Correlations between unsatisfactory colposcopy, cytology, and biopsy in patients with cervical abnormalities.

BACKGROUND: The main purpose of this study is to review the clinical features of negative loop electrosurgical procedure(LEEP)-cones, in order to lower their rate. METHODS: Some 162 patients with LEEP-cones were reviewed. Control cytology,satisfactory-unsatisfactory colposcopy, biopsies and endocervical curettage (ECC) were compared to the presence or absence of cone pathology. Statistical analysis, t -tests and Pearson x2 tests were performed, with a significance level of p<0.05. RESULTS: Negative cones are associated with unsatisfactory colposcopy in 47/60 cases (78.3%) compared to 13/60(21.8%) for satisfactory colposcopy (p=0.011). Unsatisfactory colposcopy is associated with a negative ECC in 53/74(71.6%) cases, compared to 21/74 (28.4%) for satisfactory colposcopy (p=0.024). Finally, negative ECC are associated with negative cones in 32/41 (78%) compared to 9/41 (22%) for positive ECC (p=0.002). CONCLUSIONS: Low grade cytology, CIN1 biopsies and ECC should be followed for at least 1 year. This results in a lowering of cone negativity from 60/162(37%) to 32/162 (19.8%).

Kinin-dependent hypersensitivity reactions in hemodialysis: metabolic and genetic factors.

Although the association of angiotensin I-converting enzyme inhibitors (ACEis) with a negatively charged membrane is thought to be responsible for hypersensitivity reactions (HSRs) during hemodialysis, we hypothesize that these complications are due to changes in plasma aminopeptidase P (APP) activity and genotype. To test this hypothesis, we measured plasma APP activity in 14 patients who suffered HSR (HSR+) while dialyzed with an AN69 membrane and simultaneously treated with an ACEi. APP activity was also studied in a control group (n=39) dialyzed under the same conditions, but who did not suffer any side effect (HSR-). We found significantly decreased plasma APP activity (P=0.013) in HSR+ subjects as well as altered degradation of endogenous des-Arginine(9)-bradykinin, with a significantly lower beta value (P<0.001). The same analytical approach was taken in 171 relatives of HSR+ patients. Variance component analysis suggested that genetic differences may explain 61% of the phenotypic variability of plasma APP activity (P<0.001) and the kinetic parameters that characterized kinin degradation. We also showed that the C-2399A single-nucleotide polymorphism at the XPNPEP2 locus was a significant predictor of APP activity in the 39 HSR- controls (P=0.029). Furthermore, a recessive genetic model for the A allele disclosed a significant difference in mean APP activity by genotype (P<0.001). Finally, our study defined the nonspecific inhibition of recombinant APP by some ACEis. In conclusion, this paper highlights the complexity of HSR in hemodialysis, suggesting, as with angioedema, that these rare, but life-threatening adverse events are governed by several metabolic and genetic factors.

Bradykinin and des-Arg(9)-bradykinin metabolic pathways and kinetics of activation of human plasma.

In the serum of 116 healthy individuals, exogenous bradykinin (BK) half-life (27 +/- 10 s) was lower than that of des-Arg(9)-BK (643 +/- 436 s) and was statistically different in men compared with women. The potentiating effect of an angiotensin-converting enzyme (ACE) inhibitor was, however, more extensive for BK (9.0-fold) than for des-Arg(9)-BK (2.2- fold). The activities of ACE, aminopeptidase P (APP), and kininase I were respectively 44 +/- 12, 22 +/- 9, and 62 +/- 10 nmol x min(-1) x ml(-1). A mathematical model (y = kt(alpha)e(-beta t), t > 0), applied to the BK kinetically released from endogenous high-molecular-weight kininogen (HK) during plasma activation in the presence of an ACE inhibitor, revealed a significant difference in the rate of formation of BK between men and women. For des-Arg(9)-BK, the active metabolite of BK, the rate of degradation was higher in women compared with men, correlating significantly with serum APP activity (r(2) = 0.6485, P < 0.001). In conclusion, these results constitute a basis for future pathophysiological studies of inflammatory processes where activation of the contact system of plasma and the kinins is involved.

Physical impairments in cervicogenic headache: traumatic vs. nontraumatic onset.

In order to quantify the physical impairments associated with different types of headache, 77 subjects belonging to four different groups (postmotor vehicle accident cervicogenic headache subjects, cervicogenic headache subjects nontraumatic, migraine patients and control subjects) were evaluated using the following variables: posture, cervical range of motion, strength of the neck flexors and extensors, endurance of the short neck flexors, manual segmental mobility, proprioception of the neck, and pain (McGill Pain Questionnaire and the skin roll test). The results of this study showed that postmotor vehicle accident cervicogenic patients have significantly limited active cervical range of motion (in flexion/extension and rotations), present decreased strength and endurance of neck flexors and decreased strength of the extensor muscles. Our results suggest that there are enough differences between the postmotor vehicle accident and nontraumatic cervicogenic headache subjects to warrant caution when analysing the data of these two subgroups together, as several studies have done in the past. The onset of headache is therefore an important variable that should be controlled for when attempting to characterize the physical impairments associated with cervicogenic headache.

Effects of upper and lower limb static exertions on global synkineses in hemiparetic subjects.

OBJECTIVES: Global synkineses are nonpurposive pathological involuntary muscle activities or movements elicited at several or all of the joints of the affected limb or limbs during voluntary forceful resisted contractions. The purpose of this study was to assess the effect of upper and lower limb exertions on manifestations of upper limb global synkineses in hemiparetic subjects. DESIGN: Involuntary muscle activities on the affected upper limb of 11 hemiparetic subjects and on the left or right upper limb of 10 control subjects were recorded using surface electromyography during successive bilateral maximal ankle exertions and during contralateral grips. RESULTS: Significant differences in the level of involuntary electromyography (EMG) activities were observed between experimental conditions (ANOVAs, p < 0.05). EMG levels in hemiparetic subjects were significantly higher during contralateral grip tasks than during the ankle exertions. CONCLUSION: These results suggest that upper limb global synkinases are more prevalent in specific tasks and that this task specificity may reflect the neurophysiological mechanisms involved in the generation of global synkinases.

Endocervical curettage in cervical evaluation.

OBJECTIVE: To evaluate the role of endocervical curettage (ECC) in the diagnosis of cervical intraepithelial neoplasia. MATERIALS AND METHODS: Retrospectively we studied 581 patients who had ECC, 43 (7.4%) had cervical intraepithelial lesions (CIN) 1 ECC, 23 (4.0%) CIN 2-3 ECC, and 515 negative ECC (88.6%). Analysis of variance was used to compare for age and parity, and Pearson's chi-square test was used to analyze the association with other variables such as cytology, images, acetowhite epithelium, microbiopsy, and ECC. Significance level was set at p = 0.05. RESULTS: Age for CIN 1 ECC was at 32.3 (16-66) years; parity was at 0.82 (parity 0-7) compared with 35.2 (18-70) years and parity at 1.52 (parity 0-12) for CIN 2-3 ECC, and 36.1 (14-68) years, parity at 1.1 (parity 0-10) for negative ECC. ECC is associated with Cytobrush cytology (Zelsmyr Cytobrush, International Cytobrush Inc., Hollywood. FL) (p = 0.000) in CIN 2-3 ECC and high-grade squamous intraepithelial lesion (HGSIL) cytology. Positive ECC was not overrepresented in unsatisfactory colposcopy (14/61, 23%) compared with negative ECC (158/526, 30%, p = 0.43). If positive ECC is not associated with the presence of significant acetowhite epithelium, a net association (p = 0.000) was observed between CIN 1 microbiopsies and CIN 1 ECC 9 (12/19), and CIN 2-3 biopsies and CIN 2-3 ECC (12/17). Conization for CIN 2-3 ECC (n = 23) yielded 15 CIN 2-3, two CIN 1, one microinvasive cervical cancer, one cancer of the cervix, and four negative cones. CONCLUSIONS: Positive endocervical curettage is associated with endocervical cytology and microbiopsy. In ablative treatments, when low-grade squamous intraepithelial lesion (LGSIL) smear, satisfactory colposcopy, and CIN 1 biopsy is observed, ECC appears unnecessary since CIN 2-3 ECC was not observed in these patients. All other cases should have ECC prior to ablative therapy. CIN 2-3 ECC, commands conization, in order to eliminate invasive cancer, and confirm and treat CIN 2-3. ▪.

Serum metabolism of bradykinin and des-Arg9-bradykinin in patients with angiotensin-converting enzyme inhibitor-associated angioedema.

Angioedema (AE) associated with angiotensin-converting enzyme inhibitors (ACEi) is a rare, but potentially life-threatening adverse reaction. Several studies have suggested that bradykinin (BK) is responsible for ACEi-induced AE, but the mechanism remains unclear. We investigated the metabolism of BK and des-Arg9-BK in the serum of 20 patients with a history of ACEi-associated AE and 21 control (C) subjects. Synthetic BK was incubated with the sera for various periods of time and residual BK and generated des-Arg9-BK were quantified by specific and sensitive enzyme immunoassays. No significant difference of half-life (t1/2) of both BK and des-Arg9-BK could be measured between C subjects and patients with AE (AE) in absence of ACEi. However, an analysis according to the prolonged (+) or not (-) t1/2 of des-Arg9-BK allowed a new stratification of C subjects and AE patients in four subgroups. The preincubation of sera with enalaprilat at a concentration inhibiting ACE significantly prevented the rapid degradation of BK and des-Arg9-BK in these four subgroups. In presence of ACEi, a subgroup (50%) of AE patients (AE + ) had a particularly significant rise of the t1/2 of des-Arg9-BK. Once ACE was inhibited, the concentration or the nature of the ACEi had no significant effect on the t1/2 of des-Arg9-BK. However, a test dilution of AE + sera with a control (C) serum showed that an enzyme defect rather than a circulating inhibitor could be responsible for the abnormal metabolism of des-Arg9-BK when ACE is inhibited. In conclusion, half of the patients with ACEi-associated AE present in serum had an enzyme defect involved in the des-Arg9-BK metabolism leading to its accumulation. The B1 agonist could be responsible, at least in part, for the local inflammatory reaction associated with the AE.

Studies on small (<350 microm) alginate-poly-L-lysine microcapsules. III. Biocompatibility Of smaller versus standard microcapsules.

Microencapsulation of islets of Langerhans has been proposed as a means of preventing their immune destruction following transplantation. Microcapsules of diameters <350 microm made with an electrostatic pulse system present many advantages relative to standard microcapsules (700-1500 microm), including smaller total implant volume, better insulin kinetics, better cell oxygenation, and accessibility to new implantation sites. To evaluate their biocompatibility, 200, 1000, 1120, 1340, or 3000 of these smaller microcapsules (<350 microm) or 20 standard microcapsules (1247+/-120 microm) were implanted into rat epididymal fat pads, retrieved after 2 weeks, and evaluated histologically. The average pericapsular reaction increased with the number of small microcapsules implanted (p<0.05; 3000 vs. 200, 3000 vs. 1000, and 1000 vs. 200 microcapsules). At equal volume and alginate content, standard microcapsules caused a more intense fibrosis reaction than smaller microcapsules (p<0.05). In addition, 20 standard microcapsules elicited a stronger pericapsular reaction than 200 and 1000 smaller microcapsules (p<0.05) although the latter represented a 3.4-fold larger total implant surface exposed. We conclude that microcapsules of diameters <350 microm made with an electrostatic pulse system are more biocompatible than standard microcapsules.

Bradykinin metabolism in the postinfarcted rat heart: role of ACE and neutral endopeptidase 24.11.

The respective role of angiotensin-converting enzyme (ACE) and neutral endopeptidase 24.11 (NEP) in the degradation of bradykinin (BK) has been studied in the infarcted and hypertrophied rat heart. Myocardial infarction (MI) was induced in rats by left descendant coronary artery ligature. Animals were killed, and hearts were sampled 1, 4, and 35 days post-MI. BK metabolism was assessed by incubating synthetic BK with heart membranes from sham hearts and infarcted (scar) and noninfarcted regions of infarcted hearts. The half-life (t1/2) of BK showed significant differences among the three types of tissue at 4 days [sham heart (114 +/- 7 s) > noninfarcted region (85 +/- 4 s) > infarcted region (28 +/- 2 s)] and 35 days post-MI [sham heart (143 +/- 6 s) = noninfarcted region (137 +/- 9 s) > infarcted region (55 +/- 4 s)]. No difference was observed at 1 day post-MI. The participation of ACE and NEP in the metabolism of BK was defined by preincubation of the membrane preparations with enalaprilat, an ACE inhibitor, and omapatrilat, a vasopeptidase inhibitor that acts by combined inhibition of NEP and ACE. Enalaprilat significantly prevented the rapid degradation of BK in every tissue type and at every sampling time. Moreover, omapatrilat significantly increased the t1/2 of BK compared with enalaprilat in every tissue type and at every sampling time. These results demonstrate that experimental MI followed by left ventricular dysfunction significantly modifies the metabolism of exogenous BK by heart membranes. ACE and NEP participate in the degradation of BK since both enalaprilat and omapatrilat have potentiating effects on the t1/2 of BK.

Severe neuronal losses with age in the parietal cortex and ventrobasal thalamus of mice transgenic for the human NF-L neurofilament protein.

Transgenic mice expressing human light neurofilament protein (NF-L) display early perikaryal accumulations of disarrayed neurofilaments in layers II/III of the parietal cortex and in the ventrobasal complex of thalamus. This cytoskeletal abnormality, reflected by strong NF-L immunoreactivity, is transient in the developing cortex but persists until old age in the thalamus. To investigate whether it leads to neuronal death, the unbiased cell counting method of the dissector was applied to the parietal cortex and the thalamus of normal and transgenic mice at various postnatal (P10, P20, P90) and advanced ages (14-18 months). Similar data were also obtained from the primary visual cortex free of NF-L accumulation. Compared with normal, the total number of neurons in the parietal (but not occipital) cortex of transgenic mice showed little change during the postnatal period, but decreased markedly with old age, particularly in layers II/III. Severe neuronal loss was also documented in the thalamic ventrobasal complex of aged transgenic mice. The delayed neuronal death in the parietal cortex, occurring long after recovery from the NF-L accumulations, was suggestive of a combination of deleterious factors, including the early overproduction of neurofilament protein and subsequent loss of afferent input from the affected somatosensory thalamic nuclei. Furthermore, strong accumulation of lipofuscin in the neurons of aged transgenic mice suggested that oxidative stress partakes in the mechanisms through which NF-L overproduction compromises neuronal viability.

Atypical squamous cells of undetermined significance (ASCUS): clinical-cytological significance.

The objective of this paper is to compare histologic results of microbiopsies and/or endocervical curettage obtained following the older cytological "atypical" diagnosis and the newer Bethesda ASCUS terminology. We reviewed a series of atypical smears (n = 245) from December 1991 to February 1995 and ASCUS cases (n = 120) from March 1995 to May 1996, when some atypias were renamed ASCUS according to the Bethesda classification. These patients were examined by colposcopy for cervical lesion and clinical evaluation. Menopausal women were underrepresented in atypical smears (n = 21/245, 8.6%) in comparison with ASCUS (n = 29/120, 24.2%, P = 0.001). Since, no low or high grade squamous intraepithelial lesion (L/HSIL) was ever found in the >/= 50 years group, we reviewed only patients under 50 years. Atypical smears resulted in 61/224 (27.2%) positive biopsies of which 47 (21%) were LSIL and 14 (6.2%) were HSIL; ASCUS smears yielded 17/91 (18.7%) positive pathology diagnoses with 13 (14.3%) LSIL and 4 (4.4%) HSIL. Endocervical curettage positivity (ECC) was at 6/109 (5.5%) for atypias, and 1/53 (1.9%) for ASCUS. Cervical biopsies in ASCUS smears show a tendency to a lower histologic positivity rate, in comparison with atypical cytology. Persistent ASCUS smears should be evaluated by colposcopy, and thereafter at 6-month intervals. The exact meaning of ASCUS, in spite of a 17.5% CIN rate, remains unknown, but constitutes a high-risk group.

Serotonin axons of the neostriatum show a higher affinity for striatal than for ventral mesencephalic transplants: a quantitative study in adult and immature recipient rats.

We previously showed that grafts of fetal ventral mesencephalic tissue are practically not innervated by host serotonin (5-HT) axons after implantation into the striatum of rats aged more than 14 days, at variance with transplants of cortical or striatal tissue into the adult striatum, which are well innervated by these axons. Using 5-HT immunohistochemistry and in vitro [3H]5-HT uptake/autoradiography, we have examined and quantified the innervation of ventral mesencephalic versus striatal grafts several months after implantation into the striatum of neonatal (postnatal day 5 or P5), juvenile (P15), and adult rats. Ventral mesencephalic grafts implanted in P5 rats received a moderate 5-HT innervation, while similar grafts implanted in P15 or adult recipients were almost free of any 5-HT fibers (-80%, compared to P5). The density of 5-HT innervation showed a tendency toward higher values in striatal than in ventral mesencephalic grafts (1.6-2 times higher in P5 and adult recipients; 4 times higher in P15 recipients). The difference was more striking, and significant, when only the true striatal portions of the striatal grafts were considered, i.e., DARPP-32-immunopositive areas (4-5 times higher in P5 and adult recipients; 10 times higher in P15 recipients). Accordingly, these DARPP-32-positive areas were also more densely innervated than the DARPP-32-negative zones of the same grafts (3 times higher at any age). The 5-HT innervation density also decreased with increasing age of the recipients in DARPP-32-positive, as well as DARPP-32-negative compartments of the striatal grafts (-75% in adults), but this decrease appeared more gradual (-50% in juveniles) than with mesencephalic grafts. It is concluded that the 5-HT axons innervating the neostriatum have a better affinity for striatal grafts than for ventral mesencephalic grafts or the nonstriatal portions of striatal grafts. In adulthood, the relative affinity of these axons for the different types of grafts is maintained, even though their growth capacity decreases irrespective of the target tissue considered. This experimental model may prove useful for the identification of the receptors and ligands that are responsible for target recognition by 5-HT axons and to test the possibility that the progressive decrease of axonal growth capacity from neonatal age to adulthood be related to a downregulation of such molecules.

Compared randomized roles and pain factor by Vabra and Wallach Endocell in endometrial evaluation.

This randomized study was carried out to compare pain factors of Vabra and Endocell by an ordered classification of one to ten to evaluate the respective pathological yield and to establish the clinical acceptability. Patients had endometrial evaluation either for abnormal bleeding, abnormal endometrial line as demonstrated by echography or abnormal endometrial cells in the Pap smear. Age, gravidity, parity and hysterometry were similar in both groups, with abnormal bleeding being the most frequent indication (250/370 patients, 67.5%). Both techniques yielded equal results for insufficient tissue retrieval at 46/184 (25.0%) for Vabra and at 50/183 (27.3%) for Endocell. The pain score differed significantly in favor of Wallach Endocell at 4.36+/-2.38 versus Vabra at 5.65+/-2.41 (p=0.001). Vabra and Endocell give similar pathological results; however, Endocell is significantly less painful and easier to manipulate and carry because of its weight (1.69 g vs. 37.80 g).

Predictive factors for positive or negative pathology in loop and laser conizations.

OBJECTIVE: The main purpose of this study is to predict positive-negative pathology in association with operative indications in laser and loop conizations. MATERIALS AND METHODS: This retrospective study comprises two groups of women, the first group composed of 74 loop conizations, the second of 78 laser cones. Positive endocervical curettage, unsatisfactory colposcopy with no visible lesion or junction, discrepant cytology and biopsy, suspicion of invasion, or a glandular lesion were considered as indications for cones. All cones were performed under local intramucous anesthesia, and 15 mm of endocervical mucosa was removed. RESULTS: Loop and laser cone outcomes were comparable for age, parity, and pathology with negative or positive margins. Endocervical curettage of lesions of cervical intraepithelial neoplasia grades 2 and 3 (CIN2 and CIN3) predicted both higher cone pathology (p =.048) and high-grade squamous intraepithelial lesions, as evidenced by preoperative cytology (p =.000). Among 32 negative-margins cases, 2 (6.3%) had CIN persistence as compared to 6 patients (24%) of 25 positive margins. CONCLUSIONS: Laser and loop cones yield similar pathological results, and special care should be used for CIN1 endocervical curettage and low-grade squamous intraepithelial lesion cytology with conization indication, in regard to the high possibility of negative cone pathology.

Colonic transit time after spinal cord injury.

Colonic transit time (CTT) was measured with abdominal radiographs using Chaussade's technique in 30 spinal cord injured patients (ASIA A and B) following ingestion of 20 radiomarkers per day for three days. A significant increase in total CTT (p = 0.0001) and segmental CTT of the right colon (p = 0.0004) and of the left colon (p = 0.0001) was shown. While using on the average only 2.3 films of the abdomen per patient, we obtained results comparable with other radiologic techniques which use radiomarkers to measure CTT. The clinical relevance of these results is not clear and their correlation with intestinal symptoms remains to be investigated.

Measures of effect based on the sufficient causes model. 3. Multivariate analysis.

We discuss a method based on the sufficient causes model for estimating the causal and preventable fractions associated with any number of agents. P1, the cumulative risk of disease in the exposure category of interest, is given by the function: P1 = 1 - e-(i.+i1x1+...+ijxj+...+inxn)t. The presence or absence of sufficient cause in j in this exposure category is represented by x(j) (= 1.0), and parameter ij is the incidence density of completion of sufficient cause j. From ij, one can derive the risk difference and the causal and preventable fractions associated with sufficient cause j. The main assumptions required for these measures of effect to be unbiased are the constancy of incidence densities ij over time, the homogeneity of these densities over subjects, and the independence of occurrence times of sufficient causes within subjects. The estimation of the causal fraction requires all three assumptions. The preventable fraction requires only the homogeneity assumption. The risk difference requires none of these assumptions. This causal model probably applies to very few real situations, but it can serve as an epidemiologically meaningful starting point for the development of models adapted to particular situations whose underlying causal processes are known or can be hypothesized.

Effects of transcutaneous electrical nerve stimulation on H-reflex and spinal spasticity.

The purpose of this study was to investigate the short-term effects of transcutaneous electrical nerve stimulation (TENS; 99 Hz; 250 ms pulses) on H-reflex and spinal spasticity. Considering the reflex hyperexcitability commonly displayed in spinal cord-injured subjects, it was hypothesized that repetitive low threshold afferent stimulation would have an inhibitory effect on the triceps surae H-reflexes which could also be reflected by a decrease in plantarflexor spasticity. Clonus, Achilles tendon reflex and modified Ashworth evaluations were performed on 14 spinal cord-injured subjects prior to and after 30 minutes' application of TENS. Non-parametric statistical analyses (n = 14; alpha = 0.05) failed to reveal significant effects of TENS on H-reflex amplitude. However, there was a significant decrease in scores for the Achilles tendon reflex and the modified Ashworth test. The clonus score decreased in most subjects post-TENS, although not in a statistically significant manner. The present pilot results thus suggest that TENS appears to be effective in reducing spinal spasticity, as measured clinically.

Comparison between oral and written spelling in Alzheimer's disease.

Written and oral spelling were compared in 33 patients with Alzheimer's disease (AD) and 25 control subjects. AD patients had poorer spelling results which were influenced by orthographic difficulty and word frequency, but not by grammatical word class. Lexical spelling was also more deteriorated than phonological spelling. Moreover, oral spelling was more impaired than written spelling in AD patients, whereas no difference was present between oral and written spelling of controls. Analysis of spelling errors showed that, for controls, errors were predominantly phonologically accurate in both spelling tasks. Significantly, AD patients produced more phonologically accurate than inaccurate errors in written spelling, whereas these errors did not differ in oral spelling. In contrast to controls who produced more constant than variable responses in oral and written spelling, AD patients made more variable responses (words correctly spelled in one task but incorrectly in the other) and they showed many instances of variable errors (different misspellings from one spelling task to the other). Two stepwise regression procedures showed that written misspellings were specifically correlated with language impairment, whereas oral spelling errors were correlated with attentional and language disorders. These results suggest that AD increases the attentional demands of oral spelling process as compared to written spelling. This dissociation argues, either for a unique Graphemic Buffer in which oral spelling requires more attentional resources than written spelling or for the hypothesis of separate buffers for oral and written spelling.

Comparative study of oral and written picture description in patients with Alzheimer's disease.

Oral and written picture descriptions were compared in 22 patients with Alzheimer's disease (AD) and 24 healthy elderly subjects. AD patients had a significant reduction of all word categories, which, similarly to controls, was more pronounced in written than in oral texts. They also reported fewer information units than controls, but without task difference. At the syntactic level, written descriptions of AD subjects were characterized by a diminution of subordinate clauses and a reduction of functors. More grammatical errors were present in written descriptions by AD and control subjects. AD and control groups produced an equivalent number of semantic errors in both tasks. However, in oral description, AD patients had more word-finding difficulties. In sum, AD descriptions were always shorter and less informative than control texts. Additionally, written descriptions of AD patients appeared shorter and more syntactically simplified than, but as informative as oral descriptions. Whereas no phonemic paraphasias were observed in either group, AD patients produced many more graphemic paragraphias than controls produced. Furthermore, written descriptions had more irrelevant semantic intrusions. Thus, as compared to oral descriptions, written texts appeared to be a more reliable test of semantic and linguistics difficulties in AD.