[Laryngeal adduction reflex]

BACKGROUND

Laryngeal Adductor Reflex Background: A rapid closure of the vocal folds is necessary, whenever foreign materials or food particles penetrate into the larynx. Otherwise a passage of these particles into the trachea or the lower respiratory tract would be imminent. An aspiration could mechanically block the respiratory tract and cause severe dyspnoea or cause aspiration pneumonia.

METHOD

For this systematic review a selective literature research in PubMed and Scopus using the keywords "laryngeal adductor reflex" and "vocal fold closure" has been carried out.

RESULTS

Apart from the oesophago-glottal and pharyngo-glottal closure reflexes, the laryngeal adductor reflex (LAR) has been investigated in particular. The LAR qualifies as a reflectory laryngeal adductor mechanism and involves early, presumably di- or oligosynaptic ipsilateral LAR1 as well as late polysynaptic ipsi- and contralateral LAR2 components. In clinical routine diagnostic settings of dysphagia, LAR is only assessed qualitatively and usually triggered by air pulses or tactile stimulation.

DISCUSSION

Dysphagiologists often find that not only the laryngeal sensibility in general is impaired, but especially the protective laryngeal adduction mechanism, which results in a higher risk of aspiration. Thus, it appears mandatory to test the LAR not only qualitatively but also quantitatively. Unfortunately a valid and reliable method that can be employed in clinical practice has not yet been put forward.

[Inducible laryngeal obstruction vs. bronchial asthma]

Inducible Laryngeal Obstruction vs. Bronchial -Asthma Background: Inducible laryngeal obstructions (ILO) represent paroxysmal and sometimes severe dyspnea caused by different factors. Symptomatically ILO resembles bronchial asthma and is therefore often misdiagnosed. In the following 3 cases regarding a special type of ILO, the exercise induced laryngeal obstruction (EILO) will be presented. It will also be demonstrated, how EILO can be diagnosed and differentiated from bronchial asthma.

METHOD

Laryngeal symptoms were provoked by spiroergometry (treadmill or bicycle) and inspected by laryngoscopy.

RESULTS

Symptoms could be provoked in all of the 3 patients by either treadmill or bicycle spiroergometry. When a stridor occurred, usually 1.5-2 min after the anaerobe threshold had been exceeded, spiroergometry showed a decline or plateau of carbon dioxide emission and oxygen intake. Laryngoscopy revealed adduction of the vocal cords during inspiration occa-sionally with a collapse of supraglottic structures towards the endolarynx.

DISCUSSION

This article is the first to report that EILO can be distinctly depicted by spiroergometry. The decline or plateau in oxygen and carbon dioxide curves in coordination with the onset of stridor, approximately 1.5-2 min after the anaerobe threshold had been exceeded, was found to be reproducible in all cases. Furthermore, endoscopy immediately following peak exhaustion represents a practical tool for the identification of EILO.·

[First language acquisition research and theories of language acquisition]

BACKGROUND

In principle, a child can seemingly easily acquire any given language. First language acquisition follows a certain pattern which to some extent is found to be language independent. Since time immemorial, it has been of interest why children are able to acquire language so easily. Different disciplinary and methodological orientations addressing this question can be identified.

METHODS

A selective literature search in PubMed and Scopus was carried out and relevant monographies were considered.

RESULTS

Different, partially overlapping phases can be distinguished in language acquisition research: whereas in ancient times, deprivation experiments were carried out to discover the "original human language", the era of diary studies began in the mid-19th century. From the mid-1920s onwards, behaviouristic paradigms dominated this field of research; interests were focussed on the determination of normal, average language acquisition. The subsequent linguistic period was strongly influenced by the nativist view of Chomsky and the constructivist concepts of Piaget. Speech comprehension, the role of speech input and the relevance of genetic disposition became the centre of attention. The interactionist concept led to a revival of the convergence theory according to Stern.

DISCUSSION

Each of these four major theories--behaviourism, cognitivism, interactionism and nativism--have given valuable and unique impulses, but no single theory is universally accepted to provide an explanation of all aspects of language acquisition. Moreover, it can be critically questioned whether clinicians consciously refer to one of these theories in daily routine work and whether therapies are then based on this concept. It remains to be seen whether or not new theories of grammar, such as the so-called construction grammar (CxG), will eventually change the general concept of language acquisition.

[Neuromuscular electric stimulation therapy in otorhinolaryngology]

BACKGROUND

Animal experiments have shown that after specific nerve traumatization, neuromuscular electrostimulation (NMES) can promote nerve regeneration and reduce synkinesia without negatively interfering with normal regeneration processes. NMES is used routinely in physical rehabilitation medicine.

METHODS

This systematic literature search in the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, the DAHTA database, the Health Technology Assessment Database and MEDLINE or PubMed considered studies on the use of NMES in otorhinolaryngology that have been published in German or English.

RESULTS

The search identified 180 studies. These were evaluated and relevant studies were included in the further evaluation.

DISCUSSION

In the fields of otorhinolaryngology and phoniatry/paediatric audiology, clinical studies investigating the effects of NMES on facial and laryngeal paresis, as well as dysphonia and dysphagia have been carried out. The evidence collected to date is encouraging; particularly for the treatment of certain forms of dysphagia and laryngeal paresis.

Correlation of preoperative magnetic resonance imaging of peritoneal carcinomatosis and clinical outcome after peritonectomy and HIPEC after 3 years of follow-up: preliminary results

Purpose: In patients with peritoneal carcinomatosis, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is an evolving approach with curative intention. Previous studies indicate a correlation between preoperative magnetic resonance imaging (MRI) and surgical findings regarding the extent of peritoneal carcinomatosis. The aim of this study was to assess retrospectively whether preoperative MRI can predict the outcome and is therefore a suitable tool for patient selection. Materials and methods: Fifteen patients with laparoscopically proven peritoneal carcinomatosis were preoperatively examined using a 1.5-T whole-body MRI system. Results were correlated with surgical exploration. Follow-up was done by contrast-enhanced abdominal computed tomography and, if suspicious for recurring disease, laparoscopy or laparotomy. Survival time and interval to recurring disease were correlated with the preoperative peritoneal carcinomatosis index (PCI) on MRI (Spearman’s rank correlation). Results: In five patients radical resection could not be achieved (PCI 34 ± 6.9); survival time was 78.2 ± 54.1 days. In seven patients recurring disease was found 430 ± 261.2 days after initial complete cytoreduction (PCI 11.6 ± 6.9); survival time was 765.9 ± 355 days. Two patients are still alive after 3 years. Two patients with initially complete cytoreduction are without recurring disease after 3 years (PCI 5 and 12). One patient was lost for follow-up. Conclusions: Results of the preoperative MRI correlate well with the surgical PCI, postoperative resection status, and survival time. MRI might be a suitable technique for patient selection when considering peritonectomy and HIPEC. In our patients the outcome seems to correlate well with the extent of peritoneal carcinomatosis found by the preoperative MRI.

Detection of a noble gas molecular ion, 36ArH+, in the Crab Nebula

Noble gas molecules have not hitherto been detected in space. From spectra obtained with the Herschel Space Observatory, we report the detection of emission in the 617.5- and 1234.6-gigahertz J = 1-0 and 2-1 rotational lines of (36)ArH(+) at several positions in the Crab Nebula, a supernova remnant known to contain both molecular hydrogen and regions of enhanced ionized argon emission. Argon-36 is believed to have originated from explosive nucleosynthesis in massive stars during core-collapse supernova events. Its detection in the Crab Nebula, the product of such a supernova event, confirms this expectation. The likely excitation mechanism for the observed (36)ArH(+) emission lines is electron collisions in partially ionized regions with electron densities of a few hundred per centimeter cubed.

Precise test of internal-conversion theory: transitions measured in five nuclei spanning 50≤Z≤78

In a research program aimed at testing calculated internal-conversion coefficients (ICCs), we have made precise measurements of αK values for transitions in five nuclei, (197)Pt, (193)Ir, (137)Ba, (134)Cs and (119)Sn, which span a wide range of A and Z values. In all cases, the results strongly favor calculations in which the final-state electron wave function has been computed using a potential that includes the atomic vacancy created by the internal-conversion process.

Greater occipital nerve blocks in chronic cluster headache: a prospective open-label study

BACKGROUND AND PURPOSE

Greater occipital nerve blockade (GONB) has been shown to be effective in episodic cluster headache. However, its use in chronic cluster headache (CCH) is less certain. The study aims to prospectively assess the efficacy and consistency of response to GONB in a large series of CCH patients.

METHODS

CCH patients who had a unilateral GONB and were referred to the National Hospital for Neurology and Neurosurgery were studied prospectively. Headache characteristics were collected using headache diaries. Responders were considered to be patients with a complete or partial response lasting at least 7 days. In a subgroup of responders the outcomes of serial GONB performed at 3-monthly intervals were also analysed.

RESULTS

Eighty-three CCH patients were studied. After the first GONB, a positive response was observed in 47 (57%) patients: 35 (42%) were rendered pain free, 12 (15%) had a partial benefit and one patient obtained <50% improvement. The duration of a positive response lasted a median of 21 days (range 7-504 days). There was a transient worsening of condition in 6% of patients. The overall rate and average duration of response remained consistent after the second [n = 37; 31 responders (84%); median duration 21 days], third [n = 28; 20 responders (71%); median duration 25 days] and fourth [n = 14; 10 responders (71%); median duration 23 days] injections.

CONCLUSION

GONB seems to be an efficacious treatment with reproducible effects in CCH patients. Performed three monthly, GONB may have a useful role in the management of CCH.

Enalapril-induced acute kidney injury in neonates

Angiotensin converting enzyme inhibitors have been used in the neonatal population for both cardiac and renal diseases. Past reports have described deleterious renal and neurological consequences as a result of these drugs. This report describes two infants receiving enalapril for different indications who suffered renal impairments, likely a result of concomitant diuretic use. These cases demonstrate the risks associated with ACE inhibitor use and the importance of vigilant monitoring when using these medications.

[Clicking larynx syndrome : a literature review and multiple-case report]

BACKGROUND

A clicking noise in the larynx can probably be provoked in many adults. However, these clicks are not usually associated with pain and physicians are not consulted. The combination of a clicking larynx and pain may severely reduce an individual's quality of life. Up until now, the so-called clicking larynx syndrome (CLS) has not been defined in German teaching literature. Therefore, this article reviews the international literature on CLS and also presents three case reports.

METHODS

A selective literature search using PubMed and Google was conducted. The Google search resulted in the identification of several patient forums. Three case reports are also presented (multiple-case report).

RESULTS

A total of 4 studies were identified in which different kinds of clicking sounds in the larynx were described. These sounds were typically provoked by movements of the head and/or neck, swallowing or circumlaryngeal manipulation. In forums patients reported many different types of laryngeal clicking sounds, which were often described as extremely irritating. Three patients have recently presented with such symptoms at our department.

DISCUSSION

The literature published on CLS suggests (although does not strictly prove) that laryngeal clicking sounds are caused by friction between the superior cornu or the top edge of the thyroid cartilage and the hyoid, or alternatively due to contact of these structure with the cervical spine. Seldom do patients report a former laryngeal trauma. The causes of the associated pain remain unclear. The treatment of choice seems to be resection of the structures associated with the clicking noise by thyroplastic surgery or reduction of the hyoid bone greater horn. It is therefore important to inform patients with mild CLS that these clicking sounds are harmless and to advise CLS patients suffering from pain of the appropriate treatment options.

[A phonation-related phase-model of the velopharyngeal closure based on high resolution manometry]

OBJECTIVE

The production of many speech sounds requires a complete velopharyngeal closure (VPC) caused by muscular contractions and approximation of the pharyngeal walls. The contraction pressure of the muscles involved needs to be high enough to withstand phonation pressure. It is postulated that sustained phonation consists of 3 velopharyngeal phases: an initial pressure buildup, a steady state and a final pressure decrease. To test this hypothesis, phonation induced pressure changes in the VPC were measured in healthy participants.

MATERIAL AND METHODS

High resolution manometry was performed on 8 participants during the sustained phonation of the vowel / i:/. Individual pressure curves have been compared in order to verify the postulated model and intraindividual reproducibility has been tested.

RESULTS

The intraindividual pressure curves were found to be reproducible, but an interindividual variation was observed. An initial pressure increase was detected in all participants at the onset of phonation, followed by a stable phase during sustained phonation. At the offset the pressures returned to the initial value during rest.

CONCLUSIONS

The postulated model was verified in all participants. An initial phase, a stable phase and a terminal phase could be differentiated. Further classifications can be made regarding the on- and offset of phonation allowing for a more detailed characterization of the VPC. Further studies should evaluate if this model is useful to describe changes in the VPC pressure profile of patients affected by rhinophonia.