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Biomedical subjects

U Hoppe

Publications and source records attributed to U Hoppe.

At least 19 recordsLinked to original sources
PubMed2006

Tissue-specific transcription profiles of sex steroid biosynthesis enzymes and the androgen receptor.

17beta-hydroxysteroid dehydrogenase (17beta-HSD) and 5alpha-reductase isoenzymes play a crucial role in the formation and metabolism of sex steroids. Not only the key androgens testosterone and dihydrotestosterone but also their precursors are potent activators of the androgen receptor and are, therefore, likely to act as determinants of male sexual differentiation and maturation in a differentially regulated way. The aim of the present study was to relatively quantify the expression of the mRNA of 17beta-HSD isoenzymes, namely, type 1, 2, 3, 4, 5, 7, and 10, together with the 5alpha-reductase type 1 and 2, and the androgen receptor in normal human males and females. RNA was isolated from peripheral blood cells of both sexes and from genital skin fibroblasts (GSFs) of two different localizations (foreskin and scrotal skin) obtained from phenotypically normal males. mRNA expression was semi-quantified by quantitative reverse-transcriptase polymerase chain reaction with the LightCycler Instrument (Roche). The examined enzymes show statistically significant differences in their transcription pattern between the blood and the GSF RNA samples. Within the GSF samples, there are also significant variations between the two examined localizations in the transcription of 17beta-HSD type 1, 2, 4, and 5 as well as for the androgen receptor. We found large interindividual variation of enzyme transcription patterns in all investigated tissues. In peripheral blood cells, no sex-specific differences were seen. We conclude that sex steroid enzymes are expressed not only in genital primary target tissues but also in peripheral blood. The expression in different target tissues may contribute to both the individual sexual and tissue-specific phenotype in humans.

17-Hydroxysteroid Dehydrogenases↗
PubMed2006

[Voice Handicap Index (VHI) in inpatient voice rehabilitation medicine].

BACKGROUND: The focus of this study was to determine if the Voice Handicap Index (VHI) is a valid tool for evaluating an inpatient voice rehabilitation program. PATIENTS AND METHODS: A total of 39 German-speaking patients were asked to complete a German version of the VHI questionnaire at the beginning and 3 months after attending a voice rehabilitation program on an inpatient basis at the Bad Gögging voice center. The data collected were documented and assessed using Microsoft Excel and MATLAB. RESULTS: A significant reduction of the VHI summary score was achieved by 10 of 39 patients. An increased number of voice therapy sessions before the program diminished (!) the VHI score 3 months after the program. Work disability because of the dysphonia before the beginning of the voice rehabilitation program showed no significant correlation with the VHI score. CONCLUSIONS: At present, the VHI cannot be regarded as a reliable measure to evaluate benefit derived from completing a voice rehabilitation program on an inpatient basis. Apparently, numerous prior treatment regimens constitute a negative prognostic criterion for rehabilitation success as measured subjectively by the VHI.

Adult↗
PubMed2006

[Subjective aspects in mothers of speech impaired children].

OBJECTIVE: The purpose of this study was to evaluate the subjective burden in mothers of speech impaired children against the presence or absence of emotional disorders such as anxiety and depression. METHODS: A total of 89 mothers (age 33.3+/-5.5 years, range: 19.6-43.8 years) of 89 speech impaired preschool children (23 girls, 66 boys, age: 3.9+/-1.5 years, range: 1.6-7.1 years) were examined. Screening for a depressive or anxiety disorder was performed using the German version of the Hospital Anxiety and Depression Scale HADS-D. The "Short Questionnaire on Current Burden" (Kurzfragebogen zur Aktuellen Belastung, KAB) was used to measure the level of perceived subjective burden at the time of the investigation. RESULTS: A higher score in the KAB test occurred significantly more often in mothers with a positive HADS depression/anxiety subscale result than in those with a negative one. CONCLUSIONS: There is a need for specific assessment of wellbeing in mothers of speech impaired children. In clinical practice, one may restrict oneself to the use of a screening test for anxiety and depression.

Adult↗
PubMed2005

Molecular features and clinical phenotypes in androgen insensitivity syndrome in the absence and presence of androgen receptor gene mutations.

Androgen insensitivity syndrome (AIS) is characterized by deficient or absent virilization in 46,XY individuals despite normal or even elevated androgen levels. AIS is usually caused by mutations in the androgen receptor (AR) gene. We aimed at contrasting clinical, biochemical, and molecular genetic characteristics of three patients (P1-P3) with clinically evident partial (P1) and complete (P2, P3) AIS with and without AR gene mutations. AR expression was studied in cultured genital skin fibroblasts (GSF) by Western immunoblotting, ligand binding analyses, Northern blotting, semiquantitative reverse transcription-polymerase chain reaction (RT-PCR), and RT-PCR spanning exons 1-8. AR gene DNA sequence was analyzed by single-strand conformation analysis (SSCA), and DNA sequencing. GSF revealed reduced (P1) or absent (P2, P3) ligand binding. Northern blots showed either slightly reduced hybridization of the 10.5-kb AR transcript (P3) or no hybridization (P1, P2), as confirmed by semiquantitative RT-PCR. RT-PCR spanning exons 1-8 detected single AR mRNA bands in P1-P3 excluding splicing errors. Western analyses showed either low (P1) or no (P2, P3) AR protein. While SSCA initially did not reveal any molecular abnormality, sequencing showed a novel CAG (Gln) to TAG (stop) mutation at codon 59 (P3) and a previously described 2-bp deletion at codon 472, leading to a frameshift and premature stop in codon 499 (P2). Intriguingly, P1 showed an unaltered DNA sequence of the coding region of the AR gene including all intron-exon boundaries. In conclusion, patients with clinically evident complete AIS are likely to harbor an AR gene mutation, demanding that the two polymorphic regions must always be included in molecular analyses of the AR gene. Moreover, our data support the concept that in a subset of AIS patients, particularly those with partial AIS, molecular alterations outside the coding region of the AR gene must be presumed.

Androgen-Insensitivity Syndrome↗
PubMed2005

[Physical complaints in dysphonic patients].

BACKGROUND: In previous studies, patients with benign organic and functional voice disorders were shown to suffer from physical complaints. The present study focuses on a specific nosologic classification of these disorders in the sense of diagnosing a somatoform illness. PATIENTS AND METHODS: Eighty patients (50 women, 30 men) aged 44+/-11 years (18-60), suffering from various voice disorders (functional: n=18 women, n=13 men; organic: n=32 women, n=17 men), were examined after informed consent. Physical complaints were assessed using the Giessen Complaint Questionnaire GBB-24. Age and gender matched normal controls were taken from the literature. Data were analyzed using the non parametric two-by-two four-field-test. RESULTS: The individual diagnosis of dysphonic women showed pathologic values in all subscales except limb complaints. The individual diagnosis of men showed pathologic values in the limb complaints subscale (P<0.05). When comparing functional and organic disorders, no significant difference (P>0.05) was found in neither of the gender groups. DISCUSSION AND CONCLUSIONS: Depending on gender and type of voice disorder, dysphonic patients suffer from different physical complaints. Both patients with functional and organic disorders are affected. Therefore, it does not seem justified to classify functional voice disorders as somatoform disorders.

Adolescent↗
PubMed2005

[Determination of subjective impairment in dysphonia. A methodological comparison].

OBJECTIVE: The purpose of this study was to estimate the correlation between the voice handicap index (VHI) and the voice related quality of life (VRQOL) questionnaire with respect to gender and diagnosis (functional vs organic dysphonia). MATERIALS AND METHODS: A total of 52 German speaking patients aged 48.8+/-22.0 years suffering from dysphonia of different benign etiologies (functional dysphonia: 18 women, 9 men; organic dysphonia: 13 women, 12 men) completed German versions of both the VHI and the VRQOL questionnaire without prior information on their individual diagnosis. Another 52 individuals without voice complaints served as age and sex matched controls. Complete data sets of all participants were analyzed using the Microsoft Excel and MATLAB software packages. RESULTS: The results of both questionnaires correlate at a significant level, both for total score (r=-0.9) and the subscores (r=-0.74-r=-0.84) with only slight differences when comparing women and men and patients with functional and organic voice disorders. CONCLUSIONS: Both questionnaires provide very similar results. Thus, for clinical purposes, it seems justified to restrict oneself to using only one of the questionnaires. Whenever basic information on the patients' self perception of a voice disorder is required, the VRQOL questionnaire with only ten items may be easier to handle than the VHI questionnaire with 30 items.

Disability Evaluation↗
PubMed2005

[Tactile-kinesthetic responsiveness in children with cleft lip palate].

BACKGROUND: Literature provides ample evidence that tactile-kinesthetic responsiveness is of basic importance for a normal speech development. The purpose of this study was to examine tactile-kinesthetic functions in children with cleft lip palate as they are suspected to be at risk to develop disturbances in this respect because of their anatomic defect. MATERIALS AND METHODS: Tactile-kinesthetic responsiveness was measured using the specific DEF-TK questionnaire as previously proposed by Kiese-Himmel. Twenty-seven children aged 1;3 to 7;11 years with cleft lip palate were examined. Forty-two children with an isolated speech development disorder served as age matched controls. RESULTS: The results of both the study and the control group did not differ on a statistically significant level (p > 0.05). Compared to the data taken from the test manual both groups exhibited a significant number of questionnaires which could not be analyzed because of too many unobservable (not missing!) items, yet, this number did not differ between the two groups. So a "best case" and a "worst case" were calculated but did not reveal significant differences either. CONCLUSION: Surprisingly and in contrast to the results reported in the literature the DEF-TK questionnaire exhibited methodical shortcomings with a significant number of cases in which it could not be analyzed due to too many unobservable items. So, the results obtained can only be discussed under reserve: They indicate that children with cleft lip palate do not exhibit more tactile-kinesthetic problems than children with an isolated speech development disorder and thus do not require specific therapy in this field.

Chi-Square Distribution↗
PubMed2004

[Voice handicap in patients with organic and functional dysphonia].

BACKGROUND: The goal of this study was to assess and compare voice handicap in patients with benign organic and functional dysphonia. PATIENTS AND METHODS: Voice handicap was assessed using a German version of the Voice Handicap Index. A total of 108 German speaking patients, 64 women and 44 men aged 45.3+/-15.1 years with benign organic ( n=69) or functional ( n=39) voice disorders completed the questionnaire immediately after clinical examination and without knowing their individual diagnosis. Fifty individuals without voice complaints and normal voice status, 28 women and 22 men aged 47.1+/-15.5 years, served as controls. RESULTS: Significant differences ( P<0.001) were found between all dysphonic patients and the control group. When comparing dysphonic patients according to their gender and diagnosis group (organic or functional) no significant differences were detected. CONCLUSION: It can no longer be assumed that patients with functional voice disorders over emphasize their disease. The data obtained in this study prove that there are no gender specific differences in the way a voice disorder is experienced. There are also no differences in the way patients with a different language background experience their voice handicap.

Adult↗
PubMed2003

Vocal fold vibration irregularities caused by different types of laryngeal asymmetry.

The common symptom of hoarseness is regarded to be caused by (1) turbulences and air loss due to incomplete glottic closure and (2) irregular vibrations of the vocal folds. With real time resolution, the latter can only be observed using high-speed recording techniques (> or =2,000 images/s). In this paper an actual recording method is described, called high-speed glottography (HGG), which quantifies vibration irregularities. It combines imaging and image processing techniques with a functional endoscopy of the disordered voice and delivers motion curves separately for each vocal fold. They are fitted with a computer simulation in order to identify the underlying driving parameters of the vibration. A vocal fold is assumed to vibrate as a system of two coupled oscillators ("two-mass model"). From the model fit to bilateral motion curves, the subglottal pressure, muscular tension and oscillating masses of the vocal folds can be computed with reasonable accuracy. Besides normal voices, HGG has been applied to selected clinical cases of voice disorders. Two types of irregularities have been measured: there is a frequency difference either between left and right vocal folds (horizontal asymmetry) or on one side between the ventral and dorsal third (vertical asymmetry). By modeling, both categories of irregular motion curves can be explained in detail. It is presumed that laryngeal asymmetry (either in mass or tension) causes irregular vibrations.

Adult↗
PubMed2003

[Measurement and interpretation of irregular vocal cord fold vibrations].

BACKGROUND: Irregular vibrations of the vocal folds are regarded as a main reason for the common symptom of hoarseness. With real time resolution, they can only be observed using high speed recording techniques (up to 10,000 images/s). METHOD: During the last years, we have developed a recording device and image processing software dedicated to the extraction of vocal fold motion curves from the image series. Irregular vibrations can be understood by using Hirano's "body-cover-model": one vocal fold is assumed to act as a system of two coupled oscillators (the vocal muscle and the epithelium, coupled by the connective tissue of Reinke's space). RESULTS: By applying this biomechanical two-mass model and inversely solving Bernoulli's equation, the driving parameters of the vibration were computed from the high speed image series in selected cases. These parameters, like the subglottal pressure und the bilateral tension of the vocal muscle cannot, in general, be measured directly. DISCUSSION: From the model, it can be supposed that laryngeal asymmetry (either in mass or tension) is the primary reason causing irregularity. The consequence of asymmetry in the medio-lateral direction are different fundamental frequencies on each side, while asymmetry in the anterior-posterior direction leads to ap-mode vibrations.

Diagnosis, Computer-Assisted↗
PubMed2003

[Coping strategies in laryngectomy patients].

BACKGROUND: Over the last few years, paradigms for judging the results of treatment of tumor patients have shifted. In addition to characteristics such as the complete excision of the tumor and the duration of patient survival, restoring the quality of life has become an equally important aim. There is still a lack of systematic (and sufficient) research on coping strategies as a means of dealing with malignant tumors of the head and neck. PATIENTS AND METHOD: In a cross-sectional study, 25 laryngectomees, whose voices had been successfully restored with a Provox voice prosthesis,were examined for their coping strategies and the effects of the illness on their lives. The standardized Trier Scales of Coping Strategies and a custom-made questionnaire, which helped to structure the anamnesis of disease specific functional restrictions and the state of rehabilitation, were used as the means of inquiry. RESULTS: A high percentage of patients were content despite objective and subjective restrictions. Voice replacement was mainly experienced as unproblematic,with psychosocial restraints more commonly being felt in connection with pain and difficulties ingesting food. A correlation between the patients' evaluation of physical,psychological and social experiences and the coping strategies applied could not be verified. The way laryngectomees deal with their illness does not differ from the strategies of patients suffering from malignant or chronic diseases of other organ systems. CONCLUSION: The Trier Scales of Coping Strategies is a suitable means for determining the coping strategies of laryngectomees who have been successfully rehabilitated with the help of voice prostheses. The patients examined here did not apply different coping strategies from groups of patients with other severe illnesses. Obviously, the limitations on communication do not constitute a determining factor in coping with the disease. This finding is useful when planning psychological and social rehabilitation, e.g. by psychosomatic interventions.

Adaptation, Psychological↗
PubMed2003

[Guidelines and their practical application in congenital hearing loss].

BACKGROUND: Permanent congenital hearing loss in children does not only influence speech acquisition but also has a severe impact on the entire intellectual and psychological development, and thus social integration is handicapped. However, at least partial compensation can be achieved by complex rehabilitative measures. One of the first medical therapies in children with congenital hearing loss is to equip them with hearing aids. As part of quality management the purpose of this study is to discuss pedaudiological aspects and results of hearing - impaired children equipped with hearing aids against the background of guidelines from Germany and the US. METHODS: Data of 107 children equipped with hearing aids from 1997 to 1999 were analysed referring to the relevant German and US guideline. RESULTS: In 53 girls and 54 boys, 45% were suffering from at least severe, 45% from moderate and 10% from mild hearing loss. 93 children presented sensory hearing loss, 8 combined and 2 conductive hearing loss. 2 children had unilateral hearing loss, one a combined on one ear and a sensory hearing loss on the other and one child had a central auditory processing disorder. The age when the hearing loss was diagnosed depended on its grade and correlated with adverse environmental aspects. 34 children suffered from a syndrome or multiple handicaps, in these cases, the hearing loss was diagnosed at a later date than in children suffering from hearing loss only. In cases with near deafness audiological results with hearing aids were not sufficient; in these cases, cochlea implantation had to be discussed as an alternative measure. CONCLUSION: The data obtained from this study underline the need for universal hearing screening. Discussing the data against the relevant German and US guidelines clearly shows that German benchmarks are not as strict as the American ones. This has to be taken into account for further guideline development in Germany. As permanent hearing loss in children with syndromes and multiple handicaps and children with adverse environment is diagnosed at a later date than in other children public, measures have to be taken to improve this situation.

Adolescent↗
PubMed2003

Normal voice production: computation of driving parameters from endoscopic digital high speed images.

OBJECTIVES: A central point for quantitative evaluation of pathological and healthy voices is the analysis of vocal fold oscillations. By means of digital High Speed Glottography (HGG), vocal fold oscillations can be recorded in real time. Recently, a numerical inversion procedure was developed that allows the extraction of physiological parameters from digital high speed videos and a classification of voice disorders. The aim of this work was to validate the inversion procedure and to investigate the applicability to normal voices. METHODS: High speed recordings were performed during phonation within a group of five female and five male persons with normal voices. By using knowledge based image processing algorithms, motion curves of the vocal folds were extracted at three different positions (dorsal, medial, ventral). These curves were used to obtain physiological voice parameters, and in particular the degree of symmetry of the vocal folds based upon a biomechanical model of the vocal folds. RESULTS: The highest degree of symmetry was observed for the medial motion curves. While the dorsally and ventrally extracted motion curves exhibited similar results concerning the degree of symmetry the performance of the algorithm was less stable. CONCLUSIONS: The inversion algorithm provides reasonable results for all subjects when applied to the medial motion curves. However, for dorsal and ventral motion curves, correct performance is reduced to 85%.

Algorithms↗
PubMed2003

The laryngectomee substitute voice: image processing of endoscopic recordings by fusion with acoustic signals.

OBJECTIVES: The most radical cancer therapy of the throat is the total excision of the larynx which post-operatively results in the loss of voice. A widely-used method of voice rehabilitation is the insertion of a silicone valve, which establishes an unidirectional connection between trachea and esophagus. Thus, during exhalation, air can be directed from the trachea into the esophagus. This air stream excites tissue vibrations of the esophagus and the hypo-pharynx which act as a substitute voice generator. Purpose of the current study is to present a technique for visualizing the dynamics of the substitute voice generating element. METHODS: Digital high speed videos of the vibrating tissue are simultaneously recorded with the emitted acoustic signal. The high speed sequences are directly evaluated by a three-step knowledge based algorithm. It considers correlation between image and acoustic data, information about the gray value of each pixel, and continuity of tissue vibration. The temporal properties of an image series are investigated by evaluating the time dependent gray value at each pixel position. RESULTS: The applicability of the algorithm is exemplarily demonstrated using the data of one male patient. It enables the identification of the regions within an image series which are mainly responsible for the acoustic signal. Additionally, the dynamics of tissue vibrations are visualized. The main propagation direction can be clearly identified. CONCLUSIONS: The new methodology summarizes the information about endoscopic and acoustic recordings of substitute voice into a single image. The results allow a first estimation of tissue velocity and elastic properties of oscillating tissue.

Algorithms↗
PubMed2001

[Interdisciplinary management of chronic tinnitus (II)].

Tinnitus is defined as the perception of sound in the absence of any appropriate external stimulation. It is a common, bothersome and hard-to-evaluate symptom and in most cases it cannot be objectified. Its incidence in Germany and the western world is about 10%. About 1-2% of the population are severely disturbed by tinnitus and it may disrupt everyday activities and sleep. Recent theoretical developments favour a neurophysiological approach as an explanation for tinnitus in addition to a psychoacoustic model based on peripheral lesion in the cochlea or auditory nerve. In the neurophysiological model, the processing of the tinnitus signal plays a dominant role in its detection, perception and evaluation. Therefore, attention and other psychological factors become important in the understanding and treatment of tinnitus. Many treatments of chronic tinnitus have been proposed and implemented. Today, cognitive-behavioural treatment is regarded as an important part of an integrative therapy which may be compiled of counselling, relaxation therapy, instrumental (hearing aid, tinnitus masker, tinnitus instrument, tinnitus noiser) and pharmacological tools (lidocaine, neurotransmitters). In well-controlled studies the empirical support for other therapeutical approaches such as acupuncture is weak. This work gives a review of the current knowledge of the etiology, pathogenesis, epidemiology, the interdisciplinary diagnostic approach and treatment of tinnitus and especially focuses on insurance and medico-legal aspects.

Chronic Disease↗
PubMed2001

[Rare audiometry findings in progressive, monosymptomatic low frequency deafness].

BACKGROUND: Objective audiometric methods such as the measurement of otoacoustic emissions and auditory evoked potentials (click evoked and notched-noise auditory evoked brainstem potentials, auditory evoked cortical potentials) can provide helpful information. However, information derived from the individual test is limited and each method contains specific restrictions. To illustrate the possible audiometric pitfalls this work presents a case history. CASE REPORT: The puretone audiometry showed a severe hearing loss at low frequencies up to 2 kHz, a slight hearing loss for higher frequencies up to 6 kHz and almost normal hearing thresholds above 6 kHz. Transitory evoked otoacoustic emissions could not be detected. While the auditory evoked brainstem responses (ABR) using click-stimuli showed a normal pattern no reproducible responses could be derived using the notched-noise technique. Auditory evoked cortical potentials exhibited a normal N1/P2-complex and were detectable down to stimulus levels 0-20 dB above the individual hearing threshold. DISCUSSION: Click-evoked auditory evoked brainstem potentials are widely regarded as the "gold-standard" of objective audiometry. The example presented in this work shows that in special cases it may provide false negative results. In these special cases auditory tone-evoked cortical potentials may provide better objective information. When objectively assessing the determination of the hearing threshold it may be necessary not only to use all electrophysiological measurements but also to know their methodical restrictions and pitfalls.

Adult↗