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CLINICAL REVIEW: Current Concepts in the Management of Unilateral Recurrent Laryngeal Nerve Paralysis after Thyroid Surgery  

Microsoft Academic Search

Objective: This study was designed to provide an update on the pathophysiological concepts and patient management in a common complication of thyroid surgery, unilateral recur- rent laryngeal nerve paralysis (URLNP). Method: Recent publications in physiology and head and neck surgery were reviewed. Results: Even for experienced surgeons, URLNP may occur after thyroid surgery, especially for thyroid cancer and in case

Dana M. Hartl; Jean-Paul Travagli; Sophie Leboulleux; Eric Baudin; Daniel F. Brasnu; Martin Schlumberger


[A rare late complication of radiation therapy: bilaterally recurrent laryngeal nerve paralysis].  


Peripheral neuropathy is a late complication of radiation therapy, which is least and probably threatening. As it occurs many years after the remission is achieved with a usually irreversible clinical presentation, it significantly increases morbidity in cancer survivors and has an adverse effect on the quality of life. In this article, we report a 39-year-old male patient of bilateral recurrent laryngeal nerve paralysis which developed eight years after the treatment of stage T1b glottic laryngeal carcinoma with primary radiation therapy and was treated by transverse laser cordotomy. PMID:25547749

Ba?aran, Bora; Ünsaler, Selin; Orhan, K Serkan; K?yak, Ö Erkan



[Laryngeal paralysis and laryngospasm].  


The intrinsic laryngeal muscle potential was recorded with electromyography. Vocal cord movements were observed by a video stroboscope. Laryngeal paralysis is divided into mild, moderate, and severe degrees based on the potentials of intrinsic laryngeal muscles and on the status of vocal cord movements. In the past 11 years (from 1983 to 1993) 1211 cases were diagnosed as having mild, moderate, and severe laryngeal paralysis. Among them, there were 11 cases with laryngospasm including 3 mild, 2 moderate, and 6 severe cases. The findings obtained from careful observation on these 11 cases of laryngospasm demonstrated that there were certain relationships between laryngeal paralysis and laryngospasm. During the course of exacerbation or restoration of paralysis, the laryngospasm may occur. PMID:8579868

Yang, S; He, P; Lu, S



Irregular vocal fold dynamics incited by asymmetric fluid loading in a model of recurrent laryngeal nerve paralysis  

NASA Astrophysics Data System (ADS)

Voiced speech is produced by dynamic fluid-structure interactions in the larynx. Traditionally, reduced order models of speech have relied upon simplified inviscid flow solvers to prescribe the fluid loadings that drive vocal fold motion, neglecting viscous flow effects that occur naturally in voiced speech. Viscous phenomena, such as skewing of the intraglottal jet, have the most pronounced effect on voiced speech in cases of vocal fold paralysis where one vocal fold loses some, or all, muscular control. The impact of asymmetric intraglottal flow in pathological speech is captured in a reduced order two-mass model of speech by coupling a boundary-layer estimation of the asymmetric pressures with asymmetric tissue parameters that are representative of recurrent laryngeal nerve paralysis. Nonlinear analysis identifies the emergence of irregular and chaotic vocal fold dynamics at values representative of pathological speech conditions.

Sommer, David; Erath, Byron D.; Zanartu, Matias; Peterson, Sean D.



Bilateral recurrent laryngeal neurectomy as a model for the study of idiopathic canine laryngeal paralysis.  

PubMed Central

The purposes of this study were to develop an experimental model of canine laryngeal paralysis that mimicked the naturally occurring disease and to document the upper airway changes produced, both clinically and with pulmonary function testing. Ten dogs had bilateral recurrent laryngeal neurectomy performed and were recovered from anesthesia. Tidal breathing flow-volume loop analysis and upper airway resistance measurements were taken before and after the development of clinical laryngeal paralysis while dogs breathed room air and after the individual administration of 2 respiratory stimulants. Clinical signs of laryngeal paralysis developed 38 days (median) following denervation. Although some variations were present, tidal breathing flow-volume loop analyses on room air, following denervation, were similar to those reported in naturally occurring cases. Upper airway resistance increased following denervation and was significantly increased with both respiratory stimulants. We concluded that bilateral recurrent laryngeal neurectomy resulted in clinical signs and respiratory changes similar to those of idiopathic canine laryngeal paralysis. PMID:9056067

Greenfield, C L; Alsup, J C; Hungerford, L L; McKiernan, B C



Facial nerve paralysis following pediatric cardiac surgery.  


A newborn female diagnosed with transposition of the great vessels with restrictive ventricular septal defect presented left facial peripheral nerve paralysis following anatomical surgery correction (arterial switch) by cardiopulmonary bypass. We have not found any causal factor either in the anesthesia or postoperative period. The electromyogram presented signs of peripheral nerve impairment, and the cerebral echography and electroencephalogram were normal. The facial nerve paralysis was almost recovered seven weeks after surgery. This is the first pediatric patient reported with peripheral facial nerve paralysis after cardiac surgery. PMID:8869372

Alcaraz, A; Lopez-Herce, J; Castro, P; Bustinza, A; Moroto, C



Recurrent largngeal nerve paralysis: a laryngographic and computed tomographic study  

SciTech Connect

Vocal cord paralysis is a relatively common entity, usually resulting from a pathologic process of the vagus nerve or its recurrent larynegeal branch. It is rarely caused by intralargngeal lesions. Four teen patients with recurrent laryngeal nerve paralysis (RLNP) were evaluated by laryngography, computed tomography (CT), or both. In the evaluation of the paramedian cord, CT was limited in its ability to differentiate between tumor or RLNP as the cause of the fixed cord, but it yielded more information than laryngography on the structural abnormalities of the larynx and pre-epiglottic and paralaryngeal spaces. Laryngography revealed distinct features of RLNP and is the procedure of choice for evaluation of functional abnormalities of the larynx until further experience with faster CT scanners and dynamic scanning of the larynx is gained.

Agha, F.P.



Computer-assisted evoked electromyography with stimulating surgical instruments for recurrent\\/external laryngeal nerve identification and preservation in thyroid and parathyroid operation  

Microsoft Academic Search

Background. The reported incidence of recurrent laryngeal nerve (RLN) palsy\\/paralysis in thyroid and parathyroid operation ranges from 2% to 13%. Injury to the external branch of the superior laryngeal nerve (EBSLN) is less clearly documented. We hypothesized that a novel evoked electromyography system using an audio warning alarm might be beneficial for detection and preservation of the RLN and EBSLN.

Alan P. B Dackiw; Lorne E Rotstein; Orlo H Clark



Autonomic neuropathy resulting in recurrent laryngeal nerve palsy in an HIV patient with Hodgkin lymphoma receiving vinblastine and antiretroviral therapy.  


Hoarseness of voice due to vocal cord paresis as a result of recurrent laryngeal nerve palsy has been well recognised. Recurrent laryngeal nerve palsy is commonly caused by compression due to tumour or lymph nodes or by surgical damage. Vinca alkaloids are well known to cause peripheral neuropathy. However, vinca alkaloids causing recurrent laryngeal nerve palsy has been reported rarely in children. We report a case of an adult patient with HIV who developed hoarseness of voice due to vocal cord paralysis during vinblastine treatment for Hodgkin lymphoma. Mediastinal and hilar lymph node enlargement in such patients may distract clinicians from considering alternative causes of recurrent laryngeal nerve palsy, with potential ensuing severe or even life-threatening stridor. PMID:24828552

Cherif, S; Danino, S; Yoganathan, K



A novel modification of the ansa to recurrent laryngeal nerve reinnervation procedure for young children.  


Vocal ford paralysis is a condition often seen in otolaryngologic adult and pediatric clinics. We report a case we believe to be the youngest child to undergo ansa cervicalis (ansa) to recurrent laryngeal nerve (RLN) reinnervation for unilateral vocal fold paralysis. We have included the preoperative and postoperative videostroboscopic and acoustic findings. The acoustic data shows improvement and is consistent with the patient's improved voice quality. Most notably the patient's voice quality is less raspy and his volume has improved while subjectively requiring less effort. PMID:20864189

Marcum, Kristin Kucera; Wright, S Carter; Kemp, Erin Shannon; Kitse, Daniel J



Efficient, effective, safe procedure to identify non-recurrent inferior laryngeal nerve during thyroid surgery.  


Background: The non-recurrent inferior laryngeal nerve (NRILN) is always associated with the aberrant subclavian artery. Computed Tomography (CT) images can detect this vascular anomaly, which predicts an NRILN. The purpose is to report our procedure to identify the NRILN in patients with the aberrant subclavian artery. Methods: Four of 730 patients undergoing thyroid operation in our hospital, 4 were preoperatively diagnosed with aberrant subclavian artery by CT of the neck. To avoid vocal cord paralysis, we approached the vagal nerve firstly before dissecting the paratracheal region to discover the separation point of the NRILN from the vagal nerve. Results: The NRILN was identified without difficulty in all 4 patients. No patients showed vocal cord paralysis. Conclusions: Approaching the vagal nerve firstly before dissecting the paratracheal region is an efficient, effective and safe procedure to identify an NRILN in patients who are preoperatively diagnosed as having the aberrant subclavian artery. This article is protected by copyright. All rights reserved. PMID:25488277

Watanabe, Akihito; Taniguchi, Masanobu; Kimura, Yuki; Ito, Suguru; Hosokawa, Masao; Sasaki, Shigeyuki



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.



Influence of Asymmetric Recurrent Laryngeal Nerve Stimulation on Vibration, Acoustics, and Aerodynamics  

PubMed Central

Objectives/Hypothesis Evaluate the influence of asymmetric recurrent laryngeal nerve (RLN) stimulation on the vibratory phase, acoustics and aerodynamics of phonation. Study Design Basic science study using an in vivo canine model. Methods The RLNs were symmetrically and asymmetrically stimulated over eight graded levels to test a range of vocal fold activation conditions from subtle paresis to paralysis. Vibratory phase, fundamental frequency (F0), subglottal pressure, and airflow were noted at phonation onset. The evaluations were repeated for three levels of symmetric superior laryngeal nerve (SLN) stimulation. Results Asymmetric laryngeal adductor activation from asymmetric left-right RLN stimulation led to a consistent pattern of vibratory phase asymmetry, with the more activated vocal fold leading in the opening phase of the glottal cycle and in mucosal wave amplitude. Vibratory amplitude asymmetry was also observed, with more lateral excursion of the glottis of the less activated side. Onset fundamental frequency was higher with asymmetric activation because the two RLNs were synergistic in decreasing F0, glottal width, and strain. Phonation onset pressure increased and airflow decreased with symmetric RLN activation. Conclusion Asymmetric laryngeal activation from RLN paresis and paralysis has consistent effects on vocal fold vibration, acoustics, and aerodynamics. This information may be useful in diagnosis and management of vocal fold paresis. PMID:24913182

Chhetri, Dinesh K.; Neubauer, Juergen; Sofer, Elazar



Canine awake head-out plethysmography (HOP): characterization of external resistive loading and spontaneous laryngeal paralysis.  


We applied a novel head-out plethysmographic (HOP) method to study awake canine responses to external resistive loading and natural laryngeal paralysis. Measurements of inspiratory and expiratory specific airway resistance (sRaw(insp), sRaw(exp)) were obtained before and after uni- and bidirectional loading (R(add) = 5 cmH(2)O/L/s) in large-breed dogs (n = 9). Mean sRaw(insp) after inspiratory, and sRaw(exp) after expiratory loading were 31.4 and 33.3 cmH(2)Os, respectively. Bidirectional loads induced a significantly greater rise in both sRaw(insp) and sRaw(exp) (55.1 and 61.3 cmH(2)Os) compared to unidirectional loading (P < 0.001). Yet, type of loading did not affect flow-volume indices. The mean R(aw) of dogs was 4.81 cmH(2)O/L/s. Expiratory loading resulted in a significant 8.8% increase in functional-residual-capacity (FRC), compared to FRC(baseline) (76.7 ml/kg). Dogs (n = 5) with laryngeal paralysis demonstrated a significant increase in sR(aw) and R(aw) compared to controls without changes in FRC. In conclusion, HOP precisely characterized sR(aw) in response to external resistive loading. Hence, we could accurately quantify airway obstruction in awake dogs with laryngeal paralysis. PMID:16055393

Bedenice, D; Rozanski, E; Bach, J; Lofgren, J; Hoffman, A M



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.



Intralaryngeal neuroanatomy of the recurrent laryngeal nerve of the rabbit  

PubMed Central

We undertook this study to determine the detailed neuroanatomy of the terminal branches of the recurrent laryngeal nerve (RLN) in the rabbit to facilitate future neurophysiological recordings from identified branches of this nerve. The whole larynx was isolated post mortem in 17 adult New Zealand White rabbits and prepared using a modified Sihler's technique, which stains axons and renders other tissues transparent so that nerve branches can be seen in whole mount preparations. Of the 34 hemi-laryngeal preparations processed, 28 stained well and these were dissected and used to characterize the neuroanatomy of the RLN. In most cases (23/28) the posterior cricoarytenoid muscle (PCA) was supplied by a single branch arising from the RLN, though in five PCA specimens there were two or three separate branches to the PCA. The interarytenoid muscle (IA) was supplied by two parallel filaments arising from the main trunk of the RLN rostral to the branch(es) to the PCA. The lateral cricoarytenoid muscle (LCA) commonly received innervation from two fine twigs branching from the RLN main trunk and travelling laterally towards the LCA. The remaining fibres of the RLN innervated the thyroarytenoid muscle (TA) and comprised two distinct branches, one supplying the pars vocalis and the other branching extensively to supply the remainder of the TA. No communicating anastomosis between the RLN and superior laryngeal nerve within the larynx was found. Our results suggest it is feasible to make electrophysiological recordings from identified terminal branches of the RLN supplying laryngeal adductor muscles separate from the branch or branches to the PCA. However, the very small size of the motor nerves to the IA and LCA suggests that it would be very difficult to record selectively from the nerve supply to individual laryngeal adductor muscles. PMID:12739619

Ryan, Stephen; McNicholas, Walter T; O'Regan, Ronan G; Nolan, Philip



[Intracordal injection therapy using atelocollagen for unilateral laryngeal paralysis under local anesthesia].  


Intracordal injection therapy is a surgical therapeutic modality for glottic incompetence caused by unilateral laryngeal paralysis. Atelocollagen, which has recently been attracting attention as a material for use in intracordal injection therapy that supplants silicon, was initially claimed and expected, by virtue of its salient biophysical properties, not to cause impaired wave-motion of the vocal mucosa when injected into the submucosa. Unfortunately, however, our attempt to use this material for the same purpose proved disappointingly unsuccessful, with vocal sounds produced thereafter being metallic, vocal folds becoming tense and consequently transforming the site into a muscular coat of vocal muscles. During the past 3 years, we at the Department of Otolaryngology of the Jikei University School of Medicine, have performed intracordal injection therapy with atelocollagen on 20 patients diagnosed as having unilateral laryngeal paralysis under local anesthesia using a flexible fiberscope and a stroboscope under a video monitoring system. Comparisons were made of the voice before and after injection in 6 patients receiving submucosal injection and 14 given intramuscular injection of the material. In some autopsied patients, histological findings of the treated vocal cords were scrutinized and problems regarding atelocollagen injection were investigated. Judging from pathological findings of the vocal cords after atelocollagen injection and the clinical results of this therapeutic procedure, it seems most appropriate to inject this plastic material into the vocal muscles. This will prevent atelocollagen diffusion and maintain unimpaired wave-motion of the vocal mucosa, thus resulting in an acceptable voice quality. PMID:8207601

Hesaka, H; Miyano, R; Matsui, M; Kamide, Y; Moriyama, H



Superior laryngeal nerve injury: effects, clinical findings, prognosis, and management options  

PubMed Central

Purpose of review The superior laryngeal nerve (SLN) provides motor innervation to the cricothyroid muscle. However, the functions of this muscle and the anatomic variations of the nerve that supplies it are not fully understood. SLN paresis and paralysis (SLNp) is difficult to diagnose because of a lack of consistent laryngeal findings, and its effects on the voice likely goes beyond simple pitch elevation control. Recent findings Although SLNp has traditionally been thought to lead to voice pitch limitation, recent research findings reveal multiple roles for this nerve in voice and speech. Cricothyroid muscles are the primary controls of fundamental frequency of voice. SLNp can lead to significant contraction of pitch range, vocal fold vibratory phase asymmetry, and acoustic aperiodicity, thus leading to an overall poor vocal quality. In addition, cricothyroid muscles may also play a role in pitch lowering and shifting from voiced to unvoiced sounds during speech. Summary Subtle signs, symptoms, and diagnostic findings associated with SLNp make this disorder difficult to characterize clinically. Lack of treatment methodologies to restore the dynamic action of the cricothyroid muscles poses difficulties in treating patients with this condition. A more thorough understanding of the effects of SLNp will improve diagnosis and treatment. PMID:25136863

Orestes, Michael I.; Chhetri, Dinesh K.



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. PMID:25254120

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



Recurrent laryngeal nerve activation by ? 2 adrenergic agonists in goats  

Microsoft Academic Search

The purpose of this study was to test the hypothesis that respiratory arrhythmias and apneas induced by ?2 agonists in anesthetized goats are associated with an increase of upper airway expiratory-related activity, rather than a general depression of breathing. Activities of phrenic (Phr) and recurrent laryngeal nerves (RLN) were recorded in response to the ?2 agonists clonidine (0.5–3.0 ?g ·

M. S. Hedrick; M. L. Ryan; G. E. Bisgard



The central projections of the laryngeal nerves in the rat  

PubMed Central

The larynx serves respiratory, protective, and phonatory functions. The motor and sensory innervation to the larynx controlling these functions is provided by the superior laryngeal nerve (SLN) and the recurrent laryngeal nerve (RLN). Classical studies state that the SLN innervates the cricothyroid muscle and provides sensory innervation to the supraglottic cavity, whereas the RLN supplies motor innervation to the remaining intrinsic laryngeal muscles and sensory innervation to the infraglottic cavity, but recent data suggest a more complex anatomical and functional organisation. The current neuroanatomical tracing study was undertaken to provide a comprehensive description of the central brainstem connections of the axons within the SLN and the RLN, including those neurons that innervate the larynx. The study has been carried out in 41 adult male Sprague–Dawley rats. The central projections of the laryngeal nerves were labelled following application of biotinylated dextran amines onto the SLN, the RLN or both. The most remarkable result of the study is that in the rat the RLN does not contain any afferent axons from the larynx, in contrast to the pattern observed in many other species including man. The RLN supplied only special visceromotor innervation to the intrinsic muscles of the larynx from motoneurons in the nucleus ambiguus (Amb). All the afferent axons innervating the larynx are contained within the SLN, and reach the nucleus of the solitary tract. The SLN also contained secretomotor efferents originating from motoneurons in the dorsal motor nucleus of the vagus, and special visceral efferent fibres from the Amb. In conclusion, the present study shows that in the rat the innervation of the larynx differs in significant ways from that described in other species. PMID:21599662

Pascual-Font, Arán; Hernández-Morato, Ignacio; McHanwell, Stephen; Vázquez, Teresa; Maranillo, Eva; Sañudo, Jose; Valderrama-Canales, Francisco J



A Closer Look at Laryngeal Nerves during Thyroid Surgery: A Descriptive Study of 584 Nerves  

PubMed Central

Morbidity after thyroidectomy is related to injuries to the parathyroids, recurrent laryngeal (RLN) and external branch of superior laryngeal nerves (EBSLN). Mostly these are due to variations in the surgical anatomy. In this study we analyse the surgical anatomy of the laryngeal nerves in Indian patients undergoing thyroidectomy. Materials and Methods. Retrospective study (February 2008 to February 2010). Patients undergoing surgery for benign goitres, T1, T2 thyroid cancers without lymph node involvement were included. Data on EBSLN types, RLN course and its relation to the TZ & LOB were recorded. Results. 404 thyroid surgeries (180 total & 224 hemithyroidectomy) were performed. Data related to 584 EBSLN and RLN were included (324 right sided & 260 left sided). EBSLN patterns were Type 1 in 71.4%, Type IIA in 12.3%, and Type IIB in 7.36%. The nerve was not seen in 4.3% cases. RLN had one branch in 69.34%, two branches in 29.11% and three branches in 1.36%. 25% of the RLN was superficial to the inferior thyroid artery, 65% deep to it and 8.2% between the branches. TZ was Grade 1 in 65.2%, Grade II in 25.1% and Grade III in 9.5%. 31.16% of the RLN passes through the LOB. Conclusions. A thorough knowledge of the laryngeal nerves and anatomical variations is necessary for safe thyroid surgery. PMID:22737584

Pradeep, P. V.; Jayashree, B.; Harshita, Skandha S.



Comparison of Facial Nerve Paralysis in Adults and Children  

PubMed Central

Purpose Facial nerve injury can occur in the regions ranging from the cerebral cortex to the motor end plate in the face, and from many causes including trauma, viral infection, and idiopathic factors. Facial nerve paralysis in children, however, may differ from that in adults. We, therefore, evaluated its etiology and recovery rate in children and adults. Materials and Methods We retrospectively evaluated the records of 975 patients, ranging in age from 0 to 88 years, who displayed facial palsy at Kyung Hee Medical Center between January 1986 and July 2005. Results The most frequent causes of facial palsy in adults were Bell's palsy (54.9%), infection (26.8%), trauma (5.9%), iatrogenic (2.0%), and tumors (1.8%), whereas the most frequent causes of facial palsy in children were Bell's palsy (66.2%), infection (14.6%), trauma (13.4%), birth trauma (3.2%), and leukemia (1.3%). Recovery rates in adults were 91.4% for Bell's palsy, 89.0% for infection, and 64.3% for trauma, whereas recovery rates in children were 93.1% for Bell's palsy, 90.9% for infection, and 42.9% for trauma. Conclusion These results show that causes of facial palsy are similar in adults and children, and recovery rates in adults and children are not significantly different. PMID:18972592

Cha, Chang Il; Hong, Chang Kee; Park, Moon Suh



[A rare complication of delivery: paralysis of the external popliteal sciatic nerve in the postpartum period].  


Paralysis of the lateral popliteal sciatic nerve has been known for quite some time, although it is a rare complication. It is probably a compression of the lateral popliteal sciatic nerve within the pelvis when the division of the sciatic nerve is high. But there are many hypotheses. PMID:3317763

Dumont, M



[Multiple erythema migrans and facial nerve paralysis: clinical manifestations of early disseminated Lyme borreliosis].  


Lyme borreliosis is a common vector-borne disease in Europe. The infection follows different stages with a broad variability of clinical symptoms and manifestations in different organs. A 49-year-old man presented with flu-like symptoms, facial nerve paralysis and multiple erythematous macular on his trunk and extremities. We diagnosed Lyme disease (stage II) with facial nerve paralysis and multiple erythema migrans. Intravenous ceftriaxone led to complete healing of hissymptoms within 2 weeks. PMID:24700023

Braun, S A; Baran, A M; Boettcher, C; Kieseier, B C; Reifenberger, J



Functional electrical stimulation of laryngeal adductor muscle restores mobility of vocal fold and improves voice sounds in cats with unilateral laryngeal paralysis.  


Functional electrical stimulation (FES) has been proposed as a potential treatment for restoring motor functions of denervated motor systems. We investigated whether FES of paralyzed laryngeal adductor muscles could restore adduction to the vocal folds. In addition, we studied the effect of stimulated vocal fold adduction on the intensity and overall quality of voice production. We recorded movement of the vocal fold, electromyographic activity of muscles recruited for vocalization, and sound production in unanesthetized decerebrate cats during FES of the paralyzed thyroarytenoid (TA) muscle. FES of the paralyzed TA muscle induced adduction of the vocal fold. Appropriate stimulus parameters for induction was 1.5-3.0 mA intensity pulses delivered at a frequency of 30-50 pulses per second (pps). FES of the paralyzed TA muscle prolonged phonation time and increased intensity of voice sounds during vocalization induced by electrical stimulation (0.2 ms, 20-50 microA, 50 pps) of the periaqueductal gray (PAG). The quality of voice sounds evaluated by sound spectrography was shown to improve during vocalization with FES. We conclude that FES of the paralyzed laryngeal adductor muscle was effective in restoring adduction of the vocal fold and improving voice sounds impaired by unilateral laryngeal paralysis. PMID:15380322

Katada, Akihiro; Nonaka, Satoshi; Adachi, Masaaki; Kunibe, Isamu; Arakawa, Takuya; Imada, Masanobu; Hayashi, Tatsuya; Zealear, David L; Harabuchi, Yasuaki



Flexible bronchoscopy via the laryngeal mask: a new technique  

Microsoft Academic Search

Malignant tracheal tumours often cause airway obstruction and this may be aggravated by vocal cord paralysis due to invasion of the recurrent laryngeal nerve. Conventional endoscopic techniques performed under general anaesthesia do not give a simultaneous view of vocal cord function and the distal airways. The technique of bronchoscopy via the laryngeal mask allowed full assessment of the cause of

C J McNamee; B Meyns; K M Pagliero



Ectopic thyroid tissue surrounding the right laryngeal nerve: a case report  

PubMed Central

Ectopic thyroid tissue (ETT) is a rare developmental anomaly of the thyroid tissue which is defined as the presence of thyroid tissue in locations other than the pretracheal area. However, ectopic thyroid tissue in the lateral neck surrounding the recurrent laryngeal nerve is unusually found. Here we describe a case of a 64-year-old woman who was found bilateral thyroid goiter by the ultrasound examination. The total thyroidectomy plus a modified radical neck dissection was performed. Surprisingly we also found a nodule surrounding the right recurrent laryngeal nerve at the same time. Nevertheless the diagnosis of the nodule was confirmed by pathology and Histologic examination demonstrating that it was ectopic thyroid tissue. Ectopic thyroid tissue surrounding recurrent laryngeal nerve is a rare finding, with hardly any cases reported. For it is generally thought that any thyroid tissue found in the lateral aspect of the neck may indicate metastatic deposits from well-differentiated thyroid carcinoma. Although pathogenesis of ectopic thyroid tissue surrounding recurrent laryngeal nerve without any symptoms remains unknown, our case could suggest ectopic thyroid tissue should not be excluded in the differential diagnosis of lateral neck masses especially when the recurrent laryngeal nerves were surrounded by the nodules. PMID:25197416

He, Bin; Li, Peng; Yang, Kai; Shan, Yunfeng



[A case of herpetic facial paralysis in which cochleovestibular symptoms outweigh facial nerve symptoms].  


A 42-year-old man presented with sensorineural hearing loss of acute onset, tinnitus, and vertigo. Physical examination revealed slight asymmetry in facial nerve functions and spontaneous nystagmus. Magnetic resonance imaging of the internal acoustic canal showed contrast enhancement consistent with edema-inflammation, being notable and diffuse in the seventh and eighth cranial nerve complex, and minimal in the cochlea. Non-hydropic cochleovestibular syndrome was considered and the patient was treated with antiviral and corticosteroid medications. A week later, facial paralysis improved and the acute hearing loss reversed. On the twelfth day of presentation, he had no complaints other than mild imbalance on abrupt changes in movement. In this type of herpetic facial paralysis in which cochleovestibular symptoms outweigh facial nerve symptoms, it might be argued that varicella zoster virus reactivation occurs in the spiral and/or vestibular ganglion. PMID:18443402

Avci, Suat; Kansu, Leyla; Akkuzu, Babür; Ozgirgin, Nuri; Ozlüo?lu, Levent



Central ghrelin inhibits reflex swallowing elicited by activation of the superior laryngeal nerve in the rat  

Microsoft Academic Search

The effect of ghrelin on rhythmic reflex swallowing was examined in urethane–chloralose anesthetized rats. Swallowing was monitored by recording electromyographic activities of the suprahyoid muscle. Fourth ventricular administration of ghrelin decreased swallowing frequency during electrical stimulation of the central cut end of the superior laryngeal nerve (SLN stimulation). A significant decrease in swallowing frequency was observed after ghrelin administration at

Motoi Kobashi; Song-Yu Xuan; Masako Fujita; Yoshihiro Mitoh; Ryuji Matsuo



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



[The superior laryngeal nerve: an anatomical structure at risk during thyroid surgery].  


The effects of injury to the external branch of the superior laryngeal nerve (ESLN) during thyroid surgery are well known, while the frequency and consequences of ESLN lesions aren't today well known. The Authors report their own experience of the incidence of ESLN injuries in thyroid surgery. PMID:1886684

Cannizzaro, M A; Fiocco, S; Piazza, L; De Maria, A; Liardo, G; Troiano, L; Terminella, A



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

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





... swelling and irritation (inflammation) of the voice box (larynx). Laryngitis is usually associated with hoarseness or loss ... The voice box (larynx) is located at the top of the airway to the lungs (trachea). The larynx contains the vocal cords. When ...


Pharyngolaryngeal paralysis in a patient with pharyngeal tuberculosis.  


Pharyngeal tuberculosis is a rare disease, and its commonly reported symptoms include sore throat, dysphagia, and throat discomfort. The dysphagia in pharyngeal tuberculosis cases is not due to pharyngolaryngeal paralysis but due to odynophagia. Herein, we describe the first case of dysphagia caused by pharyngolaryngeal paralysis secondary to pharyngeal tuberculosis. An irregular mass at the right nasopharynx was detected in a 57-year-old female patient, along with dysphagia and hoarseness. She had poor right soft palate elevation, inadequate right velopharyngeal closure, poor constrictor pharyngus muscle contraction, and an immobilized right vocal cord, which collectively indicate right pharyngolaryngeal paralysis. Pathological examination and culture testing revealed pharyngeal tuberculosis. She was diagnosed with pharyngolaryngeal paralysis secondary to pharyngeal tuberculosis. The pharyngolaryngeal paralysis resolved after beginning anti-tuberculous treatment. Right pharyngolaryngeal paralysis was attributed to glossopharyngeal and vagus nerve impairment in the parapharyngeal space. Prior reports indicate that peripheral nerve paralysis, including recurrent laryngeal nerve paralysis caused by tuberculous lymphadenitis, often recovers after anti-tuberculous treatment. Pharyngeal tuberculosis rarely causes dysphagia and hoarseness attributable to pharyngolaryngeal paralysis. The neuropathy may recover after anti-tuberculous treatment. Pharyngeal tuberculosis is a new potential differential diagnosis in pharyngolaryngeal paralysis. PMID:25287869

Ohki, Masafumi; Komiyama, Sakurako; Tayama, Niro



Relative direction and position of recurrent laryngeal nerve for anatomical configuration  

Microsoft Academic Search

The present study aims to describe the course of the recurrent laryngeal nerve (RLN) using the tracheoesophageal groove (TEG)\\u000a at the cricothyroid joint as a base line, and the configuration of RLN and inferior thyroid artery (ITA) for careful dissection\\u000a in thyroid surgery. The RLN of left side is likely to be found posterior to ITA and course mainly from

Mi-Sun Lee; U.-Young Lee; Jae-Hoon Lee; Seung-Ho Han



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



Role of the ventrolateral region of the nucleus of the tractus solitarius in processing respiratory afferent input from vagus and superior laryngeal nerves  

Microsoft Academic Search

The role of respiratory neurons located within and adjacent to the region of the ventrolateral nucleus of the tractus solitarius (vlNTS) in processing respiratory related afferent input from the vagus and superior laryngeal nerves was examined. Responses in phrenic neural discharge to electrical stimulation of the cervical vagus or superior laryngeal nerve afferents were determined before and after lesioning the

D. R. McCrimmon; D. F. Speck; J. L. Feldman



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


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



Cystic schwannoma of the recurrent laryngeal nerve: a rare finding posing diagnostic difficulties.  


A 49-year-old woman with a painless mass in the neck was examined by the surgeon. Imaging and cytology prior to surgery suggested the mass to be either a thyroid cyst or a branchial cleft cyst. After surgery, the patient reported a hoarse voice and the pathologist confirmed the removed lesion to be a cystic schwannoma of the left recurrent laryngeal nerve. The inconclusive imaging results, combined with colloid-like material in the punctate should prompt the investigator to include cystic schwannoma in the differential diagnosis. With the probability of a neurogenic origin of the mass in mind, nerve-sparing surgery can be performed. As a future prospect, positron emission tomography scans are mentioned as a modality with possibilities to discriminate a cystic schwannoma from other common cystic lesions. PMID:24769666

Knulst, Rowan; Bosman, Willem-Maarten; Ritchie, Ewan D; da Costa, Andy



Effects of Various Ion Transport Inhibitors on the Water Response in the Superior Laryngeal Nerve in Rats  

Microsoft Academic Search

The effects of inhibitors (acetazolamide, an inhibitor of carbonic anhydrase; amiloride, an inhibitor of the Na channel; furosemide, an inhibitor of the Na\\/K\\/2Cl transporter; 4,4'-diisothiocyanostilbene-2,2'-disulfonic acid (DIDS), an inhibitor of the Cl channel) on the water response in the superior laryngeal nerve (SLN) were investigated using whole nerve recordings from the SLN of anesthetized and paralyzed rats. Changes in spontaneous

Takamitsu Hanamori



Preoperative diagnosis and intraoperative protection of nonrecurrent laryngeal nerve: A review of 5 cases  

PubMed Central

Background Nonrecurrent laryngeal nerve (NRLN) is a risk factor for nerve injury during thyroidectomy or parathyroidectomy. It is usually associated with abnormal vasculature that can be identified by several imaging methods. The aim of this study was to retrospectively analyze the preoperative diagnosis and intraoperative protection of NRLN. Material/Methods Of the 7169 patients who underwent thyroid surgery at our hospital between August 2008 and January 2013, 5 patients with NRLN were identified. Preoperative chest X-rays, neck ultrasonography (US), and computed tomography (CT) findings were reviewed. NRLNs were carefully and systematically searched for in surgery. Results Preoperative CT predicted NRLN in all 5 cases (100% accuracy). The detection rate of NRLN by CT was 0.4% (5/1170). NRLNs were confirmed in surgery. All of them were right-sided NRLN with type IIA variant. The CT scans clearly revealed the vascular anomalies. The review of US images suggested that vascular anomalies could be identified on the images in 1 patient. No postoperative complications occurred in any patient. Conclusions The preoperative CT scan was a reliable and effective method for identifying abnormal vasculature to indirectly predict NRLN. Combining the CT and US findings with adequate surgical technique may help to reduce the risk of nerve damage, in addition to preventing nerve palsy. PMID:24518037

Wang, Zhihong; Zhang, Hao; Zhang, Ping; He, Liang; Dong, Wenwu



Differences in the microstructure and biomechanical properties of the recurrent laryngeal nerve as a function of age and location.  


Idiopathic onset of unilateral vocal fold paralysis (UVP) is caused by damage to the recurrent laryngeal nerve (RLN) and results in difficulty speaking, breathing, and swallowing. This damage may occur in this nerve as it loops around the aortic arch, which is in a dynamic biomechanical environment. The goal of this study is to determine if the location-dependent biomechanical and microstructural properties of the RLN are different in piglets versus adolescent pigs. The neck/distal and thoracic/proximal (near the aortic arch) regions of the RLN from eight adolescent pigs and six piglets were isolated and mechanically assessed in uni-axial tension. Two-photon imaging (second harmonic) data were collected at 5%, 10%, and 15% strain during the mechanical test. The tangential modulus (TM) and the strain energy density (W) were determined at each level of strain. The mean mode of the preferred fiber angle and the full width at half maximum (FWHM, a measure of fiber splay) were calculated from the imaging data. We found significantly larger values of TM, W, and FWHM in the proximal segments of the left RLN when compared to the distal segments (18.51 MPa ± 1.22 versus 10.78 MPa ± 1.22, p < 0.001 for TM, 0.046 MPa ± 0.01 versus 0.026 MPa ± 0.01, p < 0.003 for W, 15.52 deg ± 1.00 versus 12.98 deg ± 1.00, p < 0.001 for FWHM). TM and W were larger in the left segments than the right (15.32 MPa ± 1.20 versus 11.80 MPa ± 1.20, p < 0.002 for TM, 0.038 MPa ± 0.01 versus 0.028 MPa ± 0.01, p < 0.0001 for W). W was larger in piglets when compared to adolescent pigs (0.042 MPa ± 0.01 versus 0.025 MPa ± 0.01, p < 0.04). The proximal region of the left porcine RLN is more stiff than the distal region and has a higher degree of fiber splay. The left RLN of the adolescent pigs also displayed a higher degree of strain stiffening than the right. These differences may develop as a result of the more dynamic environment the left RLN is in as it loops around the aortic arch. PMID:24829083

Williams, Megan J; Utzinger, Urs; Barkmeier-Kraemer, Julie M; Vande Geest, Jonathan P



Recurrent laryngeal nerve activation by alpha 2 adrenergic agonists in goats.  


The purpose of this study was to test the hypothesis that respiratory and apneas induced by alpha 2 agonists in anesthetized goats are associated with an increase of upper airway expiratory-related activity, rather than a general depression of breathing. Activities of phrenic (Phr) and recurrent laryngeal nerves (RLN) were recorded in response to the alpha 2 agonists clonidine (0.5-3.0 i.v.) or guanabenz (7.0-20.0 i.v.) in ten chloralose-anesthetized goats. Injection of either alpha 2 agonist resulted in respiratory arrhythmias with a greater than seven-fold increase in TE and a 30% reduction in TI. During apneas RLN expiratory-related activity remained tonic until the next Phr burst, consistent with our hypothesis. Cessation of Phr activity during hypocapnia also resulted in a tonic increase of RLN expiratory activity; and injection of NaCN (50 i.v.) increased Phr and RLN inspiratory activities, while attenuating RLN expiratory-related activity. Inspiratory and expiratory-related activity of RLN motoneurons appear to be reciprocally modulated by alpha 2 agonists or changes in central or peripheral chemoreceptor drive. The results indicate that central apneas and respiratory arrhythmias may be associated with alpha 2-adrenoceptor modulation of laryngeal expiratory-related activity. PMID:8570915

Hedrick, M S; Ryan, M L; Bisgard, G E



Rhizotomy targeting the intermediate nerve, the glossopharyngeal nerve and the upper 1st to 2nd rootlets of the vagus nerve for the treatment of laryngeal neuralgia combined with intermediate nerve neuralgia-a case report  

PubMed Central

Background In neurosurgery, the most common type of facial and pharyngeal pain is trigeminal neuralgia. In contrast, glossopharyngeal neuralgia is relatively rare, and laryngeal neuralgia is the most rarely observed. Case presentation A case of laryngeal neuralgia combined with intermediate nerve neuralgia that was admitted to our hospital in May 2012 was reported here. The patient was a 58-year-old middle-aged female, who experienced 2 years of paroxysmal burning and stabbing pain near the thyroid perichodrium, in the skin covering the right front side of the neck, and deep in inner ear. Conclusion The surgical treatment plan similar to that for glossopharyngeal neuralgia could be applied if laryngeal neuralgia is associated with glossopharyngeal neuralgia and intermediate neuralgia or if no obvious improvement is achieved with the above mentioned treatment approaches. PMID:25168864



Post-traumatic dissection of the internal carotid artery associated with ipsilateral facial nerve paralysis: diagnostic and forensic issues.  


Traumatic internal carotid artery dissection may result from a direct blow to anterolateral aspect of the neck, or an extreme extension and rotation of the neck. Traumas involved are variable ranging from high speed motor vehicle accident to trivial traumas. The most frequent presentations of carotid artery dissection are stroke, Hörner syndrome, and paralysis of a cranial nerve. Time of ischemic signs onset is very variable too, diverging from immediate to several months delay. We report the case of a 60-year-old woman, who was assaulted by a young man. Immediately, she complained of headache and posterior cervical pain. Three months later she developed a left hemifacial paralysis. MRI and MRA showed a dissection of the left internal carotid artery. The causal relationship between the trauma and the carotid artery dissection as well as forensic issues are discussed. PMID:24112338

Makhlouf, F; Scolan, V; Detante, O; Barret, L; Paysant, F



Intraoperative neuromonitoring of the recurrent laryngeal nerve in robotic thyroid surgery.  


This study evaluated the technical feasibility and efficacy of intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) to aid its identification and preservation during robotic thyroidectomy (RoT). IONM of the RLN was evaluated in 30 consecutive patients undergoing RoT. All patients underwent an indirect laryngoscope examination to objectively assess vocal cord function. Their Voice Handicap Index-10 (VHI-10) was measured to subjectively assess vocal cord function preoperatively and at postoperative months 1 and 3. Of the 56 RLNs at risk in 30 patients undergoing RoT, all were visualized and identified by IONM. The IONM sensitivity for postoperative permanent RLN palsy was 100%, with a positive predictive value of 100%. The mean VHI-10 scores preoperatively and at postoperative months 1 and 3 were 0.20±0.66, 3.47±5.04, and 1.53±2.47, respectively (P<0.001). IONM of the RLN during RoT is technically feasible and effective for identifying this nerve. PMID:25238177

Bae, Dong Sik; Kim, Su-Jin



Facial nerve paralysis and partial brachial plexopathy after epidural blood patch: a case report and review of the literature  

PubMed Central

We report a complication related to epidural analgesia for delivery in a 24- year-old woman who was admitted with mild pre-eclampsia and for induction of labor. At the first postpartum day she developed a postdural puncture headache, which was unresponsive to conservative measures. On the fifth day an epidural blood patch was done, and her headache subsided. Sixteen hours later she developed paralysis of the right facial nerve, which was treated with prednisone. Seven days later she complained of pain in the left arm and the posterior region of the shoulder. She was later admitted and diagnosed with partial brachial plexopathy. PMID:21386953

Shahien, Radi; Bowirrat, Abdalla



Framework Surgery for Treatment of Unilateral Vocal Fold Paralysis.  


Laryngeal framework surgery is the current gold standard treatment for unilateral vocal fold paralysis. It provides a permanent solution to glottic insufficiency caused by injury to the recurrent laryngeal nerve. Various modifications to the original Isshiki type I laryngoplasty procedure have been described to improve voice and swallowing outcomes. The success of this procedure is highly dependent on the experience of the surgeon as it epitomizes the intersection of art and science in the field. The following article reviews the evidence, controversies, and complications related to laryngoplasty for unilateral vocal fold paralysis. It also provides a detailed analysis of how and when arytenoid-positioning procedures should be considered, and summarizes the literature on postoperative outcomes. PMID:24883239

Daniero, James J; Garrett, C Gaelyn; Francis, David O



Recurrent Vocal Fold Paralysis and Parsonage-Turner Syndrome  

PubMed Central

Background. Parsonage-Turner syndrome, or neuralgic amyotrophy (NA), is an acute brachial plexus neuritis that typically presents with unilateral shoulder pain and amyotrophy but also can affect other peripheral nerves, including the recurrent laryngeal nerve. Idiopathic vocal fold paralysis (VFP) represents approximately 12% of the VFP cases and recurrence is extremely rare. Methods and Results. We report a man with isolated recurrent unilateral right VFP and a diagnosis of NA years before. Conclusions. We emphasize that shoulder pain and amyotrophy should be inquired in any patient suffering from inexplicable dysphonia, and Parsonage-Turner syndrome should be considered in the differential diagnosis of idiopathic VFP. PMID:24288639

Joffily, Lucia; Vincent, Maurice Borges



Cross-face nerve grafting for reanimation of incomplete facial paralysis: quantitative outcomes using the FACIAL CLIMA system and patient satisfaction.  


Although in most cases Bell palsy resolves spontaneously, approximately one-third of patients will present sequela including facial synkinesis and paresis. Currently, the techniques available for reanimation of these patients include hypoglossal nerve transposition, free muscle transfer, and cross-face nerve grafting (CFNG). Between December 2008 and March 2012, eight patients with incomplete unilateral facial paralysis were reanimated with two-stage CFNG. Gender, age at surgery, etiology of paralysis denervation time, donor and recipient nerves, presence of facial synkinesis, and follow-up were registered. Commissural excursion and velocity and patient satisfaction were evaluated with the FACIAL CLIMA and a questionnaire, respectively. Mean age at surgery was 33.8 ± 11.5 years; mean time of denervation was 96.6 ± 109.8 months. No complications requiring surgery were registered. Follow-up period ranged from 7 to 33 months with a mean of 19 ± 9.7 months. FACIAL CLIMA showed improvement of both commissural excursion and velocity greater than 75% in 4 patients, greater than 50% in 2 patients, and less than 50% in the remaining two patients. Qualitative evaluation revealed a high grade of satisfaction in six patients (75%). Two-stage CFNG is a reliable technique for reanimation of incomplete facial paralysis with a high grade of patient satisfaction. PMID:23818253

Hontanilla, Bernardo; Marre, Diego; Cabello, Alvaro



Use of steroids for facial nerve paralysis after parotidectomy: A systematic review  

PubMed Central

AIM: To systematically review the literature to assess the efficacy of corticosteroids in treating post-parotidectomy facial nerve palsy (FNP). METHODS: We searched the Cochrane library, EMBASE and MEDLINE (from inception to 2014) for studies assessing the use of corticosteroids in post-parotidectomy FNP. Studies were assessed for inclusion and quality. Data was extracted from included studies. RESULTS: Two randomised controlled trials met the inclusion criteria. One study assessed the use of dexamethasone and the other prednisolone. None of the studies demonstrated a significant difference in the outcome of FNP post-parotidectomy with the use of corticosteroids vs no therapy. The majority of FNP post-parotidectomy is transient. Preoperative factors (size of tumour and malignancy), intraoperative factors (extent of parotidectomy and integrity of facial nerve at the end of the operation) are important in determining prognosis of FNP if it does occur. CONCLUSION: Corticosteroids do not appear to improve FNP prognosis post-parotidectomy. Further studies assessing patients by cohort and with long term follow-up are required to increase scientific evidence.

Varadharajan, Kiran; Beegun, Issa; Daly, Niall



Bilateral vocal cord paralysis requiring tracheostomy due to neuroborreliosis.  


Neuroborreliosis can cause multiple cranial and peripheral neuropathies; however, involvement of both recurrent laryngeal nerves is rare. We report the case of a 90-year-old man who presented with dysphonia and right upper and lower extremity weakness. His course was complicated by bilateral vocal cord paralysis and respiratory failure requiring tracheostomy. The diagnosis of borreliosis was made by detection of IgM and IgG antibodies against Borrelia burgdorferi on enzyme immunoassay and Western blot. The patient received IV ceftriaxone for 2 weeks, followed by complete recovery of motor and vocal function over 2 months. Our case is the third report of bilateral vocal cord paralysis in the literature, and the first one, to our knowledge, presenting with respiratory failure requiring an artificial airway. Physicians should be aware of this unusual complication of neuroborreliosis. PMID:25367481

Martínez-Balzano, Carlos D; Greenberg, Bruce



Acquired Unilateral Vocal Fold Paralysis: Retrospective Analysis of a Single Institutional Experience  

PubMed Central

Background: Vocal cord paralysis continues to be an important issue in laryngology and is considered as a sign of underlying disease; the etiologies of this problem are varied and changing. Aims: The study was to carry out a retrospective analysis of patients with unilateral vocal fold paralysis diagnosed. Materials and Methods: The medical records of 53 patients diagnosed and treated for unilateral vocal fold paralysis were studied retrospectively. Data regarding age, sex, duration of symptoms, etiology, and side of paralysis were recorded. Results: Out of the 53 cases, 36 were females and 17 males with a ratio of 2.1:1. The age of the patients ranged from 17-75 years. In 18.9% the cause was idiopathic. Surgical trauma (iatrogenic) problems was the most encountered etiology (66%), others included malignancy (non laryngeal) (7.5%), central (3.8%), external neck trauma (1.9%) and radiation therapy 1.9%. Thyroid surgery was the most commonly reported neck surgery in 50.9%. Conclusions: Thyroidectomy continues to be the single most common surgical procedure responsible for unilateral vocal cord paralysis. For this reason, routine pre and postoperative laryngoscopy should be considered in all patients undergoing surgeries with a potential risk for recurrent nerve paralysis to reduce the postoperative morbidity. PMID:24404552

Al-Khtoum, Nemer; Shawakfeh, Nabil; Al-Safadi, Eyad; Al-Momani, Osama; Hamasha, Khalid



Different mechanism of vocal cord paralysis between spinocerebellar ataxia (SCA 1 and SCA 3) and multiple system atrophy  

Microsoft Academic Search

While multiple system atrophy (MSA) is frequently associated with vocal cord paralysis (VCP) causing severe respiratory failure, it is still unknown whether hereditary types of spinocerebellar degeneration develop similar laryngeal paralysis. We analyzed the laryngeal function from the viewpoints of fiberoptic laryngoscopy and laryngeal myopathology and then attempted to clarify the difference of the mechanism of VCP among the patients

Eiji Isozaki; Rie Naito; Takemasa Kanda; Toshio Mizutani; Shunsaku Hirai



Tick Paralysis  


... to Remove a Tick Deer Tick Ecology Tick species that cause Tick Paralysis: Deer tick, dog tick, ... ticks Tick Paralysis is caused by over 40 species of ticks worldwide (five in North America, including ...


Phonatory Effects of Type I Thyroplasty Implant Shape and Depth of Medialization in Unilateral Vocal Fold Paralysis  

PubMed Central

Objectives/Hypothesis Medialization thyroplasty (MT) is commonly used to treat glottic insufficiency. In this study, we investigated the phonatory effects of MT implant medialization depth and medial surface shape. Methods Recurrent laryngeal nerve (RLN) and vagal paralysis were simulated in an in vivo canine. A type 1 MT was performed using a silicone elastomer implant with variable medialization depths and medial surface shapes: rectangular, V-shaped, divergent, and convergent. The effects on phonation onset flow/pressure relationships and acoustics were measured. Results Increasing depth of medialization led to improvements in fundamental frequency (F0) range and normalization of the slope of pressure/flow relationship toward baseline activation conditions. The effects of implant medial shape also depended on depth of medialization. Outcome measures were similar among the implants at smaller medialization depths. With large medialization depths and vagal paralysis conditions, the divergent implant maintained pressure/flow relationship closer to baseline. The vagal paralysis conditions also demonstrated decreased fundamental frequency range and worse flow/pressure relationship compared to RLN paralysis. Conclusions The depth and medial shape of a medialization laryngoplasty (ML) implant significantly affect both the F0 range and aerodynamic power required for phonation. These effects become more notable with increasing depth of medialization. The study also illustrates that ML is less effective in vagal paralysis compared to RLN paralysis. PMID:25046146

Orestes, Michael I.; Neubauer, Juergen; Sofer, Elazar; Salinas, Jonathon; Chhetri, Dinesh K.



Todd's Paralysis  


... completely. Todd's paralysis may also affect speech and vision. Scientists don't know what causes Todd's paralysis. Current theories propose biological processes in the brain that involve a slow down in either the energy output of neurons or in the motor centers ...


Field potentials evoked in the brain stem of the cat by stimulation of the carotid sinus, glossopharyngeal, aortic and superior laryngeal nerves  

PubMed Central

1. In a primarily topographical study, the field potentials evoked in the brain stem of the cat by stimulation of the sinus, glossopharyngeal (IX), aortic and superior laryngeal (SLN) nerves have been recorded with glass micro-electrodes. 2. Extracellular negative potentials were evoked in the region of the nucleus of the tractus solitarius and in the lateral reticular formation (LRF) by electrical stimulation of all four nerves. There were differences in the form of these potentials amongst the nerves, particularly between sinus-IX and aortic-SLN. The potentials were identified as post-synaptic with early and late components and were sometimes preceded by an afferent volley. 3. Extracellular positive potentials were evoked in the subnucleus reticularis medialis medullae oblongatae and the nucleus reticularis gigantocellularis. Intracellularly recorded hyperpolarizations recorded from six cells had the same time course as the extracellular positivity. Spontaneously active cells encountered in these regions were sometimes depressed for the duration of the positivity. 4. Each of the above field potentials was maximal in the region of Horsley—Clarke A. P. co-ordinates -10 to -13 mm. 5. At A.P. co-ordinates of -15 to -17 mm negativity showing post-tetanic potentiation was evoked, at latencies similar to the negativity in the LRF, in the commissural nucleus of Cajal, the dorsolateral reticular formation and the medial reticulo-spinal tract. 6. Negative potentials were evoked in the contralateral LRF. PMID:5499531

Biscoe, T. J.; Sampson, S. R.



Intraoperative Neuromonitoring of the External Branch of the Superior Laryngeal Nerve during Thyroidectomy: The Need for Evidence-Based Data and Perioperative Technical/Technological Standardization  

PubMed Central

The external branch of the superior laryngeal nerve (EBSLN) is surgically relevant since its close anatomical proximity to the superior thyroid vessels. There is heterogeneity in the EBSLN anatomy and EBSLN damage produces changes in voice that are very heterogenous and difficult to diagnose. The reported prevalence of EBSLN injury widely ranges. EBSLN iatrogenic injury is considered the most commonly underestimated complication in endocrine surgery because vocal assessment underestimates such event and laryngoscopic postsurgical evaluation does not show standardized findings. In order to decrease the risk for EBSLN injury, multiple surgical approaches have been described so far. IONM provides multiple advantages in the EBSLN surgical approach. In this review, we discuss the current state of the art of the monitored approach to the EBSLN. In particular, we summarize, providing our additional remarks, the most relevant aspects of the standardized technique brilliantly described by the INMSG (International Neuromonitoring Study Group). In conclusion, in our opinion, there is currently the need for more prospective randomized trials investigating the electrophysiological and pathological aspects of the EBSLN for a better understanding of the role of IONM in the EBSLN surgery. PMID:25525624

Mangano, Alberto; Lianos, Georgios D.; Boni, Luigi; Kim, Hoon Yub; Roukos, Dimitrios H.; Dionigi, Gianlorenzo



Does recurrent laryngeal nerve lymph node metastasis really affect the prognosis in node-positive patients with squamous cell carcinoma of the middle thoracic esophagus?  

PubMed Central

Background Recurrent laryngeal nerve (RLN) lymph node metastasis used to be shown a predictor for poor prognosis in esophageal squamous cell carcinoma. The purpose of this study was to evaluate the prognostic impact of RLN node metastasis and the number of metastatic lymph nodes in node-positive patients with squamous cell carcinoma of middle thoracic esophagus. Methods A cohort of 235 patients who underwent curative surgery for squamous cell carcinoma of middle thoracic esophagus was investigated. The prognostic impact was evaluated by univariate and multivariate analyses. Results Lymph node metastasis was found in 133 patients. Among them, 81 had metastatic RLN nodes, and 52 had at least one positive node but no RLN nodal involvement. The most significant difference in survival was detected between patients with metastatic lymph nodes below and above a cutoff value of six (P?



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



Isolated laryngeal myasthenia gravis for 26 years.  


Laryngeal myasthenia gravis is a relatively rare variant of myasthenia gravis. A vast portion of patients with initial laryngeal myasthenia gravis develop involvement of ocular and/or extra-ocular muscles during the years after symptom onset although a minority of laryngeal myasthenia gravis patients continues to have isolated laryngeal muscle involvement for several years. We present a 58-year-old woman with recurrent episodic isolated dysphonia (associated with diffuse bilateral vocal cord paresis on laryngoscopy) since the age of 32. Dysphonia became permanent since 6 months. A diagnosis of laryngeal myasthenia gravis was made based on abnormal single-fiber electromyography and spectacular response to pyridostigmine treatment. Repetitive nerve stimulation was normal and anti-acetylcholine receptor and anti-muscle specific tyrosine kinase antibodies were absent. This case shows that laryngeal myasthenia gravis can be isolated during 26 years of follow-up. We propose that even when myasthenia gravis seems unlikely as underlying mechanism of isolated dysphonia (because of lack of antibodies, normal repetitive nerve stimulation, and absence of extra-laryngeal involvement after years of follow-up), single-fiber electromyography should be performed and myasthenia gravis treatment should be tried. PMID:25454167

Renard, Dimitri; Hedayat, Amir; Gagnard, Corinne



Modified thyroplasty for unilateral vocal fold paralysis using an adjustable titanium implant.  


This study aimed to describe a new titanium thyroplasty implant that can be adjusted with a screw. Six Beagle dogs were randomly divided into experimental and control groups (n = 3). The titanium screw was implanted in the experimental group after the left recurrent laryngeal nerve was cut off under general anaesthesia. This procedure caused arytenoid cartilage internal shift, allowing the vocal cord to locate at the median and the glottis to close during phonation. No other operation was conducted in the control group. Each group, respectively, underwent video laryngoscopy, CT scan and histopathology before and after operation. After 4 months of follow-up, the video laryngoscopy results showed that the left arytenoid cartilage in the experimental group underwent internal adduct and shift, whereas the left vocal cords in the control group located at the paramedian position and exhibited fissure during phonation. CT scan results showed that the adjustable titanium screw was in proper position. Postoperative pathological examination showed that, in addition to early local inflammation, the laryngeal muscle may atrophy. The adjustable titanium screw requires a simple operation and can be significantly adjusted. The effect of the operation can be immediately observed without rejection. Therefore, this method is an efficient treatment for unilateral vocal cord paralysis. PMID:24728279

Wen, Wu; Sun, Guangbin; Sun, Bifeng; Liu, Chang; Zhang, Mingxing



Children and Teens with Paralysis  


... Life > Children and Teens with Paralysis Children and Teens Living with Paralysis Any time a family member ... Read more. Books and Videos for Children and Teens Helping children understand paralysis, wheelchairs and disability can ...


Palsies of Cranial Nerves That Control Eye Movement  


... 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 ...


Vocal Fold Paralysis  


... chest; lung or thyroid cancer; tumors of the skull base, neck, or chest; or viral infection (for ... vocal fold. These may involve inserting a structural implant or stitches to reposition the laryngeal cartilage and ...


Perceptual Ratings of Vocal Characteristics and Voicing Features in Untreated Patients with Unilateral Vocal Fold Paralysis  

ERIC Educational Resources Information Center

This study used visual analog scales to obtain perceptual ratings of features of voice production in subjects with unilateral vocal fold paralysis (UVFP), including clarity of laryngeal articulation, consistency of loudness across the utterance and the voiced/voiceless distinction. Recordings of repeated /i/, /isi/, and /izi/ from subjects…

Leydon, Ciara; Bielamowicz, Steven; Stager, Sheila V.



A novel endoscopically placed stent to relieve glottic obstruction from bilateral vocal fold paralysis  

Microsoft Academic Search

ObjectiveCongenital bilateral vocal fold paralysis (BVP) is a rare but serious condition often requiring a tracheostomy to temporize the airway. In cases of idiopathic BVP, studies suggest waiting twelve months prior to laryngeal surgery because of a high rate of spontaneous recovery. Therefore a less invasive and reversible intervention would be optimal. A prospective study in a piglet model was

Eitan Prisman; Neil K. Chadha; Arie Gordon; Marvin Estrada; Paolo Campisi; Vito Forte



Paralysis Facts and Figures  


... Lea la versión electrónica en español ya mismo Prevalence and Demographics The Reeve Foundation's One Degree of ... living with spinal cord injury. Below are the prevalence and demographics of paralysis and spinal cord injury ...


Effects of carbon dioxide on laryngeal receptors  

SciTech Connect

Carbon dioxide (CO{sub 2}) either stimulates or inhibits laryngeal receptors in the cat. The aim of this study was to correlate the CO{sub 2} response of laryngeal receptors with their response to other known stimuli (i.e. pressure, movement, cold, water and smoke). Single unit action potentials were recorded from fibers in the superior laryngeal nerve of 5 anesthetized, spontaneously breathing dogs together with CO{sub 2} concentration, esophageal and subglottic pressure. Constant streams of warm, humidified air or 10% CO{sub 2} in O{sub 2} were passed through the functionally isolated upper airway for 60 s. Eight of 13 randomly firing or silent receptors were stimulated by CO{sub 2} (from 0.4{plus minus}0.1 to 1.8{plus minus}0.4 imp.s). These non-respiratory-modulated receptors were more strongly stimulated by solutions lacking Cl{sup {minus}} and/or cigarette smoke. Six of 21 respiratory modulated receptors (responding to pressure and/or laryngeal motion) were either inhibited or stimulated by CO{sub 2}. Our results show that no laryngeal receptor responds only to CO{sub 2}. Silent or randomly active receptors were stimulated most often by CO{sub 2} consistent with the reflex effect of CO{sub 2} in the larynx.

Anderson, J.W.; Sant'Ambrogio, F.B.; Orani, G.P.; Sant'Ambrogio, G.; Mathew, O.P. (Univ. of Texas, Galveston (United States))



Laryngeal pacing in minipigs: in vivo test of a new minimal invasive transcricoidal electrode insertion method for functional electrical stimulation of the PCA.  


Functional electrical stimulation (FES) of the posterior cricoarytenoid muscle (PCA) to restore respiratory function of the larynx may become an option for the treatment of bilateral recurrent laryngeal nerve paralysis (RLNP) in the near future. The feasibility of this has been shown in several animal trials and in a human pilot study. The common open surgical inferolateral approach for electrode insertion into the PCA for FES has a risk of damaging the recurrent laryngeal nerve (RLN) and may result in postoperative swelling and scaring of the larynx. Therefore, a minimal invasive electrode insertion technique is needed. A new miniaturized bipolar spiral tip electrode and a new electrical stimulatable insertion needle were tested in a short-term trial for an endoscopically guided and functionally controlled transcricoidal electrode insertion in eight Göttingen minipigs with bilateral normal RLN function. The feasibility of this technique was evaluated and the achieved positions of the electrodes in the PCA were analyzed using intraoperative stimulation threshold data and 3D-CT reconstructions. In seven cases it was possible to place two well-performing electrodes into the PCA. They were positioned one on either side. In one animal no functioning electrode position could be achieved because the PCA was missed. Thresholds of the electrode tips varied between 0.2 and 2.5 mA (mean 0.71 mA). In any case maximal glottal opening could be reached before adductors were co-activated. The majority of electrodes were placed into the central lower part of the PCA with no apparent correlation between threshold and electrode position. Surgical trauma might be further reduced by using endoscopy via a laryngeal mask avoiding the temporary tracheostomy used in this trial. If the implanted electrodes remain stable in long-term tests, we suggest that this method could soon be transferred into human application. PMID:22875064

Förster, Gerhard; Arnold, Dirk; Bischoff, Sabine J; Schubert, Harald; Scholle, Hans-Christoph; Müller, Andreas H



A case of diaphragmatic paralysis complicated by herpes-zoster virus infection.  


Diaphragmatic paralysis is commonly caused by surgical and traumatic injuries, malignant neoplasm, and neurodegenerative disorders. However, in rare instances, diaphragmatic paralysis due to herpes-zoster virus infection has been reported. Here, we describe an 85-year-old woman who developed left hemidiaphragmatic paralysis within 19 days of the appearance of a typical herpes-zoster rash involving the C4-5 dermatome on the left side. Clinical and radiological findings revealed no local causes of phrenic nerve lesion. The hemidiaphragmatic paralysis was thought to be caused by herpes-zoster virus infection. PMID:22687801

Oike, Miki; Naito, Toshio; Tsukada, Mizuha; Kikuchi, Yasumi; Sakamoto, Naoharu; Otsuki, Yukiko; Ohshima, Hiroko; Yokokawa, Hirohide; Isonuma, Hiroshi; Dambara, Takashi



Laryngeal Paralyses: Theoretical Considerations and Effects on Laryngeal Vibration.  

ERIC Educational Resources Information Center

A theoretical four-mass model of the larynx was developed to simulate laryngeal biomechanical behavior and used to evaluate states of asymmetric laryngeal vibration. Simulations of laryngeal paralyses were compared with data on glottal vibration in observed laryngeal function. (Author/JDD)

Smith, Marshall E.; And Others



A computational study of the role of the aortic arch in idiopathic unilateral vocal fold paralysis.  


Unilateral vocal fold paralysis (UVP) occurs when one of the vocal folds becomes paralyzed due to damage to the recurrent laryngeal nerve (RLN). Individuals with UVP experience problems with speaking, swallowing and breathing. Nearly 2/3 of all cases of UVP are associated with impaired function of the left RLN. The left RLN branches from the vagus nerve within the thoracic cavity and loops around the aorta before ascending to the larynx within the neck. We hypothesize that this path predisposes the left RLN to a supraphysiological biomechanical environment contributing to onset of UVP. Specifically, this research focuses on identifying the contribution of the aorta to onset of left-sided UVP. Important to this goal is determining the relative influence of the material properties of the RLN and the aorta in controlling the biomechanical environment of the RLN. Finite element analysis was used to estimate the stress and strain imposed on the left RLN as a function of the material properties and loading conditions. The peak stress and strain in the RLN was quantified as a function of RLN and aortic material properties and aortic blood pressure using Spearman rank correlation coefficients. The material properties of the aortic arch showed the strongest correlation with peak stress (? = -0.63, 95% CI, -1.00 to -0.25) and strain (?=-0.62, 95%CI, -0.99 to -0.24) in the RLN. Our results suggest an important role for the aorta in controlling the biomechanical environment of the RLN and potentially in the onset of left-sided UVP that is idiopathic. PMID:25477351

Williams, Megan J; Ayyalasomayajula, Avinash; Behkam, Reza; Bierhals, Andrew J; Jacobs, M Eileen; Edgar, Julia D; Paniello, Randal C; Barkmeier-Kraemer, Julie M; Vande Geest, Jonathan P



Diaphragm strength in patients with recent hemidiaphragm paralysis.  

PubMed Central

Eleven patients with unilateral diaphragm paralysis of recent onset were studied to investigate the effect of the paralysis on inspiratory muscle function. Nine of the patients had noticed a decrease in exercise tolerance, which was not explained by any other pathological condition. Hemidiaphragm dysfunction was confirmed by the demonstration of a greatly reduced or absent transdiaphragmatic pressure on stimulation of the phrenic nerve in the neck, by means of surface bipolar electrodes (unilateral twitch Pdi), compared with normal values on the contralateral side. Transdiaphragmatic pressure was 44.6% (9.4%) predicted during a maximal sniff and 30.3% (16.8%) predicted during a maximal static inspiration against a closed airway, confirming diaphragm weakness. Maximum static inspiratory mouth pressures were also low (61.7% (12.7%) predicted), consistent with a reduction in inspiratory muscle capacity. Phrenic nerve conduction time was prolonged on the affected side in nine patients, consistent with phrenic nerve dysfunction, whereas on the unaffected side it was normal. It is concluded that recent hemidiaphragm paralysis causes a reduction in transdiaphragmatic pressure that is associated with a reduction in maximum inspiratory mouth pressure. Phrenic nerve stimulation is a useful technique with which to confirm and quantify hemidiaphragm dysfunction. Measurement of phrenic nerve conduction time provides useful information about the underlying pathology. PMID:3261460

Laroche, C M; Mier, A K; Moxham, J; Green, M



Visual Experiences during Paralysis  

PubMed Central

Rationale: Paralyzed human volunteers (n?=?6) participated in several studies the primary one of which required full neuromuscular paralysis while awake. After the primary experiment, while still paralyzed and awake, subjects undertook studies of humor and of attempted eye-movement. The attempted eye-movements tested a central, intentional component to one’s internal visual model and are the subject of this report. Methods: Subjects reclined in a supportive chair and were ventilated after paralysis (cisatracurium, 20?mg intravenously). In illumination, subjects were requested to focus alternately on the faces of investigators standing on the left and the right within peripheral vision. In darkness, subjects were instructed to look away from a point source of light. Subjects were to report their experiences after reversal of paralysis. Results: During attempted eye-movement in illumination, one subject had an illusion of environmental movement but four subjects perceived faces as clearly as if they were in central vision. In darkness, four subjects reported movement of the target light in the direction of attempted eye-movements and three could control the movement of the light at will. Conclusion: The hypothesis that internal visual models receive intended ocular-movement-information directly from oculomotor centers is strengthened by this evidence. PMID:22162967

Whitham, Emma M.; Fitzgibbon, Sean P.; Lewis, Trent W.; Pope, Kenneth J.; DeLosAngeles, Dylan; Clark, C. Richard; Lillie, Peter; Hardy, Andrew; Gandevia, Simon C.; Willoughby, John O.



Sudden flaccid paralysis.  


Periodic thyrotoxic paralysis is a genetic condition, rare in the West and in Caucasians. Thyrotoxicosis, especially in western hospitals, is an easily overlooked cause of sudden-onset paralysis. We present a case of a 40-year-old man who awoke one morning unable to stand. He had bilateral lower limb flaccid weakness of 0/5 with reduced reflexes and equivocal plantars; upper limbs were 3/5 with reduced tone and reflexes. ECG sinus rhythm was at a rate of 88/min. PR interval was decreased and QT interval increased. Bloods showed potassium of 1.8?mEq/L (normal range 3.5-5), free T4 of 29.2?pmol/L (normal range 6.5-17) and thyroid-stimulating hormone (TSH) of <0.01?mIU/L (normal range 0.35-4.94). Random urinary potassium was 8.8?mEq/L (normal range 12.5-62.5). The patient was admitted initially to intensive therapy unit and given intravenous potassium. His symptoms resolved within 24?h. He was diagnosed with thyrotoxic periodic paralysis. He was discharged on carbimazole and propanolol, and follow-up was arranged in the endocrinology clinic. PMID:25566931

Tariq, Mohammad; Peshin, Rohit; Ellis, Oliver; Grover, Karan



Ascending paralysis associated with HIV infection  

PubMed Central

We present two patients with a high viral load of HIV-1 who developed symptoms of ascending paralysis leading to respiratory failure and autonomic instability. One patient had symptom improvement with highly active antiretroviral therapy (HAART) and a subsequent decrease in viral load. The other patient improved with intravenous immunoglobulin therapy and did not show much improvement on HAART alone. There are several proposed mechanisms for peripheral neuropathies seen in HIV-infected patients, including a direct action of HIV on the nerve by neurotropic strains or formation of autoantibodies against nerve elements. The comparison of the response to different therapies in these two cases highlights the importance of understanding different pathophysiologies, as the treatment modality may differ. PMID:25552790

Afzal, Aasim; Benjamin, Mina; Gummelt, Kyle L.; Afzal, Sadaf; Tribble, Marc



Low-reactive-level laser treatment in facial paralysis  

NASA Astrophysics Data System (ADS)

This study was carried out with a 41-year-old female patient with facial paralysis as a consequence of facial nerve injury during neurosurgery. Low-reactive level laser treatment (LLLT) with a diode laser of 830 nm, 40 mw, continuous wave, spot area 3 mm2, was applied twice a week for 2 weeks, then 1 weekly session following up to 30 sessions, resulting in about 80% improvement of the motor activity.

Brugnera, Aldo, Jr.; Ladalardo, Thereza C.; Bologna, Elisangela; Castanho Garrini, Ana E.; Pinheiro, Antonio L. B.; Campos, Roberto A. d. C.



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



Selective laryngeal neurotomy and the control of phonation by the echolocating bat, Eptesicus  

Microsoft Academic Search

1.The effect, on the subglottic pressure and on the emitted orientation sounds, of selectively cutting nerves to various laryngeal muscles of the Big Brown Bat,Eptesicus fuscus, was studied.2.Bilateral inferior laryngeal neurotomy caused no change in the repetition rate, duration, initial frequency or bandwidth of downward sweeping frequency modulated (FM) pulses, but after this treatment mean subglottic pressure at pulse onset

Roderick A. Suthers; James M. Fattu



[Thyroid carcinoma and the recurrent nerve. Recurrence fall-out, incidence and causal circumstances in a large case-load of patients with thyroid carcinoma].  


Impairment of vocal cord function is a threat to patients with thyroid carcinoma; either due to the tumor having infiltrated the larynx or the recurrent nerve, or to accidental damage to the laryngeal nerves during thyroid surgery. We have reviewed 1,245 patients' records which were filed under the diagnosis of thyroid carcinoma at Det Norske Radiumhospital from 1956 to 1978. Pareses of vocal cords were noted in 465 patients (37.3%) during the course of their illness. In 135 patients (10.8%) the pareses were due to infiltration by the tumor, most commonly seen in anaplastic carcinoma. In 267 patients (21.4%) the pareses followed surgery; planned resections of the recurrent nerves were performed in 48 patients (3.9%). Transient pareses with normal vocal cord movements within months were experienced in 137 cases (11%). Permanent paralysis caused accidentally during surgery was seen in 82 patients, representing 6.6% of all patients and 4.7% of the surgically exposed nerves. We stress the need for pre- and postoperative evaluation of vocal cord movement as an aid to future diagnosis and optimal surgical planning. PMID:2321224

Høie, J; Jørgensen, O G; Karlsen, K O; Winther, F O



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



Hyperkalemic paralysis in primary adrenal insufficiency.  


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



Peroneal paralysis due to exostosis of the fibula. Report of 2 cases.  


Exostoses in certain situations such as the armpit or the popliteal region, can cause vascular or neurological compression syndromes. Exostoses of the neck of the fibula can in this way produce late paralysis of the peroneal nerve. Two such cases are presented in young patients, in whom the neurological damage was produced by increased growth distally of the neoplasm. PMID:6654662

Rinaldi, E



An Unusual Case of Neuralgic Amyotrophy Presenting with Bilateral Phrenic Nerve and Vocal Cord Paresis  

PubMed Central

Background Neuralgic amyotrophy (brachial plexus neuropathy, brachial plexus neuritis, or Parsonage-Turner syndrome) is an uncommon inflammatory condition typically characterized by acute and severe shoulder pain followed by paresis with muscle weakness and atrophy of the upper limb or shoulder girdle. We report an unusual clinical manifestation of neuralgic amyotrophy, namely bilateral phrenic nerve palsy with concomitant laryngeal paresis. Case Report A 55-year-old male presented with orthopnea and aphonia after an episode of bilateral shoulder pain preceded by an upper respiratory tract infection. Spirometry, chest X-ray and videolaryngoscopy revealed bilateral and simultaneous paresis of the diaphragm and the vocal cords. Clinical examination at admission and at the 2-month follow-up did not show upper limb weakness or atrophy, except for a mild atrophy of the right supraspinatus muscle. An electromyography of the upper limb muscles and nerve conduction studies did not reveal signs of denervation. Analysis of the cerebrospinal fluid and an MRI of the neuraxis were unremarkable. After treatment with prednisolone, vocal cord function markedly improved within 8 weeks, whereas paresis of the diaphragm persisted. Conclusion Shoulder pain followed by diaphragmatic paralysis with dyspnea and hoarseness may be a manifestation of neuralgic amyotrophy even if upper limb or shoulder girdle palsies are absent. PMID:21490716

Holtbernd, F.; Zehnhoff-Dinnesen, A. am; Duning, T.; Kemmling, A.; Ringelstein, E.B.



Different mechanism of vocal cord paralysis between spinocerebellar ataxia (SCA 1 and SCA 3) and multiple system atrophy.  


While multiple system atrophy (MSA) is frequently associated with vocal cord paralysis (VCP) causing severe respiratory failure, it is still unknown whether hereditary types of spinocerebellar degeneration develop similar laryngeal paralysis. We analyzed the laryngeal function from the viewpoints of fiberoptic laryngoscopy and laryngeal myopathology and then attempted to clarify the difference of the mechanism of VCP among the patients with spinocerebellar ataxia type 1 (SCA 1), type 3 (SCA 3), and MSA. Seven patients with SCA 1, nineteen with SCA 3, and eleven with MSA were studied. Vocal cord movement was analyzed by fiberoptic laryngoscopy during wakefulness and diazepam-induced sleep (sleep load test). Paraffin-embedded sections or cryosections of the intrinsic laryngeal muscles from five autopsied cases (one with SCA 1 and four with SCA 3) were histologically examined. VCP was found in two of the seven SCA 1 patients (29%), three of the nineteen SCA 3 patients (16%), and in nine of the eleven MSA patients (82%). VCP observed in SCA 1 and SCA 3 was various in the severity and showed no exacerbation on sleep load test in all of the eight patients but one SCA 3 patient. In this patient, the findings of fiberoptic laryngoscopy were quite similar to those found in MSA. All the intrinsic laryngeal muscles including cricothyroid (CT), interarytenoid (IA), and posterior cricoarytenoid (PCA) muscles showed neurogenic atrophy in one autopsied SCA 1 and four SCA 3 patients. Our conclusion is that VCP in SCA 1 and SCA 3 contrasts with that in MSA in its occurrence, response to the sleep load test, and the distribution of the neurogenic abnormalities among the intrinsic laryngeal muscles. PMID:11997064

Isozaki, Eiji; Naito, Rie; Kanda, Takemasa; Mizutani, Toshio; Hirai, Shunsaku



Phonation instability flow in excised canine larynges  

PubMed Central

Objective Disordered voices are often associated with abnormal changes in aerodynamic parameters of subglottal pressure and airflow. Phonation instability pressure (PIP) has been previously proposed to evaluate subglottal pressure at the onset of chaotic phonation. We propose the concept of and measure phonation instability flow (PIF), the airflow at which phonation becomes chaotic. Phonation flow range (PFR), PIF minus phonation threshold flow (PTF), is proposed to assess the range over which normal vocal fold vibration occurs. Study Design Repeated measures with each ex vivo larynx serving as its own control. Methods Pressure and airflow were measured at phonation onset and chaos onset in seven excised canine larynges under three experimental conditions: 0% elongation with no glottal gap; 20% elongation with no glottal gap; 20% elongation with a 3 mm posterior glottal gap. Paired t-tests were performed to determine if experimental measurements differed between elongations (0% and 20%) or degrees of abduction (20% elongation with and without a 3 mm glottal gap). Results Both PIF and PFR were dependent on abduction but not elongation. PIP was not significantly dependent on either condition. PIF and PFR showed greater differences for abduction than either phonation threshold pressure (PTP) or PTF. Conclusions PIF and PFR may be useful parameters in the experimental or clinical settings, particularly when evaluating disorders characterized by a glottal gap such as vocal fold paralysis and presbylaryngis. PMID:21555205

Hoffman, Matthew R.; Rieves, Adam L.; Budde, Adam J.; Surender, Ketan; Zhang, Yu; Jiang, Jack J.



Artifacts produced during electrical stimulation of the vestibular nerve in cats. [autonomic nervous system components of motion sickness  

NASA Technical Reports Server (NTRS)

Evidence is presented to indicate that evoked potentials in the recurrent laryngeal, the cervical sympathetic, and the phrenic nerve, commonly reported as being elicited by vestibular nerve stimulation, may be due to stimulation of structures other than the vestibular nerve. Experiments carried out in decerebrated cats indicated that stimulation of the petrous bone and not that of the vestibular nerve is responsible for the genesis of evoked potentials in the recurrent laryngeal and the cervical sympathetic nerves. The phrenic response to electrical stimulation applied through bipolar straight electrodes appears to be the result of stimulation of the facial nerve in the facial canal by current spread along the petrous bone, since stimulation of the suspended facial nerve evoked potentials only in the phrenic nerve and not in the recurrent laryngeal nerve. These findings indicate that autonomic components of motion sickness represent the secondary reactions and not the primary responses to vestibular stimulation.

Tang, P. C.



Successful Training of HEMS Personnel in Laryngeal Mask Airway and Intubating Laryngeal Mask Airway Placement  

Microsoft Academic Search

IntroductionTo evaluate laryngeal mask airway (LMA) and intubating laryngeal mask airway (ILMA) placement by helicopter emergency medical services (HEMS) personnel after a comprehensive training program.

R. J. Frascone; Greg Pippert; William Heegaard; Paul Molinari; David Dries



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



Section four: laryngitis and dysphonia.  


Acute laryngitis is most often caused by viral illnesses through direct inflammation of the vocal cords or from irritation due to postnasal drainage. Bacterial infections, such as acute epiglottitis, also can cause dysphonia but typically have other systemic symptoms as well as respiratory distress. Chronic laryngitis is characterized by symptoms lasting more than 3 weeks. Chronic vocal cord issues can be related to overuse or stress on the vocal cords resulting in nodules or polyps. Individuals in certain occupations, such as singers, school teachers, and chemical workers, are at greater risk of chronic laryngitis. The diagnostic approach to chronic laryngitis should include visualization of the vocal cords to rule out potential malignant lesions. For acute and chronic overuse symptoms, the best treatment is vocal rest. The use of antibiotics or decongestants should be discouraged. PMID:24328951

Hueston, William J; Kaur, Dipinpreet



Toward a simulation-based tool for the treatment of vocal fold paralysis.  


Advances in high-performance computing are enabling a new generation of software tools that employ computational modeling for surgical planning. Surgical management of laryngeal paralysis is one area where such computational tools could have a significant impact. The current paper describes a comprehensive effort to develop a software tool for planning medialization laryngoplasty where a prosthetic implant is inserted into the larynx in order to medialize the paralyzed vocal fold (VF). While this is one of the most common procedures used to restore voice in patients with VF paralysis, it has a relatively high revision rate, and the tool being developed is expected to improve surgical outcomes. This software tool models the biomechanics of airflow-induced vibration in the human larynx and incorporates sophisticated approaches for modeling the turbulent laryngeal flow, the complex dynamics of the VFs, as well as the production of voiced sound. The current paper describes the key elements of the modeling approach, presents computational results that demonstrate the utility of the approach and also describes some of the limitations and challenges. PMID:21556320

Mittal, Rajat; Zheng, Xudong; Bhardwaj, Rajneesh; Seo, Jung Hee; Xue, Qian; Bielamowicz, Steven



Common Problems That Can Affect Your Voice  


... use, see your Otolaryngologist as soon as possible. Vocal Cord Paralysis and Paresis Hoarseness and other problems can occur ... along the laryngeal nerves, or for unknown reasons. Vocal cord paralysis typically presents with a soft and breathy voice. ...


Nerve sprouting in muscle is induced and guided by processes extended by schwann cells  

Microsoft Academic Search

Partial denervation or paralysis with botulinum toxin, manipulations that induce sprouting of nerve terminals in muscle, also induced terminal Schwann cells to extend processes. These processes were associated with every nerve sprout and in some cases were longer than the sprouts that appeared to be growing along them. Following partial denervation, more than 70% of the nerve sprouts that grew

Young-Jin Son; Wesley J Thompson



Facial paralysis reconstruction in children and adolescents with central nervous system tumors.  


Facial paralysis remains a vexing problem in the treatment of posterior cranial fossa tumors in children. Fortunately, current techniques are available to reconstruct the paralyzed face in restoring balance, symmetry, and amelioration of functional sequelae. The restoration of structure and function of the paralyzed face is tantamount to proper social integration and psychosocial rehabilitation. In addition, the facial nerve is important in preventing drying of the eyes, drooling, and speech abnormalities, among other functions. The most visible evidence of facial paralysis is stark asymmetry, especially with animation. This is perhaps the most troubling aspect of facial paralysis and the one that leads to the greatest amount of psychosocial stress for the child and family members. Management strategies include early and late intervention. Early reconstructive goals focus on preservation and strengthening of intact motor end plates through native stimulatory pathways. Late reconstructive efforts are centered on surgically reconstructing permanently lost function based on each third of the face. Use of adjunct modalities such as chemical or surgical denervation and myectomies are also critical tools in restoring symmetry. Physical therapy plays a large role in both early and late facial nerve paralysis in optimizing cosmetic and functional outcome. PMID:25547882

Panossian, Andre



[Partial paralysis of the right lumbar plexus caused by a traumatic hematoma of the ileo-psoas muscle].  


The authors show a case of paralysis of right femoral nerve, subsequent to extrinsic compression due to traumatic hematoma of ileo-psoas muscle. What emerges from the revitwing of the international literature, as well as from the personal experience is both a complete nosographic framing and the necessity for an early surgical intervention. PMID:4017141

Ginanneschi, U; Capus, L; Smrekar, V; Dell'Antonio, A; Fabiani, P; Visintin, A



Glissando: laryngeal motorics and acoustics.  


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



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




Axonal transport mediates West Nile virus entry into the central nervous system and induces acute flaccid paralysis.  


West Nile virus (WNV) has emerged as a significant cause of epidemic viral encephalitis and flaccid limb paralysis, yet the mechanism by which it enters the CNS remains uncertain. We used compartmentalized neuron cultures to demonstrate that WNV spreads in both retrograde and anterograde directions via axonal transport. Transneuronal spread of WNV required axonal release of viral particles and was blocked by addition of a therapeutic neutralizing antibody. To test the physiologic significance of axonal transport in vivo, we directly inoculated the sciatic nerve of hamsters with WNV. Intrasciatic infection resulted in paralysis of the hind limb ipsilateral but not contralateral to the injection site. Limb paralysis was blocked either by surgical transection of the sciatic nerve or treatment with the therapeutic neutralizing antibody. Collectively, these studies establish that WNV undergoes bidirectional spread in neurons and that axonal transport promotes viral entry into the CNS and acute limb paralysis. Moreover, antibody therapeutics directly inhibit transneuronal spread of WNV infection and prevent the development of paralysis in vivo. PMID:17939996

Samuel, Melanie A; Wang, Hong; Siddharthan, Venkatraman; Morrey, John D; Diamond, Michael S



Axonal transport mediates West Nile virus entry into the central nervous system and induces acute flaccid paralysis  

PubMed Central

West Nile virus (WNV) has emerged as a significant cause of epidemic viral encephalitis and flaccid limb paralysis, yet the mechanism by which it enters the CNS remains uncertain. We used compartmentalized neuron cultures to demonstrate that WNV spreads in both retrograde and anterograde directions via axonal transport. Transneuronal spread of WNV required axonal release of viral particles and was blocked by addition of a therapeutic neutralizing antibody. To test the physiologic significance of axonal transport in vivo, we directly inoculated the sciatic nerve of hamsters with WNV. Intrasciatic infection resulted in paralysis of the hind limb ipsilateral but not contralateral to the injection site. Limb paralysis was blocked either by surgical transection of the sciatic nerve or treatment with the therapeutic neutralizing antibody. Collectively, these studies establish that WNV undergoes bidirectional spread in neurons and that axonal transport promotes viral entry into the CNS and acute limb paralysis. Moreover, antibody therapeutics directly inhibit transneuronal spread of WNV infection and prevent the development of paralysis in vivo. PMID:17939996

Samuel, Melanie A.; Wang, Hong; Siddharthan, Venkatraman; Morrey, John D.; Diamond, Michael S.



Inferior laryngeal paraganglioma presenting as plunging goiter  

Microsoft Academic Search

Paragangliomas are uncommon slow-growing neuroendocrine tumors that may arise from the extra-adrenal paraganglia. Paragangliomas of the inferior and superior laryngeal paraganglia are known as laryngeal paraganglioma. Inferior laryngeal paraganglioma, which is also called subglottic paraganglioma, is very seldomly observed. To our knowledge only 24 patients with subglottic paraganglioma have been found. We present a 77-year-old male patient who has been

Olgun Kadir Aribas; Fikret Kanat; Mustafa Cihat Avunduk



Multidisciplinary Management of Laryngeal Carcinoma  

SciTech Connect

The management of head and neck cancer has evolved into a multidisciplinary approach in which patients are evaluated before treatment and decisions depend on prospective multi-institutional trials, as well as retrospective outcome studies. The choice of one or more modalities to use in a given case varies with the tumor site and extent, as exemplified in the treatment of laryngeal squamous cell carcinomas. The goals of treatment include cure, laryngeal voice preservation, voice quality, optimal swallowing, and minimal xerostomia. Treatment options include transoral laser excision, radiotherapy (both definitive and postoperative), open partial laryngectomy, total laryngectomy, and neck dissection. The likelihood of local control and preservation of laryngeal function is related to tumor volume. Patients who have a relatively high risk of local recurrence undergo follow-up computed tomography scans every 3-4 months for the first 2 years after radiotherapy. Patients with suspicious findings on computed tomography might benefit from fluorodeoxyglucose positron emission tomography to differentiate post-radiotherapy changes from tumor.

Mendenhall, William M. [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL (United States)], E-mail:; Mancuso, Anthony A. [Department of Diagnostic Radiology, University of Florida College of Medicine, Gainesville, FL (United States); Hinerman, Russell W.; Malyapa, Robert S. [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL (United States); Werning, John W. [Department of Otolaryngology, University of Florida College of Medicine, Gainesville, FL (United States); Amdur, Robert J. [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL (United States); Villaret, Douglas B. [Department of Otolaryngology, University of Florida College of Medicine, Gainesville, FL (United States)



Acute Flaccid paralysis in adults: Our experience  

PubMed Central

Acute flaccid paralysis (AFP) is a complex clinical syndrome with a broad array of potential etiologies that vary with age. We present our experience of acute onset lower motor neuron paralysis. Materials and Methods: One hundred and thirty-three consecutive adult patients presenting with weakness of duration less than four weeks over 12 months period were enrolled. Detailed history, clinical examination, and relevant investigations according to a pre-defined diagnostic algorithm were carried out. The patients were followed through their hospital stay till discharge or death. Results: The mean age was 33.27 (range 13-89) years with male preponderance (67.7%). The most common etiology was neuroparalytic snake envenomation (51.9%), followed by Guillain Barre syndrome (33.1%), constituting 85% of all patients. Hypokalemic paralysis (7.5%) and acute intermittent porphyria (4.5%) were the other important conditions. We did not encounter any case of acute polio mylitis in adults. In-hospital mortality due to respiratory paralysis was 9%. Conclusion: Neuroparalytic snakebite and Guillain Barre syndrome were the most common causes of acute flaccid paralysis in adults in our study. PMID:25114422

Kaushik, Rupesh; Kharbanda, Parampreet S.; Bhalla, Ashish; Rajan, Roopa; Prabhakar, Sudesh



Laryngopharyngeal sensory discrimination testing and the laryngeal adductor reflex.  


Laryngopharyngeal sensory capacity has been determined by endoscopically administering air pulse stimuli to the mucosa innervated by the superior laryngeal nerve and asking the patient if he or she feels the stimulus. A potential shortcoming of this psychophysical testing (PT) procedure is that it is a subjective test, and patients with impaired cognition may not be able to perform the required task. In the search for an objective measure of laryngeal sensory function, we have observed that the laryngeal adductor reflex (LAR) is evoked at stimulus intensities similar to those capable of eliciting the psychophysical, or perceptual, response. The purpose of this study is to determine if the threshold for eliciting the LAR is the same as that of the sensory threshold. A specially designed endoscope was used to present air pulse stimuli (range 0.0 to 10 mm Hg) to the laryngopharynx in 20 healthy subjects and in 80 patients with dysphagia, using both PT and the LAR. The patients had a variety of underlying diagnoses, with stroke and chronic neurologic disease predominating (n = 65). In the control group and in the group of patients with dysphagia, there was no statistically significant difference between the median laryngopharyngeal sensory thresholds whether we used PT or the LAR (p>.05, Wilcoxon signed-rank test). The intraclass correlation for the total sample was .999 (U = .999, L = .998). Since psychophysical and sensorimotor reflex thresholds were not statistically significantly different and the intraclass correlation was close to a perfect correlation, we conclude that the LAR can be used as an objective and accurate clinical method of endoscopically assessing laryngopharyngeal sensory capacity. PMID:10453777

Aviv, J E; Martin, J H; Kim, T; Sacco, R L; Thomson, J E; Diamond, B; Close, L G



Genetics Home Reference: Infantile-onset ascending hereditary spastic paralysis  


... 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 ...


Polychondritis presenting with oculomotor and abducens nerve palsies as the initial manifestation.  


We treated a patient with relapsing polychondritis (RP) who presented with intermittent oculomotor and abducens nerve palsies as the first manifestation. Ear swelling and laryngeal edema emerged 7 months later, which led us to diagnose him with RP. Moderate doses of glucocorticoid resolved all symptoms. Our experience with RP accompanied by oculomotor nerve palsy suggests that RP should be considered in patients with cranial nerve palsies so that they may be promptly diagnosed and treated. PMID:24884407

Akiyama, Mitsuhiro; Kaneko, Yuko; Hanaoka, Hironari; Kuwana, Masataka; Takeuchi, Tsutomu



Transoral laser surgery for laryngeal cancer.  


Transoral laser microsurgery (TLM) was pioneered in the early 1970s as an approach to treat laryngeal pathology with precision and minimal thermal damage to the vocal cords. Over the last four decades, TLM has become an integral part of the treatment paradigm for patients with laryngeal cancer. TLM is one of the primary treatment options for early-stage laryngeal tumors. However, in recent years, surgeons have begun to develop TLM into a more versatile approach which can be used to address advanced laryngeal tumors. Although functional outcomes following TLM for advanced laryngeal disease are scarce, survival outcomes appear to be comparable with those reported for organ preservation strategies employing external beam radiation therapy (EBRT) and chemotherapy. In addition, TLM plays an important role in the setting of recurrent laryngeal cancer following primary irradiation. TLM has been demonstrated to decrease the need for salvage total laryngectomy resulting in improved functionality while retaining comparable oncologic outcomes. The aim of this review is to elucidate the indications, techniques, and oncological outcomes of TLM for advanced laryngeal cancers. PMID:24808950

Sandulache, Vlad C; Kupferman, Michael E



Reanimation of early facial paralysis with hypoglossal/facial end-to-side neurorrhaphy: a new approach.  


The classic hypoglossal transfer to the facial nerve invariably results in profound functional deficits in speech, mastication, and swallowing, and causes synkinesis and involuntary movements in the facial muscles despite good reanimation. Techniques such as a hypoglossal/facial nerve interpositional jump graft and splitting the hypoglossal nerve cause poor functional results in facial reanimation and mild-to-moderate hemiglossal atrophy, respectively. Direct hypoglossal/facial nerve cross-over through end-to-side coaptation without tension was done in three fresh cadavers and four patients. The patients had facial paralysis for less than 7 months. Complete mobilization of the facial nerve trunk and its main branches beyond the pes anserinus from the stylomastoid foramen, division of the frontal branch, if necessary, and superior elevation of the hypoglossal nerve after dividing the descendens hypoglossi, thyrohyoidal branches, occipital artery, and retromandibular veins were performed. The end of the facial nerve was hooked up through both a quarter of a partial oblique neurotomy and a perineurial window at the side of the hypoglossal nerve. Temporalis muscle transfer to the eyelids and the first stage of cross-facial nerve transfer were performed simultaneously. None of the patients experienced hemiglossal atrophy, synkinesis, and involuntary movements of the facial muscles. Regarding facial reanimation, one patient had excellent, one patient good, and the others fair and poor results after a follow-up of at least 1 year. PMID:10954315

Yoleri, L; Songür, E; Yoleri, O; Vural, T; Ca?da?, A



[Laryngeal cancer in children: case report].  


Squamous cell carcinoma of the larynx is very rare in children and adolescents. It is usually diagnosed at late stages because early symptoms are often attributed to the maturation process or other common laryngeal pediatric diseases. Early visualization of vocal cords with fexible laryngoscopy is important in children presenting suggestive symptoms of laryngeal pathology. Defnitive diagnosis of carcinoma is made by biopsy, and juvenile laryngeal papillomatosis the most important differential diagnosis. Treatment constitutes a clinical challenge. There are no established protocols, and clinicians should make a special effort to preserve the functions of the larynx, and avoid long term complications. We present a 12-years-old child with invasive laryngeal carcinoma, without prior history of juvenile papillomatosis or radiotherapy, which responded favorably to chemotherapy and radiotherapy. PMID:22760757

Zanetta, Adrián; Cuestas, Giselle; Méndez Venditto, Nicolás; Rodríguez, Hugo; Tiscornia, Carlos; Magaró, Manuel; Magaró, Salvador



Factors associated with the improvement of vocal fold movement: An analysis of LEMG and laryngeal CT parameters.  


The aim of this study is to elucidate the relationship of laryngeal electromyography (LEMG) and computed tomographic (CT) parameters to improve the prognosis of recurrent laryngeal nerve injury. 22 patients clinically suspected of having recurrent laryngeal nerve injury were examined with LEMG and CT studies. Bilateral thyroarytenoid (TA) muscles were examined and findings were interpreted by a single blind technique. Laryngeal CT image analysis of the ventricle dilation symmetry determined TA muscle atrophy. Finally, a follow-up laryngoscopic examination determined improvement of vocal fold movement. Ventricle dilation symmetry and the dichotomized TA muscle atrophy parameter significantly relate to the improvement of vocal fold movement (?(2)=4.029, P=0.039, and ?(2)=3.912, P=0.048, respectively). When the severity of vocal fold impairment was classified as severe TA muscle atrophy or none/discrete MUAP recruitment, it was found to significantly relate with the improvement of vocal fold movement (?(2)=6.712, P=.010). From this study, image analysis of the ventricle dilation symmetry to determine the severity of TA muscle atrophy shows promise for the improved prognosis of vocal fold immobility. PMID:25217204

Mengsteab, Paulos Y; Kwon, Jeong-Yi; Han, Tai Ryoon; Kwon, Tack Kyun; Kim, Deok-Ho; Kim, Sang Jun



Adult laryngeal hemangioma: report of four cases.  


Laryngeal hemangiomas in adults are uncommon. We report four such cases seen at our clinic during an 18-month period in 1996 and 1997. All masses were detected by endoscopy, and all were biopsied and ablated uneventfully with a CO2 laser. All four patients recovered without incident. We feel that laryngeal hemangiomas that affect only the glottic area can be treated endoscopically with a CO2 laser without consequences. PMID:10969468

Lomeo, P; McDonald, J; Finneman, J



Primary reconstruction of airway after resection of subglottic laryngeal and upper tracheal stenosis.  


Eighteen patients with low subglottic laryngeal stenosis and upper tracheal stenosis underwent resection of the anterior and lateral cricoid cartilage and upper trachea with reconstruction by primary laryngotracheal anastomosis. The posterior cricoid plate and recurrent laryngeal nerves were preserved. The distal trachea was tailored obliquely with an anterior prow and was anastomosed to the thyroid cartilage anteriorly and to the residual cricoid posteriorly. Where the stenosis was circumferential, scarred mucosa was resected from the anterior surface of the posterior cricoid lamina and the defect covered with a tailored flap of membranous tracheal wall. In 14 patients the lesions followed intubation injury. In 2 the stenosis was idiopathic. One stenosis resulted from inhalation burn and one from localized amyloidosis. Many patients had undergone previous surgical repairs. Sixteen patients had good to excellent results from six months to five and one-half years later. Reconstruction of the burned airway failed. One additional patient is still under treatment with a T tube. PMID:7065762

Grillo, H C





... messing with cigarettes). Did you ever notice that people who smoke a lot have rough, raspy voices? Infections from ... keep your throat from drying out. Also, never smoke and try not to be around people who are smoking. Tonight, when you open your ...


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



What Are the Key Statistics about Laryngeal and Hypopharyngeal Cancers?  


... laryngeal and hypopharyngeal cancers? What are the key statistics about laryngeal and hypopharyngeal cancers? The American Cancer ... 725 in men and 675 in women). Survival statistics for these cancers are discussed in the section “ ...


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



Diaphragmatic Paralysis: A Critical Review of its Use as a Therapeutic Measure in Respiratory Disease  

PubMed Central

Diaphragmatic paralysis first suggested as a therapeutic measure in lung disease by Steurtz (1911), who did simple phrenicotomy. Felix (1922) showed in 25% of cases this was ineffective owing to the presence of an accessory phrenic, and suggested phrenic exairesis, i.e. complete evulsion of the phrenic nerve. Goetze (1922) suggested radical phrenicotomy, i.e. division of the phrenic and excision of the nerve to the subclavius. Effects of diaphragmatic paralysis.—The diaphragm rises to the full expiratory position (4-8 cm.). Paradoxical movement (Kienböch's phenomenon) on affected side. Muscle atrophies. Collapse of the lung produced, affecting base and apex also. Lung volume reduced by ?th to ?rd. Physical signs.—Indrawing of the epigastrium. Thoracic breathing. Litten's sign absent. Less resistance to abdominal palpation on affected side. Diminished resonance at border of sternum and at base. Deficient inspiratory murmur at base. Radiography.—Paradoxical movement. Bittorf's test. Indications.—(A) Pulmonary tuberculosis. I. As the sole therapeutic measure. (1) In cases where pneumothorax has failed. (2) For relief of symptoms such as: (a) hæmoptysis; (b) cough; (c) tachycardia (d) nausea and vomiting; (e) pain; (f) hiccup. II. Combined with pneumothorax. (a) For basal adhesions; (b) alternative to bilateral pneumothorax; (c) to lengthen interval between refills; (d) at conclusion of pneumothorax treatment. III. Combined with thoracoplasty. (B) Other diseases. Unresolved pneumonia, fibrosis of the lung, bronchiectasis, abscess of the lung, hydatid disease. PMID:19989972

Campbell, A. J.



Vocal Cord Paralysis and its Etiologies: A Prospective Study  

PubMed Central

Introduction: Vocal cord paralysis is a common symptom of numerous diseases and it may be due to neurogenic or mechanical fixation of the cords. Paralysis of the vocal cords is just a symptom of underlying disease in some cases; so, clinical diagnosis of the underlying cause leading to paralysis of the vocal cords is important. This study evaluates the causes of vocal cord paralysis. Methods: In a prospective study, 45 patients with paralyzed vocal cord diagnosis were examined by tests such as examination of the pharynx, larynx, esophagus, thyroid, cervical, lung, and mediastinum, brain and heart by diagnostic imaging to investigate the cause vocal cord paralysis. The study was ended by diagnosing the reason of vocal cord paralysis at each stage of the examination and the clinical studies. Results: The mean duration of symptoms was 18.95±6.50 months. The reason for referral was phonation changes (97.8%) and aspiration (37.8%) in the subjects. There was bilateral paralysis in 6.82%, left paralysis in 56.82% and right in 63.36% of subjects. The type of vocal cord placement was midline in 52.8%, paramedian in 44.4% and lateral in 2.8% of the subjects. The causes of vocal cords paralysis were idiopathic paralysis (31.11%), tumors (31.11%), surgery (28.89%), trauma, brain problems, systemic disease and other causes (2.2%). Conclusion: An integrated diagnostic and treatment program is necessary for patients with vocal cord paralysis. Possibility of malignancy should be excluded before marking idiopathic reason to vocal cord paralysis. PMID:24753832

Seyed Toutounchi, Seyed Javad; Eydi, Mahmood; Golzari, Samad EJ; Ghaffari, Mohammad Reza; Parvizian, Nashmil



[The rare case of laryngeal lesion in idiopathic Kaposi's sarcoma].  


The case report of laryngeal Kaposi's sarcoma (KS) in 59 year old HIV-negative man infected by herpes virus 8 (HHV-8) is in the paper. The primary onset of KS was on the legs. Lesion of laryngeal mucosa was developed sequentially, resulted in laryngeal stenosis and led to application of tracheostome. The skin and laryngeal mucosa lesions had homotypic histological structure and corresponded to early manifestation of KS preceded tumor node appearance. PMID:22379900

Bykova, V P; Vinogradov, V V; Kalinin, D V; Reshul'ski?, S S; Galkina, T A



Ocular complications after posterior superior alveolar nerve block: a case of trochlear nerve palsy.  


Many intraoperative complications occurring during third molar surgery are described in the literature. Unilateral trochlear nerve palsy secondary to dental anaesthesia is a rare complication. We report the case of a 36-year-old healthy man, ASA I classification, requiring upper third molar extraction. Articaine 1:200,000 epinephrine for right posterior superior alveolar (PSA) nerve block was administered locally in the mucobuccal fold above the upper third molar. A few minutes after PSA nerve block the patient experienced double-vision. The patient was subsequently visited by an ophthalmologist and the condition was diagnosed as transient unilateral vertical diplopia due to temporary paralysis of the superior oblique muscle as a result of the anaesthetic solution involving the IV cranial nerve. The authors report this unusual case and discuss the possible anatomical pathways that might explain this rare phenomenon. PMID:23809987

Chisci, G; Chisci, C; Chisci, V; Chisci, E



Neurotrophic Factor-Secreting Autologous Muscle Stem Cell Therapy for the Treatment of Laryngeal Denervation Injury  

PubMed Central

Objectives To determine if the spontaneous reinnervation that characteristically ensues after recurrent laryngeal nerve (RLN) injury could be selectively promoted and directed to certain laryngeal muscles with the use of neurotrophic factor (NF)-secreting muscle stem cell (MSC) vectors while antagonistic reinnervation is inhibited with vincristine (VNC). Study Design Basic science investigations involving primary cell cultures, gene cloning/transfer, and animal experiments. Methods (i.) MSC survival assays were used to test multiple individual NFs in vitro. (ii.) Motoneuron outgrowth assays assessed the trophic effects of identified NF on cranial nerve X-derived (CNX) motoneurons in vitro. (iii.) Therapeutic NF was cloned into a lentiviral vector, and MSCs were tranduced to secrete NF. 60 rats underwent left RLN transection injury, and at 3 weeks received injections of either MSCs (n=24), MSCs secreting NF (n=24), or saline (n=12) into the left thyroarytenoid muscle complex (TA); half of the animals in the MSC groups simultaneously received left posterior cricoarytenoid (PCA) injections of vincristine (VNC) while half the animals received saline. Results (i.) Ciliary-derived neurotrophic factor (CNTF) had the greatest survival-promoting effect on MSCs in culture. (ii.) Addition of CNTF (50 ng/mL) to CN X motoneuron cultures resulted in enhanced neurite outgrowth and branching. (iii.) In the animal model, the injected MSCs fused with the denervated myofibers, immunohistochemistry demonstrated enhanced reinnervation based on motor endplate to nerve contact, and RT-PCR confirmed stable CNTF expression at longest follow-up (4 months) in the CNTF-secreting MSC treated groups. Conclusions MSC therapy may have a future role in selectively promoting and directing laryngeal reinnervation after RLN injury. Level of evidence: NA PMID:22965802

Halum, Stacey L.; McRae, Bryan; Bijangi-Vishehsaraei, Khadijeh; Hiatt, Kelly



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



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. PMID:25426280

Song, Sung Hyuk; Lee, Kyeong Hwan



Partial laryngeal surgery in recurrent carcinoma.  


Abstract With the growing acceptance of nonsurgical therapies for laryngeal squamous cell carcinomas (LSCCs), it has become important to delineate surgical salvage strategies for disease recurrences. Total laryngectomy is often recommended, but appropriately selected laryngeal recurrences may be treated successfully with partial laryngeal surgery: laryngeal function can be preserved with oncological efficacy. The main available studies dealing with partial laryngeal surgery in recurrent carcinoma were critically reviewed. The most appealing feature of salvage transoral laser surgery (TLS) is the opportunity to make tumor-tailored excisions without any reconstructive limitations and retaining the option to switch to open partial laryngectomy. A recent detailed review of 11 series found a pooled local control rate of 57% after a first TLS procedure. Supracricoid laryngectomy (SCL) seems to achieve good local control rates in selected cases of recurrent supraglottic-glottic carcinoma: one review considering seven series calculated that 85% of the patients treated with salvage SCL after radiotherapy experienced no local recurrence; and total laryngectomy after failure of salvage SCL afforded an overall local control rate of 65%. Neck dissection is mandatory in all cases of local LSCC recurrence with evidence of neck metastases, and routine elective neck dissection is recommended for recurrent supraglottic and transglottic cancers. PMID:25539063

Marioni, Gino; Marchese-Ragona, Rosario; Kleinsasser, Norbert H; Lionello, Marco; Lawson, Georges; Hagen, Rudolf; Staffieri, Alberto



Laryngeal aspergilloma: a complication of inhaled fluticasone therapy for asthma  

PubMed Central

Primary laryngeal aspergillosis in immunocompetent patients is rare. We describe a case of a 59-year-old woman with laryngeal aspergillosis thought to be secondary to long-term inhaled fluticasone therapy. Laryngeal aspergillosis may be an underrecognized complication of inhaled corticosteroid therapy.

Darley, David; Lowinger, David; Plit, Marshall



Laryngeal Involvement of Rhabdomyosarcoma in an Adult  

PubMed Central

Background Although initial presentation of sarcomas in the head and neck region is relatively common, involvements of the larynx by rhabdomyosarcoma either primary or metastatic have been reported rarely. Case report A case of rhabdomyosarcoma in the right thigh, which involved laryngeal structures three years after the diagnosis, is presented. Conclusions The laryngeal involvement by primary and metastatic rhabdosarcomas is very rare, however when it occurs it can result in life treating upper airway obstruction. After emergency intervention, radiotherapy and / or chemotherapy must be undertaken for long-term benefit and surgery may be helpful only in selected cases. PMID:14556654

Abali, Hüseyin; Aksoy, Sercan; Sungur, Arzu; Yalçin, Suayib



Functional and morphological evidence of age-related denervation in rat laryngeal muscles.  


Laryngeal muscle dysfunction compromises voice, swallowing, and airway protection in elderly adults. Laryngeal muscles and their motor neurons and their motor neurons communicate via the neuromuscular junction (NMJ). We tested the hypothesis that aging disrupts NMJ organization and function in the laryngeal thyroarytenoid (TA) and posterior cricoarytenoid (PCA) muscles We determined NMJ density and size and acetylcholine receptor (AChR) subunit mRNAs in TA and PCA muscles from 6-, 18-, and 30- month old-rats. NMJ function was determined with tubocurarine (TC) and contractions during nerve and muscle stimulation. NMJ size, abundance, and clustering decreased in 30-month TA and PCA muscles. AChRe mTNA and protein increased with age in both muscles. AChRg mRNA increased with age in both muscles while protein content increased in TA only. Aging PCA and TA were more sensitive to TC, demonstrating functional evidence of denervation. These results demonstrate that NMJs become smaller and less abundant in aging TA and PCA muscles. PMID:19223602

McMullen, Colleen A; Andrade, Francisco H



Isolated sleep paralysis elicited by sleep interruption.  


We elicited isolated sleep paralysis (ISP) from normal subjects by a nocturnal sleep interruption schedule. On four experimental nights, 16 subjects had their sleep interrupted for 60 minutes by forced awakening at the time when 40 minutes of nonrapid eye movement (NREM) sleep had elapsed from the termination of rapid eye movement (REM) sleep in the first or third sleep cycle. This schedule produced a sleep onset REM period (SOREMP) after the interruption at a high rate of 71.9%. We succeeded in eliciting six episodes of ISP in the sleep interruptions performed (9.4%). All episodes of ISP except one occurred from SOREMP, indicating a close correlation between ISP and SOREMP. We recorded verbal reports about ISP experiences and recorded the polysomnogram (PSG) during ISP. All of the subjects with ISP experienced inability to move and were simultaneously aware of lying in the laboratory. All but one reported auditory/visual hallucinations and unpleasant emotions. PSG recordings during ISP were characterized by a REM/W stage dissociated state, i.e. abundant alpha electroencephalographs and persistence of muscle atonia shown by the tonic electromyogram. Judging from the PSG recordings, ISP differs from other dissociated states such as lucid dreaming, nocturnal panic attacks and REM sleep behavior disorders. We compare some of the sleep variables between ISP and non-ISP nights. We also discuss the similarities and differences between ISP and sleep paralysis in narcolepsy. PMID:1621022

Takeuchi, T; Miyasita, A; Sasaki, Y; Inugami, M; Fukuda, K



Preparation of four-color arterial corrosion casts of the laryngeal arteries  

Microsoft Academic Search

Summary The supply areas of the superior and inferior laryngeal arteries were studied in order to plan tissue-sparing laryngeal surgery. Arterial corrosion casts with and without preservation of the laryngeal skeleton were prepared and the supply areas of the superior and inferior laryngeal arteries were distinguished from each other by injecting differently colored methacrylates. The ramifications of the laryngeal arteries

H Claassen; G R Klaws



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.



Sudden death caused by laryngeal papillomatosis.  


Laryngeal papillomatosis (LP) is the most frequent benign neoplasm of the larynx. Clinically it causes hoarseness and upper airway obstruction. Though the LP has the potential to endanger life by asphyxiation, this unfortunate outcome is extremely rare. We report the case of a 19-year-old female who suddenly died of asphyxiation caused by massive LP. PMID:9197496

Balazic, J; Masera, A; Poljak, M



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


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


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.



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



The laryngeal mask airway at altitude.  


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



Laryngeal papillomatosis: molecular, histopathological, and clinical evaluation  

Microsoft Academic Search

Molecular, histopathological, and clinical studies were carried out on a series of 79 laryngeal papillomas (LP) from 36 patients in order to investigate the hypothesis that juvenile and adult LP may represent a biological entity causally related to Human papilloma virus (HPV) infection. Using in situ hybridization with biotin-labelled probes and polymerase chain reaction, we detected human papilloma virus (HPV)

Nina Gale; D. Ferluga; M. Poljak; V. Kambi?; J. Fischinger



Human papillomavirus infections in laryngeal cancer  

Microsoft Academic Search

Although the association and clinical significance of human papillomavirus (HPV) infections with a subset of head and neck cancers, particularly for oropharyngeal carcinoma, has recently been well documented, the involvement of HPV in laryngeal cancer has been inadequately evaluated. Herein we review the currently known associations of HPV infections in diseases of the larynx and their potential for oncogenicity. Using

M. C. Torrente; J. P. Rodrigo; M. Haigentz Jr; F. G. Dikkers; A. Rinaldo; R. P. Takes; J. Olofsson; A. Ferlito



Selective activation of the human tibial and common peroneal nerves with a flat interface nerve electrode  

NASA Astrophysics Data System (ADS)

Objective. 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. Approach. During intraoperative trials involving three subjects, an eight-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. Main results. 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. Significance. Estimated joint moments suggest 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.

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



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



Development and validation of the Newcastle laryngeal hypersensitivity questionnaire  

PubMed Central

Background Laryngeal hypersensitivity may be an important component of the common disorders of laryngeal motor dysfunction including chronic refractory cough, pdoxical vocal fold movement (vocal cord dysfunction), muscle tension dysphonia, and globus pharyngeus. Patients with these conditions frequently report sensory disturbances, and an emerging concept of the ‘irritable larynx’ suggests common features of a sensory neuropathic dysfunction as a part of these disorders. The aim of this study was to develop a Laryngeal Hypersensitivity Questionnaire for patients with laryngeal dysfunction syndromes in order to measure the laryngeal sensory disturbance occurring in these conditions. Methods The 97 participants included 82 patients referred to speech pathology for behavioural management of laryngeal dysfunction and 15 healthy controls. The participants completed a 21 item self administered questionnaire regarding symptoms of abnormal laryngeal sensation. Factor analysis was conducted to examine correlations between items. Discriminant analysis and responsiveness to change were evaluated. Results The final questionnaire comprised 14 items across three domains: obstruction, pain/thermal, and irritation. The questionnaire demonstrated significant discriminant validity with a mean difference between the patients with laryngeal disorders and healthy controls of 5.5. The clinical groups with laryngeal hypersensitivity had similar abnormal scores. Furthermore the Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ) showed improvement following behavioural speech pathology intervention with a mean reduction in LHQ score of 2.3. Conclusion The Newcastle Laryngeal Hypersensitivity Questionnaire is a simple, non-invasive tool to measure laryngeal pesthesia in patients with laryngeal conditions such as chronic cough, pdoxical vocal fold movement (vocal cord dysfunction), muscle tension dysphonia, and globus pharyngeus. It can successfully differentiate patients from healthy controls and measure change following intervention. It is a promising tool for use in clinical research and practice. PMID:24552215



Transient muscle paralysis degrades bone via rapid osteoclastogenesis  

PubMed Central

A unilateral injection of botulinum toxin A (BTxA) in the calf induces paralysis and profound loss of ipsalateral trabecular bone within days. However, the cellular mechanism underlying acute muscle paralysis-induced bone loss (MPIBL) is poorly understood. We hypothesized that MPIBL arises via rapid and extensive osteoclastogenesis. We performed a series of in vivo experiments to explore this thesis. First, we observed elevated levels of the proosteoclastogenic cytokine receptor activator for nuclear factor-?B ligand (RANKL) within the proximal tibia metaphysis at 7 d after muscle paralysis (+113%, P<0.02). Accordingly, osteoclast numbers were increased 122% compared with the contralateral limb at 5 d after paralysis (P=0.04) and MPIBL was completely blocked by treatment with human recombinant osteoprotegerin (hrOPG). Further, conditional deletion of nuclear factor of activated T-cells c1 (NFATc1), the master regulator of osteoclastogenesis, completely inhibited trabecular bone loss (?2.2±11.9%, P<0.01). All experiments included negative control assessments of contralateral limbs and/or within-animal pre- and postintervention imaging. In summary, transient muscle paralysis induced acute RANKL-mediated osteoclastogenesis resulting in profound local bone resorption. Elucidation of the pathways that initiate osteoclastogenesis after paralysis may identify novel targets to inhibit bone loss and prevent fractures.—Aliprantis, A. O., Stolina, M., Kostenuik, P. J., Poliachik, S. L., Warner, S. E., Bain, S. D., Gross, T. S. Transient muscle paralysis degrades bone via rapid osteoclastogenesis. PMID:22125315

Aliprantis, Antonios O.; Stolina, Marina; Kostenuik, Paul J.; Poliachik, Sandra L.; Warner, Sarah E.; Bain, Steven D.; Gross, Ted S.



Shortness of breath after AV ablation: case of left phrenic nerve palsy.  


Phrenic nerve palsy has been recognized as a complication of catheter ablation with a prevalence of 0.11-0.48% after atrial fibrillation ablation, independent of the type of ablation catheter or energy source, likely due to the anatomical relationship of the nerves. This report describes a case of new onset of shortness of breath (SOB) due to left diaphragm paralysis following transcatheter radiofrequency ablation in a patient with underlying chronic obstructive pulmonary disease. PMID:23882394

Lambiris, Irene; Mehta, Jinesh; Helguera, Marcelo



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

Code of Federal Regulations, 2010 CFR

...Disposition of thyroid glands and laryngeal muscle tissue. 310.15 Section 310.15...Disposition of thyroid glands and laryngeal muscle tissue. (a) Livestock thyroid glands and laryngeal muscle tissue shall not be used for human...



Insulin-mediated hypokalemia and paralysis in familial hypokalemic periodic paralysis.  


To elucidate a potential role for insulin-mediated extra-renal potassium disposal in the clinical syndrome of hypokalemic periodic paralysis, an obese affected man was studied using the euglycemic insulin clamp, which, in normal and obese subjects, produces predictable, insulin dose-dependent declines in plasma potassium levels. During a 20 mU/m2/minute euglycemic clamp (insulin level, 88 microU/ml) procedure, while the patient with hypokalemic periodic paralysis demonstrated severe resistance to insulin-mediated glucose uptake (glucose uptake 50 percent of that of normal control subjects, n = 17), his plasma potassium declined to a degree similar to that seen in normal subjects. During a subsequent higher dose, 200 mU/m2/minute insulin infusion (insulin level, 914 microU/ml), plasma potassium declined to 2.5 meq/liter, a value significantly below that seen in normal (n = 19) (3.3 +/- 0.1 meq/liter) and obese (n = 6) (3.2 +/- 0.1 meq/liter) subjects. During this study, paralysis began in the patient's hand and forearm at the potassium nadir and lasted three hours, despite restoration of normokalemia 30 minutes after paralysis began. Glucose disposal rates during this high-dose insulin infusion were one-half that seen in lean control subjects (n = 19) and similar to those in obese control subjects. If these findings are representative of hypokalemic periodic paralysis and can be generalized to larger numbers of patients, they indicate several new features of this syndrome. The ability of insulin to induce hypokalemia is enhanced in this syndrome even in the presence of marked coexistent obesity-related resistance to the action of insulin to promote glucose utilization. Enhanced sensitivity of potassium uptake systems to activation by insulin (and other factors) may be a central feature of this syndrome. Additionally, paralytic hypokalemia can be induced during a euglycemic insulin clamp procedure, which could be utilized as a diagnostic test for this syndrome. PMID:3287913

Minaker, K L; Meneilly, G S; Flier, J S; Rowe, J W



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



[The use of ultrasonography in peroneal paralysis].  


We report the importance of ultrasound in 5 cases of neuropathies caused by popliteal compression of the peroneal nerve. The ultrasound is helpful for the indication of operative decompression. The ultrasound is a proper diagnostic method if sciatica could not be excluded. Unfortunately, not every compression can be evaluated by this method alone. PMID:8212812

Nebelung, W; Merk, H; Neumann, H W



Long-term follow-up study of browlift for treatment of facial paralysis.  


Browlift for patients with irreversible paralysis of the frontalis muscle was evaluated in a review of 40 patients who had undergone follow-up studies for durations of more than 3 years. The procedure consists of a lazy S-shaped excision above the upper border of the eyebrow and upward fixation of the lower skin margin. The results were as follows: (1) The percentage of patients for whom symmetrical positioning of the eyebrow was achieved was 65%. (2) The greater the preoperative severity of ptosis, the more often did recurrence occur. (3) Recurrence progressed rapidly during the first postoperative year, but thereafter recurrence was seen only in those patients in whom the affected eyebrow was still in a position higher than its counterpart. (4) No relationship could be seen between age at the time of surgery and postoperative position of eyebrow. (5) Improvement in contraction of the visual field was seen in 85% of patients postoperatively, and complaints were eliminated in 50%. (6) Careful preservation of the sensory nerve is required. (7) The postoperative scar was acceptable. This procedure is a simple and effective method of correction of paralytic ptosis. Although a degree of skill is required to obtain satisfactory results and a surgical scar remains at the upper border of the eyebrow, the advantages of the procedure surpass its disadvantages. It is believed that this method should be used more often in the treatment of facial paralysis. PMID:8192367

Ueda, K; Harii, K; Yamada, A



Using image processing technology combined with decision tree algorithm in laryngeal video stroboscope automatic identification of common vocal fold diseases.  


This study used the actual laryngeal video stroboscope videos taken by physicians in clinical practice as the samples for experimental analysis. The samples were dynamic vocal fold videos. Image processing technology was used to automatically capture the image of the largest glottal area from the video to obtain the physiological data of the vocal folds. In this study, an automatic vocal fold disease identification system was designed, which can obtain the physiological parameters for normal vocal folds, vocal paralysis and vocal nodules from image processing according to the pathological features. The decision tree algorithm was used as the classifier of the vocal fold diseases. The identification rate was 92.6%, and the identification rate with an image recognition improvement processing procedure after classification can be improved to 98.7%. Hence, the proposed system has value in clinical practices. PMID:23915804

Jeffrey Kuo, Chung-Feng; Wang, Po-Chun; Chu, Yueng-Hsiang; Wang, Hsing-Won; Lai, Chun-Yu



Activity of respiratory laryngeal motoneurons during fictive coughing and swallowing  

Microsoft Academic Search

Membrane potential changes and discharges from 28 laryngeal motoneurons were recorded intracellularly in the caudal nucleus\\u000a ambiguus of decerebrate, paralyzed and ventilated cats. Electrical activities were recorded from 17 expiratory laryngeal motoneurons\\u000a (ELMs) with maximal depolarizing membrane potential in early expiration, and from 11 inspiratory laryngeal motoneurons (ILMs)\\u000a with maximal depolarizing membrane potential in inspiration. Activities during breathing were compared

Christian Gestreau; Laurent Grélot; Armand Louis Bianchi



Case report Inferior laryngeal paraganglioma presenting as plunging goiter  

Microsoft Academic Search

Paragangliomas are uncommon slow-growing neuroendocrine tumors that may arise from the extra-adrenal paraganglia. Paragangliomas of the inferior and superior laryngeal paraganglia are known as laryngeal paraganglioma. Inferior laryngeal paraganglioma, which is also called subglottic paraganglioma, is very seldomly observed. To our knowledge only 24 patients with subglottic paraganglioma have been found. We present a 77-year-old male patient who has been

Olgun Kadir Aribas; Fikret Kanat; Mustafa Cihat Avunduk



Effect of isolated unilateral diaphragmatic paralysis on ventilation and exercise performance in rats.  


The degree of impairment of ventilation and exercise performance after unilateral diaphragmatic paralysis (UDP) induced by phrenic nerve injury has been controversial due to heterogeneity in the published clinical studies. The aim of this study was to assess the effect of isolated UDP on breathing and exercise performance in conscious rats. Breathing was measured by unrestrained whole body plethysmography during quiet breathing and after moderate aerobic exercise. Additionally, incremental exercise testing was performed to evaluate the effects of intensive activity. The results demonstrated that complete UDP in rats resulted in a permanent decrease of peak inspiratory flow at rest breathing. Nevertheless, adequate ventilation could be maintained, and the breathing pattern was unaltered due to a strong compensatory mechanism and central re-coordination initiated by UDP. After being affected at an early stage, the ventilatory response to exercise was gradually regained and subsequently restored. PMID:24556382

Xu, Yali; Rui, Jing; Zhao, Xin; Xiao, Chengwei; Bao, Qiyuan; Li, Jifeng; Lao, Jie



A technique for the orientation of endoscopically resected laryngeal lesions.  


Endoscopic resection is a widely accepted method of treating early laryngeal malignancies. Accurate histological assessment of resected laryngeal specimens can be difficult due to their small size and potential damage and distortion caused by standard orientation and processing techniques. A new technique is described which employs dehydrated cucumber to mount laryngeal specimens for orientation and processing. This technique is quick, easy, cheap and reliable, allowing accurate histological assessment of potentially malignant lesions. Better orientating and processing of laryngeal specimens can optimise treatment decisions based on histological results. PMID:17550514

Murray, C E; Cooper, L; Handa, K K; MacLeod, T; MacKenzie, K



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



Echovirus 19 associated with a case of acute flaccid paralysis.  


Acute flaccid paralysis can be caused by many members of the enterovirus genus, most notably the three poliviruses types 1 to 3. We report the case of acute flaccid paralysis caused by echovirus 19. The Western Pacific region has been declared polio free by the WHO since 2000. Australia is now using inactivated polio vaccine in the National Immunization Schedule. This vaccine does not carry the extremely rare risk of vaccine associated acute flaccid paralysis but it does leave our newly vaccinated population open gastrointestinal infection with polioviruses and the risk of circulation of the wild-type virus. Continued surveillance of cases of acute flaccid paralysis is to detect polioviruses is essential until poliovirus is completely eradicated. PMID:23252472

Kesson, Alison M; Choo, Chong Ming; Troedson, Christopher; Thorley, Bruce R; Roberts, Jason A



Successful plication for postoperative diaphragmatic paralysis in an adult.  


Diaphragmatic paralysis developed in an adult after a cardiac operation. The patient suffered from recurrent fevers and could not be weaned from mechanical ventilatory support. Diaphragmatic plication was performed and enabled rapid and sustained weaning from respiratory support. PMID:7979752

Glassman, L R; Spencer, F C; Baumann, F G; Adams, F V; Colvin, S B



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.



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.



The Acute bee paralysis virus-Kashmir bee virus-Israeli acute paralysis virus complex.  


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 or encountered naturally. These viruses are frequently implicated in honey bee colony losses, especially when the colonies are infested with the parasitic mite Varroa destructor. Here we review the historical and recent literature of this virus complex, covering history and origins; the geographic, host and tissue distribution; pathology and transmission; genetics and variation; diagnostics, and discuss these within the context of the molecular and biological similarities and differences between the viruses. We also briefly discuss three recent developments relating specifically to IAPV, concerning its association with Colony Collapse Disorder, treatment of IAPV infection with siRNA and possible honey bee resistance to IAPV. PMID:19909972

de Miranda, Joachim R; Cordoni, Guido; Budge, Giles



Laryngeal Motor Cortex and Control of Speech in Humans  

PubMed Central

Speech production is one of the most complex and rapid motor behaviors and involves a precise coordination of over 100 laryngeal, orofacial and respiratory muscles. Yet, we lack a complete understanding of laryngeal motor cortical control during production of speech and other voluntary laryngeal behaviors. In recent years, a number of studies have confirmed the laryngeal motor cortical representation in humans and provided some information about its interactions with other cortical and subcortical regions that are principally involved in vocal motor control of speech production. In this review, we discuss the organization of the peripheral and central laryngeal control based on neuroimaging and electrical stimulation studies in humans and neuroanatomical tracing studies in non-human primates. We hypothesize that the location of the laryngeal motor cortex in the primary motor cortex and its direct connections with the brainstem laryngeal motoneurons in humans, as oppose to its location in the premotor cortex with only indirect connections to the laryngeal motoneurons in non-human primates, may represent one of the major evolutionary developments in humans towards the ability to speak and vocalize voluntarily. PMID:21362688

Simonyan, Kristina; Horwitz, Barry



Laryngeal Structure and Function in the Pediatric Larynx: Clinical Applications  

ERIC Educational Resources Information Center

This article presents an overview of the normal anatomy and physiology of the pediatric larynx, followed by some examples of pediatric voice disorders that were chosen to exemplify the alterations to the laryngeal anatomy and the subsequent modifications to laryngeal function. Vocal fold nodules are primarily reviewed due to their high incidence…

Sapienza, Christine M.; Ruddy, Bari Hoffman; Baker, Susan



Association between human papillomavirus infection and laryngeal squamous cell carcinoma  

Microsoft Academic Search

The aim of this study was to compare the pre- valence of human papillomavirus (HPV) infection in laryngeal squamous cell carcinoma using two methods: PCR-DNA enzyme immunoassay (PCR\\/ DEIA) and immunohistochemistry (IHC) for detec- tion of HPV in specimens of laryngeal squamous cell carcinoma and to correlate the presence of HPV with the epidemiological and clinicopatho- logical features of recurrence

Kamal Morshed



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


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



[Mucoid pseudo-cysts of the sheath of the external popliteal sciatic nerve. Apropos of 2 cases].  


Two cases of paralysis of the etxernal popliteal sciatic nerve are described. They are secondary to the development of a pseudo-cyst containing mucoid matter within the connective tissue sheath of the nerve itself. The authors describe the pathological anatomy of these lesions and discuss their aetiology, favouring the theory of mucoid degeneration of the connective tissues of the nerve sheath. They give brief indication of the clinical symptoms and emphasize the need for early but simplified surgery, ruling out any nerve resection. PMID:1241153

Faivre, J; Chatel, M; Le Beguec, P; Sabouraud, O; Jan, M; Ramée, M P



Neurovascularized free short head of the biceps femoris muscle transfer for one-stage reanimation of facial paralysis.  


The single-stage technique for cross-face reanimation of the paralyzed face without nerve graft is an improvement over the two-stage procedure because it results in early reinnervation of the transferred muscle and shortens the period of rehabilitation. On the basis of an anatomic investigation, the short head of the biceps femoris muscle with attached lateral intermuscular septum of the thigh was identified as a new candidate for microneurovascular free muscle transfer. The authors performed one-stage transfer of the short head of the biceps femoris muscle with a long motor nerve for reanimation of established facial paralysis in seven patients. The dominant nutrient vessels of the short head were the profunda perforators (second or third) in six patients and the direct branches from the popliteal vessels in one patient. The recipient vessels were the facial vessels in all cases. The length of the motor nerve of the short head ranged from 10 to 16 cm, and it was sutured directly to several zygomatic and buccal branches of the contralateral facial nerve in six patients. One patient required an interpositional nerve graft of 3 cm to reach the suitable facial nerve branches on the intact side. The period required for initial voluntary movement of the transferred muscles ranged from 4 to 10 months after the procedures. The period of postoperative follow-up ranged from 5 to 42 months. Transfer of the vascularized innervated short head of the biceps femoris muscle is thought to be an alternative for one-stage reconstruction of the paralyzed face because of the reliable vascular anatomy of the muscle and because it allows two teams to operate together without the need to reposition the patient. The nerve to the short head of the biceps femoris enters the side opposite the vascular pedicle of the muscle belly, and this unique relationship between the vascular pedicle and the motor nerve is anatomically suitable for one-stage reconstruction of the paralyzed face. As much as to 16 cm of the nerve can be harvested, and the nerve is long enough to reach the contralateral intact facial nerve in almost all cases. The lateral intermuscular septum, which is attached to the short head, provides "anchor/suture-bearing" tissue, allowing reliable fixations to the zygoma and the upper and lower lips to be achieved. In addition, the scar and deformity of the donor site are acceptable, and loss of this muscle does not result in donor-site dysfunction. PMID:15692342

Hayashi, Akiteru; Maruyama, Yu



Arytenoid Cartilage Dislocation from External Blunt Laryngeal Trauma: Evaluation and Therapy without Laryngeal Electromyography  

PubMed Central

Background Intubation trauma is the most common cause of arytenoid dislocation. The aim of this study was to investigate the diagnosis and treatment of arytenoid cartilage dislocation from external blunt laryngeal trauma in the absence of laryngeal electromyography (LEMG) and to explore the role of early attempted closed reduction in arytenoids cartilage reposition. Material/Methods This 15-year retrospective study recruited 12 patients with suspected arytenoid dislocation from external blunt laryngeal trauma, who were evaluated through 7 approaches: detailed personal history, voice handicap index (VHI) test, indirect laryngoscope, flexible fiberoptic laryngoscope, video strobolaryngoscope, and/or high-resolution computed tomography (CT), and, most importantly, the outcomes after attempted closed reduction under local anesthesia. They were divided into satisfied group (n=9) and dissatisfied group (n=3) based on their satisfied with voice qualities at 1 week after the last closed reduction manipulation. Results Each patient was diagnosed with arytenoid dislocation caused by external blunt laryngeal trauma. In the satisfied group, VHI scores and maximum phonation time (MPT) at 1 week after the last reduction were significantly improved compared with those before the procedure (P<0.05). Normal or improved mobility and length of the affected vocal fold were also noted immediately after the end of the last closed reduction. The median time interval between injury and clinical intervention in satisfied group was 43.44±34.13 days, much shorter than the median time of 157.67±76.07 days in the dissatisfied group (P<0.05). Conclusions Multimodality assessment protocols are essential for suspected arytenoid dislocation after external blunt laryngeal trauma. Early attempted closed reduction should be widely recommended, especially in health facilities without LEMG, mainly, because it could be helpful for early diagnosis and treatment of this disease. In addition, early closed reduction could also improve the success of arytenoid reduction. PMID:25150338

Teng, Yaoshu; Wang, Hui-e; Lin, Zhihong



Intraneural ganglion cyst on the external popliteal nerve.  


There are many causes for the paralysis of the external sciatic popliteal nerve , such as the intraneural ganglion cyst. In this case, we evaluate a 52-year-old woman with no relevant personal record, who was admitted with paresis of the right foot of 4?months of evolution associated with alterations in the sensitivity that rose up to the posterolateral region of the leg. The diagnosis was based on MR and cyst decompression and disconnection of the articular branch. Given the low incidence of these lesions, their origin is still subject to controversy. The most widely accepted theory is the unifying articular theory described by Spinner in the year 2003. Intraneural ganglion cysts must be included in the differential diagnosis of progressive paralysis of the sciatic nerve, lesions of the nerve root at L5 and nerve sheath tumours that start at the lateral compartment of the knee. The treatment of a fibular intraneural ganglion cyst must be surgical and the operation must be performed as soon as possible. PMID:24891476

Rendon, Diego; Pescador, David; Cano, Carlos; Blanco, Juan



Comparison of hemihypoglossal- and accessory-facial neurorrhaphy for treating facial paralysis in rats.  


The aim of this study was to determine the effectiveness of hypoglossal-facial nerve "side"-to-end (HemiHN-FN) and accessory-facial nerve end-to-end (AN-FN) neurorrhaphy using a predegenerated nerve graft (PNG) for reanimating facial paralysis in a rat FN injury model. A total of 25 rats with complete unilateral facial paralysis resulting from section of the right FN were divided into 5 groups (n=5 each) that were submitted to immediate, delayed (3 months after FN injury) or no (control) FN reconstruction procedures involving HemiHN-FN or AN-FN neurorrhaphy. Approximately 3 months after FN reconstruction, cholera toxin subunit B conjugate Alexa 555 (CTB-Alexa 555) was injected into the ipsilateral whisker pad muscle and CTB-Alexa 555-labeled neurons were observed in the hypoglossal or accessory nuclei of all the FN reconstruction rats, but none of these neurons were found in the controls. There were numerous myelinated and nonmyelinated axons in both PNG and repaired FN of the FN reconstruction rats. No differences were found for these numbers between the two neurorrhaphy methods for each of the treatment time points, indicating the equal effectiveness of axon regeneration. However, a significantly higher number of CTB-Alexa 555-labeled neurons was observed in the hypoglossal nucleus of the immediate HemiHN-FN neurorrhaphy-treated rats when compared to that in the accessory nucleus of the immediate AN-FN neurorrhaphy-treated rats, consistent with the surface values of the recorded MAPs at the whisker pad muscle while electro-stimulating the FN. These results suggest that HemiHN-FN neurorrhaphy produces more efficient innervation of the paralyzed facial muscles than AN-FN neurorrhaphy without sacrificing ipsilateral hypoglossal function. Taking into consideration the clinical relevance of these findings for postoperative complications and functional reanimation in relation to the central plasticity, we suggest that HemiHN-FN neurorrhaphy may be the preferable facial reanimation procedure after an FN injury. PMID:25454640

Li, Dezhi; Wan, Hong; Feng, Jie; Wang, Shiwei; Su, Diya; Hao, Shuyu; Schumacher, Michael; Liu, Song



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



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


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



Expression of DNA topoisomerase II-?: Clinical significance in laryngeal carcinoma  

PubMed Central

DNA topoisomerase II-? (Topo II-?) is essential for numerous cell processes, including DNA replication, transcription, recombination, and chromosome separation and condensation. Altered Topo II-? expression may lead to carcinogenesis and cancer progression. The aim of the present study was to investigate the association between Topo II-? expression levels and clinicopathological data from laryngeal cancer patients. Immunohistochemistry was used to analyze Topo II-? expression in laryngeal squamous cell carcinoma and distant healthy tissues obtained from 70 patients. In addition, fluorescence in situ hybridization was used to detect Topo II-? amplification and chromosome 17 ploidy using a laryngeal cancer tissue microarray. The expression of Topo II-? protein was detected in 71.43% (50/70) of laryngeal carcinoma tissues, in contrast to 9% of healthy tissues (2/22). Furthermore, the expression of Topo II-? protein was found to be associated with tumor de-differentiation and advanced tumor T stage. However, the expression of Topo II-? protein was not identified to be associated with Topo II-? amplification in laryngeal carcinoma, although was found to positively correlate with chromosome 17 aneuploidy (P<0.05). A higher aneuploidy rate contributed to increased expression levels of Topo II-? protein. Aberrant Topo II-? expression and chromosome 17 aneuploidy contributed to the development and progression of laryngeal cancer, indicating that targeting Topo II-? may provide a treatment strategy for patients with laryngeal cancer. PMID:25202370




Neoplastic meningitis presenting with dysphagia and bilateral vocal cord paralysis.  


Neoplastic meningitis is the infiltration of the leptomeninges and subarachnoid space by tumor cells occurring in 3% to 5% of patients with systemic malignancies. Most cases present with multifocal neurological symptoms that vary according to the central nervous system territory involved. Here, we describe the first reported case to our knowledge of neoplastic meningitis causing bilateral vocal cord paralysis. Early diagnosis of this progressive disease process is essential to achieving a better treatment response and improved survival. This report demonstrates that neoplastic meningitis should be considered in the investigation of bilateral vocal cord paralysis, particularly in patients with a history of metastatic disease. PMID:24510714

Dixon, Peter R; Alsaffar, Hussain; Symons, Sean P; Enepekides, Danny; Higgins, Kevin M



Mumps, Cervical Zoster, and Facial Paralysis: Coincidence or Association?  

PubMed Central

The association of mumps with peripheral facial paralysis has been suggested, but its pathogenesis remains unclear. An 8-year-old girl simultaneously developed left peripheral facial paralysis, ipsilateral cervical herpes zoster, and bilateral mumps sialadenitis. Elevated anti-mumps and anti-varicella zoster virus IgM antibodies in serological testing indicated recent infection of mumps and reactivation of VZV. Molecular studies have provided mounting evidence that the mumps virus dysregulates the host's immune system and enables the virus to proliferate in the infected host cells. This dysregulation of the immune system by mumps virus may have occurred in our patient, enabling the latent VZV infection to reactivate. PMID:24653846

Kanaya, Kaori



Expression of atrophy-related transcription factors in the process of intrinsic laryngeal muscle atrophy after denervation.  


We examined changes in the expressions of three atrophy-related transcription factors (FOXO3a, P-FOXO3a, and PGC-1?) in the process of intrinsic laryngeal muscle atrophy after denervation. In total, 51 Wistar rats were used. After transection of the unilateral recurrent laryngeal nerve, the thyroarytenoid (TA) muscle and the posterior cricoarytenoid (PCA) muscle were excised and subjected to histological and Western blot studies. Relationships between the expressions of transcription factors during atrophy of the intrinsic laryngeal muscles were investigated by comparing the results of the treated side (T) with those of the untreated side (U), and sequential changes in the T/U ratio after denervation were assessed. Loss of wet muscle weight, together with a decrease in muscle fiber cross-sectional area and increase in the number of muscle fibers/mm(2), occurred more quickly in TA muscle than in PCA muscle. Muscle atrophy progressed rapidly between 7 and 28 days after denervation, while expression of FOXO3a was maximal on day 7, in both TA and PCA muscles. By contrast, P-FOXO3a expression decreased gradually after denervation. Expression of PGC-1? increased slowly until day 7, and then it declined. Denervation-induced atrophy of the intrinsic laryngeal muscles was closely linked with the expression of FOXO3a and PGC-1?, suggesting that atrophy of these muscles may involve the actions of these transcription factors. In addition, muscle atrophy progressed faster in TA muscle than in PCA muscle, due mainly to differences in muscle fiber composition. PMID:25099184

Sei, Hirofumi; Taguchi, Aki; Nishida, Naoya; Hato, Naohito; Gyo, Kiyofumi



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


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. PMID:25422617

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



Lyme borreliosis and facial paralysis–a prospective analysis of risk factors and outcome  

Microsoft Academic Search

Purpose: To evaluate the incidence of Lyme borreliosis in patients with acute idiopathic facial paralysis with special emphasis on the risk factors that explain the poor outcome of facial paralysis and occurrence of Lyme borreliosis.Materials and Methods: During a 2-year period, we prospectively studied 503 consecutive patients with acute idiopathic facial paralysis for the presence of Lyme borreliosis. We screened

Miikka Peltomaa; Ilmari Pyykkö; Ilkka Seppälä; Matti Viljanen



Nerve Impulses in Plants  

ERIC Educational Resources Information Center

Summarizes research done on the resting and action potential of nerve impulses, electrical excitation of nerve cells, electrical properties of Nitella, and temperature effects on action potential. (GS)

Blatt, F. J.



Analysis Paralysis-Developing A Business Continuity Plan  

E-print Network

Analysis Paralysis-Developing A Business Continuity Plan Steve Sadler, UCAR Director of Safety a Contractor · RFP: Business Impact Analysis may not be necessary · Motivational seminar may not be necessary and Site Services #12;Getting to Know A Business Continuity Survivor · Health, Environment and Safety


Co-existence of panic disorder and sleep paralysis  

Microsoft Academic Search

Sleep paralysis is a clinical phenomenon that is often a feature of narcolepsy. As its co-existence with panic disorder has not been noted before, we report on two cases in which the two conditions co-exist and postulate a neurochemical mechanism.

Danny Allen; David Nutt



Hyperkalaemic periodic paralysis: a rare presentation of Addison's disease  

Microsoft Academic Search

A 44 year old man with longstanding diabetes mellitus gave a 6-month history of periodic attacks of flaccid quadriplegia. Following one of these episodes he was admitted for assessment. In view of persistent hyperkalaemia, hypoadrenalism was suspected and Addison's disease was confirmed biochemically. Adrenal replacement therapy restored the potassium levels to normal and resulted in no further attacks of paralysis.

J. M. Sowden; D. Q. Borsey



The laryngeal motor cortex: its organization and connectivity.  


Our ability to learn and control the motor aspects of complex laryngeal behaviors, such as speech and song, is modulated by the laryngeal motor cortex (LMC), which is situated in the area 4 of the primary motor cortex and establishes both direct and indirect connections with laryngeal motoneurons. In contrast, the LMC in monkeys is located in the area 6 of the premotor cortex, projects only indirectly to laryngeal motoneurons and its destruction has essentially no effect on production of species-specific calls. These differences in cytoarchitectonic location and connectivity may be a result of hominid evolution that led to the LMC shift from the phylogenetically 'old' to 'new' motor cortex in order to fulfill its paramount function, that is, voluntary motor control of human speech and song production. PMID:24929930

Simonyan, Kristina



Laryngeal spasm after general anaesthesia due to Ascaris lumbricoides.  


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



Fatal laryngeal diphtheria in a UK child.  


Over the last century, the infectious causes of acute upper airway obstruction have changed dramatically. Toxigenic Corynebacterium diphtheriae has become rare in the UK due to national immunisation programmes. Since 1986, eight sporadic cases of C diphtheriae were reported, all of whom had recently returned from endemic areas. We describe a case of fatal laryngeal diphtheria in an unimmunised child. Although appropriate antimicrobial cover was provided, antitoxin was not administered due to a low index of suspicion. This case represents the first UK death from C diphtheriae in 14 years and where travel to an endemic country or contact with a known case of diphtheria was not identified. We highlight the need to maintain a high index of suspicion in children for whom completion of the immunisation schedule is not confirmed regardless of travel history. Prompt recognition and timely administration of antitoxin may be life-saving. PMID:22535233

Ganeshalingham, Anusha; Murdoch, Ian; Davies, Bethany; Menson, Esse



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



Timing of removal of the laryngeal mask airway.  


Previous studies reported that complications associated with removal of the laryngeal mask were more frequent in awake patients than in anaesthetised patients; however, these studies did not comply with the method described in the manufacturer's instruction manual. The reported incidences of regurgitation during the use of the laryngeal mask also differ considerably between studies. We studied these factors in 66 patients in whom the method described in the manual was used. After induction of anaesthesia, the laryngeal mask and a pH probe were inserted and the cuff of the mask was inflated with a minimum volume of air. Anaesthesia was maintained with nitrous oxide and isoflurane in oxygen. At the end of the operation, we randomly allocated patients to one of two groups and the laryngeal mask was removed either while they were still deeply anaesthetised or after they had regained consciousness. No apparent regurgitation occurred in any patient during operation, but one patient in the anaesthetised group regurgitated immediately after removal of the mask. The incidence of complications during or after removal of the laryngeal mask was significantly greater in the anaesthetised group than that in the awake group (p < 0.001; difference [95% CI]: 48.5 [30.5-66.5]%). Therefore, the laryngeal mask can be safely left in place until the patient has regained consciousness after emergence from anaesthesia. PMID:9534633

Nunez, J; Hughes, J; Wareham, K; Asai, T



Bilateral trigeminal nerve paralysis and Horner's syndrome associated with myelomonocytic neoplasia in a dog.  


A 5-year-old male Doberman Pinscher had nasal stenosis, dropped mandible, bilateral atrophy of masseter and temporalis muscles, and Horner's syndrome caused by aleukemic myelomonocytic leukemia. Neoplastic cellular neurotropism, diffuse turbinate and nodular peribronchial infiltrate, and a hepatic portal infiltrative pattern similar to that of lymphoma were microscopic features of interest. PMID:3480282

Carpenter, J L; King, N W; Abrams, K L



Fibrolipomatous hamartoma of nerve.  


Fibrolipomatous hamartomas of nerve are rare, benign, fibrofatty malformations of peripheral nerves, most commonly affecting the median nerve. Lower extremity cases are extremely rare. The authors present a very rare case of a fibrolipomatous hamartoma involving the superficial peroneal nerve, and review the literature regarding its clinical presentation and surgical management. PMID:8161996

Bibbo, C; Warren, A M



Progression of type I to type II paralysis in acute organophosphorous poisoning: is oxidative stress significant?  


Organophosphorous poisoning is a common method of deliberate self-harm in countries where the pesticides are readily available and can result in type I, II and/or III paralysis. The in-hospital morbidity and mortality of the poisoning are mostly associated with type II paralysis (intermediate syndrome). The aim of this study was to determine the role of oxidative stress in relation to the severity of poisoning and development of type II paralysis in patients suffering from acute organophosphate poisoning. This prospective study was carried out at the Christian Medical College Hospital. Thirty-two patients with acute organophosphorous poisoning, admitted in one medical unit over 17 months, were included in the study. They were clinically assessed for severity of poisoning and paralysis during the first 10 days of their hospitalisation. Temporal profiles of butyrylcholinesterase (BuChE) and oxidative stress parameters, for 4, 7 and 10 days of hospitalisation, were established in 25 of these patients. Type I and II paralysis were associated with severe poisoning. The majority of patients with type II paralysis had prior evidence of type I paralysis. The pattern of muscles that were paralysed in type I paralysis occurring alone and in type I paralysis proceeding to type II paralysis were similar. BuChE was significantly inhibited in all patients. Oxidative stress occurred in acute organophosphate poisoned patients and was greater in severe poisoning. The results suggest that type I paralysis may progress to type II paralysis in severely poisoned patients. They demonstrate early occurrence of oxidative stress in severe acute organophosphate poisoning. However, the development of type II paralysis is not associated with the level of oxidative stress. They suggest that mechanisms other than acetylcholine induced oxidative stress may be involved in the progression of type I to type II paralysis. PMID:16374596

Venkatesh, S; Kavitha, M L; Zachariah, A; Oommen, A



Acquired toxoplasmosis accompanied by facial nerve palsy in an immunocompetent 5-year-old child.  


Acquired toxoplasmosis, although relatively common in children, is usually asymptomatic but can also be clinically manifested by a benign and self-limited infectious mononucleosis-like syndrome. Neurological complications are very rare in immunocompetent children. The authors report a 5-year-old boy who presented with cervical lymphadenopathy because of acquired toxoplasmosis accompanied with unilateral facial nerve paralysis. Toxoplasma gondii DNA detection in blood by polymerase chain reaction, as well as elevated specific immunoglobulin M antibodies against it, established the diagnosis. Characteristic brain lesions on magnetic resonance imaging were absent and ophthalmologic examination revealed no inflammatory lesions in the retina and choroid. Treatment with pyrimethamine, sulfadiazine, and folic acid resulted in a complete recovery after 2 months of therapy. Although rare, acute facial nerve paralysis of unknown origin can be caused by acquired toxoplasmosis even in the immunocompetent pediatric population. Elevated titers of specific antibodies and the presence of parasite's DNA are key findings for the correct diagnosis. PMID:21148450

Galli-Tsinopoulou, Assimina; Kyrgios, Ioannis; Giannopoulou, Eleni Z; Gourgoulia, Styliani; Maggana, Ioanna; Katechaki, Elina; Chatzidimitriou, Dimitrios; Evangeliou, Athanasios E



Guillain-Barré syndrome as a prominent cause of childhood acute flaccid paralysis in post polio eradication era in Egypt.  


Guillain-Barré syndrome often follows an antecedent gastrointestinal or respiratory illness but, in rare cases, follows vaccination. This study was conducted to identify preceding events, demographic, clinical characteristics and prognostic factors of childhood Guillain-Barré syndrome after post-poliomyelitis eradication era in Egypt. This is a prospective study of all children with GBS (no = 50) admitted to pediatric Cairo University Hospital between January 2006 and June 2007 (70.42% of all acute flaccid paralysis patients during this period). Upper respiratory infection was the most common preceding event (24%) while only 4 patients (8%) reported antecedent oral polio vaccine. Motor deficit was frequent and severe (quadriparesis in 92% and paraparesis in 8%). Autonomic dysfunction was recorded in 32% of patients. Forty two percent of patients had poor outcome with 16% deaths. Presence of severe disability on admission and on nadir, cranial nerve affection or the need for mechanical ventilator were found to be significant predictors for poor outcome. PMID:21169042

Halawa, Eman F; Ahmed, Dalia; Nada, Mona A F



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

Code of Federal Regulations, 2013 CFR

...15 Section 310.15 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE...and laryngeal muscle tissue shall not be used for human food. (b) Livestock thyroid glands and laryngeal...



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

Code of Federal Regulations, 2011 CFR

...15 Section 310.15 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE...and laryngeal muscle tissue shall not be used for human food. (b) Livestock thyroid glands and laryngeal...



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



Combined modality therapy for laryngeal cancer with superselective intra-arterial cisplatin infusion and concomitant radiotherapy.  


Concomitant radiotherapy and superselective arterial infusion of cisplatin for laryngeal cancer has shown excellent therapeutic outcomes. It is expected to be a reasonable treatment option for laryngeal cancer, especially in locally advanced cases. PMID:21964674

Taki, Shigenari; Homma, Akihiro; Suzuki, Fumiyuki; Oridate, Nobuhiko; Hatakeyama, Hiromitsu; Mizumachi, Takatsugu; Kano, Satoshi; Furusawa, Jun; Sakashita, Tomohiro; Inamura, Naoya; Yoshida, Daisuke; Onimaru, Rikiya; Shirato, Hiroki; Fukuda, Satoshi



Isolated sleep paralysis, vivid dreams and geomagnetic influences: II.  


This report describes a test of the hypothesis that significant changes in the ambient geomagnetic field are associated with altered normal nighttime dream patterns. Specifically, it was predicted that there would be a greater incidence of isolated sleep, paralysis or vivid dreams with abrupt rises and falls of geomagnetic activity. The author's (JC) and a second subject's (KC) daily reports of dream-recall were analyzed in the context of daily fluctuations of geomagnetic activity (K indices). Two analyses of variance indicated (i) significantly higher geomagnetic activity three days before a recorded isolated sleep paralysis event and (ii) significantly lower geomagnetic activity three days before an unusually vivid dream took place. Conversely, geomagnetic activity did not fluctuate significantly for randomly selected days. Testing a large sample over time is required for confirmation and extension of this work. PMID:9347546

Conesa, J



Detection of diphtheritic polyneuropathy by acute flaccid paralysis surveillance, India.  


Diphtheritic polyneuropathy is a vaccine-preventable illness caused by exotoxin-producing strains of Corynebacterium diphtheriae. We present a retrospective convenience case series of 15 children (6 girls)<15 years of age (mean age 5.2 years, case-fatality rate 53%, and 1 additional case-patient who was ventilator dependent at the time of last follow-up; median follow-up period 60 days) with signs and symptoms suggestive of diphtheritic polyneuropathy. All cases were identified through national acute flaccid paralysis surveillance, which was designed to detect poliomyelitis in India during 2002-2008. We also report data on detection of diphtheritic polyneuropathy compared with other causes of acute flaccid paralysis identified by this surveillance system. PMID:23965520

Mateen, Farrah J; Bahl, Sunil; Khera, Ajay; Sutter, Roland W



[Case report: isolated facial paralysis with a tick.].  


Tick-borne diseases are seen all over the world and their importance rises increasingly. It is noticeably important that disease and death rates due to tick-bites in our country in different areas increased in 2008. In Turkey, the numbers of diseases which are transmitted by ticks are considerably large and all of them are not detected. Reports of isolated facial paralysis cases due to tick infestation in the ear are infrequent in literature. The development of isolated facial paralysis due to ticks can be explained by several theories. This article reports a case report of a 3 year- old girl who was bought to our clinic with severe left ear pain and paresthesia on the left half of her face. She couldn't close her left eye and she lisped. The tick was removed from her external auditory canal surgically. PMID:20340091

Gürbüz, Melek Kezban; Erdo?an, Murat; Do?an, Nihal; Birdane, Leyla; Cingi, Cemal; Cingi, Emre



[Meningoencephalo-myeloradiculitis due to Flavivirus: bi-brachial paralysis and respiratory insufficiency].  


3 patients developed rapid onset of fever and nuchal stiffness. Paresis of brachial muscles occurred within 4 days and all patients had respiratory failure that needed mechanical ventilation. At the peak of the disease there were bilateral asymmetrical severe atrophy of brachial, shoulder and neck muscles, cranial nerve pareses and absent or weak deep reflexes in the upper extremities. CSF analyses showed sterile lymphocytic pleocytosis. In 2 cases the patients suffered a tick bite in Switzerland and the third was probably bitten by an insect while opening a package received from Indonesia. Patients had rapid defervescence and serological tests were found to be highly positive for IgM and then IgG ELISA FSME (Frühsommer-Meningoenzephalitis). The patients were ventilated for 2 to 5 weeks before a progressive improvement was seen. However, on follow-up at 12, 18 and 30 months respectively, proximal muscles were still atrophied and quite weak. Our cases underline that: (1) FSME-ELISA results may cross-react with the Japanese and Central European encephalitis virus species; (2) Flaviviruses do induce unusual and preferential long-term paralysis of the upper extremities simulating poliomyelitis; (3) in the 2 patients studied electrophysiologically, there were signs of axonal reinnervation not seen in lower motor neuron syndrome which were important for reinnervation to permit progressive, but late, motor improvement; (4) there is no evidence of extension of the endemic foci of tick-borne encephalitis in Switzerland. PMID:7709179

Kuntzer, T; de Marval, F; Ochsner, F; de Torrenté, A; Kuhn, M; Fitting, J W



Intracordal auricular cartilage injection for unilateral vocal fold paralysis.  


We evaluated the efficacy and outcome of intracordal auricular cartilage injection in patients with unilateral vocal fold paralysis. Our interest developed from findings of a canine model study that reported that histologic characteristics of cartilage were preserved 2 and 3 years after intracordal autologous cartilage injection. Between May 2002 and July 2010, 29 patients with breathy dysphonia caused by unilateral vocal fold paralysis underwent intracordal auricular cartilage injection. Each subject underwent preoperative and postoperative perceptual assessments, acoustical voice analysis, and videostroboscopy. Fourteen patients were male, and the mean age was 52-years old. Patients were tracked for a mean duration of 257 days. Injections were performed through a transoral approach under general anesthesia. Perceptual assessments by GRBAS scale, acoustic parameters of jitter, shimmer, noise-to-harmonic ratio, and maximum phonation time significantly improved at 3, 6, and 12 months after cartilage injection (p?paralysis. Autologous auricular cartilage can be a safe, effective, and alternative material for vocal fold medialization, and can be a long lasting one. PMID:24764320

Lim, Yun-Sung; Lee, Yoon Se; Lee, Jin-Choon; Lee, Byung-Joo; Wang, Soo-Geun; Park, Hee-June; Nam, Su-Bong; Bae, Yong-Chan



Periodic paralysis: An unusual presentation of drug-induced hyperkalemia.  


Hyperkalemia is a life-threatening electrolyte abnormality. The most common cause of hyperkalemia includes renal disease and ingestion of medications. Drug-induced hyperkalemia may develop in patients with underlying renal impairment, disturbed cellular uptake of potassium load, excessive ingestion or infusion of potassium-containing substances. We report a case of "drug-induced severe hyperkalemia" presenting as periodic paralysis. A 67-year-old diabetic and hypertensive woman presented to emergency department with the complaint of intermittent episode of inability to walk for the past 5 days. Each episode lasted for 15-20 minutes and was associated with breathlessness and restlessness. There was no family history of periodic paralysis and drug history revealed that the patient was onolmesartan 20 mg per day (for past 2 years), perindopril 4 mg per day (for past 16 months), and torsemide 10 mg/day. On examination patient was found to be conscious, alert, and afebrile. Vitals were normal. Examination of cardiovascular and respiratory system did not reveal any significant finding. Blood report of the patient showed serum K+ level 8.6 mmol/l. All other investigations were within normal limits. A diagnosis of drug-induced hyperkalemia was made. Patient responded well to the symptomatic treatment. To the best of the author's knowledge, this is the first case report of drug-induced hyperkalemia presenting as periodic paralysis. PMID:24554915

Agrawal, Poonam; Chopra, Deepti; Patra, Surajeet K; Madaan, Himanshu



Sulcus vocalis in laryngeal cancer: a histopathologic study.  


The incidental finding of sulcus vocalis in surgical specimens of patients with laryngeal cancer prompted this review. Sulcus deformities were histologically identified in 28 (48%) of 58 whole-mount coronal serial-sectioned laryngeal specimens procured from laryngeal cancer patients. The lesions were analyzed, described, and graded. A control group of 20 larynges, obtained from autopsies of patients without known laryngeal pathology, were similarly processed, and whole-mount histologic sections were studied. Four of these specimens (20%) also demonstrated sulcus deformities. In the control group, the shape and location of the sulci were similar, but the lesions were smaller than in the cancer group. The sulcus lesions revealed chronic inflammation of the subepithelial tissues with vascular ingrowth and fibrosis of the superficial lamina propria (Reinke's space); in the cancer group the sulcus was usually on the opposite vocal fold, where irritation from the tumor might be anticipated. Although the etiology of the sulci remains controversial, these findings suggest that irritation and inflammation might play a role in the pathogenesis of sulcus vocalis. PMID:8295452

Nakayama, M; Ford, C N; Brandenburg, J H; Bless, D M



A many-parameter model of laryngeal flow with ventricular resonance and supraglottal vibration  

Microsoft Academic Search

A laryngeal flow model with many parameters is described. This model consists of a glottal flow model, laryngeal ventricle resonator, and supraglottal modulator. The model is capable of representing various laryngeal airflows even when they are accompanied by supraglottal constriction and vibrations, such as found in throat singing, growl, and harsh voices. The proposed model contains several parameters related to

Ken-Ichi Sakakibara; Morinosato Wakamiya; Hiroshi Imagawa


Central compartment dissection in laryngeal cancer.  


We report here a review of the literature intended to clarify the nomenclature and boundaries of the nodes in the "central compartment" of the neck, the frequency with which tumors from the different laryngeal sites metastasize to these nodes, and the indications for central compartment node dissection in the treatment of cancers of the larynx. From this review, we conclude that, until consensus is reached about grouping of the lymph nodes in this area, it is best to refer to these nodes by their anatomic location, ie, prelaryngeal, pretracheal, or paratracheal lymph nodes. It is also advisable to describe dissection of these nodes as selective neck dissection (SND) with an annotation about the specific lymph node groups removed. Metastases in prelaryngeal and paratracheal lymph nodes in patients with squamous cell carcinoma of the larynx are associated with increased tumor recurrence, more frequent metastases in lymph nodes of the lateral compartment of the neck, and decreased survival. If untreated, they may lead to the development of peristomal recurrence. Therefore, elective treatment of level VI nodes is recommended in patients with squamous cell carcinomas of the subglottic region, advanced glottis carcinomas with subglottic extension, and in certain advanced carcinomas of the supraglottic region. PMID:20652888

Medina, Jesus E; Ferlito, Alfio; Robbins, K Thomas; Silver, Carl E; Rodrigo, Juan P; de Bree, Remco; Rinaldo, Alessandra; Elsheikh, Mohamed N; Weber, Randal S; Werner, Jochen A



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



Bilateral common peroneal nerve injury after pediatric cardiothoracic surgery: A case report and review of the literature  

PubMed Central

Nerve injuries after thoracic and cardiovascular surgery have been reported but generally concern the brachial plexus, phrenic nerve, recurrent laryngeal, and facial nerve. Common peroneal nerve injury (CPNI) following cardiopulmonary bypass has been reported in adults (4); however bilateral injury is extremely uncommon. Age, low body weight, co-morbidities such as peripheral arteriosclerotic disease, diabetes mellitus, and arrhythmias were associated with CPNI following cardiothoracic surgery in adults. Common peroneal nerve injury (CPNI) following cardiopulmonary by-pass has been reported in adults; however, bilateral injury is extremely uncommon. The superficial course of CPN makes it vulnerable to traction or compression. We report a 5-year-old girl manifesting with bilateral CPNI following prolonged cardiopulmonary by-pass. To the best of our knowledge, she is the first pediatric patient presenting with bilateral CPNI following cardiothoracic surgery and cardiopulmonary by-pass.

Setty, G.; Saleem, R.; Harijan, P.; Khan, A.; Hussain, N.



A comparison of fiberoptical guided tracheal intubation via laryngeal mask and laryngeal tube  

PubMed Central

Background: Fiberoptical assisted intubation via a placed laryngeal mask airway (LMA) has been described as save and easy procedure to manage a difficult airway. The laryngeal tube (LT) is a promising alternative to the LMA as supraglottic airway device. Fiberoptical assisted intubation via LT is possible, however considered more difficult. The aim of this study was to compare the fiberoptical assisted intubation via LT and LMA. Materials and Methods: A total of 22 anesthesiologists with different levels of experience participated in the study performed on an adult airway model. Primarily the supraglottic device was placed and correct position was confirmed by successful ventilation. A 5 mm internal diameter tracheal tube was loaded onto a flexible 3.6 mm fiberscope and the so prepared device was inserted into the proximal lumen of the LMA or the LT. The glottis was passed under visual control and the tube advanced into the trachea. After removal of the fiberscope, ventilation was examined clinically by inspection. Success rates, procedure time and observed complications of LMA versus LT were compared (U-test; P < 0.05). Results: Placement of the endotracheal tube was successful in all attempts using both the LMA and LT. There was no difference in the time needed for the placement procedure (33 [26-38] s LMA; 35 [32-38] s LT). Only minor technical complications were observed in both groups. Conclusion: A fiberoptical assisted intubation via LT can be considered as a relevant alternative in advanced airway management.

Metterlein, Thomas; Plank, Christoph; Sinner, Barbara; Bundscherer, Anika; Graf, Bernhard M.; Roth, Gabriel



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



Does an ulnar nerve lesion influence the motion of the index finger?  


Clawing of the ring and little fingers and "rolling" during prehension grip are well-known clinical phenomena of ulnar nerve lesions. In contrast to this the index and middle fingers seem to move normally. We compared the movement of right index fingers in healthy people with the right index fingers of people with an ulnar nerve lesion. The movement was measured using a three-dimensional real time motion analysis system based on ultrasound. The angles of the joints were plotted in a rectangular coordinate system. Statistical analysis of the numerical data showed no difference between the two groups. We trained a neural-network (Learning Vector Quantization) with the data of both groups. The network was able to distinguish between people with and without lesions of the ulnar nerve. We conclude that prehension grip of the index finger is also influenced by paralysis of the ulnar nerve. PMID:8732411

Hahn, P; Heindl, E



[A case of facial nerve palsy induced by nab-paclitaxel].  


The patient was a 60-year-old woman who underwent total mastectomy and axillary lymph node dissection for right breast cancer. She was treated with adjuvant chemotherapy( epirubicin plus cyclophosphamide[EC]and paclitaxel), hormone therapy, and radiation therapy. Multiple lung, lymph node, and bone metastases were detected after 4 years. The patient subsequently received nab-paclitaxel (nabPTX, 260 mg/m2, triweekly) and zoledronate therapy. Ptosis of her right eyebrow and the right angle of her mouth were observed after 8 courses of nabPTX, and peripheral right facial nerve palsy was diagnosed. She underwent rehabilitation, and facial nerve palsy improved after 9 months. Peripheral facial nerve palsy is a very rare adverse event of nabPTX. This is the first case report of peripheral facial nerve paralysis associated with nab- PTX. PMID:24394117

Minatani, Naoko; Kosaka, Yoshimasa; Sengoku, Norihiko; Kikuchi, Mariko; Nishimiya, Hiroshi; Waraya, Mina; Enomoto, Takumo; Tanino, Hirokazu; Watanabe, Masahiko



[The tensegrity concept applied to the laryngeal biodynamics].  


The knowledge of spaces and sliding ways of the forehead part of the neck must be accomplished, however the microscopic observation of these sliding ways shows in fact a real concrete material continuity, through the existence of a binding tissue between the sliding structures. This tissue is shaped in a web form system of multimicrovacuolar collagenic fibers. It respects the functional unit, while saving the relative independance of moving between the different structures concerned. The architectural features of any living tissue may be reported to a tensegrity system. The word of tensegrity is a portmanteau of tensional-integrity, as proposed by the american architect Richard Buckmister Fuller. Following tensegrity the laryngeal biodynamic behaviour is based on two sets of tensions and compressions applied on itself. The laryngeal system is therefore in a constant balance of tissular tensions. The multimicrovacuolar system has a main place. This new point of view may be applied to the laryngeal dysfunctions. PMID:20387372

Piron, A



Metastasis of Laryngeal Squamous Cell Carcinoma to Bilateral Thigh Muscles  

PubMed Central

Importance. Laryngeal cancer infrequently results in distant metastases, but metastasis to skeletal muscle is extremely uncommon. Observations. A 55-year-old male presenting with progressive dyspnea and hoarseness was found to have Stage IVA T4aN2cM0 laryngeal cancer and eventually underwent total laryngectomy. Before the patient could be started on adjuvant chemoradiation, the patient developed masses on both thighs. Biopsy revealed metastatic squamous cell carcinoma consistent with the primary laryngeal cancer. He was offered palliative chemotherapy; however, he developed new soft tissue masses to the left of his stoma and in the prevertebral area one week later. He also had new cervical and supraclavicular nodes and a pathological compression fracture of L3. Patient died within 4 months of diagnosis. Conclusions. Distant metastasis such as skeletal metastasis portends a poor prognosis. Further studies are required to determine the best course of treatment in these patients. PMID:25580324

Lucas, Zarah; Veytsman, Irina



Occupational laryngitis caused by formaldehyde: a case report.  


Formaldehyde is commonly accepted to be an allergen and irritant. However, specifically diagnosed occupational respiratory diseases caused by formaldehyde are relatively rare. Occupational laryngitis was diagnosed in a 47-year-old dairy foreman. He had been exposed for 9 years to formaldehyde emitted from a milk-packing machine situated underneath his office. His exposure level varied considerably. Under normal process conditions, the measured formaldehyde level was 0.03 mg/m3. The patient was examined by different specialists over 1 1/2 years. It was concluded that he had psychogenic dysphonia. However, a specific laryngeal provocation test with formaldehyde carried out at the Finnish Institute of Occupational Health was positive. His laryngitis was so serious that he was pensioned. During the 3 years of follow-up his condition gradually worsened. He now reacts especially to tobacco smoke and other air impurities known to contain formaldehyde. PMID:8833780

Roto, P; Sala, E



Nerve conduction velocity  


... to determine the speed of the nerve signals. Electromyography (recording from needles placed into the muscles) is ... Often, the nerve conduction test is followed by electromyography (EMG). In this test, needles are placed into ...


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.



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.



Rosai-Dorfman disease with isolated laryngeal involvement.  


Rosai-Dorfman disease is a rare histiocyte disorder that is typically characterized by massive cervical lymphadenopathy. Isolated extranodal involvement is uncommon, and isolated laryngeal involvement is extremely rare. We report an unusual case of Rosai-Dorfman disease with isolated laryngeal involvement that led to recurrent dysphonia and airway obstruction. We discuss the challenges we faced in reaching a correct pathologic diagnosis and in deciding on an appropriate treatment regimen. Based on our experience, we believe that Rosai-Dorfman disease should be considered as a differential diagnosis in patients who present with a recurrent inflammatory (histiocytic) mass lesion of the larynx. PMID:23076853

Illing, Elisa A; Halum, Stacey L



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

PubMed Central

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 (Nav1.4, 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 22Na 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 86Rb uptake was 83% larger than in WT. Salbutamol stimulated 86Rb 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 86Rb 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

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



Protein-polysaccharides of pig laryngeal cartilage  

PubMed Central

1. Protein–polysaccharides of chondroitin 4-sulphate were extracted with neutral calcium chloride from pig laryngeal cartilage that was not completely homogenized. The protein–polysaccharides were purified by precipitation with 9-aminoacridine. On zone electrophoresis in compressed glass fibre at pH7·2 it was separated into two fractions, although two distinct zones were not obtained. These fractions, which had already been shown to differ in their antigenic determinants, also differed considerably in amino acid composition, total protein, hexose and glucosamine contents. 2. The fraction of higher mobility contained approx. 2% of protein and only traces of glucosamine. Serine and glycine accounted for over half the total amino acid residues, but aromatic, basic and sulphur-containing amino acids were not detected. The weight-average molecular weight, determined by sedimentation, was 230000. 3. Assuming that there was the same sequence of neutral sugars at the linkage points as in PP-L fraction (protein–polysaccharide light fraction), the approximate molar ratio of hexose to serine suggested that most of the serine residues were linked to chondroitin sulphate chains. Support for this was derived from the agreement between the weight-average molecular weight of the chondroitin sulphate–peptide after proteolysis, and the chain weight calculated from its serine content. The chain weight based on the serine content of the fraction of higher electrophoretic mobility was approximately similar. 4. In contrast, the fraction of lower electrophoretic mobility resembled PP-L fraction in its amino acid composition, protein and glucosamine contents. The presence of glucosamine, together with the higher hexose content, suggested that this fraction contained some keratan sulphate. 5. The relatively low molecular weight of the fraction of higher mobility enabled it to be extracted without complete disintegration of the cartilage. The unlikelihood of its being produced by autolytic enzymes is discussed. PMID:4226692

Muir, Helen; Jacobs, S.



The Role of H. pylori in the Development of Laryngeal Squamous Cell Carcinoma  

PubMed Central

Aim. This study aims to investigate the possible role of H. pylori as a cause of laryngeal squamous cell carcinoma. Method. This controlled study was performed with 31 consecutive laryngeal cancer and 28 cancer-free patients who underwent direct laryngoscopy and biopsy of laryngeal lesions. To document the previous H. pylori infection, serological analysis of the antibody titers was done. Immunohistochemical analyses were applied to the tissue samples. Results. Serology was found positive at the 90.3% of the laryngeal cancer patients and 96.4% of the benign group. There were no statistically significant differences between the two groups (P > 0.05). Immunohistochemical analysis results were determined as negative at all of the specimens of laryngeal cancer patients and patients with benign lesions. Conclusion. There were no signs of colonization of H. pylori in laryngeal tissues of both groups' patients. It is thought that no relationship exists between the H. pylori infection and laryngeal squamous cell carcinoma. PMID:24198443

Genç, Ra?an; Ça?l?, Sedat; Yüce, ?mdat; Vural, Alperen; Okuducu, Hac?; Pat?ro?lu, Tahir; Güney, Ercihan



Laryngeal salivary duct carcinoma: a light and electron microscopic study.  


The light microscopic and ultrastructural features of a laryngeal salivary duct carcinoma are presented. By light microscopy, the neoplasm bore a marked resemblance to the infiltrating duct carcinoma of the breast. Ultrastructurally, the tumour was characterized by the presence of two principal types of cells, i.e. epithelial and myoepithelial cells, arranged in duct-formation. PMID:7252354

Ferlito, A; Gale, N; Hvala, H



Laryngeal obstruction caused by lymphoma in an adult dairy cow  

PubMed Central

A Holstein cow was presented for inspiratory dyspnea. Endoscopic evaluation revealed swollen arytenoids and a presumptive diagnosis of bilateral arytenoidal chondritis was made. A partial arytenoidectomy was performed, the right arytenoid was submitted for histopathology, and a diagnosis of laryngeal lymphoma was made. Due to the poor prognosis, the cow was euthanized. PMID:24489391

Lardé, Hélène; Nichols, Sylvain; Babkine, Marie; Chénier, Sonia



Catecholamine inputs to expiratory laryngeal motoneurons in rats.  


Many respiration-related interneurons and motoneurons receive a catecholaminergic input, but the extent and distribution of this input to recurrent laryngeal motoneurons that innervate intrinsic muscles of the larynx are not clear. In the present study, we examined the catecholaminergic input to expiratory laryngeal motoneurons in the caudal nucleus ambiguus by combining intracellular labeling of single identified motoneurons, with immunohistochemistry to reveal tyrosine hydroxylase immunoreactive (catecholaminergic) terminal varicosities. Close appositions were found between the two structures, with 18?±?5 close appositions per motoneuron (n?=?7). Close appositions were more frequently observed on distal rather than proximal dendrites. Axosomatic appositions were not seen. In order to determine the source of this input, microinjections of cholera toxin B subunit (1%, 20 nl) were made into the caudal nucleus ambiguus. Retrogradely labeled neurons, located in the ipsilateral nucleus tractus solitarius and the area postrema, were tyrosine hydroxylase-positive. Our results not only demonstrate details of the extent and distribution of potential catecholamine inputs to the expiratory laryngeal motoneuron, but further indicate that the inputs, at least in part, originate from the dorsomedial medulla, providing a potential anatomical basis for previously reported catecholaminergic effects on the laryngeal adductor reflex. J. Comp. Neurol. 523:381-390, 2015. © 2014 Wiley Periodicals, Inc. PMID:25224923

Zhao, Wen-Jing; Sun, Qi-Jian; Guo, Rui-Chen; Pilowsky, Paul M



Atropine for the Treatment of Hiccup After Laryngeal Mask Insertion  

Microsoft Academic Search

fter laryngeal mask airway (LMA) insertion, hic- cups is observed in 1%-14% of patients (1,2). Although hiccups is a common and benign phe- nomenon, it may disturb surgery. We describe three patients in whom hiccups were treated successfully by atropine.

Noriaki Kanaya; Masayasu Nakayama; Junko Kanaya; Akiyoshi Namiki



Refinements in modeling the passive properties of laryngeal soft tissue.  


The nonlinear viscoelastic passive properties of three canine intrinsic laryngeal muscles, the lateral cricoarytenoid (LCA), the posterior cricoarytenoid (PCA), and the interarytenoid (IA), were fit to the parameters of a modified Kelvin model. These properties were compared with those of the thyroarytenoid (TA) and cricothyroid (CT) muscles, as well as previously unpublished viscoelastic characteristics of the human vocal ligament. Passive parameters of the modified Kelvin model were summarized for the vocal ligament, mucosa, and all five laryngeal muscles. Results suggest that the LCA, PCA, and IA muscles are functionally different from the TA and CT muscles in their load-bearing capacity. Furthermore, the LCA, PCA, and IA have a much larger stress-strain hysteresis effect than has been previously reported for the TA and CT or the vocal ligament. The variation in this effect suggests that the connective tissue within the TA and CT muscles is somehow similar to the vocal ligament but different from the LCA, PCA, or IA muscles. Further demonstrating the potential significance of grouping tissues in the laryngeal system by functional groups in the laryngeal system was the unique finding that, over their working elongation range, the LCA and PCA were nearly as exponentially stiff as the vocal ligament. This paper was written in conjunction with an online technical report ( in which comprehensive muscle data and sensitivity analysis, as well as downloadable data files and computer scripts, are made available. PMID:17412782

Hunter, Eric J; Titze, Ingo R



Foresight in laryngology and laryngeal surgery: a 2020 vision.  


Laryngology and laryngeal surgery have been in the vanguard of minimally invasive human procedural interventions for approximately 150 years. The natural passages through the oral cavity, nose, and pharynx have provided an accessible gateway to the larynx that has allowed for rapid translation of a variety of diagnostic and therapeutic technologies. Transoral and transcervical laryngeal surgery have been further facilitated by progressive advancements in local, topical, intravenous, and general anesthesia. With rapid developments in engineering disciplines (ie, tissue, chemical, mechanical) and voice science, there are a variety of current and near-term opportunities to advance our field. This report represents a panel at the 2005 American Broncho-Esophagological Association meeting that sought to use present perspectives, combined with cutting-edge research insights, to provide foresight into key aspects of laryngology that we believe will be developed by the year 2020. We hope that aspiring laryngeal surgeons will find elements of this discussion valuable for devising a strategic roadmap for research initiatives in laryngology and laryngeal surgery. PMID:17937068

Zeitels, Steven M; Blitzer, Andrew; Hillman, Robert E; Anderson, R Rox



Surgery for Complete Vertical Rectus Paralysis Combined with Horizontal Strabismus  

PubMed Central

Aims. To report outcomes of the simultaneous surgical correction of vertical rectus paralysis combined with moderate-to-large angle horizontal strabismus. Methods. If a preoperative forced duction test was positive, antagonist muscle weakening surgery was performed, and then augmented partial rectus muscle transposition (APRMT) + partial horizontal rectus recession-resection was performed 2 months later. If a preoperative forced duction test was negative, APRMT + partial horizontal rectus recession-resection was performed. Antagonistic muscle weakening surgery and/or conventional recession-resection of the horizontal and/or vertical muscles of the contralateral eye was performed 2 months later, as needed. Results. Ten patients with a mean age of 22.3 ± 13.0 years were included and mean follow-up was 7.1 months. The mean vertical deviation that APRMT corrected was 21.4 ± 3.7 PD (prism diopter). The absolute deviation in horizontal significantly decreased from a preoperative value of 48.5 ± 27.4 PD to a value of 3.0 ± 2.3 PD 6 months postoperatively. The movement score decreased from a value of ?5 ± 0 preoperatively to a value of ?2.7 ± 0.8 at 6 months postoperatively. Conclusion. For patients with complete vertical rectus paralysis combined with a moderate- to-large angle of horizontal strabismus, combined APRMT and partial horizontal rectus recession-resection is safe and effective for correcting vertical and horizontal strabismus. PMID:24883204

Zou, Leilei; Liu, Rui; Liu, Yan; Lin, Jing; Liu, Hong



Focal and abnormally persistent paralysis associated with congenital paramyotonia.  


Mutations of the skeletal muscle voltage-gated sodium channel (NaV1.4) are an established cause of several clinically distinct forms of periodic paralysis and myotonia. Focal paresis has sometimes already been described. We report a case with atypical clinical manifestation comprising paramyotonia and cold-induced persistent and focal paralysis. A 27-year-old woman presented with paramyotonia congenita since her childhood. She experienced during her childhood one brief episode of generalised weakness. At the age of 27, she experienced a focal paresis lasting for several months. The known mutation p.Val1293Ile was found in the muscle sodium channel gene (SCN4A). Channel inactivation is involved in most Na(+) channelopathies. Fast inactivation is known to be responsible for the myotonia phenotype. We hypothesise that the V1293I mutation may also alter the slow inactivation in specific conditions, for example, prolonged cold exposure or prolonged and intensive exercise. This observation broadens the spectrum of clinical manifestations of this sodium channel mutation. PMID:24939454

Magot, Armelle; David, Albert; Sternberg, Damien; Péréon, Yann



Laryngeal findings and acoustic changes in hubble-bubble smokers.  


The purpose of our investigation was to evaluate the laryngeal findings and acoustic changes in hubble-bubble smokers. A total of 42 subjects with history of hubble-bubble smoking were recruited for this study. A corresponding group with a history of cigarette smoking and controls were matched. All subjects underwent laryngeal video-endostroboscopic evaluation and acoustic analysis. In the hubble-bubble smoking group, 61.9% were males. The average age was 30.02 +/- 9.48 years and the average number of years of smoking was 8.09 +/- 6.45 years. Three subjects had dysphonia at the time of examination. The incidence of benign lesions of the vocal folds in the hubble-bubble group was 21.5%, with edema being the most common at 16.7% followed by cyst at 4.8%. The incidence of laryngeal findings was significantly higher in the hubble-bubble group compared to controls. In the cigarette-smoking group, the most common finding was vocal fold cyst in 14.8% followed by polyps in 7.4%, and edema, sulcus vocalis and granuloma. These findings were not significantly different from the hubble-bubble group except for the thick mucus, which was significantly higher in the latter. There were no significant changes in any of the acoustic parameters between hubble-bubble smokers and controls except for the VTI and MPT, which were significantly lower in the hubble-bubble group. In comparison with the cigarette-smoking group, hubble-bubble smokers had significantly higher Fundamental frequency and habitual pitch (p value 0.042 and 0.008, respectively). The laryngeal findings in hubble-bubble smokers are comparable to cigarette smokers. These laryngeal findings are not translated acoustically, as all the acoustic parameters are within normal range compared to controls. PMID:20480370

Hamdan, Abdul-latif; Sibai, Abla; Oubari, Dima; Ashkar, Jihad; Fuleihan, Nabil



Wasp Venom Blocks Central Cholinergic Synapses to Induce Transient Paralysis in Cockroach Prey  

E-print Network

Wasp Venom Blocks Central Cholinergic Synapses to Induce Transient Paralysis in Cockroach Prey G 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

Libersat, Frederic


Protection against nerve agent poisoning by a noncompetitive nicotinic antagonist.  


The acute toxicity of organophosphorus (OP) nerve agents arises from accumulation of acetylcholine (ACh) and overstimulation of ACh receptors. The mainstay of current pharmacotherapy is the competitive muscarinic antagonist, atropine. Nicotinic antagonists have not been used due to the difficulties of administering a dose of a competitive neuromuscular blocker sufficient to antagonise the effects of excessive ACh, but not so much that it paralyses the muscles. An alternative approach would be to use a noncompetitive antagonist whose effects would not be overcome by increasing ACh concentrations. This study demonstrates that the compound 1,1'-(propane-1,3-diyl)bis(4-tert-butylpyridinium), which blocks open nicotinic ion channels noncompetitively, is able to reverse the neuromuscular paralysis after nerve agent poisoning in vitro and to protect guinea pigs against poisoning by nerve agents when used as part of a therapeutic drug combination including a muscarinic antagonist. In contrast to the oxime HI-6, this compound was equally effective in protecting against poisoning by sarin or tabun. Further studies should identify more effective compounds with this action and optimise doses for protection against nerve agent poisoning in vivo. PMID:21641979

Turner, S R; Chad, J E; Price, M; Timperley, C M; Bird, M; Green, A C; Tattersall, J E H



Generating Sexually Differentiated Vocal Patterns: Laryngeal Nerve and EMG Recordings from Vocalizing Male and Female African  

E-print Network

Vocalizing Male and Female African Clawed Frogs (Xenopus laevis) Ayako Yamaguchi and Darcy B. Kelley clawed frogs (Xenopus laevis) produce sexually dimorphic vocalizations; for males these include ad is the source of sexually differentiated vocalizations in Xenopus laevis. Fur- thermore, detailed analyses

Kelley, Darcy B.


Voltage sensor charge loss accounts for most cases of hypokalemic periodic paralysis  

PubMed Central

Background: Several missense mutations of CACNA1S and SCN4A genes occur in hypokalemic periodic paralysis. These mutations affect arginine residues in the S4 voltage sensors of the channel. Approximately 20% of cases remain genetically undefined. Methods: We undertook direct automated DNA sequencing of the S4 regions of CACNA1S and SCN4A in 83 cases of hypokalemic periodic paralysis. Results: We identified reported CACNA1S mutations in 64 cases. In the remaining 19 cases, mutations in SCN4A or other CACNA1S S4 segments were found in 10, including three novel changes and the first mutations in channel domains I (SCN4A) and III (CACNA1S). Conclusions: All mutations affected arginine residues, consistent with the gating pore cation leak hypothesis of hypokalemic periodic paralysis. Arginine mutations in S4 segments underlie 90% of hypokalemic periodic paralysis cases. GLOSSARY HypoPP = hypokalemic periodic paralysis. PMID:19118277

Matthews, E; Labrum, R; Sweeney, M G.; Sud, R; Haworth, A; Chinnery, P F.; Meola, G; Schorge, S; Kullmann, D M.; Davis, M B.; Hanna, M G.



Nerve sprouting in innervated adult skeletal muscle induced by exposure to elevated levels of insulin-like growth factors  

Microsoft Academic Search

Partial denervation or paralysis of adult skeletal muscle is followed by nerve sprouting, proba- bly due to release of diffusible sprout-inducing activity by inactive muscle. Insulin-like growth factors (IGF1 and IFG2) are candidates for muscle-derived sprouting activity, because (a) they induce neurite growth from peripheral neurons in vitro; and (b) their mRNA lev- els in adult skeletal muscle increase severalfold

Pico Caroni; Pedro Grandes



Clinical and electromyographic study of lateral preference in mastication in patients with longstanding peripheral facial paralysis.  


Peripheral facial paralysis (PFP) usually affects the facial nerve in part or in whole on one side of the face. Most patients with acute PFP find it difficult to chew on the paralyzed side, especially due to compromised buccinator function. In addition, the sagging of the ipsilateral lip commissure tends to compromise lip competence. The purpose of this study was to evaluate the impact of long-standing PFP upon mastication, relating to clinical mastication sidedness as determined by clinical and electromyographic activity of the masseters. The study included 27 male and female subjects aged 16-69 years with permanent natural dentition and long-standing PFP. Patients answered questions on their mastication habits before and after onset of PFP and were submitted to clinical myofunctional examination and electromyographical tests of the masseters during clenching and habitual mastication. According to the anamnesis, 77.8 % claimed to prefer chewing on the unaffected side. Clinically, 70% presented a lateral preference in mastication. In the clinical evaluation the buccinators and orbicularis oris differed significantly (p = 0.025) between the healthy and the paralyzed side. Only 22.2% of the patients showed increased thickness of the contralateral masseters. No statistically significant electromyographic difference was observed between the masseters on the affected and unaffected side. Conclusions In general indicated that subjects with flaccid-stage PFP for 6 months or longer preferred to masticate on the unaffected side. No significant clinical or electromyographic differences were found in masseter activity between the affected and unaffected side in this patient sample. PMID:20572435

Rahal, Adriana; Goffi-Gomez, Maria Valéria Schmidt



The furcal nerve revisited.  


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. PMID:25317309

Harshavardhana, Nanjundappa S; Dabke, Harshad V



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


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


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



Contralateral facial nerve palsy following mandibular second molar removal: is there co-relation or just coincidence?  

PubMed Central

Peripheral facial nerve palsy (FNP) is the most common cranial nerves neuropathy. It is very rare during dental treatment. Classically, it begins immediately after the injection of local anaesthetic into the region of inferior dental foramen and it's homolateral to the injection. Recovery takes a few hours, normally as long the anaesthetic lasts. The authors present a 44-year-old patient who presented a contralateral delayed-onset facial paralysis arising from dental procedure and discuss the plausible pathogenesis mechanism of happen and a possible relationship between dental procedure and contralateral FNP. PMID:25419300

Zalagh, Mohammed; Boukhari, Ali; Attifi, Hicham; Hmidi, Mounir; Messary, Abdelhamid



Delayed presentation of a large congenital laryngeal cleft in an adult.  


Laryngeal clefts are rare congenital malformations of the posterior laryngotracheal wall that lead to an abnormal communication between the airway and pharyngo-oesophageal tract. The condition is almost universally identified during infancy with minor laryngeal clefts very rarely diagnosed in adulthood. We present our tertiary centre's experience of a large laryngeal cleft presenting at an advanced age, with the aim of increasing awareness of this correctible cause of respiratory distress and aspiration in adults. PMID:25519258

Bakir, M; Hughes, J; Madani, G; Sandhu, G



Complete bilateral horizontal gaze paralysis disclosing multiple sclerosis  

PubMed Central

Two women presented with bilateral internuclear ophthalmoplegia evolving in a few days to complete bilateral horizontal gaze paralysis. Convergence and vertical eye movements were normal. Cerebral MRI showed a few small white matter lesions in the lateral ventricle regions, and, at the brainstem level, a single, small, bilateral lesion affecting the posterior part of the medial pontine tegmentum and responsible for the clinical syndrome. The condition gradually improved in both patients, following a similar progression as at the onset: improvement first involved the adduction movements in both eyes, whereas bilateral abduction paresis still persisted for a few weeks, before complete recovery of eye movements. Bilateral damage to the medial longitudinal fasciculus and subsequent lateral extent of damage to the region of the two abducens emerging fibres may explain the clinical findings. In both cases, the cause was probably multiple sclerosis.?? PMID:11160480

Milea, D; Napolitano, M; Dechy, H; Le Hoang, P; Delattre, J; Pierrot-Deseillig..., C



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



Pityriasis rubra pilaris in association with laryngeal carcinoma.  


Pityriasis rubra pilaris (PRP) is a rare group of hyperkeratotic, papulosquamous diseases that can be acquired or inherited. Cases of PRP associated with malignancy have been rarely reported. We report a case of 46-year-old man who presented with rapidly progressing PRP as a possible initial cutaneous symptom of a previously undiagnosed laryngeal carcinoma. Microlaryngoscopy was performed because of the patient's hoarseness, and this revealed leucoplakia on the left vocal cord. Histopathological examination led to the diagnosis of squamous cell carcinoma in situ. After surgical treatment, the clinical signs of PRP began to resolve, and the patient was free of skin lesions at follow-up. This case represents a rare coexistence of PRP with malignancy, and indicates that PRP can occur as paraneoplastic dermatosis associated with laryngeal cancer. PMID:20055867

Batinac, T; Kujundzi?, M; Peternel, S; Cabrijan, L; Troselj-Vuki?, B; Petranovi?, D



Virological and immunological aspects in the juvenile laryngeal papillomatosis.  


The juvenile laryngeal papillomatosis, a disease which in the absence of an adequate monitoring may have an invalidating character, represented for a long time a problem as regards both its treatment and its possible etiology. The use of monoclonal antibodies, as well as of molecular biology techniques, permitted to elucidate some aspects, such as the viral origin of the infection. Twenty five juvenile laryngeal papillomas, removed intra-operatively, were investigated immunohistochemically, a significant increase of the epidermal growth factor (EGF) receptor being found. Ten samples were also analyzed with the PCR technique, for the purpose of detecting the presence of the corresponding DNA sequences of human papillomaviruses (HPV): all were positive. The HPV genotyping showed the presence of only the HPV6 and 11 genotypes. PMID:11601383

Gheorghe, D C; Ardelean, C; Anton, G



Surgical treatment of laryngeal papillomatosis using narrow band imaging.  


Laryngeal papillomatosis has a high rate of recurrence after surgery. Narrow band imaging (NBI) is a novel optical enhancement technology used for the diagnosis. This is the first report to date to indicate the availability of the combination of laryngomicro surgery and videoendoscopic surgery for laryngeal papillomatosis using NBI technology. The patients were a 34-year-old man and a 30-year-old man. Both patients underwent surgery in another hospital. However, due to recurrence, they were subsequently referred to the authors' department for further evaluation. The presence of papillomas was confirmed by NBI, and the papillomas were removed using an XPS Micro Debrider and a CO2 laser. Using the NBI system, the border between the normal mucosa and the papillomas could be clearly identified, allowing precise resection. Further treatment on the lesions has been carried out several times to date using NBI. The lesions have now been eradicated without further recurrence. PMID:22597574

Imaizumi, Mitsuyoshi; Okano, Wataru; Tada, Yasuhiro; Omori, Koichi



Clinical Features and Differential Diagnoses in Laryngeal Mucoepidermoid Carcinoma  

PubMed Central

Mucoepidermoid carcinoma is the most common malignant tumor of salivary glands. However, it is a rare entity in larynx. Laryngeal cases are frequently misdiagnosed with other malignancies and they are under-reported. So, recognizing the clinical and histological features of this tumor is essential. Laryngeal mucoepidermoid carcinoma can arise in supraglottis, glottis and subglottis. Generally, it presents as a submucosal mass; therefore, progressive symptoms without any identifiable lesion in laryngoscopy must be well considered. The prognosis is somehow dependent on the histological features. In high-grade tumors, recurrence is more common and radical surgery with radiotherapy is recommended. In this paper, we provide a thorough literature review on mucoepidermoid carcinoma in the larynx. The most important distinguishing features of mucoepidermoid carcinoma and its two major differential diagnoses (squamous cell carcinoma and adenosquamous carcinoma) are clearly stated and pitfalls in true diagnosis of this tumor are discussed. PMID:22262946

Mokhtari, Sepideh; Mokhtari, Saeedeh



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



[Nerve sheath tumours].  


Peripheral nerve sheath tumors are common neoplasms in daily practice. Diagnosis and classification of most conventional peripheral nerve sheath tumors are relatively straightforward for the experienced observer; but on occasion, they are diagnostically challenging (especially with locally aggressive and malignant tumors). This article aims to provide an update of the data (clinical, histological, immunohistochemistry and genomic) of benign, intermediate and malignant peripheral nerve sheath tumors, thanks to the latest WHO "Classification of Tumors of Soft Tissue and Bone", published in 2013, which includes a new chapter on "Nerve Sheath Tumors". Advances in molecular biology have provided new insights into the nature of the various peripheral nerve sheath tumors, and have begun to suggest novel targeted therapeutic approaches. PMID:25541115

Le Guellec, Sophie



Recurrent Temporary Paralysis Reported After Human Rabies Post-Exposure Prophylaxis.  


Adverse events can occur after rabies post-exposure prophylaxis (PEP), and linkage to causality is often difficult to determine. We report a case of recurrent temporary paralysis that began immediately after the initiation of rabies PEP in a man exposed to a bat. The recurrent temporary paralysis first occurred in the patient after his initial dose and then again after day 3 of his rabies PEP. The PEP was terminated prior to a serologic response. The patient continued to experience numerous discrete episodes of temporary paralysis for over two years. PMID:24995792

Dato, V M; Campagnolo, E R; Shah, D U; Bellush, M J; Rupprecht, C E



Laryngeal electromyographic activity in adductor and abductor spasmodic dysphonia.  


Vocal symptoms in spasmodic dysphonia (SD) range from strain-strangle phonation and glottal-stop phonatory breaks of adductor SD to breathy phonation and aspirate phonatory breaks of abductor SD. Many SD subjects show both symptom types. Heterogeneity in vocal symptoms contributes to controversy surrounding the etiology(s) of SD. Acoustic/perceptual analyses of vocal symptoms are inconclusive in resolving this controversy. This investigation moves the search for distinguishing features of adductor and abductor SD to the level of neuromuscular control and analysis of intrinsic laryngeal muscle (adductor and abductor) activity. Subjects rated perceptually as primarily adductor or abductor SD sustained production of vegetative gestures and isolated speech sounds (/i/ and /s/). Qualitative and quantitative analyses of electromyographic signals recorded from thyroarytenoid (TA) failed to differentiate SD subjects by symptom type. Analysis of TA and posterior cricoarytenoid (PCA) activity in one abductor SD revealed high levels in both muscles during production of the voiced vowel. Data suggest that a possible explanation for symptom heterogeneity in SD is the relation between disrupted neuromotor input to laryngeal muscles and reflexive or conscious compensations constrained by laryngeal biomechanics. PMID:2072670

Watson, B C; Schaefer, S D; Freeman, F J; Dembowski, J; Kondraske, G; Roark, R



Laryngeal Tumor Detection and Classification in Endoscopic Video.  


The development of the narrow-band imaging has been increasing the interest of medical specialists in the study of laryngeal microvascular network to establish diagnosis without biopsy and pathological examination. A possible solution to this challenging problem is presented in this paper, which proposes an automatic method based on anisotropic filtering and matched filter to extract the lesion area and segment blood vessels. Lesion classification is then performed based on a statistical analysis of the blood vessels' characteristics, such as thickness, tortuosity and density. Here, the presented algorithm is applied to 50 NBI endoscopic images of laryngeal diseases and the segmentation and classification accuracies are investigated. The experimental results show the proposed algorithm provides reliable results, reaching an overall classification accuracy rating of 84.3%. This is a highly motivating preliminary result that proves the feasibility of the new method and supports the investment in further research and development to translate this work into clinical practice. Furthermore, to our best knowledge this is the first time image processing is used to automatically classify laryngeal tumors in endoscopic videos based on tumor vascularization characteristics. Therefore, the introduced system represents an innovation in biomedical and health informatics. PMID:25438330

Barbalata, Corina; Mattos, Leonardo



Laryngeal response to nasal ventilation in nonsedated newborn lambs.  


Although endoscopic studies in adult humans have suggested that laryngeal closure can limit alveolar ventilation during nasal intermittent positive pressure ventilation (nIPPV), there are no available data regarding glottal muscle activity during nIPPV. In addition, laryngeal behavior during nIPPV has not been investigated in neonates. The aim of the present study was to assess laryngeal muscle response to nIPPV in nonsedated newborn lambs. Nine newborn lambs were instrumented for recording states of alertness, electrical activity [electromyograph (EMG)] of glottal constrictor (thyroarytenoid, TA) and dilator (cricothyroid, CT) muscles, EMG of the diaphragm (Dia), and mask and tracheal pressures. nIPPV in pressure support (PS) and volume control (VC) modes was delivered to the lambs via a nasal mask. Results show that increasing nIPPV during wakefulness and quiet sleep led to a progressive disappearance of Dia and CT EMG and to the appearance and subsequent increase in TA EMG during inspiration, together with an increase in trans-upper airway pressure (TUAP). On rare occasions, transmission of nIPPV through the glottis was prevented by complete, active glottal closure, a phenomenon more frequent during active sleep epochs, when irregular bursts of TA EMG were observed. In conclusion, results of the present study suggest that active glottal closure develops with nIPPV in nonsedated lambs, especially in the VC mode. Our observations further suggest that such closure can limit lung ventilation when raising nIPPV in neonates. PMID:17332270

Moreau-Bussière, François; Samson, Nathalie; St-Hilaire, Marie; Reix, Philippe; Lafond, Joëlle Rouillard; Nsegbe, Elise; Praud, Jean-Paul



The effect of width of facial canal in patients with idiopathic peripheral facial paralysis on the development of paralysis.  


The aim of this prospective study is to investigate whether the possible stenosis due to anatomic variations of labyrinthine segment (LS), tympanic segment (TS) and mastoid segment (MS) of the facial canal in the temporal bone is a predisposing factor in the development of paralysis. 22 patients with idiopathic peripheral facial paralysis (IPFP) were included in the study. Multi-slice computed tomography (MSCT) with 64 detectors was used for temporal bone imaging of the patients. Reconstruction images in axial, coronal and sagittal planes were created in workstation computers from the captured images. The diameters and lengths of LS, TS and MS of the facial canal were measured. The mean values of LD, ND and SL of LS were 1.31 ± 0.39, 0.91 ± 0.27, 4.17 ± 0.48 in patient group and 1.26 ± 0.29, 0.95 ± 0.21, 4.60 ± 1.36 in control group, respectively. The mean values of LD, ND and SL of TS were 1.11 ± 0.22, 0.90 ± 0.14, 12.63 ± 1.47 in patient group and 1.17 ± 0.23, 0.85 ± 0.24, 12.10 ± 1.79 in control group, respectively. The mean values of LD, ND and SL of MS were 1.80 ± 0.30, 1.44 ± 0.29 vs. 14.3 ± 1.90 in patient group 1.74 ± 0.38, 1.40 ± 0.29, 14.15 ± 2.16 in control group, respectively. The measurements of the parameters of all three segments in patient group and control group were similar. Similar results between patient and control group were obtained in this study investigating the effect of stenosis in facial canal in the development of IPFP. PMID:25015010

Eksi, Guldem; Akbay, Ercan; Bayarogullari, Hanifi; Cevik, Cengiz; Yengil, Erhan; Ozler, Gul Soylu



Spontaneous nerve torsion: unusual cause of radial nerve palsy.  


Spontaneous nerve torsion is a rare cause of nerve palsy. We describe a case of nerve torsion affecting the radial nerve in order to inform radiologists of the existence of this condition and subtle features on cross-sectional imaging that can suggest the diagnosis preoperatively. PMID:25244923

Endo, Yoshimi; Miller, Theodore T; Carlson, Erik; Wolfe, Scott W



Advances in nerve repair.  


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



Changes in nerve microcirculation following peripheral nerve compression?  

PubMed Central

Following peripheral nerve compression, peripheral nerve microcirculation plays important roles in regulating the nerve microenvironment and neurotrophic substances, supplying blood and oxygen and maintaining neural conduction and axonal transport. This paper has retrospectively analyzed the articles published in the past 10 years that addressed the relationship between peripheral nerve compression and changes in intraneural microcirculation. In addition, we describe changes in different peripheral nerves, with the aim of providing help for further studies in peripheral nerve microcirculation and understanding its protective mechanism, and exploring new clinical methods for treating peripheral nerve compression from the perspective of neural microcirculation. PMID:25206398

Gao, Yueming; Weng, Changshui; Wang, Xinglin



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

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



[Transplantation of nerve tissue].  


The results of transplantation of various parts of the central and peripheral nervous system are considered. Transplantation of nerve trunks is used clinically, and heterogenous regeneration of the nerves results in reinnervation of tissues and organs. The spinal ganglion transplantation is successfully used in experiments with both embryonic and mature differentiated neurons. Transplantation of different parts of the cortex, some subcortical structures, hyppocampus, hypothalamus, cerebellum and the spinal cord is made using immature neurons. Some attempts have been made to transplant the nerve tissue grown in vitro into a host. PMID:6998434

Chumasov, E I; Chalisova, N I



Suprascapular nerve entrapment.  


It is important to be aware of neuropathy involving the suprascapular nerve. While direct trauma to the suprascapular nerve is the usual cause (direct blow to the base of the neck or posterior shoulder, shoulder dislocation or fracture), the problem may result from overuse injuries (such as repetitive tennis serving or spiking of a volley ball), excessive horizontal adduction, weight lifting, backpacking or no apparent reason. These last three years we have operated 8 cases of suprascapular nerve neurolysis at the level of suprascapular incision, and section of the transverse scapular ligament through the back supraspinal approach. PMID:15830964

Corò, L; Azuelos, A; Alexandre, A



The acute treatment of nerve agent exposure.  


Nerve agents (NA) are simple and cheap to produce but can produce casualties on a massive scale. They have already been employed by terrorist organizations and rogue states on civilians and armed forces alike. By inhibiting the enzyme acetylcholine esterase, NAs prevent the breakdown of the neurotransmitter acetylcholine. This results in over-stimulation of muscarinic and nicotinic receptors in the autonomic and central nervous systems and at the neuromuscular junction. Increased parasympathetic stimulation produces miosis, sialorrhea, bronchospasm and bronchorrhea. Effects at the neuromuscular junction cause weakness, fasciculations, and eventually paralysis. Central effects include altered behavior and mental status, loss of consciousness, seizures, or apnea. Most deaths are due to respiratory failure. Treatment with atropine competitively blocks the parasympathetic effects. Oximes like pralidoxime salvage acetylcholine esterase by "prying off" NA, provided the attachment has not "aged" to an irreversible bond. This reverses weakness. Benzodiazepines like diazepam are effective against NA induced seizures. Mortality has been surprisingly low. If victims can survive the first 15 to 20 min of a vapor attack, they will likely live. The low mortality rate to date underscores that attacks are survivable and research reveals even simple barriers such as clothing offer substantial protection. This article reviews the properties of NAs and how to recognize the clinical features of NA intoxication, employ the needed drugs properly, and screen out anxious patients who mistakenly believe they have been exposed. PMID:16945386

Cannard, Kevin



Hypokalaemic paralysis precipitated by distal renal tubular acidosis secondary to Sjögren's syndrome.  


A 43-year-old woman presented with a sudden onset of hypokalaemic paralysis requiring intubation and ventilatory support. Subsequent biochemical and clinical assessments established a diagnosis of distal renal tubular acidosis (RTA) in association with underlying Sjögren's syndrome as the aetiology of her profound hypokalaemia. Distal RTA is rare, but Sjögren's syndrome is one of the more common causes in adults and should be considered in the differential diagnosis of patients who present with hypokalaemic muscular paralysis. PMID:18325192

Comer, D M; Droogan, A G; Young, I S; Maxwell, A P



Congenital vocal cord paralysis with possible autosomal recessive inheritance: Case report and review of the literature  

SciTech Connect

We describe an infant with congenital vocal cord paralysis born to consanguineous parents. While autosomal dominant and X-linked inheritance have been previously reported in this condition, we conclude that the degree of parental consanguinity in this case strongly suggests autosomal recessive inheritance. Although we cannot exclude X-linked inheritance, evidence from animal studies demonstrates autosomal recessive inheritance and provides a possible molecular basis for congenital vocal cord paralysis. 14 refs., 1 fig.

Koppel, R.; Friedman, S.; Fallet, S. [Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, NY (United States)] [Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, NY (United States)



Fibrolipomatous hamartoma of median nerve.  


Fibrolipomaous hamartoma is a benign neoplasm of nerves, resulting from anomalous growth of fibroadipose tissue of the nerve sheath. The median nerve is the most commonly involved nerve. Magnetic resonance imaging (MRI) features are pathognomonic, showing a coaxial cable-like appearance on axial images and spaghetti-like appearance on coronal images. Preferred management of the lesion is conservative. PMID:17875173

Jain, T P; Srivastava, D N; Mittal, R; Gamanagatti, S



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



Association between tea and coffee consumption and risk of laryngeal cancer: a meta-analysis  

PubMed Central

Objective: Epidemiological studies evaluating the association of tea and coffee consumption and the risk of laryngeal cancer have produced inconsistent results. Thus, we conducted a meta-analysis to assess the relationship between tea and coffee consumption and laryngeal cancer risk. Methods: Pertinent studies were identified by a search in PubMed, Web of Knowledge and Wan Fang Med Online. The random effect model was used based on heterogeneity test. Publication bias was estimated using Egger’s regression asymmetry test. As a result, 11 articles were included in this meta-analysis. Results: For tea consumption and laryngeal cancer, data from 8 studies including 2167 laryngeal cancer cases were used, and the pooled results suggested that highest tea consumption versus lowest level wasn’t associated with the risk of laryngeal cancer [summary RR = 0.909, 95% CI = 0.674-1.227]. Eight studies comprising 2596 laryngeal cancer cases for coffee consumption and laryngeal cancer risk were included, and no association was found (summary RR = 1.218, 95% CI = 0.915-1.622). Conclusions: Finding from this meta-analysis suggested that tea and coffee consumption weren’t associated with the risk of laryngeal cancer. Since the potential biases and confounders could not be ruled out completely in this meta-analysis, further studies are warranted to confirm this result. PMID:25664021

Ouyang, Zhiguo; Wang, Zhaoyan; Jin, Jian



Histopathologic Examination for Helicobacter pylori as a Possible Etiopathogenic Factor in Laryngeal Carcinoma  

Microsoft Academic Search

Objective: We investigated the presence of Helicobacter pylori in laryngeal cancer specimens to reveal whether or not this is a risk factor in the development of squamous cell carcinoma of the larynx. Methods: Sixty-nine total laryngectomy specimens with the pathologic diagnosis of squamous cell carcinoma and 30 laryngeal tissue samples that had been taken for the investigation of nonneoplastic (polyp,

Ahmet Kizilay; Levent Saydam; Abdullah Aydin; M. Tayyar Kalcioglu; Orhan Ozturan; N. Engin Aydin



Adductor laryngeal breathing dystonia in a patient with lubag (X-linked dystonia-Parkinsonism syndrome).  


We report a patient with Lubag (X-linked dystonia-parkinsonism) who presented with severe respiratory stridor from adductor laryngeal breathing dystonia. Emergency tracheostomy was necessary, and subsequent laryngeal injection with botulinum toxin led to worsening aspiration. Botulinum toxin injection for severe lingual dystonia was successful. PMID:8041372

Lew, M F; Shindo, M; Moskowitz, C B; Wilhelmsen, K C; Fahn, S; Waters, C H



Laryngeal somatosensory deficits in Parkinson’s disease: implications for speech respiratory and phonatory control  

PubMed Central

Parkinson’s disease (PD) is often associated with substantial impairment of speech respiratory and phonatory control. However, the degree to which these impairments are related to abnormal laryngeal sensory function is unknown. This study examined whether individuals with PD exhibited abnormal and more asymmetric laryngeal somatosensory function compared with healthy controls, and whether these deficits were associated with disease and voice severity. Nineteen PD participants were tested and compared with 18 healthy controls. Testing included endoscopic assessment of laryngeal somatosensory function, with aerodynamic and acoustic assessment of respiratory and phonatory control, and clinical ratings of voice and disease severity. PD participants exhibited significantly abnormal and asymmetric laryngeal somatosensory function compared with healthy controls. Sensory deficits were significantly associated with timing of phonatory onset, voice intensity, respiratory driving pressure, laryngeal resistance, lung volume expended per syllable, disease severity, and voice severity. These results suggest that respiratory and phonatory control are influenced by laryngeal somatosensory function, that speech-related deficits in PD are related to abnormal laryngeal somatosensory function, and that this function may degrade as a function of disease severity. Thus, PD may represent a model of airway sensorimotor disintegration, highlighting the important role of the basal ganglia and related neural networks in the integration of laryngeal sensory input for speech-related motor control. PMID:20012947

Barlow, Steven M.



Respiratory and Laryngeal Function during Spontaneous Speaking in Teachers with Voice Disorders  

ERIC Educational Resources Information Center

Purpose: To determine if respiratory and laryngeal function during spontaneous speaking were different for teachers with voice disorders compared with teachers without voice problems. Method: Eighteen teachers, 9 with and 9 without voice disorders, were included in this study. Respiratory function was measured with magnetometry, and laryngeal

Lowell, Soren Y.; Barkmeier-Kraemer, Julie M.; Hoit, Jeannette D.; Story, Brad H.



Tea and Coffee Consumption and Risk of Laryngeal Cancer: A Systematic Review Meta-Analysis  

PubMed Central

Background Tea and coffee are the most commonly consumed beverages in the worldwide. The relationship between tea and coffee consumption on the risk of laryngeal cancer was still unclear. Methods Relevant studies were identified by searching electronic database (Medline and EMBASE) and reviewing the reference lists of relevant articles until Oct. 2013. Observational studies that reported RRs and 95% CIs for the link of tea and coffee consumption on the risk of laryngeal cancer were eligible. A meta-analysis was obtained to combine study-specific RRs with a random-effects model. Results A total of 2,803 cases and 503,234 controls in 10 independent studies were identified. The overall analysis of all 10 studies, including the case-control and cohort studies, found that tea drinking was not associated with laryngeal carcinoma (RR?=?1.03; 95% CI: 0.66–1.61). However, coffee consumption was significantly associated with the laryngeal carcinoma (RR?=?1.47; 95% CI: 1.03–2.11). A dose-response relationship between coffee intake and laryngeal carcinoma was detected; however, no evidence of dose-response link between tea consumption and laryngeal carcinoma risk was detected. Conclusions The results from this meta-analysis of observational studies demonstrate that coffee consumption would increase the laryngeal cancer risk, while tea intake was not associated with risk of laryngeal carcinoma. PMID:25502726

Chen, Jiangbo; Long, Shuo



Sarcoidosis with major airway, vascular and nerve compromise  

PubMed Central

The present report describes a 60-year-old Caucasian woman who presented with progressive dyspnea, cough and wheeze. A computed tomography scan of the chest showed innumerable bilateral inflammatory pulmonary nodules with bronchovascular distribution and a mediastinal and hilar infiltrative process with calcified lymphadenopathy leading to narrowing of lobar bronchi and pulmonary arteries. An echocardiogram revealed pulmonary hypertension. Bronchoscopy showed left vocal cord paralysis and significant narrowing of the bilateral bronchi with mucosal thickening and multiple nodules. Transbronchial biopsy was compatible with sarcoidosis. Despite balloon angioplasty of the left lower lobe and pulmonary artery, and medical therapy with oral corticosteroids, her symptoms did not significantly improve. To the authors’ knowledge, the present report describes the first case of pulmonary sarcoidosis resulting in major airway, vascular and nerve compromise due to compressive lymphadenopathy and suspected concurrent granulomatous infiltration. Its presentation mimicked idiopathic mediastinal fibrosis. PMID:23717817

Sekiguchi, Hiroshi; Suzuki, Jun; Utz, James P



Cervical Radiculopathy (Pinched Nerve)  


... nerve. The medical term for this condition is cervical radiculopathy. Understanding your spine and how it works can help you better understand cervical radiculopathy. Learn more about your spine online at Spine Basics: http://orthoinfo. org/topic. ...


Diabetic Nerve Problems  


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


Extracellular Potassium Homeostasis: Insights from Hypokalemic Periodic Paralysis  

PubMed Central

The extracellular potassium makes up only about 2% of the total body potassium store. The majority of the body potassium is distributed in the intracellular space, and 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+-ATPase 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 will be reviewed. PMID:23953801

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



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


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



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.



Local Chemokine Paralysis, a Novel Pathogenic Mechanism for Porphyromonas gingivalis  

PubMed Central

Periodontitis, which is widespread in the adult population, is a persistent bacterial infection associated with Porphyromonas gingivalis. Gingival epithelial cells are among the first cells encountered by both P. gingivalis and commensal oral bacteria. The chemokine interleukin 8 (IL-8), a potent chemoattractant and activator of polymorphonuclear leukocytes, was secreted by gingival epithelial cells in response to components of the normal oral flora. In contrast, P. gingivalis was found to strongly inhibit IL-8 accumulation from gingival epithelial cells. Inhibition was associated with a decrease in mRNA for IL-8. Antagonism of IL-8 accumulation did not occur in KB cells, an epithelial cell line that does not support high levels of intracellular invasion by P. gingivalis. Furthermore, a noninvasive mutant of P. gingivalis was unable to antagonize IL-8 accumulation. Invasion-dependent destruction of the gingival IL-8 chemokine gradient at sites of P. gingivalis colonization (local chemokine paralysis) will severely impair mucosal defense and represents a novel mechanism for bacterial colonization of host tissue. PMID:9529095

Darveau, Richard P.; Belton, Carol M.; Reife, Robert A.; Lamont, Richard J.



BCCIP as a prognostic marker for radiotherapy of laryngeal cancer  

PubMed Central

Background Recent studies have shown that BCCIP (BRCA2 & CDKN1A interacting protein) is essential for maintaining the transactivation activity of wild type p53. We analyzed the expression of BCCIP and p53 in a cohort of laryngeal cancer treated with radiotherapy and assessed whether BCCIP and p53, alone or in combination, would correlate with local control and overall survival. Methods One hundred twenty-three patients treated between 1975 and 2000 for early stage (stage I & II) squamous cell carcinoma of the larynx were included in the study. Treatment consisted of radiation therapy (RT) with standard fields and fractionation to a median dose of 66 GY. Tissue was collected from pre-RT biopsies and constructed in a tissue microarray and BCCIP and p53 expression was determined using immunohistochemistry. Results Loss of expression of BCCIP in combination with normal p53 (negative p53 staining) was associated with local recurrence (RR 2.04; 95% CI 0.99–4.56, p=0.05) and poor overall survival (RR 2.09; 95% CI 1.21–4.00, p=0.008) compared to patients who did express BCCIP. Expression of BCCIP or p53 alone was not found to be independently associated with benefits in local control or overall survival. Conclusions This study provides clinical evidence that BCCIP contributes to outcomes in patients with laryngeal cancer treated with RT. This benefit may be a result of increased radiosensitivity in patients who have functional BCCIP and p53. These data may be used to identify sub-groups of laryngeal cancer patients who are more likely to be cured with radiotherapy. PMID:19046788

Rewari, Amar; Lu, Huimei; Parikh, Rahul; Yang, Qifeng; Shen, Zhiyuan; Haffty, Bruce G.



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



A new suspension device for laryngeal endoscopy in developing countries.  


In view of the various technical and electricity maintainance problems with endoscopes in any developing country, a new suspension device for laryngeal endoscopy with a straight-bladed anaesthetic laryngoscope has been described. The advantages of this system are its small size, cheap cost, lack of a chest piece and the use of a non-failing battery source. It also makes use of bipod stands already available in a tonsillectomy set. It can be used in the countryside, and in out-patient and mobile clinics. PMID:3723000

Ijaduola, T G



Raman spectroscopy for optical diagnosis of laryngeal cancer  

NASA Astrophysics Data System (ADS)

In this report, the diagnostic ability of near-infrared (NIR) Raman spectroscopy for identifying the malignant tumors from normal tissues in the larynx was studied. A rapid NIR Raman system was utilized. Multivariate statistical techniques were employed to develop effective diagnostic algorithms. Raman spectra in the range of 800-1,800 cm-1 differed significantly between normal and malignant tumor tissues. The diagnostic algorithms can yielded a diagnostic sensitivity of 92.9% and specificity 83.3% for separating malignant tumors from normal laryngeal tissues. NIR Raman spectroscopy with multivariate statistical techniques has a potential for the non-invasive detection of malignant tumors in the larynx.

Teh, Seng Khoon; Zheng, Wei; Lau, David P.; Huang, Zhiwei



A congenital foregut malformation with a laryngeal bronchus.  


We present the case of a 2-month-old boy who required intubation at birth for stridor, at which point a supraglottic cyst was noted. With recurrence of the cyst, a subsequent computed tomographic scan and magnetic resonance imaging demonstrated a mass encroaching on the larynx, descending into the mediastinum, and encasing the major vessels. A median sternotomy and transcervical incision enabled excision of a well-defined mass with a laryngeal attachment. This attachment was consistent with a bronchus on histopathologic investigation. To our knowledge, this is the first reported case of ectopic lung tissue arising from the larynx and descending into the mediastinum. PMID:25639410

Cullen, Paul; Pio Tito Dias, Andrew; Milligan, Thomas W; Rea, David; Russell, John; McGuinness, Jonathan



The response of laryngeal afferent fibres to mechanical and chemical stimuli.  


1. We have recorded afferent activity from ;single fibres' dissected from the superior laryngeal nerve of anaesthetized cats.2. Units which responded to gentle mechanical stimulation of the larynx epithelium were chosen for study.3. Receptors with myelinated fibres were grouped according to their spontaneous activity. Group 1 fibres had little or no spontaneous activity: group 2 fibres had constant and continuous spontaneous activity.4. Group 1 fibres had a wide range of adaptation rates. Their conduction velocities lay between 3.0 and 30 m/sec. The receptors were generally stimulated by ammonia and distilled water and often by CS riot control agent, 5 and 10% CO(2), 200 ppm SO(2), and cigarette smoke. Histamine, phenyl diguanide, graphite dust, 100 ppm SO(2) and saline drops did not generally excite the fibres.5. Group 2 fibres were slowly adapting. Their conduction velocities ranged between 8.0 and 26.5 m/sec. Ammonia usually, and distilled water sometimes, excited these fibres while 5 and 10% CO(2) mixtures inhibited them. A minority of group 2 fibres were pH sensitive, inhibited by acids and stimulated by alkaline buffers. Cigarette smoke had complex actions, either excitation, inhibition or, at different times, both. Histamine, P.d.g., CS, SO(2), saline drops and dust had no action on these fibres.6. Recordings were made from one unmyelinated fibre (conduction velocity 1.9 m/sec) which responded to stroking of the epithelium with a thread and to histamine, P.d.g. and ammonia vapour applied to the epithelium.7. We consider the site, method of excitation and reflex actions of the different receptors described. PMID:4855058

Boushey, H A; Richardson, P S; Widdicombe, J G; Wise, J C



Repair of sciatic nerve defects using tissue engineered nerves  

PubMed Central

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



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



A calcium channel mutant mouse model of hypokalemic periodic paralysis  

PubMed Central

Hypokalemic periodic paralysis (HypoPP) is a familial skeletal muscle disorder that presents with recurrent episodes of severe weakness lasting hours to days associated with reduced serum potassium (K+). HypoPP is genetically heterogeneous, with missense mutations of a calcium channel (CaV1.1) or a sodium channel (NaV1.4) accounting for 60% and 20% of cases, respectively. The mechanistic link between CaV1.1 mutations and the ictal loss of muscle excitability during an attack of weakness in HypoPP is unknown. To address this question, we developed a mouse model for HypoPP with a targeted CaV1.1 R528H mutation. The Cav1.1 R528H mice had a HypoPP phenotype for which low K+ challenge produced a paradoxical depolarization of the resting potential, loss of muscle excitability, and weakness. A vacuolar myopathy with dilated transverse tubules and disruption of the triad junctions impaired Ca2+ release and likely contributed to the mild permanent weakness. Fibers from the CaV1.1 R528H mouse had a small anomalous inward current at the resting potential, similar to our observations in the NaV1.4 R669H HypoPP mouse model. This “gating pore current” may be a common mechanism for paradoxical depolarization and susceptibility to HypoPP arising from missense mutations in the S4 voltage sensor of either calcium or sodium channels. PMID:23187123

Wu, Fenfen; Mi, Wentao; Hernández-Ochoa, Erick O.; Burns, Dennis K.; Fu, Yu; Gray, Hillery F.; Struyk, Arie F.; Schneider, Martin F.; Cannon, Stephen C.



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



Analysis Of Laryngeal Biomechanics Of Deaf Speakers Utilizing High-Speed Cinematography  

NASA Astrophysics Data System (ADS)

Since the formalization of the myoelastic-aerodynamic theory of vocal fold vibration, it has been generally accepted that biomechanical and aerodynamic forces determine the nature of vocal fold vibration patterns, speaking fundamental frequency and vocal intensity. The speech of the deaf is frequently characterized by abnormal voice qualities and aberrant frequency and intensity variations suggesting mismanagement of the biomechanical and aerodynamic forces acting on the larynx. Unfortunately, efforts to remediate these abnormal laryngeal activities are frequently ineffective. It is reasonable to suggest that more effective remedial strategies could be developed if we had a better understanding of the underlying nature of the problems deaf persons experience when trying to control laryngeal functioning for speech purposes. Toward this end, we are employing high speed laryngeal filming procedures in conjunction with glottal impedance, respiratory kinematic and acous-tical measurement procedures to assess abnormal laryngeal functioning of deaf speakers. All data are collected simultaneously and are time-locked to facilitate analysis of specific laryngeal events. This unique combination of instrumentation has provided important insights regarding laryngeal functioning of the deaf. For example, we have observed that deaf speakers may assume abnormal glottal configurations during phonation that pro-hibit normal laryngeal functioning and disturb upper airway dynamics. Also, normal vibratory patterns are frequently disturbed. Instrumentation, data collection protocols, analysis procedures and selected findings will be discussed.

Metz, Dale E.; Whitehead, Robert L.



Laryngeal muscle activities with cerebral hypoxia-ischemia in newborn lambs.  


This study tested the hypotheses that (1) acute cerebral hypoxia-ischemia changes laryngeal adductor, laryngeal abductor, and diaphragmatic activities, resulting in central apnea with laryngeal closure; and (2) these laryngeal muscle activities act to maintain absolute lung volume. The respiratory pattern was determined in three asphyxiated, awake preterm lambs after cesarean section birth and in 12 awake, term lambs, with normal lung function, after induction of acute cerebral hypoxia-ischemia by occlusion of the brachiocephalic artery. Electrocorticogram activity, flow, volume, electromyograms of laryngeal abductor and adductor muscles and diaphragm, and, in the term lambs, trans-upper airway pressure and carotid blood flow were recorded. With either preterm birth asphyxia or induced acute cerebral hypoxia-ischemia, minute ventilation initially increased, and then hypopnea occurred. During the hypopnea, laryngeal adductor activity was prominent, accompanied by an increased upper airway pressure and a maintained/raised absolute lung volume. Thus, when acute hypoxia-ischemia limited to the upper body is induced in lambs with normal lung function, expiratory laryngeal adduction with closure of the upper airway occurs and likely functions to aid autoresuscitation. PMID:12091176

Hutchison, Alastair A; Burchfield, David J; Wozniak, John A; Mohrman, Sondra J



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



Intraglottal geometry and velocity measurements in canine larynges  

PubMed Central

Previous flow velocity measurements during phonation in canine larynges were done above the glottal exit. These studies found that vortical structures are present in the flow above the glottis at different phases of the glottal cycle. Some vortices were observed to leave the glottis during the closing phase and assumptions were proposed regarding their formation mechanism. In the current study, intraglottal velocity measurements are performed using PIV, and the intraglottal flow characteristics are determined. Results from five canine larynges show that at low subglottal pressure the glottis assumes a minimal divergence angle during closing and the flow separates at the glottal exit. Vortical structures are observed above the glottis but not inside. As the subglottal pressure is increased, the divergence angle between the folds during closing increases and the location of the flow separation moves upstream into the glottis. Entrainment flow enters the glottis to fill the void that is formed between the glottal jet and the fold. Vortical structures develop near the superior edge at medium and high subglottal pressures from the flow separation. The magnitude of their swirling strength changes as a function of the wall dynamics. PMID:24437778

Oren, Liran; Khosla, Sid; Gutmark, Ephraim



[First case described of isolated, complete and fluctuating cranial nerve III palsy heralding multiple myeloma].  


INTRODUCTION. Multiple myeloma is the most common plasma-cell malignancy. To be incurable, treatment aims to obtain the longest non-clinical survival time. Cranial nerve palsy in multiple myeloma is extremely rare and is usually due to an intracranial plasmacytoma. We present a multiple myeloma case, with an intracranial plasmacytoma, which debuted clinically with isolated, complete and fluctuating cranial nerve III palsy. CASE REPORT. A 63-year-old woman presented an oscillating clinical picture, consisting of horizontal binocular diplopia and later, headache. The neuro-ophthalmologic examination revealed a complete cranial nerve III palsy of the right eye. An urgent cranial CT-scan was requested. It showed multiple diploic osteolytic lesions, associating soft-parts component in the right superior orbital fissure. The patient was admitted, being diagnosed subsequently of IgA-kappa multiple myeloma. After receiving induction-chemotherapy and undergoing autologous stem cell transplantation, she achieved full remission. CONCLUSIONS. Multiple myeloma is a rare cranial nerves disorder, very uncommon cause of cranial nerve III full isolated paralysis and even less fluctuating, not having found any case published with this clinical onset. Awareness of possible multiple myeloma neuro-ophthalmic manifestations may bring about an early diagnosis and a positive impact on the disease course. PMID:25624087

Leon-Ruiz, M; Benito-Leon, J; Sierra-Hidalgo, F; Garcia-Soldevilla, M A; Izquierdo-Esteban, L; Tejeiro-Martinez, J; Cabrera-Valdivia, F; Garcia-Albea Ristol, E



Vitamin D3 potentiates myelination and recovery after facial nerve injury.  


Roles of vitamin D on the immune and nervous systems are increasingly recognized. Two previous studies demonstrated that ergocalciferol (vitamin D2) or cholecalciferol (vitamin D3) induced functional recovery and increased myelination in a rat model of peroneal nerve transection. The current report assessed whether cholecalciferol was efficient in repairing transected rabbit facial nerves. Animals were randomized into two groups of rabbits with an unilateral facial nerve surgery: the vitamin D group included animals receiving a weekly oral bolus of vitamin D3 (200 IU/kg/day), from day 1 post-surgery; the control group included animals receiving a weekly oral bolus of vehicle (triglycerides). Contralateral unsectioned facial nerves from all experimental animals were used as controls for the histological study. The facial functional index was measured every week while the inner diameter of myelin sheath and the G ratio were quantified at the end of the 3 month experiment. The current report indicates that cholecalciferol significantly increases functional recovery and myelination, after 12 weeks of treatment. To the best of our knowledge, this is the first study investigating the therapeutic benefit of vitamin D supplementation in an animal model of facial paralysis. It paves further the way for clinical trials based on the administration of this steroid in individuals with injured facial nerves. PMID:25261104

Montava, Marion; Garcia, Stéphane; Mancini, Julien; Jammes, Yves; Courageot, Joël; Lavieille, Jean-Pierre; Feron, François



Fibrolipomatous hamartoma of the inferior calcaneal nerve (Baxter nerve).  


Fibrolipomatous hamartoma (FLH) is a rare, benign lesion of the peripheral nerves most frequently involving the median nerve and its digital branches (80 %). Pathognomonic MR features of FLH such as coaxial-cable-like appearance on axial planes and a spaghetti-like appearance on coronal planes have been described by Marom and Helms, obviating the need for diagnostic biopsy. We present a case of fibrolipomatous hamartoma of the inferior calcaneal nerve (Baxter nerve) with associated subcutaneous fat proliferation. PMID:22526881

Zeng, Rong; Frederick-Dyer, Katherine; Ferguson, N Lynn; Lewis, James; Fu, Yitong



Laryngeal effects of nasal allergen provocation in singers with allergic rhinitis.  


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



MicroRNA-196a Is a Putative Diagnostic Biomarker and Therapeutic Target for Laryngeal Cancer  

PubMed Central

Background MicroRNA (miRNA) is an emerging subclass of small non-coding RNAs that regulates gene expression and has a pivotal role for many physiological processes including cancer development. Recent reports revealed the role of miRNAs as ideal biomarkers and therapeutic targets due to their tissue- or disease-specific nature. Head and neck cancer (HNC) is a major cause of cancer-related mortality and morbidity, and laryngeal cancer has the highest incidence in it. However, the molecular mechanisms involved in laryngeal cancer development remain to be known and highly sensitive biomarkers and novel promising therapy is necessary. Methodology/Principal Findings To explore laryngeal cancer-specific miRNAs, RNA from 5 laryngeal surgical specimens including cancer and non-cancer tissues were hybridized to microarray carrying 723 human miRNAs. The resultant differentially expressed miRNAs were further tested by using quantitative real time PCR (qRT-PCR) on 43 laryngeal tissue samples including cancers, noncancerous counterparts, benign diseases and precancerous dysplasias. Significant expressional differences between matched pairs were reproduced in miR-133b, miR-455-5p, and miR-196a, among which miR-196a being the most promising cancer biomarker as validated by qRT-PCR analyses on additional 84 tissue samples. Deep sequencing analysis revealed both quantitative and qualitative deviation of miR-196a isomiR expression in laryngeal cancer. In situ hybridization confirmed laryngeal cancer-specific expression of miR-196a in both cancer and cancer stroma cells. Finally, inhibition of miR-196a counteracted cancer cell proliferation in both laryngeal cancer-derived cells and mouse xenograft model. Conclusions/Significance Our study provided the possibilities that miR-196a might be very useful in diagnosing and treating laryngeal cancer. PMID:23967217

Saito, Koichiro; Inagaki, Koji; Kamimoto, Takahiro; Ito, Yoko; Sugita, Toshiaki; Nakajo, Satoko; Hirasawa, Akira; Iwamaru, Arifumi; Ishikura, Takashi; Hanaoka, Hideki; Okubo, Keisuke; Onozaki, Tokio; Zama, Takeru



Dual-Energy Subtraction Imaging for Diagnosing Vocal Cord Paralysis with Flat Panel Detector Radiography  

PubMed Central

Objective To investigate the clinical feasibility of dual energy subtraction (DES) imaging to improve the delineation of the vocal cord and diagnostic accuracy of vocal cord paralysis as compared with the anterior-posterior view of flat panel detector (FPD) neck radiography. Materials and Methods For 122 consecutive patients who underwent both a flexible laryngoscopy and conventional/DES FPD radiography, three blinded readers retrospectively graded the radiographs during phonation and inspiration on a scale of 1 (poor) to 5 (excellent) for the delineation of the vocal cord, and in consensus, reviewed the diagnostic accuracy of vocal cord paralysis employing the laryngoscopy as the reference. We compared vocal cord delineation scores and accuracy of vocal cord paralysis diagnosis by both conventional and DES techniques using ? statistics and assessing the area under the receiver operating characteristic curve (AUC). Results Vocal cord delineation scores by DES (mean, 4.2 ± 0.4) were significantly higher than those by conventional imaging (mean, 3.3 ± 0.5) (p < 0.0001). Sensitivity for diagnosing vocal cord paralysis by the conventional technique was 25%, whereas the specificity was 94%. Sensitivity by DES was 75%, whereas the specificity was 96%. The diagnostic accuracy by DES was significantly superior (? = 0.60, AUC = 0.909) to that by conventional technique (? = 0.18, AUC = 0.852) (p = 0.038). Conclusion Dual energy subtraction is a superior method compared to the conventional FPD radiography for delineating the vocal cord and accurately diagnosing vocal cord paralysis. PMID:20461186

Yoda, Keiko; Arai, Yasuko; Nishida, Suguru; Masukawa, Ai; Asanuma, Masayasu; Yuhara, Toshiyuki; Morita, Satoru; Suzuki, Kazufumi; Ueno, Eiko; Sabol, John M



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



Velo-pharyngo-laryngeal myoclonus: evaluation of objective tinnitus and extrathoracic airway obstruction.  


Velo-pharyngo-laryngeal myoclonus, the rapid, rhythmic contraction of muscles of the pharynx and larynx, is a rare neurological manifestation of numerous disease processes affecting the cerebellum. In its most common form, palatal myoclonus, this disease frequently presents to the otolaryngologist as objective tinnitus. Impedance audiometry provides a useful means of verifying suspected palatal myoclonic activity through recorded changes in the middle ear pressure, as mediated by muscle activity at the proximal portion of the eustachian tube. A very rare case of velo-pharyngo-laryngeal myoclonic with clonic contraction of the laryngeal adductors and subsequent extrathoracic airway obstruction is presented. Tracheostomy provided immediate symptomatic relief of dyspnea. PMID:6717228

Toland, A D; Porubsky, E S; Coker, N J; Adams, H G



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

PubMed Central

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 the cuff and that they conducted impulses normally in their distal parts. There was a significant correlation between the duration of compression and that of the subsequent conduction block. When tested two to three weeks after the tourniquet, the amplitude of the response of m. abductor hallucis to nerve stimulation distal to the cuff was usually slightly reduced compared with the precompression figure. This was assumed to mean that a small proportion of the motor fibres had undergone Wallerian degeneration as a result of compression. Maximal motor conduction velocity was reduced in recovering nerves. It was also reduced when a cuff pressure of 500 mm Hg was used, which was insufficient to produce persistent conduction block. In such cases a reduced velocity without evidence of block could be demonstrated 24 hours after compression. Ascending nerve action potentials were recorded from the sciatic nerve in the thigh, with stimulation at the ankle. Before compression the fastest afferent fibres had a significantly higher velocity than the fastest motor fibres in the same nerve trunk. Results after compression suggested that the high-velocity afferent fibres had a susceptibililty to the procedure similar to that of the fastest motor fibres. PMID:4628467

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



Optic nerve hypoplasia in children.  

PubMed Central

Optic nerve hypoplasia (ONH) is characterised by a diminished number of optic nerve fibres in the optic nerve(s) and until recently was thought to be rare. It may be associated with a wide range of other congenital abnormalities. Its pathology, clinical features, and the conditions associated with it are reviewed. Neuroendocrine disorders should be actively sought in any infant or child with bilateral ONH. Early recognition of the disorder may in some cases be life saving. Images PMID:2191713

Zeki, S. M.; Dutton, G. N.



Relationship between isolated sleep paralysis and geomagnetic influences: a case study.  


This preliminary report, of a longitudinal study, looks at the relationship between geomagnetic activity and the incidence of isolated sleep paralysis over a 23.5-mo. period. The author, who has frequently and for the last 24 years experienced isolated sleep paralysis was the subject. In addition, incidence of lucid dreaming, vivid dreams, and total dream frequency were looked at with respect to geomagnetic activity. The data were in the form of dream-recall frequency recorded in a diary. These frequency data were correlated with geomagnetic activity k-index values obtained from two observatories. A significant correlation was obtained between periods of local geomagnetic activity and the incidence of isolated sleep paralysis. Specifically, periods of relatively quiet geomagnetic activity were significantly associated with an increased incidence of episodes. PMID:7478886

Conesa, J



Peroneal nerve entrapment in runners  

Microsoft Academic Search

In a practice involving large groups of athletes, seven runners and one soccer player with peroneal nerve compression neuropathy secondary to exercise have been found. Running incited pain, numbness and tin gling to varying degrees in all patients, and examination after running revealed muscle weakness and a positive percussion test as the nerve winds around the fibular neck. Nerve conduction

Robert E. Leach; Michael B. Purnell; Akiyoshi Saito



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



Vagus Nerve Stimulation  

Microsoft Academic Search

Vagus nerve stimulation (VNS) is a safe and reliable treatment adjunct for patients with medically intractable epilepsy. It is both a preventive and an abortive form of therapy, potentially effective against both partial and generalized seizures in adults and children. VNS also has a number of serendipitous effects on mood, memory, and attention and has been approved for the treatment

Arun Paul Amar; Michael L. Levy; Charles Y. Liu; Michael L. J. Apuzzo



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.


[Malignant schwannoma of acoustic nerve: a case report].  


During a routine physical examination in 1976, a 54-year-old man was noted to suffer from hearing difficulty and continuing tinnitus of his right ear. He had, however, no further consultations for the next five years, although the symptom persisted and gradually worsened. In May 1981, he experienced complete hearing loss in his right ear. A computed tomography disclosed no abnormalities, and other laboratory tests were unremarkable. In September 1981, the patient began to complain of paresthesia of the right angle of the mouth and tongue, right-sided facial paralysis, and walking difficulty. A repeated computed tomography showed a tumor at the right cerebellopontine angle region. A clinical diagnosis of acoustic schwannoma was made. The first operation was performed in December 1981. Complete removal of the tumor was impossible because of its unexpected, unusual hardness. The pathologic diagnosis was a malignant mesenchymal tumor, compatible with a malignant nerve sheath tumor of the acoustic nerve. A second operation was performed in January 1982, but the rapid postoperative regrowth of the tumor necessitated a third operation in March 1982. The patient died in the next month. Family histories did not show any evidence of von Recklinghausen's disease, and neither did the patient have any clinical stigmata of this disease. PMID:2406637

Matsumoto, M; Sakata, Y; Sanpei, K; Onagi, A; Terao, H; Kudo, M



Burkitt's non-Hodgkins lymphoma presenting as facial nerve palsy in HIV-positive patients.  


An isolated facial nerve palsy is rare as the presentation of a central nervous system lymphoma. In this case series, we present the clinical features of three HIV-positive patients presenting with facial nerve palsies due to HIV-associated Burkitt's lymphoma. These patients had a non-resolving facial paralysis, which occurred during a late stage of HIV. Magnetic resonance imaging (MRI) did not show leptomeningeal enhancement. Cerebrospinal fluid revealed a lymphocytosis with elevated protein and low glucose levels. The diagnosis of Burkitt's lymphoma was made on histology which showed the characteristic 'starry sky' appearance due to scattered tangible body-laden macrophages. The patients were commenced on the intensive chemotherapy regimen of CODOX-M/IVAC. Two patients died of disease progression and the third patient died of chemotherapy toxicity. This case series highlights the need for a high index of suspicion for underlying malignancy when a patient presents with a persistent facial paralysis in the later stages of HIV infection. PMID:21427436

Woodcock, H; Nelson, M



Segmental thoracic lipomatosis of nerve with nerve territory overgrowth.  


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



Avian tick paralysis caused by Ixodes brunneus in the southeastern United States  

USGS Publications Warehouse

Between 1988 and 1994, 16 definitive and 26 presumptive cases of tick paralysis were diagnosed in 10 species of birds from five southeastern states in the USA. All birds had engorged adult female Ixodes brunneus ticks on the head region and were partially paralyzed or dead. Cases occurred in the winter and early spring months, and most birds were passerines found in private yards or near feeders. All stages of I. brunneus feed exclusively on birds, and this species previously has been associated with avian tick paralysis. Little is known concerning the life cycle of this ixodid tick and its impact on wild bird populations.

Luttrell, M.P.; Creekmore, L.H.; Mertins, J.W.



First report of Israeli acute paralysis virus in asymptomatic hives of Argentina.  


Honey bee mortality has recently been associated with Israeli acute paralysis virus (IAPV), a proposed etiological agent for a new syndrome known as Colony Collapse Disorder. Bees infected with this virus show shivering wings, progress into paralysis, and finally die outside the hive. During the last years, honey bee mortality became a serious problem for Argentinean beekeepers. We herein report the preliminary results of a survey carried out to detect IAPV in samples taken from several Argentine provinces, by using a reverse transcription Polymerase Chain Reaction assay. Our data indicate the existence of high frequency of IAPV in asymptomatic hives of Argentina. PMID:21731968

Reynaldi, Francisco J; Sguazza, Guillermo H; Tizzano, Marco A; Fuentealba, Nadia; Galosi, Cecilia M; Pecoraro, Marcelo R



Functional and Physiologic Results of Video Assisted Thoracoscopic Diaphragm Plication in Adult Patients With Unilateral Diaphragm Paralysis  

Microsoft Academic Search

Background. Plication of the hemidiaphragm for uni- lateral diaphragm paralysis is infrequently performed in adults. Barriers to diaphragm plication have included the perceived need for thoracotomy and uncertainty of the potential benefits. The purpose of this investigation was to assess the effects of video-assisted thoracoscopic dia- phragm plication in symptomatic adult patients with unilateral diaphragm paralysis. Methods. Patients with unilateral

Richard K. Freeman; Thomas C. Wozniak; Edward B. Fitzgerald



Development of laryngeal video stroboscope with laser marking module for dynamic glottis measurement.  


Physicians clinically use laryngeal video stroboscope as an auxiliary instrument to test glottal diseases, and read vocal fold images and voice quality for diagnosis. As the position of vocal fold varies in each person, the proportion of the vocal fold size as presented in the vocal fold image is different, making it impossible to directly estimate relevant glottis physiological parameters, such as the length, area, perimeter, and opening angle of the glottis. Hence, this study designs an innovative laser projection marking module for the laryngeal video stroboscope to provide reference parameters for image scaling conversion. This innovative laser projection marking module to be installed on the laryngeal video stroboscope using laser beams to project onto the glottis plane, in order to provide reference parameters for scaling conversion of images of laryngeal video stroboscope. PMID:24238805

Kuo, Chung-Feng Jeffrey; Wang, Hsing-Won; Hsiao, Shang-Wun; Peng, Kai-Ching; Chou, Ying-Liang; Lai, Chun-Yu; Hsu, Chien-Tung Max



Sensory nerve conduction of the plantar nerve compared with other nerve conduction tests in rats  

Microsoft Academic Search

ObjectiveIn rats the available techniques for evaluation of sensory nerve conduction are limited. We report a new method of sensory nerve conduction of the plantar nerve using needle electrodes as the recording electrodes behind the medial malleolus and ring electrodes as the stimulating electrodes around the three middle toes.

Katsumi Kurokawa; Diogo F de Almeida; Yun Zhang; Charles D Hébert; John G Page; Karen M Schweikart; Shin J Oh



Pharmacologic rescue of motor and sensory function by the neuroprotective compound P7C3 following neonatal nerve injury.  


Nerve injuries cause pain, paralysis and numbness that can lead to major disability, and newborns often sustain nerve injuries during delivery that result in lifelong impairment. Without a pharmacologic agent to enhance functional recovery from these injuries, clinicians rely solely on surgery and rehabilitation to treat patients. Unfortunately, patient outcomes remain poor despite application of the most advanced microsurgical and rehabilitative techniques. We hypothesized that the detrimental effects of traumatic neonatal nerve injury could be mitigated with pharmacologic neuroprotection, and tested whether the novel neuroprotective agent P7C3 would block peripheral neuron cell death and enhance functional recovery in a rat neonatal nerve injury model. Administration of P7C3 after sciatic nerve crush injury doubled motor and sensory neuron survival, and also promoted axon regeneration in a dose-dependent manner. Treatment with P7C3 also enhanced behavioral and muscle functional recovery, and reversed pathological mobilization of spinal microglia after injury. Our findings suggest that the P7C3 family of neuroprotective compounds may provide a basis for the development of a new neuroprotective drug to enhance recovery following peripheral nerve injury. PMID:25313000

Kemp, S W P; Szynkaruk, M; Stanoulis, K N; Wood, M D; Liu, E H; Willand, M P; Morlock, L; Naidoo, J; Williams, N S; Ready, J M; Mangano, T J; Beggs, S; Salter, M W; Gordon, T; Pieper, A A; Borschel, G H



Laryngeal mask airway (LMA) artefact resulting in MRI misdiagnosis.  


We report a 7-year-old child who underwent brain MRI for a known seizure disorder. The technique used for general anesthesia included inhalation induction followed by placement of a laryngeal mask airway (LMA) for airway maintenance. Because the reviewing radiologist was unfamiliar with the use of an LMA during anesthesia, and because the attending anesthesiologist did not communicate his technique to the radiologist, an MRI misdiagnosis was reported because of artefact created by the in situ LMA. As a result of this misdiagnosis the child was subjected to unnecessary subsequent testing to rule out a reported anatomic abnormality induced by the LMA. Our case illustrates the need for coordination of patient care among hospital services. PMID:17994296

Schieble, Thomas; Patel, Anuradha; Davidson, Melissa



Laryngeal Chondroma: A Rare Diagnosis in This Localization  

PubMed Central

Primary chondroid tumors of the larynx represent less than 1% of all laryngeal tumors. Most of them are chondromas and they often involve to the cricoid cartilage. A 31-year-old male patient applied to the oto-laryngology service with a history of dysphonia and dyspnea. Microlaryngoscopy revealed 2?cm sized, ill-defined, covered with regular mucosa, porous, and hard mass on posterior surface of crycoid cartilage in subglottic area. Following the excision of the lesion, histopathologic examination revealed as chondroma. Two years later, local recurrence was detected and the diagnosis was again chondroma. There was no complaint of the patient in last 3 and half years of follow-up. Chondroma should carefully be differentiated from chondrosarcoma and the patients should be followed for possible recurrences. PMID:22937396

Tastekin, Ebru; Altaner, Semsi; Uzun, Cem; Karasalihoglu, Ahmet R.; Ozdemir, Cigdem; Kutlu, Ali Kemal



Salmonella typhimurium Mediated Delivery of Apoptin in Human Laryngeal Cancer  

PubMed Central

An effective cancer therapeutic should target tumours specifically with limited systemic toxicity. Here, we transformed an attenuated Salmonella typhimurium (S. typhimurium) with an Apoptin expressing plasmid into a human laryngeal carcinoma cell line. The expression of the inserted gene was measured using fluorescence and immunoblotting assays. The attenuated S. typhimurium-mediated Apoptin significantly decreased cytotoxicity and strongly increased cell apoptosis through the activation of caspase-3. The process was mediated by Bax, cytochrome c and caspase-9. A syngeneic nude murine tumour model was used to determine the anti-tumour effects of the recombinant bacteria in vivo. Systemic injection of the recombinant bacteria with and without re-dosing caused significant tumour growth delay and reduced tumour microvessel density, thereby extending host survival. Our findings indicated that the use of recombinant Salmonella typhimurium as an Apoptin expression vector has potential cancer therapeutic benefits. PMID:24155656

Guan, Guo-fang; Zhao, Ming; Liu, Li-ming; Jin, Chun-shun; Sun, Kai; Zhang, De-jun; Yu, Duo-jiao; Cao, Hong-wei; Lu, Yan -qing; Wen, Lian-ji



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



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



The Role of Host Immune Response and Apoptosis in Patients with Laryngeal Squamous Cell Carcinoma  

Microsoft Academic Search

Purpose: To determine whether the combined use of markers of host immune response (HLA-DR) and apoptosis (bax and bcl-2) can predict prognosis in laryngeal carcinoma patients. Procedures: Immunohistochemical staining for HLA-DR, bax and bcl-2 proteins was investigated retrospectively in 37 patients with laryngeal squamous cell carcinoma. Seven healthy adult males were used as the control group. Results: HLA-DR antigen expression

I. P. Gomatos; A. Georgiou; J. Giotakis; L. Manolopoulos; K. Apostolou; E. Chatzigianni; K. Albanopoulos; E. Ferekidou



[Laryngeal papillomatosis in children: therapeutic problems apropos of 39 cases at the Lomé University Hospital Center].  


The retrospective study about 39 cases of laryngeal papillomatosis emphasizes the management difficulties due to slenderness of therapeutical resources, delayed consultations because of health under education of the community and patients' discouragement during treatment of such a relapsing disease. Consequently, tracheostomy was needed immediately (25.64%), breaking of the voice (48.72%) was noted as well as school backwardness. The use of laser and interferon in laryngeal papillomatosis treatment is for the future in Togo. PMID:8677369

Kpemissi, E; Agbere, A R; Sossou, K



Behcet's disease impairs voice quality without laryngeal and hypopharyngeal involvement.  


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



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



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.



Varroa destructor, a potential vector of Israeli Acute Paralysis Virus in honey bees, Apis mellifera  

Technology Transfer Automated Retrieval System (TEKTRAN)

Although the role of the parasitic mite, Varroa destructor, as a vector in transmission of viruses between honey bees is well established, no study has shown that it can similarly transmit Israeli Acute Paralysis Virus (IAPV), a virus that was found to be associated with Colony Collapse Disorder (CC...


Genetic analysis of Israel Acute Paralysis Virus: distinct clusters are circulating into the United States.  

Technology Transfer Automated Retrieval System (TEKTRAN)

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, Austral...


A 59-year-old man with acute onset of paralysis.  


Botulism is a neuroparalytic illness resulting from the action of a potent toxin produced by the organism Clostridium botulinum. It can present with a classic triad of clear mentation, bulbar palsy and symmetric descending paralysis. Treatment is symptomatic and includes a botulinum antitoxin. PMID:25054790

Cassa, Richard S; Rosengart, Axel J



Concerned public and the paralysis of decision?making: nuclear waste management policy in Germany  

Microsoft Academic Search

Efforts to site a high level nuclear waste repository in Germany date back to the 1960s. Ten years later the site Gorleben was officially selected and designated as a host for nuclear waste. However, public opposition and maneuvering by the major political actors prevented the completion of the site selection process, resulting in decades of political paralysis. The main reasons

Peter Hocke; Ortwin Renn



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



Acute flaccid paralysis associated with circulating vaccine-derived poliovirus--Philippines, 2001.  


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



Luxation de l’épaule compliquée de paralysie du plexus brachial  

PubMed Central

Les auteurs rapportent l'observation d'une paralysie totale du plexus brachial survenue trois mois après un épisode de luxation antéro-interne sous coracoïdienne associée à une fracture du trochiter chez une patiente âgée de 88 ans. PMID:25426187

Lukulunga, Loubet Unyendje; Moussa, Abdou Kadri; Mahfoud, Mustapha; EL Bardouni, Ahmed; Berrada, Mohamed Saleh; El Yaacoubi, Moradh



Device Lets Monkey's Brain Move Robot Arm Research could one day aid amputees or paralysis victims  

E-print Network

Device Lets Monkey's Brain Move Robot Arm Research could one day aid amputees or paralysis victims successfully wired monkey brains to robot arms, raising hope that science is moving closer to finding ways to help paralyzed people control their world. Using their brains to control their robot arms, monkeys

Schwartz, Andrew


Brain correlates of hypnotic paralysis-a resting-state fMRI study.  


Hypnotic paralysis has been used since the times of Charcot to study altered states of consciousness; however, the underlying neurobiological correlates are poorly understood. We investigated human brain function during hypnotic paralysis using resting-state functional magnetic resonance imaging (fMRI), focussing on two core regions of the default mode network and the representation of the paralysed hand in the primary motor cortex. Hypnotic suggestion induced an observable left-hand paralysis in 19 participants. Resting-state fMRI at 3T was performed in pseudo-randomised order awake and in the hypnotic condition. Functional connectivity analyses revealed increased connectivity of the precuneus with the right dorsolateral prefrontal cortex, angular gyrus, and a dorsal part of the precuneus. Functional connectivity of the medial frontal cortex and the primary motor cortex remained unchanged. Our results reveal that the precuneus plays a pivotal role during maintenance of an altered state of consciousness. The increased coupling of selective cortical areas with the precuneus supports the concept that hypnotic paralysis may be mediated by a modified representation of the self which impacts motor abilities. PMID:21497656

Pyka, M; Burgmer, M; Lenzen, T; Pioch, R; Dannlowski, U; Pfleiderer, B; Ewert, A W; Heuft, G; Arolt, V; Konrad, C



Ligation of mouse L4 and L5 spinal nerves produces robust allodynia without major motor function deficit.  


Spinal nerve L5/L6 ligation (SNL) in rats has become the standard for mechanistic studies of peripheral neuropathy and screening for novel analgesics. Conventional SNL in our hybrid mice resulted in a wide range of allodynia. Anatomical evaluation indicated that a variable number of lumbar vertebrae existed, resulting in L4/L5 or L5/L6 being ligated. Surprisingly, L4/L5 ligation did not result in ipsilateral hind limb paralysis and produced robust allodynia. Following a recent report that the mouse L4 neural segment is homologous with rat L5 we generated L4, L5 or both L4 and L5 (L4/L5) ligations in C57 mice after establishing a modified set of surgical landmarks. In contrast to rats, L4 ligation in these mice did not result in hind limb paralysis. Robust allodynia was observed in all three ligation groups. Nerve degeneration confirmed that L4 and L5, respectively, are primary contributors to the tibial and sural branches of the sciatic nerve in mice. A larger von Frey sensitive area reflected the wider distribution of Wallerian degeneration in the hindlimb of L4- compared to L5-ligated mice. Ligation of mouse L4 and L5 spinal nerves produces consistent, robust neuropathic pain behaviors and is suitable as a model for investigating mechanisms of neuropathic pain and for testing of novel analgesics. Gabapentin, used as a validation drug in neuropathic pain models and as a reference compound for novel analgesics, significantly reduced allodynia in the mice tested (L4/L5 ligations). Given the ease of surgery, robust allodynia, and larger von Frey sensitive area, we conclude that combined ligation of spinal nerves L4 and L5 optimizes the SNL model in mice. PMID:24786331

Ye, Gui-Lan; Savelieva, Katerina V; Vogel, Peter; Baker, Kevin B; Mason, Sara; Lanthorn, Thomas H; Rajan, Indrani



Value of Narrow Band Imaging (NBI) Endoscopy in the Early Diagnosis of Laryngeal Cancer and Precancerous Lesions

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



Subthreshold continuous electrical stimulation facilitates functional recovery of facial nerve after crush injury in rabbit.  


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



Evaluation of Acute Flaccid Paralysis in Hamadan, Iran from 2002 to 2009  

PubMed Central

OBJECTIVES To achieve a polio-free certification in Iran, a nationwide active surveillance program for acute flaccid paralysis (AFP) was set up following World Health Organization guidelines. This article describes the results of an eight-year surveillance of AFP in Hamadan, in the west of Iran. METHODS A standard set of minimum core variables were collected. All cases of non-polio AFP in children aged <15 years old were reported. Two stool specimens were collected within 14 days of the onset of paralysis. RESULTS During the eight-year survey, 88 AFP cases aged <15 years old were reported. About 40% (35/88) of cases were aged ?5 years, 56% (49/88) were boys, 19 (21.6%) had fever at the onset of paralysis, 74 (84.0%) had complete paralysis within four days of onset, and 22 (24.7%) had asymmetric paralysis. More than one AFP case was detected per 100,000 children aged <15 years old in all years. The risk of AFP in patients aged <5 years old was almost double that of older patients. Guillain-Barré Syndrome was the major leading cause of AFP (66/88). Adequate stool specimens were collected from 85% of AFP patients. All stool specimens were tested virologically, but no wild polioviruses were detected. CONCLUSION The active surveillance of non-polio AFP was efficient over the last eight years and exceeded 1.0 case per 100,000 children aged <15 years old. Nonetheless, there was a decreasing trend in the detection of AFP cases during the last two years and should be the focus of the policymakers' special attention, although AFP cases were still above the target level. PMID:22111031

Ghasemi, Shadi; Farahani, Leila Nezamabadi; Hosseini, Atefeh Sadat; Bathaei, Seyyed Jalal; Zahiri, Ali



Nerve allografts and conduits in peripheral nerve repair.  


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



Durable Long-Term Remission With Chemotherapy Alone for Stage II to IV Laryngeal Cancer  

PubMed Central

Purpose For patients with stage II to IV laryngeal cancer, radiation therapy (RT) either alone or with concurrent chemotherapy provides the highest rate of organ preservation but can be associated with functional impairment. Thus, we studied the use of induction chemotherapy with or without conservation laryngeal surgery (CLS). Our objectives were to study the sensitivity of laryngeal cancer to platinum-based chemotherapy alone and to highlight the efficacy of CLS in this setting. Patients and Methods Thirty-one previously untreated patients with laryngeal cancer (T2-4, N0-1, M0), who were resectable with CLS, were enrolled. Patients received three to four cycles of paclitaxel, ifosfamide, and cisplatin (TIP) chemotherapy, and response was assessed histologically. Patients with partial response (PR) proceeded to CLS. Patients achieving pathologic complete response (pCR) received an additional three cycles of TIP and no other treatment. Results Thirty patients were assessable for response. With TIP chemotherapy alone, 11 patients (37%) achieved pCR, 10 of whom (33%) remain alive with durable disease remission and no evidence of recurrence over a median follow-up time of 5 years. Nineteen patients (63%) treated with TIP alone achieved PR. The overall laryngeal preservation (LP) rate was 83%, and only five patients (16%) required postoperative RT. No patient required a gastrostomy tube or tracheotomy. Conclusion Chemotherapy alone in selected patients with T2-4, N0-1 laryngeal cancer can provide durable disease remission at 5 years. For patients with PR, CLS provides a high rate of LP. This prospective study suggests that chemotherapy alone may cure selected patients with laryngeal cancer, warranting further prospective investigation. PMID:19289628

Holsinger, F. Christopher; Kies, Merrill S.; Diaz, Eduardo M.; Gillenwater, Ann M.; Lewin, Jan S.; Ginsberg, Lawrence E.; Glisson, Bonnie S.; Garden, Adam S.; Ark, Nebil; Lin, Heather Y.; Lee, J. Jack; El-Naggar, Adel K.; Ki Hong, Waun; Shin, Dong M.; Khuri, Fadlo R.



Fibrolipoma of the median nerve.  


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



Vocal cord and diaphragm paralysis, as clinical features of a French family with autosomal recessive Charcot-Marie-Tooth disease, associated with a new mutation in the GDAP1 gene.  


Axonal forms of Charot-Marie-Tooth disease, either dominantly or recessively inherited, are clinically and genetically heterogeneous. We describe the clinical and electrophysiological characteristics of an axonal autosomal recessive form of Charot-Marie-Tooth disease in a French family, associated with a new mutation of the ganglioside-induced differentiation-associated protein-1 gene (GDAP1). Two sisters, born to non-consanguineous parents, presented severe proximal and distal sensorimotor deficit, areflexia, pes cavus, scoliosis and vocal cord and diaphragm paralysis. They lost ambulation in the third decade and since then they have been wheelchair bound. Nerve conduction studies were consistent with an axonal neuropathy. Clinical and electrophysiological examination of their parents and their brother was normal. Genetic analysis revealed a homozygous thymidine deletion at nucleotide position 558 resulting in a frameshift at codon 186 and a stop codon at position 205. This axonal form of Charot-Marie-Tooth disease associated with a new GDAP1 mutation is recessively inherited and is characterized by a severe phenotype, since patients become wheelchair bound in the third decade, and present vocal cord and diaphram paralysis, which may be missed as they had no respiratory symptoms until the third decade. PMID:15019704

Stojkovic, Tanya; Latour, Philippe; Viet, Ghislaine; de Seze, Jérôme; Hurtevent, Jean-François; Vandenberghe, Antoon; Vermersch, P



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



Peripheral nerve repair with nerve growth factor and fibrin matrix  

Microsoft Academic Search

A fibrin sealant matrix (FS) with or without a nerve growth factor (NGF) has been used to improve the recovery of severed peripheral nerves, and these have been compared with the results of using only the standard epineural suture (SUT). Regeneration in the early phase (up to 6 days) was measured by the pinch test. The functional recovery process (up

L. Zeng; A. Worseg; H. Redl; G. Schlag



Nerve-pulse interactions  

SciTech Connect

Some recent experimental and theoretical results on mechanisms through which individual nerve pulses can interact are reviewed. Three modes of interactions are considered: (1) interaction of pulses as they travel along a single fiber which leads to velocity dispersion; (2) propagation of pairs of pulses through a branching region leading to quantum pulse code transformations; and (3) interaction of pulses on parallel fibers through which they may form a pulse assembly. This notion is analogous to Hebb's concept of a cell assembly, but on a lower level of the neural hierarchy.

Scott, A.C.



Association between CYP1B1 Gene Polymorphisms and Risk Factors and Susceptibility to Laryngeal Cancer  

PubMed Central

Background The aim of this study was to investigate the association between polymorphism of the cytochrome P450 1B1 (CYP1B1) gene, a metabolic enzyme gene, and the susceptibility to laryngeal cancer among the Chinese Han population. Material/Methods In a case-control study, we investigated polymorphisms in the CYP1B1 gene (rs10012, rs1056827, and rs1056836) with a real-time quantitative polymerase chain reaction (PCR) assay (TaqMan). The study was conducted with 300 Chinese Han patients with laryngeal cancer and 300 healthy Chinese Han subjects in a control group. We also studied the interactions between genetic polymorphism and risk factors such as smoking and alcohol consumption in the pathogenesis of laryngeal cancer. Results There were statistically significant differences in the distributions of the rs1056827 and rs1056836 genotypes between the 2 groups. Regarding rs1056827, carriers of the T allele had a significantly higher risk of laryngeal cancer than the G-allele carriers (OR=1.4339, 95% CI: 1.1268–1.8247; P=0.0034). The difference was still statistically significant after adjusting for factors such as age, sex, smoking, and drinking (adjusted OR=1.743, 95% CI: 1.124–3.743, P<0.001). However, regarding rs1056836, the G allele carriers had a significantly lower risk of laryngeal cancer than the C allele carriers (OR=0.5557, 95% CI: 0.3787–0.8154; P=0.0027). The difference was statistically significant even after adjusting for factors such as age, sex, smoking, and drinking (adjusted OR=0.5641, 95% CI: 0.3212–0.8121, P=0.001). Subjects who carry the C-T-C haplotype have a significantly increased incidence of laryngeal cancer. We also found that CYP1B1 rs1056827 polymorphism had synergistic effects with smoking or alcohol consumption regarding the risk of laryngeal cancer. Conclusions CYP1B1 gene polymorphism is closely related to the onset of laryngeal cancer. There is a mutually synergistic effect between smoking, alcohol consumption, and CYP1B1 gene polymorphisms regarding laryngeal cancer. PMID:25619313

Yu, Peng-Ju; Chen, Wei-Guan; Feng, Quan-Lin; Chen, Wei; Jiang, Man-Jie; Li, Ze-Qing



Managing Chemotherapy Side Effects: Nerve Changes  


... institutes of health Managing Chemotherapy Side Effects Nerve Changes “My fingers and toes felt numb and tingly. ... getting cuts, I always wore shoes.” About nerve changes Some chemotherapy can cause nerve problems. You may ...


Subthalamic nucleus deep brain stimulation changes speech respiratory and laryngeal control in Parkinson's disease  

PubMed Central

Adequate respiratory and laryngeal motor control are essential for speech, but may be impaired in Parkinson's disease (PD). Bilateral subthalamic nucleus deep brain stimulation (STN DBS) improves limb function in PD, but the effects on respiratory and laryngeal control remain unknown. We tested whether STN DBS would change aerodynamic measures of respiratory and laryngeal control, and whether these changes were correlated with limb function and stimulation parameters. Eighteen PD participants with bilateral STN DBS were tested within a morning session after a minimum of 12 h since their most recent dose of anti-PD medication. Testing occurred when DBS was on, and again 1 h after DBS was turned off, and included aerodynamic measures during syllable production, and standard clinical ratings of limb function. We found that PD participants exhibited changes with DBS, consistent with increased respiratory driving pressure (n = 9) and increased vocal fold closure (n = 9). However, most participants exceeded a typical operating range for these respiratory and laryngeal control variables with DBS. Changes were uncorrelated with limb function, but showed some correlation with stimulation frequency and pulse width, suggesting that speech may benefit more from low-frequency stimulation and shorter pulse width. Therefore, high-frequency STN DBS may be less beneficial for speech-related respiratory and laryngeal control than for limb motor control. It is important to consider these distinctions and their underlying mechanisms when assessing the impact of STN DBS on PD. PMID:20582431

Barlow, Steven M.; Lyons, Kelly E.; Pahwa, Rajesh



Effects of nerve growth factor on nerve regeneration after corneal nerve damage  

PubMed Central

The study aims to determine the relation between the effects of mouse nerve growth factor (mNGF) and nerve regeneration after corneal surgery nerve damage. Mechanical nerve injury animal model was established by LASIK (the excimer laser keratomileusis) surgery in 12 Belgian rabbits. mNGF and the balanced salt solution (BBS) were alternatively administered in the left and right eye two times every day for 8 weeks. The morphous and growth of the sub-basal nerve plexus and superficial stroma were observed by in vivo confocal microscopy at the end of weeks 1, 2, 4 and 8 after the surgery. The animal model is successfully established. The morphology and density of corneal nerve have been observed and demonstrated by confocal microscopy. A systematic administration of mNGF can significantly promote the nerve regeneration at the end of weeks 1, 2, 4 and 8, which comparing to the administration of balanced salt solution (P < 0.05). mNGF has effect on sub-basal nerve plexus and superficial stroma after corneal nerve damage which is caused by LASIK. The experimental results suggested that the mNGF may solve the problem of dry eye after LASIK. PMID:25550989

Ma, Ke; Yan, Naihong; Huang, Yongzhi; Cao, Guiqun; Deng, Jie; Deng, Yingping



Comparison of two laryngeal tissue fiber constitutive models  

NASA Astrophysics Data System (ADS)

Biological tissues are complex time-dependent materials, and the best choice of the appropriate time-dependent constitutive description is not evident. This report reviews two constitutive models (a modified Kelvin model and a two-network Ogden-Boyce model) in the characterization of the passive stress-strain properties of laryngeal tissue under tensile deformation. The two models are compared, as are the automated methods for parameterization of tissue stress-strain data (a brute force vs. a common optimization method). Sensitivity (error curves) of parameters from both models and the optimized parameter set are calculated and contrast by optimizing to the same tissue stress-strain data. Both models adequately characterized empirical stress-strain datasets and could be used to recreate a good likeness of the data. Nevertheless, parameters in both models were sensitive to measurement errors or uncertainties in stress-strain, which would greatly hinder the confidence in those parameters. The modified Kelvin model emerges as a potential better choice for phonation models which use a tissue model as one component, or for general comparisons of the mechanical properties of one type of tissue to another (e.g., axial stress nonlinearity). In contrast, the Ogden-Boyce model would be more appropriate to provide a basic understanding of the tissue's mechanical response with better insights into the tissue's physical characteristics in terms of standard engineering metrics such as shear modulus and viscosity.

Hunter, Eric J.; Palaparthi, Anil Kumar Reddy; Siegmund, Thomas; Chan, Roger W.



Laryngeal spasm mimicking asthma and vitamin d deficiency.  


We present a woman with heterozygous carnitine palmitoyl transferase 2 (CPT-2) deficiency who in the last 6 months suffered from episodic dyspnea and choking. Symptoms could not be attributed to her muscular energy defect, since heterozygous CPT-2 deficiency is usually asymptomatic or causes only mild muscle fatigability. Myopathy is usually triggered by concurrent factors, either genetic (additional muscle enzymes defects) or acquired (metabolic stress). The patient was referred to our respiratory clinic for suspect bronchial asthma. Spirometry showed mild decrease in inspiratory flows. Methacholine challenge was negative. Dyspnea was triggered by hyperventilation-induced hypocapnia, which produced marked decrease in airflow rates, particularly in inspiratory flows, consistent with laryngospasm. Nutritional assessment of the patient showed low serum level of calcium and vitamin D, attributable to avoidance of milk and dairy products for lactose intolerance and to insufficient sunlight exposure. After calcium and vitamin D supplementation episodic laryngospasm disappeared and hypocapnic hyperventilation test induced very mild change in airflow rates. Calcium and vitamin D deficiency may favour laryngeal spasm mimicking asthma, particularly in subjects with underlying myopathy. PMID:24843804

Masoero, Monica; Bellocchia, Michela; Ciuffreda, Antonio; Ricciardolo, Fabio Lm; Rolla, Giovanni; Bucca, Caterina



[A new method of anastomosing severed nerves].  


Nerve anastomoses glued with "Fribrinkleber" can be protected from tissue plasminogen-activators both by natural and synthetic inhibitors of fibrinolysis whether administered locally or systemically. The glued nerve-anastomoses do not attain the bond strength of sutured nerves, but show less foreign body reaction. Gluing nerves with Fibrinkleber" combined with inhibition of fibrinolysis would seem to be a good method for reuniting severed nerves. It may be especially useful in nerve transplantation if tension is avoided. PMID:376235

Duspiva, W; Blümel, G; Haas-Denk, S; Wriedt-Lübbe, I



Feeding Artery of Laryngeal and Hypopharyngeal Cancers: Role of the Superior Thyroid Artery in Superselective Intraarterial Chemotherapy  

SciTech Connect

The purpose of this study was to elucidate the role of the superior thyroid artery in intra-arterial infusion chemotherapy for laryngeal and hypopharyngeal cancers. Thirty-nine patients with laryngeal cancer and 29 patients with hypopharyngeal cancer underwent intra-arterial infusion chemotherapy. We performed a retrospective analysis of the feeding arteries confirmed by computed tomography during selective arteriography and compared the results with the extent of the tumors. In 14 of 39 laryngeal and 15 of 29 hypopharyngeal cancers, the tumor did not cross the midline (group 1). In the remaining 25 and 14 cancers, respectively, the tumor crossed the midline or located in the center (group 2). For 13 of 14 laryngeal and 7 of 15 hypopharyngeal cancers in group 1 and for 6 of 25 laryngeal cancers in group 2, the entire tumor was contrast enhanced by the ipsilateral superior thyroid and/or superior laryngeal artery. For 12 of 25 laryngeal and 1 of 14 hypopharyngeal cancers in group 2, the entire tumor was contrast enhanced by the bilateral superior thyroid artery. For the other patients, infusion via the other arterial branches such as the inferior thyroid and the lingual arteries were needed to achieve contrast enhancement of the entire tumor. Superselective intra-arterial chemotherapy for laryngeal cancer from the superior thyroid artery is appropriate, whereas that for hypopharyngeal cancer is less sufficient. To accomplish contrast enhancement of the entire tumor, additional intra-arterial infusion from other arteries such as the inferior thyroid artery is often necessary.

Terayama, Noboru, E-mail:; Sanada, Junichiro; Matsui, Osamu; Kobayashi, Satoshi; Kawashima, Hiroko; Yamashiro, Masashi; Takanaka, Tsuyoshi; Kumano, Tomoyasu; Yoshizaki, Tomokazu [Kanazawa University Graduate School of Medical Science, Department of Radiology (Japan); Furukawa, Mitsuru [Kanazawa University Graduate School of Medical Science, Department of Otorhinolaryngology (Japan)



Acquiring a New Second Language Contrast: An Analysis of the English Laryngeal System of Native Speakers of Dutch  

ERIC Educational Resources Information Center

This study examines the acquisition of the English laryngeal system by native speakers of (Belgian) Dutch. Both languages have a two-way laryngeal system, but while Dutch contrasts prevoiced with short-lag stops, English has a contrast between short-lag and long-lag stops. The primary aim of the article is to test two hypotheses on the acquisition…

Simon, Ellen



Acoustic Correlates of Fatigue in Laryngeal Muscles: Findings for a Criterion-Based Prevention of Acquired Voice Pathologies  

ERIC Educational Resources Information Center

Purpose: The objective was to identify acoustic correlates of laryngeal muscle fatigue in conditions of vocal effort. Method: In a previous study, a technique of electromyography (EMG) served to define physiological signs of "voice fatigue" in laryngeal muscles involved in voicing. These signs correspond to spectral changes in contraction…

Boucher, Victor J.



Laryngeal mask airway in neonatal resuscitation: a survey of current practice and perceived role by anaesthesiologists and paediatricians  

Microsoft Academic Search

Objectives: To survey current practice and to compare the opinion of paediatricians and anaesthesiologists regarding laryngeal mask airway (LMA) in neonatal resuscitation. Design: A structured postal questionnaire on the use of the laryngeal mask airway in neonatal resuscitation was sent to the heads of department of the paediatric and anaesthesiology services. Setting: Forty-three hospitals in the Veneto Region, Italy. Results:

Daniele Trevisanuto; Paola Ferrarese; Vincenzo Zanardo; Lino Chiandetti



Single-stage surgery combining nerve and tendon transfers for bilateral upper limb reconstruction in a tetraplegic patient: case report.  


A 39-year-old tetraplegic patient had paralysis of elbow, thumb, and finger extension and thumb and finger flexion. We transferred axillary nerve branches to the triceps long and upper medial head motor branches, supinator motor branches to the posterior interosseous nerve, and brachioradialis tendon to the flexor pollicis longus and flexor superficialis of the index finger. Surgery was performed bilaterally 18 months after spinal cord injury. At 12 months after surgery, we performed bilateral distal radioulnar arthrodesis percutaneously. By 22 months postoperatively, we observed triceps strength scoring M3 bilaterally and full metacarpophalangeal joint extension scoring M4 bilaterally. The thumb span was 53 and 66 mm from the proximal index phalanx on the right and left sides, respectively. Pinch strength measured 1.5 kg on the left side and 2.0 kg on the right. Before surgery, the patient was incapable of grasping; after surgery, a useful grasp had been restored bilaterally. PMID:23751324

Bertelli, Jayme Augusto; Ghizoni, Marcos Flávio



Peripheral nerve lengthening as a regenerative strategy  

PubMed Central

Peripheral nerve injury impairs motor, sensory, and autonomic function, incurring substantial financial costs and diminished quality of life. For large nerve gaps, proximal lesions, or chronic nerve injury, the prognosis for recovery is particularly poor, even with autografts, the current gold standard for treating small to moderate nerve gaps. In vivo elongation of intact proximal stumps towards the injured distal stumps of severed peripheral nerves may offer a promising new strategy to treat nerve injury. This review describes several nerve lengthening strategies, including a novel internal fixator device that enables rapid and distal reconnection of proximal and distal nerve stumps. PMID:25317163

Vaz, Kenneth M.; Brown, Justin M.; Shah, Sameer B.



Peripheral nerve conduits: technology update  

PubMed Central

Peripheral nerve injury is a worldwide clinical problem which could lead to loss of neuronal communication along sensory and motor nerves between the central nervous system (CNS) and the peripheral organs and impairs the quality of life of a patient. The primary requirement for the treatment of complete lesions is a tension-free, end-to-end repair. When end-to-end repair is not possible, peripheral nerve grafts or nerve conduits are used. The limited availability of autografts, and drawbacks of the allografts and xenografts like immunological reactions, forced the researchers to investigate and develop alternative approaches, mainly nerve conduits. In this review, recent information on the various types of conduit materials (made of biological and synthetic polymers) and designs (tubular, fibrous, and matrix type) are being presented. PMID:25489251

Arslantunali, D; Dursun, T; Yucel, D; Hasirci, N; Hasirci, V



Lessons learned from muscle fatigue: implications for treatment of patients with hyperkalemic periodic paralysis.  


Hyperkalemic periodic paralysis (HyperKPP) is a disease characterized by periods of myotonic discharges and paralytic attacks causing weakness, the latter associated with increases in plasma [K(+)]. The myotonic discharge is due to increased Na(+) influx through defective Na(+) channels that triggers generation of several action potentials. The subsequent increase in extracellular K(+) concentration causes excessive membrane depolarization that inactivates Na(+) channels triggering the paralysis. None of the available treatments is fully effective. This paper reviews the capacity of Na(+) K(+)ATPase pumps, KATP and ClC-1 Cl(-) channels in improving membrane excitability during muscle activity and how using these three membrane components we can study future and more effective treatments for HyperKPP patients. The review of current patents related to HyperKPP reinforces the need of novel approaches for the treatment of this channelopathy. PMID:23092434

Renaud, Jean-Marc; Hayward, Lawrence J



Thyrotoxic hypokalaemic periodic paralysis: a rare presentation of Graves' disease in a Hispanic patient.  


A 26-year-old Hispanic man with no significant medical history presented to our emergency room with gradual onset weakness of his lower extremities. He was haemodynamically stable and examination revealed loss of motor function in his lower limbs up to the level of hips. Laboratory data revealed hypokalaemia. The patient was started on potassium supplementation and he recovered his muscle strength. Differential diagnosis included familial hypokalaemic periodic paralysis and thyrotoxic periodic paralysis (TPP). Further investigations revealed a low thyroid-stimulating hormone and high free thyroxine levels. Radio iodine 123 scan revealed an enhanced homogeneous uptake in the thyroid suggesting Graves' disease. Thyroid stimulating antibodies were also found to be elevated. The patient was started on methimazole and propranolol and he never had another attack of TPP even at 1 year follow-up. PMID:24717588

Matta, Abhishek; Koppala, Jahnavi; Gossman, William



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



An undescribed Rhipicephalus species associated with field paralysis of Angora goats.  


Paralysis of Angora goat kids caused by adult ticks, which most probably belong to an undescribed species of the Rhipicephalus pravus group, is described. Confirmed cases of paralysis occurred in the south-western Orange Free State between the second half of September and the first half of November as well as during the first half of February. The mean female tick burdens (mean = 21.4) of paralysed Angora kids were significantly higher than those of healthy kids (mean = 4.4). The predilection attachment site of the adult ticks was the ears of the goats. The elephant shrew Elephantulus myurus is a preferred host of the immature stages whereas the scrub hare Lepus saxatilis serves as an important host for the adult ticks. PMID:3361560

Fourie, L J; Horak, I G; Marais, L



Stroboscopic Parameters Reported as Voice Outcome Measures in Patients Treated for Laryngeal Cancer: A Systematic Review  

PubMed Central

Background A systematic review of the use of stroboscopy as a treatment outcome measure of vocal fold function in patients treated for laryngeal cancer is presented. Methods Computerized literature searches were performed. Eligible articles were admitted when stroboscopy was used to measure vocal fold function before and after treatment in patients with laryngeal cancer. Data extracted included: tumor stage and location, treatment modality, stroboscopy parameters, parameter scale, number of raters, rater reliability, methodology, and level of evidence. Results Of 520 articles retrieved, 11 studies met inclusion criteria. A total of twenty-four parameters were reported. Rating scales and rater reliability varied. Discussion Major methodological differences exist in studies using stroboscopic findings as voice outcome measures in patients’ post-cancer treatment. These differences lead to equivocal findings when assessing the utility of stroboscopy as an outcome measure. Standardized, reliable scoring and reporting systems for laryngeal stroboscopic examinations are needed. PMID:25339842

Focht, Kendrea L.; Martin-Harris, Bonnie; Bonilha, Heather Shaw



Effects of benzodiazepines on laryngeal reflexes. Comparison of lormetazepam and Diazemuls.  


Of 20 volunteers, five were given intravenous Diazemuls 15 mg over 15 seconds, and three groups of five were given lormetazepam 2 mg intravenously over 10, 20 and 60 seconds, respectively. Laryngeal reactivity and psychomotor function were tested at intervals from prior to injection until 4 hours after injection. For equivalent degrees of depression of psychomotor function, lormetazepam depressed the laryngeal reflex less than Diazemuls (p = 0.004). Lormetazepam give over 60 seconds depressed the laryngeal reflex more than when given over 10 seconds (p = 0.008) or over 20 seconds (p = 0.048), although a significant difference was not demonstrated between the 10-second and 20-second groups. These results concur with experimental evidence that benzodiazepine receptor multiplicity exists, which allows various members of the benzodiazepine group of drugs to exhibit differing therapeutic ratios for their various effects. PMID:2889388

Groves, N D; Rees, J L; Rosen, M



Towards Computational Modeling of Phonation Using CT--Based Laryngeal Models  

NASA Astrophysics Data System (ADS)

The oscillatory flow generated in human larynx plays a key role in the process of phonation. While much has been done to understand the main features of such flow by using idealized geometry models and simplified flow conditions, there is still little known about the 3D features of laryngeal flow. In this work, anatomically realistic models of the human larynx are used to analyze the fluid dynamics of 3D laryngeal flow using high--fidelity numerical simulations. A Cartesian--grid--based, finite--difference Navier--Stokes solver is used to carry out these simulations. Three--dimensional models of human larynx are extracted from CT images and unstructured surface grids are generated for the model geometries. The pressure driven flow is simulated for a range of Reynolds numbers. The main objective in this work is to understand more in--depth the effect of 3D geometric features of glottal airway on the laryngeal flow structure.

Mohsen Karimian, S. A.; Mittal, Rajat



Metagenomic detection of viral pathogens in Spanish honeybees: co-infection by Aphid Lethal Paralysis, Israel Acute Paralysis and Lake Sinai Viruses.  


The situation in Europe concerning honeybees has in recent years become increasingly aggravated with steady decline in populations and/or catastrophic winter losses. This has largely been attributed to the occurrence of a variety of known and "unknown", emerging novel diseases. Previous studies have demonstrated that colonies often can harbour more than one pathogen, making identification of etiological agents with classical methods difficult. By employing an unbiased metagenomic approach, which allows the detection of both unexpected and previously unknown infectious agents, the detection of three viruses, Aphid Lethal Paralysis Virus (ALPV), Israel Acute Paralysis Virus (IAPV), and Lake Sinai Virus (LSV), in honeybees from Spain is reported in this article. The existence of a subgroup of ALPV with the ability to infect bees was only recently reported and this is the first identification of such a strain in Europe. Similarly, LSV appear to be a still unclassified group of viruses with unclear impact on colony health and these viruses have not previously been identified outside of the United States. Furthermore, our study also reveals that these bees carried a plant virus, Turnip Ringspot Virus (TuRSV), potentially serving as important vector organisms. Taken together, these results demonstrate the new possibilities opened up by high-throughput sequencing and metagenomic analysis to study emerging new diseases in domestic and wild animal populations, including honeybees. PMID:23460860

Granberg, Fredrik; Vicente-Rubiano, Marina; Rubio-Guerri, Consuelo; Karlsson, Oskar E; Kukielka, Deborah; Belák, Sándor; Sánchez-Vizcaíno, José Manuel



Human Papillomavirus Prevalence in Invasive Laryngeal Cancer in the United States  

PubMed Central

Purpose Human papillomavirus (HPV) is a major risk factor for specific cancers of the head and neck, particularly malignancies of the tonsil and base of the tongue. However, the role of HPV in the development of laryngeal cancer has not been definitively established. We conducted a population-based, cancer registry study to evaluate and characterize the genotype-specific prevalence of HPV in invasive laryngeal cancer cases diagnosed in the U.S. Methods The presence of genotype-specific HPV DNA was evaluated using the Linear Array HPV Genotyping Test and the INNO-LiPA HPV Genotyping Assay in formalin-fixed paraffin embedded tissue from 148 invasive laryngeal cancer cases diagnosed in 1993–2004 within the catchment area of three U.S. SEER cancer registries. Results HPV DNA was detected in 31 of 148 (21%) invasive laryngeal cancers. Thirteen different genotypes were detected. Overall, HPV 16 and HPV 33 were the most commonly detected types. HPV was detected in 33% (9/27) of women compared with 18% (22/121) of men (p?=?0.08). After adjustment for age and year of diagnosis, female patients were more likely to have HPV-positive laryngeal tumors compared to males (adjusted OR 2.84, 95% CI 1.07–7.51). Viral genotype differences were also observed between the sexes. While HPV 16 and 18 constituted half of HPV-positive cases occurring in men, among women, only 1 was HPV 16 positive and none were positive for HPV 18. Overall 5-year survival did not vary by HPV status. Conclusions HPV may be involved in the development of a subset of laryngeal cancers and its role may be more predominant in women compared to men. PMID:25546150

Hernandez, Brenda Y.; Goodman, Marc T.; Lynch, Charles F.; Cozen, Wendy; Unger, Elizabeth R.; Steinau, Martin; Thompson, Trevor; Saber, Maria Sibug; Altekruse, Sean F.; Lyu, Christopher; Saraiya, Mona



Occupational exposure and laryngeal and hypopharyngeal cancer risk in central and eastern Europe  

SciTech Connect

A multicenter case-control study was conducted during 1999-2002 in four European countries (Poland, Romania, Russia, and Slovakia) to evaluate the role of occupational exposures in risk of laryngeal/hypopharyngeal cancer. Male cancer cases (34 hypopharyngeal, 316 laryngeal) with full data on occupational history and nonoccupational factors were compared with 728 hospital controls for occupational exposure to 73 suspected carcinogens. Occupational history was evaluated by industrial hygienists blinded to case/control status. Elevated risks for over exposure to coal dust were found for both hypopharyngeal (odds ratio (OR) = 4.19, 95% confidence interval (CI): 1.18, 14.89) and laryngeal (OR = 1.81, 95% CI: 0.94, 3.47) cancer, with clear dose-response patterns. Inclusion of a 20-year lag in the analysis strengthened these associations. Hypopharyngeal cancer risk was also significantly associated with exposure to mild steel dust (OR = 3.04, 95% CI: 1.39, 6.64) and iron compounds and fumes (OR = 2.74, 95% CI: 1.29, 5.84), without clear dose-response relations. Laryngeal cancer was significantly associated with exposure to hard-alloys dust (OR = 2.23, 95% CI: 1.08, 4.57) and chlorinated solvents (OR = 2.18, 95% CI: 1.03, 4.61), without dose-response relations. A possible link between high formaldehyde exposure and laryngeal cancer was suggested. These data indicate that occupational exposure to coal dust may play a role in laryngeal and hypopharyngeal cancer. Other possible relations need further evaluation.

Shangina, O.; Brennan, P.; Szeszenia-Dabrowska, N.; Mates, D.; Fabianova, E.; Fletcher, T.; Mannetje, A.; Boffetta, P.; Zaridze, D. [International Agency for Research Center, Lyon (France)



Biological characteristics of CD133+ cancer stem cells derived from human laryngeal carcinoma cell line  

PubMed Central

Objective: To investigate the in vitro invasive capability, clone-forming ability, resistance to anti-tumor treatments of CD133+ human laryngeal carcinoma stem cells, and characterize the related signaling pathways in these cells. Methods: Human laryngeal carcinoma Hep-2 cells were subjected to flow cytometry sorting to obtain CD133+ stem cells. Transwell chamber assay and clone-formation forming test were performed to evaluate the invasive capability and the clone-forming ability of CD133+ laryngeal carcinoma tumor stem cells, respectively. MTT assay was used to assess the resistance of CD133+ Hep-2 cells to radiotherapy and chemotherapy, respectively. Western blot and real-time PCR were applied to characterize the signaling pathways in these stem cells. Results: Our results from the transwell chamber assay indicated that the migrating capability of CD133+ Hep-2 cells was significantly higher than CD133- cells, and the invasive capability of CD133+ Hep-2 cells was also significantly elevated. Moreover, clone-formation forming test showed higher clone-forming ability for CD133+ Hep-2 cells, compared with CD133- cells. Furthermore, CD133+ Hep-2 cells displayed significant resistance to radiotherapy and chemotherapy. The Bcl-2/Bax ratio was increased, and Hedgehog, Wnt, and Bmi-l signaling pathways were all activated, in CD133+ laryngeal carcinoma stem cells, which might be involved in the self-renewal process of these stem cells. Conclusion: The invasive capability, clone-forming ability, and resistance to anti-tumor treatments are enhanced, and anti-apoptotic and proliferation-related signaling pathways are activated in CD133+ laryngeal carcinoma tumor stem cells. These findings might provide new insights into the prevention and/or treatment of laryngeal carcinoma, especially concerning target-oriented therapies. PMID:25356097

Wei, Xudong; Wang, Jingyu; He, Jian; Ma, Bingjuan; Chen, Jing



Effect of Dominant Hand Paralysis on Quality of Life in Patients With Subacute Stroke  

PubMed Central

Objective To evaluate the degree to which the paralysis of a dominant hand affects quality of life (QOL) in patients with subacute stroke. Methods We recruited 75 patients with subacute hemiplegic stroke. Patients were divided into two groups according to the location of the lesion and the side of the dominant hand. Group 1 consisted of patients whose strokes affected the dominant hand (i.e., right hemiplegia and right dominant hand or left hemiplegia and left dominant hand). Group 2 consisted of patients whose strokes affected the non-dominant hand (i.e., left hemiplegia and right dominant hand or right hemiplegia and left dominant hand). The primary outcome measure was the Short-Form 36-Item Health Survey (SF-36), which was used to evaluate health-related QOL. Secondary outcomes were scores on the Modified Barthel Index (MBI) and Beck Depression Inventory (BDI). Results We did not find any statistically significant differences between the groups in any SF-36 domain including the summaries of physical and mental component. Similarly, the MBI and BDI scores were not significantly different between the groups. Conclusion The effect of paralysis on the dominant hand and QOL in patients with subacute stroke was not significantly different from the effect of paralysis on the non-dominant hand. PMID:25229023

Nam, Hyeon Uk; Huh, Jin Seok; Yoo, Ji Na; Hwang, Jong Moon; Lee, Byung Joo; Min, Yu-Sun; Kim, Chul-Hyun



Novel mutations in human and mouse SCN4A implicate AMPK in myotonia and periodic paralysis.  


Mutations in the skeletal muscle channel (SCN4A), encoding the Nav1.4 voltage-gated sodium channel, are causative of a variety of muscle channelopathies, including non-dystrophic myotonias and periodic paralysis. The effects of many of these mutations on channel function have been characterized both in vitro and in vivo. However, little is known about the consequences of SCN4A mutations downstream from their impact on the electrophysiology of the Nav1.4 channel. Here we report the discovery of a novel SCN4A mutation (c.1762A>G; p.I588V) in a patient with myotonia and periodic paralysis, located within the S1 segment of the second domain of the Nav1.4 channel. Using N-ethyl-N-nitrosourea mutagenesis, we generated and characterized a mouse model (named draggen), carrying the equivalent point mutation (c.1744A>G; p.I582V) to that found in the patient with periodic paralysis and myotonia. Draggen mice have myotonia and suffer from intermittent hind-limb immobility attacks. In-depth characterization of draggen mice uncovered novel systemic metabolic abnormalities in Scn4a mouse models and provided novel insights into disease mechanisms. We discovered metabolic alterations leading to lean mice, as well as abnormal AMP-activated protein kinase activation, which were associated with the immobility attacks and may provide a novel potential therapeutic target. PMID:25348630

Corrochano, Silvia; Männikkö, Roope; Joyce, Peter I; McGoldrick, Philip; Wettstein, Jessica; Lassi, Glenda; Raja Rayan, Dipa L; Blanco, Gonzalo; Quinn, Colin; Liavas, Andrianos; Lionikas, Arimantas; Amior, Neta; Dick, James; Healy, Estelle G; Stewart, Michelle; Carter, Sarah; Hutchinson, Marie; Bentley, Liz; Fratta, Pietro; Cortese, Andrea; Cox, Roger; Brown, Steve D M; Tucci, Valter; Wackerhage, Henning; Amato, Anthony A; Greensmith, Linda; Koltzenburg, Martin; Hanna, Michael G; Acevedo-Arozena, Abraham



One explanatory basis for the discrepancy of reported prevalences of sleep paralysis among healthy respondents.  


In a previous study, the author and coworkers found 39.8% of healthy young adults had experienced sleep paralysis. Some other studies reported prevalence as about the same or higher (i.e., 40.7% to 62.0%) than that previous estimate, while yet other studies, including Goode's work cited by ASDC and ASDA classifications, suggested much lower prevalences (i.e., 4.7% to 26.2%). The author tested the hypothesis that this discrepancy among the reported prevalences is partly due to the expression used in each questionnaire. University students who answered the questionnaire using the term 'transient paralysis' reported the lower prevalence (26.4%), while the second group of respondents who answered the questionnaire using the term kanashibari, the Japanese folklore expression for sleep paralysis, gave the higher prevalence (39.3%). The third group who answered the questionnaire with the term 'condition,' probably a rather neutral expression, marked the middle (31.0%) of these. PMID:8284156

Fukuda, K



Novel mutations in human and mouse SCN4A implicate AMPK in myotonia and periodic paralysis  

PubMed Central

Mutations in the skeletal muscle channel (SCN4A), encoding the Nav1.4 voltage-gated sodium channel, are causative of a variety of muscle channelopathies, including non-dystrophic myotonias and periodic paralysis. The effects of many of these mutations on channel function have been characterized both in vitro and in vivo. However, little is known about the consequences of SCN4A mutations downstream from their impact on the electrophysiology of the Nav1.4 channel. Here we report the discovery of a novel SCN4A mutation (c.1762A>G; p.I588V) in a patient with myotonia and periodic paralysis, located within the S1 segment of the second domain of the Nav1.4 channel. Using N-ethyl-N-nitrosourea mutagenesis, we generated and characterized a mouse model (named draggen), carrying the equivalent point mutation (c.1744A>G; p.I582V) to that found in the patient with periodic paralysis and myotonia. Draggen mice have myotonia and suffer from intermittent hind-limb immobility attacks. In-depth characterization of draggen mice uncovered novel systemic metabolic abnormalities in Scn4a mouse models and provided novel insights into disease mechanisms. We discovered metabolic alterations leading to lean mice, as well as abnormal AMP-activated protein kinase activation, which were associated with the immobility attacks and may provide a novel potential therapeutic target. PMID:25348630

Corrochano, Silvia; Männikkö, Roope; Joyce, Peter I.; McGoldrick, Philip; Lassi, Glenda; Raja Rayan, Dipa L.; Blanco, Gonzalo; Quinn, Colin; Liavas, Andrianos; Lionikas, Arimantas; Amior, Neta; Dick, James; Healy, Estelle G.; Stewart, Michelle; Carter, Sarah; Hutchinson, Marie; Bentley, Liz; Fratta, Pietro; Cortese, Andrea; Cox, Roger; Brown, Steve D. M.; Tucci, Valter; Wackerhage, Henning; Amato, Anthony A.; Greensmith, Linda; Koltzenburg, Martin; Hanna, Michael G.; Acevedo-Arozena, Abraham



Prenatal Diagnosis and Pathology of Laryngeal Atresia in Congenital High Airway Obstruction Syndrome  

PubMed Central

Congenital high airway obstruction syndrome is a rare but life-threatening condition. Therefore, prenatal diagnosis is important. The obstruction can be due to laryngeal/tracheal atresia or external compression. While a differential diagnosis with congenital cystic adenomatoid malformation (CCAM) type III may be difficult, it is still possible with ultrasonography. In this study, we report a case of bilateral echogenic lungs with hydrops fetalis. After the prenatal diagnosis of laryngeal atresia, the couple opted to have an elective termination of pregnancy performed at 20 weeks of gestation. The diagnosis was confirmed by a complete pathological examination. PMID:23424705

Chaemsaithong, Piya; Chansoon, Tharintorn; Chanrachakul, Boonsri; Worawichawong, Suchin; Wongwaisayawan, Sansanee; Promsonthi, Patama



The Assessment Methods of Laryngeal Muscle Activity in Muscle Tension Dysphonia: A Review  

PubMed Central

The purpose of this paper is to review the methods used for the assessment of muscular tension dysphonia (MTD). The MTD is a functional voice disorder associated with abnormal laryngeal muscle activity. Various assessment methods are available in the literature to evaluate the laryngeal hyperfunction. The case history, laryngoscopy, and palpation are clinical methods for the assessment of patients with MTD. Radiography and surface electromyography (EMG) are objective methods to provide physiological information about MTD. Recent studies show that surface EMG can be an effective tool for assessing muscular tension in MTD. PMID:24319372

Khoddami, Seyyedeh Maryam; Nakhostin Ansari, Noureddin; Izadi, Farzad; Talebian Moghadam, Saeed



The assessment methods of laryngeal muscle activity in muscle tension dysphonia: a review.  


The purpose of this paper is to review the methods used for the assessment of muscular tension dysphonia (MTD). The MTD is a functional voice disorder associated with abnormal laryngeal muscle activity. Various assessment methods are available in the literature to evaluate the laryngeal hyperfunction. The case history, laryngoscopy, and palpation are clinical methods for the assessment of patients with MTD. Radiography and surface electromyography (EMG) are objective methods to provide physiological information about MTD. Recent studies show that surface EMG can be an effective tool for assessing muscular tension in MTD. PMID:24319372

Khoddami, Seyyedeh Maryam; Nakhostin Ansari, Noureddin; Izadi, Farzad; Talebian Moghadam, Saeed



Isosulfan Blue Dye Anaphylaxis Presenting as Impaired Ability to Ventilate via a Laryngeal Mask Airway.  


A 44-year-old woman presented for sentinel node biopsy and segmental mastectomy. After anesthetic induction, a laryngeal mask airway was placed, and ventilation was satisfactory. Three minutes after isosulfan blue dye injection, ventilation became difficult. The laryngeal mask airway was removed, and an endotracheal tube was easily placed. Twenty minutes later, she became hypotensive and unresponsive to phenylephrine, ephedrine, and vasopressin. With erythema and swelling in her arm and chest, low-dose epinephrine was titrated until her mean arterial blood pressure stabilized. Serum tryptase was increased to 27.2 ?g/L (normal 0.4-10.9 ?g/L). PMID:25612264

Reed, Heather; Shaw, Christiana; Rice, Mark; Le, Huong Thi



Occipital nerve stimulation.  


Occipital nerve stimulation (ONS) is a form of neuromodulation therapy aimed at treating intractable headache and craniofacial pain. The therapy utilizes neurostimulating electrodes placed subcutaneously in the occipital region and connected to a permanently implanted programmable pulse generator identical to those used for dorsal column/spinal cord stimulation. The presumed mechanisms of action involve modulation of the trigeminocervical complex, as well as closure of the physiologic pain gate. ONS is a reversible, nondestructive therapy, which can be tailored to a patient's individual needs. Typically, candidates for successful ONS include those patients with migraines, Chiari malformation, or occipital neuralgia. However, recent MRSA infections, unrealistic expectations, and psychiatric comorbidities are generally contraindications. As with any invasive procedure, complications may occur including lead migration, infection, wound erosion, device failure, muscle spasms, and pain. The success of this therapy is dependent on careful patient selection, a preimplantation trial, meticulous implantation technique, programming strategies, and complication avoidance. PMID:25411143

Mammis, Antonios; Agarwal, Nitin; Mogilner, Alon Y



Peripheral nerve fibromyxoid sarcoma.  


Low-grade fibromyxoid sarcoma (LGFMS) is a rare soft-tissue neoplasm with metastatic potential and needs to be recognized as such, because it can be mistaken for other types of sarcoma due to its unremarkable appearance. This 49-year-old man presented with an approximately 5-cm mass on the anteromedial aspect of his left thigh that slowly increased over 10 years. Clinical symptoms were limited to local discomfort and intermittent distal numbness. Due to the location, imaging findings, and lack of serious symptoms, the initial differential diagnosis favored a schwannoma. An initial biopsy revealed histopathological findings consistent with a perineurioma, although with atypical features. The patient elected to have the mass excised, and the tumor, which arose from a branch of the saphenous nerve, could be separated well from the surrounding soft tissue. Histopathological investigation of the mass displayed characteristic features of a fibromyxoid sarcoma, which was confirmed by subsequent fluorescence in situ hybridization analysis. Due to concerns about infiltration beyond the margins, radical reexcision was advocated and performed, resulting in definite clear surgical margins. At follow-up, the patient had regained full strength with no residual neurological symptoms or any new deficits. He has since been healthy and disease free for a total of 4 years in follow-up. This case documents, to the authors' knowledge, the first observation of an LGFMS associated with a peripheral nerve. It also supports the use of fluorescence in situ hybridization analysis as an essential diagnostic method in establishing the diagnosis of LGFMS. PMID:24766104

Alter, Raanan Y; Wamsley, Christina C; Mullen, John T; Haile, Winta Z; Goldsmith, Jeffrey D; Kasper, Ekkehard M



Peripheral nerve injury of various types, for example complete nerve transection or loose nerve constrictions (Bennett model), results in  

E-print Network

Summary Peripheral nerve injury of various types, for example complete nerve transection or loose-protein-coupled receptors, ion channels, enzymes, and other types of molecules. Peripheral nerve injuries are often transmission. It has been postulated that nerve injury causes sprouting of large-diameter primary afferents

Sandini, Giulio


Nanofibrous nerve conduit-enhanced peripheral nerve regeneration.  


Fibre structures represent a potential class of materials for the formation of synthetic nerve conduits due to their biomimicking architecture. Although the advantages of fibres in enhancing nerve regeneration have been demonstrated, in vivo evaluation of fibre size effect on nerve regeneration remains limited. In this study, we analyzed the effects of fibre diameter of electrospun conduits on peripheral nerve regeneration across a 15-mm critical defect gap in a rat sciatic nerve injury model. By using an electrospinning technique, fibrous conduits comprised of aligned electrospun poly (?-caprolactone) (PCL) microfibers (981?±?83 nm, Microfiber) or nanofibers (251?±?32 nm, Nanofiber) were obtained. At three months post implantation, axons regenerated across the defect gap in all animals that received fibrous conduits. In contrast, complete nerve regeneration was not observed in the control group that received empty, non-porous PCL film conduits (Film). Nanofiber conduits resulted in significantly higher total number of myelinated axons and thicker myelin sheaths compared to Microfiber and Film conduits. Retrograde labeling revealed a significant increase in number of regenerated dorsal root ganglion sensory neurons in the presence of Nanofiber conduits (1.93 ± 0.71 × 10(3) vs. 0.98 ± 0.30 × 10(3) in Microfiber, p?nerve regeneration. These results could provide useful insights for future nerve guide designs. PMID:22700359

Jiang, Xu; Mi, Ruifa; Hoke, Ahmet; Chew, Sing Yian



Multiple schwannomas of the sciatic nerve  

Microsoft Academic Search

Schwannomas are rare benign tumours of nerve sheath cells of neural crest origin. Often these tumours are solitary and encapsulated. Multiple schwannomas can arise from the peripheral nervous system including cranial nerves, spinal roots, the brachial and lumbar–sacral plexus or major peripheral nerves. We report an extremely rare case of schwannomatosis of the sciatic nerve in a young female and

J. Huang; R. Mobbs; C. Teo



Endometriotic lesions of the lower troncular nerves.  


Although exceptional, endometriotic lesions of the troncular nerves of the lower limb may occur and are often diagnosed with delay. We report, hereby, the first case of femoral nerve endometriosis the treatment of which consisted of radical resection with femoral nerve transplant. We completed a review of the literature on sciatic nerve endometriotic lesions and discussed the physiopathology and surgical treatment. PMID:25267476

Niro, J; Fournier, M; Oberlin, C; Le Tohic, A; Panel, P



A Randomized Crossover Comparison of the Size 2?? Laryngeal Mask Airway ProSeal??? Versus Laryngeal Mask Airway-Classic??? in Pediatric Patients  

Microsoft Academic Search

The laryngeal mask airway (LMA)-ProSeal™ (P-LMA) forms a more effective seal than the LMA-Classic™ (C- LMA) and facilitates gastric tube (g-tube) placement in adults. The first pediatric sizes of P-LMA recently became available. In 30 anesthetized, nonparalyzed children, aged 7.7 2 yr and weighing 27 (20-35) kg, we inserted the size 21Ú2 P-LMA and C-LMA in random order. Ease of

Kai Goldmann; Christian Jakob



Regeneration of perivascular adrenergic innervation in rat tibial nerve after nerve crush  

Microsoft Academic Search

Adrenergic innervation of blood vessels in the rat tibial nerve during degeneration and regeneration was studied using the formaldehyde-induced fluorescence method. The left sciatic nerve was crushed with suture threads to produce a 4-mm length of crushed nerve. At 1, 3, 7, 14, 28, 56 and 84 days after nerve crush, degenerative and regenerative changes in the nerve were verified

J. Koistinaho; K. C. Wadhwani; A. Balbo; S. I. Rapoport



Video-Gait Analysis of Functional Recovery of Nerve Repaired with Chitosan Nerve Guides  

E-print Network

Video-Gait Analysis of Functional Recovery of Nerve Repaired with Chitosan Nerve Guides MINAL PATEL assessment of functional sciatic nerve recovery treated with chitosan nerve guides. We used video to functional nerve recovery. The chitosan group showed increased functional improvement compared to the control

VandeVord, Pamela


Spectrum of optic nerve hypoplasia.  

PubMed Central

Optic nerve hypoplasia is a non-progressive condition characterised by subnormal vision and a subnormal number of optic nerve axons. It may be unilateral or bilateral, isolated or combined with other defects. Analysis of fundus photographs from a series of 7 patients with a stationary abnormality of different degrees showed that the functional defects could be closely correlated with defects in the retinal nerve fibre layer. Our observations show that the condition has a wide range of both functional and anatomical defects and that a subnormal diameter of the optic disc is not a requisite for the diagnosis. Presumably, there is also a wide variety of causes, not only a primary failure of development of retinal ganglion cells. We suggest that optic nerve hypoplasia can be viewed as a non-specific manifestation of damage to the visual system, sustained any time before its full development. Images PMID:629914

Frisén, L.; Holmegaard, L.



Ion Channels in Nerve Membranes  

ERIC Educational Resources Information Center

Discusses research that indicates that nerve membranes, which play a key role in the conduction of impulses, are traversed by protein channels with ion pathways opened and closed by the membrane electric field. (Author/MLH)

Ehrenstein, Gerald



Overview of Optic Nerve Disorders  


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Complications associated with removal of the laryngeal mask airway: a comparison of removal in deeply anaesthetised versus awake patients.  


The purpose of the study was to compare the incidence of complications (coughing, biting, retching, vomiting, excessive salivation and airway obstruction) associated with removal of the laryngeal mask airway. The laryngeal mask airway was used in 100 adults undergoing urological procedures. The patients were randomly assigned to two groups. In 50 patients the laryngeal mask was removed by a nurse when the patient responded to commands in the recovery area. In the other 50 patients it was removed by the anaesthetist with the patient deeply anaesthetized in theatre. The majority of patients were elderly men who had relatively short procedures. The incidence of gastric regurgitation was assessed by measurement of pH of secretions at the tip of the laryngeal mask airway. Complications occurred more frequently in the awake patients (P < 0.01). Most were minor and occurred before removal of the laryngeal mask airway during emergence in the recovery room. Airway obstruction occurred in three patients in whom the laryngeal mask was removed in the recovery room. In two of these patients the oxygen saturation decreased below 80% and the other to 90%. No decrease in arterial oxygenation occurred in the anaesthetised patients in whom the laryngeal mask was removed by the anaesthetist. In 14 patients in the awake group the pH of secretions at the tip of the laryngeal mask was < or = 3 compared with only four patients in the anaesthetised group (P < 0.05). It is concluded that it may be safer to remove the laryngeal mask airway whilst the patients are deeply anaesthetised in the operating room than when they are awake in the recovery room. PMID:8595687

Gataure, P S; Latto, I P; Rust, S



The Composition of Microbiome in Larynx and the Throat Biodiversity between Laryngeal Squamous Cell Carcinoma Patients and Control Population  

PubMed Central

The throat is an ecological assemblage involved human cells and microbiota, and the colonizing bacteria are important factors in balancing this environment. However, this bacterial community profile has thus been poorly investigated. The purpose of this study was to investigate the microbial biology of the larynx and to analyze the throat biodiversity in laryngeal carcinoma patients compared to a control population in a case-control study. Barcoded pyrosequencing analysis of the 16S rRNA gene was used. We collected tissue samples from 29 patients with laryngeal carcinoma and 31 control patients with vocal cord polyps. The findings of high-quality sequence datasets revealed 218 genera from 13 phyla in the laryngeal mucosa. The predominant communities of phyla in the larynx were Firmicutes (54%), Fusobacteria (17%), Bacteroidetes (15%), Proteobacteria (11%), and Actinobacteria (3%). The leading genera were Streptococcus (36%), Fusobacterium (15%), Prevotella (12%), Neisseria (6%), and Gemella (4%). The throat bacterial compositions were highly different between laryngeal carcinoma subjects and control population (p?=?0.006). The abundance of the 26 genera was significantly different between the laryngeal cancer and control groups by metastats analysis (p<0.05). Fifteen genera may be associated with laryngeal carcinoma by partial least squares discriminant analysis (p<0.001). In summary, this study revealed the microbiota profiles in laryngeal mucosa from tissue specimens. The compositions of bacteria community in throat were different between laryngeal cancer patients and controls, and probably were related with this carcinoma. The disruption of this bio-ecological niche might be a risk factor for laryngeal carcinoma. PMID:23824228

Gong, Hong-Li; Shi, Yi; Zhou, Liang; Wu, Chun-Ping; Cao, Peng-Yu; Tao, Lei; Xu, Chen; Hou, Dong-Sheng; Wang, Yue-Zhu



Array CGH analysis of the rare laryngeal basaloid squamous cell carcinoma - a case report  

PubMed Central

The aim of this study was to define copy number alterations in a rare laryngeal type basaloid squamous cell carcinoma (laryngeal BSCC) using high throughput array comparative genomic hybridization. This is the first genome wide screening of a laryngeal BSCC describing the unique events of DNA copy number changes. By Nimble-Gen Whole Genome Tiling Array CGH (consisting of 72,000 probes) we were able to identify 3,777 genes altered by copy number changes (1,726 genes with copy number gains and 2,051 genes with copy number with losses). The resolution of the array allowed us to identify a new alteration at the 17q21.31 region covering the DUSP3 gene which encodes the dual-specific protein phosphatase. Functional studies of the altered genes (Database for Annotation, Visualization and Integrated Discovery v6.7 analysis) highlighted molecular pathways including chemokine signaling, cell cycle, adherent junction-, VEGF- and TGF-beta signaling pathways that might be disrupted by copy number alterations in laryngeal BSCC. PMID:23071866

Ecsedi, Szilvia; Tóth, László; Balázs, Margit



The role of contact endoscopy in screening for premalignant laryngeal lesions: a study of 141 patients.  


At their earliest stage, pathologic lesions of the laryngeal epithelium are macroscopically invisible. Ideally, these lesions should be detected before their clinical manifestations appear so that prompt management can be initiated. However, most diagnostic modalities are unable to detect early premalignant lesions. We conducted a retrospective study of the use of contact endoscopy in analyzing the vocal fold mucosal epithelium in adults who had been operated on at our hospital under general anesthesia for various nonlaryngeal diseases. After we identified 71 such patients who were smokers, we chose an almost equal number of nonsmokers (n = 70) for comparison purposes. In all, our study population was made up of 141 patients--51 men and 90 women, aged 21 to 78 years (mean: 52). All patients had normal findings on preoperative laryngeal endoscopy. Our goal was to determine if the routine use of this diagnostic modality is justified in selected cases. Contact endoscopy identified dysplastic vocal fold lesions in 4 patients and chronic laryngitis in 3; all 7 of these patients were smokers. Since early laryngeal lesions are not macroscopically evident, early detection of these changes by other means is associated with a better prognosis and easier management. Our study demonstrates that the use of contact endoscopy during general anesthesia as a standard diagnostic method in long-time cigarette smokers is fully justified. PMID:24817233

Klan?nik, Marisa; Glun?i?, Ivo; Cikojevi?, Draško



The Laryngeal Mask Airway: A New Standard for Airway Evaluation in Thoracic Surgery  

Microsoft Academic Search

Background. Thoracic surgeons typically perform fiberoptic bronchoscopy (FOB) before thoracotomy, usually on the day of the operation after intubation with a single-lumen endotracheal tube (ETT) and before insertion of a double-lumen ETT. This routine requires two laryngoscopies and two intubations. The laryngeal mask airway (LMA) is an airway device developed in England and approved by the Food and Drug Administration

David Z Ferson; Jonathan C Nesbitt; Kimberly Kenfield Nesbitt; Garrett L Walsh; Joe B Putnam; David S Schrump; Mary J Johansen; Robert L Jones; Jack A Roth



Effects of Masking Noise on Laryngeal Resistance for Breathy, Normal, and Pressed Voice  

ERIC Educational Resources Information Center

Purpose: The purpose of the present study was to explore the effects of masking noise on laryngeal resistance for breathy, normal, and pressed voice in vocally trained women. Method: Eighteen vocally trained women produced breathy, normal, and pressed voice across 7 fundamental frequencies during a repeated CV utterance of /pi/ under normal and…

Grillo, Elizabeth U.; Abbott, Katherine Verdolini; Lee, Timothy D.



Intensity and Inhalation of Smoking in the Aetiology of Laryngeal Cancer  

PubMed Central

The carcinogenic effect of smoking on laryngeal cancer is well established; however, the risk pattern for detailed smoking characteristics is less clear. Thus, the aim of this analysis was to quantify the impact of different inhalation behaviours on the risk of laryngeal cancer. We conducted a population-based case control study in Germany, frequency-matched for sex and age, using a standardized questionnaire covering lifelong smoking details, including age at start, time since quitting, types of smoking products, duration, intensity and inhalation behaviour. We found higher risks for increasing duration and intensity of smoking. A clear dose-response relationship was found in all inhalation subgroups, i.e., not only for deep inhalers, but also for those puffing on a cigarette. Clearly reduced risks could be observed for quitting smoking. Changing inhalation habits might be considered as a first step to reducing the risk of developing laryngeal cancer. However, the best way to effectively reduce laryngeal cancer risk is to quit smoking. PMID:21695025

Ramroth, Heribert; Dietz, Andreas; Becher, Heiko



Molecular markers in laryngeal squamous cell carcinoma: towards an integrated clinicobiological approach.  


Of the most frequent malignancies in the United States, cancers of the larynx and of the uterine corpus are the only ones not to show an increase in 5-year survival rates over the last 30 years. The increasing use of chemo- and radiotherapy and conservative surgery to preserve organs and their functions has probably led to a better quality of life in patients with laryngeal cancer, but has definitely failed to improve survival, which remains the primary aim. In our opinion, to reduce laryngeal cancer-related mortality, a change in clinical approach is required. We have reviewed the literature on the potential role of molecular markers in the clinical management of laryngeal cancer. We believe that some of the most significant biological markers might be integrated with the evaluation of behavioural risk factors, clinical TNM staging and histopathological grading for a novel clinicomolecular approach to laryngeal cancer. We foresee the use of the most promising biological markers in the phases of prevention, diagnosis, prognostic assessment and drug design. PMID:15763643

Almadori, Giovanni; Bussu, Francesco; Cadoni, Gabriella; Galli, Jacopo; Paludetti, Gaetano; Maurizi, Maurizio



Quantitative Lingual, Pharyngeal and Laryngeal Ultrasonography in Swallowing Research: A Technical Review  

ERIC Educational Resources Information Center

Because of its distinct advantage in radiation-free soft tissue imaging, ultrasonography has been widely used to study lingual, pharyngeal, hyoid, laryngeal, and even esophageal action during swallowing in individuals of all ages. Qualitative ultrasonographic observations have made considerable contributions to our understanding of deglutition.…

Chi-Fishman, Gloria



Aerodynamic and Acoustic Effects of Abrupt Frequency Changes in Excised Larynges  

ERIC Educational Resources Information Center

Purpose: To determine the aerodynamic and acoustic effects due to a sudden change from chest to falsetto register or vice versa. It was hypothesized that the continuous change in subglottal pressure and flow rate alone (pressure-flow sweep [PFS]) can trigger a mode change in the canine larynx. Method: Ten canine larynges were each mounted over a…

Alipour, Fariborz; Finnegan, Eileen M.; Scherer, Ronald C.



Videofiberoptic Laryngeal Data and Acoustic Analysis of the O rnamentations used in Mongolian Long Song  

E-print Network

) "lyrical" vibratos mobilizing the entire laryngeal block; (2) "Mongolian" trills with essentially modulations/s); (2) for the "Mongolian" trill: the fundamental frequency and the intensity were in opposite" trill. Claire Pillot-Loiseau, PhD, Assistant Professor, Phonetics, Speech Therapist, Phonetics

Boyer, Edmond


Analogy between Laryngeal Gesture in Mongolian "Long Song" and Supracricoid Partial Laryngectomy  

ERIC Educational Resources Information Center

This article reports the results of a multiparametrical analysis of "Mongolian Long Song," characterised by multiple ornamentation and shows the similarities between the laryngeal behaviour observed during these ornamentations and the compensatory gesture produced by patients after supracricoid partial laryngectomy. This study includes (1) a…

Crevier-Buchman, Lise; Pillot-Loiseau, Claire; Rialland, Annie; Narantuya; Vincent, Coralie; Desjacques, Alain



Quantitative Study of Vibrational Symmetry of Injured Vocal Folds via Digital Kymography in Excised Canine Larynges  

ERIC Educational Resources Information Center

Purpose: Digital kymography and vocal fold curve fitting are blended with detailed symmetry analysis of kymograms to provide a comprehensive characterization of the vibratory properties of injured vocal folds. Method: Vocal fold vibration of 12 excised canine larynges was recorded under uninjured, unilaterally injured, and bilaterally injured…

Krausert, Christopher R.; Ying, Di; Zhang, Yu; Jiang, Jack J.



Lingual Ischemia from Prolonged Insertion of a Fastrach Laryngeal Mask Airway  

PubMed Central

We report a case of lingual ischemia and swelling in an elderly stroke patient from prolonged insertion of a FastrachTM Laryngeal Mask Airway ® following a failed Emergency Department intubation. Simple suggestions to mitigate such injury are provided. PMID:21691488

Gerstein, Neal S.; Braude, Darren; Harding, James S.; Douglas, Angela



Comorbid occurrence of laryngeal or pulmonary disease with esophagitis in United States military veterans  

Microsoft Academic Search

BACKGROUND & AIMS: It has been speculated that gastroesophageal reflux disease (GERD) represents a risk factor for the occurrence of extraesophageal complications. The aim of this study was to compare the comorbid occurrence of sinus, laryngeal, and pulmonary diseases in case subjects with and control subjects without reflux esophagitis. METHODS: The case population consisted of all patients with erosive esophagitis

HB el-Serag; A Sonnenberg



Effect of stroke location on the laryngeal cough reflex and pneumonia risk  

Microsoft Academic Search

BACKGROUND: The purpose of this study was to evaluate the risk of developing pneumonia in acute stroke patients comparing the early anatomical stroke location and laryngeal cough reflex (LCR) testing. METHODS: A prospective study of 818 consecutive acute stroke patients utilizing a reflex cough test (RCT), which assesses the neurological status of the LCR compared to magnetic resonance imaging or

W Robert Addington; Robert E Stephens; John G Widdicombe; Kamel Rekab



Nebulized Isotonic Saline versus Water following a Laryngeal Desiccation Challenge in Classically Trained Sopranos  

ERIC Educational Resources Information Center

Purpose: To examine the effects of nebulized isotonic saline (IS) versus sterile water (SW) on self-perceived phonatory effort (PPE) and phonation threshold pressure (PTP) following a surface laryngeal dehydration challenge in classically trained sopranos. Method: In a double-blind, within-subject crossover design, 34 sopranos breathed dry air…

Tanner, Kristine; Roy, Nelson; Merrill, Ray M.; Muntz, Faye; Houtz, Daniel R.; Sauder, Cara; Elstad, Mark; Wright-Costa, Julie



Emergency use of the laryngeal mask airway in severe upper airway obstruction caused by supraglottic oedema  

Microsoft Academic Search

Summary We report two cases of severe upper airway obstruction caused by supraglottic oedema which developed rapidly at the time of anaesthesia. Conventional methods to relieve the obstruction failed and it was only overcome when a laryngeal mask airway (LMA) was inserted and positive pressure applied manually during inspiration. In one case a fibrescope was passed via the LMA and




Tea Intake and Risk of Oral, Pharyngeal, and Laryngeal Carcinoma: A Meta-Analysis  

PubMed Central

Background The association between tea intake and risk of oral, pharyngeal, and laryngeal carcinoma is still unclear. The aim of this meta-analysis was to quantify the effect of tea consumption on the incidence of oral, pharyngeal, and laryngeal cancer to provide a better understanding on this issue. Material/Methods A literature search was conducted before January 2014 in MEDLINE and EMBASE databases. The relative risk (RR) estimates that extracted or calculated from all included studies were combined together. Given the existing heterogeneity in the study design and data source, a random-effects model was obtained. Results A total of 20 articles were included in the quantitative synthesis. Fourteen RR estimates (11 from case-control studies and 3 from cohort studies) were pooled together and the result demonstrated that tea consumption reduced the incidence of oral cancer (RR=0.85; 95% CI 0.76–0.96). The summary RR of 4 observational studies (3 case-control studies and 1 cohort study) for pharyngeal cancer was 0.87 (95% CI 0.74–1.04). The association between tea consumption and oral and pharyngeal carcinoma was reported. The summary RR for laryngeal carcinoma was 1.05 (95% CI 0.70–1.57). The Begg’s funnel plot and the Egger’s test showed no evidence of publication bias. Conclusions Tea consumption was associated with decreased risk of oral cancer, while no association was detected with oral/pharyngeal, pharyngeal, or laryngeal cancer. PMID:25363316

Zhang, Wendong; Geng, Tao; Han, Wenfei; Dou, Huiqin



Low Phosphorylated AKT Expression in Laryngeal Cancer: Indications for a Higher Metastatic Risk  

SciTech Connect

Purpose: To validate the association of phosphorylated (p)AKT with lymph node metastasis in an independent, homogeneous cohort of patients with larynx cancer. Methods and Materials: Seventy-eight patients with laryngeal cancer were included. Epidermal growth factor receptor, pAKT, vimentin, E-cadherin, hypoxia, and blood vessels were visualized in biopsy material using immunohistochemistry. Positive tumor areas and spatial relationships between markers were assessed by automated image analysis. In 6 laryngeal cancer cell lines, E-cadherin and vimentin messenger RNA was quantified by real-time polymerase chain reaction and by immunohistochemistry before and after treatment with the pAKT inhibitor MK-2206. Results: A significant correlation was found between low pAKT in the primary tumor and positive lymph node status (P=.0005). Tumors with lymph node metastases had an approximately 10-fold lower median pAKT value compared with tumors without lymph node metastases, albeit with large intertumor variations, validating our previous results. After inhibition of pAKT in laryngeal cancer cells with MK-2206, up-regulation of vimentin and a downregulation of E-cadherin occurred, consistent with epithelial–mesenchymal transition. Conclusion: Low pAKT expression in larynx tumors is associated with lymph node metastases. Further, inhibition of pAKT in laryngeal cancer induces epithelial–mesenchymal transition, predisposing for an increased metastatic risk.

Nijkamp, Monique M.; Span, Paul N.; Stegeman, Hanneke [Department of Radiation Oncology, Radboud University Nijmegen Medical Center, Nijmegen (Netherlands); Grénman, Reidar [Departments of Otorhinolaryngology-Head-and-Neck-Surgery and Medical Biochemistry, Turku University Hospital and University of Turku, Turku (Finland); Kaanders, Johannes H.A.M. [Department of Radiation Oncology, Radboud University Nijmegen Medical Center, Nijmegen (Netherlands); Bussink, Johan, E-mail: [Department of Radiation Oncology, Radboud University Nijmegen Medical Center, Nijmegen (Netherlands)



“Mouth to mouth ventilation”: A comparison of the laryngeal mask airway with the Laerdal Pocket Facemask  

Microsoft Academic Search

Ten nurses with basic airway management experience were formally trained to use a classic laryngeal mask airway (LMA) and a Laerdal Pocket Facemask (LPFM) for oxygen enriched expired air ventilation (EEAV). They then used both of these devices for EEAV in a randomised fashion in 100 anaesthetised ASA I\\/II patients for elective surgery. EEAV was considered successful if the patient's

R. Alexander; J. P. Chinery; H. Swales; D. Sutton



Airway management training using the laryngeal mask airway: a comparison of two different training programmes  

Microsoft Academic Search

Nurses without prior experience in the use of the laryngeal mask airway (LMA) were randomly allocated to one of two groups to be trained in the emergency technique of insertion of an LMA. Group A (32 nurses) were trained only on a manikin and group B (20 nurses) were trained on a manikin and with live anaesthetised patient practice in

I. Roberts; P. Allsop; M. Dickinson; P. Curry; P. Eastwick-Field; G. Eyre



Coordination of Oral and Laryngeal Movements in the Perceptually Fluent Speech of Adults Who Stutter  

ERIC Educational Resources Information Center

This work investigated whether stuttering and nonstuttering adults differ in the coordination of oral and laryngeal movements during the production of perceptually fluent speech. This question was addressed by completing correlation analyses that extended previous acoustic studies by others as well as inferential analyses based on the…

Max, Ludo; Gracco, Vincent L.



Estrogen and Laryngeal Synaptic Strength in Xenopus laevis: Opposite Effects of Acute and Chronic Exposure  

Microsoft Academic Search

Synaptic transmission at the vocal synapse, the laryngeal neuromuscular junction, of Xenopus laevis has been shown to be regulated by long-term changes in circulating estrogen. In females, high levels of circulating estrogen also accompany gonadotropin-induced ovulation and oviposition and the switch from sexually unreceptive to receptive states, including changes in vocal behaviors (ticking to rapping). Here we examine the effects

Kwok Hang Wu; Martha L. Tobias; Darcy B. Kelley



A Generalized Net, Description for Laryngeal Pathology Detection Excluding the Refusal from Classification Option*  

E-print Network

classification scheme excluding the refusal option have been modelled by generalized nets. 2. The model Below we2 7 A Generalized Net, Description for Laryngeal Pathology Detection Excluding the Refusal from Classification Option* Stefan Hadjitodorov1 , Petar Mitev1 , Krassimir Atanassov1 , Georgi Gluhchev2 , Vassil

Borissova, Daniela


Nerve conduction during Wallerian degeneration in the baboon  

Microsoft Academic Search

Conduction in the lateral popliteal nerve of the baboon was studied during the course of Wallerian degeneration. Six nerves were examined. In each case the muscle response to nerve stimulation and the ascending nerve action potential were recorded daily until the nerve became inexcitable. The muscle response to nerve stimulation disappeared after four to five days, but ascending nerve action

R. W. Gilliatt; R. J. Hjorth



Optic Nerve Monitoring  

PubMed Central

Orbital and anterior skull base surgery is generally performed close to the prechiasmatic visual pathway, and clear strategies for detecting and handling visual pathway damage are essential. To overcome the common problem of a missed clinical examination because of an uncooperative or unresponsive patient, flash visual evoked potentials and electroretinograms should be used. These electrophysiologic examination techniques can provide evidence of intact, pathologic, or absent conductivity of the visual pathway when clinical assessment is not feasible. Visual evoked potentials and electroretinograms are thus essential diagnostic procedures not only for primary diagnosis but also for intraoperative evaluation. A decision for or against treatment of a visual pathway injury has to be made as fast as possible due to the enormous importance of the time elapsed with such injuries; this can be achieved additionally using multislice spiral computed tomography. The first-line conservative treatment of choice for such injuries is megadose methylprednisolone therapy. Surgery is used to decompress the orbital compartment by exposure of the intracanalicular part of the optic nerve in the case of optic canal compression. Modern craniomaxillofacial surgery requires detailed consideration of the diagnosis and treatment of traumatic visual pathway damage with the ultimate goal of preserving visual acuity. PMID:24436741

Schumann, Paul; Kokemüller, Horst; Tavassol, Frank; Lindhorst, Daniel; Lemound, Juliana; Essig, Harald; Rücker, Martin; Gellrich, Nils-Claudius



Vocal power and pressure–flow relationships in excised tiger larynges  

PubMed Central

Despite the functional importance of loud, low-pitched vocalizations in big cats of the genus Panthera, little is known about the physics and physiology of the mechanisms producing such calls. We investigated laryngeal sound production in the laboratory using an excised-larynx setup combined with sound-level measurements and pressure–flow instrumentation. The larynges of five tigers (three Siberian or Amur, one generic non-pedigreed tiger with Bengal ancestry and one Sumatran), which had died of natural causes, were provided by Omaha's Henry Doorly Zoo over a five-year period. Anatomical investigation indicated the presence of both a rigid cartilaginous plate in the arytenoid portion of the glottis, and a vocal fold fused with a ventricular fold. Both of these features have been confusingly termed ‘vocal pads’ in the previous literature. We successfully induced phonation in all of these larynges. Our results showed that aerodynamic power in the glottis was of the order of 1.0 W for all specimens, acoustic power radiated (without a vocal tract) was of the order of 0.1 mW, and fundamental frequency ranged between 20 and 100 Hz when a lung pressure in the range of 0–2.0 kPa was applied. The mean glottal airflow increased to the order of 1.0 l s–1 per 1.0 kPa of pressure, which is predictable from scaling human and canine larynges by glottal length and vibrational amplitude. Phonation threshold pressure was remarkably low, on the order of 0.3 kPa, which is lower than for human and canine larynges phonated without a vocal tract. Our results indicate that a vocal fold length approximately three times greater than that of humans is predictive of the low fundamental frequency, and the extraordinarily flat and broad medial surface of the vocal folds is predictive of the low phonation threshold pressure. PMID:21037066

Titze, Ingo R.; Fitch, W. Tecumseh; Hunter, Eric J.; Alipour, Fariborz; Montequin, Douglas; Armstrong, Douglas L.; McGee, JoAnn; Walsh, Edward J.



Micro-ribonucleic acid expression profiling and bioinformatic target gene analyses in laryngeal carcinoma.  


Abnormal expression of micro-ribonucleic acid (miRNA) might be clinically valuable as a biomarker or treatment target in the early diagnosis, treatment, and prognosis of tumors. However, little is known concerning abnormal miRNA expression of laryngeal carcinoma, one of the most commonly encountered head and neck tumors. Microarray analysis was used to obtain miRNA-expression profiles of ten pairs of freshly frozen laryngeal carcinoma tissue and surrounding normal tissue specimens. Characteristic miRNAs that were significantly related to laryngeal carcinoma were identified. Verification was performed using an additional 32 pairs of samples. The expression of two miRNAs (miR-21-3p and miR-106b-3p) was upregulated in both microarray and quantitative real-time polymerase chain-reaction analyses, whereas the expression of six miRNAs (let-7f-5p, miR-10a-5p, miR-125a-5p, miR-144-3p, miR-195-5p, and miR-203) was downregulated. The decreased expression of let-7f-5p and miR-195-5p is a novel finding in head and neck cancer. The target genes of these miRNAs were also predicted through multiple software programs. The differential expression of miRNAs might be related to the early onset and development of laryngeal carcinoma, and may be exploited as new biomarkers and therapeutic targets in the treatment of laryngeal carcinoma. PMID:24741319

Lu, Zhong-Ming; Lin, Ye-Feng; Jiang, Li; Chen, Liang-Si; Luo, Xiao-Ning; Song, Xin-Han; Chen, Shao-Hua; Zhang, Si-Yi



Vocal power and pressure-flow relationships in excised tiger larynges.  


Despite the functional importance of loud, low-pitched vocalizations in big cats of the genus Panthera, little is known about the physics and physiology of the mechanisms producing such calls. We investigated laryngeal sound production in the laboratory using an excised-larynx setup combined with sound-level measurements and pressure-flow instrumentation. The larynges of five tigers (three Siberian or Amur, one generic non-pedigreed tiger with Bengal ancestry and one Sumatran), which had died of natural causes, were provided by Omaha's Henry Doorly Zoo over a five-year period. Anatomical investigation indicated the presence of both a rigid cartilaginous plate in the arytenoid portion of the glottis, and a vocal fold fused with a ventricular fold. Both of these features have been confusingly termed 'vocal pads' in the previous literature. We successfully induced phonation in all of these larynges. Our results showed that aerodynamic power in the glottis was of the order of 1.0 W for all specimens, acoustic power radiated (without a vocal tract) was of the order of 0.1 mW, and fundamental frequency ranged between 20 and 100 Hz when a lung pressure in the range of 0-2.0 kPa was applied. The mean glottal airflow increased to the order of 1.0 l s(-1) per 1.0 kPa of pressure, which is predictable from scaling human and canine larynges by glottal length and vibrational amplitude. Phonation threshold pressure was remarkably low, on the order of 0.3 kPa, which is lower than for human and canine larynges phonated without a vocal tract. Our results indicate that a vocal fold length approximately three times greater than that of humans is predictive of the low fundamental frequency, and the extraordinarily flat and broad medial surface of the vocal folds is predictive of the low phonation threshold pressure. PMID:21037066

Titze, Ingo R; Fitch, W Tecumseh; Hunter, Eric J; Alipour, Fariborz; Montequin, Douglas; Armstrong, Douglas L; McGee, Joann; Walsh, Edward J



Reversible paralysis of Schistosoma mansoni by forchlorfenuron, a phenylurea cytokinin that affects septins.  


Septins are guanosine-5'-triphosphate-binding proteins involved in wide-ranging cellular processes including cytokinesis, vesicle trafficking, membrane remodelling and scaffolds, and with diverse binding partners. Precise roles for these structural proteins in most processes often remain elusive. Identification of small molecules that inhibit septins could aid in elucidating the functions of septins and has become increasingly important, including the description of roles for septins in pathogenic phenomena such as tumorigenesis. The plant growth regulator forchlorfenuron, a synthetic cytokinin known to inhibit septin dynamics, likely represents an informative probe for septin function. This report deals with septins of the human blood fluke Schistosoma mansoni and their interactions with forchlorfenuron. Recombinant forms of three schistosome septins, SmSEPT5, SmSEPT7.2 and SmSEPT10, interacted with forchlorfenuron, leading to rapid polymerization of filaments. Culturing developmental stages (miracidia, cercariae, adult males) of schistosomes in FCF at 50-500 ?M rapidly led to paralysis, which was reversible upon removal of the cytokinin. The reversible paralysis was concentration-, time- and developmental stage-dependent. Effects of forchlorfenuron on the cultured schistosomes were monitored by video and/or by an xCELLigence-based assay of motility, which quantified the effect of forchlorfenuron on fluke motility. The findings implicated a mechanism targeting a molecular system controlling movement in these developmental stages: a direct effect on muscle contraction due to septin stabilization might be responsible for the reversible paralysis, since enrichment of septins has been described within the muscles of schistosomes. This study revealed the reversible effect of forchlorfenuron on both schistosome motility and its striking impact in hastening polymerization of septins. These novel findings suggested routes to elucidate roles for septins in this pathogen, and exploitation of derivatives of forchlorfenuron for anti-schistosomal drugs. PMID:24768753

Zeraik, Ana E; Galkin, Vitold E; Rinaldi, Gabriel; Garratt, Richard C; Smout, Michael J; Loukas, Alex; Mann, Victoria H; Araujo, Ana P U; DeMarco, Ricardo; Brindley, Paul J



A Case of Periodic Hypokalemic Paralysis in a Patient with Celiac Disease  

PubMed Central

A 4-year-old male child presented with recurrent episodes of diarrhoea for 6-months, each episode associated with weakness of all four limbs and documented hypokalemia who on examination had some pallor, short stature, flaccid quadriparesis with absent DTR. The patient responded clinically and biochemically to potassium supplement. TTG and Intestinal biopsy confirmed celiac disease. Patient was put on gluten free diet and patient is doing well with no recurrence. We present a case of Recurrent hypokalemic paralysis with previously unsuspected celiac disease who was not in celiac crisis. PMID:25121038

Debata, Pradeep K



Genetic analysis of Israel acute paralysis virus: distinct clusters are circulating in the United States.  


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 indicate the existence of at least three distinct IAPV lineages, two of them circulating in the United States. Analysis of representatives from each proposed lineage suggested the possibility of recombination events and revealed differences in coding sequences that may have implications for virulence. PMID:18434396

Palacios, G; Hui, J; Quan, P L; Kalkstein, A; Honkavuori, K S; Bussetti, A V; Conlan, S; Evans, J; Chen, Y P; vanEngelsdorp, D; Efrat, H; Pettis, J; Cox-Foster, D; Holmes, E C; Briese, T; Lipkin, W I



A case of periodic hypokalemic paralysis in a patient with celiac disease.  


A 4-year-old male child presented with recurrent episodes of diarrhoea for 6-months, each episode associated with weakness of all four limbs and documented hypokalemia who on examination had some pallor, short stature, flaccid quadriparesis with absent DTR. The patient responded clinically and biochemically to potassium supplement. TTG and Intestinal biopsy confirmed celiac disease. Patient was put on gluten free diet and patient is doing well with no recurrence. We present a case of Recurrent hypokalemic paralysis with previously unsuspected celiac disease who was not in celiac crisis. PMID:25121038

Ranjan, Amitabh; Debata, Pradeep K




PubMed Central

1. A modified Osterhout respiratory apparatus for the detection of CO2 from nerve is described. 2. The lateral-line nerve from the dogfish discharges CO2 at first with a gush for half an hour or so and then steadily at a lower rate for several hours. 3. Simple handling of the nerve does not increase the output of CO2; cutting it revives gush. 4. The CO2 produced by nerve is not escaping simply from a reservoir but is a true nervous metabolite. 5. The rate of discharge of CO2 from a quiescent nerve varied from 0.0071 to 0.0128 mg. per gram of nerve per minute and averaged 0.0095 mg. 6. Stimulated nerve showed an increased rate of CO2 production of 15.8 percent over that of quiescent nerve. 7. The results of these studies indicate that chemical change is a factor in nerve transmission. PMID:19872167

Parker, G. H.



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

Microsoft Academic Search

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

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



A case of thyrotoxic periodic paralysis as initial manifestation of Graves' disease in a 16-year-old Korean adolescent  

PubMed Central

Thyrotoxic periodic paralysis (TPP) is a rare complication of hyperthyroidism, with recurrent muscle paralysis and hypokalemia that are caused by an intracellular shift of potassium. TPP is relatively common in Asian males, but is extremely rare in children and adolescents, even for those of Asian descent. We describe a 16-year-old Korean adolescent presenting with a two-week history of episodic leg weakness in the morning. He showed sinus tachycardia, lower leg weakness, and hypokalemia. Thyroid function test showed hyperthyroidism, and thyroid ultrasonography revealed a diffuse enlarged thyroid with increased vascularity, consistent with Graves' disease. He was treated with ?-adrenergic blocker and antithyroid drugs. He has been symptom free for one year, as his hyperthyroidism has been controlled well with antithyroid drugs. TPP should be considered in children and adolescents with acute paralysis of the lower extremities and hypokalemia. PMID:25346923

Jung, Se Yong; Song, Kyung Chul; Shin, Jae Il; Chae, Hyun Wook; Kim, Ho-Seong



Nerve-Muscle-Endplate Band Grafting: A New Technique for Muscle Reinnervation  

PubMed Central

Background As currently existing reinnervation methods result in poor functional recovery, there is a great need to develop new treatment strategies. Objectives To investigate the efficacy of our recently developed nerve-muscle-endplate band grafting (NMEG) technique for muscle reinnervation. Methods Twenty-five adult rats were used in this study. Sternohyoid (SH) and sternomastoid (SM) muscles served as a donor and a recipient muscle, respectively. Neural organization of the SH and SM muscles and surgical feasibility of the NMEG technique were determined. A NMEG contained a muscle block, a nerve branch with nerve terminals, and a motor endplate (MEP) band with numerous neuromuscular junctions. After a 3-month recovery period, the degree of functional recovery was evaluated using maximal tetanic force measurement. Retrograde horseradish peroxidase (HRP) tracing was used to track the origin of the motor innervation of the reinnervated muscles. The reinnervated muscles were examined morphohistologically and immunohistochemicaly to assess the extent of axonal regeneration. Results Nerve supply patterns and locations of the MEP bands in the SH and SM muscles were documented. The results demonstrated that the reinnervated SM muscles gained motor control from the SH motoneurons. NMEG technique yielded extensive axonal regeneration and significant recovery of SM muscle force generating capacity (67% of the control). The mean wet weight of the NMEG reinnervated muscles (87% of the control) was greater than that of the denervated SM muscles (36% of the control). Conclusion NMEG resulted in successful muscle reinnervation and functional recovery. This technique holds promise in the treatment of muscle paralysis. PMID:21796004

Mu, Liancai; Sobotka, Stanislaw; Su, Hungxi



Acute flaccid paralysis due to West nile virus infection in adults: A paradigm shift entity  

PubMed Central

Three cases of acute flaccid paralysis (AFP) with preceding fever are described. One patient had a quadriparesis with a florid meningoencephalitic picture and the other two had asymmetric flaccid paralysis with fasciculations at the onset of illness. Magnetic resonance imaging in two cases showed prominent hyperintensitities in the spinal cord and brainstem with prominent involvement of the grey horn (polio-myelitis). Cerebrospinal fluid (CSF) polymerase chain reaction was positive for West Nile virus (WNV) in the index patient. All three cases had a positive WNV immunoglobulin M antibody in serum/CSF and significantly high titer of WNV neutralizing antibody in serum, clearly distinguishing the infection from other Flaviviridae such as Japanese encephalitis. WNV has been recognized in India for many decades; however, AFP has not been adequately described. WNV is a flavivirus that is spread by Culex mosquitoes while they take blood meals from humans and lineage 1 is capable of causing a devastating neuro-invasive disease with fatal consequences or severe morbidity. We describe the first three laboratory confirmed cases of WNV induced AFP from Kerala and briefly enumerate the salient features of this emerging threat. PMID:24753667

Maramattom, Boby Varkey; Philips, Geetha; Sudheesh, Nittur; Arunkumar, Govindakarnavar



Posttraumatic therapeutic vaccination with modified myelin self-antigen prevents complete paralysis while avoiding autoimmune disease  

PubMed Central

Spinal cord injury results in a massive loss of neurons, and thus of function. We recently reported that passive transfer of autoimmune T cells directed against myelin-associated antigens provides acutely damaged spinal cords with effective neuroprotection. The therapeutic time window for the passive transfer of T cells was found to be at least 1 week. Here we show that posttraumatic T cell–based active vaccination is also neuroprotective. Immunization with myelin-associated antigens such as myelin basic protein (MBP) significantly promoted recovery after spinal cord contusion injury in the rat model. To reduce the risk of autoimmune disease while retaining the benefit of the immunization, we vaccinated the rats immediately after severe incomplete spinal cord injury with MBP-derived altered peptide ligands. Immunization with these peptides resulted in significant protection from neuronal loss and thus in a reduced extent of paralysis, assessed by an open-field behavioral test. Retrograde labeling of the rubrospinal tracts and magnetic resonance imaging supported the behavioral results. Further optimization of nonpathogenic myelin-derived peptides can be expected to lead the way to the development of an effective therapeutic vaccination protocol as a strategy for the prevention of total paralysis after incomplete spinal cord injury. PMID:11518733

Hauben, Ehud; Agranov, Eugenia; Gothilf, Amalia; Nevo, Uri; Cohen, Avi; Smirnov, Igor; Steinman, Lawrence; Schwartz, Michal



PD-1 promotes immune exhaustion by inducing antiviral T cell motility paralysis  

PubMed Central

Immune responses to persistent viral infections and cancer often fail because of intense regulation of antigen-specific T cells—a process referred to as immune exhaustion. The mechanisms that underlie the induction of exhaustion are not completely understood. To gain novel insights into this process, we simultaneously examined the dynamics of virus-specific CD8+ and CD4+ T cells in the living spleen by two-photon microscopy (TPM) during the establishment of an acute or persistent viral infection. We demonstrate that immune exhaustion during viral persistence maps anatomically to the splenic marginal zone/red pulp and is defined by prolonged motility paralysis of virus-specific CD8+ and CD4+ T cells. Unexpectedly, therapeutic blockade of PD-1–PD-L1 restored CD8+ T cell motility within 30 min, despite the presence of high viral loads. This result was supported by planar bilayer data showing that PD-L1 localizes to the central supramolecular activation cluster, decreases antiviral CD8+ T cell motility, and promotes stable immunological synapse formation. Restoration of T cell motility in vivo was followed by recovery of cell signaling and effector functions, which gave rise to a fatal disease mediated by IFN-?. We conclude that motility paralysis is a manifestation of immune exhaustion induced by PD-1 that prevents antiviral CD8+ T cells from performing their effector functions and subjects them to prolonged states of negative immune regulation. PMID:23530125

Zinselmeyer, Bernd H.; Heydari, Sara; Sacristán, Catarina; Nayak, Debasis; Cammer, Michael; Herz, Jasmin; Cheng, Xiaoxiao; Davis, Simon J.; Dustin, Michael L.



An Unusual Initial Presentation of Sjögren’s Syndrome: Severe Hypokalemic Paralysis Secondary to Distal Renal Tubular Acidosis  

PubMed Central

Sjögren’s syndrome is mainly affects the exocrine glands. Patients usually complain of persistent dryness of the mouth and eyes. However, nonexocrine organs such as the kidneys are often affected in these patients. Distal renal tubular acidosis (dRTA) and interstitiel nephritis are common in Sjögren’s syndrome. Nonetheless, severe hypokalemia and paralysis secondary to dRTA are unusual initial manifestation of Sjögren’s syndrome. Here, we describe a case of a 48 year old women admitted to the emergency setting with severe hypokalemic paralysis and diagnosed Sjögren’s syndrome.

Sengul, Erkan; Bunul, Fatih; Yazici, Ayten; Sengul, Aysun; Dindar, Sevim; Halhalli, Gökçen Selma Kilic; Binnetoglu, Emine



Invasive primary aspergillosis of the larynx presenting as hoarseness and a chronic nonhealing laryngeal ulcer in an immunocompetent host: a rare entity.  


Primary aspergillosis usually affects the paranasal sinuses, orbit, ear, and lower respiratory tract. Laryngeal aspergillosis usually occurs as a result of secondary invasion from the tracheobronchial tree, more commonly in immunocompromised hosts. Primary laryngeal localization of Aspergillus infection is seldom encountered. We report the case of an immunocompetent 42-year-old man who presented with hoarseness and a laryngeal ulcer of fairly long duration. A malignancy was initially suspected clinically, but a laryngoscopic biopsy led to a diagnosis of invasive primary laryngeal aspergillosis. No other focus of aspergillosis was found on x-ray and computed tomography. After identification of Aspergillus niger on culture, inquiries revealed no exposure to steroids, cytotoxic drugs, or irradiation, and workups for malignancy, human immunodeficiency virus infection, tuberculosis, and diabetes were negative. Although isolated laryngeal involvement is rare, aspergillosis may be considered in the differential diagnosis of a chronic nonhealing laryngeal ulcer that is clinically suggestive of a malignancy, even in an immunocompetent host. PMID:25025412

Gangopadhyay, Mimi; Majumdar, Kaushik; Bandyopadhyay, Arghya; Ghosh, Anup



Improving the Functionality of Intra-Operative Nerve Monitoring During Thyroid Surgery: Is Lidocaine an Option?  

PubMed Central

Intra-operative nerve monitoring (IONM) is rapidly becoming a standard of care in many institutions across the country. In the absence of neuromuscular blocking agents to facilitate the IONM, the depth of anesthesia required to abolish the laryngo tracheal reflexes often results in profound hemodynamic instability during surgery, necessitating the use of large doses of sympathomimetic amines. The excessive alpha and beta adrenergic effects exhibited by these agents are undesirable in the presence of cardiovascular co-morbidities. Trying to strike a balance frequently results in an unsatisfactory intra-operative course. In the course of the near total thyroidectomy performed on a 60-year-old female, we employed lidocaine infusion at 1.5 mg/kg/hour following a bolus dose of 1 mg/kg. The troublesome laryngo tracheal reflexes were successfully blunted and we were able to moderate the depth of anesthesia resulting in stable hemodynamics. A bispectral index monitor was employed to guard against “recall” and a train of four monitor was used to ensure the absence of inadvertent neuromuscular blockade. During the surgery, there was loss of signal on the left recurrent laryngeal nerve (RLN). The signal strength was restored by rotating the endotracheal tube on its long axis to realign the electrode with the vocal cords under Glidescope® visualization.

Govindarajan, Ramasamy; Shah, Ajay; Reddy, Vemuru Sunil; Parithivel, Vellore; Ravikumar, Saiganesh; Livingstone, Dave



Neuromodulation of the suprascapular nerve.  


The shoulder joint is an enarthrodial or ball-and-socket joint. A complex network of anatomic structures endows the human shoulder with tremendous mobility, greater than any other joint in the body. Many pathologies can been found in those patients with chronic shoulder pain. The painful limitation of shoulder motion affects hand and arm motion as well; therefore, it significantly influences work performance and everyday activities as well as the quality of life. Therefore, the treatment of patients with chronic shoulder pain has major social and health economic implications. In this article we present a patient with a complex history of shoulder pathology including 7 surgeries that left the patient with chronic debilitating shoulder pain. She was suffering from chronic pain and limited mobility of the shoulder joint due to adhesive shoulder capsulitis. She was treated with a multimodality approach with the goals of increasing shoulder range of motion and decreasing her pain. This did not provide significant improvement. The suprascapular nerve supplies motor and sensory innervation to the shoulder, and can be easily accessible in the supraspinatus fossa. A suprascapular nerve block dramatically decreased her pain. This clinical observation along with confirmatory nerve block play an important role during the decision-making process for a trial period of electrical neuromodulation. She was followed for 3 months after the permanent implantation of a suprascapular nerve stimulator. Her pain and shoulder range of motion in all planes improved dramatically. Peripheral nerve stimulation (PNS) of the suprascapular nerve, in addition to multimodality pain management, is one approach to the difficult task of treating adhesive capsulitis with accompanying pain and the inability to move the shoulder. We conducted a literature review on PubMed and found no case describing a similar patient to our knowledge. PMID:25415792

Elahi, Foad; Reddy, Chandan G



Nerve lesioning with direct current  

NASA Astrophysics Data System (ADS)

Spastic hypertonus (muscle over-activity due to exaggerated stretch reflexes) often develops in people with stroke, cerebral palsy, multiple sclerosis and spinal cord injury. Lesioning of nerves, e.g. with phenol or botulinum toxin is widely performed to reduce spastic hypertonus. We have explored the use of direct electrical current (DC) to lesion peripheral nerves. In a series of animal experiments, DC reduced muscle force by controlled amounts and the reduction could last several months. We conclude that in some cases controlled DC lesioning may provide an effective alternative to the less controllable molecular treatments available today.

Ravid, E. Natalie; Shi Gan, Liu; Todd, Kathryn; Prochazka, Arthur



Take Charge of Your Diabetes (Nerve Damage)  


... gov . Diabetes Public Health Resource Share Compartir Take Charge of Your Diabetes Some Signs of Diabetic Nerve ... There’s a lot you can do to take charge and prevent nerve damage. A recent study shows ...


Nerve blocks in the treatment of headache.  


Nerve blocks and neurostimulation are reasonable therapeutic options in patients with head and neck neuralgias. In addition, these peripheral nerve procedures can also be effective in primary headache disorders, such as migraine and cluster headaches. Nerve blocks for headaches are generally accomplished by using small subcutaneous injections of amide-type local anesthetics, such as lidocaine and bupivicaine. Targets include the greater occipital nerve, lesser occipital nerve, auriculotemporal nerve, supratrochlear and supraorbital nerves, sphenopalatine ganglion, cervical spinal roots, and facet joints of the upper cervical spine. Although definitive studies examining the usefulness of nerve blocks are lacking, reports suggest that this area deserves further attention in the hope of acquiring evidence of effectiveness. PMID:20430319

Levin, Morris



Multiple schwannomas of the sciatic nerve.  


Schwannomas are rare benign tumours of nerve sheath cells of neural crest origin. Often these tumours are solitary and encapsulated. Multiple schwannomas can arise from the peripheral nervous system including cranial nerves, spinal roots, the brachial and lumbar-sacral plexus or major peripheral nerves. We report an extremely rare case of schwannomatosis of the sciatic nerve in a young female and include a comprehensive literature review. Treatment options are discussed. PMID:12763357

Huang, J; Mobbs, R; Teo, C



Proximal Sciatic Nerve Intraneural Ganglion Cyst  

PubMed Central

Intraneural ganglion cysts are nonneoplastic, mucinous cysts within the epineurium of peripheral nerves which usually involve the peroneal nerve at the knee. A 37-year-old female presented with progressive left buttock and posterior thigh pain. Magnetic resonance imaging revealed a sciatic nerve mass at the sacral notch which was subsequently revealed to be an intraneural ganglion cyst. An intraneural ganglion cyst confined to the proximal sciatic nerve has only been reported once prior to 2009. PMID:20069041

Swartz, Karin R.; Wilson, Dianne; Boland, Michael; Fee, Dominic B.



An isoflavone from Dipteryx alata Vogel is active against the in vitro neuromuscular paralysis of Bothrops jararacussu snake venom and bothropstoxin I, and prevents venom-induced myonecrosis.  


Snakebite is a neglected disease and serious health problem in Brazil, with most bites being caused by snakes of the genus Bothrops. Although serum therapy is the primary treatment for systemic envenomation, it is generally ineffective in neutralizing the local effects of these venoms. In this work, we examined the ability of 7,8,3'-trihydroxy-4'-methoxyisoflavone (TM), an isoflavone from Dipteryx alata, to neutralize the neurotoxicity (in mouse phrenic nerve-diaphragm preparations) and myotoxicity (assessed by light microscopy) of Bothrops jararacussu snake venom in vitro. The toxicity of TM was assessed using the Salmonella microsome assay (Ames test). Incubation with TM alone (200 ?g/mL) did not alter the muscle twitch tension whereas incubation with venom (40 ?g/mL) caused irreversible paralysis. Preincubation of TM (200 ?g/mL) with venom attenuated the venom-induced neuromuscular blockade by 84% ± 5% (mean ± SEM; n = 4). The neuromuscular blockade caused by bothropstoxin-I (BthTX-I), the major myotoxic PLA2 of this venom, was also attenuated by TM. Histological analysis of diaphragm muscle incubated with TM showed that most fibers were preserved (only 9.2% ± 1.7% were damaged; n = 4) compared to venom alone (50.3% ± 5.4% of fibers damaged; n = 3), and preincubation of TM with venom significantly attenuated the venom-induced damage (only 17% ± 3.4% of fibers damaged; n = 3; p < 0.05 compared to venom alone). TM showed no mutagenicity in the Ames test using Salmonella strains TA98 and TA97a with (+S9) and without (-S9) metabolic activation. These findings indicate that TM is a potentially useful compound for antagonizing the neuromuscular effects (neurotoxicity and myotoxicity) of B. jararacussu venom. PMID:24806579

Ferraz, Miriéle C; Yoshida, Edson H; Tavares, Renata V S; Cogo, José C; Cintra, Adélia C O; Dal Belo, Cháriston A; Franco, Luiz M; dos Santos, Márcio G; Resende, Flávia A; Varanda, Eliana A; Hyslop, Stephen; Puebla, Pilar; San Feliciano, Arturo; Oshima-Franco, Yoko



Lubrication mechanism of the larynx during phonation: an experiment in excised canine larynges.  


To evaluate how the viscosity of the laryngeal mucus influences vocal fold vibration, two fluids of differing viscosity were applied separately to excised canine larynges and experimental phonation was induced. Vibration of the vocal folds was measured by use of a laryngostroboscope and an X-ray stroboscope. With the high viscosity fluid, the amplitude of vibration of the free edge and the peak glottal area was decreased while the open quotient was increased. Because the viscosity of this fluid affected the wave motion of the vocal fold mucosa, changes in viscosity of the mucus may be involved in causing such disorders as hoarseness, in the absence of apparent changes in the vocal folds themselves. PMID:9819480

Nakagawa, H; Fukuda, H; Kawaida, M; Shiotani, A; Kanzaki, J



Epidermal growth factor receptor (EGFR) expression in patients with laryngeal squamous cell carcinoma.  


To assess the epidermal growth factor receptor (EGFR) correlation with histopathologic and clinical characteristics of laryngeal squamous cell carcinoma (SCC) and the impact of EGFR overexpression on patient survival. This retrospective study included 185 SCC patients treated at Clinical Department of ENT, Head and Neck Surgery, Split University Hospital Center between January 1, 2000 and December 31, 2009. A statistically significant correlation (p < 0.001) was recorded between the level of EGFR expression and SCC histopathologic grade, stage, metastasizing potential, relapsing potential, and patient survival. Kaplan-Meier survival curve yielded a statistically significant difference (? (2) = 75.05; p < 0.001) among the four patient groups with different levels of EGFR expression. The higher the level of EGFR expression, the poorer is the patient prognosis and survival. In our study, expression of EGFR as a biomarker showed a potential predictive value in laryngeal SCC. PMID:25294054

Konti?, Mirko; Milovanovi?, Jovica; ?olovi?, Zaviša; Poljak, Nikola Kolja; Šundov, Željko; Su?i?, Ante; Pešuti?-Pisac, Valdi



Cryosurgery and laser surgery in the treatment of malignant and benign laryngeal processes.  


Cryosurgery of the larynx is still in the stage of development. In the treatment of laryngeal papillomas cryosurgery has been quite successful. The use of cryosurgery in laryngo-hypopharyngeal carcinoma and in laryngeal stenosis is still restricted to special indications (old age, risk patients). A combination of cryosurgery and telecobalt irradiation has proven valuable in the management of tumors. After the basic physics of laser radiation are explained, the principle mechanisms of interaction between the CO2 laser on human tissue are mentioned. This is followed by the description of the different indications for laser surgery in the larynx. A chordectomy and the opening of a subglottic stenosis with the laser beam are described and documented with photographs. Finally, there is an outlook to an eventually broader spectrum of indications for laser surgery in the field of ent. PMID:575205

Miehlke, A; Chilla, R; Vollrath, M



[Cryosurgery and laser surgery as a therapy of malignant and benign laryngeal processes (author's transl)].  


Cryosurgery of the larynx is still in a state of development. In the treatment of laryngeal papillomas cryosurgery has been quite successful. The use of cryosurgery in laryngo-hypopharyngeal carcinoma and in laryngeal stenosis is so far restricted to special indications (old age, risk patients). A combination of cryosurgery with telecobalt irradiation has proved valuable in the managemenmt of tumors. After the basic physics of laser radiation are explained, the principle mechanisms of interaction between the CO2-laser and human tissue are mentioned. This is followed by the description of the different indications for laser surgery in the larynx. A chordectomy and the opening of a subglottic stenosis with the laser beam are described and documented with photographs. Finally there is an outlook to an eventually broader spectrum of indications for laser surgery in the ENT-field. PMID:6780490

Miehlke, A; Chilla, R; Vollrath, M