Clinical study of otological manifestations in cases of cleft palate

Cleft palate (with or without cleft lip) occurs in about 1: 750-1: 2000 births in different societies in the world. Cleft palate individuals have a greater incidence of hearing loss than the general population. The primary cause of the ear problem in cleft patients is eustachian tube dysfunction. The cause for which is abnormal insertion of levator veli palatini and tensor veli palatini muscles into the posterior margin of the hard palate and the palatal aponeurosis and associated muscular hypoplasia.

Treating children with expressive phonological disorders: does phonological awareness therapy work in the clinic?

BACKGROUND

Recent research has shown that phonological awareness therapy can improve speech production in children with expressive phonological disorders. This approach may be appealing to clinicians as the therapy may also benefit the children's general phonological abilities and lead to gains in their literacy skills.

AIMS

To examine the effectiveness of phonological awareness therapy under conditions more similar to those prevailing in many speech and language therapy clinics. Children were treated in small groups and less intensive therapy was offered than in previous studies.

METHODS & PROCEDURES

Twenty children were randomly assigned to treated and untreated groups. A pre-/post-test design was used to monitor their progress in phonological awareness, literacy and speech production. Children were treated in groups of three. They received 12 hours of therapy.

OUTCOMES & RESULTS

Comparisons of the groups showed that the treated group made significantly greater gains in phonological awareness. However, differences between the groups in the measures of literacy and speech production were smaller and non-significant. Considerable variation was detected in the response of individual children to the therapy.

CONCLUSIONS

The results show the effectiveness of phonological awareness therapy in benefiting children's general phonological skills. However, the comparison of these and previous findings suggest that children may require more therapy than is often available if literacy and speech production are also to benefit. Further research is required to confirm the duration and intensity of therapy required. Until such information is available, clinicians might want to take a cautious approach and combine therapies that target phonological awareness with more traditional approaches, that target speech production more directly.

The single-dose pharmacokinetics of the novel CCK1 receptor antagonist, dexloxiglumide, are not influenced by age and gender

OBJECTIVE

The effects of age and gender on the single-dose pharmacokinetics of dexloxiglumide, a selective cholecystokinin (CCK1-subtype) receptor antagonist, were assessed in healthy young and elderly male and female subjects.

METHODS

In total, 24 males and 24 females (12 young and 12 elderly subjects per gender group) received a single oral dose of 200 mg dexloxiglumide under fasted conditions. Mean (range) ages were 23.8 (18 - 32) and 71.3 (66 - 88) years for young and elderly subjects, respectively. Analysis of covariance (ANCOVA) with age group and gender as factors and body weight as a covariate was performed on the dexloxiglumide pharmacokinetic parameters of peak plasma concentration (C(max)) and the area under the plasma concentration-time curve (AUC). The p values obtained from ANCOVA were considered for the assessment of age and gender effects.

RESULTS

A small (approximately 18%) but statistically significant (p < or = 0.036) increase in the area under the plasma concentration-time curve from 0 to time of last quantifiable concentration (AUC(0-t) and the area under the plasma concentration-time curve from 0 to infinity (AUC(0-infinity)) in elderly compared to young subjects was noted. Given the lack of age effects on the other pharmacokinetic parameters of dexloxiglumide, this limited difference is unlikely to be clinically relevant. Without the adjustment for body weights, female subjects exhibited mean C(max) and AUC values approximately 26% and 36% higher than male subjects; however, these exposure differences did not reach statistical significance (p > 0.05) following ANCOVA analysis with body weight as a covariate. Likewise, there were no statistically significant differences (p > 0.05) observed for any other pharmacokinetic parameters between young and elderly and between male and female groups.

CONCLUSIONS

Dose adjustments based on age and gender are not necessary. Dexloxiglumide administration was safe and well tolerated in these subjects.

Signatures of the hydrogen bonding in the infrared bands of water

Infrared spectroscopy measurements have been completed over a wide range of frequencies allowing to measure the evolution of both intramolecular and intermolecular vibrational modes in water as a function of temperature. Emphasis is made on the high frequency OH stretching band and the so-called connectivity band that lies in the far infrared region. The substructures of the two infrared bands are analyzed in terms of different levels of connectivity of the water molecules, along the statements of the percolation model. Both band profiles appear to be related to the different degrees of connectivity of water molecules. Comparison of the data with the predictions of the percolation model shows good agreement as for the temperature evolution of liquid water. This work provides additional support to the interpretation of water bands substructures as signatures of its very specific connectivity pattern.

An impacted meat bone in the larynx with an unusual presentation

Lodgment of foreign bodies in the aero-digestive tract commonly occurs in the infant and children (Hazra et al, Indian J Otolaryngol Head Neck Surg 1993;2:216). Children especially between 1 and 3 years appear to be more vulnerable (Aylec et al, J Thoracic Cardiovascular Surg 1977;74:145). Ninety percent of these foreign bodies are accidental in nature and are due to carelessness and are avoidable (Holinger and Holinger. Chest 1978;73:721). Lodgment of foreign body has been usually seen to occur in mentally retarded intoxicated, or edentulous adult and to some other persons like fishermen. electrician, and decoration worker who use to hold those materials in between their teeth during their work. Usually, the victims present with respiratory distress. hoarseness of voice and/or dysphagia, which are proceeded by a severe history of choking cough immediately after ingestion of foreign bodies. Heroic attempts of removal of the foreign bodies may be dangerous to life. Therefore, each case should be dealt with proper care and precautionary measures. Here we present a case of an impacted meat bone in the larynx with the only complaint of hoarseness of voice for 2 weeks.

[Benefits of a thickened infant formula with lactase activity in the management of benign digestive disorders in newborns]

This study aimed at evaluating the interest of a thickened infant formula with lactase activity by comparison with a standard infant formula in the management of benign digestive disorders in infants. Infants of both sex (N =109), ranging in age from 0 to 3 months, were included in a randomised double blind trial. Infants went to the paediatrician because of benign digestive disorders such as regurgitation, eructation or hiccup, colic, persistent crying and/or meteorism. Nine hundred and three infants were included and randomised in two parallel groups: they consumed daily either the thickened infant formula with lactase activity or a standard infant formula. There were no significant difference in the infants included in both groups. Both formula were well accepted and tolerated. Growth of the infants and compliance during the study were identical and good in the two groups. The efficiency of the formula tested was showed on digestive symptoms through: a decrease of the intensity of the digestive discomforts more important in the test than in the standard formula group; a decrease of the intensity of the gaz significantly more important in the test than in the standard formula group; significant decreases in frequency and intensity of the gaz in the test group while there were no significant diminution in the standard group; This study showed the good tolerance, acceptability and efficiency of a thickened infant formula with lactase activity on benign digestive disorders of young infants.

Structural brain abnormalities in multiple sclerosis patients with major depression

OBJECTIVE

To assess the association between major depression and structural brain abnormalities in patients with multiple sclerosis (MS).

METHODS

Two groups of patients with clinically definite MS were studied: 21 with Diagnostic and Statistical Manual of Mental Disorders (4th ed.)-defined major depression and 19 without. The groups did not differ on demographic, disease, or cognitive measures. All subjects underwent brain MRI. Tissue segmentation and regional brain masking were applied to the MRI data.

RESULTS

Compared with the euthymic subjects, those with major depression had a greater T2-weighted lesion volume (p = 0.003) and more extensive T1-weighted lesion volume in the left medial inferior prefrontal cortex (p = 0.01) and less gray matter volume (p = 0.01) and more CSF volume in the left anterior temporal region (p = 0.005). A logistic regression analysis identified two independent predictors of depression: left medial inferior prefrontal cortex T2 lesion volume and left anterior temporal CSF volume. These variables accounted for 42% of the depression variance score.

CONCLUSION

Whereas both lesion burden and atrophy are important in the pathogenesis of depression in MS, psychosocial influences should also be considered.

Nucleotide sequence analysis of the L1 loop variable region of hexon gene of fowl adenovirus 4 isolates from India

Three fowl adenovirus 4 (FAV4) isolates from chicken and one from quail, all from Tamil Nadu, India were analyzed. The L1 loop variable region of hexon gene of these isolates was amplified by PCR and sequenced. The nucleotide sequences (442 bp) and deduced amino acid sequences of the four isolates were compared with those of other isolates of FAV4. The nucleotide sequences of the four isolates had a 98% homology with other Indian isolates and a 96% homology with Belgian and Russian isolates. The amino acid sequences of the four Indian isolates had a more than 98% homology with other Indian isolates and a more than 92% homology with Belgian and Russian isolates. Hence, the variable of L1 loop region of hexon gene was found to be highly homologous in all the FAV4 isolates tested both at nucleotide and amino acid level.

A Randomised, Double-Blind, Parallel, Placebo-Controlled Study to??Evaluate the Efficacy of MF 5232 (Mucotrol???), a Concentrated Oral Gel??Wafer, in the Treatment of Oral Mucositis

OBJECTIVE

Oral mucositis is a major complication of cytotoxic chemotherapy and radiotherapy associated with significant morbidity, pain, odynophagia, dysgeusia and subsequent dehydration and malnutrition, and effective prophylaxis and/or treatment of this condition is essential. The currently available palliative treatment shows improvement only in patients with mild to moderate mucositis. The primary aim of this study was to compare the clinical efficacy of MF 5232 (Mucotrol), a concentrated oral polyherbal gel wafer formulation, with placebo in the management of chemoradiation-induced mucositis in cancer patients.

PATIENTS AND DESIGN

In this randomised, double-blind, pilot study a total of 30 patients of either sex with chemoradiation-induced oral mucositis were randomised to receive MF 5232 (n = 15) or a matching placebo (n = 15) after food three times a day for 7-10 days. Patients were evaluated using validated and standardised scoring systems at baseline and after 7-10 days of treatment.

RESULTS

There were 11 evaluable patients in each treatment group. There was a significant reduction in mean mucositis scores with MF 5232 as follows: WHO (from 3.0 to 1.8), Radiation Therapy Oncology Group (gross score: from 2.8 to 1.8; functional score: from 2.9 to 1.0), and Objective Scoring System (ulceration score: from 7.4 to 4.4; erythema score: from 13.7 to 7.0). There were no significant changes in scores for placebo recipients. The treatments were well tolerated, with the exception of two patients in the treatment group who reported a burning sensation in the mouth after dissolving the wafer.

CONCLUSION

This pilot study provided positive evidence for the efficacy of MF 5232 therapy in chemoradiation-induced mucositis. This was probably a result of its local analgesic, antioxidant and immunomodulatory activity and wound-healing properties. Further in-depth analysis in a larger number of patients is required to confirm these positive results.

Contrast enhancement in atherosclerosis development in a mouse model: in vivo results at 2 Tesla

To develop an MRI method for the evaluation of contrast enhancement in early atherosclerotic plaque development in the abdominal aorta of a mouse model. Male apoE-/- mice from three groups, respectively 4 (n = 6), 8 (n = 11) and 16 (n = 4) weeks were included. Axial T1 spin echo images of the abdominal aorta were obtained above and below the renal arteries (90 microm spatial resolution) before and over 1 h after the injection of a macromolecular contrast agent. Signal enhancement was measured in the vessel wall and compared to histological features. Maximal arterial wall signal enhancement was obtained from 16 to 32 min post injection. During this time, the signal-to-noise ratio increased by a factor up to 1.7 in 16 week mice and 2.7 and 2.4 in 8 and 4 weeks mice, respectively. The enhancement of the arterial wall appeared less pronounced in the oldest mice, 16 weeks old, exhibiting more advanced lesions. Using a macromolecular gadolinium agent, contrast uptake in atherogenesis varies with lesion stage and may be related to vessel-wall permeability. Dynamic contrast-enhanced MRI may be useful to evaluate the atherosclerotic plaque activity in mice.

Strictureplasty

BACKGROUND

Advances in the use of bowel-sparing surgery for Crohn's disease have led to the development of strictureplasty as an important technique to conserve small bowel length and reduce morbidity associated with malabsorption.

METHODS

A literature review of long-term studies on strictureplasty was undertaken, and evidence of its safety and efficacy was evaluated.

RESULTS

The safety and efficacy of strictureplasty is confirmed in retrospective studies carried out over a period of 5-10 years, particularly when employed in patients at risk of short bowel syndrome, but certain questions regarding bowel function and disease activity after surgery remain unanswered. There is also concern that diseased tissue is left in situ after strictureplasty; this tissue has the potential for malignant transformation in the long term.

CONCLUSION

Strictureplasty has been used in surgery for Crohn's disease for the past 25 years. Studies have proven its efficacy in the treatment of carefully selected patients at risk of malabsorption owing to short bowel syndrome.

Stewart–Treves syndrome—treatment and outcome in six patients from a single centre

AIMS

Stewart-Treves syndrome is an angiosarcoma associated with long-standing lymphoedema, most commonly seen as a rare complication of breast cancer treatment, and is associated with a poor outcome. We present results from six patients supporting the use of early radical surgery to improve prognosis.

METHODS

Six patients with Stewart-Treves syndrome were diagnosed and treated at our centre over an 11-year period. Five patients had forequarter amputation and the sixth had a through-hip amputation.

RESULTS

Four of the six patients are alive and well following surgery (at 3, 16, 23, and 135 months after amputation); one patient died from metastatic disease at 15 months and the second died due to an unrelated malignancy.

CONCLUSION

Early diagnosis and treatment by radical ablative surgery confers a reasonable prognosis with this rare but aggressive disease. A nihilistic approach is unjustified.

Prevalence of BSE in cattle found dead, euthanased or emergency slaughtered on farms in western France in 2000, 2001 and 2002

The overall trend and the trend within birth cohorts of the prevalence of bovine spongiform encephalopathy (BSE) in cattle found dead, euthanased or emergency slaughtered on farms in the Bretagne, Basse Normandie and Pays de la Loire regions of France, during the periods from August 7 to December 22 in 2000, 2001 and 2002, were analysed by non-conditional logistic regression, adjusted for the region and for the type of animals. The overall prevalence of BSE during these three periods decreased from 2.71 per 1000 in 2000 to 1.41 per 1000 in 2001 and 0.42 per 1000 in 2002. The prevalence within birth cohorts started to decrease for the cohort born between July 1, 1995 and June 30, 1996 (cohort 95/96) and the trend was reinforced for cohort 96/97, suggesting that the exposure of animals to the BSE agent had started to decrease for animals born after July 1995, that is, one year before the ban on specified risk materials in meat and bone meal was implemented in France. However, considering that most of the animals would have been infected at between six and 18 months of age, the decrease may have been due, at least partly, to this control measure.

Genetically engineered structure-based vaccine for bluetongue disease

At present the only vaccines used against bluetongue (BT) disease are live-attenuated virus vaccines. Since viruses with RNA genomes such as BT virus (BTV) have a high frequency of mutations, live virus vaccines could have breakthroughs (vaccine failures) and mutate into virulent strains. In addition, multiple BTV serotypes exist in nature which could potentially cause additional problems with live virus vaccines. The BTV genome is made up of 10 segments and therefore potentially could exchange these segments (or genes) randomly between different viruses including vaccine strains, generating novel viruses with mixed genes. Hence it is necessary to develop BTV vaccines that pose no such threat. Ideally BTV vaccines should be completely devoid of harmful genes. Recent protein expression technology has provided novel approaches for the development of intrinsically safe vaccines. The technology involves the synthesis of immunogenic proteins and particles that elicit highly protective immune responses. We have generated such vaccines, termed virus-like particle (VLP) vaccines. These vaccines (which do not carry either BTV or foreign genes) give the immune system information about viral structures so that it can generate a complete defence against the real virus infection very efficiently. A series of vaccine trials were undertaken outdoors under natural UV light using 50-200 BTV-susceptible sheep per trial. Vaccination trials of sheep showed that the VLPs were highly immunogenic, and protected sheep when animals were challenged with virulent virus even 15 months after the first immunisation. Moreover, a cocktail of five VLPs afforded protection against not only each of the homologous BTV serotypes but also against certain heterologous serotypes that are genetically related to some of these vaccine strains. VLPs representing a number of serotypes are currently available and can be produced fairly quickly if there is such a need. Based on our sequence data it can be predicted that a mixture of seven or eight types of VLPs (that are already available) will provide protection against at least 10 or more serotypes depending on their phylogenetic relationships. BTV VLPs offer particular advantages as potential vaccines over other systems. Large quantities of VLPs can be produced and easily purified using a one-step protocol based on the physical properties of the particle. More importantly, these particles are devoid of any nucleic acid and thus pose no threat by re-assortment or the re-emergence of virulence that attenuated vaccines can cause.

Semiautomatic brain region extraction: a method of parcellating brain regions from structural magnetic resonance images

Structural MR imaging has become essential to the evaluation of regional brain changes in both healthy aging and disease-related processes. Several methods have been developed to measure structure size and regional brain volumes, but many of these methods involve substantial manual tracing and/or landmark identification. We present a new technique, semiautomatic brain region extraction (SABRE), for the rapid and reliable parcellation of cortical and subcortical brain regions. We combine the SABRE parcellation with tissue compartment segmentation [NeuroImage 17 (2002) 1087] to produce measures of gray matter (GM), white matter (WM), ventricular CSF, and sulcal CSF for 26 brain regions. Because SABRE restricts user input to a few easily identified landmarks, inter-rater reliability is high for all volumes, with all coefficients between 0.91 and 0.99. To assess construct validity, we contrasted SABRE-derived volumetric data from healthy young and older adults. Results from the SABRE parcellation and tissue segmentation showed significant differences in multiple brain regions in keeping with regional atrophy described in the literature by researchers using lengthy manual tracing methods. Our findings show that SABRE is a reliable semiautomatic method for assessing regional tissue volumes that provides significant timesavings over purely manual methods, yet maintains information about individual cortical landmarks.