Combining treatment for written and spoken naming.

Individuals with left-hemisphere damage often have concomitant impairment of spoken and written language. Whereas some treatment studies have shown that reading paired with spoken naming can benefit both language modalities, little systematic research has been directed toward the treatment of spelling combined with spoken naming. The purpose of this study was to examine the therapeutic effect of pairing a lexical spelling treatment referred to as Copy and Recall Treatment (CART) with verbal repetition of target words. This approach (CART + Repetition) was compared with treatment using verbal repetition without the inclusion of orthographic training (Repetition Only). Two individuals with moderate aphasia and severe impairment of spelling participated in the study using a multiple baseline design across stimulus sets and treatment conditions. Both participants improved spelling of targeted words as well as spoken naming of those items, but improvement in spoken naming was marked for one individual in the CART + Repetition condition, while the other participant made smaller gains in spoken than written naming irrespective of treatment condition. Consideration of the participant profiles suggested that CART + Repetition provides greater benefit when there is some residual phonological ability and the treatment serves to stimulate links between orthography and phonology.     

Ventricular peritoneal shunt malfunction after operative correction of scoliosis: report of three cases

Background contextTwo of the most common disease processes associated with hydrocephalus in children are spina bifida and intraventricular hemorrhage of prematurity, both of which are known to be also associated with spinal deformity in later childhood. The occurrence of shunt malfunction after mechanical injury or stress to the hardware has been well documented. Newer techniques in the treatment of neuromuscular scoliosis, including anterior release with segmental fixation, have resulted in more powerful corrections of these large spinal deformities. A new potential cause of shunt malfunction is the aggressive correction of scoliosis.PurposeTo report patients with neuromuscular curves averaging 100° who were subsequently recognized to have perioperative shunt malfunction.Study designThree case studies from a university hospital setting were included.Patient sampleAll three children were young adolescents and had-long term shunts. Two of the children had spina bifida and a third had cerebral palsy. All children underwent anterior release of their scoliosis with posterior segmental instrumentation, with unit rods and sublaminar wires. All had significant correction of their scoliosis.Outcome measuresMalfunctioning of the ventriculoperitoneal shunts were recorded.MethodsChart reviews of three cases were analyzed.ResultsTwo children had shunt malfunctions within a month of their surgery, and one child had intraoperative recognition and externalization of the shunt.ConclusionsOlder children undergoing repair of neuromuscular scoliosis are often preadolescents or adolescents who have the same indwelling shunt systems originally implanted in early infancy. The shunt may be brittle and calcified, and the peritoneal catheter may be short. The correction of scoliosis often results in an almost instantaneous growth of a few inches. Because of the potential difficulty in recognizing shunt malfunction in the perioperative period, consideration should be given for elective revision of the peritoneal catheter in children at risk.     

A model of pulsations in communicating hydrocephalus

The traditional theory of communicating hydrocephalus has implicated the bulk flow component of CSF motion; that is, hydrocephalus is generally understood as an imbalance between CSF formation and absorption. The theory that the cause of communicating hydrocephalus is malabsorption of CSF at the arachnoid villi is not substantiated by experimental evidence or by physical reasoning. Flow-sensitive MRI has shown that nearly all CSF motion is pulsatile, and there is substantial evidence that hyperdynamic choroid plexus pulsations are necessary and sufficient for ventricular dilation in communicating hydrocephalus. We have developed a model of intracranial pulsations based on the analogy between the pulsatile motion of electrons in an electrical circuit and the pulsatile motion of blood and CSF in the cranium. Increased impedance to the flow of CSF pulsations in the subarachnoid space redistributes the flow of pulsations into the ventricular CSF and into the capillary and venous circulation. The salient features of communicating hydrocephalus, such as ventricular dilation, intracranial pressure waves, narrowing of the CSF-venous pressure gradient, diminished cerebral blood flow, elevated resistive index and malabsorption of CSF, emerge naturally from the model. We propose that communicating hydrocephalus is the result of a redistribution of CSF pulsations in the cranium.     

Changes in cAMP phosphodiesterase activity during oral mucosal regeneration

Preliminary studies (Lineweaver-Burk, Ca²⁺ calmodulin sensitivity) suggest that oral mucosa contains at least two cyclic AMP phosphodiesterases, one a high affinity (low Km) enzyme and the other a low affinity (high Km) enzyme. Analysis of the distribution of both enzymatic forms during oral mucosal regeneration revealed that the low Km, and high Km cAMP phosphodiesterase activities were significantly elevated prior to the first wave of cAMP accumulation and during the second cAMP wave. Although the cAMP peaks declined between 20–24 h, both cAMP phosphodiesterases remained significantly elevated at the wound site. The apparent Km of the low Km form increased from 5.3 to 7.5 uM, while that of the high Km form remained essentially unaltered 20 h after wounding. The low Km, and high Km cAMP phosphodiesterase activities in normal rat oral mucosa were not affected by epinephrine or insulin; were slightly inhibited by glucagon, and significantly inhibited by methylprednisolone. Imidazole and histamine activated both forms and theophylline was inhibitory to the enzyme. The high Km cAMP phosphodiesterase was sensitive, and the low Km form insensitive to Ca²⁺ calmodulin stimulation.     

Effects of pH and cyclic adenosine monophosphate on ileal electrolyte transport in the rat and rabbit.

Alterations in extracellular pH cause reciprocal changes in NaCl absorption in the rat and rabbit ileum. The presence of cholera toxin-induced secretion does not affect pH action measured by in vivo perfusion of the rat ileum. We examined the interaction of pH and cyclic adenosine monophosphate-induced secretion in the rabbit ileum. We found that alterations in arterial pH did not affect ileal absorption in the rabbit in the presence of cholera toxin-induced secretion. This was true whether transport was studied during in vivo ileal perfusion of anesthetized rabbits or by measuring Na+ and Cl- fluxes across isolated, short-circuited tissues in the Ussing chamber. The effects of pH also were blocked when normal rabbit ileum was exposed to 1 mmol/L dibutyryl cyclic adenosine monophosphate in vitro. By contrast, alterations in bathing solution pH affected ileal absorption in the rat in the presence and absence of cyclic adenosine monophosphate. Similarly, exposure to cyclic adenosine monophosphate did not affect the response of the rat colon to PCO2. These findings suggest that the apparently independent effects of pH and cyclic adenosine monophosphate in the rat ileum are not universal. In tissues such as the rabbit ileum, the mechanisms of pH and cyclic adenosine monophosphate action may have biochemical or physiological pathways in common.     

Changes in cAMP phosphodiesterase activity during oral mucosal regeneration

Preliminary studies (Lineweaver-Burk, Ca2+ calmodulin sensitivity) suggest that oral mucosa contains at least two cyclic AMP phosphodiesterases, one a high affinity (low Km) enzyme and the other a low affinity (high Km) enzyme. Analysis of the distribution of both enzymatic forms during oral mucosal regeneration revealed that the low Km, and high Km cAMP phosphodiesterase activities were significantly elevated prior to the first wave of cAMP accumulation and during the second cAMP wave. Although the cAMP peaks declined between 20-24 h, both cAMP phosphodiesterases remained significantly elevated at the wound site. The apparent Km of the low Km form increased from 5.3 to 7.5 microM, while that of the high Km form remained essentially unaltered 20 h after wounding. The low Km, and high Km cAMP phosphodiesterase activities in normal rat oral mucosa were not affected by epinephrine or insulin; were slightly inhibited by glucagon, and significantly inhibited by methylprednisolone. Imidazole and histamine activated both forms and theophylline was inhibitory to the enzyme. The high Km cAMP phosphodiesterase was sensitive, and the low Km form insensitive to Ca2+ calmodulin stimulation.     

Methylprednisolone effects upon cytochrome oxidase activity during gingival wound healing in rats

Methylprednisolone injected intraperitoneally in rats (pharmacological doses) during a short time (1–2 days) interval activated gingival cytochrome oxidase activity at drug treated sham, and drug treated wound and distal (contralateral) non-injured sites. Gingival cytochrome oxidase was activated in drug treated sham and injured gingiva between the 5th and 7th days after drug (2 doses) initiation. Enzymatic activities in both groups declined between the 7th and 10th days toward control levels. An increase in enzymatic activity occurred within 1 day at the distal (non-injured) contralateral site in animals which received only one dose of methylprednisolone. The enzymatic activity declined between the 1st and 2nd day to control values and remained at that level for the duration of the experiment.     

Effect of inflammation upon human gingival oxidative metabolism

Cytochrome oxidase and NADH cytochrome c reductase activities were analyzed biochemically in gingival biopsy specimens obtained from 22 male patients (age 23–72) undergoing periodontal treatment. Histologically, 13 specimens exhibited mild inflammation, while 9 showed more severe inflammatory responses. Cytochrome oxidase activity was significantly greater in the mildly inflamed than in markedly inflamed tissue samples. NADH cytochrome c reductase activity on the other hand was not significantly altered by the increasing degree of inflammation. The possible implication of the effect of inflammation upon oxidative enzymes is discussed in relationto degenerative and proliferative changes occurring in both types of tissue.