Late results of laterofixation in the treatment of bilateral abductor paralysis of the vocal cords: a clinical study with long-term follow-up

Thirty-four patients with bilateral vocal cord abductor paralysis were treated surgically during the period from 1960 to 1979. The main cause of paralysis was thyroid surgery (85%). Woodman's external laterofixation was performed in 31 patients, 1 had laterofixation by laryngofissure and 2 had endoscopic arytenoidectomy. In Woodman's procedure the body of the arytenoid cartilage was removed in 10 cases and mobilized from the cricoarytenoid joint in 21 cases. Thirteen of the 34 patients needed further surgery. Including previously performed procedures in 6 patients, altogether 68 operations were performed and 17 patients (50%) were operated on more than once. The immediate failure rate of laterofixation was 22% but the need for reoperation increased with time and the total failure rate of the method was 44%. Endoscopic arytenoidectomy was successful in 1 of 2 cases as a primary operation and in 3 of 3 cases as secondary operation. Follow-up time ranged from 2 months to 29 years 8 months (mean 15 years 10 months).     

Resolution of oral lichenoid lesions after replacement of amalgam restorations in patients allergic to mercury compounds

The significance of contact allergy in patients with various oral symptoms was studied. Positive patch-test reactions to mercury compounds were found in 21/91 patients. Of these, 18 had lichenoid lesions in oral mucosa in close contact to amalgam fillings, and three patients with contact allergy had neither amalgam fillings in their teeth nor visible oral lesions. Amalgam replacement was carried out in 15/18 symptomatic patients. The fillings were replaced with gold in three cases, composite resin fillings in six, glass ionomer in three and both gold and composite materials in three cases. In 10 patients there was complete replacement and in five it was restricted to the fillings adjacent to the mucosal lesions. After a mean follow-up period of 3.2 years a complete cure was seen in seven patients, each of whom had had all their fillings changed. A marked improvement occurred in six patients, and there was no change in two.     

AUTONOMIC DYSFUNCTION IN LONG-STANDING ALCOHOLISM

Twenty-eight male alcoholics were studied for peripheral sensory-motorand autonomic neuropathy. The patients were examined neurologicallyand neurophysiologically after a period of withdrawal treatmentin hospital. The function tests of the autonomic nervous systemperformed were: measurement of the variation of the heart rateat rest and during maximal breathing, Valsalva manoeuvre, posturalpulse and blood pressure reactions, and isometric test. Slight abnormalities in the peripheral nervous system were observedin 8 patients, but a frank clinical polyneuropathy supportedby neurophysiological findings could be diagnosed only in 2.All of the parameters which reflect the function of the parasympatheticdivision of the autonomic nervous system were lower in the alcoholicscompared with the controls. The most sensitive variables werethe heart rate variation at rest, and the postural pulse reaction.The functions mediated by the sympathetic nervous system werenot abnormal among this group of alcoholics.     

The ontogenetically earliest discriminative response of the human brain

Speech sounds elicited electric brain responses in healthy premature infants born 30–35 weeks after conception, demonstrating that the human brain is able to discriminate speech sounds even at this early age, well before term, and supporting previous results suggesting that the human fetus may learn to discriminate sounds while still in the womb. We presented preterm infants with stimulus sequences consisting of a repetitive vowel that was occasionally replaced by a different vowel. This infrequent vowel elicited a response resembling the adult mismatch negativity, which is known to reflect the brain's automatic detection of stimulus change. The present results constitute the ontogenetically earliest discriminative response of the human brain ever recorded.     

Thallium Scintigraphy in Prediction of Occlusion of Bypass Grafts in Asymptomatic and Symptomatic Patients

ABSTRACT To evaluate thallium scintigraphy in predicting coronary artery bypass graft patency, exercise thallium scintigraphy and selective graft and native vessel angiograms were performed in 22 asymptomatic and 29 symptomatic consecutive patients three months after coronary artery bypass grafting (CABG). Twelve out of 22 asymptomatic patients (55%) had reversible thallium defects on postoperative images; in 10 patients the postoperative scans were normal. The graft patency was significantly lower in asymptomatic patients with abnormal thallium perfusion compared to those with normal perfusion after CABG (68% vs. 91%. p<0.05). The rate of graft patency in symptomatic patients was 66/87 (76%). Thallium scintigraphy was 77% sensitive and 78% specific in detecting one or more stenosed or occluded bypass grafts in patients without angina (accuracy 77%). When data from exercise electrocardiography were combined with scintigraphy, all but one patient with incomplete revascularization could be detected (positive predictive accuracy 92%). In symptomatic patients, thallium scintigraphy accurately predicted the presence or absence of graft occlusion in 24/29 (83%) cases. Thus, abnormal myocardial perfusion due to stenosis or occlusion of bypass grafts is common in both asymptomatic and symptomatic patients after CABG. Thallium scintigraphy together with exercise electrocardiography appear to be useful non-invasive methods in detecting painless myocardial ischemia and in predicting bypass graft occlusion after CABG.     

Electrophysiological evidence for cross-modal plasticity in humans with early- and late-onset blindness

It is commonly believed that sensory deprivation can lead to cross-modal reorganization in an immature hut not in a mature brain. The results of the present study suggest, however, that plasticity between sensory modalities is possible even in adults: activity indicating involvement of parietal or occipital brain areas in pitch-change discrimination was found in individuals blinded after childhood. Event-related brain potentials of early blinded (before the age of 2 years). late-blinded (12–28 years of age), and sighted adults were recorded to stimulus sequences consisting of standard tones occasionally replaced by deviant tones. Even when participants were not attending to auditory stimuli, the deviant tones elicited the mismatch negativity (MMN) in each group. There were no significant MMN front-back scalp distribution differences among the groups. However, when participants were detecting deviant stimuli, these stimuli elicited N2 and P3 waves that were posterior in distribution in both groups of blind participants relative to those of the sighted participants. These results suggest that cross-modal reorganization may occur even in the mature human brain.     

EPIDEMIOLOGY of PARKINSON''S DISEASE IN FINLAND

This investigation was conducted to clarify the epidemiology of Parkinson's disease in Finland. A community survey was made in a selected area in southwest Finland in addition to an analysis of Finnish mortality statistics for Parkinson's disease. The annual mortality rate from Parkinson's disease was found to average 2 per 100,000 population. Almost 70 per cent of the deaths occurred between 65-79 years of age. The total and age-specific mortality rates for males were greater than those for females whereas the proportionate mortality rates were almost identical. This was considered to indicate that suggestions of greater male prevalence, based on mortality statistics, do not appear justified. On prevalence day, Dec. 31st, 1971, 484 patients with Parkinson's disease (of which 444 were personally examined) lived in the area of investigation (population 402,988), the prevalence rate being 120.1 per 100,000 population. The highest annual incidence rate was 16.6 per 100,000 population. The age-specific prevalence rates showed a rapid increase after the 50th year of age. The greatest prevalence was shown by the age group 70-79 years of age in which almost 0.8 per cent of the population are affected. Age-specific incidence rates also displayed an increase after the 50th year of age. The greatest incidence was observed in the age group 70-79 years of age in which almost 1 per 1,000 of the population are annually affected by the disease. A difference between the sexes was demonstrable in the prevalence and incidence rates showing greater values for females, but in the age-specific frequencies the differences were reduced. This probably reflects the difference between the age structures of the male and female populations, suggesting that both sexes have a similar risk of being affected by the disease. The permanent age structure shown by idiopathic patients in comparison with previous investigations as well as the increased mean age and proportionate decrease of postencephalitic patients was found to be in disagreement with the cohort theory according to which all parkinsonian patients are previously victims of encephalitis lethargica.