The Ethiopian Government surveyed the site in October and August In Novembera design for the dam was submitted. It was slated for completion in July
Sleep apnea Asthma What about asthma? Is it a symptom of reflux? Their symptoms are due to reactive airway disease secondary to airway reflux. Under development are new diagnostic tests that are specific for airway reflux and utilize pepsin as a marker.
The author currently uses a combination of diagnostics. The RSI a nine-item, symptom severity scale is completed by the patient, and it is a validated reflux outcomes instrument29 Table 4.
Theoretically, the RFS can be calculated on the fly during a visual laryngoscopy; however, grading the RFS after the examination is completed from an archived laryngeal image is preferred, and that image should show the larynx in abduction, not adduction.
This grading system was developed using images obtained by transnasal flexible laryngoscopy TFLand TFL is the preferred examination. The RFS is a weighted nine-item scoring system devised by the author in and subsequently reported. In addition, when calculated at each visit, it is an excellent parameter to evaluate the effectiveness of therapy.
Patients who are successfully treated will have a normal less that 4 RFS. Below are descriptive parameters for each of the nine items: Pseudosulcus vocalis refers to subglottic edema that gives the vocal fold the appearance of being three-dimensional, almost having the appearance of an open hotdog bun.
The normal non-swollen, non-inflamed vocal fold appears to be a two-dimensional structure. Pseudosulcus is a finding usually associated with reflux and diffuse laryngeal edema. A finding of pseudosulcus gets two points in the RFS system. After Treatment Ventricular obliteration.
The ventricle is a grove-like structure or recess between the true and false vocal folds. When it is normal and open, the ventricular band is sharp and the depth of the ventricle glistens.
If, however, both the true and false folds are swollen, the ventricle can be partly or completely obliterated. Partial ventricular obliteration scores two points, and complete ventricular obliteration scores four points in the RFS. The case, Figure 2-A, shows partial ventricular obliteration that resolves after treatment Figure 2-B.
Erythema, the third item, is graded two points for red arytenoids and four points for diffuse laryngeal erythema. In reality, erythema is grossly overcalled. The main finding of LPR is edema not erythema. The normal vascularity of the posterior larynx will vary a lot depending upon the brightness of the light source.
Vocal fold edema is graded as follows: Diffuse laryngeal edema is the most subjective finding of the RFS. It relates to the size of the glottal opening chink relative to the size of the entire larynx.
Diffuse laryngeal edema is rarely graded more than one or two points. Posterior commissure hypertrophy is graded as follows: Before treatment for LPR; the reflux finding score is 11 partial ventricular obliteration 2, vocal fold edema 2, diffuse laryngeal edema 1, posterior commissure hypertrophy 2, post-cricoid edema 2, endolaryngeal mucus 2.
After treatment; normal, the RFS is 0. Tiger-stripe post-cricoid edema is a highly reliable reflux finding Figure 3. Under normal circumstances, the post-cricoid region is smooth. When swollen, it may give the appearance of having wet, edematous stripes.
Tiger-striping was not originally reported8,29 but added later. Tiger-stripe edema is usually seen in patients who are supine nocturnal refluxers. Severe LPR with Tiger-Stripe Post-Cricoid Edema arrow The RFS is 17 complete ventricular obliteration 4, vocal fold edema 4, diffuse laryngeal edema 3, posterior commissure hypertrophy 2, post-cricoid edema 2, endolaryngeal mucus 2.
Thick, white, tenacious mucus on the vocal folds counts as two points in the RFS. This useful screening test will become commercially available as soon as it receives FDA approval.To understand gastroesophageal reflux disease or GERD, it is first necessary to understand what causes heartburn.
Most people will experience heartburn if the lining of the esophagus comes in contact with too much stomach juice for too long a period of time. Fiend and Felon. America's Idol - a Crook! Power, Perjury and Murder in Simon Wiesenthal's Footsteps.
To understand gastroesophageal reflux disease or GERD, it is first necessary to understand what causes heartburn. Most people will experience heartburn if the lining of the esophagus comes in contact with too much stomach juice for too long a period of time.
The Grand Ethiopian Renaissance Dam (GERD or Taehige; Amharic: ታላቁ የኢትዮጵያ ሕዳሴ ግድብ Tālāqu ye-Ītyōppyā Hidāsē Gidib), formerly known as the Millennium Dam and sometimes referred to as Hidase Dam, is a gravity dam on the Blue Nile River in Ethiopia that has been under construction since It is in the Benishangul-Gumuz Region of Ethiopia, about 15 km (9 mi.
MCKENZIE SANTIMER, GIA GG, GJ. McKenzie Santimer is the Manager of Museum Exhibits & In-Kind Gifts at GIA in Carlsbad.
Oct 17, · Gastroesophageal reflux disease occurs when the amount of gastric juice that refluxes into the esophagus exceeds the normal limit, causing symptoms with or without associated esophageal mucosal injury (ie, esophagitis; see the image below).