Acoustic analysis after radiotherapy in T1 vocal cord carcinoma: a new approach to the analysis of voice quality

PURPOSE: The study of acoustic voice parameters (fundamental frequency, jitter, shimmer, and harmonics-to-noise ratio) in extended vowel production, oral reading of a standard paragraph, spontaneous speech and a song in irradiated patients for Tis-T1 vocal cord carcinoma. METHODS AND MATERIALS: Eighteen male patients irradiated for Tis-T1 vocal cord carcinoma and a control group of 31 nonirradiated subjects of the same age were included in a study of acoustic voice analysis. The control group had been rigorously selected for voice quality and the irradiated group had previous history of smoking in two-thirds of the cases and a vocal cord biopsy. Radiotherapy patients were treated with a 6MV Linac receiving a total dose of 66 Gy, 2 Gy/day, with median treatment areas of 28 cm(2). Acoustic voice analysis was performed 1 year after radiotherapy, the voice of patients in extended vowel production, oral reading of a standard paragraph, spontaneous speech, and in a song was tape registered and analyzed by a Kay Elemetric's Computerized Speech Lab (model CSL# 4300). Fundamental frequency, jitter, shimmer, and harmonics-to-noise ratio were obtained in each case. Mann Whitney analysis was used for statistical tests. RESULTS: The irradiated group presented higher values of fundamental frequency, jitter, shimmer, and harmonics-to-noise ratio. Mann-Whitney analysis showed significant differences for fundamental frequency and jitter in vowel production, oral reading, spontaneous speech, and song. Shimmer only showed differences in vowel production and harmonics-to-noise ratio in oral reading and song. CONCLUSIONS: In our study only fundamental frequency and jitter showed significant increased values to the control group in all the acoustic situations. Sustained vowel production showed the worst values of the acoustic parameters in comparison with the other acoustic situations. This study seems to suggest that more work should be done in this field.     

Importance of early adequate exposure to cyclosporine in renal transplant outcome: study of 1-year creatinine

INTRODUCTION: One-year serum creatinine (SCr) level has been used as a surrogate marker for graft survival in kidney transplantation. We evaluated the importance of different factors on this parameter, emphasizing the importance of adequate exposure to Cyclosporine (CyA). METHODS: Ninety-six consecutive renal transplant recipients who underwent transplantation between 1996 and 2002 were treated with CyA, steroids, and azathioprine. Univariate and multivariate regression analyses were performed for 1-year SCr, acute rejection episodes (ARE), and duration of delayed graft function (DGF). We considered adequate CyA levels within 1 week to be >250 ng/mL trough levels (38%) or 3 hour postdose level (C3) >1100 ng/mL (62%). RESULTS: Mean 1-year SCr was 1.52 +/- 0.5, ARE rate was 27%, and DGF rate was 31%. Overall, 53% of patients achieved adequate exposure to CyA at 1 week (68% on those monitored by C3). Univariate analysis identified female recipient gender, decreasing donor age, absence of ARE, and decreased DGF duration to yield lower 1-year SCr (P < .05). On multivariate analysis for donor age (lower), ARE rate, and duration of DGF (shorter) were the only factors considered to be significant for a lower 1-year SCr level. Multivariate analysis for ARE showed that adequate CyA exposure and lower HLA mismatch decreased ARE, whereas the ability to achieve adequate exposure to CyA and shorter cold ischemia time (CIT) correlated with a reduced incidence of DGF. CONCLUSIONS: One-year SCr level is affected primarily by the incidence of ARE, by donor age, and by duration of DGF. Adequate CyA exposure is related to lower ARE; however, its relation to DGF may be influenced by the reluctance to increase exposure on patients with a nonfunctioning graft.     

Production and suppression of tremor by mesencephalic tegmental lesions in monkeys

In a group of rhesus monkeys two consecutive lesions were placed in the mesencephalic tegmental region. The first lesion, for tremor production, was placed ventromedially in a region where multiunit activity was organized in rhythmic bursts of 4 to 8 cps and threshold electrical stimulation induced III nerve type of responses. The second lesion, for tremor suppression, was placed dorsolateral to the previous one, in a region where nonrhythmic multiunit activity was enhanced by peripheral nociceptive stimulus and threshold electrical stimulation produced awakening. Studying the lesions by planimetry in a quantitative manner, it was found that tremor production depended on the involvement of a critical amount of the pars compacta of the substantia nigra and the region immediately behind it, whereas tremor suppression depended on the involvement of a critical amount of the nucleus reticularis mesencephali. Involvement of other adjacent structures was not significant for either tremor production or suppression.     

A quantitative evaluation of the effects of l-DOPA on Parkinson's disease

Clinical estimation of the degree of muscular rigidity and akinesia in cases of Parkinson's disease is difficult, as both produce slowing of voluntary movements. However, while akinesia interferes mainly with the speed at which the movement is initiated following extereoceptive and propioceptive demands, muscular rigidity interferes only with the speed at which a body segment is transferred in the space. The present report describes a series of tests for an objective and quantitative evaluation of the initiation of movement and the transference of a body segment in the space. The tests allow comparative analysis between different patients and within the same patient at different time. In a group of Parkinsonian patients treated with l-DOPA, tests were performed to follow patients' improvement. Results showed that patients receiving l-DOPA significantly improved in the performance of tests that measure transference of a body segment in space, but not in tests that measure initiation of movements. Tremor frequency was decreased and amplitude increased by treatment with l-DOPA although not in a significant way. In agreement a careful clinical evaluation demonstrated improvement mainly in cogwheel sign and less in other clinical manifestations of rigidity. It is concluded that l-DOPA improves the clinical picture of Parkinson's disease by relieving muscular rigidity and its secondary negative symptoms, but has limited effect on akinesia. These results may explain why l-DOPA has not been useful in the treatment of akinesia when due to other causes (progressive supranuclear palsy).