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نوشته شده توسط محمد جواد سعيدي بروجني در 17 Dec 2009 ساعت 9 PM موضوع | لینک ثابت
Absence or underdevelopment of breast tissue
The absence or underdevelopment of breast tissue is less common than the presence of supernumerary tissue. These conditions may be unilateral or bilateral and result from partial or complete underdevelopment of the mammary bud. The most severe form is amastia, the complete absence of glandular tissue, nipple, and areola. Hypoplasia, the presence of very small rudimentary breasts, is the most common form. Amastia and hypoplasia may be associated with scalp defects, ear abnormalities, renal hypoplasia, and cataracts in patients with the rare autosomal dominant Finlay-Marks syndrome.6Hypoplasia also may occur in patients with Turner syndrome (ovarian agenesis), congenital adrenal hyperplasia, and delayed menarche where the administration of oral estrogen therapy usually promotes glandular development.
Aplasia, the absence of glandular tissue in the presence of a nipple and areola, is most commonly encountered in Poland syndrome, first described in 1841. This condition is often accompanied by musculoskeletal deformities of the chest wall and ipsilateral upper extremity and is discussed in a separate article. Athelia, absence of the nipple and areola in the presence of glandular tissue, is the rarest of these conditions. It is infrequently seen as an isolated defect except in ectodermal dysplasia syndromes.
The goal of surgical therapy in these patients is to achieve breast symmetry. This may best be performed in late adolescence when the contralateral breast has reached its mature size and shape. However, earlier intervention may be indicated in the patient with a significant sense of deformity that is adversely affecting body image. Techniques to achieve symmetry may include prosthetic devices such as implants or expanders, autologous tissue such as the latissimus dorsi or rectus abdominis muscles, or both. These patients and their families should seek plastic surgery consultation early in the process so all options can be explained to them.
Preoperative side view of patient with Poland syndrome.
Preoperative frontal view of patient with Poland syndrome.
Preoperative profile view of patient with Poland syndrome.
Postoperative side view of patient with Poland syndrome shown in media files 9-11. This patient underwent reconstruction with a form stable gel device in the right breast and a nonform stable gel device in the left breast.
Postoperative frontal view of patient with Poland syndrome shown in media files 9-11. This patient underwent reconstruction with a form stable gel device in the right breast and a nonform stable gel device in the left breast.
Postoperative profile view of the patient with Poland syndrome shown in media files 9-11. This patient underwent reconstruction with a form stable gel device in the right breast and a nonform stable gel device in the left breast.
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نوشته شده توسط محمد جواد سعيدي بروجني در 17 Dec 2009 ساعت 0 AM موضوع | لینک ثابت
Multiple Sclerosis: Speech and Swallowing Problems
People with multiple sclerosis (MS) often have swallowing difficulties. In many cases, they are associated with speech problems as well.
What Causes Speech and Swallowing Problems in People With MS?
Like other symptoms of MS, if you're experiencing swallowing or speech difficulties, it's because you have an area of damaged nerves that normally aid in performing these tasks.
Locating the damaged areas responsible for the speech problem is often difficult. Many areas in the brain, especially the brainstem, control speech patterns. Thus, lesions -- damaged areas -- in different parts of the brain can cause several types of changes in normal speech patterns. They range from mild difficulties to severe problems that make it difficult to speak and be understood.
What Are the Symptoms of a Swallowing Problem?
· Coughing or choking when eating
· Feeling like food is lodged in the throat
· Unexplained recurrent lung infections (pneumonia)
· Otherwise unexplained malnutrition or dehydration
When swallowing difficulties are present, food or liquids that you eat may be inhaled into the trachea (windpipe) instead of going down the esophagus and into the stomach. Once in the lungs, the inhaled food or liquids can cause pneumonia or abscesses. Because the food or drink is not reaching the stomach, a person may also be at risk for malnutrition or dehydration.
How Are Swallowing Problems Diagnosed?
Initially, your doctor will ask you many questions about the nature of your problem and perform a physical exam, paying attention to the function of your tongue and swallowing muscles.
Occasionally, your doctor may recommend that you get a test called a modified barium swallow. This is a special imaging procedure where you drink or eat contrast material of different consistencies -- solid, thick liquid, and thin liquids after which a machine takes pictures tracing the path of the contrast material. Thus the precise location and manner of the swallowing problem can be identified.
How Are Swallowing Problems Treated?
A speech therapist (or speech and language pathologist) usually treats swallowing problems. Treatment typically consists of changes in diet, positioning of the head, exercises, or stimulation designed to improve swallowing. In very severe cases that do not respond to these measures, feeding tubes may be inserted directly into the stomach to provide the necessary fluids and nutrition.
Here are some tips that may make swallowing easier:
· Sit upright at a 90-degree angle, tilt your head slightly forward, and/or remain sitting or standing upright for 45 to 60 minutes after eating a meal.
· Minimize distractions in the area where you eat. Stay focused on the tasks of eating and drinking. Do not talk with food in your mouth.
· Eat slowly. Cut your food into small pieces and chew it thoroughly. Do not try to eat more than 1/2 teaspoon of your food at a time.
· You may need to swallow two or three times per bite or sip. If food or liquid catches in your throat, cough gently or clear your throat, and swallow again before taking a breath. Repeat if necessary.
· Concentrate on swallowing frequently. It may help to alternate a bite of food with a sip of liquid. If you have difficulty sucking liquid all the way up a straw, cut the straw down so that there is less distance for the liquid to travel.
· Change the temperature and texture of liquids (make the liquids colder, try carbonated beverages).
· Drink plenty of fluids. Periodically suck on Popsicles, ice chips, lemon ice, or lemon-flavored water to increase saliva, which will increase swallowing frequency.
· If chewing is difficult or tiring, minimize (or eliminate) foods that require chewing, and eat more soft foods. Puree your foods in a blender.
· If thin liquids cause you to cough, use a liquid thickener. You can also substitute thin liquids with thicker liquid choices such as nectars for juices and cream soups for plain broths.
· When taking medication, crush your pills and mix them with applesauce or pudding. Ask your pharmacist for recommendations on which pills should not be crushed and which medications can be purchased in a liquid form.
نوشته شده توسط محمد جواد سعيدي بروجني در 16 Feb 2009 ساعت 6 PM موضوع | لینک ثابت
The Larynx serves a number of purposes. Though it may seem designed specifically for our speaking and singing, the larynx has evolved to allow us this control. It has other purposes too, ones that are essential to life. These purposes are called "biological", while speaking and singing are called "non-biological", as it is quite possible to survive without speech or singing. Witness those individuals who have had to have their larynges ( La - rin - jeeze,the plural of larynx) removed due to cancer and who talk through a process much like burping. Perhaps not very aesthetically pleasing, but possible.
Biological Function:
Non-Biological Function:
Skeleton of the Larynx
gross features viewed from the front.
Hyoid Bone The yellowish bone in the image, it is horseshoe shaped and is the only bone in the body that floats, unconnected to another bone. It can be felt by pressing a finger into the crease where your chin becomes your neck.
Cartilages (visible in this image)
Trachea
Made up of a series of cartilaginous rings, the trachea can stretch, much like a vacuum cleaner hose. Compress it by swallowing, stretch it by tipping your head back.
The Larynx, viewed from behind 
The Epiglottis
Functioning much like a "flap valve" on a toilet, the epiglottis drops down in swallowing to close off the entrance to the larynx, thereby protecting the airway.
The Fat Pad
Sitting behind the Epiglottis is a pad of fat (yellowish in the image above) which cushions it as it rises.
The Arytenoid Cartilages
The arytenoids are pyramid shaped and sit on top of the widest part of the cricoid cartilage. The vocal folds are attached to these cartilages and it is their movement that opens and closes the glottis (the space between the vocal folds).
This image shows the larynx from the side, featuring the vocal ligament, so that you can visualize the placement of the vocal folds within the structure of the cartilages.
This image shows the cartilages of the larynx from above, giving an excellent reference point for future images of the larynx as seen through an endoscope, as they really appear.
On to part two, Muscles and Mucosa
Back to Phonation
Anatomy of the Larynx
by Dr Donal Shanahan, Anatomy & Clinical Skills Centre, The School of Surgical Sciences at the University of Newcastle-upon-Tyne. A fabulous use of web technology to teach the anatomy of the larynx. Some of the best stuff I've seen. Highly recommended.
The Voice-Centre at Eastern Virginia Medical School
A site dedicated to voice and the larynx, this site has a few excellent pages on the larynx and its anatomy. Highly recommended.
Anatomy of the Larynx
The Gross Anatomy Course at The University of Texas Medical School at Houston has a very in depth on line resource from their 1997 labs. Designed for medical students, it is an excellent source on detailed information beyond the scope of what is covered here.
Thyroid Cartilage
An image of the thyroid cartilage view from front, back and side.
نوشته شده توسط محمد جواد سعيدي بروجني در 16 Dec 2008 ساعت 12 PM موضوع | لینک ثابت
Philip Lieberman - Human Language and Our Reptilian Brain: The Subcortical Bases of Speech, Syntax, and Thought - Perspectives in Biology and Medicine 44:1 Perspectives in Biology and Medicine 44.1 (2001) 32-51 Human Language and Our Reptilian Brain: the subcortical bases of speech, syntax, and thought Philip Lieberman * For the past 200 years, virtually all attempts to account for the neural bases and the evolution of human language have focused on the neocortex. And in the past 40 years, linguists adhering to Noam Chomsky's theories have essentially equated language with syntax, hypothetically specified by an innate, genetically transmitted "universal grammar." In Human Language and our Reptilian Brain (2000), I attempt to shift the focus. My premise is that speech is the central element of human linguistic ability and both speech and syntax are learned skills, based on a neural "functional language system" (FLS). Although neither the anatomy nor the physiology of the FLS can be specified with certainty at the present time, converging behavioral and neurobiological data point to language being regulated by a distributed network that crucially involves subcortical structures, the basal ganglia, often associated with reptilian brains though they derive from amphibians. Like other distributed neural systems that regulate complex behavior, the architecture of the FLS consists of circuits linking segregated populations of neurons in structures distributed...
نوشته شده توسط محمد جواد سعيدي بروجني در 16 Dec 2008 ساعت 12 PM موضوع | لینک ثابت
نوشته شده توسط محمد جواد سعيدي بروجني در 4 Dec 2008 ساعت 1 AM موضوع | لینک ثابت
LSVT® is a proven effective speech treatment program that restores oral communication in individuals with Parkinson disease (PD) beyond what current pharmacological and surgical interventions can offer (Schultz et al., 2000). LSVT® has been scientifically studied over 15 years with 5 million dollars in NIH funding and is considered the first speech treatment with Level I evidence for individuals with PD (Goetz, 2003; Ramig et al., 2001). Observations by patients, family members and professionals confirm that patients are more effective and emotionally engaged communicators after LSVT.
Recently, LSVT has been successfully applied to individuals with multiple sclerosis, stroke, ataxic dysarthria, aging voice, vocal fold paralysis and children with cerebral palsy and Down syndrome (Sapir et al., 2003; Sapir et al., 2004; Ramig et al., Fox, 2003; Robinson et al., 2004).
Invention of a Speech Treatment for PD
In 1987 when we began our work in PD, speech disorders were considered resistant to traditional speech treatment. Today, LSVT is the first and only documented efficacious speech treatment for individuals with PD (Goetz, 2003; Ramig et al., 2001). The development of LSVT was motivated by the recognition that the reduced ability to communicate is one of the most difficult aspects of PD. Soft voice, monotone, hoarse voice quality, and imprecise articulation, together with lessened facial expression (masked faces), contribute to limitations in communication in nearly 90% of individuals with PD (Pitcairn et al., 1990a,b). In addition, disordered swallowing, which may be associated with life-threatening pneumonia, has been reported in many of these individuals (Logemann et al., 1975; Silbiger et al., 1967; Stroudley and Walsh, 1991). While surgical and pharmacological treatments have had success in managing the motor-limb problems in PD (Benabid et al., 1987; Bergman et al., 1990; Jankovic & Marsden, 1998; Pollack et al., 1996), their impact on motor speech production (Baker et al., 1997; Larson, et al., 1994; Solomon, et al., 1998) and swallowing problems (Logemann, 1998) has not been consistently demonstrated. Traditional speech treatment focusing on articulation and rate has had limited efficacy (Hammen & Yorkston, 1996; Yorkston, 1996), and traditional approaches to swallowing treatment have had variable success (Logemann, 1998).
The LSVT approach centers on a very specific therapeutic target: increased vocal loudness. This key target acts as a "trigger" to increase effort and coordination across the speech production system. This focus provides a comprehensive motor organizing theme that impacts multiple levels of the motor output process in patients while limiting cognitive load, as individuals with neurological disorders often have difficulty with attention-demanding, complex tasks (Fox et al., 2002). At the end of one month of treatment, patients are able to self-generate treatment strategies resulting in dramatically improved functional communication. Quality of life is considerably improved with this intensive but rather short duration therapeutic intervention. LSVT empowers individuals by enabling them to maintain or regain functioning in their workplace or home environment, which enhances self-confidence and quality of life. After LSVT, patient comments include, "My voice is alive again!", "Now I have the feeling that I have declared war on PD. I am not going to let it take my voice away!" To see a video tape of an individual with PD pre-post-LSVT visit www.lsvt.org
Established Efficacy through Scientific Evaluation
In contrast to previous unsuccessful approaches to speech treatment in PD (Aronson, 1990; Greene, 1990; Weiner & Singer, 1989), LSVT has generated the first short- and long-term efficacy data (Ramig et al., 1995a; 1996; 2001), documenting a functional impact on speech production. LSVT (Ramig et al., 2001) has been identified as the first Level 1 evidence for speech treatment for PD (Goetz, 2003). In addition, data (El Sharkawi et al., 2002) have documented an overall 51% reduction in the number of swallowing disorders in a group of eight individuals with PD after LSVT. Published data support improvements in speech articulation, respiratory excursion, facial expression, communicative gesture and neural functioning (Positron Emission Tomography; PET) (Liotti et al., 2003; Spielman et al., 2003) following one month of LSVT and suggest a fundamental impact of treatment on patients' affect and arousal.
نوشته شده توسط محمد جواد سعيدي بروجني در 8 Oct 2008 ساعت 9 AM موضوع | لینک ثابت
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the director of this webloge is m.javad saeedi and he is a pathologist of neurogenic speech and language disorders (anatomoaphasiologist - clinical pathologist
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