Mucosal Bridge of the Vocal Fold: Difficulties in the Diagnosis and Treatment

Mucosal bridges are rare laryngeal lesions probably of genetic origin. They may cause dysphonia of varying degrees, especially when associated with other laryngeal lesions such as vocal sulci and cysts. Reports on mucosal bridges are rare, and the better treatment is inconclusive.Aim. To report the authors' experience in 14 cases of mucosal bridge showing details on endoscopic examinations and treatment.Study Design. Retrospective study.Methods. We reviewed the medical records of 14 patients with a diagnosis of mucosal bridge confirmed by video-laryngostroboscopy and direct laryngoscopy who attended the Outpatient Clinic of Voice Disorders of the Discipline of Otorhinolaryngology, Botucatu Medical School, São Paulo State University, São Paulo. Data collected included information on gender, age, symptoms, time of onset, history of intubation, smoking status, alcohol intake, associated laryngeal lesions, treatment, and GRBAS (grade of hoarseness, roughness, breathiness, asthenia, and stress) scale ratings.Results. of 14 patients, 10 were females and four were males. There was a prevalence of adults (n = 12), with only two of the patients being younger than 13 years (10 and 13 years). Mucosal bridges showed no correlations with smoking, alcohol intake, or gastroesophageal and sinonasal symptoms. Voice abuse was reported in 50% of the cases that consisted of patients who had high-voice demand occupations. In seven cases, mucosal bridges were associated with other laryngeal lesions, particularly vocal cysts and sulci. All patients who underwent surgery and phonotherapy showed improved vocal quality.Conclusions. We documented 14 patients with dysphonia caused by mucosal bridge. Promising results were obtained with surgery.

Vocal Fold Nodules: Morphological and Immunohistochemical Investigations

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An effective singular oscillator for Duffin-Kemmer-Petiau particles with a nonminimal vector coupling: a two-fold degeneracy

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The late precambrian K-alkaline magmatism in the Ribeira Fold Belt: a case study of the Piracaia Pluton, State of São Paulo, SE Brazil, and its potential mineralization (Cu, Zn, Gd)

The Pluriserial Ribeira Magmatic System-590 of the Late Precambrian Ribeira Fold Belt comprises seven groups of high-K rocks of crustal or mantle origin with ages ranging between 620 and 570 Ma. One of these groups is represented by transalkaline suites akin to appinitic lamprophyres. The suites assemble one or more of following lithologies: (+/- quartz) gabbros and monzogabbros, (+/- quartz) diorites and monzodiorites, (+/- quartz) monzonites and syenites in addition to rare granites. All these rocks occur together in the Piracaia pluton, State of São Paulo. The mineralogy of the Piracaia suite comprises variable amounts of plagioclase (An 60-10), alkali-feldspars (orthoclase, microcline, albite), ortho- (Fe-hypersthene) and clinopyroxenes (augite), amphiboles (hornblende and rare late Fe-hastingsite), abundant biotite, quartz, opaques, sphene, allanite and zircon. Several magmatic pulses constructed the pluton. The Piracaia magma bulk trend evolved initially along the silica-undersaturation plane with simultaneous fractionation of accessory, mafic and felsic minerals. These are segregated in feldspar-rich cumulates. In the late stage, the evolutionary trend followed two distinct paths: one along the or-ab thermal barrier with the crystallization of syenites; the second one along the thermal valley in the or-ab-qz subsystem, producing quartz-syenites and granites. The source of the Piracaia magma was a 'vein-plus-wall-rock-system '. Together the pulses reflect increasing and decreasing participation of peridotites and mica pyroxenites, respectively, in the magmatogenic process. The magmatic pulses were stored in magma chambers, several drained by deep faults or fractures, which were successively reactivated and recharged. Each new pulse underwent mixing with earlier residual magma, followed by fractionation. During ascent through the hot and thickened post-collisional crust, the magma pulses underwent minor compositional changes by crustal contamination. The concentration of valuable elements (Cu, Zn, Gd) in the Piracaia pluton occurred during two phases of the magmatic evolution. Cu and Zn were enriched in cumulates and Gd was concentrated in residual quartz-syenitic veins. Due to their homogeneous dark colour and texture, the monzodiorites are exploited both for polished dimension stones and supports for sensitive scientific instruments. (C) 2001 Elsevier B.V. Ltd. All rights reserved.

Fold, transcritical and pitchfork singularities for time-reversible systems

This paper deals with a class of singularly perturbed reversible planar vector fields around the origin where the normal hyperbolicity assumption is not assumed. We exhibit conditions for the existence of infinitely many periodic orbits and hetero-clinic cycles converging to singular orbits with respect to the Hausdorf distance. In addition, generic normal forms of such singularities are presented.

The Araguaia fold belt, Brazil: A reactivated Brasiliano-Pan-African cycle (550 Ma) geosuture

The Araguaia-Tocantins geosuture, which separates the Araguaia Fold Belt (AFB) from the Archean Amazonian Craton, was active in the late Middle Proterozoic. The Baixo Araguaia Supergroup was deposited, consisting of the Estrondo Group (lower quartzites with intercalated schists), Xambioá Formation (schists), and Canto da Vazante Formation (upper feldspathic schists); and the Tocantins Group consisting of the Couto Magalhaës Formation (phyllites, quartzites, slates, limestones, and metacherts) and Pequizeiro Formation (upper chlorite schists); and associated mafic-ultramafic bodies. The deformational history includes four regional phases of deformation within this supracrustal sequence: recumbent folds with vergence to the west; refolding with a N-S trend; an intense crenulation episode; and late thrusting from east to west. Metamorphism is of intermediate or intermediate-high pressure type with garnet, biotite, chlorite, and sericite isograds succeeded by a slightly or non-metamorphosed zone, from east to west. Rocks surrounding sparse gneissic-cored domes contain isograds of staurolite, kyanite, and fibrolite. These isograds are believed to be associated with the 1100 Ma Uruaçuano event. The Brasiliano Orogeny strongly affected the AFB with displacements due to transcurrent reactivation of great and old faults of the basement, slight folding in the supracrustal sequence, intrusion of small granite bodies, and development of domes with associated normal faults. The area underlain by the Estrondo Group was uplifted at this time, causing the deposition of the Rio das Barreiras polymictic conglomerate of the central area. K-Ar and Rb-Sr analyses date this thermo-tectonic event at 550 ± 100 Ma. The Archean basement is exposed in the cores of domes as a granite-gneiss association, the Colméia complex, which shows thermo-tectonic features that may be interpreted as polycyclic imprints (Jequié, Transamazonian?, Uruaçuano, and Brasiliano Events). © 1989.

Laryngeal electromyography: Contribution to vocal fold immobility diagnosis

Laryngeal Electromyography (LEMG) is a diagnostic test commonly used in patients with vocal fold movement disorder The aim of this study is to describe LEMG in patients with vocalfold immobility. A total of 55 dysphonic patients with vocal fold immobility diagnosed by laryngeal endoscopy were grouped according to probable clinical cause: 1) unknown; 2) traumatic; or 3) tumoral compression. They were submitted to LEMG by percutaneous insertion of concentric needle electrode. LEMG was conclusive in all patients and showed a majority with peripheral nerve injury. LEMG diagnosed peripheral nerve damage in 25 group 1, 12 group 2, and 11 group 3 patients. LEMG was normal in 4 patients, suggesting cricoarytenoid joint fixation. Central nervous system disorders was suggested in 2 and myopathic pattern in 1. As the major cause of vocal fold immobility is peripheral nerve damage, LEMG is an important test to confirm diagnosis.

Autoregressive decomposition and pole tracking applied to vocal fold nodule signals

This letter describes a novel algorithm that is based on autoregressive decomposition and pole tracking used to recognize two patterns of speech data: normal voice and disphonic voice caused by nodules. The presented method relates the poles and the peaks of the signal spectrum which represent the periodic components of the voice. The results show that the perturbation contained in the signal is clearly depicted by pole's positions. Their variability is related to jitter and shimmer. The pole dispersion for pathological voices is about 20% higher than for normal voices, therefore, the proposed approach is a more trustworthy measure than the classical ones. © 2007.

Morphological and histochemical analysis of the human vestibular fold

A morphological and histochemical study of the human vestibular fold was carried out using routine histological techniques. Seven μm-thick histological sections stained with hematoxylin-eosin (HE) and Calleja showed the presence of elastic collagen fibers and seromucous glands in the vestibular fold. Muscle fibers forming the ventricular muscle were also identified. Ultrastructural analyses of the epithelial layer by scanning electron microscopy (SEM) revealed ciliated cells and gland ducts opening on the epithelial surface. Histochemical analyses were performed on ventricular muscles submitted to nicotinamide-adenine-dinucleotide tetrazolium reductase (NADH-TR), succinate dehydrogenase (SDH), and myofibrillar adenosine triphosphatase (mATPase) reactions. Based on these reactions, it was observed that the muscle is formed by three types of muscle fibers: slow-twitch oxidative (SO), fast-twitch oxydative glycolytic (FOG) and fast-twitch glycolytic (FG) fibers distributed in a mosaic pattern. The fiber frequency was 22.7%, 69.9% and 7.4%, respectively. The higher frequency of SO and FOG fibers characterized the muscle as having aerobic metabolism and resistance to fatigue. The ventricular muscle was considered fast. The study of the neuromuscular junctions performed after nonspecific esterase reaction showed that they are of the en-plaque type and have multiple occurrences in the ventricular muscle.

RPA-1 from Leishmania amazonensis (LaRPA-1) structurally differs from other eukaryote RPA-1 and interacts with telomeric DNA via its N-terminal OB-fold domain

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Transmission coefficient and two-fold degenerate discrete spectrum of spin-1 bosons in a double-step potential

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Dynamic Viscosity of Implantable Autologous Materials Into the Vocal Fold

Objective. To compare the dynamic viscosity (DV) of superficial layer of temporalis fascia (SLTF) with that of other biological tissues traditionally used for vocal fold implants to treat vocal fold rigidity. Study Design. Experimental. Method. Measurement of DV of samples of SLTF, deep layer of temporalis fascia (DLTF), and abdominal fat of 12 cadavers. Results. DV values of the different samples were presented in the following increasing order: SLTF, DLTF, and abdominal fat. There was statistical difference between the samples. Conclusion. DV of SLTF is lower than of other tissues tested.

Effects of Hepatocyte Growth Factor Injection and Reinjection on Healing in the Rabbit Vocal Fold

Objectives/Hypothesis. Hepatocyte growth factor (HGF) is a multifunctional polypeptide that plays various roles in embryogenesis and tissue regeneration and exhibits marked antifibrotic activity. The present study sought to assess the effects of HGF injection and reinjection coinciding with its peak of activity on collagen density, vessel density, inflammatory reaction in the lamina propria, and mean epithelial thickness in the injured rabbit vocal fold. Study Design. Prospective, controlled, experimental animal study. Methods. Fourteen rabbits were subdivided into two groups and underwent injury of the vocal folds. Immediately after injury, animals in group 1 received HGF injections into the right vocal fold (RVF), whereas those in group 2 received bilateral HGF injections and a single reinjection into the RVF 10 days after the first, to coincide with the peak of HGF activity. The left vocal folds (LVFs) served as controls in both groups. Histological assessment of laryngeal specimens was performed at 30 and 40 days, respectively. Results. In both groups, collagen density was lower in the right (treated) vocal folds than in the left (control) folds (P = 0.018). Vessel density was higher in the RVFs in group 2 (P = 0.018). Differences were found in mean epithelial thickness and inflammatory reaction in the lamina propria but did not reach statistical significance. Conclusions. In the scarred rabbit vocal fold, HGF injection is associated with decreased collagen density in the lamina propria, whereas reinjection after 10 days produces decreased collagen density and higher vessel density.