Citations

Although ataxic dysarthria has been studied with various methods in several languages, questions remain concerning which features of the disorder are most consistent, which speaking tasks are most sensitive to the disorder, and whether the different speech production subsystems are uniformly affected. Perceptual and acoustic data were obtained from 14 individuals (seven men, seven women) with ataxic dysarthria for several speaking tasks, including sustained vowel phonation, syllable repetition, sentence recitation, and conversation. Multidimensional acoustic analyses of sustained vowel phonation showed that the largest and most frequent abnormality for both men and women was a long-term variability of fundamental frequency. Other measures with a high frequency of abnormality were shimmer and peak amplitude variation (for both sexes) and jitter (for women). Syllable alternating motion rate (AMR) was typically slow and irregular in its temporal pattern. In addition, the energy maxima and minima often were highly variable across repeated syllables, and this variability is thought to reflect poorly coordinated respiratory function and inadequate articulatory/voicing control. Syllable rates tended to be slower for sentence recitation and conversation than for AMR, but the three rates were highly similar. Formant-frequency ranges during sentence production were essentially normal, showing that articulatory hypometria is not a pervasive problem. Conversational samples varied considerably across subjects in intelligibility and number of words/ morphemes in a breath group. Qualitative analyses of unintelligible episodes in conversation showed that these samples generally had a fairly well-defined syllable pattern but subjects differed in the degree to which the acoustic contrasts typical of consonant and vowel sequences were maintained. For some individuals, an intelligibility deficit occurred in the face of highly distinctive (and contrastive) acoustic patterns.

Experience with patient-controlled audiometers in a clinical setting suggests that group testing can be accomplished satisfactorily with most adult subjects. Some of the findings and a comparison of results obtained with automatic and conventional audiometry are presented as a basis for evaluating this means of auditory screening. Generally, the findings justify the use of automatic screening audiometry as one means of handling large numbers of patients with relative convenience and economy. Certain problems inherent in the procedure appear to make it impractical for some clinical patients.

Conventional volume unit (VU) and auditory monitors of signals generated by or fed through an audiometer do not allow monitoring of the signal after the attenuator or output selector. An amplifier-compressor circuit has been designed and constructed which allows auditory monitoring of the electrical signal at the transducer. The circuit and its use are described.

Tongue force, rate of syllable repetition, and judgments of articulatory defectiveness were measures obtained on 19 dysarthric adults with amyotrophic lateral sclerosis and on 125 normal adults. Anterior and lateral tongue forces were measured by means of a pressure transducer clasped between the teeth; the tongue forces were recorded on a pen-writing ECG apparatus. Audio-recorded syllable repetitions of /p/, /t/, and /k/ also were transcribed on ECG paper and counted. Three listeners rated articulatory precision on a 7-point scale of severity. The normal males had significantly higher tongue forces than normal females; normal subjects had significantly higher tongue forces than dysarthric patients; and anterior tongue forces were significantly greater than lateral in normal and dysarthric patients. There was a high negative correlation between tongue force and severity of articulatory defect. Syllable repetitions were significantly slower in the dysarthric patients than in the normal patients, and a high negative correlation was obtained between syllabic rate and severity of articulatory defect.

Purpose: To examine the effects of antibiotic prophylaxis on postoperative infection rate in patients with negative urine cultures undergoing ureteroscopy (URS). Patients and Methods: Using the Clinical Research Office of the Endourological Society (CROES) URS Global Study database, patients with a negative baseline urine culture undergoing URS for ureteral stones ( n =1141) or kidney stones ( n =184) not receiving antibiotic prophylaxis were matched with those who were predefined by risk factors, including gender, American Society of Anesthesiologists (ASA) score, and ureteral stent placement. Patient characteristics, operative data, and postoperative outcomes, including the development of urinary tract infection (UTI) and fever, in the two groups were compared. Results: Antibiotic prophylaxis use differed widely across participating countries (13%–100%). Differences were found between patients who did or did not receive antibiotic prophylaxis regarding the frequency of anticoagulation medication, previous treatment with URS, stone burden, previous presence of kidney stones, duration of current URS, and complications post-URS. The prevalence of fever and UTI was low (≤2.2%) and similar in both groups. Factors predictive of postoperative UTI or fever were female gender, Crohn's and cardiovascular disease, a high stone burden, and an ASA score of II or higher. Conclusions: In patients with a negative baseline urine culture undergoing URS for ureteral or renal stones, rates of postoperative UTI and fever were not reduced by preoperative antibiotic prophylaxis. Female gender and a high ASA score were specific risk factors for postoperative infection in this patient group.

Objective To assess the occurrence of acute coronary syndrome (ACS) in patients with giant cell arteritis (GCA) compared to subjects without GCA. Methods We retrospectively reviewed a population‐based incidence cohort of Olmsted County, Minnesota residents with GCA diagnosed in 1950–2009. We compared this cohort with a cohort of patients without GCA of similar age, sex, and calendar year from the same population. Results The study included 245 patients with GCA and 245 non‐GCA subjects. The mean ± SD Framingham cardiovascular risk score was 30% ± 19% in GCA patients and 34% ± 23% in non‐GCA subjects ( P = 0.096) at the incidence/index date. Diabetes mellitus was significantly less common in GCA patients than non‐GCA subjects at the index date. The mean high‐density lipoprotein was higher and triglycerides were lower, with fewer patients taking lipid‐lowering medications in the GCA cohort compared to the non‐GCA cohort at the index date. During followup, no difference between the 2 cohorts was noted in the overall rate of ACS events (hazard ratio 0.74, 95% confidence interval 0.44–1.26). Overall thrombosis in myocardial infarction scores were similar in both cohorts. Revascularization procedures were done less frequently in GCA than in non‐GCA subjects (19% versus 50%; P = 0.015). Post‐ACS hospital length of stays and complications were similar in both cohorts. Conclusion Multiple cardiovascular risk factors are less atherogenic at incidence of GCA. There is no overall increased risk of ACS in patients with GCA.

AbstractBackgroundThe utility of diagnostic imaging in paraneoplastic autoimmune multiorgan syndrome (PAMS) is unknown.MethodsWe examined the role of diagnostic imaging in patients with PAMS evaluated at our tertiary referral center (at Mayo Clinic, Rochester, MN, USA) and in the English literature between January 1, 1996, and August 31, 2012.ResultsWe included 17 patients from our institution and 208 patients from the literature review. Of these 225 patients, 113 (50.2%) were not known to have a malignancy diagnosis at the time of PAMS diagnosis. Of the 123 patients from our institution and from the literature reported to undergo imaging studies, conventional computed tomography (CT) was the predominant imaging modality (n = 110; 89.4%); 18F‐fluorodeoxyglucose (18F‐FDG) positron emission tomography (PET)/CT was also used, albeit infrequently (n = 12; 9.8%). When CT was included in imaging to identify or confirm the presence of a malignancy, imaging was successful in all patients who ultimately were diagnosed with an associated malignancy. At our institution, a relatively high percentage (n = 7; 41%) of patients had 18F‐FDG PET/CT, which not only identified all tumors found on CT but also facilitated staging of lymphoma and guided biopsy procedures.ConclusionDiagnostic imaging is frequently utilized in PAMS with unknown malignancy. Both conventional CT and 18F‐FDG PET/CT are likely to detect the typical underlying neoplasms. Relative to conventional CT, 18F‐FDG PET/CT may provide additional useful information regarding prognosis for the likely underlying malignancies, although there is a paucity of reports describing the use of this modality for this purpose.

The challenge in treating the older adult with cancer is accurately accounting for and adapting management to the heterogeneity in health status of the individual patient. Many oncologists recognize that chronological age alone should not be the determinant when deciding on a treatment regimen. Easily measurable markers that provide an assessment of functional age would be ideal to assess frailty, which may predispose the patient to complications from cancer treatment, including increased toxicity, functional decline, decreased quality of life, and poorer survival. Several categories of potential markers, including chronic inflammatory markers, markers of cellular senescence, and imaging to assess muscle mass to detect sarcopenia, may provide insight into the likelihood of treatment-related complications. This article discusses candidate markers and strategies to evaluate these markers in cancer treatment trials, with the aim of developing a method to assess risk of oncologic outcomes and guide management decisions for both the physician and patient.

Lung cancer is a disease of the elderly. In older patients, the management of a malignancy as complex and potentially as lethal as lung cancer is challenging. Despite the fact that a large proportion of patients with non–small-cell lung cancer are elderly, information remains scant on how best to treat these patients. The goal of this review is to discuss the published literature and to provide guidance on how to treat elderly patients within three broad stages: (1) metastatic cancer, (2) early-stage cancer after surgery, and (3) locally advanced inoperable cancer. Because decisions on how and when to prescribe systemic treatment can be particularly difficult, this review focuses heavily on chemotherapy-related treatment decisions with some discussion of emerging data on the use of the comprehensive geriatric assessment.