Small optic suspensions for Advanced LIGO input optics and other precision optical experiments.

We report on the design and performance of small optic suspensions developed to suppress seismic motion of out-of-cavity optics in the input optics subsystem of the Advanced Laser Interferometer Gravitational Wave Observatory. These compact single stage suspensions provide isolation in all six degrees of freedom of the optic, local sensing and actuation in three of them, and passive damping for the other three.

Swallowing therapy--a prospective study on patients with neurogenic dysphagia due to unilateral paresis of the vagal nerve, Avellis' syndrome, Wallenberg's syndrome, posterior fossa tumours and cerebellar hemorrhage.

BACKGROUND: No studies exist dealing with the outcome of dysphagic patients with posterior fossa (IV. ventricle) tumours (PFT) or cerebellar hemorrhage (CH), and the outcome of patients with Wallenberg's syndrome (WS) after functional swallowing therapy (FST) has so far not been studied in detail. Patients and methods. 208 patients with neurogenic dysphagia (ND) who were consecutively admitted for functional swallowing therapy (FST) over a 3 year period to our hospital were examined clinically, by use of a videofluoroscopic swallowing study (VFSS) and/or fibreoptic evaluation of swallowing (FEES). The most frequent etiology was stroke (48%), followed by CNS tumours (13%). In the present study we defined three groups. Group 1 comprised 8 patients with PFT or CH. Group 2 consisted of 27 patients with WS, which was the leading cause among patients with non-hemispheric stroke. Since in WS a vagal nerve paresis due to affection of the Nucleus ambiguus occurs, 8 patients with Avellis' syndrome or unilateral paresis of the vagal nerve served as controls and were defined as group 3. Findings. In the three groups, functional feeding status showed significant improvement after FST comprising methods of restitution, compensation and adaptation, each of which were applied in more than 80% of patients. Outcome was, however, significantly worse in group 1 as compared to group 2 and in group 2 as compared to group 3. Dysfunction of the upper esophageal sphincter and reflex triggering were significantly more severely disturbed in groups 1 and 2 as compared to group 3. Group 1 showed significantly more severe disturbances of the oral phase as compared to groups 2 and 3. After FST, more than 50% (5/8) of group 1 and 30% (8/27) of WS patients (group 2) were dependent on tube feeding, whereas all patients of group 3 were full-oral feeders. Interpretation. This is the first study dealing with the outcome of dysphagic patients with PFT or CH. Based on our results it can be assumed that in these patients pressure is exerted on both dorsomedial central pattern generators (DMCPGs) for swallowing in a posterior-anterior direction. Due to the importance of the DMCPGs for swallowing, bilateral (and often MRI-invisible) lesions seem to be very harmful. For a better understanding of the pathomechanism responsible for ND in patients with PFT or CH, modern imaging methods such as proton magnetic resonance spectroscopy should be used for studying metabolic changes in the dorsal medulla in the future. Since the outcome of patients with WS with regard to dependence of tube feeding was not associated with the site or size of the lesion, it may due to the individual asymmetry of the swallowing-dominant forebrain hemisphere - depend on the side of the medullary infarction.

The localization of central pattern generators for swallowing in humans--a clinical-anatomical study on patients with unilateral paresis of the vagal nerve, Avellis' syndrome, Wallenberg's syndrome, posterior fossa tumours and cerebellar hemorrhage.

BACKGROUND: Our understanding of brainstem swallowing centers is mainly based on experimental animals. In order to solve this problem also in humans, a clinical-anatomical study on dysphagic patients with different lesion patterns was performed. PATIENTS AND METHODS: We studied 43 consecutively admitted dysphagic patients with unilateral paresis of the vagal nerve (PVN), Avellis' syndrome (AS), Wallenberg's syndrome (WS), posterior fossa tumour (PFT) or cerebellar hemorrhage (CH) with regard to clinical and anatomical aspects. FINDINGS: There was a continuum with regard to functional outcome from neurogenic dysphagia (ND): Patients with PFT or CH had a significantly worse outcome than patients with WS; the outcome of WS patients was significantly worse than that of patients with PVN or AS. In AS only the Nucleus ambiguus (NA) and its surrounding reticular formation (RF) were affected. In all patients with WS, the infarctions of the dorsolateral medulla were situated in the rostral third of the medulla and affected the NA and the Nucleus tractus solitarii (NTS) with their surrounding RF. In patients with PFT and CH, the NTS and its surrounding RF were affected on both sides. The overlap area of WS and PFT lesions is situated in the NTS and the surrounding RF, especially in its Nucleus parvocellularis. INTERPRETATION: Our results point to the fact, that in humans the dorsomedial central pattern generators (CPGs) for swallowing are situated in the rostral part of the dorsal medulla oblongata near the NTS/surrounding RF (especially Nucleus parvocellularis) and that the dorsomedial CPGs are superior to the ventrolateral CPGs (near the NA/surrounding RF) with regard to their swallowing-relevance. Furthermore, we hypothesize that due to the individual asymmetry of the swallowing-dominant forebrain hemisphere - the outcome from ND in WS depends on the side of the medullary infarction.

[Deglutition disorders in neurological patients. A prospective study of diagnosis, pattern of impairment, therapy and outcome]. / Schluckstörungen bei neurologischen Patienten. Eine prospektive Studie zu Diagnostik, Störungsmustern, Therapie und Outcome.

We performed a prospective study on 208 patients with neurogenic dysphagia who were consecutively admitted for swallowing therapy over a 3-year period. The most frequent etiology was stroke (48%). Videofluoroscopic and/or fiber optic endoscopic evaluation of swallowing were performed in 204 patients. Swallowing therapy was comprised of restitution methods, compensation, and adaptation, each of which was applied in more than 80% of the patients. Mean duration of swallowing therapy was 2 months (full oral patients 1 month, patients dependent on tube feeding or tracheostomy 2.5 and 3.5 months, respectively). Fifty-five percent of the patients initially dependent on tube feeding were full oral feeders after swallowing therapy. A target variable reflecting functional feeding status showed significant improvement after swallowing therapy, also in patients with a disease duration of more than half a year, ruling out spontaneous recovery as a sole explanation of amelioration. The following variables were the main contributors to outcome prediction: functional feeding status, Barthel index, duration of disease, and degree of aspiration as shown by endoscopy.

Kinematic analysis of laryngeal movements in patients with neurogenic dysphagia before and after swallowing rehabilitation.

To examine whether kinematic analysis of laryngeal movements (which are closely linked to pharyngeal swallowing) can differentiate between normal and disturbed swallowing, we used a three-dimensional ultrasound movement recording system to measure the movements of the larynx during swallowing in 32 patients with neurogenic dysphagia caused by central nervous system lesions and in 32 age- and sex-matched healthy individuals. At the beginning of an inpatient rehabilitation swallowing program, laryngeal movements in 24 patients were highly disturbed in terms of velocity curve irregularities. After rehabilitation, the majority of patients with hitherto irregular velocity profiles exhibited laryngeal kinematics that were indistinguishable from those of 32 healthy subjects. Kinematic analysis of laryngeal movements, therefore, is suitable for monitoring motor recovery of swallowing disturbances in patients with neurogenic dysphagia while undergoing swallowing rehabilitation.

[The thyrotropic function of the hypophysis and peripheral thyroid hormones after removal of bland and autonomous nodular goiters]. / Die thyreotrope Funktion der Hypophyse und die peripheren Schilddrüsenhormone nach Operation blander und autonomer Knotenstrumen.

Bilateral subtotal resection or enucleation or unilateral resection was performed in 60 patients (36 with bland nodular goitre, 24 with autonomic adenoma). The thyrotropic pituitary activity and the peripheral thyroid function were examined in all patients preoperatively and followed up for 12 months postoperatively. The results show that all patients with bilaterally resected bland nodular goitre require postoperative administration of thyroid hormone, since enhanced thyrotropic activity is seen not later than three months after surgery. Since thyrotropic function remains normal in unilaterally operated nodular goitre, thyroid hormone administration does not appear generally necessary. In patients with autonomic adenoma there is postoperatively variability of function, independent of the surgical method employed. In view of possible functional recompensation, final decision on the administration of thyroid hormones should not be made before the end of the sixth postoperative month. These results can be considered as guidelines for a differentiated postoperative management.

[First experiences with short-term lithium therapy in severe thyrotoxicosis]. / Erste Erfahrungen mit der Lithiumkurzzeittherapie bei schwerer thyreotoxikose.

Even nowadays the therapy of severe, particularly of contrast remedy-induced hyperthyroidism is not without any problems. According to reports in literature the application of lithium salts seems to be an expedient from this dilemma. We controlled the effect of a short-term lithium therapy of 7 days in combination with methimazole in comparison to a group with methimazole monotherapy. The examination showed a good effectiveness and tolerability of the lithium methimazole therapy. While the decrease of the thyroxin concentration in the two groups was not different, in the group with combined therapy a more rapid per cent decrease of the triiodothyronine concentration appeared. In primarily strict selection of the therapy severe side-effects are not to be expected. According to the results yielded up to now the described form of therapy is an actual enrichment for selected forms of hyperthyreosis.