Folds In Patients Research Articles

24 Hours prior to curtain

A retrospective review was conducted of 40 singers presenting with acute voice problems prior to performance. The purpose of this study was to determine the reasons for seeking emergent voice treatment, the types of acute voice disorders, and the performance outcome. The patients were assessed by age, singing style, years of experience, chief complaint, laryngovideostroboscopic findings, and treatment regimens. The outcomes were classified as full, restricted, or no performance. The majority of patients were classical singers. Laryngovideostroboscopy frequently revealed a pattern of early glottic contact at the mid-portion of the membranous vocal fold in patients with acute laryngitis. Experienced singers uniformly sought treatment many days before their performance compared with inexperienced singers who presented closer in time to performance. Six patients initially withheld information, which had a bearing on their acute management. The results of this study suggest that there is a need to accurately diagnose and treat the singer's emergent problem and educate singers regarding early evaluation of medical problems. With modern evaluation techniques and multi-modality treatment, 85% of the singers proceeded to full performance without negative sequelae.

The fissura antitragohelicina: an anatomic aid to the correction of prominent ears.

One of the important features of correction of prominent ears involves the creation of an antihelical fold in the ear cartilage. The precise and symmetrical location of this fold is crucial for the aesthetic result. This study investigated the use of the fissura antitragohelicina, a constant anatomic landmark, as a guide to the correct line for the new antihelix. In the first part of the study, 16 cadaveric ears were dissected. The fissura antitragohelicina was present in each specimen, and measurements of the distance between the fissura antitragohelicina and the helix and the antihelix were recorded. Based on this study, a clinical series of 20 consecutive prominent ear corrections were performed using the fissura antitragohelicina as a guide for the creation of a new, symmetrical antihelical fold. The aesthetic results were satisfactory by subjective assessment in every one of this group of patients. This study showed that the fissura antitragohelicina was a constant, reliable, and simple guide to the creation of the antihelical fold in patients with prominent ears.

The cytotoxicity of methylglyoxal and 3-deoxyglucosone is decreased in the aldehyde reductase gene-transfected cells.

Glycation (the initial portion of the Maillard reaction) plays a major role in diabetic complications since some of the reaction intermediates are responsible for the modification and cross-linking of long-lived proteins, which, in turn, result in a deterioration of normal cell function. Included among these reaction intermediates are methylglyoxal(MG) and 3-deoxyglucosone(3-DG) both of which are cytotoxic dicarbonyl compounds. MG, a reactive α, β-dicarbonyl metabolite and physiological substrate for the glyoxalase system (Thornalley, 1993), is formed via the non-enzymatic and enzymatic elimination of phosphate from dihydroxyacetone phosphate, glyceraldehyde-3-phosphate (Phillips and Thornalley, 1993; Pompliano et al., 1990), as well as by the oxidation of hydroxyacetone and aminoacetone (Reichard et al., 1986; Koop et al., 1985; Lyles et al., 1992). The serum concentration of MG increased 5–6 fold in patients with insulin-dependent diabetes mellitus and 2–3 fold in patients with non-insulin-dependent diabetic mellitus (McLellan et al., 1994). 3-DG, another glucose-derived dicarbonyl compound, is a major and highly reactive intermediate in the Maillard reaction and a potent cross-linking agent responsible for the polymerization of proteins and the formation of advanced glycation end products (Niwa et al., 1993). Plasma 3-DG levels are also increased under diabetic conditions (Yamada et al.; 1994).

The study of vocal fold vibratory patterns in patients with unilateral vocal fold paralysis before and after type I thyroplasty with or without arytenoid adduction

Type I thyroplasty and arytenoid adduction have been used for the treatment of symptomatic unilateral vocal fold paralysis since the mid-1970s. To this date, the vibratory patterns of the vocal folds in patients with unilateral vocal fold paralysis undergoing thyroplasty have not been studied in depth. Abnormal vibration of the vocal fold mucosa often contributes to voice problems in persons diagnosed with vocal diseases or disorders. The preoperative and postoperative videostroboscopic vibratory patterns including mucosal wave, amplitude, glottic closure, and symmetry were studied in 12 patients who underwent unilateral type I thyroplasty separately or in combination with an arytenoid adduction. The observed changes and clinical implications are discussed.

Potentiation of GM-CSF or GCSF Induced Mobilization of Circulating Progenitor Cells by Pretreatment with IL-3 and Harvest by Apheresis

Recombinant human colony-stimulating factors (CSFs) are increasingly used for mobilizing progenitor cells in the peripheral blood (PB). 7 patients were treated with GM-CSF or G-CSF at a dose of 5 micrograms/kg/d for 5 days and after a treatment free interval received another cycle of the same cytokine after pretreatment with IL-3. Pretreatment with 5 micrograms/kg/d of IL-3 for 7 days did not mobilize by itself but significantly potentiated GM-CSF or G-CSF induced mobilization of PB progenitor cells in all 5 patients tested. As compared to the mobilization capacity of GM-CSF or G-CSF alone, 7 day IL-3 pretreatment potentiated maximum values of CFU-GM by 3.7-6.3 fold in patients receiving GM-CSF (n = 2) and by 1.8-3.3 fold in patients receiving G-CSF leading to a 10-23 fold increase in numbers of circulating CFU-GM by the combination IL-3/GM-CSF, and a 26-101 fold increase by IL-3/G-CSF, respectively. Stem cell apheresis in patients treated with IL-3 + G-CSF or GM-CSF yielded enough PB-stem cells to ensure complete engraftment after ablative chemotherapy.

An improved technique for creation of the inframammary fold in silicone implant breast reconstruction.

A "lipo-fascial" flap is described for creation of the inframammary fold in patients undergoing breast reconstruction with silicone implants. We have employed this technique in 13 patients. The fold has been enhanced in all cases, and we have not encountered any significant complications. This technique is a useful adjunct to breast reconstruction with a silicone implant, and we recommend that it be considered in appropriate patients.

Increased Endogenous Neuropeptide Ligand for Benzodiazepine Receptors in Hepatic Encephalopathy

The neuropeptide diazepam binding inhibitor (DBI) is an endogeneous allosteric modulator of gammaaminobutyric acid (GABA) receptors at the benzodiazepine recognition site. Recent theories on the neurochemical cause for hepatic encephalopathy have implicated activation of inhibitory neurotransmitter GABA systems. In 20 patients with hepatic disease, blood and cerebrospinal fluid (CSF) levels of ammonia and amino acids were measured. As in previous studies there was a selective elevation of CSF amino acids as well as a correlation between CSF glutamine levels and encephalopathy. CSF DBI levels were maximally elevated 5–fold in patients with hepatic encephalopathy, but they were normal in those patients with liver disease not associated with changes in mental status and in patients with nonhepatic encephalopathy. Levels of DBI correlated with the clinical staging of hepatic encephalopathy. These data suggest that DBI may participate in the modulation of cerebral function in hepatic encephalopathy.

Angioscopic observation of the coronary luminal changes induced by percutaneous transluminal coronary angioplasty

Coronary luminal changes induced by percutaneous balloon or laser coronary angioplasty were examined angioscopically in 10 patients with ischemic heart disease. A fiberscope (2.6F to 5.3F) was introduced into the coronary artery with the use of a guiding catheter with or without a balloon at the tip. Angioscopy was successful before angioplasty in nine and after angioplasty in 10 of 11 coronary segments. Before angioplasty, the stenotic segments were composed of yellowish or whitish atheromatous piaques with smooth surfaces or spiral folds in patients with stable angina pectoris. In one patient with unstable angina pectoris, the stenotic segment was scalloped angiographically and showed an irregular and whitish plaque angioscopically. After angioplasty, endothelial exfoliation with scattered thrombl (10 segments), bellows-like folds (two), longitudinal cleft (one), plaque rupture (two), and intimal dissection (two) could be identified angioscopically. These changes, with the exception of dissection, could not be identified angiographically. In one patient who underwent thermal argon laser angioplasty, the dilated segment appeared brownish, which indicated carbonization. In one patient with acute myocardial infarction, the occlusive thrombl were vaporized by thermal laser angioplasty. The results demonstrate the clinical feasibility of percutaneous angioscopy for pathologic documentation of coronary luminal changes before and after angioplasty.

Effects of Repeated Stripping on Vocal Fold Mucosa in Cats

Repeated stripping of the vocal folds in patients with recurrent vocal nodules may produce permanent, negative effects on voice quality. Hoarseness can be present with no evidence of structural or functional disease on indirect laryngoscopy. A common assumption is that scar tissue has formed, though the relationship between scarring and voice quality is not clear. In the study reported here, cats were subjected to four strippings of the left vocal fold at 6- to 8-week intervals. Tissues obtained were examined for changes in the composition of the mucosa and its nervous network. Alterations observed over the four strippings included 1) an increasing component of fibrous tissue and 2) apparent changes in both the number and structure of nervous elements. Implications of the findings for voice production, clinical management, and further research are discussed.

192Ir pharyngoepiglottic fold interstitial implants. The key to successful treatment of base tongue carcinoma by radiation therapy.

Twenty-eight patients with squamous carcinomas of the base tongue were seen and evaluated in a conjoint Head and Neck Tumor Board at Stanford between 1976 and 1982. Fourteen patients were treated by combined external beam and interstitial irradiation, 11 of whom had Stage III and IV carcinomas (American Joint Committee). An initial dose of 5000 to 5500 rad was first delivered by external beam irradiation in 5 to 5.5 weeks, followed approximately 3 weeks later by an iridium 192 (192Ir) interstitial implant boost by the trocar and loop technique. The key to successful treatment of these neoplasms was found to be the use of a lateral percutaneous cervical technique, which placed horizontal loops through the oropharyngeal wall above and below the hyoid bone; the superior loop included the pharyngoepiglottic fold and the tonsilloglossal groove. Standard multiple loop implants (submentally inserted) of the base tongue from the vallecula anteriorly to the circumvallate papillae were also used routinely. This approach has been successful, since 10 of the 14 patients (71%) remain without evidence of disease (mean follow-up, 32 months). There have been only two local recurrences, both on the pharyngoepiglottic fold in patients who did not receive the now standard pharyngoepiglottic fold/lateral pharyngeal wall implants. No patients have relapsed after 18 months. The other 14 patients were treated prospectively during the same period by combining initial resection, radical neck dissection, and postoperative irradiation. In this group, there were more locoregional failures compared to the group treated with radiation therapy alone (5 tongue recurrences and 7 neck relapses); in addition, more severe complications were noted in these 14 patients who received surgery and postoperative irradiation. The authors believe that combined external beam and interstitial irradiation is effective treatment for base tongue carcinomas, especially when the high-dose distribution includes the adjacent tonsilloglossal groove, pharyngoepiglottic fold, and oropharyngeal wall to and below the level of the hyoid bone, in addition to treating an adequate base tongue volume.

Clinical pharmacology of pyridostigmine and neostigmine in patients with myasthenia gravis.

Determination of plasma concentration of pyridostigmine in 20 myasthenic patients on maintenance therapy revealed rather small intraindividual variations within a dose interval. The predose concentration varied considerably between different patients and up to seven fold in patients on the same daily dose. No pharmacokinetic interaction between pyridostigmine and neostigmine was found in five patients studied. In six patients the decrement in the deltoid muscle was studied in parallel with determination of the plasma concentrations following administration of pyridostigmine or neostigmine. In these patients the existence of a "bell-shaped" dose response curve is suggested with the maximal effect at a concentration of 30-60 ng/ml for pyridostigmine and 5-15 ng/ml for neostigmine.

Capillary Microscopy of the Nail Fold in Patients with Psoriasis and Psoriatic Arthritis

The Capillary characteristics of the nail fold area were examined and compared by capillary microscopy in 31 patients with psoriasis (PS) and 34 patients with psoriatic arthritis (PA). 70 healthy persons served as controls. Significantly shorter mean capillary loop lengths and characteristic morphological capillary changes were found both in patients with PS and in patients with PA as compared to the controls. The number of hemorrhages and sluggishness of blood flow was more pronounced in both groups of patients as compared to the control group, but only significantly so in patients with PA. The only significant difference between the PS and the PA groups was a higher subpapillary plexus visibility (SPV) index in the latter. It is concluded that most of the capillary changes demonstrable in patients with PA are clinical manifestations of PS. The difference in the SPV index, however, warrants a follow-up study to elucidate whether patients with PS and a high SPV index are likely to develop arthritis.

Infraorbital Fold in Atopic Dermatitis

An infraorbital fold (Dennie-Morgan fold) occurred in 74 (25%) of 300 patients with atopic dermatitis. Lower eyelid dermatitis was initially seen in 69 (23%) of these 300 patients. Of the 69 patients with lower eyelid dermatitis, 57 (83%) showed the infraorbital fold. However, such a fold was seen only in 17 (7%) of 231 patients who lacked lower eyelid dermatitis. An infraorbital fold also was observed in eight of 11 patients with contact dermatitis of the lower eyelid. Thus, it is likely that an infraorbital fold develops when the lower eyelid is affected with eczematous dermatoses of diverse origins. The frequent occurrence of an infraorbital fold in patients with atopic dermatitis may be caused by the fact that the eyelid is a site of predilection for this dermatitis.

Coarse duodenal mucosal folds in patients with dyspepsia and a high gastric acid output

It is suggested that patients with coarse mucosal folds in the first part of the duodenum, who have dyspepsia with a high gastric acid output, but without duodenal ulceration, should be treated as if they had active duodenal ulceration. The radiological, histological and operative findings in six such patients are described. It is suggested that coarse mucosal folds in the duodenum are very unlikely to be due to hyperplasia of Brunner's glands, which is considered to be an extremely rare condition. It is our opinion that the radiological appearances are due to excessive activity of the muscularis rather than mucosal oedema. It is suggested that patients with coarse mucosal folds in the first part of the duodenum, who have dyspepsia with a high gastric acid output, but without duodenal ulceration, should be treated as if they had active duodenal ulceration. The radiological, histological and operative findings in six such patients are described. It is suggested that coarse mucosal folds in the duodenum are very unlikely to be due to hyperplasia of Brunner's glands, which is considered to be an extremely rare condition. It is our opinion that the radiological appearances are due to excessive activity of the muscularis rather than mucosal oedema.

Coarse duodenal folds in patients with peptic ulcer.

Coarse duodenal folds in patients with peptic ulcer.

Surgical formation of upper lid fold.

There are many occasions when an ophthalmic surgeon deems it surgically necessary to produce an upper lid fold for functionally reparative or basically cosmetic purposes. The spectrum of causative factors, necessitating subsequent surgical formation of the upper lid fold, may be divided into the following broad categories: ( a ) loss of upper lid fold following severe trauma as a result of an automobile accident, hand-to-hand fighting, etc.; ( b ) loss of upper lid fold (previously existent—a possible aftermath of ptosis surgery; ( c ) creation of upper lid fold (previously non-existent). Numerous upper lid fold surgical procedures are executed throughout the world and many have been assiduously described in medical journals. Some of these methods have required incisions through the skin resulting, sometimes, in cosmetically unattractive lid folds in patients with a tendency toward keloid formation. After having been stationed in military service in the Far East, I am of the firm opinion that