Spatial and Temporal Brain Responses to Noxious Heat Thermal Stimuli in Burning Mouth Syndrome.

Burning mouth syndrome (BMS) is an idiopathic orofacial pain condition. Although the pathophysiology of BMS is not clearly understood, central and peripheral neuropathic mechanisms are thought to be involved. The authors compared brain response to noxious heat stimuli in 16 right-handed women with primary BMS and 15 sex- and age-matched right-handed healthy female controls. A thermal stimulus sequence of 32 °C to 40 °C to 32 °C to 49 °C was repeated 4 times in a cycle. Warm and noxious heat stimuli were delivered with a Peltier thermode placed on the right palm or right lower lip for 32 s each in a session. Functional magnetic resonance imaging data were obtained by recording echoplanar images with a block design. Statistical Parametric Mapping 8 software was used to analyze the data. Patients and controls both reported feeling more pain during palm stimulation than during lip stimulation. Repetition of noxious heat stimulus on the lower lip but not on the palm induced habituation in brain activity in the cingulate cortex without reduction in pain perception. Multiple regression analysis revealed a correlation between perceived pain intensity and suppression of brain activity in the anterior cingulate cortex when the repeated thermal sequence was applied at the lower lip. Furthermore, the response of the parahippocampal area differed in BMS patients and controls when the same repeated thermal sequence was applied at the palm. The authors' findings indicate that BMS patients show specific brain responses due to impaired function of the central and peripheral nervous systems (clinical trial registration: UMIN000015002).

Measurement of B(0)(d)-B_(0)(d) mixing rate from the time evolution of dilepton events at the upsilon(4S).

We report a determination of the B(0)(d)-&B_(0)(d) mixing parameter Deltam(d) based on the time evolution of dilepton yields in Upsilon(4S) decays. The measurement is based on a 5.9 fb(-1) data sample collected by the Belle detector at KEKB. The proper-time difference distributions for same-sign and opposite-sign dilepton events are simultaneously fitted to an expression containing Deltam(d) as a free parameter. Using both muons and electrons, we obtain Deltam(d) = 0.463+/-0.008 (stat)+/-0.016 (syst) ps(-1). This is the first determination of Deltam(d) from time evolution measurements at the Upsilon(4S). We also place limits on possible CPT violations.

Thyroplasty for adductor spasmodic dysphonia: further experiences.

OBJECTIVES: Two different surgical techniques for midline lateralization thyroplasty (type 2 thyroplasty) for adductor spasmodic dysphonia (SD) have been described, one using a composite graft and the other without. Indications and results for each method among different types of SD were compared, together with the theoretical background for the surgery. STUDY DESIGN: Retrospective. METHODS: The medical records of six patients with SD together with the fiberscopic video recording of laryngeal findings before, during, and after surgery were reviewed. The intraoperative video recordings of the surgical procedures were compared with the postoperative findings. RESULTS: The vocal features of SD, diverse preoperatively, disappeared postoperatively and a normal, or almost normal, voice was attained in 5 of 6 cases. The failure in one patient was attributed to combined focal dystonia of the neck muscles and difficulty in lateralization. Type 2 thyroplasty without a graft, which causes bowing of both vocal folds, is simple to perform and effective enough for most SD cases. No recurrence has been noted so far over postoperative periods ranging from 6 months to more than 3 years. CONCLUSION: The results suggest that thyroplasty is an effective therapeutic approach for SD.

Measurement of the CP violation parameter sin2 phi(1) in B(0)(d) meson decays.

We present a measurement of the standard model CP violation parameter sin2 phi(1) (also known as sin2beta) based on a 10.5 fb(-1) data sample collected at the Upsilon(4S) resonance with the Belle detector at the KEKB asymmetric e(+)e(-) collider. One neutral B meson is reconstructed in the J/psiK(S), psi(2S)K(S), chi(c1)K(S), eta(c)K(S), J/psiK(L), or J/psipi(0) CP-eigenstate decay channel and the flavor of the accompanying B meson is identified from its charged particle decay products. From the asymmetry in the distribution of the time interval between the two B-meson decay points, we determine sin2 phi(1) = 0.58(+0.32)(-0.34)(stat)+0.09-0.10(syst).

Ventilation grilles as a potential source of methicillin-resistant Staphylococcus aureus causing an outbreak in an orthopaedic ward at a district general hospital.

The spread of methicillin-resistant Staphylococcus aureus (MRSA) in a hospital is thought to be mainly by direct contact. Environmental sources such as exhaust ducting systems have been increasingly recognized as a source for MRSA outbreaks in intensive therapy units. We describe an outbreak of MRSA related to ventilation grilles in an orthopaedic ward. Six patients and one nurse were involved in an outbreak with EMRSA-15 during March 1996. The index case was transferred from a large university hospital in Leeds. One of the patients had shared the same bay with the index case. The rest of the patients were in another bay of the same ward and had no direct contact with the index patient. An environmental source was suspected and the ventilation grilles in boys 1 and 2 were found to be harbouring EMRSA-15. The ventilation system at that time was working on an intermittent cycle from 4 p.m.-8 a.m. Daily shut-down of the system temporarily created a negative pressure, sucking air in from the ward environment into the ventilation system and probably contaminating the outlet grilles. It is likely that contaminated air was blown back into the ward when the ventilation system was started. The system was thoroughly cleaned, appropriate infection control measures were instituted and the ventilation system was put back on a continuous running cycle and the outbreak terminated. Six months after the outbreak no isolates of EMRSA-15 had been made on the ward.

[Acoustic analysis of certain consonants using a computed model of the peripheral auditory system].

Stop consonants [p], [t], [k] and a fricative [s] were acoustically analyzed using a computed model of the peripheral auditory system in 12 normal subjects and 12 patients with tumors of the tongue who had undergone surgical resection and reconstruction. The model is a combination of the cochlear model that consists of 28 FIR filters (Delgutte) and the inner hair-cell/auditory nerve synapse model (Meddis), with some modification. It simulates firing of the auditory nerve in every channel related to the FIR filters in response to an input voice signal. Phonetic characteristics of the tested consonants were more clearly visualized by observing firing patterns and voice onset time (VOT) using this auditory model than with use of the conventional soundspectrogram. In patients with tumors of the tongue, the degree of distorted articulation and the area of surgical resection were significantly related to obscurity of the phonetic characteristics of the stop consonants [t] and [k]. Acoustic analysis using this auditory model may serve as a useful tool for voice analysis in research and in the clinical field.

Facial nerve stimulation through Stensen's duct.

We report on a new method of stimulating the facial nerve through Stensen's duct. Electrical resistance of the skin and subcutaneous tissue is one of the major problems of neurophysiological facial nerve testing. To overcome this disadvantage, the authors show that the facial nerve can be stimulated with far less current through Stensen's duct. The NET, ENoG, and antidromic facial nerve responses are recordable at less than a third of the current required for conventional percutaneous stimulation. It is our belief that nerve stimulation through Stensen's duct will be a new and useful method for assessing facial nerve dysfunction in the early stage of palsy.

Experimental studies on the viscoelasticity of the vocal fold.

Viscoelasticity of the vocal fold was assessed by analyzing the stress-strain relationship under several experimental conditions. The stiffness increased with greater tension of the vocal fold. Marked differences in the mechanical properties were noted between the "body" and the "cover" of the vocal fold, especially when tension was applied. Contraction of the thyroarytenoid muscle tended to make the vocal fold less stiff and more viscous. Dry vocal-fold mucosa was associated with greater stiffness. Submucosal injection of saline solution to simulate edema increased the stiffness and viscosity of the vocal fold.

Mechanical properties of the vocal fold. Stress-strain studies.

The viscoelasticity of the vocal and ventricular folds was experimentally assessed by analyzing the stress-strain relationships obtained using a newly developed measuring system. The degree of stiffness of the mid-membranous portion of the vocal fold was less than that near the anterior commissure or the vocal process. The ventricular fold was much less stiff and significantly more viscous than the vocal fold. At the membranous portion of the vocal fold, the degree of stiffness was less and that of viscosity greater at 2 mm above and below the free margin than at the free margin itself.

Eustachian tube patency detected by a photoelectric method.

A method was developed to observe tubal orifice movement by fiberscope and detect patency of the eustachian tube by a photoelectric device (phototubometry). A highly sensitive photodiode in the external ear canal detected tube opening as increased luminosity in the tympanic cavity from a light source placed at the pharyngeal portion of the eustachian tube. The phototubometric record was superimposed on a TV screen to compare the opening in the pharyngeal portion of the eustachian tube to the tube opening during swallowing. The phototubometric records of 21 normal subjects examined by phototubometry showed the close relationship with the opened tubal lumen at the tensor veli palatini muscle (TVP) attached portion. This method is useful for examining tubal patency and observing changes in the pharyngeal portion of the eustachian tube.

Frequency and amplitude perturbation analysis of electroglottograph during sustained phonation.

Electroglottography (EGG) was used to monitor vocal fold vibration patterns in normal subjects and patients with various laryngeal disorders. In order to evaluate the regularity of vocal fold vibration, frequency and amplitude perturbation of EGG waves during sustained phonation were measured with a laboratory computer. The data were compared to the degree of hoarseness evaluated by auditory perception and by sound spectrographic analysis. Frequency and amplitude perturbation measures showed some overlap between normal and pathological groups. However, there was a close relation between perturbation analysis of EGG waves and degree of hoarseness (Spearman's rank correlation coefficient rs = 0.73, p less than 0.0005). Amplitude perturbation was found to be a more sensitive measure of the irregularity of vocal fold vibration than frequency perturbation.

Transfer of group B streptococci from mothers to neonates: effect of whole body washing of mothers with chlorhexidine.

Seven babies born to 28 mothers who were vaginal carriers of group B streptococci and who bathed or showered with chlorhexidine during the last 2 weeks of pregnancy were colonized with an organism of the same phage type as their mothers. In contrast, nine babies of 14 carrier mothers who were given no instructions regarding washing were colonized with the same phage type as their mothers. Ten of the 84 sites sampled for group B streptococci on the babies born to mothers using chlorhexidine were positive, whereas 17 of 42 were positive in the babies born to control mothers. This trial suggests that whole body washing with chlorhexidine may reduce the transfer of group B streptococci from mothers to infants, but did not exclude the possibility that body washing by itself may have a similar effect.

Voice analysis of the partially ablated larynx. A preliminary report.

This study attempts to obtain a data base of objective formation on the phonatory characteristics of the partially ablated larynx. Twenty patients who had previously undergone partial laryngectomy with glottic reconstruction underwent videolaryngoscopy. The visualizations obtained revealed that the mechanism of voice production was due in part to sphincterization and compensatory hypertrophy of glottic and supraglottic remnants. Aerodynamic and phonatory function tests together with acoustical and perceived voice quality analyses of these partially ablated larynges tend to corroborate the videotape impressions in many instances. However, data accumulated thus far only reveal trends that cannot yet be subjected to definitive interpretations. With the incorporation of other methods of evaluation, augmented by the inclusion of more patient material, it is hoped that the information obtained can be used to improve reconstructive techniques, monitor surgical results, and enhance methods of voice rehabilitation in these patients.

Role of the tensor tympani muscle in eustachian tube function.

In order to determine the role of the tensor tympani muscle in Eustachian tube function, pressure changes in the external and middle ear of 13 cats were measured under four experimental conditions. It was revealed that contraction of the tensor tympani muscle during swallowing did not result in any tympanic pressure rise which might assist in tubal ventilation. Acoustic stimulation was then used to measure consistent contraction of the tensor tympani muscle. Combined contraction of the tensor veli palatini and tensor tympani muscle under the condition of positive tympanic pressure failed to open the tube. It was concluded that the tensor tympani muscle might not play any part in tubal function.