[FEES in Infants with Swallowing Disorders - A Feasible Procedure?]. / FEES bei Säuglingen mit Schluckstörungen - wie sinnvoll ist die Untersuchung?

BACKGROUND: Although FEES has been established as a valid procedure in instrumental evaluation of swallowing even in young children, the significance of the endoscopic method on infants has not yet been fully clarified. The aim of this prospective study was to evaluate fiberoptic endoscopic examination of swallowing in infants by focusing on its feasibility and limits. PATIENTS AND METHODS: From 11/2011 to 3/2015 27 infants from a neuropediatric hospital presented for fiberoptic endoscopic examination of swallowing. Compared with Langmore standard FEES was carried out in a modified algorithm. RESULTS: In 24 of the 27 infants information about swallowing pathology could be obtained. Silent aspiration of saliva (Penetration Aspiration Scale (PAS) level 8) or silent deep penetration of test diets to the level of the glottis (PAS level 5) presented in 10 children and overt deep penetration of test diets in 3 children. In no case a sufficient insight into the subglottis or trachea could be obtained. Therefore a differentiation of silent deep penetration and aspiration of test diets was impossible. As a consequence of the FEES results, probe and diet management was changed in 7 children. CONCLUSIONS: In this study fiberoptic endoscopic evaluation of swallowing in a modified algorithm turned out to be a feasible tool for the diagnostics of swallowing disorders in about 89 percent of the infants. The procedure was limited in terms of providing direct evidence on aspiration in cases of deep penetrations of test diets.

An experimental study on bacterial colonization, nitrite and nitrosamine production in the operated stomach.

Intragastric bacterial growth and nitrite and nitrosamine formation were investigated in animal experiments after different surgical procedures of ulcer management with regard to carcinogenesis in the operated stomach. The operative procedures resulted in an alteration in the gastric flora with an increase and predominance of nitrate-reducing bacteria. There was an increase in the intragastric nitrite and nitrosamine concentration corresponding to the increase in nitrate-reducing bacteria. All three parameters showed the greatest increase after gastric resection, whereas there were no significant differences after vagotomy with pyloroplasty, compared with a control group. These findings in animal experiments are of etiopathological relevance to the known danger of cancer in the resected human stomach and should be taken into consideration when choosing a procedure for surgical ulcer therapy.

Nitrite and N-nitroso compounds in the operated stomach.

The concentration of nitrite and N-nitroso compounds was examined in the fasting gastric juice of 44 patients with regard to the known cancer risk of the operated stomach. All patients had been operated for ulcer disease in average 2.5 years previously. Twenty-six age-matched individuals with healthy stomachs figures as a control group. The concentration of nitrite and N-nitroso compounds in the gastric juice of the vagotomized patients (PGV) did not differ from that of the controls. On the other hand, a significant increase of the nitrite concentration was found in gastric juice of patients resected according to Billroth I or II procedure. The fraction of N-nitroso compounds, however, was significantly elevated in comparison to the other gastric juice samples only in the Billroth II-resected stomach. The importance of the increase of nitrite and N-nitroso compounds for the cancer risk inherent to the gastric stump is discussed.

Frequency of cancerous and precancerous epithelial lesions in the stomach in different models for enterogastric reflux.

A gastroenterostomy without entero-anastomosis in rats favours the development of adenomatous epithelial lesions at the gastroenteral borderline in dependence of exposition to MNNG. The extent of such changes in the mucosa could be modified by vagotomy, pyloroplasty, or the prevention of duodenogastric reflux (Roux-en-Y method), whereby vagotomy has an enhancing effect on proliferation. A comparison of the mucosal changes at the gastroenteral anastomosis indicates that a multitude of factors causes environmental changes at the gastroenteral borderline, stimulating epithelial proliferation to the point of cancer formation. Thus, it is not possible to accuse any single factor such as intestinal reflux, carcinogens or different surgical techniques as the sole culprit in carcinogenesis.

[Ultrasonography of the tongue in the rehabilitation of speech articulation disorders]. / Ultrasonografia jezyka w rehabilitacji zaburzen artykulacyjnych.

There has been presented a possibility of application of ultrasound examination of the tongue in the diagnosis and phoniatric rehabilitation exemplified by exposing shapes of the lateral surface of the tongue during correct articulation of the Polish vowels and articulatory exercises in the system of visual feedback in a normally hearing child and in a deaf one.

[Influence of neck soft tissue vibrations on the EGG-Lx signal]. / Schwingungen der Halsweichteile und das EGG-Lx-Signal.

An 3 männlichen und 2 weiblichen stimmgesunden Probanden wurde untersucht, ob sich Schwingungen der Halsweichteile im EGG-Lx-Signal nachweisen lassen. Im ersten Schritt wurde das <> bei am Hals positionierter, schwingender Stimmgabel ohne begleitende Phonation aufgezeichnet. Im zweiten Schritt wurde das EGG-Lx-Signal bei der Phonation des Vokales /a/ registriert; während der Messung war eine schwingende Stimmgabel am Hals plaziert. Im dritten Schritt wurde das EGG-Lx-Signal bei Phonation des Vokales /a/ aufgezeichnet, während eine nichtschwingende Stimmgabel am Hals positioniert war. Die Stimmgabelschwingung war im Spektrogramm der EGG-Lx-Signale als frequenzspezifischer Peak erkennbar, dagegen war dieser Peak im EGG-Lx-Spektrogramm des dritten Untersuchungsschrittes nicht nachweisbar. Dieses Ergebnis kann für die Interpretation des EGG-Lx-Signales von Bedeutung sein.

Nitrite and nitrosamines in gastric juice: risk factors for gastric cancer?

Nitrite and nitrosamine concentrations have been measured in 108 patients undergoing gastroscopy as a part of routine gastrointestinal investigations. The nitrite and nitrosamine values of 20 patients with duodenal and 11 patients with benign gastric ulcer were within the range of the values of 26 normal subjects. The nitrite and nitrosamine concentrations in 32 patients with inflammatory changes of the gastric mucosa were slightly higher than normal values and correlated with the progressive degrees of the severity. In 19 patients with atrophic gastritis the concentrations of nitrite and nitrosamines were significantly elevated in comparison with those of all other groups. Our data suggest a relationship between the constant exposure of an already damaged gastric mucosa to N-nitroso compounds and the known high incidence of gastric cancer in atrophic gastritis.

[Ultrasound sonography of active and passive tongue motility]. / Ultraschalluntersuchung der aktiven und passiven Beweglichkeit der Zunge.

Applying both B- and M-mode sonography, we examined tongue movements during swallowing, during repetitions of identical and changing syllables and during continuous articulation of voiced apical /r/. A pseudo-three-dimensional reconstruction was developed for tongue movements registered in B-mode. Our approach can be easily applied for the evaluation of impaired tongue motility in speech pathology.

Temporal reconstruction of sonographic imaging of disturbed tongue movements.

Documentation of tongue movement during swallowing has been restricted to the recording of fluorographic or ultrasound images on cine- or videofilm. The new approach of temporal sonographic imaging with reconstruction of one single image for the total act of swallowing presents a direct approach to obtaining substantial information concerning tongue movements and motility. The applicability of this reconstructed image for the documentation, interpretation, and comparison of tongue movements is demonstrated using examples of normal and pathologic swallowing.

[High resolution computer tomography of the middle and inner ear]. / Die hochauflösende Computertomographie des Mittel- und Innenohres.

High-resolution CT enables exact visualisation of the bony structures of the petrous bone; at the same time, all relevant nerval, vascular and muscular elements of the middle and inner ear are visualised. A wider range of findings can be attained in this region of wide differences in density than via conventional pluridirectional tomography. The normal anatomy of the petrous bone is demonstrated via CT series of slices in axial and coronal projection.

[Ultrasonic diagnosis of the pseudoglottis in laryngectomized patients]. / Die Ultraschalluntersuchung der Pseudoglottis bei Kehlkopflosen.

The validity of ultrasonic imaging as a tool for the investigation of pseudoglottal movements was studied in five good to excellent esophageal speakers. The length of pseudoglottis and vibration rate during phonation of vowels was evaluated by means of B-mode and M-mode sonography respectively. The pseudoglottal vibration rate as seen in M-mode sonography was in high agreement with the fundamental frequency of the simultaneously recorded sound as assessed by speech analysis. Ultrasound imaging is a promising diagnostic and therapeutic tool for the control and development of esophageal speech.

[Indications for vocal cord augmentation with collagen]. / Indikationen zur Stimmlippenaugmentation mit Kollagen.

BACKGROUND: Vocal fold augmentation through an indirect laryngoscopic injection has been largely supplanted by the external approach of vocal fold medialization. Vocal fold augmentation with collagen is still of clinical importance for the temporary treatment of glottic insufficiencies. The different elimination time of certain collagen compounds in the vocal fold tissue enables individual therapeutic applications. PATIENTS AND METHODS: The collagen compounds Zyderm I and II and Zyplast were injected into the vocal fold in 37 patients with neurogenic glottic insufficiency and 2 patients with vocal fold atrophy during indirect laryngoscopy. The choice of compound was made depending on the case, prognosis, severity of the disorder, the persistence of the glottic insufficiency, and the patient's age and condition. RESULTS: Thirty-three patients showed an significant improvement of the glottic closure. However, 6 patients showed hardly any change. CONCLUSION: Collagen augmentation can be used for the temporary medialization of the vocal fold. It is a suitable method for the treatment of vocal fold paralysis a) within the neural regeneration time, and b) in patients with reduced condition and/or a short life expectancy due to severe diseases.

[Comparative voice quality evaluation after laser surgical versus fronto-lateral partial laryngectomy in T1b and T2 vocal cord carcinoma]. / Vergleichende Stimmuntersuchung nach laserchirurgischer versus fronto-lateraler Kehlkopfteilresektion bei T1b- und T2-Stimmlippencarcinom.

BACKGROUND: We conducted a study to compare the voice quality after transoral endolaryngeal laser surgery versus anterolateral partial laryngectomy in terms of ability to communicate effectively. MATERIAL AND METHODS: Two groups each of 8 patients were reexamined at least 6 months after either a laser surgical or a partial anterolateral laryngectomy for a T1b or T2 vocal chord carcinoma was performed by the same surgeon. The following examinations were conducted: video-laryngoscopy, video-stroboscopy, phonetogram when reading a standard text or when speaking and shouting, voice load test, respiratory flow measurement, auditive voice rating following the RBH model, and auditive rating of the voice by the patients according to a questionnaire. RESULTS: A voice disorder with a medium-grade dysphony and an essential limitation of the speaking and shouting voice function and voice quality was detected in both groups of patients. No significant differences were observed in any of the parameters evaluation in both groups of patients. CONCLUSIONS: Both surgical techniques appear to be equivalent in terms of postoperative voice function. However, the tracheotomy was avoided in the patients undergoing laser surgery.

[Computerized sonographic imaging of tongue motility using pseudo-3 dimensional reconstruction]. / Computer-sonographische Darstellung der Zungenmotilität mittels Pseudo-3D-Rekonstruktion.

A new method for analysis and documentation of tongue movements was used in 24 healthy volunteers. This method enables direct digitalization of the information obtained from sequences of B-Mode pictures. Besides of allowing to further digital evaluation of the findings, it offers the facility of "pseudo 3D"-reconstruction of the tongue movements occurring on swallowing. The method appears to be of particular value for therapy control in neurological and phoniatric patients.

[Intragastral nitrosation - cancer risk in the operated stomach (author's transl)]. / Intragastrale Nitrosatin - Risikofaktor für die Carcinomentstehung im operierten Magen?

The concentration of nitrite and N-nitroso compounds was examined in the fasting gastric juice of 44 patients with regard to the known cancer risk to the operated stomach. All patients had surgery for therapy of an ulcer disease. The operation had taken place an average of 2.5 years previously. Enlisted as a control group were 26 age-matched individuals with healthy stomachs. The concentration of nitrite and N-nitroso compounds in the gastric juice of the vagotomized patiens (PGV) did not differ from that of the controls. On the other hand, a significant increase of the nitrite concentration was found in the gastric juice of those patients resected according to the Billroth I or II procedures. The fraction of N-nitroso compounds, however, was significantly elevated in relation to the other gastric juice samples only in the Billroth II resected stomach. The importance of the increase of nitrite and N-nitroso compounds to the cancer risk inherent in the gastric stump is the subject of discussion.

[Computerized ultrasound imaging of the shape of the tongue in forming long vowels in German]. / Computersonographische Darstellung von Zungenformen bei der Bildung der langen Vokale des Deutschen.

The contours of the tongue during pronunciation of the long German vowels were assessed by ultrasound in 22 healthy volunteers. Using statistical methods, models of the shape of tongue were calculated. These models can be used for clinical diagnosis and bio-feedback therapy in patients with speech disorders.

Are nitrite and N-nitroso compounds in gastric juice risk factors for carcinoma in the operated stomach?

The concentration of nitrite and N-nitroso compounds was examined in the fasting gastric juice of 44 patients operated on for ulcer disease an average of 2.5 years previously and in 26 age-matched patients with healthy stomachs (controls). The concentration of nitrite and N-nitroso compounds in the gastric juice of the vagotomised patients did not differ from that of the controls. On the other hand, significant increases in nitrite concentrations were found in the gastric juice of patients managed by Billroth I or II procedures. The fraction of N-nitroso compounds was significantly increased only in the Billroth II resected stomach. These findings are relevant to the known cancer risk inherent in the gastric stump.