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PubMed1984

Artificial larynx prosthesis: comparative clinical evaluation.

The work pioneered by Drs. Singer and Blom established the clinical feasibility of controlled tracheoesophageal fistula for generation of fluent esophageal speech. There have been numerous practical difficulties that have been encountered with the use of voice prosthesis. Problems encountered are: extrusion, speech initiation delay, leakage around the prosthesis, stoma obstruction, and low volume output. A second generation laryngeal prosthesis is introduced for comparison. Its design incorporates features that will significantly improve the clinical problems encountered; extrusion is minimized; and the new prosthesis allows for one size to fit all patients. A clinical trial was established to directly compare the artificial speech generated by the currently existing laryngeal prosthesis. Each laryngectomy patient was fitted with three different devices and the resulting speech was evaluated. Video recordings of patients are presented to illustrate the type of speech produced by each device. Comparisons of intelligibility, fluency, volume, and patient preference are made. Results indicate that a significant variation in the speech obtained is critically dependent on the choice of prosthesis.

Consumer Behavior↗

PubMed1988

Photodynamic therapy: response of normal canine urethra using a cylindrical fiber.

Normal urethral response to photodynamic therapy (PDT) utilizing a cylindrical fiber was assessed in ten study and two control NIH fox-hounds. The canine urethras were treated 48 hours after intravenous injection of 3 mg/kg dihematoporphyrin ether (Photofrin II). A 1-mm fused silica optical fiber, with the distal 2-3 cm modified for cylindrical light distribution (660-microns diameter), was placed in the pendulous urethra. An argon-pumped dye laser delivered 100 mW of 630-nm light for 7 minutes (42 J) to the treatment area. Urethroscopy using either a 2.5-mm or a 2.8-mm flexible pediatric bronchoscope with video recording capability was performed immediately after PDT (12 animals) and 6 weeks later (nine animals); intravenous urography was performed 3 days and 6 weeks after PDT. There was no evidence of either urethral damage or stricture formation in any animal. Histopathology of the first three study specimens, obtained at 6 weeks, confirmed the absence of any pathology. Flexible instrumentation facilitates post-treatment assessment. This study demonstrates for the first time that, when a cylindrical fiber is used, photodynamic therapy may be applied to the urethra without damage to the normal urethral mucosa. This result has implications for potential treatment of initial or recurrent carcinoma in situ of the urethra using PDT.

Animals↗

PubMed2001

Unilateral periodic limb movements during sleep in corticobasal degeneration.

Periodic limb movements in sleep (PLM) have been associated with several degenerative disorders and other focal or diffuse diseases. We present a patient with clinical diagnosis of corticobasal degeneration and sleep complaints, in whom video recording and polygraphic study confirmed the presence of right PLM. The unilaterality of the movements and the positron emission tomography findings (hypometabolism in the left frontoparietal, basal ganglia, and thalamic areas) suggest that the loss of inhibitory descending central pathways, with origin in the cortex or basal ganglia, may be involved in the pathogenesis of PLM.

Aged↗

PubMed2005

Continuous subcutaneous apomorphine therapy improves dyskinesias in Parkinson's disease: a prospective study using single-dose challenges.

Continuous subcutaneous (SC) infusion of the dopamine agonist apomorphine was shown in retrospective studies to improve drug-induced dyskinesias in Parkinson's disease (PD). We prospectively assessed the antidyskinetic effect of continuous SC apomorphine therapy using subjective and objective measures, and sought to determine whether any observed dyskinesia reduction could be corroborated using single-dose dopaminergic challenges. Twelve PD patients with on-off fluctuations and disabling dyskinesias who were scheduled to start apomorphine pump treatment underwent acute levodopa and apomorphine challenges at baseline and 6 months later. Video recordings involving motor tasks were rated blindly by two independent raters using modified AIMS and Goetz dyskinesia scales. At 6 months, mean apomorphine dose was 75.2 mg per day and the mean L-dopa dose had been reduced by 55%. Daily off time in patients' diaries was reduced by 38% (2.4 hours). The L-dopa challenges showed a reduction of 44% in AIMS and 40% in Goetz scores (both P < 0.01). Apomorphine challenges showed a reduction of 39% in AIMS and 36% in Goetz scores (both P < 0.01). Patients' self-assessment scores reflected these significant changes. Dyskinesia improvement correlated with reduction in oral medication and with the final apomorphine dose (P < 0.05). This prospective study confirms marked dyskinesia reduction on continuous subcutaneous apomorphine therapy, paralleled by reduced dyskinesias during dopaminergic challenge tests. Our findings support the concept that replacement of short-acting oral antiparkinsonian medication with continuous dopamine receptor stimulation may reverse, at least partially, the sensitization process believed to mediate the development of drug-induced dyskinesias in PD.

Aged↗

PubMed2006

Botulinum toxin A may be efficacious as treatment for jaw tremor in Parkinson's disease.

Jaw tremor in Parkinson's disease (PD) may not respond well to conventional treatment. It causes embarrassment and social handicap. We piloted the use of botulinum toxin (BTX) injections in three patients with PD jaw tremor. BTX A (Dysport; mean, 53 U; range, 30-100 U) was given into each masseter muscle. Outcome was assessed by subjective and clinical improvement and by video recording before and 4 to 9 weeks after injections. There was an excellent response in all without side effects. BTX injections into the masseter may effectively improve jaw tremor and be useful in PD and other conditions.

Aged↗

PubMed1990

Diurnal variability in cranial dystonia.

Eleven patients with cranial dystonia were investigated for diurnal variations in disability by means of video recordings. Disability increased significantly from morning to evening. The increase was not related to changes in vigilance levels assessed by dynamic electroencephalogram. Cranial movement disorders display diurnal fluctuations that are probably related to endogenous circadian rhythms.

Adult↗

PubMed1993

Reliability of the Columbia scale for assessing signs of Parkinson's disease.

Inter- and intrarater reliability in scoring the signs of Parkinson's disease using the original Columbia scale and a modified version of this, the Sydney scale, were assessed in five neurologists participating in a long-term study of Parkinson's disease. Scoring was done on video recordings of 41 patients whose disability ranged from mild to severe. Although all the neurologists were familiar with the scales and had received training designed to produce uniformity of scoring, interrater reliability was poor. The mean score for the Columbia scale varied from 18.6 to 30 and for the Sydney scale from 15.2 to 23.2. By contrast, intrarater reliability was good. This study highlights the limitations of clinical rating scales in Parkinson's disease when more than one rater is used. In designing clinical trials, every effort should be made to ensure that the same patient is always assessed by the same rater.

Analysis of Variance↗

PubMed1994

N-0923, a selective dopamine D2 receptor agonist, is efficacious in rat and monkey models of Parkinson's disease.

Certain aminotetralins are known to be potent dopamine D2 receptor agonists. N-0923, [-]2-(N-propyl-N-2-thienylethylamino)-5- hydroxytetralin HCl, recognizes the high and low affinity states of the D2 receptor in membranes from bovine caudate with a Klow of 79 nM. The selectivity ratio is D2/D1 = 15 and D2/alpha 2 = 1.4. N-0923 also inhibits dopamine uptake and prolactin secretion, and it is an antagonist at the alpha 2 receptor. N-0923 (3-300 nmol/kg, s.c.) induced dose-dependent contralateral turning behavior in rats with unilateral 6-hydroxydopamine lesions of the substantia nigra. The ED50 of 30 nmol/kg was effective for 1 h. The positive enantiomer (N-0924; 300 nmol/kg, s.c.) was without effect. A hemiparkinsonian syndrome was induced in four Macaca nemestrina monkeys by unilateral infusion of the neurotoxin MPTP into the right carotid artery. Video recordings of free-moving behavior revealed bradykinesia, disuse of the contralateral upper limb and turning in a direction ipsilateral to the lesion. N-0923 (3-300 nmol/kg, i.m.) induced contralateral turning behavior, exploratory activity, and contralateral limb usage. The ED50 for turning (30 nmol/kg) was effective for 0.5 h. The potency order for induction of contralateral rotations was (+)-PHNO > N-0923 > bromocriptine. N-0924 (300 nmol/kg, i.m.) was ineffective. We conclude that N-0923 may be useful as a therapeutic agent in the treatment of Parkinson's disease.

1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine↗

PubMed2002

Effect of Timolol vs. a postural orthotic on hand tremor during microsurgery.

The efficacy of beta blockers to control hand tremor remains equivocal. This study evaluated the effectiveness of Timolol, as well as a postural orthotic, in reducing movement deviation during a laboratory exercise. Eleven volunteers completed three randomized trials involving administration of Timolol, a placebo, or a postural orthotic. Drug administration was blinded. Each trial consisted of a simulated 2-hr clinical procedure, punctuated by video recordings of the subject's hand motion during a standardized pattern of instrument movement. ECRL EMG activity and digital oxygen perfusion were also measured. Recordings were converted into estimates of linear variance at baseline and 1 and 2 hr. A repeated-measures ANOVA, or the Friedman test, were used to assess significant differences. Movement deviation, EMG activity, and oxygen perfusion were unaffected by the duration of exercise or treatment (P > or = 0.454). We conclude that none of the treatments accorded a significant benefit in allaying hand tremor.

Adrenergic beta-Antagonists↗

PubMed1994

Timetable of in vivo embryonic development in the grey short-tailed opossum (Monodelphis domestica).

The timing of development was examined in 496 embryos from female Monodelphis domestica collected at known time intervals after video recorded mating. Ovulation occurred approximately 20 hr (day 1) after mating, and fertilization was observed by 24 hr. Transport through the oviducts was rapid, and pronuclear stage embryos were recovered from the uterus as early as 24 hr after mating. Second cleavage had occurred by 55 hr after mating. Three-celled embryos were among those collected on day 3 after mating, indicating that asynchronous cleavage of blastomeres can occur from the two-cell stage. The four-cell stage persisted for approximately 24 hr, and embryos that had undergone third cleavage were first recovered 74 hr after mating. Embryos that had undergone fourth to fifth cleavage were found 96-100 hr (4 days) after mating and complete unilaminar blastocysts by 5.5 days after mating. Primary endoderm formed from an already distinct embryonic area of the unilaminar blastocyst early on day 7 after mating. Formation of the bilaminar blastocyst was completed rapidly, on day 7 after mating. The primitive streak appeared on day 10 after mating, and organogenesis rapidly ensued on a timetable similar to that reported for Didelphis virginiana (McCrady, 1938). Close contact with the maternal circulation was established on day 11 and by day 12 maternal and embryonic tissues could not be separated without damage. The length of the gestation period from fertilization to birth was approximately 13.5 days. These observations provide the basis for further embryological cellular and molecular studies of this species as a laboratory model for marsupial development.

Animals↗

PubMed1988

Studies of stallion sperm survival: preservation of progressive motility of stallion spermatozoa by low ionic strength media.

Preservation of stallion sperm forward motility was studied using a video recording system in semen diluted with media of different ionic strength and sodium content. After 8 hr of incubation at room temperature, semen diluted in a low ionic strength media containing sucrose displayed 65 +/- 9% motility with 68 +/- 3% of the motile sperm showing forward motility (diameter of head trajectory greater than or equal to 80 microns). In contrast, sperm populations diluted and incubated with a normal ionic strength media containing sodium had 56 +/- 7% motile sperm of which only 36 +/- 7% displayed forward progression. Replacement of the sodium ion in the normal ionic strength media by a different cation (choline) produced results similar to those of the media containing high sodium concentration. These results indicate that the preservation of stallion sperm progressive motility is highly dependent on the ionic strength of the media. Membrane depolarization caused by the replacement of ions by noncharged particles in the sperm's external medium might be responsible for the sustained coordination of the flagellar movements.

Animals↗

PubMed2005

Centrophobism/thigmotaxis, a new role for the mushroom bodies in Drosophila.

Insects, like vertebrates, exhibit spatially complex locomotor activity patterns when foraging or navigating. Open field studies recently showed that Drosophila avoids central zones and stays at the periphery, an effect that can be interpreted as centrophobism and/or thigmotaxis. In this study, we further characterized this phenomenon and studied the responsible underlying neural mechanisms. The implication of the Drosophila mushroom bodies (MBs) in olfactory learning and memory processes is well documented. In an open field situation in which fly locomotor activity is recorded by video tracking, we show that center avoidance is greatly diminished in flies with hydroxyurea-ablated MBs, suggesting a new role for these structures. Furthermore, the temperature-sensitive allele of the dynamin gene shibire was expressed in various enhancer-trap P[GAL4] lines, disrupting synaptic transmission in different MB lobes. Specifically blocking the gamma lobes alters centrophobism/thigmotaxis while blocking the alpha/beta lobes does not, suggesting a functional specialization of MB lobes. Drosophila may serve as a new model system for elucidating the genetic and neural bases of such complex phenomena as centrophobism/thigmotaxis.

Analysis of Variance↗

PubMed2002

Series of laryngomalacia, tracheomalacia, and bronchomalacia disorders and their associations with other conditions in children.

Laryngomalacia, bronchomalacia, and tracheomalacia are commonly seen in pediatric respiratory medicine, yet their patterns and associations with other conditions are not well-understood. We prospectively video-recorded bronchoscopic data and clinical information from referred patients over a 10-year period and defined aspects of interrelationships and associations. Two hundred and ninety-nine cases of malacia disorders (34%) were observed in 885 bronchoscopic procedures. Cough, wheeze, stridor, and radiological changes were the most common symptoms and signs. The lesions were most often found in males (2:1) and on the left side (1.6:1). Concomitant malacia lesions ranged from 24% for laryngotracheobronchomalacia to 47% for tracheobronchomalacia. The lesions were found in association with other disorders such as congenital heart disorders (13.7%), tracheo-esophageal fistula (9.6%), and various syndromes (8%). Even though the understanding of these disorders is in its infancy, pediatricians should maintain a level of awareness for malacia lesions and consider the possibility of multiple lesions being present, even when one symptom predominates or occurs alone.

Adolescent↗

PubMed1989

Fiberoptic bronchoscopy in the neonate.

Over a 37 month period 113 flexible fiberoptic bronchoscopies were performed in 77 neonates, using a variety of instruments. Thirty-six examinations were done via an endotracheal tube or tracheostomy. In addition to elective examination of the infant's airway, bronchoscopy has been found valuable in the management of emergency situations such as suspected tube blockage or malposition and difficult intubations. A video recording system is useful for teaching and documentation of abnormal findings.

Bronchoscopy↗

PubMed2005

Postural instability during reaching tasks in Parkinson's disease.

BACKGROUND AND PURPOSE: Reaching, like turning and rising from sitting, is an activity commonly associated with falls by people with Parkinson's disease. We set out to: (a) identify how people with moderate and severe Parkinson's disease performed high and low reaches and (b) to explore in detail the standard functional reach (functional reach) test and the fall histories of those who appeared unstable when reaching. METHOD: In this cross-sectional study, people with moderate or severe Parkinson's disease (Hoehn and Yahr Grade III or IV) were video-recorded at home, reaching above shoulder height and below knee level. Blinded observers rated stability, alignment, foot position, floor contact, use of support and reach type. Functional reach was also measured and participants were interviewed about falls. RESULTS: Of 51 participants, 33 (65%) had moderate Parkinson's disease and 18 (35%) severe. A greater proportion of the latter used support when reaching high (p = 0.029) and aligned forward when reaching low (p = 0.015); otherwise, strategies were similar across groups. Six people (all with severe Parkinson's disease) appeared unstable when reaching: they had a shorter functional reach than the others (median 10 cm versus 18 cm; p = 0.042) and had fallen frequently (median five falls in a year), although rarely when reaching. CONCLUSIONS: Reaching tasks challenge postural stability in severe Parkinson's disease. People who appear unstable when reaching are likely to be repeat-fallers and at risk of further falls during more demanding activities. Research should address whether discouraging potentially destabilizing manoeuvres (such as squatting and toe-standing) and promoting safety-enhancing strategies (such as using support and facing forward), with or without balance retraining, reduces the risk of falling among people with severe Parkinson's disease.

Accidental Falls↗

PubMed2004

The behavioural response of slugs and snails to novel molluscicides, irritants and repellents.

The behavioural response of the slug Deroceras panormitanum (Lessona and Pollonera) and the snail Oxyloma pfeifferi (Rossmässler) to novel molluscicides was investigated in choice and no-choice experiments. Low-light video-recording in combination with automated tracking and event recording was used to identify the repellent and irritant effects of (1) cinnamamide, (2) copper ammonium carbonate, (3) a mulch, (4) a horticultural ground-cover matting impregnated with a copper formulation and (5) urea/formaldehyde. In the no-choice experiments the products had a stronger irritant effect on the snails than on the slugs. All products tested except the mulch significantly reduced the locomotor activity of both the slugs and snails. The most effective product, cinnamamide, reduced snail locomotor activity by 94% and track length by 96%. The overall repellent effect of the treatments in the choice experiments was stronger in the slugs; where presence, locomotor activity and track length in the treated area were significantly reduced by all products. The avoidance of treated areas exceeded 95% with the mulch (for slugs) and with copper ammonium carbonate (for snails).

Animals↗

PubMed2004

The fetal esophagus: anatomical and physiological ultrasonographic characterization using a high-resolution linear transducer.

OBJECTIVE: To study the sonographic anatomy and physiology of the human fetal esophagus during the mid-trimester of pregnancy using a high-resolution linear transducer. METHODS: This was a prospective observational study of the fetal esophagus between 19 and 25 weeks' gestation. The study was performed in 60 consecutive fetuses, after a normal anatomy scan, using a 5-13-MHz matrix array wide-band transducer. During the examination the collapsed esophagus was first visualized, and followed by a 5-min video recording in order to demonstrate luminal patency and peristaltic waves. RESULTS: Complete anatomical visualization of the esophagus was possible in 52 (86.7%) patients and at least partial visualization in 58 (96.7%) patients. Three different patterns of esophageal motility were observed: a simultaneous and short opening of the whole esophagus was found in 35 (58.3%) fetuses; a segmental, peristalsis-like movement from the pharynx, through the mediastinum, and into the stomach was found in 18 (30%) fetuses; and in one fetus reflux-like passage of solid contents from the stomach was observed. The mean time required for demonstration of esophageal patency was 96.1 (range, 10-300) s. CONCLUSIONS: Demonstration of normal anatomy and physiological activity of the fetal esophagus is feasible using appropriate transducers. The most commonly observed pattern of esophageal motility in the mid-trimester of pregnancy is the simultaneous relaxation of the upper and lower esophageal sphincters with concurrent opening of the esophageal lumen from the upper thorax to the stomach. Demonstration of a patent esophagus may be helpful in fetuses with suspected esophageal atresia.

Esophagus↗

PubMed2005

Fetal echocardiographic evaluation of atrial morphology and the prediction of laterality in cases of heterotaxy syndromes.

OBJECTIVE: To evaluate whether abnormal atrial morphology, which is well recognized in autopsy series, is detectable by fetal echocardiographic examination of the four-chamber view, and can therefore be utilized to differentiate left from right isomerism in heterotaxy syndromes. METHODS: This study was a retrospective review of 30 cases with prenatally diagnosed heterotaxy syndromes. Ultrasound video recordings and still images were reviewed with respect to atrial morphology in the four-chamber view. In 25 cases the morphology of both atria was sufficiently well visualized on the recordings to be evaluated and only these were included in the study. RESULTS: Two types of atrial morphology were distinguished in our cohort: a sickle-shape with the tip pointing laterally and apically, and a blunt shape resembling the usual atrial appearance in the four-chamber view. Nineteen out of the 25 cases (76%) presented with isomerism of the atria in the four-chamber view. Thirteen had bilateral sickle-shaped atrial morphology, all associated with left isomerism. Six had bilateral blunt-shaped atrial morphology, all associated with right isomerism. The atria of the remaining six cases were not isomeric, the right atrium being sickle-shaped and the left blunt-shaped. Five of the latter cases were associated with left and one with right isomerism. CONCLUSIONS: The majority of prenatally diagnosed heterotaxy syndromes seem to present with isomeric atrial morphology in the four-chamber view. In these cases a differentiation between left and right isomerism can be based on the two distinct types of atrial morphology. This may further enhance the prenatal differentiation of these syndromes.

Chi-Square Distribution↗