The effectiveness of voice therapy for teachers with dysphonia.

OBJECTIVE: An incorrect voice emission is a risk factor for developing occupational voice disorders. The study aimed at assessing the effectiveness of voice therapy in female teachers with dysphonia. METHODS: The study comprised 133 subjects with voice disorders, taking part in a vocal training programme. A reference group for the present study included 53 teachers with dysphonia. Questionnaire surveys, phoniatric examination and videostroboscopic evaluation were conducted at initial and control examination. RESULTS: In the study group, an improvement after the vocal training was noted in most of the reported symptoms and also in some quantitative parameters of phoniatric examinations compared to the findings for the reference group. The number of patients who assessed their voice as normal increased significantly after the vocal training (2.3 vs. 46.6%). A significant increase in the mean maximum phonation time, from 13.3 to 16.6 s, was observed. The same applied to voice frequency range (increase from 171 to 226.8 Hz). CONCLUSIONS: The outcomes of vocal training, such as a subjective improvement of voice quality and an increase in the quantitative parameters (prolonged maximum phonation time, extended voice range) seem to be important parameters for monitoring the effectiveness of training in correct voice emission.

The prevalence and risk factors for occupational voice disorders in teachers.

OBJECTIVE: Occupational voice disorders in Poland account for over 25% of all occupational diseases. The aim of the study was to assess the prevalence of voice problems in the general population of Polish teachers, and identify risk factors for developing voice pathology. PATIENTS AND METHODS: The study group comprised 425 female full-time teachers (most of them primary and secondary school, age ranging from 23 to 61 years) and 83 non-teacher women (control) whose jobs did not involve vocal effort, matched for age to the study group. All participants were subjected to a survey using an extensive questionnaire, and to laryngological, phoniatric and videostroboscopic examinations. RESULTS: The overall lifetime vocal symptoms were more frequent in the teachers than in the non-teachers (69 vs. 36%), and in particular it related to permanent and recurrent hoarseness, and dryness in the throat. Mean number of the voice symptoms was 3.21 in teachers and 1.98 in controls (p < 0.001). Abnormal (non-euphonic) voice, neck muscle hypertension during phonation and incorrect resonator function were also significantly more frequent in the teachers. Mean maximum phonation time was shorter in teachers than in the controls (14.3 vs. 15.9 s, p < 0.01). Occupational voice disorders and hyperfunctional dysphonia (that is thought to predispose to such pathology) were found in 32.7% of teachers and 9.6% of control subjects. The probability of developing incomplete glottal closure (odds ratio 13.2x; 95% CI: 1.8-96.8) and hyperfunctional dysphonia (odds ratio 2.7; 95% CI: 1.14-6.44) were significantly higher in the teacher group versus non-teachers. A significant positive relationship was found in teachers between the prevalence of hyperfunctional dysphonia and strained phonation, neck muscle hypertension, instability of voice, self-assessed hyper-arousal, and lifetime vocal effort index (years of employment as a teacher x hours of professional activity/week). The prevalence of vocal nodules and incomplete glottal closure were correlated with incorrect phonation technique parameters, but not with psychological factors. No correlation was found with environmental variables, such as classroom temperature, humidity, airborne dust. CONCLUSION: The prevalence of self-reported symptoms and clinical signs of voice disorders is around 2-3 times more frequent in Polish female teachers than in non-teachers. Lifetime vocal effort, incorrect technique of phonation and psychological predisposition seem to constitute major risk factors for developing occupational voice disorders.

Potential role of hematopoietic stem cell transplantation in children with secondary acute lymphocytic leukemia.

Secondary acute lymphocytic leukemias (ALL) are uncommon events in the pediatric patient population. There are few detailed reports on the laboratory characteristics and clinical course of patients with secondary lymphocytic leukemia. Historically, these patients have had a poor outcome. We report two patients treated at one institution who developed treatment-related secondary ALL. Both patients underwent hematopoietic stem cell transplantation, one with a compatible unrelated donor cord blood unit and one with an HLA-matched sibling donor bone marrow. One of the two patients survives disease-free 3 years after transplantation.

Hearing loss among workers exposed to moderate concentrations of solvents.

OBJECTIVES: It is known that some industrial organic solvents are ototoxic. This study was aimed at evaluating the hearing effects of a mixture of organic solvents alone or in combination with noise on employees in paint and lacquer enterprises. The concentration of solvents was below the occupational exposure limits (OEL) for most of the subjects. METHODS: Altogether 517 subjects were divided into the following three groups: persons with no risk due to noise or organic solvent exposure at the workplace, workers exposed to organic solvents only, and workers exposed to both organic solvents and noise. RESULTS: The relative risk (RR) of hearing loss in the solvent-only exposure group was significantly increased (RR 4.4 and RR 2.8 for noise exposure of < 80 dB-A and < 85 dB-A, respectively) in a wide range of frequencies (2-8 kHz). No additional risk in the solvent + noise exposure group was found (RR 2.8). Hearing thresholds were significantly poorer in a wide range of frequencies (1-8 kHz) for both groups exposed to solvents, when compared with the reference group. The mean hearing thresholds at frequencies of 2-4 kHz were poorer for workers exposed to solvents + noise than for the solvent-only group; this finding suggests an additional effect for noise. However, there was no correlation between hearing loss and the extent of solvent exposure. CONCLUSIONS: The results indicate that occupational organic solvent exposure at moderate concentrations increases the risk of hearing loss, and the ototoxic effects should be considered when the health effects of exposed workers are monitored.

[Hearing impairment in the plastics industry workers exposed to styrene and noise]. / Ocena uszkodzen sluchu u pracowników narazonych na styren i halas w przemysle tworzyw sztucznych.

Styrene exerts ototoxic effect in animals, and the combined exposure to this solvent and noise produces a synergistic effect relative to the isolated exposure to noise. However, there is a lack of reliable evidence that chronic occupational exposure to styrene is ototoxic to humans. Neither has been documented its additive effect with noise. The present study was aimed to assess hearing impairment and the risk of hearing loss in workers exposed to both styrene and noise. The study group included 72 male workers occupationally exposed to styrene in the plastics industry. The results were compared with two control groups, matched by age, gender and personal traits: one group composed of 82 male workers employed in a printing house and exposed only to noise at the levels almost twice as high as those observed in the group exposed to styrene and noise, and the other consisted of 65 male workers exposed neither to solvents nor to noise at workplace. In the group exposed to styrene and noise, significantly increased average hearing loss, as compared to both control groups, was found at all frequencies (1-8 kHz). The risk of hearing loss in the group exposed to styrene and noise was seven times higher (RR: 6.6; 3.0-15.9) than in the non-exposed group, and four times higher (RR: 4.0; 1.8-9.1) than in when workers exposed only to noise. However, no relationship could be observed between the amount of styrene exposure and hearing impairment, taking account of the confounding effect of noise and age. The results of the study suggest that the exposure to solvent mixtures with styrene as a basic component may exert additional, to noise, adverse effect on the auditory organ.

Analysis of engraftment, graft-versus-host disease, and immune recovery following unrelated donor cord blood transplantation.

Unrelated cord blood (UCB) is being used as a source of alternative hematopoietic stem cells for transplantation with increasing frequency. From November 1994 to February 1999, 30 UCB transplant procedures were performed for both malignant and nonmalignant diseases in 27 children, aged 0.4 to 17.1 years. Patients received either HLA-matched (n = 3) or 1- or 2-antigen-mismatched (n = 27) UCB following 1 of 2 standardized preparative and graft-versus-host disease regimens (hyperfractionated total body irradiation, cyclophosphamide, and antithymocyte globulin [ATG] with cyclosporine A and methotrexate; or busulfan, melphalan, and ATG with cyclosporine A and prednisone). The median time to neutrophil and platelet engraftment was 27 days (12-60 days) and 75 days (33-158 days) posttransplantation, respectively. No correlation was noted between neutrophil and platelet engraftment and nucleated cells per kilogram, CD34(+) cells per kilogram infused, or cytomegalovirus status of recipient. The cumulative probability of acute grade 2 or greater graft-versus-host disease (GVHD) was 37.2%, and of grade 3 or greater GVHD was 8.8%. No patients developed chronic GVHD. CD4, CD19, and natural killer cell recovery was achieved at a median of 12, 6, and 2 months, respectively. CD8 recovery was delayed at a median of 9 months. Normal mitogen response was achieved at 6 to 9 months. The probability of survival, disease-free survival, and event-free survival at 1 year was 52.3% (34.1%-70.5%), 54.7% (34.5%-74.9 %) and 49.6% (29.9%-69.4%), respectively. This series of 30 UCB transplants suggests that although CD8 cell recovery is delayed, the pattern of immune reconstitution with UCB is similar to that reported for other stem cell sources. (Blood. 2000;96:2703-2711)

[Assessment of hearing impairment in workers exposed to mixtures of organic solvents in the paint and lacquer industry]. / Ocena uszkodzen sluchu u pracowników narazonych na mieszaniny rozpuszczalników organicznych w przemysle farb i lakierów.

Clinical and experimental studies indicate a possible harmful effect of chemicals, especially organic solvents, on the hearing system. In combined exposure to noise and solvents, very common in industry, it is most likely that a synergetic action of these factors enhances the traumatising effect of exposure to noise. The aim of this study was to assess the incidence and the risk of hearing impairment in 117 paint and lacquer factory workers exposed to a mixture of organic solvents. An analysis of organic solvent mixtures reveals that xylene and ethyl acetate are their major components whose concentrations depend on individual workposts. The control group consisted of 76 workers exposed to noise exceeding, Threshold Limit Value and 125 healthy subjects exposed neither to noise nor to solvents in their occupational setting. Pure tone audiometry revealed the highest hearing thresholds in workers exposed to solvents, lower thresholds in those exposed to noise, and the lowest ones in the non-exposed individuals. Hearing loss was found in 30% of workers exposed to organic solvents, in 20% of noise-exposed subjects, and in only 6% of non-exposed subjects. The comparison of relative risk values also indicated significantly enhanced probability of hearing impairment in workers of the paint and lacquer factory (9.6; 3.2-25.6), which is even more strongly pronounced than in the group of subjects exposed to noise (4.2; 1.2-13.2). An analysis of hearing impairment risk in particular frequencies suggests that organic solvents may damage the inner ear in much greater extent than noise. The results of the study show that exposure to organic solvents may create a significant risk of hearing impairment. Therefore, further steps should be taken to include the exposed population into effective preventive programmes.

Immunohistochemistry can be used to subtype acute myeloid leukemia in routinely processed bone marrow biopsy specimens. Comparison with flow cytometry.

Flow cytometry (FC) is the preferred method of immunophenotyping acute myeloid leukemia (AML). However, there are situations in which FC is unavailable and in which immunohistologic staining of bone marrow biopsy specimens can be used to provide immunophenotypic information. To evaluate immunohistologic staining and to confirm its value, we selected 80 newly diagnosed cases of AML that were classified according to French-American-British (FAB) criteria and confirmed by flow cytometric analysis for this study. Paraffin-embedded bone marrow specimens were stained using a panel of antibodies that included CD34 (QBEND10), antimyeloperoxidase (anti-MPO), antihemoglobin, factor VIII-related antigen, and 3 epitopes of CD68 (HAM56, KP1, and PG-M1). Our findings suggest that with the use of the paraffin-reactive antibodies CD34 (QBEND10), MPO, CD68 (PG-M1), antihemoglobin, and factor VIII-related antigen, immunohistochemistry can be used to subclassify AML. Comparison of immunohistochemical results with FC immunophenotyping suggests that there is significant concordance in the results for markers that can be used with both techniques, indicating that the sensitivity and specificity of both methods is comparable (P > .53 in all cases).

Flow cytometric immunophenotypic characterization of pediatric and adult minimally differentiated acute myeloid leukemia (AML-M0).

We reviewed the clinicopathologic and immunophenotypic profiles of 7 pediatric and 11 adult minimally differentiated acute myelogenous leukemias (AML-M0). We also compared and evaluated myeloperoxidase in leukemic blasts using standard cytochemical and polyclonal antibody immunohistochemical stains. No distinctive clinical findings were noted in either patient group; however, thrombocytopenia typically was more prominent in adults. Adult AML-M0 also was associated with an immature myeloid profile (CD34+, terminal deoxynucleotidyl transferase positive, CD13+, and CD33+), in contrast with pediatric AML-M0, which usually lacked terminal deoxynucleotidyl transferase or CD34 but expressed bright CD33 with weak or negative CD13. Coexpression of the T-cell-associated antigen CD7 was observed in both groups. Antibody immunohistochemical stains were more sensitive than cytochemical stains for detection of myeloperoxidase activity and a useful adjunct for establishing a diagnosis of myeloid leukemia in paraffin-embedded marrow tissues.

[Evaluation of voice quality in students from teaching colleges]. / Ocena stanu narzadu glosu u studentów szkoly pedagogicznej.

Vocal disorders are very common occupation-related disease in teachers. Their remarkable incidence might be associated with inappropriate techniques of speech and poor vocal hygiene. The aim of this study was to assess the function of vocal organ including voice emission technique in persons starting their teaching occupation. The study group included 66 female students at Teaching College. Their were thoroughly interviewed and subjected to laryngological, phoniatric and videostroboscopic examinations. All subjects reported subjective symptoms after vocal effort. Hoarseness and throat dryness were the most common. In the majority of students functional vocal disorders were observed. In 30% of them insufficiency of glottis and in four (6.1%) students soft vocal nodules were found. Signs and symptoms of vocal diseases were more frequent in a subgroup of students exposed to increased vocal effort during their professional education. The results indicate that young teachers are not sufficiently prepared for increased vocal strain, apparently associated with their profession. It is indeed necessary to introduce preventive programs including special training of appropriate speech technique, into the curricula of schools for teachers.

[The application of otoacoustic emissions measurement in the assessment of the function of cochlear efferent fibers: the study of normal hearing subjects]. / Zastosowanie pomiarów emisji otoakustycznej do oceny funkcji ukladu eferentnego slimaka--badania osób z prawidlowym sluchem.

It has been shown by L. Collet in 1990 that the contralateral noise stimulation causes the decrease in the amplitude of otoacoustic emissions in the ipsilateral (tested) ear. This effect is linked to the activation of crossed efferent fibres in the cochlea. This non-invasive method is becoming a useful tool in assessing the function of efferent system in human. In this study the effect of contralateral noise stimulation was assessed in 10 young subjects with normal hearing. The contralateral stimulation caused the decrease in the amplitude of both transient evoked otoacoustic emission (TEOAE) and distortion-product otoacoustic emission (DPOAE) in the majority of tested ears. The statistically significant effect was observed already at the intensity of noise of 40 dB (A). At the lower level of noise (30 dB-A) the small increase in the amplitude of otoacoustic emissions in some ears was observed. The suppressive effect of contralateral stimulation depended clearly on the intensity of noise; the higher intensity of noise, the greater suppressive effect was seen. However, the decrease in the otoacoustic emissions was very small (usually in the range from 1 to 2 dB), which may limit practical application of this method in the assessment of the function of efferent system.

[Is otoacoustic emission useful in the differential diagnosis of occupational noise-induced hearing loss?]. / Czy emisja otoakustyczna moze byc przydatna w diagnostyce róznicowej zawodowych uszkodzen sluchu?

It is very difficult to distinguish between occupational noise-induced hearing loss and other diseases with cochlear hearing loss by the means of conventional audiometric tests. Otoacoustic emission measurement is a relatively new tool for assessing the inner ear function. It gives an opportunity of monitoring the status of the outer hair cells, the elements which are the most sensitive to noise-induced damage. In this study the results of distortion product otoacoustic emission (DPOAE) measurement in subjects with industrial noise-induced hearing loss, presbycusis and hearing impairment caused by gentamycin, are presented. In all these cases pure-tone audiometry revealed similar shape of the audiograms with cochlear hearing loss mainly at high frequencies. In the cases of industrial noise-induced hearing loss, DPOAE measurements demonstrated a very typical shape of DP-gram with the decrease (notch) in otoacoustic primarily at the frequencies of 3-4 kHz. Such a notch in DP-grams was not observed in the cochlear hearing loss caused by factors other than noise. The data indicate that otoacoustic emissions may be useful in the differential diagnosis of occupational noise-induced hearing loss.

Flow cytometric DNA analysis of pediatric intracranial ependymomas.

OBJECTIVE: To examine the clinicopathologic features and perform flow cytometric DNA analysis of pediatric intracranial ependymomas to determine whether any of these parameters were predictors of clinical outcome. METHODS: Flow cytometric DNA analysis was performed on 17 paraffin-embedded tumors from patients aged 7 months to 16 years. RESULTS: Seven cases were aneuploid, while the remaining 10 were diploid. Proliferative fractions varied from 1% to 17%. CONCLUSIONS: No correlation between histologic features such as mitotic activity, cellularity, pleomorphism, vascular proliferation, and length of survival was observed. However, the presence of a diploid DNA stemline, elevated proliferative fraction, or young age were associated with a poor clinical outcome and shortened survival times (P < 0.05). Additional studies of larger patient groups with extended follow-up are necessary to confirm these findings.

DNA ploidy, cell cycle kinetics, and low versus high grade atypia in endometrial hyperplasia.

There have been few studies of DNA ploidy and cell cycle kinetics in endometrial hyperplasia. The authors studied archival cases of proliferative endometrium, simple, complex and atypical endometrial hyperplasia and well, moderately, and poorly differentiated endometrial adenocarcinoma by flow cytometry and also evaluated the significance of the degree of cytologic atypia (low versus high) in endometrial hyperplasia relative to the occurrence of carcinoma. All proliferative endometria, all types of hyperplasia and well and moderately differentiated carcinomas were diploid. Two-thirds of poorly differentiated adenocarcinomas were aneuploid. Neither S-phase fractions or proliferative fractions (S+G2M) could distinguish among the different types of hyperplasia or predict which hyperplasias were associated with carcinomas. The degree of cytologic atypia in atypical hyperplasia was not predictive of the occurrence of carcinoma. Poorly differentiated carcinomas showed significant differences in DNA ploidy, S-phase, and proliferative fractions from endometrial hyperplasia and lower grade carcinoma. These results support the concept that there are two fundamentally different types of endometrial carcinoma.

Haemophilus ducreyi elicits a cutaneous infiltrate of CD4 cells during experimental human infection.

Human subjects were experimentally infected with Haemophilus ducreyi for up to 2 weeks. Bacterial suspensions were delivered into the epidermis and dermis through puncture wounds made by an allergy-testing device. Subjects developed papular lesions that evolved into pustules resembling natural disease. Some papular lesions resolved spontaneously, indicating that host responses may clear infection. Bacteria were shed intermittently from lesions, suggesting that H. ducreyi may be transmissible before ulceration. Host responses to infection consisted primarily of cutaneous infiltrate of polymorphonuclear leukocytes, Langerhans cells, macrophages, and CD4 T cells of alpha beta lineage. Expression of HLA-DR by keratinocytes was associated with the presence of interferon-gamma mRNA in the skin. There was little evidence for humoral or peripheral blood mononuclear cell responses to bacterial antigens. The cutaneous infiltrate of CD4 cells and macrophages provides a mechanism that facilitates transmission of human immunodeficiency virus by H. ducreyi.

Flow cytometric DNA analysis of extramammary Paget's disease of the vulva.

Vulvar extramammary Paget's disease (EMPD) is an uncommon disease entity that occurs predominantly in postmenopausal white women. The clinical behavior of this neoplasm is extremely variable, reflecting the various histological patterns that have been reported with this lesion. Flow cytometry has been used as a method of obtaining prognostic information about a number of gynecological neoplasms, yet to date there have been no flow cytometric studies performed on this unusual neoplasm. We performed flow cytometric analysis of 14 cases of paraffin-embedded vulvar EMPD in patients ranging from 45 to 86 years of age. We correlated histological features and clinical recurrence risk with DNA analysis. Although we were unable to show a statistically significant correlation between DNA ploidy or S-phase and time to recurrence, we did show a statistically significant correlation between DNA ploidy and histological features. Aneuploidy appears to be associated with in situ sweat gland adenocarcinoma, invasive carcinoma, and lymphatic invasion. These results suggest that Paget's cells with aneuploid DNA stem lines may be associated with the potential for aggressive biologic behavior.

Proliferating thymolipoma: ultrastructural, immunohistochemical, and flowcytometric study.

A superior-anterior mediastinal tumor was excised from a 50-year-old man. The 207-g mass was encapsulated and multilobulated. It contained adipose tissue and abnormal thymic tissue. In some areas the thymic tissue was characterized by cords and nests of epithelial cells lying within either the adipose tissue or a myxoid matrix. Other areas were characterized by cortical thymic tissue with increased numbers of epithelial cells. Foci of normal medullary tissue were present. The prominent epithelial cells were immunoreactive for cytokeratin and nonimmunoreactive for vimentin, S-100, chromogranin, and parathyroid hormone. Flow cytometry showed that the lymphocyte populations were consistent with a late cortical thymic phenotype. The tumor was diploid. By electron microscopy, the prominent epithelial cells had desmosomes and a few tonofilaments. The cytoplasm contained additional organelles including mitochondria, polyribosomes, and occasional lysosomes. Nuclei were oval and had relatively smooth contours, prominent nucleoli, and moderate quantities of heterochromatin. Basal lamina was present around many nests and cords of cells. This is the first such study of a tumor with this histology.

Terminal deoxynucleotidyl transferase staining in acute leukemia and normal bone marrow in routinely processed paraffin sections.

Terminal deoxynucleotidyl transferase (TdT) is a nuclear protein widely used as a marker for the diagnosis and classification of acute leukemia. The usual methods for detecting TdT require smears, imprints, or cryostat sections of unfixed tissue. A polyclonal rabbit anti-TdT serum was used to immunostain 54 routinely processed bone marrow sections from patients with acute leukemic disorders, using a recently described antigen-unmasking technique based on microwave oven heating. The specificity of this method of TdT analysis was confirmed by comparing the results obtained with conventional TdT analysis by indirect immunofluorescence. Terminal deoxynucleotidyl transferase reactivity was also evaluated in 44 nonmalignant and normal bone marrow specimens. All cases that were TdT-positive by immunofluorescence (41 of 42 "pre-B" and T-cell acute lymphoblastic leukemia, 2 of 5 acute myeloid leukemia, and 1 of 5 chronic myeloid leukemia in blast crisis) were also positive in paraffin sections. The percentage fluorescence positivity correlated with the percentage of immunoperoxidase stained cells in 44 of 45 cases. The remaining nonneoplastic and normal bone marrow biopsy specimens were TdT-negative. These results show that TdT immunoperoxidase staining of conventionally processed bone marrow specimens can be readily achieved by the use of a simple antigen-unmasking technique and may provide useful diagnostic information particularly in cases in which fresh tissue samples are unavailable.