Bilateral Vocal Fold Posterior Glottic/Subglottic Stenotic Web Resected with Contact Tip Nd-YAG Laser

The standard treatment for respiratory failure remains endotracheal intubation, with periods of 22 or more days being commonplace. Posterior glottic stenotic web formation, from scarring in the posterior interarytenoid area, may occur after endotracheal intubation, thermal, corrosive, or direct surgical injury. A commonly used classification system for posterior glottic stenosis divides the occurrence into four types. Type I involves an interarytenoid scar band between the vocal folds that is anterior and separate from the posterior interarytenoid mucosa. Type II stenosis involves scarring of the mucosa or musculature of the posterior interarytenoid area. Types III and IV involve unilateral and bilateral cricoarytenoid joint fixation, respectively. Strobovideolaryngoscopy (SVL), rigid and flexible fiberoptic bronchoscopy, electromyography (EMG), radiologic imaging of the neck, larynx, and trachea as well as pulmonary function tests, including flow volume loops, provide important objective measurements of upper airway obstruction. A representative case of a professional voice user who suffered a Type II posterior glottic stenosis is presented. The treatment utilized a specific contact-tip neodymium-yttrium aluminum garnet (Nd-YAG) laser delivery system to achieve precise cutting, vaporization, and coagulation simultaneously, returning tactile touch technique to the airway/voice surgeon. Completely successful restoration of voice and airway have been maintained for 2 1/2 years postoperatively.     

Botulinum Toxin Type B for Treatment of Spasmodic Dysphonia: A Case Report

Although treatment with botulinum toxin type A (BTXA) has become the standard of care for most patients with laryngeal dystonia, its use is limited by the development of resistance to the toxin in some patients. Botulinum toxin type B (BTXB) has been found to be safe and effective in the treatment of cervical dystonia, but it has not been used previously to treat spasmodic dysphonia. Our experience with BTXB in a patient who developed resistance to BTXA suggests that BTXB may be safe and effective for the treatment of laryngeal dystonia, as well.     

Dynamics of proteins encapsulated in silica sol-gel glasses studied with IR vibrational echo spectroscopy

Spectrally resolved infrared stimulated vibrational echo spectroscopy is used to measure the fast dynamics of heme-bound CO in carbonmonoxy-myoglobin (MbCO) and -hemoglobin (HbCO) embedded in silica sol-gel glasses. On the time scale of approximately 100 fs to several picoseconds, the vibrational dephasing of the heme-bound CO is measurably slower for both MbCO and HbCO relative to that of aqueous protein solutions. The fast structural dynamics of MbCO, as sensed by the heme-bound CO, are influenced more by the sol-gel environment than those of HbCO. Longer time scale structural dynamics (tens of picoseconds), as measured by the extent of spectral diffusion, are the same for both proteins encapsulated in sol-gel glasses compared to that in aqueous solutions. A comparison of the sol-gel experimental results to viscosity-dependent vibrational echo data taken on various mixtures of water and fructose shows that the sol-gel-encapsulated MbCO exhibits dynamics that are the equivalent of the protein in a solution that is nearly 20 times more viscous than bulk water. In contrast, the HbCO dephasing in the sol-gel reflects only a 2-fold increase in viscosity. Attempts to alter the encapsulating pore size by varying the molar ratio of silane precursor to water (R value) used to prepare the sol-gel glasses were found to have no effect on the fast or steady-state spectroscopic results. The vibrational echo data are discussed in the context of solvent confinement and protein-pore wall interactions to provide insights into the influence of a confined environment on the fast structural dynamics experienced by a biomolecule.     

Three homeotropically aligned nematic liquid crystals: comparison of ultrafast to slow time-scale dynamics

The dynamics of two nematic liquid crystals, 4-(trans-4(')-n-octylcyclohexyl)isothiocyanatobenzene and 4-(4-pentyl-cyclohexyl)-benzonitrile, are investigated as a function of temperature both in the homeotropically aligned nematic phase and in the isotropic phase using optical heterodyne-detected optical Kerr effect experiments, which measures the time derivative of the polarizability-polarizability-correlation function (orientational relaxation). Data are presented over a time range of 500 fs-70 micros for the nematic phase and 500 fs to a few hundred nanoseconds for the isotropic phase. The nematic dynamics are compared with a previously studied liquid crystal in the nematic phase. All three liquid crystals have very similar dynamics in the nematic phase that are very different from the isotropic phase. On the slowest time scale (20 ns-70 micros), a temperature-independent power law, the final power law, t(-f) with f approximately 0.5, is observed. On short time scales (approximately 3 ps to approximately 1 ns), a temperature-dependent intermediate power law is observed with an exponent that displays a linear dependence on the nematic order parameter. Between the intermediate power law and the final power law, there is a crossover region that has an inflection point. For times that are short compared to the intermediate power law (approximately <2 ps), the data decay much faster, and can be described as a third power law, although this functional form is not definitive. The isotopic phase data have the same features as found in previous studies of nematogens in the isotropic phase, i.e., the temperature-independent intermediate power law and von Schweidler power law at short to intermediate times, and a highly temperature-dependent long time exponential decay that is well described by the Landau-de Gennes theory. The results show that liquid-crystal dynamics in the nematic phase exhibit universal behavior.