Voice Improvement in Patients with Functional Dysphonia Treated with the Proprioceptive-Elastic (PROEL) Method.

The objective of the study was to analyze the outcome of the proprioceptive-elastic (PROEL) voice therapy method in patients with functional dysphonia (FD). Fifty-two patients with FD were involved in the study; they were composed of three subgroups of patients with (1) FD without glottal insufficiency (n = 28), (2) FD and glottal insufficiency (n = 9), and (3) FD, glottal insufficiency, and vocal nodules (n = 15). A multidimensional assessment protocol including videolaryngostroboscopy; maximum phonation time; perceptual evaluation of dysphonia with the Grade, Instability, Roughness, Breathiness, Asthenia, and Strain (GIRBAS) scale; and 10-item version of the Voice Handicap Index was conducted before and after 15 sessions of voice therapy. All voice therapy sessions were conducted by the same speech-language pathologist. The comparison between voice assessment before and after voice therapy with the PROEL method in patients with FD, in all the three subgroups, revealed a statistically significant improvement in periodicity and the mucosal wave in the laryngostroboscopy, maximum phonation time, GIRBAS scale scores, and VHI-10. Voice of patients with FD improved after treatment with the PROEL method. Further studies are needed to analyze the efficacy of the PROEL method with randomized double-blind clinical trials using different methods for voice therapy. At present, the PROEL method represents an alternative tool for the speech pathologist to improve voice in patients with FD.

[Comparison of SAPS II, MPM II24 and SAPS in intensive care]. / Confronto fra SAPS II, MPM II24 e SAPS in terapia intensiva.

OBJECTIVE: To compare the performance of the new SAPS II, new MPM2 and SAPS in a cohort of patients admitted to our polyvalent ICU. DESIGN: the ability of the SAPS II scoring system to predict the probability of hospital mortality was assessing calibration and discrimination (ROC curve) measures obtained using published coefficients and within relevant subgroups using formal statistic assessment (goodness of fit). PATIENTS: from May 1997 to May 1998, 420 consecutive patients over 18 years old. RESULTS: When the parameters based on the standard model were applied, the SAPS II discrimination (area under ROC curve) was = 0.889 and calibration (chi square test) of SAPS II was = 4.448 with p = 0.879; MPM2 chi 2 = 0.9385, p = 0.402 and SAPS chi 2 = 27.089, p = 0.0001. The performance of SAPS II model was very good. Worst predictive accuracy was achieved in trauma and elective surgery patients. CONCLUSIONS: SAPS II model gave good results in terms of calibration and discrimination. SAPS II has better accuracy then SAPS and MPM2. Concerning the performance of models, large differences were apparent in relevant subgroups: trauma and sepsis patients. Moreover the choice of adequate statistic method to compare intensive care populations appeared to need more research.

Yohimbine and aldosterone responsiveness to angiotensin II or corticotrophin in normal subjects.

In normal man the sympathetic nervous system exerts an inhibitory influence on aldosterone responsiveness to angiotensin II. The possible role of alpha-2 adrenoceptors was assessed by studying the changes of plasma aldosterone during an angiotensin II infusion at the dose of 1, 2, 5 and 10 ng/kg. min or after corticotrophin infusion, 0.25 mg, in 8 normal subjects before and after treatment with the selective alpha-2 adrenoceptor antagonist, yohimbine, at a maximal dosage of 60 mg daily. Yohimbine did not modify blood pressure, body weight, the supine levels of angiotensin II, renin and aldosterone, the pressor response to angiotensin II and the correlation relating plasma aldosterone to plasma angiotensin II obtained during infusion studies. These findings suggest that the inhibitory influence of the sympathetic nervous system on aldosterone responsiveness to angiotensin II.