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Biomedical subjects

S Fleischer

Publications and source records attributed to S Fleischer.

At least 19 recordsLinked to original sources
PubMed2007

[Glottal and supraglottal configuration during whispering].

BACKGROUND: The purpose of the study was to assess glottal and supraglottal configurations during whispering in comparison to habitual phonation and to visually estimate to what extent force is exerted onto the vocal fold epithelium during whispering. Is whispering a good compromise between preservation of epithelium and permission to communicate orally, e. g. postoperatively? PATIENTS AND METHODS: We investigated on 100 patients with organic or non-organic voice disorders. Patients with vocal fold immobility and patients with organic lesions large enough to impede glottal closure were excluded. Videolaryngoscopy and stroboscopy was performed via flexible endoscopy. During fiberoscopy the patients were asked (i) to phonate and then whisper a series of vowels in various loudness levels and (ii) to count to 10 voiced and whispered in various loudness levels. The extent of vocal fold adduction and supraglottal configuration were assessed and whispering compared with voiced phonation. RESULTS: Interindividual differences in glottal and supraglottal configuration during whispering were seen. The two different and most frequently seen glottal area patterns were determined by the position of the vocal processes - either adducted or abducted. Adduction resulted in sole cartilaginous triangle formation or 'kissing processes', abduction in ligamentous and cartilaginous triangle. Another surprising result was that with increasing loudness either a narrowing or widening of glottal and supraglottal structures was visible. CONCLUSIONS: There are different patterns of glottal and supraglottal configuration during whispering. Although the vocal folds can show partial or total contact over the membranous parts, the lack of additional vibration of the vocal folds suggests that epithelial forces are smaller than with additional vibratory shear stress. Thus, whispering may be considered and allowed for postoperative communication purposes, when patients follow instructions for low-effort whispering.

Adult↗
PubMed2006

[Unilateral auditory neuropathy. A rare differential diagnosis of unilateral deafness].

Auditory neuropathy presents with normal otoacoustic emissions combined with pathological findings in brainstem evoked response audiometry. Normally, the auditory neuropathy is bilateral. We report about a 9 year old child where we could diagnose a unilateral deafness in spite of regular TEOAE and DPOAE. No reproducible biosignals were seen when the right ear was stimulated with alternating click stimuli at a level of 80 dB. On the left side, the latency of the potentials was normal. A cranial MRI showed normal anatomy. In order to determine a unilateral deafness, objective tests (e.g., OAE, BERA) and subjective tests should be used.

Auditory Diseases, Central↗
PubMed2006

[Bright white vocal folds and capillary ectasias. Late sequelae after radiotherapy].

We report on visible laryngeal changes after radiotherapy. In this study, three women and two men aged 50-64 years were involved. In three cases, the primary tumor was a carcinoma of the thyroid gland and in one case a carcinoma of the esophagus. Due to dysplasia of the vocal folds, one patient underwent primary radiotherapy. Endoscopy was performed 4 to 22 years after radiotherapy. The larynx was examined by video-laryngoscopy and stroboscopy. We found a characteristic pattern of the vocal folds in all patients: bright white vocal fold surface, ectasia of capillaries and increased angiogenesis. We only found this pattern in patients after radiotherapy. In our opinion, these findings are late sequelae of radiotherapy. The picture of laryngitis due to radiotherapy can be distinguished from chronic laryngitis of other etiology using these criteria.

Adenocarcinoma, Follicular↗
PubMed2006

[The significance of videostroboscopy in laryngological practice].

The assessment of laryngeal pathology and voice dysfunction requires knowledge of anatomy and physiology as well as thorough understanding of the biomechanical (non)linear behaviour of vocal fold vibration. Videostroboscopy adds useful information to voice assessment, which always includes perceptual voice assessment and endoscopy of the larynx. Videostroboscopy can help in differentiating between benign vocal fold lesions, invasive processes, vocal fold scarring and functional disorders. Videostroboscopic evaluation can be improved by using different endoscopes and specific evaluation manoeuvres.

Germany↗
PubMed2005

Differential expression of ryanodine receptors in the rat cochlea.

This study examined the localization and functional expression of ryanodine receptors (RyR) within the cochlea using a combination of reverse transcription-polymerase chain reaction, immunolabeling techniques, and confocal Ca2+ imaging. All three RyR isoform mRNA transcripts were detected in the adult rat cochlea. Immunoperoxidase and immunofluorescence labeling showed that the three isoforms were differentially expressed. The most pronounced RyR protein expression, involving all three isoforms, occurred in the cell bodies of the spiral ganglion neurons. RyR3 labeling extended to the synaptic terminals innervating the inner and outer hair cells. RyR2 expression also occurred in the inner hair cells and supporting cells of the organ of Corti, while cells associated with ion homeostasis in the cochlea, such as the interdental cells of the spiral limbus (RyR1), and the epithelial cells of the spiral prominence and basal cells of the stria vascularis (RyR2 and RyR3), were also immunopositive. The functionality of RyR-gated Ca2+ stores in the spiral ganglion neurons was shown by confocal calcium imaging of fluo-4 fluorescence in rat cochlear slices. Caffeine (5 mM) evoked an increase in intracellular Ca2+ concentration in the cell bodies of the spiral ganglion neurons which occurred inthe absence of external Ca2+. Ryanodine (50 nm-1 microM) evoked comparable increases in intracellular Ca2+ concentration. These findings suggest that RyR-mediated Ca2+ release may be involved in auditory neurotransmission, sound transduction, and cochlear electrochemical homeostasis.

Animals↗
PubMed2005

[Early diagnosis of language development disorders in children].

In a prospective study, we examined whether it is possible to diagnose language disorders in children in their second and third years. Twenty patients aged 17-35 months (average 26 months) were examined from August 2002 to June 2004. Language development was tested on the basis of a questionnaire for parents (ELFRA-1 or ELFRA-2) and on a detailed language assessment. After 3-8 months, the children's language was examined again by the same speech pathologist. In 12 children, in whom we had suspected a language disorder, the diagnosis was confirmed. Eight patients showed age-appropriate language development, which was confirmed in six patients at follow-up. In two cases, the follow-up revealed a language disorder. On the basis of a parent questionnaire and examination by a speech therapist, language disorders can be diagnosed in the second and third years of life. However, control assessments are necessary in order to reveal language development disturbances beginning at later ages.

Child, Preschool↗
PubMed2005

[Experiences with intraoperative application of prednisolone during Isshiki type I thyroplasty].

Laryngeal edema is considered a postoperative problem in phonosurgery. In a prospective study we examined if a single intraoperative application of prednisolone can decrease the incidence of postoperative laryngeal edema after Isshiki type I thyroplasty. We examined ten patients undergoing unilateral type I thyroplasty [seven men and three women, age range: 19-60 years (average: 48 years)]. In six patients we administered 250 mg prednisolone i.v. during surgery. In four patients no steroids were given at all. On the 1st and 2nd postoperative day, the larynx was examined in a clinical setting. Five of six patients who received intraoperative steroid medication had no postoperative laryngeal edema. Only in one of those patients we examined a small edema of the arytenoid region. In all four patients without steroid medication a postoperative edema of the ipsilateral arytenoid hump was seen. Thus, intraoperative intravenous steroid administration seems to prevent, or at least reduce, postoperative laryngeal edema. Only in one of those patients we examined a small edema of the arytenoid region.

Adult↗
PubMed2004

[Vocal cord dysfunction. An important differential diagnosis to bronchial asthma].

Vocal cord dysfunction (VCD) is described as a functional disorder of the vocal folds which leads to an intermittent, inspiratory 'paradoxical' glottal closure. We report on three women with frequent repetitive shortness of breath attacks caused by VCD. This was diagnosed by transnasal videofiberendoscopy, with glottal closure being seen during inspiration. Because of the different etiologies, one of the patients was treated with breathing and speech therapy, another received Omeprazol for laryngopharyngeal reflux, and the third was treated by intralaryngeal botulinum toxin injections. All three patients showed a reduction in attacks. Clinically, VCD seems to mimic asthma. However, with a thorough patient history and diagnostics, especially with transnasal laryngoscopy during a (triggered) attack, a precise diagnosis seems possible.

Adult↗
PubMed2004

[Pronounced bilateral mesocochlear hearing impairment from 40-45 dB in spite of regular TEOAE, DPOAE and inconspicuous click-BERA].

An objective screening method for assessment of inner ear function of babies and small children can be carried out by measuring TEOAE and DPOAE. In particular, TEOAE can be used as a cheap and quick method to determine, with very high sensitivity and moderate specificity, whether middle to severe peripheral hearing impairment is present. In order to assess the threshold more precisely, the click-BERA is routinely used. We present a case report of a 6 year old girl with regular TEOAE and DPOAE, and who also had bilateral normal thresholds in the click-BERA. With subjective audiometry, the girl could be diagnosed having bilateral mesocochlear hearing impairment (so called cookie-bite audiogram) ranging at 40-45 dB. The child was helped considerably by fitting of hearing aids bilaterally. In order to determine the auditory ability of children and to provide adequate care, subjective as well as objective tests should be used.

Audiometry↗
PubMed2004

[Influence of the head position in laryngoscopy].

INTRODUCTION: The aim of this study was to determine the optimal position of the head during larygoscopy. MATERIAL AND METHODS: During fiberoptic evaluation of the larynx, the head position of eight subjects (5 male, 3 female) was changed systematically. The influence of reclining and anteversion, tilting and rotation of the head on the quality of the endoscopic images was determined. RESULTS: The vocal tract became wider and the view onto the glottis could be improved by reclining the head and anteversion of the chin. On rotation of the head, the hypopharynx of the same side became narrower. This is well known and is used worldwide in the therapy of dysphagia. DISCUSSION: Positioning of the patient is important in laryngoscopy. Reclining the head and forward inclination of the trunk (horizontal axis of the mouth) seems to be the best position for obtaining an optimal view onto the glottis.

Adult↗
PubMed2003

[Diagnosis of psychogenic hearing disorders in childhood].

In comparison with organic hearing loss, which is commonly reported, non-organic hearing loss is under-represented in the literature. The audiological results for 20 patients, aged between 6 and 17 years (mean 11.3), with psychogenic hearing disturbances were analysed prospectively. In 17 cases, the disturbance was bilateral and in three cases unilateral. In no case was the result of an objective hearing test exceptional, while a hearing threshold of between 30 and 100 dB was reported in single ear, pure-tone audiograms. In 12 cases, single ear speech audiograms were unexceptional. Suprathreshold tests, such as the dichotic discrimination test or the speech audiogram with noise disturbance, could lead to a clearer diagnosis in cases of severe psychogenic auditory impairment. In half of the patients, a conflict situation in the school or family was evident. After treatment for this conflict, hearing ability returned to normal. There was no improvement for six patients.

Adolescent↗
PubMed2003

Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults.

BACKGROUND: Displaced intracapsular fractures may be treated by either reduction and internal fixation which preserves the femoral head, or by replacement of the femoral head with an arthroplasty. OBJECTIVES: To review all randomised trials that have compared internal fixation and arthroplasty. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register (January 2002), MEDLINE (1966 to January 2002), EMBASE (1988 to 2002, Week 2), Current Contents (1993 to 2002, Week 4), PREMEDLINE (January 2002) and selected orthopaedic journals and conference proceedings, and reference lists of relevant articles. We contacted trialists where possible. SELECTION CRITERIA: All randomised and quasi-randomised trials comparing internal fixation with arthroplasty for intracapsular hip fractures in adults. DATA COLLECTION AND ANALYSIS: Trial quality was assessed by use of a 10 item scale. Data from the majority of trials were independently extracted by three reviewers with the remaining extracted by two. Additional information was sought from trialists. After grouping into three broad categories, comparable groups of trials were subgrouped and where appropriate, data were pooled using the fixed effects model. MAIN RESULTS: Thirteen trials involving 2091 patients were included. Internal fixation had a reduced length of surgery, operative blood loss, need for blood transfusion and risk of deep wound infection. Arthroplasty had a lower re-operation rate in comparison with fixation. No definite differences for hospital stay, mortality, degree of residual pain, regain of mobility or regain of same residential state were found. REVIEWER'S CONCLUSIONS: Internal fixation is associated with less initial operative trauma but has an increased risk of re-operation on the hip. Definite conclusions cannot be made for differences in pain and residual disability between the two groups. Future studies should concentrate on better reporting of final outcome measures and there is still a need for studies to define which patient groups are better served by the different treatment methods.

Adult↗
PubMed2003

[Reinke edema--helpful in unilateral recurrent laryngeal nerve paralysis?].

We report on a 57-year-old teacher who consulted us for her known unilateral recurrent nerve paralysis subsequent to strumectomy. Video laryngoscopic and stroboscopic examinations revealed Reinke's edema in addition to the left-sided immobile vocal fold with maintenance of good vocal function. Because of the left-sided Reinke's edema, complete glottal closure was possible although the left vocal ligament remained slack. Surgical removal of the vocal fold edema in this case would presumably result in considerable impairment of vocal function. This example illustrates that in selected cases Reinke's edema can contribute to maintenance of phonation in unilateral vocal fold paralysis. In these cases, indication for edema surgery should be very restrictive and should always take the vocal function into consideration.

Female↗
PubMed2003

[Prediction of mortality, mobility and admission to long-term care after hip fractures].

INTRODUCTION: Surgical treatment, discharge planning and rehabilitation procedures are rarely based upon defined assessment procedures. It might therefore be useful to develop simple and reliable screening tools to identify patients for early discharge, intensified rehabilitation and limited treatment. PATIENTS AND METHODS: 234 patients were initially contacted. From these 217 gave informed consent. The reported study included the 134 home dwelling elderly. All patients could be contacted or died after six month. Thus,data from more than 90% could be used for the analysis. The six month mortality was 10%. A population based cohort of elderly patients referred to five local hospitals was tested. Mortality, institutionalisation and mobility were defined as major outcome criteria. Only information that was available during the first week of treatment was used in the model. Predictors expressed as odd ratios (OR) were calculated using logistic regression with variable selection. RESULTS: The most important predictors for institutionalisation were age, inability to eat without assistance, postoperative night time confusion, stroke history, cognitive deficit and fear of falling. Outdoor mobility was strongly associated to the preoperative ADL performance measured as the Barthel-Index, history of malignancy and fear of falling. Six month mortality was associated with male sex, the Barthel-Index and fear of falling. DISCUSSION: It seems feasible to improve postoperative resource allocation by predictor led stratification. This need to be tested in intervention trials under the specific condition of the German health care system.

Activities of Daily Living↗
PubMed2003

[Oropharyngeal vocal tract space during singing--comparison of tactile-kinesthetic and auditory perception with objective endoscopic findings].

BACKGROUND: In this study we compared the perceived diameter of the vocal tract's oropharyngeal part with the diameter that was determined endoscopically. METHODS: 28 singers (13 male, 15 female) were examined with transnasal fiberscopic pharyngoscopy while singing the vowels /a/, /i/ and /u/ in 4 different timbres (normal, opened, covered, dumpled) and 3 different pitches (chest/modal register, subjective comfortable pitch for singing, head/falsetto register). The tactile-kinesthetic and auditive rating of the singers, the auditive rating of a singing teacher and the visual-endoscopic analysis of three laryngologists were compared. RESULTS: The tactile-kinesthetic and auditory self-perception of the singers was quite different from the auditive perception of a singing teacher and visual endoscopic findings of the laryngologists. The singers had the impression that the different singing timbres (normal, opened, covered, dumpled) influence oropharyngeal vocal tract space during singing. They judged the vowel itself and the pitch as having very little influence. Based on his auditory perception, the singing teacher also rated that the timbre plays an important role for the oropharyngeal vocal tract space but he found vowels to be the parameter with the greatest impact. Via visual endoscopic examination we found that, among the three parameters (vowel, timbre, pitch), the different vowels are most influential on the oropharyngeal vocal tract space. Analysis of video sequences revealed that pitch and timbre are less important. CONCLUSION: Subjective tactile-kinesthetic and auditory perception of the singers differs from auditory perception of the singing teacher as well as from endoscopic findings. The endoscopically determined oropharyngeal vocal tract space during singing the vowels /i/ or /u/ tends to be larger compared to the oropharyngeal vocal tract space while singing the vowel /a/.

Adult↗
PubMed2002

Differential activation by Ca2+, ATP and caffeine of cardiac and skeletal muscle ryanodine receptors after block by Mg2+.

The block of rabbit skeletal ryanodine receptors (RyR1) and dog heart RyR2 by cytosolic [Mg2+], and its reversal by agonists Ca2+, ATP and caffeine was studied in planar bilayers. Mg2+ effects were tested at submaximal activating [Ca2+] (5 microM). Approximately one third of the RyR1s had low open probability ("LA channels") in the absence of Mg2+. All other RyR1s displayed higher activity ("HA channels"). Cytosolic Mg2+ (1 mM) blocked individual RyR1 channels to varying degrees (32 to 100%). LA channels had residual P(o) <0.005 in 1 mM Mg2+ and reactivated poorly with [Ca2+] (100 microM), caffeine (5 mM), or ATP (4 mM; all at constant 1 mM Mg2+). HA channels had variable activity in Mg2+ and variable degree of recovery from Mg2+ block with Ca2+, caffeine or ATP application. Nearly all cardiac RyR2s displayed high activity in 5 microM [Ca2+]. They also had variable sensitivity to Mg2+. However, the RyR2s consistently recovered from Mg2+ block with 100 microM [Ca2+] or caffeine application, but not when ATP was added. Thus, at physiological [Mg2+], RyR2s behaved as relatively homogeneous Ca2+/caffeine-gated HA channels. In contrast, RyR1s displayed functional heterogeneity that arises from differential modulatory actions of Ca2+ and ATP. These differences between RyR1 and RyR2 function may reflect their respective roles in muscle physiology and excitation-contraction coupling.

Adenosine Triphosphate↗