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    An evaluation of the effectiveness of castellated laryngofissure and bilateral arytenoid lateralisation for the relief of laryngeal paralysis in dogs : a thesis presented for the degree of Master of Veterinary Science at Massey University
    (Massey University, 1989) Burbidge, Hilary
    In recent years, laryngeal paralysis in dogs, has become a frequently recognised disorder. Various surgical procedures have been advocated to relieve the consequential laryngeal obstruction, but few critical examinations of the effectiveness of these procedures have been attempted. The aim of this study was to determine and compare the efficacy of two of the more commonly used surgical methods (i) castellated laryngofissure with vocal fold resection and (ii) bilateral arytenoid lateralisation in providing an adequate laryngeal airway in dogs after surgically Induced laryngeal paralysis. The laryngeal function of ten adult healthy experimental dogs was assessed by clinical examination, laryngoscopy, blood gas and tidal breathing flow-volume loop analyses prior to and after bilateral recurrent laryngeal nerve resection. Five dogs then underwent a castellated laryngofissure with vocal fold resection and the remaining five, bilateral arytenoid lateralisation. Six weeks later, the laryngeal function of the ten dogs was reassessed using the same investigative techniques. Radiographs of the chest were taken at the start and completion of the experiment on the live dogs to help detect the presence of any co-existent lower respiratory tract disease. An autopsy was performed on each dog. six weeks after surgery, and details of visible changes in the laryngeal structure recorded. After neurectomy, all of the dogs had inspiratory stridor, a hoarse bark and reduced exercise tolerance. Medial displacement of the arytenoid cartilages and vocal cords caused narrowing of the rima glottidis. No abduction of these structures occurred during inspiration. There was a significant fall in arterial oxygen tension and inspiratory airflow recorded on blood gas analyses and tidal breathing flow-volume loop studies, respectively. The degree of relief from the laryngeal obstruction in the neurectomised dogs after castellated laryngofissure with vocal fold resection was variable. Some of the animals still had signs of respiratory embarrassment. The size of the rima glolhdis achieved was either slightly narrower or similar to that seen in the non-abducted. pre-neurectomised larynx of the experimental dogs. No significant improvement in blood gas or tidal breathing flow-volume loop analyses were recorded following the surgical technique. In contrast, bilateral arytenoid lateralisation consistently alleviated the clinical signs of bilateral recurrent laryngeal neurectomy. The rima glottidis width was increased to either the non-abducted, pre-neurectomised size or greater, depending on the position of the lateralisation suture. Furthermore, blood gas and tidal breathing flow-volume analyses recorded a significant increase in arterial oxygen tension and inspiratory airflow, respectively. Although bilaterial arytenoid lateralisation was more efficient than castellated laryngofissure with vocal fold resection in alleviating the laryngeal obstruction caused by bilateral recurrent laryngeal neurectomy, it did have some inadequacies. The fixed abduction of the arytenoid cartilages destroyed the expiratory braking mechanism of the larynx. Furthermore, execution of the surgical technique requires intimate knowledge of the anatomy of the larynx and the surrounding structures and, since the position of the lateralisation suture is imporlant,best results are likely to bo achieved by surgeons experienced with the procedure.
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    An inquiry into the meaning of Guillain-Barré syndrome : a thesis submitted in partial fulfillment of the requirements for the degree of Master of Arts
    (Massey University, 2001) Mace, Janet-Lee
    Guillain-Barré Syndrome (GBS) is an autoimmune syndrome characterized by a severe and rapid onset of paralysis that ascends without warning. It has an unknown aetiology and is generally unknown by most people, including medical professionals. When a person who has had GBS is asked to speak about their experience, they are likely to talk about aspects of it that are personally meaningful. Their account can be likened to a story in that it collates seemingly unconnected facts, episodes of activity and emotional attributions into a sequence that provides knowledge and understanding. A story is a powerful form for expressing suffering and experiences and so is particularly suitable for the study of trauma and illness. The actual process of creating the story, plus its presentational and organisational forms, provides sources for uncovering the identities authors choose to create and present of themselves. Six people who have had GBS were interviewed about their experience, and their stories were analysed using a narrative inquiry to discern the meanings attributed to GBS from the participants’ own understandings and perspectives. The intended focus of the research was holistic and content based. The result of the narrative inquiry was a plot common to all six narratives. Namely, GBS is an inexplicable condition, during which horrendous things happen, but people do recover with time and it is likely their life view will be changed in the process. Four fundamental issues, identity, meaning, making sense and meaningfulness were drawn from the stories and configured into a narrative of the researcher’s making. What the participants chose to speak about became the meanings, or themes, major and minor, of their stories. No event has meaning in itself, however traumatic events can precipitate crises of meaning. When these crises are viewed within the context of other events, and are perceived to add value to life, then they have meaningfulness. In the telling of meanings and meaningfulness, the purpose for storying and the audience to whom the story is directed are the criteria for which the storylines are chosen. Both the story and the storying provide opportunities for the authors to create and offer images of themselves, that are then open to interpretation by an audience. As a traumatic experience, GBS enabled six people to tell their stories. In doing so they were able to make sense of important issues for themselves, and re-examine the way they saw themselves and the world.