Speaking proficiency variations according to method of alaryngeal voicing

Twelve judges, with no previous exposure to laryngectomees, rated the speaking proficiencies of 33 laryngectomees divided into the following groups: esophageal speakers (n = 12); electrolarynx speakers (n = 11); and tracheoesophageal puncture speakers (n = 10). In addition, the speech of ten normal subjects was rated. Specific speaking parameters examined included voice quality, pitch, loudness, intelligibility, rate of speaking, visual presentation during speech, extraneous speaking noise, and overall communicative effectiveness. Multiple discriminant analyses performed on the ratings made by each judge revealed significant differences in ratings for various speaking parameters in the four subject groups. Results generally support the stance that tracheoesophageal speech is perceived as superior to communication with either an electrolarynx or with traditional esophageal speech, even though it is not viewed as comparable to normal voice.

Characteristics of gentamicin uptake in the isolated crista ampullaris of the inner ear of the guinea pig

The characteristics of aminoglycoside uptake in the inner ear were investigated in the isolated crista ampullaris. The organ was incubated with radiolabeled gentamicin, and the stable, nonexchangeable radioactivity was considered the intracellular pool of the drug. Gentamicin was transported against a concentration gradient, and the resulting tissue to medium ratios ranged from 1.4 to 18.6. Transport was inhibited by reduction in temperature or by the addition of metabolic blockers, indicative of an energy-dependent component. The uptake system showed at least two sites, the first a high-affinity site with a dissociation constant KD = 39 nM and a capacity of n = 0.2 pmole/crista; the second had a KD = 16 microM and a capacity of n = 11 pmoles/crista. Aminoglycosides competed with uptake of gentamicin in the order netilmicin greater than or equal to neomycin greater than tobramycin, and polyamines competed in the order spermine greater than spermidine greater than putrescine; glucosamine and the basic amino acids lysine and asparagine were ineffective, excluding the participation of glucose and basic amino acid transport systems in gentamicin uptake. These results along with direct comparisons with some characteristics of putrescine uptake suggest that aminoglycoside and polyamine transport have common features in the crista ampullaris.

Three molecular steps of aminoglycoside ototoxicity demonstrated in outer hair cells

Previously postulated molecular mechanisms of aminoglycoside ototoxicity were investigated in outer hair cells in vitro. Cells were isolated by microdissection from the organ of Corti of the guinea pig and maintained in Hank's balanced salt solution. (1) Approx. 100 cells (the standard number per assay) bound 432 +/- 198 pmol calcium as determined with 45Ca2+ (1.2 mM). 1 mM neomycin or gentamicin lowered this value by 28% and 45%, respectively. (2) Binding of radiolabeled gentamicin (28 fmol per 100 cells at 0.1 microM gentamicin) was reduced by 55% by 1 mM neomycin or spermine. Washing with an excess of unlabeled gentamicin displaced only 60% of the drug, the remainder being tightly bound to a less accessible compartment. Incubation at low temperature essentially abolished gentamicin uptake. (3) Phospholipids were labeled with [32P]orthophosphate which was mostly incorporated into phosphatidylinositol 4,5-bisphosphate (PIP2), phosphatidylinositol 4-phosphate, phosphatidylinositol, and phosphatidic acid. When the lipids were chromatographed over immobilized gentamicin PIP2, in contrast to other lipids, was strongly retained. These results are compatible with the following actions of aminoglycosides in outer hair cells: (1) competition with calcium; (2) energy-dependent uptake competitive with polyamines; and (3) binding to the phospholipid PIP2.

Second hepatoma developing 13 years after resection of first tumor

A patient underwent a left-sided hepatic lobectomy for primary hepatocellular carcinoma 13 years ago and remained symptom free. He then presented with spontaneous rupture of a large tumor in the right lobe of the liver. Although this tumor proved to be primary hepatocellular carcinoma, there were significant histological differences between the two lesions, suggesting that this was a second primary liver tumor. Bleeding from the tumor was controlled by selectively ligating the branches supplying the area of hemorrhage.

Aphasia: its effect on marital relationships

The primary purpose of this study was to determine if a relationship exists between marital satisfaction and knowledge of aphasia of the spouse of a stroke patient. Other factors such as the severity of the aphasia, length of time poststroke, and length of marriage were also examined. The subjects, 16 spouses of aphasic patients, were grouped according to severity of the aphasia (mild, moderate, severe). Spouses completed a Knowledge of Aphasia questionnaire and pre/poststroke forms of a Marital Satisfaction Scale (MSS). The questionnaire measured spouse understanding of aphasia, while the MSS examined changes in spouse attitudes toward their marriages after the patients became aphasic. Neither spouses' knowledge of aphasia nor its severity was related to their marital satisfaction. However, there was a significant negative change between the pre/poststroke MSS scores. Spouses of mildly impaired patients were less knowledgeable about aphasia than were those of severely impaired patients. Results are discussed in terms of the counseling needs of families of aphasic patients.

Binding of neomycin and calcium to phospholipids and other anionic compounds

In order to assess the potential importance of different cellular binding sites for the adverse effects of aminoglycosides (i.e. oto- and nephrotoxicity) the binding of neomycin and calcium to phospholipids and other anionic cell constituents was assayed in vitro. Phospholipids demonstrated binding affinities that strongly favored neomycin (Km, 10 to 100 microM) over calcium (Km, 300 to 1,120 microM). Both neomycin and calcium showed strongest binding to lipids with monoester phosphate groups: phosphatidic acid, phosphatidylinositol 4-phosphate, and phosphatidylinositol 4,5-bisphosphate. The lipids bound 0.2 to 0.4 molecules of neomycin and 0.5 to 1 molecule of calcium, respectively, per lipid. Anionic non-lipid compounds such as melanin, gangliosides or chondroitin sulfate were ineffective competitors of neomycin binding to lipids. The results emphasize the importance of phospholipids as cellular binding sites for aminoglycosides. Furthermore, if one considers extra- and intracellular calcium and neomycin concentrations, the relative affinity of lipids for these two compounds suggests an explanation for both the reversible and the essentially irreversible toxic effects of the aminoglycosides.

Hypertrophy and coronary and collateral vascularity in dogs with severe chronic anemia

The purpose of this study was to determine 1) whether a severe hypoxic stimulus could produce an increase in coronary and collateral vascularization and 2) whether minimal coronary resistance, which increases with hypertension-induced hypertrophy, decreases when hypoxia is superimposed on volume load hypertrophy. Data were obtained on 11 dogs rendered anemic to a hematocrit of 11 +/- 0.2 vol% and maintained at this level for 4 wk. Eighteen dogs with a hematocrit of 42 +/- 0.02 vol% were used as controls. After chronic anemia the coronary and collateral flows were quantitated in a beating, vasodilated, isolated heart preparation perfused solely with blood from two normal donor dogs. The following variables were significantly increased in anemia-exposed hearts compared with controls: coronary flow per gram myocardium for the left anterior descending, the circumflex, the right, and the septal arteries; ratio of total coronary flow of each vessel to body weight; and the collateral flows to each coronary vessel. Both the right and left ventricles were hypertrophied. We conclude that severe chronic anemia produces a dissociation between hypertrophy and increased minimal coronary resistance. Severe chronic anemia appears to increase vascularization of both coronary and collateral circulation probably due to tissue hypoxia. In this model coronary collateral vascularity seems to increase in the absence of a pressure difference across collaterals.

The interaction between the TSH receptor and Graves' sera with TSH agonist or antagonist properties

The A subunit of the TSH receptor was prepared by reduction of human thyroid membranes with dithiothreitol, and partially purified by gel filtration. The ability of Graves' sera to inhibit TSH binding to the TSH receptor and to stimulate cyclic AMP release from isolated thyroid cells was abolished by incubation with crude and partially purified preparations of the A subunit.

Differences in speaking proficiencies in three laryngectomee groups

Speaking proficiencies of three groups of alaryngeal speakers were examined: (1) esophageal speakers (n = 12), (2) electrolarynx speakers (n = 11), and (3) tracheoesophageal puncture speakers (n = 10). Subjects were videotaped while engaged in a variety of speaking tasks. Three groups of judges, varying in their knowledge about laryngectomees, independently rated the speaking proficiency of each videotaped speaker. Specific variables rated included voice quality, pitch, loudness, intelligibility, rate of speaking, visual presentation during speech, extraneous speaking noise, and overall communicative effectiveness. Multivariate analyses of variance performed on the ratings made by each judge group disclosed significant differences in ratings for various speaking variables for the three laryngectomee groups. In addition, differences in proficiency ratings for the laryngectomees were found, depending on the expertise level of the judges.

Long term study of the effect of rifampicin and isoniazid on vitamin D metabolism

Eight patients with tuberculosis were studied before, during and after 9 months treatment with rifampicin and isoniazid to assess the overall effect on vitamin D metabolism. No significant uniform change in either 1,25(OH)2D or 25 OH D nor in any of the other biochemistry measured occurred during the study. It seems unlikely that the combined effects of these drugs causes clinically significant derangement of vitamin D metabolism in patients treated over a 9 month period for tuberculosis.

Recent experience of tuberculosis in junior hospital doctors in Leeds and Bradford

Over a 2-year period, six cases of active tuberculosis were seen in doctors in two adjacent northern cities. Five patients were junior hospital doctors and three were in close contact with children. Pre-employment screening in four doctors did not take place. Despite screening, two subsequently developed active disease. The advisability and difficulties of screening junior hospital doctors are discussed.

CTP:phosphorylcholine cytidylyltransferase in rat lung. The effect of free fatty acids on the translocation of activity between microsomes and cytosol

Phosphatidylglycerol and oleic acid had differential effects on cytidylyltransferase activity in cytosol and microsomes. The low-molecular-weight cytidylyltransferase in cytosol was stimulated more by phosphatidylglycerol than by oleic acid, whereas microsomal activity was stimulated more by oleic acid than by phosphatidylglycerol. Microsomal activity was stimulated by several unsaturated fatty acids but was not stimulated by saturated fatty acids. Bovine serum albumin decreased cytidylyltransferase activity in microsomes in the presence or absence of oleic acid but did not alter the activity measured in the presence of phosphatidylglycerol. The addition of oleic acid to albumin/microsome mixtures in amounts exceeding the binding capacity of albumin lead to complete recovery of the oleic acid stimulation. The addition of oleic acid to postmitochondrial supernatants resulted in a translocation of cytidylyltransferase activity from cytosol to microsome. The magnitude of the shift was severalfold greater with fetal preparations than adult. The free fatty acid content of microsomes increased coincident with the translocation. Bovine serum albumin, added to postmitochondrial supernatants, caused a release of cytidylyltransferase from microsomes to cytosol and a corresponding decrease in microsomal free fatty acid content. The amount of cytidylyltransferase activity in microsomes increased shortly after birth. The increase was accompanied by an increase in free fatty acid content of the microsomes. The increase in cytidylyltransferase activity and free fatty acids which occurred in vivo following birth was nearly identical to that obtained by adding oleic acid to postmitochondrial supernatants from fetal lung. We conclude that free fatty acids may affect the intracellular activity of cytidylyltransferase by promoting the translocation of inactive cytosolic forms to microsomes as well as by stimulating microsomal bound activity.

Persistence of an antigen recognized by Crohn's disease sera during in vivo passage of a Crohn's disease-induced lymphoma in athymic nude mice

Previous studies from this laboratory have shown that lymphoma and lymph node hyperplasia develop in athymic nude mice injected with Crohn's disease tissue filtrates. In addition, use of an indirect immunofluorescence assay has demonstrated that an antigen(s) in these lymphoid tissues is recognized by sera from patients with Crohn's disease. In our study, one such lymphoma was passed through 10 generations of athymic nude mice and used for immunofluorescence studies. Suspended cells (1 to 5 X 10(8)/mouse) from the primary lymphoma and from the lymphomas that developed in mice of each subsequent generation were injected subcutaneously into groups of three to eight mice. As a control, lymphoma induced in a nude mouse by the injection of sarcoid lymph node filtrate was passed through successive generations in the same manner as the Crohn's disease-induced lymphoma. Lymphoma developed locally in 81% of recipient mice 3 to 6 weeks after injection of suspended cells. In 47 mice, representing 10 generations, Crohn's disease-related lymphoma developed at the sites of injection and at axillary or inguinal lymph nodes. These tumors were examined by immunofluorescence assay using a panel of 20 sera coded for Crohn's disease or control. Immunofluorescence assay yielded positive results in 61% of the lymphomas and 59% of the lymph node with sera from patients with Crohn's disease, but not with control sera. Control lymphomas did not stain with any serum. Our studies demonstrate the transmissibility or inducibility of an antigen(s) in lymphoid tissue of athymic nude mice that is recognized by sera from patients with Crohn's disease, but not by control sera.

Non-compliance with antituberculous drugs

A case of inadvertent 'total' non-compliance with a course of antituberculous drugs is described. Subsequently the value of routine urine testing for rifampicin in a chest clinic was assessed. The butanol extraction test was found to be a simple and rapid guide to the identification of defaulting patients.

Influence of written form on reading comprehension in aphasia

Reading comprehension of 20 aphasic patients was systematically assessed using equivalent stimuli written in both print and cursive form. A Single-Word-to-Picture Matching task and a Sentence-to-Picture Matching task were employed. Performances of the aphasics were not uniformly facilitated by one written form over the other. Furthermore, the reading comprehension of the majority of individual patients was not influenced by written form. Four of the subjects, however, did appear to display real performance discrepancies when reading cursive versus print, particularly on the Sentence-to-Picture Matching task. Two of these patients performed better when reading cursive, while two performed better when reading print. Reevaluation of two of these patients 6 mo after initial testing revealed that they continued to display the same performance patterns originally demonstrated. Clinical implications of these results for the evaluation and treatment of reading comprehension in aphasia are discussed.

Factors influencing naming performance in aphasia: a review of the literature

The naming performance of aphasic patients may vary substantially, depending upon linguistic factors associated with the target words, characteristics of the referent (real or pictured), the manner in which the response is elicited, and the particular situation in which the naming response is produced. Furthermore, the specific influence of certain of these factors on naming performance appears to vary with type of aphasia. This article reviews and evaluates the literature pertaining to factors that influence adult aphasics' naming performances. Implications for future research are discussed.

Absorption of prednisolone in patients with Crohn's disease

The absorption of prednisolone in patients with Crohn's disease was investigated. Seven patients with Crohn's disease and eight normal control subjects were given a tracer dose of tritiated prednisolone with 20 mg cold prednisolone by mouth. On a separate occasion they were given an intravenous injection of radiolabelled prednisolone. After oral ingestion only 53.4 +/- 11.7% of labelled material was excreted in the urine of Crohn's patients compared with 82.5 +/- 3.6% in the normal subjects. The oral/intravenous availability ratio was 0.61 +/- 0.14 in Crohn's patients and 0.89 +/- 0.07 in the normal group. Areas under plasma concentration-time curves were lower in patients than normal subjects and the oral/intravenous ratios were 0.6 +/- 0.2 and 0.86 +/- 0.09 respectively. Faecal excretion of radioactivity after oral ingestion was greater in Crohn's patients (19.3 +/- 2.5%, n = 3) than in normal subjects (7 +/- 2.8%, n = 4). The range for each type of measurement was much wider in the patient group than in the normal subjects. These data suggest that patients with Crohn's disease do not absorb prednisolone normally and that absorption varies between patients.

Studies of the etiology of Crohn's disease using athymic nude mice

Following injection of Crohn's disease tissue filtrates, lymphomas and hyperplastic lymph nodes developed in 16% of athymic nude (nu/nu) mice; whereas only 4% of control nude mice developed lymphadenopathy (p less than 0.025). One hundred forty coded sera from 111 patients (Crohn's disease = 36, ulcerative colitis = 28, diarrheal and other controls = 47) were assayed by indirect immunofluorescence for immunoreactivity with the lymphomas and hyperplastic lymph nodes. Coded sections were examined by two observers and scored on a 0 to 3 + scale. Fifty-four percent of the sera from patients with Crohn's disease were reactive with the Crohn's disease induced lymphoma by this assay. Eighty percent of sera from patients with symptomatic Crohn's disease were positive, whereas 22% of sera from patients in remission were positive. Sixty-six percent of sera from patients with symptomatic Crohn's disease reacted against hyperplastic lymph nodes induced by Crohn's disease filtrates. In contrast, only one control serum (from a patient with ulcerative colitis) reacted with the lymphomas or hyperplastic lymph nodes. Lymphomas induced by other means or arising spontaneously did not show immunofluorescence with Crohn's disease or control sera. Electron microscopy revealed C-type viral particles in five lymphomas induced by Crohn's disease filtrates and in one control lymphoma, but not in five hyperplastic lymph nodes and five control lymph nodes. Absorption of Crohn's disease sera with control lymphoma or with murine leukemia virus infected fibroblasts did not diminish immunoreactivity, whereas similar absorption with lymphomas induced by Crohn's disease filtrates abolished the immunofluorescence. These studies indicate that Crohn's disease tissue, when injected into athymic nude mice, induces lymphoid hyperplasia and lymphomas that contain an antigen(s) recognized by Crohn's disease sera.