Relationship between stuttering severity in children and their mothers speaking rate.

CONTEXT AND OBJECTIVE: Stuttering is a complex disease that influences occupational, social, academic and emotional achievements. The aim of this study was to correlate the stuttering severity index with speaking rates of mothers and children. DESIGN AND SETTING: Cross-sectional study, at the child rehabilitation clinics of Tehran city. METHODS: 35 pairs of mothers and their children who stuttered were studied. There were 29 boys and six girls, of mean age 8.5 years (range: 5.1-12.0). Speech samples from the mother-child pairs were audiotaped for approximately 15 minutes, until a reciprocal verbal interaction had been obtained. This sample was then analyzed in accordance with a stuttering severity index test and speaking rate parameters. RESULTS: The research results outlined a significant relationship between the mothers speaking rate and their childrens stuttering severity. CONCLUSION: The results suggest that the mothers speaking rate should be incorporated in the assessment and treatment of stuttering.     

Chronische sakrale bilaterale Neuromodulation Einsatz einer minimalinvasiven Implantationstechnik bei Patienten mit Blasenfunktionsstörungen

The implantable neuromodulation system described by Tanagho and Schmidt enables unilateral sacral nerve stimulation. Reports have been made on sacral neuromodulation failures of up to 50% in patients undergoing this procedure. We chose the bilateral electrode implantation and a minimal invasive laminectomy to ensure a more effective modulation and better placement and fixation of the electrodes. After successful assessment using a peripheral nerve evaluation test, 20 patients (14 with detrusor instability, 6 with hypocontractile detrusor) underwent minimally invasive laminectomy and bilateral electrode placement. In the patients with detrusor instability, the incontinence episodes were reduced from 7.2 to 1 per day and the bladder capacity improved from 198 to 352 ml. In patients with hypocontractile detrusor, the initial residual urine level of 450 ml dropped to 108 ml. Maximum detrusor pressure during micturition rose from 12 cmH2O initially to 34 cmH2O. The average follow up period was 17.5 months. There was no sign of deterioration in the modulation effect in any of the patients. Bilateral electrode implantation and the new sacral approach allow optimal neuromodulation in patients with bladder dysfunction. Laminectomy enables optimum electrode placement and fixation with minimal trauma.     

Selective block of urethral sphincter contraction using a modified Brindley electrode in sacral anterior root stimulation of the dog

AIMS: Patients with spinal cord injury often present with dysfunction of urinary bladder and urethral sphincter. One treatment option is sacral rhizotomy and sacral anterior root stimulation with the Finetech Brindley stimulator. However, a major disadvantage is the lack of selective stimulation, resulting in simultaneous contraction of sphincter and bladder followed by unphysiological micturition. This study investigated the possibility of selective bladder stimulation by using a Brindley electrode. METHODS: In 11 male anaesthetized foxhounds, a complete posterior rhizotomy was perormed. The anterior S2 roots were stimulated with different quasi-trapezoidal (QT) pulses (pulse length range, 600-1,400 microsec; stimulation current, 0.1-2.0 mA; frequency, 20 Hz) by using a tripolar Brindley electrode. Sphincter and bladder pressures were measured urodynamically. RESULTS: All 11 animals showed a maximal reduction of the highest sphincter pressure over 80%, and in 6 of 11 trials, the sphincter pressure was inhibited completely (100%). With stimulations at maximal sphincter blockade, the average achievable bladder pressure was 33.48 cm H(2)O higher than the average sphincter pressure, and in three cases, a strong micturition was observed. Selective blockade of the sphincter was possible by applying QT pulses. The bladders remained uninfluenced by this blockade and kept their excitability at any time. CONCLUSIONS: This study shows that selective bladder stimulation with little or no coactivation of the sphincter is possible. A physiological micturition can be achieved by using a tripolar Brindley electrode. Introduction of this stimulation technique into clinical practice should not face major difficulties, considering that the device is an established electrode.     

Altered zincergic innervation of the developing primary somatosensory cortex in monoamine oxidase-A knockout mice

Genetic inactivation of monoamine oxidase-A (MAO-A) significantly elevates levels of serotonin (5-HT) during early development and causes a disruption in the compartmented organization of thalamocortical axon terminals in layer 4 of the somatosensory cortex. In order to determine whether corticocortical innervation of the primary somatosensory cortex is also affected by this mutation, we examined the distribution of zinc-containing axon terminals (terminals known to originate from within the cortex) in the developing somatosensory cortex of MAO-A knockout mice, at postnatal days (PD) 3, 5, 6, 8, 10, 12, 15, 28, and 60. In layer 4 of wild-type mice, histochemical staining for zinc respected barrel-specific compartments at all ages beyond PD 5. By contrast, zinc staining in MAO-A knockout mice did not exhibit signs of barrel compartmentation at any age. Across cortical layers, substantial developmental changes in the distribution of zinc-containing terminals were observed in wild-type mice up until PD 12, at which time the mature lamina-specific pattern of zinc staining was achieved. Similar changes were observed in the somatosensory cortex of MAO-A knockout mice, except that its developmental time course was significantly compressed, with zincergic innervation achieving a mature appearance by PD 8. These results provide evidence that an excess of monoamines, most likely 5-HT, dramatically perturbs the columnar organization of intracortical zincergic afferents in layer 4 and significantly accelerates the appearance of a mature laminar pattern of zinc-containing corticocortical terminals.     

Altered regulation of the 5-HT system in the brain of MAO-A knock-out mice

Genetic deficiency of monoamine oxidase-A (MAO-A) induces major alterations of mood and behaviour in human. Because serotonin (5-HT) is involved in mood regulation, and MAO-A is responsible for the catabolism of 5-HT, we investigated 5-HT mechanisms in knock-out mice (2-month-old) lacking MAO-A, using microdialysis, electrophysiological, autoradiographic and molecular biology approaches. Compared to paired wild-type mice, basal extracellular 5-HT levels were increased in ventral hippocampus (+202%), frontal cortex (+96%) and dorsal raphe nucleus (DRN, +147%) of MAO-A mutant mice. Conversely, spontaneous firing rate of 5-HT neurons in the DRN (recorded under chloral hydrate anaesthesia) was approximately 40% lower in mutants. Acute 5-HT reuptake blockade by citalopram (0.2 and 0.8 mg/kg i.v.) produced a much larger increase in extracellular 5-HT levels (by approximately 4 fold) and decrease in DRN neuronal firing (with a approximately 4.5 fold decrease in the drug's ED50) in MAO-A knock-out mice, which expressed lower levels of the 5-HT transporter throughout the brain (-13 to -34% compared to wild-type levels). The potency of the 5-HT1A agonist 8-OH-DPAT to produce hypothermia and to reduce the firing of DRN serotoninergic neurons was significantly less in the mutants, indicating a desensitization of 5-HT1A autoreceptors. This was associated with a decreased autoradiographic labelling of these receptors (-27%) in the DRN. Altogether, these data indicate that, in MAO-A knock-out mice, the enhancement of extracellular 5-HT levels induces a down-regulation of the 5-HT transporter, and a desensitization of 5-HT1A autoreceptors which allows the maintenance of tonic activity of 5-HT neurons in the DRN.     

Adult experience-dependent plasticity of S1 barrel cortex in the normal and monoamine oxidase-A knockout (Tg8) mouse

By restricted use of D2 and D3 whiskers for 3-20 days at maturity (whisker pairing, WP), receptive field plasticity of adult D2 barrel cortex cells was compared in vivo for Tg8 mutant and normal (NOR) mice. Little plasticity was achieved until 20 days of WP in both mice. For Tg8, which lacks segregation of thalamocortical (TC) terminals into barrels, the first relay (TC) responses in layer IV to the principal whisker were potentiated more than in NOR mice by 20 days of WP. In parallel, secondary discharges were reduced more in Tg8 than NOR. It is suggested that both TC excitation and feed-forward inhibition in Tg8 are greater and potentiated more by WP than in NOR mice. Similar differences were reflected in supragranular (SG) cells. For Tg8 but not NOR mice, first latencies of one in five cells in layer IV to an adjacent surround whisker matched those of the principal whisker, increasing to one in three by 20 days of WP experience. Converse decreases occurred for the deprived surround whisker. Changes were similar but smaller for SG cells. Lack of TC segregation in Tg8, therefore, allows substantial overlapping TC terminals of immediate surround whiskers to activate neighbouring D2 column cells directly with potentiated relay to a whisker paired input and weakened relay to a deprived input. Although differing from NOR mice, experiential plasticity was not strongly compromised in Tg8 mice. Differences in WP plasticity from rat barrel cortex are discussed.     

The prevalence of obsessive compulsive symptoms in a sample of Egyptian psychiatric patients

Obsessions can occur in many psychiatric disorders or they may constitute the entire illness, which is then referred to as an obsessional state (Rees, 1993). The relationship of obsessive compulsive symptoms (OCS) to different psychiatric disorders is still controversial. This work was undertaken to study the co-occurrence and phenomenology of OCS with other psychiatric disorders. We examined a sample of 372 psychiatric outpatients using the arabic version of Yale Brown obsessive-compulsive symptom (Y-BOCS) checklist and compared them with a control group composed of 308 non-psychiatric subjects. Subjects were additionally assessed by means of the obsession symptom section of the PSE (10th) edition for trait rating, the arabic version of the Eysenck rigidity scale and the arabic version of the religious orientation scale. OCS were found to be significantly higher in the different psychiatric categories than in the non-psychiatric categories; 83% of patients with neurotic, stress related and somatoform disorders, 51% of patients with mood disorders and 47% of patients with schizophrenia, schizotypal and delusional disorders were found to have OCS in their symptomatology. Furthermore, the data suggest that OCS in psychiatric patients have a distinct phenomenology from that in non-psychiatric subjects. The results did not however reveal a relationship between OCS and either rigidity or religious orientation.     

Prolapschirurgie

Zusammenfassung Zysto-/Rektozelen und prolapschirurgische Eingriffe gewinnen innerhalb der urogynäkologischen Operationslehre zunehmend an Bedeutung. Das Risiko für einen prolapschirurgischen Eingriff bei der Frau liegt heute bei ca. 11%, in einem Drittel der Fälle handelt es sich um eine Rezidivoperation. Dabei treten 3 mögliche Operationsverfahren in Konkurrenz zueinander: 1. der transvaginale Zugang mit einer Vaginae fixatio sacrospinalis vaginalis oder sacrotuberalis, 2. die transabdominale, offen-chirurgisch durchgeführte Sakrokolpopexie und 3. die transabdominale, laparoskopisch durchgeführte Sakrokolpopexie.Über eine Internetrecherche der letzten 10 Jahre, einschließlich 1995, wurden Effizienz, Rezidiv- und Komplikationsraten der abdominalen Sakrokolpopexie überprüft und mit den Ergebnissen des transvaginalen bzw. laparoskopischen Zugangsweges verglichen.Die Analyse der gesammelten Daten zeigt, dass randomisierte, prospektive Studien zu den unterschiedlichen Operationsverfahren fehlen und dringend durchgeführt werden müssen, um Effektivität, Dauerhaftigkeit und Komplikationsraten exakt bewerten zu können.