The joint between the arytenoid cartilage and the cricoid cartilage is one of the smallest in the body. Its existence has been known since, if not before, the time of Galen (130-201 A.D.). However, little anatomical study has been carried out on this synovial joint and publications based on research into its exact anatomy and function are few. The results of these studies have been rarely questioned or scientifically re-examined, with the consequence that authoritative anatomical texts have perpetuated unconfirmed ideas of the behaviour of the cricoarytenoid joint. The purpose of this thesis is to present in detail the results of research into the anatomy and the functions of the cricoarytenoid joint and of the muscles that act upon it. This research began in 1977 with the dissection of 45 cadaver larynges. In this initial study the most striking anatomical finding was the identification of the so-called "posterior" cricoarytenoid ligament, of which inadequate and often incorrect detail has been presented in standard anatomy texts. Another surprising finding of this work was the variability of the shape and positions of the two cricoid facets. In 1978 these findings were published in detail (Sellars and Keen). An attempt to understand the accepted muscular control of the cricoarytenoid joint led to further research. This was carried out by the dissection of a further 23 larynges, with special care to examine the exact origin, direction and insertion of each muscle concerned. Six of these larynges, which had been surgically excised, were also stimulated electrically immediately after excision and the resultant arytenoid cartilage movements were recorded and analysed. The findings of this study were published in 1978 (Sellars) and these articles (Sellars and Keen, 1978; Sellars, 1978) are referred to in "Gray's Anatomy" and in Grant's "Method of Anatomy" (Sellars and Keen, 1978). Further examination of the reactions of these intrinsic laryngeal muscles to electrical stimulation has since been done on three additional fresh operative specimens. This additional work on laryngeal muscle action suggests that the explanation of specific intrinsic laryngeal muscle actions made in the earlier publication (Sellars, 1978) had been oversimplified. The main experimental work, on which this thesis is based, attempts to clarify and interpret the highly complex synchronized muscle actions that occur at the cricoarytenoid joint. Relevant facts found in both recent and old publications relating to this subject are presented and discussed. Before the review of literature is presented the embryology and basic anatomy of the larynx are described.

No description available.

This thesis seeks to reconcile aspects of philology with aspects of linguistics and to illustrate the advances in understanding that can be achieved in this way. The principal empirical focus is provided by four sets of 'classic' data from Germanic historical phonology and the theoretical background is provided by recent developments in non-linear models of phonology. The mutual implications of these are addressed to provide both a new understanding of the data and a coherent theoretical understanding of the types of phonological process that they exemplify. The data sets are chosen partly because of their iconic status in historical phonology and partly also because they all, at times, have been described as examples of a general process-type: 'lenition'. The background is provided by chapters one and two. Chapter one introduces the way in which the relationship between historical and synchronic phonology is understood in the thesis. Chapter two introduces the classic sets of data, namely: (i) the 'Germanic Consonant Shift', (ii) the 'High German Consonant Shift', (iii) the 'English Initial Fricative Voicing', (iv) the 'Inner-German Consonant Weakening'. Chapter three problematises these sets of data in two main ways. The first of these is through an investigation of how they fit with recent advances in the understanding of phonological structure and phonological processes which have been developed in phonological traditions that see sub segmental units as privative (eg, Dependency Phonology, Government Phonology, Articulatory Phonology). Particular emphasis is placed on the units needed to account for laryngeal specifications (traditionally described as 'aspirated', 'glottalised', 'voiced' and 'voiceless') and a position is defended whereby three privative units are required: [spread], [voice] and [constricted]. The first two of these are shown to be used differently in languages to account for the two traditional categories of 'voiced' and 'voiceless'. The second problematising factor is a discussion of how the data sets fit with the concept of obstruent 'lenition', a notion which has a clear, if problematic, place in both historical and synchronic phonology. Lenition trajectories of the type 'stop > affricate > fricative > glottal' and 'voiceless > voiced' are discussed in the light of the data introduced in chapter two and the theoretical discussion of sub segmental structure developed in the first half of chapter three. Further data from Dutch, Spanish, Dravidian, Indo-Iranian, Greek, Bantu, Celtic and Liverpool English is discussed and a synthesis is proposed which takes into account both attested historical data and a theoretical phonological understanding. A notion of 'lenition inhibition' is developed to explain some of the exceptions (which are frequent in lenitions, but are rarely discussed) whereby the sharing of autosegmental phonological units gives a segment 'strength' in certain environments. Chapter four revisits the data introduced in chapter two and provides a reinterpretation in accordance with the understanding of 'lenition' processes developed in chapter three. The data in (i) and (ii) are essentially shown to be dependent on the presence of a [spread] laryngeal specification and to be qualitatively different from the data in (iii) and (iv), which are shown to be unifiable as the loss of [spread]. Additionally, the patterns of exceptions to these processes are examined in light of the understanding of lenition inhibition developed in chapter three. In chapter five, general conclusions are drawn. It is argued that not all lenition processes are unifiable as a single process type. It is further shown that previous discussions of historical 'lenition' processes have missed generalisations, both in terms of the necessary conditions for their diachronic innovation and in terms of the environments which can be seen to partially inhibit their introduction. It is also shown how a detailed understanding of the diachronic data which is discussed here can make a contribution to theoretical models of phonology.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

Thesis--Copenhagen. / Summary in Danish. Includes bibliographical references (p. 276-309) and index.

Thesis--Copenhagen. / Summary in Danish. Includes bibliographical references (p. 276-309) and index.

The purpose of this study was to compare major theories of laryngeal vibration. The basic hypothesis of the study was that the differences and similarities between the major theories of laryngeal vibration could be made evident and clear through a comparative study. It was assumed that there are two or more theories of laryngeal vibration and that all the major theories of laryngeal vibration from 1945 to the present have been described in written form in English.

The very first anaesthetics were gaseous. These early slow, irritant or flammable drugs were ultimately displaced by intravenous agents, despite other beneficial properties. Preliminary work with two new insoluble, potentially rapid-acting nonflammable anaesthetics showed desflurane, the less soluble, to be too irritant while sevoflurane was smooth and well-tolerated. This thesis set out to examine possible clinical andlor financial benefits from the use of sevoflurane in day case patients. A double-blind comparison showed sevoflurane to induce anaesthesia almost as rapidly as the most common intravenous drug, but to minimise apnoea and hypotension, with a smoother transition to the maintenance phase and faster emergence from brief day case anaesthesia. While a few patients found gaseous induction unpleasant, this was not confirmed by an audit of sevoflurane's more widespread use. Further work evaluated alternative, vital capacity, induction techniques. However, simple tidal breathing was found to be equally effective but more consistent, appearing to be the method of choice, even compared with the most recent, optimised delivery of intravenous anaesthetics. Gaseous induction was shown to facilitate airway maintenance with either a face mask or laryngeal mask. Double-blind comparisons showed that it also provided acceptable conditions for tracheal intubation in the small minority of day case patients in whom this is required. Compared to the usual intravenous anaesthetic, gaseous induction with sevoflurane was shown to be less expensive under most common circumstances. Gaseous induction also reduced anaesthetic consumption during the subsequent maintenance phase, making it the most efficient way in which to use inhalation anaesthetics. Having reestablished gaseous induction as an important technique with clinical and financial benefits in modem day case practice, this thesis concludes with suggestions for future research to further refine the process and find solutions to some minor problems, such as occasional patient reticence and the possibility of increased postoperative nausea.

Exercise-induced laryngeal obstruction (EILO) is one of many different causes for adolescents to experience dyspnoea during exercise. Objective exercise-testing with continuous video laryngoscopy is crucial for a correct diagnosis since it is difficult to differentiate EILO from other exercise related conditions in the airways only on the symptomatology. The main symptom in EILO is inspiratory stridor arising from an obstruction at the laryngeal level during ongoing exercise which quickly resolves after the exercise has stopped. EILO is often misdiagnosed as exercise-induced bronchoconstriction (EIB), which is obstruction in the peripheral airways that typically arises after cessation of exercise. From a previous survey investigating self-reported exercise-induced dyspnoea in all 12-13-year-old adolescents in Uppsala (n=3,838, response rate 60.2%) a subset of 150 randomly selected adolescents (103 with dyspnoea and 47 controls) performed standardized treadmill exercise-tests for EIB and EILO. During the exercise-test for EIB the subjects breathed dry air according to the current recommended guidelines. EIB was defined as a decrease in FEV1 ≥10% from baseline. EILO was diagnosed during a continuous laryngoscopy exercise (CLE) test by use of the CLE-score method and was defined as an obstruction of grade 2 at either glottic or/and supraglottic laryngeal level. The estimated prevalence of EIB in the general population was 19.2% and the estimated prevalence of EILO was 5.7%. No gender differences were detected. A diagnostic software program for EILO, EILOMEA, was compared with the CLE-score and the methods were found to be compatible. EILOMEA was used to map and compare laryngeal response patterns in adolescents with exercise-induced dyspnoea (EIB and/or EILO), in adolescents with dyspnoea but without a diagnosis of EIB or EILO, and in healthy controls, all of whom had performed the CLE-test. No differences were seen between the healthy controls and the adolescents with dyspnoea without a diagnosis. Only adolescents diagnosed with EILO showed a significant different laryngeal response pattern which strongly suggests that the diagnostic procedure is reliable. In a follow-up study of patients referred for investigation of exercise-induced dyspnoea, we investigated the outcome of surgical vs. conservative treatment of EILO-positive subjects and subjects tested negative for the diagnosis, regarding the level of exercise-induced dyspnoea and physical activity. Surgically treated patients had less breathing problems and were more physically active than both conservatively treated patients and patients who were tested negative.

Made available in DSpace on 2014-06-11T19:32:13Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-03-31Bitstream added on 2014-06-13T19:42:39Z : No. of bitstreams: 1 ambrosio_ep_dr_botib.pdf: 788460 bytes, checksum: 18c7bc4e895b27a25ad6c61e3df95d08 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O câncer de laringe ocorre em 25% dos carcinomas de cabeça e pescoço e compreende 2% de todas as doenças malignas. É comum o aparecimento de segundos tumores primários e, aproximadamente, 5% dos pacientes apresentam cânceres sincrônicos. Há várias evidências indicando que a população celular presente no fronte de invasão possui características moleculares diferentes das áreas tumorais superficiais, tornando esta região importante para avaliação prognóstica. Neste estudo foram investigadas por CGH cromossômico de alta resolução (HR-CGH) as alterações genômicas na área superficial e no fronte de invasão de carcinomas de laringe e selecionadas regiões específicas para serem avaliadas por outras metodologias para a confirmação dos resultados. O componente superficial e o fronte de invasão de 33 carcinomas de laringe fixados em formalina e em blocos de parafina foram avaliados por HR-CGH. Foram detectadas alterações comuns aos dois componentes assim como alterações exclusivas a cada um deles. Adicionalmente, foi investigada e confirmada a expressão aumentada da proteína ciclina D1 o gene CCND1 esta mapeada em 11q13) por análise de expressão em plataformas de microarranjos de tecidos contendo as areas do tumor e do fronte de invasão. Foi realizada também a análise de marcadores polimórficos de microssatélites mapeados em 3q e 18q em um grupo independente de 33 amostras (DNA tumoral e do sangue periférico) cujos resultados confirmaram as perdas encontradas nestas regiões cromossômicas. A expressão do gene CTTN (mapeada em 11q13) e de sua proteína foram avaliadas e revelaram que os altos níveis de expressão proteica foram correlacionados com invasão perineural nas células do fronte de invasão, sugerindo que esta área pode ser considerada como ferramenta prognóstica em carcinomas de laringe. Foram investigados os ganhos detectados... / Laryngeal cancer occurs in 25% of head and neck carcinomas and comprises 2% of all malignant diseases. The appearance of secondary tumors is common and approximately 5% of patients present concurrent cancers. Preliminary evidence indicates that the cell population present at the source of the invasion front possesses distinct molecular characteristics to surface tumor areas, making this an important region for prognostic evaluation. In this study, genomic alterations in superficial areas and the invasion front of laryngeal carcinomas were investigated by high resolution chromosomal comparative genomic hybridization (HR-CGH) and specific areas were selected for evaluation by other methodologies to confirm the results. The superficial and invasion front components of 33 laryngeal carcinomas fixed in formalin and embedded in paraffin blocks were analyzed by HR-CGH. Alterations common to both components and those exclusive to each area were detected. Additionally, increased ciclin D1 (gene is mapped at 11q13) protein expression was confirmed through immunohistochemistry analysis of tissue microarray platforms containing superficial tumor and invasion front tissues. Polymorphic microsatellites markers mapped at 3q and 18q was also performed on an independent group of 33 samples (tumor and peripheral blood DNA); the results confirmed the losses verified in these chromosomal regions. Expression of the gene CTTN (mapped at 11q13) and its protein were evaluated revealing that high levels of protein expression were correlated with perineural invasion in invasion front cells, suggesting that this area could be considered a prognostic tool in laryngeal carcinomas. The gains detected at 2q24 by HR-CGH were confirmed by FISH and transcript analysis by qRT-PCR. It was found an association between copy number gains of ACVR1 and its overexpression with increased overall survival in laryngeal... (Complete abstract click electronic access below)