Basics of Voice Dysfunction – Etiology and Prevention of Voice Damage

Voice is one of the most important means of communication and as such should be taken care of. The etiology of voice disorders is diverse. Due to the development of the society we live in, way of life, environmental factors, and exposure to pharmacological agents as well as demands we make towards our voice, there is a substantial growth in the number of people with voice disorders. We tasked ourselves to find out if it is possible to enlighten people on the importance of voice, to motivate them to take care of it, to notice the changes in its quality and eventually ask for help. We assessed in which measure do we understand the importance of a healthy voice, and do we know which is the most important factor that adds to its decline. For a long number of years voice therapists and other experts in the voice disorder field have been discussing the optimal voice impostation as well as vocal exercises and methods behind voice recovery. They have all come to the same conclusion that phonation is dependant on the sort of the voice disorder and the patient motivation. We wanted to go one step further and investigate, dependence of voice quality and the damage etiology (organic – functional), which are the predominant causes, what are the factors that account for the damage and how the disorder motivates the patient and therefore influences the rehabilitation success rate

Basics of Voice Dysfunction – Etiology and Prevention of Voice Damage

Voice is one of the most important means of communication and as such should be taken care of. The etiology of voice disorders is diverse. Due to the development of the society we live in, way of life, environmental factors, and exposure to pharmacological agents as well as demands we make towards our voice, there is a substantial growth in the number of people with voice disorders. We tasked ourselves to find out if it is possible to enlighten people on the importance of voice, to motivate them to take care of it, to notice the changes in its quality and eventually ask for help. We assessed in which measure do we understand the importance of a healthy voice, and do we know which is the most important factor that adds to its decline. For a long number of years voice therapists and other experts in the voice disorder field have been discussing the optimal voice impostation as well as vocal exercises and methods behind voice recovery. They have all come to the same conclusion that phonation is dependant on the sort of the voice disorder and the patient motivation. We wanted to go one step further and investigate, dependence of voice quality and the damage etiology (organic – functional), which are the predominant causes, what are the factors that account for the damage and how the disorder motivates the patient and therefore influences the rehabilitation success rate

Clinical and Medicolegal Characteristics of Neck Injuries

The predominance in performing surgery of major spine injuries by neurosurgeons usually has the consequence of treating all types of spine injuries by neurosurgeons – neurotraumatologists. In the neurosurgical wards of Clinical Hospital Rijeka, we take care of the majority of these patients, following both the major, as well as minor – whiplash injuries of the neck. This article is an overview of the patients admitted in the one year period (October 1st 2009–October 1st 2010) where 1077 cases of neck injuries were analyzed. Vast majority of these injuries were due to traffic accidents (over 94%), and only a small proportion were serious injuries that needed a surgical approach – decompression and stabilization (~1%). We analyzed minor neck injuries thoroughly both because of the increasing number of whiplash neck injuries and because more complicated diagnostic and therapeutic protocols occupy too much time in the ambulatory practice of our neurotraumatologists each year thus representing a growing financial burden to the health organizations and to the society as a whole. Our results proved that the majority of the injured are male (over 60%), young and active (almost two thirds 21–40 years of age), had commonly sustained a Quebec Task Force (QTF) injury of grades 2 and 3 (almost 90%), and, if properly treated, recovered completely after a mean therapy period of ten weeks. Only a minority complained of prolonged residual symptoms, some of them connected with medico-legal issues (less than 20%). The results shown are in contrast with the general opinion that malingerers in search of financial compensation prevail in these cases, and leads to the conclusion that minor neck injuries (including whiplash) as well as Whiplash Associated Disorder (WAD) are real traumatological entities, that have to be seriously dealt with

High Resolution Close-up Laringoscopy in Diagnosis of Vocal Folds Defects

Cilj: Cilj nam je istaknuti superiornost Wolfove endokamere nad ostalim uređajima za izravnu laringoskopiju visoke rezolucije. Kamera koju koristimo, High-Speed Endocam 5562®, izgrađena je posebno za laringoskopiju, te je opremljena automatskim fokusom, a proizvodi je Richard Wolf GmbH (Knittlingen, Njemačka). Prikaz slučaja: Prikazujemo 58-godišnju bolesnicu koja se žali na teškoće s grlom i hrapav glas kroz gotovo mjesec dana. Povijest bolesti ne pokazuje osobitosti, osim palpatorne bolne osjetljivosti vratne kralježnice. Pregledom kamerom High-Speed Endocam 5562 jasno smo uočili vokalni hematom. Rasprava: Tijekom svakodnevnih pregleda nalazimo razne anatomske varijacije, neke uz oštećenje, a neke bez oštećenja epitela. Laringoskopija visoke rezolucije omogućuje bolji pregled defekata vokalnih nabora, ne ostavljajući prostor za spekulacije i subjektivnost. Korištenjem Wolfove endokamere određuje se i precizna pozicija lezije, te je lakše odrediti adekvatnu terapiju. Kod indiciranog kirurškog zahvata ovakva vizualizacija poboljšava predoperativno razumijevanje problema, a time i izglede za uspjeh. Zaključak: Ako je kamera u rukama iskusnih liječnika, moguće je obraditi do 20 bolesnika dnevno. Pregled se obavlja brzo i bez potrebe za lokalnom anestezijom. Endokamera nudi pouzdanost i objektivnost, a rezultati se mogu snimiti i pregledati kada je to potrebno. To omogućuje adekvatno liječenje bolesnika i stvaranje potpuno informirane odluke zasnovane na vrhunskoj vizualnoj dokumentaciji lokalnog stanja.Aim: Our aim is to underline the superiority of Wolf endocam among other high resolution close-up laryngoscopy devices. We use a camera made by Richard Wolf GmbH (Knittlingen, Germany). High-Speed Endocam 5562 was constructed specifically for laryngoscopy, so it is equipped with an automatic focus. Case report: Patient whom we present is a 58-years old female who displayed throat discomfort and harsh voice for nearly a month. Her medical history was unremarkable except for the cervical spine tenderness. When examined with High-Speed Endocam 5562, vocal fold hematoma became visible. Discussion: So far, we have found various anatomical variations with or without epithelial damage. High resolution laryngoscopy shows a better and more objective view of vocal fold defects with no room for speculation based on subjective observation of obvious defects. With the use of Wolf endocamera precise positions are determined and accurate treatment can be achieved, also choosing a suitable approach. When surgical treatment is indicated, this imagining improves preoperative understanding of the problem, subsequently increasing the odds of success. Conclusion: Once handled by an experienced physician, up to 20 patients can be examined each day. Examination is performed quickly and without the need for local anesthesia. Endocamera offers reliability and objectivity as findings may be recorded and reviewed when necessary. This enables treating the patients adequately as making a fully informed decision is significantly upgraded by superior visual documentation of local condition

Clinical and Medicolegal Characteristics of Neck Injuries

The predominance in performing surgery of major spine injuries by neurosurgeons usually has the consequence of treating all types of spine injuries by neurosurgeons – neurotraumatologists. In the neurosurgical wards of Clinical Hospital Rijeka, we take care of the majority of these patients, following both the major, as well as minor – whiplash injuries of the neck. This article is an overview of the patients admitted in the one year period (October 1st 2009–October 1st 2010) where 1077 cases of neck injuries were analyzed. Vast majority of these injuries were due to traffic accidents (over 94%), and only a small proportion were serious injuries that needed a surgical approach – decompression and stabilization (~1%). We analyzed minor neck injuries thoroughly both because of the increasing number of whiplash neck injuries and because more complicated diagnostic and therapeutic protocols occupy too much time in the ambulatory practice of our neurotraumatologists each year thus representing a growing financial burden to the health organizations and to the society as a whole. Our results proved that the majority of the injured are male (over 60%), young and active (almost two thirds 21–40 years of age), had commonly sustained a Quebec Task Force (QTF) injury of grades 2 and 3 (almost 90%), and, if properly treated, recovered completely after a mean therapy period of ten weeks. Only a minority complained of prolonged residual symptoms, some of them connected with medico-legal issues (less than 20%). The results shown are in contrast with the general opinion that malingerers in search of financial compensation prevail in these cases, and leads to the conclusion that minor neck injuries (including whiplash) as well as Whiplash Associated Disorder (WAD) are real traumatological entities, that have to be seriously dealt with

Is the Term »Fasciculus Opticus Cerebralis« more Justifiable Than the Term »Optic Nerve«?

The terminology of the optic nerve had already been changed three times, since 1895 until 1955 when the term »nervus opticus« was introduced in the »Terminologia Anatomica«. Following our study we claim that, from the aspect of phylogenetic evolution of binocular vision development as well as optical embryogenesis where opticus is evidently presented as a product of diencephalic structures, the addition of the term »nervus« to opticus is not adequate and justified. From the clinical aspect the term »nervus opticus« is also inadequate, both as a »nerve« that has no functional regenerative properties, unlike other cranial nerves, as well as from a pedagogical and didactical aspect of educating future physicians. We suggest that the term »Fasciculus Opticus Cerebralis« should be used as it much better explains the origin as well as its affiliation to the central nervous system

Refractive Errors in Children of Primorsko-Goranska County – Epidemiological study

Three institutions: Teaching Institute of Public Health of Primorsko-Goranska County, Croatian Association »Albert Einstein« and Eye Clinic »Dr B.Vojnikovi}« Rijeka agreed a five-year project to study children´s health status of vision at Primorsko-Goranska County. Main task was the study of damage of vision in children due to prolonged sun exposure. Examination were conducted on a three locations, with the assumption of varying insolation: Island of Rab, Novi Vinodolski and Delnice. The study included children aged between 9 to 14 years. The study included 189 children. Except routine ophthalmologic examinations in addition were preformed biomicroscopic examination of the anterior segment of the eye, intraocular pressure and eye fundus. In a certain number of children with suspect of a specific disease (macular degeneration, glaucoma and refractive error), additional tests were performed: glaucoma treatment, field of vision, optical coherence tomography (OCT) of the eye and detailed eye refraction. This study specifically addressed of refractive error at that three different regions. It was found that the most difficult situation was at the Novi Vinodolski where as many as 40% of children have a refractive error, followed by Island of Rab with 17% and Delnice with 9%. Especially like to mention that on the island of Rab, 50–60 years ago, it was a very rare occurrence of some refractive errors in children

Putative Hormone with Antiobesogenic and Insulin-Sensitizing Effect

It was confirmed that bone morphogenetic protein – 9 (BMP-9), like insulin, improves glycaemia in diabetic mice and regulates glucose metabolism in hepatocytes, which is why it is proposed as a candidate for the hepatic insulin-sensitizing substance (HISS). Regarding the fact that BMP9 has the signalling pathway alike other BMPs and insulin too, it is to expect that BMP-9 has certain effects regarding the liver. In our 2011 hypothesis, we did aim towards BMP-9 as a possible “hepatic insulin-sensitizing substance” (HISS) and in this article, we provide evidences from the literature suggesting that this putative hormone might in fact be none other than BMP-9.

How Could Analyzing the Activity of Two Matrix Metalloproteinases Unveil the Cause of Sudden Cardiac Death

Sudden cardiac death is natural, unexpected, related to cardiovascular disease. Their postmortem diagnosis is significant, as the family of the deceased will strain to prevent other sudden deaths. Irrespective of proper etiological entity, the myocardial collagen matrix remodels, associated with the progression of cardiovascular diseases. It has become evident that many mediators such as humoral factors, transforming growth factor (TGF) -β1 among them, are involved in the remodeling process. Cardiac remodeling is the balance of regenerative and eliminatory processes that include enzymes involved in the degradation of extracellular matrix (ECM) components. Enzymes capable of degrading native fibrillar collagen are interstitial collagenases, specifically matrix metalloproteinases (MMP)-1 and -8. Here, we suggest a technique of visualizing turnover of collagen in cardiac tissue

How Could Analyzing the Activity of Two Matrix Metalloproteinases Unveil the Cause of Sudden Cardiac Death

Sudden cardiac death is natural, unexpected, related to cardiovascular disease. Their postmortem diagnosis is significant, as the family of the deceased will strain to prevent other sudden deaths. Irrespective of proper etiological entity, the myocardial collagen matrix remodels, associated with the progression of cardiovascular diseases. It has become evident that many mediators such as humoral factors, transforming growth factor (TGF) -β1 among them, are involved in the remodeling process. Cardiac remodeling is the balance of regenerative and eliminatory processes that include enzymes involved in the degradation of extracellular matrix (ECM) components. Enzymes capable of degrading native fibrillar collagen are interstitial collagenases, specifically matrix metalloproteinases (MMP)-1 and -8. Here, we suggest a technique of visualizing turnover of collagen in cardiac tissue