Cases reported "Chronic Disease"

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1/11. role of esophageal pH recording in management of chronic laryngitis: an overview.

    Chronic laryngitis typically produces symptoms of frequent throat-clearing, soreness, decreased voice quality with use, nonproductive cough, globus sensation, and odynophagia. The endoscopic laryngeal examination usually demonstrates posterior glottic edema, erythema, and increased vascularity and nodularity. There is increasing support for the hypothesis that reflux of acidic gastric contents is often responsible for the symptoms and findings of chronic laryngitis. Prospective trials of acid suppression therapy demonstrate not only efficacy in symptom reduction, but also objective improvement in measurements of voice quality and mucosal erythema. Although traditionally considered the "gold standard" for diagnosis of reflux causing laryngitis, routine esophageal pH recording may result in false negatives in up to 50% of patients. This may confound the diagnosis of chronic laryngitis and delay treatment. Conversely, a positive study during comprehensive therapy may help identify patients who need additional treatment. A single distal probe is probably insufficient for evaluation of a supraesophageal disorder. Current recommendations for double-probe pH study in the evaluation of chronic laryngitis fall into 2 categories: 1) a double-probe pH study is indicated if there is ongoing moderate-to-severe laryngitis despite antireflux precautions and proton pump inhibitor treatment for at least 6 to 12 weeks; and 2) a double-probe pH study is indicated as a baseline measurement before Nissen or Toupet fundoplication. The pH study would also be indicated in patients who have symptoms after fundoplication. There is clearly much more work to be done on the technical issues of obtaining accurate objective data related to laryngeal acidification. In addition, although acid reflux appears to be causative in many cases of chronic laryngitis, further work is indicated to identify reliable testing methods that will predict treatment success.
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keywords = voice
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2/11. Training agrammatic subjects on passive sentences: implications for syntactic deficit theories.

    We trained two subjects with chronic agrammatic aphasia on production of passive sentences using a computerized, iconic-based communication system. After training, one of the subjects demonstrated significant improvements in his abilities to comprehend and verbally produce English passive voiced sentences, including sentences with conjoined subjects and objects. These results suggest that agrammatism does not represent a fixed syntactic deficit.
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keywords = voice
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3/11. Otorhinolaringologic manifestation of smith-magenis syndrome.

    smith-magenis syndrome (SMS) is a multiple congenital anomaly/mental retardation (MCA/MR) syndrome link to a contiguous-gene deletion syndrome, involving chromosome 1 7p 11.2,whose incidence is estimated to be 1:25,000 livebirth. SMS is characterised by a specific physical, behavioural and developmental pattern. The main clinical features consist of a broad flat midface with brachycefaly, broad nasal bridge, brachydactily, speech delay, hoarse deep voice and peripheral neuropathy. Behavioural abnormalities include hypermotility, self-mutilation and sleep disturbance. This report defines the otorhinolaryngological aspects of a new case of SMS, confirmed by cytogenetic-molecular analysis, in a 9 year old girl affected by chronic otitis media, deafness and sinusitis, who presented with typical clinical signs and symptoms.
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keywords = voice
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4/11. Management of respiratory failure with noninvasive positive pressure ventilation and heliox adjunct.

    Exhausted by persistent coughing and dyspnea, a 63-year-old man with chronic obstructive pulmonary disease was admitted to the emergency department. Initial treatment included oxygen and pharmacologic and noninvasive positive pressure ventilation (NPPV) therapy with minimal clinical improvement. In view of this situation, a gas mixture of helium-oxygen (heliox) 70%:30% was introduced into the nasal mask as an adjunct. Within 20 minutes of therapy, a marked improvement in arterial blood gases and a reduction in respiratory rate and accessory muscle use was noted. The patient expressed in a high-pitched voice that he was "breathing easier." He remained on NPPV-heliox adjunct for 80 minutes. At the end of this period, the patient was placed on a 50% Venturi oxygen mask. He was transferred to the intensive care unit, and 6 days later he was discharged from the hospital without incident.
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keywords = voice
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5/11. When words fail: psychosomatic illness and the talking cure.

    This paper discusses psychosomatic illness as a disorder of the individual's subjectivity in relation, or a surrender of mind and mindfulness to the other. Illustrative clinical material highlights the usefulness of Harry Stack Sullivan's (I954) detailed inquiry in locating the psychosomatic patient's own voice in the consulting room. Particular attention is paid to the form and use of language to impede or foster private experience and personal agency.
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6/11. Reversal of laryngotracheal separation: a detailed case report with long-term followup.

    Chronic aspiration is a difficult and potentially lethal problem. patients who have persistent soilage of the upper respiratory tract despite discontinuing oral intake may be offered surgical intervention to avoid life-threatening pulmonary infections. The Lindeman procedures (tracheoesophageal diversion and laryngotracheal separation) have gained popularity as surgical treatments for intractable aspiration because of their efficacy in preventing aspiration and their technical simplicity. A major downside of these procedures is the necessity for a tracheostoma and the loss of speech following surgery. Rarely, patients recover from the neurologic deficits which led to their intractable aspiration and desire reversal of their Lindeman procedure. While few "successful" reversals have been reported, detailed accounts of the long-term results of such patients are lacking. We describe a patient who underwent a laryngotracheal separation for intractable aspiration following a brainstem stroke. In the following six months he experienced significant neurologic recovery and, after careful evaluation, underwent surgical restoration of laryngotracheal continuity. Five years later he speaks fluently and has no dietary restrictions. Videofluooroscopic examination and quantitative voice analysis reveal near-normal laryngeal function.
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keywords = voice
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7/11. Partial cricotracheal resection for successful reversal of laryngotracheal separation in patients with chronic aspiration.

    OBJECTIVE: To present our experience with successful reversal of laryngotracheal separation in patients with chronic aspiration, to discuss our surgical technique, and to review the literature. STUDY DESIGN: Retrospective case review. methods: The medical records of two patients who underwent a successful reversal of laryngotracheal reversal after separation were reviewed. The two patients were evaluated clinically with videostroboscopy and videofluoroscopy. RESULTS: Both patients presented with intractable aspiration despite protective tracheostomy because of impairment of lower cranial nerve function. After laryngotracheal separation, swallowing rehabilitation was safely possible, and neurologic improvement allowed reversal of the separation procedure. For reversal, we present the use of a partial cricotracheal resection with tracheocricothyropexia similar to the technique used for subglottic stenosis. Both patients were successfully reversed.Satisfactory voice and swallowing function 7 and 10 years after reversal, respectively, could be assessed through our evaluation. review of the literature revealed a total of 13 cases of successful reversal after laryngotracheal separation. Technical details of surgery and functional results are rarely reported.
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keywords = voice
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8/11. Bilateral medialization thyroplasty: an effective approach to severe, chronic aspiration.

    AIMS: To demonstrate the efficacy of bilateral medialization thyroplasty as a treatment for severe, chronic aspiration. To review the literature on surgical options available in the treatment of severe aspiration. MATERIALS AND methods: Three cases that underwent bilateral medialization thyroplasty are described. The technique used was the standard medialization thyroplasty described by Isshiki as a unilateral procedure. The assessment and rehabilitation of these patients is discussed. RESULTS: All patients stopped aspirating following surgery. One patient returned to a normal diet and one patient returned to a solid diet. All patients required a permanent tracheostomy. CONCLUSION: Bilateral medialization thyroplasty offers an effective surgical option in the treatment of severe, chronic aspiration. It maintains good voice, with a possible return to oral diet. The operation is easily reversible if the patient's condition alters.
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keywords = voice
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9/11. Listening to the family's voice: Nordic nurses' movement toward family centered care.

    Clinical nurses, teachers, and researchers in the Nordic countries are faced with increasing expectations in identifying their contribution to knowledge development in family nursing at national and international levels. In this paper, I provide an insight into the contribution of Nordic nurses to family centred care (family system nursing), present findings from an integrative review on family nursing in the Nordic countries, share with you examples of family level interventions, and offer some ideas regarding where we might want to direct our focus in family system nursing in the future.
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ranking = 2
keywords = voice
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10/11. Chronic cough: in search of the etiology.

    Successful treatment of a voice problem requires an accurate diagnosis. The clinician often needs to piece the diagnosis together from previous treatments that failed, from an accurate and involved case history, and from examination of the larynx during speech and vegetative tasks. This case challenges the clinician's ability to question appropriately, to listen intently, and to observe critically before making the diagnosis. With the correct diagnosis, the patient found relief from her chronic cough.
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keywords = voice
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