Laser tenotomy and vocal process resection for bilateral midline vocal fold fixation

Background: The present retrospective study presents the outcomes of a group of 21 patients with laryngeal obstruction caused by bilateral vocal fold fixation. All of these patients were treated by laser assisted muscle tenotomy and vocal process resection ? a modification of the technique described by Michael and Eugene Rontal in 1994. 1 Methods: Between January 1997 and March 2002 the senior author performed muscle tenotomy and vocal process resection for bilateral vocal fold fixation on 21 patients. Results: The mean follow‐up time was 2.3 years. The technique was successful in achieving an adequate airway and good voice with no aspiration in every case. Conclusions: Laser assisted muscle tenotomy and vocal process resection is a proven treatment for bilateral medial vocal fold fixation with the provision of a good airway, good voice and the avoidance of aspiration.     

Vocal cord paralysis, synkinesis and vocal fold motion impairment

Felix Semon's 'laws' of vocal cord paralysis were conceived over a century ago, based on the simple concept that abductor function of the recurrent laryngeal nerve was more vulnerable than adductor function. It is now clear that the neuromuscular pathology of laryngeal innervation is much more complex. Whether the nerve has been cut, crushed, stretched, cauterized or otherwise injured, it is seldom completely transected. There might be no detectable vocal cord movement at laryngoscopy, yet, electromyography usually shows at least some activity because of incomplete denervation and/or developing synkinesis. Electrical silence hardly ever persists forever. Disordered vocal fold movement following nerve injury appears to depend on laryngeal synkinesis with disorganized neuromuscular function caused by misdirected regeneration and aberrant reinnervation, sometimes by adjacent nerves. The severity of the injury, abnormal random reinnervation, scar tissue formation and nerve growth-stimulating and inhibiting factors influence the final position of the vocal fold. For a better understanding of neurolaryngological disorders it is no longer sufficient to think merely in terms of 'vocal cord paralysis'.     

膀胱白斑膀胱镜影像系统显像特点及临床意义

目的 探讨膀胱白斑在膀胱镜影像系统的显像特点及临床意义.方法 采用双盲随机法抽取经病理检查确诊的膀胱白斑患者556例,观察膀胱镜影像系统中病变的显像特点.患者均予抗感染治疗1～2周,复查膀胱镜,对比观察治疗前后的变化.结果 556例患者膀胱镜显像中膀胱白斑病变呈4种表现,按病情轻到重分别为:充血型42例、斑点型56例、薄斑型399例、厚斑型59例.抗感染治疗后,病变各型可相互转化,其中好转131例、无变化304例、加重121例.统计学分析显示:膀胱白斑4种类型变化比率差异有统计学意义(x2=130.92,v=6,P<0.001),从充血型到斑点型、薄斑型、厚斑型,治疗后好转比率有逐渐减少趋势,无明显变化和加重比率有逐渐增多趋势.结论 在膀胱镜影像系统中膀胱白斑显像表现町初步分为充血型、斑点型、薄斑型、厚斑型4型,根据分型不同应采取不同的治疗方案.     

Autologous fat injection laryngoplasty for unilateral vocal fold paralysis

Background: Fat injection laryngoplasty has been used at the Sydney Voice Clinic for selected cases of unilateral vocal fold paralysis since 1989. Methods: Forty‐five consecutive cases deemed suitable for treatment by this technique are presented in this paper. Results: Mean follow up for this group of patients was 33 months. Over the period of follow up, 39 of the 45 patients achieved normal or near normal voice, with four patients requiring additional surgical intervention. Conclusion: Fat injection laryngoplasty is a quick, simple, inexpensive and reliable procedure, with few complications and good long‐term results in suitable selected cases of unilateral vocal fold paralysis.     

膀胱白斑不同病变部位超微病理及其临床意义

目的 探讨膀胱白斑不同病变部位超微病理及其临床意义.方法 随机抽取膀胱白斑病变中部标本80例次,白斑边缘处、白斑边缘外1.0 cm处、2.0 cm处及2.5 cm处标本共89例次,用双肓法进行电子显微镜检查.并与非膀胱白斑患者的正常膀胱黏膜比较.结果 膀胱镜下所见白斑旁区均已存在早期病变.从白斑边缘外2 cm处到白斑中央,膀胱黏膜由移行上皮逐渐变为尿路上皮与鳞状生皮交错、鳞状上皮化生、鳞状上皮化生伴不全角化或角化.基膜由平直变弯曲,呈现出4型(5种)典型表现.病变中部的80例,0 Ⅰ型5例.0Ⅱ型8例,Ⅰ型12例,Ⅱ型42例.Ⅲ型13例.结论 以病变中部为准,可将膀胱白斑的超微结构表现分为4型,即0型(0 Ⅰ型、0Ⅱ型)、Ⅰ型、Ⅱ型、Ⅲ型.该分型能较好地说明膀胱白斑的发生、发展过程,对膀胱白斑的诊断及治疗方法的选择有参考价值.     

Accuracy,intra‐ and inter‐rater reliability of three scoring systems for the glottic view at videolaryngoscopy

An accurate and reproducible recording of laryngoscopic view at tracheal intubation is an important aspect of anaesthetic practice. Unlike direct laryngoscopy, in which the view achieved by the line of sight directly relates to the ease of intubating the trachea, videolaryngoscopy can create a situation in which the view is good, but intubation difficult or impossible. Communicating this to a subsequent anaesthetist is important. We compared three scoring systems: Cormack and Lehane; POGO (percentage of glottic opening); and the Fremantle score, as used by 74 critical care doctors rating 30 anonymised videos of videolaryngoscopic intubations. Accuracy (degree of agreement of score with an expert panel assessment) was higher for POGO (75.5%) and the Fremantle score (73.9%) than for Cormack and Lehane (65.4%; p < 0.001). Intra‐rater reliability (mean free marginal Kappa for ordinal scores and mean Cronbach's Alpha for continuous score) was higher for Fremantle score (0.796) and Cormack and Lehane (0.773) than POGO (0.693). Inter‐rater reliability for Fremantle score (0.618) and POGO (0.614) were similar and higher than the inter‐rater reliability of Cormack and Lehane 0.464 (p < 0.001). The higher accuracy and inter‐rater reliability of POGO and the Fremantle score suggest they are preferable to Cormack and Lehane for use when documenting videolaryngoscopy. The additional information about ease of intubation conveyed by the Fremantle score may support its routine use in recording videolaryngoscopic intubation.     

膀胱白斑四型法病理分型及临床意义

目的 探讨膀胱自斑的病理分型及其临床意义.方法 经膀胱镜下活检病理确诊膀胱白斑患者726例.女710例,男16例.平均年龄41(17～78)岁.随机取白斑边缘旁1.0、1.5、2.0、2.5 cm处膀胱黏膜共121例次,同期50例慢性膀胱炎膀胱黏膜标本作为对照,根据膀胱白斑的病理特点进行病理分型.并与传统分型法比较.结果 726例标本根据细胞变异程度、鳞状细胞角化程度、基膜形状等不同分为4型:0型30例、Ⅰ型42例、Ⅱ型585例、Ⅲ型69例.而按传统分型法其中60例难以确切分型.101例白斑边缘旁2.0 cm内膀胱黏膜标本中已存在病理改变64例.结论 膀胱白斑4型病理分型法可较全面地反映膀胱自斑的病理特点及发生、发展过程.根据病理分型可考虑改进膀胱白斑的传统治疗方式.