Phonological awareness and early reading development in childhood apraxia of speech (CAS).

BACKGROUND: Childhood apraxia of speech (CAS) is associated with phonological awareness, reading, and spelling deficits. Comparing literacy skills in CAS with other developmental speech disorders is critical for understanding the complexity of the disorder. AIMS: This study compared the phonological awareness and reading development of children with CAS and children with inconsistent speech disorder (ISD). METHOD & PROCEDURES: Participants included twelve children with CAS aged 4-7 years. Their performance was compared with twelve children with ISD (and normal speech motor planning) and twelve children with typical development on tasks measuring phonological awareness, letter-sound knowledge, real and non-word decoding, and access to underlying phonological representations of words. There was no significant difference in the age, gender, socio-economic status, and receptive vocabulary of the groups. The two groups with speech disorder were matched for severity and inconsistency of their speech impairment. OUTCOMES & RESULTS: The results indicated that the CAS group had inferior phonological awareness than the ISD and typical development groups. The CAS group had a greater proportion of participants performing below their expected age level than the comparison groups on phonological awareness, letter-sound knowledge and decoding tasks. There was no difference in the performance of the CAS and ISD groups on the phonological representation task. CONCLUSIONS & IMPLICATIONS: Children with CAS are particularly susceptible to phonological awareness and reading delay. Intervention for children with CAS must facilitate skills underlying reading development in addition to resolving speech deficits in order to improve the spoke and written language outcomes of this population.

Sequential study of bacterial clearance in experimental cystitis.

Clearance of Escherichia coli in experimental cystitis was studied in the diuresing mouse model. Urine was collected daily; sediment was isolated by cytocentrifugation and either stained or treated with fluorescent antibodies directed against mouse immunoglobulins. During the initial phase of the infection the bacteria were either free and dispersed or adhering to epithelial cells but not generally to polymorphonuclear cells (PMNs). Subsequently, the bacteria adhered to each other, to epithelial cells and to PMNs, were phagocytosed by the latter and showed strong fluorescence. It is postulated that the appearance of opsonising and agglutinating antibodies in conjunction with activity of the PMNs is involved in bacterial clearance.

Cavernosometry: a theoretical analysis.

Erectile dysfunction may be caused by hormonal, neural, arterial, or venous factors. Cavernosometry is used to test for venous leaks. The outcome of surgical procedures attempting to block off veins that allow blood to leak from the penile tissues is still poor. This procedure commonly follows a diagnostic procedure based on cavernosometry after good arterial inflow has been established. To study the cavernosometry test, a mathematical model of penile hemodynamics was used to analyze the significance of its indications and its sensitivity to both arterial and venous factors. The model elucidates the mechanism of cavernosometry and shows that indeed this test is sensitive to venous factors and insensitive to arterial factors. The model also supports the use of supra-arterial pressure during cavernosometry, and the use of the slope of the flow-to-maintain vs maintained-pressure curve as an indicator of venous leak severity.

Involvement of internal genitalia in female patients undergoing radical cystectomy for bladder cancer: a clinicopathologic study of 37 cases.

Radical cystectomy for invasive bladder cancer in female patients implies anterior pelvic exenteration. The necessity for routine removal of all internal female genitalia has not, as yet, been investigated. The present study was conducted to investigate the involvement of internal genitalia in these patients. Cystectomy specimens from 37 consecutive female patients with bladder cancer were examined for internal genitalia and urethral involvement. Clinical data were retrospectively collected from hospital charts. Thirty-four patients were available for postoperative follow-up. Of the 37 cases, 30 were transitional cell carcinoma (TCC), 4 squamous cell carcinoma, 1 adenocarcinoma, and 2 undifferentiated carcinoma. Uterine involvement was observed in only 1 case: TCC, stage D1, grade IV. All patients had normal ovaries and a normal vagina regardless of tumor site or stage; however, late ovarian and vaginal recurrences developed in one patient, in whom one ovary had been preserved. Sixteen percent of the patients had urethral involvement. We conclude that synchronous or metachronous involvement of female internal genitalia in bladder cancer is uncommon. Preservation of ovaries and vagina in young patients undergoing radical cystectomy may be considered under strict criteria.

Model-based estimation of male urethral resistance and elasticity using pressure-flow data.

To assess urethral resistance and changes in the urethral elasticity during voiding, a lumped parameter model of the urethra was developed. The model uses pressure and flow measurements to estimate time-dependent resistance and elasticity factor. The model includes a resistance that has a function of the cross-section and urethral elasticity. Two resistivity types are compared in the constricted flow-controlling zone of the urethra: Poiseouille resistance and the Bernoulli effect. Using real pressure-flow data sets, the model was used to estimate urethral resistance and changes in urethral elasticity during voiding. Estimation of the elasticity show that in a normal patient relaxation of the urethra is a process that continues until the end of voiding. This has important implications with regard to the present methods that are used in the clinic to assess urethral obstruction or constriction. The resistance as calculated by this model, may be a useful indicator of urethral constriction and obstruction, since it is especially independent of the bladder function. Changes in the urethral elasticity during voiding which are estimated by the model add a new diagnostic parameter to pressure-flow studies.

[Repeated self-catheterization of the bladder].

41 adults with urinary retention of various etiologies (including 10 after cystoplastic surgery) were treated by clean, intermittent, self-catheterization (CISC) for a mean of 37 months. Most learned the technique in the outpatient clinic. 4 needed assistance in performing CISC by family members. None stopped the treatment. In 72% there was no discomfort or only mild discomfort. 39% had acute UTI in the preceding year. We conclude that emptying the bladder by CISC is effective and easy to learn. Although patients are initially reluctant, most adapt well to the technique and morbidity is relatively low.

[Surgery for women with urethral diverticulum].

Urethral diverticulum in the female is an acquired lesion following infection of the para-urethral glands. Its symptoms are often nonspecific and only by increased awareness of this condition can delay in diagnosis be avoided. Radiologic imaging of the urethra allows diagnosis of this lesion and determination of its location, extent and the number of lesions. Complete surgical excision is the optimal therapy. In recent years 8 women with this condition were admitted aged 21-52 years. It had been an average of 11 months before their lesions were diagnosed. All had complete surgical excision without perioperative complications. In 5 a Martius labial fat pad was used to facilitate prompt healing of the urethral defect. 6 have been followed for over a year and are completely symptom-free. Judicious choice of surgical technique is required to reduce the rate of complications in the management of these lesions.

Inference comprehension of adolescents with traumatic brain injury: a working memory hypothesis.

This study investigated inference comprehension performance in adolescents who had suffered a traumatic brain injury (TBI). Using stimuli adapted from Lehman-Blake and Tompkins, participants listened to short paragraphs that varied according to the working memory demands of the task and answered comprehension questions that required inferences to be generated. Six adolescents, aged 12-16 years, who had suffered a TBI prior to the age of 10 years, were assessed and their performance was compared to six individually age-matched peers with typical development. Analysis revealed that individuals with TBI did not differ from non-injured peers in their understanding of inferences when the storage demands of the task were minimized. However, when storage demands were high, adolescents with TBI performed poorly compared to their age-matched peers. Results are discussed relative to a working-memory hypothesis of impairment following TBI.

Enhancing the phonological processing skills of children with specific reading disability.

The present study evaluated the benefits of phonological processing skills training for children with persistent reading difficulties. Children aged between 9-14 years, identified as having a specific reading disability, participated in the study. In a series of three experiments, pedagogical issues related to length of training time, model of intervention and severity of readers' phonological processing skills deficit prior to intervention, were explored. The results indicated that improvement in poor readers' phonological processing skills led to a dramatic improvement in their reading accuracy and reading comprehension performance. Increasing the length of training time significantly improved transfer effects to the reading process. Children with particularly severe phonological processing skill deficits benefited from an extended training period, and both individual and group intervention models for phonological processing training proved successful. Implications for speech and language therapists are discussed.

Sequential study of macrophage migration inhibition factor in renal cell carcinoma patients.

Preliminary investigation of cell-mediated immunity (CMI) in 49 patients harboring renal cell carcinoma (RCC) by the migration inhibition factor (MIF) tests as compared to 47 patients with simple renal cysts or normal kidneys established the specificity (85%) and reproducibility of this test. A retrospective analysis of the results of the MIF test was conducted in 35 patients followed for a minimum 20-month period. A marked difference was observed between the group of patients with localized disease who remained disease free and those with metastatic lesions and disease progression. The first group sustained their positive response of the MIF tests for a longer time during the study period, while the latter had a decrease of the MIF test response shortly after surgery. This difference may indicate that immune response as reflected in the positive MIF test has a role in RCC patients' defense mechanism.

Bladder diverticula in elderly females with urgency, dysuria and incontinence.

Bladder diverticula are usually encountered in the male. Their occurrence in women is scarcely appreciated. The association of bladder diverticula with urinary tract infection, dysuria, urgency and incontinence is reported in a series of 11 elderly female patients. The etiology of this finding is discussed based on urodynamic evaluation of these patients.

The dissolution of urinary mucus after cystoplasty.

Three agents have been tested for mucolytic activity to prevent or treat difficulties in bladder emptying following augmentation and substitution cystoplasty, particularly in patients emptying by intermittent self-catheterisation. Carbocysteine produced precipitation of mucus, which was found not to be helpful. N-acetylcysteine and urea both dissolved mucus, but urea proved to be more effective.

Risk factors and their effect on the results of Burch colposuspension for urinary stress incontinence.

Forty patients with urinary stress incontinence were studied and the results of Burch colposuspension evaluated. Combined detrusor instability and stress incontinence were found in 22.5% of the patients. The results of surgery showed that 87.5% of the patients (35/40) were cured of incontinence. None of the contributing risk factors of incontinence had a significant role in the outcome of surgery. In view of this, all patients with surgically amenable urinary incontinence should be considered for surgical resolution of this condition.

Long-term follow-up of surgery for urinary incontinence in elderly women.

This study reviews the 3- to 5-year follow-up of 35 elderly women treated by colposuspension for incontinence due to urethral sphincter incompetence (genuine stress incontinence). All patients had pre- and post-operative urodynamic studies and were followed up annually by clinical assessment and Urilos test. Thirty-two patients were subjectively cured and 31 objectively cured. Cystocele was corrected by the colposuspension. Rectocele and enterocele were frequently encountered at follow-up and prophylactic closure of the pouch of Douglas or posterior repair were recommended. Although the peak urine flow rate measurements at follow-up were reduced, no patient encountered difficulty in bladder emptying. The low operative and post-operative morbidity rate was due to careful pre-operative medical selection.

Computed tomography of renal agenesis and ectopy.

The position and shape of the organs normally adjacent to the kidney were evaluated by computed tomography in seven patients with renal agenesis and in two patients with unilateral renal ectopy. The major findings were displacement of colonic flexures, small intestine loops, duodenum, spleen, and tail of the pancreas. The shape and position of the adrenal gland was found abnormal in cases with left-sided anomaly. Genital abnormalities such as absent seminal vesicle were frequently encountered. The presence of abnormally shaped adrenal glands in patients with left renal agenesis and ectopy is a new diagnostic radiologic sign for these conditions.