Semantic Versus Orthographic Preferences in Aphasia: Behavioral Evidence.

In this study, we compared the orthographic and semantic preferences of healthy adults and age and gender matched adults with aphasia, an acquired language disorder. Previous research in word retrieval and word associations has addressed semantic and phonological connections, but it has not as often included analyses of orthographic skills. We matched (on age and gender) 10 neurotypical adults and 11 older adults with aphasia and administered to both groups a lexical discrimination task requiring them to select, from 18 choices, those words that were most different from three words (daughter, laughter, son). Among the choices were foil words (e.g., daughter), orthographic similarities (laughter) and semantic similarities (son). Results revealed that individuals with aphasia focused on orthographic differences, while healthy adults chose semantic differences. Further studies should further explore this orthographic focus to develop treatment strategies, using behavioral and objective measures, for word-finding deficits in aphasia.

Population Analysis of Male Urethral Stricture Management and Urethroplasty Success in the United States.

OBJECTIVE: To examine population-based practice patterns and outcomes related to urethroplasty for urethral stricture management. METHODS: We conducted a retrospective study of adult males with urethral stricture disease treated from January 2001 to June 2015 using the Clinformatics Data Mart Database. Treatment was defined as urethral dilation, direct visualized internal urethrotomy, and urethroplasty. We then examined anterior or posterior urethroplasty outcomes defining failure as any subsequent procedure specific to urethral stricture disease occurring >30 days after urethroplasty. We used multivariable and time-to-event analysis to examine factors associated with failure. RESULTS: We identified 75,666 patients treated for urethral stricture disease, with 420 and 367 undergoing anterior and posterior urethroplasty, respectively. Urethroplasty utilization doubled from 2005 to 2015. One- and 5-year failure rates for anterior and posterior urethroplasty were 25% and 18%, and 40% and 25%, respectively, with median times to failure of 5.1 and 4.1 months. Failures were salvaged primarily with direct visualized internal urethrotomy, with salvage urethroplasty in 19% and 12% of anterior and posterior repairs, respectively. CONCLUSION: Despite increasing population-based urethroplasty utilization over the past decade in our insured cohort, we found higher rates of salvage treatments than reported by high-volume and expert surgeon reports. Further efforts appear warranted to balance workforce expertise and quality of urethroplasty care to meet increasing urethral stricture population needs.

Primary cryotherapy for localised or locally advanced prostate cancer.

BACKGROUND: Traditionally, radical prostatectomy and radiotherapy with or without androgen deprivation therapy have been the main treatment options to attempt to cure men with localised or locally advanced prostate cancer. Cryotherapy is an alternative option for treatment of prostate cancer that involves freezing of the whole prostate (whole gland therapy) or only the cancer (focal therapy), but it is unclear how effective this is in comparison to other treatments. OBJECTIVES: To assess the effects of cryotherapy (whole gland or focal) compared with other interventions for primary treatment of clinically localised (cT1-T2) or locally-advanced (cT3) non-metastatic prostate cancer. SEARCH METHODS: We updated a previously published Cochrane Review by performing a comprehensive search of multiple databases (CENTRAL, MEDLINE, EMBASE), clinical trial registries (ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform) and a grey literature repository (Grey Literature Report) up to 6 March 2018. We also searched the reference lists of other relevant publications and conference proceedings. We applied no language restrictions. SELECTION CRITERIA: We included randomised or quasi-randomised trials comparing cryotherapy to other interventions for the primary treatment of prostate cancer. DATA COLLECTION AND ANALYSIS: Two independent reviewers screened the literature, extracted data, and assessed risk of bias. We performed statistical analyses using a random-effects model and interpreted them according to the Cochrane Handbook for Systematic Reviews of Interventions. We rated the quality of evidence (QoE) according to the GRADE approach. MAIN RESULTS: We included only one comparison of whole gland cryotherapy versus external beam radiotherapy, which was informed by two trials with a total of 307 randomised participants. The median age of the included studies was around 70 years. The median follow-up of included studies ranged from 100 to 105 months.Primary outcomes: we are uncertain about the effect of whole gland cryotherapy compared to radiation therapy on time to death from prostate cancer; hazard ratio (HR) of 1.00 (95% confidence interval (CI) 0.11 to 9.45; 2 trials, 293 participants; very low QoE); this would correspond to zero fewer death from prostate cancer per 1000 men (95% CI 85 fewer to 520 more). We are equally uncertain about the effect of quality of life-related urinary function and bowel function (QoL) at 36 months using the UCLA-Prostate Cancer Index score for which higher values (range: 0 to 100) reflect better quality of life using minimal clinically important differences (MCID) of 8 and 7 points, respectively; mean difference (MD) of 4.4 (95% CI -6.5 to 15.3) and 4.0 (95% CI -73.96 to 81.96), respectively (1 trial, 195 participants; very low QoE). We are also uncertain about sexual function-related QoL using a MCID of 8 points; MD of -20.7 (95% CI -36.29 to -5.11; 1 trial, 195 participants; very low QoE). Lastly, we are uncertain of the risk for major adverse events; risk ratio (RR): 0.91 (95% CI 0.47 to 1.78; 2 trials, 293 participants; very low QoE); this corresponds to 10 fewer major adverse events per 1000 men (95% CI 58 fewer to 86 more). SECONDARY OUTCOMES: we are very uncertain about the effects of cryotherapy on time to death from any cause (HR 0.99, 95% CI 0.05 to 18.79; 2 trials, 293 participants; very low QoE), and time to biochemical failure (HR 2.15, 95% CI 0.07 to 62.12; 2 trials, 293 participants; very low QoE). Rates of secondary interventions for treatment failure and minor adverse events were either not reported in the trials, or the data could not be used for analyses.We found no trials that compared whole gland cryotherapy or focal cryotherapy to other treatment forms such as radical surgery, active surveillance, watchful waiting or other forms of radiotherapy. AUTHORS' CONCLUSIONS: Based on very low quality evidence, primary whole gland cryotherapy has uncertain effects on oncologic outcomes, QoL, and major adverse events compared to external beam radiotherapy. Reasons for downgrading the QoE included serious study limitations, indirectness due to the use of lower doses of radiation in the comparison group than currently recommended, and serious or very serious imprecision.

Urethral Rest with Suprapubic Cystostomy for Obliterative or Nearly Obliterative Urethral Strictures: Urethrographic Changes and Implications for Management.

PURPOSE: Precise preoperative characterization of urethral stricture is important for surgical planning. A period of urethral rest by a suprapubic cystostomy tube may aid in stricture characterization and affect the surgical approach. In this study fellowship trained reconstructive urologists compared the radiographic characterization of anterior urethral strictures before and after a period of urethral rest. We then determined how this changed the planned operative approach. MATERIALS AND METHODS: We queried our prospectively maintained urethroplasty database at our institution for men with an anterior urethral stricture who underwent retrograde urethrogram and voiding cystourethrogram before and after preoperative suprapubic cystostomy tube placement. A total of 29 men were identified for analysis. To minimize responder fatigue 20 pairs of radiographs were selected at random. All images before and after suprapubic tube placement were interpreted in random order by 11 fellowship trained reconstructive urologists. Interpretation included stricture length, diameter, location and surgeon operative plan. Preplacement and post-placement results were compared. Post-placement stricture length was also compared to intraoperative length. ICC was used to evaluate homogeneity among the urologists. Linear regression analysis was performed to determine the association of post-radiographic length after tube placement with intraoperative stricture length. RESULTS: Imaging agreement among interpreting urologists was satisfactory (ICC 0.72). There was no statistically significant difference in stricture length before vs after suprapubic tube placement. Of the images 23% were considered obliterative before tube placement while 58% were obliterative after placement (p = 0.0005). Mean ± SD post-placement radiographic and intraoperative stricture length was 3.0 ± 2.6 and 3.8 ± 3.3 cm, respectively (p <0.0001). Deviation between the radiographic and intraoperative lengths increased with stricture length (slope 0.26, p = 0.0023). The surgeon operative plan changed 47% of the time, including to an excision approach in 37% of cases. CONCLUSIONS: Despite optimal urethral imaging with a suprapubic tube in men with high grade stricture reconstructive urologists underestimated length by an average of almost 1 cm. This underestimation was less for shorter strictures and it increased with stricture length. In addition, a period of urethral rest resulted in more frequent stricture obliteration, which was associated with a change in the planned operative approach about half of the time. If urologists do not place a suprapubic cystostomy tube prior to urethroplasty for high grade stricture, the operative plan should account for the stricture being tighter than it may appear.

Penile Lengthening, Girth, and Size Preservation at the Time of Penile Prosthesis Insertion.

INTRODUCTION: Penile prosthetic devices are the gold standard treatment of medication-refractory erectile dysfunction. Inflatable penile prosthetic (IPP) devices have been available and used for more than four decades. Oftentimes, medical conditions causing erectile dysfunction also cause penile shortening, causing decreased patient quality of life. AIM: To identify and review all available penile lengthening procedures that can be performed at time of IPP insertion. METHODS: An extensive, systematic literature review was performed using PubMed searching for key terms penile lengthening, inflatable penile prosthesis, penile girth, corporoplasty, glans augmentation, and penile enhancement; all articles with subjective and/or objective penile length outcomes were reviewed. MAIN OUTCOME MEASURES: A review of various techniques for penile length and girth preservation and enhancement during penile prosthesis insertion. RESULTS: Several advanced and novel techniques were found for penile length preservation and enhancement at time of IPP insertion, including the sub-coronal IPP insertion technique, and adjuvant maneuvers during insertion, such as the sliding technique, modified sliding technique, multiple slice technique, and circumferential incision and grafting. Other adjuvant techniques that can enhance perception of increased length include ventral phalloplasty, suprapubic lipectomy, and suspensory ligament release. Further enhancement can be obtained using augmentation corporoplasty and glans augmentation with hyaluronic acid and other fillers. The different techniques vary in complexity and could require specialized training and experience. Maximum length gain appears to be limited by the length of the neurovascular bundles. CONCLUSION: Overall, surgical penile lengthening procedures at time of IPP insertion appear safe and effective for treatment of patients with penile shortening and severe erectile dysfunction. These therapies can significantly improve patient self-esteem and quality of life in properly selected patients. Tran H, Goldfarb R, Ackerman A, Valenxuela RJ. Penile Lengthening, Girth and Size Preservation at the Time of Penile Prosthesis Insertion. Sex Med Rev 2017;5:403-412.

The burden of chronic ureteral stenting in cervical cancer survivors

ABSTRACT Purpose Ureteral obstruction in cervical cancer occurs in up to 11% of patients, many of whom undergo ureteral stenting. Our aim was to describe the patient burden of chronic ureteral stenting in a population-based cohort by detailing two objectives: (1) the frequency of repeat procedures for ureteral obstruction; and, (2) the frequency of urinary adverse effects (UAEs) (e.g., lower urinary tract symptoms, flank pain). Materials and Methods From SEER-Medicare, we identified 202 women who underwent ureteral stent placement prior to or following cervical cancer treatment. The frequency of repeat procedures and rate ratios were compared between treatment modalities. The rates and rate ratios of UAEs were compared between our primary cohort (stent + cervical cancer) and the following groups: no stent + cervical cancer, stent + no cancer, and no stent + no cancer. The “no cancer” group was drawn from the 5% Medicare sample. Results 117/202 women (58%) underwent >1 stent procedure. The frequency of additional procedures was significantly higher in patients who received radiation as part of their treatment. UAEs were very common in women with stent + cancer. The rate of UTI was 190 (per 100 person-years), 67 for LUTS, 42 for stones, and 6 for flank pain. These rates were 3-10 fold higher than in the no stent + no cancer control group; rates were also higher than in the no stent + cancer and the stent + no cancer women. Conclusions The burden of disease associated with ureteral stents is higher than expected and urologists should be actively involved in stent management, screening for associated symptoms and offering definitive reconstruction when appropriate.

Urinary Diversion for Severe Urinary Adverse Events of Prostate Radiation: Results from a Multi-Institutional Study.

PURPOSE: We evaluated the short and long-term surgical outcomes of urinary diversion done for urinary adverse events arising from prostate radiation therapy. We hypothesized that patient characteristics are associated with complications after urinary diversion. MATERIALS AND METHODS: We performed a retrospective cohort study of 100 men who underwent urinary diversion (urinary conduit or continent catheterizable pouch) due to urinary adverse events after prostate radiotherapy from 2007 to 2016 from 9 academic centers in the United States. Outcome measurements included predictors of short and long-term complications, and readmission after urinary diversion of patients who had prostate cancer treated with radiotherapy. The data were summarized using descriptive statistics and univariate associations with complications were identified with logistic regression controlling for center. RESULTS: Mean patient age was 71 years and median time from radiotherapy to urinary diversion was 8 years. Overall 81 (81%) patients had combined modality therapy (radical prostatectomy plus radiotherapy or various combinations of radiotherapy). Grade 3a or greater Clavien-Dindo complications occurred in 31 (35%) men, including 4 deaths (4.5%). Normal weight men had more short-term complications compared to overweight (OR 4.9, 95% CI 1.3-23.1, p=0.02) and obese men (OR 6.3, 95% CI 1.6-31.1, p=0.009). Hospital readmission within 6 weeks of surgery occurred for 35 (38%) men. Surgery was needed to treat long-term complications after urinary diversion in 19 (22%) patients with a median followup of 16.3 months. CONCLUSIONS: Urinary diversion after prostate radiotherapy has a considerable short and long-term surgical complication rate. Urinary diversion most often cannot be avoided in these patients but appreciation of the risks allows for informed shared decision making between surgeons and patients.

The burden of chronic ureteral stenting in cervical cancer survivors.

PURPOSE: Ureteral obstruction in cervical cancer occurs in up to 11% of patients, many of whom undergo ureteral stenting. Our aim was to describe the patient burden of chronic ureteral stenting in a population-based cohort by detailing two objectives: (1) the frequency of repeat procedures for ureteral obstruction; and, (2) the frequency of urinary adverse effects (UAEs) (e.g., lower urinary tract symptoms, flank pain). MATERIALS AND METHODS: From SEER-Medicare, we identified 202 women who underwent ureteral stent placement prior to or following cervical cancer treatment. The frequency of repeat procedures and rate ratios were compared between treatment modalities. The rates and rate ratios of UAEs were compared between our primary cohort (stent + cervical cancer) and the following groups: no stent + cervical cancer, stent + no cancer, and no stent + no cancer. The "no cancer" group was drawn from the 5% Medicare sample. RESULTS: 117/202 women (58%) underwent >1 stent procedure. The frequency of additional procedures was significantly higher in patients who received radiation as part of their treatment. UAEs were very common in women with stent + cancer. The rate of UTI was 190 (per 100 person-years), 67 for LUTS, 42 for stones, and 6 for flank pain. These rates were 3-10 fold higher than in the no stent + no cancer control group; rates were also higher than in the no stent + cancer and the stent + no cancer women. CONCLUSIONS: The burden of disease associated with ureteral stents is higher than expected and urologists should be actively involved in stent management, screening for associated symptoms and offering definitive reconstruction when appropriate.

Urodynamic Findings in Adults With Moderate to Severe Cerebral Palsy.

OBJECTIVE: To determine urodynamic studies (UDS) findings in adult cerebral palsy (CP) patients. CP patients may suffer from voiding dysfunction. UDS in children with CP has consistently shown an upper motor neuron bladder with detrusor-sphincter dyssynergia. METHODS: We included adult CP patients seen at Gillette Transitional Urology Clinic who underwent UDS for voiding dysfunction between 2011 and 2014. Descriptive statistics were used to characterize findings. RESULTS: There were 49/211 CP patients who underwent UDS. Average age was 30 years; 55% were men. Ninety-eight percent had moderate to severe CP. UDS was initiated for irritative symptoms in 55%, obstructive voiding symptoms in 25%, hydronephrosis in 18%, and other reasons in 2%. Incontinence was reported in 57%. Detrusor-sphincter dyssynergia was seen in 12%, detrusor overactivity in 30%, and detrusor leak point pressure (DLPP) >40 cmH2O in 51%. Median compliance was 18 mL/cmH2O (0.78-365). Maximum cystometric capacity (MCC) was 80-1400 mL and was <300 mL in 27%. Sixteen percent had an MCC <300 mL and a compliance <20 mL/cmH2O. Twelve percent had an MCC <300 mL and a DLPP >40 cmH2O. CONCLUSION: UDS findings in symptomatic adult CP patients are varied. Fifty-one percent had upper motor neuron bladder findings, similar to that seen in the pediatric literature, but 6% had large flaccid bladders. Half of the patients had concerning findings, such as compliance <20 or DLPP >40 cmH2O. Our results emphasize the need to thoroughly investigate voiding dysfunction in those with CP. Further characterization of this population is needed to correlate these UDS findings with clinical outcomes.

The diagnostic accuracy of 18F-fluorodeoxyglucose positron emission tomography and computed tomography in staging bladder cancer: a single-institution study and a systematic review with meta-analysis.

PURPOSE: The purpose of this study was to assess the diagnostic accuracy of 18F-fluorodeoxyglucose with positron emission tomography and computed tomography (FDG-PET-CT) to predict nodal metastases in patients with bladder cancer (BC) scheduled to undergo radical cystectomy (RC). METHODS: We retrospectively reviewed records of patients diagnosed with BC and scheduled to undergo RC at our center from January 2011 through February 2015, who also underwent FDG-PET-CT at the time of diagnosis. All patients underwent RC and an extended pelvic lymph node dissection as the reference standard. The primary endpoints were the sensitivity, specificity and overall accuracy of FDG-PET-CT in detecting lymph node metastasis. We also examined its accuracy in identifying distant metastasis. In addition, we conducted a protocol-driven systematic review and meta-analysis of accuracy of FDG-PET-CT for preoperative staging of BC, as compared to CT alone, as reported in individual studies. To assess the methodological quality of eligible studies, we used the QUADAS-2 tool (a revised tool for the Quality Assessment of Diagnostic Accuracy Studies) and pooled diagnostic accuracy measures using Meta-DiSc statistical software. RESULTS: For detecting nodal metastases in 78 patients, the sensitivity of FDG-PET-CT was 0.56 (95 % CI 0.29-0.80) and the specificity, 0.98 (95 % CI 0.91-1.00). Pooled sensitivity and specificity for detecting lymph node metastasis were 0.57 and 0.95, respectively. Positive likelihood ratio was 9.02. All lesions that were suspicious for distant metastasis were found to be positive on biopsy. CONCLUSION: FDG-PET-CT was more accurate than CT alone in staging BC in patients undergoing surgery. Standardization of FDG-PET-CT protocol and cost-effectiveness analysis are required before widespread implementation of this technology.

Neurogenic Lower Urinary Tract Dysfunction in Adults with Cerebral Palsy: Outcomes following a Conservative Management Approach.

PURPOSE: Cerebral palsy is characterized by motor impairment following injury to the developing brain. Neurogenic lower urinary tract dysfunction is estimated to affect at least a third of children with cerebral palsy. However there are limited data as patients transition to adulthood. We sought to describe the symptoms, sequelae and management of neurogenic lower urinary tract dysfunction in adults with cerebral palsy. MATERIALS AND METHODS: We retrospectively reviewed the charts of adult patients with cerebral palsy between 2011 and 2014. Patients with prior bladder reconstruction or catheterization based bladder drainage were excluded from study. Cerebral palsy severity was determined using GMFCS (Gross Motor Function Classification System). A conservative evaluation and treatment paradigm was used. Noninvasive treatments were encouraged. Specifically clean intermittent catheterization, which is often not feasible, is avoided unless urinary retention, hydronephrosis or refractory lower urinary tract symptoms develop. RESULTS: There were 121 patients included in final analysis. Median age was 25 and 61 patients (50%) had GMFCS level V. Noninvasive management failed in 28 of 121 patients (23%) as defined by hydronephrosis in 9, persistent urinary retention in 10 and refractory lower urinary tract symptoms/incontinence in 9. Urethral clean intermittent catheterization was poorly tolerated. Of all patients 25% showed evidence of urolithiasis during the study period. Surgical intervention was rare and associated with significant morbidity. CONCLUSIONS: Adults with cerebral palsy may present with variable signs and symptoms of neurogenic lower urinary tract dysfunction. Conservative treatment was successful in more than 75% of patients. Clean intermittent catheterization was poorly tolerated in patients in whom conservative treatment failed. Surgical intervention was rarely indicated and it should be reserved for select individuals.

Fibromuscular Dysplasia in a Normotensive Patient Presented With Renal Infarct: Case Report and Endovascular Technique.

Fibromuscular dysplasia (FMD) is a well-known disease, but its diagnosis can be challenging. Typically, the symptomatic FMD are reported by young and middle aged people with high blood pressure refractory to medical treatment. We present a rare case of a young, healthy, and normotensive patient who presented with pain secondary to renal infarction, without any prior signs or symptoms or history of hypertension. This presentation of FMD has not been previously described. The typical but subtle angiographic findings of the macro-aneurysmal FMD as well as the successful endovascular treatment are discussed herein. The macro-aneurysmal form of FMD should be considered in the differential diagnosis of acute renal infarction in young and middle aged patients even if they do not have a history of hypertension.

Transcriptional repression of Caveolin-1 (CAV1) gene expression by GATA-6 in bladder smooth muscle hypertrophy in mice and human beings.

Hypertrophy occurs in urinary bladder wall smooth muscle (BSM) in men with partial bladder outlet obstruction (PBOO) caused by benign prostatic hyperplasia (BPH) and in animal models of PBOO. Hypertrophied BSM from the rabbit model exhibits down-regulation of caveolin-1, a structural and functional protein of caveolae that function as signaling platforms to mediate interaction between receptor proteins and adaptor and effector molecules to regulate signal generation, amplification, and diversification. Caveolin-1 expression is diminished in PBOO-induced BSM hypertrophy in mice and in men with BPH. The proximal promoter of the human and mouse caveolin-1 (CAV1) gene was characterized, and it was observed that the transcription factor GATA-6 binds this promoter, causing reduced expression of caveolin-1. Furthermore, caveolin-1 expression levels inversely correlate with the abundance of GATA-6 in BSM hypertrophy in mice and human beings. Silencing of GATA6 gene expression up-regulates caveolin-1 expression, whereas overexpression of GATA-6 protein sustains the transcriptional repression of caveolin-1 in bladder smooth muscle cells. Together, these data suggest that GATA-6 acts as a transcriptional repressor of CAV1 gene expression in PBOO-induced BSM hypertrophy in men and mice. GATA-6-induced transcriptional repression represents a new regulatory mechanism of CAV1 gene expression in pathologic BSM, and may serve as a target for new therapy for BPH-induced bladder dysfunction in aging men.

Accuracy of clinical judgment of the chin-down posture for dysphagia during the clinical/bedside assessment as corroborated by videofluoroscopy in adults with acute stroke.

Speech-language pathologists tend to rely on the noninstrumental swallowing evaluation in making recommendations about a patient's diet and management plan. The present study was designed to examine the sensitivity and specificity of the accuracy of using the chin-down posture during the clinical/bedside swallowing assessment. In 15 patients with acute stroke and clinically suspected oropharyngeal dysphagia, the correlation between clinical and videofluoroscopic findings was examined. Results identified that there is a difference in outcome prediction using the chin-down posture during the clinical/bedside assessment of swallowing compared to assessment by videofluoroscopy. Results are discussed relative to statistical and clinical perspectives, including site of lesion and factors to be considered in the design of an overall treatment plan for a patient with disordered swallowing.

Noun-verb ambiguity in chronic undifferentiated schizophrenia.

UNLABELLED: This study investigated noun-verb retrieval patterns of 30 adults with chronic undifferentiated schizophrenia and 67 typical adults, to determine if schizophrenia affected nouns (associated with temporal lobe function) differently from verbs (associated with frontal lobe function). Stimuli were homophonic homographic homonyms, balanced according to frequency of occurrence, where N>V, N

Making sense of competing nursing shortage concepts.

Widespread and continuing discussions of nursing shortages frequently involve divergent concepts of shortage that can have differing policy implications. This article explains the shortage concepts used by economists, hospital administrators, and government policy makers. It discusses measurement problems and suggests possible improvements. It then sets forth the divergent policy implications of competing shortage concepts. The article's aim is to promote greater clarity in analyses of nursing shortages and more fruitful conversations among participants who use different notions of shortages.

A behavioral model of cyclical dieting.

This paper presents a behavioral economics model with bounded rationality to describe an individual's food consumption choices that lead to weight gain and dieting. Using a physiological relationship determining calories needed to maintain weight, we simulate the food consumption choices of a representative female over a 30-year period. Results show an individual will periodically choose to diet, but that diet will reduce weight only temporarily. Recurrence of weight gain leads to cyclical dieting, which reduces the trend rate of weight increase. Dieting frequency is shown to depend on decision period length, dieting costs, and habit persistence.

Grammatical category ambiguity in aphasia.

This study asked whether aphasic adults show different noun/verb retrieval patterns based upon their clinical categorization as fluent or nonfluent. Participants selected either the noun or the verb meaning of target words, as presented in three contexts. The framework was that nouns (associated with temporal lobe function) are processed, stored, and retrieved separately from verbs (associated with frontal lobe function), implying separate status in the mental lexicon. Stimuli were homophonic homographs, words that are spelled and pronounced the same but which have different meanings (in this case, noun and verb meanings). Another contrast was the putative difference between systematic pairs (e.g., "kiss" and "farm"), in which noun and verb meanings are transparently related, and may be stored as a unit, and unsystematic pairs (e.g., "squash" and "sink"), in which noun and verb meanings are apparently unrelated, implying discrete storage. Results demonstrated significant interactions between fluent and nonfluent participants, suggesting that, as expected, fluent aphasic adults have more difficulty with nouns, nonfluent aphasic adults have more difficulty with verbs. There was no effect of systematicity. Contrary to expectations, verbs proved less vulnerable, rather than more vulnerable, to aphasic impairment.