<p>Говор представља врло сложену људску делатност. За његову успешну реализацију потребно је ускладити правилну артикулацију, исправан акустички сигнал, несметану перцепцију и одговарајућу когнитивну спознају. Као најзначајнији модалитет реализације језика у процесу комуникације у великој мери зависи од квалитетагласа који је његов неодвојиви део. Патолошке карактеристике гласа и говора особа са бенигним и малигним израштајима на гласницама перципирају се као различите варијације висине, интензитета и квалитета говорног гласа. Циљеви истраживања: Утврдити говорни капацитет особа са малигним, бенигним и псеудотуморима, на гласницама пре и после оперативног лечења, разлику између њиховог говорног капацитета и утврдити како оперативно лечење утиче на разумљивост и временске одреднице говора. Истраживање је спроведено током 2016. и 2017. годинена Клиници за болести ува, грла и носа Клиничког центра Војводине. Узорак је чинило 67 испитаника подељених у 2 групе према врсти израштаја на оне који су имали бенигне и псеудотуморе и испитанике са малигним туморима на гласницама старости од 23 до 74 године (AS 55,43 године; SD 11,95 година). Методе примењене у истраживању: Општи упитник, Тестови за искључивање из узорка (Мини-Ментал тест - Mini mental State Examination, Упитник о анксиозности-GAD-7 Anxiety, Тријажни артикулациони тест), Индекс говорног хендикепа -Speech Handicap Index,Акустичка анализа гласа, Максимално фонацијско време вокала /а/, Анализа временске организације говора, Разумљивост говора, Анализа мелодије реченице. Према нашим резултатима, пре операције у обе групе испитаника говорни капацитет је био готово уједначен са малом разликом јер су ипак нешто бољи говорни капацитет имале особе са малигним израштајима на гласницама али без статистичке значајности у поређеним групама. После оперативног лечења бенигних и псеудотумора на гласницама дошло је до статистички значајног побољшања говорног капацитета (p=0,005). После операције постојалаје статистички значајна разлика између говорног капацитета испитиваних група, при чему су бољи говорни капацитет имали испитаници групе I &ndash; са бенигним и псеудотуморима (t=-3,807, p&lt;0,001). Разумљивост говора је код испитаника са малигним туморима гласнице била статистички значајно повезана са вредностима говорног капацитета пре операције (p=0,008). У погледу временске организације говора, код испитаника са малигним туморима на гласницама после операције дошло је до статистички значајног погоршања (p=0,025). У истраживању није добијен изоловани ефекат времена или врсте израштаја на говорни капацитет, али постоји њихов удружени ефекат (f = 10,079, p = 0,002). Препорука је да се сви пацијенти после оперативног лечења израштаја на гласницама укључе у поступак рехабилитације гласа и говора.</p> / <p>Govor predstavlja vrlo složenu ljudsku delatnost. Za njegovu uspešnu realizaciju potrebno je uskladiti pravilnu artikulaciju, ispravan akustički signal, nesmetanu percepciju i odgovarajuću kognitivnu spoznaju. Kao najznačajniji modalitet realizacije jezika u procesu komunikacije u velikoj meri zavisi od kvalitetaglasa koji je njegov neodvojivi deo. Patološke karakteristike glasa i govora osoba sa benignim i malignim izraštajima na glasnicama percipiraju se kao različite varijacije visine, intenziteta i kvaliteta govornog glasa. Ciljevi istraživanja: Utvrditi govorni kapacitet osoba sa malignim, benignim i pseudotumorima, na glasnicama pre i posle operativnog lečenja, razliku između njihovog govornog kapaciteta i utvrditi kako operativno lečenje utiče na razumljivost i vremenske odrednice govora. Istraživanje je sprovedeno tokom 2016. i 2017. godinena Klinici za bolesti uva, grla i nosa Kliničkog centra Vojvodine. Uzorak je činilo 67 ispitanika podeljenih u 2 grupe prema vrsti izraštaja na one koji su imali benigne i pseudotumore i ispitanike sa malignim tumorima na glasnicama starosti od 23 do 74 godine (AS 55,43 godine; SD 11,95 godina). Metode primenjene u istraživanju: Opšti upitnik, Testovi za isključivanje iz uzorka (Mini-Mental test - Mini mental State Examination, Upitnik o anksioznosti-GAD-7 Anxiety, Trijažni artikulacioni test), Indeks govornog hendikepa -Speech Handicap Index,Akustička analiza glasa, Maksimalno fonacijsko vreme vokala /a/, Analiza vremenske organizacije govora, Razumljivost govora, Analiza melodije rečenice. Prema našim rezultatima, pre operacije u obe grupe ispitanika govorni kapacitet je bio gotovo ujednačen sa malom razlikom jer su ipak nešto bolji govorni kapacitet imale osobe sa malignim izraštajima na glasnicama ali bez statističke značajnosti u poređenim grupama. Posle operativnog lečenja benignih i pseudotumora na glasnicama došlo je do statistički značajnog poboljšanja govornog kapaciteta (p=0,005). Posle operacije postojalaje statistički značajna razlika između govornog kapaciteta ispitivanih grupa, pri čemu su bolji govorni kapacitet imali ispitanici grupe I &ndash; sa benignim i pseudotumorima (t=-3,807, p&lt;0,001). Razumljivost govora je kod ispitanika sa malignim tumorima glasnice bila statistički značajno povezana sa vrednostima govornog kapaciteta pre operacije (p=0,008). U pogledu vremenske organizacije govora, kod ispitanika sa malignim tumorima na glasnicama posle operacije došlo je do statistički značajnog pogoršanja (p=0,025). U istraživanju nije dobijen izolovani efekat vremena ili vrste izraštaja na govorni kapacitet, ali postoji njihov udruženi efekat (f = 10,079, p = 0,002). Preporuka je da se svi pacijenti posle operativnog lečenja izraštaja na glasnicama uključe u postupak rehabilitacije glasa i govora.</p> / <p>Speech represents a very complicated human ability. For its successful realization, it&rsquo;s necessary to coordinate proper articulation, correct acoustical signal, unobstructed perception and adequate cognitive recognition. The most significant modality of language realization in the process of communication greatly depends on vocal quality, which is its inseparable element. Pathological vocal and speech characteristics in people with benign and malign growths on the vocal cords are perceived as different variations of pitch, intensity and quality of the speaking voice. Aims of the research: Determining the vocal capacity of people with malign, benign tumors and pseudo-tumors on the vocal cords, before and after surgical treatment, determining the difference between their vocal capacity and how surgical treatment affects comprehensibility and time determinants of speech. The research was conducted during 2016 and 2017 on the Otorhinolaryngology clinic of Vojvodina Clinical Centre. The sample consisted of 67 participants divided into 2 groups based on the type of growth present, into participants with benign and pseudo tumors and participants with malign tumors of the vocal chords, aged 23 &ndash; 74 (M=55,43; SD=11,95). Methods used in the research: General Questionnaire, Tests for exclusion from the sample (Mini mental State Examination), Anxiety Questionnaire &ndash; GAD-7 Anxiety, Triage Articulatory Test, Speech Handicap Index, Acoustic Vocal Analysis, Maximum phonation time vowel /a/, Time organization of speech analysis, Speech comprehensibility, Sentence melody analysis. According to the results of the research, before surgical treatment, the vocal capacity of both participant groups was nearly equable with a small difference of a somewhat higher vocal capacity in participants with malign growths on the vocal cords, but with no statistical significance between the compared groups. After surgical treatment of benign and pseudo tumors on the vocal cords, a statistically significant improvement of vocal capacity was observed (p=0,005). Post surgically, a statistically significant difference between the vocal capacity of tested groups was observed, with a higher vocal capacity present in the first group of participants with benign and pseudo tumors (t=-3,807, p&lt;0,001). Speech comprehensibility in participants with malign tumors of the vocal cords was significantly correlated with the values of speech capacity prior to the surgical treatment (p=0,008). In regards to time organization of speech, there was a statistically significant deterioration in patients with malign vocal cord tumors (p=0,025). The research showed no isolated effect of time or type of growth on speech capacity, but a combined effect was observed (f=10,079, p=0,002). The recommendation is that all patients are included in the procedure of speech and vocal rehabilitation after surgical treatment.</p>

Much of the impetus for this research can be attributed to Kenneth W. Hinchcliff, who has studied exercise-induced pulmonary haemorrhage (EIPH) extensively. This thesis focused on EIPH in Thoroughbred racehorses competing in South Africa. Using tracheobronchoscopy, the prevalence and severity of EIPH and the association with racing performance was determined. Thereafter, the prevalence of other respiratory tract disorders and their association with racing performance is reported. This is followed by a study assessing interobserver variability using grading systems in the detection of respiratory tract disorders. Finally, there is a report on the immunopathogenesis of EIPH. Using tracheobronchoscopy after racing, the prevalence and severity of EIPH was assessed in 1,005 racehorses competing at high altitude (> 1,400 meters above sea level) and at sea level in a racing jurisdiction that does not allow the use of furosemide and nasal dilator strips. The prevalence and severity of EIPH was affected by altitude as racing at sea level was associated with a higher prevalence and greater severity of EIPH. Results also suggested that EIPH was associated with superior performance in South African Thoroughbred racehorses. Upper and lower respiratory tract disorders identified following tracheobronchoscopic examination included left arytenoid asymmetry, left laryngeal hemiplegia, epiglottic deformity, epiglottic entrapment, subepiglottic cysts, dorsal displacement of the soft palate, pharyngeal lymphoid hyperplasia (PLH), laryngeal and tracheal dirt, tracheal mucous (TM), tracheal stenosis and tracheal cartilage ring spikes in Thoroughbred racehorses after racing. Overall, there was a low prevalence of grade 2 and 3 arytenoid cartilage asymmetry, left laryngeal hemiplegia, epiglottic entrapment, subepiglottic cysts and epiglottic deformity, while more severe grades of PLH, laryngeal debris, tracheal debris, TM and tracheal cartilage ring spikes had a higher prevalence. An association with sex was identified as tracheal cartilage ring spikes occurred more often in male racehorses. Superior racing performance was identified in racehorses with grade 3 tracheal mucous and tracheal cartilage ring spikes. Endoscopic grading of EIPH, PLH, arytenoid cartilage movement (ACM), and TM was performed by 3 observers that were blinded to each racehorse’s identity and race day performance using previously established grading criteria. Excellent interobserver reliability was seen using the EIPH grading system, while the weighted kappa for PLH, ACM and TM was lower. The study demonstrated sufficient reliability for the use of the EIPH, PLH, ACM and TM grading systems in racehorses competing in South Africa. The study concluded that tracheobronchoscopy seemed to be a practical screening technique that may have prognosticative validity and clinical dependability and that would allow safe and quick assessment of the respiratory tract of a large number of racehorses in field conditions. Venous blood was collected from 10 horses in each EIPH grade classification (grade 0 to 4) following tracheobronchoscopic examinations for the determination of the presence and severity of EIPH. Following RNA isolation and cDNA synthesis, real-time PCR was used to detect equine cytokine-specific mRNA for interleukin (IL) -1, -6, -10, interferon (INF) -ã, and tumor necrosis factor (TNF) -á. Results of this study indicated that increased IL-6, and -10 mRNA production was associated with more severe forms of EIPH. Also, there was greater expression of IL-6 mRNA at sea level and TNF-á mRNA at high altitude. This study concluded that although it was unclear whether the inflammatory response observed in the study was due to pre-existing pulmonary inflammation or as a direct consequence of pulmonary bleeding, the study demonstrated a systemic correlation to pulmonary inflammation. The research reported in this thesis has contributed substantially to the determination of the prevalence, severity and affect on racing performance of respiratory tract disorders in Thoroughbred racehorses competing in South Africa. Also, determination of an association between EIPH and inflammation at a molecular level may assist future researchers in anti-cytokine therapies which may help reduce the prevalence and severity of EIPH. / Thesis (PHD)--University of Pretoria, 2007. / Companion Animal Clinical Studies / unrestricted

Einleitung: Hunde mit brachyzephalem Syndrom zeigen multiple obstruktive Fehlbildungen der oberen Atemwege. Im Larynx können evertierte laterale Ventrikel, sogenannte La-ryngozelen die Rima glottidis verengen. In der bisherigen Literatur werden die evertierten Ventrikel in der Regel dem Kehlkopfkollaps zugeordnet und als Grad I Kollaps beschrieben. Die Ausprägung der Laryngozelen zeigt sich endoskopisch in unterschiedlichem Ausmaß. Die Indikation zur operativen Entfernung der evertierten Schleimhaut wird kontrovers diskutiert. Ziele der Untersuchungen: Nach Entwicklung einer standardisierten Untersuchungsmethode zur Beurteilung von Laryngozelen sollen Kriterien definiert werden, die eine Graduierung der Ausprägung erlauben. Anhand einer solchen Graduierung soll die Häufigkeit und die Ausprä-gung von Laryngozelen in einem Patientenkollektiv zwischen den Rassen Französische Bull-dogge und Mops verglichen werden. Anhand dieser Graduierung soll die Indikation zur chi-rurgischen Intervention definiert werden. Als neu entwickelte chirurgische Therapie soll die transorale laser-assistierte videomikroskopische Ablation, die Laryngozelektomie beschrie-ben werden und das Outcome 6 Monate postoperativ im Rahmen einer erneuten standardi-sierten Untersuchung und Graduierung evaluiert werden. Tiere und Methoden: In diese prospektive Studie eingeschlossen wurden in einem Zeitraum von 3 Jahren insgesamt 109 Hunde mit Brachyzephalem Syndrom der Rassen Mops und Französische Bulldogge. Alle Hunde wurden zur Therapie schwerer obstruktiver Malformati-onen der oberen Atemwege zur Multi-Level-Chirurgie vorgestellt. 64 Tiere waren Französi-sche Bulldoggen und 45 gehörten der Rasse Mops an. Nach einer ausführlichen Befunderhe-bung der oberen Atemwege wurden endoskopische Standbilder der Rima glottidis prä- und postoperativ angefertigt, um die Laryngozelen nach einer neuen Graduierung einheitlich zu evaluieren. Die evertierten Ventrikel wurden bei moderater bis starker Ausprägung mit der neuen Methode, der Laryngozelektomie, entfernt. Die erstellten endoskopischen Aufnahmen wurden prä- und postoperativ verglichen. Die erhobenen Befunde wurden zwischen den beiden Hunderassen Französische Bulldogge und Mops verglichen. Der Ausprägungsgrad der Laryngozelen und der Bezug zum Signale-ment der Hunde sowie zu einzelnen Befunden an den oberen Atemwegen der Tiere wurde ermittelt. Beim Vergleich von mehr als zwei unabhängigen, nicht normalverteilten Stichpro-ben wurde der H-Test nach Kruskal und Wallis eingesetzt, während beim Vergleich von mehr als zwei unabhängigen, normalverteilten Stichproben die einfaktorielle ANOVA Anwendung fand. Ordinale Daten wurden mit dem Vorzeichentest ausgewertet. Bei den kategorisierten bzw. nominalen Daten dagegen wurden der Chi-Quadrat-Tests angewendet. Bei allen durch-geführten Tests erfolgte eine zweiseitige Signifikanzüberprüfung, wobei für alle statistischen Tests ein p-Wert < 0,05 als statistisch signifikant angenommen wurde. Ergebnisse: Über 50% der Hunde beider Rassen (51,6 % Französische Bulldogge, 51,1 % Mops) litten unter einer ausgeprägten Malformation des Larynx mit Laryngozelen der schwersten Ausprägungsform (Grad 2). Nur 2 % der Hunde der Rasse Mops und 14 % der Französischen Bulldoggen zeigen physiologische Larynxventrikel (Grad 0). Nach Ablation der Laryngozelen bestand 6 Monate postoperativ bei keinem der Tiere mehr eine Grad 2 Mal-formation der lateralen Ventrikel, bei 64 der 84 Hunde (76,2 %) war die Obstruktion voll-ständig beseitigt (Grad 0). Schlussfolgerung: Die Hälfte der Hunde der Rassen Französische Bulldogge und Mops sind vom schwersten Grad der Laryngozelen betroffen. Die Eversion der Schleimhaut der latera-len Ventrikel reicht bei Grad 2 über das Niveau der Ligg. Vocalia hinaus, engt die Rima glot-tidis ein und somit den Eingang des Kehlkopfes. Hunde der Rasse Mops sind schwerer betrof-fen als die Französischen Bulldoggen. Die Laryngozelektomie wurde als ein wesentlicher Be-standteil der Multi-Level-Chirurgie durchgeführt und hat sich als praktikable und wirksame Methode erwiesen, um obstruierendes Gewebe der evertierten lateralen Ventrikel komplikationsarm zu entfernen.:INHALT 1 Einleitung 1.1 Allgemeines 1.2 Hypothesen und Zielstellung 2 Allgemeine Grundlagen 2.1 Der Kehlkopf des Hundes 2.1.1 Die Anatomie des Kehlkopfes 2.1.2 Die Funktionen des Kehlkopfes und der Rima glottidis 2.2 Das Problem beim Tier 2.2.1 Das Brachyzephale Syndrom (BZS) 2.2.2 Der Kehlkopfkollaps 2.2.3 Die Laryngozelen (Evertierte laterale Ventrikel) 2.3 Diagnostik und Therapie 2.3.1 Diagnostik von Laryngozelen 2.3.2 Funktionelle Larynx-Diagnostik 2.3.3 Chirurgische Therapie von Laryngozelen 2.3.4 Laserchirurgie in der Tiermedizin 3 Tiere und Methoden 3.1 Tiere 3.2 Allgemeiner Ablauf 3.3 Anästhesie 3.4 Endoskopie der oberen Atemwege 3.4.1 Lagerung des Patienten 3.4.2 Equipment für die Endoskopie 3.4.3 Untersuchungsgang 3.5 Graduierung der Laryngozelen 3.5.1 Laryngozelen während der Larynxfunktionsprüfung 3.5.2 Beurteilung der Laryngozelen in der endexspiratorischen Pause 3.6 Graduierung endoskopischer Zusatzbefunde 3.7 Laryngozelektomie – Die transorale laser-assistierte video-mikroskopische Ablation der Laryngozelen 3.7.1 Lagerungstechnik und Zugangswege 3.7.2 Instrumentarium und Geräte 3.7.3 Operationsschritte der laser-assistierten video-mikroskopischen Laryngozelektomie 3.7.4 Multi-Level-Chirurgie 3.8 Statistik 4 Ergebnisse 4.1 Graduierung der Laryngozelen 4.1.1 Präoperative Ausprägung der Laryngozelen bei Französischer Bulldogge und Mops 4.1.2 Postoperative Ausprägung der Laryngozelen bei Französischer Bulldogge und Mops 4.1.3 Evaluierung der prä- und postoperativen Ausprägung der Laryngozelen 4.1.4 Evaluierung von Hunden ohne Laryngozelektomie 4.2 Weitere Parameter zur Beurteilung evertierter Ventrikel 4.2.1 Kehlkopffunktionsprüfung 4.2.2 Kontaktflächen der Laryngozelen 4.3 Demographische Daten und Befunde und deren Bezug zur Ausprägung der Laryngozelen 4.4 Weitere Befunde in Bezug zur Ausprägung der Laryngozelen 4.4.1 Endoskopie der Atemwege 4.4.2 Vorangegangene Operationen 4.4.3 Zeitpunkt der Kontrolluntersuchung 5 Diskussion 5.1 Diskussion der Kernaussagen 5.2 Diskussion der weiteren Ergebnisse 5.3 Limitationen 6 Zusammenfassung 7 Summary 8 Literaturverzeichnis 9 Anhang 9.1 Verzeichnis der Abbildungen 9.2 Verzeichnis der Tabellen / Introduction: Dogs with brachycephalic syndrome show multiple obstructive malformations of the upper airways. In the larynx, everted lateral ventricles called laryngoceles may nar-row the rima glottidis. In previous studies, everted ventricles are usually attributed to la-ryngeal collapse and are described as grade I laryngeal collapse. The prominence of the laryngoceles is seen endoscopically to varying degrees. The indication for surgical removal of the everted mucosa is controversial. Objectives: After proposing a standardized examination technique for the evaluation of laryngoceles, criteria are defined which allow the graduation of the eversion by intensity. Through the classification by intensity, the frequency, and the expression of laryngoceles in a patient collective are compared between the breeds French bulldog and pug. The indication for surgical intervention is then defined based on differentiation criteria mentioned above. Transoral laser-assisted videomicroscopic ablation, laryngocelectomy, is described as a new-ly developed surgical therapy. The outcome is evaluated 6 months postoperatively during a repeat standardized examination and graduation. Animals and Methods: A total of 109 brachycephalic dogs of the French bulldog (n=64) and pug (n=45) breeds were included in this prospective study over a 3-year period. All dogs pre-sented for multi-level upper airway surgery for the treatment of severe obstructive malfor-mations because of brachycephalic syndrome. Moderately to severely everted ventricles were removed through the new method, the laryngocelectomy. After a comprehensive sur-vey of the upper airways, endoscopic still images of the rima glottidis were obtained pre- and postoperatively to consistently evaluate the laryngoceles after the proposed degrees of graduation. The findings were compared between the two dog breeds French bulldog and pug. Relations between the severity of the laryngoceles, the dogs signalment and to individual findings in the upper airways of the animals were determined. The Kruskal and Wallis H-test was used when comparing more than two independent, nonnormally distributed samples, whereas one-factor ANOVA was used when comparing more than two independent, normally distrib-uted samples. Ordinal data were analyzed using the sign test. For categorized or nominal data, the chi-square test was applied. Two-sided significance testing was performed for all tests and a p-value of <0.05 was assumed to be statistically significant for all statistical tests. Results: More than 50% of the dogs of both breeds (51.6% of French bulldogs, 51.1% of pugs) suffered from a pronounced malformation of the larynx with laryngoceles of the most se-vere form (grade 2). Only 2% of the pugs and 14% of the French bulldogs showed physiologi-cal laryngeal ventricles (grade 0). Six months after laryngocelectomy, none of the animals had grade 2 malformation of the lateral ventricles; in 64 of the 84 dogs who underwent sur-gery (76.2%), the obstruction was completely cleared (grade 0). Conclusion: Half of the French bulldogs and pugs were affected by the most severe grade of laryngoceles. The eversion of the mucosa of the ventricles extends within grade 2 above the level of the vocal ligaments, narrowing the rima glottidis, and thus the entrance of the lar-ynx. Dogs of the pug breed are more severely affected than French bulldogs. Laryngocelec-tomy was performed as one essential component of a multi-level surgery. We conclude that laryngocelectomy has proven to be a feasible and effective method of removing obstructing tissue of everted lateral ventricles with few complications.:INHALT 1 Einleitung 1.1 Allgemeines 1.2 Hypothesen und Zielstellung 2 Allgemeine Grundlagen 2.1 Der Kehlkopf des Hundes 2.1.1 Die Anatomie des Kehlkopfes 2.1.2 Die Funktionen des Kehlkopfes und der Rima glottidis 2.2 Das Problem beim Tier 2.2.1 Das Brachyzephale Syndrom (BZS) 2.2.2 Der Kehlkopfkollaps 2.2.3 Die Laryngozelen (Evertierte laterale Ventrikel) 2.3 Diagnostik und Therapie 2.3.1 Diagnostik von Laryngozelen 2.3.2 Funktionelle Larynx-Diagnostik 2.3.3 Chirurgische Therapie von Laryngozelen 2.3.4 Laserchirurgie in der Tiermedizin 3 Tiere und Methoden 3.1 Tiere 3.2 Allgemeiner Ablauf 3.3 Anästhesie 3.4 Endoskopie der oberen Atemwege 3.4.1 Lagerung des Patienten 3.4.2 Equipment für die Endoskopie 3.4.3 Untersuchungsgang 3.5 Graduierung der Laryngozelen 3.5.1 Laryngozelen während der Larynxfunktionsprüfung 3.5.2 Beurteilung der Laryngozelen in der endexspiratorischen Pause 3.6 Graduierung endoskopischer Zusatzbefunde 3.7 Laryngozelektomie – Die transorale laser-assistierte video-mikroskopische Ablation der Laryngozelen 3.7.1 Lagerungstechnik und Zugangswege 3.7.2 Instrumentarium und Geräte 3.7.3 Operationsschritte der laser-assistierten video-mikroskopischen Laryngozelektomie 3.7.4 Multi-Level-Chirurgie 3.8 Statistik 4 Ergebnisse 4.1 Graduierung der Laryngozelen 4.1.1 Präoperative Ausprägung der Laryngozelen bei Französischer Bulldogge und Mops 4.1.2 Postoperative Ausprägung der Laryngozelen bei Französischer Bulldogge und Mops 4.1.3 Evaluierung der prä- und postoperativen Ausprägung der Laryngozelen 4.1.4 Evaluierung von Hunden ohne Laryngozelektomie 4.2 Weitere Parameter zur Beurteilung evertierter Ventrikel 4.2.1 Kehlkopffunktionsprüfung 4.2.2 Kontaktflächen der Laryngozelen 4.3 Demographische Daten und Befunde und deren Bezug zur Ausprägung der Laryngozelen 4.4 Weitere Befunde in Bezug zur Ausprägung der Laryngozelen 4.4.1 Endoskopie der Atemwege 4.4.2 Vorangegangene Operationen 4.4.3 Zeitpunkt der Kontrolluntersuchung 5 Diskussion 5.1 Diskussion der Kernaussagen 5.2 Diskussion der weiteren Ergebnisse 5.3 Limitationen 6 Zusammenfassung 7 Summary 8 Literaturverzeichnis 9 Anhang 9.1 Verzeichnis der Abbildungen 9.2 Verzeichnis der Tabellen

Submitted by Johnny Rodrigues (johnnyrodrigues@ufcg.edu.br) on 2018-08-13T16:22:35Z No. of bitstreams: 1 WASHINGTON CÉSAR DE ALMEIDA COSTA - TESE PPGEE 2012..pdf: 6463355 bytes, checksum: 40d8703ef8a6dd3ef05acde3025cf628 (MD5) / Made available in DSpace on 2018-08-13T16:22:35Z (GMT). No. of bitstreams: 1 WASHINGTON CÉSAR DE ALMEIDA COSTA - TESE PPGEE 2012..pdf: 6463355 bytes, checksum: 40d8703ef8a6dd3ef05acde3025cf628 (MD5) Previous issue date: 2012-11-09 / Patologias na laringe podem afetar a qualidade vocal, prejudicando a comunicação humana. As técnicas objetivas tradicionais para o diagnóstico dessas patologias fazem uso de exames considerados invasivos, causando certo desconforto ao paciente. Análise acústica, utilizando técnicas de processamento digital de sinais de voz, pode ser utilizada para o desenvolvimento de ferramentas não invasivas de auxílio ao diagnóstico de patologias laríngeas. A precisão do diagnóstico, contudo, depende da escolha das características e parâmetros da fala que melhor representem a desordem vocal provocada por uma determinada patologia. Este trabalho trata da caracterização e da classificação de sinais de vozes saudáveis e vozes afetadas por diferentes patologias laríngeas (edema, paralisia e nódulos nas pregas vocais), por meio da análise dinâmica não linear (e teoria do caos), como também por meio da análise de quantificação de recorrência. No processo de caracterização é investigado, por meio de testes estatísticos, o potencial de cada característica em discriminar os tipos de sinais de voz considerados. Para a classificação é empregada a técnica de análise discriminante com as funções linear ou quadrática, com validação cruzada, sendo considerado um intervalo de confiança de 95% para as médias das taxas de acuraria do classificador. A partir da combinação de características dos conjuntos das medidas de análise não linear (MNL) e das medidas de quantificação de recorrência (MQR), as médias da taxa de acurácia obtidas variaram nos intervalos de confiança: [95,44%; 100%) para a classificação entre vozes saudáveis e patológicas; [94,75%; 100%] entre vozes saudáveis e afetadas por edema, e entre saudáveis e nódulos. Para a classificação entre saudável e paralisia, obteve-se uma acurácia de 100% . Também são avaliados os efeitos do uso de vetores híbridos formados por características MNL, MQR e coeficientes extraídos da análise preditiva linear (LPC). Neste caso. as taxas de acurácia variaram nos intervalos de confiança: [95,02%; 97,62%] na discriminação entre vozes afetadas por paralisia e edema; [98,29%; 99,93%] para paralisia versus nódulos e [97,98%; 99,84%] para edema versus nódulos. Os resultados encontrados indicam que o método utilizado é promissor, podendo ser empregado no desenvolvimento de uma ferramenta computacional para apoio ao diagnóstico de patologias laríngeas. / Laryngeal pathologies may affect the voice quality, harniing human communication. The traditional objective techniques for diagnosing these pathologies make use of exams, considered invasive, causing discomfort to the patient. Acoustic analysis, using digital speech signal processing techniques. can be used for the development of non-invasive tools in order to aid laryngeal diseases diagnosis. The accuracy of diagnosis, however. depends on the choice of parameters and the speech characteristics diat better represent the voice disorder caused by a given pathology. This work deals with the characterization and classification of healthy voice signals and voices affecied by different laryngeal diseases (edema, paralysis and vocal fold nodules), by means of nonlinear dynamic analysis (and chãos theory) as well as recurrence quantification analysis. In the characterization process, the potential of each feature is investigated to discriminate the types of voice signals considered, by means of statistical tests. For the classification, the technique of discriminam analysis is employed with linear or quadratic functions, with cross-validation. A 95% confidence levei was considered for the average of accuracy rates of the classifier performance. From the feature combination of the set of nonlinear analysis measures (MNL) and the quantification recurrence measures (MQR). the average of accuracy rates varied in the following confidence intervals: [95.44%; 100%] for healthy and pathologícal classification: [94.75%; 100%] between healdiy and edema voices, and also between healthy and nodules. The accuracy rate was 100% between healthy and paralysis. We also evaluated the effects of using hybrid vectors formed by MNL, MQR and linear predictive coding (LPC) coefficients. In this case, the accuracy rates ranged in the confidence intervals: [95.02%; 97.62%] in the paralysis versus edema voices discrimination; [98.29%; 99.93%] for paralysis versus nodules and [97.98%; 99.84%] for edema versus nodules. Obtained results indicate that the used method is promising and it can even be used to develop a computational tool to support diagnosis of laryngeal diseases.

<p>Sudden unexpected death in epilepsy (SUDEP) is a fatal complication of epilepsy that kills 1̃2 of every 10,000 epileptic patients every year. SUDEP has proven difficult to study because it frequently occurs unobserved and cannot be predicted. What limited clinical data exists suggests that SUDEP occurs as a cardiorespiratory collapse immediately following a seizure. In this work, I explore how a group of autonomic reflexes termed collectively as “oxygen‐conserving reflexes (OCRs)” lead to sudden death when activated during seizures. I also demonstrate multiple physiological parallels between the OCR‐mediated deaths that I report and the clinical data on cases of human SUDEP. Additionally, I explore the neural pathway underlying OCRs, identify the carotid body as a potential target for intervention, and demonstrate the efficacy of electroceutical intervention in reducing the mortality risk of OCR activation during seizures. This work seeks to both offer a neural explanation for SUDEP as well as present a promising target and means for potential intervention.</p>