A case of catastrophic antiphospholipid syndrome in an adolescent girl with parvovirus B19 infection

Antiphospholipid syndrome is an autoimmune disease characterized by recurrent thrombosis and the presence of antiphospholipid antibodies. Clinical presentations are dependent on the affected vessels and organs. The most common presentation of antiphospholipid syndrome is arterial or venous thrombosis. An unusual presentation of the disease is characterized by microvascular thrombosis with multiorgan involvement, which is termed catastrophic antiphospholipid syndrome. The diagnosis of catastrophic antiphospholipid syndrome can be difficult because of the heterogeneity of the different clinical forms. Clinical manifestations of catastrophic antiphospholipid syndrome are complex with multiple organ involvement, resulting in renal insufficiency, heart failure, acute respiratory distress syndrome, and liver involvement. Early diagnosis and aggressive therapies are essential in this condition because of the extremely high mortality rate. Herein, the case of a 14-year-old girl with catastrophic antiphospholipid syndrome that was previously misdiagnosed as a vasculitis related to parvovirus B19 infection is presented.     

Changes in pharyngeal (airway) morphology in Class III Turkish female patients after mandibular setback surgery

INTRODUCTION: The aim of this study was to evaluate changes in the pharyngeal and lower facial morphology in Turkish female Class III patients 1.5+/-0.4 years after mandibular setback surgery (bilateral sagittal split osteotomy), and orthodontic multi-bracket treatment. Only women with mandibular prognathism were selected because sex differences in pharyngeal airway changes were evident. MATERIAL AND METHODS: Lateral cephalograms of 25 Turkish female Class III patients (mean age: 25.4+/-2.6 years) with mandibular prognathism, were assessed before and 1.5+/-0.4 years after operation. Paired t and Pearson tests were used. RESULTS: The pharyngeal airway morphology showed significant changes in soft-palate length and posterior reference line (PRL) to point of posterior tongue. The decrease in PTV-Pg distance was correlated with the decreases in PRL-PSP, PRL-PTO and PRL-E distances. It was considered normal for the pharyngeal airway morphology to adapt after surgery to improve the hard tissue relationship. CONCLUSION: The lower facial morphology significantly changed and the pharyngeal airway narrowed 1.5+/-0.4 years after mandibular setback surgery.     

Jaw-phonatory coordination in chronic developmental stuttering

A deficiency in sensorimotor integration in a person who stutters may be a factor in the pathophysiology of developmental stuttering. To test oral sensorimotor function in adults who stutter, we used a task that requires the coordination of a jaw-opening movement with phonation onset. The task was adapted from previous limb coordination studies, which show that movement coordination depends on intact proprioception. We hypothesized that adult stutterers would show deficient jaw-phonatory coordination relative to control participants. The task required initiation of phonation as a jaw-opening movement passed through a narrow spatial target. Target amplitude and jaw movement speed were varied. The stuttering group showed significantly higher movement error and spatial variability in jaw-phonatory coordination compared to the control group, but group differences in movement velocity or duration were not found. The aberrant jaw-phonatory coordination of the stuttering participants suggests that stuttering is associated with an oral proprioceptive limitation, although, the findings are also consistent with a motor control deficit. LEARNING OUTCOMES: As a result of this activity, reader will (1) learn about a hypothesis and evidence supporting the view that a sensorimotor deficit contributes to chronic developmental stuttering and (2) will obtain information about the role of proprioception in multi-articulatory coordination and how it can be tested using an oral-phonatory coordination task.     

Bite-block perturbation in people who stutter: immediate compensatory and delayed adaptive processes

This exploratory study investigated sensory-motor mechanisms in five people who stutter (PWS) and five people who do not (PNS). Lip kinematic and coordination data were recorded as they produced bi-syllabic nonwords at two rates (normal and fast) in three conditions (jaw-free, immediately after insertion of a bite-block, and after a 10-min accommodation period). At normal speech rates, effects of bite-blocks on lip kinematics were similar for both PWS and PNS speakers showing larger amplitudes, peak velocities, shorter durations and more stable movement cycle patterns. However, at fast speech rates upper lip responses of PWS exhibited larger amplitudes and peak velocities. At both speech rates, the presence of a bite-block changed movement coordination patterns only for PNS. However, at fast speech rates bite-blocks decreased variability of coordination patterns for both groups. No adaptive changes in movement stability were found for either group, but a practice-related increase in lower lip peak velocity was found at normal speech rates. These findings indicate that bite-block perturbation did not exacerbate any hypothesized limitation or difficulty in controlling individual articulatory movements or their coordination in PWS. The results also support the position that specific motor control strategies are used by PWS as compared to PNS to compensate for bite-block perturbations under increased speech rate demands.

Learning outcomes: The reader will be able to: (1) distinguish between compensatory and adaptive responses to bite-block perturbation; (2) explain the measurement of articulatory stability; (3) summarize the potential role of motor control strategies in people who stutter; and (4) discuss the assumptions of the motor skills approach to stuttering.     

Wood smoke inhalation increases pulmonary microvascular permeability

The effect of wood smoke inhalation (SI) on pulmonary vascular permeability was studied in open-chested, anesthetized dogs. Animals were divided into two groups. A prenodal lymphatic vessel was cannulated in group I (n = 7), and baseline (BL) lung lymph flow (QL) and lymph (CL) and plasma (CP) protein concentrations were measured. The animals' lungs were then ventilated with wood smoke for 5 minutes. Left atrial pressure (Pla) was increased above baseline (mean 16.7 +/- 2.2 mm Hg), and the ratio of CL to CP was used to assess endothelial permeability at high lymph flows. There was little change in either QL (BL: 27 +/- 9; SI: 27 +/- 5 microliters/min) or CL/CP (BL: 0.76 +/- 0.03; SI: 0.74 +/- 0.02) after SI at normal Pla. Elevation of Pla caused a significant increase in QL (136 +/- 15 microliters/min), but CL/CP (0.67 +/- 0.02) failed to decrease significantly at high lymph flows. In group II (n = 15) total protein concentration of airway fluid was compared with that of plasma after smoke inhalation, intravenous alloxan, and increased Pla. The ratio of protein concentration in airway fluid to plasma after SI (0.70 +/- 0.07) was greater than that obtained with increased Pla (0.64 +/- 0.07) but less than that after alloxan (0.85 +/- 0.04). These data indicate that SI in the dog results in a moderate increase in pulmonary vascular permeability that is less severe than that induced by alloxan.