We investigated the swallowing function of 21 patients with multiple system atrophy with a clinical predominance of cerebellar symptoms (MSA-C) by videofluoroscopy (VF). Twenty-six VF examinations ...were performed at various time points, and they were divided into three groups according to the duration following disease onset: Group A had 1 to 3 years following disease onset (the early stage of the disease), group B had 4 to 6 years following disease onset (the middle stage of the disease), and group C had more than 7 years following disease onset (the late stage of the disease). Swallowing function in the oral phase became gradually disturbed over the progression of MSA. Delayed bolus transport from the oral cavity to the pharynx was already seen in 50% of the patients in group A, and it was seen in more than 85% of the patients in group C. Bolus holding in the oral cavity was slightly disturbed in group A, but it was seen in 57% of the patients in group C. Our study shows that parkinsonism is related to swallowing dysfunction in MSA, but cerebellar dysfunction also affects coordination of the tongue; bolus transport in the oral cavity was disturbed in the early stage of disease. Progression of cerebellar dysfunction and overlapped parkinsonism will worsen tongue movement, and in the late stage of the disease, swallowing function of the oral phase (bolus transport and bolus holding) was remarkably disturbed. Swallowing function in the pharyngeal phase was not significantly correlated to the duration of the disease; however, our study showed that swallowing function in the pharyngeal phase was not assessed fully by VF examination in MSA-C only. Combination with other examinations, such as manometry and electromyography, may be useful, especially in the late stage of the disease. In addition, an analysis concerning the relationship between aspiration seen on VF examination and a history of aspiration pneumonia in MSA-C patients suggested that the sensory system at the larynx and trachea should also be assessed in patients in the late stage of MSA-C.
Objective To elucidate the time‐course changes of swallowing function in amyotrophic lateral sclerosis (ALS) by videomanofluorometry.
Study Design Videomanofluorometry was conducted on 21 patients ...with ALS, who were divided into five groups according to type of disease and according to the length of time following the appearance of bulbar symptoms.
Methods Videomanofluorometry, which is videofluoroscopic and manometric study conducted simultaneously, was performed on patients in the five groups, and swallowing function in each group was evaluated. Some of the patients were followed up by videomanofluorometry performed several times, and their swallowing function changes over time were investigated.
Results A decrease of swallowing pressure first appeared in the oropharynx, then the hypopharynx became involved. Oropharyngeal swallowing pressure had already decreased to approximately 50 mm Hg within 6 months after the appearance of bulbar symptoms; however, hypopharyngeal swallowing pressure was relatively maintained until 1 year after the onset of bulbar symptoms. Most of the patients with ALS maintained normal upper esophageal sphincter relaxation, but upper esophageal sphincter spasm was seen in some patients with ALS. Aspiration was seen in eight cases, five of which showed upper esophageal sphincter spasm.
Conclusions Patients with ALS gradually face the danger of aspiration as decreases of oropharyngeal and hypopharyngeal swallowing pressure progress. Upper esophageal sphincter spasm occurs in some patients with ALS, and it is an important cause of aspiration. Both videofluoroscopic and manometric evaluation are necessary to assess these conditions, and they are quite useful for follow‐up of swallowing function in patients with ALS.
The prognostic value of heart rate variability in patients with dilated cardiomyopathy (DCM) is limited and does not contribute to risk stratification although the dynamics of ventricular ...repolarization differs considerably between DCM patients and healthy subjects. Neither linear nor nonlinear methods of heart rate variability analysis could discriminate between patients at high and low risk for sudden cardiac death.
The aim of this study was to analyze the suitability of the new developed segmented Poincaré plot analysis (SPPA) to enhance risk stratification in DCM.
In contrast to the usual applied Poincaré plot analysis the SPPA retains nonlinear features from investigated beat-to-beat interval time series. Main features of SPPA are the rotation of cloud of points and their succeeded variability depended segmentation.
Significant row and column probabilities were calculated from the segments and led to discrimination (up to p<0.005) between low and high risk in DCM patients.
For the first time an index from Poincaré plot analysis of heart rate variability was able to contribute to risk stratification in patients suffering from DCM.
This paper focusses on the person identification problem based on features extracted from the ElectroEncephaloGram (EEG). A bilinear rather than a purely linear model is fitted on the EEG signal, ...prompted by the existence of non-linear components in the EEG signal--a conjecture already investigated in previous research works. The novelty of the present work lies in the comparison between the linear and the bilinear results, obtained from real field EEG data, aiming towards identification of healthy subjects rather than classification of pathological cases for diagnosis.
The EEG signal of a, in principle, healthy individual is processed via (non)linear (AR, bilinear) methods and classified by an artificial neural network classifier.
Experiments performed on real field data show that utilization of the bilinear model parameters as features improves correct classification scores at the cost of increased complexity and computations. Results are seen to be statistically significant at the 99.5% level of significance, via the chi 2 test for contingency.
The results obtained in the present study further corroborate existing research, which shows evidence that the EEG carries individual-specific information, and that it can be successfully exploited for purposes of person identification and authentication.
A clinical case of a patient in whom seizure developed after topical application of lidocaine to the oropharyngeal region was described. The exploratory studies on the optimal dosage of lidocaine in ...the surgery under laryngomicroscope was performed in 22 patients. During the application of 2% lidocaine viscous and 4% lidocaine solution to the oropharyngeal region, the patient was instructed to expectorate the excess intermittently to avoid absorption. In addition, the oropharyngeal region was swabbed with gauze. The serum lidocaine concentrations after application were less than 1.8 μg/ml. The total application dose of the drug was within the range of 324 to 640 mg, and the total recovery rate from the saliva and gauze was 52% to 81%. We found a good correlation between net application dose (total application dose minus excessive lidocaine dose) and serum lidocaine concentration. In this study, it was shown that the safe and effective net application dose of lidocaine for the surgery may be within the range of 127 to 260 mg.
Clinical Pharmacology & Therapeutics (1996) 60, 229–235; doi:
Active and passive characteristics of the canine adductor- abductor muscles were investigated through a series of experiments conducted in vitro. Samples of canine posterior cricoarytenoid muscle ...(PCA), lateral cricoarytenoid muscle (LCA), and interarytenoid muscle (IA) were dissected from dog larynges excised a few minutes before death and kept in Krebs-Ringer solution at a temperature of 37°C ± 1°C and a pH of 7.4 ± 0.05. Active twitch and tetanic force was obtained in an isometric condition by applying field stimulation to the muscle samples through a pair of parallel-plate platinum electrodes. Force and elongation of the samples were obtained electronically with a dual-servo system (ergometer). The results indicate that the twitch contraction times of the three muscles are very similar, with the average of 32 ± 1.9 ms for PCA, 29 ± 1.6 ms for LCA, and 32 ± 2.4 ms for IA across all elongations. Thus, PCA, LCA, and IA muscles are all faster than the cricothyroid (CT) muscles but slower than the thyroarytenoid (TA) muscles. The tetanic force response times of these muscles are also similar, with a maximum rate of force increase of 0.14 N/ms.
Descriptions of vocal fold lesions related to autoimmune diseases are rare in the literature, and focus mainly on rheumatoid nodules. This is the first report in which autoimmune diseases were ...promptly suspected by the observation of a unique white transverse submucosal lesion in the vocal fold during clinical examination. This lesion, reported only in autoimmune disease, has been called the bamboo node and its features are different from those of rheumatoid nodules. We report here on two patients who did not have a diagnosis of systemic disease before investigation of their main complaint of hoarseness. At the patients' first visit, vocal fold bamboo nodes were seen in the vocal fold and the otolaryngologist suspected the presence of an autoimmune disease. We requested clinical investigation to clarify our suspicion that there was an underlying systemic disease. After the investigation, both patients were shown to have autoimmune disease, Sjögren's syndrome and systemic lupus erythematous, respectively. This paper emphasizes the important role of the otolaryngologist in the detection of these unique lesions in the vocal folds through the conventional laryngeal methods. These methods consisted of direct observation with a rigid laryngeal endoscope and investigation of the patient's distinctive vibratory pattern by means of laryngeal stroboscopy. The method of treatment we used to obtain the best outcome in terms of voice improvement is also discussed.
The pyrophotosensor PPS with 1.0 /spl mu/m-thickness is a device utilizing the magnetic property of a thermally-sensitive ferrimagnetic thin film with low Curie temperature. The conventional ...photomagnetic semiconductor using a thick film with 55 /spl mu/m-thickness has a slow response and a large size, while the PPS is characterized by a quick pulse response and a high sensitivity. When light is radiated to the PPS, the PPS absorbs light energy which causes the reluctance change to the PPS. The reluctance change can be read out by a magnetoresistive element and it is converted into voltage of which the peak value grows with an increase in illuminance. The PPS is useful as a magnetic sensor as an alternative to electric photosensors.
Objectives/Hypothesis Many existing studies of vocal fold geometry are based on anatomical measurements made on histologically fixed laryngeal tissues using formalin. However, the validity of these ...geometric data is questionable because of the potentially significant tissue deformation associated with formalin fixation, particularly tissue shrinkage. Previous experiments have shown that valid geometric data may be obtained on vocal fold tissue samples quickly frozen with liquid nitrogen. Based on this finding, the present study attempted to quantify the geometric deformation of formalin‐fixed vocal fold tissues with respect to quick‐frozen tissues.
Methods Six freshly harvested canine larynges were quickly frozen with liquid nitrogen and sectioned at the mid‐membranous coronal plane. Each larynx was thawed and divided into halves along the midsagittal plane, one of which was not fixed; the other was fixed with formalin, from which histological tissue sections were also prepared. Measurements of vocal fold geometry were made on digital images of mid‐membranous coronal sections of the tissue samples, based on linear dimensions of vocal fold depth and thickness defined functionally for biomechanical applications.
Results Significant shrinkage of the vocal fold (particularly the vocal fold body) and considerable distortion of the vocal fold contour (particularly at the free edge) were observed for the formalin‐fixed samples and the histological sections in comparison with the unfixed samples.
Conclusions Results of the present study suggested that significant geometric artifacts are induced by conventional histological fixation of laryngeal tissues using formalin. These artifacts should be carefully considered for interpreting any vocal fold geometric data obtained through formalin fixation.
We investigated swallowing function of 29 patients with multiple system atrophy (MSA) by videofluoroscopy and manometry. Abnormal findings in videofluoroscopy were generally consistent with those in ...Parkinson's disease. Although findings of videofluoroscopy were not correlated with a history of aspiration pneumonia, severity of disease was significantly correlated with a history of aspiration pneumonia. Oropharyngeal and hypopharyngeal swallowing pressures of the patients were decreased to 73.9 ± 48.4 mm Hg and 85.3 ± 42.9 mm Hg, respectively, both of which were significantly different from the pressures of the control group. Incomplete relaxation of the upper esophageal sphincter was seen in 23.1% of the MSA patients, all of whom had had MSA for more than 5 years. In conclusion, patients with MSA are at risk for aspiration pneumonia as disease severity increases, and the swallowing function of patients with more than 5 years' duration of MSA should be routinely followed up with both videofluoroscopy and manometry.
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