Nomenclature proposal to describe vocal fold motion impairment

The terms used to describe vocal fold motion impairment are confusing and not standardized. This results in a failure to communicate accurately and to major limitations of interpreting research studies involving vocal fold impairment. We propose standard nomenclature for reporting vocal fold impairment. Overarching terms of vocal fold immobility and hypomobility are rigorously defined. This includes assessment techniques and inclusion and exclusion criteria for determining vocal fold immobility and hypomobility. In addition, criteria for use of the following terms have been outlined in detail: vocal fold paralysis, vocal fold paresis, vocal fold immobility/hypomobility associated with mechanical impairment of the crico-arytenoid joint and vocal fold immobility/hypomobility related to laryngeal malignant disease. This represents the first rigorously defined vocal fold motion impairment nomenclature system. This provides detailed definitions to the terms vocal fold paralysis and vocal fold paresis

Treatment of recurrent respiratory papillomatosis and adverse reactions following off-label use of cidofovir (Vistide®)

Recurrent respiratory papillomatosis (RRP) is caused by a human papilloma virus (HPV). It is a rare, sometimes debilitating disease compromising voice and airway. RRP is characterized by a variable course of disease, potentially leading to frequent annual surgical procedures, the number of which may exceed a hundred during the life time. The therapy focuses on surgical removal of the mucosal lesions in order to keep the airway open and the voice satisfactory. Till now, there is no curative therapy for the virus infection in itself. As recurrent surgery alone has proven to be insufficient in many cases, adjuvant therapy is increasingly being used. One of the mainstays of adjuvant therapy is the administration of intralesional cidofovir (Vistide Ò). Cidofovir is an antiviral agent, registered for the treatment of cytomegalovirus (CMV) retinitis in patients wit

Fiberoptic endoscopic evaluation of swallowing in intensive care unit patients

Aspiration in critically ill patients frequently causes severe co-morbidity. We evaluated a diagnostic protocol using routine FEES in critically ill patients at risk to develop aspiration following extubation. We instructed intensive care unit physicians on specific risk factors for and clinical signs of aspiration following extubation in critically ill patients and offered bedside FEES for such patients. Over a 45-month period, we were called to perform 913 endoscopic examinations in 553 patients. Silent aspiration or aspiration with acute symptoms (cough or gag reflex as the bolus passed into the trachea) was detected in 69.3% of all patients. Prolonged non-oral feeding via a naso-gastric tube was initiated in 49.7% of all patients. In 13.2% of patients, a percutaneous endoscopic gastrostomy was initiated as a result of FEES findings, and in 6.3% an additional tracheotomy to prevent aspiration had to be initiated. In 59 out of 258 patients (22.9%), tracheotomies were closed, and 30.7% of all 553 patients could be managed with the immediate onset of an oral diet and compensatory treatment procedures. Additional radiological examinations were not required. FEES in critically ill patients allows for a rapid evaluation of deglutition and for the immediate initiation of symptom-related rehabilitation or for an early resumption of oral feeding

Review on Japanese-German-U.S. Cooperation on Laser-Ablation Propulsion

We report on an international cooperation between Nagoya University (NU), Japan and DLR Stuttgart, Germany on scaling issues in laser ablative propulsion. Lessons learned from collaborative work in the laboratory will be summarized with respect to the comparability of experimental methods and corresponding standardization issues. With the background of previous experimental research at the University of Alabama in Huntsville (UAH), experimental work with CO2 lasers in a moderate (NU) and high (DLR) pulse energy range on laser ablation of POM is presented. Profilometry results of target surfaces are compared with fluence distributions from beam propagation modeling. Ablation from flat targets is reported with respect to energy and area scaling and compared with results from ablative propulsion employing parabolic nozzles

Comparative lightcraft impulse measurements

The impulse coupling coefficients of two radically different laser propulsion thruster concepts (lightcrafts), each 10 cm in diameter, have been measured under equal conditions using two different pendulum test stands. One test stand and one lightcraft of toroidal shape were provided by the U.S. Air Force Research Laboratory. The other test stand and a bell shaped (i.e. a paraboloid) lightcraft were those of the German Aerospace Center (DLR). All experiments employed the DLR electron-beam sustained, pulsed CO2 laser with pulse energies up to 400 J. The laser was operated with two configurations: 1) a stable resonator (flat beam profile); and, 2) an unstable resonator (ring shaped beam profile). A first series of experiments was carried out in the open laboratory environment. Propellant, therefore, was either the surrounding air alone, or Delrin as an added solid propellant. The coupling coefficient was determined as a function of the laser pulse energy. In a second series, the same experiments were repeated at various reduced pressure levels with the German lightcraft suspended in a vacuum vessel. This simulates the conditions of a transitional flight from within the atmosphere to outer space. As an additional parameter the specific mass consumption of Delrin (gram/Joule) was measured for each parameter set, allowing the determination of the average exhaust velocity in vacuum