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At least 1,423 records · Page 79Linked to original sources
PubMed1994

[Morphometric studies at the level of the glottis as a principle in larynx enlarging microlaryngoscopic surgical procedures in bilateral recurrent nerve paralysis].

Dimensions of laryngeal and tracheal cross-sectional areas are not well explored and yet are of definite interest in endoscopic airway restorative surgery for the treatment of bilateral vocal cord paralysis. Twenty fresh, intact human larynges were shock-frozen in liquid nitrogen. Four-millimetre horizontal sections were then produced with a slicing machine. Cross-sectional areas of the vocal cords and arytenoids were measured using a computer-aided morphometry device. In addition, casts of 14 larynges were available for morphometric investigation as well as video-laryngoscopic images of 50 volunteers. The results demonstrate that the glottis is the narrowest part of the larynx even in healthy subjects. Its diameter is reduced approximately by the factor 4 in the bilaterally paralysed larynx. Cordectomy potentially offers more enlargement of the glottic airway (169 +/- 20 mm2 in males and 138 +/- 22 mm2 in females) than arytenoidectomy (42 +/- 12 mm2 in males and 34 +/- 6 mm2 in females). The knowledge of morphometric details of the glottic plane should contribute to an individualized planning of airway restoring surgery in bilateral vocal cord paralysis.

Airway Resistance↗
PubMed1997

[Case report: a traumatic facial paralysis caused by a fish].

BACKGROUND: Due to the increase in worldwide tourism more and more unusual injuries are observed. CASE: We report on a patient who was diving near the Maledives, where a fish weighing 30 kg collided with his head. Four to five hours later he suffered from paralysis of the facial nerve. During an operation performed after his return a part of the jaw of the fish was removed from the retromandibular fossa. The fish jaw had compressed the facial nerve. RESULT: Three months later the function of the nerve was normal again. CONCLUSION: Even simple accidents require a detailed patient history and the use of computed tomography. This made it possible to determine the cause of this unusual facial paralysis and cure the patient.

Animals↗
PubMed1996

[Endolaryngeal surgical procedures in glottis expansion in bilateral recurrent nerve paralysis].

OBJECTIVE: Subtotal cordectomy and posterior cordectomy have repeatedly been recommended as surgical interventions restoring the airway, for the treatment of bilateral vocal cord paralysis. The objective of this study was to assess the effectiveness of transoral laser cordectomy and posterior cordectomy as compared to laser arytenoidectomy and to compare the respiratory and phonatory results of these minimally invasive procedures. MATERIAL AND METHODS: Forty patients with bilateral vocal cord paralysis were included in a prospective study and operated upon to improve their laryngeal airways. Twenty-two patients had cordectomy, 13 had arytenoidectomy, and 5 had posterior cordectomy. Lung function tests and voice analysis were obtained preoperatively and postoperatively. Subclinical aspiration was determined by endoscopic evaluation of the larynx during deglutition. The results were compared to determine the relative effectiveness of the three surgical methods. RESULTS: Flow volume spirograms documented equally improved flow rates in both groups. Final voice evaluation revealed maximum phonation time. Peak sound pressure levels and frequency range were reduced in all 28 patients, but phonatory results varied considerably in each group. Subclinical aspiration was noticed in 5 out of 10 patients after arytenoidectomy, but in none of 18 patients after cordectomy. Four previously tracheotomised patients were decannulated within 2 weeks after surgery, while the other 24 patients had no perioperative tracheotomies. CONCLUSION: Transoral laser cordectomy and arytenoidectomy are equally effective and reliable in the management of the restricted airway. Cordectomy and posterior cordectomy offer the advantage of uncompromised deglutition after surgery. Although no clinically relevant aspiration occurred in any of the patients, cordectomy should be considered as the method of choice in patients for whom subclinical aspiration could be potentially harmful due to coexisting pulmonary or cardiac disease. Phonatory outcome is not predictable with both surgical procedures. Subtotal cordectomy and posterior cordectomy are easier and faster to perform, and subclinical aspiration is not encountered with these procedures.

Airway Resistance↗
PubMedDate not supplied

[Atlas fractures with paralysis of the caudal cranial nerves. A case report].

The fracture of the Atlas is a serious trauma, associated with important diagnostic traps. Whether operative or noninvasive treatment should be used depends on the type of fracture. Paralysis of brain nerves are exceptionally rare. We present a case in which fracture of the atlas was associated with paralysis of the 9th through 12th brain nerves, to which differential diagnostic considerations are discussed.

Accessory Nerve Injuries↗
PubMed1993

Peripheral neuropathy and neuromuscular blockade presenting as prolonged respiratory paralysis following critical illness.

We report two patients who following critical illness presented with generalised paralysis associated with persistent failure to breathe. Both patients eventually recovered and were weaned from the ventilator. The cause of the paralysis was an unusual peripheral neuropathy in the first patient and persistent neuromuscular blockade secondary to vecuronium in the second. It is important to consider a reversible, possibly even iatrogenic, cause of this type of complication.

Acute Disease↗
PubMed2002

Surgery for pediatric vocal cord paralysis: a meta-analysis.

OBJECTIVE: The study goal was to determine the impact of various surgical procedures for bilateral vocal cord paralysis in children by using established principles of meta-analysis. STUDY DESIGN AND SETTING: We conducted a retrospective review of the literature in which a predetermined protocol was used to identify articles for meta-analysis. Six articles met inclusion criteria, and pertinent data were extracted. RESULTS: Pooled data analysis demonstrated primary procedure-specific decannulation rates for external arytenoidopexy for 19 of 24 (79%), external arytenoidectomy for 14 of 19 (74%), CO2 laser arytenoidectomy for 4 of 10 (40%), and costal cartilage graft procedures for 2 of 2 (100%). External arytenoid procedures are more efficacious than CO2 laser procedures in terms of primary decannulation (P = 0.02). CONCLUSION: Meta-analysis of the existing literature reveals that external arytenoidopexy and external arytenoidectomy are equivalently effective procedures and that the two combined are significantly more effective than CO2 ablative procedures. SIGNIFICANCE: External procedures appear to be more effective as a first-line treatment in pediatric vocal cord paralysis, with arytenoidopexy with or without partial arytenoidectomy offering an attractive first-line surgical option.

Adolescent↗
PubMed2003

Laryngeal function and vocal fatigue after prolonged reading in individuals with unilateral vocal fold paralysis.

The purpose of the present study was to examine the effect of prolonged loud reading, intended to induce fatigue, on vocal function in adults with unilateral vocal fold paralysis (UVFP). Subjects were 20 adults, 37-60 years old, with UVFP secondary to recurrent laryngeal nerve paralysis. Subjective ratings and instrumental measures of vocal function were obtained before and after reading. Statistical analysis revealed subjects rated their vocal quality and physical effort for voicing more severely following prolonged loud reading, whereas expert raters did not detect a significant perceptual difference in vocal quality. Reading fundamental frequency (F0) was significantly increased following prolonged loud reading, as were mean airflow rates at all pitch conditions. Maximum phonation times for comfort and low pitches significantly decreased during posttests. Multiple regression analyses revealed significant associations between ratings of posttest physical effort and select posttest measures. Interpretation of results indicates the prolonged loud reading task was successful in vocally fatiguing most of the UVFP subjects. Key physiologic correlates of vocal fatigue, in individuals with UVFP, include further reduction of glottic efficiency, resulting in decreased regulation of glottic airflow and a temporary destabilization of speaking fundamental frequency.

Adult↗
PubMed1971

Temperature-sensitive mutations in Drosophila melanogaster. VII. A mutation (para-ts) causing reversible adult paralysis.

A temperature-sensitive mutation, para(ts), in Drosophila melanogaster causes an immediate, but reversible, paralysis of adult flies when they are shifted from 22 degrees C to 29 degrees C. The mutation is a sex-linked recessive that maps 2.8 units to the left of f. Wild-type flies observed for 2-hr periods exhibited normal mobility at all temperatures between 22 degrees C and 35 degrees C. From 22 degrees C to 25 degrees C, para(ts) flies were wild type in walking, climbing, and flying ability. At 1-degree intervals above 25 degrees C, para(ts) flies became increasingly debilitated; at 29 degrees C, complete paralysis occurred. After flies were maintained for prolonged intervals at 29 degrees C, some activity could be recovered at that temperature. Studies of the behavior of mosaics at 29 degrees C revealed a requirement of the (+) allele in the head for mobility, and a thoracic component for proper leg movement. Normal electroretinograms were obtained at both 22 degrees C and 30 degrees C. The results suggest a temperature-sensitive defect in the nervous system.

Animals↗
PubMed1999

Lethal paralysis of Caenorhabditis elegans by Pseudomonas aeruginosa.

Identification of host factors that interact with pathogens is crucial to an understanding of infectious disease, but direct screening for host mutations to aid in this task is not feasible in mammals. The nematode Caenorhabditis elegans is a genetically tractable alternative for investigating the pathogenic bacterium Pseudomonas aeruginosa. A P. aeruginosa toxin, produced at high cell density under control of the quorum-sensing regulators LasR and RhlR, rapidly and lethally paralyzes C. elegans. Loss-of-function mutations in C. elegans egl-9, a gene required for normal egg laying, confer strong resistance to the paralysis. Thus, activation of EGL-9 or of a pathway that includes it may lead to the paralysis. The molecular identity of egl-9 was determined by transformation rescue and DNA sequencing. A mammalian homologue of EGL-9 is expressed in tissues in which exposure to P. aeruginosa could have clinical effects.

Amino Acid Sequence↗
PubMed2000

Magnetic resonance imaging findings in a patient with bilateral facial paralysis due to malignant lymphoma.

In malignant lymphomas, especially non-Hodgkin's lymphomas, invasion to the central nervous system (CNS) often occurs. A patient is reported here with bilateral facial paralysis due to invasion of a malignant lymphoma to the CNS. Contrast magnetic resonance imaging (MRI) revealed swelling of the entire length internal auditory meatus and enhancement in the entire length of the facial nerve. Transcranial magnetic stimulation and MRI revealed that later facial nerve injury was present before the onset of paralysis due to a malignant lymphoma. Therefore treatment should be performed with consideration given to the possible invasion of the tumor to the CNS.

Adult↗
PubMed2003

Candidal abscess of the parotid gland associated with facial nerve paralysis.

Facial nerve paralysis associated with parotid gland mass is usually caused by malignant neoplasms and facial nerve dysfunction due to parotid infection is exceedingly rare. A review of the literature revealed approximately 15 cases of facial nerve palsy associated with suppurative parotitis or parotid abscess. We report the first case of candidal abscess of the parotid gland associated with facial nerve paralysis in a 74-year-old insulin-dependent diabetic patient. The differential diagnosis in these unusual cases occurring in diabetic, immunodeficient patients should include Candida albicans infection.

Abscess↗
PubMed2003

Hoarseness caused by unilateral vocal fold paralysis: how long should one delay phonosurgery?

We present a case of idiopathic right vocal fold paralysis which resolved completely 18 months after onset. Instead of using surgery to improve the hoarseness of our patient, our experience suggested that speech therapy might be effective. Although the voice can be improved by overadduction of the healthy vocal fold, as surgery is irreversible it is better to wait for 18 months after onset in case spontaneous recovery occurs. During this period, one should of course continue to investigate the origin of the paralysis.

Aged↗
PubMed2000

Response of prolonged flaccid paralysis to FNS rehabilitation techniques.

PURPOSE: The purpose of this study was to investigate the response of muscles with prolonged flaccid paralysis (a year after stroke) to two types of treatment: (1) functional neuromuscular stimulation (FNS) with surface electrodes; and (2) FNS with intramuscular (IM) electrodes (FNS-IM). A second purpose was to compare FNS-gait versus volitional gait (no FNS activation). METHOD: We used a single case study design; our patient was age 72, with flaccid paralysis of knee flexors and ankle dorsiflexors. RESULTS: Following four months of treatment with surface-stimulation, there was no change in muscle function or gait. Following treatment with FNS-IM, the patient regained partial volitional control of knee flexors and dorsiflexors; untreated muscles did not change. CONCLUSION: FNS-gait provided more normal knee and ankle dorsiflexion during swing phase versus volitional gait swing phase (no FNS activation).

Aged↗
PubMed2004

Individual differences in lateralisation of hallucinations associated with sleep paralysis.

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

Adolescent↗
PubMed2005

Hoarseness due to bilateral vocal cord paralysis as an initial manifestation of familial amyotrophic lateral sclerosis.

Bulbar palsy is unusual as an initial manifestation of amyotrophic lateral sclerosis (ALS), although common in the advanced stages. In terms of bulbar palsy as a presenting symptom, dysarthria and dysphagia are of common features. Hoarseness, however, is an initial symptom of ALS in only a small number of patients. We report a 43-year-old female with hoarseness due to bilateral vocal cord paralysis as the first manifestation of ALS. Gene analysis revealed a heterozygous missense mutation in the SOD1 gene, which resulted in an amino acid substitution of isoleucine 149 by threonine. Hoarseness can be the initial symptom of ALS. Therefore, in cases of bilateral vocal cord paralysis of unknown etiology, ALS should be taken into consideration.

Adult↗
PubMed2001

Thyrotoxic periodic paralysis in a patient abusing thyroxine for weight reduction.

Thyrotoxic periodic paralysis is a rare endocrine disorder most prevalent among individuals of Asian descent that presents as proximal muscle weakness, hypokalemia, and signs of hyperthyroidism. We present an unusual patient with previous normal thyroid function who had abused thyroxine as antiobesity pills and developed periodic paralysis affecting the upper and lower limbs.

Acute Disease↗
PubMed2002

Infantile-onset ascending hereditary spastic paralysis is associated with mutations in the alsin gene.

We studied 15 patients, from 10 families, who presented with severe spastic paralysis with an infantile onset and an ascending progression. Spastic paraplegia began during the first 2 years of life and extended to upper limbs within the next few years. During the first decade of life, the disease progressed to tetraplegia, anarthria, dysphagia, and slow eye movements. Overall, the disease was compatible with long survival. Signs of lower motor-neuron involvement were never observed, whereas motor-evoked potentials and magnetic resonance imaging demonstrated a primitive, pure degeneration of the upper motor neurons. Genotyping and linkage analyses demonstrated that this infantile-onset ascending hereditary spastic paralysis (IAHSP) is allelic to the condition previously reported as juvenile amyotrophic lateral sclerosis at the ALS2 locus on chromosome 2q33-35 (LOD score 6.66 at recombination fraction 0). We analyzed ALS2, recently found mutated in consanguineous Arabic families presenting either an ALS2 phenotype or juvenile-onset primary lateral sclerosis (JPLS), as a candidate gene. In 4 of the 10 families, we found abnormalities: three deletions and one splice-site mutation. All the mutations lead to a truncated alsin protein. In one case, the mutation affected both the short and the long alsin transcript. In the six remaining families, absence of cDNA ALS2 mutations suggests either mutations in regulatory ALS2 regions or genetic heterogeneity, as already reported in JPLS. Alsin mutations are responsible for a primitive, retrograde degeneration of the upper motor neurons of the pyramidal tracts, leading to a clinical continuum from infantile (IAHSP) to juvenile forms with (ALS2) or without (JPLS) lower motor-neuron involvement. Further analyses will determine whether other hereditary disorders with primitive involvement of the central motor pathways, as pure forms of spastic paraplegia, could be due to alsin dysfunction.

Adolescent↗
PubMed1999

Lessons from diagnostic investigations of patients with poliomyelitis and their direct contacts for the present surveillance of acute flaccid paralysis.

One of the key strategies for the global eradication of poliomyelitis is the virological investigation of stool samples in cases of acute flaccid paralysis (AFP) to exclude poliovirus as a possible cause. Clinical specimens from a serotype 3 outbreak provided an opportunity to examine the potential of newly developed methods for the diagnosis of poliomyelitis. The virus isolation rate was maximal (89.6%) during the first 2 weeks after the onset of paralysis and then dropped sharply to 18.6%. In contrast, a high percentage of patients tested positive for poliovirus-specific IgM (93.9%) in the early phase of the infection and remained positive for up to 8 weeks. Virus isolation would have correctly identified only 54.9% of the AFP cases. This rate would have been increased to 92% through the use of the poliovirus-specific IgM ELISA. The IgM ELISA could serve as an important additional tool for the rapid diagnosis of poliomyelitis.

Acute Disease↗