Science.gov

Sample records for laryngeal mask airway

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

    PubMed

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

    2014-10-01

    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.

  2. Use of the laryngeal mask airway for laser treatment of the subglottis.

    PubMed

    Jameson, J J; Moses, R D; Vellayappan, U; Lathi, K G

    2000-07-01

    A technique for treating subglottic lesions with the intubating laryngeal mask airway is described. It provides unhampered exposure of the subglottis and upper trachea, excellent airway control, and a means of access for ablation with flexible laser bronchoscopy.

  3. Laryngeal mask airways in ear, nose, and throat procedures.

    PubMed

    Mandel, Jeff E

    2010-09-01

    The use of laryngeal mask airway (LMA) and its variants in ear, nose, and throat procedures have been extensively described in case reports, retrospective reviews, and randomized clinical trials. The LMA has developed a considerable following because of its lack of tracheal stimulation, which can be a considerable advantage in ear, nose, and throat (ENT) procedures. The incidence of coughing on emergence has been shown to be lower with the LMA than with the endotracheal tube (ETT). Although other approaches to smooth emergence have been described, few would argue that it is as easy to achieve a smooth emergence with an ETT as with an LMA. Although patients certainly exist for whom the LMA is contraindicated, many will experience better results with the LMA because of the features delineated in this article.

  4. [Rare problem with the insertion of a Supreme™ laryngeal mask airway device. Case of the trimester].

    PubMed

    2014-03-01

    A breast tumor was resected under general anesthesia. After induction, the airway was managed with a Supreme™ laryngeal mask airway device. The insertion of the laryngeal mask airway device, the insertion of the orogastric tube through the drain tube, as well as the mechanical ventilation, were very difficult from the beginning. On removing the laryngeal mask airway device to solve the problem, it was observed that the drain tube was broken, and the orogastric tube had passed into the anterior, laryngeal part of the device through the split. It was later found out that the laryngeal mask airway device, as well as the whole manufacturing batch, had suffered a design modification: the cuff was constructed with a softer material without reinforcement in the tip, and the drain tube had a heat-sealing defect that facilitated the break. The incident was reported to the local supplier and the manufacturer, and the defective batch of laryngeal mask airway devices was recalled. The incident was also reported to other hospitals via SENSAR, to warn other users of the potential dangers of the design modification in the Supreme™ laryngeal mask airway.

  5. The laryngeal mask airway in experimental pig anaesthesia.

    PubMed

    Wemyss-Holden, S A; Porter, K J; Baxter, P; Rudkin, G E; Maddern, G J

    1999-01-01

    The pig is used as a large animal model in many research projects. Standard practice for airway maintenance under general anaesthesia is using endotracheal (ET) intubation after intravenous induction to a near surgical plane. This is a technically demanding skill, requiring the assistance of an experienced technician. A technique is required which simplifies pig anaesthesia. This study examined the feasibility and potential advantages of using the laryngeal mask airway (LMA) in 10 pigs during laparotomy under spontaneous breathing anaesthesia. The results show that the LMA can be inserted rapidly, with minimal time for airway control by researchers relatively inexperienced in anaesthesia and is associated with few complications. By removing the need for intravenous induction, an entire step in the anaesthetic process is removed. The LMA designed for humans fits well in the pig hypopharynx; all pigs could be manually ventilated with no detectable gas leak. Although the pigs in this study were spontaneously breathing it is proposed that the LMA should be further investigated in studies of artificially ventilated pigs.

  6. A randomised crossover trial comparing a single-use polyvinyl chloride laryngeal mask airway with a single-use silicone laryngeal mask airway.

    PubMed

    Bell, S F; Morris, N G; Rao, A; Wilkes, A R; Goodwin, N

    2012-12-01

    We compared insertion rates of single-use polyvinyl chloride laryngeal mask airways (LMAs) vs single-use silicone LMAs in 72 anaesthetised patients. Both airways were produced by Flexicare Medical. Laryngeal mask airway insertion was successful on the first attempt in 68/72 (94%) polyvinyl chloride LMAs vs 64/72 (89%) silicone LMAs (p = 0.39). Overall insertion rates were 72/72 (100%) for the polyvinyl chloride LMAs and 71/72 (99%) for the silicone LMAs (p = 1.0). Mean (SD) insertion times were similar for polyvinyl chloride and silicone LMAs: 24.3 (5.1)s vs 24.8 (7.8)s (p = 0.64). Laryngeal mask airway position, as assessed using a fibrescope, was not different (p = 0.077). The median (IQR [range]) leak pressure was 16 (12-20 [6-30]) cmH(2) O for the polyvinyl LMA and 18 (13-22 [6-30]) cmH(2) O or the silicone LMA (p = 0.037). In conclusion, we did not find any important differences between polyvinyl chloride and silicone laryngeal mask airways.

  7. Chondronecrosis of the larynx following use of the laryngeal mask airway.

    PubMed

    Beswick, Daniel M; Collins, Jeremy; Nekhendzy, Vladimir; Damrose, Edward J

    2015-04-01

    This case describes the development of laryngeal chondronecrosis after use of the laryngeal mask airway (LMA). A 69-year-old male with prior laryngeal irradiation underwent total knee replacement with general anesthesia via LMA. Postoperatively, he developed laryngeal chondronecrosis, bilateral vocal fold immobility, and aspiration, necessitating tracheostomy and gastrostomy placement. He improved with hyperbaric oxygen therapy, intravenous antibiotics, and endoscopic repair of a residual fistula. Vocal fold motion returned and he was decannulated. Chondronecrosis of the larynx may occur with the use of the LMA, and caution should be used in patients with a history of prior laryngeal irradiation.

  8. Intubating condition, hemodynamic parameters and upper airway morbidity: A comparison of intubating laryngeal mask airway with standard direct laryngoscopy

    PubMed Central

    Kavitha, J.; Tripathy, Debendra Kumar; Mishra, Sandeep Kumar; Mishra, Gayatri; Chandrasekhar, L. J.; Ezhilarasu, P.

    2011-01-01

    Background: Intubating Laryngeal Mask Airway (ILMA) is a relatively new device designed to have better intubating characteristics than the standard Laryngeal Mask Airway. This study was designed to compare Intubating Laryngeal Mask with standard Direct Laryngoscopy (DLS), taking into account ease of intubation, time taken for intubation, success rate of intubation, hemodynamic responses and upper airway morbidity. Materials and Methods: Sixty patients, ASA I or II, of age between 20 and 60 years, were enrolled in this prospective and randomized study. They were randomly allocated to one of the two groups: group ILMA, Intubating Laryngeal Mask Airway; group DLS, Direct Laryngoscopy. The patients were intubated orally using either equipment after induction of general anesthesia. Results and Conclusions: DLS is comparatively a faster method to secure tracheal intubation than Intubating Laryngeal Mask. ILMA offers no advantage in attenuating the hemodynamic responses compared to direct laryngoscope. The success rate of intubation through Intubating Laryngeal Mask is comparable with that of DLS. The upper airway morbidity and mean oxygen saturation are comparable in both the groups. PMID:25885300

  9. Comparison of laryngeal mask airway vs tracheal intubation: a systematic review on airway complications.

    PubMed

    van Esch, Babette F; Stegeman, Inge; Smit, Adriana L

    2017-02-01

    To determine whether the laryngeal mask airway (LMA) has advantages over the tracheal tube (TT) in terms of incidence of cough, sore throat, laryngospasm, dysphagia, dysphonia, and blood staining. This is a systematic literature review performed at the Universtity Medical Center of Utrecht. The online databases PubMed, Embase, and the Cochrane Library were searched for relevant randomized controlled trials. Two independent reviewers selected relevant articles after title, abstract, and full text screening. Articles were assessed on risk of bias in accordance with the Cochrane risk of bias tool. Study results of the LMA and the TT were related to the method of selection of the device size and the method for cuff inflation. Of the 1718 unique articles, we included 19 studies which used the LMA Classic, the LMA Proseal, the Flexible Reinforced LMA, and the LMA Supreme compared with TT. After methodological inspection, data could not be pooled due to heterogeneity among the selected studies. Overall, no clear advantage of the LMA over the TT was found but the LMA Supreme was related to the lowest incidence of airway complications. In this review, no clear difference in incidence of postoperative airway complications could be demonstrated between LMA and TT. The LMA Supreme may reduce the incidence of airway complication in comparison to the TT but high quality randomized trials are recommended to further objectify if use of the LMA decreases the risk on postoperative airway complications.

  10. Application of the laryngeal mask airway for anesthesia in three chimpanzees and one gibbon.

    PubMed

    Johnson, Jacob A; Atkins, Adrienne L; Heard, Darryl J

    2010-09-01

    Three pediatric chimpanzees and one pediatric gibbon were anesthetized for routine physical examination. Anesthesia was maintained with inhalant delivered via a laryngeal mask airway (LMA). The LMA was easy to insert, provided adequate control of the airway for ventilation, and caused no tracheal stimulation. No complications were observed. As compared with a face mask, the LMA has the advantage of a more secure airway; the ability to effectively ventilate the patient; less dead space, which leads to lower rebreathing of carbon dioxide; and less exposure of personnel to waste gases. As compared with an endotracheal tube, the LMA causes less airway trauma, is easier to place, and is less stimulating to the patient. The LMA should be considered for use in fasted non-human primates presented for procedures lasting less than 60 min where high peak inspiratory pressures are not needed.

  11. Comparative Study of Two Laryngeal Mask Airways: Proseal Laryngeal Mask Airway and Supreme Laryngeal Mask Airway in Anesthetized Paralyzed Adults Undergoing Elective Surgery

    PubMed Central

    Gill, Ravneet Kaur; Tarat, Abhijit; Pathak, Debagopal; Dutta, Suneeta

    2017-01-01

    Context: Supraglottic airway devices can act as an alternative to endotracheal intubation in both normal and difficult airway. LMA Proseal (P-LMA) and LMA Supreme (S-LMA) alongwith acting as effective ventilating device, provide port for gastric drainage. Aim: The objective of this study was to compare the two devices for effective ventilation and complications. Setting and Design: A prospective, randomized, single-blinded study was conducted in a tertiary care teaching hospital. Methods: 100 patients of ASA grade I–II undergoing elective surgery under general anaesthesia were included after ethical committee clearance and written consent. Patients were randomly allocated size 4 P-LMA (Group P) or S-LMA (Group S) (50 patients in each group). Insertion attempt, insertion time, oropharyngeal leak pressure (OLP) and complications were compared. Results: There was no difference demographically. The first insertion attempts were successful in 92% with P-LMA and 96% with S-LMA. Insertion time was faster in S-LMA. The mean OLP was 24.04 cmH2O in Group P and 20.05 cmH2O in Group S. Complications were cough, mild blood staining. Conclusion: Both can act as an effective ventilatory devices. But where LMA Proseal provides a more effective glottic seal by having a greater OLP, single use LMA Supreme provides acceptable glottic seal with easier and faster insertion, therefore, it can be accepted as better alternative to LMA Proseal. PMID:28298751

  12. A new laryngeal mask supraglottic airway device with integrated balloon line: a descriptive and comparative bench study

    PubMed Central

    Zhou, YingHai; Jew, Korinne

    2016-01-01

    Laryngeal masks are invasive devices for airway management placed in the supraglottic position. The Shiley™ laryngeal mask (Shiley™ LM) features an integrated inflation tube and airway shaft to facilitate product insertion and reduce the chance of tube occlusion when patients bite down. This study compared the Shiley LM to two other disposable laryngeal mask devices, the Ambu® AuraStraight™ and the LMA Unique™. Overall device design, tensile strength, flexibility of various structures, and sealing performance were measured. The Shiley LM is structurally stronger and its shaft is more resistant to compression than the other devices. The Shiley LM is generally less flexible than the other devices, but this relationship varies with device size. Sealing performance of the devices was similar in a bench assay. The results of this bench study demonstrate that the new Shiley LM resembles other commercially available laryngeal mask devices, though it exhibits greater tensile strength and lower flexibility. PMID:27843359

  13. A clinical trial evaluating the laryngeal mask airway-Supreme in obese children during general anesthesia

    PubMed Central

    Tian, Yue; Li, Lu; Ma, Ling; Li, Yun-feng

    2016-01-01

    Introduction The laryngeal mask airway (LMA)-Supreme is a disposable double-lumen laryngeal mask airway that is widely used in clinical practice. However, its use in obese children has not been evaluated. The aim of this study was to determine whether the LMA-Supreme could perform equally as well as endotracheal intubation in obese children having a minor surgical procedure. Material and methods After ethical board approval, 100 obese male children receiving non-emergent appendectomy for chronic appendicitis or surgery to correct concealed penis were randomly divided into an endotracheal intubation group and an LMA-Supreme group. Endotracheal intubation was performed under direct vision laryngoscopy. In the LMA group, a size-3 LMA-Supreme was placed and a stomach tube inserted via the drainage tube of the mask. Cardiovascular and respiratory parameters, time taken for placement, placement attempts, time to removal of the endotracheal tube/LMA, length of stay in the post-anesthesia care unit (PACU), and complications were recorded. Results Insertion time was significantly longer (p < 0.001) in the LMA-Supreme group than in the endotracheal intubation group. Peak airway pressure was significantly higher, and pulmonary compliance and PACU stay time lower in the LMA-Supreme group. No significant differences between endotracheal intubation and the LMA-Supreme were seen in other parameters, except for a higher incidence of coughing in the endotracheal intubation group. Conclusions The LMA-Supreme can be easily inserted and effectively used for airway management in obese children undergoing minor surgery. PMID:28144270

  14. Randomised Comparison of the AMBU AuraOnce Laryngeal Mask and the LMA Unique Laryngeal Mask Airway in Spontaneously Breathing Adults

    PubMed Central

    Williams, Daryl Lindsay; Zeng, James M.; Alexander, Karl D.; Andrews, David T.

    2012-01-01

    We conducted a randomised single-blind controlled trial comparing the LMA-Unique (LMAU) and the AMBU AuraOnce (AMBU) disposable laryngeal mask in spontaneously breathing adult patients undergoing general anaesthesia. Eighty-two adult patients (ASA status I–IV) were randomly allocated to receive the LMAU or AMBU and were blinded to device selection. Patients received a standardized anesthetic and all airway devices were inserted by trained anaesthetists. Size selection was guided by manufacturer recommendations. All data were collected by a single, unblinded observer. When compared with the LMAU, the AMBU produced significantly higher airway sealing pressures (AMBU 20 ± 6; LMAU 15 ± 7 cm H2O; P = 0.001). There was no statistical difference between the two devices for overall success rate, insertion time, number of adjustments, laryngeal alignment, blood-staining, and sore throat (P ≥ 0.05). The AMBU AuraOnce disposable laryngeal mask provided a higher oropharyngeal leak pressure compared to the LMA Unique in spontaneously breathing adult patients. PMID:22505884

  15. Comparison of laryngeal mask airway use with endotracheal intubation during anesthesia of western lowland gorillas (Gorilla gorilla gorilla).

    PubMed

    Cerveny, Shannon N; D'Agostino, Jennifer J; Davis, Michelle R; Payton, Mark E

    2012-12-01

    The laryngeal mask airway is an alternative to endotracheal intubation that achieves control of the airway by creating a seal around the larynx with an inflatable cuff. This study compared use of the laryngeal mask airway with endotracheal intubation in anesthetized western lowland gorillas (Gorilla gorilla gorilla). Eight adult gorillas were immobilized for routine and diagnostic purposes for a total of nine anesthetic events. During each anesthetic event, gorillas were either intubated (n = 4; group A) or fitted with a laryngeal mask airway (n= 5; group B). Time required to place each airway device, physiologic parameters, and arterial blood gas were measured and compared between the two groups. There were no significant differences between the two groups for time required to place airway device, heart rate, hemoglobin oxygen saturation, end-tidal carbon dioxide, arterial partial pressure of carbon dioxide, or arterial pH between the two groups. Mean arterial partial pressure of oxygen was significantly greater in group B, 15 (group A: 94 +/- 44 mm Hg; group B: 408 +/- 36 mm Hg; P= 0.0025) and 45 (group A: 104 +/- 21 mm Hg; group B: 407 +/- 77 mm Hg; P = 0.0026) min after airway device placement. Mean respiratory rate was significantly greater in group A at multiple time points. Mean arterial pressure (group A: 129 +/- 16 mm Hg; group B: 60 +/- 8 mm Hg) and diastolic blood pressure (group A: 115 +/- 21 mm Hg; group B: 36 +/- 10 mm Hg) were significantly greater in group A at the time of airway device placement. The laryngeal mask airway maintained oxygenation and ventilation effectively in all gorillas and is a useful alternative to endotracheal intubation in western lowland gorillas.

  16. Evaluation of Fastrach Laryngeal Mask Airway as an Alternative to Fiberoptic Bronchoscope to Manage Difficult Airway: A Comparative Study

    PubMed Central

    Shyam, Radhey; Sachan, Pushplata; Singh, Prithvi Kumar; Singh, Gyan Prakash; Bhatia, Vinod Kumar; Chandra, Girish; Singh, Dinesh

    2017-01-01

    Introduction Awake intubation via Fiberoptic Bronchoscope (FB) is the gold standard for management of difficult airway but patients had to face problems like oxygen desaturation, tachycardia, hypertension and anxiety due to awake state. This study was conducted to assess feasibility of Fastrach Laryngeal Mask Airway (FLMA) to manage difficult airway as a conduit for intubation as well as for ventilation. Materials and Methods After ethical approval and informed consent, 60 patients with difficult airway were randomly enrolled in FB group and FLMA group. In FB group, patients were sedated with midazolam/fentanyl. Airway anaesthetization of oropharynx was done with xylocaine spray and viscous and larynx and trachea by superior laryngeal nerve block and transtracheal block respectively. In FLMA group, initially patients were induced with propofol for FLMA insertion then succinylcholine was given for Tracheal Intubation (TI). The first TI attempt was done blindly via the FLMA and all subsequent attempts were performed with fiberoptic guidance. Haemodynamic monitoring was done during induction, intubation, immediately post insertion and there after at five minutes interval for 30 minutes. Results All patients in the FLMA group were successfully ventilated (100%). In both the groups 28 (93.33%) patients were successfully intubated. However, first/second/third attempt intubation rate in FLMA vs FB group was 15 (50%) vs 13 (43.3%), 8 (26.66%) vs 10 (33.33%) and 5 (16.66%) in both groups respectively. Patients in the FLMA group were more satisfied with their method of TI and had lesser complications (p<0.05). Conclusion So the FLMA may be a better technique for management of patients with difficult airways. PMID:28274023

  17. [Difficult Ventilation Requiring Emergency Endotracheal Intubation during Awake Craniotomy Managed by Laryngeal Mask Airway].

    PubMed

    Matsuda, Asako; Mizota, Toshiyuki; Tanaka, Tomoharu; Segawa, Hajime; Fukuda, Kazuhiko

    2016-04-01

    We report a case of difficult ventilation requiring emergency endotracheal intubation during awake craniotomy managed by laryngeal mask airway (LMA). A 45-year-old woman was scheduled to receive awake craniotomy for brain tumor in the frontal lobe. After anesthetic induction, airway was secured using ProSeal LMA and patient was mechanically ventilated in pressure-control mode. Patient's head was fixed with head-pins at anteflex position, and the operation started. About one hour after the start of the operation, tidal volume suddenly decreased. We immediately started manual ventilation, but the airway resistance was extremely high and we could not adequately ventilate the patient. We administered muscle relaxant for suspected laryngospasm, but ventilatory status did not improve; so we decided to conduct emergency endotracheal intubation. We tried to intubate using Airwayscope or LMA-Fastrach, but they were not effective in our case. Finally trachea was intubated using transnasal fiberoptic bronchoscopy. We discuss airway management during awake craniotomy, focusing on emergency endotracheal intubation during surgery.

  18. Fiberoptic intubation through laryngeal mask airway for management of difficult airway in a child with Klippel-Feil syndrome.

    PubMed

    Bhat, Ravi; Mane, Rajesh S; Patil, Manjunath C; Suresh, S N

    2014-07-01

    The ideal airway management modality in pediatric patients with syndromes like Klippel-Feil syndrome is a great challenge and is technically difficult for an anesthesiologist. Half of the patients present with the classic triad of short neck, low hairline, and fusion of cervical vertebra. Numerous associated anomalies like scoliosis or kyphosis, cleft palate, respiratory problems, deafness, genitourinary abnormalities, Sprengel's deformity (wherein the scapulae ride high on the back), synkinesia, cervical ribs, and congenital heart diseases may further add to the difficulty. Fiberoptic bronchoscopy alone can be technically difficult and patient cooperation also becomes very important, which is difficult in pediatric patients. Fiberoptic bronchoscopy with the aid of supraglottic airway devices is a viable alternative in the management of difficult airway in children. We report a case of Klippel-Feil syndrome in an 18-month-old girl posted for cleft palate surgery. Imaging of spine revealed complete fusion of the cervical vertebrae with hypoplastic C3 and C6 vertebrae and thoracic kyphosis. We successfully managed airway in this patient by fiberoptic intubation through classic laryngeal mask airway (LMA). After intubation, we used second smaller endotracheal tube (ETT) to stabilize and elongate the first ETT while removing the LMA.

  19. Comparison of streamlined liner of the pharynx airway (SLIPA ™) and laryngeal mask airway: a systematic review and meta-analysis.

    PubMed

    Choi, G J; Kang, H; Baek, C W; Jung, Y H; Woo, Y C; Kim, S H; Kim, J G

    2015-05-01

    We performed a systematic review to compare the efficacy and safety of the streamlined liner of the pharynx airway and laryngeal mask airway used in adults during general anaesthesia. We included 14 studies with studies with 1273 patients in total. There was no evidence of a difference between the two devices in insertion success rate on the first attempt (13 studies, 1143 patients), insertion time (seven studies, 576 patients), ease of insertion (five studies, 466 patients), oropharyngeal leak pressure (eight studies, 771 patients) and the quality of the fibreoptic view of the larynx through the device (three studies, 281 patients). The relative risk (95% CI) of bloodstaining of the device (nine studies, 859 patients) was 2.09 (1.46-3.00) for the streamlined liner of the pharynx airway compared with the laryngeal mask airway. Other adverse events were comparable. Subgroup analysis suggested that the insertion by novice users might be faster and more successful with the streamlined liner of the pharynx airway than the laryngeal mask airway; however, this was from only two studies and 186 patients. The method of size selection of the streamlined liner of the pharynx airway device might also affect the speed of insertion: choosing according to the width of the patient's thyroid cartilage, rather than height, may produce better results.

  20. Laryngeal Mask Airway for Cesarean Delivery: A 5-Year Retrospective Cohort Study

    PubMed Central

    Geng, Zhi-Yu; Wang, Dong-Xin

    2017-01-01

    Background: The laryngeal mask airway (LMA) is the most commonly used rescue airway in obstetric anesthesia. The aim of this retrospective cohort study was to evaluate the application of the LMA in parturients undergoing cesarean delivery (CD) for 5 years in our hospital. As a secondary objective, we investigated the incidence of airway-related complication in obstetric general anesthesia (GA). Methods: We collected electronic data for all obstetric patients who received GA for CD between January 2010 and December 2014 in Peking University First Hospital. Based on the different types of airway device, patients were divided into endotracheal intubation (ET) group and LMA group. The incidences of regurgitation and aspiration, as well as maternal and neonatal postoperative outcomes were compared between groups. Results: During the 5-year study, GA was performed in 192 cases, which accounted for 2.0% of all CDs. The main indications for GA were contraindication to neuraxial anesthesia or a failed block. Among these, ET tube was used in 124 cases (68.9%) and LMA in 56 cases (31.1%). The percentage of critical patients above the American Society of Anesthesiologists' Grade II was 24/124 in ET group and 4/56 in LMA group (P = 0.036). The emergent delivery rate was 63.7% for ET group and 37.5% for LMA group (P = 0.001). None of the patients had regurgitation or aspiration. There were no significant differences in terms of neonatal Apgar scores, maternal and neonatal postoperative outcomes between the two groups. Conclusions: Our results suggested that GA was mainly used for contraindication to neuraxial anesthesia or a failed block, and emergent CDs accounted for most cases. The second-generation LMA could be used for obstetric anesthesia, but correct position to achieve a good seal is the key to prevent reflux and aspiration. Whether they could replace the tracheal tube in routine practice needs further large prospective studies. PMID:28218212

  1. Comparison of three insertion techniques of ProSeal laryngeal mask airway: A randomized clinical trial

    PubMed Central

    Nalini, Kadirehally Bheemanna; Shivakumar, Shivanna; Archana, Shivashankar; Sandhya Rani, Doddagavanahalli Channaiah; Mohan, Chadalavada Venkata Rama

    2016-01-01

    Background and Aims: We aimed to compare three techniques for insertion of ProSeal laryngeal mask airway (PLMA). Material and Methods: Two hundred ten patients (American Society of Anaethesiologists I-II, aged 18–60 years) undergoing general anesthesia using the PLMA as an airway management device were randomly allocated to digital (D), rotational (R), or pharyngoscopic (P) techniques. In the D group (n = 70), the PLMA insertion was performed by using digital manipulation. In the R group (n = 70), the PLMA was inserted into the mouth, rotated anticlockwise through 90° and advanced into the hypopharynx. In the P group (n = 70), the PLMA was inserted after gentle pharyngoscopy using laryngoscope. Success rate at the first attempt, insertion time, airway manipulations required, and postoperative complications were noted. Results: Insertion at first attempt was more successful with P technique than the R and D groups (100% vs. 98.5% vs. 81.4% respectively, P < 0.01). Insertion time was shortest for the P group which was statistically significant compared to the group D (P < 0.001), but comparable with the R group. None of the patients required manipulation in the P group compared to the group R (P = 0.04) and D (P < 0.001). Blood staining (group P = 2.8% vs. group R = 2.8% vs. group D = 22%, P < 0.0001) and sore throat (group P = 0% vs. group R = 6.9% vs. group D = 16.7%, both: P < 0.005) were lower with the pharyngoscopic technique. Conclusion: We conclude that the pharyngoscopic technique for PLMA insertion is more successful with lower incidence of complications (mucosal bleeding and sore throat). PMID:28096585

  2. Residual protein contamination of ProSeal laryngeal mask airways after two washing protocols.

    PubMed

    Stone, T; Brimacombe, J; Keller, C; Kelley, D; Clery, G

    2004-06-01

    The risk of prion protein cross-infection has focussed attention on the potential hazards of protein contamination of re-usable medical devices. This study determined the frequency of protein contamination of ProSeal laryngeal mask airways (PLMA) after two cleaning procedures and tested the hypothesis that the combination of hand- and machine-washing removes protein contamination more effectively than hand-washing alone. After clinical use fifty-four PLMAs were randomly allocated to be washed by hand or by hand then machine. All PLMAs were then autoclaved at 134 degrees C for 4 minutes. After processing, each PLMA was immersed in a 1.2% solution of erythrosin B and examined for uptake of stain. The site (outer surface, bowl and edges of the cuff airway and drain tube, finger strap) and severity (nil/mild/moderate/severe) of staining was scored by a blinded observer. There were no differences in the site or severity of staining between the two cleaning procedures. Staining was detected on 89% of PLMAs that were hand-washed and 78% of PLMAs that were hand-, then machine-washed (P=0.27). When staining occurred, it was mild in 98%, moderate in 2% and was never severe. Staining was more frequent on the edge than at any other location (all comparisons: P < or = 0.01). The strap never had any staining. We conclude that residual contamination of PLMAs with protein deposits is common even when machine-washing is used to augment hand-washing before autoclaving. The infection risk associated with these deposits remains to be determined.

  3. Laryngeal mask airway without muscle relaxant in femoral head replacement in elderly patients

    PubMed Central

    KONG, MING; LI, BEIPING; TIAN, YUNPING

    2016-01-01

    The number of elderly patients undergoing femoral head replacement surgeries is on the increase. These patients often suffer from comorbidity such as cardiovascular and cerebrovascular complications, which limits the ability of medical teams to employ anesthesia. Thus, alternative methods are required. The aim of this study was to examine the advantage of laryngeal mask airway (LMA) in the absence of muscle relaxant in elderly patients undergoing femoral head replacement operations. Fifty patients (27 males and 23 females) undergoing femoral head replacements were selected for the study between March 2013 and May 2014. The mean value for the age in this group was 74.6±12.5 years. The patients were randomly distributed into two groups of 25. One group was designated as the treatment group and the second group as the control group. For the treatment group, LMA without muscle relaxant was used, and the control group received routine anesthesia. Variations in heart rate (HR), mean arterial pressure (MAP) and oxygen saturation (SPO2) in the two groups were monitored at different times. Clinical efficacy and muscle relaxation effects were also analyzed. For the treatment group, the HR, MAP and SPO2 measurements did not reveal any significant variation while these values in the control group demonstrated important dissimilarities. Time to recovery, time to extubation and incidence of throat pain in the treatment group were all markedly decreased as compared to those in control group. The operation time in the treatment group was not significantly different to that of control group. The satisfaction of the muscle relaxation effect in the treatment group was significantly higher than that in the control group while the incidence of adverse reactions was not considerably different. In conclusion, the use of LMA without using muscle relaxant in femoral head replacement surgeries performed on elderly patients showed to be effective and safe. PMID:26889218

  4. [Intubation of a patient with rheumatoid arthritis with a 7.5-mm-ID armored endotracheal tube using a laryngeal mask airway].

    PubMed

    Mashio, H; Kojima, T; Goda, Y; Kawahigashi, H; Ito, Y; Kato, M

    1997-12-01

    A 71-year-old male patient with rheumatoid arthritis was scheduled for posterior fusion of the cervical spine. He showed limited cervical movement and atrophic mandible. Tracheal intubation was difficult in his last anesthetic management for the same surgery. This time, we planned a special procedure for predicted difficult tracheal intubation. After induction of general anesthesia, a size-4 laryngeal mask airway was inserted. Next, a flexible fiberscope sheathed with a 6.0-mm-ID cuffed endotracheal tube was inserted through a laryngeal mask airway into the trachea, and the fiberscope was withdrawn. Then, an endotracheal tube changer was inserted through the endotracheal tube. The laryngeal mask airway and the endotracheal tube were withdrawn simultaneously leaving the tube changer. Finally, a 7.5-mm-ID armored endotracheal tube was inserted through the tube changer. The procedure applied in this case is a safe and reliable intubating method in patients with difficult tracheal intubation.

  5. Successful weaning of a laryngeal mask airway after a tongue-lip adhesion operation in a case with cerebro-costo-mandibular syndrome.

    PubMed

    So, Chi-Yung; Ng, Yan-Yan; Peng, Chih-Yu; Hu, Jui-Ming; Chen, Suh-Jen; Chen, Jia-Yuh; Su, Pen-Hua

    2010-02-01

    Cerebro-costo-mandibular syndrome (CCMS) consists of severe micrognathia, glossoptosis, posterior rib-gap defects and developmental delay. It may cause upper airway obstruction andflail chest, resulting in neonatal hypoxia, and possibly death. Early airway management or surgical intervention to maintain a patent airway is critical to avoid hypoxia in CCMS patients. We report a newborn with CCMS who was successfully weaned from a laryngeal mask after undergoing a tongue-lip adhesion operation at 164 days of age.

  6. ProSeal Laryngeal Mask Airway as an Alternative to Standard Endotracheal Tube in Securing Upper Airway in the Patients Undergoing Beating-heart Coronary Artery Bypass Grafting

    PubMed Central

    Shah, Kalpana

    2017-01-01

    Background: ProSeal laryngeal mask airways (PLMAs) are routinely used after failed tracheal intubation as airway rescue, facilitating tracheal intubation by acting as a conduit and to secure airway during emergencies. In long duration surgeries, use of endotracheal tube (ETT) is associated with various hemodynamic complications, which are minimally affected during PLMA use. However, except for few studies, there are no significant data available that promote the use of laryngeal mask during cardiac surgery. This prospective study was conducted with the objective of demonstrating the advantages of PLMA over ETT in the patients undergoing beating-heart coronary artery bypass graft (CABG). Methodology: This prospective, interventional study was carried out in 200 patients who underwent beating-heart CABG. Patients were randomized in equal numbers to either ETT group or PLMA group, and various hemodynamic and respiratory parameters were observed at different time points. Results: Patients in PLMA group had mean systolic blood pressure 126.10 ± 5.31 mmHg compared to the patients of ETT group 143.75 ± 6.02 mmHg. Pulse rate in the PLMA group was less (74.52 ± 10.79 per min) (P < 0.05) compared to ETT group (81.72 ± 9.8). Thus, hemodynamic changes were significantly lower (P < 0.05) in PLMA than in ETT group. Respiratory parameters such as oxygen saturation, pressure CO2 (pCO2), peak airway pressure, and lung compliance were similar to ETT group at all evaluation times. The incidence of adverse events was also lower in PLMA group. Conclusion: In experience hand, PLMA offers advantages over the ETT in airway management in the patients undergoing beating-heart CABG. PMID:28074798

  7. The comparison of ProSeal and I-gel laryngeal mask airways in anesthetized adult patients under controlled ventilation

    PubMed Central

    Ekinci, Osman; Abitagaoglu, Süheyla; Turan, Güldem; Sivrikaya, Zübeyir; Bosna, Gülşen; Özgultekin, Asu

    2015-01-01

    Objectives: To compare the insertion time, ease of device insertion, ease of gastric tube insertion, airway leakage pressure, and complications between the laryngeal mask airway (LMA) ProSeal (P-LMA) and I-gel (I-gel) groups. Methods: Eighty patients with age range 18-65 years who underwent elective surgery were included in the study. The study took place in the operation rooms of Haydarpaşa Numune Hospital, Istanbul, Turkey from November 2013 to April 2014. Patients were equally randomized into 2 groups; the I-gel group, and the P-LMA group. In both groups, the same specialist inserted the supraglottic airway devices. The insertion time of the devices, difficulty during insertion, difficulty during gastric tube insertion, coverage of airway pressure, and complications were recorded. Results: The mean insertion time in the I-gel group was significantly lower than that of the P-LMA group (I-gel: 8±3; P-LMA: 13±5 s). The insertion success rate was higher in the I-gel group (100%, first attempt) than in the P-LMA group (82.5%, first attempt). The gastric tube placement success rate was higher in the I-gel group (92.5%, first attempt) than in the P-LMA group (72.5%, first attempt). The airway leakage pressures were similar. Conclusion: Insertion was easier, insertion time was lower, and nasogastric tube insertion success was higher with the I-gel application, and is, therefore, the preferred LMA. PMID:25828279

  8. Effect of low dose rocuronium in preventing ventilation leak for flexible laryngeal mask airway during radical mastectomy

    PubMed Central

    Gong, Ya-Hong; Yi, Jie; Zhang, Qian; Xu, Li

    2015-01-01

    The flexible laryngeal mask airway (FLMA) is becoming more and more popular in general anesthesia during surgery of head, neck and upper chest. But very limited information has been published about whether muscle relaxant was necessary or not for anesthesia with FLMA. To investigate whether low-dose muscle relaxant is necessary in preventing ventilation leak of FLMA in radical mastectomy, forty-eight female patients undergoing radical mastectomy were enrolled in the study. They were randomly divided into low-dose muscle relaxant (LD-MR) group and non-muscle relaxant (non-MR) group. All the included patients received total intravenous anesthesia (with propofol, fentanyl and remifentanil) and controlled mechanical ventilation with FLMA during the surgery. Patients in LD-MR group received 0.4 mg/kg rocuronium during anesthesia induction, while patients in non-MR group received equivalent volumes of physiological saline. Insertion time was shorter in LD-MR group than that in non-MR group (P < 0.05). Peak airway pressures and ventilation leak volumes at 10, 20 and 30 minutes were lower in LD-MR group than those in non-MR group (P < 0.05). No difference was found between LD-MR and non-MR group in terms of emergence time, FLMA extraction time, and maximum tidal volumes before FLMA extraction. The results show that low-dose rocuronium could reduce the ventilation leak for mechanical ventilation with FLMA during radical mastectomy without prolonging the emergence time. PMID:26550303

  9. Efficacy of the New Perilaryngeal Airway (CobraPLA™) Versus the Laryngeal Mask Airway (LMA™) to Improve Oropharyngeal Leak Pressure in Obese and Overweight Patients

    PubMed Central

    Yaghoobi, Siamak; Abootorabi, Seyed Mohamadreza; Kayalha, Hamid; Van Zundert, Tom C

    2015-01-01

    Background: This study aimed to evaluate the applicability of Cobra perilaryngeal airway (Cobra PLA™) for obese patients under general anesthesia and also to compare the results with those of classic laryngeal mask airway (LMA™). Materials and Methods: Seventy-three overweight and obese patients were included in this study. The patients were randomly assigned to LMA™ or Cobra PLA™ groups. Time required for intubation, successful intubation attempt, airway sealing pressure and incidence of complications including blood staining, sore throat and dysphagia were assessed and noted. Results: Thirty-six and 37 patients were randomly allocated to LMA™ and Cobra PLA™ groups, respectively. Most patients were males and had Mallampati Class II airway in both groups. The first attempt and overall insertion success for Cobra PLA™ was significantly higher compared to LMA (P<0.05). Airway insertion was more successful (P = 0.027; 94% vs. 77%) with Cobra PLA™. Insertion times were similar with Cobra PLA™ and LMA™ (Cobra PLA™, 29.94±16.35s; LMA™, 27.00±7.88s). The oropharyngeal leak pressure in the Cobra PLA™ group (24.80±0.90 H2O) was significantly higher than that in LMA™ group (19±1 H2O, p<0.001). Sore throat was more frequent in the LMA™ group although it did not reach statistical significance (Fisher’s exact test, P = 0.33). Blood staining on airway tube was seen in both groups with a higher incidence in the Cobra PLA™ group (Fisher’s Exact test, P = 0.02). Incidence of dysphagia was not different between the two groups. Conclusion: CobraPLA™ was found to be safe with low complications. It provided better airway sealing with high rate of the first insertion success for use in obese and overweight patients. This study recommends the use of CobraPLA™ as a rescue device in emergency situations for obese and overweight patients. PMID:26221151

  10. A randomised trial to compare i-gel and ProSeal™ laryngeal mask airway for airway management in paediatric patients

    PubMed Central

    Nirupa, R; Gombar, Satinder; Ahuja, Vanita; Sharma, Preeti

    2016-01-01

    Background and Aims: i-gel™ is a newer supraglottic airway device with a unique non-inflatable cuff. We aimed to compare i-gel™ with ProSeal™ laryngeal mask airway (PLMA™) in children scheduled for surgery under general anaesthesia (GA) with controlled ventilation. Methods: This prospective, randomised controlled study was conducted in 100 surgical patients, aged 2–6 years of American Society of Anesthesiologists Physical Status I–II scheduled under GA. Patients were randomly allocated to receive either size 2 i-gel™ or PLMA™ as an airway device. The primary aim was oropharyngeal leak pressure assessed at 5 min following correct placement of the device. Secondary outcomes measured included number of attempts, ease of insertion, time of insertion, quality of initial airway, fibre-optic grading and effects on pulmonary mechanics. Statistical analysis was done using paired t-test and Chi-square test. Results: The demographic data were similar in both the groups. The oropharyngeal leak pressure in the i-gel™ group was 29.5 ± 2.5 cmH2 O as compared to 26.1 ± 3.8 cmH2 O in PLMA™ group (P = 0.002). The time taken for successful insertion in PLMA™ was longer as compared to i-gel (12.4 ± 2.7 vs. 10.2 ± 1.9 s, P = 0.007). The quality of initial airway was superior with i-gel™. The number of attempts, ease of insertion of supraglottic device, insertion of orogastric tube and pulmonary mechanics were similar in both the groups. Conclusion: Size 2 i-gel™ exhibited superior oropharyngeal leak pressure and quality of airway in paediatric patients with controlled ventilation as compared to PLMA™ although the pulmonary mechanics were similar. PMID:27761035

  11. Airway Complications during and after General Anesthesia: A Comparison, Systematic Review and Meta-Analysis of Using Flexible Laryngeal Mask Airways and Endotracheal Tubes

    PubMed Central

    Xu, Rui; Lian, Ying; Li, Wen Xian

    2016-01-01

    Objective Flexible laryngeal mask airways (FLMAs) have been widely used in thyroidectomy as well as cleft palate, nasal, upper chest, head and neck oncoplastic surgeries. This systematic review aims to compare the incidence of airway complications that occur during and after general anesthesia when using the FLMA and endotracheal intubation (ETT). We performed a quantitative meta-analysis of the results of randomized trials. Methods A comprehensive search of the PubMed, Embase and Cochrane Library databases was conducted using the key words "flexible laryngeal mask airway" and "endotracheal intubation". Only prospective randomized controlled trials (RCTs) that compared the FLMA and ETT were included. The relative risks (RRs) and the corresponding 95% confidence intervals (95% CIs) were calculated using a quality effects model in MetaXL 1.3 software to analyze the outcome data. Results Ten RCTs were included in this meta-analysis. There were no significant differences between the FLMA and ETT groups in the incidence of difficulty in positioning the airway [RR = 1.75, 95% CI = (0.70–4.40)]; the occurrence of sore throat at one hour and 24 hours postoperative [RR = 0.90, 95% CI = (0.13–6.18) and RR = 0.95, 95% CI = (0.81–1.13), respectively]; laryngospasms [RR = 0.58, 95% CI = (0.27–1.23)]; airway displacement [RR = 2.88, 95% CI = (0.58–14.33)]; aspiration [RR = 0.76, 95% CI = (0.06–8.88)]; or laryngotracheal soiling [RR = 0.34, 95% CI = (0.10–1.06)]. Patients treated with the FLMA had a lower incidence of hoarseness [RR = 0.31, 95% CI = (0.15–0.62)]; coughing [RR = 0.28, 95% CI = (0.15–0.51)] during recovery in the postanesthesia care unit (PACU); and oxygen desaturation [RR = 0.43, 95% CI = (0.26–0.72)] than did patients treated with ETT. However, the incidence of partial upper airway obstruction in FLMA patients was significantly greater than it was for ETT patients [RR = 4.01, 95% CI = (1.44–11.18)]. Conclusion This systematic review showed

  12. Randomized Comparison of Actual and Ideal Body Weight for Size Selection of the Laryngeal Mask Airway Classic in Overweight Patients.

    PubMed

    Kim, Min-Soo; Lee, Jong Seok; Nam, Sang Beom; Kang, Hyo Jong; Kim, Ji Eun

    2015-08-01

    Size selection of the laryngeal mask airway (LMA) Classic based on actual body weight remains a common practice. However, ideal body weight might allow for a better size selection in obese patients. The purpose of our study was to compare the utility of ideal body weight and actual body weight when choosing the appropriate size of the LMA Classic by a randomized clinical trial. One hundred patients with age 20 to 70 yr, body mass index ≥25 kg/m(2), and the difference between LMA sizes based on actual weight and ideal weight were allocated to insert the LMA Classic using either actual body weight or ideal body weight in a weight-based formula for size selection. After insertion of the device, several variables including insertion parameters, sealing function, fiberoptic imaging, and complications were investigated. The insertion success rate at the first attempt was lower in the actual weight group (82%) than in the ideal weight group (96%), even it did not show significant difference. The ideal weight group had significantly shorter insertion time and easier placement. However, fiberoptic views were significantly better in the actual weight group. Intraoperative complications, sore throat in the recovery room, and dysphonia at postoperative 24 hr occurred significantly less often in the ideal weight group than in the actual weight group. It is suggested that the ideal body weight may be beneficial to the size selection of the LMA Classic in overweight patients (Clinical Trial Registry, NCT 01843270).

  13. Use of laryngeal mask airway for non-endotracheal intubated anesthesia for patients with pectus excavatum undergoing thoracoscopic Nuss procedure

    PubMed Central

    Du, Xiaojun; Mao, Songsong; Cui, Jianxiu; Ma, Jue; Zhang, Guangyan; Zheng, Yong; Zhou, Haiyu; Xie, Liang; Zhang, Dongkun; Shi, Ruiqing

    2016-01-01

    Background The aim of the present study was to determine the safety and feasibility of the use of laryngeal mask airway (LMA) for non-endotracheal intubated anesthesia for patients with pectus excavatum (PE) undergoing thoracoscopic Nuss procedure. Methods Between July 2015 and December 2015, 30 selected patients with PE were planned to undergo a thoracoscopic Nuss procedure using LMA for non-endotracheal intubated anesthesia in the Guangdong General Hospital. The clinical data were analyzed to evaluate the safety and feasibility of this technique. Results Of the 30 selected patients, two were female, the mean age was 16.04±5.09 years and the average Haller index was 3.37±0.88. A total of 27 cases (90%) succeeded at the first attempt, one patient required conversion to an endotracheal tube (ETT) because of continuous air leak. The peripheral O2 saturation (SpO2), end-tidal carbon dioxide (EtCO2) values, heart rate (HR), and mean arterial blood pressure (MAP) remained stable throughout the procedure in all cases. All of the 30 patients were successfully corrected without requiring conversion to an open surgery. Two patients experienced postoperative nausea and one reported a sore throat. Neither gastro-esophageal reflux nor in-hospital mortality occurred. Conclusions The use of LMA for non-endotracheal intubated anesthesia for selected patients with PE undergoing thoracoscopic Nuss procedure is clinically safe and technically feasible. PMID:27621860

  14. Comparison of streamlined liner of the pharynx airway (SLIPA™) with the laryngeal mask airway Proseal™ for lower abdominal laparoscopic surgeries in paralyzed, anesthetized patients

    PubMed Central

    Abdellatif, Ashraf Abualhassan; Ali, Monaz Abdulrahman

    2011-01-01

    Context: Supraglottic airway devices have been used as an alternative to tracheal intubation during laparoscopic surgery. Aims: The study was designed to compare the efficacy of Streamlined Liner of the Pharynx Airway (SLIPA) for positive pressure ventilation and postoperative complications with the Laryngeal Mask Airway ProSeal (PLMA) for patients undergoing lower abdominal laparoscopies under general anesthesia with controlled ventilation. Settings and Design: Prospective, crossover randomized controlled trial performed on patients undergoing lower abdominal laparoscopic surgeries. Methods: A total of 120 patients undergoing lower abdominal laparoscopic surgeries were randomly allocated into two equal groups; PLMA and SLIPA groups. Number of intubation attempts, insertion time, ease of insertion, and fiberoptic bronchoscopic view were recorded. Lung mechanics data were collected 5 minutes after securing the airway, then after abdominal insufflation. Blood traces and regurgitation were checked for; postoperative sore throat and other complications were recorded. Statistical Analysis: Arithmetic mean and standard deviation values were calculated and statistical analyses were performed for each group. Independent sample t-test was used to compare continuous variables exhibiting normal distribution, and Chi-squared test for noncontinuous variables. P value <0.05 was considered significant. Results: Insertion time, first insertion success rate, and ease of insertion were comparable in both groups. Fiberoptic bronchoscopic view was significantly better and epiglottic downfolding was significantly lower in SLIPA group. Sealing pressure and lung mechanics were similar. Gastric distension was not observed in both groups. Postoperative sore throat was significantly higher in PACU in PLMA group. Blood traces on the device were significantly more in SLIPA group. Conclusions: SLIPA can be used as a useful alternative to PLMA in patients undergoing lower abdominal laparoscopic

  15. The clinical effectiveness of the streamlined liner of pharyngeal airway (SLIPA™) compared with the laryngeal mask airway ProSeal™ during general anesthesia

    PubMed Central

    Choi, Yun Mi; Cha, Su Man; Baek, Chong Wha; Jung, Yong Hun; Woo, Young Cheol; Kim, Jin Yun; Koo, Gill Hoi; Park, Sun Gyoo

    2010-01-01

    Background The aim of this study was to compare the streamlined liner of the pharynx airway (SLIPA), a new supraglottic airway device (SGA), with the laryngeal mask airway ProSeal™ (PLMA) during general anesthesia. Methods Sixty patients were randomly allocated to two groups; a PLMA group (n = 30) or a SLIPA group (n = 30). Ease of use, first insertion success rate, hemodynamic responses to insertion, ventilatory efficiency and positioning confirmed by fiberoptic bronchoscopy were assessed. Lung mechanics data were collected with side stream spirometry at 10 minutes after insertion. We also compared the incidence of blood stain, incidence and severity of postoperative sore throat and other complications. Results First attempt success rates were 93.3% and 73.3%, and mean insertion time was 7.3 sec and 10.5 sec in PLMA and SLIPA. There was a significant rise in all of hemodynamic response from the pre-insertion value at one minute following insertion of SLIPA. But, insertion of PLMA was no significant rise in hemodynamic response. There was no statistically significant difference in the mean maximum sealing pressure, gas leakage, lung mechanics data, gastric distension, postoperative sore throat and other complication between the two groups. Blood stain were noted on the surface of the device in 40% (n = 12) in the SLIPA vs. 6.7% (n = 2) in the PLMA. Conclusions The SLIPA is a useful alternative to the PLMA and have comparable efficacy and complication rates. If we acquire the skill to use, SLIPA may be considered as primary SGA devices during surgery under general anesthesia. PMID:20532053

  16. Endotracheal tubes versus laryngeal mask airways in rabbit inhalation anesthesia: ease of use and waste gas emissions.

    PubMed

    Smith, Jennifer C; Robertson, Linda D; Auhll, Ann; March, Tim J; Derring, Cheryl; Bolon, Brad

    2004-07-01

    In this study, we compared two endotracheal tubes (cuffed [Murphy Eye type] and uncuffed [Cole type]) and a pediatric laryngeal mask airway (LMA) with respect to their ease of use in rabbits and their capacities to limit waste isoflurane emissions. Animals (New Zealand White, 3.3 to 5.0 kg, n = 8) were sedated with intramuscular ketamine (50 mg/kg) and xylazine (10 mg/kg). After 5 min, the larynx was numbed with cetocaine, an intubation device was positioned, and anesthesia was maintained with isoflurane (2%) in oxygen (1 liter/min). Real-time atmospheric isoflurane emissions were assessed at the rabbit's oral commissure and in the operator's breathing zone (45 cm from the rabbit's nose) by using a portable infrared spectrophotometer. The LMA was placed more easily than was either endotracheal tube, especially by novices. The cuffed tube was positioned more readily than was the uncuffed variant. All three devices emitted isoflurane. The concentrations measured at the oral commissure for the LMA (mean +/- standard error, 8.4 +/- 0.6 ppm) were modestly higher than those acquired for the cuffed (6.7 +/- 0.5 ppm) and uncuffed (6.3 +/- 0.4 ppm) endotracheal tubes; the difference between the LMA and uncuffed tube was significant (P = 0.012). Isoflurane was not detected in the operator's breathing zone. These data show that the uncuffed endotracheal tube (usually used to anesthetize birds and reptiles) and the pediatric LMA can be used in rabbits as readily as a cuffed tube. In addition, our findings indicate that tradeoffs will be required in selecting a delivery system for this species, as the easiest apparatus (the LMA) also emits the most isoflurane waste.

  17. The effects of laryngeal mask airway passage simulation training on the acquisition of undergraduate clinical skills: a randomised controlled trial

    PubMed Central

    2011-01-01

    Background Effective use of the laryngeal mask airway (LMA) requires learning proper insertion technique in normal patients undergoing routine surgical procedures. However, there is a move towards simulation training for learning practical clinical skills, such as LMA placement. The evidence linking different amounts of mannequin simulation training to the undergraduate clinical skill of LMA placement in real patients is limited. The purpose of this study was to compare the effectiveness in vivo of two LMA placement simulation courses of different durations. Methods Medical students (n = 126) enrolled in a randomised controlled trial. Seventy-eight of these students completed the trial. The control group (n = 38) received brief mannequin training while the intervention group (n = 40) received additional more intensive mannequin training as part of which they repeated LMA insertion until they were proficient. The anaesthetists supervising LMA placements in real patients rated the participants' performance on assessment forms. Participants completed a self-assessment questionnaire. Results Additional mannequin training was not associated with improved performance (37% of intervention participants received an overall placement rating of > 3/5 on their first patient compared to 48% of the control group, X2 = 0.81, p = 0.37). The agreement between the participants and their instructors in terms of LMA placement success rates was poor to fair. Participants reported that mannequins were poor at mimicking reality. Conclusions The results suggest that the value of extended mannequin simulation training in the case of LMA placement is limited. Educators considering simulation for the training of practical skills should reflect on the extent to which the in vitro simulation mimics the skill required and the degree of difficulty of the procedure. PMID:21834978

  18. End-tidal sevoflurane concentration for ProSeal(TM) versus Classic(TM) laryngeal mask airway insertion in unpremedicated anaesthetised adult females.

    PubMed

    Ghai, B; Jain, K; Bansal, D; Bhatia, N

    2016-03-01

    The optimal end-tidal sevoflurane concentration for successful ProSealTM (Teleflex, Morrisville, NC, USA) laryngeal mask airway (PLMA) versus ClassicTM (Teleflex, Morrisville, NC, USA) laryngeal mask airway (CLMA) insertion in unpremedicated anaesthetised adults is unknown. We determined end-tidal sevoflurane concentrations for successful insertion in fifty percent of anaesthetised adults. This randomised, prospective, double-blind study was conducted in the operating theatre of a government tertiary care hospital. Forty-four unpremedicated American Society of Anesthesiologists physical status I and II women with cervical carcinoma (aged 30 to 60 years), scheduled for intracavity caesium implantation under general anaesthesia with a laryngeal mask airway (LMA) were included in the study. The participants were randomised to one of the two groups, to receive either a PLMA or CLMA. After anaesthetic induction with sevoflurane, a predetermined end-tidal sevoflurane concentration (starting at 2.5%) was sustained for 10 minutes before LMA insertion was attempted. End-tidal sevoflurane concentration was increased/decreased (step-size 0.25%) using Dixon and Massey's up-and-down method for the next patient based on the previous patient's response. Placement without clenching, movement, coughing or biting within one minute was considered successful insertion. The end-tidal sevoflurane concentration required for successful LMA insertion in fifty percent of anaesthetised adults was calculated as the mean of the crossover pairs' midpoints in each group and further confirmed by probit regression analysis. The end-tidal sevoflurane concentration (95% confidence interval) required for successful PLMA insertion in 50% of anaesthetised adults (3.15% [3.12% to 3.18%]) was significantly higher than that for CLMA insertion (2.71% [2.66% to 2.76%], P<0.001). These findings suggest that deeper anaesthesia is required for placement of a PLMA in comparison to a CLMA.

  19. Fentanyl dose for the insertion of Classic Laryngeal Mask Airways in non-paralysed patients induced with propofol 2.5 mg/kg.

    PubMed

    Tan, A S B; Wang, C Y

    2010-01-01

    The aim of this randomised, controlled trial was to determine the optimum dose of fentanyl in combination with propofol 2.5 mg x kg(-1) when inserting the Classic Laryngeal Mask Airway. Seventy-five ASA I or II patients were randomly assigned to five groups of fentanyl dosage: 0 microg x kg(-1) (placebo), 0.5 microg x kg(-1), 1.0 microg x kg(-1), 1.5 microg x kg(-1) and 2.0 microg x kg(-1). Anaesthesia was induced by first injecting the study drug over 10 seconds. Three minutes after the study drug was injected, propofol (2.5 mg x kg(-1)) was injected over 10 seconds. The Classic Laryngeal Mask Airway was inserted four minutes and 30 seconds after injection of the study drug. Insertion conditions were evaluated using a four-category score. Thirty-nine males and 36 females aged 19 to 59 years were studied. The incidence of prolonged apnoea increased as fentanyl dose increased. We found that there was a high rate of successful first attempt at insertion with 1 microg x kg(-1) and 1.5 microg x kg(-1), 93% and 87% respectively, compared to 87% in the 2.0 microg x kg(-1) group. The 1.0 microg x kg(-1) group also achieved an 80% optimal insertion conditions score of 4, compared to 73% in the 1.5 microg x kg(-1) group and 80% in the 2 microg x kg(-1) group. Therefore we recommend 1.0 microg x kg(-1) as the optimal dose of fentanyl when used in addition to propofol 2.5 mg/kg for the insertion of the Classic Laryngeal Mask Airway.

  20. I-gel versus laryngeal mask airway-Proseal: Comparison of two supraglottic airway devices in short surgical procedures

    PubMed Central

    Jadhav, Poonam A; Dalvi, Naina P; Tendolkar, Bharati A

    2015-01-01

    Background and Aims: Supraglottic airway devices have been established in clinical anesthesia practice and have been previously shown to be safe and efficient. The objective of this prospective, randomized trial was to compare I-Gel with LMA-Proseal in anesthetized spontaneously breathing patients. Material and Methods: Sixty patients undergoing short surgical procedures were randomly assigned to I-gel (Group I) or LMA- Proseal (Group P). Anesthesia was induced with standard doses of propofol and the supraglottic airway device was inserted. We compared the ease and time required for insertion, airway sealing pressure and adverse events. Results: There were no significant differences in demographic and hemodynamic data. I-gel was significantly easier to insert than LMA-Proseal (P < 0.05) (Chi-square test). The mean time for insertion was more with Group P (41 + 09.41 secs) than with Group I (29.53 + 08.23 secs) (P < 0.05). Although the airway sealing pressure was significantly higher with Group P (25.73 + 02.21 cm of H2O), the airway sealing pressure of Group I (20.07 + 02.94 cm of H2O) was very well within normal limit (Student's t test). The success rate of first attempt insertion was more with Group I (P < 0.05). There was no evidence of airway trauma, regurgitation and aspiration. Sore throat was significantly more evident in Group P. Conclusion: I-Gel is a innovative supraglottic device with acceptable airway sealing pressure, easier to insert, less traumatic with lower incidence of sore throat. Hence I-Gel can be a good alternative to LMA-Proseal. PMID:25948905

  1. Relationship Between Respiratory Dynamics and Body Mass Index in Patients Undergoing General Anesthesia with Laryngeal Mask Airway (LMA) and Comparison Between Lithotomy and Supine Positions.

    PubMed

    Zhao, Xiao; Huang, Shiwei; Wang, Zhaomin; Chen, Lianhua; Li, Shitong

    2016-08-01

    BACKGROUND This study aimed to compare respiratory dynamics in patients undergoing general anesthesia with a laryngeal mask airway (LMA) in lithotomy and supine positions and to validate the impact of operational position on effectiveness of LMA ventilation. MATERIAL AND METHODS A total of 90 patients (age range, 18-65 years) who underwent general anesthesia were selected and divided into supine position (SP group) and lithotomy position groups (LP group). Vital signs and respiratory dynamic parameters of the 2 groups were measured at different time points and after implantation of an LMA. The arterial blood gas was monitored at 15 min after induction. The intraoperative changes of hemodynamic indexes and postoperative adverse reactions of LMA were recorded. The possible correlation between body mass index (BMI) and respiratory dynamic indexes was analyzed. RESULTS With prolonged duration of the operation, the inspiratory plateau pressure (Pplat), inspiratory resistance (RI), and work of breathing (WOB) gradually increased, while chest-lung compliance (Compl) and partial pressure of carbon dioxide in end-expiratory gas (PetCO2) gradually decreased (all P value <0.05). The mean airway pressure (Pmean), Pplat, and expiratory resistance (Re) in the LP group were significantly higher than in the SP group (P<0.05), while the peak inspiratory flow (FImax), peak expiratory flow (FEmax), WOB, and Compl in the LP group were significantly lower than in the SP group (P<0.05). BMI was positively correlated with peak airway pressure (PIP/Ppeak), Pplat, and airway resistance (Raw) and was negatively correlated with Compl; the differences among patients in lithotomy position were more remarkable (P<0.05). CONCLUSIONS The inspiratory plateau pressure and airway resistance increased with prolonged duration of the operation, accompanied by decreased chest-lung compliance. Peak airway pressure and airway resistance were positively correlated with BMI, and chest-lung compliance was

  2. A novel combination of the Arndt endobronchial blocker and the laryngeal mask airway ProSeal™ provides one-lung ventilation for thoracic surgery.

    PubMed

    Li, Qiong; Li, Peiying; Xu, Jianghui; Gu, Huahua; Ma, Qinyun; Pang, Liewen; Liang, Weimin

    2014-11-01

    In this study, the feasibility and performance of the combination of the Arndt endobronchial blocker and the laryngeal mask airway (LMA) ProSeal™ in airway establishment, ventilation, oxygenation and lung isolation was evaluated. Fifty-five patients undergoing general anesthesia for elective thoracic surgeries were randomly allocated to group Arndt (n=26) or group double-lumen tube (DLT; n=29). Data concerning post-operative airway morbidity, ease of insertion, hemodynamics, lung collapse, ventilators, oxygenation and ventilation were collected for analysis. Compared with group DLT, group Arndt showed a significantly attenuated hemodynamic response to intubation (blood pressure, 149±31 vs. 115±16 mmHg; heart rate, 86±15 vs. 68±15 bpm), less severe injuries to the bronchus (injury score, 1.4±0.2 vs. 0.4±0.1) and vocal cords (injury score, 1.3±0.2 vs. 0.6±0.1), and lower incidences of post-operative sore throat and hoarseness. Furthermore, the novel combination of the Arndt and the LMA ProSeal showed similar ease of airway establishment, comparable ventilation and oxygenation performance, and an analogous lung isolation effect to DLT. The novel combined use of the Arndt endobronchial blocker and the LMA ProSeal can serve as a promising alternative for thoracic procedures requiring one-lung ventilation. The less traumatic properties and equally ideal lung isolation are likely to promote its use in rapidly spreading minimally invasive thoracic surgeries.

  3. [A new bite block for laryngeal mask].

    PubMed

    Ohe, Y; Ota, M; Tachibana, C; Aoyama, Y

    2001-05-01

    We devised a new bite block made of a used connector of anesthesia machine (ACOMA medical industry CO., LTD.) for laryngeal mask. Fitness for laryngeal mask and strength against patient's biting are the key for its use. Cutting lengthwise the connector (the outside diameter 22 mm, inside diameter 15-19 mm, 55 mm in length) we made a bite block for laryngeal mask. We studied the strength of a new bite block experimentally and recognized its ability to bear the human biting. We conclude a new bite block for laryngeal mask is clinically useful and can be used during anesthesia for its fitness and safety.

  4. [Application of the laryngeal mask in pediatric anesthesiology].

    PubMed

    López Gil, T; Cebrián Pazos, J; González Zarco, L M; Mateos Arribas, M T; Blanco Sánchez, T; Navia Roque, J

    1995-10-01

    To analyze problems with inserting, maintaining and removing a laryngeal mask in children, as well as to assess the possible involvement of certain factors (experience with the laryngeal mask, type of anesthesia, duration of surgery, type of surgery, obesity, etc.) in favoring the development of complications. One hundred eighty-nine children undergoing a variety of surgical procedures under general anesthesia were studied; patients with full stomachs and/or a history of hiatus hernia were excluded. The agent used for anesthetic induction and the method of ventilation were chosen by the anesthesiologist responsible for each case. Variables monitored in all patients were continuous ECG, heart rate, systolic and diastolic arterial pressure, capnography, pulse oximetry, airways pressure and respiratory rate. Values were recorded at five times: before induction (T1), immediately after induction (T2), after placement of the laryngeal mask (T3), before removing the laryngeal mask (T4) and after removing the laryngeal mask (T5). Correct insertion was achieved on the first try in 85%. The remaining 15% required 2 or more tries. There were no cases in which a tracheal tube or face mask were required. We found no correlation between type or duration of surgery and the occurrence of complications. Complications were more frequent when the laryngeal mask was placed by inexperienced personnel, when inhalational anesthetics were used for induction and maintenance, and when a No. 1 laryngeal mask was used. Adequate ventilation was provided for the patients who required it with an airways pressure between 8 and 18 cmH2O, arterial oxygen saturation over 98% and end-expiratory CO2 pressure under 35 mmHg. Cardiovascular repercussions were slight and hemodynamic stability was good.(ABSTRACT TRUNCATED AT 250 WORDS)

  5. The role of ventilation mode using a laryngeal mask airway during gynecological laparoscopy on lung mechanics, hemodynamic response and blood gas analysis

    PubMed Central

    Jarahzadeh, Mohammad Hossein; Halvaei, Iman; Rahimi-Bashar, Farshid; Behdad, Shekoufeh; Abbasizadeh Nasrabady, Rouhollah; Yasaei, Elahe

    2016-01-01

    Background: There are two methods for ventilation in gynecological laparoscopy: volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV). Objective: To compare the lung mechanics, hemodynamic response and arterial blood gas analysis and gas exchange of two modes of VCV and PCV using laryngeal mask airway (LMA) at different time intervals. Materials and Methods: Sixty infertile women referred for diagnostic laparoscopy, based on ventilation mode, were randomly divided into two groups of VCV (tidal volume: 10 ml/kg) and PCV. In the PCV group, ventilation was initiated with a peak airway pressure (tidal volume: 10 ml/kg, upper limit: 35 cm H2O). In both groups, the arterial blood samples were taken in several time intervals (5, 10 and 15 min after LMA insertion) for blood gas evaluation. Also the lung mechanics parameters were continuously monitored and were recorded at different time intervals. Results: There were no significant differences for patient’s age, weight, height and BMI in two groups. The peak and plateau airway pressure were significantly higher in VCV group compared to PCV group 5 and 10 min after insertion of LMA. PaO2 was significantly higher after 10 and 15 min in VCV group compared to PCV group (p=0.005 and p=0.03, respectively). PaCO2 showed significant increase after 5 min in PCV group, but the differences were not significant after 10 and 15 min in two groups. The end tidal CO2 showed significant increase after 10 and 15 min in VCV compared to PCV group. Conclusion: Both VCV and PCV seem to be suitable for gynecological laparoscopy. However, airway pressures are significantly lower in PCV compared to VCV. PMID:28066834

  6. Comparison of the i-gel and the LMA-Unique laryngeal mask airway in patients with mild to moderate obesity during elective short-term surgery.

    PubMed

    Weber, U; Oguz, R; Potura, L A; Kimberger, O; Kober, A; Tschernko, E

    2011-06-01

    The aim of our study was to compare leakage pressure, ease and time of insertion of the i-gel and the LMA-Unique laryngeal mask airway in patients with mild to moderate obesity during elective short-term surgery. In this prospective, randomised crossover trial, we included patients with a body mass index (BMI) >25 and <35 kg.m(-2) , and , age >18 years, undergoing elective surgery in the supine position with an expected duration of surgery <2 h. Leakage pressures, insertion difficulty, time and number of insertion attempts were evaluated. We included 50 patients consisting of 29 mildly (BMI>25 and < 30 kg.mg(-2) ) and 21 moderately (BMI>30 and < 35 kg.mg(-2) ) obese patients. Mean (SD) leakage pressures were 23.7 (9.2) cmH₂O (i-gel) and 17.4 (7.0) cmH₂O (LMA-Unique) (p<0.01). Subgroup analyses showed leakage pressures of 22.2 (9.4) cmH₂O (i-gel) and 17.5 (7.5) cmH₂O (LMA-Unique) (p=0.013) in the mild subgroup, and 25.7 (8.6) cmH₂O (i-gel) and 17.0 (6.2) cmH₂O (LMA-Unique) (p<0.01), in the moderate subgroup. Insertion of the i-gel was associated with significantly higher leakage pressures compared with the LMA-Unique in mildly and moderately obese patients.

  7. Comparison of i-gel™ and laryngeal mask airway Classic™ in terms of ease of insertion and hemodynamic response: A randomized observational study

    PubMed Central

    Pratheeba, N.; Ramya, G. S.; Ranjan, R. V.; Remadevi, R.

    2016-01-01

    Context: Laryngeal mask airway (LMA) Classic™ has an inflatable cuff while i-gel™ has a noninflatable cuff made of thermoplastic elastomer. Aims: To compare ease of insertion, number, and duration of insertion attempts among the two device. Secondary objectives were to evaluate the hemodynamic response and SpO2 during device insertion and during maintenance of general anesthesia. Settings and Design: This study was conducted as randomized observational study in a teaching hospital. Subjects and Methods: One hundred American Society of Anesthesiologists I and II, patients posted for surgery under general anesthesia were divided in two groups of fifty each. LMA Classic™ and i-gel™. Ease of insertion, duration of insertion, hemodynamic data, and episodes of hypoxia during insertion, 1, 3 and 5 min for 30 min, during removal and 1 min after removal. Statistical Analysis Used: Descriptive analyses were expressed as a mean ± standard deviation. Independent t-test used for parametric data, Chi-square test for nonparametric data and hemodynamic data were analyzed using repeated measures ANOVA to find statistical difference within the groups. Results: Devices were easy to insert, the mean duration of insertion attempts was 15.92 ± 1.62 s in the i-gel™ group, while it was 26.06 ± 5.12 s in the LMA Classic™ group, was statistically significant (P = 0.0001). Conclusions: Successful and shorter duration of insertion, with less hemodynamic response makes i-gel™ a suitable alternative to LMA Classic™ during general anesthesia. PMID:27746545

  8. [Use of ProSeal laryngeal mask airway in a patient with spontaneous ventilation for anesthetic management in off-pump coronary artery bypass grafting by lower-end sternal splitting approach].

    PubMed

    Matsumoto, Kappei

    2006-10-01

    Use of the laryngeal mask airway in off-pump coronary artery bypass grafting is controversial, largely because of a concern about increased risk for derangement in pulmonary mechanics. The author used the ProSeal LMA in a patient with spontaneous respiration for anesthetic management of off-pump coronary artery bypass grafting by the lower-end sternal splitting approach. There were no critical hypercapnea, hypoxia, ventilatory problems and pulmonary hypertension. This method provided suitable conditions for maintenance and emergence of anesthesia, providing shorter stay of less than 22 hours in ICU.

  9. I-gel Laryngeal Mask Airway Combined with Tracheal Intubation Attenuate Systemic Stress Response in Patients Undergoing Posterior Fossa Surgery

    PubMed Central

    Tang, Chaoliang; Chai, Xiaoqing; Kang, Fang; Huang, Xiang; Hou, Tao; Tang, Fei; Li, Juan

    2015-01-01

    Background. The adverse events induced by intubation and extubation may cause intracranial hemorrhage and increase of intracranial pressure, especially in posterior fossa surgery patients. In this study, we proposed that I-gel combined with tracheal intubation could reduce the stress response of posterior fossa surgery patients. Methods. Sixty-six posterior fossa surgery patients were randomly allocated to receive either tracheal tube intubation (Group TT) or I-gel facilitated endotracheal tube intubation (Group TI). Hemodynamic and respiratory variables, stress and inflammatory response, oxidative stress, anesthesia recovery parameters, and adverse events during emergence were compared. Results. Mean arterial pressure and heart rate were lower in Group TI during intubation and extubation (P < 0.05 versus Group TT). Respiratory variables including peak airway pressure and end-tidal carbon dioxide tension were similar intraoperative, while plasma β-endorphin, cortisol, interleukin-6, tumor necrosis factor-alpha, malondialdehyde concentrations, and blood glucose were significantly lower in Group TI during emergence relative to Group TT. Postoperative bucking and serious hypertensions were seen in Group TT but not in Group TI. Conclusion. Utilization of I-gel combined with endotracheal tube in posterior fossa surgery patients is safe which can yield more stable hemodynamic profile during intubation and emergence and lower inflammatory and oxidative response, leading to uneventful recovery. PMID:26273146

  10. Comparison of propofol (1%) with admixture (1:1) of thiopentone (1.25%) and propofol (0.5%) for laryngeal mask airway insertion in children undergoing elective eye surgery: Double-masked randomized clinical trial

    PubMed Central

    Sinha, Renu; Shende, Dilip; Garg, Rakesh

    2010-01-01

    Intravenous propofol 1% has been the preferred agent for Laryngeal Mask Airway (LMA) insertion. Admixture of thiopentone 1.25% and propofol 0.5% (1:1) has been used by various authors for induction as well as insertion of LMA in adults. There is no previous report where this admixture has been used for insertion of LMA in children. This study has been designed to investigate whether this admixture can be a suitable alternative to propofol, in relation to ease of insertion of the LMA, haemodynamic stability, cost containment, pain on injection and recovery in children. In this randomized, double-masked study, 50 ASA grade 1 and 2 patients of age 3 – 15 years and weighing more than 10 kg were included. The patients were divided into two groups; the P group received propofol 1%, while the Ad group received an admixture of thiopentone 1.25% and propofol 0.5% (1:1). All the children were evaluated for incidence of apnoea, pain on injection, jaw relaxation, ease of LMA insertion, coughing, gagging, laryngospasm, involuntary limb movements, incidence of hypotension and recovery. The demographic data, incidence of apnoea, pain on injection, jaw relaxation, ease of LMA insertion, coughing, gagging and involuntary movements were comparable in both groups. In the P group recovery was faster as compared to the Ad group. The admixture was cost effective as compared to Propofol alone [Indian National Rupees (INR) 24.64 ± 7.62 vs. INR 48.75 ± 23.25] (P = 0.001)). Admixture of propofol and thiopentone was a cheap, safe and effective alternative to propofol alone, for LMA insertion in children. PMID:20661346

  11. [Acute pulmonary edema from inhalation of the bite-block after anesthesia with a laryngeal mask].

    PubMed

    Banchereau, F; Marié, S; Pez, H; Boully-Balihaut, A; Tueux, O

    2001-12-01

    We report a case of acute pulmonary oedema, consecutive to upper airway obstruction due to the inhalation of the laryngeal mask airway (LMA) bite block during recovery. The LMA was used for general anaesthesia with the bite-block provided in France. No trouble occurred during LMA insertion and anaesthesia. Symptomatic treatment provided complete resolution within a few days.

  12. Postoperative pharyngolaryngeal adverse events with laryngeal mask airway (LMA Supreme) in laparoscopic surgical procedures with cuff pressure limiting 25 cmH₂O: prospective, blind, and randomised study.

    PubMed

    Kang, Joo-Eun; Oh, Chung-Sik; Choi, Jae Won; Son, Il Soon; Kim, Seong-Hyop

    2014-01-01

    To reduce the incidence of postoperative pharyngolaryngeal adverse events, laryngeal mask airway (LMA) manufacturers recommend maximum cuff pressures not exceeding 60 cmH₂O. We performed a prospective randomised study, comparing efficacy and adverse events among patients undergoing laparoscopic surgical procedures who were allocated randomly into low (limiting 25 cmH₂O, L group) and high (at 60 cmH₂O, H group) LMA cuff pressure groups with LMA Supreme. Postoperative pharyngolaryngeal adverse events were evaluated at discharge from postanaesthetic care unit (PACU) (postoperative day 1, POD 1) and 24 hours after discharge from PACU (postoperative day 2, POD 2). All patients were well tolerated with LMA without ventilation failure. Before pneumoperitoneum, cuff volume and pressure and oropharyngeal leak pressure (OLP) showed significant differences. Postoperative sore throat at POD 2 (3 versus 12 patients) and postoperative dysphagia at POD 1 and POD 2 (0 versus 4 patients at POD 1; 0 versus 4 patients at POD 2) were significantly lower in L group, compared with H group. In conclusion, LMA with cuff pressure limiting 25 cmH₂O allowed both efficacy of airway management and lower incidence of postoperative adverse events in laparoscopic surgical procedures. This clinical trial is registered with KCT0000334.

  13. Comparative study of heart rate responses to laryngoscopic endotracheal intubation and to endotracheal intubation using intubating laryngeal mask airway under general anaesthesia in patients with pure mitral stenosis for closed mitral commissurotomy.

    PubMed

    Das, Soumi; Gupta, Sampa Dutta; Goswampi, Anupam; Kundu, Kanak Kanti

    2013-04-01

    The various drugs and methods studied in an attempt to curb the haemodynamic stress response associated with conventional laryngoscopic endotracheal intubation have not been found to be ompletely satisfactory. The rise in heart rate can be detrimental to patients with mitral stenosis. This study was aimed to compare the heart rate responses to endotracheal intubation using conventional laryngoscope and with the help of intubating laryngeal mask airway (ILMA) in patients with isolated mitral stenosis. Thirty-four adult patients of either sex, aged between 18 and 40 years with isolated mitral stenosis to undergo closed mitral commissurotomy were randomly allocated into two groups : Group A (n=17)- To be intubated using laryngoscopy. Group B (n=17)- To be intubated with the help of ILMA. The heart rate was recorded immediately preinduction, just prior to introducing the intubating device and postintubation every minute up to first 5 minutes. On applying statistical tests, it was found that the median heart rate values in group A at 2, 3, 4 and 5 minutes postintubation were significantly higher than in group B (p<0.05). Although use of both laryngosope and ILMA for endotracheal intubation was associated with rise in heart rate, the rise was less with ILMA compared to laryngoscope. Hence, it can be concluded that use of ILMA may be a preferable device for endotracheal intubation laryngoscopy in patients with isolated mitral stenosis.

  14. Unilateral Vocal Cord Paralysis following Insertion of a Supreme Laryngeal Mask in a Patient with Sjögren's Syndrome

    PubMed Central

    Herold, I. H. F.; Tabor, M.; Bouwman, R. A.

    2016-01-01

    Since its introduction in 1988 by Dr. Archie Brain, the laryngeal mask airway (LMA) is being used with increasing frequency. Its ease of use has made it a very popular device in airway management and compared to endotracheal intubation it is less invasive. The use of LMA was on the rise, so has been the incidence of its related complications. We report severe unilateral vocal cord paralysis following the use of the supreme laryngeal mask (sLMA) in a patient with Sjögren's syndrome. In addition, we propose possible mechanisms of injury, review the existing case reports, and discuss our findings. PMID:28018681

  15. Ventilation of Nonparalyzed Patients Under Anesthesia with Laryngeal Mask Airway, Comparison of Three Modes of Ventilation: Volume Controlled Ventilation, Pressure Controlled Ventilation, and Pressure Controlled Ventilation-volume Guarantee

    PubMed Central

    Ghabach, Maroun Badwi; El Hajj, Elie M.; El Dib, Rouba D.; Rkaiby, Jeanette M.; Matta, May S.; Helou, May R.

    2017-01-01

    Background: Pressure controlled ventilation (PCV) is the preferable mode of ventilation of nonparalyzed patients undergoing anesthesia with laryngeal mask airway (LMA) as compared to volume controlled ventilation (VCV) and spontaneously breathing patient. In this study, we compared the PC–volume guarantee (PC-VG) mode of ventilation with VCV and PCV modes. Materials and Methods: A total of 30 patients, American Society of Anesthesiologists (ASA) physical status Classes I and II, scheduled for elective surgery under general anesthesia with a classic LMA were ventilated, subsequently, with the three modes of ventilation: VCV, PCV, and PC-VG for 10 min each mode. Tidal volume set for all patients was 8 ml/kg of ideal body weight. Parameters measured with modes of ventilation include peak inspiratory pressure (PIP), compliance, measured tidal volume, O2 saturation, end-tidal CO2, and presence of an oropharyngeal leak. Results: The PIP was significantly higher with the application of VCV mode of ventilation than PCV and PC-VG modes. The compliance was significantly lower when using the mode of ventilation VCV than PCV and PC-VG. The PIP and the compliance were not statistically different between the PCV and PC-VG modes of ventilation. Conclusions: Ventilation of nonparalyzed patients with LMA under anesthesia with PC-VG is advantageous over VCV in reducing PIP and increasing lung compliance. No difference was noted between PCV and PC-VG in ASA Classes I or II under the adequate depth of anesthesia in patients with normal pulmonary function. PMID:28298784

  16. Insertion Success of the Laryngeal Tube in Emergency Airway Management.

    PubMed

    Bernhard, Michael; Gries, André; Ramshorn-Zimmer, Alexandra; Wenzel, Volker; Hossfeld, Bjoern

    2016-01-01

    Background. Emergency airway management (AM) is a priority when resuscitating critically ill or severely injured patients. The goal of this study was to determine the success rates of LT insertion during AM. Methods. Studies that included LT first-pass insertion (FPI) and overall-pass insertion (OPI) success by emergency medical services and in-hospital providers performing AM for emergency situations as well as for scheduled surgery published until July 2014 were searched systematically in Medline. Results. Data of 36 studies (n = 1,897) reported a LT FPI success by physicians of 82.5% with an OPI success of 93.6% (p < 0.001). A cumulative analysis of all 53 studies (n = 3,600) led to FPI and OPI success of 80.1% and 92.6% (p < 0.001), respectively. The results of 26 studies (n = 2,159) comparing the LT with the laryngeal mask airway (LMA) demonstrated a FPI success of 77.0 versus 78.7% (p = 0.36) and an OPI success of 92.2 versus 97.7% (p < 0.001). Conclusion. LT insertion failed in the first attempt in one out of five patients, with an overall failure rate in one out of 14 patients. When compared with the LT, the LMA had a cumulative 5.5% better OPI success rate.

  17. Insertion Success of the Laryngeal Tube in Emergency Airway Management

    PubMed Central

    Gries, André; Ramshorn-Zimmer, Alexandra; Wenzel, Volker

    2016-01-01

    Background. Emergency airway management (AM) is a priority when resuscitating critically ill or severely injured patients. The goal of this study was to determine the success rates of LT insertion during AM. Methods. Studies that included LT first-pass insertion (FPI) and overall-pass insertion (OPI) success by emergency medical services and in-hospital providers performing AM for emergency situations as well as for scheduled surgery published until July 2014 were searched systematically in Medline. Results. Data of 36 studies (n = 1,897) reported a LT FPI success by physicians of 82.5% with an OPI success of 93.6% (p < 0.001). A cumulative analysis of all 53 studies (n = 3,600) led to FPI and OPI success of 80.1% and 92.6% (p < 0.001), respectively. The results of 26 studies (n = 2,159) comparing the LT with the laryngeal mask airway (LMA) demonstrated a FPI success of 77.0 versus 78.7% (p = 0.36) and an OPI success of 92.2 versus 97.7% (p < 0.001). Conclusion. LT insertion failed in the first attempt in one out of five patients, with an overall failure rate in one out of 14 patients. When compared with the LT, the LMA had a cumulative 5.5% better OPI success rate. PMID:27642595

  18. Air-Q intubating laryngeal airway: A study of the second generation supraglottic airway device

    PubMed Central

    Attarde, Viren Bhaskar; Kotekar, Nalini; Shetty, Sarika M

    2016-01-01

    Background and Aims: Air-Q intubating laryngeal mask airway (ILA) is used as a supraglottic airway device and as a conduit for endotracheal intubation. This study aims to assess the efficacy of the Air-Q ILA regarding ease of insertion, adequacy of ventilation, rate of successful intubation, haemodynamic response and airway morbidity. Methods: Sixty patients presenting for elective surgery at our Medical College Hospital were selected. Following adequate premedication, baseline vital parameters, pulse rate and blood pressure were recorded. Air-Q size 3.5 for patients 50-70 kg and size 4.5 for 70-100 kg was selected. After achieving adequate intubating conditions, Air-Q ILA was introduced. Confirming adequate ventilation, appropriate sized endotracheal tube was advanced through the Air-Q blindly to intubate the trachea. Placement of the endotracheal tube in trachea was confirmed. Results: Air-Q ILA was successfully inserted in 88.3% of patients in first attempt and 11.7% patients in second attempt. Ventilation was adequate in 100% of patients. Intubation was successful in 76.7% of patients with Air-Q ILA. 23.3% of patients were intubated by direct laryngoscopy following failure with two attempts using Air-Q ILA. Post-intubation the change in heart rate was statistically significant (P < 0.0001). 10% of patients were noted to have a sore throat and 5% of patients had mild airway trauma. Conclusion: Air-Q ILA is a reliable device as a supraglottic airway ensuring adequate ventilation as well as a conduit for endotracheal intubation. It benefits the patient by avoiding the stress of direct laryngoscopy and is also superior alternative device for use in a difficult airway. PMID:27212722

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

    ERIC Educational Resources Information Center

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

    2010-01-01

    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…

  20. Association between Laryngeal Airway Aperture and the Discharge Rates of Genioglossus Motor Units

    PubMed Central

    LaCross, Amy; Watson, Peter J.; Bailey, E. Fiona

    2017-01-01

    We know very little about how muscles and motor units in one region of the upper airway are impacted by adjustments in an adjacent airway region. In this case, the focus is on regulation of the expiratory airstream by the larynx and how changes in laryngeal aperture impact muscle motor unit activities downstream in the pharynx. We selected sound production as a framework for study as it requires (i) sustained expiratory airflow, (ii) laryngeal airway regulation for production of whisper and voice, and (iii) pharyngeal airway regulation for production of different vowel sounds. We used these features as the means of manipulating expiratory airflow, pharyngeal, and laryngeal airway opening to compare the effect of each on the activation of genioglossus (GG) muscle motor units in the pharynx. We show that some GG muscle motor units (a) discharge stably on expiration associated with production of vowel sounds, (b) are exquisitely sensitive to subtle alterations in laryngeal airflow, and (c) discharge at higher firing rates in high flow vs. low flow conditions even when producing the same vowel sound. Our results reveal subtle changes in GG motor unit discharge rates that correlate with changes imposed at the larynx, and which may contribute to the regulation of the expiratory airstream. PMID:28179887

  1. The Effects of Hyper- and Hypocapnia on Phonatory Laryngeal Airway Resistance in Women

    ERIC Educational Resources Information Center

    Gillespie, Amanda I.; Slivka, William; Atwood, Charles W., Jr.; Abbott, Katherine Verdolini

    2015-01-01

    Purpose: The larynx has a dual role in the regulation of gas flow into and out of the lungs while also establishing resistance required for vocal fold vibration. This study assessed reciprocal relations between phonatory functions--specifically, phonatory laryngeal airway resistance (R[subscript law])--and respiratory homeostasis during states of…

  2. Upper Airway Obstruction Requiring Emergent Tracheostomy Secondary to Laryngeal Sarcoidosis: A Case Report

    PubMed Central

    Ryu, Changwan; Herzog, Erica L.; Pan, Hongyi; Homer, Robert; Gulati, Mridu

    2017-01-01

    Patient: Female, 35 Final Diagnosis: Laryngeal sarcoidosis Symptoms: Hoarseness • stridor Medication: — Clinical Procedure: Tracheostomy Specialty: Otolaryngology Objective: Rare disease Background: Laryngeal sarcoidosis is a rare extrapulmonary manifestation of sarcoidosis, accounting for 0.33–2.1% of cases. A life-threatening complication of laryngeal sarcoidosis is upper airway obstruction. In this report we describe our experience in the acute and chronic care of a patient who required an emergent tracheostomy, with the aim to provide further insight into this difficult to manage disease. Case Report: A 37-year-old African American female with a 10-year history of stage 1 sarcoidosis presented with severe dyspnea. Laryngeal sarcoidosis was diagnosed three years previously, and she remained stable on low-dose prednisone until six months prior to admission, at which time she self-discontinued her prednisone for the homeopathic treatment Nopalea cactus juice. Her physical examination was concerning for impending respiratory failure as she presented with inspiratory stridor and hoarseness. Laryngoscopy showed a retroflexed epiglottis obstructing the glottis with edematous arytenoids and aryepiglottic folds. Otolaryngology performed an emergent tracheostomy to secure her airway and obtained epiglottic biopsies, which were consistent with sarcoidosis. She was eventually discharged home on prednisone 60 mg daily. Following months of corticosteroids, a laryngoscopy showed the epiglottis continuing to obstruct the glottis. The addition of methotrexate to a tapered dosage of prednisone 10 mg daily was unsuccessful, and she remains on prednisone 20 mg daily for disease control. Conclusions: Laryngeal sarcoidosis, a rare extrapulmonary manifestation of sarcoidosis, uncommonly presents as the life-threatening complication of complete upper airway obstruction. As such, laryngeal sarcoidosis is associated with significant morbidity and mortality, requiring a high index

  3. Upper Airway Obstruction Requiring Emergent Tracheostomy Secondary to Laryngeal Sarcoidosis: A Case Report.

    PubMed

    Ryu, Changwan; Herzog, Erica L; Pan, Hongyi; Homer, Robert; Gulati, Mridu

    2017-02-13

    BACKGROUND Laryngeal sarcoidosis is a rare extrapulmonary manifestation of sarcoidosis, accounting for 0.33-2.1% of cases. A life-threatening complication of laryngeal sarcoidosis is upper airway obstruction. In this report we describe our experience in the acute and chronic care of a patient who required an emergent tracheostomy, with the aim to provide further insight into this difficult to manage disease. CASE REPORT A 37-year-old African American female with a 10-year history of stage 1 sarcoidosis presented with severe dyspnea. Laryngeal sarcoidosis was diagnosed three years previously, and she remained stable on low-dose prednisone until six months prior to admission, at which time she self-discontinued her prednisone for the homeopathic treatment Nopalea cactus juice. Her physical examination was concerning for impending respiratory failure as she presented with inspiratory stridor and hoarseness. Laryngoscopy showed a retroflexed epiglottis obstructing the glottis with edematous arytenoids and aryepiglottic folds. Otolaryngology performed an emergent tracheostomy to secure her airway and obtained epiglottic biopsies, which were consistent with sarcoidosis. She was eventually discharged home on prednisone 60 mg daily. Following months of corticosteroids, a laryngoscopy showed the epiglottis continuing to obstruct the glottis. The addition of methotrexate to a tapered dosage of prednisone 10 mg daily was unsuccessful, and she remains on prednisone 20 mg daily for disease control. CONCLUSIONS Laryngeal sarcoidosis, a rare extrapulmonary manifestation of sarcoidosis, uncommonly presents as the life-threatening complication of complete upper airway obstruction. As such, laryngeal sarcoidosis is associated with significant morbidity and mortality, requiring a high index of suspicion for timely diagnosis and treatment.

  4. Laryngitis

    MedlinePlus

    ... your laryngitis symptoms last more than two weeks. Seek immediate medical attention if you: Have trouble breathing ... go away Have increasing pain Have trouble swallowing Seek immediate medical attention if your child: Makes noisy, ...

  5. Spirometric and plethysmographic assessment of upper airway obstruction in laryngeal hemiplegia.

    PubMed

    Cantarella, Giovanna; Fasano, Valter; Bucchioni, Enrica; Domenichini, Elena; Cesana, Bruno M

    2003-12-01

    Laryngeal hemiplegia (LH) is the most common disorder of laryngeal motility. It is deemed not to cause obstruction of the upper airway; in fact, the main symptoms are dysphonia and breathiness, and respiratory impairment is not commonly reported. The aim of this study was to objectively assess upper airway patency in 41 patients affected by LH (mean age, 54.4 +/- 15.2 years; 27 female) and 30 controls (mean age, 50.0 +/- 16.1 years; 19 female) by means of flow-volume loop spirometry and body plethysmography to measure specific airway resistance (sRaw) at increasing respiratory frequencies. The causes of LH were cervical surgery (28), tumor infiltration (5), and unexplained (8). None of the patients or controls was affected by lower airway disease. Spirometry showed that the patients had inspiratory flows (PIF, FIF50) significantly lower than those of the controls (p < .0001), whereas the expiratory flows (FEV1, FEF50) were normal, with the exception of peak expiratory flow (PEF), which was reduced, especially in female patients. The mean FEF50/FIF50 ratio (about unity in the normal subjects) was >1, as is typical of variable extrathoracic obstruction. Plethysmography showed that the values of sRaw of the LH group were not statistically different from those of the controls at 30 +/- 5 breaths per minute, but they progressively and significantly increased at 60 +/- 5 (p < .01) and 90 +/- 5 breaths per minute (p < .002), whereas no significant sRaw change was observed in the controls. These results show that LH causes obstruction of the upper airway that can be assessed and quantified by means of spirometry and body plethysmography. A dynamic narrowing due to inspiratory medialization of the paralytic vocal fold and flow turbulence during hyperventilation seem to be the causes of patency impairment. The flow-volume loop is an excellent, inexpensive, and easily available means of functionally evaluating upper airway obstruction, but some patients have difficulty in

  6. The Effects of Hyper- and Hypocapnia on Phonatory Laryngeal Airway Resistance in Women

    PubMed Central

    Slivka, William; Atwood, Charles W.; Verdolini Abbott, Katherine

    2015-01-01

    Purpose The larynx has a dual role in the regulation of gas flow into and out of the lungs while also establishing resistance required for vocal fold vibration. This study assessed reciprocal relations between phonatory functions—specifically, phonatory laryngeal airway resistance (Rlaw)—and respiratory homeostasis during states of ventilatory gas perturbations. Method Twenty-four healthy women performed phonatory tasks while exposed to induced hypercapnia (high CO2), hypocapnia (low CO2), and normal breathing (eupnea). Effects of gas perturbations on Rlaw were investigated as were the reciprocal effects of Rlaw modulations on respiratory homeostasis. Results Rlaw remained stable despite manipulations of inspired gas concentrations. In contrast, end-tidal CO2 levels increased significantly during all phonatory tasks. Thus, for the conditions tested, Rlaw did not adjust to accommodate ventilatory needs as predicted. Rather, stable Rlaw was spontaneously accomplished at the cost of those needs. Conclusions Findings provide support for a theory of regulation wherein Rlaw may be a control parameter in phonation. Results also provide insight into the influence of phonation on respiration. The work sets the foundation for future studies on laryngeal function during phonation in individuals with lower airway disease and other patient populations. PMID:25764093

  7. Repair of damaged supraglottic airway devices: A novel method

    PubMed Central

    2010-01-01

    Damage of laryngeal mask airway and other supraglottic airway devices has always been a matter of concern. Although manufacturer recommends maximum 40 uses of LMA (and its congeners) but damage before 40 uses needs to be evaluated. We hereby, describe a novel method of repair of supraglottic devices when damage occurs at mask inflation line or pilot balloon valve assembly. PMID:20565731

  8. Comparison of the Upper Airway Dynamics of Oronasal and Nasal Masks with Positive Airway Pressure Treatment using cine Magnetic Resonance Imaging

    PubMed Central

    Ebben, Matthew R.; Milrad, Sara; Dyke, Jonathan P.; Phillips, C. Douglas; Krieger, Ana C.

    2016-01-01

    Purpose It is known that oronasal masks are not as effective at opening the upper airway compared to nasal only continuous positive airway pressure (CPAP) masks in patients with sleep disordered breathing. However, the physiological mechanism for this difference in efficacy is not known; although, it has been hypothesized to involve the retroglossal and/or retropalatal region of the upper airway. The objective of this study was to investigate differences in retroglossal and retropalatal anterior-posterior space with the use of oronasal vs. nasal CPAP masks using real-time cine Magnetic Resonance Imaging (cMRI). Methods 10-Subjects (8-men, 2-women) with obstructive sleep apnea (OSA) were given cMRI with both nasal and oronasal CPAP masks. Each subject was imaged with each interface at pressures of 5, 10 and 15 cm of H2O, while in the supine position along the sagittal plane. Results The oronasal mask produced significantly less airway opening in the retropalatal region of the upper airway compared to the nasal mask interface. During exhalation, mask style had a significant effect on anterior-posterior distance p=0.016. No differences were found in the retroglossal region between mask styles. Conclusions Our study confirmed previous findings showing differences in treatment efficacy between oronasal and nasal mask styles. We have shown anatomic evidence that the nasal mask is more effective in opening the upper airway compared to the oronasal mask in the retropalatal region. PMID:25924934

  9. Laryngitis

    MedlinePlus

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

  10. Controversies in Pediatric Perioperative Airways

    PubMed Central

    Klučka, Jozef; Štourač, Petr; Štoudek, Roman; Ťoukálková, Michaela; Harazim, Hana; Kosinová, Martina

    2015-01-01

    Pediatric airway management is a challenge in routine anesthesia practice. Any airway-related complication due to improper procedure can have catastrophic consequences in pediatric patients. The authors reviewed the current relevant literature using the following data bases: Google Scholar, PubMed, Medline (OVID SP), and Dynamed, and the following keywords: Airway/s, Children, Pediatric, Difficult Airways, and Controversies. From a summary of the data, we identified several controversies: difficult airway prediction, difficult airway management, cuffed versus uncuffed endotracheal tubes for securing pediatric airways, rapid sequence induction (RSI), laryngeal mask versus endotracheal tube, and extubation timing. The data show that pediatric anesthesia practice in perioperative airway management is currently lacking the strong evidence-based medicine (EBM) data that is available for adult subpopulations. A number of procedural steps in airway management are derived only from adult populations. However, the objective is the same irrespective of patient age: proper securing of the airway and oxygenation of the patient. PMID:26759809

  11. Characteristics of the turbulent laryngeal jet and its effect on airflow in the human intra-thoracic airways.

    PubMed

    Lin, Ching-Long; Tawhai, Merryn H; McLennan, Geoffrey; Hoffman, Eric A

    2007-08-01

    A computational fluid dynamics technique is applied to understand the relative importance of the upper and intra-thoracic airways and their role in determining central airflow patterns with particular attention paid to the importance of turbulence. The geometry of the human upper respiratory tract is derived from volumetric scans of a volunteer imaged via multidetector-row computed tomography. Geometry 1 consists of a mouthpiece, the mouth, the oropharynx, the larynx, and the intra-thoracic airways of up to six generations. Geometry 2 comprises only the intra-thoracic airways. The results show that a curved sheet-like turbulent laryngeal jet is observed only in geometry 1 with turbulence intensity in the trachea varying from 10% to 20%, whereas the turbulence in geometry 2 is negligible. The presence of turbulence is found to increase the maximum localised wall shear stress by three-folds. The proper orthogonal decomposition analysis reveals that the regions of high turbulence intensity are associated with Taylor-Görtler-like vortices. We conclude that turbulence induced by the laryngeal jet could significantly affect airway flow patterns as well as tracheal wall shear stress. Thus, airflow modeling, particularly subject specific evaluations, should consider upper as well as intra-thoracic airway geometry.

  12. Choosing an Oronasal Mask to Deliver Continuous Positive Airway Pressure May Cause More Upper Airway Obstruction or Lead to Higher Continuous Positive Airway Pressure Requirements than a Nasal Mask in Some Patients: A Case Series

    PubMed Central

    Ng, Justin R.; Aiyappan, Vinod; Mercer, Jeremy; Catcheside, Peter G.; Chai-Coetzer, Ching Li; McEvoy, R. Doug; Antic, Nick

    2016-01-01

    Study Objectives: The choice of mask interface used with continuous positive airway pressure (CPAP) therapy can affect the control of upper airway obstruction (UAO) in obstructive sleep apnea (OSA). We describe a case series of four patients with paradoxical worsening of UAO with an oronasal mask and the effect of changing to a nasal mask. Methods: We retrospectively reviewed the case histories of 4 patients and recorded patient demographics, in-laboratory and ambulatory CPAP titration data, CPAP therapy data, type of mask interface used and potential confounding factors. Results: The 4 cases (mean ± SD: age = 59 ± 16 y; BMI = 30.5 ± 4.5 kg/m2) had a high residual apnoea-hypopnea index (AHI) (43 ± 14.2 events/h) and high CPAP pressure requirements (14.9 ± 6.6 cmH2O) with an oronasal mask. Changing to a nasal mask allowed adequate control of UAO with a significant reduction in the average residual AHI (3.1 ± 1.5 events/h). In two of the four cases, it was demonstrated that control of UAO was obtained at a much lower CPAP pressure compared to the oronasal mask (Case one = 17.5 cmH2O vs 12cmH2O; Case two = 17.9 cmH2O vs 7.8 cmH2O). Other potential confounding factors were unchanged. There are various physiological observations that may explain these findings but it is uncertain which individuals are susceptible to these mechanisms. Conclusions: If patients have OSA incompletely controlled by CPAP with evidence of residual UAO and/or are requiring surprisingly high CPAP pressure to control OSA with an oronasal mask, the choice of mask should be reviewed and consideration be given to a trial of a nasal mask. Commentary: A commentary on this article appears in this issue on page 1209. Citation: Ng JR, Aiyappan V, Mercer J, Catcheside PG, Chai-Coetzer CL, McEvoy RD, Antic N. Choosing an oronasal mask to deliver continuous positive airway pressure may cause more upper airway obstruction or lead to higher continuous positive airway pressure requirements than a nasal

  13. Supraglottic airway devices in children

    PubMed Central

    Ramesh, S; Jayanthi, R

    2011-01-01

    Modern anaesthesia practice in children was made possible by the invention of the endotracheal tube (ET), which made lengthy and complex surgical procedures feasible without the disastrous complications of airway obstruction, aspiration of gastric contents or asphyxia. For decades, endotracheal intubation or bag-and-mask ventilation were the mainstays of airway management. In 1983, this changed with the invention of the laryngeal mask airway (LMA), the first supraglottic airway device that blended features of the facemask with those of the ET, providing ease of placement and hands-free maintenance along with a relatively secure airway. The invention and development of the LMA by Dr. Archie Brain has had a significant impact on the practice of anaesthesia, management of the difficult airway and cardiopulmonary resuscitation in children and neonates. This review article will be a brief about the clinical applications of supraglottic airways in children. PMID:22174464

  14. CHALLENGES OF OBSTETRIC ANESTHESIA: DIFFICULT LARYNGEAL VISUALIZATION.

    PubMed

    Alanoğlu, Zekeriyya; Erkoç, Süheyla Karadağ; Güçlü, Çiğdem Yildirim; Meço, Başak Ceyda Orbey; Baytaş, Volkan; Can, Özlem Selvi; Alkiş, Neslihan

    2016-03-01

    Obstetric anesthesia is one of the high risk subspecialties of anesthesia practice. Anesthesia related complications are the sixth leading cause of maternal mortality. Difficult or failed intubation following induction of general anesthesia for CS remains the major contributory factor to anesthesia-related maternal complications. The airway management of obstetric patients is a challenging issue for several reasons. Anatomic and physiologic changes related to pregnancy may increase the difficult and failed intubation rates compared to the general surgical population. Proper evaluation of the airway anatomy and airway structures is vital to prevent airway management related catastrophes. In addition to basic airway and intubation equipment, each anesthesia department must have difficult intubation equipment cart including fiber optic laryngoscope, video laryngoscopes, and different types of laryngeal masks. It is essential that all anesthesiologists have a preconceived and well thought-out algorithm and emergency airway equipment to deal with airway emergencies during difficult or failed intubation of a parturient.

  15. A randomised comparison of the self-pressurised air-QTM intubating laryngeal airway with the LMA Unique™ in children.

    PubMed

    Jagannathan, N; Sohn, L E; Sawardekar, A; Shah, R; Ryan, K; Jagannathan, R; Anderson, K

    2012-09-01

    We conducted a randomised trial comparing the self-pressurised air-Q™ intubating laryngeal airway (air-Q SP) with the LMA-Unique in 60 children undergoing surgery. Outcomes measured were airway leak pressure, ease and time for insertion, fibreoptic examination, incidence of gastric insufflation and complications. Median (IQR [range]) time to successful device placement was faster with the air-Q SP (12 (10-15 [5-18])) s than with the LMA-Unique (14 (12-17 [6-22]) s; p=0.05). There were no statistically significant differences between the air-Q SP and LMA-Unique in initial airway leak pressures (16 (14-18 [10-29]) compared with 18 (15-20 [10-30]) cmH2 O, p=0.12), an airway leak pressures at 10 min (19 (16-22 [12-30]) compared with 20 (16-22 [10-30]) cmH2 O, p=0.81); fibreoptic position, incidence of gastric insufflation, or complications. Both devices provided effective ventilation without the need for airway manipulation. The air-Q SP is an alternative to the LMA-Unique should the clinician prefer a device not requiring cuff monitoring during anaesthesia.

  16. Recent advances and key challenges in investigations of the flow inside human oro-pharyngeal-laryngeal airway

    NASA Astrophysics Data System (ADS)

    Pollard, A.; Uddin, M.; Shinneeb, A.-M.; Ball, C. G.

    2012-07-01

    The oro-pharyngeal-laryngeal human airway is a complex geometry; the flow physics within are subjected to and influenced by a variety of different factors that produce jet-like flow, re-circulating flows that are enhanced by curvature, detached and secondary flows. Simulation and experiment are the tools available to the fluid dynamics researcher. Simulation results obtained from direct and large-eddy simulation, and Reynolds-averaged Navier-Stokes and associated models of turbulence are reviewed. Experimental data obtained through the use of flow visualisation, hot-wire anemometry and particle image velocimetry are also reviewed. A comparison of data obtained from the application of these tools reveals many inconsistencies that are explored in this article. While much progress has been made to understand some of the physics of the flow in the human airway, we continue to uncover new and significant fluid dynamic behaviour. Finally, future research directions are suggested.

  17. Comparison of the air-Q intubating laryngeal airway and the cobra perilaryngeal airway as conduits for fiber optic-guided intubation in pediatric patients

    PubMed Central

    Girgis, Karim K.; Youssef, Maha M. I.; ElZayyat, Nashwa S.

    2014-01-01

    Background: One of the methods proposed in cases of difficult airway management in children is using a supraglottic airway device as a conduit for tracheal intubation. The aim of this study was to compare the efficacy of the Air-Q Intubating Laryngeal Airway (Air-Q) and the Cobra Perilaryngeal Airway (CobraPLA) to function as a conduit for fiber optic-guided tracheal intubation in pediatric patients. Materials and Methods: A total of 60 children with ages ranging from 1 to 6 years, undergoing elective surgery, were randomized to have their airway managed with either an Air-Q or CobraPLA. Outcomes recorded were the success rate, time and number of attempts required for fiber optic-guided intubation and the time required for device removal after intubation. We also recorded airway leak pressure (ALP), fiber optic grade of glottic view and occurrence of complications. Results: Both devices were successfully inserted in all patients. The intubation success rate was comparable with the Air-Q and the CobraPLA (96.7% vs. 90%), as was the first attempt success rate (90% vs. 80%). The intubation time was significantly longer with the CobraPLA (29.5 ± 10.9 s vs. 23.2 ± 9.8 s; P < 0.05), but the device removal time was comparable in the two groups. The CobraPLA showed a significantly higher ALP (20.8 ± 5.2 cmH2O vs. 16.3 ± 4.5 cmH2O; P < 0.001), but the fiber optic grade of glottic view was comparable with the two devices. The CobraPLA was associated with a significantly higher incidence of blood staining of the device on removal and post-operative sore throat. Conclusion: Both the Air-Q and CobraPLA can be used effectively as a conduit for fiber optic-guided tracheal intubation in children. However, the Air-Q proved to be superior due to a shorter intubation time and less airway morbidity compared with the CobraPLA. PMID:25422603

  18. Potential Masking of Airway Eosinophilic Inflammation by Combination Therapy in Asthma

    PubMed Central

    Lee, Byung-Jae; Jeung, Yun-Jin; Lee, Jin-Young; Oh, Mi-Jung

    2014-01-01

    Purpose Long-acting β2 agonists (LABA) may mask ongoing bronchial inflammation, leaving asthmatic patients at greater risk of severe complications. The aim of this study was to compare the effect of combination therapy using low-dose inhaled corticosteroids (ICS) plus LABA on airway inflammation in asthma to the effect of medium-dose ICS alone. Methods Twenty-four patients with asthma not controlled by low-dose (400 µg per day) budesonide alone were enrolled in this prospective crossover study. Patients were randomized into 2 treatment phases: one receiving medium-dose (800 µg per day) budesonide (ICS phase), and the other receiving a combination therapy of low-dose budesonide/formoterol (360 µg/9 µg per day) delivered by a single inhaler (LABA phase). Each treatment phase lasted for 6 week, after which patients were crossed over. Asthma symptoms, lung function, and airway inflammation were compared between the 2 phases. Results Twenty-three patients completed the study; adequate sputum samples were collected from 17 patients. Asthma symptoms and lung function remained similar between the 2 phases. However, the mean sputum eosinophil percentage was higher in the LABA phase than in the ICS phase (5.07±3.82% vs. 1.02±1.70%; P<0.01). Sputum eosinophilia (≥3%) was more frequently observed in the LABA phase than in the ICS phase (six vs. two). Conclusion Addition of LABA may mask airway eosinophilic inflammation in asthmatic patients whose symptoms are not controlled with low-dose ICS. PMID:24587956

  19. Controlled trial of continuous positive airway pressure given by face mask for hyaline membrane disease.

    PubMed Central

    Allen, L P; Reynolds, E R; Rivers, R P; Le Souëf, P M; Wimberley, P D

    1977-01-01

    A controlled trial of elective intervention with continuous positive airway pressure (CPAP) was performed on 24 infants with hyaline membrane disease whose arterial oxygen tension (Pao2) fell below 8kPa (60 mmHg) while they were breathing a fractional inspired oxygen concentration (F1O2) greater than 0.60. A face mask was used to apply the CPAP. The progress of the 12 infants who were treated on entry to the trial was compared with that of 12 infants who were treated later. All 12 infants in the early-intervention group and 8 infants in the late-intervention group survived. When CPAP was started, Pao2 increased and the early-treated infants breathed high concentrations of oxygen for a shorter period than the late-treated infants. The 4 infants in the early-intervention group who required mechanical ventilation needed lower mean airway pressures to achieve satisfactory gas exchange than the 7 ventilated infants in the late-intervention group. We conclude that a Pao2 less than 8 kPa while breathing an F1o2 greater than 0.60 is an adequate indication for giving CPAP in hyaline membrane disease, and that early intervention with CPAP allows infants who go on to require mechanical ventilation to be ventilated at lower pressures. PMID:326199

  20. Pathogenesis of laryngeal narrowing in patients with multiple system atrophy

    PubMed Central

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

    2001-01-01

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

  1. Breathing resistance and ultrafine particle deposition in nasal-laryngeal airways of a newborn, an infant, a child, and an adult.

    PubMed

    Xi, Jinxiang; Berlinski, Ariel; Zhou, Yue; Greenberg, Bruce; Ou, Xiawei

    2012-12-01

    As a human grows from birth to adulthood, both airway anatomy and breathing conditions vary, altering the deposition rate and pattern of inhaled aerosols. However, deposition studies have typically focused on adult subjects, results of which may not be readily extrapolated to children. This study numerically evaluated the age-related effects on the airflow and aerosol dynamics in image-based nose-throat models of a 10-day-old newborn, a 7-month-old infant, a 5-year-old child, and a 53-year-old adult. Differences in airway physiology, breathing resistance, and aerosol filtering efficiency among the four models were quantified and compared. A high-fidelity fluid-particle transport model was employed to simulate the multi-regime airflows and particle transport within the nasal-laryngeal airways. Ultrafine particles were evaluated under breathing conditions ranging from sedentary to heavy activities. Results of this study indicate that the nasal-laryngeal airways at different ages, albeit differ significantly in morphology and dimension, do not significantly affect the total deposition fractions or maximum local deposition enhancement for ultrafine aerosols. Further, the deposition partitioning in the sub-regions of interest is different among the four models. Results of this study corroborate the use of the in vivo-based diffusion parameter (D(0.5)Q(-0.28)) over the replica-based parameter in correlating nasal-laryngeal depositions of ultrafine aerosols. Improved correlations have been developed for the four age groups by implementing this in vivo-based diffusion parameter as well as the Cunningham correction factor.

  2. Transmission of human papillomavirus DNA from patient to surgical masks, gloves and oral mucosa of medical personnel during treatment of laryngeal papillomas and genital warts.

    PubMed

    Ilmarinen, Taru; Auvinen, Eeva; Hiltunen-Back, Eija; Ranki, Annamari; Aaltonen, Leena-Maija; Pitkäranta, Anne

    2012-11-01

    The risk of occupational human papillomavirus (HPV) transmission from patient to medical personnel during laser vaporization procedures remains controversial. The purpose of this study was to determine the risk of HPV transmission from the patient to the protective surgical masks, gloves and oral mucosa of medical personnel during the treatment of laryngeal papillomas and genital warts. The study involved five male patients scheduled for the surgical treatment of laryngeal papillomas, and five male patients undergoing carbon dioxide (CO(2)) laser treatment for urethral warts. Oral mucosa specimens were obtained from the study patients and the employees pre- and postoperatively. Samples were collected from the HPV-infected patient tissue, and from the surgical masks and gloves used by the employees. A total of 120 samples were analyzed for the presence of HPV DNA by PCR, using the degenerated MY09/11/HMB01 primers. After the papilloma procedures, the surgeons' gloves tested HPV positive in one of the five cases and those of the surgical nurse in three of the five cases. After the treatment of genital warts, HPV DNA corresponding to the patient tissue specimens was present in all the samples obtained from the surgical gloves of the operators. All oral mucosa samples obtained from 18 different employees tested HPV negative, as did the surgical mask specimens. According to our study, HPV may contaminate protective equipment, most of all surgical gloves, but transmission of HPV DNA to medical personnel is unlikely to occur provided that protective surgical gloves and masks are applied and disposed of properly.

  3. Pre-pharyngeal Swallow Effects of Recurrent Laryngeal Nerve Lesion on Bolus Shape and Airway Protection in an Infant Pig Model.

    PubMed

    Gould, Francois D H; Yglesias, B; Ohlemacher, J; German, R Z

    2016-11-21

    Recurrent laryngeal nerve (RLN) damage in infants leads to increased dysphagia and aspiration pneumonia. Recent work has shown that intraoral transport and swallow kinematics change following RLN lesion, suggesting potential changes in bolus formation prior to the swallow. In this study, we used geometric morphometrics to understand the effect of bolus shape on penetration and aspiration in infants with and without RLN lesion. We hypothesized (1) that geometric bolus properties are related to airway protection outcomes and (2) that in infants with RLN lesion, the relationship between geometric bolus properties and dysphagia is changed. In five infant pigs, dysphagia in 188 swallows was assessed using the Infant Mammalian Penetration-Aspiration Scale (IMPAS). Using images from high-speed VFSS, bolus shape, bolus area, and tongue outline were quantified digitally. Bolus shape was analyzed using elliptical Fourier analysis, and tongue outline using polynomial curve fitting. Despite large inter-individual differences, significant within individual effects of bolus shape and bolus area on airway protection exist. The relationship between penetration-aspiration score and both bolus area and shape changed post lesion. Tongue shape differed between pre- and post-lesion swallows, and between swallows with different IMPAS scores. Bolus shape and area affect airway protection outcomes. RLN lesion changes that relationship, indicating that proper bolus formation and control by the tongue require intact laryngeal sensation. The impact of RLN lesion on dysphagia is pervasive.

  4. Laryngitis: types, causes, and treatments.

    PubMed

    Dworkin, James Paul

    2008-04-01

    Inflammatory processes that affect the unified airway can concurrently exert significant influence on the larynx and surrounding mucosal surfaces. Laryngeal inflammation can be present secondary to direct effects of irritants, toxins, and antigens, but can also involve mechanical and infectious effects as well as secondary inflammation from behavioral mechanisms. This review examines laryngeal inflammation in the context of the unified airway and discusses pathophysiologic mechanisms that are central to the development of acute and chronic laryngitis.

  5. The airway approach to a neonate with Treacher Collins syndrome - Case report.

    PubMed

    Marques-Pires, R; Trindade, H

    2017-01-13

    Neonates and small infants with syndromes characterized by the presence of craniofacial abnormalities may represent great challenges regarding the management of the airway. We describe the case of a 9-day-old neonate with Treacher Collins syndrome, in which a laryngeal mask was essential to improve the airway obstruction, ventilate the patient and serve as an airway conduit for a fiberoptic intubation. By presenting this case, we intend to show that in neonates with Treacher Collins syndrome, in whom difficulties ventilation and intubation are expected, a thoughtful airway management planning is mandatory.

  6. Fetoscopic and ultrasound-guided decompression of the fetal trachea in a human fetus with Fraser syndrome and congenital high airway obstruction syndrome (CHAOS) from laryngeal atresia.

    PubMed

    Kohl, T; Hering, R; Bauriedel, G; Van de Vondel, P; Heep, A; Keiner, S; Müller, A; Franz, A; Bartmann, P; Gembruch, U

    2006-01-01

    Congenital high airway obstruction syndrome (CHAOS) from laryngeal atresia bears a poor prognosis for hydropic fetuses owing to cardiac failure. We attempted percutaneous fetoscopic and ultrasound-guided tracheal decompression in a hydropic human fetus with CHAOS associated with Fraser syndrome. Percutaneous fetoscopic and ultrasound-guided tracheal decompression was performed using three trocars under general materno-fetal anesthesia at 19 + 5 weeks of gestation. Abnormal fetoplacental blood flow normalized within hours as a result of the intervention. Furthermore, a normalization of lung : heart size and lung echogenicity was observed within days. Resolution of hydrops was complete within 3 weeks. Premature rupture of membranes and premature contractions prompted emergency delivery of the fetus by ex-utero intrapartum treatment (EXIT) at 28 + 2 weeks of gestation. Following delivery, the lungs could be ventilated at low pressures and ambient oxygen concentration. Weaning from ventilation was achieved at 18 days of postnatal life. Our experience indicated that percutaneous fetoscopic and ultrasound-guided decompression of the fetal trachea is feasible and may permit normalization of hemodynamics in hydropic human fetuses with CHAOS from laryngeal atresia. The procedure may also result in normalization of heart : lung size and provide the time needed to regain the function of the overstretched diaphragm in this grave fetal condition.

  7. Design and Implementation of the Resuscitation Outcomes Consortium Pragmatic Airway Resuscitation Trial (PART)

    PubMed Central

    Wang, Henry E.; Prince, David; Stephens, Shannon W.; Herren, Heather; Daya, Mohamud; Richmond, Neal; Carlson, Jestin; Warden, Craig; Colella, M. Riccardo; Brienza, Ashley; Aufderheide, Tom P.; Idris, Ahamed; Schmicker, Robert; May, Susanne; Nichol, Graham

    2016-01-01

    Airway management is an important component of resuscitation from out-of-hospital cardiac arrest (OHCA). The optimal approach to advanced airway management is unknown. The Pragmatic Airway Resuscitation Trial (PART) will compare the effectiveness of endotracheal intubation (ETI) and Laryngeal Tube (LT) insertion upon 72-hour survival in adult OHCA. Encompassing United States Emergency Medical Services agencies affiliated with the Resuscitation Outcomes Consortium (ROC), PART will use a cluster-crossover randomized design. Participating subjects will include adult, non-traumatic OHCA requiring bag-valve-mask ventilation. Trial interventions will include 1) initial airway management with ETI and 2) initial airway management with LT. The primary and secondary trial outcomes are 72-hour survival and return of spontaneous circulation. Additional clinical outcomes will include airway management process and adverse events. The trial will enroll a total of 3,000 subjects. Results of PART may guide the selection of advanced airway management strategies in OHCA. PMID:26851059

  8. Use of a novel one-nostril mask-spacer device to evaluate airway hyperresponsiveness (AHR) in horses after chronic administration of albuterol.

    PubMed

    Mazan, Melissa R; Lascola, Kara; Bruns, Susan J; Hoffman, Andrew M

    2014-07-01

    Inflammatory airway disease (IAD) is very common in stabled horses. Short-acting beta agonist (SABA) drugs are often used to relieve clinical signs, although long-term exposure to these drugs may result in rebound bronchoconstriction. The purpose of this study was twofold: i) to describe the deposition of radiolabeled drugs using a novel one-nostril design mask-spacer combination with a breath-activated inhaler (BAI), and ii) to determine whether treatment for 10 d with inhaled albuterol using this device would impair the ability of albuterol to prevent bronchospasm during a histamine challenge test. The percentage of radio-aerosol deposited in the total lung was 12.39% ± 5.05%. All study horses demonstrated airway hyperresponsiveness (AHR) before enrollment in the study [mean provocative concentration eliciting 35% increase in delta flow (PC35) < 6 mg/mL histamine]. There was no significant difference in airway hyperresponsiveness to post-albuterol histamine challenge before or after treatment with albuterol. A 10-d treatment with placebo, however, caused a significant increase in airway hyperresponsiveness in all horses (P < 0.001). The results of this study show that the novel mask-spacer device was effective in delivering radiolabeled aerosolized drug to the lung and that delivery of a SABA for 10 d using this device did not result in increased airway hyperresponsiveness.

  9. Measurements of electrodynamic effects on the deposition of MDI and DPI aerosols in a replica cast of human oral-pharyngeal-laryngeal airways.

    PubMed

    Ali, Mohammed; Mazumder, Malay K; Martonen, Ted B

    2009-03-01

    Metered dose inhalers (MDIs) and dry powder inhalers (DPIs) are popular drug delivery devices used in the treatment of respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD). Integrated effects of electrostatic charges and aerodynamic sizes on the deposition of MDI and DPI particles in a replica cast of human oral-pharyngeal-laryngeal (OPL) airways were examined. Experimental aerosols were generated from commercially available MDI and DPI devices. They are the trademarked brands of the same pharmaceutical company, and contain the same amounts of different drugs. Inhalations were administered as boluses and characterized with an Electronic Single Particle Aerodynamic Relaxation Time (ESPART) analyzer before and after passing through the cadaver-based OPL cast. The MDI and DPI aerosols were not only of different sizes but also carried different positive, negative and zero electrostatic charges; 42.2% of the total number of DPI particles was charged in comparison to 6% of those produced by the MDI. Electrodynamic properties (e.g., charges and sizes) played significant roles on the behavior and deposition of aerosols in the OPL airways. As detailed herein, deposition fractions of the total (charged and uncharged) DPI aerosols were 21.5% in contrast to 2.8% for the MDI aerosols, whereas the charged particle deposition for the DPI was 46.7% in contrast to 22.5% for the MDI. Particle losses in the OPL passages were greater for the DPI than the MDI as the former generated more charged particles than the latter. This finding is consistent with results reported by other researchers but contradicts the observation of another investigator where MDI losses were reported as being higher than those for DPIs. The chief reason for this difference may be that the latter study did not account for the electrical properties of aerosol particles, but only for their mechanical properties. Because the measured deposition efficiencies of MDI and DPI aerosols

  10. [Regional anesthesia of the airways in difficult tracheal intubation in a conscious patient with spontaneous respiration].

    PubMed

    Dziadz'ko, A M

    2002-01-01

    Clinical pattern of anesthesia, hemodynamic and gas exchange states were evaluated in 64 patients with congenital or acquired damage of maxillary-facial region due to tumor or trauma. 51 patients were intubated under locoregional anesthesia of the upper respiratory tract (superior laryngeal nerves, glossopharyngeal nerves, intratracheal anesthesia) by means of blind nasal or oral fiberoptic retrograde and by using laryngeal mask technique. In 12 cases fiberoptic device was used for intubation under local anesthesia by lidocaine solution. There was no airways obstruction in any case. Satisfactory anesthesia in oropharynx, larynx and trachea was reached in all cases, the most profound blockage of airways and lack of pharyngeal and laryngeal reflexes being in patients under locoregional anesthesia. So locoregional anesthesia can be used for awake intubation.

  11. Histoplasmosis laryngeal

    PubMed Central

    Moriones Robayo, Carlos Alberto

    2014-01-01

    Laryngeal histoplasmosis is a fungal infection that is frequent in Colombia. Laryngeal histoplasmosis usually occurs in immunocompromised patients through the dissemination of the fungus from the lungs to other organs. Histoplasmosis isolated laryngeal (primary) is rare. If a patient presents with a history of immunosuppression by renal transplant, primary laryngeal histoplasmosis with supraglottic granulomatous inflammation that was treated with amphotericin B and Itraconazole, with complete resolution of laryngeal lesions. PMID:25767308

  12. Impact of the type of mask on the effectiveness of and adherence to continuous positive airway pressure treatment for obstructive sleep apnea.

    PubMed

    Andrade, Rafaela Garcia Santos de; Piccin, Vivien Schmeling; Nascimento, Juliana Araújo; Viana, Fernanda Madeiro Leite; Genta, Pedro Rodrigues; Lorenzi-Filho, Geraldo

    2014-01-01

    Continuous positive airway pressure (CPAP) is the gold standard for the treatment of obstructive sleep apnea (OSA). Although CPAP was originally applied with a nasal mask, various interfaces are currently available. This study reviews theoretical concepts and questions the premise that all types of interfaces produce similar results. We revised the evidence in the literature about the impact that the type of CPAP interface has on the effectiveness of and adherence to OSA treatment. We searched the PubMed database using the search terms "CPAP", "mask", and "obstructive sleep apnea". Although we identified 91 studies, only 12 described the impact of the type of CPAP interface on treatment effectiveness (n = 6) or adherence (n = 6). Despite conflicting results, we found no consistent evidence that nasal pillows and oral masks alter OSA treatment effectiveness or adherence. In contrast, most studies showed that oronasal masks are less effective and are more often associated with lower adherence and higher CPAP abandonment than are nasal masks. We concluded that oronasal masks can compromise CPAP OSA treatment adherence and effectiveness. Further studies are needed in order to understand the exact mechanisms involved in this effect.

  13. Sleep and neuromuscular disease: bilevel positive airway pressure by nasal mask as a treatment for sleep disordered breathing in patients with neuromuscular disease

    PubMed Central

    Guilleminault, C.; Philip, P.; Robinson, A.

    1998-01-01

    OBJECTIVE—Investigation of the therapeutic effects of bilevel positive airway pressure delivered by nasal mask in patients with neuromuscular disease.
METHODS—20 patients with neuromuscular disease were evaluated for symptoms of nocturnal sleep disruption. These symptoms included daytime tiredness, fatigue, sleepiness, and complaints of insomnia. The patients were studied with nocturnal polysomnograms and daytime multiple sleep latency tests (MSLT). Their immediate and long term responses to bilevel positive airway pressure were also investigated. The study took place at the Stanford University Sleep Disorders Clinic. Some of the polygraphic evaluations were performed with portable equipment in the patients' homes. The reported population comprised 20 patients, all of whom had progressive neuromuscular disease. Five of the patients were women. Four patients had muscular dystrophy, six had myotonic dystrophy, and two patients each had mitochondrial myopathy and glycogen storage disease. Two patients had post-traumatic lesions, one bulbar and the other phrenic. The remaining patients had vascular myopathy, unclassified myopathy, syringomyelia, and slow evolving spinocerebellar degeneration.
RESULTS—19 of the 20 patients accepted some form of non-invasive ventilation. All but one of these were initially maintained on bilevel positive airway pressure spontaneous (S) mode, although one patient required a switch to the timed (T) mode within a year. The mean expiratory positive airway pressure (EPAP) used was 4.5 with a range of 4 to 5 cm H2O. The mean inspiratory positive airway pressure (IPAP) was 11.5, range 9 to 14 cm H2O. Before treatment the MSLTs were ⩽ 8 minutes in 11 of the patients. The overall mean score was 8.2 (SD) 1.3 minutes. After long term treatment the mean MSLT was 12.5 (SD 2) minutes and the mean ESS score was 7 (SD 3). During the mean 3.5 years of follow up, three patients needed supplemental oxygen at a flow of 0.5 to 1.0 l/min bled into

  14. Oxygenation, Ventilation, and Airway Management in Out-of-Hospital Cardiac Arrest: A Review

    PubMed Central

    Henlin, Tomas; Michalek, Pavel; Tyll, Tomas; Hinds, John D.; Dobias, Milos

    2014-01-01

    Recently published evidence has challenged some protocols related to oxygenation, ventilation, and airway management for out-of-hospital cardiac arrest. Interrupting chest compressions to attempt airway intervention in the early stages of OHCA in adults may worsen patient outcomes. The change of BLS algorithms from ABC to CAB was recommended by the AHA in 2010. Passive insufflation of oxygen into a patent airway may provide oxygenation in the early stages of cardiac arrest. Various alternatives to tracheal intubation or bag-mask ventilation have been trialled for prehospital airway management. Simple methods of airway management are associated with similar outcomes as tracheal intubation in patients with OHCA. The insertion of a laryngeal mask airway is probably associated with worse neurologically intact survival rates in comparison with other methods of airway management. Hyperoxemia following OHCA may have a deleterious effect on the neurological recovery of patients. Extracorporeal oxygenation techniques have been utilized by specialized centers, though their use in OHCA remains controversial. Chest hyperinflation and positive airway pressure may have a negative impact on hemodynamics during resuscitation and should be avoided. Dyscarbia in the postresuscitation period is relatively common, mainly in association with therapeutic hypothermia, and may worsen neurological outcome. PMID:24724081

  15. Comparative Efficacy of the Air-Q Intubating Laryngeal Airway during General Anesthesia in Pediatric Patients: A Systematic Review and Meta-Analysis

    PubMed Central

    Ahn, Eun Jin; Choi, Geun Joo; Kang, Hyun; Baek, Chong Wha; Jung, Yong Hun; Woo, Young Cheol; Bang, Si Ra

    2016-01-01

    Air-Q® (air-Q) is a supraglottic airway device which can be used as a guidance of intubation in pediatric as well as in adult patients. We evaluated the efficacy and safety of air-Q compared to other airway devices during general anesthesia in pediatric patients by conducting a systematic review and meta-analysis. A total of 10 studies including 789 patients were included in the final analysis. Compared with other supraglottic airway devices, air-Q showed no evidence for a difference in leakage pressure and insertion time. The ease of insertion was significantly lower than other supraglottic airway devices. The success rate of intubation was significantly lower than other airway devices. However, fiberoptic view was better through the air-Q than other supraglottic airway devices. Therefore, air-Q could be a safe substitute for other airway devices and may provide better fiberoptic bronchoscopic view. PMID:27419134

  16. Laypersons can successfully place supraglottic airways with 3 minutes of training. A comparison of four different devices in the manikin

    PubMed Central

    2011-01-01

    Introduction Supraglottic airway devices have frequently been shown to facilitate airway management and are implemented in the ILCOR resuscitation algorithm. Limited data exists concerning laypersons without any medical or paramedical background. We hypothesized that even laymen would be able to operate supraglottic airway devices after a brief training session. Methods Four different supraglottic airway devices: Laryngeal Mask Classic (LMA), Laryngeal Tube (LT), Intubating Laryngeal Mask (FT) and CobraPLA (Cobra) were tested in 141 volunteers recruited in a technical university cafeteria and in a shopping mall. All volunteers received a brief standardized training session. Primary endpoint was the time required to definitive insertion. In a short questionnaire applicants were asked to assess the devices and to answer some general questions about BLS. Results The longest time to insertion was observed for Cobra (31.9 ± 27.9 s, range: 9-120, p < 0.0001; all means ± standard deviation). There was no significant difference between the insertion times of the other three devices. Fewest insertion attempts were needed for the FT (1.07 ± 0.26), followed by the LMA (1.23 ± 0.52, p > 0.05), the LT (1.36 ± 0.61, p < 0.05) and the Cobra (1.45 ± 0.7, p < 0.0001). Ventilation was achieved on the first attempt significantly more often with the FT (p < 0.001) compared to the other devices. Nearly 90% of the participants were in favor of implementing supraglottic airway devices in first aid algorithms and classes. Conclusion Laypersons are able to operate supraglottic airway devices in manikin with minimal instruction. Ventilation was achieved with all devices tested after a reasonable time and with a high success rate of > 95%. The use of supraglottic airway devices in first aid and BLS algorithms should be considered. PMID:22024311

  17. A randomised, non-crossover study of the GuardianCPV Laryngeal Mask versus the LMA Supreme in paralysed, anaesthetised female patients.

    PubMed

    Tiefenthaler, W; Eschertzhuber, S; Brimacombe, J; Fricke, E; Keller, C; Kaufmann, M

    2013-06-01

    We investigated the hypothesis that the oropharyngeal leak pressure would differ between the GuardianCPV™ and the LMA Supreme™ in anaesthetised patients. We randomly assigned 120 patients to receive either the GuardianCPV or the LMA Supreme for airway management. Oropharyngeal leak pressure was measured during cuff inflation from 0 to 40 ml in 10-ml steps. In addition, intracuff pressure, fibreoptic position of the airway and drain tube, device insertion success, ventilation success, blood staining and airway morbidity were determined. Mean (SD) oropharyngeal leak pressures for clinically acceptable cuff volumes of 20-40 ml were 31 (7) cmH2O for the GuardianCPV and 27 (7) cmH2O for the LMA Supreme (p < 0.0001); mean (SD) intracuff pressures were 68 (33) cmH2O and 88 (43) cmH2O (p < 0.0001), respectively. We found no differences in device insertion success, ventilation success, fibreoptic position of the airway and drain tube, blood staining or airway morbidity. We conclude that the oropharyngeal leak pressure is better for the GuardianCPV than for the LMA Supreme in anaesthetised patients.

  18. Severe micrognathia: indications for EXIT-to-Airway.

    PubMed

    Morris, Lee M; Lim, Foong-Yen; Elluru, Ravindhra G; Hopkin, Robert J; Jaekle, Ronald K; Polzin, William J; Crombleholme, Timothy M

    2009-01-01

    The ex utero intrapartum treatment (EXIT) procedure has become an important management option in cases of fetal airway obstruction. Select cases of severe micrognathia may be candidates for EXIT-to-Airway due to high-risk of airway obstruction at birth. Here we present three successful EXIT-to-Airway procedures for the management of congenital micrognathia in its most severe manifestations. CASE 1: A 23-year-old G3P1011 with a pregnancy complicated by severe micorgnathia, jaw index <5th percentile, as well as polyhydramnios. At 36 weeks EXIT-to-Airway was performed utilizing a bronchoscopically positioned laryngeal mask airway (LMA) during 23 min of uteroplacental support followed by tracheostomy. CASE 2: A 26-year-old G4P0120 with a pregnancy complicated by severe micrognathia, jaw index <5th percentile, and an obstructed oropharynx associated with polyhydramnios. At 37 weeks EXIT-to-Airway was performed with placement of tracheostomy. CASE 3: A 36-year-old G6P3023 with fetal magnetic resonance imaging (MRI) revealing esophageal atresia, polyhydramnios, and severe micrognathia with a jaw index <5th percentile. At 35 weeks the patient underwent EXIT-to-Airway with formal tracheostomy during 35 min of uteroplacental bypass. In the most severe cases of fetal micrognathia, EXIT-to-Airway provides time to evaluate and secure the fetal airway prior to delivery. We propose indications for EXIT-to-Airway in micrognathia to include a jaw index <5%, with indirect evidence of aerodigestive tract obstruction such as polyhydramnios, glossoptosis or an absent stomach bubble.

  19. Comparison of the Ambu Aura-i with the Air-Q Intubating Laryngeal Airway as A Conduit for Fiberoptic-guided Tracheal Intubation in Children with Ear Deformity.

    PubMed

    Zhi, Juan; Deng, Xiao-Ming; Yang, Dong; Wen, Chao; Xu, Wen-Li; Wang, Lei; Xu, Jin

    2016-12-20

    Objective To compare the Ambu Aura-i with the Air-Q intubating laryngeal airway for fiberoptic-guided tracheal intubation in ear deformity children.Methods Totally 120 children who were scheduled for elective auricular reconstruction surgery requiring general anaesthesia with tracheal intubation were enrolled in this prospective study. They were randomized to receive either the Ambu Aura-i (Aura-i group) or Air-Q (Air-Q group). The time for successful tracheal intubation was assessed. The attempts for successful device insertion, leak pressures, cuff pressures, fiberoptic grade of laryngeal view, time for removal of the device after endotracheal intubation, and complications were recorded. Results Device placement, endotracheal intubation, and removal after endotracheal intubation were successful in all patients. The Air-Q group required longer time than the Aura-i group in device placement[(14.1±7.2) s vs. (10.8±5.2) s, P<0.05], successful endotracheal intubation [(39.8±9.5) s vs. (24.1±8.2) s, P<0.05], and device removal [(18.2±5.1) s vs. (14.7±3.7) s, P<0.05]. There were no differences in fiberoptic grade of view between these devices, and the percentage of glottis seen was 80.0% (Air-Q group) vs. 86.7% (Aura-i group). The leak pressure was (20.5±4.8) cmH2O in the Air-Q group and (22.2±5.0) cmH2O in the Aura-i group (P<0.05), and the cuff pressure was (22.9±11.5)cmH2O in the Air-Q group and (33.9±15.9) cmH2O in the Aura-i group (P<0.05). Hemodynamic changes were not significantly different between two group. The incidence rate of sore throat two hours after operation was 6.5% (n=4) in the Air-Q group and 5% (n=3) in the Aura-i group. Conclusion Both Ambu Aura-i and Air-Q intubating laryngeal airway are effective conduits for beroptic-guided tracheal intubation, with advantages including simple operation, high success rate, and fewer complications, especially the Ambu Aura-i.

  20. Laryngeal actinomycosis.

    PubMed

    Lensing, Forrester; Abele, Travis; Wiggins, Richard; Quigley, Edward

    2014-01-01

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

  1. Laryngeal spasm after general anaesthesia due to Ascaris lumbricoides.

    PubMed

    Finsnes, K D

    2013-08-01

    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.

  2. Laryngeal structure and function in dogs with cough.

    PubMed

    Johnson, Lynelle R

    2016-07-15

    OBJECTIVE To investigate the prevalence and type of laryngeal abnormalities in dogs examined because of cough that did not have signs of upper airway disease and to compare the prevalence of those abnormalities among dogs with various respiratory tract diseases. DESIGN Prospective study. ANIMALS 138 dogs with cough that did not have signs of upper airway disease. PROCEDURES The study was conducted between July 2001 and October 2014 and included dogs examined for cough that had laryngoscopic and bronchoscopic examinations performed by 1 examiner. Laryngeal hyperemia and swelling were recorded, and laryngeal function was assessed before and after doxapram stimulation when indicated. Results were compared among dogs on the basis of cough duration (acute [< 2 weeks], subacute [2 weeks to 2 months], and chronic [> 2 months]) and disease diagnosed (inflammatory airway disease, airway collapse, lower respiratory tract infection, and eosinophilic bronchopneumopathy). RESULTS Laryngeal hyperemia was detected in 73 of 134 (54%) dogs with cough of subacute or chronic duration, and its prevalence did not vary significantly among dogs with various diseases. Thirteen dogs had laryngeal paresis, and 13 dogs had laryngeal paralysis; dysphonia (n = 2) and stridor (1) were uncommon findings in those dogs. The prevalence of laryngeal dysfunction (paresis or paralysis) did not differ significantly among diseases. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that 26 of 138 (19%) dogs examined because of cough alone had laryngeal dysfunction, which suggested that a complete laryngoscopic examination should be included in the diagnostic evaluation of dogs with cough.

  3. Complications of upper airway surgery in companion animals.

    PubMed

    Mercurio, Andrew

    2011-09-01

    Surgery of the upper airway is performed in dogs for the correction of brachycephalic airway syndrome and laryngeal paralysis and for temporary or permanent tracheostomy. Although technically simple to perform, upper airway surgeries can lead to the development of significant postoperative complications. This article reviews complications associated with common surgical conditions of the upper airway. It involves a discussion of brachycephalic airway syndrome and associated respiratory and gastrointestinal complications. It also covers laryngeal paralysis with a focus on unilateral arytenoid lateralization and the complication of aspiration pneumonia. The condition of acquired laryngeal webbing/stenosis and potential treatment options is also discussed. Finally, tracheostomies and associated complications in dogs and cats are reviewed.

  4. Effects of nasal mask leak and heated humidification on nasal mucosa in the therapy with nasal continuous positive airway pressure (nCPAP).

    PubMed

    Fischer, Yvonne; Keck, Tilman; Leiacker, Richard; Rozsasi, Ajnacska; Rettinger, Gerhard; Gruen, Philipp M

    2008-11-01

    The purpose of this study was to determine the objective short-term influence of nasal continuous positive airway pressure (nCPAP) therapy, nasal mask leak (NML) and heated humidifiers (HH) to nasal conditioning of spontaneously breathing subjects. This was a prospective, non-randomized, non-blinded day-time study. Eighteen healthy subjects were enrolled in the study. All subjects received nCPAP therapy for 60 min in three different conditions successively: (1) nCPAP without humidification, (2) nCPAP with a defined leakage of nasal mask (slashed circle 28.3 mm2) and (3) nCPAP with HH. Nasal humidity and temperature were measured in the anterior turbinate area using a miniaturized thermocouple and a relative humidity sensor. The measurements were accomplished at the beginning of therapy, after 60, 120 and 180 min. Absolute humidity (aH) in the anterior turbinate area decreased significantly (p = 0.0075) from 17.41 +/- 3.81 mg/l (baseline) to 15.27 +/- 2.21 mg/l (nCPAP alone). With attachment of a NML, aH decreased from 15.27 mg/l not significantly (p = 0.058) to 13.77 +/- 2.28 mg/l (nCPAP and NML) compared to nCPAP alone. After addition of heated humidification to nCPAP, aH increased again from 13.77 mg/l significantly (p = 0.042) to 15.29 +/- 3.51 mg/l (nCPAP and HH) compared to aH (nCPAP+NML). No difference was found between aH (nCPAP and HH) and aH (nCPAP alone). Airway temperature did not change significantly after application of nCPAP alone, nCPAP and NML, and nCPAP and HH. These data indicate that nCPAP therapy with NML tends to have more remarkable reduction of the nasal humidity than nCPAP therapy without NML. nCPAP with heated humidifier is able to compensate the dehydration effects induced by nCPAP therapy with NML by increasing the aH at the anterior turbinate area to the levels observed during breathing with nCPAP alone.

  5. Laryngeal stridor in multiple system atrophy: Clinicopathological features and causal hypotheses.

    PubMed

    Ozawa, Tetsutaro; Sekiya, Kanako; Aizawa, Naotaka; Terajima, Kenshi; Nishizawa, Masatoyo

    2016-02-15

    Laryngeal stridor is recognized as a characteristic clinical manifestation in patients with multiple system atrophy (MSA). However, the pathogenic mechanisms underlying this symptom are controversial. Neurogenic atrophy of the posterior cricoarytenoid muscle has been identified in cases of MSA, suggesting that laryngeal abductor weakness contributes to laryngeal stridor. However, dystonia in the laryngeal adductor muscles has also been reported to cause laryngeal stridor. Depletion of serotonergic neurons in the medullary raphe nuclei, which exert tonic drive to activate the posterior cricoarytenoid muscle, has recently been identified in MSA cases. This adds weight to the possibility that laryngeal abductor weakness underlies laryngeal stridor in MSA. Continuous positive airway pressure therapy is currently used in the treatment of laryngeal stridor, but should be used with caution in patients showing contraindications. Current knowledge of the clinical and neuropathological features of laryngeal stridor is summarized in this paper, and the hypothesized causes and possible therapeutic options for this symptom are discussed.

  6. Death due to obstruction of the upper airways caused by edema of the laryngeal mucosa in the course of hereditary angioedema.

    PubMed

    Arkuszewski, Piotr; Meissner, Ewa; Szram, Stefan

    2015-09-01

    A rare case of death of a young man due to airway obstruction in the course of angioedema (Quincke's edema). Type I hereditary angioedema due to C1 esterase inhibitor deficiency had been diagnosed in the man while he was alive. The information concerning the man's health state was given in the Public Prosecutor's decision ordering medico legal autopsy, which was extremely helpful in recognizing the cause of death.

  7. The Role of Airway and Endobronchial Ultrasound in Perioperative Medicine

    PubMed Central

    Votruba, Jiri; Zemanová, Petra; Lambert, Lukas; Vesela, Michaela Michalkova

    2015-01-01

    Recent years have witnessed an increased use of ultrasound in evaluation of the airway and the lower parts of the respiratory system. Ultrasound examination is fast and reliable and can be performed at the bedside and does not carry the risk of exposure to ionizing radiation. Apart from use in diagnostics it may also provide safe guidance for invasive and semi-invasive procedures. Ultrasound examination of the oral cavity structures, epiglottis, vocal cords, and subglottic space may help in the prediction of difficult intubation. Preoperative ultrasound may diagnose vocal cord palsy or deviation or stenosis of the trachea. Ultrasonography can also be used for confirmation of endotracheal tube, double-lumen tube, or laryngeal mask placement. This can be achieved by direct examination of the tube inside the trachea or by indirect methods evaluating lung movements. Postoperative airway ultrasound may reveal laryngeal pathology or subglottic oedema. Conventional ultrasound is a reliable real-time navigational tool for emergency cricothyrotomy or percutaneous dilational tracheostomy. Endobronchial ultrasound is a combination of bronchoscopy and ultrasonography and is used for preoperative examination of lung cancer and solitary pulmonary nodules. The method is also useful for real-time navigated biopsies of such pathological structures. PMID:26788507

  8. The Role of Airway and Endobronchial Ultrasound in Perioperative Medicine.

    PubMed

    Votruba, Jiri; Zemanová, Petra; Lambert, Lukas; Vesela, Michaela Michalkova

    2015-01-01

    Recent years have witnessed an increased use of ultrasound in evaluation of the airway and the lower parts of the respiratory system. Ultrasound examination is fast and reliable and can be performed at the bedside and does not carry the risk of exposure to ionizing radiation. Apart from use in diagnostics it may also provide safe guidance for invasive and semi-invasive procedures. Ultrasound examination of the oral cavity structures, epiglottis, vocal cords, and subglottic space may help in the prediction of difficult intubation. Preoperative ultrasound may diagnose vocal cord palsy or deviation or stenosis of the trachea. Ultrasonography can also be used for confirmation of endotracheal tube, double-lumen tube, or laryngeal mask placement. This can be achieved by direct examination of the tube inside the trachea or by indirect methods evaluating lung movements. Postoperative airway ultrasound may reveal laryngeal pathology or subglottic oedema. Conventional ultrasound is a reliable real-time navigational tool for emergency cricothyrotomy or percutaneous dilational tracheostomy. Endobronchial ultrasound is a combination of bronchoscopy and ultrasonography and is used for preoperative examination of lung cancer and solitary pulmonary nodules. The method is also useful for real-time navigated biopsies of such pathological structures.

  9. A pilot study to examine the effect of the Tulip oropharyngeal airway on ventilation immediately after mask ventilation following the induction of anaesthesia.

    PubMed

    Robinson, P N; Shaikh, A; Sabir, N M; Vaughan, D J A; Kynoch, M; Hasan, M

    2014-07-01

    The Tulip airway is an adult, disposable, single-sized oropharyngeal airway, that is connectable to an anaesthetic circuit. After a standardised induction of anaesthesia in 75 patients, the ease of insertion, intracuff pressure and intracuff volume were measured, as were the end-tidal carbon dioxide levels, airway pressures and tidal volumes over three breaths. Successful first-time insertion was achieved in 72 patients (96%, CI 88.8-99.2%) and after two attempts in 74 patients (99%, CI 92.8-100%). There was outright failure only in one patient. In 60 patients (80%, CI 72.2-90.4%), the Tulip airway provided a patent airway without additional manoeuvres, but in 14 patients, jaw thrust or head extension was necessary for airway patency. The main need for these adjuncts appeared to be an initial under-inflation of the cuff. These promising results are consistent with recent manikin studies using this device.

  10. Laryngeal histoplasmosis.

    PubMed

    Ansari, Hina A; Saeed, Noora; Khan, Nazoora; Hasan, Naba

    2016-08-17

    Histoplasmosis is a fungal infection, having interesting synonyms such as Cave disease, Darling's disease, Ohio Valley disease, reticuloendotheliosis, Spelunker's lung and Caver's disease. The aetiological agent is a dimorphic fungus, Histoplasma capsulatum, causing chronic granulomatous disease. The route of transmission is by inhalation of dust particles from soil contaminated by excrement of birds or bats, harbouring the small spores or microconidia, which is considered the infectious form of fungus. The spectrum of illness ranges from subclinical infection of the lung to progressive disseminated disease. The major bulk of histoplasmosis infections are asymptomatic or present with mild influenza like illness and involve immunocompetent individuals. However, the immunocompromised or immunodeficient cases have disseminated/haematogenous infections with multiple organs involved and are usually fatal unless treated immediately. Laryngeal involvement is associated with the disseminated form of the disease. Histoplasmosis of larynx is a rare entity and poses diagnostic difficulty to otolaryngologists because clinically it may be mistaken for malignancy. We report an unusual case of laryngeal histoplasmosis in a man aged 60 years who presented with provisional diagnosis of tuberculosis/malignancy.

  11. Effects of carbon dioxide on laryngeal receptors

    SciTech Connect

    Anderson, J.W.; Sant'Ambrogio, F.B.; Orani, G.P.; Sant'Ambrogio, G.; Mathew, O.P. )

    1990-02-26

    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.

  12. Comparison of three supraglottic airway devices for airway rescue in the prone position: A manikin-based study

    PubMed Central

    Gupta, Babita; Gupta, Surender; Hijam, Bijaya; Shende, Pallavi; Rewari, Vimi

    2015-01-01

    Background: Accidental extubation during surgery in prone position can be life-threatening. Supraglottic airway devices (SAD) have been used successfully in such situations to rescue the airway. However, which SAD would be most appropriate in this setting has not been described in the literature. Aims: The aim of our study was to determine the most appropriate SAD for securing airway in a prone position during accidental extubation. Materials and Methods: In the study, Airway Trainer (Laerdal) manikin was used for studying insertion of three SADs; I-gel, Laryngeal Mask Airway ProSeal™ (PLMA) and LMA Classic™ (CLMA) in the prone position. Forty anesthesia resident doctors participated in this study. The time taken for insertion; ease of insertion and ventilation; bronchoscopic view; and insertion score were compared among the three groups. Results: The time taken for I-gel insertion was significantly lesser (12.89 ± 3.94 seconds) as compared to CLMA (17.07 ± 3.5 seconds) and PLMA (25 + 4.78 seconds). Least resistance was encountered in the insertion of I-gel, while maximum resistance was experienced in PLMA group (22.5% vs. 90%). The maneuver required for optimal positioning was observed in 27.5% of PLMA insertion, 2.5% in CLMA while no maneuver was required in any of the I-gel insertion. Ease of ventilation was comparable in all three SADs. The bronchoscopic view and insertion score were significantly higher with I-gel as compared to CLMA and PLMA. Conclusion: All three SADs were successful as rescue devices during accidental extubation in the prone position. However, the ease of insertion was maximum with I-gel, followed by CLMA and PLMA. PMID:26604523

  13. Acute pulmonary edema and airway hemorrhage in a goat during sevoflurane anesthesia.

    PubMed

    Adami, C; Levionnois, O; Spadavecchia, C

    2011-02-01

    A goat was scheduled for experimental surgery under general anesthesia. The first attempt of performing endotracheal intubation failed and provoked laryngeal spasm. After repeated succesful intubation of inhalation anesthesia was delivered in high concentrations of sevoflurane. Suddenly hypertension and tachycardia were observed, followed by foamy airway secretion and then severe airway hemorrhage. The authors hypothesize that laryngeal spasm provoked respiratory distress and pulmonary edema. The delivered high concentrations of sevoflurane probably enhanced a hyperadrenergic response, predisposing to the development of airway hemorrhage.

  14. Atraumatic laser treatment for laryngeal papillomatosis

    NASA Astrophysics Data System (ADS)

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

    1994-09-01

    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.

  15. Laryngeal Paralyses: Theoretical Considerations and Effects on Laryngeal Vibration.

    ERIC Educational Resources Information Center

    Smith, Marshall E.; And Others

    1992-01-01

    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)

  16. Optimizing Mask Ventilation: Literature Review and Development of a Conceptual Framework.

    PubMed

    Saddawi-Konefka, Daniel; Hung, Susan L; Kacmarek, Robert M; Jiang, Yandong

    2015-12-01

    Mask ventilation is lifesaving, especially in cases of difficult intubation. Many publications have offered distinct techniques for optimizing mask ventilation. This article reviews currently available difficult mask ventilation literature and theory. We divide difficult mask ventilation into 3 broad categories based on etiology: inadequate mask seal, increased airway resistance, and decreased respiratory compliance. Published strategies for overcoming difficulty are presented and organized by etiology.

  17. Life-threatening upper airway edema caused by a distal rattlesnake bite.

    PubMed

    Hinze, J D; Barker, J A; Jones, T R; Winn, R E

    2001-07-01

    A 36-year-old man captured a timber rattlesnake and was accidentally envenomated in the thumb by the severed head. At a local emergency department, hypotension and confusion developed. Facial and glossal edema were also observed. Oxygen was delivered by face mask, and crystalloids and dopamine were administered. Respiratory distress developed with progressive hypoxemia. Intubation was unsuccessful because of massive glossal and epiglottic (laryngeal) edema, and an emergency cricothyrotomy was performed. High-dose antivenom therapy was administered, and mechanical ventilation was started. Recovery was rapid, and the patient was discharged from the hospital a week later. This is the first report of life-threatening upper airway edema caused by snake envenomation not in the vicinity of the head or neck.

  18. Laryngeal Dysfunction: Assessment and Management for the Clinician.

    PubMed

    Hull, James H; Backer, Vibeke; Gibson, Peter G; Fowler, Stephen J

    2016-11-01

    The larynx is one of the most highly innervated organs in humans and serves a number of vitally important, complex, and highly evolved biological functions. On a day-to-day basis, the larynx functions autonomously, addressing several roles including airway protection, swallowing, and phonation. In some situations the larynx appears to adopt a functional state that could be considered maladaptive or "dysfunctional." This laryngeal dysfunction can underpin and account for a number of respiratory symptoms that otherwise appear incongruous with a clinical disease state and/or contribute to the development of symptoms that appear "refractory" to treatment. These include conditions associated with a heightened tendency for inappropriate laryngeal closure (e.g., inducible laryngeal obstruction), voice disturbance, and chronic cough. Recognition of laryngeal dysfunction is important to deliver targeted treatment and failure to recognize the condition can lead to repeated use of inappropriate treatment. Diagnosis is not straightforward, however, and many patients appear to present with symptoms attributable to laryngeal dysfunction, but in whom the diagnosis has been overlooked in clinical work-up for some time. This review provides an overview of the current state of knowledge in the field of laryngeal dysfunction, with a focus on pragmatic clinical assessment and management.

  19. SafAIRway: an airway training for pulmonologists performing a flexible bronchoscopy with nonanesthesiologist administered propofol sedation: A prospective evaluation.

    PubMed

    Schulze, Melanie; Grande, Bastian; Kolbe, Michaela; Kriech, Sarah; Nöthiger, Christoph B; Kohler, Malcolm; Spahn, Donat R; Franzen, Daniel

    2016-06-01

    Nonanesthesiologist administered propofol (NAAP) sedation for flexible bronchoscopy is controversial, because there is no established airway management (AM) training for pulmonologists. The aim was to investigate the performance and acceptance of a proposed AM algorithm and training for pulmonologists performing NAAP sedation. The algorithm includes using 3 maneuvers including bag mask ventilation (BMV), laryngeal tube (LT), and needle cricothyrotomy (NCT). During training (consisting of 2 sessions with a break of 9 weeks in between), these maneuvers were demonstrated and exercised, followed by 4 consecutive attempts to succeed with each of these devices. The primary outcome was the improvement of completion time needed for a competent airway. Secondary outcomes were the trainees' overall reactions to the training and algorithm, and the perceptions of psychological safety (PS). The 23 staff members of the Department of Pulmonology performed a total of 552 attempts at AM procedures (4 attempts at each of the 3 maneuvers in 2 sessions), and returned a total of 42 questionnaires (4 questionnaires were not returned). Median completion times of LT and NCT improved significantly between Sessions 1 and 2 (P = 0.005 and P = 0.04, respectively), whereas BMV was only marginally improved (P = 0.05). Trainees perceived training to be useful and expressed satisfaction with this training and the algorithm. The perception of PS increased after training. An AM algorithm and training for pulmonologists leads to improved technical AM skills, and is considered useful by trainees and raised their perception of PS during training. It thus represents a promising program.

  20. A case of difficult airway due to lingual tonsillar hypertrophy in a patient with Down's syndrome.

    PubMed

    Nakazawa, Koichi; Ikeda, Daisuke; Ishikawa, Seiji; Makita, Koshi

    2003-09-01

    In this report, we describe airway management of symptomatic lingual tonsillar hypertrophy in a pediatric patient with Down's syndrome. Besides obstructive sleep apnea, the history included a small atrial septal defect with mild aortic regurgitation and Moyamoya disease. Anesthesia was induced with IV administration of 1 mg/kg of propofol, followed by inhalation of sevoflurane in 100% oxygen. Muscle relaxants were not used on induction. Rigid laryngoscopy could not visualize the epiglottis because of hypertrophied tonsillar tissue, and mask ventilation became difficult when spontaneous breathing stopped. We avoided using a laryngeal mask airway because of a slight bleeding tendency presumably caused by preoperative antiplatelet therapy. Fiberoptic bronchoscopy through the nasal cavity in combination with jet ventilation successfully identified the glottis and allowed nasotracheal intubation to be accomplished. After lingual tonsillectomy, the patient was extubated on the seventh postoperative day, after supraglottic edema had resolved. Fiberoptic nasotracheal intubation under inhaled anesthesia may therefore be preferable in pediatric or uncooperative patients with symptomatic lingual tonsillar hypertrophy.

  1. Development of Sub-optimal Airway Protocols for the International Space Station (ISS) by the Medical Operation Support Team (MOST)

    NASA Technical Reports Server (NTRS)

    Polk, James D.; Parazynski, Scott; Kelly, Scott; Hurst, Victor, IV; Doerr, Harold K.

    2007-01-01

    Airway management techniques are necessary to establish and maintain a patent airway while treating a patient undergoing respiratory distress. There are situations where such settings are suboptimal, thus causing the caregiver to adapt to these suboptimal conditions. Such occurrences are no exception aboard the International Space Station (ISS). As a result, the NASA flight surgeon (FS) and NASA astronaut cohorts must be ready to adapt their optimal airway management techniques for suboptimal situations. Based on previous work conducted by the Medical Operation Support Team (MOST) and other investigators, the MOST had members of both the FS and astronaut cohorts evaluate two oral airway insertion techniques for the Intubating Laryngeal Mask Airway (ILMA) to determine whether either technique is sufficient to perform in suboptimal conditions within a microgravity environment. Methods All experiments were conducted in a simulated microgravity environment provided by parabolic flight aboard DC-9 aircraft. Each participant acted as a caregiver and was directed to attempt both suboptimal ILMA insertion techniques following a preflight instruction session on the day of the flight and a demonstration of the technique by an anesthesiologist physician in the simulated microgravity environment aboard the aircraft. Results Fourteen participants conducted 46 trials of the suboptimal ILMA insertion techniques. Overall, 43 of 46 trials (94%) conducted were properly performed based on criteria developed by the MOST and other investigators. Discussion The study demonstrated the use of airway management techniques in suboptimal conditions relating to space flight. Use of these techniques will provide a crew with options for using the ILMA to manage airway issues aboard the ISS. Although it is understood that the optimal method for patient care during space flight is to have both patient and caregiver restrained, these techniques provide a needed backup should conditions not present

  2. Imaging of laryngeal trauma.

    PubMed

    Becker, Minerva; Leuchter, Igor; Platon, Alexandra; Becker, Christoph D; Dulguerov, Pavel; Varoquaux, Arthur

    2014-01-01

    External laryngeal trauma is a rare but potentially life-threatening situation in the acutely injured patient. Trauma mechanism and magnitude, maximum focus of the applied force, and patient related factors, such as age and ossification of the laryngeal cartilages influence the spectrum of observed injuries. Their correct diagnosis and prompt management are paramount in order to avoid patient death or long-term impairment of breathing, swallowing and speaking. The current review provides a comprehensive approach to the radiologic interpretation of imaging studies performed in patients with suspected laryngeal injury. It describes the key anatomic structures that are relevant in laryngeal trauma and discusses the clinical role of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the acute emergency situation. The added value of two-dimensional multiplanar reconstructions (2D MPR), three-dimensional volume rendering (3D VR) and virtual endoscopy (VE) for the non-invasive evaluation of laryngeal injuries and for treatment planning is discussed. The clinical presentation, biomechanics of injury, diagnostic pitfalls and pearls, common and uncommon findings are reviewed with emphasis of fracture patterns, involvement of laryngeal joints, intra- and extralaryngeal soft tissue injuries, and complications seen in the acute emergency situation. The radiologic appearance of common and less common long-term sequelae, as well as treatment options are equally addressed.

  3. Management of laryngeal radionecrosis: Animal and clinical experience

    SciTech Connect

    Oppenheimer, R.W.; Krespi, Y.P.; Einhorn, R.K.

    1989-05-01

    Radiation necrosis of the laryngeal cartilages is an uncommon complication of radiotherapy for laryngeal carcinoma. It is a devastating process for which there is no one acceptable treatment. Medical management offers only temporary, symptomatic relief, which further necessitates surgical treatment. Surgical management may start with a tracheotomy; however, it often ends with a total laryngectomy. Physiologically, the necrotic cartilages are the source of the problem. It is a general surgical principle that nonviable tissue must be excised to promote healing. Therefore, if the affected laryngeal cartilages were removed, the larynx should heal. Total or near total removal of the thyroid and cricoid cartilages with preservation of the endolaryngeal soft tissues has not been reported in the literature. Theoretically, if the entire cartilaginous framework is removed, there would be no structural support for the airway. We have found using animal models, that submucosal resection of the laryngeal cartilages, leaving the perichondrium and endolaryngeal soft tissues intact can result in a competent airway. Animal and clinical experience will be presented.

  4. [Laryngeal interarytenoid neurilemmoma excised via microlaryngeal endoscopy: two case reports].

    PubMed

    Shen, Yi; Cheng, Lixin; Tang, Ming

    2015-12-01

    Laryngeal interarytenoid neurilemmomas (LIN) is a benign encapsulated tumor originating from the schwann cells lining nerve fibers. Even though LINs are extremely rare in incidence, they could present with potential threat to the airway and thus requiring prompt diagnosis and treatment. Here, we report two cases of LINs. Both patients underwent excision of the tumor via microlaryngeal endoscopic procedures and recovered well postoperatively without complications. No recurrence was observed postoperatively on routine follow-up after 14 months.

  5. Evolution of the extraglottic airway: a review of its history, applications, and practical tips for success.

    PubMed

    Hernandez, Michael R; Klock, P Allan; Ovassapian, Adranik

    2012-02-01

    The development of the laryngeal mask airway in 1981 was an important first step toward widespread use and acceptance of the extraglottic airway (EGA). The term extraglottic is used in this review to encompass those airways that do not violate the larynx, in addition to those with a supraglottic position. Although the term extraglottic may be broad and include airways such as tracheostomy tubes, the term supraglottic does not describe a large number of devices with subglottic components and is too narrow for a discussion of modern devices. EGAs have flourished in practice, and now a wide variety of devices are available for an ever-expanding array of applications. In this review we attempt to clarify the current state of EGA devices new and old, and to illustrate their use in numerous settings. Particular attention is paid to the use of EGAs in special situations such as obstetric, pediatric, prehospital, and nontraditional "out of the operating room" settings. The role of the EGA in difficult airway management is discussed. EGA devices have saved countless lives because they facilitate ventilation when facemask ventilation and tracheal intubation were not possible. Traditionally, difficult airway management focused on successful tracheal intubation. The EGA has allowed a paradigm shift, changing the emphasis of difficult airway management from tracheal intubation to ventilation and oxygenation. EGA devices have proved to be useful adjuncts to tracheal intubation; in particular, the combination of EGA devices and fiberoptic guidance is a powerful technique for difficult airway management. Despite their utility, EGAs do have disadvantages. For example, they typically do not provide the same protection from pulmonary aspiration of regurgitated gastric material as a cuffed tracheal tube. The risk of aspiration of gastric contents persists despite advances in EGA design that have sought to address the issue. The association between excessive EGA cuff pressure and

  6. Laryngeal leiomyosarcoma masquerading as laryngeal carcinoma

    PubMed Central

    Singh, Lavleen; Mallick, Saumyaranjan; Singh, Shuchita; Safaya, Rajni

    2013-01-01

    Laryngeal leiomyosarcoma is an exceedingly rare malignant tumour, with fewer than 50 reported cases in scientific literature. Diagnosis is based on immunohistochemistry, supplemented with ultrastructural studies, if required. It is aggressive and associated with variable survival outcomes. A 63-year-old man presented with hoarseness for 7 months and breathlessness for 3 months. Imaging showed a well-defined 3 cm glottic mass. Total laryngectomy was performed. The histopathological examination showed features of leiomyosarcoma. The index case has been presented owing to its rarity, variable clinical manifestations and diagnostic dilemmas and to stress upon the importance of ancillary techniques for confirmation. PMID:23729706

  7. The critical airway in adults: The facts

    PubMed Central

    Bonanno, Fabrizio Giuseppe

    2012-01-01

    An algorithm on the indications and timing for a surgical airway in emergency as such cannot be drawn due to the multiplicity of variables and the inapplicability in the context of life-threatening critical emergency, where human brain elaborates decisions better in cluster rather than in binary fashion. In particular, in emergency or urgent scenarios, there is no clear or established consensus as to specifically who should receive a tracheostomy as a life-saving procedure; and more importantly, when. The two classical indications for emergency tracheostomy (laryngeal injury and failure to secure airway with endotracheal intubation or cricothyroidotomy) are too generic and encompass a broad spectrum of possibilities. In literature, specific indications for emergency tracheostomy are scattered and are biased, partially comprehensive, not clearly described or not homogeneously gathered. The review highlights the indications and timing for an emergency surgical airway and gives recommendations on which surgical airway method to use in critical airway. PMID:22787346

  8. Laryngeal hypersensitivity in chronic cough.

    PubMed

    Hull, J H; Menon, A

    2015-12-01

    Patients with chronic cough often report symptoms arising in the throat, in response to non-specific stimuli. Accordingly, the concept of a 'hypersensitivity' of the larynx in chronic cough has evolved over the past ten years. Patients with cough and laryngeal hypersensitivity frequently report features that overlap other laryngeal dysfunction syndromes, including a tendency for the vocal cords to inappropriately adduct. The mechanisms underlying laryngeal hypersensitivity in chronic cough are currently unclear, however recent studies provide new clinical and physiological techniques to aid detection and monitoring of laryngeal hypersensitivity. This review provides an overview of the current state of knowledge in this field.

  9. Laryngeal elevation by selective stimulation of the hypoglossal nerve

    NASA Astrophysics Data System (ADS)

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

    2013-08-01

    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.

  10. SafAIRway: an airway training for pulmonologists performing a flexible bronchoscopy with nonanesthesiologist administered propofol sedation

    PubMed Central

    Schulze, Melanie; Grande, Bastian; Kolbe, Michaela; Kriech, Sarah; Nöthiger, Christoph B.; Kohler, Malcolm; Spahn, Donat R.; Franzen, Daniel

    2016-01-01

    Abstract Nonanesthesiologist administered propofol (NAAP) sedation for flexible bronchoscopy is controversial, because there is no established airway management (AM) training for pulmonologists. The aim was to investigate the performance and acceptance of a proposed AM algorithm and training for pulmonologists performing NAAP sedation. The algorithm includes using 3 maneuvers including bag mask ventilation (BMV), laryngeal tube (LT), and needle cricothyrotomy (NCT). During training (consisting of 2 sessions with a break of 9 weeks in between), these maneuvers were demonstrated and exercised, followed by 4 consecutive attempts to succeed with each of these devices. The primary outcome was the improvement of completion time needed for a competent airway. Secondary outcomes were the trainees’ overall reactions to the training and algorithm, and the perceptions of psychological safety (PS). The 23 staff members of the Department of Pulmonology performed a total of 552 attempts at AM procedures (4 attempts at each of the 3 maneuvers in 2 sessions), and returned a total of 42 questionnaires (4 questionnaires were not returned). Median completion times of LT and NCT improved significantly between Sessions 1 and 2 (P = 0.005 and P = 0.04, respectively), whereas BMV was only marginally improved (P = 0.05). Trainees perceived training to be useful and expressed satisfaction with this training and the algorithm. The perception of PS increased after training. An AM algorithm and training for pulmonologists leads to improved technical AM skills, and is considered useful by trainees and raised their perception of PS during training. It thus represents a promising program. PMID:27281093

  11. Primary laryngeal localization of multiple myeloma: A case report

    PubMed Central

    Allegra, Eugenia; Marino, Nicolò; Modica, Domenico; Emmanuele, Carmela; Saita, Vincenzo

    2017-01-01

    Multiple myeloma is a lymphoproliferative disease that may involve the bone marrow as well as extramedullary soft tissues. However, laryngeal localization of multiple myeloma is extremely rare. We herein present the case of a 68-year-old male patient with a history of dyspnea, dysphonia and dysphagia. Laryngoscopic examination revealed a lesion involving the right glottis and right vestibular (false) vocal fold, with absence of ipsilateral laryngeal motility and constriction of the airway. Computed tomography and magnetic resonance imaging revealed a gross swelling infiltrating the right glottis and right false vocal fold, sized 33×19×33 mm, with sub-centimeter laterocervical lymph nodes bilaterally. Careful integration of the clinical manifestations with the radiological and pathological data led to the diagnosis of multiple myeloma. Given the rarity of this localization, the purpose of this study was to increase knowledge of this disease among ear, nose and throat specialists, in order to enable a more timely diagnosis. PMID:28357083

  12. Computed tomography of nonanesthetized cats with upper airway obstruction.

    PubMed

    Stadler, Krystina; O'Brien, Robert

    2013-01-01

    Upper airway obstruction is a potentially life-threatening problem in cats and for which a noninvasive, sensitive method rapid diagnosis is needed. The purposes of this prospective study were to describe a computed tomography (CT) technique for nonanesthetized cats with upper airway obstruction, CT characteristics of obstructive diseases, and comparisons between CT findings and findings from other diagnostic tests. Ten cats with clinical signs of upper airway obstruction were recruited for the study. Four cats with no clinical signs of upper airway obstruction were recruited as controls. All cats underwent computed tomography imaging without sedation or anesthesia, using a 16-slice helical CT scanner and a previously described transparent positional device. Three-dimensional (3D) internal volume rendering was performed on all CT image sets and 3D external volume rendering was also performed on cats with evidence of mass lesions. Confirmation of upper airway obstruction was based on visual laryngeal examination, endoscopy, fine-needle aspirate, biopsy, or necropsy. Seven cats were diagnosed with intramural upper airway masses, two with laryngotracheitis, and one with laryngeal paralysis. The CT and 3D volume-rendered images identified lesions consistent with upper airway disease in all cats. In cats with mass lesions, CT accurately identified the mass and location. Findings from this study supported the use of CT imaging as an effective technique for diagnosing upper airway obstruction in nonanesthetized cats.

  13. Histoplasmosis laryngeal: report first case in Colombia.

    PubMed

    Moriones Robayo, Carlos Alberto; Guerra Ortiz, Claudia Patricia

    2014-01-01

    Laryngeal histoplasmosis is a fungal infection that is frequent in Colombia. Laryngeal histoplasmosis usually occurs in immunocompromised patients through the dissemination of the fungus from the lungs to other organs. Histoplasmosis isolated laryngeal (primary) is rare. If a patient presents with a history of immunosuppression by renal transplant, primary laryngeal histoplasmosis with supraglottic granulomatous inflammation that was treated with amphotericin B and Itraconazole, with complete resolution of laryngeal lesions.

  14. Recent Advances in Management of Laryngeal Cancer

    PubMed Central

    2004-01-01

    Laryngeal cancers account for approximately 1.5% (1~2%) of the total cancers in Korea, and 30% of all head and neck cancers, not including thyroid cancer. Early laryngeal cancer is treated by operation, including transoral laser excision or radiotherapy. Advanced laryngeal cancer has been treated with mutilating operations, such as a total laryngectomy. However, a laryngeal preserving approach, which can improve the quality of life, has recently been tried with advanced laryngeal cancer. PMID:20396561

  15. Mask cost and specification

    NASA Astrophysics Data System (ADS)

    Watanabe, Hisashi; Higashikawa, Iwao

    2003-12-01

    At the panel discussion of Photomask Japan 2003, we discussed about Mask cost and specification. The topics are (1) Mask price trend and its impact, (2) How to reduce the mask costs; solutions from a mask shop, mask writing tool and mask inspection tool 3) Partnering mask suppliers with mask users; reasonable mask specification and OPC strategies. The choice of DUV laser writer instead of e-beam writer is one solution for reduction of mask cost. The continuous improvement of e-beam writer and resist sensitivity for high throughput is another solution. The partnership between designer, EDA vender, mask maker and wafer lithographer becomes more important.

  16. Clay Mask Workshop

    ERIC Educational Resources Information Center

    Gamble, David L.

    2012-01-01

    Masks can represent so many things, such as emotions (happy, sad, fearful) and power. The familiar "comedy and tragedy" masks, derived from ancient Greek theater, are just one example from mask history. Death masks from the ancient Egyptians influenced the ancient Romans into creating similar masks for their departed. Masks can represent many…

  17. Activation of upper airway muscles during breathing and swallowing

    PubMed Central

    Ludlow, Christy L.

    2013-01-01

    The upper airway is a complex muscular tube that is used by the respiratory and digestive systems. The upper airway is invested with several small and anatomically peculiar muscles. The muscle fiber orientations and their nervous innervation are both extremely complex, and how the activity of the muscles is initiated and adjusted during complex behaviors is poorly understood. The bulk of the evidence suggests that the entire assembly of tongue and laryngeal muscles operate together but differently during breathing and swallowing, like a ballet rather than a solo performance. Here we review the functional anatomy of the tongue and laryngeal muscles, and their neural innervation. We also consider how muscular activity is altered as respiratory drive changes, and briefly address upper airway muscle control during swallowing. PMID:24092695

  18. [Open and closed laryngeal injuries].

    PubMed

    Bartnik, Władysław; Bartnik-Krystalska, Alicja

    2003-01-01

    Treatment and results of 13 laryngeal and trachea traumas have been presented. All patients were operated in 24 hours after the injury. We had good results, only two patients had vocal chord paralysis. After phoniatric rehabilitation they regained good voice.

  19. Nasal mask ventilation is better than face mask ventilation in edentulous patients

    PubMed Central

    Kapoor, Mukul Chandra; Rana, Sandeep; Singh, Arvind Kumar; Vishal, Vindhya; Sikdar, Indranil

    2016-01-01

    Background and Aims: Face mask ventilation of the edentulous patient is often difficult as ineffective seating of the standard mask to the face prevents attainment of an adequate air seal. The efficacy of nasal ventilation in edentulous patients has been cited in case reports but has never been investigated. Material and Methods: Consecutive edentulous adult patients scheduled for surgery under general anesthesia with endotracheal intubation, during a 17-month period, were prospectively evaluated. After induction of anesthesia and administration of neuromuscular blocker, lungs were ventilated with a standard anatomical face mask of appropriate size, using a volume controlled anesthesia ventilator with tidal volume set at 10 ml/kg. In case of inadequate ventilation, the mask position was adjusted to achieve best-fit. Inspired and expired tidal volumes were measured. Thereafter, the face mask was replaced by a nasal mask and after achieving best-fit, the inspired and expired tidal volumes were recorded. The difference in expired tidal volumes and airway pressures at best-fit with the use of the two masks and number of patients with inadequate ventilation with use of the masks were statistically analyzed. Results: A total of 79 edentulous patients were recruited for the study. The difference in expiratory tidal volumes with the use of the two masks at best-fit was statistically significant (P = 0.0017). Despite the best-fit mask placement, adequacy of ventilation could not be achieved in 24.1% patients during face mask ventilation, and 12.7% patients during nasal mask ventilation and the difference was statistically significant. Conclusion: Nasal mask ventilation is more efficient than standard face mask ventilation in edentulous patients. PMID:27625477

  20. Interrelation of mandibular laryngeal functions.

    PubMed

    Cookman, S; Verdolini, K

    1999-03-01

    The purpose of the experiment was to explore relations between jaw and laryngeal functions. The general question was whether laryngeal adduction was affected by jaw opening or by jaw biting. Twelve untrained, vocally healthy male and female adults participated as subjects. Subjects produced repeated tokens of /uh/ in each of 12 experimental conditions involving combinations of 3 jaw openings (10 mm, 25 mm, 40 mm), 2 jaw biting pressures (10 kPa, 200 kPa), and 2 fundamental frequencies (conversational and high). For each token, laryngeal adduction was estimated from the electroglottographic closed quotient. The most straightforward results were that (1) laryngeal adduction increased as jaw opening increased at the conversational pitch, for all subjects, independent of biting pressure, and (2) laryngeal adduction increased as biting pressure increased, at the conversational pitch, for males, independent of jaw opening. Other relations between estimated laryngeal adduction and jaw manipulations were more complex, varying with fundamental frequency and gender. Speculations are made about possible biomechanical and neurological explanations for the findings.

  1. Laser applications in pediatric airway surgery

    NASA Astrophysics Data System (ADS)

    Karamzadeh, Amir M.; Ahuja, Gurpreet S.; Nguyen, John D.; Crumley, Roger

    2003-06-01

    The smaller anatomy and limited access to instrumentation pose a challenge to the pediatric airway surgeon. The enhanced precision and ability to photocoagulate tissue while operating with the laser enhances the surgeon"s ability to successfully treat unique pediatric conditions such subglottic hemangiomas, congenital cysts, respiratory papillomatosis, and laryngeal or tracheal stenosis. Due to its shallow tissue penetration and thermal effect, the carbon dioxide (CO2) laser is generally considered the laser of choice for pediatric airway applications. The potential for increased scarring and damage to underlying tissue caused by the greater penetration depth and thermal effect of the Nd:YAG and KTP lasers preclude their use in this population. In this review, we will describe the specific advantages of using lasers in airway surgery, the current technology and where the current technology is deficient.

  2. Masks: Interpretations and Variations.

    ERIC Educational Resources Information Center

    Basso, Robert

    1990-01-01

    Presents a high school art teacher's views of and experiences with masks. Outlines a maskmaking activity in which students were required to create variations on existing masks. Emphasizes use of experimental materials. Displays examples of student-created masks. (DB)

  3. Teaching laryngeal electromyography.

    PubMed

    Volk, Gerd Fabian; Pototschnig, Claus; Mueller, Andreas; Foerster, Gerhard; Koegl, Sophie; Schneider-Stickler, Berit; Rovo, Laszlo; Nawka, Tadeus; Guntinas-Lichius, Orlando

    2015-07-01

    To achieve consensus in the methodology, interpretation, validity, and clinical application of laryngeal electromyography (LEMG), a working group on neurolaryngology from the European Laryngological Society (ELS) was founded in 2010. The main task of the working group was to teach key techniques like LEMG procedures. The objective of this study was to collect information on the teaching techniques used and describe them. A multicenter registry was created to analyze the data collected from LEMGs in 14 departments. We screened how often different departments participated in teaching events. Teaching events were classified retrospectively: presentations at conferences and meetings; workshops with hands-on training on patients; workshops with hands-on training on animal models; workshops with hands-on training on anatomic specimens; and supervision by experts to perform LEMG together. Both, supervision to perform LEMG together and the total number of PCA-LEMGs (r = 0.713), as well as supervision to perform LEMG together and the PCA/total-number-of-LEMG ratio (r = 0.814) were correlated significantly (p < 0.05). Similarly, the sum of teaching events was correlated significantly with the total number of PCA-LEMGs (r = 0.605), and so did the sum of teaching events with the PCA/total-number-of-LEMG ratio (r = 0.704). Participation in hands-on training in humans was correlated significantly with the PCA/total-number-of-LEMG ratio (r = 0.640). The data presented herein suggest that multimodal teaching techniques are most effective. To promote multimodal learning an interactive webpage ( http://www.lemg.org) providing videos and animations, and the possibility to discuss cases with other experts was established.

  4. Masks and Other Disguises.

    ERIC Educational Resources Information Center

    Ploghoft, Debra

    Instructions for making simple masks are provided in this guide for teachers of elementary children. Directions with illustrations are given for constructing masks from paper plates, construction paper, plastic milk jugs, and papier-mache. Ideas include a clown mask, a flower mask, a top hat, a paper crown, and "Groucho" glasses. Types…

  5. Dosimetric Predictors of Laryngeal Edema

    SciTech Connect

    Sanguineti, Giuseppe . E-mail: gisangui@utmb.edu; Adapala, Prashanth; Endres, Eugene J. C; Brack, Collin; Fiorino, Claudio; Sormani, Maria Pia; Parker, Brent

    2007-07-01

    Purpose: To investigate dosimetric predictors of laryngeal edema after radiotherapy (RT). Methods and Materials: A total of 66 patients were selected who had squamous cell carcinoma of the head and neck with grossly uninvolved larynx at the time of RT, no prior major surgical operation except for neck dissection and tonsillectomy, treatment planning data available for analysis, and at least one fiberoptic examination of the larynx within 2 years from RT performed by a single observer. Both the biologically equivalent mean dose at 2 Gy per fraction and the cumulative biologic dose-volume histogram of the larynx were extracted for each patient. Laryngeal edema was prospectively scored after treatment. Time to endpoint, moderate or worse laryngeal edema (Radiation Therapy Oncology Group Grade 2+), was calculated with log rank test from the date of treatment end. Results: At a median follow-up of 17.1 months (range, 0.4- 50.0 months), the risk of Grade 2+ edema was 58.9% {+-} 7%. Mean dose to the larynx, V30, V40, V50, V60, and V70 were significantly correlated with Grade 2+ edema at univariate analysis. At multivariate analysis, mean laryngeal dose (continuum, hazard ratio, 1.11; 95% confidence interval, 1.06-1.15; p < 0.001), and positive neck stage at RT (N0-x vs. N +, hazard ratio, 3.66; 95% confidence interval, 1.40-9.58; p = 0.008) were the only independent predictors. Further stratification showed that, to minimize the risk of Grade 2+ edema, the mean dose to the larynx has to be kept {<=}43.5 Gy at 2 Gy per fraction. Conclusion: Laryngeal edema is strictly correlated with various dosimetric parameters; mean dose to the larynx should be kept {<=}43.5 Gy.

  6. CO2 laser excision of pediatric airway lesions.

    PubMed

    Bagwell, C E

    1990-11-01

    Treatment of life-threatening pediatric airway lesions has been greatly enhanced by development of the CO2 laser. Using this modality, endoscopic access and precise tissue destruction are possible with minimal local inflammation and subsequent edema of the narrow airway. From October 1986 through October 1988, 26 patients underwent 96 laser procedures for excision of airway lesions, in 23 patients via bronchoscopy and in three patients via microlaryngoscopy. Ages ranged from 1 day to 20 years, with most patients under 2 years of age. Diagnoses included: laryngeal cysts (1); cystic hygroma (3); tumor (neurofibroma, 1) subglottic hemangioma (1); excision of airway granulation tissue (8); and tracheal stenosis (13, including subglottic stenosis in 9). Therapy of the offending lesion required from one to eight laser procedures (mean, 2.8), excluding one patient with congenital long-segment tracheal stenosis who required 24 laser treatments for repeated excision of tracheal granulation tissue. Most lesions responded to only one or two laser treatments. No bleeding or perforation occurred secondary to laser use. Use of the laser was responsible for salvaging the airway or simplifying management of the airway in 21 of the 26 patients. In three patients with cystic hygroma affecting the laryngeal structures as well as soft tissues of the neck, laser excision was performed to maintain upper airway patency with a tracheostomy for airway control. Two patients with critical subglottic stenosis initially responded to laser excision, but moved away from the area and developed recurrence of their subglottic stenosis requiring tracheostomy, because further laser treatment was either unavailable or was deferred in their new locale.(ABSTRACT TRUNCATED AT 250 WORDS)

  7. Topical airway anesthesia for awake fiberoptic intubation: Comparison between airway nerve blocks and nebulized lignocaine by ultrasonic nebulizer

    PubMed Central

    Gupta, Babita; Kohli, Santvana; Farooque, Kamran; Jalwal, Gopal; Gupta, Deepak; Sinha, Sumit; Chandralekha

    2014-01-01

    Overview: Awake fiberoptic bronchoscope (FOB) guided intubation is the gold standard of airway management in patients with cervical spine injury. It is essential to sufficiently anesthetize the upper airway before the performance of awake FOB guided intubation in order to ensure patient comfort and cooperation. This randomized controlled study was performed to compare two methods of airway anesthesia, namely ultrasonic nebulization of local anesthetic and performance of airway blocks. Materials and Methods: A total of 50 adult patients with cervical spine injury were randomly allocated into two groups. Group L received airway anesthesia through ultrasonic nebulization of 10 ml of 4% lignocaine and Group NB received airway blocks (bilateral superior laryngeal and transtracheal recurrent laryngeal) each with 2 ml of 2% lignocaine and viscous lignocaine gargles. FOB guided orotracheal intubation was then performed. Hemodynamic variables at baseline and during the procedure, patient recall, vocal cord visibility, ease of intubation, coughing/gagging episodes, and signs of lignocaine toxicity were noted. Results: The observations did not reveal any significant differences in demographics or hemodynamic parameters at any time during the study. However, the time taken for intubation was significantly lower in Group NB as compared with the Group L. Group L had an increased number of coughing/gagging episodes as compared with Group NB. Vocal cord visibility and ease of intubation were better in patients who received airway blocks and hence the amount of supplemental lignocaine used was less in this group. Overall patient comfort was better in Group NB with fewer incidences of unpleasant recalls as compared with Group L. Conclusion: Upper airway blocks provide better quality of anesthesia than lignocaine nebulization as assessed by patient recall of procedure, coughing/gagging episodes, ease of intubation, vocal cord visibility, and time taken to intubate. PMID:25538514

  8. Oronasal Masks Require a Higher Pressure than Nasal and Nasal Pillow Masks for the Treatment of Obstructive Sleep Apnea

    PubMed Central

    Deshpande, Sheetal; Joosten, Simon; Turton, Anthony; Edwards, Bradley A.; Landry, Shane; Mansfield, Darren R.; Hamilton, Garun S.

    2016-01-01

    Study Objectives: Oronasal masks are frequently used for continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea (OSA). The aim of this study was to (1) determine if CPAP requirements are higher for oronasal masks compared to nasal mask interfaces and (2) assess whether polysomnography and patient characteristics differed among mask preference groups. Methods: Retrospective analysis of all CPAP implementation polysomnograms between July 2013 and June 2014. Prescribed CPAP level, polysomnography results and patient data were compared according to mask type (n = 358). Results: Oronasal masks were used in 46%, nasal masks in 35% and nasal pillow masks in 19%. There was no difference according to mask type for baseline apnea-hypopnea index (AHI), body mass index (BMI), waist or neck circumference. CPAP level was higher for oronasal masks, 12 (10–15.5) cm H2O compared to nasal pillow masks, 11 (8–12.5) cm H2O and nasal masks, 10 (8–12) cm H2O, p < 0.0001 (Median [interquartile range]). Oronasal mask type, AHI, age, and BMI were independent predictors of a higher CPAP pressure (p < 0.0005, adjusted R2 = 0.26.). For patients with CPAP ≥ 15 cm H2O, there was an odds ratio of 4.5 (95% CI 2.5–8.0) for having an oronasal compared to a nasal or nasal pillow mask. Residual median AHI was higher for oronasal masks (11.3 events/h) than for nasal masks (6.4 events/h) and nasal pillows (6.7 events/h), p < 0.001. Conclusions: Compared to nasal mask types, oronasal masks are associated with higher CPAP pressures (particularly pressures ≥ 15 cm H2O) and a higher residual AHI. Further evaluation with a randomized control trial is required to definitively establish the effect of mask type on pressure requirements. Commentary: A commentary on this article appears in this issue on page 1209. Citation: Deshpande S, Joosten S, Turton A, Edwards BA, Landry S, Mansfield DR, Hamilton GS. Oronasal masks require a higher pressure than nasal and

  9. [Laryngeal tuberculosis: study of 11 cases].

    PubMed

    Montejo, M; Alonso, M; Aguirrebengoa, K; Moreno, G; Goicoetxea, J; Petreñas, E; Bañuelos, S; Vergez, A

    2001-01-01

    We report 11 patients with laryngeal tuberculosis seen in our hospital, January 1990 to July 2000. Eight were men and all cases presented with dysphonia and/or disphagia. In 8 pulmonary tuberculosis was associated. Mycobacterium tuberculosis was isolated from the sputum in 7 patients. Granulomatous laryngitis was demonstrated in the eight patients with laryngeal biopsy. The evolution with medical treatment was favourable in all patients.

  10. Laryngeal histoplasmosis: an occupational hazard.

    PubMed

    Teoh, Jian Woei; Hassan, Faridah; Mohamad Yunus, Mohd Razif

    2013-10-01

    Isolated laryngeal histoplasmosis is a very rare entity. It has variable clinical presentations that might mimic both benign and malignant lesions, and is usually associated with pulmonary and other disseminated forms of histoplasmosis. Herein, we report a case of primary laryngeal histoplasmosis without the involvement of other systems in a 70-year-old Chinese man, who previously worked as a miner. He presented with a history of hoarseness for two months, with no other associated symptoms. Direct laryngoscopy revealed irregularity of the posterior one-third of both vocal folds. Histopathological examination revealed the presence of Histoplasma capsulatumon periodic acidSchiff and Grocott's methenamine silver staining. The lesion resolved after one month of oral itraconazole treatment. However, the patient had to complete six months of antifungal treatment to prevent recurrence.

  11. [Aspiration syndrome due to laryngeal cleft in an infant].

    PubMed

    Cuestas, Giselle; Demarchi, Victoria; Zanetta, Adrián; Urquizo, Mauricio; Lobos, Pablo; Razetti, Juan

    2014-02-01

    Aspiration is the passage of food content and endogenous secretions into the airway. Anatomical, neuromuscular or functional anomalies are among the major causes. The laryngeal cleft is a rare congenital anomaly that should be considered in the differential diagnosis of aspiration syndrome in neonates and infants. The main symptoms are stridor, recurrent respiratory infections and cyanotic crisis, cough and choking during feeding. The diagnosis is confirmed by endoscopic examination. The therapeutic behaviour will depend on the extent of the cleft, among other factors. We describe the clinical manifestations, diagnostic methods and treatment of an infant with this disease, and we emphasize the need for recognition of swallowing disorders in children in order to establish an accurate diagnosis and appropriate treatment to prevent and avoid malnutrition as well as a severe and potentially irreversible lung compromise.

  12. [Dysphonia in children due to congenital laryngeal web. Case series].

    PubMed

    Rodríguez, Hugo; Cuestas, Giselle; Zanetta, Adrián

    2013-01-01

    Dysphonia is common in children. Its main cause is the abuse or misuse of the voice. Congenital, neoplastic, infectious, neurological or iatrogenic causes are less frequent. The laryngeal web is a rare congenital anomaly resulting from an incomplete recanalization of the primitive larynx. This condition should be suspected in any newborn with dysphonic cry with or without stridor and respiratory distress. The diagnosis is confirmed by endoscopic examination. Therapy depends on the extent and thickness of the membrane and the severity of the symptoms. We describe our experience with 8 patients suffering this condition, and we emphasize the need to recognize voice disorders and to evaluate the airway for accurate diagnosis and appropriate treatment in every newborn, infant or child with persistent dysphonia.

  13. Laryngeal Cuff Force Application Modeling During Air Medical Evacuation Simulation.

    PubMed

    Eisenbrey, David; Eisenbrey, Arthur B; Pettengill, Patrick

    2016-01-01

    Endotracheal tubes are intended to protect the airway and assist with mechanical ventilation in sedated patients. The blood vessels of the tracheal mucosa can be compressed by high tracheal tube cuff pressures (> 30 cm H2O), leading to reduced mucosal blood flow with resulting ischemia and morbidity. Previous research showed a direct correlation between aircraft pressure altitude and the pressure reading from the tracheal cuff, with resulting pressures > 80 cm H2O at 10,000 ft. Standard practice is to periodically remove air from the cuff during ascent based on assumed increased pressure on the adjacent tracheal mucosa. Using a vacuum chamber and a direct reading micropressure sensor in a 22-mm-diameter semirigid tube, we assessed the direct force applied by the tracheal cuff against the laryngeal tube analog. Standard tracheal cuffs showed direct force/pressure relationships when properly inflated to 20 cm H2O but much less than reported in the literature. Current literature reports values of 55 to 150 cm H2O at 5,000 ft, whereas we report 23 to 25 cm H2O. Our data indicate that a properly inflated cuff does not exceed the critical pressure of 30 cm H2O until the altitude exceeds 8,000 ft. Thus, the standard practice of deflating the laryngeal cuff on ascent should be reconsidered because it may be counterproductive to patient safety.

  14. The Phillips airway.

    PubMed

    Haridas, R P; Wilkinson, D J

    2012-07-01

    The Phillips airway was developed by George Ramsay Phillips. There is no known original description of the airway and the earliest known reference to it is from 1919. The airway and its modifications are described.

  15. A newborn case of congenital laryngeal cyst complicated with pneumothorax and pneumomediastinum.

    PubMed

    Bamba, Hitoshi; Hirasugi, Kaheita; Okano, Hiroyuki; Nishio, Takeshi; Uno, Toshiyuki; Hisa, Yasuo

    2006-06-01

    Benign congenital laryngeal cysts are rare entities. They often cause chronic hoarseness and severe stridor. Case reports of congenital laryngeal cyst complicated with pneumothorax and pneumomediastinum are very rare. A 3,112 g full-term male newborn developed stridor which got worse during crying for 12 h after birth. Chest retractions were present with inspiration. Chest X-rays showed the presence of right pneumothorax and pneumomediastinum. Transnasal flexible laryngoscopic examination revealed a large cystic mass, which occupied almost the entire supraglottic airway. The operation was performed with the techniques of laryngomicrosurgery under general anesthesia. The cystic wall was punctured and serous liquid contents were aspirated. Excision of the entire cystic lesion was performed. The next day, extubation was performed without any troubles. The stridor had disappeared and the pneumothorax and pneumomediastinum were improved without further medical intervention. The histopathological examination revealed that the cystic wall consisted of normal squamous epithelial cells. It is reasonable to think that the high airway pressure due to congenital laryngeal cyst was responsible for pneumothorax and pneumomediastinum.

  16. Multidisciplinary Management of Laryngeal Carcinoma

    SciTech Connect

    Mendenhall, William M. Mancuso, Anthony A.; Hinerman, Russell W.; Malyapa, Robert S.; Werning, John W.; Amdur, Robert J.; Villaret, Douglas B.

    2007-10-01

    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.

  17. Masks in Pedagogical Practice

    ERIC Educational Resources Information Center

    Roy, David

    2016-01-01

    In Drama Education mask work is undertaken and presented as both a methodology and knowledge base. There are numerous workshops and journal articles available for teachers that offer knowledge or implementation of mask work. However, empirical examination of the context or potential implementation of masks as a pedagogical tool remains…

  18. Keeping African Masks Real

    ERIC Educational Resources Information Center

    Waddington, Susan

    2012-01-01

    Art is a good place to learn about our multicultural planet, and African masks are prized throughout the world as powerfully expressive artistic images. Unfortunately, multicultural education, especially for young children, can perpetuate stereotypes. Masks taken out of context lose their meaning and the term "African masks" suggests that there is…

  19. Blockage of upper airway

    MedlinePlus

    ... Airway obstruction - acute upper Images Throat anatomy Choking Respiratory system References Cukor J, Manno M. Pediatric respiratory emergencies: upper airway obstruction and infections. In: Marx ...

  20. Upper airway obstruction in a patient with Ehlers-Danlos syndrome.

    PubMed

    Chatzoudis, D; Kelly, T J; Lancaster, J; Jones, T M

    2015-04-01

    We report a case of recurrent airway obstruction episodes resulting from laryngeal hypermobility in a patient with Ehlers-Danlos syndrome. A 44-year-old woman, with known Ehlers-Danlos syndrome, presented with recent onset of episodes of upper airway obstruction due to hypermobility of her larynx. A suitable conservative management strategy proved elusive and the patient finally underwent a thyrohyoidopexy. The patient remains symptom free nine months after the procedure. This is the first report of spontaneous life threatening upper airway obstruction due to hypermobility of the suprahyoid suspensory soft tissues in Ehlers-Danlos syndrome.

  1. Mask degradation monitoring with aerial mask inspector

    NASA Astrophysics Data System (ADS)

    Tseng, Wen-Jui; Fu, Yung-Ying; Lu, Shih-Ping; Jiang, Ming-Sian; Lin, Jeffrey; Wu, Clare; Lifschitz, Sivan; Tam, Aviram

    2013-06-01

    As design rule continues to shrink, microlithography is becoming more challenging and the photomasks need to comply with high scanner laser energy, low CDU, and ever more aggressive RETs. This give rise to numerous challenges in the semiconductor wafer fabrication plants. Some of these challenges being contamination (mainly haze and particles), mask pattern degradation (MoSi oxidation, chrome migration, etc.) and pellicle degradation. Fabs are constantly working to establish an efficient methodology to manage these challenges mainly using mask inspection, wafer inspection, SEM review and CD SEMs. Aerial technology offers a unique opportunity to address the above mask related challenges using one tool. The Applied Materials Aera3TM system has the inherent ability to inspect for defects (haze, particles, etc.), and track mask degradation (e.g. CDU). This paper focuses on haze monitoring, which is still a significant challenge in semiconductor manufacturing, and mask degradation effects that are starting to emerge as the next challenge for high volume semiconductor manufacturers. The paper describes Aerial inspector (Aera3) early haze methodology and mask degradation tracking related to high volume manufacturing. These will be demonstrated on memory products. At the end of the paper we take a brief look on subsequent work currently conducted on the more general issue of photo mask degradation monitoring by means of an Aerial inspector.

  2. 2013 mask industry survey

    NASA Astrophysics Data System (ADS)

    Malloy, Matt

    2013-09-01

    A comprehensive survey was sent to merchant and captive mask shops to gather information about the mask industry as an objective assessment of its overall condition. 2013 marks the 12th consecutive year for this process. Historical topics including general mask profile, mask processing, data and write time, yield and yield loss, delivery times, maintenance, and returns were included and new topics were added. Within each category are multiple questions that result in a detailed profile of both the business and technical status of the mask industry. While each year's survey includes minor updates based on feedback from past years and the need to collect additional data on key topics, the bulk of the survey and reporting structure have remained relatively constant. A series of improvements is being phased in beginning in 2013 to add value to a wider audience, while at the same time retaining the historical content required for trend analyses of the traditional metrics. Additions in 2013 include topics such as top challenges, future concerns, and additional details in key aspects of mask masking, such as the number of masks per mask set per ground rule, minimum mask resolution shipped, and yield by ground rule. These expansions beyond the historical topics are aimed at identifying common issues, gaps, and needs. They will also provide a better understanding of real-life mask requirements and capabilities for comparison to the International Technology Roadmap for Semiconductors (ITRS).

  3. Analyzing EUV mask costs

    NASA Astrophysics Data System (ADS)

    Lercel, Michael; Kasprowicz, Bryan

    2016-10-01

    The introduction of Extreme Ultraviolet Lithography (EUV) as a replacement for multiple patterning is based on improvements of cycle time, yield, and cost. Earlier cost studies have assumed a simple assumption that EUV masks (being more complex with the multilayer coated blank) are not more than three times as expensive as advanced ArFi (ArF immersion) masks. EUV masks are expected to be more expensive during the ramp of the technology because of the added cost of the complex mask blank, the use of EUV specific mask tools, and a ramp of yield learning relative to the more mature technologies. This study concludes that, within a range of scenarios, the hypothesis that EUV mask costs are not more than three times that of advanced ArFi masks is valid and conservative.

  4. [Laryngeal edema and vocal cord paralysis due to lithium battery ingestion; a case report].

    PubMed

    Nagao, Namiko; Kaneko, Takaho; Hikawa, Yoshio; Yanagihara, Satoko

    2007-08-01

    We report a case of an 8-year-old boy with laryngeal edema and vocal cord paralysis due to lithium battery ingestion. He had ingested a lithium battery of a television remote controller, and was admitted to our hospital. He was suffering from wheezing and retractive respiration with crying. The foreign body was removed under general anesthesia about two hours after the ingestion. It was a 3 volt lithium battery of 20 millimeters in diameter. Endoscopy showed chemical burn of the postcricoid area and severe edema of the laryngeal arytenoids. Twelve days later we confirmed healing of edema and extubated the tracheal tube, but endoscopy showed bilateral vocal fold paralysis. He had no difficulty in breathing and eating but the vocal cord paralysis remained. Lithium batteries ingestion may cause severe airway injury in a short period because of their large size and high voltage. Immediate removal and careful management are required.

  5. [Laryngeal and larynx-associated reflexes].

    PubMed

    Ptok, M; Kühn, D; Miller, S; Jungheim, M; Schroeter, S

    2016-06-01

    The laryngeal adductor reflex and the pharyngoglottal closure reflex protect the trachea and lower respiratory tract against the entrance of foreign material. The laryngeal expiration reflex and the cough reflex serve to propel foreign material, which has penetrated in the cranial direction. The inspiration reflex, the sniff reflex, and the swallowing reflex are further larynx-associated reflexes. In patients with dysphagia the laryngeal adductor reflex can be clinically tested with air pulses. The water swallow test serves to show the integrity of the cough reflex. The sniff reflex is useful to test the abduction function of the vocal folds. Future studies should address laryngeal reflexes more specifically, both for a better understanding of these life-supporting mechanisms and to improve diagnostic procedures in patients with impaired laryngeal function.

  6. Tracheostomy, lingular tonsillectomy and sleep-related breathing disorders.

    PubMed

    Conache, I D; Meikle, D; O'Brien, C

    2002-05-01

    Laser resection of lingual tonsils and formal closure of a tracheostomy improved the airway in a 14-yr-old patient with Down's syndrome. Non-invasive airway support to treat obstructive sleep apnoea was postponed with this treatment. During the anaesthetic a laryngeal mask airway was used to support the airway after lingual tonsillectomy, to assess the suitability of defunctioning the tracheostomy. Laryngeal mask airways assist management of lingual tonsils. Lingual tonsillar hypertrophy can lead to obstructive sleep disorders.

  7. Difficult fiber-optic intubation in a patient with giant neck masses: The role of McCoy laryngoscope in elevating compressed laryngeal aperture.

    PubMed

    Yeh, Lijen; Chen, Hung-Shu; Tan, Ping-Heng; Liu, Ping-Hsin; Hsieh, Shao-Wei; Hung, Kuo-Chuan

    2013-12-01

    Airway management in patients with giant neck masses is usually a challenge to anesthesiologists. A giant neck mass could compress the airway and thus impede endotracheal intubation. We encountered a situation where the giant neck masses of a patient pushed the epiglottis posteriorly toward the posterior pharyngeal wall and compressed the laryngeal aperture narrowing after anesthetic induction, causing direct laryngoscopic intubation and sequential fiber-optic intubation failed. The neck masses twisted the aryepiglottic fold tortuously and clogged the laryngeal aperture tightly, making a flexible fiber-optic bronchoscope unable to pass through the laryngeal aperture. Later, we utilized a McCoy laryngoscope alternately to lift the compressed larynx up and away from the posterior pharyngeal wall, creating a passage and completing endotracheal intubation successfully with the aid of a gum elastic bougie. Our case suggested that the tilting tip blade of the McCoy laryngoscope could lever the tongue base up against the tumor mass compression to improve laryngeal views and facilitate endotracheal intubation when a difficult fiber-optic intubation was encountered on a compressed laryngeal aperture.

  8. [Pretherapeutic and posttherapeutic laryngeal imaging].

    PubMed

    Becker, M; Burkhardt, K; Allal, A S; Dulguerov, P; Ratib, O; Becker, C D

    2009-01-01

    Cross-sectional imaging with CT, MRI and more recently PET CT plays an indispensable complementary role to endoscopy in the pretherapeutic diagnostic and staging of laryngeal neoplasms and in the evaluation of the operated or irradiated larynx. Adequate interpretation of the CT, PET CT and MR images requires a thorough knowledge of the patterns of submucosal spread and familiarity with the diagnostic signs of neoplastic invasion as seen with each modality. In addition, one should be aware of the implications of imaging for staging and treatment. Both CT and MR imaging are highly sensitive for the detection of neoplastic invasion of the preepiglottic and paraglottic spaces, subglottic region and cartilage. The high negative predictive value of both CT and MRI allows a relatively reliable exclusion of neoplasm cartilage invasion. The specificity of both CT and MRI is, however, moderately high and both methods may, therefore, overestimate the extent of tumor spread. However, recent investigations have shown that the specificity of MRI may be significantly improved by using new diagnostic criteria which allow differentiation of tumor from peritumoral inflammation in many instances. Both cross-sectional imaging methods also significantly improve the pretherapeutic staging accuracy of laryngeal tumors if used in addition to clinical examination and endoscopic biopsy. In the presence of a submucosal mass, CT and MRI play a key role for the diagnosis, as they may characterize the lesion, reliably depict its submucosal extent and guide the endoscopist to perform deep biopsies which allow the definitive histological diagnosis. Cross-sectional imaging also plays a key role in the evaluation of laryngoceles, recurrent laryngeal nerve paralysis and fractures.

  9. Occupational risk for laryngeal cancer.

    PubMed

    Flanders, W D; Rothman, K J

    1982-04-01

    In a case-control analysis, we studied the effects of type of employment on laryngeal cancer risk using the interview data from the Third National Cancer Survey. Effects were measured relative to the risk for those employed in a group of arbitrarily defined industries and occupations with low risk. We excluded females and controlled for age, tobacco use, alcohol use, and race in the analysis. We found ratio estimates above 3.0 for workers in the railroad industry and the lumber industry; and for sheetmetal workers, grinding wheel operators, and automobile mechanics.

  10. The indirect measurement of laryngeal and tracheal resistance.

    PubMed

    Schumann, K; Beck, C; Mann, W

    1979-06-01

    We used a body-plethysmograph to determine air-way resistances in 485 cases of laryngeal and tracheal stenoses. We decided in 143 cases to intervene after observing resistance exceeding 60 mm H2O/l and sec. A vocal chord was lateral fixated in 49 patients suffering bilateral recurrent paralysis. Optimal results were obtained at a postoperative resistance level of 30 mm H2O/l and sec (standard value: 14.77+/-6.53--n = 387). The patients could carry out work of medium intensity and had a steady voice. We performed tracheal interventions in 94 cases of tracheal stenoses. A mean, post-operative resistance of 29.9 mm H2O/l and sec, with a tracheal diameter of 7--8 mm was attained. In practice, only a few patients found the remaining obstruction a hindrance during work of maximal intensity. No recurrences were observed after treatment. Airway resistances exceeding 150 mm H2O/l and sec were found in 13 new admissions and 73 times in those undergoing therapy. In these cases asphyxiation threatens. These patients have to be tracheotomized or intubated immediately.

  11. [Diode laser surgery in the endoscopic treatment of laryngeal paralysis].

    PubMed

    Ferri, E; García Purriños, F J

    2006-01-01

    Several surgical procedures have been proposed for the treatment of respiratory distress secondary to bilateral vocal cord paralysis. The aim of all surgical techniques used is to restore a glottic lumen sufficient to guarantee adequate breathing through the natural airway, without tracheotomy and preserving an acceptable phonatory quality. In this study we present our experience from 1998 to 2004 concerning the use of the diode contact laser for a modified Dennis-Kashima posterior endoscopic cordectomy (extended to the false homolateral chord in 3 cases and to the homolateral arytenoid vocal process in 6 cases). 18 patients (15 male, 3 female) were treated; the age range was 35-84 years. The etiology of paralysis varied: iatrogenic post-thyroidectomy and post-thoracic surgery in 5 cases (28%), post-traumatic in 2 cases (11%), secondary to a central lesion in 11 (61%). The operation was carried out with a diode contact laser (60W; 810 nm). Follow-up was 20 months. Dyspnea improved in all patients; the 9 tracheostomized patients were decannulated within 2 months after surgery. Final voice quality was subjectively good in 16 patients (88%). None of patients had any complications after surgery. In conclusion, the endoscopic posterior cordectomy performed by contact diode laser is an effective and reliable method for the treatment of dyspnea secondary to bilateral laryngeal paralysis, guaranteing a sufficient airway without impairing swallowing and maintaining acceptable voice quality.

  12. Isolated laryngeal myasthenia gravis for 26 years.

    PubMed

    Renard, Dimitri; Hedayat, Amir; Gagnard, Corinne

    2015-02-01

    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.

  13. Mask industry assessment: 2003

    NASA Astrophysics Data System (ADS)

    Kimmel, Kurt R.

    2003-12-01

    Microelectronics industry leaders routinely name mask technology and mask supply issues of cost and cycle time as top issues of concern. A survey was initiated in 2002 with support from International SEMATECH (ISMT) and administered by SEMI North America to gather information about the mask industry as an objective assessment of its overall condition.1 This paper presents the results of the second annual survey which is an enhanced version of the inaugural survey building upon its strengths and improving the weak points. The original survey was designed with the input of member company mask technologists, merchant mask suppliers, and industry equipment makers. The assessment is intended to be used as a baseline for the mask industry and the microelectronics industry to gain a perspective on the technical and business status of the critical mask industry. An objective is to create a valuable reference to identify strengths and opportunities and to guide investments on critical-path issues. As subsequent years are added, historical profiles can also be created. This assessment includes inputs from ten major global merchant and captive mask manufacturers representing approximately 80% of the global mask market (using revenue as the measure) and making this the most comprehensive mask industry survey ever. The participating companies are: Compugraphics, Dai Nippon Printing, Dupont Photomask, Hoya, IBM, Infineon, Intel, Taiwan Mask Company, Toppan, and TSMC. Questions are grouped into five categories: General Business Profile Information; Data Processing; Yields and Yield loss Mechanisms; Delivery Time; and Returns and Services. Within each category are a multitude of questions that create a detailed profile of both the business and technical status of the mask industry.

  14. Object Substitution Masking: When Does Mask Preview Work?

    ERIC Educational Resources Information Center

    Lim, Stephen Wee Hun; Chua, Fook K.

    2008-01-01

    When a target is enclosed by a 4-dot mask that persists after the target disappears, target identification is worse than it is when the mask terminates with the target. This masking effect is attributed to object substitution masking (OSM). Previewing the mask, however, attenuates OSM. This study investigated specific conditions under which mask…

  15. Triggers of airway inflammation.

    PubMed

    Kerrebijn, K F

    1986-01-01

    Most asthmatics have hyperresponsive airways. This makes them more sensitive than non-asthmatics to bronchoconstricting environmental exposures which, in their turn, may enhance responsiveness. Airway inflammation is considered to be a key determinant of airway hyperresponsiveness: the fact that chronic airway inflammation in cystic fibrosis does not lead to airway hyperresponsiveness of any importance indicates, however, that the role of airway inflammation is complex and incompletely elucidated. The main inducers of airway inflammation are viral infections, antigens, occupational stimuli and pollutants. Although exercise, airway cooling and hyper- or hypotonic aerosols are potent stimuli of bronchoconstriction, it is questionable if airway inflammation is involved in their mode of action. Each of the above-mentioned stimuli is discussed, with emphasis laid on the relation of symptoms to mechanisms.

  16. Effectiveness of applying continuous positive airway pressure in a patient with paradoxical vocal fold movement after endotracheal extubation: a case report

    PubMed Central

    Song, Keu La Me; Ko, Dong Chan; Pin, Jung Woo; Ryu, Kyong Ho; Kim, Hyun Soo

    2016-01-01

    Paradoxical vocal fold movement (PVFM) is an uncommon upper airway disorder defined as paradoxical adduction of the vocal folds during inspiration. The etiology and treatment of PVFM are unclear. The physician should manage this condition because of the possibility of near complete airway obstruction in severe case of PVFM. We report a case of successful airway management in a patient with PVFM by applying continuous positive airway pressure (CPAP). In this case, PVFM was detected after removing an endotracheal tube from a 67-year-old male who underwent excision of a laryngeal mass. The patient recovered without complications in 1 day with support by CPAP. PMID:26885309

  17. Hibernoma larynx with large multinodular goitre: unusual airway challenge.

    PubMed

    Iftikhar, Haissan; Siddiqui, Moghira Iqbaluddin

    2015-08-06

    A 56-year-old man presented with a 6-month history of progressively increasing neck swelling, dysphagia and hoarseness of voice. CT scan revealed multi-nodular goitre and also showed a lesion in the supraglottis. It also showed another lesion in the supraglottis. Fine-needle aspiration cytology of thyroid revealed follicular cells. Routine flexible laryngoscopy was performed to evaluate vocal cord function; however, we found a smooth well-defined lesion just above the glottis, obstructing the direct view of the vocal cords, and an endangered airway. A provisional diagnosis of a laryngeal cyst was made. With all necessary precautions intubation was performed with a bougie and a reinforced endotracheal tube was inserted. Total thyroidectomy was performed first. With direct suspension laryngoscopy an attempt was made to deliver the laryngeal lesion, however, the lesion could not be removed. A suprahyoid lateral pharyngotomy was performed to deliver the lesion. Histopathology of the lesion revealed hibernoma.

  18. Enhancement in Informational Masking

    ERIC Educational Resources Information Center

    Cao, Xiang; Richards, Virginia M.

    2012-01-01

    Purpose: The ability to detect a tone added to a random masker improves when a preview of the masker is provided. In 2 experiments, the authors explored the role that perceptual organization plays in this release from masking. Method: Detection thresholds were measured in informational masking studies. The maskers were drawn at random prior to…

  19. Lightweight Face Mask

    NASA Technical Reports Server (NTRS)

    Cason, W. E. I.; Baucom, R. M.; Evans, R. C.

    1982-01-01

    Lightweight face mask originally developed to protect epileptic patients during seizures could have many other medical and nonmedical applications such as muscular distrophy patients, football linesmen and riot-control police. Masks are extremely lightweight, the lightest of the configurations weighing only 136 grams.

  20. Laryngeal Reflexes: Physiology, Technique and Clinical Use

    PubMed Central

    Ludlow, Christy L.

    2015-01-01

    This review examines the current level of knowledge and techniques available for the study of laryngeal reflexes. Overall, the larynx is under constant control of several systems (including respiration, swallowing and cough) as well as sensory-motor reflex responses involving glossopharyngeal, pharyngeal, laryngeal and tracheobronchial sensory receptors. Techniques for the clinical assessment of these reflexes are emerging and need to be examined for sensitivity and specificity in identifying laryngeal sensory disorders. Quantitative assessment methods for the diagnosis of sensory reductions as well as sensory hypersensitivity may account for laryngeal disorders such as chronic cough, paradoxical vocal fold disorder and muscular tension dysphonia. The development of accurate assessment techniques could improve our understanding of the mechanisms involved in these disorders. PMID:26241237

  1. Trends in laryngeal cancer mortality in Europe.

    PubMed

    Bosetti, Cristina; Garavello, Werner; Levi, Fabio; Lucchini, Franca; Negri, Eva; La Vecchia, Carlo

    2006-08-01

    After a steady increase since the 1950s, laryngeal cancer mortality had tended to level off since the early 1980s in men from most European countries. To update trends in laryngeal cancer mortality in Europe, age-standardized (world standard) mortality rates per 100,000 were derived from the WHO mortality database for 33 European countries over the period 1980-2001. Jointpoint analysis was used to identify significant changes in mortality rates. In the European Union (EU) as a whole, male mortality declined by 0.8% per year between 1980 and 1989, by 2.8% between 1989 and 1995, by 5.3% between 1995 and 1998, and by 1.5% thereafter (rates were 5.1/100,000 in 1980-1981 and 3.3/100,000 in 2000-2001). This mainly reflects a decrease in rates in men from western and southern European countries, which had exceedingly high rates in the past. Male laryngeal mortality rose up to the early 1990s, and leveled off thereafter in several countries from central and eastern Europe. In 2000-2001 there was still a 10-15-fold variation in male laryngeal mortality between the highest rates in Croatia (7.9/100,000) and Hungary (7.7/100,000) and the lowest ones in Sweden (0.5/100,000) and Finland (0.8/100,000). Laryngeal cancer mortality was comparatively low in women from most European countries, with stable rates around 0.3/100,000 in the EU as a whole over the last 2 decades. Laryngeal cancer trends should be interpreted in terms of patterns and changes in exposure to alcohol and tobacco. Despite recent declines, the persistence of a wide variability in male laryngeal cancer mortality indicates that there is still ample scope for prevention of laryngeal cancer in Europe.

  2. An Unusual Laryngeal Foreign Body in Adult

    PubMed Central

    Ndiaye, Cire; Ahmed, Houra; Diom, Evelyne Siga; Deguenonvo, Richard Edouard Alain; Mbaye, Aminata; Zemene, Yilkal; Ndiaye, Issa Cheikh

    2016-01-01

    The accidental aspiration of a foreign body is a frequent domestic accident among children but a rare occurrence in adults. The laryngeal impaction of a coin is an unusual accident; only a few cases have been reported in the literature. Diagnosis is mostly achieved by clinicoradiological examinations. The authors report an uncommon case of laryngeal impaction of a coin in a 21-year-old patient, presenting with dysphonia without dyspnea or stridor. The extraction was performed by endoscopy. PMID:27999701

  3. [Severe laryngitis associated to gastroesophageal reflux].

    PubMed

    Botto, Hugo; Antonioli, Cintia; Nieto, Mary; Cocciaglia, Alejandro; Cuestas, Giselle; Roques Revol, Magdalena; López Marti, Jessica; Rodríguez, Hugo

    2014-02-01

    There is a strong association between gastroesophageal reflux and pharyngolaryngeal reflux as factors leading to respiratory disease, manifested as dysphonia, wheezing, coughing, recurrent laryngitis, bronchial obstruction, laryngospasm and apparent life-threatening events (ALTEs). These manifestations can be mild or severe and may sometimes put the patient's life at risk. We present two cases of patients with severe laryngitis who required endotracheal intubation, one of which underwent tracheostomy. The diagnostic methods and their limitations and the patients outcomes are described.

  4. Emergency airway puncture

    MedlinePlus

    ... support for only a very short period of time. Alternative Names Needle cricothyrotomy Images Emergency airway puncture Cricoid cartilage Emergency airway puncture - series References Hebert RB, Bose S, Mace SE. Cricothyrotomy and ...

  5. Upper airway biopsy

    MedlinePlus

    ... upper airway Images Upper airway test Bronchoscopy Throat anatomy References Yung RC, Boss EF. Tracheobronchial endoscopy. In: Flint PW, Haughey BH, Lund LJ, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, PA: Elsevier Mosby; ...

  6. 2012 Mask Industry Survey

    NASA Astrophysics Data System (ADS)

    Malloy, Matt; Litt, Lloyd C.

    2012-11-01

    A survey supported by SEMATECH and administered by David Powell Consulting was sent to semiconductor industry leaders to gather information about the mask industry as an objective assessment of its overall condition. The survey was designed with the input of semiconductor company mask technologists and merchant mask suppliers. 2012 marks the 11th consecutive year for the mask industry survey. This year's survey and reporting structure are similar to those of the previous years with minor modifications based on feedback from past years and the need to collect additional data on key topics. Categories include general mask information, mask processing, data and write time, yield and yield loss, delivery times, and maintenance and returns. Within each category are multiple questions that result in a detailed profile of both the business and technical status of the mask industry. Results, initial observations, and key comparisons between the 2011 and 2012 survey responses are shown here, including multiple indications of a shift towards the manufacturing of higher end photomasks.

  7. Careers in Airway Science.

    ERIC Educational Resources Information Center

    Federal Aviation Administration (DOT), Washington, DC.

    The Federal Aviation Administration (FAA) has initiated the Airway Science curriculum as a method of preparing the next generation of aviation technicians and managers. This document: (1) discusses the FAA's role in the Airway Science program; (2) describes some of the career fields that FAA offers to Airway Science graduates (air traffic control…

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

    MedlinePlus

    ... Hypopharyngeal Cancer About Laryngeal and Hypopharyngeal Cancer What’s New in Laryngeal and Hypopharyngeal Cancers Research and Treatment? ... to better tests for early detection and to new targeted treatments. Chemoprevention Chemoprevention is the use of ...

  9. What Are the Key Statistics about Laryngeal and Hypopharyngeal Cancers?

    MedlinePlus

    ... Laryngeal and Hypopharyngeal Cancer What Are the Key Statistics About Laryngeal and Hypopharyngeal Cancers? The American Cancer ... 000 cancers will start in the hypopharynx. Survival statistics for these cancers are discussed in “ Survival rates ...

  10. Maturation of cough and other reflexes that protect the fetal and neonatal airway

    PubMed Central

    Thach, Bradley T.

    2007-01-01

    Although aspiration of contaminated amniotic fluid and gastric contents is common at birth, anecdotal evidence indicates that coughing occurs rarely if at all. Studies in which cough and other airway protective responses have been stimulated by introducing a small bolus of water or saline into the pharynx of sleeping infants have found that the predominant responses are swallowing, apnoea and laryngeal closure. Coughing is rare. Collectively these responses are known as the laryngeal chemoreflexes (LCR). These are mediated by receptors in the inter-arytenoid space. The LCR has been studied extensively in animal models. Upper airway infection increases the responses and in this case coughing becomes a common component. Studies in animal models indicate that with maturation, apnoea and swallowing components of the LCR decrease while cough becomes increasing prominent. PMID:17374497

  11. [Effectiveness of the GlideScope video laryngoscope in a case of unexpected difficult airway due to lingual tonsil hypertrophy].

    PubMed

    Cruz, P; Alarcón, L; Del Castillo, T; Cabrerizo, P; Díaz, S

    2015-05-01

    Lingual tonsil hypertrophy can cause varying degrees of airway obstruction and is considered a risk factor for difficult mask ventilation and tracheal intubation. We report a case of unexpected difficult airway in a patient with unknown lingual tonsil hypertrophy that was solved with the use of the GlideScope video laryngoscope.

  12. New mask technology challenges

    NASA Astrophysics Data System (ADS)

    Kimmel, Kurt R.

    2001-09-01

    Mask technology development has accelerated dramatically in recent years from the glacial pace of the last three decades to the rapid and sometimes simultaneous introductions of new wavelengths and mask-based resolution enhancement techniques. The nature of the semiconductor business has also become one driven by time-to-market as an overwhelming factor in capturing market share and profit. These are among the factors that have created enormous stress on the mask industry to produce masks with enhanced capabilities, such as phase-shifting attenuators, sub-resolution assist bars, and optical proximity correction (OPC) features, while maintaining or reducing cost and cycle time. The mask can no longer be considered a commodity item that is purchased form the lowest-cost supplier. Instead, it must now be promoted as an integral part of the technical and business case for a total lithographic solution. Improving partnership between designer, mask-maker, and wafer lithographer will be the harbinger of success in finding a profitable balance of capability, cost, and cycle time. Likewise for equipment infrastructure development, stronger partnership on the international level is necessary to control development cost and mitigate schedule and technical risks.

  13. Mask Industry Assessment: 2011

    NASA Astrophysics Data System (ADS)

    Chan, Y. David

    2011-11-01

    A survey supported by SEMATECH and administered by David Powell Consulting was sent to microelectronics industry leaders to gather information about the mask industry as an objective assessment of its overall condition. The survey was designed with the input of semiconductor company mask technologists and merchant mask suppliers. This year's assessment is the tenth in the current series of annual reports. With ongoing industry support, the report has been used as one of the baselines to gain perspective on the technical and business status of the mask and microelectronics industries. It continues to serve as a valuable reference to identify the strengths and opportunities of the mask industry. The results will be used to guide future investments pertaining to critical path issues. This year's survey was essentially the same as the 2005 through 2010 surveys. Questions are grouped into following categories: General Business Profile Information, Data Processing, Yields and Yield Loss Mechanisms, Delivery Times, Returns, and Services. Within each category are multiple questions that result in a detailed profile of both the business and technical status of the critical mask industry. This profile combined with the responses to past surveys represents a comprehensive view of changes in the industry.

  14. Mask Industry Assessment: 2010

    NASA Astrophysics Data System (ADS)

    Hughes, Greg; Chan, David Y.

    2010-09-01

    A survey created supported by SEMATECH and administered by David Powell Consulting was sent to microelectronics industry leaders to gather information about the mask industry as an objective assessment of its overall condition. The survey was designed with the input of semiconductor company mask technologists and merchant mask suppliers. This year's assessment is the ninth in the current series of annual reports. With ongoing industry support, the report can be used as a baseline to gain perspective on the technical and business status of the mask and microelectronics industries. It will continue to serve as a valuable reference to identify the strengths and opportunities of the mask industry. The results will be used to guide future investments pertaining to critical path issues. This year's survey was basically the same as the 2005 through 2009 surveys. Questions are grouped into categories: General Business Profile Information, Data Processing, Yields and Yield Loss Mechanisms, Delivery Times, Returns, and Services. Within each category are multiple questions that result in a detailed profile of both the business and technical status of the critical mask industry. This profile combined with the responses to past surveys represents a comprehensive view of changes in the industry.

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

    PubMed Central

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

    2014-01-01

    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

  16. Laryngeal response patterns influence the efficacy of mechanical assisted cough in amyotrophic lateral sclerosis

    PubMed Central

    Andersen, Tiina; Sandnes, Astrid; Brekka, Anne Kristine; Hilland, Magnus; Clemm, Hege; Fondenes, Ove; Tysnes, Ole-Bjørn; Heimdal, John-Helge; Halvorsen, Thomas; Vollsæter, Maria; Røksund, Ola Drange

    2017-01-01

    Background Most patients with amyotrophic lateral sclerosis (ALS) are treated with mechanical insufflation–exsufflation (MI-E) in order to improve cough. This method often fails in ALS with bulbar involvement, allegedly due to upper-airway malfunction. We have studied this phenomenon in detail with laryngoscopy to unravel information that could lead to better treatment. Methods We conducted a cross-sectional study of 20 patients with ALS and 20 healthy age-matched and sex-matched volunteers. We used video-recorded flexible transnasal fibre-optic laryngoscopy during MI-E undertaken according to a standardised protocol, applying pressures of ±20 to ±50 cm H2O. Laryngeal movements were assessed from video files. ALS type and characteristics of upper and lower motor neuron symptoms were determined. Results At the supraglottic level, all patients with ALS and bulbar symptoms (n=14) adducted their laryngeal structures during insufflation. At the glottic level, initial abduction followed by subsequent adduction was observed in all patients with ALS during insufflation and exsufflation. Hypopharyngeal constriction during exsufflation was observed in all subjects, most prominently in patients with ALS and bulbar symptoms. Healthy subjects and patients with ALS and no bulbar symptoms (n=6) coordinated their cough well during MI-E. Conclusions Laryngoscopy during ongoing MI-E in patients with ALS and bulbar symptoms revealed laryngeal adduction especially during insufflation but also during exsufflation, thereby severely compromising the size of the laryngeal inlet in some patients. Individually customised settings can prevent this and thereby improve and extend the use of non-invasive MI-E. PMID:27174631

  17. Masks: The Artist in Me

    ERIC Educational Resources Information Center

    Skophammer, Karen

    2009-01-01

    Whether masks are made from cardboard, papier-mache, metal, wood, leather, fabric, clay or any combination of these materials, they bring out the artist in people. Young children like to wear masks when they play to pretend they were another person or animal. Masks let them fantasize and be creative. The author's students made masks representing…

  18. Tumor Volumes and Prognosis in Laryngeal Cancer

    PubMed Central

    Issa, Mohamad R.; Samuels, Stuart E.; Bellile, Emily; Shalabi, Firas L.; Eisbruch, Avraham; Wolf, Gregory

    2015-01-01

    Tumor staging systems for laryngeal cancer (LC) have been developed to assist in estimating prognosis after treatment and comparing treatment results across institutions. While the laryngeal TNM system has been shown to have prognostic information, varying cure rates in the literature have suggested concern about the accuracy and effectiveness of the T-classification in particular. To test the hypothesis that tumor volumes are more useful than T classification, we conducted a retrospective review of 78 patients with laryngeal cancer treated with radiation therapy at our institution. Using multivariable analysis, we demonstrate the significant prognostic value of anatomic volumes in patients with previously untreated laryngeal cancer. In this cohort, primary tumor volume (GTVP), composite nodal volumes (GTVN) and composite total volume (GTVP + GTVN = GTVC) had prognostic value in both univariate and multivariate cox model analysis. Interestingly, when anatomic volumes were measured from CT scans after a single cycle of induction chemotherapy, all significant prognosticating value for measured anatomic volumes was lost. Given the literature findings and the results of this study, the authors advocate the use of tumor anatomic volumes calculated from pretreatment scans to supplement the TNM staging system in subjects with untreated laryngeal cancer. The study found that tumor volume assessment after induction chemotherapy is not of prognostic significance. PMID:26569309

  19. Viscoelastic properties of laryngeal posturing muscles

    NASA Astrophysics Data System (ADS)

    Alipour, Fariborz; Hunter, Eric; Titze, Ingo

    2003-10-01

    Viscoelastic properties of canine laryngeal muscles were measured in a series of in vitro experiments. Laryngeal posturing that controls vocal fold length and adduction/abduction is an essential component of the voice production. The dynamics of posturing depends on the viscoelastic and physiological properties of the laryngeal muscles. The time-dependent and nonlinear behaviors of these tissues are also crucial in the voice production and pitch control theories. The lack of information on some of these muscles such as posterior cricoarytenoid muscle (PCA), lateral cricoarytenoid muscle (LCA), and intraarytenoid muscle (IA) was the major incentive for this study. Samples of PCA and LCA muscles were made from canine larynges and mounted on a dual-servo system (Ergometer) as described in our previous works. Two sets of experiments were conducted on each muscle, a 1-Hz stretch and release experiment that provides stress-strain data and a stress relaxation test. Data from these muscles were fitted to viscoelastic models and Young's modulus and viscoelastic constants are obtained for each muscle. Preliminary data indicates that elastics properties of these muscles are similar to those of thyroarytenoid and cricothyroid muscles. The relaxation response of these muscles also shows some similarity to other laryngeal muscles in terms of time constants.

  20. Diesel exhaust, diesel fumes, and laryngeal cancer.

    PubMed

    Muscat, J E; Wynder, E L

    1995-03-01

    A hospital-based, case-control study of 235 male patients with laryngeal cancer and 205 male control patients was conducted to determine the effects of exposure to diesel engine exhaust and diesel fumes and the risk of laryngeal cancer. All patients were interviewed directly in the hospital with a standardized questionnaire that gathered information on smoking habits, alcohol consumption, employment history, and occupational exposures. Occupations that involve substantial exposure to diesel engine exhaust include mainly truck drivers, as well as mine workers, firefighters, and railroad workers. The odds ratio for laryngeal cancer associated with these occupations was 0.96 (95% confidence interval, 0.5 to 1.8). The odds ratio for self-reported exposure to diesel exhaust was 1.47 (95% confidence interval, 0.5 to 4.1). An elevated risk was found for self-reported exposure to diesel fumes (odds ratio, 6.4; 95% confidence interval, 1.8 to 22.6). No association was observed between jobs that entail exposure to diesel fumes, such as automobile mechanics, and the risk of laryngeal cancer. These results show that diesel engine exhaust is unrelated to laryngeal cancer risk. The different findings for self-reported diesel fumes and occupations that involve exposure to diesel fumes could reflect a recall bias.

  1. Computer simulation of fluid flow and particle diffusion within human upper airways system

    NASA Astrophysics Data System (ADS)

    Yu, Genqiang

    Computer simulation of air flow and particle transport phenomenon within the human upper respiratory system has important applications in inhalation toxicology, aerosol medicine delivery as well as basic medical science research. A three-dimensional physiologically realistic computer model of the human upper respiratory tract has been developed. The respiratory tract consists of nasal airways, oral airways, laryngeal airways and the first two generations of tracheobronchial airways. A rubber mold of the airway system was first cast from the impression of the human head airway teaching model. The rubber cast was sliced into 2mm-apart parallel pieces. The cross-sectional geometry of the sliced rubber pieces were then scanned into the computer to be stored as the digital information. A body-fitted three-dimensional curvilinear grid system and a multi-block method have been employed to mimic the complex head airway. A total of 280,000 grid node was used for the entire respiratory tract. Air flow patterns within the human upper airways are investigated by numerically solving the corresponding full Navier-Stokes equations using the flow simulation software CFX-F3D. Effects of human breath patterns on respiratory flow distribution and ultrafine particle deposition are investigated. Results of ultrafine particle deposition generated by computer simulation show reasonable agreements with the experimental measurements.

  2. Fulminant Laryngeal-tracheobronchial-pulmonary Aspergillosis: A Rare and Fatal Complication in Allogeneic Hematopoietic Stem Cell Transplantation Recipients

    PubMed Central

    Tao, Tao; Zhang, Ying-Hui; Xue, Sheng-Li; Wu, De-Pei; Chen, Feng

    2017-01-01

    A 23-year-old man who had previously undergone allogeneic hematopoietic stem cell transplantation (allo-HSCT) for severe aplastic anemia was diagnosed with invasive laryngeal-tracheobronchial-pulmonary aspergillosis after presenting with a persistent dry cough at six months post-transplantation based on the findings of laryngoscopy and fiberoptic bronchoscopy. A fiberoptic bronchoscope was used to remove the obstructive material from the patient's airway and posaconazole plus caspofungin were administered to successfully to treat the patient. Our report suggests that laryngoscopy and fiberoptic bronchoscopy should be considered as alternative approaches to the diagnosis and treatment of allo-HSCT recipients with persistent respiratory symptoms when invasive laryngeal aspergillosis and invasive tracheobronchial aspergillosis are suspected. PMID:28154281

  3. Overview of Mask Metrology

    NASA Astrophysics Data System (ADS)

    Rice, Bryan J.; Jindal, Vibhu; Lin, C. C.; Harris-Jones, Jenah; Kwon, Hyuk Joo; Ma, Hsing-Chien; Goldstein, Michael; Chan, Yau-Wai; Goodwin, Frank

    2011-11-01

    Extreme ultraviolet (EUV) lithography is the successor to optical lithography and will enable advanced patterning in semiconductor manufacturing processes down to the 8 nm half pitch technology node and beyond. However, before EUV can successfully be inserted into high volume manufacturing a few challenges must be overcome. Central among these remaining challenges is the requirement to produce "defect free" EUV masks. Mask blank defects have been one of the top challenges in the commercialization of extreme ultraviolet (EUV) lithography. To determine defect sources and devise mitigation solutions, detailed characterization of defects is critical. However, small defects pose challenges in metrology scale-up. SEMATECH has a comprehensive metrology strategy to address any defect larger than a 20 nm core size to obtain solutions for defect-free EUV mask blanks. SEMATECH's Mask Blank Development Center has been working since 2003 to develop the technology to support defect free EUV mask blanks. Since 2003, EUV mask blank defects have been reduced from 10000 of size greater than 100 nm to about a few tens at size 70 nm. Unfortunately, today's state of the art defect levels are still about 10 to 100 times higher than needed. Closing this gap requires progress in the various processes associated with glass substrate creation and multilayer deposition. That process development improvement in turn relies upon the availability of metrology equipment that can resolve and chemically characterize defects as small as 30 nm. The current defect reduction efforts at SEMATECH have intensively included a focus on inspection and characterization. The facility boasts nearly 100M of metrology hardware, including an FEI Titan TEM, Lasertec M1350 and M7360 tools, an actinic inspection tool, AFM, SPM, and scanning auger capabilities. The newly established Auger tool at SEMATECH can run a standard 6-inch mask blank and is already providing important information on sub-100 nm defects on EUV

  4. The Effects of Treadmill Running on Aging Laryngeal Muscle Structure

    PubMed Central

    Kletzien, Heidi; Russell, John A.; Connor, Nadine P.

    2015-01-01

    Levels of Evidence NA (animal study) Objective Age-related changes in laryngeal muscle structure and function may contribute to deficits in voice and swallowing observed in elderly people. We hypothesized that treadmill running, an exercise that increases respiratory drive to upper airway muscles, would induce changes in thyroarytenoid muscle myosin heavy chain (MHC) isoforms consistent with a fast-slow transformation in muscle fiber type. Study Design Randomized parallel group controlled trial. Methods Fifteen young adult and 14 old Fischer 344/Brown Norway rats received either treadmill running or no exercise (5 days/week/8 weeks). Myosin heavy chain isoform composition in the thyroarytenoid muscle was examined at the end of 8 weeks. Results Significant age and treatment effects were found. The young adult group had the greatest proportion of superfast contracting MHCIIL. The treadmill running group had the lowest proportion of MHCIIL and the greatest proportion of MHCIIx. Conclusion Thyroarytenoid muscle structure was affected both by age and treadmill running in a fast-slow transition that is characteristic of exercise manipulations in other skeletal muscles. PMID:26256100

  5. [Diagnosis and therapy of laryngitis gastrica].

    PubMed

    Pahn, J; Schlottmann, A; Witt, G; Wilke, W

    2000-07-01

    We treated 64 patients with the diagnosis of laryngitis gastrica with Antra (Omeprazol) in doses of 10, 20, and 40 mg. To determine the success of the therapy, pH monitoring of the esophagus and hypopharynx, the voice status and measurement of vocal penetrating capacity were used. The results prove that a 20-mg dose of Antra is suitable for the therapy of laryngitis gastrica with a high rate of success. Problems which arose during the investigation, consequent changes of the original concept of the project as well as new aspects and questions which resulted from this are discussed with respect to further investigation.

  6. Vocal Cord Actinomycosis Mimicking a Laryngeal Tumor

    PubMed Central

    Yoshihama, Keisuke; Kato, Yasumasa; Baba, Yuh

    2013-01-01

    Laryngeal carcinoma and laryngeal papilloma are the most commonly encountered tumorous lesions in the larynx. Herein, we report a case of the mass arising from the left vocal cord in a 49-year-old Japanese man. Endoscopic examination suggested that the mass is a tumor such as carcinoma and papilloma. Pathological examination showed that the specimen demonstrated actinomycosis in the left vocal cord. Although vocal cord actinomycosis is extremely rare, the otolaryngologist should recognize this condition during the inspection of the larynx. PMID:23573444

  7. Primary laryngeal lymphoma in a child.

    PubMed

    Rodríguez, Hugo; Cuestas, Giselle; Bosaleh, Andrea; Passali, Desiderio; Zubizarreta, Pedro

    2015-01-01

    Malignant tumors of the larynx are very rare in children. They are often diagnosed late, since the initial symptoms are attributed to the process of larynx development or to other, more common pediatric diseases. Early visualization of the larynx with the aid of flexible or rigid fiberoptic laryngoscopy is essential in children having symptoms suggestive of laryngeal disease. Laryngeal lymphoma in children is exceptionally unusual. The certainty of the diagnosis, which is often very difficult to achieve, is generally confirmed by a tissue biopsy. In the present work, we describe the case of a non-Hodgkin lymphoblastic T-cell lymphoma of the larynx in an eight-year-old boy.

  8. Variations in the origin of superior laryngeal artery

    PubMed Central

    Devadas, Deepa; Sukumaran, Tintu Thottiyil

    2016-01-01

    The superior laryngeal artery is the principal artery supplying the laryngeal mucosa, musculature, and glands. Knowledge of variations in the origin of superior laryngeal artery could prove to be very useful during reconstructive surgeries of the larynx, partial laryngectomy, laryngeal transplantation, and also during procedures like super-selective intra-arterial chemotherapy for laryngeal and hypolaryngeal cancers. However, relatively few studies have been done on the superior laryngeal artery in comparison to its clinical importance. The present study was aimed at documenting the prevalence of variable origin of the superior laryngeal artery within the carotid triangle. Sixty hemi-necks obtained from 30 South Indian cadavers were dissected and studied for variations in the origin of superior laryngeal artery. It was observed that the superior laryngeal artery took origin from superior thyroid in 91.7% cases. Variable origin from the external carotid artery was noted in 5% cases. The superior laryngeal artery was found to arise from the lingual artery in one case alone (1.7%). In addition to the above findings, a very rare variation of superior laryngeal artery arising from the ascending pharyngeal (1.7%) was also observed in the hemi-neck of one cadaver. All the variations that were observed were unilateral and on the left side. These findings may help provide further insight to the anatomists, radiologists and surgeons and can help improve performances during surgical manipulations of the larynx. PMID:28127500

  9. MSB for ILT masks

    NASA Astrophysics Data System (ADS)

    Gramss, Juergen; Weidenmueller, Ulf; Stoeckel, Arnd; Jaritz, Renate; Doering, Hans-Joachim; Boettcher, Monika

    2011-03-01

    Multi Shaped Beam (MSB) throughput simulation results have already been published in the past. An IC mask set of a 32nm node logic device was one of the applications that had been analyzed in more detail. In this paper we want to highlight results of shot count and write time evaluations done for Inverse Lithography Technology (ILT) masks targeting the 22nm technology node. The test pattern data we used for these practice-oriented analyses was designed by DNP / Japan and created by Luminescent Technologies, Inc. / USA. To achieve reliable evaluation results, the influence of different MSB configurations on shot count and mask write time has been taken into account and will be discussed here. Exposure results of pattern details are presented and compared with the fracturing result. The MSB engineering tool we used for our investigations covers such major components like an electron-optical column, a precision x/y stage and the MSB data path.

  10. Effects of CO2 and H+ on laryngeal receptor activity in the perfused larynx in anaesthetized cats.

    PubMed

    Wang, Z H; Bradford, A; O'Regan, R G

    1999-09-01

    1. Intralaryngeal CO2 reflexly decreases ventilation and increases upper airway muscle activity. Topical anaesthesia of the laryngeal mucosa or cutting the superior laryngeal nerves (SLNs) abolishes these reflexes, indicating that the receptors responsible are superficially located and that their afferent fibres are in the SLN. Intralaryngeal CO2 affects the activity of receptors recorded from the SLN. 2. An isolated, luminally perfused laryngeal preparation was developed in anaesthetized, paralysed cats in order to compare the effects of solutions with varying levels of pH and PCO2 on pressure-sensitive laryngeal receptor activity. Since the pH of tracheal surface fluid is reported to be approximately 7.0, two neutral (pH 7.4 and 7.0) and two acidic (pH 6.8 and 6.3) solutions were used. 3. Compared with neutral acapnic control solutions, neutral hypercapnic (PCO2 64 mmHg) solutions either excited or inhibited the discharge of 113 out of 211 pressure-sensitive SLN afferents. In 24 receptors, the effects of hypercapnic solutions with either neutral or acidic pH were similar in both direction and magnitude. In 50 receptors affected by neutral hypercapnic solutions, acidic acapnic solutions had no effect on 66 % of units and significantly smaller effects in the remaining units. In 17 receptors, the effects of neutral solutions with a PCO2 of 35 mmHg were significantly less than for neutral solution with a PCO2 of 64 mmHg. 4. These results show that the effects of CO2 on laryngeal pressure-sensitive receptors are independent of the pH of the perfusing media, and suggest that acidification of the receptor cell or its microenvironment is the main mechanism of CO2 chemoreception.

  11. Integrated Multipoint-Laser Endoscopic Airway Measurements by Transoral Approach

    PubMed Central

    Neitsch, Marie; Horn, Iris-Susanne; Hofer, Mathias; Dietz, Andreas; Fischer, Miloš

    2016-01-01

    Objectives. Optical and technical characteristics usually do not allow objective endoscopic distance measurements. So far no standardized method for endoscopic distance measurement is available. The aim of this study was to evaluate the feasibility and accuracy of transoral airway measurements with a multipoint-laser endoscope. Methods. The semirigid endoscope includes a multipoint laser measurement system that projects 49 laser points (wavelength 639 nm, power < 5 mW) into the optical axis of the endoscopic view. Distances, areas, and depths can be measured in real-time. Transoral endoscopic airway measurements were performed on nine human cadavers, which were correlated with CT measurements. Results. The preliminary experiment showed an optimum distance between the endoscope tip and the object of 5 to 6 cm. There was a mean measurement error of 3.26% ± 2.53%. A Spearman correlation coefficient of 0.95 (p = 0.01) was calculated for the laryngeal measurements and of 0.93 (p < 0.01) for the tracheal measurements compared to the CT. Using the Bland-Altman-Plot, the 95% limits of agreement for the laryngeal measurements were satisfactory: −0.76 and 0.93. Conclusions. Integrated multipoint-laser endoscopic measurement is a promising technical supplement, with potential use in diagnostic endoscopy and transoral endoscopic surgery in daily practice. PMID:27022612

  12. Epidemiological evidence indicates asbestos causes laryngeal cancer

    SciTech Connect

    Smith, A.H.; Handley, M.A.; Wood, R. )

    1990-06-01

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

  13. Dysphagia Caused by Chronic Laryngeal Edema.

    PubMed

    Delides, Alexander; Sakagiannis, George; Maragoudakis, Pavlos; Gouloumi, Αlina-Roxani; Katsimbri, Pelagia; Giotakis, Ioannis; Panayiotides, John G

    2015-10-01

    A rare case of a young female with chronic diffuse laryngeal edema causing severe swallowing difficulty is presented. The patient was previously treated with antibiotics and steroids with no improvement. Diagnosis was made with biopsy of the epiglottis under local anesthesia in the office.

  14. A genetic view of laryngeal cancer heterogeneity

    PubMed Central

    de Miguel-Luken, María José; Chaves-Conde, Manuel; Carnero, Amancio

    2016-01-01

    ABSTRACT During the recent decades significant improvements in the understanding of laryngeal molecular biology allowed a better characterization of the tumor. However, despite increased molecular knowledge and clinical efforts, survival of patients with laryngeal cancer remains the same as 30 years ago. Although this result may not make major conclusions as preservation approaches were not broadly used until the time of database collection, it seems to be clear that there is still window for improvement. Although the cornerstone for laryngeal cancer eradication is to implement smoking cessation programs, survival progresses will be hopefully seen in the future. Introducing molecular biomarkers as predictive factors to determine which patients will benefit of preservation treatments may become one of the next steps to improve survival. Furthermore, the development of new therapeutic modalities joint to biomarkers to selectively apply such new therapy in these patients may help to define new modalities with improved survival. New inhibitors against Notch pathway, EGFR, VRK1 or DNA damage repair may become gold standard if we are able to identify patients that may benefit from them, either on survival or functional larynx preservation. It is the moment for an inflexion point on the way laryngeal cancer is clinically managed. PMID:26940775

  15. Palliative Airway Stenting Performed Under Radiological Guidance and Local Anesthesia

    SciTech Connect

    Profili, Stefano; Manca, Antonio; Feo, Claudio F. Padua, Guglielmo; Ortu, Riccardo; Canalis, Giulio C.; Meloni, Giovanni B.

    2007-02-15

    Purpose. To assess the effectiveness of airway stenting performed exclusively under radiological guidance for the palliation of malignant tracheobronchial strictures. Methods. We report our experience in 16 patients with malignant tracheobronchial stricture treated by insertion of 20 Ultraflex self-expandable metal stents performed under fluoroscopic guidance only. Three patients presented dysphagia grade IV due to esophageal malignant infiltration; they therefore underwent combined airway and esophageal stenting. All the procedures were performed under conscious sedation in the radiological room; average procedure time was around 10 min, but the airway impediment never lasted more than 40 sec. Results. We obtained an overall technical success in 16 cases (100%) and clinical success in 14 patients (88%). All prostheses were successfully placed without procedural complications. Rapid clinical improvement with symptom relief and normalization of respiratory function was obtained in 14 cases. Two patients died within 48 hr from causes unrelated to stent placement. Two cases (13%) of migration were observed; they were successfully treated with another stent. Tumor overgrowth developed in other 2 patients (13%); however, no further treatment was possible because of extensive laryngeal infiltration. Conclusions. Tracheobronchial recanalization with self-expandable metal stents is a safe and effective palliative treatment for malignant strictures. Airway stenting performed exclusively under fluoroscopic view was rapid and well tolerated.

  16. Masked mycotoxins: A review

    PubMed Central

    Berthiller, Franz; Crews, Colin; Dall'Asta, Chiara; Saeger, Sarah De; Haesaert, Geert; Karlovsky, Petr; Oswald, Isabelle P; Seefelder, Walburga; Speijers, Gerrit; Stroka, Joerg

    2013-01-01

    The aim of this review is to give a comprehensive overview of the current knowledge on plant metabolites of mycotoxins, also called masked mycotoxins. Mycotoxins are secondary fungal metabolites, toxic to human and animals. Toxigenic fungi often grow on edible plants, thus contaminating food and feed. Plants, as living organisms, can alter the chemical structure of mycotoxins as part of their defence against xenobiotics. The extractable conjugated or non-extractable bound mycotoxins formed remain present in the plant tissue but are currently neither routinely screened for in food nor regulated by legislation, thus they may be considered masked. Fusarium mycotoxins (deoxynivalenol, zearalenone, fumonisins, nivalenol, fusarenon-X, T-2 toxin, HT-2 toxin, fusaric acid) are prone to metabolisation or binding by plants, but transformation of other mycotoxins by plants (ochratoxin A, patulin, destruxins) has also been described. Toxicological data are scarce, but several studies highlight the potential threat to consumer safety from these substances. In particular, the possible hydrolysis of masked mycotoxins back to their toxic parents during mammalian digestion raises concerns. Dedicated chapters of this article address plant metabolism as well as the occurrence of masked mycotoxins in food, analytical aspects for their determination, toxicology and their impact on stakeholders. PMID:23047235

  17. COAs: Behind the Masks.

    ERIC Educational Resources Information Center

    Birke, Szifra

    1993-01-01

    Provides information on alcoholism and codependency to help teachers identify and respond to children of alcoholics (COAs). Discusses characteristics of alcoholic homes and problems encountered by children and adult COAs. Examines survival "masks" of COAs, including hero, rebel, adjustor, clown, and caretaker. Lists organizational,…

  18. Apodized Phase Mask Coronagraphs

    NASA Astrophysics Data System (ADS)

    Carlotti, Alexis

    2013-01-01

    Among the optical instruments proposed to detect and characterize exoplanets, phase masks coronagraphs offer very small inner working angles. Designed for off-axis telescopes, their performance is greatly reduced when used with centrally obstructed apertures such as those of the Palomar telescope, the very large telescope, or the James Webb space telescope. However, a clear circular aperture is not the only pupil shape for which a phase mask coronagraph can work properly. In fact, for a given centrally obstructed aperture, we show that it is possible to compute optimal apodizers that help achieve stellar extinction levels similar to those obtained in the ideal case of an off-axis telescope. Trade-offs exist between these levels, the transmission of the apodizer, and the area covered by the Lyot stop. We detail the Fourier optics formalism that makes these optimizations possible, as well as a few examples of shaped pupils. Some are designed for a four-quadrants phase mask, and some others for a vortex phase mask. We also offer a comparison with a coronagraph solely composed of a shaped pupil.

  19. Masked mycotoxins: a review.

    PubMed

    Berthiller, Franz; Crews, Colin; Dall'Asta, Chiara; Saeger, Sarah De; Haesaert, Geert; Karlovsky, Petr; Oswald, Isabelle P; Seefelder, Walburga; Speijers, Gerrit; Stroka, Joerg

    2013-01-01

    The aim of this review is to give a comprehensive overview of the current knowledge on plant metabolites of mycotoxins, also called masked mycotoxins. Mycotoxins are secondary fungal metabolites, toxic to human and animals. Toxigenic fungi often grow on edible plants, thus contaminating food and feed. Plants, as living organisms, can alter the chemical structure of mycotoxins as part of their defence against xenobiotics. The extractable conjugated or non-extractable bound mycotoxins formed remain present in the plant tissue but are currently neither routinely screened for in food nor regulated by legislation, thus they may be considered masked. Fusarium mycotoxins (deoxynivalenol, zearalenone, fumonisins, nivalenol, fusarenon-X, T-2 toxin, HT-2 toxin, fusaric acid) are prone to metabolisation or binding by plants, but transformation of other mycotoxins by plants (ochratoxin A, patulin, destruxins) has also been described. Toxicological data are scarce, but several studies highlight the potential threat to consumer safety from these substances. In particular, the possible hydrolysis of masked mycotoxins back to their toxic parents during mammalian digestion raises concerns. Dedicated chapters of this article address plant metabolism as well as the occurrence of masked mycotoxins in food, analytical aspects for their determination, toxicology and their impact on stakeholders.

  20. Competing for Consciousness: Prolonged Mask Exposure Reduces Object Substitution Masking

    ERIC Educational Resources Information Center

    Goodhew, Stephanie C.; Visser, Troy A. W.; Lipp, Ottmar V.; Dux, Paul E.

    2011-01-01

    In object substitution masking (OSM) a sparse, temporally trailing 4-dot mask impairs target identification, even though it has different contours from, and does not spatially overlap with the target. Here, we demonstrate a previously unknown characteristic of OSM: Observers show reduced masking at prolonged (e.g., 640 ms) relative to intermediate…

  1. Magnetic Resonance Imaging Protocol Optimization for Delineation of Gross Tumor Volume in Hypopharyngeal and Laryngeal Tumors

    SciTech Connect

    Verduijn, Gerda M.; Bartels, Lambertus W. Ph.D.; Pameijer, Frank A.

    2009-06-01

    Purpose: To optimize the use of MRI for delineation of gross tumor volume for radiotherapy treatment planning purposes in hypopharyngeal and laryngeal tumors. Methods and Materials: Magnetic resonance images (T1 weighted and T2 weighted) of a healthy volunteer were acquired using a 1.5 T and 3.0 T MR scanner. Various receiver coils were investigated that were compatible with the immobilization mask needed for reliable coregistration with computed tomography data. For the optimal receiver coil, the influence of resolution, slice thickness, and strength of magnetic field on the signal-to-noise ratio (SNR) was studied. Feasibility of the definitive protocol was tested on patients with hypopharyngeal (n = 19) and laryngeal (n = 42) carcinoma. Results: Large differences in SNR were obtained for the various coils. The SNR values obtained using surface coils that were compatible with the immobilization mask were three times higher than those obtained using a standard head-and-neck coil and five times higher than those obtained using a body coil. High-resolution images (0.4 x 0.4 x 4 mm{sup 3}) showed superior anatomic detail and resulted in a 4-min scan time. Image quality at 3.0 T was not significantly better compared with 1.5 T. In 3 patients the MR study could not be performed; for 5 patients images were severely deteriorated by motion artefacts. High-quality MR images were obtained in 53 patients. Conclusions: High-resolution MR images of the hypopharynx and larynx can be obtained in the majority of patients using surface receiver coils in combination with the radiotherapy mask. These MR images can be successfully used for tumor delineation in radiotherapy.

  2. The afferent activity of the superior laryngeal nerve, and respiratory reflexes specifically responding to intralaryngeal pressure changes in anesthetized Shiba goats.

    PubMed

    Sekizawa, S; Tsubone, H; Hishida, N; Kuwahara, M; Sugano, S

    1997-10-01

    This study was aimed at characterizing the superior laryngeal nerve (SLN) afferent activities under four different respiratory conditions, i.e., tracheostomy breathing (TB), upper airway breathing (UAB), tracheal occlusion (TO) and upper airway occlusion (UAO), and investigating respiratory changes in response to transmural pressures applied to the larynx in anesthetized Shiba goats. The activity recorded from the whole SLN increased at both inspiration and expiration during TB, UAB and TO, while an expiratory augmentation accompanied by an inspiratory inhibition was found during UAO. Based on recordings from 109 thin filament-preparations, 47 units were identified as 'drive' receptors, 31 as 'pressure' receptors (22 'positive' and 9 'negative' pressure receptors), and the rest 31 as 'non-modulated type' of receptors. The posterior cricoarytenoid (PCA) muscle activity showed a clear inspiratory modulation during UAB and was significantly enhanced by negative pressure applied to the isolated upper airway, where such an augmented activity was abolished by bilateral section of the SLN. No significant changes were found in the respiratory cycle during application of negative pressures to the larynx. The respiratory modulation of the SLN in Shiba goats was essentially identical to that reported for rabbits, rats and guinea pigs, but not in dogs. The reflex response of the upper airway muscles to the laryngeal pressure changes in Shiba goats were found to be less noticeable than in rabbits and dogs.

  3. Evaluation of mask manufacturing efficiency using mask data rank information

    NASA Astrophysics Data System (ADS)

    Kato, Kokoro; Endo, Masakazu; Inoue, Tadao; Yamabe, Masaki; Nakatake, Shigetoshi

    2010-05-01

    The photomask cost is becoming one of the challenging issues in the semiconductor industry, as the cost of photomasks has been rising year by year. ASET started Mask D2I (Mask Design, Drawing and Inspection Technology) project with the sponsorship from the NEDO (New Energy and Industrial Technology Development Organization) in 2006 for the purpose of the mask cost reduction. In earlier papers[1-5], we introduced the idea of photomask data prioritization method which is referred to as Mask Data Rank (MDR). We have built our software system to convert Design Intent (DI) to MDR with cooperation of STARC. Then we showed the results of experiments with mask data provided by semiconductor companies. In this paper we show the additional report of mask inspection experiments using real photomasks. Then we show the evaluation results about mask drawing time reduction using MDR flow. Finally we introduce detailed algorithm to extract design intent from analog circuits.

  4. Effects of continuous negative airway pressure-related lung deflation on upper airway collapsibility.

    PubMed

    Sériès, F; Marc, I

    1993-09-01

    Continuous negative airway pressure (CNAP) causes a decrease in lung volume, which is known to increase upper airway resistance by itself. We studied how this lung volume change could modify upper airway collapsibility with five normal awake subjects. In a first trial, pressure in a nasal mask (Pm) was progressively decreased in 3- to 5-cmH2O steps (CNAP). In a second trial, changes in lung volumes resulting from CNAP were prevented by applying simultaneously an equivalent level of negative extrathoracic pressure into a poncho-type respirator [isovolumetric CNAP (CNAPisovol)]. For each trial, we examined the relationship between the maximal inspiratory airflow of each flow-limited inspiratory cycle and the corresponding Pm by least-squares linear regression analysis and determined the critical pressure. We also determined the Pm threshold corresponding to the first Pm value below which flow limitation occurred. Flow limitation was observed in each subject with CNAP but in only two subjects with CNAPisovol. In these two subjects, the Pm threshold values were -20 and -9 cmH2O with CNAP and -39 and -16 cmH2O with CNAPisovol, respectively. Critical pressures for the same two subjects were -161 and -96 cmH2O with CNAP and -202 and -197 cmH2O with CNAPisovol, respectively. We conclude that CNAP-induced decreases in lung volume increase upper airway collapsibility.

  5. RHIC Prefire Protection Masks

    SciTech Connect

    Drees, A.; Biscardi, C.; Curcio, T.; Gassner, D.; DeMonte, V.; DeSanto, L.; Fu, W.; Liaw, C. J.; Montag, C.; Thieberger, P.; Yip, K.

    2015-01-07

    The protection of the RHIC experimental detectors from damage due to beam hitting close upstream elements in cases of abort kicker prefires requires some dedicated precautionary measures with two general options: to bring the beam close to a limiting aperture (i.e. the beam pipe wall), as far upstream of the detector components as possible or, alternatively, to bring a limiting aperture close to the circulating beam. During the FY 2014 RHIC Heavy Ion run the first option was chosen because of the limited time available for preparation before the start of the run. For future runs the second option, in this case the installation of dual-sided movable masks, is preferred. The installation of the masks, one per ring, is planned before the start of the FY 2015 run.

  6. On Masking Effect

    DTIC Science & Technology

    1993-07-01

    solution will perform better than the others and present experimental data supportive of the analysis. This investigation is based on simulated robot...solution will perform better than the agent’s task is to catch the evasion agent. Both agents others, and present experimental data supportive of the...Masking interception, and the resultant time lost from hiding and The previous section ruled out refinement stratgies replanning. Without the learned rule

  7. Masked multichannel analyzer

    DOEpatents

    Winiecki, Alan L.; Kroop, David C.; McGee, Marilyn K.; Lenkszus, Frank R.

    1986-01-01

    An analytical instrument and particularly a time-of-flight-mass spectrometer for processing a large number of analog signals irregularly spaced over a spectrum, with programmable masking of portions of the spectrum where signals are unlikely in order to reduce memory requirements and/or with a signal capturing assembly having a plurality of signal capturing devices fewer in number than the analog signals for use in repeated cycles within the data processing time period.

  8. Masked multichannel analyzer

    DOEpatents

    Winiecki, A.L.; Kroop, D.C.; McGee, M.K.; Lenkszus, F.R.

    1984-01-01

    An analytical instrument and particularly a time-of-flight-mass spectrometer for processing a large number of analog signals irregularly spaced over a spectrum, with programmable masking of portions of the spectrum where signals are unlikely in order to reduce memory requirements and/or with a signal capturing assembly having a plurality of signal capturing devices fewer in number than the analog signals for use in repeated cycles within the data processing time period.

  9. Masks: Culture and Kids.

    ERIC Educational Resources Information Center

    Patterson, MaryEllen; And Others

    This guide describes a 7-day lesson plan to be used with bilingual 3rd and 4th graders and 6th, 7th, and 8th graders in English-as-a-Second-Language (ESL) classes. The guide shows how mask making can be tied into each class, and then how to pull the classes together for the older students to become peer tutors to the younger ones in the…

  10. The Attentional Dynamics of Masked Detection

    ERIC Educational Resources Information Center

    Smith, Philip L.; Wolfgang, Bradley J.

    2004-01-01

    A dichoptic masking procedure was used to test whether the mask-dependent cuing effects found in luminance detection by P. L. Smith (2000a) were due to integration masking or interruption masking. Attentional cuing enhanced detection sensitivity (d') when stimuli were backwardly masked with either dichoptic or monoptic masks, whereas no cuing…

  11. AANA journal course: update for nurse anesthetists. The SLAM Emergency Airway Flowchart: a new guide for advanced airway practitioners.

    PubMed

    Rich, James M; Mason, Andrew M; Ramsay, Michael A E

    2004-12-01

    Advanced airway practitioners in anesthesiology, emergency medicine, and prehospital care can suddenly and unexpectedly face difficult airway situations that can surface without warning during mask ventilation or tracheal intubation. Although tracheal intubation remains the "gold standard" in airway management, it is not always achievable, and, when it proves impossible, appropriate alternative interventions must be used rapidly to avoid serious morbidity or mortality. The SLAM Emergency Airway Flowchart (SEAF) is intended to prevent the 3 reported primary causes of adverse respiratory events (ie, inadequate ventilation, undetected esophageal intubation, and difficult intubation). The 5 pathways of the SEAF include primary ventilation, rapid-sequence intubation, difficult intubation, rescue ventilation, and cricothyrotomy. It is intended for use with adult patients by advanced airway practitioners competent in direct laryngoscopy, tracheal intubation, administration of airway drugs, rescue ventilation, and cricothyrotomy. The SEAF has limitations (eg, suitable only for use with adult patients, cannot be used by certain categories of rescue personnel, and depends heavily on assessment of Spo2). A unique benefit is provision of simple alternative techniques that can be used when another technique fails.

  12. Mask strategy at International SEMATECH

    NASA Astrophysics Data System (ADS)

    Kimmel, Kurt R.

    2002-08-01

    International SEMATECH (ISMT) is a consortium consisting of 13 leading semiconductor manufacturers from around the globe. Its objective is to develop the infrastructure necessary for its member companies to realize the International Technology Roadmap for Semiconductors (ITRS) through efficiencies of shared development resources and knowledge. The largest area of effort is lithography, recognized as a crucial enabler for microelectronics technology progress. Within the Lithography Division, most of the efforts center on mask-related issues. The development strategy at International SEMATCH will be presented and the interlock of lithography projects clarified. Because of the limited size of the mask production equipment market, the business case is weak for aggressive investment commensurate with the pace of the International Technology Roadmap for Semiconductors. With masks becoming the overwhelming component of lithography cost, new ways of reducing or eliminating mask costs are being explored. Will mask technology survive without a strong business case? Will the mask industry limit the growth of the semiconductor industry? Are advanced masks worth their escalating cost? An analysis of mask cost from the perspective of mask value imparted to the user is presented with examples and generic formulas for the reader to apply independently. A key part to the success for both International SEMATECH and the industry globally will be partnerships on both the local level between mask-maker and mask-user, and the macro level where global collaborations will be necessary to resolve technology development cost challenges.

  13. EUV mask black border evolution

    NASA Astrophysics Data System (ADS)

    Turley, Christina; Bonam, Ravi; Gallagher, Emily; Grohs, Jonathan; Kagawa, Masayuki; Kindt, Louis; Narita, Eisuke; Nash, Steven; Sakamoto, Yoshifumi

    2014-10-01

    The black border is a frame created by removing all the multilayers on the EUV mask in the region around the chip. It is created to prevent exposure of adjacent fields when printing an EUV mask on a wafer. Papers have documented its effectiveness. As the technology transitions into manufacturing, the black border must be optimized from the initial mask making process through its life. In this work, the black border is evaluated in three stages: the black border during fabrication, the final sidewall profile, and extended lifetime studies. This work evaluates the black border through simulations and physical experiments. The simulations address concerns for defects and sidewall profiles. The physical experiments test the current black border process. Three masks are used: one mask to test how black border affects the image placement of features on mask and two masks to test how the multilayers change through extended cleans. Data incorporated in this study includes: registration, reflectivity, multilayer structure images and simulated wafer effects. By evaluating the black border from both a mask making perspective and a lifetime perspective, we are able to characterize how the structure evolves. The mask data and simulations together predict the performance of the black border and its ability to maintain critical dimensions on wafer. In this paper we explore what mask changes occur and how they will affect mask use.

  14. Masks in imaging flow cytometry.

    PubMed

    Dominical, Venina; Samsel, Leigh; McCoy, J Philip

    2017-01-01

    Data analysis in imaging flow cytometry incorporates elements of flow cytometry together with other aspects of morphological analysis of images. A crucial early step in this analysis is the creation of a mask to distinguish the portion of the image upon which further examination of specified features can be performed. Default masks are provided by the manufacturer of the imaging flow cytometer but additional custom masks can be created by the individual user for specific applications. Flawed or inaccurate masks can have a substantial negative impact on the overall analysis of a sample, thus great care must be taken to ensure the accuracy of masks. Here we discuss various types of masks and cite examples of their use. Furthermore we provide our insight for how to approach selecting and assessing the optimal mask for a specific analysis.

  15. Oral airway flow dynamics in healthy humans.

    PubMed

    Amis, T C; O'Neill, N; Wheatley, J R

    1999-02-15

    1. Oral airway resistance (RO) is an important determinant of oro-nasal partitioning of airflow (e.g. during exercise and sleep); however, little is known of factors influencing its magnitude and measurement. 2. We developed a non-invasive standardized technique for measuring RO (based on a modification of posterior rhinomanometry) and examined inspiratory RO in 17 healthy male subjects (age, 36 +/- 2 years (mean +/- s.e.m.); height, 177 +/- 2 cm; weight, 83 +/- 3 kg). 3. Inspiratory RO (at 0.4 l s-1) was 0.86 +/- 0.23 cmH2O l-1 s-1 during resting mouthpiece breathing in the upright posture. RO was unaffected by assumption of the supine posture, tended to decrease with head and neck extension and increased to 1.22 +/- 0.19 cmH2O l-1 s-1 (n = 10 subjects, P < 0.01) with 40-45 deg of head and neck flexion. When breathing via a mouth-mask RO was 2.98 +/- 0.42 cmH2O l-1 s-1 (n = 7) and not significantly different from nasal airway resistance. 4. Thus, in awake healthy male subjects with constant jaw position, RO is unaffected by body posture but increases with modest degrees of head and neck flexion. This influence on upper airway patency may be important when oral route breathing is associated with alterations in head and neck position, e.g. during sleep.

  16. Relationship between gastro-oesophageal reflux and airway diseases: the airway reflux paradigm.

    PubMed

    Pacheco-Galván, Adalberto; Hart, Simon P; Morice, Alyn H

    2011-04-01

    Our understanding of the relationship between gastro-oesophageal reflux and respiratory disease has recently undergone important changes. The previous paradigm of airway reflux as synonymous with the classic gastro-oesophageal reflux disease (GORD) causing heartburn has been overturned. Numerous epidemiological studies have shown a highly significant association of the acid, liquid, and gaseous reflux of GORD with conditions such as laryngeal diseases, chronic rhinosinusitis, treatment resistant asthma, COPD and even idiopathic pulmonary fibrosis. However, it has become clear from studies on cough hypersensitivity syndrome that much reflux of importance in the airways has been missed, since it is either non- or weakly acid and gaseous in composition. The evidence for such a relationship relies on the clinical history pointing to symptom associations with known precipitants of reflux. The tools for the diagnosis of extra-oesophageal reflux, in contrast to the oesophageal reflux of GORD, lack sensitivity and reproducibility. Unfortunately, methodology for detecting such reflux is only just becoming available and much additional work is required to properly delineate its role.

  17. Laryngeal and respiratory protective reflexes.

    PubMed

    Altschuler, S M

    2001-12-03

    Swallowing is a complex motor behavior that relies on an interneuronal network of premotor neurons (PMNs) to organize the sequential activity of motor neurons that are active during the buccopharyngeal and esophageal phases. Swallowing PMNs are highly interconnected to multiple areas of the brain stem and the central nervous system and provide a potential anatomic substrate integration of swallowing activity with airway protective reflexes. Because these neurons have synaptic contact with both afferent inputs and motor neurons and exhibit a true central activity, they appear to constitute the swallowing central pattern generator. We studied the viscerotopic organization of the nucleus of the solitary tract (NTS), the nucleus ambiguus (NA), the dorsal motor nucleus (DMN), and the hypoglossal nucleus (XII) using cholera toxin horseradish peroxidase (CT-HRP), a sensitive antegrade and retrograde tracer that effectively labels afferent terminal fields within the NTS as well as swallowing motor neurons and their dendritic fields within the NA, DMN, and XII. We used CT-HRP to provide a comprehensive description of the dendritic architecture of NA motor neurons innervating swallowing muscles. We also conducted studies using pseudorabies virus (PRV), a swine alpha-herpesvirus, to map central neural circuits after injection in the peripheral or central nervous systems. One attenuated vaccine strain, Bartha PRV, has preferential affinity for sites of afferent synaptic contact on the cell body and dendrites and a reactive gliosis that effectively isolates the infected neurons and provides a barrier to the nonspecific spread to adjacent neurons. The findings provide a basis for the central integration of swallowing and respiratory protective reflexes.

  18. Mask requirements for advanced lithography

    NASA Astrophysics Data System (ADS)

    Trybula, Walter J.; Engelstad, Roxann L.

    1998-06-01

    Within the n ext 10 years, sub-100 nm features will be required for state-of-the-industry devices. The tolerances for errors at 100 nm or less are substantially smaller than can be achieved today. A critical element of the error budget is the mask. For the 100 nm generation, the 4x mask image placement requirement is 20 nm with CD requirements as low as 9 nm. The challenge would be significant if the only improvement were to develop superior optical masks. There are multiple advanced technologies that are vying to be the successor to optical lithography. Each of these has a unique mask requirement. The leading contenders for the next generation are 1x x-ray, projection e-beam, ion beam, EUV and cell projection e-beam. The x-ray design is a proximity system that employs a 1x membrane mask. Projection e-beam uses a membrane mask with stabilizing struts. Ion beam lithography employs a stencil membrane mask with a carbon coating. EUV employs a 13 nm radiation source that requires a reflective mask. Cell projection e-beam has 25x or greater image masks that are stitched on the wafer. All the technologies indicated above. Once a total error budget for the mask is known, it is necessary to divide the total into the constituent parts. The major sources of distortion can be categorized into eight areas: mask blank processing, e- beam writing, pattern transfer, pellicle effects, mounting, thermal loadings, dynamic effects during exposure and radiation damage. The distortions introduced by each of these depend upon the type of mask; so, individual mask calculations must be made. The purpose of this paper is to review the modeling requirements of each of the categories and to highlight some results from each of the mask configurations.

  19. Organ preservation surgery for laryngeal cancer

    PubMed Central

    Chawla, Sharad; Carney, Andrew Simon

    2009-01-01

    The principles of management of the laryngeal cancer have evolved over the recent past with emphasis on organ preservation. These developments have paralleled technological advancements as well as refinement in the surgical technique. The surgeons are able to maintain physiological functions of larynx namely speech, respiration and swallowing without compromising the loco-regional control of cancer in comparison to the more radical treatment modalities. A large number of organ preservation surgeries are available to the surgeon; however, careful assessment of the stage of the cancer and selection of the patient is paramount to a successful outcome. A comprehensive review of various organ preservation techniques in vogue for the management of laryngeal cancer is presented. PMID:19442314

  20. Fatal laryngeal oedema in an adult from an air rifle injury, and related ballistics.

    PubMed

    Radojevic, Nemanja; Cukic, Dragana; Curovic, Ivana; Golubovic, Mileta

    2015-01-01

    Air guns (air pistols and rifles) are already recognized as being potentially lethal. The diabolo pellet has a calibre of .177 (4.5 mm), a 1250 fps velocity, is high energetic, and is most commonly used in such weapons. In the presented case, the victim sustained an air rifle injury to the neck. The pellet passed through the thyroid cartilage, subsequently causing the extensive laryngeal swelling with haematoma around the pellet channel which fatally obstructed the airway. It is estimated microscopically that at least a number of hours must have passed from the injury to the time of death. For this case, a shooting distance was estimated by using experimental shooting values compared to physics formulas for accelerated motion. The case under question has confirmed an applicable legal approach that can be utilized by countries to classify air rifles as being as harmful as other firearms, especially those with high muzzle velocities.

  1. Fatal laryngeal angioedema: a case report and a workup of angioedema in a forensic setting.

    PubMed

    Krizova, Adriana; Gardner, Taylor; Little, D'Arcy L; Arcieri-Piersanti, V; Pollanen, Michael S

    2015-12-01

    Angioedema is an episodic swelling of the deep dermis, subcutis, and/or submucosal tissue due to an increase in local vascular permeability. Swelling may involve skin, respiratory, and gastrointestinal tracts. The most commonly involved areas are the periorbital region and the lips. Here we report a case of a fatal laryngeal obstruction due to angioedema likely caused by an angiotensin-converting-enzyme inhibitor. The decedent, a 58-year-old man, was witnessed developing sudden facial swelling and acute respiratory difficulties quickly followed by unresponsiveness. His past medical history suggested that this was his second episode of angioedema without urticaria. Postmortem examination revealed a complete laryngeal obstruction in the absence of infection, neoplasm, or autoimmune disease. Postmortem computed tomography of the head and neck showed a complete obstruction of the upper airway. Based on the current understanding of the pathophysiology of different types of angioedema, we will suggest a workup of angioedema without urticaria in the forensic setting and offer readers resources they can use in their practice.

  2. Retrospective analysis of the clinical course for intubation vs. unspecified laryngeal granulomas.

    PubMed

    Kumai, Yoshihiko; Yumoto, Eiji; Nishimoto, Kohei; Minoda, Ryosei

    2014-05-01

    Intubation laryngeal granulomas (ILGs) are a well-known complication of endotracheal intubation. Cases other than ILGs can be categorized as unspecified laryngeal granulomas (ULGs) since their etiologies are often difficult to confirm. We intended to clarify clinical features of both ILGs and ULGs and that anticoagulant medication could cause the formation and delayed healing of ILGs in terms of wound-healing delay. We compared the results of our treatment of ILGs (n = 16) and ULGs (n = 47) treated between 1998 and 2009 to characterize these patients. The clinical course, treatment (medical vs. surgical), indications for surgical resection, treatment outcome, and use of anticoagulants for preexisting disease were reviewed and compared between these two groups. The resolution rate was significantly better in ILGs (p < .05). Five ILGs and seven ULGs were surgically resected. The main reason for resection was airway obstruction and the need for histological assessment, respectively. The use of anticoagulants was significantly higher in ILGs than ULGs (8/16 vs. 4/47, p < .01). The resolution period was significantly longer in the ILGs patients with anticoagulant medication compared to that in the ILGs patients without anticoagulant medication (152 ± 101 days vs. 76 ± 44 days, p < .05). ILGs may have different clinical course from ULGs, especially in terms of the resolution period. Moreover, administration of anticoagulants may deter healing of small injury due to intubation. Patients taking anticoagulants should be managed carefully during the perioperative period to prevent the occurrence of ILGs.

  3. Intensity and frequency dependence of laryngeal afferent inputs to respiratory hypoglossal motoneurons.

    PubMed

    Mifflin, S W

    1997-12-01

    Inspiratory hypoglossal motoneurons (IHMs) mediate contraction of the genioglossus muscle and contribute to the regulation of upper airway patency. Intracellular recordings were obtained from antidromically identified IHMs in anesthetized, vagotomized cats, and IHM responses to electrical activation of superior laryngeal nerve (SLN) afferent fibers at various frequencies and intensities were examined. SLN stimulus frequencies <2 Hz evoked an excitatory-inhibitory postsynaptic potential (EPSP-IPSP) sequence or only an IPSP in most IHMs that did not change in amplitude as the stimulus was maintained. During sustained stimulus frequencies of 5-10 Hz, there was a reduction in the amplitude of SLN-evoked IPSPs with time with variable changes in the EPSP. At stimulus frequencies >25 Hz, the amplitude of EPSPs and IPSPs was reduced over time. At a given stimulus frequency, increasing stimulus intensity enhanced the decay of the SLN-evoked postsynaptic potentials (PSPs). Frequency-dependent attenuation of SLN inputs to IHMs also occurred in newborn kittens. These results suggest that activation of SLN afferents evokes different PSP responses in IHMs depending on the stimulus frequency. At intermediate frequencies, inhibitory inputs are selectively filtered so that excitatory inputs predominate. At higher frequencies there was no discernible SLN-evoked PSP temporally locked to the SLN stimuli. Alterations in SLN-evoked PSPs could play a role in the coordination of genioglossal contraction during respiration, swallowing, and other complex motor acts where laryngeal afferents are activated.

  4. Responses of laryngeal receptors to intralaryngeal CO2 in the cat.

    PubMed Central

    Bartlett, D; Knuth, S L

    1992-01-01

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

  5. [Electrostimulation of laryngeal muscles with fluctuating currents in the treatment of patients with unilateral laryngeal paralysis].

    PubMed

    Romanenko, S G; Tokarev, O P; Vasilenko, Iu S

    2001-01-01

    Intralaryngeal electrostimulation of the laryngeal muscles with fluctuating currents with simultaneous mobilization of the arytenoid cartilage and paralysed vocal cord were used in 42 patients with unilateral laryngeal paralysis. The treatment was combined with phonopedic lessons. The control group consisted of 32 patients receiving standard electrostimulation with diadynamic currents. The effect was evaluated by changes in vocal acoustic parameters and stroboscopic parameters. In patients with paramedian fixation of the vocal cords voice improvement was obtained irrespective of electrostimulation type. For patients with intermedian and lateral fixation of the vocal cords more effective was intralaryngeal electrostimulation with fluctuating currents. A good therapeutic effect was achieved in patients with dislocation of the arytenoid cartilage.

  6. COMPLIANCE MEASUREMENTS OF THE UPPER AIRWAY IN PEDIATRIC DOWN SYNDROME SLEEP APNEA PATIENTS

    PubMed Central

    Subramaniam, Dhananjay Radhakrishnan; Mylavarapu, Goutham; McConnell, Keith; Fleck, Robert J.; Shott, Sally R.; Amin, Raouf S.; Gutmark, Ephraim J.

    2015-01-01

    Compliance of soft tissue and muscle supporting the upper airway are two of several factors contributing to pharyngeal airway collapse. We present a novel, minimally invasive method of estimating regional variations in pharyngeal elasticity. Magnetic resonance images for pediatric sleep apnea patients with Down syndrome (9.5 ± 4.3 years (mean age ± standard deviation)) were analyzed to segment airways corresponding to baseline (no mask pressure) and two positive pressures. A three dimensional map was created to evaluate axial and circumferential variation in radial displacements of the airway, dilated by the positive pressures. The displacements were then normalized with respect to the appropriate transmural pressure and radius of an equivalent circle to obtain a measure of airway compliance. The resulting elasticity maps indicated the least and most compliant regions of the pharynx. Airway stiffness of the most compliant region (403 ± 204 (mean ± standard deviation) Pa) decreased with severity of OSA. The non-linear response of the airway wall to CPAP was patient specific and varied between anatomical locations. We identified two distinct elasticity phenotypes. Patient phenotyping based on airway elasticity can potentially assist clinical practitioners in decision making on the treatments needed to improve airway patency. PMID:26215306

  7. A cohort and database study of airway management in patients undergoing thyroidectomy for retrosternal goitre.

    PubMed

    Gilfillan, N; Ball, C M; Myles, P S; Serpell, J; Johnson, W R; Paul, E

    2014-11-01

    Patients undergoing thyroid surgery with retrosternal goitre may raise concerns for the anaesthetist, especially airway management. We reviewed a multicentre prospective thyroid surgery database and extracted data for those patients with retrosternal goitre. Additionally, we reviewed the anaesthetic charts of patients with retrosternal goitre at our institution to identify the anaesthetic induction technique and airway management. Of 4572 patients in the database, 919 (20%) had a retrosternal goitre. Two cases of early postoperative tracheomalacia were reported, one in the retrosternal group. Despite some very large goitres, no patient required tracheostomy or cardiopulmonary bypass and there were no perioperative deaths. In the subset of 133 patients managed at our institution over six years, there were no major adverse anaesthetic outcomes and no patient had a failed airway or tracheomalacia. In the latter cohort, of 32 (24%) patients identified as having a potentially difficult airway, 17 underwent awake fibreoptic tracheal intubation, but two of these were abandoned and converted to intravenous induction and general anaesthesia. Eleven had inhalational induction; two of these were also abandoned and converted to intravenous induction and general anaesthesia. Of those suspected as having a difficult airway, 28 (87.5%) subsequently had direct laryngoscopy where the laryngeal inlet was clearly visible. We found no good evidence that thyroid surgery patients with retrosternal goitre, with or without symptoms and signs of tracheal compression, present the experienced anaesthetist with an airway that cannot be managed using conventional techniques. This does not preclude the need for multidisciplinary discussion and planning.

  8. Mask alignment system for semiconductor processing

    DOEpatents

    Webb, Aaron P.; Carlson, Charles T.; Weaver, William T.; Grant, Christopher N.

    2017-02-14

    A mask alignment system for providing precise and repeatable alignment between ion implantation masks and workpieces. The system includes a mask frame having a plurality of ion implantation masks loosely connected thereto. The mask frame is provided with a plurality of frame alignment cavities, and each mask is provided with a plurality of mask alignment cavities. The system further includes a platen for holding workpieces. The platen may be provided with a plurality of mask alignment pins and frame alignment pins configured to engage the mask alignment cavities and frame alignment cavities, respectively. The mask frame can be lowered onto the platen, with the frame alignment cavities moving into registration with the frame alignment pins to provide rough alignment between the masks and workpieces. The mask alignment cavities are then moved into registration with the mask alignment pins, thereby shifting each individual mask into precise alignment with a respective workpiece.

  9. Mask fabrication process

    DOEpatents

    Cardinale, Gregory F.

    2000-01-01

    A method for fabricating masks and reticles useful for projection lithography systems. An absorber layer is conventionally patterned using a pattern and etch process. Following the step of patterning, the entire surface of the remaining top patterning photoresist layer as well as that portion of an underlying protective photoresist layer where absorber material has been etched away is exposed to UV radiation. The UV-exposed regions of the protective photoresist layer and the top patterning photoresist layer are then removed by solution development, thereby eliminating the need for an oxygen plasma etch and strip and chances for damaging the surface of the substrate or coatings.

  10. Masks of the Universe

    NASA Astrophysics Data System (ADS)

    Harrison, Edward

    2003-05-01

    Preface; Introducing the masks; Part I. Worlds in the Making: 1. The magic Universe; 2. The mythic Universe; 3. The geometric Universe; 4. The medieval Universe; 5. The infinite Universe; 6. The mechanistic Universe; Part II. The Heart Divine: 7. Dance of the atoms and waves; 8. Fabric of space and time; 9. Nearer to the heart's desire; 10. The cosmic tide; 11. Do dreams ever come true?; Part III. The Cloud of Unknowing: 12. The witch universe; 13. The spear of Archytas; 14. All that is made; 15. The cloud of unknowing; 16. Learned ignorance.

  11. Trends in mask data preparation

    NASA Astrophysics Data System (ADS)

    Fujimura, Aki; Pang, Liyong; Su, Bo; Choi, Yohan

    2014-10-01

    Whether for VSB mask writing or for multibeam mask writing, the shapes we need to write on masks are increasingly complex, increasingly curvilinear, and smaller in minimum width and space. The overwhelming trend in mask data preparation (MDP) is the shift from deterministic, rule-based, geometric, context-independent, shape-modulated, rectangular processing to statistical, simulation-based, context-dependent, dose- and shape-modulated any-shape processing. The paper briefly surveys the history of MDP, and explains through a simulation-based study that 50nm line and space is the tipping point where rule-based processing gives away to simulation-based processing.

  12. A Masked Photocathode in Photoinjector

    SciTech Connect

    Qiang, Ji

    2010-12-14

    In this paper, we propose a masked photocathode inside the photoinjector for generating high brightness election beam. Instead of mounting the photocathode onto an electrode, an electrode with small hole is used as a mask to shield the photocathode from the accelerating vacuum chamber. Using such a masked photocathode will make the replacement of photocathode material easy by rotating the photocathode behind the electrode into the hole. Furthermore, this helps reduce the dark current or secondary electron emission from the photocathode material. The masked photocathode also provides transverse cut-off to a Gaussian laser beam that reduces electron beam emittance growth from nonlinear space-charge effects.

  13. Masked hypertension: a systematic review.

    PubMed

    Bobrie, Guillaume; Clerson, Pierre; Ménard, Joël; Postel-Vinay, Nicolas; Chatellier, Gilles; Plouin, Pierre-François

    2008-09-01

    The purpose of this research was to review the literature on masked hypertension. Studies, reviews and editorials on masked hypertension were identified by PubMed, Pascal BioMed and Cochrane literature systematic searches. Then, we carried out a meta-analysis of the six cohort studies reporting quantitative data for masked hypertension prognosis. There is still no clear consensus definition of masked hypertension and the reproducibility of the phenomenon is unknown. Nevertheless, the prevalence of masked hypertension seems to lie between 8 and 20%, and can be up to 50% in treated hypertensive patients. Subjects with masked hypertension have a higher risk of cardiovascular accidents [hazard ratios: 1.92 (1.51-2.44)] than normotensive subjects. This is due to a possible failure to recognize and appropriately manage this particular form of hypertension, the frequent association with other risk factors and coexisting target organ damage. The remaining unresolved questions are as follows: is masked hypertension a clinical entity that requires identification and characterization or a statistical phenomenon linked to the variability of blood pressure measurements?; because screening of the entire population is not feasible, how to identify individuals with masked hypertension?; and, in the absence of randomized trial, how to treat masked hypertension?

  14. Akathisia masked by hypokinesia.

    PubMed

    Tuisku, K; Lauerma, H; Holi, M M; Honkonen, T; Rimon, R

    2000-07-01

    Here, we will discuss the concept of subjective akathisia and present a patient case. Our patient was suffering from neuroleptic-induced hypokinesia and akathisia at the same time. The typical motor manifestations of akathisia were masked by hypokinesia, which made the diagnosis difficult. However, the subjective symptoms of akathisia were evident and distressing. Although not observable to bare eye, the pathognomonic pattern of motor activity detected in akathisia was demonstrated by actometric recording. Changing the conventional neuroleptic to an atypical one brought relief to the subjective symptoms of akathisia and hypokinesia, while the motor activity was clearly diminished in actometric recording. Actometric recording may be useful in diagnosing akathisia masked by hypokinesia, but the typical subjective symptoms of akathisia should not be ignored, even when actometry is not available to demonstrate the missing motor component of akathisia. Not only akathisia defined by DSM-IV but also subjective akathisia should be adequately treated to relieve the subjective distress, and to diminish the unfavorable effects on psychotic symptoms, behavior, and drug compliance.

  15. Laryngeal Structure and Function in the Pediatric Larynx: Clinical Applications

    ERIC Educational Resources Information Center

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

    2004-01-01

    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…

  16. Using Laryngeal Electromyography to Differentiate Presbylarynges from Paresis

    ERIC Educational Resources Information Center

    Stager, Sheila V.; Bielamowicz, Steven A.

    2010-01-01

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

  17. 21 CFR 874.3730 - Laryngeal prosthesis (Taub design).

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Prosthetic Devices § 874.3730 Laryngeal prosthesis (Taub design). (a) Identification. A laryngeal prosthesis (Taub design) is a device intended to direct... device is interposed between openings in the trachea and the esophagus and may be removed and...

  18. 21 CFR 874.3730 - Laryngeal prosthesis (Taub design).

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Prosthetic Devices § 874.3730 Laryngeal prosthesis (Taub design). (a) Identification. A laryngeal prosthesis (Taub design) is a device intended to direct... device is interposed between openings in the trachea and the esophagus and may be removed and...

  19. Quantitative PCR Analysis of Laryngeal Muscle Fiber Types

    ERIC Educational Resources Information Center

    Van Daele, Douglas J.

    2010-01-01

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

  20. 21 CFR 874.3730 - Laryngeal prosthesis (Taub design).

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Laryngeal prosthesis (Taub design). 874.3730 Section 874.3730 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Prosthetic Devices § 874.3730 Laryngeal...

  1. 21 CFR 874.3730 - Laryngeal prosthesis (Taub design).

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Laryngeal prosthesis (Taub design). 874.3730 Section 874.3730 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Prosthetic Devices § 874.3730 Laryngeal...

  2. 21 CFR 874.3730 - Laryngeal prosthesis (Taub design).

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Laryngeal prosthesis (Taub design). 874.3730 Section 874.3730 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Prosthetic Devices § 874.3730 Laryngeal...

  3. Airway Preparation Techniques for the Cervical Spine-Injured Football Player

    PubMed Central

    Ray, Richard; Luchies, Carl; Bazuin, Doug; Farrell, Robert N.

    1995-01-01

    Athletic health care professionals have been concerned about how to optimize the emergency care the cervical spine-injured football player receives on the field. Much of the discussion has centered on how to best expose and prepare the airway for rescue breathing in the quickest and safest manner possible. This study compared the time required and the extraneous motion induced at the cervical spine during three traditional and one new airway exposure and preparation technique. Twelve subjects wearing football helmets and shoulder pads were exposed to multiple trials of airway exposure via face mask repositioning using a manual screwdriver, power screwdriver, and the Trainer's Angel cutting device. Subjects also underwent airway preparation using the pocket mask insertion technique. Cervical spine motion was measured in two dimensions using an optoelectronic motion analysis system. Time and qualitative assessment were obtained through videotape analysis. Significant differences were found between the techniques with respect to time and cervical spine motion. The pocket mask allowed quicker activation of rescue breathing than the other three traditional techniques. There was no significant difference in the amount of extraneous motion induced at the cervical spine between the pocket mask, manual screwdriver, and power screwdriver techniques. The Trainer's Angel induced significantly more motion than the other three techniques in each of the four motions measured. Changes in traditional protocols used to treat cervical spine-injured football players on the field are recommended based on these data. ImagesFig 1.Fig 2. PMID:16558339

  4. Central nervous system control of the laryngeal muscles in humans

    PubMed Central

    Ludlow, Christy L.

    2005-01-01

    Laryngeal muscle control may vary for different functions such as: voice for speech communication, emotional expression during laughter and cry, breathing, swallowing, and cough. This review discusses the control of the human laryngeal muscles for some of these different functions. Sensori-motor aspects of laryngeal control have been studied by eliciting various laryngeal reflexes. The role of audition in learning and monitoring ongoing voice production for speech is well known; while the role of somatosensory feedback is less well understood. Reflexive control systems involving central pattern generators may contribute to swallowing, breathing and cough with greater cortical control during volitional tasks such as voice production for speech. Volitional control is much less well understood for each of these functions and likely involves the integration of cortical and subcortical circuits. The new frontier is the study of the central control of the laryngeal musculature for voice, swallowing and breathing and how volitional and reflexive control systems may interact in humans. PMID:15927543

  5. An unusual course of the left recurrent laryngeal nerve.

    PubMed

    Khaki, Amir A; Tubbs, R Shane; Shoja, Mohammadali M; Zarrintan, Sina

    2007-04-01

    Variation in the course of the left recurrent laryngeal nerve is seemingly very rare. During the routine dissection of an adult male cadaver, the entire left recurrent laryngeal nerve after branching from the left vagus nerve was noted to travel medial to the ligamentum arteriosum. We hypothesize that this rare variation may occur, if the left recurrent laryngeal nerve passes inferior to the fifth rather than the sixth aortic arch during embryological development. As our case report demonstrates, the relationship between the ligamentum arteriosum and the left recurrent laryngeal nerve is not absolute. Although seemingly rare, cardiothoracic surgeons must consider variations of the left recurrent laryngeal nerve during surgical procedures in the region of the ligamentum arteriosum in order to minimize potential postoperative complications.

  6. Laryngeal Elevation Velocity and Aspiration in Acute Ischemic Stroke Patients

    PubMed Central

    Zhang, Jing; Zhou, Yun; Wei, Na; Yang, Bo; Wang, Anxin; Zhou, Hai; Zhao, Xingquan; Wang, Yongjun; Liu, Liping; Ouyoung, Melody; Villegas, Brenda; Groher, Michael

    2016-01-01

    Objectives Aspiration after stroke has been associated with aspiration pneumonia, which contributes to increased mortality of stroke. Laryngeal elevation is a core mechanism for protection from aspiration. Few studies have explored the predictive value of laryngeal elevation velocity for aspiration after stroke. This study aimed to explore the ability of laryngeal elevation velocity to predict aspiration in patients with acute ischemic stroke. Methods This was a prospective cohort study that included consecutive acute ischemic stroke patients treated at a teaching hospital during a 10-month period. Patients underwent magnetic resonance imaging (MRI) to confirm the diagnosis of acute ischemic stroke. Patients who were at risk of aspiration and could swallow 5 ml of diluted barium (40%, w/v) for a videofluoroscopic swallowing (VFS) study were included. The association between abnormal indices in the oral and pharyngeal phase of the VFS study and aspiration was examined using univariate analyses. These indices included the lip closure, tongue movement and control, laryngeal elevation velocity and range, the latency of pharyngeal swallowing, pharyngeal transit time (PTT), abnormal epiglottis tilt, residual barium in the pharynx, and the duration of upper esophageal sphincter (UES) opening. The laryngeal elevation velocity (%/s) was calculated as the range of laryngeal elevation (%) from the resting position to the maximum superior position or to the position where the laryngeal vestibule is fully closed divided by the corresponding duration of laryngeal elevation. The range of laryngeal elevation (%) was the percentage calculated as the distance between the resting laryngeal position and the maximum superior excursion position or position where the laryngeal vestibule is fully closed divided by the distance between the resting laryngeal position and the lowest edge of the mandible. A logistic regression analysis was used to determine the predictive value for aspiration

  7. Role of Advanced Laryngeal Imaging in Glottic Cancer: Early Detection and Evaluation of Glottic Neoplasms.

    PubMed

    Tibbetts, Kathleen M; Tan, Melin

    2015-08-01

    Laryngeal cancer accounts for approximately 2.4% of new malignancies worldwide each year. Early identification of laryngeal neoplasms results in improved prognosis and functional outcomes. Imaging plays an integral role in the diagnosis, staging, and long-term follow-up of laryngeal cancer. This article highlights advanced laryngeal imaging techniques and their application to early glottic neoplasms.

  8. 9 CFR 310.15 - Disposition of thyroid glands and laryngeal muscle tissue.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... laryngeal muscle tissue. 310.15 Section 310.15 Animals and Animal Products FOOD SAFETY AND INSPECTION... of thyroid glands and laryngeal muscle tissue. (a) Livestock thyroid glands and laryngeal muscle tissue shall not be used for human food. (b) Livestock thyroid glands and laryngeal muscle tissue may...

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

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... laryngeal muscle tissue. 310.15 Section 310.15 Animals and Animal Products FOOD SAFETY AND INSPECTION... of thyroid glands and laryngeal muscle tissue. (a) Livestock thyroid glands and laryngeal muscle tissue shall not be used for human food. (b) Livestock thyroid glands and laryngeal muscle tissue may...

  10. 9 CFR 310.15 - Disposition of thyroid glands and laryngeal muscle tissue.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... laryngeal muscle tissue. 310.15 Section 310.15 Animals and Animal Products FOOD SAFETY AND INSPECTION... of thyroid glands and laryngeal muscle tissue. (a) Livestock thyroid glands and laryngeal muscle tissue shall not be used for human food. (b) Livestock thyroid glands and laryngeal muscle tissue may...

  11. 9 CFR 310.15 - Disposition of thyroid glands and laryngeal muscle tissue.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... laryngeal muscle tissue. 310.15 Section 310.15 Animals and Animal Products FOOD SAFETY AND INSPECTION... of thyroid glands and laryngeal muscle tissue. (a) Livestock thyroid glands and laryngeal muscle tissue shall not be used for human food. (b) Livestock thyroid glands and laryngeal muscle tissue may...

  12. 9 CFR 310.15 - Disposition of thyroid glands and laryngeal muscle tissue.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... laryngeal muscle tissue. 310.15 Section 310.15 Animals and Animal Products FOOD SAFETY AND INSPECTION... of thyroid glands and laryngeal muscle tissue. (a) Livestock thyroid glands and laryngeal muscle tissue shall not be used for human food. (b) Livestock thyroid glands and laryngeal muscle tissue may...

  13. SEMATECH EUVL mask program status

    NASA Astrophysics Data System (ADS)

    Yun, Henry; Goodwin, Frank; Huh, Sungmin; Orvek, Kevin; Cha, Brian; Rastegar, Abbas; Kearney, Patrick

    2009-04-01

    As we approach the 22nm half-pitch (hp) technology node, the industry is rapidly running out of patterning options. Of the several lithography techniques highlighted in the International Technology Roadmap for Semiconductors (ITRS), the leading contender for the 22nm hp insertion is extreme ultraviolet lithography (EUVL). Despite recent advances with EUV resist and improvements in source power, achieving defect free EUV mask blank and enabling the EUV mask infrastructure still remain critical issues. To meet the desired EUV high volume manufacturing (HVM) insertion target date of 2013, these obstacles must be resolved on a timely bases. Many of the EUV mask related challenges remain in the pre-competitive stage and a collaborative industry based consortia, such as SEMATECH can play an important role to enable the EUVL landscape. SEMATECH based in Albany, NY is an international consortium representing several of the largest manufacturers in the semiconductor market. Full members include Intel, Samsung, AMD, IBM, Panasonic, HP, TI, UMC, CNSE (College of Nanoscience and Engineering), and Fuller Road Management. Within the SEMATECH lithography division a major thrust is centered on enabling the EUVL ecosystem from mask development, EUV resist development and addressing EUV manufacturability concerns. An important area of focus for the SEMATECH mask program has been the Mask Blank Development Center (MBDC). At the MBDC key issues in EUV blank development such as defect reduction and inspection capabilities are actively pursued together with research partners, key suppliers and member companies. In addition the mask program continues a successful track record of working with the mask community to manage and fund critical mask tools programs. This paper will highlight recent status of mask projects and longer term strategic direction at the MBDC. It is important that mask technology be ready to support pilot line development HVM by 2013. In several areas progress has been

  14. EUVL alternating phase shift mask

    NASA Astrophysics Data System (ADS)

    Yan, Pei-Yang; Myers, Alan; Shroff, Yashesh; Chandhok, Manish; Zhang, Guojing; Gullikson, Eric; Salmassi, Farhad

    2011-04-01

    Extreme ultra-violet Lithography (EUVL) alternating phase shift mask (APSM) or other optical enhancement techniques are likely needed for 16nm (half pitch) technology generation and beyond. One possible option is the combination of EUVL and APSM. The fabrication of EUVL APSM is more difficult than either the fabrication of an EUVL binary mask or a conventional optical APSM mask. In the case of EUVL APSM, the phase difference in the two regions (0 and 180-degree phase regions) is created by a phase step in the substrate prior to the multilayer (ML) coating. The step height that induces 180-degree phase mismatch in the ML is determined by [λ/(4cosθ)](2m+1), where m are integers (0, 1, 2,...). In this experiment, we targeted for a step height with m=1. The same mask design also contains the standard binary structures so that the comparison between the EUVL APSM and the EUVL binary mask can be performed under the same illumination and wafer process conditions. The EUVL APSM mask was exposed using Nikon's EUV1 scanner in Kumagaya Japan. The wafer level results showed higher dense line resolution for EUVL APSM as compared to that of EUVL binary mask. APSM also showed improved line width roughness (LWR) and depth of focus (DoF) as compared to the best EUVL binary results obtained with C-dipole off-axis illumination (OAI). The wafer CD resolution improvement obtained by APSM in this experiment is partially limited by the resist resolution and the mask phase edge spread during ML deposition. We believe that wafer CD resolution and can further be improved with imaging imbalance compensation mask design and improvements in resist resolution and the phase generation portion of the mask fabrication process. In this paper, we will discuss in detail the mask fabrication process, wafer level data analysis, and our understanding of EUVL APSM related issues.

  15. Pharyngolaryngeal location of Kaposi's sarcoma with airway obstruction in an HIV-negative patient.

    PubMed

    Torretta, Sara; Gaffuri, Michele; Recalcati, Sebastiano; Marzano, Angelo Valerio; Cantarella, Giovanna; Iofrida, Elisabetta; Pignataro, Lorenzo

    2013-01-01

    Kaposi's sarcoma (KS) is a human herpes virus-8 (HHV-8)-associated angioproliferative disorder, and its occurrence may be favored by human immunodeficiency virus (HIV) infection and iatrogenic immunosuppression. It has also been postulated that a chronic inflammatory disease of the skin can pave the way to its development. KS generally involves mucosal and cutaneous sites, including the head and neck. An oropharyngeal location is quite common, but laryngeal involvement with possible upper airway obstruction and respiratory distress requiring tracheotomy is rare, and no hypopharyngeal locations have yet been reported. We describe the case of a 68-year-old male patient who developed KS after immunosuppressive treatment for pemphigus vulgaris, an autoimmune bullous disease presenting with blisters and erosions on the skin and the oral mucosa. KS was initially localized to the oral cavity and oropharynx, but subsequent involvement of the laryngeal and hypopharyngeal tract led to acute airway obstruction and the need for tracheotomy. This unique case of pharyngolaryngeal KS suggests that clinicians faced with purple nodular lesions should consider a differential diagnosis of KS in immunocompromised patients, even if they are HIV negative, and should carefully manage the patency of the upper airways.

  16. Exchanging digital video of laryngeal examinations.

    PubMed

    Crump, John M; Deutsch, Thomas

    2004-03-01

    Laryngeal examinations, especially stroboscopic examinations, are increasingly recorded using digital video formats on computer media, rather than using analog formats on videotape. It would be useful to share these examinations with other medical professionals in formats that would facilitate reliable and high-quality playback on a personal computer by the recipients. Unfortunately, a personal computer is not well designed for reliable presentation of artifact-free video. It is particularly important that laryngeal video play without artifacts of motion or color because these are often the characteristics of greatest clinical interest. With proper tools and procedures, and with reasonable compromises in image resolution and the duration of the examination, digital video of laryngeal examinations can be reliably exchanged. However, the tools, procedures, and formats for recording, converting to another digital format ("transcoding"), communicating, copying, and playing digital video with a personal computer are not familiar to most medical professionals. Some understanding of digital video and the tools available is required of those wanting to exchange digital video. Best results are achieved by recording to a digital format best suited for recording (such as MJPEG or DV),judiciously selecting a segment of the recording for sharing, and converting to a format suited to distribution (such as MPEG1 or MPEG2) using a medium suited to the situation (such as e-mail attachment, CD-ROM, a "clip" within a Microsoft PowerPoint presentation, or DVD-Video). If digital video is sent to a colleague, some guidance on playing files and using a PC media player is helpful.

  17. Masked Repetition Priming Using Magnetoencephalography

    ERIC Educational Resources Information Center

    Monahan, Philip J.; Fiorentino, Robert; Poeppel, David

    2008-01-01

    Masked priming is used in psycholinguistic studies to assess questions about lexical access and representation. We present two masked priming experiments using MEG. If the MEG signal elicited by words reflects specific aspects of lexical retrieval, then one expects to identify specific neural correlates of retrieval that are sensitive to priming.…

  18. Simplified tooling for spray masking

    NASA Technical Reports Server (NTRS)

    Dinbar, B. J.; Hammons, R. E.

    1978-01-01

    Tooling technique involves positioning tiles within acrylic plastic masking frames that attach magnetically to holding fixture. Plastics are "magnetized" with adhesive mangetic-rubber strips. Technique is simpler and less expensive than conventional methods. L-shaped masks are easily cut and altered.

  19. Coordinated Respiratory Motor Activity in Nerves Innervating the Upper Airway Muscles in Rats.

    PubMed

    Tachikawa, Satoshi; Nakayama, Kiyomi; Nakamura, Shiro; Mochizuki, Ayako; Iijima, Takehiko; Inoue, Tomio

    2016-01-01

    Maintaining the patency of the upper airway during breathing is of vital importance. The activity of various muscles is related to the patency of the upper airway. In the present study, we examined the respiratory motor activity in the efferent nerves innervating the upper airway muscles to determine the movements of the upper airway during respiration under normocapnic conditions (pH = 7.4) and in hypercapnic acidosis (pH = 7.2). Experiments were performed on arterially perfused decerebrate rats aged between postnatal days 21-35. We recorded the efferent nerve activity in a branch of the cervical spinal nerve innervating the infrahyoid muscles (CN), the hypoglossal nerve (HGN), the external branch of the superior laryngeal nerve (SLN), and the recurrent laryngeal nerve (RLN) with the phrenic nerve (PN). Inspiratory nerve discharges were observed in all these nerves under normocapnic conditions. The onset of inspiratory discharges in the CN and HGN was slightly prior to those in the SLN and RLN. When the CO2 concentration in the perfusate was increased from 5% to 8% to prepare for hypercapnic acidosis, the peak amplitudes of the inspiratory discharges in all the recorded nerves were increased. Moreover, hypercapnic acidosis induced pre-inspiratory discharges in the CN, HGN, SLN, and RLN. The onset of pre-inspiratory discharges in the CN, HGN, and SLN was prior to that of discharges in the RLN. These results suggest that the securing of the airway that occurs a certain time before dilation of the glottis may facilitate ventilation and improve hypercapnic acidosis.

  20. Coordinated Respiratory Motor Activity in Nerves Innervating the Upper Airway Muscles in Rats

    PubMed Central

    Tachikawa, Satoshi; Nakayama, Kiyomi; Nakamura, Shiro; Mochizuki, Ayako; Iijima, Takehiko; Inoue, Tomio

    2016-01-01

    Maintaining the patency of the upper airway during breathing is of vital importance. The activity of various muscles is related to the patency of the upper airway. In the present study, we examined the respiratory motor activity in the efferent nerves innervating the upper airway muscles to determine the movements of the upper airway during respiration under normocapnic conditions (pH = 7.4) and in hypercapnic acidosis (pH = 7.2). Experiments were performed on arterially perfused decerebrate rats aged between postnatal days 21–35. We recorded the efferent nerve activity in a branch of the cervical spinal nerve innervating the infrahyoid muscles (CN), the hypoglossal nerve (HGN), the external branch of the superior laryngeal nerve (SLN), and the recurrent laryngeal nerve (RLN) with the phrenic nerve (PN). Inspiratory nerve discharges were observed in all these nerves under normocapnic conditions. The onset of inspiratory discharges in the CN and HGN was slightly prior to those in the SLN and RLN. When the CO2 concentration in the perfusate was increased from 5% to 8% to prepare for hypercapnic acidosis, the peak amplitudes of the inspiratory discharges in all the recorded nerves were increased. Moreover, hypercapnic acidosis induced pre-inspiratory discharges in the CN, HGN, SLN, and RLN. The onset of pre-inspiratory discharges in the CN, HGN, and SLN was prior to that of discharges in the RLN. These results suggest that the securing of the airway that occurs a certain time before dilation of the glottis may facilitate ventilation and improve hypercapnic acidosis. PMID:27832132

  1. [Oral blastomycosis, laryngeal papillomatosis and esophageal tuberculosis].

    PubMed

    Montoya, Manuel; Chumbiraico, Robert; Ricalde, Melvin; Cazorla, Ernesto; Hernández-Córdova, Gustavo

    2012-06-01

    Esophageal involvement is an extremely rare complication of tuberculosis even in countries with high prevalence of infection. We report the case of a 57 year-old hiv-seronegative patient with simultaneous diagnoses of oral blastomycosis and laryngeal papillomatosis. Both were confirmed by anatomopathological analysis. The esophageal biopsy revealed granulomatous esophagitis with necrosis and ziehl-neelsen stain showed acid-fast alcohol resistant bacilli suggestive of tuberculosis. The patient's history included pulmonary tuberculosis twice and previous abandonment of therapy. Thus, it was necessary to use oral itraconazole combined with second-line anti-tuberculosis drugs administered through a gastrostomy tube. The clinical development was favorable.

  2. Defect tolerant transmission lithography mask

    DOEpatents

    Vernon, Stephen P.

    2000-01-01

    A transmission lithography mask that utilizes a transparent substrate or a partially transparent membrane as the active region of the mask. A reflective single layer or multilayer coating is deposited on the membrane surface facing the illumination system. The coating is selectively patterned (removed) to form transmissive (bright) regions. Structural imperfections and defects in the coating have negligible effect on the aerial image of the mask master pattern since the coating is used to reflect radiation out of the entrance pupil of the imaging system. Similarly, structural imperfections in the clear regions of the membrane have little influence on the amplitude or phase of the transmitted electromagnetic fields. Since the mask "discards," rather than absorbs, unwanted radiation, it has reduced optical absorption and reduced thermal loading as compared to conventional designs. For EUV applications, the mask circumvents the phase defect problem, and is independent of the thermal load during exposure.

  3. The human laryngeal microbiome: effects of cigarette smoke and reflux

    PubMed Central

    Jetté, Marie E.; Dill-McFarland, Kimberly A.; Hanshew, Alissa S.; Suen, Garret; Thibeault, Susan L.

    2016-01-01

    Prolonged diffuse laryngeal inflammation from smoking and/or reflux is commonly diagnosed as chronic laryngitis and treated empirically with expensive drugs that have not proven effective. Shifts in microbiota have been associated with many inflammatory diseases, though little is known about how resident microbes may contribute to chronic laryngitis. We sought to characterize the core microbiota of disease-free human laryngeal tissue and to investigate shifts in microbial community membership associated with exposure to cigarette smoke and reflux. Using 454 pyrosequencing of the 16S rRNA gene, we compared bacterial communities of laryngeal tissue biopsies collected from 97 non-treatment-seeking volunteers based on reflux and smoking status. The core community was characterized by a highly abundant OTU within the family Comamonadaceae found in all laryngeal tissues. Smokers demonstrated less microbial diversity than nonsmokers, with differences in relative abundances of OTUs classified as Streptococcus, unclassified Comamonadaceae, Cloacibacterium, and Helicobacter. Reflux status did not affect microbial diversity nor community structure nor composition. Comparison of healthy laryngeal microbial communities to benign vocal fold disease samples revealed greater abundance of Streptococcus in benign vocal fold disease suggesting that mucosal dominance by Streptococcus may be a factor in disease etiology. PMID:27775059

  4. Laryngeal disease in cats: a retrospective study of 35 cases.

    PubMed

    Taylor, Samantha S; Harvey, Andrea M; Barr, Frances J; Moore, Alasdair H; Day, Michael J

    2009-12-01

    The aim of this retrospective study was to review the medical records of cats referred to the University of Bristol for investigation of laryngeal disease (n=35). Cases were categorised into one of four groups: cats with laryngeal paralysis (LP, n=14), laryngeal neoplasia (n=10), laryngeal inflammation (n=6), or miscellaneous laryngeal diseases (n=5). Laryngoscopy and echolaryngography were useful diagnostic techniques but histology was required for diagnosis of diseases other than LP. Two cats with lymphoma received chemotherapy achieving survival times of 60 and 1440 days. Four cats with LP were treated surgically, with a median survival time of 300 days (range 10-360 days) and six were treated conservatively with a median survival time of 780 days (range 300-2520 days). Three cats with inflammatory disease were treated medically and one by excision of the lesion. Two cats achieved survival times of 120 and 2800 days. Cats with LP, laryngeal lymphoma or laryngitis had excellent long-term survival following appropriate treatment.

  5. Upper airway radiographs in infants with upper airway insufficiency.

    PubMed Central

    Tonkin, S L; Davis, S L; Gunn, T R

    1994-01-01

    Upper airway measurements in nine infants considered to be at risk of upper airway insufficiency, six of whom presented after an apnoeic episode, were compared with measurements taken in two age groups of healthy infants. Paired, inspiratory and expiratory, lateral upper airway radiographs were obtained while the infants were awake and breathing quietly. The radiographs of all nine infants demonstrated narrowing in the oropharyngeal portion of the airway during inspiration and in six infants there was ballooning of the upper airway during expiration. Seven of the nine infants subsequently experienced recurrent apnoeic episodes which required vigorous stimulation to restore breathing. Experience suggests that respiratory phase timed radiographs are a useful adjunct to the evaluation of infants who are suspected of having upper airway dysfunction. They provide information regarding both the dimensions and compliance of the upper airway as well as the site of any restriction. Images PMID:8048825

  6. Diet, cigarettes and alcohol in laryngeal cancer

    SciTech Connect

    Freudenheim, J.L.; Graham, S.; Byers, T.E.; Marshall, J.R.; Haughey, B.P.; Swanson, M.K.; Wilkinson, G. )

    1991-03-11

    Diet and other risk factors for cancer of the larynx were examined in a case-control study among white males in Western New York, conducted in 1975-1985. Incident, pathologically-confirmed cases and age- and neighborhood-matched controls were interviewed to determine usual diet, and lifetime use of tobacco and alcohol. Because response rates were low for both cases and controls, this cannot be considered a population-based study. A strong association of risk with cigarette but not pipe and cigar smoking was found. Beer and hard liquor but not wine were associated with increased risk. After control for cigarettes, alcohol and education, the upper quartile odds ratio for fat was 2.40, while the odds ratio for high intake of carotenoids was 0.51. There was effect modification by smoking. Carotenoids were most negatively associated with risk among lighter smokers; dietary fat was most positively associated with risk among heavier smokers. Total calories, protein, and retinol were associated with increased risk; there was no relationship between laryngeal cancer and vitamins C and E or carbohydrate. This study again demonstrates the strong association between tobacco and alcohol and laryngeal cancer and also suggests that diets low in carotenoids and high fat may increase risk.

  7. Laryngeal cancer in acquired immunodeficiency syndrome.

    PubMed

    Shushan, S; Cinamon, U; Levy, D; Sokolov, M; Roth, Y

    2009-08-01

    With improved survival, more AIDS patients, especially heavy smokers and alcohol abusers, may be confronted with laryngeal squamous cell carcinoma. Since curative treatment may require aggressive combined therapy, these patients, often suffering from immunosupression and poor general condition, present unique therapeutic challenges. The objective of the study was to describe treatment dilemmas. This case report presents a detailed description of an AIDS patient with carcinoma of the larynx. A patient with T3N0M0 laryngeal carcinoma and AIDS underwent tracheotomy and biopsy, followed by severe neck and pulmonary infection. After convalescence, radiotherapy was administered, with no evidence of a disease during a 3.5-year follow-up. During his remaining life, the patient developed severe psychoaffective disorder, his immune state deteriorated until he demised from sepsis. In conclusion, patients with HIV infection, especially having a history of tobacco or alcohol abuse, should be carefully examined for head and neck carcinoma that is likely to be more aggressive. Following surgery, AIDS patients may have worse wound healing and a greater tendency to contract infections. Radiotherapy and especially chemotherapy may cause life-threatening complications. Although early detection may increase survival, curative treatment should involve many disciplines and extra caution.

  8. Laryngeal complications by orotracheal intubation: Literature review

    PubMed Central

    Mota, Luiz Alberto Alves; de Cavalho, Glauber Barbosa; Brito, Valeska Almeida

    2012-01-01

    Sumamry Introduction: The injuries caused for the orotracheal intubation are common in our way and widely told by literature. Generally the pipe rank of or consequence of its permanence in the aerial ways of the patient is caused by accidents in. It has diverse types of larynx injuries, caused for multiple mechanisms. Objective: To verify, in literature, the main causes of laryngeal complications after- orotracheal intubation and its mechanisms of injury. Revision of Literature: The searched databases had been LILACS, BIREME and SCIELO. Were updated, books and theses had been used, delimiting itself the period enters 1953 the 2009. The keywords used for the search of articles had been: complications, injuries, larynx, intubation, endotracheal, orotracheal, granulomas, stenosis. 59 references had been selected. The used criteria of inclusion for the choice of articles had been the ones that had shown to the diverse types of injuries caused for the orotracheal intubation and its pathophysiology. Final Considerations: This revision of literature was motivated by the comment in the practical clinic of a great number of laryngeal sequels in patients submitted to the orotracheal intubation. Of that is ahead important the knowledge, for the professionals of the area of health, the types of complications and its causes, with intention to prevent them, adopting measured of prevention of these injuries. PMID:25991942

  9. Sensitivity of coded mask telescopes

    SciTech Connect

    Skinner, Gerald K

    2008-05-20

    Simple formulas are often used to estimate the sensitivity of coded mask x-ray or gamma-ray telescopes, but these are strictly applicable only if a number of basic assumptions are met. Complications arise, for example, if a grid structure is used to support the mask elements, if the detector spatial resolution is not good enough to completely resolve all the detail in the shadow of the mask, or if any of a number of other simplifying conditions are not fulfilled. We derive more general expressions for the Poisson-noise-limited sensitivity of astronomical telescopes using the coded mask technique, noting explicitly in what circumstances they are applicable. The emphasis is on using nomenclature and techniques that result in simple and revealing results. Where no convenient expression is available a procedure is given that allows the calculation of the sensitivity. We consider certain aspects of the optimization of the design of a coded mask telescope and show that when the detector spatial resolution and the mask to detector separation are fixed, the best source location accuracy is obtained when the mask elements are equal in size to the detector pixels.

  10. Biological Activity of Masked Endotoxin

    PubMed Central

    Schwarz, Harald; Gornicec, Jan; Neuper, Theresa; Parigiani, Maria Alejandra; Wallner, Michael; Duschl, Albert; Horejs-Hoeck, Jutta

    2017-01-01

    Low endotoxin recovery (LER) is a recently discovered phenomenon describing the inability of limulus amebocyte lysate (LAL)-based assays to detect lipopolysaccharide (LPS) because of a “masking effect” caused by chelators or detergents commonly used in buffer formulations for medical products and recombinant proteins. This study investigates the masking capacities of different buffer formulations and whether masked endotoxin is biologically active. We show that both naturally occurring endotoxin as well as control standard endotoxin can be affected by LER. Furthermore, whereas masked endotoxin cannot be detected in Factor C based assays, it is still detectable in a cell-based TLR4-NF-κB-luciferase reporter gene assay. Moreover, in primary human monocytes, masked LPS induces the expression of pro-inflammatory cytokines and surface activation markers even at very low concentrations. We therefore conclude that masked LPS is a potent trigger of immune responses, which emphasizes the potential danger of masked LPS, as it may pose a health threat in pharmaceutical products or compromise experimental results. PMID:28317862

  11. Sensitivity of coded mask telescopes.

    PubMed

    Skinner, Gerald K

    2008-05-20

    Simple formulas are often used to estimate the sensitivity of coded mask x-ray or gamma-ray telescopes, but these are strictly applicable only if a number of basic assumptions are met. Complications arise, for example, if a grid structure is used to support the mask elements, if the detector spatial resolution is not good enough to completely resolve all the detail in the shadow of the mask, or if any of a number of other simplifying conditions are not fulfilled. We derive more general expressions for the Poisson-noise-limited sensitivity of astronomical telescopes using the coded mask technique, noting explicitly in what circumstances they are applicable. The emphasis is on using nomenclature and techniques that result in simple and revealing results. Where no convenient expression is available a procedure is given that allows the calculation of the sensitivity. We consider certain aspects of the optimization of the design of a coded mask telescope and show that when the detector spatial resolution and the mask to detector separation are fixed, the best source location accuracy is obtained when the mask elements are equal in size to the detector pixels.

  12. [Neuralgia of the superior laryngeal nerve caused by phonatory malfunctions].

    PubMed

    Kittel, G

    1986-09-01

    Clinical observations show a close relationship between neuralgia of the superior laryngeal nerve and disorders of the larynx. Neuralgia, and more minor symptoms are usually caused by hyper- and hypotonic phonatory disorders. An unphysiological compensation for glottic insufficiency causes irritation of the sensory telodendrons of the superior laryngeal nerve. As incomplete adduction of the vocal cords can often be found in patients with an autonomic laryngeal dystonia, a syndrome related to anxiety, these disturbances are often misinterpreted as "globus hystericus". However, this diagnosis does not take into account the cause and should therefore no longer be used.

  13. [Candida laryngitis and HIV infection: description of 4 cases].

    PubMed

    Roig, P; Carrasco, R; Salavert, M; Navarro, V; Guix, J; Nieto, A; Bernacer, B

    1992-10-01

    Candidiasic laryngitis is a very rare Candida spp infection of mucosa, appearing typically in immunosuppressed patients, mainly in patients with neoplasia, and, recently, in patients with Human Immunodeficiency Virus (VIH) infection. We present four cases of candidiasic laryngitis and HIV infection, as well as the clinical description and evolution of said cases after treatment with fluconazole. We review, as well, the cases published on the scientific literature. We maintain that in each HIV infected patient, with or without oral candidiasis, who shows dysphonia, candidiasic laryngitis should be ruled out.

  14. [Simultaneous pulmonar, laryngeal and lingual affectation by Mycobacterium tuberculosis].

    PubMed

    Díaz Manzano, J A; Castillo Romero, J L; Padilla Romero, M J; Sánchez Laínez, J J; Castillo Aguilar, C; Cegarra Navarro, M F

    2007-01-01

    The incidence of tuberculosis has lately increased in developed countries. The most frequent affectation is the pulmonar one and in the ORL area the laryngeal. The lingual affectation is exceptional. We present a case of a man 39 years old, with bilateral pulmonar, left vocal cord and mobile tongue affectation, negative Mantoux, positive spit culture and presence of acido-alcohol resistent bacillus in lingual and laryngeal biopsies. After antituberculosis treatment during 6 months the laryngeal and lingual lesions disappeared. We have only found two cases published of simultaneous tuberculosis in these three localisations in the last 30 years.

  15. ERp57 modulates STAT3 activity in radioresistant laryngeal cancer cells and serves as a prognostic marker for laryngeal cancer.

    PubMed

    Choe, Min Ho; Min, Joong Won; Jeon, Hong Bae; Cho, Dong-Hyung; Oh, Jeong Su; Lee, Hyun Gyu; Hwang, Sang-Gu; An, Sungkwan; Han, Young-Hoon; Kim, Jae-Sung

    2015-02-20

    Although targeting radioresistant tumor cells is essential for enhancing the efficacy of radiotherapy, the signals activated in resistant tumors are still unclear. This study shows that ERp57 contributes to radioresistance of laryngeal cancer by activating STAT3. Increased ERp57 was associated with the radioresistant phenotype of laryngeal cancer cells. Interestingly, increased interaction between ERp57 and STAT3 was observed in radioresistant cells, compared to the control cells. This physical complex is required for the activation of STAT3 in the radioresistant cells. Among STAT3-regulatory genes, Mcl-1 was predominantly regulated by ERp57. Inhibition of STAT3 activity with a chemical inhibitor or siRNA-mediated depletion of Mcl-1 sensitized radioresistant cells to irradiation, suggesting that the ERp57-STAT3-Mcl-1 axis regulates radioresistance of laryngeal cancer cells. Furthermore, we observed a positive correlation between ERp57 and phosphorylated STAT3 or Mcl-1 and in vivo interactions between ERp57 and STAT3 in human laryngeal cancer. Importantly, we also found that increased ERp57-STAT3 complex was associated with poor prognosis in human laryngeal cancer, indicating the prognostic role of ERp57-STAT3 regulation. Overall, our data suggest that ERp57-STAT3 regulation functions in radioresistance of laryngeal cancer, and targeting the ERp57-STAT3 pathway might be important for enhancing the efficacy of radiotherapy in human laryngeal cancer.

  16. Hg-Mask Coronagraph

    NASA Astrophysics Data System (ADS)

    Bourget, P.; Veiga, C. H.; Vieira Martins, R.; Assus, P.; Colas, F.

    In order to optimize the occulting process of a Lyot coronagraph and to provide a high dynamic range imaging, a new kind of occulting disk has been developed at the National Observatory of Rio de Janeiro. A mercury (Hg) drop glued onto an optical window by molecular cohesion and compressed by a pellicle film is used as the occulting disk. The minimum of the superficial tension potential function provides an optical precision (lambda/100) of the toric free surface of the mercury. This process provides a size control for the adaptation to the seeing conditions and to the apparent diameter of a resolved object, and in the case of adaptive optics, to the Airy diameter fraction needed. The occultation is a three dimensional process near the focal plane on the toric free surface that provides an apodization of the occultation. The Hg-Mask coronagraph has been projected for astrometric observations of faint satellites near to Jovian planets and works since 2000 at the 1.6 m telescope of the Pico dos Dias Observatory (OPD - Brazil).

  17. Mechanical alignment of substrates to a mask

    SciTech Connect

    Webb, Aaron P.; Carlson, Charles T.; Honan, Michael; Amato, Luigi G.; Grant, Christopher Neil; Strassner, James D.

    2016-11-08

    A plurality of masks is attached to the underside of a mask frame. This attachment is made such that each mask can independently move relative to the mask frame in three directions. This relative movement allows each mask to adjust its position to align with respective alignment pins disposed on a working surface. In one embodiment, each mask is attached to the mask frame using fasteners, where the fasteners have a shaft with a diameter smaller than the diameter of the mounting hole disposed on the mask. A bias element may be used to allow relative movement between the mask and the mask frame in the vertical direction. Each mask may also have kinematic features to mate with the respective alignment pins on the working surface.

  18. Routine exposure of recurrent laryngeal nerve in thyroid surgery can prevent nerve injury★

    PubMed Central

    Shen, Chenling; Xiang, Mingliang; Wu, Hao; Ma, Yan; Chen, Li; Cheng, Lan

    2013-01-01

    To determine the value of dissecting the recurrent laryngeal nerve during thyroid surgery with respect to preventing recurrent laryngeal nerve injury, we retrospectively analyzed clinical data from 5 344 patients undergoing thyroidectomy. Among these cases, 548 underwent dissection of the recurrent laryngeal nerve, while 4 796 did not. There were 12 cases of recurrent laryngeal nerve injury following recurrent laryngeal nerve dissection (injury rate of 2.2%) and 512 cases of recurrent laryngeal nerve injury in those not undergoing nerve dissection (injury rate of 10.7%). This difference remained statistically significant between the two groups in terms of type of thyroid disease, type of surgery, and number of surgeries. Among the 548 cases undergoing recurrent laryngeal nerve dissection, 128 developed anatomical variations of the recurrent laryngeal nerve (incidence rate of 23.4%), but no recurrent laryngeal nerve injury was found. In addition, the incidence of recurrent laryngeal nerve injury was significantly lower in patients with the inferior parathyroid gland and middle thyroid veins used as landmarks for locating the recurrent laryngeal nerve compared with those with the entry of the recurrent laryngeal nerve into the larynx as a landmark. These findings indicate that anatomical variations of the recurrent laryngeal nerve are common, and that dissecting the recurrent laryngeal nerve during thyroid surgery is an effective means of preventing nerve injury. PMID:25206452

  19. Reversing Age Related Changes of the Laryngeal Muscles by Chronic Electrostimulation of the Recurrent Laryngeal Nerve.

    PubMed

    Karbiener, Michael; Jarvis, Jonathan C; Perkins, Justin D; Lanmüller, Hermann; Schmoll, Martin; Rode, Hanna S; Gerstenberger, Claus; Gugatschka, Markus

    2016-01-01

    Age related atrophy of the laryngeal muscles -mainly the thyroarytenoid muscle (TAM)- leads to a glottal gap and consequently to a hoarse and dysphonic voice that significantly affects quality of life. The aim of our study was to reverse this atrophy by inducing muscular hypertrophy by unilateral functional electrical stimulation (FES) of the recurrent laryngeal nerve (RLN) in a large animal model using aged sheep (n = 5). Suitable stimulation parameters were determined by fatiguing experiments of the thyroarytenoid muscle in an acute trial. For the chronic trial an electrode was placed around the right RLN and stimulation was delivered once daily for 29 days. We chose a very conservative stimulation pattern, total stimulation time was two minutes per day, or 0.14% of total time. Overall, the mean muscle fiber diameter of the stimulated right TAM was significantly larger than the non-stimulated left TAM (30μm±1.1μm vs. 28μm±1.1 μm, p<0.001). There was no significant shift in fiber type distribution as judged by immunohistochemistry. The changes of fiber diameter could not be observed in the posterior cricoarytenoid muscle (PCAM). FES is a possible new treatment option for reversing the effects of age related laryngeal muscle atrophy.

  20. Reversing Age Related Changes of the Laryngeal Muscles by Chronic Electrostimulation of the Recurrent Laryngeal Nerve

    PubMed Central

    Karbiener, Michael; Jarvis, Jonathan C.; Perkins, Justin D.; Lanmüller, Hermann; Schmoll, Martin; Rode, Hanna S.; Gerstenberger, Claus; Gugatschka, Markus

    2016-01-01

    Age related atrophy of the laryngeal muscles -mainly the thyroarytenoid muscle (TAM)- leads to a glottal gap and consequently to a hoarse and dysphonic voice that significantly affects quality of life. The aim of our study was to reverse this atrophy by inducing muscular hypertrophy by unilateral functional electrical stimulation (FES) of the recurrent laryngeal nerve (RLN) in a large animal model using aged sheep (n = 5). Suitable stimulation parameters were determined by fatiguing experiments of the thyroarytenoid muscle in an acute trial. For the chronic trial an electrode was placed around the right RLN and stimulation was delivered once daily for 29 days. We chose a very conservative stimulation pattern, total stimulation time was two minutes per day, or 0.14% of total time. Overall, the mean muscle fiber diameter of the stimulated right TAM was significantly larger than the non-stimulated left TAM (30μm±1.1μm vs. 28μm±1.1 μm, p<0.001). There was no significant shift in fiber type distribution as judged by immunohistochemistry. The changes of fiber diameter could not be observed in the posterior cricoarytenoid muscle (PCAM). FES is a possible new treatment option for reversing the effects of age related laryngeal muscle atrophy. PMID:27893858

  1. Vibrotactile masking through the body.

    PubMed

    D'Amour, Sarah; Harris, Laurence R

    2014-09-01

    Touches on one hand or forearm can affect tactile sensitivity at contralateral locations on the opposite side of the body. These interactions suggest an intimate connection between the two sides of the body. Here, we explore the effect of masking not across the body but through the body by measuring the effect of a masking stimulus on the back on the tactile sensitivity of the corresponding point on the front. Tactile sensitivity was measured on each side of the stomach, while vibrotactile masking stimulation was applied to one side of the front and to points on the back including the point directly behind the test point on the front. Results were compared to sensitivity, while vibrotactile stimulation was applied to a control site on the shoulder. A reduction in sensitivity of about .8 dB was found that required the masking stimulus to be within about 2 cm of the corresponding point on the back.

  2. The Laryngeal Motor Cortex: Its Organization and Connectivity

    PubMed Central

    Simonyan, Kristina

    2014-01-01

    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, i.e., voluntary motor control of human speech and song production. PMID:24929930

  3. The laryngeal motor cortex: its organization and connectivity.

    PubMed

    Simonyan, Kristina

    2014-10-01

    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.

  4. Subdivisions with infinitely supported mask

    NASA Astrophysics Data System (ADS)

    Li, Song; Pan, Yali

    2008-04-01

    In this paper we investigate the convergence of subdivision schemes associated with masks being polynomially decay sequences. Two-scale vector refinement equations are the formwhere the vector of functions [phi]=([phi]1,E..,[phi]r)T is in and is polynomially decay sequence of rxr matrices called refinement mask. Associated with the mask a is a linear operator on given byBy using same methods in [B. Han, R. Q. Jia, Characterization of Riesz bases of wavelets generated from multiresolution analysis, manuscript]; [BE Han, Refinable functions and cascade algorithms in weighted spaces with infinitely supported masks, manuscript]; [R.Q. Jia, Q.T. Jiang, Z.W. Shen, Convergence of cascade algorithms associated with nonhomogeneous refinement equations, Proc. Amer. Math. Soc. 129 (2001) 415-427]; [R.Q. Jia, Convergence of vector subdivision schemes and construction of biorthogonal multiple wavelets, in: Advances in Wavelet, Hong Kong,1997, Springer, Singapore, 1998, pp. 199-227], a characterization of convergence of the sequences in the L2-norm is given, which extends the main results in [R.Q. Jia, S.D. Riemenschneider, D.X. Zhou, Vector subdivision schemes and multiple wavelets, Math. Comp. 67 (1998) 1533-1563] on convergence of the subdivision schemes associated with a finitely supported mask to the case in which mask a is polynomially decay sequence. As an application, we also obtain a characterization of smoothness of solutions of the refinement equation mentioned above for the case r=1.

  5. Visual Masking During Pursuit Eye Movements

    ERIC Educational Resources Information Center

    White, Charles W.

    1976-01-01

    Visual masking occurs when one stimulus interferes with the perception of another stimulus. Investigates which matters more for visual masking--that the target and masking stimuli are flashed on the same part of the retina, or, that the target and mask appear in the same place. (Author/RK)

  6. Hyperbaric oxygen therapy for laryngeal radionecrosis

    SciTech Connect

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

    1987-01-01

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

  7. [Laryngeal movements during wind instruments play].

    PubMed

    Mukai, S

    1989-02-01

    Historically, the concern of wind instrumentalists has been diaphragm control and embouchure. Laryngeal movement during "blow" has been overlooked or neglected by wind musicians. It has been said that musical tone has to be produced by the resonances of the player's air column by opening his larynx during blow. In the present study, fiberscopic observations of the larynx during blow revealed that musical tones were played with adducted vocal cords. Narrowed glottis appeared to control the airflow of the blow. Persons who could not make musical tone blew with open glottis. Vibrato was also made by rhythmic open and narrowing movements of the glottis. The authors concluded that the larynx regulates the airflow of the "blow". The authors postulated that the embouchure might be important as the receptor of the airflow rather than controlling the movement for "blow".

  8. Airflow behavior changes in upper airway caused by different head and neck positions: Comparison by computational fluid dynamics.

    PubMed

    Wei, Wei; Huang, Shi-Wei; Chen, Lian-Hua; Qi, Yang; Qiu, Yi-Min; Li, Shi-Tong

    2017-02-08

    The feasibility of computational fluid dynamics (CFD) to evaluate airflow characteristics in different head and neck positions has not been established. This study compared the changes in volume and airflow behavior of the upper airway by CFD simulation to predict the influence of anatomical and physiological airway changes due to different head-neck positions on mechanical ventilation. One awake volunteer with no risk of difficult airway underwent computed tomography in neutral position, extension position (both head and neck extended), and sniffing position (head extended and neck flexed). Three-dimensional airway models of the upper airway were reconstructed. The total volume (V) and narrowest area (Amin) of the airway models were measured. CFD simulation with an Spalart-Allmaras model was performed to characterize airflow behavior in neutral, extension, and sniffing positions of closed-mouth and open-mouth ventilation. The comparison result for V was neutral airway patency by increasing airway volume and decreasing airway resistance, suggesting that sniffing position may be the optimal choice for mask ventilation.

  9. Dysphonia – the single symptom of rifampicin resistant laryngeal tuberculosis

    PubMed Central

    Mickevičienė, Vaiva

    2016-01-01

    Abstract Tuberculosis is still the most frequent granulomatous laryngeal disease. Absence of pathognomonic symptoms and change in clinical pattern frequently leads to misdiagnosis and delayed treatment. Hoarseness is the commonest symptom of laryngeal tuberculosis and constitutional symptoms are usually rare. However dysphonia can be caused by many other more common conditions. Hoarseness can be a symptom of organic (nodules and polyps of vocal folds, tumors, vocal fold paresis) or functional (functional dysphonia, laryngeal conversion disorder, paradoxical vocal folds motion) conditions. Rarely systemic diseases as amyloidosis, sarcoidosis, Wegener’s granulomatosis or tuberculosis can cause vocal dysfunction too. That is why laryngeal tuberculosis is often forgotten in case of persistent hoarseness. In this article, we present a case of a young previously healthy woman, complaining of persistent hoarseness with no other leading symptoms. Though endoscopic image suggested a malignancy, histology showed granulomatous lesion. Detailed examination revealed laryngeal and pulmonary tuberculosis resistant to rifampicin. Conclusion: Dysphonia can be the only one symptom of laryngeal tuberculosis. The disease should be taken into consideration when a patient complains of persistent hoarseness in order to avoid delays in treatment and spread of infection. PMID:28352769

  10. Anatomic study of human laryngeal ganglia: number and distribution.

    PubMed

    Maranillo, Eva; Vazquez, Teresa; Ibanez, Marta; Hurtado, Miguel; Pascual-Font, Aran; McHanwell, Stephen; Valderrama-Canales, Francisco; Sanudo, Jose

    2008-10-01

    We have studied 12 laryngeal nerves: six internal branches of the superior laryngeal nerve (ILN) and six recurrent laryngeal nerves (RLN) from three human adult larynges (two males and one female). After dissection of each individual laryngeal nerve using a surgical microscope, the nerves were preserved in 10% formalin, embedded in paraffin wax, serially sectioned transversely at a thickness of 10 microm and stained with hematoxylin and eosin. We found 2-4 ganglia associated with the ILN. At least two ganglia were always present (six out of six cases), the largest one being associated with the branch of the nerve innervating the vestibule and the smallest one associated with the branch innervating the aryepiglottic fold. Other ganglia were found associated with the branches for the glosso-epiglottic fold and vallecula (four out of six cases) and interarytenoid muscle (three out of six cases). The RLN showed from two to six ganglia, all of them located in its anterior terminal division. Two of the ganglia were located in the part of the nerve between the origin of the branches for the interarytenoid and lateral cricoarytenoid muscles (three out of six cases). The remaining ganglia were located close to or at the origin of the muscular branches innervating the intrinsic laryngeal muscles. The cytology of the ganglia reported suggests that they were all autonomic in nature, probably parasympathetic.

  11. Laryngeal sensation and pharyngeal delay time after (chemo)radiotherapy.

    PubMed

    Maruo, Takashi; Fujimoto, Yasushi; Ozawa, Kikuko; Hiramatsu, Mariko; Suzuki, Atsushi; Nishio, Naoki; Nakashima, Tsutomu

    2014-08-01

    The objective of the study was to evaluate the association between changes in laryngeal sensation and initiation of swallowing reflex or swallowing function before and after (chemo)radiotherapy. A prospective study was conducted in a tertiary referral university hospital. Thirteen patients who received (chemo)radiotherapy for treatment of laryngeal or hypopharyngeal cancer were included. Laryngeal sensation was evaluated at the tip of the epiglottis before and 1, 3 months, and 1 year after (chemo)radiotherapy. Videofluoroscopy was performed at the same time. Quantitative determinations included changes in laryngeal sensation, computed analysis of pharyngeal delay time, the distance and velocity of hyoid bone movement during the phase of hyoid excursion, and pharyngeal residue rate (the proportion of the bolus that was left as residue in the pharynx at the first swallow). Laryngeal sensation significantly deteriorated 1 month after (chemo)radiotherapy, but there was a tendency to return to pretreatment levels 1 year after treatment. Neither pharyngeal delay time nor displacement of the hyoid bone changed significantly before and after (chemo)radiotherapy. In addition, there was no significant difference in the mean velocity of hyoid bone movement and the amount of stasis in the pharynx at the first swallow before and after (chemo)radiotherapy. After (chemo)radiotherapy, laryngeal sensation deteriorated. But, in this study, videofluoroscopy showed that swallowing reflex and function were maintained.

  12. Laryngeal Cancer: 12-Year Experience of a Single Center.

    PubMed

    Calkovsky, V; Wallenfels, P; Calkovska, A; Hajtman, A

    2016-01-01

    Laryngeal cancer is about the twentieth most common cancer in the world and more than 150,000 new cases are diagnosed annually. The aim of the study was to evaluate the history, diagnostics, treatment outcomes, and prognosis in patients with laryngeal cancer in Northern Slovakia. We analyzed retrospectively 227 patients (207 males, 20 females) with laryngeal carcinoma treated in the period 2003-2014 at the Clinic of Otorhinolaryngology and Head and Neck Surgery of the Jessenius Faculty of Medicine and Martin University Hospital in Martin, Slovakia. The majority of patients were in the sixth (38.0 %) and seventh decade of life (30.8 %). Two hundred and seventeen patients (95.6 %) were smokers or ex-smokers. Sixty-six percent of patients were diagnosed with glottic or transglottic carcinoma, related probably to the anatomical structure of the larynx and exposure to inhalation pollutants. It is alarming that the majority of patients with malignant laryngeal disease were admitted to the hospital in advanced stages. In 151 (66.5 %) of patients, the extent of infiltration was T3 or T4, and 156 (68 %) patients were in disease stage III and IV. The incidence and mortality of laryngeal cancer suggest the need to intensify the prevention and to search for an early clinical stage of laryngeal cancer using a targeted screening.

  13. Risk of Recurrence in Laryngeal Cancer

    PubMed Central

    Sørum Falk, Ragnhild; Folkvard Evensen, Jan; Boysen, Morten; Brøndbo, Kjell

    2016-01-01

    A cohort study was undertaken to analyze the risk of recurrence among 1616 patients with primary squamous cell carcinoma of the larynx from 1983 to 2010 at a single, tertiary academic center in Oslo, Norway. The cohort was followed from the date of diagnosis to September 2011. Competing risk regression analysis assessed the association between various risk factors and the risk of recurrence, where death was considered a competing event. Recurrence was observed in 368 patients (23%) during the study period. The majority (71%) of recurrences involved the location of the primary tumor. The overall risk of recurrence during the first three years after initiating treatment was 20.5%. Increased risk of recurrence was observed in patients with supraglottic cancer, younger patients, those with T2–T3 tumors and in patients treated in the earlier part of the study period. Significant factors for recurrence in glottic carcinomas were age, treatment in the earlier part of the study and T-status, whereas age was a significant factor in supraglottic cancer. N-status appeared less significant. In conclusion, follow-up of laryngeal squamous cell carcinoma should place particular emphasis on the site of the primary tumor, younger patients, cases of supraglottic cancer and T2-T4 primary tumors, especially during the first three years after treatment. More studies are needed to assess the impact of surgical versus non-surgical treatment, and eventually the significance of recurrence, for disease-specific and overall survival in cases of advanced laryngeal squamous cell carcinoma. PMID:27716797

  14. Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach

    PubMed Central

    Barak, Michal; Bahouth, Hany; Leiser, Yoav; Abu El-Naaj, Imad

    2015-01-01

    According to the Advanced Trauma Life Support recommendations for managing patients with life-threatening injuries, securing the airway is the first task of a primary caregiver. Airway management of patients with maxillofacial trauma is complex and crucial because it can dictate a patient's survival. Securing the airway of patients with maxillofacial trauma is often extremely difficult because the trauma involves the patient's airway and their breathing is compromised. In these patients, mask ventilation and endotracheal intubation are anticipated to be difficult. Additionally, some of these patients may not yet have been cleared of a cervical spine injury, and all are regarded as having a full stomach and having an increased risk of regurgitation and pulmonary aspiration. The requirements of the intended maxillofacial operation may often preclude the use of an oral intubation tube, and alternative methods for securing the airway should be considered before the start of the surgery. In order to improve the clinical outcome of patients with maxillofacial trauma, cooperation between maxillofacial surgeons, anesthesiologists, and trauma specialists is needed. In this review, we discuss the complexity and difficulties of securing the airway of patients with maxillofacial trauma and present our approach for airway management of such patients. PMID:26161411

  15. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults.

    PubMed

    Frerk, C; Mitchell, V S; McNarry, A F; Mendonca, C; Bhagrath, R; Patel, A; O'Sullivan, E P; Woodall, N M; Ahmad, I

    2015-12-01

    These guidelines provide a strategy to manage unanticipated difficulty with tracheal intubation. They are founded on published evidence. Where evidence is lacking, they have been directed by feedback from members of the Difficult Airway Society and based on expert opinion. These guidelines have been informed by advances in the understanding of crisis management; they emphasize the recognition and declaration of difficulty during airway management. A simplified, single algorithm now covers unanticipated difficulties in both routine intubation and rapid sequence induction. Planning for failed intubation should form part of the pre-induction briefing, particularly for urgent surgery. Emphasis is placed on assessment, preparation, positioning, preoxygenation, maintenance of oxygenation, and minimizing trauma from airway interventions. It is recommended that the number of airway interventions are limited, and blind techniques using a bougie or through supraglottic airway devices have been superseded by video- or fibre-optically guided intubation. If tracheal intubation fails, supraglottic airway devices are recommended to provide a route for oxygenation while reviewing how to proceed. Second-generation devices have advantages and are recommended. When both tracheal intubation and supraglottic airway device insertion have failed, waking the patient is the default option. If at this stage, face-mask oxygenation is impossible in the presence of muscle relaxation, cricothyroidotomy should follow immediately. Scalpel cricothyroidotomy is recommended as the preferred rescue technique and should be practised by all anaesthetists. The plans outlined are designed to be simple and easy to follow. They should be regularly rehearsed and made familiar to the whole theatre team.

  16. [Monitoring of recurrent laryngeal nerve injury using an electromyographic endotracheal tube in thyroid and parathyroid surgery. Anesthetic aspects].

    PubMed

    Martín Jaramago, J; Tamarit Conejeros, M; Escudero Torrella, M; Solaz Roldán, C

    2013-12-01

    Recurrent laryngeal nerve injury remains one of the main complications in thyroid and parathyroid surgery. When this injury is bilateral, an acute upper airway obstruction may occur, leading to a potentially life-threatening situation for the patient. The visual identification of the nerve during surgery is the best way to preserve its integrity. However identification of the nerves by means of electromyographic stimuli through electrodes attached to endotracheal tubes could help in decreasing nerve injury. In these cases the experience and role of the anesthetist is essential to correctly place the electromyographic endotracheal tube and ensure that the electrodes are in touch with the vocal cords during the surgery. Moreover, the results of the electromyography can be affected by the neuromuscular blocking agents. Therefore, the choice and dose must be adapted, in order to ensure a suitable anesthetic depth, and adequate response.

  17. Contralateral tactile masking between forearms.

    PubMed

    D'Amour, Sarah; Harris, Laurence R

    2014-03-01

    Masking effects have been demonstrated in which tactile sensitivity is affected when one touch is close to another on the body surface. Such effects are likely a result of local lateral inhibitory circuits that sharpen the spatial tuning of a given tactile receptor. Mutually inhibitory pathways have also been demonstrated between cortical tactile maps of the two halves of the body. Occasional reports have indicated that touches on one hand or forearm can affect tactile sensitivity at contralateral locations. Here, we measure the spatial tuning and effect of posture on this contralateral masking effect. Tactile sensitivity was measured on one forearm, while vibrotactile masking stimulation was applied to the opposite arm. Results were compared to sensitivity while vibrotactile stimulation was applied to a control site on the right shoulder. Sensitivity on the forearm was reduced by over 3 dB when the arms were touching and by 0.52 dB when they were held parallel. The masking effect depended on the position of the masking stimulus. Its effectiveness fell off by 1 STD when the stimulus was 29 % of arm length from the corresponding contralateral point. This long-range inhibitory effect in the tactile system suggests a surprisingly intimate relationship between the two sides of the body.

  18. Tactical Combat Casualty Care 2007: Evolving Concepts and Battlefield Experience

    DTIC Science & Technology

    2007-11-01

    or thoracic) hemorrhage: no IV fluid resuscitation Head wound patient: Hespan at minimal flow to maintain infusion unless there is concurrent...airway obstruction: chin lift or jaw thrust, nasopharyngeal airway, place casualty in recovery position Surgical cricothyroidotomy (with lidocaine ...laryngeal mask airway /ILMA or Combitube or endotracheal intubation or surgical cricothyroidotomy (with lidocaine if conscious) Spinal immobilization is

  19. Identification of key target genes and pathways in laryngeal carcinoma

    PubMed Central

    Liu, Feng; Du, Jintao; Liu, Jun; Wen, Bei

    2016-01-01

    The purpose of the present study was to screen the key genes associated with laryngeal carcinoma and to investigate the molecular mechanism of laryngeal carcinoma progression. The gene expression profile of GSE10935 [Gene Expression Omnibus (GEO) accession number], including 12 specimens from laryngeal papillomas and 12 specimens from normal laryngeal epithelia controls, was downloaded from the GEO database. Differentially expressed genes (DEGs) were screened in laryngeal papillomas compared with normal controls using Limma package in R language, followed by Gene Ontology (GO) enrichment analysis and pathway enrichment analysis. Furthermore, the protein-protein interaction (PPI) network of DEGs was constructed using Cytoscape software and modules were analyzed using MCODE plugin from the PPI network. Furthermore, significant biological pathway regions (sub-pathway) were identified by using iSubpathwayMiner analysis. A total of 67 DEGs were identified, including 27 up-regulated genes and 40 down-regulated genes and they were involved in different GO terms and pathways. PPI network analysis revealed that Ras association (RalGDS/AF-6) domain family member 1 (RASSF1) was a hub protein. The sub-pathway analysis identified 9 significantly enriched sub-pathways, including glycolysis/gluconeogenesis and nitrogen metabolism. Genes such as phosphoglycerate kinase 1 (PGK1), carbonic anhydrase II (CA2), and carbonic anhydrase XII (CA12) whose node degrees were >10 were identified in the disease risk sub-pathway. Genes in the sub-pathway, such as RASSF1, PGK1, CA2 and CA12 were presumed to serve critical roles in laryngeal carcinoma. The present study identified DEGs and their sub-pathways in the disease, which may serve as potential targets for treatment of laryngeal carcinoma. PMID:27446427

  20. Applying the laser beam for reconstruction of the upper airway

    NASA Astrophysics Data System (ADS)

    Kukwa, Andrzej; Tulibacki, Marek P.; Wojtowicz, Piotr; Dudziec, Katarzyna; Oledzka, Iwona

    2000-11-01

    The authors present their own experience in restoration of the upper airway using a different source of high power laser. There are many patients with a stricture of the upper airway. One of the most common cause insufficiency of this is nosal polyps. Surgical treatment of polyps till now is not sufficiently effective. For this reason we work out a Nd:YAG laser applying technique that let us to reduce a hospitalization time with elongation of an asymptotic period of our patients. Nd:YAG energy we apply for conchoplasty benefiting of its profound coagulation as a distinctive role. This type of laser is very useful in removing of granulation tissue from different areas of the upper airway. Other applications of Nd:YAG laser in our hands is very useful for: coagulation of vessels in Kisselbach area, especially in Rendou-Osler's diseases, resection of the nosal Septo-turbinate adhesions, treatment of hemangiomas and small papillomas in nasal cavity, diminishing of the hypertrophied mucosa in the nasopharyngeal space as well as, reduction of the uvula and soft palate in OSAS patients. In our department we use a Nd:YAG for treatment of precancerous and early stages of cancer and for a palliation procedures in an advanced cancer infiltration in mouth, pharynx and laryngeal region. For treatment removing of cicatrix tissue in a larynx and trachea we use to use a Holm: YAG laser their very superficial penetration of tissues is used for a coagulation of small vessels too let us to resect it without bleeding from a bony and mucosa tissue, as a fragments maxillary sinus wall, nosal septum crest or spine with resection of the posterior pole of a turbinate. Both laser are conveyed by fiberoptic, to reach a pathological changes in many plans, places for this reason we are able to continuously work on a new its applications.

  1. Coatings on reflective mask substrates

    SciTech Connect

    Tong, William Man-Wai; Taylor, John S.; Hector, Scott D.; Mangat, Pawitter J. S.; Stivers, Alan R.; Kofron, Patrick G.; Thompson, Matthew A.

    2002-01-01

    A process for creating a mask substrate involving depositing: 1) a coating on one or both sides of a low thermal expansion material EUVL mask substrate to improve defect inspection, surface finishing, and defect levels; and 2) a high dielectric coating, on the backside to facilitate electrostatic chucking and to correct for any bowing caused by the stress imbalance imparted by either other deposited coatings or the multilayer coating of the mask substrate. An film, such as TaSi, may be deposited on the front side and/or back of the low thermal expansion material before the material coating to balance the stress. The low thermal expansion material with a silicon overlayer and a silicon and/or other conductive underlayer enables improved defect inspection and stress balancing.

  2. Dietary consumption patterns and laryngeal cancer risk.

    PubMed

    Vlastarakos, Petros V; Vassileiou, Andrianna; Delicha, Evie; Kikidis, Dimitrios; Protopapas, Dimosthenis; Nikolopoulos, Thomas P

    2016-06-01

    We conducted a case-control study to investigate the effect of diet on laryngeal carcinogenesis. Our study population was made up of 140 participants-70 patients with laryngeal cancer (LC) and 70 controls with a non-neoplastic condition that was unrelated to diet, smoking, or alcohol. A food-frequency questionnaire determined the mean consumption of 113 different items during the 3 years prior to symptom onset. Total energy intake and cooking mode were also noted. The relative risk, odds ratio (OR), and 95% confidence interval (CI) were estimated by multiple logistic regression analysis. We found that the total energy intake was significantly higher in the LC group (p < 0.001), and that the difference remained statistically significant after logistic regression analysis (p < 0.001; OR: 118.70). Notably, meat consumption was higher in the LC group (p < 0.001), and the difference remained significant after logistic regression analysis (p = 0.029; OR: 1.16). LC patients also consumed significantly more fried food (p = 0.036); this difference also remained significant in the logistic regression model (p = 0.026; OR: 5.45). The LC group also consumed significantly more seafood (p = 0.012); the difference persisted after logistic regression analysis (p = 0.009; OR: 2.48), with the consumption of shrimp proving detrimental (p = 0.049; OR: 2.18). Finally, the intake of zinc was significantly higher in the LC group before and after logistic regression analysis (p = 0.034 and p = 0.011; OR: 30.15, respectively). Cereal consumption (including pastas) was also higher among the LC patients (p = 0.043), with logistic regression analysis showing that their negative effect was possibly associated with the sauces and dressings that traditionally accompany pasta dishes (p = 0.006; OR: 4.78). Conversely, a higher consumption of dairy products was found in controls (p < 0.05); logistic regression analysis showed that calcium appeared to be protective at the micronutrient level (p < 0

  3. Informational masking and musical training

    NASA Astrophysics Data System (ADS)

    Oxenham, Andrew J.; Fligor, Brian J.; Mason, Christine R.; Kidd, Gerald

    2003-09-01

    The relationship between musical training and informational masking was studied for 24 young adult listeners with normal hearing. The listeners were divided into two groups based on musical training. In one group, the listeners had little or no musical training; the other group was comprised of highly trained, currently active musicians. The hypothesis was that musicians may be less susceptible to informational masking, which is thought to reflect central, rather than peripheral, limitations on the processing of sound. Masked thresholds were measured in two conditions, similar to those used by Kidd et al. [J. Acoust. Soc. Am. 95, 3475-3480 (1994)]. In both conditions the signal was comprised of a series of repeated tone bursts at 1 kHz. The masker was comprised of a series of multitone bursts, gated with the signal. In one condition the frequencies of the masker were selected randomly for each burst; in the other condition the masker frequencies were selected randomly for the first burst of each interval and then remained constant throughout the interval. The difference in thresholds between the two conditions was taken as a measure of informational masking. Frequency selectivity, using the notched-noise method, was also estimated in the two groups. The results showed no difference in frequency selectivity between the two groups, but showed a large and significant difference in the amount of informational masking between musically trained and untrained listeners. This informational masking task, which requires no knowledge specific to musical training (such as note or interval names) and is generally not susceptible to systematic short- or medium-term training effects, may provide a basis for further studies of analytic listening abilities in different populations.

  4. Production mask composition checking flow

    NASA Astrophysics Data System (ADS)

    Ma, Shou-Yuan; Yang, Chuen-Huei; Tsai, Joe; Wang, Alice; Lin, Roger; Lee, Rachel; Deng, Erwin; Lin, Ling-Chieh; Liao, Hung-Yueh; Tsai, Jenny; Bowhill, Amanda; Vu, Hien; Russell, Gordon

    2016-05-01

    The mask composition checking flow is an evolution of the traditional mask rule check (MRC). In order to differentiate the flow from MRC, we call it Mask Data Correctness Check (MDCC). The mask house does MRC only to identify process limitations including writing, etching, metrology, etc. There still exist many potential errors that could occur when the frame, main circuit and dummies all together form a whole reticle. The MDCC flow combines the design rule check (DRC) and MRC concepts to adapt to the complex patterns in today's wafer production technologies. Although photomask data has unique characteristics, the MRC tool in Calibre® MDP can easily achieve mask composition by using the Extended MEBES job deck (EJB) format. In EJB format, we can customize the combination of any input layers in an IC design layout format, such as OASIS. Calibre MDP provides section-based processing for many standard verification rule format (SVRF) commands that support DRC-like checks on mask data. Integrating DRC-like checking with EJB for layer composition, we actually perform reticle-level DRC, which is the essence of MDCC. The flow also provides an early review environment before the photomask pattern files are available. Furthermore, to incorporate the MDCC in our production flow, runtime is one of the most important indexes we consider. When the MDCC is included in the tape-out flow, the runtime impact is very limited. Calibre, with its multi-threaded processes and good scalability, is the key to achieving acceptable runtime. In this paper, we present real case runtime data for 28nm and 14nm technology nodes, and prove the practicability of placing MDCC into mass production.

  5. Psychometric functions for informational masking

    NASA Astrophysics Data System (ADS)

    Lutfi, Robert A.; Kistler, Doris J.; Callahan, Michael R.; Wightman, Frederic L.

    2003-12-01

    The term informational masking has traditionally been used to refer to elevations in signal threshold resulting from masker uncertainty. In the present study, the method of constant stimuli was used to obtain complete psychometric functions (PFs) from 44 normal-hearing listeners in conditions known to produce varying amounts of informational masking. The listener's task was to detect a pure-tone signal in the presence of a broadband noise masker (low masker uncertainty) and in the presence of multitone maskers with frequencies and amplitudes that varied at random from one presentation to the next (high masker uncertainty). Relative to the broadband noise condition, significant reductions were observed in both the slope and the upper asymptote of the PF for multitone maskers producing large amounts of informational masking. Slope was affected more for some listeners and conditions while asymptote was affected more for others; consequently, neither parameter alone was highly predictive of individual thresholds or the amount of informational masking. Mean slopes and asymptotes varied nonmonotonically with the number of masker components in a manner similar to mean thresholds, particularly when the estimated effect of energetic masking on thresholds was subtracted out. As in past studies, the threshold data were well described by a model in which trial-by-trial judgments are based on a weighted sum of levels in dB at the output of independent auditory filters. The psychometric data, however, complicated the model's interpretation in two ways: First, they suggested that, depending on the listener and condition, the weights can either reflect a fixed influence of masker components on each trial or the effect of occasionally mistaking a masker component for the signal from trial to trial. Second, they indicated that in either case the variance of the underlying decision variable as estimated from PF slope is not by itself great enough to account for the observed changes

  6. Psychometric functions for informational masking

    PubMed Central

    Lutfi, Robert A.; Kistler, Doris J.; Callahan, Michael R.; Wightman, Frederic L.

    2010-01-01

    The term informational masking has traditionally been used to refer to elevations in signal threshold resulting from masker uncertainty. In the present study, the method of constant stimuli was used to obtain complete psychometric functions (PFs) from 44 normal-hearing listeners in conditions known to produce varying amounts of informational masking. The listener’s task was to detect a pure-tone signal in the presence of a broadband noise masker (low masker uncertainty) and in the presence of multitone maskers with frequencies and amplitudes that varied at random from one presentation to the next (high masker uncertainty). Relative to the broadband noise condition, significant reductions were observed in both the slope and the upper asymptote of the PF for multitone maskers producing large amounts of informational masking. Slope was affected more for some listeners and conditions while asymptote was affected more for others; consequently, neither parameter alone was highly predictive of individual thresholds or the amount of informational masking. Mean slopes and asymptotes varied nonmonotonically with the number of masker components in a manner similar to mean thresholds, particularly when the estimated effect of energetic masking on thresholds was subtracted out. As in past studies, the threshold data were well described by a model in which trial-by-trial judgments are based on a weighted sum of levels in dB at the output of independent auditory filters. The psychometric data, however, complicated the model’s interpretation in two ways: First, they suggested that, depending on the listener and condition, the weights can either reflect a fixed influence of masker components on each trial or the effect of occasionally mistaking a masker component for the signal from trial to trial. Second, they indicated that in either case the variance of the underlying decision variable as estimated from PF slope is not by itself great enough to account for the observed

  7. Optimizing bag-valve-mask ventilation with a new mouth-to-bag resuscitator.

    PubMed

    Wagner-Berger, Horst G; Wenzel, Volker; Stallinger, Angelika; Voelckel, Wolfgang G; Rheinberger, Klaus; Augenstein, Sven; Herff, Holger; Idris, Ahamed H; Dörges, Volker; Lindner, Karl H; Hörmann, Christoph

    2003-02-01

    When ventilating an unintubated patient with a self-inflating bag, high peak inspiratory flow rates may result in high peak airway pressure with subsequent stomach inflation; this may occur frequently when rescuers without daily experience in bag-valve-mask ventilation need to perform advanced airway management. The purpose of this study was to assess the effects of a newly developed self-inflating bag (mouth-to-bag resuscitator; Ambu, Glostrup, Denmark) that limits peak inspiratory flow. A bench model simulating a patient with an unintubated airway was used, consisting of a face mask, manikin head, training lung (lung compliance, 100 ml/0.098 kPa (100 ml/cm H(2)O)); airway resistance, 0.39 kPa/l per second (4 cm H(2)O/l/s), oesophagus (LESP, 1.96 kPa (20 cm H(2)O)) and simulated stomach. Twenty nurses were randomised to ventilate the manikin for 1 min (respiratory rate: 12 per minute) with either a standard self-inflating bag or the mouth-to-bag resuscitator, which requires the rescuer to blow up a single-use balloon inside the self-inflating bag, which in turns displaces air towards the patient. When supplemental oxygen is added, ventilation with up to 100% oxygen may be obtained, since expired air is only used as the driving gas. The mouth-to-bag resuscitator therefore allows two instead of one hand sealing the mask on the patient's face. The volunteers were blinded to the experimental design of the model until completion of the experimental protocol. The mouth-to-bag resuscitator versus standard self-inflating bag resulted in significantly (P<0.05) higher mean+/-S.D. mask tidal volumes (1048+/-161 vs. 785+/-174 ml) and lung tidal volumes (911+/-148 vs. 678+/-157 ml), longer inspiratory times (1.7+/-0.4 vs. 1.4+/-0.4 s), but significantly lower peak inspiratory flow rates (50+/-9 vs. 62+/-13 l/min) and mask leakage (10+/-4 vs. 15+/-9%); peak inspiratory pressure (17+/-2 vs. 17+/-2 cm H(2)O) and stomach tidal volumes (16+/-30 vs. 18+/-35 ml) were comparable. In

  8. The man in the mask.

    PubMed

    Zugibe, F T; Costello, J T; Breithaupt, M K

    1987-05-01

    A skeletonized body, wearing a black leather bondage mask, was found in a Revolutionary War smokehouse cave with two bullet holes in the back of the head. The body was skeletonized up to the maxillary area but the head region under the mask was well preserved and permitted a positive visual identification. There was evidence that the body had been eaten by small animals and subsequently burned. Investigations into this brutal murder revealed a tale of a bizarre sadomasochistic ritual that attained national prominence.

  9. Aperture masking interferometry research simulation

    NASA Astrophysics Data System (ADS)

    Wang, Haitao; Luo, Qiufeng; Fan, Weijun; Zhang, Xian Ling; Tao, Chunkan; Zhu, Yongtian; Zhou, Bifang; Chen, Hanliang

    2004-10-01

    Aperture Masking Interferometry (AMI) is one of the high-resolution astronomical image observation technologies. It is also an important research way to the Optical Aperture Synthesis (OAS). The theory of OAS is simply introduced and AMI simulation method is raised. The mathematics model is built and the interferogram fringes are got. The aperture mask u-v coverage is discussed and one image reconstruction method is done. The reconstructed image result is got with CLEAN method. Shortcoming of this work is also referred and the future research work is mentioned at last.

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

  11. Respiratory mechanics in conscious swine: effects of face mask, head position and bronchoconstriction evaluated by impulse oscillometry.

    PubMed

    Klein, C; Smith, H-J; Reinhold, P

    2003-08-01

    Airway obstruction in pigs (sedated or non-sedated) fixed in a sling was studied using impulse oscillometry (IOS). (i) Vertical flexion of the pig's head was used to simulate an artificial obstruction of the upper airways. (ii) Bronchial obstruction was induced by inhaling differing quantities of an aerosol produced from 0.33% carbachol solution. The ventilatory pattern was examined by measuring respiratory rate (RR) and tidal volume (V(t)). To evaluate respiratory mechanics, impedance parameters resistance (R) and reactance (X) as well as coherence (Co) were examined, each at frequencies of 5, 10, 15, 20, 25 and 35 Hz. Using a simple 7-element-model introduced by J. Mead [Physiological Review 41 (1961) 281], distal respiratory resistance (R(dist)), proximal airway resistance (R(prox)), and additional shunt compliance (C(a)) of the animal's snout and the air inside the facemask were evaluated. By fitting this model to the primary measured impedance spectra, the influence of the face mask could be eliminated in the model calculation to allow assessment of the real respiratory impedance. This recalculation made clear that the facemask had an influence on the spectral course of R and X, depending on the clinical situation, and the upper frequency range was altered the most. Under conditions of (i) upper airway obstruction, especially the X values were distorted by facemask almost over the whole frequency range. Once the data were corrected for the mask, resistance was increased across all frequencies by a fixed amount while reactance was not affected. Under (ii) bronchial airway obstruction (bronchospasm) caused the resistance spectrum to be increased mainly in the lower frequency range. This became visible in both, originally measured impedance spectra and spectra after correction of the mask influence. The reactance course (originally measured and recalculated) decreased at all frequencies during bronchospasm. Coherence over the whole frequency range was lowered at

  12. Evidence and evidence gaps of laryngeal cancer surgery

    PubMed Central

    Wiegand, Susanne

    2016-01-01

    Surgical treatment of laryngeal cancer has been established for decades. In addition to total laryngectomy, which was first performed in 1873, a large number or organ preservation surgical techniques, like open partial laryngectomy, transoral laser microsurgery, and transoral robotic surgery have been developed. Studies on laryngeal cancer surgery are mainly retrospective case series and cohort studies. The evolution of chemoradiation protocols and their analysis in prospective randomized trials have led to an increasing acceptance of non-surgical treatment procedures. In addition to an improvement of prognosis, in recent years the preservation of function and maintenance of life quality after primary therapy of laryngeal cancer has increasingly become the focus of therapy planning. Significant late toxicity after chemoradiation has been identified as an important issue. This leads to a reassessment of surgical concepts and initiation of studies on laryngeal cancer surgery which was additionally stimulated by the advent of transoral robotic surgery in the US. Improving the evidence base of laryngeal cancer surgery by successful establishment of surgical trials should be the future goal. PMID:28025603

  13. [Morphometry of the recurrent laryngeal nerves of the rat].

    PubMed

    Pascual-Font, A; Merchán, A; Maranillo, E; Brillas, A; Sañudo, J R; Valderrama-Canales, F J

    2006-12-01

    In mammals the recurrent laryngeal nerves are dissimilar in length between both sides. This asymmetry involves different time of arrival of the stimulus to the laryngeal musculature controlled by each nerve. Thus, several explanations have been addressed to elucidate the closest of the glottis at the same time despite the unlike length of the nerves. However, previous works on the topic lack of several important data. The present study compares, in two groups of 10 and 6 rats, the length and the composition of myelinated fibers in the recurrent laryngeal nerves of both sides, by means of light microscopy and a computerized morphometric analysis. The results show a mean difference of 0,84 cm longer the left than the right recurrent laryngeal nerve. No statistical differences were observed in the number of myelinated fibers between both sides. However, the myelinated fibers of the right side were statistically bigger in diameter than the fibers of the left side. The data are discussed in the context of the mechanisms for the compensation of the dissimilar length of both recurrent laryngeal nerves.

  14. CO2 laser management of laryngeal stenosis.

    PubMed

    Schmidt, F W; Piazza, L S; Chipman, T J; Campbell, B H; Toohill, R J

    1986-11-01

    The introduction of the carbon dioxide laser as an endoscopic surgical instrument has stimulated interest in its application for removal of stenotic lesions of the larynx. Clinical reports have indicated mixed results in the efficacy of this treatment modality. Nineteen large dogs received acute subglottic injuries from a high-speed electric drill and electrocautery. All animals developed obstructing lesions from 7 to 21 days after injury. With at least weekly removal of granulation tissue and dilations, all animals developed mature subglottic and/or posterior commissure scars. Two animals required tracheostomy. The 15 animals in the experimental group underwent 16 laser procedures. Three animals had vaporization of one third of the scar, three of one half of the scar, and three had total circumferential vaporization. Five animals underwent microtrapdoor flap procedures. Of these, four had a single flap and one had three separate flaps created. In the remaining animal in the experimental group a glottic web developed, which was totally ablated. In one animal treated with a microtrapdoor flap procedure a posterior sinus tract also developed and was treated with laser ablation. The animals undergoing segmental resection of scar demonstrated no improvement in airway size. Those undergoing total resection experienced a worsening of the condition. Those undergoing microtrapdoor flap repair demonstrated moderate improvement in airway size. It can be concluded that large areas of scar removal in the larynx by the CO2 laser will result in prompt recurrence and possible worsening of the scar and smaller submucosal resection of the scar, with preservation of mucosa by the microtrapdoor flap technique, may be helpful in improving the airway.

  15. Operative endoscopy of the airway

    PubMed Central

    Walters, Dustin M.

    2016-01-01

    Airway endoscopy has long been an important and useful tool in the management of thoracic diseases. As thoracic specialists have gained experience with both flexible and rigid bronchoscopic techniques, the technology has continued to evolve so that bronchoscopy is currently the foundation for diagnosis and treatment of many thoracic ailments. Airway endoscopy plays a significant role in the biopsy of tumors within the airways, mediastinum, and lung parenchyma. Endoscopic methods have been developed to treat benign and malignant airway stenoses and tracheomalacia. And more recently, techniques have been conceived to treat end-stage emphysema and prolonged air leaks in select patients. This review describes the abundant uses of airway endoscopy, as well as technical considerations and limitations of the current technologies. PMID:26981263

  16. Global airway disease beyond allergy.

    PubMed

    Hellings, Peter W; Prokopakis, Emmanuel P

    2010-03-01

    Besides the anatomic continuity of the upper and lower airways, inflammation in one part of the airway influences the homeostasis of the other. The mechanisms underlying this interaction have been studied primarily in allergic disease, showing systemic immune activation, induction of inflammation at a distance, and a negative impact of nasal inflammation on bronchial homeostasis. In addition to allergy, other inflammatory conditions of the upper airways are associated with lower airway disease. Rhinosinusitis is frequently associated with asthma and chronic obstructive pulmonary disease. The impairment of purification, humidification, and warming up of the inspired air by the nose in rhinosinusitis may be responsible in part for bronchial pathology. The resolution of sinonasal inflammation via medical and/or surgical treatment is responsible for the beneficial effect of the treatment on bronchial disease. This article provides a comprehensive overview of the current knowledge of upper and lower airway communication beyond allergic disease.

  17. Recurrent airway obstruction: a review.

    PubMed

    Pirie, R S

    2014-05-01

    Recurrent airway obstruction is a widely recognised airway disorder, characterised by hypersensitivity-mediated neutrophilic airway inflammation and lower airway obstruction in a subpopulation of horses when exposed to suboptimal environments high in airborne organic dust. Over the past decade, numerous studies have further advanced our understanding of different aspects of the disease. These include clarification of the important inhaled airborne agents responsible for disease induction, improving our understanding of the underlying genetic basis of disease susceptibility and unveiling the fundamental immunological mechanisms leading to establishment of the classic disease phenotype. This review, as well as giving a clinical overview of recurrent airway obstruction, summarises much of the work in these areas that have culminated in a more thorough understanding of this debilitating disease.

  18. The airway microbiome and disease.

    PubMed

    Marsland, Benjamin J; Yadava, Koshika; Nicod, Laurent P

    2013-08-01

    Although traditionally thought to be sterile, accumulating evidence now supports the concept that our airways harbor a microbiome. Thus far, studies have focused upon characterizing the bacterial constituents of the airway microbiome in both healthy and diseased lungs, but what perhaps provides the greatest impetus for the exploration of the airway microbiome is that different bacterial phyla appear to dominate diseased as compared with healthy lungs. As yet, there is very limited evidence supporting a functional role for the airway microbiome, but continued research in this direction is likely to provide such evidence, particularly considering the progress that has been made in understanding host-microbe mutualism in the intestinal tract. In this review, we highlight the major advances that have been made discovering and describing the airway microbiome, discuss the experimental evidence that supports a functional role for the microbiome in health and disease, and propose how this emerging field is going to impact clinical practice.

  19. Phonation instability flow in excised canine larynges

    PubMed Central

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

    2011-01-01

    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

  20. Angiogenesis: prognostic significance in laryngeal cancer.

    PubMed

    Beatrice, F; Cammarota, R; Giordano, C; Corrado, S; Ragona, R; Sartoris, A; Bussolino, F; Valente, G

    1998-01-01

    The aim of this study was to evaluate the role of angiogenesis in the progression of laryngeal squamous cell carcinoma (LSCC). We correlated disease-free survival with microvessel count (MC) in the hot spot areas of 97 randomly selected caucasian males with LSCC followed for 60 to 90 months after surgery with or without radiotherapy. The results obtained indicate that: a) MC higher than 130 microvessels/mm2 is a cut-off value that distinguished patients who relapsed during the follow up period; b) multivariated analysis indicates that MC (p < 0.00001) is an independent predictor of disease free-survival; c) multivariated analysis selectively done on cases with relapse demonstrates that MC correlates with the presence of metastasis (or/and M) with local relapse (T). We suggest that MC is useful in the assessment of prognosis in LSCC and probably will permit selection of patients that could benefit from anti-angiogenic therapy associated with chemotherapy and/or radiotherapy.

  1. Exolaryngoscopy: a new technique for laryngeal surgery.

    PubMed

    Carlucci, C; Fasanella, L; Ricci Maccarini, A

    2012-10-01

    The aim of this study is to assess the use of a telescope with a high definition endoscopic video system as an alternative to the operating microscope in endoscopic laryngeal surgery. The system is economic, and allows optimal vision and improved surgeon comfort and ease. In exolaryngoscopy, the optic vitom is positioned in place of the microscope. An extracorporeal optical system (exoscope) is positioned 25 cm from the surgical field. Under exoscopic control, it is possible to use the same series of instruments using a long handle through the laryngoscope. The CO2 laser may also be used by fixing it coaxially to the optical system, and it is possible to use a classic set of microinstruments for phonosurgery. Endoscopic study with auto-fluorescence (NBI; narrow band imaging) can be easily used to visualize both precancerous and cancerous lesions. We treated 12 patients with benign and malign pathologies of the vocal cords; in all cases, the predicted result was reached, and the optic vitom showed its potential advantages in ease and comfort of the surgeon.

  2. Salvage total laryngectomy after conservation laryngeal surgery for recurrent laryngeal squamous cell carcinoma.

    PubMed

    De Virgilio, A; Greco, A; Bussu, F; Gallo, A; Rosati, D; Kim, S-H; Wang, C-C; Conte, M; Pagliuca, G; De Vincentiis, M

    2016-10-01

    The aim of the present study was to evaluate the oncological efficacy of salvage total laryngectomy in patients who had previously undergone supracricoid partial laryngectomy or transoral laser microsurgery for treatment of laryngeal squamous cell carcinoma. We retrospectively reviewed the medical, surgical and pathological records of 35 patients who underwent salvage total laryngectomy after recurrence of laryngeal cancer (following supracricoid partial laryngectomy or transoral laser microsurgery). Kaplan-Meier survival curves as well as univariate and multivariate analyses of prognostic factors were performed. No statistically significant differences were seen comparing the supracricoid partial laryngectomy group with the transoral laser microsurgery group for overall survival and disease-specific survival at 3 years (OS = 38% vs. 52%, p = 0.16; DSS = 40% vs. 61%, p = 0.057) or locoregional control at 2 years (LRC = 40% vs. 54%, p = 0.056). A trend indicating worse survival and locoregional control for supracricoid partial laryngectomy patients emerged. Preservation of the osteocartilaginous frame in transoral laser microsurgery could hypothetically result in better salvageability of anterior recurrences with extralaryngeal spread.

  3. Laryngeal function reconstruction with hyoid osteomuscular flap in partial laryngectomy for laryngeal cancer

    PubMed Central

    WEI, BOJUN; SHEN, HONG; XIE, HONG

    2015-01-01

    The present study aimed to evaluate the clinical outcome of using a hyoid osteomuscular flap to repair the laryngeal defect after extended vertical partial laryngectomy. A total of 26 glottic cancer patients underwent reconstruction with osteomuscular hyoid flaps following tumor resections. Ipsilateral arytenoid cartilage was resected in all cases, and the upper region of the cricoid cartilage was resected in 11 cases. Selective ipsilateral level II, III and IV neck dissections were performed in node (N)-positive patients and ipsilateral level II, and III neck dissections in N0 patients. The bone grafts were then fixed to the cricoid and contralateral thyroid cartilages. Invasion of the thyroid cartilage endochorium was present in 12 cases and lymph nodes metastases was present in 11 cases. The extubation rate of the tracheostomy tube was 100%. The glottides of all patients were almost symmetrical. Patients were followed up for 2–7 years. One patient developed local recurrence, ipsilateral regional recurrence, contralateral regional recurrence and lung metastasis, respectively. The disease-free survival rates at 3 and 5 years were 100% (20/20) and 79% (11/14), respectively. Overall, laryngeal function recovered well upon hyoid osteomuscular flap reconstruction following extended vertical partial laryngectomy, with a high extubation rate and good sound quality. PMID:26622546

  4. The Marine Mask of War

    DTIC Science & Technology

    2011-11-10

    America’s Army. To the Marines, it is teamwork and the subordination of the individual to the common good of the unit. First person pronouns are shunned...As demonstrated over the last decade, this versatility and cost effectiveness is a good deal for the American taxpayer. Having examined the Mask

  5. Imaging With the IBIS Mask

    NASA Astrophysics Data System (ADS)

    Berná, J. A.; Torrejón, J. M.; Bernabeu, G.

    2001-03-01

    We present very preliminary results on the imaging capabilities of the IBIS instrument, the gamma ray imager on board ESA's INTEGRAL satellite, regarding the coded mask subsystem. For this purpose we perform a simulation of a pointed observation to the Galactic Centre region and investigate the detection of the most prominent sources.

  6. Masked Hypertension in Diabetes Mellitus

    PubMed Central

    Franklin, Stanley S.; Thijs, Lutgarde; Li, Yan; Hansen, Tine W.; Boggia, José; Liu, Yanping; Asayama, Kei; Björklund-Bodegård, Kristina; Ohkubo, Takayoshi; Jeppesen, Jørgen; Torp-Pedersen, Christian; Dolan, Eamon; Kuznetsova, Tatiana; Stolarz-Skrzypek, Katarzyna; Tikhonoff, Valérie; Malyutina, Sofia; Casiglia, Edoardo; Nikitin, Yuri; Lind, Lars; Sandoya, Edgardo; Kawecka-Jaszcz, Kalina; Filipovský, Jan; Imai, Yutaka; Wang, Jiguang; Ibsen, Hans; O’Brien, Eoin; Staessen, Jan A.

    2013-01-01

    Although distinguishing features of masked hypertension in diabetics are well known, the significance of antihypertensive treatment on clinical practice decisions has not been fully explored. We analyzed 9691 subjects from the population-based 11-country International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes. Prevalence of masked hypertension in untreated normotensive participants was higher (P<0.0001) among 229 diabetics (29.3%, n=67) than among 5486 nondiabetics (18.8%, n=1031). Over a median of 11.0 years of follow-up, the adjusted risk for a composite cardiovascular end point in untreated diabetic-masked hypertensives tended to be higher than in normotensives (hazard rate [HR], 1.96; 95% confidence interval [CI], 0.97–3.97; P=0.059), similar to untreated stage 1 hypertensives (HR, 1.07; CI, 0.58–1.98; P=0.82), but less than stage 2 hypertensives (HR, 0.53; CI, 0.29–0.99; P=0.048). In contrast, cardiovascular risk was not significantly different in antihypertensive-treated diabetic-masked hypertensives, as compared with the normotensive comparator group (HR, 1.13; CI, 0.54–2.35; P=0.75), stage 1 hypertensives (HR, 0.91; CI, 0.49–1.69; P=0.76), and stage 2 hypertensives (HR, 0.65; CI, 0.35–1.20; P=0.17). In the untreated diabetic-masked hypertensive population, mean conventional systolic/diastolic blood pressure was 129.2±8.0/76.0±7.3 mm Hg, and mean daytime systolic/diastolic blood pressure 141.5±9.1/83.7±6.5 mm Hg. In conclusion, masked hypertension occurred in 29% of untreated diabetics, had comparable cardiovascular risk as stage 1 hypertension, and would require considerable reduction in conventional blood pressure to reach daytime ambulatory treatment goal. Importantly, many hypertensive diabetics when receiving antihypertensive therapy can present with normalized conventional and elevated ambulatory blood pressure that mimics masked hypertension. PMID:23478096

  7. "The Mask Who Wasn't There": Visual Masking Effect with the Perceptual Absence of the Mask

    ERIC Educational Resources Information Center

    Rey, Amandine Eve; Riou, Benoit; Muller, Dominique; Dabic, Stéphanie; Versace, Rémy

    2015-01-01

    Does a visual mask need to be perceptually present to disrupt processing? In the present research, we proposed to explore the link between perceptual and memory mechanisms by demonstrating that a typical sensory phenomenon (visual masking) can be replicated at a memory level. Experiment 1 highlighted an interference effect of a visual mask on the…

  8. All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in adults

    PubMed Central

    Myatra, Sheila Nainan; Shah, Amit; Kundra, Pankaj; Patwa, Apeksh; Ramkumar, Venkateswaran; Divatia, Jigeeshu Vasishtha; Raveendra, Ubaradka S; Shetty, Sumalatha Radhakrishna; Ahmed, Syed Moied; Doctor, Jeson Rajan; Pawar, Dilip K; Ramesh, Singaravelu; Das, Sabyasachi; Garg, Rakesh

    2016-01-01

    The All India Difficult Airway Association (AIDAA) guidelines for management of the unanticipated difficult airway in adults provide a structured, stepwise approach to manage unanticipated difficulty during tracheal intubation in adults. They have been developed based on the available evidence; wherever robust evidence was lacking, or to suit the needs and situation in India, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the AIDAA and the Indian Society of Anaesthesiologists. We recommend optimum pre-oxygenation and nasal insufflation of 15 L/min oxygen during apnoea in all patients, and calling for help if the initial attempt at intubation is unsuccessful. Transnasal humidified rapid insufflations of oxygen at 70 L/min (transnasal humidified rapid insufflation ventilatory exchange) should be used when available. We recommend no more than three attempts at tracheal intubation and two attempts at supraglottic airway device (SAD) insertion if intubation fails, provided oxygen saturation remains ≥ 95%. Intubation should be confirmed by capnography. Blind tracheal intubation through the SAD is not recommended. If SAD insertion fails, one final attempt at mask ventilation should be tried after ensuring neuromuscular blockade using the optimal technique for mask ventilation. Failure to intubate the trachea as well as an inability to ventilate the lungs by face mask and SAD constitutes ‘complete ventilation failure’, and emergency cricothyroidotomy should be performed. Patient counselling, documentation and standard reporting of the airway difficulty using a ‘difficult airway alert form’ must be done. In addition, the AIDAA provides suggestions for the contents of a difficult airway cart. PMID:28003690

  9. Physiological functioning of the ear and masking

    NASA Technical Reports Server (NTRS)

    1984-01-01

    The physiological functions of the ear and the role masking plays in speech communication are examined. Topics under investigation include sound analysis of the ear, the aural reflex, and various types of noise masking.

  10. Human laryngeal ganglia contain both sympathetic and parasympathetic cell types.

    PubMed

    Ibanez, Marta; Valderrama-Canales, Francisco J; Maranillo, Eva; Vazquez, Teresa; Pascual-Font, Arán; McHanwell, Stephen; Sanudo, Jose

    2010-09-01

    The presence of ganglia associated with the laryngeal nerves is well documented. In man, these ganglia have been less well studied than in other species and, in particular, the cell types within these ganglia are less well characterized. Using a panel of antibodies to a variety of markers found in the paraganglion cells of other species, we were able to show the existence of at least two populations of cells within human laryngeal paraganglia. One population contained chromogranin and tyrosine hydroxylase representing a neurosecretory population possibly secreting dopamine. A second population of choline acetyltransferase positive cells would appear to have a putative parasympathetic function. Further work is needed to characterize these cell populations more fully before it will be possible to assign functions to these cell types but our results are consistent with the postulated functions of these ganglia as chemoreceptors, neurosecretory cells, and regulators of laryngeal mucus secretion.

  11. Voice range in superior laryngeal nerve paresis and paralysis.

    PubMed

    Eckley, C A; Sataloff, R T; Hawkshaw, M; Spiegel, J R; Mandel, S

    1998-09-01

    Evaluation of Physiologic Frequency Range (PFR) and Musical Frequency Range (MRP) of Phonation was performed on 56 adults (singers and nonsingers) presenting with superior laryngeal nerve (SLN) paresis or paralysis confirmed by laryngeal electromyography. The most common etiology was neuritis (69.7%), followed by iatrogenic and unknown causes,each accounting for 10.2% of cases, and finally trauma (8.9%). Both female and male singers with SLN paresis or paralysis had significantly higher PFR and MPR than nonsingers. Female classical singers presented PFR and MPR of up to 10 semitones (ST) higher than nonclassical singers and nonsingers. The lowest PFR and musical ranges were found in patients with SLN paresis associated with recurrent laryngeal nerve paresis or paralysis. The authors suggest that voice range measurement is a useful parameter for analyzing the effects of SLN paresis or paralysis on voice and that it may also assist in measuring outcome following voice therapy.

  12. Fraser syndrome with laryngeal webs: Report of two cases and a review of the literature.

    PubMed

    Izadi, Farzad; Ahmadi, Aslan; Zobairy, Hosna; Bakhti, Sepideh; Hirbod, Hengameh; Safdarian, Mahdi

    2015-11-01

    Fraser syndrome is a rare genetic disorder characterized by cryptophthalmos, syndactyly and laryngeal atresia. Although laryngeal webs occur uncommonly, they are the main cause of death in the first week of life in these patients. In this paper, we report two cases of Fraser syndrome with laryngeal webs. One of them was a twelve-year-old girl, primarily diagnosed with a supraglottic laryngeal web. In the course of treatment, a second web was also identified at the level of vocal cords, which is to our knowledge the first case of Fraser syndrome with two laryngeal webs in different levels.

  13. Patient Reflections on Decision Making for Laryngeal Cancer Treatment.

    PubMed

    Shuman, Andrew G; Larkin, Knoll; Thomas, Dorothy; Palmer, Frank L; Fins, Joseph J; Baxi, Shrujal S; Lee, Nancy; Shah, Jatin P; Fagerlin, Angela; Patel, Snehal G

    2017-02-01

    Objective To describe the reflections of patients treated for laryngeal cancer with regard to treatment-related decision making. Study Design Cross-sectional survey-based pilot study. Setting Single-institution tertiary care cancer center. Subjects/Methods Adults with laryngeal carcinoma were eligible to participate (N = 57; 46% treated surgically, 54% nonsurgically). Validated surveys measuring decisional conflict and regret explored patients' reflections on their preferences and priorities regarding treatment-related decision making for laryngeal cancer and how patient-reported functional outcomes, professional referral patterns, and desired provider input influenced these reflections. Results When considering the level of involvement of surgeons, radiation oncologists, and medical oncologists in their care, patients were more likely to believe that the specialist whom they saw first was the most important factor in deciding how to treat their cancer (Fisher's exact, ~χ(2) = 16.2, df = 6, P = .02). Patients who were treated for laryngeal cancer who reported worse voice-related quality of life recalled more decisional conflict ( P = .01) and experienced more decisional regret ( P < .001). Of the patients for whom speech was a top priority prior to treatment, better voice-related quality of life overall scores were correlated with less decision regret about treatment decisions ( P < .02). Of the patients for whom eating and drinking were top priorities prior to treatment, better MD Anderson Dysphagia Inventory global scores were correlated with less decision regret about treatment decisions ( P < .002). Conclusion Patient priorities and attitudes, coupled with functional outcomes and professional referral patterns, influence how patients reflect on their choices regarding management of laryngeal cancer. Better understanding of these variables may assist in ensuring that patients' voices are integrated into individualized laryngeal cancer treatment planning.

  14. Factors Associated with Clinical and Topographical Features of Laryngeal Tuberculosis

    PubMed Central

    Reis, João Gustavo Corrêa; Reis, Clarissa Souza Mota; da Costa, Daniel César Silva; Lucena, Márcia Mendonça; Schubach, Armando de Oliveira; Oliveira, Raquel de Vasconcellos Carvalhaes; Rolla, Valéria Cavalcanti; Conceição-Silva, Fátima; Valete-Rosalino, Cláudia Maria

    2016-01-01

    Introduction Laryngeal tuberculosis (LTB) is the most frequent granulomatous disease of the larynx and represents less than 2% of extrapulmonary TB cases. There are no pathognomonic clinical and endoscopic features of this disease and studies on LTB that can assist in its diagnostic characterization are lacking. Objective To identify factors associated with clinical and topographical features of LTB. Method a retrospective cross-sectional study was conducted from the medical records of 36 patients with confirmed LTB diagnosis. Results Dysphonia and cough were the main symptoms presented by patients and the true vocal folds the most frequently affected site. The average of the duration of the disease evolution was significantly higher in patients with dysphonia than in patients without this symptom. We observed association between dysphonia and true vocal fold lesions and between odynophagia and lesions in the epiglottis, arytenoids and aryepiglottic folds. Odynophagia was more frequent in individuals with lesions in four or more laryngeal sites. Weight loss equal or above 10% of the body weight was more frequent in patients with odynophagia as first symptom and in patients with ulcerated lesion. Dyspnea on exertion was more frequent in individuals with more extensive laryngeal lesions. The percentage of smokers with lesions in four or more laryngeal sites was greater than that found in non-smokers. Laryngeal tissue fragment bacilloscopy and culture examinations were less positive than sputum ones. Conclusions Smoking appears to be associated with the development of more extensive LTB lesions, and LTB with dyspnea on exertion and odynophagia with consequent impairment of nutritional status. We emphasize the need for histopathologic confirmation, once positive sputum bacteriological examinations seem not to necessarily reflect laryngeal involvement. PMID:27077734

  15. An evaluation of the effects of three laryngeal lubricants on phonation threshold pressure (PTP).

    PubMed

    Roy, Nelson; Tanner, Kristine; Gray, Steven D; Blomgren, Michael; Fisher, Kimberly V

    2003-09-01

    Clinicians frequently offer advice to performers and voice-disordered patients aimed ostensibly to manipulate the water content and/or viscosity of the mucus blanket covering the vocal folds. To evaluate the relative effects of three potential laryngeal lubricants on phonatory function (ie, water, Mannitol--an osmotic agent, and Entertainer's Secret Throat Relief (Kli Corp., Carmel, IN)--a glycerin-based product), phonation threshold pressure (PTP) was measured in 18 healthy, vocally normal female participants twice before (baseline) and then four times after 2 ml of each substance were nebulized. PTP is the minimum subglottal pressure required to initiate vocal fold oscillation, and the lowering of PTP is assumed to correspond to physiologically more efficient phonation and reduced phonatory effort. Over a 3-week period, participants were tested on three separate occasions (at 1-week intervals). On each occasion, a different nebulized treatment was administered. PTP for both comfortable and high fundamental frequency productions was measured using an oral pressure-flow system (Perci-Sars, MicroTronics Corp., Chapel Hill, NC). Analysis of the results revealed that Mannitol, an agent that encourages osmotic water flux to the luminal airway surface, lowered PTP immediately after its administration (ie, p = 0.071, for high-pitched productions only). However, the duration of its PTP lowering effect was less than 20 minutes. The other two substances did not demonstrate any significant postadministration effect on PTP.

  16. Method for mask repair using defect compensation

    DOEpatents

    Sweeney, Donald W.; Ray-Chaudhuri, Avijit K.

    2001-01-01

    A method for repair of amplitude and/or phase defects in lithographic masks. The method involves modifying or altering a portion of the absorber pattern on the surface of the mask blank proximate to the mask defect to compensate for the local disturbance (amplitude or phase) of the optical field due to the defect.

  17. 21 CFR 868.5600 - Venturi mask.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Venturi mask. 868.5600 Section 868.5600 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5600 Venturi mask. (a) Identification. A venturi mask is...

  18. 47 CFR 90.210 - Emission masks.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 47 Telecommunication 5 2011-10-01 2011-10-01 false Emission masks. 90.210 Section 90.210... MOBILE RADIO SERVICES General Technical Standards § 90.210 Emission masks. Except as indicated elsewhere... emission masks outlined in this section. Unless otherwise stated, per paragraphs (d)(4), (e)(4), and (m)...

  19. 47 CFR 90.210 - Emission masks.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 5 2013-10-01 2013-10-01 false Emission masks. 90.210 Section 90.210... MOBILE RADIO SERVICES General Technical Standards § 90.210 Emission masks. Except as indicated elsewhere... emission masks outlined in this section. Unless otherwise stated, per paragraphs (d)(4), (e)(4), and (o)...

  20. 47 CFR 90.210 - Emission masks.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 5 2014-10-01 2014-10-01 false Emission masks. 90.210 Section 90.210... MOBILE RADIO SERVICES General Technical Standards § 90.210 Emission masks. Except as indicated elsewhere... emission masks outlined in this section. Unless otherwise stated, per paragraphs (d)(4), (e)(4), and (o)...

  1. 47 CFR 90.210 - Emission masks.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 5 2010-10-01 2010-10-01 false Emission masks. 90.210 Section 90.210... MOBILE RADIO SERVICES General Technical Standards § 90.210 Emission masks. Except as indicated elsewhere... emission masks outlined in this section. Unless otherwise stated, per paragraphs (d)(4), (e)(4), and (m)...

  2. 47 CFR 90.210 - Emission masks.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 47 Telecommunication 5 2012-10-01 2012-10-01 false Emission masks. 90.210 Section 90.210... MOBILE RADIO SERVICES General Technical Standards § 90.210 Emission masks. Except as indicated elsewhere... emission masks outlined in this section. Unless otherwise stated, per paragraphs (d)(4), (e)(4), and (m)...

  3. 21 CFR 868.5580 - Oxygen mask.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Oxygen mask. 868.5580 Section 868.5580 Food and... ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5580 Oxygen mask. (a) Identification. An oxygen mask is a device placed over a patient's nose, mouth, or tracheostomy to administer oxygen or aerosols. (b)...

  4. 21 CFR 868.5580 - Oxygen mask.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Oxygen mask. 868.5580 Section 868.5580 Food and... ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5580 Oxygen mask. (a) Identification. An oxygen mask is a device placed over a patient's nose, mouth, or tracheostomy to administer oxygen or aerosols. (b)...

  5. 21 CFR 868.5580 - Oxygen mask.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Oxygen mask. 868.5580 Section 868.5580 Food and... ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5580 Oxygen mask. (a) Identification. An oxygen mask is a device placed over a patient's nose, mouth, or tracheostomy to administer oxygen or aerosols. (b)...

  6. 21 CFR 868.5580 - Oxygen mask.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Oxygen mask. 868.5580 Section 868.5580 Food and... ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5580 Oxygen mask. (a) Identification. An oxygen mask is a device placed over a patient's nose, mouth, or tracheostomy to administer oxygen or aerosols. (b)...

  7. 21 CFR 868.5580 - Oxygen mask.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Oxygen mask. 868.5580 Section 868.5580 Food and... ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5580 Oxygen mask. (a) Identification. An oxygen mask is a device placed over a patient's nose, mouth, or tracheostomy to administer oxygen or aerosols. (b)...

  8. Object Substitution Masking Induced by Illusory Masks: Evidence for Higher Object-Level Locus of Interference

    ERIC Educational Resources Information Center

    Hirose, Nobuyuki; Osaka, Naoyuki

    2009-01-01

    A briefly presented target can be rendered invisible by a lingering sparse mask that does not even touch it. This form of visual backward masking, called object substitution masking, is thought to occur at the object level of processing. However, it remains unclear whether object-level interference alone produces substitution masking because…

  9. Putting the Squeeze on Airway Epithelia

    PubMed Central

    Park, Jin-Ah; Fredberg, Jeffrey J.

    2015-01-01

    Asthma is characterized by chronic inflammation, airway hyperresponsiveness, and progressive airway remodeling. The airway epithelium is known to play a critical role in the initiation and perpetuation of these processes. Here, we review how excessive epithelial stress generated by bronchoconstriction is sufficient to induce airway remodeling, even in the absence of inflammatory cells. PMID:26136543

  10. Objective measurements to evaluate glottal space segmentation from laryngeal images.

    PubMed

    Gutiérrez-Arriola, J M; Osma-Ruiz, V; Sáenz-Lechón, N; Godino-Llorente, J I; Fraile, R; Arias-Londoño, J D

    2012-01-01

    Objective evaluation of the results of medical image segmentation is a known problem. Applied to the task of automatically detecting the glottal area from laryngeal images, this paper proposes a new objective measurement to evaluate the quality of a segmentation algorithm by comparing with the results given by a human expert. The new figure of merit is called Area Index, and its effectiveness is compared with one of the most used figures of merit found in the literature: the Pratt Index. Results over 110 laryngeal images presented high correlations between both indexes, demonstrating that the proposed measure is comparable to the Pratt Index and it is a good indicator of the segmentation quality.

  11. Reflux Laryngitis: Correlation between the Symptoms Findings and Indirect Laryngoscopy

    PubMed Central

    Silva, Carlos Eduardo Dilen da; Niedermeier, Bruno Taccola; Portinho, Fernando

    2015-01-01

    Introduction The indirect laryngoscopy has an important role in the characterization of reflux laryngitis. Although many findings are nonspecific, some strongly suggest that the inflammation is the cause of reflux. Objective The aim of this study was to evaluate the correlation between reflux symptoms and the findings of indirect laryngoscopy. Methods We evaluated 27 patients with symptoms of pharyngolaryngeal reflux disease. Results Laryngoscopy demonstrated in all patients the presence of hypertrophy of the posterior commissure and laryngeal edema. The most frequent symptoms were the presence of dry cough and foreign body sensation. Conclusion There was a correlation between the findings at laryngoscopy and symptoms of reflux. PMID:26157498

  12. [First confirmed case of laryngeal diphtheria in Djibouti].

    PubMed

    Koeck, J L; Merle, C; Bimet, F; Kiredjian, M; Goullin, B; Teyssou, R

    2000-01-01

    The first bacteriologically confirmed case of laryngeal diphtheria in Djibouti was reported in 1998. It involved a three-year-old native-born infant who had been vaccinated during the first year of life with three doses of a combined vaccine against diphtheria, tetanus, poliomyelitis, and pertussis. A rapid clinical improvement was observed under erythromycin treatment. Other cases of laryngeal diphtheria have been observed. It is important to reverse decreasing vaccinal coverage in Djibouti and to warn incoming travelers of the need to be adequate immunized against diphtheria. Enhanced epidemiologic surveillance of this disease is also needed.

  13. Experimental and numerical study of patterns in laryngeal flow

    NASA Astrophysics Data System (ADS)

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

    2009-05-01

    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.

  14. Critical analysis of robotic surgery for laryngeal tumours.

    PubMed

    Esteban, Francisco; Menoyo, Alicia; Abrante, Antonio

    2014-01-01

    In recent years, transoral robotic surgery (TORS) with the Da Vinci robot has been used for the removal of laryngeal cancers with the objective to improve functional and aesthetic outcomes without worsening survival. The advantages of TORS are described in this article. However, its disadvantages, mainly high cost amongst others, do not make robotic surgery the current treatment of choice for laryngeal tumours; transoral laser surgery is superior in most cases. Major technical improvements are expected. Smaller, more ergonomic, new-generation robots better adapted to the head and neck will probably be available in the near future.

  15. Functional Outcomes after Chemoradiotherapy of Laryngeal and Pharyngeal Cancers

    PubMed Central

    Hutcheson, Katherine A.; Lewin, Jan S.

    2014-01-01

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

  16. Histoplasmosis Presenting as a Laryngeal Ulcer in an Immunocompetent Host.

    PubMed

    John, Mary; Koshy, Jency Maria; Mohan, Sangeetha; Paul, Preethi

    2015-06-01

    Histoplasmosis is a granulomatous disease of worldwide distribution caused by a dimorphic fungus Histoplasma capsulatum. Majority of primary infections in immunocompetent hosts are asymptomatic or may present with flu-like illness. Histoplasmosis may occur in three forms: (i) Primary acute pulmonary form, (ii) chronic pulmonary and (iii) disseminated form. The manifestations of disseminated form of histoplasmosis are fever, weakness, weight loss, hepatosplenomegaly, and mucocutaneous lesions. The mucosal involvement could be oropharyngeal or laryngeal involvement. We report an unusual case of histoplasmosis presenting as a laryngeal ulcer in an immunocompetent host.

  17. Use of King Vision(®) videolaryngoscope in an unanticipated difficult airway in an adult patient with giant vallecular cyst, a case report.

    PubMed

    España Fuente, L; de la Rica Fernández, P; González González, J L

    2017-02-01

    Laryngeal cysts are largely asymptomatic and typically described in the context of incidental discovery on routine laryngoscopy. These cysts, in adults are even rarer and can have catastrophic consequences in an anaesthetized patient if airway management is inappropriate. We describe a case of difficult endotracheal intubation and the treatment of an adult patient with an asymptomatic, giant vallecular cyst that was discovered during rapid-sequence induction of general anesthesia in urgent surgery. In conclusion, vallecular cysts can cause extreme problems in securing the airway. It is important to avoid complications associated with repeated attempts at intubation, airway loss, or cyst rupture causing difficulty visualizing vocal cords and aspiration. The use of King Vision(®) videolaryngoscope is a good alternative in these cases. Close attention to logistics and the immediate availability of an otolaryngologist is vital.

  18. Performance of GFIS mask repair system for various mask materials

    NASA Astrophysics Data System (ADS)

    Aramaki, Fumio; Kozakai, Tomokazu; Matsuda, Osamu; Yasaka, Anto; Yoshikawa, Shingo; Kanno, Koichi; Miyashita, Hiroyuki; Hayashi, Naoya

    2014-10-01

    We have developed a new focused ion beam (FIB) technology using a gas field ion source (GFIS) for mask repair. Meanwhile, since current high-end photomasks do not have high durability in exposure nor cleaning, some new photomask materials are proposed. In 2012, we reported that our GFIS system had repaired a representative new material "A6L2". It is currently expected to extend the application range of GFIS technology for various new materials and various defect shapes. In this study, we repaired a single bridge, a triple bridge and a missing hole on a phase shift mask (PSM) of "A6L2", and also repaired single bridges on a binary mask of molybdenum silicide (MoSi) material "W4G" and a PSM of high transmittance material "SDC1". The etching selectivity between those new materials and quartz were over 4:1. There were no significant differences of pattern shapes on scanning electron microscopy (SEM) images between repair and non-repair regions. All the critical dimensions (CD) at repair regions were less than +/-3% of those at normal ones on an aerial image metrology system (AIMS). Those results demonstrated that GFIS technology is a reliable solution of repairing new material photomasks that are candidates for 1X nm generation.

  19. Airway complications after lung transplantation.

    PubMed

    Machuzak, Michael; Santacruz, Jose F; Gildea, Thomas; Murthy, Sudish C

    2015-01-01

    Airway complications after lung transplantation present a formidable challenge to the lung transplant team, ranging from mere unusual images to fatal events. The exact incidence of complications is wide-ranging depending on the type of event, and there is still evolution of a universal characterization of the airway findings. Management is also wide-ranging. Simple observation or simple balloon bronchoplasty is sufficient in many cases, but vigilance following more severe necrosis is required for late development of both anastomotic and nonanastomotic airway strictures. Furthermore, the impact of coexisting infection, rejection, and medical disease associated with high-level immunosuppression further complicates care.

  20. Gene Delivery to the Airway

    PubMed Central

    Keiser, Nicholas W.; Engelhardt, John F.

    2013-01-01

    This unit describes generation of and gene transfer to several commonly used airway models. Isolation and transduction of primary airway epithelial cells are first described. Next, the preparation of polarized airway epithelial monolayers is outlined. Transduction of these polarized cells is also described. Methods are presented for generation of tracheal xenografts as well as both ex vivo and in vivo gene transfer to these xenografts. Finally, a method for in vivo gene delivery to the lungs of rodents is included. Methods for evaluating transgene expression are given in the support protocols. PMID:23853081

  1. Multidimensional voice analysis of reflux laryngitis patients.

    PubMed

    Pribuisienë, Rûta; Uloza, Virgilijus; Saferis, Viktoras

    2005-01-01

    The aim of the study was to analyze and quantify the voice characteristics of reflux laryngitis (RL) patients and to determine the most important voice tests and voice-quality parameters in the functional diagnostics of RL. The voices of 83 RL patients and 31 persons in the control group were evaluated. Vocal function was assessed using a multidimensional set of video laryngostroboscopic, perceptual, acoustic, aerodynamic and subjective measurements according to the protocol elaborated by the Committee on Phoniatrics of the European Laryngological Society. The mean values of the hoarseness visual analogue scale assessment and voice handicap index were significantly higher (P<0.05) in the group of RL patients as compared to the controls. Objective voice assessment revealed a significant increase in mean values of jitter, shimmer and normalized noise energy (NNE), along with a significant decrease in pitch range, maximum frequency, phonetogram area (S) and maximum phonation time (MPT) in RL patients, both in the male and female subgroups. According to the results of discriminant analysis, the NNE, MPT, S and intensity range were determined as an optimum set for functional diagnostics of RL. The derived function (equation) makes it possible to assign the person to the group of RL patients with an accuracy of 86.7%. The sensitivity and specificity of eight voice parameters were found to be higher than 50%. The results of the present study demonstrate a reduction of phonation capabilities and voice quality in RL patients. Multidimensional voice evaluation makes it possible to detect significant differences in mean values of perceptual, subjective and objective voice quality parameters between RL patients and controls groups. Therefore, multidimensional voice analysis is an important tool in the functional diagnostics of RL.

  2. Nordic rattle: the hoarse vocalization and the inflatable laryngeal air sac of reindeer (Rangifer tarandus)

    PubMed Central

    Frey, Roland; Gebler, Alban; Fritsch, Guido; Nygrén, Kaarlo; Weissengruber, Gerald E

    2007-01-01

    Laryngeal air sacs have evolved convergently in diverse mammalian lineages including insectivores, bats, rodents, pinnipeds, ungulates and primates, but their precise function has remained elusive. Among cervids, the vocal tract of reindeer has evolved an unpaired inflatable ventrorostral laryngeal air sac. This air sac is not present at birth but emerges during ontogenetic development. It protrudes from the laryngeal vestibulum via a short duct between the epiglottis and the thyroid cartilage. In the female the growth of the air sac stops at the age of 2–3 years, whereas in males it continues to grow up to the age of about 6 years, leading to a pronounced sexual dimorphism of the air sac. In adult females it is of moderate size (about 100 cm3), whereas in adult males it is large (3000–4000 cm3) and becomes asymmetric extending either to the left or to the right side of the neck. In both adult females and males the ventral air sac walls touch the integument. In the adult male the air sac is laterally covered by the mandibular portion of the sternocephalic muscle and the skin. Both sexes of reindeer have a double stylohyoid muscle and a thyroepiglottic muscle. Possibly these muscles assist in inflation of the air sac. Head-and-neck specimens were subjected to macroscopic anatomical dissection, computer tomographic analysis and skeletonization. In addition, isolated larynges were studied for comparison. Acoustic recordings were made during an autumn round-up of semi-domestic reindeer in Finland and in a small zoo herd. Male reindeer adopt a specific posture when emitting their serial hoarse rutting calls. Head and neck are kept low and the throat region is extended. In the ventral neck region, roughly corresponding to the position of the large air sac, there is a mane of longer hairs. Neck swelling and mane spreading during vocalization may act as an optical signal to other males and females. The air sac, as a side branch of the vocal tract, can be considered as

  3. Impossible laryngeal intubation in an infant with Fraser syndrome.

    PubMed

    Crowe, Suzanne; Westbrook, Andrew; Bourke, Margaret; Lyons, Barry; Russell, John

    2004-03-01

    Congenital webbing of the vocal cords is rare, and is usually incompatible with life. We report a case of an infant with Fraser syndrome who required a surgical airway because of a severe stenosis of her airway secondary to a glottic web. The decision process leading to tracheostomy in this neonate is described. The pertinent features of Fraser syndrome in relation to airway management are discussed.

  4. Improving vision by pupil masking

    PubMed Central

    Bonaque-González, Sergio; Ríos-Rodríguez, Susana; López-Gil, Norberto

    2016-01-01

    We propose an alternative solution to improve visual quality by spatially modulating the amplitude of light passing into the eye (related to the eye's transmittance), in contrast to traditional correction of the wavefront phase (related to the local refractive power). Numerical simulations show that masking the aberrated areas at the pupil plane should enhance visual function, especially in highly aberrated eyes. This correction could be implemented in practice using customized contact or intraocular lenses. PMID:27446688

  5. Mask pattern generator employing EPL technology

    NASA Astrophysics Data System (ADS)

    Yoshioka, Nobuyuki; Yamabe, Masaki; Wakamiya, Wataru; Endo, Nobuhiro

    2003-08-01

    Mask cost is one of crucial issues in device fabrication, especially in SoC (System on a Chip) with small-volume production. The cost mainly depends on productivity of mask manufacturing tools such as mask writers and defect inspection tools. EPL (Electron Projection Lithography) has been developing as a high-throughput electron beam exposure technology that will succeed optical lithography. The application of EPL technology to mask writing will result in high productivity and contribute to decrease the mask cost. The concept of a mask pattern generator employing EPL technology is proposed in this paper. It is very similar to EPL technology used for pattern printing on a wafer. The mask patterns on the glass substrate are exposed by projecting the basic circuit patterns formed on the mother EPL mask. One example of the mother EPL mask is a stencil type made with 200-mm Si wafer. The basic circuit patterns are IP patterns and logical primitive patterns such as cell libraries (AND, OR, Inverter, Flip-Flop and etc.) to express the SoC device patterns. Since the SoC patterns are exposed with its collective units such as IP and logical primitive patterns by using this method, the high throughput will be expected comparing with conventional mask E-beam writers. In this paper, the mask pattern generator with the EPL technology is proposed. The concept, its advantages and issues to be solved are discussed.

  6. Spatial release from informational masking

    NASA Astrophysics Data System (ADS)

    Rakerd, Brad; Aaronson, Neil L.

    2001-05-01

    A new method for investigating spatial release from informational masking was developed and employed in two experiments. The new method is computer controlled and efficient. It employs the versatile coordinate response measure speech stimulus set [Bolia et al., J. Acoust. Soc. Am. 107, 1065 (2000)]. The experiments were conducted in an anechoic room, with a primary loudspeaker in front of the listener and a secondary loudspeaker at 60 deg to the right. Target messages were presented from the primary speaker only. For a standard, distractor messages, simultaneous with the target, were also presented from the primary speaker only. Spatial release was measured by presenting the distractors from both primary and secondary speakers with a temporal offset. Experiment 1 fixed the offset (secondary leading, +4 ms) and varied the number of distractors (1 to 3) and the target-to-distractor ratio (-12 to +4 dB). Masking release, sometimes as large as 10 dB, was found for all combinations of these variables. Experiment 2 varied the offset over a wide range of values. Substantial release from masking was found for both positive and negative offsets, but only in the range in which speech echoes are suppressed (<50 ms). [Work supported by NIDCD grant DC 00181.

  7. History and future of mask making

    NASA Astrophysics Data System (ADS)

    Levy, Ken L.

    1996-12-01

    The history of the mask industry has three main periods, which I call the Classical Period, the Dark Ages, and the Renaissance, by analogy with those periods in the history of Western Europe. During the Classical Period, people developed 1X masks and the technology to make them. In the Dark Ages, people exploited the equipment developed during the Classical Period to make 5X reduction reticle, ending the nobility of mask making. In today's Renaissance of mask making, a proliferation of mask types is requiring a rebirth of innovation and creativity. The Renaissance resembles the Classical Period: masks are once again strategic, and technological capability is once again the driver. Meanwhile, the mask industry is carrying forward the productivity and efficiency gains it achieved during the Dark Ages. We must create a new business and economic model to support these changes in the characteristics of the marketplace.

  8. United airway disease: current perspectives

    PubMed Central

    Giavina-Bianchi, Pedro; Aun, Marcelo Vivolo; Takejima, Priscila; Kalil, Jorge; Agondi, Rosana Câmara

    2016-01-01

    Upper and lower airways are considered a unified morphological and functional unit, and the connection existing between them has been observed for many years, both in health and in disease. There is strong epidemiologic, pathophysiologic, and clinical evidence supporting an integrated view of rhinitis and asthma: united airway disease in the present review. The term “united airway disease” is opportune, because rhinitis and asthma are chronic inflammatory diseases of the upper and lower airways, which can be induced by allergic or nonallergic reproducible mechanisms, and present several phenotypes. Management of rhinitis and asthma must be jointly carried out, leading to better control of both diseases, and the lessons of the Allergic Rhinitis and Its Impact on Asthma initiative cannot be forgotten. PMID:27257389

  9. Apoptosis and the Airway Epithelium

    PubMed Central

    White, Steven R.

    2011-01-01

    The airway epithelium functions as a barrier and front line of host defense in the lung. Apoptosis or programmed cell death can be elicited in the epithelium as a response to viral infection, exposure to allergen or to environmental toxins, or to drugs. While apoptosis can be induced via activation of death receptors on the cell surface or by disruption of mitochondrial polarity, epithelial cells compared to inflammatory cells are more resistant to apoptotic stimuli. This paper focuses on the response of airway epithelium to apoptosis in the normal state, apoptosis as a potential regulator of the number and types of epithelial cells in the airway, and the contribution of epithelial cell apoptosis in important airways diseases. PMID:22203854

  10. Extraglottic airway devices: A review

    PubMed Central

    Ramaiah, Ramesh; Das, Debasmita; Bhananker, Sanjay M; Joffe, Aaron M

    2014-01-01

    Extraglottic airway devices (EAD) have become an integral part of anesthetic care since their introduction into clinical practice 25 years ago and have been used safely hundreds of millions of times, worldwide. They are an important first option for difficult ventilation during both in-hospital and out-of-hospital difficult airway management and can be utilized as a conduit for tracheal intubation either blindly or assisted by another technology (fiberoptic endoscopy, lightwand). Thus, the EAD may be the most versatile single airway technique in the airway management toolbox. However, despite their utility, knowledge regarding specific devices and the supporting data for their use is of paramount importance to patient's safety. In this review, number of commercially available EADs are discussed and the reported benefits and potential pitfalls are highlighted. PMID:24741502

  11. Fabrication and commercialization of scalpel masks

    NASA Astrophysics Data System (ADS)

    Novembre, Anthony E.; Peabody, Milton L., Jr.; Blakey, Myrtle I.; Farrow, Reginald C.; Kasica, Richard J.; Liddle, James A.; Saunders, Thomas E.; Tennant, Donald M.

    1998-09-01

    SCALPEL masks have been fabricated for use in the Proof-of- Lithography system and to demonstrate the feasibility of having them produced by a commercial blank manufacturer and optical mask shops. Masks blanks are formed from 100 mm diameter silicon wafers. A 100-150 nm thick SiNx layer is LPCVD deposited onto the wafers followed by magnetron sputter deposition of a thin Cr/W metal layer which is used as the scatterer layer for the mask>the mask is supported by an underlying network of struts which are arranged to be compatible with the step and scan writing strategy of the exposure tool and to provide robustness to the mask. Crystallographic wet etching of the silicon wafer forms membranes and struts. To date over 300 mask blanks have been formed and yield data as a function of the thickness of the silicon nitride membrane has been quantified. Recent developments in the mask blank formation process include the production of blanks by MCNC who serve as a commercial source of SCALPEL mask blanks. They have successfully delivered 36 blanks that exhibit equivalent properties to those produced at Lucent. Mask patterning has been performed at the commercial optical mask shops of PHOTRONICS and DUPONT. In this investigation a MEBES exposure system has been used to write patterns. The resist used is ZEP-520 and development and pattern transfer processes are performed in the STEAG-Hammatech spray/spin processing tool. Metrology is performed using a KMS 310 RT optical microscope. Pattern placement accuracy is measured on the LMS 2020 system without modification. The masks are inspected for defects using the optical based KLA 300 series inspection system in a die to die mode and in transmission. Results to date suggest feasibility of producing SCALPEL masks by a commercial blank supplier and by merchant optical mask shops.

  12. Observation of the laryngeal movements for throat singing

    NASA Astrophysics Data System (ADS)

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

    2002-11-01

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

  13. Diode Laser for Laryngeal Surgery: a Systematic Review

    PubMed Central

    Arroyo, Helena Hotz; Neri, Larissa; Fussuma, Carina Yuri; Imamura, Rui

    2016-01-01

    Introduction The diode laser has been frequently used in the management of laryngeal disorders. The portability and functional diversity of this tool make it a reasonable alternative to conventional lasers. However, whether diode laser has been applied in transoral laser microsurgery, the ideal parameters, outcomes, and adverse effects remain unclear. Objective The main objective of this systematic review is to provide a reliable evaluation of the use of diode laser in laryngeal diseases, trying to clarify its ideal parameters in the larynx, as well as its outcomes and complications. Data Synthesis We included eleven studies in the final analysis. From the included articles, we collected data on patient and lesion characteristics, treatment (diode laser's parameters used in surgery), and outcomes related to the laser surgery performed. Only two studies were prospective and there were no randomized controlled trials. Most of the evidence suggests that the diode laser can be a useful tool for treatment of different pathologies in the larynx. In this sense, the parameters must be set depending on the goal (vaporization, section, or coagulation) and the clinical problem. Conclusion: The literature lacks studies on the ideal parameters of the diode laser in laryngeal surgery. The available data indicate that diode laser is a useful tool that should be considered in laryngeal surgeries. Thus, large, well-designed studies correlated with diode compared with other lasers are needed to better estimate its effects. PMID:27096024

  14. [Central projections of the rat recurrent laryngeal nerve].

    PubMed

    Pascual-Font, A; Maranillo, E; Merchán, A; Vázquez, T; Sañudo, J R; Valderrama-Canales, F J

    2006-01-01

    Laryngeal nerves contain the fibres that control the laryngeal function. The studies carried out on the rat with the purpose of having a better knowledge of the functional components and the real origin of the fibres conveyed by the recurrent laryngeal nerve (RLN) are few and in disagreement. No one of such papers were developed using biotinylated dextrane amines (BDA), a powerful tool for tracing neural pathways. The aim of our study was to identify in the rat using BDA, the nuclei of real origin of the fibres of the RLN, knowing in this way the functional components of this nerve. The study has been developed in 31 adult male Sprague-Dawley rats, applying the BDA into the lesioned RLN. The results obtained in all the animals show that the rat's RLN does not contain afferent fibres, whereas the efferent fibres were originated within the ipsilateral nucleus ambiguus (NA). So, in the rat, the RLN seems to contain exclusively efferent fibres, probably been the superior laryngeal nerve who conveyed the afferent fibres.

  15. [Central projections of the rat superior laryngeal nerve].

    PubMed

    Pascual-Font, A; Maranillo, E; Merchán, A; Vázquez, T; Safiudo, J R; Valderrama-Canales, F

    2006-01-01

    Laryngeal nerves contain the fibres that control the laryngeal function. On the rat, the studies on the functional components and the real origin of the fibres conveyed by the superior laryngeal nerve (SLN) are few. No one of such works were developed using biotinylated dextrane amines (BDA), a powerful tool for tracing neural pathways. The aim of our study was to identify by using BDA, in the rat, the nuclei of real origin of the fibres of the SLN, knowing in this way the functional components of this nerve. The study has been developed in 11 adult male Sprague-Dawley rats, applying the BDA into the damaged SLN. The results obtained in all the animals shown that the rat SLN carries efferent fibres originated within the ipsilateral nucleus ambiguous (NA) and dorsal nucleus of the vagus (DNV), and that afferent fibres reach the tractus solitari and the nucleus tractus solitari. So, in the rat, the SLN seems to convey efferent fibres from the NA and DNV and, probably, all the laryngeal afferent fibres.

  16. A bony connection signals laryngeal echolocation in bats.

    PubMed

    Veselka, Nina; McErlain, David D; Holdsworth, David W; Eger, Judith L; Chhem, Rethy K; Mason, Matthew J; Brain, Kirsty L; Faure, Paul A; Fenton, M Brock

    2010-02-18

    Echolocation is an active form of orientation in which animals emit sounds and then listen to reflected echoes of those sounds to form images of their surroundings in their brains. Although echolocation is usually associated with bats, it is not characteristic of all bats. Most echolocating bats produce signals in the larynx, but within one family of mainly non-echolocating species (Pteropodidae), a few species use echolocation sounds produced by tongue clicks. Here we demonstrate, using data obtained from micro-computed tomography scans of 26 species (n = 35 fluid-preserved bats), that proximal articulation of the stylohyal bone (part of the mammalian hyoid apparatus) with the tympanic bone always distinguishes laryngeally echolocating bats from all other bats (that is, non-echolocating pteropodids and those that echolocate with tongue clicks). In laryngeally echolocating bats, the proximal end of the stylohyal bone directly articulates with the tympanic bone and is often fused with it. Previous research on the morphology of the stylohyal bone in the oldest known fossil bat (Onychonycteris finneyi) suggested that it did not echolocate, but our findings suggest that O. finneyi may have used laryngeal echolocation because its stylohyal bones may have articulated with its tympanic bones. The present findings reopen basic questions about the timing and the origin of flight and echolocation in the early evolution of bats. Our data also provide an independent anatomical character by which to distinguish laryngeally echolocating bats from other bats.

  17. Laryngeal obstruction caused by lymphoma in an adult dairy cow.

    PubMed

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

    2014-02-01

    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.

  18. Laryngeal Aerodynamics Associated with Oral Contraceptive Use: Preliminary Findings

    ERIC Educational Resources Information Center

    Gorham-Rowan, Mary; Fowler, Linda

    2009-01-01

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

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  20. Phonatory characteristics of patients undergoing thyroidectomy without laryngeal nerve injury.

    PubMed

    Hong, K H; Kim, Y K

    1997-10-01

    Complications that arise after thyroid surgery may be associated with infection, hemorrhage, hormonal problems, and laryngeal nerve injury. Voice alteration after thyroidectomy is usually caused by recurrent or superior laryngeal nerve injury. This voice dysfunction may also be associated with laryngotracheal fixation with impairment of vertical movement or by temporary malfunction of the strap muscles after surgery. In this study, we evaluated the voice function phonetically before and after thyroidectomy in 54 patients, although function of the recurrent and superior laryngeal nerves was normal. During surgery, the superior and recurrent laryngeal nerves were identified and protected, and after surgery electromyographic testing of the cricothyroid muscle was performed. Typical voice symptoms after surgery were easy fatigue during phonation and difficulty with high pitch and singing voice. Acoustic analysis revealed that the phonation time and fundamental frequency were not changed after surgery, but the speaking fundamental frequency, range of speaking fundamental frequency, and vocal range were significantly diminished after surgery. These data allowed us to suggest that the cause of voice dysfunction is not seen in neural lesions, but in a disturbance of the extralaryngeal skeleton. These voice changes emphasize the importance of the extralaryngeal mechanism for pitch control.

  1. Regional deposition of particles in an image-based airway model: large-eddy simulation and left-right lung ventilation asymmetry.

    PubMed

    Lambert, Andrew R; O'Shaughnessy, Patrick; Tawhai, Merryn H; Hoffman, Eric A; Lin, Ching-Long

    2011-01-01

    Regional deposition and ventilation of particles by generation, lobe and lung during steady inhalation in a computed tomography (CT) based human airway model are investigated numerically. The airway model consists of a seven-generation human airway tree, with oral cavity, pharynx and larynx. The turbulent flow in the upper respiratory tract is simulated by large-eddy simulation. The flow boundary conditions at the peripheral airways are derived from CT images at two lung volumes to produce physiologically-realistic regional ventilation. Particles with diameter equal to or greater than 2.5 microns are selected for study because smaller particles tend to penetrate to the more distal parts of the lung. The current generational particle deposition efficiencies agree well with existing measurement data. Generational deposition efficiencies exhibit similar dependence on particle Stokes number regardless of generation, whereas deposition and ventilation efficiencies vary by lobe and lung, depending on airway morphology and airflow ventilation. In particular, regardless of particle size, the left lung receives a greater proportion of the particle bolus as compared to the right lung in spite of greater flow ventilation to the right lung. This observation is supported by the left-right lung asymmetry of particle ventilation observed in medical imaging. It is found that the particle-laden turbulent laryngeal jet flow, coupled with the unique geometrical features of the airway, causes a disproportionate amount of particles to enter the left lung.

  2. A new removable airway stent

    PubMed Central

    Amundsen, Tore; Sørhaug, Sveinung; Leira, Håkon Olav; Tyvold, Stig Sverre; Langø, Thomas; Hammer, Tommy; Manstad-Hulaas, Frode; Mattsson, Erney

    2016-01-01

    Background Malignant airway obstruction is a feared complication and will most probably occur more frequently in the future because of increasing cancer incidence and increased life expectancy in cancer patients. Minimal invasive treatment using airway stents represents a meaningful and life-saving palliation. We present a new removable airway stent for improved individualised treatment. Methods To our knowledge, the new airway stent is the world's first knitted and uncovered self-expanding metal stent, which can unravel and be completely removed. In an in vivo model using two anaesthetised and spontaneously breathing pigs, we deployed and subsequently removed the stents by unravelling the device. The procedures were executed by flexible bronchoscopy in an acute and a chronic setting – a ‘proof-of-principle’ study. Results The new stent was easily and accurately deployed in the central airways, and it remained fixed in its original position. It was easy to unravel and completely remove from the airways without clinically significant complications. During the presence of the stent in the chronic study, granulation tissue was induced. This tissue disappeared spontaneously with the removal. Conclusions The new removable stent functioned according to its purpose and unravelled easily, and it was completely removed without significant technical or medical complications. Induced granulation tissue disappeared spontaneously. Further studies on animals and humans are needed to define its optimal indications and future use. PMID:27608269

  3. Airway Management in Patients with Tracheal Compression Undergoing Thyroidectomy: A Retrospective Analysis

    PubMed Central

    Sajid, Binu; Rekha, K.

    2017-01-01

    Background: Airway management in large and retrosternal goiters with tracheal compression is often fraught with challenges and is a source of apprehension among anesthesiologists globally. Aims: In this study we attempt to delineate the preferred techniques of airway management of such cases in our institution and also to assess whether airway management was unnecessarily complicated. Setting and Design: Retrospective analysis. Materials and Methods: A retrospective review was conducted of thyroidectomies performed in our institution over a three year period from January 2013. Clinical, radiological, pathological, anesthetic and surgical data were obtained from hospital case records. Statistical Analysis: Qualitative data is represented as frequencies and percentages and quantitative data as mean and standard deviation. Results: Of 1861 thyroidectomies tracheal compression were present in 50 patients with minimum tracheal diameter ranging from 4-12mm (mean 7.84); with majority(95%) having a benign pathology. Critical tracheal compression (≤5 mm) was observed in four patients. Conventional intravenous induction and intubation under muscle relaxant was performed in majority (64%) of these patients. The rest of the cases (n=18) were intubated while preserving spontaneous ventilation after induction. Primary technique of airway management was reported successful in all cases with no instances of difficult ventilation or intubation. Postoperative morbidity in few cases resulted from hematoma (n=1), recurrent laryngeal nerve palsy (n=1), tracheomalacia (n=1) and pulmonary complications (n=2). Conclusion: Airway management in patients with tracheal compression due to benign goiter is quite straightforward and can be managed in the conventional manner with little or no complications. PMID:28298767

  4. High performance mask fabrication process for the next-generation mask production

    NASA Astrophysics Data System (ADS)

    Yagawa, Keisuke; Ugajin, Kunihiro; Suenaga, Machiko; Kobayashi, Yoshihito; Motokawa, Takeharu; Hagihara, Kazuki; Saito, Masato; Itoh, Masamitsu

    2014-07-01

    ArF immersion lithography combined with double patterning has been used for fabricating below half pitch 40nm devices. However, when pattern size shrinks below 20nm, we must use new technology like quadruple patterning process or next generation lithography (NGL) solutions. Moreover, with change in lithography tool, next generation mask production will be needed. According to ITRS 2013, fabrication of finer patterns less than 15nm will be required on mask plate in NGL mask production 5 years later [1]. In order to fabricate finer patterns on mask, higher resolution EB mask writer and high performance fabrication process will be required. In a previous study, we investigated a potential of mask fabrication process for finer patterning and achieved 17nm dense line pattern on mask plate by using VSB (Variable Shaped Beam) type EB mask writer and chemically amplified resist [2][3]. After a further investigation, we constructed higher performance mask process by using new EB mask writer EBM9000. EBM9000 is the equipment supporting hp16nm generation's photomask production and has high accuracy and high throughput. As a result, we achieved 15.5nm pattern on mask with high productivity. Moreover, from evaluation of isolated pattern, we proved that current mask process has the capability for sub-10nm pattern. These results show that the performance of current mask fabrication process have the potential to fabricate the next-generation mask.

  5. Laryngeal findings and acoustic changes in hubble-bubble smokers.

    PubMed

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

    2010-10-01

    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.

  6. Microbiota in the Throat and Risk Factors for Laryngeal Carcinoma.

    PubMed

    Gong, Hongli; Shi, Yi; Zhou, Xia; Wu, Chunping; Cao, Pengyu; Xu, Chen; Hou, Dongsheng; Wang, Yuezhu; Zhou, Liang

    2014-12-01

    The compositions and abundances of the microbiota in the ecological niche of the human throat and the possible relationship between the microbiota and laryngeal cancer are poorly understood. To obtain insight into this, we enrolled 27 laryngeal carcinoma patients and 28 subjects with vocal cord polyps as controls. For each subject, we simultaneously collected swab samples from the upper throat near the epiglottis (site I) and tissue samples from the vestibulum laryngis to the subglottic region (site II). The microbiota of the throat were fully characterized by pyrosequencing of barcoded 16S rRNA genes. We found 14 phyla, 20 classes, 38 orders, 85 families, and 218 genera in the throats of enrolled subjects. The main phyla were Firmicutes (54.7%), Fusobacteria (14.8%), Bacteroidetes (12.7%), and Proteobacteria (10.6%). Streptococcus (37.3%), Fusobacterium (11.3%), and Prevotella (10.6%) were identified as the three most predominant genera in the throat. The relative abundances of 23 bacterial genera in site I were significantly different from those in site II (P < 0.05). The relative proportions of 12 genera largely varied between laryngeal cancer patients and control subjects (P < 0.05). Collectively, this study outlined the spatial structure of microbial communities in the human throat. The spatial structure of bacterial communities significantly varied in two anatomical sites of the throat. The bacterial profiles of the throat of laryngeal cancer patients were strongly different from those of control subjects, and several of these microorganisms may be related to laryngeal carcinoma.

  7. Microbiota in the Throat and Risk Factors for Laryngeal Carcinoma

    PubMed Central

    Gong, Hongli; Zhou, Xia; Wu, Chunping; Cao, Pengyu; Xu, Chen; Hou, Dongsheng; Wang, Yuezhu

    2014-01-01

    The compositions and abundances of the microbiota in the ecological niche of the human throat and the possible relationship between the microbiota and laryngeal cancer are poorly understood. To obtain insight into this, we enrolled 27 laryngeal carcinoma patients and 28 subjects with vocal cord polyps as controls. For each subject, we simultaneously collected swab samples from the upper throat near the epiglottis (site I) and tissue samples from the vestibulum laryngis to the subglottic region (site II). The microbiota of the throat were fully characterized by pyrosequencing of barcoded 16S rRNA genes. We found 14 phyla, 20 classes, 38 orders, 85 families, and 218 genera in the throats of enrolled subjects. The main phyla were Firmicutes (54.7%), Fusobacteria (14.8%), Bacteroidetes (12.7%), and Proteobacteria (10.6%). Streptococcus (37.3%), Fusobacterium (11.3%), and Prevotella (10.6%) were identified as the three most predominant genera in the throat. The relative abundances of 23 bacterial genera in site I were significantly different from those in site II (P < 0.05). The relative proportions of 12 genera largely varied between laryngeal cancer patients and control subjects (P < 0.05). Collectively, this study outlined the spatial structure of microbial communities in the human throat. The spatial structure of bacterial communities significantly varied in two anatomical sites of the throat. The bacterial profiles of the throat of laryngeal cancer patients were strongly different from those of control subjects, and several of these microorganisms may be related to laryngeal carcinoma. PMID:25239901

  8. Association between UGT1A1 Polymorphism and Risk of Laryngeal Squamous Cell Carcinoma

    PubMed Central

    Huangfu, Hui; Pan, Hong; Wang, Binquan; Wen, Shuxin; Han, Rui; Li, Li

    2016-01-01

    Laryngeal cancer is one of the largest subgroups of head and neck cancers. In addition to smoking and alcohol consumption, genetic polymorphisms are also risk factors for the development of laryngeal cancer. However, the exact relation between genetic variants and pathogenesis of laryngeal cancer has remained elusive. The aim of this study was to examine UGT1A1*6 (rs4148323 A/G) polymorphisms in 103 patients with laryngeal cancer and 220 controls using the high resolution melting curve (HRM) technique and to explore the association between UGT1A1*6 (rs4148323 A/G) polymorphisms and laryngeal cancer. The results showed an association between the rs4148323 G allele and increased risk of laryngeal cancer. While there was no statistically significant difference between rs4148323 genotype frequencies and different histological grades or different clinical stages of laryngeal cancer, stratification analysis indicated smoking or alcohol consumption and rs4148323 G allele combined to increase the risk of laryngeal cancer. In conclusion, the rs4148323 G allele is associated with the high UGT1A1 enzyme activity, and might increase the risk of laryngeal cancer. Furthermore, smoking or alcohol consumption and the rs4148323 G allele act synergistically to increase the risk of laryngeal cancer. PMID:26751466

  9. Human airway ciliary dynamics

    PubMed Central

    Thompson, Kristin; Knowles, Michael R.; Davis, C. William

    2013-01-01

    Airway cilia depend on precise changes in shape to transport the mucus gel overlying mucosal surfaces. The ciliary motion can be recorded in several planes using video microscopy. However, cilia are densely packed, and automated computerized systems are not available to convert these ciliary shape changes into forms that are useful for testing theoretical models of ciliary function. We developed a system for converting planar ciliary motions recorded by video microscopy into an empirical quantitative model, which is easy to use in validating mathematical models, or in examining ciliary function, e.g., in primary ciliary dyskinesia (PCD). The system we developed allows the manipulation of a model cilium superimposed over a video of beating cilia. Data were analyzed to determine shear angles and velocity vectors of points along the cilium. Extracted waveforms were used to construct a composite waveform, which could be used as a standard. Variability was measured as the mean difference in position of points on individual waveforms and the standard. The shapes analyzed were the end-recovery, end-effective, and fastest moving effective and recovery with mean (± SE) differences of 0.31(0.04), 0.25(0.06), 0.50(0.12), 0.50(0.10), μm, respectively. In contrast, the same measures for three different PCD waveforms had values far outside this range. PMID:23144323

  10. Airway Hydration and COPD

    PubMed Central

    Ghosh, Arunava; Boucher, R.C.; Tarran, Robert

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) is one of the prevalent causes of worldwide mortality and encompasses two major clinical phenotypes, i.e., chronic bronchitis (CB) and emphysema. The most common cause of COPD is chronic tobacco inhalation. Research focused on the chronic bronchitic phenotype of COPD has identified several pathological processes that drive disease initiation and progression. For example, the lung’s mucociliary clearance (MCC) system performs the critical task of clearing inhaled pathogens and toxic materials from the lung. MCC efficiency is dependent on: (i) the ability of apical plasma membrane ion channels such as the cystic fibrosis transmembrane conductance regulator (CFTR) and the epithelial Na+ channel (ENaC) to maintain airway hydration; (ii) ciliary beating; and, (iii) appropriate rates of mucin secretion. Each of these components is impaired in CB and likely contributes to the mucus stasis/accumulation seen in CB patients. This review highlights the cellular components responsible for maintaining MCC and how this process is disrupted following tobacco exposure and with CB. We shall also discuss existing therapeutic strategies for the treatment of chronic bronchitis and how components of the MCC can be used as biomarkers for the evaluation of tobacco or tobacco-like-product exposure. PMID:26068443

  11. Efficacy of Surgical Airway Plasty for Benign Airway Stenosis

    PubMed Central

    Takahama, Makoto; Nakajima, Ryu; Kimura, Michitaka; Inoue, Hidetoshi; Yamamoto, Ryoji

    2015-01-01

    Background: Long-term patency is required during treatment for benign airway stenosis. This study investigated the effectiveness of surgical airway plasty for benign airway stenosis. Methods: Clinical courses of 20 patients, who were treated with surgical plasty for their benign airway stenosis, were retrospectively investigated. Results: Causes of stenosis were tracheobronchial tuberculosis in 12 patients, post-intubation stenosis in five patients, malacia in two patients, and others in one patient. 28 interventional pulmonology procedures and 20 surgical plasty were performed. Five patients with post-intubation stenosis and four patients with tuberculous stenosis were treated with tracheoplasty. Eight patients with tuberculous stenosis were treated with bronchoplasty, and two patients with malacia were treated with stabilization of the membranous portion. Anastomotic stenosis was observed in four patients, and one to four additional treatments were required. Performance status, Hugh–Jones classification, and ventilatory functions were improved after surgical plasty. Outcomes were fair in patients with tuberculous stenosis and malacia. However, efficacy of surgical plasty for post-intubation stenosis was not observed. Conclusion: Surgical airway plasty may be an acceptable treatment for tuberculous stenosis. Patients with malacia recover well after surgical plasty. There may be untreated patients with malacia who have the potential to benefit from surgical plasty. PMID:26567879

  12. Airway management in emergency situations.

    PubMed

    Dörges, Volker

    2005-12-01

    Securing and monitoring the airway are among the key requirements of appropriate therapy in emergency patients. Failures to secure the airways can drastically increase morbidity and mortality of patients within a very short time. Therefore, the entire range of measures needed to secure the airway in an emergency, without intermediate ventilation and oxygenation, is limited to 30-40 seconds. Endotracheal intubation is often called the 'gold standard' for airway management in an emergency, but multiple failed intubation attempts do not result in maintaining oxygenation; instead, they endanger the patient by prolonging hypoxia and causing additional trauma to the upper airways. Thus, knowledge and availability of alternative procedures are also essential in every emergency setting. Given the great variety of techniques available, it is important to establish a well-planned, methodical protocol within the framework of an algorithm. This not only facilitates the preparation of equipment and the training of personnel, it also ensures efficient decision-making under time pressure. Most anaesthesia-related deaths are due to hypoxaemia when difficulty in securing the airway is encountered, especially in obstetrics during induction of anaesthesia for caesarean delivery. The most commonly occurring adverse respiratory events are failure to intubate, failure to recognize oesophageal intubation, and failure to ventilate. Thus, it is essential that every anaesthesiologist working on the labour and delivery ward is comfortable with the algorithm for the management of failed intubation. The algorithm for emergency airway management describing the sequence of various procedures has to be adapted to internal standards and to techniques that are available.

  13. Impact of a New Nasal Pillows Mask on Patients' Acceptance, Compliance, and Willingness to Remain on CPAP Therapy.

    PubMed

    Wimms, Alison; Ketheeswaran, Sahisha; Ziegenbein, Claus; Jennings, Laura; Woehrle, Holger

    2016-01-01

    Aim. Continuous positive airway pressure (CPAP) masks are a key factor in patient compliance. This program assessed the performance of a new nasal pillows mask (NPM) on a variety of new and established obstructive sleep apnea (OSA) patients using CPAP therapy. Methods. Five programs were developed to assess the new NPM [AirFit P10, ResMed] on naïve patients; patients established on another NPM; patients using a nasal mask; patients with low CPAP compliance; and patients who wished to stop using CPAP therapy. Results. A total of 212 patients were included. In naïve patients, CPAP usage after 3 months was 5.9 ± 1.7 hours/night, compared with the control group at 4.6 ± 2.4 hours/night (p < 0.05). In patients established on another NPM, usage improved to 7.4 ± 1.1 hours/night versus 6.7 ± 1.4 (p = 0.001). 78% of nasal mask users wished to continue using the new NPM. Low compliance patients improved with an average of 0.87 hours/night (p = 0.001) when using the new NPM. In patients at the point of quitting CPAP, 60% continued with therapy using the new NPM. Conclusion. The new NPM mask performed well in a variety of clinical groups of OSA patients receiving CPAP therapy and shows that technical advances in CPAP masks can improve patient compliance.

  14. Impact of a New Nasal Pillows Mask on Patients' Acceptance, Compliance, and Willingness to Remain on CPAP Therapy

    PubMed Central

    Ketheeswaran, Sahisha; Jennings, Laura; Woehrle, Holger

    2016-01-01

    Aim. Continuous positive airway pressure (CPAP) masks are a key factor in patient compliance. This program assessed the performance of a new nasal pillows mask (NPM) on a variety of new and established obstructive sleep apnea (OSA) patients using CPAP therapy. Methods. Five programs were developed to assess the new NPM [AirFit P10, ResMed] on naïve patients; patients established on another NPM; patients using a nasal mask; patients with low CPAP compliance; and patients who wished to stop using CPAP therapy. Results. A total of 212 patients were included. In naïve patients, CPAP usage after 3 months was 5.9 ± 1.7 hours/night, compared with the control group at 4.6 ± 2.4 hours/night (p < 0.05). In patients established on another NPM, usage improved to 7.4 ± 1.1 hours/night versus 6.7 ± 1.4 (p = 0.001). 78% of nasal mask users wished to continue using the new NPM. Low compliance patients improved with an average of 0.87 hours/night (p = 0.001) when using the new NPM. In patients at the point of quitting CPAP, 60% continued with therapy using the new NPM. Conclusion. The new NPM mask performed well in a variety of clinical groups of OSA patients receiving CPAP therapy and shows that technical advances in CPAP masks can improve patient compliance. PMID:27648308

  15. Holographically Encoded Volume Phase Masks

    DTIC Science & Technology

    2015-07-13

    experiments have been performed using an HPM recorded in a 1.97-mm thick photo -thermo-refractive (PTR) glass sample as illustrated in Fig. 1. PTR glass is a...spiral phase plate,” Appl. Opt. 43(12), 2397–2399 (2004). 19. K. Peithmann et al., “Low-spatial-frequency refractive-index changes in iron- doped ...Binary volume phase masks in photo -thermo-refrac- tive glass,” Opt. Lett. 37(7), 1190–1192 (2012). 21. M. Bass, Handbook of Optics, 2nd ed., McGraw-Hill

  16. Induction of periodic breathing during sleep causes upper airway obstruction in humans.

    PubMed

    Onal, E; Burrows, D L; Hart, R H; Lopata, M

    1986-10-01

    To test the hypothesis that occlusive apneas result from sleep-induced periodic breathing in association with some degree of upper airway compromise, periodic breathing was induced during non-rapid-eye-movement (NREM) sleep by administering hypoxic gas mixtures with and without applied external inspiratory resistance (9 cmH2O X l-1 X s) in five normal male volunteers. In addition to standard polysomnography for sleep staging and respiratory pattern monitoring, esophageal pressure, tidal volume (VT), and airflow were measured via an esophageal catheter and pneumotachograph, respectively, with the latter attached to a tight-fitting face mask, allowing calculation of total pulmonary system resistance (Rp). During stage I/II NREM sleep minimal period breathing was evident in two of the subjects; however, in four subjects during hypoxia and/or relief from hypoxia, with and without added resistance, pronounced periodic breathing developed with waxing and waning of VT, sometimes with apneic phases. Resistive loading without hypoxia did not cause periodicity. At the nadir of periodic changes in VT, Rp was usually at its highest and there was a significant linear relationship between Rp and 1/VT, indicating the development of obstructive hypopneas. In one subject without added resistance and in the same subject and in another during resistive loading, upper airway obstruction at the nadir of the periodic fluctuations in VT was observed. We conclude that periodic breathing resulting in periodic diminution of upper airway muscle activity is associated with increased upper airway resistance that predisposes upper airways to collapse.

  17. Reorganization of laryngeal motoneurons after crush injury in the recurrent laryngeal nerve of the rat

    PubMed Central

    Hernández-Morato, Ignacio; Valderrama-Canales, Francisco J; Berdugo, Gabriel; Arias, Gonzalo; McHanwell, Stephen; Sañudo, José; Vázquez, Teresa; Pascual-Font, Arán

    2013-01-01

    Motoneurons innervating laryngeal muscles are located in the nucleus ambiguus (Amb), but there is no general agreement on the somatotopic representation and even less is known on how an injury in the recurrent laryngeal nerve (RLN) affects this pattern. This study analyzes the normal somatotopy of those motoneurons and describes its changes over time after a crush injury to the RLN. In the control group (control group 1, n = 9 rats), the posterior cricoarytenoid (PCA) and thyroarytenoid (TA) muscles were injected with cholera toxin-B. In the experimental groups the left RLN of each animal was crushed with a fine tip forceps and, after several survival periods (1, 2, 4, 8, 12 weeks; minimum six rats per time), the PCA and TA muscles were injected as described above. After each surgery, the motility of the vocal folds was evaluated. Additional control experiments were performed; the second control experiment (control group 2, n = 6 rats) was performed labeling the TA and PCA immediately prior to the section of the superior laryngeal nerve (SLN), in order to eliminate the possibility of accidental labeling of the cricothyroid (CT) muscle by spread from the injection site. The third control group (control group 3, n = 5 rats) was included to determine if there is some sprouting from the SLN into the territories of the RLN after a crush of this last nerve. One week after the crush injury of the RLN, the PCA and TA muscles were injected immediately before the section of the SLN. The results show that a single population of neurons represents each muscle with the PCA in the most rostral position followed caudalwards by the TA. One week post-RLN injury, both the somatotopy and the number of labeled motoneurons changed, where the labeled neurons were distributed randomly; in addition, an area of topographical overlap of the two populations was observed and vocal fold mobility was lost. In the rest of the survival periods, the overlapping area is larger, but the movement of

  18. Reorganization of laryngeal motoneurons after crush injury in the recurrent laryngeal nerve of the rat.

    PubMed

    Hernández-Morato, Ignacio; Valderrama-Canales, Francisco J; Berdugo, Gabriel; Arias, Gonzalo; McHanwell, Stephen; Sañudo, José; Vázquez, Teresa; Pascual-Font, Arán

    2013-04-01

    Motoneurons innervating laryngeal muscles are located in the nucleus ambiguus (Amb), but there is no general agreement on the somatotopic representation and even less is known on how an injury in the recurrent laryngeal nerve (RLN) affects this pattern. This study analyzes the normal somatotopy of those motoneurons and describes its changes over time after a crush injury to the RLN. In the control group (control group 1, n = 9 rats), the posterior cricoarytenoid (PCA) and thyroarytenoid (TA) muscles were injected with cholera toxin-B. In the experimental groups the left RLN of each animal was crushed with a fine tip forceps and, after several survival periods (1, 2, 4, 8, 12 weeks; minimum six rats per time), the PCA and TA muscles were injected as described above. After each surgery, the motility of the vocal folds was evaluated. Additional control experiments were performed; the second control experiment (control group 2, n = 6 rats) was performed labeling the TA and PCA immediately prior to the section of the superior laryngeal nerve (SLN), in order to eliminate the possibility of accidental labeling of the cricothyroid (CT) muscle by spread from the injection site. The third control group (control group 3, n = 5 rats) was included to determine if there is some sprouting from the SLN into the territories of the RLN after a crush of this last nerve. One week after the crush injury of the RLN, the PCA and TA muscles were injected immediately before the section of the SLN. The results show that a single population of neurons represents each muscle with the PCA in the most rostral position followed caudalwards by the TA. One week post-RLN injury, both the somatotopy and the number of labeled motoneurons changed, where the labeled neurons were distributed randomly; in addition, an area of topographical overlap of the two populations was observed and vocal fold mobility was lost. In the rest of the survival periods, the overlapping area is larger, but

  19. Glottic and skull indices in canine brachycephalic airway obstructive syndrome

    PubMed Central

    2014-01-01

    Background Forty dogs presented for brachycephalic airway obstructive syndrome with laryngeal collapse not over 1st degree (saccule eversion) underwent glottis endoscopic and radiographic skull measurements before surgery. Fifteen Pugs, fifteen French and ten English Bulldogs were included. The goals were prospectively to compare three common brachycephalic breeds for anatomical differences regarding glottis and skull measurements, and to assess if any correlation between glottis and skull measurements was present. Linear measurements were used to obtain glottis and skull indices. Correlations between glottis and skull indices and glottic measurements were evaluated. Finally, glottis indices were compared among the three breeds. Results No correlation was found for glottis and skull indices. The glottic index differed among the three breeds (smaller in Pugs and higher in English Bulldogs), ultimately representing a morphologic indicator of the different larynx shape in the three breeds (more rounded in English Bulldogs, more elliptical in Pugs and in-between in French Bulldogs). Conclusions The lack of correlation between skull/glottic indices does not support skull morphology as predictor of glottic morphology. As Pugs had the lowest glottic index, it may be speculated that Pugs’ original narrow glottic width may predispose to further progressive respiratory deterioration more easily than in the other two breeds. PMID:24410902

  20. Polyurethane Masks Large Areas in Electroplating

    NASA Technical Reports Server (NTRS)

    Beasley, J. L.

    1985-01-01

    Polyurethane foam provides effective mask in electroplating of copper or nickel. Thin layer of Turco maskant painted on area to be masked: Layer ensures polyurethane foam removed easily after served its purpose. Component A, isocyanate, and component B, polyol, mixed together and brushed or sprayed on mask area. Mixture reacts, yielding polyurethane foam. Foam prevents deposition of nickel or copper on covered area. New method saves time, increases productivity and uses less material than older procedures.

  1. The Airway Microbiome at Birth

    PubMed Central

    Lal, Charitharth Vivek; Travers, Colm; Aghai, Zubair H.; Eipers, Peter; Jilling, Tamas; Halloran, Brian; Carlo, Waldemar A.; Keeley, Jordan; Rezonzew, Gabriel; Kumar, Ranjit; Morrow, Casey; Bhandari, Vineet; Ambalavanan, Namasivayam

    2016-01-01

    Alterations of pulmonary microbiome have been recognized in multiple respiratory disorders. It is critically important to ascertain if an airway microbiome exists at birth and if so, whether it is associated with subsequent lung disease. We found an established diverse and similar airway microbiome at birth in both preterm and term infants, which was more diverse and different from that of older preterm infants with established chronic lung disease (bronchopulmonary dysplasia). Consistent temporal dysbiotic changes in the airway microbiome were seen from birth to the development of bronchopulmonary dysplasia in extremely preterm infants. Genus Lactobacillus was decreased at birth in infants with chorioamnionitis and in preterm infants who subsequently went on to develop lung disease. Our results, taken together with previous literature indicating a placental and amniotic fluid microbiome, suggest fetal acquisition of an airway microbiome. We speculate that the early airway microbiome may prime the developing pulmonary immune system, and dysbiosis in its development may set the stage for subsequent lung disease. PMID:27488092

  2. Opium Addiction and Risk of Laryngeal and Esophageal Carcinoma

    PubMed Central

    Bakhshaee, Mehdi; Raziee, Hamid Reza; Afshari, Reza; Amali, Amin; Roopoosh, Mahmoud; Lotfizadeh, Ali

    2017-01-01

    Introduction: Cigarette smoking and alcohol consumption have a well-known effect on the development of upper aerodigestive tract carcinomas, but such a role for opium is questionable. This study was designed to assess the correlation between opium inhalation and cancer of the larynx and upper esophagus. Materials and Methods: Fifty eight patients with laryngeal cancer, ninety eight patients with upper esophageal cancer and twenty seven healthy individuals with no evidence of head and neck or esophageal malignancies were selected from Otolaryngology and Radiation Oncology Department of Mashhad University of Medical Sciences. Duration and amount of cigarette smoking and opium consumption were recorded through comprehensive interviews. Results: The crude odds ratio for laryngeal cancer was 5.58 (95% CI 2.05-15.15, P=0.000) in cigarette smokers relative to non-smokers and 9.09 (95% CI 3.21-25.64, P=0.000) in opium users relative to non-users. The crude odds ratio for esophageal cancer was 0.44 (95% CI 0.18-1.09, P=0.07) in cigarette smokers relative to non-smokers and 1.44 (95% CI 0.57-3.62, P=0.43) in opium users relative to non-users. After adjusting for smoking, the odds ratio for laryngeal cancer in opium users relative to non-users was 6.06 (95% CI 1.10-33.23, P=0.05). Laryngeal cancer was detected at a significantly lower age in opium users (54.54±10.93 vs 62.92±10.10 years, P=0.02) than in smokers. This effect was not observed in esophageal cancer. Although the duration (year 17.50±14.84 vs 21.91±14.03; P=0.34) and amount (pack/day 0.625 vs 0.978; P=0.06) of smoking were higher among those who were opium dependent, these differences were not statistically significant (P=0.34 and P=0.06, respectively). Conclusion: Opium addiction by snuffing is an independent risk factor for the development laryngeal cancer but not esophageal cancer. Cigarette smoking increases this risk. Opium dependency increases the likelihood of developing laryngeal cancer at a younger

  3. Temporal masking of multidimensional tactual stimuli

    NASA Astrophysics Data System (ADS)

    Tan, Hong Z.; Reed, Charlotte M.; Delhorne, Lorraine A.; Durlach, Nathaniel I.; Wan, Natasha

    2003-12-01

    Experiments were performed to examine the temporal masking properties of multidimensional tactual stimulation patterns delivered to the left index finger. The stimuli consisted of fixed-frequency sinusoidal motions in the kinesthetic (2 or 4 Hz), midfrequency (30 Hz), and cutaneous (300 Hz) frequency ranges. Seven stimuli composed of one, two, or three spectral components were constructed at each of two signal durations (125 or 250 ms). Subjects identified target signals under three different masking paradigms: forward masking, backward masking, and sandwiched masking (in which the target is presented between two maskers). Target identification was studied as a function of interstimulus interval (ISI) in the range 0 to 640 ms. For both signal durations, percent-correct scores increased with ISI for each of the three masking paradigms. Scores with forward and backward masking were similar and significantly higher than scores obtained with sandwiched masking. Analyses of error trials revealed that subjects showed a tendency to respond, more often than chance, with the masker, the composite of the masker and target, or the combination of the target and a component of the masker. The current results are compared to those obtained in previous studies of tactual recognition masking with brief cutaneous spatial patterns. The results are also discussed in terms of estimates of information transfer (IT) and IT rate, are compared to previous studies with multidimensional tactual signals, and are related to research on the development of tactual aids for the deaf.

  4. Evaluation of a native vegetation masking technique

    NASA Technical Reports Server (NTRS)

    Kinsler, M. C.

    1984-01-01

    A crop masking technique based on Ashburn's vegetative index (AVI) was used to evaluate native vegetation as an indicator of crop moisture condition. A mask of the range areas (native vegetation) was generated for each of thirteen Great Plains LANDSAT MSS sample segments. These masks were compared to the digitized ground truth and accuracies were computed. An analysis of the types of errors indicates a consistency in errors among the segments. The mask represents a simple quick-look technique for evaluating vegetative cover.

  5. Mask lithography for display manufacturing

    NASA Astrophysics Data System (ADS)

    Sandstrom, T.; Ekberg, P.

    2010-05-01

    The last ten years have seen flat displays conquer our briefcases, desktops, and living rooms. There has been an enormous development in production technology, not least in lithography and photomasks. Current masks for large displays are more than 2 m2 and make 4-6 1X prints on glass substrates that are 9 m2. One of the most challenging aspects of photomasks for displays is the so called mura, stripes or blemishes which cause visible defects in the finished display. For the future new and even tighter maskwriter specifications are driven by faster transistors and more complex pixel layouts made necessary by the market's wish for still better image quality, multi-touch panels, 3D TVs, and the next wave of e-book readers. Large OLED screens will pose new challenges. Many new types of displays will be lowcost and use simple lithography, but anything which can show video and high quality photographic images needs a transistor backplane and sophisticated masks for its production.

  6. X-ray lithography masking

    NASA Technical Reports Server (NTRS)

    Smith, Henry I. (Inventor); Lim, Michael (Inventor); Carter, James (Inventor); Schattenburg, Mark (Inventor)

    1998-01-01

    X-ray masking apparatus includes a frame having a supporting rim surrounding an x-ray transparent region, a thin membrane of hard inorganic x-ray transparent material attached at its periphery to the supporting rim covering the x-ray transparent region and a layer of x-ray opaque material on the thin membrane inside the x-ray transparent region arranged in a pattern to selectively transmit x-ray energy entering the x-ray transparent region through the membrane to a predetermined image plane separated from the layer by the thin membrane. A method of making the masking apparatus includes depositing back and front layers of hard inorganic x-ray transparent material on front and back surfaces of a substrate, depositing back and front layers of reinforcing material on the back and front layers, respectively, of the hard inorganic x-ray transparent material, removing the material including at least a portion of the substrate and the back layers of an inside region adjacent to the front layer of hard inorganic x-ray transparent material, removing a portion of the front layer of reinforcing material opposite the inside region to expose the surface of the front layer of hard inorganic x-ray transparent material separated from the inside region by the latter front layer, and depositing a layer of x-ray opaque material on the surface of the latter front layer adjacent to the inside region.

  7. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults†

    PubMed Central

    Frerk, C.; Mitchell, V. S.; McNarry, A. F.; Mendonca, C.; Bhagrath, R.; Patel, A.; O'Sullivan, E. P.; Woodall, N. M.; Ahmad, I.

    2015-01-01

    These guidelines provide a strategy to manage unanticipated difficulty with tracheal intubation. They are founded on published evidence. Where evidence is lacking, they have been directed by feedback from members of the Difficult Airway Society and based on expert opinion. These guidelines have been informed by advances in the understanding of crisis management; they emphasize the recognition and declaration of difficulty during airway management. A simplified, single algorithm now covers unanticipated difficulties in both routine intubation and rapid sequence induction. Planning for failed intubation should form part of the pre-induction briefing, particularly for urgent surgery. Emphasis is placed on assessment, preparation, positioning, preoxygenation, maintenance of oxygenation, and minimizing trauma from airway interventions. It is recommended that the number of airway interventions are limited, and blind techniques using a bougie or through supraglottic airway devices have been superseded by video- or fibre-optically guided intubation. If tracheal intubation fails, supraglottic airway devices are recommended to provide a route for oxygenation while reviewing how to proceed. Second-generation devices have advantages and are recommended. When both tracheal intubation and supraglottic airway device insertion have failed, waking the patient is the default option. If at this stage, face-mask oxygenation is impossible in the presence of muscle relaxation, cricothyroidotomy should follow immediately. Scalpel cricothyroidotomy is recommended as the preferred rescue technique and should be practised by all anaesthetists. The plans outlined are designed to be simple and easy to follow. They should be regularly rehearsed and made familiar to the whole theatre team. PMID:26556848

  8. Upper airway tract and upper gastrointestinal tract involvement in patients with pemphigus vulgaris.

    PubMed

    Su, Ozlem; Onsun, Nahide; Meric Teker, Aysenur; Cinkaya, Ayse; Yasemin Korkut, Arzu; Seremet, Sila; Davutoglu, Can; Demirkesen, Cuyan

    2010-01-01

    Pemphigus vulgaris (PV) is an autoimmune disease involving the skin and mucous membranes. The frequency of upper airway tract (UAT) and upper gastrointestinal tract (UGIT) involvement in PV is not clearly known. Our aim was to determine the incidence of UAT and UGIT involvement in patients with PV. Thirty-seven patients who were diagnosed with PV and treated between March 2008 and April 2009 at the Dermatology Department of the Vakif Gureba Teaching and Research Hospital were included. All patients were evaluated for UAT manifestations by endoscopic examination, and 22 of 37 patients were investigated for UGIT involvement by gastrointestinal endoscopy. Mucosal biopsies were obtained by UGIT endoscopy for direct immunofluorescence (DIF) examination, and a histopathological examination was conducted in patients with active UGIT mucosal lesions. Thirty-five of 37 patients (94.6%) had active pharyngeal, laryngeal, or nasal PV lesions on endoscopic evaluation. Oral symptoms (83.8%) and active oral PV lesions were the most frequent findings (100%). Pharyngeal lesions (64.9%) were the most commonly present lesions on UAT examination. The frequency for laryngeal and nasal lesions was 51.4% and 21.6%, respectively. Five of 22 patients (22.7%) presented with active laryngeal and esophageal lesions. Twenty-one of 22 (95.4%) patients had positive DIF results. We believe that UAT and UGIT endoscopies are useful and necessary diagnostic methods in patients with PV with or without UAT and UGIT symptoms. UAT and UGIT endoscopies should be performed as standard diagnostic procedures in all patients with PV.

  9. Cystic Fibrosis Transmembrane Conductance Regulator in Sarcoplasmic Reticulum of Airway Smooth Muscle. Implications for Airway Contractility

    PubMed Central

    Cook, Daniel P.; Rector, Michael V.; Bouzek, Drake C.; Michalski, Andrew S.; Gansemer, Nicholas D.; Reznikov, Leah R.; Li, Xiaopeng; Stroik, Mallory R.; Ostedgaard, Lynda S.; Abou Alaiwa, Mahmoud H.; Thompson, Michael A.; Prakash, Y. S.; Krishnan, Ramaswamy; Meyerholz, David K.; Seow, Chun Y.

    2016-01-01

    Rationale: An asthma-like airway phenotype has been described in people with cystic fibrosis (CF). Whether these findings are directly caused by loss of CF transmembrane conductance regulator (CFTR) function or secondary to chronic airway infection and/or inflammation has been difficult to determine. Objectives: Airway contractility is primarily determined by airway smooth muscle. We tested the hypothesis that CFTR is expressed in airway smooth muscle and directly affects airway smooth muscle contractility. Methods: Newborn pigs, both wild type and with CF (before the onset of airway infection and inflammation), were used in this study. High-resolution immunofluorescence was used to identify the subcellular localization of CFTR in airway smooth muscle. Airway smooth muscle function was determined with tissue myography, intracellular calcium measurements, and regulatory myosin light chain phosphorylation status. Precision-cut lung slices were used to investigate the therapeutic potential of CFTR modulation on airway reactivity. Measurements and Main Results: We found that CFTR localizes to the sarcoplasmic reticulum compartment of airway smooth muscle and regulates airway smooth muscle tone. Loss of CFTR function led to delayed calcium reuptake following cholinergic stimulation and increased myosin light chain phosphorylation. CFTR potentiation with ivacaftor decreased airway reactivity in precision-cut lung slices following cholinergic stimulation. Conclusions: Loss of CFTR alters porcine airway smooth muscle function and may contribute to the airflow obstruction phenotype observed in human CF. Airway smooth muscle CFTR may represent a therapeutic target in CF and other diseases of airway narrowing. PMID:26488271

  10. [Orthodontics and the upper airway].

    PubMed

    Cobo Plana, J; de Carlos Villafranca, F; Macías Escalada, E

    2004-03-01

    One of the general aims of orthodontic treatment and of the combination of orthodontics and orthognathic surgery is to achieve good occlusion and aesthetic improvement, especially in cases of severe dentoskeletal deformities. However, on many occasions, the parameters of the upper airways are not taken into account when the aims of conventional treatment are fulfilled. Patients with obstructive alterations during sleep represent for the orthodontist a type of patient who differs from the normal; for them, treatment should include the objective of improving oxygen saturation. Here, functional considerations should outweigh purely aesthetic ones. It is important, when making an orthodontic, surgical or combined diagnosis for a patient, to bear in mind the impact that treatment may have on the upper airways. Good aesthetics should never be achieved for some of our patients at the expense of diminishing the capacity of their upper airways.

  11. Changes in expression of p53, proliferating cell nuclear antigen and bcl-2 in recurrent laryngeal cancer after radiotherapy.

    PubMed

    Lee, B-J; Wang, S-G; Roh, H-J; Goh, E-K; Chon, K-M; Park, D-Y

    2006-07-01

    The biological changes in recurrent laryngeal cancer following radiotherapy are not fully understood. The authors investigated differences in the expression of p53, proliferating cell nuclear antigen (PCNA) and bcl-2 in laryngeal cancer specimens before radiotherapy and in recurrent laryngeal cancer specimens following radiotherapy in the same patients. The authors investigated the expression of p53, PCNA and bcl-2 by immunohistochemical stain in 30 specimens from 15 patients with primary laryngeal cancer and recurrent laryngeal cancer after radiotherapy. The expression of p53 protein was significantly different in laryngeal cancer before radiotherapy (4/15, 26.7 per cent) compared with recurrent laryngeal cancer after radiotherapy (8/15, 53.3 per cent) (p<0.05). The PCNA index was also significantly different in laryngeal cancer specimens before radiotherapy (mean, 11.9 per cent) compared with recurrent laryngeal cancer after radiotherapy (mean, 18.0 per cent) (p<0.05). However, there was no statistically significant alteration of bcl-2 expression in primary compared with recurrent laryngeal cancer. The expression of p53 and PCNA increased in recurrent laryngeal cancers after radiotherapy, compared with that in laryngeal cancers before radiotherapy. Recurrent laryngeal cancers arising following radiotherapy became biologically aggressive.

  12. Detection of helicobacter pylori in benign laryngeal lesions by polymerase chain reaction: a cross sectional study

    PubMed Central

    2012-01-01

    Background Although Helicobacter Pylori (HP) was detected in some cases of chronic laryngitis, the results were not confirmed by polymerase chain reaction (PCR). By this time, it has not been found in laryngeal lesions by in house PCR, the most sensitive method for detecting the genome tracks. Regarding the previous results and also few numbers of studies about the presence of HP in benign laryngeal lesions, specifically by PCR, we aimed to investigate the presence of HP in benign laryngeal lesions by in-house PCR. Methods The samples were taken from 55 patients with benign laryngeal lesions and frozen in −20°C. One milliliter (ml) of lysis buffer was added to 100 mg (mg) of each sample and the tube was placed in 56°C overnight. Then DNA extraction was carried out. Results To find HP DNA, in-house PCR was performed that revealed 5 positive results among 55 patients with benign laryngeal lesions. Of them, 3 were polyp, 1 was nodule and 1 was papilloma. Conclusion Although the number of positive results was not a lot in this study, it was in contrast with previous studies which could not find any HP tracks in benign laryngeal lesions by other methods. More studies about the prevalence of HP in benign laryngeal lesions improve judging about the effect of this infection on benign laryngeal lesions. PMID:22515206

  13. Laryngeal muscular control of vocal fold posturing: Numerical modeling and experimental validation

    PubMed Central

    Yin, Jun; Zhang, Zhaoyan

    2016-01-01

    A three-dimensional continuum model of vocal fold posturing was developed to investigate laryngeal muscular control of vocal fold geometry, stiffness, and tension, which are difficult to measure in live humans or in vivo models. This model was able to qualitatively reproduce in vivo experimental observations of laryngeal control of vocal fold posturing, despite the many simplifications which are necessary due to the lack of accurate data of laryngeal geometry and material properties. The results present a first comprehensive study of the co-variations between glottal width, vocal fold length, stiffness, tension at different conditions of individual, and combined laryngeal muscle activation. PMID:27914396

  14. Set Size and Mask Duration Do Not Interact in Object-Substitution Masking

    ERIC Educational Resources Information Center

    Argyropoulos, Ioannis; Gellatly, Angus; Pilling, Michael; Carter, Wakefield

    2013-01-01

    Object-substitution masking (OSM) occurs when a mask, such as four dots that surround a brief target item, onsets simultaneously with the target and offsets a short time after the target, rather than simultaneously with it. OSM is a reduction in accuracy of reporting the target with the temporally trailing mask, compared with the simultaneously…

  15. Variations in backward masking with different masking stimuli: I. Local interaction versus attentional switch.

    PubMed

    Bachmann, Talis; Luiga, Iiris; Põder, Endel

    2005-01-01

    The types of stimuli used as targets and masks considerably change the masking functions in a way that requires us to abandon any single mechanism of masking as the sole explanation of backward masking. In the first of two reports in which the problem of the mask-dependence of masking is addressed, we explore the role of the relative spatial positioning of targets and masks in order to differentiate between local interaction and attentional models. If single letters were masked by double-letter masks then the relative spatial arrangement of the letters, which was changed in order to vary the involvement of metacontrast-like processes, had an effect at shorter SOAs, but not at longer SOAs where strong masking still persisted. This poses difficulties for proposing local contour interaction as the main mechanism of masking. Similarly, crowding effects alone cannot explain the results. Backward masking also involves attention being directed to working-memory processing of the succeeding object while abandoning the preceding object.

  16. Alternating phase-shifted mask for logic gate levels, design, and mask manufacturing

    NASA Astrophysics Data System (ADS)

    Liebmann, Lars W.; Graur, Ioana C.; Leipold, William C.; Oberschmidt, James M.; O'Grady, David S.; Regaill, Denis

    1999-07-01

    While the benefits of alternating phase shifted masks in improving lithographic process windows at increased resolution are well known throughout the lithography community, broad implementation of this potentially powerful technique has been slow due to the inherent complexity of the layout design and mask manufacturing process. This paper will review a project undertaken at IBM's Semiconductor Research and Development Center and Mask Manufacturing and Development facility to understand the technical and logistical issues associated with the application of alternating phase shifted mask technology to the gate level of a full microprocessor chip. The work presented here depicts an important milestone toward integration of alternating phase shifted masks into the manufacturing process by demonstrating an automated design solution and yielding a functional alternating phase shifted mask. The design conversion of the microprocessor gate level to a conjugate twin shifter alternating phase shift layout was accomplished with IBM's internal design system that automatically scaled the design, added required phase regions, and resolved phase conflicts. The subsequent fabrication of a nearly defect free phase shifted mask, as verified by SEM based die to die inspection, highlights the maturity of the alternating phase shifted mask manufacturing process in IBM's internal mask facility. Well defined and recognized challenges in mask inspection and repair remain and the layout of alternating phase shifted masks present a design and data preparation overhead, but the data presented here demonstrate the feasibility of designing and building manufacturing quality alternating phase shifted masks for the gate level of a microprocessor.

  17. EUVL masks: paving the path for commercialization

    NASA Astrophysics Data System (ADS)

    Mangat, Pawitter J. S.; Hector, Scott D.

    2001-09-01

    Optical projection lithography has been the principal vehicle of semiconductor manufacturing for more than 20 years and is marching aggressively to satisfy the needs of semiconductor manufacturers for 100nm devices. However, the complexity of optical lithography continues to increase as wavelength reduction continues to 157nm. Extreme Ultraviolet Lithography (EUVL), with wavelength from 13-14 nm, is evolving as a leading next generation lithography option for semiconductor industry to stay on the path laid by Moore's Law. Masks are a critical part of the success of any technology and are considered to be high risk both for optical lithography and NGL technologies for sub-100nm lithography. Two key areas of EUV mask fabrication are reflective multilayer deposition and absorber patterning. In the case of reflective multilayers, delivering defect free multilayers for mask blanks is the biggest challenge. Defect mitigation is being explored as a possible option to smooth the multilayer defects in addition to optimization of the deposition process to reduce defect density. The mask patterning process needs focus on the defect-free absorber stack patterning process, mask cleaning, inspection and repair. In addition, there is considerable effort to understand by simulations, the defect printability, thermal and mechanical distortions, and non-telecentric illumination, to mention a few. To protect the finished mask from defects added during use, a removable pellicle strategy combined with thermophoretic protection during exposure is being developed. Recent migration to square form factor using low thermal expansion material (LTEM) is advantageous as historical developments in optical masks can be applied to EUV mask patterning. This paper addresses recent developments in the EUV mask patterning and highlights critical manufacturing process controls needed to fabricate defect-free full field masks with CD and image placement specifications for sub-70nm node lithography. No

  18. Laryngeal Granuloma – Benefit in Treatment with Zinc Supplementation?

    PubMed Central

    Djukić, Vojko; Krejović-Trivić, Sanja; Vukašinović, Milan; Trivić, Aleksandar; Pavlović, Bojan; Milovanović, Aleksandar; Milovanović, Jovica

    2015-01-01

    Summary Laryngeal granulomas present as contact and postintubation ulcers and granulomas. Essentially, a contact granuloma is a pseudotumor of the lateral wall of the posterior glottis. The most common etiological factor is voice abuse, with predisponing factors such as reflux disease. Postintubation ulcers and granulomas, although of different etiology, according to all the other traits belong to this clinical entity. The therapy of choice is conservative treatment. Surgical laser excision is indicated for resistant cases and those whose size is causing respiratory distress. Treatment of laryngeal granulomas with zinc supplementation is reported in the literature as one of the forms of conservative treatment, and we wanted to consider it in this review. Zinc is an essential mineral that plays a vital role in many biochemical reactions and is considered very important for wound healing. PMID:28356836

  19. Airway Assessment for Office Sedation/Anesthesia.

    PubMed

    Rosenberg, Morton B; Phero, James C

    2015-01-01

    Whenever a patient is about to receive sedation or general anesthesia, no matter what the technique, the preoperative assessment of the airway is one of the most important steps in ensuring patient safety and positive outcomes. This article, Part III in the series on airway management, is directed at the ambulatory office practice and focuses on predicting the success of advanced airway rescue techniques.

  20. Cough reflex is additively potentiated by inputs from the laryngeal and tracheobronchial [corrected] receptors and enhanced by stimulation of the central respiratory neurons.

    PubMed

    Kondo, Tetsuri; Hayama, Naoki

    2009-09-01

    The cough is an essential airway defense reflex. In this study we investigated the coordination of inputs from the laryngeal and tracheobronchial receptors in the cough reflex. In 15 beagle dogs (7-9 kg) lightly anesthetized with intravenous profobol (20-30 mg/kg/h), the cough response was elicited with mechanical stimulation of either the vocal chord or tracheal bifurcation. Simultaneous stimulation of both sites increased all the parameters of cough strength, that is, mean pleural pressure (P (pl)), mean expiratory flow, number of cough bouts, and cough duration, in comparison with stimulation of the sites individually. The increases in mean P (pl) and cough duration reached statistical significance (13.3 vs. 18.4 cmH(2)O and 13.3 vs. 18.2 s, respectively). When the anesthetic level became deeper, the prolongation of cough duration almost disappeared, but the augmentation of mean P (pl) was much less affected. During stimulation of the central respiratory neurons by intravenous dimorphoramine or acute hyperoxic hypercapnia, the cough strength increased significantly. We concluded that inputs from the laryngeal and tracheobonchial cough receptors acted in concert and potentiated the cough reflex. Furthermore, stimulation of the central respiratory neurons may increase the intensity of a cough response.

  1. Comments to Role of upper airway ultrasound in airway management.

    PubMed

    Lien, Wan-Ching

    2017-01-01

    Tracheal ultrasound can be an alternative diagnostic tool in airway management, besides traditional confirmatory methods such as capnography and auscultation. The standard image is a hyperechoic air-mucosa (A-M) interface with a reverberation artifact posteriorly (comet-tail artifact). If the second A-M interface appears, which we call a "double-tract sign," esophageal intubation is considered.

  2. The central projections of the laryngeal nerves in the rat.

    PubMed

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

    2011-08-01

    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.

  3. [Laryngeal paralysis and olivopontocerebellar atrophy. Apropos of a case].

    PubMed

    Sánchez Segura, A; Ramos Pérez, P L; Rodríguez Sánchez, A; Aguirre Sánchez, J J; Gutiérrez Díez, J A; Alvarez Domínguez, J

    1990-01-01

    We display the study performed to a female patient affected of laryngeal paralysis to become, based in clinical and radiologic criteria, to diagnose her cerebellar atrophy. We justify our work because of how infrequently this illness heredodegenerative of the central nervous system begins with cranial pairs paralysis. We emphasize the importance that the new methods of explorations specially TAC and IRM, have to guess the possible etiologies of central originated paralysis.

  4. [Endotracheal tube for laryngeal CO2 laser microsurgery. 208 cases].

    PubMed

    Brille, P; Milhaud, A; Starobinsky, E; Postel, J P; Buffet, J P; Vaquette, C; Boudin, G; Daelman, F; Lemoine, E

    1985-07-06

    To suppress the risk inherent in laryngeal microsurgery performed with a CO2 laser beam, the authors suggest to use a reinforced silicone endotracheal tube, the cuff of which is protected by a silicone plus aluminium powder shield. The resistance of silicone to fire is augmented during laser shots by a nitrogen flow on the upper side of the shield at the rates of 2 l/min in patients breathing air and 30 l/min in patients give oxygen.

  5. Laryngeal Sensitivity in Patients with Amyotrophic Lateral Sclerosis

    PubMed Central

    Ruoppolo, Giovanni; Onesti, Emanuela; Gori, Maria Cristina; Schettino, Ilenia; Frasca, Vittorio; Biasiotta, Antonella; Giordano, Carla; Ceccanti, Marco; Cambieri, Chiara; Greco, Antonio; Buonopane, Costantino Eugenio; Cruccu, Giorgio; De Vincentiis, Marco; Inghilleri, Maurizio

    2016-01-01

    Recent studies have shown the involvement of the sensory nervous system in patients with amyotrophic lateral sclerosis (ALS). The aim of our study was to investigate the correlation between the laryngeal sensitivity deficit and the type of ALS onset (bulbar or spinal) in a large series of 114 consecutive ALS patients. Participants were subdivided into two groups, bulbar and spinal ALS, according to the clinical onset of disease and submitted to a clinical and instrumental evaluation of swallowing, including a fiber-optic endoscopic evaluation of swallowing with sensory testing. Dysphagia severity was scored using the Penetration–Aspiration Scale (PAS) and the Pooling score (P-score). In addition, three patients with laryngeal sensitivity deficit were submitted to a laryngeal biopsy to assess the status of the sensory innervation. All patients showed a normal glottal closure during phonation and volitional cough. Fifty-six subjects (49%), 14 spinal- and 42 bulbar-onset ALS, showed dysphagia at the first clinical observation (PAS score >1; P-score >5). Dysphagia resulted more frequently in bulbar-onset ALS (P < 0.01). Thirty-eight (33%) patients had a sensory deficit of the larynx. The sensory deficit of the larynx was significantly more frequent in bulbar-onset ALS (P < 0.01). The sensory deficit of the larynx among dysphagic patients was also significantly more frequent in bulbar-onset ALS (P = 0.02). Several abnormalities were found in all three subjects who underwent a laryngeal biopsy: in one patient, no intraepidermal fiber was found; in the other two, the fibers showed morphological changes. Our observations are important to consider for assessment and management of dysphagia in patients with ALS. PMID:27965622

  6. The central projections of the laryngeal nerves in the rat

    PubMed Central

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

    2011-01-01

    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

  7. Laryngeal schwannoma: a case report with emphasis on sonographic findings.

    PubMed

    de Souza, Luis Ronan Marquez Ferreira; De Nicola, Harley; Yamasaki, Rosiane; Pedroso, José Eduardo; do Brasil, Osíris de Oliveira Camponês; Yamashita, Hélio

    2014-01-01

    Schwannomas are benign nerve sheath tumors composed of Schwann cells, which normally produce the insulating myelin sheath covering peripheral, cranial and autonomic nerves. Twenty-five to forty-five percent of all schwannomas occur in the head and neck region, but location of such tumors in the larynx is rarely observed. The present report is aimed at describing a clinical case of laryngeal schwannoma, with emphasis on sonographic findings.

  8. Usefulness of ultrasonography in assessment of laryngeal carcinoma

    PubMed Central

    Xia, C-X; Zhao, H-X; Yan, F; Li, S-L; Zhang, S-M

    2013-01-01

    Objective: To evaluate the usefulness of ultrasonography in assessing laryngeal cancer. Methods: 72 patients with laryngeal carcinoma proven by surgery and pathology were enrolled. The pre-therapeutic ultrasonography and CT images were retrospectively evaluated, including tumour detection, localisation and invasion of intra- and extralaryngeal structures. A comparative assessment was made between the detection rate, correspondence rate of localisation and sensitivity and specificity of ultrasonography and CT. The mobility of the larynx was observed on real-time ultrasonography and compared with laryngoscopy. Results: The detection rate of ultrasonography [63 (87.5%)/72] was lower than that of CT [72 (100.0%)/72] (p=0.006). The primary foci were accurately located in 59 (93.7%) of 63 lesions using ultrasonography compared with 70 (97.2%) of 72 lesions using CT (p=0.392). In the evaluation of invasion, the sensitivity and specificity of ultrasonography were similar to that of CT in most of the intra- and extralaryngeal structures (p=0.059–1.000). A higher specificity was obtained during the assessment of the paraglottic space involvement when using ultrasonography than CT (94.9% vs 66.7%, p=0.001). For vocal cord fixation, no statistical difference was found between ultrasonography and laryngoscopy (p=0.223). Conclusion: Ultrasonography could be used as a valuable supplementary imaging method to CT and laryngoscopy in the assessment of laryngeal carcinoma, even in male adults with some calcifications of the thyroid cartilage. Advances in knowledge: Our study demonstrates that ultrasonography, which has been used scarcely in the larynx, could supply useful information on the detection, localisation and intra- and extralaryngeal invasion of laryngeal carcinoma. PMID:24004487

  9. Cervical metastasis on level IV in laryngeal cancer.

    PubMed

    Furtado de Araújo Neto, V J; Cernea, C R; Aparecido Dedivitis, R; Furtado de Araújo Filho, V J; Fabiano Palazzo, J; Garcia Brandão, L

    2014-02-01

    The presence of cervical metastasis has substantial negative impact on survival of patients with laryngeal cancer. Bilateral elective selective neck dissection of levels II, III and IV is usually the chosen approach in these patients. However, there is significant morbidity associated with level IV dissection, such as phrenic nerve injury and lymphatic fistula. The objective of the present study was to evaluate the frequency of metastatic nodes in level IV in clinically T3/T4N0 patients with laryngeal cancer. The pathological reports of 77 patients with clinically T3/T4N0 laryngeal squamous cell carcinoma were reviewed. Patients underwent bilateral lateral neck dissection from January 2007 to November 2012. The surgical specimens were subdivided in levels before evaluation. There were 12 patients with neck metastasis (15.58%). In 3 cases (3.89%), there were metastatic lymph nodes in level IV, all T4 and with ipsilateral metastasis. In conclusion, the incidence of level IV metastasis was 3.89%, an in all patients was staged as T4.

  10. Cyclicity of laryngeal cavity resonance due to vocal fold vibration.

    PubMed

    Kitamura, Tatsuya; Takemoto, Hironori; Adachi, Seiji; Mokhtari, Parham; Honda, Kiyoshi

    2006-10-01

    Acoustic effects of the time-varying glottal area due to vocal fold vibration on the laryngeal cavity resonance were investigated based on vocal tract area functions and acoustic analysis. The laryngeal cavity consists of the vestibular and ventricular parts of the larynx, and gives rise to a regional acoustic resonance within the vocal tract, with this resonance imparting an extra formant to the vocal tract resonance pattern. Vocal tract transfer functions of the five Japanese vowels uttered by three male subjects were calculated under open- and closed-glottis conditions. The results revealed that the resonance appears at the frequency region from 3.0 to 3.7 kHz when the glottis is closed and disappears when it is open. Real spectra estimated from open- and closed-glottis periods of vowel sounds also showed the on-off pattern of the resonance within a pitch period. Furthermore, a time-domain acoustic analysis of vowels indicated that the resonance component could be observed as a pitch-synchronized rise-and-fall pattern of the bandpass amplitude. The cyclic nature of the resonance can be explained as the laryngeal cavity acting as a closed tube that generates the resonance during a closed-glottis period, but damps the resonance off during an open-glottis period.

  11. Laryngeal and vocal evaluation in untreated growth hormone deficient adults

    PubMed Central

    Barreto, Valéria M.P.; D'Ávila, Jeferson S.; Sales, Neuza J.; Gonçalves, Maria Inês R.; Seabra, Juliane Dantas; Salvatori, Roberto; Aguiar-Oliveira, Manuel H.

    2009-01-01

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

  12. Neck ultrasonography for detection of non-recurrent laryngeal nerve

    PubMed Central

    Citton, Marilisa; Viel, Giovanni

    2016-01-01

    Background Non-recurrent laryngeal nerve (NRLN) is a rare anatomical variant (0.3–6%) that is associated with some arterial abnormalities (absence of the brachiocephalic trunk and presence of a right aberrant subclavian lusorian artery). The availability of a preoperative diagnosis of NRLN may reduce the risk of nerve injuries. Preoperative ultrasonography (US) has been suggested as a reliable diagnostic tool to detect the arterial abnormalities associated with NRLN, but the literature is relatively scarce. This paper was aimed to review the literature, in order to offer an up to-date on this technique and its results. Methods A web search, focusing on humans, was performed by PubMed database, including papers published up to August 2016, using the key words “ultrasonography” AND “non-recurrent laryngeal nerve” or “nonrecurrent laryngeal nerve”. Results Eight papers, including 3,740 patients who underwent neck US for the detection of NRLN were selected. Only five studies focused on the preoperative use of US. The incidence of NRLN varied between 0.4% and 1.94%. The sensitivity and specificity varied between 99–100% and 41–100%, respectively. Conclusions US is a simple, non-invasive and cost-effective method to detect NRLN, also if its accuracy is not absolute. It may be used preoperatively and to prevent the intraoperative nerve damage, since the risk of NRLN palsies is significantly reduced when a preoperative diagnosis is available. PMID:28149804

  13. Stem Cell-Based Tissue-Engineered Laryngeal Replacement.

    PubMed

    Ansari, Tahera; Lange, Peggy; Southgate, Aaron; Greco, Karin; Carvalho, Carla; Partington, Leanne; Bullock, Anthony; MacNeil, Sheila; Lowdell, Mark W; Sibbons, Paul D; Birchall, Martin A

    2017-02-01

    Patients with laryngeal disorders may have severe morbidity relating to swallowing, vocalization, and respiratory function, for which conventional therapies are suboptimal. A tissue-engineered approach would aim to restore the vocal folds and maintain respiratory function while limiting the extent of scarring in the regenerated tissue. Under Good Laboratory Practice conditions, we decellularized porcine larynges, using detergents and enzymes under negative pressure to produce an acellular scaffold comprising cartilage, muscle, and mucosa. To assess safety and functionality before clinical trials, a decellularized hemilarynx seeded with human bone marrow-derived mesenchymal stem cells and a tissue-engineered oral mucosal sheet was implanted orthotopically into six pigs. The seeded grafts were left in situ for 6 months and assessed using computed tomography imaging, bronchoscopy, and mucosal brushings, together with vocal recording and histological analysis on explantation. The graft caused no adverse respiratory function, nor did it impact swallowing or vocalization. Rudimentary vocal folds covered by contiguous epithelium were easily identifiable. In conclusion, the proposed tissue-engineered approach represents a viable alternative treatment for laryngeal defects. Stem Cells Translational Medicine 2017;6:677-687.

  14. A facial mask comprising Dead Sea mud.

    PubMed

    Abu-Jdayil, Basim; Mohameed, Hazim A

    2006-01-01

    Many investigators have proved that Dead Sea salt and mud are useful in treating skin disorders and skin diseases. Therefore, the black mud has been extensively used as a base for the preparation of soaps, creams, and unguents for skin care. This study concerns a facial mask made mainly of Dead Sea mud. The effects of temperature and shearing conditions on the rheological behavior of the facial mask were investigated. The mud facial mask exhibited a shear thinning behavior with a yield stress. It was found that the apparent viscosity of the mask has a strong dependence on the shear rate as well as on the temperature. The facial mask exhibited a maximum yield stress and very shear thinning behavior at 40 degrees C, which is attributed to the gelatinization of the polysaccharide used to stabilize the mud particles. On the other hand, the mud mask exhibited a time-independent behavior at low temperatures and shear rates and changed to a thixotropic behavior upon increasing both the temperature and the shear rate. The shear thinning and thixotropic behaviors have a significant importance in the ability of the facial mask to spread on the skin: the Dead Sea mud mask can break down for easy spreading, and the applied film can gain viscosity instantaneously to resist running. Moreover, particle sedimentation, which in this case would negatively affect consumer acceptance of the product, occurs slowly due to high viscosity at rest conditions.

  15. 21 CFR 868.5590 - Scavenging mask.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Scavenging mask. 868.5590 Section 868.5590 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5590 Scavenging mask. (a) Identification....

  16. 21 CFR 868.5570 - Nonrebreathing mask.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nonrebreathing mask. 868.5570 Section 868.5570 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5570 Nonrebreathing mask....

  17. Spatial processing and visual backward masking.

    PubMed

    Herzog, Michael H

    2008-07-15

    Most theories of visual masking focus prima-rily on the temporal aspects of visual information processing, strongly neglecting spatial factors. In recent years, however, we have shown that this position is not tenable. Spatial aspects cannot be neglected in metacontrast, pattern and un-masking. Here, we review these results.

  18. Spatial processing and visual backward masking

    PubMed Central

    Herzog, Michael H.

    2008-01-01

    Most theories of visual masking focus prima-rily on the temporal aspects of visual information processing, strongly neglecting spatial factors. In recent years, however, we have shown that this position is not tenable. Spatial aspects cannot be neglected in metacontrast, pattern and un-masking. Here, we review these results. PMID:20517500

  19. Masking the Feeling of Being Stupid.

    ERIC Educational Resources Information Center

    Smith, Sally L.

    1988-01-01

    Teaching experience at The Lab School of Washington has shown that learning-disabled children and adults cope with their lack of self-esteem and feelings of stupidity by developing masks to hide their hurt. These include masks of super-competence, helplessness, invisibility, clowning, injustice collecting, indifference, boredom, outrageousness,…

  20. Implicit Semantic Perception in Object Substitution Masking

    ERIC Educational Resources Information Center

    Goodhew, Stephanie C.; Visser, Troy A. W.; Lipp, Ottmar V.; Dux, Paul E.

    2011-01-01

    Decades of research on visual perception has uncovered many phenomena, such as binocular rivalry, backward masking, and the attentional blink, that reflect "failures of consciousness". Although stimuli do not reach awareness in these paradigms, there is evidence that they nevertheless undergo semantic processing. Object substitution masking (OSM),…

  1. Computing Challenges in Coded Mask Imaging

    NASA Technical Reports Server (NTRS)

    Skinner, Gerald

    2009-01-01

    This slide presaentation reviews the complications and challenges in developing computer systems for Coded Mask Imaging telescopes. The coded mask technique is used when there is no other way to create the telescope, (i.e., when there are wide fields of view, high energies for focusing or low energies for the Compton/Tracker Techniques and very good angular resolution.) The coded mask telescope is described, and the mask is reviewed. The coded Masks for the INTErnational Gamma-Ray Astrophysics Laboratory (INTEGRAL) instruments are shown, and a chart showing the types of position sensitive detectors used for the coded mask telescopes is also reviewed. Slides describe the mechanism of recovering an image from the masked pattern. The correlation with the mask pattern is described. The Matrix approach is reviewed, and other approaches to image reconstruction are described. Included in the presentation is a review of the Energetic X-ray Imaging Survey Telescope (EXIST) / High Energy Telescope (HET), with information about the mission, the operation of the telescope, comparison of the EXIST/HET with the SWIFT/BAT and details of the design of the EXIST/HET.

  2. Expression of calcium-buffering proteins in rat intrinsic laryngeal muscles.

    PubMed

    Ferretti, Renato; Marques, Maria Julia; Khurana, Tejvir S; Santo Neto, Humberto

    2015-06-01

    Intrinsic laryngeal muscles (ILM) are highly specialized muscles involved in phonation and airway protection, with unique properties that allow them to perform extremely rapid contractions and to escape from damage in muscle dystrophy. Due to that, they may differ from limb muscles in several physiological aspects. Because a better ability to handle intracellular calcium has been suggested to explain ILM unique properties, we hypothesized that the profile of the proteins that regulate calcium levels in ILM is different from that in a limb muscle. Calcium-related proteins were analyzed in the ILM, cricothyroid (CT), and tibialis anterior (TA) muscles from male Sprague-Dawley rats (8 weeks of age) using quantitative PCR and western blotting. Higher expression of key Ca(2+) regulatory proteins was detected in ILM compared to TA, such as the sarcoplasmic reticulum (SR) Ca(2+)-reuptake proteins (Sercas 1 and 2), the Na(+)/Ca(2+) exchanger, phospholamban, and the Ca(2+)-binding protein calsequestrin. Parvalbumin, calmodulin and the ATPase, Ca(2+)-transporting, and plasma membrane 1 were also expressed at higher levels in ILM compared to TA. The store-operated calcium entry channel molecule was decreased in ILM compared to the limb muscle and the voltage-dependent L-type and ryanodine receptor were expressed at similar levels in ILM and TA. These results show that ILM have a calcium regulation system profile suggestive of a better ability to handle calcium changes in comparison to limb muscles, and this may provide a mechanistic insight for their unique pathophysiological properties.

  3. Expression of calcium-buffering proteins in rat intrinsic laryngeal muscles

    PubMed Central

    Ferretti, Renato; Marques, Maria Julia; Khurana, Tejvir S; Santo Neto, Humberto

    2015-01-01

    Intrinsic laryngeal muscles (ILM) are highly specialized muscles involved in phonation and airway protection, with unique properties that allow them to perform extremely rapid contractions and to escape from damage in muscle dystrophy. Due to that, they may differ from limb muscles in several physiological aspects. Because a better ability to handle intracellular calcium has been suggested to explain ILM unique properties, we hypothesized that the profile of the proteins that regulate calcium levels in ILM is different from that in a limb muscle. Calcium-related proteins were analyzed in the ILM, cricothyroid (CT), and tibialis anterior (TA) muscles from male Sprague–Dawley rats (8 weeks of age) using quantitative PCR and western blotting. Higher expression of key Ca2+ regulatory proteins was detected in ILM compared to TA, such as the sarcoplasmic reticulum (SR) Ca2+-reuptake proteins (Sercas 1 and 2), the Na+/Ca2+ exchanger, phospholamban, and the Ca2+-binding protein calsequestrin. Parvalbumin, calmodulin and the ATPase, Ca2+-transporting, and plasma membrane 1 were also expressed at higher levels in ILM compared to TA. The store-operated calcium entry channel molecule was decreased in ILM compared to the limb muscle and the voltage-dependent L-type and ryanodine receptor were expressed at similar levels in ILM and TA. These results show that ILM have a calcium regulation system profile suggestive of a better ability to handle calcium changes in comparison to limb muscles, and this may provide a mechanistic insight for their unique pathophysiological properties. PMID:26109185

  4. An Anesthesiologist's Perspective on the History of Basic Airway Management: The "Artisanal Anesthetic" Era: 1846 to 1904.

    PubMed

    Matioc, Adrian A

    2017-03-01

    This second installment of the history of basic airway management covers the early-artisanal-years of anesthesia from 1846 to 1904. Anesthesia was invented and practiced as a supporting specialty in the context of great surgical and medical advances. The current-day anesthesia provider tends to equate the history of airway management with the history of intubation, but for the first 58 yr after the introduction of ether anesthesia, airway management was provided by basic airway techniques with or without the use of a face mask. The jaw thrust and chin lift were described in the artisanal years and used primarily with inhalation anesthesia in the spontaneously breathing patient and less often with negative-pressure ventilation in the apneic victim. Positive-pressure ventilation and intubation stayed at the fringes of medical practice, and airway techniques and devices were developed by trial and error. At the beginning of the 20th century, airway management and anesthetic techniques lagged behind surgical requirements.

  5. Long-Term Results of Conformal Radiotherapy for Progressive Airway Amyloidosis

    SciTech Connect

    Truong, Minh Tam; Kachnic, Lisa A.; Grillone, Gregory A.; Bohrs, Harry K.; Lee, Richard; Sakai, Osamu; Berk, John L.

    2012-06-01

    Purpose: To evaluate the efficacy of conformal external beam radiotherapy (RT) for local control of progressive airway amyloidosis. Methods and Materials: We conducted a retrospective review of patients with biopsy-proven progressive airway amyloidosis treated with conformal RT between 2000 and 2006 at Boston Medical Center. The patients were evaluated for performance status and pulmonary function, with computed tomography and endoscopy after RT compared with the pretreatment studies. Local control was defined as the lack of progression of airway wall thickening on computed tomography imaging and stable endobronchial deposits by endoscopy. Results: A total of 10 symptomatic airway amyloidosis patients (3 laryngeal and 7 tracheobronchial) received RT to a median total dose of 20 Gy in 10 fractions within 2 weeks. At a median follow-up of 6.7 years (range, 1.5-10.3), 8 of the 10 patients had local control. The remaining 2 patients underwent repeat RT 6 and 8.4 months after initial RT, 1 for persistent bronchial obstruction and 1 for progression of subglottic amyloid disease with subsequent disease control. The Eastern Cooperative Oncology Group performance status improved at a median of 18 months after RT compared with the baseline values, from a median score of 2 to a median of 1 (p = .035). Airflow (forced expiratory volume in 1 second) measurements increased compared with the baseline values at each follow-up evaluation, reaching a 10.7% increase (p = .087) at the last testing (median duration, 64.8 months). Acute toxicity was limited to Grade 1-2 esophagitis, occurring in 40% of patients. No late toxicity was observed. Conclusions: RT prevented progressive amyloid deposition in 8 of 10 patients, resulting in a marginally increased forced expiratory volume in 1 second, and improved functional capacity, without late morbidity.

  6. The Lung Microbiome and Airway Disease.

    PubMed

    Lynch, Susan V

    2016-12-01

    A growing body of literature has demonstrated relationships between the composition of the airway microbiota (mixed-species communities of microbes that exist in the respiratory tract) and critical features of immune response and pulmonary function. These studies provide evidence that airway inflammatory status and capacity for repair are coassociated with specific taxonomic features of the airway microbiome. Although directionality has yet to be established, the fact that microbes are known drivers of inflammation and tissue damage suggests that in the context of chronic inflammatory airway disease, the composition and, more importantly, the function, of the pulmonary microbiome represent critical factors in defining airway disease outcomes.

  7. Airway nerves: in vitro electrophysiology.

    PubMed

    Fox, Alyson

    2002-06-01

    Recording the activity of single airway sensory fibres or neuronal cell bodies in vitro has allowed detailed characterisation of fibre types and membrane properties. Fibre types can be identified by their conduction velocities and further studied by the application of drugs to their receptive field. C-fibres are sensitive to mechanical stimuli and a range of irritant chemicals (bradykinin, capsaicin, low pH, platelet-activating factor), whereas Adelta-fibres are relatively insensitive to chemical stimuli and appear to correlate to the rapidly adapting receptors identified in airways in vivo. Their site of origin also differs: upper airway C-fibres arise predominantly from the jugular ganglion and Adelta-fibres from the jugular and nodose ganglia. Intracellular recording from cell bodies in the ganglia has revealed a calcium-dependent potassium current common to many putative C-fibre cell bodies. This slow after hyperpolarisation current may be inhibited by stimuli that excite and sensitise C-fibres - this could be an important mechanism underlying the sensitisation of C-fibres in airway irritability.

  8. Airway malacia in children with achondroplasia.

    PubMed

    Dessoffy, Kimberly E; Modaff, Peggy; Pauli, Richard M

    2014-02-01

    This study was undertaken to assess the frequency of airway malacia in infants and young children with achondroplasia, a population well known to be at risk for a variety of respiratory problems. We also wished to evaluate what, if any, contribution airway malacia makes to the complex respiratory issues that may be present in those with achondroplasia. Retrospective chart review of all infants and young children with achondroplasia who were assessed through the Midwest Regional Bone Dysplasia Clinics from 1985 through 2012 (n = 236) was completed. Records of comprehensive clinical examinations, polysomnographic assessments, and airway visualization were reviewed and abstracted using a data collection form. Analyses were completed comparing the group with and those without evidence for airway malacia. Thirteen of 236 patients (5.5%) were found to have airway malacia. Most of those affected had lower airway involvement (9/13). The presence of airway malacia was correlated with an increased occurrence of obstructive sleep apnea as well as need for oxygen supplementation, airway surgeries and tracheostomy placement. Although estimates of the frequency of airway malacia in the general population are limited, its frequency in children with achondroplasia appears to be much higher than any published general population estimate. The presence of airway malacia appears to confound other breathing abnormalities in this population and results in the need for more invasive airway treatments.

  9. Native Small Airways Secrete Bicarbonate

    PubMed Central

    Quinton, Paul M.

    2014-01-01

    Since the discovery of Cl− impermeability in cystic fibrosis (CF) and the cloning of the responsible channel, CF pathology has been widely attributed to a defect in epithelial Cl− transport. However, loss of bicarbonate (HCO3−) transport also plays a major, possibly more critical role in CF pathogenesis. Even though HCO3− transport is severely affected in the native pancreas, liver, and intestines in CF, we know very little about HCO3− secretion in small airways, the principle site of morbidity in CF. We used a novel, mini-Ussing chamber system to investigate the properties of HCO3− transport in native porcine small airways (∼ 1 mm φ). We assayed HCO3− transport across small airway epithelia as reflected by the transepithelial voltage, conductance, and equivalent short-circuit current with bilateral 25-mM HCO3− plus 125-mM NaGlu Ringer’s solution in the presence of luminal amiloride (10 μM). Under these conditions, because no major transportable anions other than HCO3− were present, we took the equivalent short-circuit current to be a direct measure of active HCO3− secretion. Applying selective agonists and inhibitors, we show constitutive HCO3− secretion in small airways, which can be stimulated significantly by β-adrenergic– (cAMP) and purinergic (Ca2+) -mediated agonists, independently. These results indicate that two separate components for HCO3− secretion, likely via CFTR- and calcium-activated chloride channel–dependent processes, are physiologically regulated for likely roles in mucus clearance and antimicrobial innate defenses of small airways. PMID:24224935

  10. Sarcoidosis of the upper and lower airways.

    PubMed

    Morgenthau, Adam S; Teirstein, Alvin S

    2011-12-01

    Sarcoidosis is a systemic granulomatous disease of undetermined etiology characterized by a variable clinical presentation and disease course. Although clinical granulomatous inflammation may occur within any organ system, more than 90% of sarcoidosis patients have lung disease. Sarcoidosis is considered an interstitial lung disease that is frequently characterized by restrictive physiologic dysfunction on pulmonary function tests. However, sarcoidosis also involves the airways (large and small), causing obstructive airways disease. It is one of a few interstitial lung diseases that affects the entire length of the respiratory tract - from the nose to the terminal bronchioles - and causes a broad spectrum of airways dysfunction. This article examines airway dysfunction in sarcoidosis. The anatomical structure of the airways is the organizational framework for our discussion. We discuss sarcoidosis involving the nose, sinuses, nasal passages, larynx, trachea, bronchi and small airways. Common complications of airways disease, such as, atelectasis, fibrosis, bullous leions, bronchiectasis, cavitary lesions and mycetomas, are also reviewed.

  11. Masking property of quantum random cipher with phase mask encryption

    NASA Astrophysics Data System (ADS)

    Sohma, Masaki; Hirota, Osamu

    2014-10-01

    The security analysis of physical encryption protocol based on coherent pulse position modulation (CPPM) originated by Yuen is one of the most interesting topics in the study of cryptosystem with a security level beyond the Shannon limit. Although the implementation of CPPM scheme has certain difficulty, several methods have been proposed recently. This paper deals with the CPPM encryption in terms of symplectic transformation, which includes a phase mask encryption as a special example, and formulates a unified security analysis for such encryption schemes. Specifically, we give a lower bound of Eve's symbol error probability using reliability function theory to ensure that our proposed system exceeds the Shannon limit. Then we assume the secret key is given to Eve after her heterodyne measurement. Since this assumption means that Eve has a great advantage in the sense of the conventional cryptography, the lower bound of her error indeed ensures the security level beyond the Shannon limit. In addition, we show some numerical examples of the security performance.

  12. Airway remodeling in asthma: what really matters.

    PubMed

    Fehrenbach, Heinz; Wagner, Christina; Wegmann, Michael

    2017-03-01

    Airway remodeling is generally quite broadly defined as any change in composition, distribution, thickness, mass or volume and/or number of structural components observed in the airway wall of patients relative to healthy individuals. However, two types of airway remodeling should be distinguished more clearly: (1) physiological airway remodeling, which encompasses structural changes that occur regularly during normal lung development and growth leading to a normal mature airway wall or as an acute and transient response to injury and/or inflammation, which ultimately results in restoration of a normal airway structures; and (2) pathological airway remodeling, which comprises those structural alterations that occur as a result of either disturbed lung development or as a response to chronic injury and/or inflammation leading to persistently altered airway wall structures and function. This review will address a few major aspects: (1) what are reliable quantitative approaches to assess airway remodeling? (2) Are there any indications supporting the notion that airway remodeling can occur as a primary event, i.e., before any inflammatory process was initiated? (3) What is known about airway remodeling being a secondary event to inflammation? And (4), what can we learn from the different animal models ranging from invertebrate to primate models in the study of airway remodeling? Future studies are required addressing particularly pheno-/endotype-specific aspects of airway remodeling using both endotype-specific animal models and "endotyped" human asthmatics. Hopefully, novel in vivo imaging techniques will be further advanced to allow monitoring development, growth and inflammation of the airways already at a very early stage in life.

  13. Endoscopic laryngeal patterns in vagus nerve stimulation therapy for drug-resistant epilepsy.

    PubMed

    Felisati, Giovanni; Gardella, Elena; Schiavo, Paolo; Saibene, Alberto Maria; Pipolo, Carlotta; Bertazzoli, Manuela; Chiesa, Valentina; Maccari, Alberto; Franzini, Angelo; Canevini, Maria Paola

    2014-01-01

    In 30% of patients with epilepsy seizure control cannot be achieved with medications. When medical therapy is not effective, and epilepsy surgery cannot be performed, vagus nerve stimulator (VNS) implantation is a therapeutic option. Laryngeal patterns in vagus nerve stimulation have not been extensively studied yet. The objective was to evaluate laryngeal patterns in a cohort of patients affected by drug-resistant epilepsy after implantation and activation of a vagus nerve stimulation therapy device. 14 consecutive patients underwent a systematic otolaryngologic examination between 6 months and 5 years after implantation and activation of a vagus nerve stimulation therapy device. All patients underwent fiberoptic endoscopic evaluation, which was recorded on a portable device allowing a convenient slow-motion analysis of laryngeal patterns. All recordings were blindly evaluated by two of the authors. We observed three different laryngeal patterns. Four patients showed left vocal cord palsy at the baseline and during vagus nerve stimulation; seven showed left vocal cord palsy at the baseline and left vocal cord adduction during vagus nerve stimulation; and three patients showed a symmetric pattern at the baseline and constant left vocal cord adduction during vagus nerve stimulation. These laryngeal findings are here described for the first time in the literature and can be only partially explained by existing knowledge of laryngeal muscles and vagus nerve physiology. This might represent a new starting point for studies concerning laryngeal physiology and phonation, while the vagus nerve stimulation therapy could act as a new and ethical experimental model for human laryngeal physiology.

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

    ERIC Educational Resources Information Center

    Huber, Jessica E.; Stathopoulos, Elaine T.

    2003-01-01

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

  15. Laryngeal reflex mechanism during deglutition--observation of subglottal pressure and afferent discharge.

    PubMed

    Shin, T; Maeyama, T; Morikawa, I; Umezaki, T

    1988-11-01

    In this investigation, particular attention was paid to elucidate the laryngeal reflex mechanism of protective closure and the sensory function of the larynx during deglutition. For this purpose, three different experimental procedures were adopted: (1) subglottal pressure of felines was measured during deglutition using a pressure transducer; (2) subglottal pressure of human beings was measured during deglutition using a pressure transducer; and (3) afferent discharges from superior and recurrent laryngeal nerves of felines were recorded. The following conclusions appear justified. (1) Feline and human subglottal pressure during deglutition showed the following pattern. The pressure rises with onset of deglutition, temporarily drops during laryngeal elevation, rises again during the downward movement of the larynx, and drops again at the end of the glutition. This pattern was not affected by the resection of the unilateral recurrent laryngeal nerve. (2) The superior laryngeal nerve is involved in the sensory function of the pharynx, larynx, and trachea. At least two types of afferent discharges from superficial and internal sensory nerves are suspected. Afferent discharges from the recurrent laryngeal nerves in the larynx and trachea are not as distinct as those of the superior laryngeal nerve, and this seems to correspond with various changes in the thorax. During deglutition, afferent discharges were recorded from superior to recurrent laryngeal nerves.

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

    PubMed

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

    2014-11-01

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

  17. Laryngeal cryptococcus: a rare cause of hoarseness in renal allograft recipient

    PubMed Central

    Sandhu, Jashan; Sandhu, Jasvinder Singh; Kaur Puri, Harpreet; Munjal, Manish

    2017-01-01

    Cryptococcosis commonly involves central nervous system and lungs in organ transplant recipients. Isolated laryngeal infection is extremely rare. We report a rare case of cryptococcus in a renal allograft recipient that clinically presented with hoarseness of voice and mimicked laryngeal carcinoma on examination. PMID:28197527

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

    ERIC Educational Resources Information Center

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

    2014-01-01

    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 /?/…

  19. Association between XRCC3 Thr241Met polymorphism and laryngeal cancer susceptibility in Turkish population.

    PubMed

    Mutlu, Pelin; Mutlu, Murad; Yalçın, Serap; Yaylacı, Atılay; Ünsoy, Gözde; Saylam, Güleser; Akın, İstemihan; Gündüz, Ufuk; Korkmaz, Hakan

    2015-12-01

    DNA repair systems are essential for normal cell function. Genetic alterations in the DNA repair genes such as X-ray repair cross-complementing group 3 (XRCC3), can cause a change in protein activity which results in cancer susceptibility. The aim of this study was to investigate the association of XRCC3 Thr241Met single nucleotide polymorphism (SNP), smoking and alcohol consumption with the risk of laryngeal cancer in Turkish population. The frequencies of Thr241Met SNP were studied in 58 laryngeal cancer cases (SSC) and 67 healthy individuals. Genomic DNA was isolated from peripheral blood samples of both controls and laryngeal cancer cases. Thr241Met SNP was genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The genotype and allele frequencies of Thr241Met polymorphism were not statistically significant between the laryngeal cancer and control groups. Carrying mutant allele was not associated with the risk of laryngeal cancer. On the other hand, smoking and chronic alcohol consumption were associated with the risk of laryngeal cancer but there is no association between Thr241Met, smoking and alcohol consumption in laryngeal cancer cases. These results indicate that Thr241Met polymorphism was not associated with the development of laryngeal cancer in Turkish population. However, it should be kept in mind that the association of a polymorphism with cancer susceptibility can differ due to several factors such as cancer type, selection criteria, ethnic differences and size of the studied population.

  20. The Sensitivity of Coded Mask Telescopes

    NASA Technical Reports Server (NTRS)

    Skinner, Gerald K.

    2008-01-01

    Simple formulae are often used to estimate the sensitivity of coded mask X-ray or gamma-ray telescopes, but t,hese are strictly only applicable if a number of basic assumptions are met. Complications arise, for example, if a grid structure is used to support the mask elements, if the detector spatial resolution is not good enough to completely resolve all the detail in the shadow of the mask or if any of a number of other simplifying conditions are not fulfilled. We derive more general expressions for the Poisson-noise-limited sensitivity of astronomical telescopes using the coded mask technique, noting explicitly in what circumstances they are applicable. The emphasis is on using nomenclature and techniques that result in simple and revealing results. Where no convenient expression is available a procedure is given which allows the calculation of the sensitivity. We consider certain aspects of the optimisation of the design of a coded mask telescope and show that when the detector spatial resolution and the mask to detector separation are fixed, the best source location accuracy is obtained when the mask elements are equal in size to the detector pixels.

  1. Achievements and challenges of EUV mask imaging

    NASA Astrophysics Data System (ADS)

    Davydova, Natalia; van Setten, Eelco; de Kruif, Robert; Connolly, Brid; Fukugami, Norihito; Kodera, Yutaka; Morimoto, Hiroaki; Sakata, Yo; Kotani, Jun; Kondo, Shinpei; Imoto, Tomohiro; Rolff, Haiko; Ullrich, Albrecht; Lammers, Ad; Schiffelers, Guido; van Dijk, Joep

    2014-07-01

    The impact of various mask parameters on CDU combined in a total mask budget is presented, for 22 nm lines, for reticles used for NXE:3300 qualification. Apart from the standard mask CD measurements, actinic spectrometry of multilayer is used to qualify reflectance uniformity over the image field; advanced 3D metrology is applied for absorber profile characterization including absorber height and side wall angle. The predicted mask impact on CDU is verified using actual exposure data collected on multiple NXE:3300 scanners. Mask 3D effects are addressed, manifesting themselves in best focus shifts for different structures exposed with off-axis illumination. Experimental NXE:3300 results for 16 nm dense lines and 20 nm (semi-)isolated spaces are shown: best focus range reaches 24 nm. A mitigation strategy by absorber height optimization is proposed based on experimental results of a special mask with varying absorber heights. Further development of a black image border for EUV mask is considered. The image border is a pattern free area surrounding image field preventing exposure the image field neighborhood on wafer. Normal EUV absorber is not suitable for this purpose as it has 1-3% EUV reflectance. A current solution is etching of ML down to substrate reducing EUV reflectance to <0.05%. A next step in the development of the black border is the reduction of DUV Out-of-Band reflectance (<1.5%) in order to cope with DUV light present in EUV scanners. Promising results achieved in this direction are shown.

  2. Mask Fabrication Using Electron Beam Exposure System

    NASA Astrophysics Data System (ADS)

    Watakabe, Y.; Shigetomi, A.; Morimoto, H.; Kato, T.

    1981-07-01

    This study describes the results of feature size distribution, pattern location accuracy and level to level registration error on chrominum master masks fabricated by EeBES-40. This system has the capability of high speed electron beam blanking at 40MHz, the capacity for large size masks (with 6 inch mask cassette), and the automatic cassette handling system. OEBR-100(PGMA), as the electron beam negative resist, is used for 5 inch and 6 inch chrominum masks. The chrominum etching process is used for both wet and dry plasma technology. Test patterns and 64 K bit memory TEG, as the practical pattern, are used in this study. More than 40 measurements are taken, uniformly distributed over 96 to 112mm square, and the feature size distribution is measured by a laser interferometer X-Y measuring system. Pattern location accuracy and level to level registration error are obtained using EeBES-40 quality assurance programs called MARKET/PLOTMARKET. This program operates by scanning over the resist image of the test pattern, utilizing the normal fiducial mark location hardware. The followinc results are obtained; (1) Feature size distribution within 6 inch mask : -/+0.1 μm (2) Level-to-level registration error2 : less than 0.1 pm High quality masks with about 0.02 defects/cm2 , and rapid throughput of 6 hr./10 masks using the auto-matic 10-cassette handling system are obtained.

  3. Reflective masks for extreme ultraviolet lithography

    SciTech Connect

    Nguyen, Khanh Bao

    1994-05-01

    Extreme ultraviolet lithographic masks are made by patterning multilayer reflective coatings with high normal incidence reflectivity. Masks can be patterned by depositing a patterned absorber layer above the coating or by etching the pattern directly into the coating itself. Electromagnetic simulations showed that absorber-overlayer masks have superior imaging characteristics over etched masks (less sensitive to incident angles and pattern profiles). In an EUVL absorber overlayer mask, defects can occur in the mask substrate, reflective coating, and absorber pattern. Electromagnetic simulations showed that substrate defects cause the most severe image degradation. A printability study of substrate defects for absorber overlayer masks showed that printability of 25 nm high substrate defects are comparable to defects in optical lithography. Simulations also indicated that the manner in which the defects are covered by multilayer reflective coatings can affect printability. Coverage profiles that result in large lateral spreading of defect geometries amplify the printability of the defects by increasing their effective sizes. Coverage profiles of Mo/Si coatings deposited above defects were studied by atomic force microscopy and TEM. Results showed that lateral spread of defect geometry is proportional to height. Undercut at defect also increases the lateral spread. Reductions in defect heights were observed for 0.15 μm wide defect lines. A long-term study of Mo/Si coating reflectivity revealed that Mo/Si coatings with Mo as the top layer suffer significant reductions in reflectivity over time due to oxidation.

  4. Intact crowding and temporal masking in dyslexia.

    PubMed

    Doron, Adi; Manassi, Mauro; Herzog, Michael H; Ahissar, Merav

    2015-01-01

    Phonological deficits in dyslexia are well documented. However, there is an ongoing discussion about whether visual deficits limit the reading skills of people with dyslexia. Here, we investigated visual crowding and backward masking. We presented a Vernier (i.e., two vertical bars slightly offset to the left or right) and asked observers to indicate the offset direction. Vernier stimuli are visually similar to letters and are strongly affected by crowding, even in the fovea. To increase task difficulty, Verniers are often followed by a mask (i.e., backward masking). We measured Vernier offset discrimination thresholds for the basic Vernier task, under crowding, and under backward masking, in students with dyslexia (n = 19) and age and intelligence matched students (n = 27). We found no group differences in any of these conditions. Controls with fast visual processing (good backward masking performance), were faster readers. By contrast, no such correlation was found among the students with dyslexia, suggesting that backward masking does not limit their reading efficiency. These findings indicate that neither elevated crowding nor elevated backward masking pose a bottleneck to reading skills of people with dyslexia.

  5. The effect of Le Fort I maxillary impaction on nasal airway resistance.

    PubMed

    Guenthner, T A; Sather, A H; Kern, E B

    1984-04-01

    To evaluate the effect of maxillary superior movement via Le Fort I osteotomy on nasal airway resistance, eleven Caucasian patients whose surgical orthodontic treatment included Le Fort I impaction (range 2 to 8 mm, mean 5.3 mm) were selected. Nasal airway resistance in these patients was determined a few days before and approximately 8 weeks after the Le Fort I surgical procedure. Nasal airway resistance was determined by means of a uninasal active mask rhinomanometric technique. Contrary to the predicted negative effects of maxillary superior movement on nasal airway function, there was a statistically significant improvement in nasal airway resistance (P less than 0.01) after maxillary superior movement. This rather unexpected finding can be explained by examining the effect of maxillary superior movement on the nasal valve area in the anterior nose. The nasal valve area is a teardrop-shaped area bordered by the nasal septum, the caudal end of the upper lateral nasal cartilage, the floor of the nose, and the soft fibrofatty tissue on the lateral aspect of the nose. The apex of the teardrop-shaped area (the angle between the nasal septum and the upper lateral cartilage) is called the nasal valve. In the Caucasian type of nose, the nasal valve accounts for most of the inspiratory resistance to airflow. Maxillary superior movement increases the alar width. It is proposed that this increase in alar width is transmitted at least partially to the nasal valve angle, causing it to widen slightly, paradoxically reducing nasal airway resistance while reducing skeletal intranasal dimensions.

  6. Integrated care pathways for airway diseases (AIRWAYS-ICPs).

    PubMed

    Bousquet, J; Addis, A; Adcock, I; Agache, I; Agusti, A; Alonso, A; Annesi-Maesano, I; Anto, J M; Bachert, C; Baena-Cagnani, C E; Bai, C; Baigenzhin, A; Barbara, C; Barnes, P J; Bateman, E D; Beck, L; Bedbrook, A; Bel, E H; Benezet, O; Bennoor, K S; Benson, M; Bernabeu-Wittel, M; Bewick, M; Bindslev-Jensen, C; Blain, H; Blasi, F; Bonini, M; Bonini, S; Boulet, L P; Bourdin, A; Bourret, R; Bousquet, P J; Brightling, C E; Briggs, A; Brozek, J; Buhl, R; Bush, A; Caimmi, D; Calderon, M; Calverley, P; Camargos, P A; Camuzat, T; Canonica, G W; Carlsen, K H; Casale, T B; Cazzola, M; Cepeda Sarabia, A M; Cesario, A; Chen, Y Z; Chkhartishvili, E; Chavannes, N H; Chiron, R; Chuchalin, A; Chung, K F; Cox, L; Crooks, G; Crooks, M G; Cruz, A A; Custovic, A; Dahl, R; Dahlen, S E; De Blay, F; Dedeu, T; Deleanu, D; Demoly, P; Devillier, P; Didier, A; Dinh-Xuan, A T; Djukanovic, R; Dokic, D; Douagui, H; Dubakiene, R; Eglin, S; Elliot, F; Emuzyte, R; Fabbri, L; Fink Wagner, A; Fletcher, M; Fokkens, W J; Fonseca, J; Franco, A; Frith, P; Furber, A; Gaga, M; Garcés, J; Garcia-Aymerich, J; Gamkrelidze, A; Gonzales-Diaz, S; Gouzi, F; Guzmán, M A; Haahtela, T; Harrison, D; Hayot, M; Heaney, L G; Heinrich, J; Hellings, P W; Hooper, J; Humbert, M; Hyland, M; Iaccarino, G; Jakovenko, D; Jardim, J R; Jeandel, C; Jenkins, C; Johnston, S L; Jonquet, O; Joos, G; Jung, K S; Kalayci, O; Karunanithi, S; Keil, T; Khaltaev, N; Kolek, V; Kowalski, M L; Kull, I; Kuna, P; Kvedariene, V; Le, L T; Lodrup Carlsen, K C; Louis, R; MacNee, W; Mair, A; Majer, I; Manning, P; de Manuel Keenoy, E; Masjedi, M R; Melen, E; Melo-Gomes, E; Menzies-Gow, A; Mercier, G; Mercier, J; Michel, J P; Miculinic, N; Mihaltan, F; Milenkovic, B; Molimard, M; Momas, I; Montilla-Santana, A; Morais-Almeida, M; Morgan, M; N'Diaye, M; Nafti, S; Nekam, K; Neou, A; Nicod, L; O'Hehir, R; Ohta, K; Paggiaro, P; Palkonen, S; Palmer, S; Papadopoulos, N G; Papi, A; Passalacqua, G; Pavord, I; Pigearias, B; Plavec, D; Postma, D S; Price, D; Rabe, K F; Radier Pontal, F; Redon, J; Rennard, S; Roberts, J; Robine, J M; Roca, J; Roche, N; Rodenas, F; Roggeri, A; Rolland, C; Rosado-Pinto, J; Ryan, D; Samolinski, B; Sanchez-Borges, M; Schünemann, H J; Sheikh, A; Shields, M; Siafakas, N; Sibille, Y; Similowski, T; Small, I; Sola-Morales, O; Sooronbaev, T; Stelmach, R; Sterk, P J; Stiris, T; Sud, P; Tellier, V; To, T; Todo-Bom, A; Triggiani, M; Valenta, R; Valero, A L; Valiulis, A; Valovirta, E; Van Ganse, E; Vandenplas, O; Vasankari, T; Vestbo, J; Vezzani, G; Viegi, G; Visier, L; Vogelmeier, C; Vontetsianos, T; Wagstaff, R; Wahn, U; Wallaert, B; Whalley, B; Wickman, M; Williams, D M; Wilson, N; Yawn, B P; Yiallouros, P K; Yorgancioglu, A; Yusuf, O M; Zar, H J; Zhong, N; Zidarn, M; Zuberbier, T

    2014-08-01

    The objective of Integrated Care Pathways for Airway Diseases (AIRWAYS-ICPs) is to launch a collaboration to develop multi-sectoral care pathways for chronic respiratory diseases in European countries and regions. AIRWAYS-ICPs has strategic relevance to the European Union Health Strategy and will add value to existing public health knowledge by: 1) proposing a common framework of care pathways for chronic respiratory diseases, which will facilitate comparability and trans-national initiatives; 2) informing cost-effective policy development, strengthening in particular those on smoking and environmental exposure; 3) aiding risk stratification in chronic disease patients, using a common strategy; 4) having a significant impact on the health of citizens in the short term (reduction of morbidity, improvement of education in children and of work in adults) and in the long-term (healthy ageing); 5) proposing a common simulation tool to assist physicians; and 6) ultimately reducing the healthcare burden (emergency visits, avoidable hospitalisations, disability and costs) while improving quality of life. In the longer term, the incidence of disease may be reduced by innovative prevention strategies. AIRWAYSICPs was initiated by Area 5 of the Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing. All stakeholders are involved (health and social care, patients, and policy makers).

  7. When Bad Masks Turn Good

    NASA Astrophysics Data System (ADS)

    Abraham, Roberto G.

    In keeping with the spirit of a meeting on ‘masks,' this talk presents two short stories on the theme of dust. In the first, dust plays the familiar role of the evil obscurer, the enemy to bedefeated by the cunning observer in order to allow a key future technology (adaptive optics) to be exploited fully by heroic astronomers. In the second story, dust itself emerges as the improbable hero, in the form of a circumstellar debris disks. I will present evidence of a puzzling near-infrared excess in the continuum of high-redshift galaxies and will argue that the seemingly improbable origin of this IR excess is a population of young circumstellar disks formed around high-mass stars in distant galaxies. Assuming circumstellar disks extend down to lower masses,as they do in our own Galaxy, the excess emission presents us with an exciting opportunity to measure the formation rate of planetary systems in distant galaxies at cosmic epochs before our own solar system formed.

  8. Investigation of EUV haze defect: molecular behaviors of mask cleaning chemicals on EUV mask surfaces

    NASA Astrophysics Data System (ADS)

    Choi, Jaehyuck; Novak, Steve; Kandel, Yudhishthir; Denbeaux, Greg; Lee, Han-shin; Ma, Andy; Goodwin, Frank

    2012-03-01

    Photo-induced defects (or haze defects) on 193nm optic masks (haze defects) have been a serious problem not only to reticle engineers working for mask manufacturing and handling but also to photo-lithography engineers. The most widely accepted explanation of the root causes of haze defects is the cleaning chemical residues remaining on the mask surface and unavoidable outgassed molecules that outgas from pellicle materials when exposed to 193nm radiation. These have been significant challenges for reticle cleaning engineers who need to use cleaning chemicals whose residues do not lead to progressive defect formation on the mask and to find improved materials to minimize pellicle outgassing. It is assumed that contamination generation on EUV masks would have a higher probability than on optic masks, primarily since EUV masks are not protected by a pellicle and amorphous carbon films can accumulate during exposure to EUV light. While there is potential to mitigate the generation of carbon contamination by improving the exposure tool environment and removing carbon films using in-situ atomic hydrogen cleaning, it is not yet clear whether the reaction of mask cleaning chemicals to EUV radiation will lead to creation of progressive defects on EUV mask surfaces. With the work to being done it has been observed that carbon contamination on EUV masks dominates any effects of solvent chemicals under normal environmental or exposure conditions (from atmospheric pressure up to a vacuum level of 10-6 Torr) during EUV exposure. However, it is still unknown whether residual cleaning chemicals will provide a nucleus for progressive defect formation during exposure. This lack of understanding needs to be addressed by the industry as EUV masks are expected to undergo more frequent cleaning cycles. In this work, we will report on an investigation of the molecular behavior of cleaning chemicals on EUV mask surfaces during EUV exposure. Movement (e.g., migration or aggregation) of

  9. Generation of Pig Airways using Rules Developed from the Measurements of Physical Airways

    PubMed Central

    Azad, Md Khurshidul; Mansy, Hansen A.

    2017-01-01

    Background A method for generating bronchial tree would be helpful when constructing models of the tree for benchtop experiments as well as for numerical modeling of flow or sound propagation in the airways. Early studies documented the geometric details of the human airways that were used to develop methods for generating human airway tree. However, methods for generating animal airway tree are scarcer. Earlier studies suggested that the morphology of animal airways can be significantly different from that of humans. Hence, using algorithms for the human airways may not be accurate in generating models of animal airway geometry. Objective The objective of this study is to develop an algorithm for generating pig airway tree based on the geometric details extracted from the physical measurements. Methods In the current study, measured values of branch diameters, lengths and bifurcation angles and rotation of bifurcating planes were used to develop an algorithm that is capable of generating a realistic pig airway tree. Results The generation relations between parent and daughter branches were found to follow certain trends. The diameters and the length of different branches were dependent on airway generations while the bifurcation angles were primarily dependent on bifurcation plane rotations. These relations were sufficient to develop rules for generating a model of the pig large airways. Conclusion The results suggested that the airway tree generated from the algorithm can provide an approximate geometric model of pig airways for computational and benchtop studies. PMID:28255517

  10. A study of defects on EUV mask using blank inspection, patterned mask inspection, and wafer inspection

    SciTech Connect

    Huh, S.; Ren, L.; Chan, D.; Wurm, S.; Goldberg, K. A.; Mochi, I.; Nakajima, T.; Kishimoto, M.; Ahn, B.; Kang, I.; Park, J.-O.; Cho, K.; Han, S.-I.; Laursen, T.

    2010-03-12

    The availability of defect-free masks remains one of the key challenges for inserting extreme ultraviolet lithography (EUVL) into high volume manufacturing. yet link data is available for understanding native defects on real masks. In this paper, a full-field EUV mask is fabricated to investigate the printability of various defects on the mask. The printability of defects and identification of their source from mask fabrication to handling were studied using wafer inspection. The printable blank defect density excluding particles and patterns is 0.63 cm{sup 2}. Mask inspection is shown to have better sensitivity than wafer inspection. The sensitivity of wafer inspection must be improved using through-focus analysis and a different wafer stack.

  11. Recent trends in airway management

    PubMed Central

    Karlik, Joelle; Aziz, Michael

    2017-01-01

    Tracheal intubation remains a life-saving procedure that is typically not difficult for experienced providers in routine conditions. Unfortunately, difficult intubation remains challenging to predict and intubation conditions may make the event life threatening. Recent technological advances aim to further improve the ease, speed, safety, and success of intubation but have not been fully investigated. Video laryngoscopy, though proven effective in the difficult airway, may result in different intubation success rates in various settings and in different providers’ hands. The rescue surgical airway remains a rarely used but critical skill, and research continues to investigate optimal techniques. This review highlights some of the new thoughts and research on these important topics. PMID:28299194

  12. Active Mask Segmentation of Fluorescence Microscope Images

    PubMed Central

    Srinivasa, Gowri; Fickus, Matthew C.; Guo, Yusong; Linstedt, Adam D.; Kovačević, Jelena

    2009-01-01

    We propose a new active mask algorithm for the segmentation of fluorescence microscope images of punctate patterns. It combines the (a) flexibility offered by active-contour methods, (b) speed offered by multiresolution methods, (c) smoothing offered by multiscale methods, and (d) statistical modeling offered by region-growing methods into a fast and accurate segmentation tool. The framework moves from the idea of the “contour” to that of “inside and outside”, or, masks, allowing for easy multidimensional segmentation. It adapts to the topology of the image through the use of multiple masks. The algorithm is almost invariant under initialization, allowing for random initialization, and uses a few easily tunable parameters. Experiments show that the active mask algorithm matches the ground truth well, and outperforms the algorithm widely used in fluorescence microscopy, seeded watershed, both qualitatively as well as quantitatively. PMID:19380268

  13. Masking properties of APD communication systems

    NASA Astrophysics Data System (ADS)

    Fernandez, J. G.; Larrondo, H. A.; Slavin, H. A.; Levin, D. G.; Hidalgo, R. M.; Rivera, R. R.

    2003-10-01

    In this paper, we explore the ability of wavelet multilevel analysis to unmask the information hidden in a chaotic mask. This digital filtering technique has been recently reported as particularly well suited for the detection of coherent structures. In a recent paper the capability of wavelets to unmask a message, in cases where a chaotic signal is just added to the information, has also been demonstrated. The case of an active passive decomposition scheme, where message is mixed with the chaotic signal, is studied here. A representative case employing Daubechies wavelets and a typical Rossler-oscillator-based communication system is reported. Using a time scaling parameter modifies the spectrum of the mask. The results show that wavelets are effective only in particular cases with poor masking. The fast Fourier transform analysis demonstrates that the spectrum of the chaotic mask shows no holes and then other digital filtering techniques such as Wiener filters or comb filters must also been disregarded.

  14. Xanthohumol inhibits proliferation of laryngeal squamous cell carcinoma.

    PubMed

    Li, Yan; Wang, Kai; Yin, Shankai; Zheng, Hongliang; Min, Daliu

    2016-12-01

    Xanthohumol is a flavonoid compound that exhibits antioxidant and anticancer effects, and is used to treat atherosclerosis. The aim of the present study was to investigate the effect of xanthohumol on the cell proliferation of laryngeal squamous cell carcinoma and to understand the mechanism of its action. The effects of xanthohumol on the cell viability and apoptosis rate of laryngeal squamous cell carcinoma SCC4 cells were assessed by Annexin V-fluorescein isothiocyanate/propidium iodide staining. In addition, the expression levels of pro-apoptotic proteins, caspase-3, caspase-8, caspase-9, poly ADP ribose polymerase (PARP) p53 and apoptosis-inducing factor (AIF), as well as anti-apoptotic markers, B-cell lymphoma 2 (Bcl-2) and myeloid cell leukemia 1 (Mcl-1), were analyzed by western blotting. The results revealed that treatment with 40 µM xanthohumol significantly inhibited the proliferation of SCC4 cells. Furthermore, xanthohumol treatment (40 µM) induced SCC4 cell apoptosis, as indicated by the significant increase in activity and expression of caspase-3, caspase-8, caspase-9, PARP, p53 and AIF. By contrast, the protein expression of Bcl-2 and Mcl-1 was significantly decreased following treatment with 40 µM xanthohumol. Taken together, the results of the present study indicated that xanthohumol mediates growth suppression and apoptosis induction, which was mediated via the suppression of Bcl-2 and Mcl-1 and activation of PARP, p53 and AIF signaling pathways. Therefore, future studies that investigate xanthohumol as a potential therapeutic agent for laryngeal squamous cell carcinoma are required.

  15. Xanthohumol inhibits proliferation of laryngeal squamous cell carcinoma

    PubMed Central

    Li, Yan; Wang, Kai; Yin, Shankai; Zheng, Hongliang; Min, Daliu

    2016-01-01

    Xanthohumol is a flavonoid compound that exhibits antioxidant and anticancer effects, and is used to treat atherosclerosis. The aim of the present study was to investigate the effect of xanthohumol on the cell proliferation of laryngeal squamous cell carcinoma and to understand the mechanism of its action. The effects of xanthohumol on the cell viability and apoptosis rate of laryngeal squamous cell carcinoma SCC4 cells were assessed by Annexin V-fluorescein isothiocyanate/propidium iodide staining. In addition, the expression levels of pro-apoptotic proteins, caspase-3, caspase-8, caspase-9, poly ADP ribose polymerase (PARP) p53 and apoptosis-inducing factor (AIF), as well as anti-apoptotic markers, B-cell lymphoma 2 (Bcl-2) and myeloid cell leukemia 1 (Mcl-1), were analyzed by western blotting. The results revealed that treatment with 40 µM xanthohumol significantly inhibited the proliferation of SCC4 cells. Furthermore, xanthohumol treatment (40 µM) induced SCC4 cell apoptosis, as indicated by the significant increase in activity and expression of caspase-3, caspase-8, caspase-9, PARP, p53 and AIF. By contrast, the protein expression of Bcl-2 and Mcl-1 was significantly decreased following treatment with 40 µM xanthohumol. Taken together, the results of the present study indicated that xanthohumol mediates growth suppression and apoptosis induction, which was mediated via the suppression of Bcl-2 and Mcl-1 and activation of PARP, p53 and AIF signaling pathways. Therefore, future studies that investigate xanthohumol as a potential therapeutic agent for laryngeal squamous cell carcinoma are required. PMID:28105237

  16. Efficacy of autofluoroscence videoendoscopy in the diagnosis of laryngeal lesions

    PubMed Central

    Saetti, R; Derosas, F; Silvestrini, M; Narne, S

    2007-01-01

    Summary Aim of this prospective preliminary study was to assess effectiveness and reliability of autofluorescence endoscopy in the diagnosis of laryngeal lesions, in particular, evaluating whether it could represent an improvement in comparison to standard endoscopy alone. A total of 81 laryngeal biopsy specimens, taken from 46 consecutive patients who underwent intra-operative endoscopic assessment in a period of 2 years, were examined. Thirteen patients underwent the procedure for presumed benign lesions; the other 33 cases for pre-operative endoscopic suspicion of pre-cancerous or cancerous lesions. In our experience, autofluorescence evaluation seemed to accurately delineate the limits of the tumour and the possible presence of second primary, proving a useful guide in the choice of sites to make a biopsy. In particular, this endoscopic method has proved to be characterized by higher sensitivity and specificity not inferior to standard endoscopy, both in the discrimination between benign and preneoplastic/neoplastic lesions and between pre-neoplastic and neoplastic. Correct choice of the application field is mandatory in order to obtain the maximum effectiveness of this method. Autofluorescence endoscopy, in fact, was found to be very useful in the evaluation of untreated tissues with suspected pre-cancerous or cancerous lesions. On the contrary, in the study of “frankly benign” laryngeal lesions, this exam does not improve upon the results obtained by standard endoscopy but increases the risk of false positives. The best results can be obtained only by integration of data provided by both white-light and accurate auto-fluorescence endoscopic assessment. PMID:17957848

  17. Myeloid sarcoma: An unusual and rare laryngeal presentation

    PubMed Central

    Tan, S.N.; Gendeh, H.S.; Sani, A.; Mat-Baki, M.

    2016-01-01

    Introduction Myeloid Sarcoma (MS) or Granulocytic Sarcoma is an uncommon laryngeal malignancy. It may arise from myelodysplastic syndromes, malignancy or de novo. Presentation in the larynx is rare and some may present with Acute Myeloid Leukaemia (AML) whereby the later may be asymptomatic. Case Presentation A 44-year-old South East Asian lady presented with a six months history of hoarseness, shortness of breath, reduced exercise tolerance, weight loss and laryngeal irritation. Symptoms progressed to coughing with liquids two months prior. On examination, she had a resting biphasic stridor and laryngoscopy revealed right immobile vocal cord with a firm right ventricle mass extending into the right paraglottic space. She was pale and haematology investigations revealed microcytic hypochromic anaemia. Magnetic Resonance Imaging (MRI) of the neck and thorax showed thickening of the right false cord, true cord and aryepiglottic fold. A biopsy taken during endolaryngeal microsurgery (ELMS) confirmed myeloid sarcoma of the right ventricle and para glottic mass. Further investigation revealed a background of AML and she then underwent chemotherapy. Discussion MS is a rarity with only nine reported cases between the years of 1954 until 2015. Immunohistochemistry and immunophenotyping are definite for diagnosis confirmation as MS cells often exhibit myeloperoxidase (MPO), lymphocyte common antigen (LCA) and CD117 markers. MS is treated with are chemotherapy (either systemic or intrathecal), radiotherapy, surgical excision or in combination. Systemic chemotherapy has better efficacy and prognosis as compared to localised treatment of radiotherapy or surgical excision. However, there has yet to be a definitive chemotherapy protocol. Prognosis is poor with a 5-year survival rate of 48%. Conclusion Although laryngeal MS is a rare phenomenon, early recognition is key and patients should always be investigated for an underlying myeloproliferative or dysplastic disease. PMID

  18. Correction of deflection under mask's own weight by bending mask technology

    NASA Astrophysics Data System (ADS)

    Yagami, Takashi; Kambayashi, Takashi; Azumi, Minako

    2016-10-01

    It is known that the photomask substrate deflects when the mask is set on the frame and the deflection is an obstacle to light exposure. In this study, we introduce "the bending mask" to cancel out the deflection. The surface of the bending mask has the height distribution in advance to cancel out the deflection, owing to Nikon's accurate polishing technology and Nikon's accurate measurement machine.

  19. Inspection of lithographic mask blanks for defects

    DOEpatents

    Sommargren, Gary E.

    2001-01-01

    A visible light method for detecting sub-100 nm size defects on mask blanks used for lithography. By using optical heterodyne techniques, detection of the scattered light can be significantly enhanced as compared to standard intensity detection methods. The invention is useful in the inspection of super-polished surfaces for isolated surface defects or particulate contamination and in the inspection of lithographic mask or reticle blanks for surface defects or bulk defects or for surface particulate contamination.

  20. Achromatic phase shifting focal plane masks

    NASA Astrophysics Data System (ADS)

    Newman, Kevin

    The search for life on other worlds is an exciting scientific endeavor that could change the way we perceive our place in the universe. Thousands of extrasolar planets have been discovered using indirect detection techniques. One of the most promising methods for discovering new exoplanets and searching for life is direct imaging with a coronagraph. Exoplanet coronagraphy of Earth-like planets is a challenging task, but we have developed many of the tools necessary to make it feasible. The Phase-Induced Amplitude Apodization (PIAA) Coronagraph is one of the highest-performing architectures for direct exoplanet imaging. With a complex phase-shifting focal plane mask, the PIAA Complex Mask Coronagraph (PIAACMC) can approach the theoretical performance limit for any direct detection technique. The architecture design is flexible enough to be applied to any arbitrary aperture shape, including segmented and obscured apertures. This is an important feature for compatibility with next-generation ground and space-based telescopes. PIAA and PIAACMC focal plane masks have been demonstrated in monochromatic light. An important next step for high-performance coronagraphy is the development of broadband phase-shifting focal plane masks. In this dissertation, we present an algorithm for designing the PIAA and PIAACMC focal plane masks to operate in broadband. We also demonstrate manufacturing of the focal plane masks, and show laboratory results. We use simulations to show the potential performance of the coronagraph system, and the use of wavefront control to correct for mask manufacturing errors. Given the laboratory results and simulations, we show new areas of exoplanet science that can potentially be explored using coronagraph technology. The main conclusion of this dissertation is that we now have the tools required to design and manufacture PIAA and PIAACMC achromatic focal plane masks. These tools can be applied to current and future telescope systems to enable new