Intensity and fundamental frequency control in tracheoesophageal voice

Tracheo-oesophageal voice prostheses are currently widely used following total laryngectomy. Data on maximum phonation time and spectrum have been studied by various Authors and are well known. On the contrary, intensity and fundamental frequency control have received little attention. Intensity and fundamental frequency play an important role in the prosodic aspects of speech. Fundamental frequency variations have been studied in tone language speakers, but the ability to voluntarily change intensity and fundamental frequency remain to be fully investigated. Aim of the present study was to analyse the ability of tracheo-oesophageal voice users to change intensity and fundamental frequency. A total of 12 male subjects who underwent total laryngectomy, in whom a tracheo-oesophageal prosthesis had been inserted, were considered. Maximum phonation time was calculated. Each subject was asked to utter an /a/ as loud as possible and an /a/ as soft as possible. Each subject was then asked to utter an /a/ at comfortable pitch and then at an interval of a fifth. Intensity as well as fundamental frequency variations were compared using Wilcoxon signed rank test. Correlation between maximum phonation time and variation in intensity and in fundamental frequency as well as between the two latter variables was calculated using Spearman's rank correlation coefficient. Mean maximum phonation time was 8 (+/- 3.8) sec. Mean energy was 50 (+/- 4.8) dB SPL for soft phonation and 68 (+/- 4.7) dB SPL for loud phonation. The difference observed was statistically significant (p < 0.02). Mean fundamental frequency values were 106 (+/- 14) Hz and 135 (+/- 34) Hz at the interval of a fifth. The difference observed was statistically significant (p < 0.02). Tracheo-oesophageal voice users were able to change intensity and fundamental frequency, but their control was rather poor. Variations in intensity, as well as fundamental frequency, did not show any correlation with maximum phonation time, and were not correlated with each other. In conclusion, the tracheo-oesophageal voice allows small fundamental frequency variations, but their control appears difficult. On the contrary, intensity variations appear larger and control somewhat easier.

Role of videoendoscopy in phoniatrics: data from three years of daily practice

Phoniatrics is the medical specialty involved in the management of communication and swallowing disorders. Videoendoscopy plays an important role in the assessment of various disorders in the clinical practice of phoniatrics: the voice as well as the speech and swallowing mechanisms can be analysed through this procedure. Aim of the study is to describe videoendoscopic application in daily phoniatric practice: data on 1627 participants, consecutively examined, are reported. A total of 2004 videoendoscopy examinations were performed between March 1999 and December 2002. Study population comprising 1627 patients (716 male, 911 female); age ranged from 0.6 to 97 years. The following parameters were considered: a) function to be assessed through videoendoscopy (voice, speech, swallowing, other); b) phoniatric nosological chapter in participants with a recognized disease; c) age of participant; d) occupation of participant; d) medical discipline related to disease identified. Three populations were analysed: study population (1627 subjects), subjects requiring phoniatric consultation for voice and swallowing assessment. The participants examined endoscopically required a phoniatric consultation in order to have a voice or a swallowing assessment, respectively, in 67% and 20% of the cases. In 411 out of 1095 (37.5%) voice evaluations, no disorder was identified, while in most of the swallowing assessments (93.1%), a clear dysphagic disorder was detected. A bimodal distribution appeared in the 1627 participants and in the voice population with a first peak at age 20-40 years and a second peak at age 50-70. In the swallowing population, the number of participants examined appeared to increase with age. In the swallowing population, pensioners and clerks represent almost 80% of the population; in the total population, as well as in the voice populations, pensioners as well as teachers, singers and students are well represented. In most cases (52.5%), no clear disease was present. The two areas of disease most represented were otorhinolaryngology and neurology.

[AWMF-guideline: cocaine-, amphetamine-, ecstasy- and hallucinogen-related disorders]

Actually, guidelines for treatment of substance-related disorders were written under the overall control of the DG-Sucht e. V. and the DGPPN e. V. This appears within the framework of the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaft (AWMF). The leading objective of these guidelines is the description of the current scientifically proven and evidence-based medicine in addiction to derive recommendations to therapy. In this context, the guideline for treatment of cocaine-, amphetamine-, ecstasy-, and halluzinogen-related disorders is introduced.

Treatment of phonic tics in patients with Tourette's syndrome using botulinum toxin type A

We assessed the effect of botulinum toxin type A (BTX-A) on phonic tics in patients with Tourette's syndrome. A total of 30 patients received 2.5 IU BTX-A (BOTOX; Allergan) in both vocal cords. All patients were assessed after 15 days and then 4 times over a 12-month period. At each visit the following data were collected: phenomenology of tics, global impression of changes by physician and patient, number of BTX-A injections given, interval between injections, time to response, duration of response, presence of post-injection hypophonia and side effects, presence of premonitory sensory tic component, and interference with social life and work or school activities. Vocal tics improved after treatment in 93% patients, with 50% being tic-free. Mean response time was 5.8 days, and mean duration of response was 102 days. Quality of life improved, and premonitory experiences dropped from 53% to 20%. Hypophonia was the only side effect of note (80% of patients). BTX-A is an effective and safe treatment for phonic tics associated with Tourette's syndrome.

Treatment of phonic tics in patients with Tourette's syndrome using botulinum toxin type A

We assessed the effect of botulinum toxin type A (BTX-A) on phonic tics in patients with Tourette's syndrome. A total of 30 patients received 2.5 IU BTX-A (BOTOX; Allergan) in both vocal cords. All patients were assessed after 15 days and then 4 times over a 12-month period. At each visit the following data were collected: phenomenology of tics, global impression of changes by physician and patient, number of BTX-A injections given, interval between injections, time to response, duration of response, presence of post-injection hypophonia and side effects, presence of premonitory sensory tic component, and interference with social life and work or school activities. Vocal tics improved after treatment in 93% patients, with 50% being tic-free. Mean response time was 5.8 days, and mean duration of response was 102 days. Quality of life improved, and premonitory experiences dropped from 53% to 20%. Hypophonia was the only side effect of note (80% of patients). BTX-A is an effective and safe treatment for phonic tics associated with Tourette's syndrome.

Swallowing disorders: management data

Aim of the investigation was to assess the workload and verify the results of oropharyngeal dysphagia management in a large state hospital by means of a descriptive, observational prospective study and descriptive statistical analysis. 81 patients [37 females, 44 males, mean age 61.3 (+/- 13) years] suffering from oropharyngeal dysphagia were evaluated and treated in the in- and outpatient Divisions of the "Azienda Ospedaliera S. Giovanni Battista" in Turin. Treatment of oropharyngeal dysphagia included changes in consistency and texture of food, compensatory postures of head, strengthening exercises for oropharyngeal muscles, and stimulation of pharyngeal sensitivity. In data collection and analysis, the following were used as outcome measures: mode of nutrition delivery (oral, enteral, parenteral), dietary adjustments, presence of aspiration or penetration, and use of compensatory head positioning. Results showed that the number of patients fed by parenteral or enteral tube (50/81 prior to treatment) dropped to 36/81 upon discharge from hospital. Those unable to take anything by mouth, from 55 dropped to 9. The number of patients with aspiration or penetration dropped, respectively, from 47 and 8 to 20 and 4. Postural changes were used in 15 cases. Data obtained indicate that oropharyngeal dysphagia rehabilitation outcomes are promising. Better understanding of the rheological characteristics of food and a stricter, more rigorous evaluation of the outcomes on activities and social participation are warranted.

Comparison between two perception tests in patients with severe and profoundly severe prelingual sensori-neural deafness

Patients with severe and profoundly severe bilateral sensorineural prelingual deafness constitute a group of particular interest in the organization of the National Health Service; every patient must, in fact, follow a prosthetic-rehabilitative-educational programme lasting many years and organized under different areas to compensate for his/her communicative difficulties, especially with regard to the speech canal. No reliable data providing details of the efficacy and efficiency of any of these points is available. A critical point in the rehabilitation process is that of auditory perception training. Of the few auditory perception tests presently available in Italian, the following were examined: namely, EARS (Evaluation of Auditory Responses to Speech) battery, on the one hand, and the Italian version of the ESP (Early Speech Perception), GASP (Glendonald Auditory Screening Procedure). NU-CHIPS (Northwestern University Children's Perception of Speech) and WIPI (Word Intelligibility by Picture Identification) tests on the other. A group of 10 patients presenting severe and profoundly severe bilateral sensori-neural prelingual deafness received the two tests at the beginning and after six months of auditory perception rehabilitation. The findings emerging from the two different test sessions were analysed and compared. The EARS battery was seen to have enabled even very early and highly developed stages of auditory perception to be detected in comparison with the other battery, which, however, was more accurate in evaluating the ability to discriminate and identify words on the basis of their spectral characteristics. The Authors propose the combined use of the two test batteries to evaluate the efficacy and efficiency of auditory perception training in patients with severe and profoundly severe bilateral sensori-neural prelingual deafness.

Cloning, genomic organization and expression pattern of a novel Drosophila gene, the disco-interacting protein 2 (dip2), and its murine homolog

We report the cloning and initial characterization of a novel gene encoding the Disco interacting protein 2 (Dip2). dip2 DNA complementary to RNA (cDNA) showed a high degree of sequence similarity to cDNAs of unknown function previously identified in humans and Caenorhabditis elegans. We have cloned the mouse homolog of the dip2 cDNA and characterized the expression of this gene by Northern blotting analysis and in situ hybridization to whole mount embryos. Our observations demonstrate that there is a remarkable degree of sequence conservation at the dip2 locus that is reflected in the nervous system-specific expression of both the Drosophila and mouse homologs.

[Hearing disability in relation to audiometric threshold values: hypothesis on the determination of the onset of hearing loss]

BACKGROUND

The term auditory disability (AD) means the presence of auditory symptoms due to hearing loss. Until now the audiometric threshold cut-off between the presence or absence of AD was not clear.

OBJECTIVES

In this study we attempted to define the value of audiometric threshold that could be considered as the limit between the presence or absence of weakness of auditory function, considered as the threshold as the 95th percentile of subjects that did not report AD.

METHODS

The study group consisted of 1641 males, 891 normally hearing and 750 affected by noise-induced hearing loss (NIHL) Each subject was submitted to a questionnaire specifically created in order to determine the presence of AD.

RESULTS

Statistical analysis confirmed the reliability of answers to items. AD was present in 577 subjects, not all affected by NIHL. Audiometric threshold and age correlated significatively with the degree of AD.

CONCLUSIONS

The results obtained allowed the audiometric threshold values to be determined at the 95th percentile of subjects who did not report AD, in relation to the average of frequencies normally used in hearing loss evaluation.

[Management of oropharyngeal dysphagia: outcomes in a group of 81 adult patients]

BACKGROUND

Aim of the study is to assess outcomes in the management of 81 patients with diagnosis of oropharyngeal dysphagia.

METHODS

DESIGN

retrospective study on the outcome of logopedic treatment.

SETTING

patients have been assessed and treated as in- and out-patients of the Azienda Ospedaliera "S. Giovanni Battista" of Turin.

PATIENTS

81 patients, 37 female and 44 male, mean age of 61,3 years, with diagnosis of oropharyngeal dysphagia.

INTERVENTION

phoniatric and logopedic assessment and management including: food consistency change, compensatory head posture, oropharyngeal muscle strengthen and pharyngeal sensibility stimulation.

SURVEY

tube feeding, dietary adjustments, presence of aspiration or penetration and postural techniques utilization were used as outcome measures.

RESULTS

The number of patients on tube feeding changed from 50 out of 81 before treatment to 36 out of 81 at discharge time. Subjects who couldn't take anything by mouth decreased from 55 to 9. The number of patients with aspiration or penetration changed respectively from 47 and 8 to 20 and 4. Postural techniques were used in 15 cases.

CONCLUSIONS

The data suggest that outcomes of oropharyngeal dysphagia rehabilitation are promising. The role of tube feeding and of food consistencies is of key importance in the management of deglutition disorders. All clinicians dealing with dysphagic patients should know the importance of food rheologic characteristics, the consequences of alimentation by nasogastric tube and percutaneous endoscopic gastrostomy.

[Validity of operationalized psychodynamic diagnostics]

The paper describes results of "operationalized psychodynamic diagnostics" (OPD) with 54 adolescent and young adult drug addicts prior to outpatient family therapy. Focus of investigation is the prognostic and factorial validity of the OPD-system. Furthermore, relationships between conflicts and psychic structure are investigated. The use of the OPD-system allows a clinical description of the patient sample. Thus, adolescent drug addicts are characterized by autonomy versus dependence and self-esteem conflicts. A neurotic or sometimes borderline level is found on the structure axis. Low scores on the structure axis are significantly correlated with self-esteem conflicts. There is some evidence for the prognostic validity of the OPD I axis. However, prognostic validity of the structure and conflict axes require further research.

Human telomerase reverse transcriptase antisense treatment downregulates the viability of prostate cancer cells in vitro

Telomerase, a ribonucleoprotein complex is activated in the vast majority of human malignancies, including prostate cancer. Its inhibition is a putative way to affect cancer proliferation and might be used in the therapy of tumors. We analysed the influence of antisense phosphorothioate oligonucleotides (PTO) against the reverse transcriptase subunit of telomerase on prostate cancer cell viability, telomerase activity and telomere length. DU145 prostate cancer cells were cultivated in PTO containing medium. The PTO-incorporation was confirmed by confocal laser scanning microscopy. Cell viability was measured by a WST-1 tetrazolium assay. After 15 days of antisense PTO treatment, a significant inhibition of cell viability occurred. Telomerase activity was determined by a telomeric repeat amplification protocol (TRAP) assay and telomere length by Southern blot analysis. Since the long-term telomerase antisense treatment reduces the viability of prostate cancer cells significantly, this antisense approach could be a new therapeutic strategy to treat patients with advanced prostate cancer.

[Hiatal hernia and risk of aspiration in anesthesia induction]

Papers recently published in the literature have questioned whether residual gastric fluid volume at the time of induction is the most important risk factor for pulmonary aspiration. To estimate the risk, more factors than the gastric fluid volume have to be considered. Concomitant diseases such as the hiatal hernia must be considered. Pulmonary aspiration during induction of anaesthesia seems to be caused by a multifactorial process, which consists of gastric fluid volume, anaesthetic technique and concomitant disease. A fifty-year-old man was scheduled for elective cholecystectom. During induction, the patient surprisingly regurgitated and aspirated gastric fluid. Postoperatively, an additional barium-swallowing x-ray examination showed a hiatal hernia. This case report shows that patients who report heartburn in their case history should be prophylactically treated as endangered by aspiration, even when they are considered to have an empty stomach.

Hemichondrodiastasis for the treatment of genu varum deformity associated with bone dysplasias

Hemichondrodiastasis has been reported for treatment of angular deformities in children close to skeletal maturity. The use of distraction through the physis in younger children was not recommended. The authors report three children 3 to 7 years of age who underwent bilateral proximal tibial hemichondrodiastasis for correction of genu varum due to bone dysplasia. Ilizarov external fixators were applied in all cases. The patients underwent gradual angular correction at a rate of 0.5 mm/d. Distraction was continued until a normal mechanical axis was achieved. Normal alignment was achieved in two patients and slight overcorrection in the third. The patients were followed for 3 to 11 years, and no adverse affects on the physis were identified. This is the first report of physeal distraction in patients this young. Our results are good, and we believe that hemichondrodiastasis can be safely used for correction of angular deformities in young children.

Roughness evolution of ion sputtered rotating InP surfaces: pattern formation and scaling laws

The topography evolution of simultaneously rotated and Ar (+) ion sputtered InP surfaces was studied using scanning force microscopy. For certain sputter conditions, the formation of a highly regular hexagonal pattern of close-packed mounds was observed with a characteristic spatial wavelength which increases with sputter time t according to lambda approximately t(gamma) with gamma approximately 0.26. Based on the analysis of the dynamic scaling behavior of the surface roughness, the evolution of the surface topography will be discussed within the limits of existing models for surface erosion by ion sputtering.

Water vapour in a closed anaesthesia circuit reduces degradation/adsorption of halothane by dried soda lime

Dry lime causes a loss of volatile anaesthetics by degrading and adsorbing them. Degradation produces toxic substances and heat. Rehydration of lime stops degradation. If humidified breathing gases rehydrate lime, closed anaesthesia-circuits may reduce the loss of anaesthetics. To test this hypothesis we ventilated a reservoir bag with PhysioFlex-devices using fresh (F) and dried (D) soda lime both in the presence (+H) and absence (-H) of halothane. We measured halothane delivery, humidity, temperature, and lime weight. Halothane was lost for 13 min in D + H. Humidity increased steeper with fresh lime, whereas absorbent weight increased more with dried lime; halothane increased both variables (F + H: 99%, 8 g; F - H: 93%, 6 g; D + H: 58%, 17 g; D - H: 24%, 15 g). Surprisingly, temperature remained constant, probably because of the high gas flow (70 litres min-1) generated inside the Physioflex. These findings indicate rehydration of dried lime by humid gases and a rapid cessation of the loss of halothane in the PhysioFlex.

Accuracy and reproducibility of long-term implanted transit-time ultrasound flow probes in dogs

OBJECTIVE

To assess the accuracy and reproducibility of long-term implanted ultrasound transit-time flow probes for measuring cardiac output.

DESIGN

Prospective animal study.

SETTINGS

Animal research laboratory in a university department.

ANIMALS

Eleven anaesthetised dogs, 24-34 kg.

MEASUREMENTS AND RESULTS

Flow probes (16-24 mm S-series, Transonic) were implanted around the pulmonary artery for a mean duration of 22 months (range 6-47 months). Comparisons (n = 147) were made between cardiac output thus obtained and that measured by the direct Fick principle using oxygen uptake (Deltatrac II Metabolic Monitor) and the arterial to mixed venous oxygen content difference measured by a galvanic cell (Lex-O2-Con-TL). Measurements were made either during baseline conditions or during pharmacologically altered cardiac output (range 22-180 ml x kg(-1) x min(-1)). Regardless of the intervention, the two methods yielded the same results in half of the dogs. In the others, however, cardiac output was underestimated by the flow probes by up to 38% (probably because of non-perpendicular position of the probe towards the vessel). This difference was constant for the whole range of cardiac output studied and remained constant over the entire observation period for each individual dog, so that a correction factor was used. Thereafter, the mean difference between the two methods was -1.1 ml x kg(-1) x min(-1) with a precision (SD) of 14.2 ml x kg(-1) x min(-1) for all experiments.

CONCLUSIONS

After in vivo calibration, ultrasound transit-time flow probes measure cardiac output precisely for several years, regardless of the intervention.

[Iodine therapy for iodine deficiency goiter and autoimmune thyroiditis. A prospective study]

PROBLEM

There is epidemiological and clinical evidence that iodine may induce or promote the manifestation of autoimmune thyroiditis. For this reason it is important to know if substitution of alimentary iodine deficiency or iodine treatment of endemic goitre can cause formation of thyroid antibodies. On the other hand the practical importance of this phenomenon should be evaluated.

PATIENTS AND METHODS

During a prospective study we examined 209 patients with endemic non-toxic goitre and 53 healthy people. For treatment were used 200 micrograms iodine/d (n = 119), 500 micrograms iodine/d (n = 27), 1.5 mg iodine/week (n = 41), 150 micrograms iodine/d plus 75 to 100 micrograms T4/d (n = 26), 100 micrograms iodine plus 100 micrograms T4/d (n = 24). The observation took 1 year with a 3-month interval for check ups including clinical examination, ultrasound, TSH, T3, fT4, TPO- and thyreoglobuline antibodies and urinary iodine.

RESULTS

After 12 months 7.5% of iodine treated persons had produced antibodies, most of them at low levels. In healthy people we found increased antibody-levels in 3.8%, in patients with goitre in 9.0%, in patients with nodular goitres in 11.1%. 500 micrograms iodine caused the most antibody reaction in 14.8%. People treated with 200 micrograms iodine/d showed positive antibody levels in 5%. T4 seems to reduce antibody-reactions. Pathological antibody-levels were not found in patients with combined iodine/T4- and single-T4 therapy. Among the 22 primary pathological antibody levels only 4 increased further (18.2%). Three of them belonged to the group of 5 persons treated with 500 micrograms iodine/d. Primary high antibody values were normalized in 5 patients (22.7%). Hypothyroid disturbances were not found. Ultrasound did not show any alterations, and the reduction of thyroid volumes in antibody-positive patients was not affected. Median urinary iodine excretion during the observation-interval was 5.2 to 7.2 micrograms/dl.

CONCLUSIONS

Possible antibody reactions have no clinical importance at all. Individual cases must be observed. Low iodine doses should be preferred. Combined iodine/T4 treatment seems to have an advantage regarding immunological thyroidal reactions.