Changes in Vocal Fold Morphology During Singing Over Two Octaves.

OBJECTIVE: Vocal folds are widely assumed to only elongate to raise vocal pitch. However, the mechanisms seem to be more complex and involve both elongation and tensioning of the vocal folds in series. The aim of the present study was to show that changes in vocal fold morphology depend on vocal fold elongation and tensioning during singing. STUDY DESIGN: This was a prospective study. METHODS: Forty-nine professional female singers (25 sopranos, 24 altos) were recruited and three-dimensional laryngeal images analyzed in a coronal view derived from high-resolution computed tomography scans obtained at the mean speaking fundamental frequency (ƒ0) and one (2ƒ0) and two octaves (4ƒ0) above ƒ0. RESULTS: The vocal fold angle, defined by a tangent above and below the vocal folds, was 58° at ƒ0, 47° at 2ƒ0, and 59° at 4ƒ0. CONCLUSION: The decreased caudomedial angle of the vocal fold from ƒ0 to 2ƒ0 (change in muscle belly from ";fat" to "thin") and increased angle from 2ƒ0 to 4ƒ0 (from "thin" to "fat") strongly supports the hypothesis that the vocal folds elongate and then tension when singing from ƒ0 to 4ƒ0. This is the first study to show this relationship in vivo.

A transthyroidal method for arytenoid adduction: a basic anatomical study.

INTRODUCTION: Arytenoid adduction is a very effective procedure for medializing the posterior part of the vocal fold in vocal fold paralysis. Major drawback of the method is the technically sometimes-difficult access to the arytenoid with increased postoperative morbidity. Aim of this study was to provide basic anatomical data regarding the accessibility of the arytenoid cartilage through a thyroplasty window. Furthermore, to investigate the feasibility of an arytenoid adduction by fixation of a surgical screw to the arytenoid cartilage by using this approach. MATERIALS AND METHODS: 10 cadaver larynges, six female and four male, were dissected and measured for our points of interest. A standard manufacture-made surgical screw attached to a suture was anchored to the fovea oblonga of the arytenoid cartilage. RESULTS: Our anatomical measurements proved a mean distance from the posterior edge of the thyroid window to the arytenoid of about 8-9 mm in male larynges and 7-8 mm in female larynges. The distances did not differ significantly between the sexes. Pulling the anchored surgical screw medializes the posterior part of the vocal fold. DISCUSSION: Our data showed that there is a very constant morphometric relation between the thyroplasty window and the arytenoid cartilage. It is known that gender-related differences result in a veritable laryngeal dimorphism in nearly all absolute laryngeal dimensions. These differences appear to a much lesser extend in the distances from the surface to the depth, as was confirmed in our series. Using these findings led us to identification of the fovea oblonga near the muscular process as the most favorable point for fixation of a surgical screw through a conventional thyroplasty window. Pulling the attached suture medializes the arytenoid cartilage.

[Molecular diagnosis of a fatal primary amoebic meningoencephalitis in Guadeloupe (French West Indies)]. / Diagnostic moléculaire d'une méningoencéphalite amibienne primitive à l'occasion d'un cas fatal en Guadeloupe.

We report the first case of primary amoebic meningoencephalitis in a 9-year-old boy in Guadeloupe. The outcome was rapidly fatal in 7 days. The patient presumably acquired the infection by swimming and diving in a basin supplied by natural thermal water 1 week before onset of the disease. The possibility of a free-living amoeba infection was suspected both on the negativity of all bacterial and viral initial tests and on the observation of peculiar cells in stained cerebrospinal fluid samples. Although the amoeba was not isolated, Naegleria fowleri could be identified by polymerase chain reaction with specific primers on DNA extracted from frozen cerebrospinal fluid samples. Furthermore, as the internal transcribed spacer (ITS1) region of DNA is variable in length between the different strains of N. fowleri, sequencing of the amplified ITS1 demonstrated that the responsible N. fowleri strain belongs to a common genotype present in the American and European continent.

[Laryngeal granuloma. Aetiology, clinical signs, diagnostic procedures, and treatment]. / Laryngeales Kontaktgranulom. Atiologie, Symptomatik, Diagnose und Therapie.

Vocal cord granulomas are benign inflammatory lesions of the vocal cords. They are usually located over the vocal process of the arytenoid cartilage. A corresponding ulcer on the contralateral side is a common finding. Clinical signs include foreign body sensation, a need to repeatedly clear one's throat, hoarseness, and reduced voice resilience. Voice abuse and gastro-oesophageal reflux are commonly cited important aetiological factors. Differentiation from malignant lesions is usually possible by history and clinical examination; biopsy is only rarely necessary. The primary treatment is speech therapy or voice counselling, if necessary, supported by antacids. Surgical excision is not helpful because contact granulomas tend to recur. We present two typical cases of vocal cord granulomas and discuss their management.

[Granular cell tumor of the larynx: a case report]. / Granularzelltumor des Larynx.

Granular cell tumors are benign subcutaneous or submucosal lesions of neurogenic origin. They are quite commonly found in the head and neck region, particularly in the tongue. However, only about 200 cases of laryngeal granular cell tumors have been reported so far. Most laryngeal granular cell tumors are located in the posterior part of the vocal fold and in the posterior commissure. Differentiation from inflammatory as well as from malignant lesions is possible only by biopsy. The treatment of choice is complete excision. However, tumor extension and expected morbidity of the surgery will inevitably influence the extent of the resection. Recurrences after complete excision are rare.

Changes in epidemiology of leptospirosis in 2003--2004, a two El Niño Southern Oscillation period, Guadeloupe archipelago, French West Indies.

Our study aimed at analysing the changes in epidemiological features of leptospirosis cases from the hospital of Pointe à Pitre in Guadeloupe in 2003--2004 compared to reliable data in 1994--2001. Leptospirosis incidence increased fourfold during 2002--2004, a period with two El Niño events. Whereas the main risk factors were unchanged (male gender, occupational exposure, contact with cattle or pigs) a major role of rodent exposure emerged (52%, P=0.02, multivariate analysis). Interestingly, mean age of cases shifted to the older population (51.7 years vs. 43 years, P<0.05). Moreover, the Ballum serogroup rose dramatically (36% of incidence) competing with the Icterohaemorragiae serogroup (62%). However, severe forms were less recorded. Our data suggest that the changes in leptospirosis features could be related to exceptional meteorological events and their consequences on rodent populations. We propose the monitoring of rodent population and climatic data as a tool of management of leptospirosis in Guadeloupe.

Retrospective review of leptospirosis in Guadeloupe, French West Indies 1994-2001.

Demographic, clinical, biological and personal data were obtained from patients hospitalized with symptoms of leptospirosis in the Hospital of Pointe a Pitre, Guadeloupe, French West Indies from 1994 to 2001. Of the 897 screened patients, 212 were acute cases, 607 were non-infected and 78 were undetermined cases. There was no predominant age group. Leptospirosis transmission followed the rainfall cycle and was greater in rural areas. Jaundice and conjunctival suffusion were significantly more frequent in cases than non-cases. Males, professions considered to be at risk and contact with swine or bovine were associated with infection. Serogroups Icterohaemorrhagiae, Cynopteri, Australis, Sejroe, Pomona and Ballum were serovars presumed responsible for acute cases.

[Dysphagia: clinical management in diagnostics and therapy]. / Schluckstörungen: Möglich- keiten in der Diagnostik und der Therapie.

The oral nutrition is a complex procedure of different mechanisms. It saves the survival and is part of the social integration. That's why dysphagia seems to be a serious symptom. The aetiology is multiple and is often not recognized. With a profound diagnostic algorithm a lot of aetiologies can be discovered. Treatments can be conservative or surgical. The aim of therapy is to develop techniques of swallowing to reach an oral nutrition and to reintegrate patients in their social net. It is important to recognize early signs. The general practicer is an important initiator to introduce a differential diagnostic procedure.

Retrospective review of leptospirosis in Guadeloupe, French West Indies 1994-2001 / Revisión retrospectiva de la leptospirosis en Guadalupe, Indias Occidentales Francesas 1994­2001

Demographic, clinical, biological and personal data were obtained from patients hospitalized with symptoms of leptospirosis in the Hospital of Pointe a Pitre, Guadeloupe, French West Indies from 1994 to 2001. Of the 897 screened patients, 212 were acute cases, 607 were non-infected and 78 were undetermined cases. There was no predominant age group. Leptospirosis transmission followed the rainfall cycle and was greater in rural areas. Jaundice and conjunctival suffusion were significantly more frequent in cases than non-cases. Males, professions considered to be at risk and contact with swine or bovine were associated with infection. Serogroups Icterohaemorrhagiae, Cynopteri, Australis, Sejroe, Pomona and Ballum were serovars presumed responsible for acute cases

Se obtuvieron los datos demográficos, clínicos, biológicos y personales de pacientes hospitalizados con síntomas de leptospirosis en el Hospital de Pointe à Pitre, Guadalupe, Indias Orientales Francesas, en el período comprendido de 1994 a 2001. De los 897 pacientes investigados, 212 eran casos graves, 607 eran no infectados y 78 eran casos indeterminados. No hubo grupo etario predominante. La transmisión de la leptospirosis seguía el ciclo hidrológico y era mayor en las áreas rurales. La ictericia y sufusión conjuntival fueron significativamente más frecuentes en los casos que en los no casos. Los varones, las profesiones consideradas en riesgo, y el contacto con cerdos o bovinos estuvieron asociados con la infección. Los serogrupos Icterohemorragia, Cynopteri, Australis, Sejroe, Pomona y Ballum fueron serovares presumiblemente responsables de los casos graves

Hsp27 anti-sense oligonucleotides sensitize the microtubular cytoskeleton of Chinese hamster ovary cells grown at low pH to 42 degrees C-induced reorganization.

Chinese hamster ovary (CHO) cells maintained in vitro at pH 6.7 were used to model cells in the acidic environment of tumours. CHO cells grown at pH 6.7 develop thermotolerance during 42 degrees C heating at pH 6.7 and their cytoskeletal systems are resistant to 42 degrees C-induced perinuclear collapse. Hsp27 levels are elevated in cells grown at pH 6.7 and are further induced during 42 degrees C heating, while Hsp70 levels remain low or undetectable, suggesting that Hsp27 is responsible for some of the novel characteristics of these cells. An anti-sense oligonucleotide strategy was used to test the importance of Hsp27 by lowering heat-induced levels of the protein. The response of the microtubular cytoskeleton to heat was used as an endpoint to assess the effectiveness of the anti-sense strategy. Treatment with anti-sense oligonucleotides prevented the heat-induced increase of Hsp27 levels measured immediately following heat. Treatment with anti-sense oligonucleotides also sensitized the cytoskeleton of cells grown at low pH to heat-induced perinuclear collapse. However, cytoskeletal collapse was not evident in cells grown at pH 6.7 and treated with 4-nt mismatch oligonucleotides or in control cells maintained and heated at pH 6.7. The cytoskeleton collapsed around the nucleus in cells cultured and heated at pH 7.3. These results confirm that over-expression of Hsp27 confers heat protection to the microtubular cytoskeleton in CHO cells grown at low pH.

Epidemiologic study of the association between human T-cell lymphotropic virus type 1 and Strongyloides stercoralis infection in female blood donors (Guadeloupe, French West Indies).

This case control study was conducted among female blood donors in Guadeloupe. A total of 85 HTLV-1 positive subjects were matched by age (+/- 5 years) in a 1:3 ratio to 255 HTLV-1 negative controls. The mean age was 48.5 and 48.9 years respectively. Ethnic, environmental and socio-economic risk factors were studied. Four risk factors were found independently associated with HTLV-1 seropositivity: Strongyloides stercoralis antibodies (OR = 3.6, CI 1.8, 7.3), low socio-economic status (OR = 2.0 CI 1.0, 4.0), low educational level (OR = 2.0 CI 1.0, 4.0) and agricultural activity (OR = 2.8 CI 1.4, 5.6). This logistic regression analysis demonstrates the reality of the association between HTLV-1 carriers and Strongyloides stercoralis, and its association with socio-economic and environmental risk factors.

Epidemiologic study of the association between human T-cell lymphotropic virus type 1 and Strongyloides stercoralis infection in female blood donors (Guadeloupe, French West Indies)

This case control study was conducted among female blood donors in Guadeloupe. A total of 85 HTLV-1 positive subjects were matched by age (+/- 5 years) in a 1:3 ratio to 255 HTLV-1 negative controls. The mean age was 48.5 and 48.9 years respectively. Ethnic, environmental and socio-economic risk factors were studied. Four risk factors were found independently associated with HTLV-1 seropositivity: Strongyloides stercoralis antibodies (OR = 3.6, CI 1.8, 7.3), low socio-economic status (OR = 2.0 CI 1.0, 4.0), low educational level (OR = 2.0 CI 1.0, 4.0) and agricultural activity (OR = 2.8 CI 1.4, 5.6). This logistic regression analysis demonstrates the reality of the association between HTLV-1 carriers and Strongyloides stercoralis, and its association with socio-economic and environmental risk factors

[Tinnitus--classification, causes, diagnosis, treatment and prognosis]. / Geräusch im Ohr: Wie hoch ist der Leidensdruck? Klassifikation, Ursachen und Diagnose des Tinnitus.

Up to 45% of all adults in the industrialized countries are afflicted by noises in the ears--approximately one million people require treatment in Germany alone. Classification of tinnitus is oriented to the duration of symptoms and their severity, the latter taking into account the victim's distress both at work and during leisure time. Acute tinnitus is often caused by an ear condition or psychosocial stress. Chronic tinnitus can be caused by persistent exposure to noise, whiplash injuries or functional disorders of the cervical spine. The diagnosis is based on audiometric and otoneurologic investigations, possibly magnetic resonance tomography and serology when an infection is suspected. Acute tinnitus is treated with infusions--mostly with cortisone or pentoxifylline--or a short-term oral medication with these substances. Since no causal therapy is available for chronictinnitus, therapeutic counseling has a particular role to play with emphasis on informing the patient on the results of investigations and suggesting coping strategies. Following an appropriate diagnostic work-up, the patient should be advised of the harmless nature of the noises and encouraged to adopt a positively motivated approach to the symptoms. Tinnitus retraining therapy aims to permanently suppress conscious awareness of the noises in the ear. For this purpose, a noise generator, generally worn within the ear auricle, is employed among other things. The prognosis is dependent not only on the presence or otherwise of organic disease but also--almost always--on such aspects as perception and coping by the individual patient.