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[Pliability of vocal fold mucosa in relation to the location of subglottic mucosal upheaval during phonation].

Mucosal pliability was measured in 23 excised larynges, 19 canine and four human, at the three portions of the vocal fold, namely the midline, the anterior 1/4 and the posterior 1/4. The pliability at the midline showed a greater value than those at the other two portions. The free edge of the vocal fold showed a maximum pliability which gradually diminished toward the tracheal side and reached a minimum 3mm from the free edge of the fold. An increase in vocal fold tension resulted in lowering of mucosal pliability at all measured points and the point of minimal pliability shifted toward the oral side. The point of minimal pliability moved toward the tracheal side with direct electrical stimulation of the thyroarytenoid muscle (TA). Both pliability measurement and observation of mucosal vibration from the tracheal side using high speed cinematography or stroboscopy were performed on eleven of the excised canine larynges. The mucosal upheaval occurred at the point around which pliability was minimal. An increase in vocal fold tension resulted in an upward shift of the mucosal upheaval which occurred slightly below the point of minimal pliability. Electric stimulation of the TA resulted in a downward shift of the mucosal upheaval which occurred in accordance with the point of minimal pliability. Histological examination of the canine larynges revealed that the lamina propria became increasingly thin toward the point around which pliability was minimal and at which the mucosal upheaval occurred. At this point, the muscle layer approximated the epithelial layer with disappearance of the deep layer of the lamina propria. The point shifted to the oral side following an increment in vocal fold tension, while the point moved toward the tracheal side following contraction of the TA. Pliability of the vocal fold is minimal at the point around which the deep layer of the lamina propria disappears and the mucosal upheaval occurs.

Animals

Pliability of the vocal fold mucosa in relation to the mucosal upheaval during phonation.

OBJECTIVES: To quantitatively evaluate the effect of vocal fold lengthening on pliability of the mucosa measured along the superior-inferior axis and to examine the relation of the location of mucosal upheaval (MU) during phonation to the changes in pliability pattern of the mucosa when the vocal fold was lengthened. DESIGN: Investigation of mechanical characteristics of the vocal fold in relation to the MU during phonation. MATERIALS: Five excised canine larynges. INTERVENTIONS: Vibrations with and without vocal fold lengthening were recorded from the tracheal side via high-speed photography or video recording combined with stroboscopic illumination. Tattooed marks on the lower surface of the vocal fold were used to locate the MU. Pliability was defined as the maximal distance elevated in response to a constant focal negative pressure. RESULTS: Pliability decreased significantly (P=.05) when the vocal fold was lengthened. The point of minimal pliability and MU without vocal fold lengthening were located slightly above the area where the muscular layer approached the epithelial layer. They were located closer to the free edge of the vocal fold when it was lengthened than when it was not. Discrepancy of their locations when the vocal fold was lengthened was suggested. CONCLUSIONS: The MU occurs around the point of minimal pliability when the vocal fold is not lengthened, whereas the MU occurs slightly more laterally than the point of minimal pliability when the vocal fold is lengthened. Although further study is necessary to explain this discrepancy, the presence of the sparse deep layer of the lamina propria seems to be essential in the generation of the mucosal wave.

Animals

Quantitative evaluation of the effects of thyroarytenoid muscle activity upon pliability of vocal fold mucosa in an in vivo canine model.

Stiffness of the vocal fold is a significant factor in determining mucosal wave propagation and in the control of the fundamental frequency of phonation. We measured pliability of the vocal fold mucosa in an in vivo canine model as an index of stiffness while the histological layer-by-layer structure of the vocal fold was not disrupted. The point 1 mm below the free edge showed a maximal pliability that gradually diminished toward the tracheal side and reached a minimum. When the thyroarytenoid (TA) muscle contracted, pliability of the mucosa was significantly increased (P < 0.001). Mucosal pliability of the excised larynx was significantly increased compared with that in vivo (P < 0.001). The point of minimal pliability in the absence of TA muscle contraction did not shift after excision of the larynx, while TA muscle contraction caused a downward shift of the point of minimal pliability. Mucosal pliability can thus be used to quantitatively assess the effects of TA muscle contraction on stiffness of the vocal fold mucosa.

Animals

Cusp pliability of the mitral valve: Doppler-echocardiographic and computer-tomographic study.

In order to study the mitral cusp pliability and calcification "in vivo" on the basis of the difference in the maximal and effective valve area, the Doppler-echocardiographic and computer tomographic method was used. The cusp pliability on the basis of the difference between the maximal and effective mitral valve area in absolute measures of cm2 was significantly smaller in patients with mitral stenosis, but in the deviations from normal indexed values of cusp pliability excluding the influence of the anatomic or maximal orifice area, there were no significant differences (normal values 0.00 +/- 27%). The normal relationship of the difference between the maximal and effective mitral valve area in absolute measures (y = cm2) and the maximal mitral valve area (x = cm2) is formulated with the regression equation: y = 0.317x - 0.245. The linear correlation of the normal mitral valve area and the stroke volume at rest in patients with the normal mitral valve is very tight. The stroke volume is significantly lower in mitral stenosis, and the time-velocity integral in the diastole or the mitral stroke distance was significantly greater. The relationship of the percentual deviation from the normal indexed values of cusp pliability excluding the influence of the anatomic or maximal orifice area, on the one hand, and the computer-tomographic approximation of calcium incrustation in mitral leaflets on the other are defined with a tight linear correlation. One could conclude that the magnitude of cusp pliability or calcification can be approximated by the Doppler-echocardiographic method.

Adult

Restoration of pliability to the mitral leaflets during reconstruction.

From July 1992 through February 1994, 34 patients have undergone a leaflet thinning procedure during reconstruction of the mitral valve. In this procedure a fibrous layer is separated from the atrial and/or ventricular surface of the anterior and posterior mitral leaflets. This reduces the thickness of the mitral leaflets and improves pliability and mobility. To our knowledge this procedure has not been reported previously.

Adolescent

The effects of soft tissue mobilization on the immature burn scar: results of a pilot study.

The purpose of this pilot study was determine the effects of soft tissue mobilization (STM) on range of motion (ROM), scar pliability, and vascularity. Patients received either one treatment session of standard physical therapy or standard physical therapy plus 10 to 15 minutes of STM. Before and after ROM, scar pliability and vascularity measurements were obtained. The student's t test was used to compare measurements and revealed the STM group (n = 5) had significant (p < 0.10) gains in wrist extension and radial deviation, and the control group (n = 5) had significant gains in wrist extension and ulnar deviation. No significant difference was found in ROM, scar pliability, and vascularity when the STM group was compared to the control group. Further study of a larger sample over multiple treatment sessions is necessary to determine the true efficacy of STM.

Adult

Pulsed dye laser treatment of hypertrophic burn scars.

Hypertrophic burn scars are notoriously difficult to treat because of their extensive tissue involvement and tendency to worsen with hypertrophy and contracture formation. Various therapies have been advocated in the past, including surgical excision and grafting, dermabrasion, and corticosteroids, with distinct cosmetic limitations. The 585-nm pulsed dye laser has been shown previously to be effective in the treatment of a variety of traumatic and surgical scars with improvement in scar texture, color, and pliability with minimal side effects. Sixteen patients with 40 hypertrophic burn scars resulting from chemical peels, carbon dioxide laser procedures, and accidental thermal injury were treated with a 585-nm pulsed dye laser. Sequential photographic and clinical assessments were recorded in all patients. Histologic evaluations of skin punch biopsies before and after laser irradiation were performed when possible. Symptomatic improvement of scars was reported after one treatment. Decreased scar erythema with improved texture and pliability was observed after an average of 2.5 treatments. No correlation was found between scar duration, location, or etiology and response to treatment. Normal number of dermal fibroblasts with decreased sclerosis was observed on histologic examination of laser-irradiated scars. The 585-nm pulsed dye laser irradiation of hypertrophic burn scars can effectively improve scar pliability and texture and decrease erythema and associated symptoms yielding cosmetically and functionally acceptable clinical results.

Adult

Early experience with a new collagen-impregnated aortic graft.

Standard knitted Dacron prosthetic grafts in the aortic position have performed well in terms of patency and durability, but require preclotting and lose their pliability with use. In an effort to overcome these problems, a collagen-impregnated double-velour knitted Dacron graft has been developed. This graft is impervious to blood, does not require preclotting, and maintains its pliability. During a 2 and one half year period, 590 of these grafts have been used at our institution for abdominal aortic replacement in both emergent and elective cases. Indications have included aneurysmal disease (67%), occlusive disease (30%), and failed previous aortic graft (3%). A bifurcated graft has been used in most cases (68%). The patient population has included 449 men and 141 women. Their median age is 68 years, with a range from 15 to 91 years. Seventy nine per cent of the patients experienced no perioperative complications. The remaining twenty one per cent have had a variety of complications, most of them cardiac or pulmonary, but none related directly to the graft. Twenty nine patients died in the perioperative period, for a mortality of 4.9 per cent. Late complications have been infrequent and in no cases directly related to the graft. There have been no graft-related late deaths. It is concluded that, at least in this early experience, there are no problems inherent in the use of this graft. Its pliability and the fact that it does not require preclotting are distinct advantages over previous Dacron grafts.

Adolescent

[Progression of senile aortic valve calcification: echocardiographic and clinical assessment].

Factors involved in the progression of senile aortic valve calcification were evaluated by analyzing the clinical and echocardiographic characteristics of patients older than 69 years with senile aortic valve calcification. The patients were divided into three groups; group 1: 46 male and 40 female patients with calcification of one cusp and almost normal pliability of three cusps, group 2: 48 males and 55 female patients with calcification of two or three cusps, mildly reduced pliability of calcified cusps, and aortic valve area (AVA) > or = 2.0 cm2, group 3: 26 male and 31 female patients with calcification of two or three cusps, significantly reduced pliability of calcified cusps, and AVA < or = 1.5 cm2. There were no significant differences in age, weight, height, left ventricular dimension, or left ventricular wall thickness between these three groups. For male patients, the end-diastolic maximum left ventricular outflow tract dimensions (LVOT) in groups 1, 2, and 3 were 20 +/- 2 mm, 19 +/- 2 mm (p < 0.01 vs group 1), and 17 +/- 3 mm (p < 0.001 vs group 1, p < 0.01 vs group 2), respectively. For female patients, the LVOTs of groups 1, 2, and 3 were 18 +/- 2 mm, 16 +/- 2 mm (p < 0.001 vs group 1), and 16 +/- 2 mm (p < 0.001 vs group 1), respectively. Reduction in LVOT was not associated with left ventricular hypertrophy or decrease in dimension of aortic annulus. In female patients, the frequency of mitral annular calcification of group 3 was 61% [p < 0.05 vs group 1 (35%), p < 0.01 vs group 2 (25%)].(ABSTRACT TRUNCATED AT 250 WORDS)

Aged

Rheumatic mitral stenosis:cross-sectional echocardiographic analysis.

Twenty-one patients with rheumatic mitral stenosis diagnosed by both M-mode echocardiography and hemodynamic findings were subjected to detailed cross-sectional echocardiographic studies. The age of the patients ranged from 27 to 79 years with 76% females. Left ventricular longitudinal, short axis, and apical four-chamber cross-sectional echocardiographic views were obtained in each patient. Three predominant patterns of anterior mitral leaflet motion on left ventricular longitudinal view were observed and correlated with the severity of mitral stenosis: Pattern A (eight patients) with diastolic leaflet doming and restricted leaflet tip motion. Pattern B (eight patients) tip and body leaflet motion, and Pattern C (five patients) with the entire leaflet motion restricted. Mitral valve prolapse as a rebound phenomenon was observed in three patients who had marked leaflet doming in Pattern A and two had severe obstruction. The longitudinal cross-sectional echocardiography was superior to the apical view in assessing the diastolic doming motion of the anterior mitral leaflet. Thus, longitudinal cross-sectional echocardiographic analysis of the pliability and degree of doming of the anterior of the pliability and degree of doming of the anterior mitral leaflet is valuable in estimating the severity of mitral stenosis.

Adult

Ghost cells as a cause of glaucoma.

Clinical and investigative evidence indicated a glaucoma caused mainly by degenerated red blood cells, or ghost cells. These ghost cells, with altered shape, color, and pliability, accumulated in the vitreous cavity after hemorrhage. Following disruption of the anterior hyaloid face, they passed into the anterior chamber and caused severe glaucoma. In the anterior chamber, the tiny, khakicolored cells, circulating slowly, were frequently mistaken for white blood cells. They covered the trabecular meshwork or filled the inferior angle with a pathognomonic khaki-colored layer. They were identified by phase-contrast microscopic examination of anterior chamber aspirates. The decreased pliability of these degenerated cells seemed to account for their inability to pass easily through the human trabecular meshwork and, therefore, to cause severe glaucoma.

Aged