged 8 years from northern Mindanao island (500 miles south of Manila) who had received 3 doses of oral polio vaccine (OPV), had onset of paralysis on March 15. A second child, aged 3 years from Laguna province on Luzon island (60 miles south of Manila) who had received 3 OPV doses, presented with signs of meningitis but no paralysis on July 23. A third child, aged 14 months from Cavite province (25 miles from Manila and 45 miles north of Laguna province) who had received 2 OPV doses, had onset of paralysis on July 26. No patients had traveled outside of their province of residence since birth. Characterization of isolates from the three patients revealed type 1 polioviruses derived from Sabin vaccine strain type 1, with a 3% genetic sequence difference between Sabin 1 vaccine and vaccine-derived poliovirus (VDPV) isolates. The three polioviruses are not identical but are closely related (>99% sequence homology); they also appear to share an identical recombination site with a nonpolio enterovirus in the noncapsid region of the genome. PMID:11666115

2001-10-12

406

Ultrasound of Peripheral Nerves  

PubMed Central

Over the last decade, neuromuscular ultrasound has emerged as a useful tool for the diagnosis of peripheral nerve disorders. This article reviews sonographic findings of normal nerves including key quantitative ultrasound measurements that are helpful in the evaluation of focal and possibly generalized peripheral neuropathies. It also discusses several recent papers outlining the evidence base for the use of this technology, as well as new findings in compressive, traumatic, and generalized neuropathies. Ultrasound is well suited for use in electrodiagnostic laboratories where physicians, experienced in both the clinical evaluation of patients and the application of hands-on technology, can integrate findings from the patient’s history, physical examination, electrophysiological studies, and imaging for diagnosis and management. PMID:23314937

Suk, Jung Im; Walker, Francis O.; Cartwright, Michael S.

2013-01-01

407

Cranial Nerve II  

PubMed Central

This article contains a brief review of the anatomy of the visual system, a survey of diseases of the retina, optic nerve and lesions of the optic chiasm, and other visual field defects of special interest to the psychiatrist. It also includes a presentation of the corticothalamic mechanisms, differential diagnosis, and various manifestations of visual illusions, and simple and complex visual hallucinations, as well as the differential diagnoses of these various visual phenomena. PMID:19855858

Gillig, Paulette Marie; Sanders, Richard D.

2009-01-01

408

Peripheral Nerve Tumors  

Microsoft Academic Search

\\u000a Peripheral nerve tumors (PNTs) are rare soft tissue lesions that can arise anywhere on the body and as a result have a wide\\u000a differential diagnosis, which is often confirmed to be a PNT only at surgery. PNTs occur both sporadically and within the\\u000a context of genetically predisposing syndromes; hence, a thorough history of the mass and associated symptoms, with a

Joseph Wiley; Asis Kumar Bhattacharyya; Gelareh Zadeh; Patrick Shannon; Abhijit Guha

409

Optic nerve hypoplasia  

PubMed Central

Optic nerve hypoplasia (ONH) is a congenital anomaly of the optic disc that might result in moderate to severe vision loss in children. With a vast number of cases now being reported, the rarity of ONH is obviously now refuted. The major aspects of ophthalmic evaluation of an infant with possible ONH are visual assessment, fundus examination, and visual electrophysiology. Characteristically, the disc is small, there is a peripapillary double-ring sign, vascular tortuosity, and thinning of the nerve fiber layer. A patient with ONH should be assessed for presence of neurologic, radiologic, and endocrine associations. There may be maternal associations like premature births, fetal alcohol syndrome, maternal diabetes. Systemic associations in the child include endocrine abnormalities, developmental delay, cerebral palsy, and seizures. Besides the hypoplastic optic nerve and chiasm, neuroimaging shows abnormalities in ventricles or white- or gray-matter development, septo-optic dysplasia, hydrocephalus, and corpus callosum abnormalities. There is a greater incidence of clinical neurologic abnormalities in patients with bilateral ONH (65%) than patients with unilateral ONH. We present a review on the available literature on the same to urge caution in our clinical practice when dealing with patients with ONH. Fundus photography, ocular coherence tomography, visual field testing, color vision evaluation, neuroimaging, endocrinology consultation with or without genetic testing are helpful in the diagnosis and management of ONH. (Method of search: MEDLINE, PUBMED). PMID:24082663

Kaur, Savleen; Jain, Sparshi; Sodhi, Harsimrat B. S.; Rastogi, Anju; Kamlesh

2013-01-01

410

Near nerve potential of sural nerve in leprosy.  

PubMed

Leprosy neuropathy is characterized by initial involvement of the small nerve fibers, later followed by involvement of the large fibers, when routine nerve conduction studies become abnormal. To increase the diagnostic yield and precocity of these studies, we applied the near nerve technique to the sural nerve of 8 leprosy patients. Contrary to our expectations, the main component of the sural nerve sensory action potential was abnormal in all patients, but the minimum conduction velocity originating from small 3-6 mm fibers was normal or only mildly involved in three patients. Also, although Schwann cells are the first to be involved in leprosy, the results are suggestive of axonal degeneration instead of demyelination. To better understand the neurophysiology and physiology of leprosy and to increase the accuracy and precocity of the diagnosis, it will be necessary to investigate patients in the very early stages of the disease and to correlate these findings with the corresponding nerve pathology. PMID:15334210

Arruda, Ana Paula M; Marques, Wilson; Foss, Norma T; Garbino, José A; Virmond, Marcos; Barreira, Amilton A

2004-09-01

411

Subthreshold continuous electrical stimulation facilitates functional recovery of facial nerve after crush injury in rabbit.  

PubMed

We sought to determine whether electrical stimulation (ES) with subthreshold, continuous, low-frequency impulses is a viable clinical method for improving functional recovery after facial nerve crush injury. In 10 rabbits, bilateral crush injuries were made on the facial nerve by compression for 30 s with mosquito forceps, causing complete facial paralysis. Subthreshold continuous direct current ES with 20-Hz square-wave pulses was applied to the proximal stump on one side for 4 weeks. Vibrissae movement returned significantly earlier on the ES side, with a less variable recovery time. Electrophysiologically, the stimulated side had a significantly shorter latency, longer duration, and faster conduction velocity. Light and transmission electron microscopy revealed that the electrical stimulation also markedly decreased Wallerian degeneration. The average numbers of fluorescent, double-labeled nerve cells were significantly different between the ES and non-ES sides. This study shows that subthreshold, continuous, low-frequency ES immediately after a crush injury of the facial nerve results in earlier recovery of facial function and shorter overall recovery time. PMID:21254091

Kim, Jin; Han, Su Jin; Shin, Dong Hyun; Lee, Won-Sang; Choi, Jae Young

2011-02-01

412

A Prospective, Randomized Comparison of Cobra Perilaryngeal Airway and Laryngeal Mask Airway Unique in Pediatric Patients  

Microsoft Academic Search

BACKGROUND: The Cobra Perilaryngeal Airway (PLA) provides better sealing pres- sure than the Laryngeal Mask Airway Unique (LMAU) during positive-pressure ventilation in adults. We compared the performance of the CobraPLA and LMAU in infants and children. METHODS: Two-hundred pediatric patients were randomly assigned to a CobraPLA or an Laryngeal Mask Airway (LMA). We measured airway sealing at cuff inflation pressures

Peter Szmuk; Oscar Ghelber; Maria Matuszczak; Marry F. Rabb; Tiberiu Ezri; Daniel I. Sessler

2008-01-01

413

Primary Laryngeal Neuroendocrine Carcinoma - A Rare Entity with Deviant Clinical Presentation  

PubMed Central

Primary laryngeal neuroendocrine carcinomas are rare neoplasms. WHO classifies them under five categories of which, the moderately differentiated neuroendocrine carcinoma is synonymous with atypical or malignant carcinoid tumour. We report a rare case of primary laryngeal neuroendocrine carcinoma with an unusual and misleading clinical presentation. The initial cytological diagnosis of secondary neuroendocrine carcinoma in the cervical lymph node led to the suspicion of primary neuroendocrine carcinoma in the larynx. PMID:25386445

K, Anoosha; K, Amita; Shankar S, Vijay; Geeta K, Avadhani

2014-01-01

414

Gastroesophageal reflux disease is a risk factor for laryngeal and pharyngeal cancer  

Microsoft Academic Search

OBJECTIVE:Gastroesophageal reflux disease (GERD) is a proposed risk factor for developing laryngeal and pharyngeal cancers. No controlled study has examined this association.METHODS:A case-control study was performed using the computerized hospitalization and outpatient databases of the US Department of Veterans Affairs. All patients, who were veterans, had been identified as being hospitalized with laryngeal or pharyngeal during 1991 to 1997. In

Hashem B. El-Serag; Edward J. Hepworth; Patty Lee; Amnon Sonnenberg

2001-01-01

415

Coordinated Upregulation of COX2 and NF-?B Is a Steady Feature of Laryngeal Carcinogenesis  

Microsoft Academic Search

Background\\/Aims: Laryngeal cancer is the endpoint of a multistage process involving hyperplastic and dysplastic lesions, not adequately defined in their molecular aspect. Our objective was to evaluate the expression of the prostaglandin-synthesizing enzyme cyclooxygenase-2 (COX-2) and the chief transcription factor nuclear factor-?B (NF-?B) in laryngeal carcinomas and their precursors, as well as to explore any association between the two molecules.

Konstantinos Kourelis; Georgia Sotiropoulou-Bonikou; Gerasimos Vandoros; Maria Repanti; Ioannis Varakis; Panagiotis Goumas

2007-01-01

416

Laryngeal Chondrosarcoma: an Exceptional Localisation of a not Unfrequent Bone Tumor  

PubMed Central

After osteosarcoma, chondrosarcoma is the second most common primary bone tumor accounting for 26% of all malignancies. In the laryngeal region however, chondrosarcomas are rather rare. Only 300 cases are reported in literature. Considering laryngeal chondrosarcoma, about 75% occur in the cricoid cartilage, whereas 20% occur in the thyroid cartilage. In this paper we report a case of thyroidal chondrosarcoma, and based on a thorough literature search we suggest some practical guidelines concerning diagnosis and therapy. PMID:20066164

Moerman, Mieke; Kreps, Bernard; Forsyth, Ramses

2009-01-01

417

Nerve allografts and conduits in peripheral nerve repair.  

PubMed

Since the last update on nerve conduits and allograft in 2000, investigations have established the efficacy of these alternatives to autograft in the repair of small sensory neural gaps. However, limited insights into the biology of the regenerating nerve continue to preclude intelligent conduit design. Ongoing discoveries in neuroscience and biomaterial engineering hold promise for the eventual development of allograft and conduits with potential of surpassing nerve autografts in clinical efficacy. In this review, we summarize the history, recent advances, and emerging developments in nerve conduits and allograft. PMID:23895714

Lin, Michael Y; Manzano, Givenchy; Gupta, Ranjan

2013-08-01

418

A comparison of the oropharyngeal leak pressure between the reusable Classic laryngeal mask airway and the single-use Soft Seal laryngeal mask airway.  

PubMed

We tested the oropharyngeal leak pressure with the reusable laryngeal mask airway and the single-use Soft Seal laryngeal mask airway. These two types of laryngeal mask airway (LMA) have a similar design but the reusable LMA cuff is made from silicone whereas the Soft Seal LMA cuff is polyvinylchloride. Thirty-five healthy subjects were anaesthetized and paralyzed and the two types of Soft Seal LMA were compared in a blinded randomized cross-over trial. The oropharyngeal leak pressure was significantly higher with the Soft Seal than the reuable (21 +/- 7.6 and 16 +/- 6.7 cm H2O respectively, P = 0.002). However, in four subjects the oropharyngeal leak pressure was higher with the reusable by > 4 cm H2O. We concluded that the reusable LMA may provide a better seal in some individuals but that, on average, the Soft Seal provides a higher oropharyngeal leak pressure than the reusable LMA. PMID:16617647

Hanning, S J; McCulloch, T J; Orr, B; Anderson, S P

2006-04-01

419

Laryngeal lymphoma derived from mucosa-associated lymphoid tissue.  

PubMed

Extranodal lymphomas account for as many as 40% of non-Hodgkin's lymphomas, and most arise in the gastrointestinal tract, but other mucosal organs may be involved, especially the upper aerodigestive tract. Low-grade B-cell lymphomas arising in the gastrointestinal tract and other mucosae have been found to recapitulate the structure and cytologic features of mucosa-associated lymphoid tissue (MALT). Histologically low-grade MALT lymphomas are characterized by centrocyte-like B-cells with a phenotype similar to that of so-called marginal zone B-cells. Tumors evolving from MALT are generally rare among lymphomas of the upper aerodigestive tract, but a few cases of laryngeal lymphomas derived from MALT have been reported. Primary MALT lymphoma of the larynx should always be considered in tumors with histopathologic features of low-grade B-cell lymphoma, or so-called pseudolymphoma. PMID:8678438

Horny, H P; Ferlito, A; Carbone, A

1996-07-01

420

Automatic segmentation of equine larynx for diagnosis of laryngeal hemiplegia  

NASA Astrophysics Data System (ADS)

This paper presents an automatic segmentation method for delineation of the clinically significant contours of the equine larynx from an endoscopic image. These contours are used to diagnose the most common disease of horse larynx laryngeal hemiplegia. In this study, hierarchal structured contour map is obtained by the state-of-the-art segmentation algorithm, gPb-OWT-UCM. The conic-shaped outer boundary of equine larynx is extracted based on Pascal's theorem. Lastly, Hough Transformation method is applied to detect lines related to the edges of vocal folds. The experimental results show that the proposed approach has better performance in extracting the targeted contours of equine larynx than the results of using only the gPb-OWT-UCM method.

Salehin, Md. Musfequs; Zheng, Lihong; Gao, Junbin

2013-10-01

421

Is the Frequency Content of the Calls in North American Treefrogs Limited by Their Larynges?  

PubMed Central

A high diversity of mating calls is found among frogs. The calls of most species, however, are simple, in comparison to those of mammals and birds. In order to determine if the mechanics of the larynx could explain the simplicity of treefrog calls, the larynges of euthanized males were activated with airflow. Laryngeal airflow, sound frequency, and sound intensity showed a positive direct relationship with the driving air pressure. While the natural calls of the studied species exhibit minimal frequency modulation, their larynges produced about an octave of frequency modulation in response to varying pulmonary pressure. Natural advertisement calls are produced near the higher extreme of frequency obtained in the laboratory and at a slightly higher intensity (6?dB). Natural calls also exhibit fewer harmonics than artificial ones, because the larynges were activated with the mouth of the animal open. The results revealed that treefrog larynges allow them to produce calls spanning a much greater range of frequencies than observed in nature; therefore, the simplicity of the calls is not due to a limited frequency range of laryngeal output. Low frequencies are produced at low intensities, however, and this could explain why treefrogs concentrate their calling at the high frequencies. PMID:25332838

2014-01-01

422

Effects of surface dehydration on mucosal wave amplitude and frequency in excised canine larynges  

PubMed Central

Objective Evaluate the effect of vocal fold surface dehydration on mucosal wave amplitude and frequency. Study Design Controlled test-retest. Setting Larynges were mounted on an excised larynx phonation system and attached to a pseudolung in a triple-walled sound-attenuated room that eliminated background noise and maintained a stabilized room temperature and humidity level. Subjects and Methods High-speed video was recorded for eight excised canine larynges during exposure to dehumidified air at 20 cm H2O. Control trials consisted of high-speed videos recorded for two excised canine larynges during exposure to humidified air at the same pressure. Results In the majority of larynges, increased levels of dehydration were correlated with decreased amplitude and frequency. The slope of the linear regression fitted to the change in amplitude (p=0.003) as well as the percent change (p<0.001) between the initial and final trials were significantly decreased in dehydrated larynges. These measurements with respect to the change in frequency were also significantly decreased in dehydrated larynges (p<0.001; p=0.027). Conclusion Vocal fold surface dehydration caused a decrease in mucosal wave amplitude and frequency. This study provides objective, quantitative support for the mechanism of voice deterioration observed after extreme surface dehydration. PMID:21493398

Witt, Rachel E.; Taylor, Lindsay N.; Regner, Michael F.; Jiang, Jack J.

2011-01-01

423

Behcet's disease impairs voice quality without laryngeal and hypopharyngeal involvement.  

PubMed

The objective of the study was to investigate voice evaluation parameters in Behcet's disease patients. A prospective controlled study was performed in a tertiary referral center. A total of 31 patients (21 female, 10 male) with a diagnosis of Behcet's disease had voice evaluations by means of laryngostroboscopy, acoustic analysis, aerodynamic measurements and perceptual assessment. Data obtained from the patients were compared to 31 healthy control subjects. Laryngeal endoscopy was within normal limits in all patients. The mean fundamental frequency in male control subjects (134 ± 14 Hz) was significantly higher than in male patients (124 ± 20 Hz), (p = 0.043). Mean intensity was significantly higher in control subjects (74 ± 5 dB) than in the patients (63 ± 4.6 dB), (p < 0.001). Shimmer in patients (3.4 ± 2.5) was significantly higher than in control subjects (2 ± 1.3), (p = 0.01). Maximum phonation time in control subjects (25 ± 5.8 s) was significantly longer than in patients (20 ± 7.9 s), (p = 0.007), and s/z ratio was found to be nearly equal between patients (0.9 ± 0.2) and control subjects (0.96 ± 0.1), (p > 0.05). The patients showed a mean GRBAS score of 1.8 ± 1.9 and the control group showed a mean score of 0.48 ± 1.06, (p = 0.002). The VHI-10 scale revealed a mean score of 2.2 ± 4.8 in BD patients and 2 ± 2 in control subjects (p > 0.05). Behcet's disease impaired voice quality without laryngostroboscopically visible laryngeal and hypopharyngeal involvement. This impairment was documented by objective voice evaluation methods including acoustic analysis and aerodynamic voice measurements and by subjective voice evaluation method including perceptual assessment. PMID:22763430

Gurbuzler, Levent; Inanir, Ahmet; Yelken, Kursat; Koc, Sema; Eyibilen, Ahmet; Uysal, Ismail Onder; Aladag, Ibrahim

2012-12-01

424

Fibrolipoma of the median nerve.  

PubMed

Neural fibrolipoma or fibrolipomatous hamartoma is an uncommon benign tumor that usually arises in the median nerve. Fibrofatty tissue proliferates around the nerve and infiltrates the epineurium and perineurium. We report a case of fibrolipomatous hamartoma of the left median nerve in an 18-year-old woman. Our objective was to describe the pathognomonic magnetic resonance imaging features, whose presence obviates the need for a diagnostic biopsy. PMID:17178460

Nouira, Kais; Belhiba, Hend; Baccar, Sofiène; Miaaoui, Anissa; Ben Messaoud, Monia; Turki, Imène; Cheour, Ilhem; Menif, Emna

2007-01-01

425

Live-Donor Nerve Transplantation  

Microsoft Academic Search

We recently reported the first case of live-donor nerve transplantation, performed in November 2000 in an 8-month-old infant\\u000a with global obstetric brachial plexus palsy (OBPP) and four root avulsion who had undergone prior sural nerve autografting\\u000a at 3 months. Cross-chest C7 nerve transfer and temporary tacrolimus (TCL)\\/prednisone immunosuppression were utilized. The\\u000a purpose of this chapter is twofold. First, we provide

Scott A. Gruber; Pedro Mancias

426

Acute Respiratory Distress in Patient with Laryngeal Schwannoma  

PubMed Central

Schwannoma is a neurogenic benign tumour arising from the proliferation of Schwann cells present in the peripheral nerve sheath of myelinated nerves. This proliferation can hypothetically appear in every anatomic region of the human body, but the nerve sheath tumors rarely occur within the larynx. In this paper the authors discuss the case of a 74-year-old female who presented to Emergency Unit (EU) for an important acute respiratory distress. Airway flexible endoscopy revealed a bulky mass of the aryepiglottic fold measuring 3.5?cm in diameter. The patient underwent tracheotomy and a single-step surgical excision treatment of the mass which was recognized as a schwannoma at pathological examination. Tracheotomy was closed 2 weeks postoperatively. After 18 months of followup, the patient is alive and free of disease and her voice had improved markedly. PMID:22701490

Mannarini, Laura; Morbini, Patrizia; Bertino, Giulia; Gatti, Omar; Benazzo, Marco

2012-01-01

427

Value of Narrow Band Imaging (NBI) Endoscopy in the Early Diagnosis of Laryngeal Cancer and Precancerous Lesions  

ClinicalTrials.gov

Chronic Inflammation of Hypopharynx; Hoarseness; Macroscopic Laryngeal Lesions; Histological Confirmation of Dysplasia; Carcinoma in Situ; Invasive Carcinoma of Larynx; Invasive Carcinoma of Hypo Pharynx; Recurrent Respiratory Papillomatosis

2014-08-13

428

The laryngeal mask airway Unique versus the Soft Seal laryngeal mask: a randomized, crossover study in paralyzed, anesthetized patients.  

PubMed

We tested the hypothesis that ease of insertion, oropharyngeal leak pressure, fiberoptic position, ease of ventilation, and mucosal trauma are different for the Soft Seal laryngeal mask airway (SSLM) and the laryngeal mask airway Unique (LMA-U). Ninety paralyzed, anesthetized adult patients (ASA I-II; 18-80 yr old) were studied. Both devices were inserted into each patient in random order. Oropharyngeal leak pressure and fiberoptic position were determined during cuff inflation from 0-40 mL in 10-mL increments and at an intracuff pressure of 60 cm H(2)O. Ease of ventilation was determined by controlling ventilation for 10 min at 8 and 12-mL/kg tidal volume and recording hemoglobin oxygen saturation, end-tidal CO(2), leak fraction, peak airway pressure, and the presence or absence of gastric insufflation. Mucosal trauma was determined by examining the first randomized device for the presence of visible and occult blood. Insertion time was shorter (P = 0.0001) and fewer attempts were required (P = 0.005) for the LMA-U. There were no failed uses of either device. Oropharyngeal leak pressures were similar, but fiberoptic position was superior with the LMA-U (P < or = 0.0003). There were no differences in hemoglobin oxygen saturation, end-tidal CO(2), leak fraction, or peak airway pressure at either tidal volume. Gastric insufflation was not detected in either group at either tidal volume. The frequency of visible (P = 0.009) and occult blood (P = 0.0001) was less with the LMA-U. We conclude that the LMA-U is superior to the SSLM in terms of ease of insertion, fiberoptic position, and mucosal trauma, but similar in terms of oropharyngeal leak pressure and ease of ventilation. PMID:15502065

Brimacombe, Joseph; von Goedecke, Achim; Keller, Christian; Brimacombe, Lawrence; Brimacombe, Moira

2004-11-01

429

In vivo nerve-macrophage interactions following peripheral nerve injury  

PubMed Central

In vertebrates, the peripheral nervous system has retained its regenerative capacity, enabling severed axons to reconnect with their original synaptic targets. While it is well documented that a favorable environment is critical for nerve regeneration, the complex cellular interactions between injured nerves with cells in their environment, as well as the functional significance of these interactions, have not been determined in vivo and in real time. Here we provide the first minute-by-minute account of cellular interactions between laser transected motor nerves and macrophages in live intact zebrafish. We show that macrophages arrive at the lesion site long before axon fragmentation, much earlier than previously thought. Moreover, we find that axon fragmentation triggers macrophage invasion into the nerve to engulf axonal debris, and that delaying nerve fragmentation in a Wlds model does not alter macrophage recruitment but induces a previously unknown ‘nerve scanning’ behavior, suggesting that macrophage recruitment and subsequent nerve invasion are controlled by separate mechanisms. Finally, we demonstrate that macrophage recruitment, thought to be dependent on Schwann cell derived signals, occurs independently of Schwann cells. Thus, live cell imaging defines novel cellular and functional interactions between injured nerves and immune cells. PMID:22423110

Rosenberg, Allison; Wolman, Marc A.; Franzini-Armstrong, Clara; Granato, Michael

2012-01-01

430

Paralysis Developing as a Paradoxical Response During the Treatment for Tuberculous Spondylitis: A Case Report  

PubMed Central

It can be difficult for clinicians to distinguish a paradoxical response to antituberculous therapy, worsening of an existing lesion despite adequate treatment, treatment failure, and drug resistance. We report a case of a 69-year-old woman who experienced bilateral lower extremity paralysis secondary to a paradoxical response. She had been suffering for 1 month from low back pain, due to tuberculous spondylitis. Her low back pain improved after antituberculous therapy. The low back pain, however, reappeared 2 months after treatment, accompanied by newly developed lower extremity weakness. Imaging studies showed an increased extent of her previous lesions. Consequently, the patient underwent a vertebral corpectomy with interbody fusion of the thoracolumbar spine. Histopathological examination showed chronic inflamed granulation tissue with no microorganisms. Although the antituberculous medication was not changed, the patient's symptoms and signs, including the paralysis, resolved after surgery. PMID:25024967

Park, Jae Hyeon; Kim, Yeo Hyung; Kwon, Chan Hyuk

2014-01-01

431

A Case Report on the Bardet Biedl Syndrome with Hypokalaemic Paralysis  

PubMed Central

The Bardet-Biedl syndrome (BBS), a rare autosomal recessive disorder, was first described by Bardet and Biedl in 1920. Here, we are reporting a case of the Bardet-Biedl syndrome with hypokalaemic paralysis. A 22 years old male patient presented with an acute onset, rapidly progressive, flaccid weakness in all four limbs. An examination revealed a moon shaped face, acanthosis nigricans, lower limb polydactyly, central obesity, small testicular size, absence of the axillary and pubic hairs, severely impaired social adaptive functioning and retinitis pigmentosa. The central nervous system examination showed hypotonia, a grade zero power and absent reflexes. The laboratory reports showed that the patient had hypokalaemia and diabetes mellitus. The literature showed hypokalaemic paralysis as a rare complication of the Bardet-Biedl syndrome. PMID:23905129

Y.M., Prasanth; Ashraf, Mohammed; B.M., Venkatesh; Menezes, Sharol; Mohan, Abraham

2013-01-01

432

Electromyographic feedback in the treatment of bilateral facial paralysis: a case study.  

PubMed

Electromyographic feedback in the treatment of facial paralysis has been shown to be a useful alternative to surgical procedures. In this paper we report on the partial recovery of a 7-year-old patient with congenital bilateral facial paralysis (Moebius syndrome) that had been considered untreatable by medical specialists. Biofeedback of electromyographic activity was provided together with specific instructions, social reinforcement, and exercises that the patient carried out at home. The rehabilitation training lasted 1 year, during which there was a substantial increase in the electromyographic activity of the muscles on both sides of the face. A follow-up after 1 year of discontinuing the treatment showed that the muscle activity had been maintained and that there was a marked improvement in the patient's mood and facial expression. PMID:1447762

Gallegos, X; Medina, R; Espinoza, E; Bustamante, A

1992-10-01

433

Acute flaccid paralysis surveillance: looking beyond the global poliomyelitis eradication initiative.  

PubMed

In 1992 surveillance of acute flaccid paralysis (AFP) cases was introduced in Malaysia along with the establishment of a national referral laboratory at the Institute for Medical Research. The objective of this study was to determine the incidence, viral etiology and clinical picture of AFP cases below 15 years of age, reported from 2002 to 2007. Six hundred seventy-eight of 688 reported cases were confirmed as AFP by expert review. The clinical presentation of acute flaccid paralysis in these cases was diverse, the most commonly reported being Guillian-Barre syndrome (32.3%). Sixty-nine viruses were isolated in this study. They were Sabin poliovirus (25), Echovirus (22), Cocksackie B (11), EV71 (5), Cocksackie A (1), and untypable (5). Malaysia has been confirmed as free from wild polio since the surveillance was established. PMID:19062691

Saraswathy, T S; Zahrin, H Nor; Apandi, M Y; Kurup, D; Rohani, J; Zainah, S; Khairullah, N S

2008-11-01

434

Unilateral gynecomastia and hypokalemic periodic paralysis as first manifestations of Graves' disease.  

PubMed

A 39-year-old Chinese man presented to the study hospital with right-sided gynecomastia. Underlying Graves' disease was not diagnosed until recurrent episodes of hypokalemic periodic paralysis were observed. The estradiol (E2) and progesterone levels and the E2-to-testosterone (T) (E2/T) ratio of the patient were elevated before treatment. Immediate intravenous potassium supplementation was started to reverse the paralysis. Additionally, antithyroid drugs were administered to restore a euthyroid state. After treatment, the patient gained strength. Gynecomastia regressed with a return to the euthyroid state; the E2 and progesterone levels normalized and the plasma E2/T ratio declined. In addition to the classic symptoms, some atypical symptoms of Graves' disease may also occur. One of the challenges lies in recognizing the underlying etiology. Early diagnosis and appropriate treatment can avoid unnecessary investigations and serious cardiopulmonary complications. PMID:23276903

Wang, Yufan; Zhao, Li; Li, Fan; Chen, Hai-xi; Fang, Fang; Peng, Yong-de

2013-06-01

435

An outbreak of suspected tick paralysis in one-humped camels (Camelus dromedarius) in the Sudan.  

PubMed

An outbreak of suspected tick paralysis occurred in one-humped camels in Southern Darfur, the Sudan, between latitudes 11-12 degrees N and longitudes 24-25 degrees E, when the camels were herded in tick infested areas. It involved 251 camels of different ages, in ten herds causing 34.3% mortality. The symptoms were incoordination of movements, unsteady gait and recumbency followed by death or recovery. Hyalomma adults and/or Rhipicephalus nymphs and adults were incriminated to be the cause of the disease. Transient paralysis in a guinea pig was produced after experimental feeding of ticks. Removal of the camels from the tick infested areas and treatment against the ectoparasites with Lindane at the concentration of 0.23% contributed to controlling the disease. PMID:2132792

Musa, M T; Osman, O M

1990-01-01

436

Diabetic Neuropathies: The Nerve Damage of Diabetes  

MedlinePLUS

... nerve damage to the bowels can cause constipation alternating with frequent, uncontrolled diarrhea, especially at night. Problems ... Nerve conduction studies check the transmission of electrical current through a nerve. Electromyography shows how well muscles ...

437

Wasp venom blocks central cholinergic synapses to induce transient paralysis in cockroach prey.  

PubMed

The parasitoid wasp Ampulex compressa induces a set of unique behavioral effects upon stinging its prey, the cockroach. It stings into the first thoracic segment inducing 2 to 3 min of transient flaccid paralysis of the front legs. This facilitates a second sting in the cockroach's head that induces 30 min of excessive grooming followed by a 2 to 5-week long lethargic state. In the present study, we examine the immediate effect of the first sting, which is a transient paralysis of the front legs. Using radiolabeled wasps, we demonstrate that the wasp injects its venom directly into the cockroach's first thoracic ganglion. The artificial injection of milked venom into a thoracic ganglion abolishes spontaneous and evoked responses of the motoneurons associated with leg movements. To investigate the physiological mechanism of action of the venom, we injected venom into the last abdominal ganglion of the cockroach, which houses a well-characterized cholinergic synapse. Injected venom abolishes both sensory-evoked and agonist-evoked postsynaptic potentials recorded in the postsynaptic neuron for 2 to 3 min without affecting action potential propagation. Thus, the venom blocking effect has a postsynaptic component that follows the same time course as the transient paralysis induced by the thoracic sting. Finally, injection of a nicotinic antagonist in the front thoracic ganglion induces paralysis of the front legs. We conclude that the transient paralytic effect of the thoracic sting can be mainly accounted for by the presence of a venom active component that induces a posts