Evaluation of palatal prosthesis for the treatment of velopharyngeal dysfunction

Some patients presenting velopharyngeal dysfunction need treatment with a palatal prosthesis, and few researches attempt to evaluate the judgement of its efficacy. For that reason, a questionnaire was submitted to 48 patients with a palatal prosthesis, with ages from 8 to 74 (mean 31.47), from which 42 had a congenital cleft, 2 exhibited an acquired cleft and 4 presented total or partial palsy of the soft palate. Results reveled that 81.2% of these patients were able to eat while using their prostheses; 85.4% stated their speech had improved with the prostheses; 75% considered the prosthesis stable during nourishment, and 91.7% during speech; 79.2% felt comfortable using the prosthesis; and 85.4% related a general improvement in life quality with the prosthetic treatment of velopharyngeal dysfunction. It was concluded that the prosthetic treatment of velopharyngeal dysfunction demonstrated efficacy in improving speech, despite of the heterogeneous sample. Besides, it offered the other basic requirements of a prosthesis whenever it was needed.     

Joy at work!: creating a positive workplace

How can we regain a sense of joy through our work? Many nurses feel disconnected from their organizations, morale is plummeting, and employee mistrust and cynicism are growing. Reversing these trends is crucial in the face of current and future labor shortages. The author shares recent information on healthcare workers who experience joy through their work with implications for today's nurse leaders.     

Contact endoscopy for intraoperative parathyroid identification

Experienced thyroid surgeons are often able to identify the parathyroid glands, but sometimes it is difficult to differentiate them from other contiguous tissues. Contact endoscopy was introduced in otolaryngology for the characterization of normal and pathological epithelia. Our objective was to analyze contact endoscopy as an auxiliary method for identification of the parathyroid glands during thyroid surgery. Five total thyroidectomies and 5 hemithyroidectomies were performed in September 2001. After surgical exposure, contact endoscopy was performed. A total of 15 peritracheal regions were studied. Superior and inferior parathyroid tissues were identified on the basis of color, size, and probable location. Contact endoscopy was performed before and after use of methylene blue stain. Contact endoscopy was also used in neighboring areas. We compared the visual impression to the contact endoscopy findings. Two structures were visually supposed to be the superior and inferior parathyroid glands in each case. From 30 visually supposed glands, 25 were confirmed by telescope. Of the other 5 structures initially supposed to be parathyroid tissue, 3 were adipose tissue and 2 were thyroid parenchyma. In the 5 cases in which the identification of one of the glands was not confirmed, an additional contact examination enabled us to further identify parathyroid glands in 3 cases in which structures were initially identified as adipose tissue. Contact endoscopy is an efficient auxiliary method for the identification of the parathyroid glands during thyroid surgery that poses little risk of morbidity to the patient.     

Glycosaminoglycan profile in bladder and urethra of castrated rats treated with estrogen, progestogen, and raloxifene

OBJECTIVE: This study was undertaken to evaluate the action of conjugated equine estrogens alone, medroxyprogesterone, the combination of these estrogens with progestogens, and of raloxifene on the glycosaminoglycan profile in the bladder and urethra of adult oophorectomized rats in comparison with noncastrated rats. STUDY DESIGN: Sixty adult rats, of which 50 were submitted to bilateral oophorectomy, were studied. After 4 days, the latter were assigned to five groups of 10 animals each. For 30 consecutive days the following treatments were given: group 1, conjugated equine estrogens; group 2, conjugated equine estrogens combined with medroxyprogesterone acetate; group 3, medroxyprogesterone; group 4, raloxifene; and group 5, placebo. Thereafter the bladders and urethras of the animals were removed, processed to yield a dry powder of which the sulfated glycosaminoglycan content was determined by densitometry after agarose gel electrophoresis and that of hyaluronic acid by a fluorimetric assay. RESULTS: Glycosaminoglycans found in the bladder and urethra were dermatan sulfate, heparan sulfate, and hyaluronic acid. In the bladder, hypoestrogenism or replacement with estrogens led to a lower sulfated glycosaminoglycan content. Replacement with estrogens and/or medroxyprogesterone reverted this effect. Hypoestrogenism decreased the dermatan sulfate/heparan sulfate ratio and reduced hyaluronic acid content. Estrogen therapy reverted this alteration and medroxyprogesterone addition annulled the estrogenic effect. In the urethra, castration did not alter hyaluronic acid content and sulfated glycosaminoglycan content, but raloxifene decreased the latter. CONCLUSION: Castrated rats had a decrease in sulfated glycosaminoglycans and hyaluronic acid content in the bladder. Hormonal replacement altered the quantity and quality of glycosaminoglycans. In the urethra, raloxifene reduced sulfated glycosaminoglycans.     

Diffusion imaging may predict reversible brain lesions in eclampsia and severe preeclampsia: initial experience

OBJECTIVE: The purpose of this study was to validate diffusion-weighted magnetic resonance imaging in the prediction of the evolutive course of brain edema and to establish its pathophysiologic presence in patients with eclampsia/severe preeclampsia. STUDY DESIGN: Seventeen patients with a clinical diagnosis of severe eclampsia/preeclampsia and T2 hyperintense brain lesions on routine magnetic resonance imaging were evaluated at hospital admission and 8 weeks later. RESULTS: Brain edema was reversible in 13 patients and irreversible in 4 patients, as indicated on follow-up magnetic resonance imaging. Sixteen of 17 patients were differentiated accurately into reversible and irreversible groups on the basis of diffusion imaging on hospital admission. Diffusion-weighted magnetic resonance imaging demonstrated a significant increase in water mobility in abnormal regions compared with normal-appearing brains in patients in the reversible group (1.34+/-0.10 mm(2) vs 0.79+/-0.08 mm(2)/s x 10(-3), P<.001). In the irreversible group, restricted water diffusion was present, which was consistent with cytotoxic edema and early brain infarction in 3 of 4 patients. CONCLUSION: Diffusion-weighted magnetic resonance imaging can predict successfully the evolutive course of brain edema in an acute setting in these patients. Our findings indicate that brain edema is vasogenic, although ischemic/cytotoxic edema was observed less commonly.     

Coordination of early antral follicles by luteal estradiol administration provides a basis for alternative controlled ovarian hyperstimulation regimens

OBJECTIVE: To investigate whether luteal E(2) administration reduces size discrepancies of early antral follicles. DESIGN: Prospective, crossover study. SETTING: ART unit, Clamart, France. PATIENT(S): Sixty women and 120 cycles. INTERVENTION(S): On cycle day 3 (baseline day 3), all women underwent measurements of early antral follicles by ultrasound and serum FSH and ovarian hormones. From day 20 until the next cycle day 2, 30 of them received oral 17beta-E(2), whereas the remaining women served as controls. The day after E(2) discontinuation (E(2) day 3) or on subsequent cycle day 3 (control day 3), participants were reevaluated as on baseline day 3. MAIN OUTCOME MEASURE(S): Magnitude of follicular size discrepancies. RESULT(S): Follicular size discrepancies and follicular diameters were significantly attenuated on E(2) day 3 (3.7 +/- 0.5 mm) as compared with baseline day 3 (4.9 +/- 1.0 mm), but not in controls (5.0 +/- 0.8 vs. 4.9 +/- 0.8 mm). FSH (4.3 +/- 1.9 vs. 7.3 +/- 3.3 mIU/mL) and inhibin B (34 +/- 28 vs. 71 +/- 32 pg/mL) levels were consistently lower on E(2) day 3 than on baseline day 3 but remained unchanged in controls. CONCLUSION(S): Luteal E(2) administration reduces the size and improves the homogeneity of early antral follicles on day 3. This approach may be instrumental in synchronizing follicular development during controlled ovarian hyperstimulation.     

Role of follicle-stimulating hormone receptor Ser680Asn polymorphism in the efficacy of follicle-stimulating hormone

OBJECTIVE: To evaluate the association between FSH efficacy and FSHR alleles. DESIGN: Retrospective study. SETTING: University-based fertility unit and a private center for biomedical research. PATIENT(S): One hundred two women with ovarian function who were undergoing controlled ovarian stimulation (COS). Women were categorized as poor responders (< or =3 ovarian follicles at the end of the cycle) or normal responders (>3 follicles). INTERVENTION(S): Daily administration of exogenous FSH. MAIN OUTCOME MEASURE(S): Number of good or poor responders. RESULT(S): The allele frequency and genotype distribution of the Ser680Asn marker differed significantly between groups. Cycle cancellations were increased (21%) among women who were homozygous for Ser680 compared with Ser/Asn and Asn/Asn patients, and 36% of poor-responders were homozygous for Ser680. CONCLUSION(S): The results support a role for FSHR gene in COS outcome. However, the weight of this factor is probably low. The Ser680 allele may act in concert with other environmental and genetic factors that contribute to FSH efficacy.     

Three-wall decompression technique using transpalpebral and endonasal approach in patients with Graves' ophthalmopathy

PURPOSE: To evaluate the effects of the three-wall decompression technique using transpalpebral and endonasal approach in patients suffering from Graves' ophthalmopathy. METHODS: In this prospective study, we present a consecutive series of 15 subjects (17 eyes) who were submitted to orbital decompression by removing the inferior and lateral walls using transpalpebral incision combined with a transnasal endoscopic resection of the medial wall. The surgical technique involved the preservation of the bone structure between the lamina papyracea of the ethmoid and the maxillary orbital floor. MAIN RESULTS: The mean ocular recession based on Hertel measurements was 6.00 mm (range, 4-9 mm). None of the patients presented pre-operation diplopia, and one developed post-operation diplopia. Visual acuity was preserved in all cases. CONCLUSION: It is safe and efficient to perform three-wall decompression, combining transpalpebral and endoscopic transnasal approach, with preservation of the bone structure and the bone lateral to the infraorbital canal with fixation by two titanium plates on the lateral edge and removal of intraorbital fat, which results in significant proptosis reduction and minimal complications.