Speech assessment in cleft palate patients: a descriptive study.

OBJECTIVE: Speech disorders could affect the intelligibility, but also social competence and emotional development of a cleft-palate child. In this study, we proposed to examine the phono-articulatory defects of a group of surgically treated cleft palate patients, relatively to the familial social background, and children ability of self-controlling during spontaneous language. METHODS: Sixty-eight children (22 males and 46 females) mean age 6.87 years, affected by a non-syndromic isolated cleft of the palate underwent to the same surgical protocol. Linguistic level was evaluated using the speech assessment protocol of Accordi and colleagues that focuses on intelligibility, nasality, nasal air escape, pharyngeal friction, and glottal stop. Each of these parameters is evaluated on a four-point scale, ranging from 0 to 3. Spearman rank order correlation was used to detect significant association between analyzed parameters; also the patient social background was considered for statistical analysis. RESULTS: The 5.88% of the sample had a negative result, with a severe to moderate degree of nasality and nasal air escape, presence of pharyngeal friction and glottal stop and, obviously a systematic compromising of the intelligibility. Also grimace was evident. The 38.23% of the sample showed an acceptable phonological outline; nasality and nasal air escape were mild, and the intelligibility resulted normal. Thirty-eight children (55.88%) showed a perfectly normal speech. Statistical analysis (Spearman rank order correlation) revealed a positive correlation between the severity of nasality and nasal air escape and the patient social contest of life (p

Matrix metalloproteinase gene expression in oral lichen planus: erosive vs. reticular forms.

BACKGROUND: Oral lichen planus (OLP) is an autoimmune disease of unknown aetiology. The pathogenesis is characterized by apoptosis of basal keratinocytes, triggered by contact between CD8+ -activated lymphocytes and an unknown antigen expressed on the surface of the basal cells. Basement membrane (BM) degradation, which allows lymphocytes to migrate, involves proteolytic enzymes known as matrix metalloproteinases (MMPs). OBJECTIVES: This study aimed to evaluate the expression of a series of MMPs in biopsies from OLP patients, to reveal correlations with different clinical forms of OLP. METHODS: Twenty-six patients diagnosed with OLP (14 reticular and 12 erosive) were studied, together with seven healthy patients as negative controls. RESULTS: Reverse transcriptase polymerase chain reaction (RT-PCR) showed that the overall levels of expression of MMP mRNAs were higher in erosive lichen planus (E-OLP) than in the reticular forms (R-OLP). Moreover, MMP-1 and MMP-3 may be principally associated with erosion development. The expression of specific tissue inhibitors of metalloproteinases (TIMPs) was also evaluated. CONCLUSIONS: The different clinical appearances of OLP are associated with significant differences in MMP mRNA levels.

Orofacial cleft in Southern Italy.

AIM: Cleft lip and palate or orofacial cleft (OFC) is one of the most common congenital malformations. The average incidence is around 1 every 1 000 live births. Different types of cleft lip and palate exist: cleft lip (CL), cleft lip and alveolus (CLA), cleft lip, alveolus and palate (CLP), and cleft palate only (CPO). Genetic studies on human samples have demonstrated that OFC has a heterogeneous genetic background and environmental factors also contribute to disclose this malformation. Because of the complex aetiology of OFC, studies on different and homogeneous populations can be useful in detecting environmental and genetic factors involved in the onset of this disease. The aim of the present study is to evaluate the relation between gender, type of cleft and affected side in a group of patients in Southern Italy. METHODS: Six hundred and fifty patients were enrolled in this retrospective study. They were operated at the Dental Clinic of the Second University of Naples in the period 1980-2002. Gender, type of cleft and affected side were analysed by means of the "Test for comparing two proportions". RESULTS: Among the analysed variables it was statistically demonstrated that overall CLP is more frequent in males as well as bilateral CLP whereas overall CPO is more frequent in females as well as right microform of CL. CONCLUSION: The identification of gender related subtypes of cleft is in accordance with data reported in similar studies on different populations and confirms that OFC is an heterogeneous disease even in a homogeneous ethnic group.

Treadmill training program for a bilateral below-knee amputee patient with cardiopulmonary disease.

This study was undertaken to determine the degree of progress an elderly bilateral below-knee amputee with cardiopulmonary disease could achieve by endurance training on a treadmill. Aspects of medications, orthotic/prosthetic evaluation, and energy expenditure are discussed. The subject was a 63-year-old Class IV cardiac patient with combined restrictive-obstructive pulmonary disease of moderate severity. He had undergone a coronary artery bypass graft (two-vessel) followed by a bilateral below-knee amputation for an ascending dry gangrene. The initial ambulatory aerobic evaluation showed the patient achieving only 50% of predicted maximal heart rate and 20% of maximal oxygen consumption. An individualized daily training program started the patient walking at .5 mph, 0% elevation, for five repetitions at two minutes each. By the end of the six-month training program the workload reached 1.4 mph at 2.5% elevation, for 30 minutes of total external work. The final exercise test evaluation showed an overall increase in age-predicted maximal heart rate (90%) and oxygen consumption (55%). The patient improved from cardiac Class IV to Class II, and therapeutically from Class E (bed rest) to Class C (moderate exercise restriction). These findings suggest a need for endurance training programs for patients with cardiopulmonary disease hindered by additional physical disabilities. The program enabled the participant to engage in significantly higher levels of activity for daily living within the community.

Ergometer modification for combined arm-leg use by lower extremity amputees in cardiovascular testing and training.

A commercial arm-leg ergometer was adapted so that combined bilateral arm-single leg work could be performed by unilateral lower extremity amputees from their own wheelchairs. Three middle-aged to elderly unilateral amputees performed progressive discontinuous bilateral arm crank and combined bilateral arm-single leg cycle exercise tests on the same air-braked ergometer adapted for either form of ergometry. Select amputees may achieve greater peak oxygen uptakes (VO2), power outputs (PO), and heart rates (HR) during combined bilateral arm-single leg cycle testing versus bilateral arm crank testing. Following 14 weeks of combined arm-leg training on the modified ergometer, a 73-year-old above-knee amputee demonstrated peak VO2 and PO increases of 25% (+3.8 mL X kg-1 X min-1) and 33% (+25W) respectively. Combined arm-leg ergometry as described herein may activate the largest available muscle mass and elicit the greatest oxygen uptake during exercise testing. In addition this exercise modality may simultaneously condition the arms and leg, providing functional gains in both wheelchair propulsion and prosthetic ambulation.