Obtenção minimamente invasiva de veia safena para cirurgia de revascularização do miocárdio / Minimally invasive procurement of saphenous veins for coronary artery bypass grafting

OBJETIVO: Analisar, comparativamente, a obtenção minimamente invasiva com o uso do MINI-HARVEST® e com instrumental tradicional adaptado. MÉTODO: De junho de 1996 a janeiro de 1999, 63 pacientes submetidos à cirurgia de revascularização do miocárdio tiveram suas veias safenas retiradas segundo técnica minimamente invasiva. Nos 30 primeiros pacientes da série utilizou-se método de visão direta com auxílio de dois afastadores de Langenbeck, e nos 33 restantes utilizou-se o MINI-HARVEST®. RESULTADOS: A idade média dos pacientes era de 61 ± 8,75 anos, sendo 52 homens e 11 mulheres. Quarenta e cinco pacientes eram diabéticos, 45 apresentavam sobrepeso/obesidade, 25 eram tabagistas ativos, 32 apresentavam história pregressa de infarto do miocárdio. O tempo médio de retirada da veia safena com afastadores Langenbeck foi de 34,2 ± 8,14 minutos e com o MINI-HARVEST® de 39,20 ± 9,12 minutos. A extensão de veia retirada foi similar nos dois grupos, variando de 10 a 30 cm. Houve uma deiscência superficial no grupo com afastadores de Langenbeck. Houve necessidade de reversão para método tradicional de retirada em dois casos do grupo MINI-HARVEST® e um do grupo Langenbeck. A incidência de infarto transoperatório foi 4,5 por cento (três) no grupo Langenbeck e 3,1 por cento(dois) no grupo MINI-HARVEST®. CONCLUSÕES: Podemos concluir que o método de obtenção de veia safena minimamente invasivo sob visão direta é efetivo e seguro, tanto com o uso de instrumentos tradicionais adaptados para este fim, como com afastadores especialmente constituídos, ressaltando-se que o MINI-HARVEST® dispensa a presença de um auxiliar.

Host defense function in neutrophils from the American bison (Bison bison).

Selected host defense functions of neutrophils isolated from American bison (Bison bison) were characterized and compared with those of cattle (Bos taurus). Bison neutrophils had a robust chemotactic response to both IL-8 and LTB(4), with maximal responses occurring at 10(-7) M (IL-8) and 10(-8) M (LTB(4)). The magnitude of the chemotactic response to IL-8 was similar in bison and bovine neutrophils (except at 10(-7) M IL-8, where bison had a stronger response). In response to LTB(4), bison neutrophils had a much stronger chemotaxis at both 10(-8) and 10(-7) M than did bovine cells. Production of reactive oxygen species (ROS) in response to phorbol myristate acetate (PMA) and opsonized zymosan (OpZ) was similar between bison and bovine neutrophils. However, the production of ROS in bison neutrophils stimulated with OpZ was primarily intracellular, while extracellular release of ROS was evident in bovine neutrophils stimulated with OpZ. Like bovine neutrophils, bison neutrophils did not generate a respiratory burst in response to fMLF. Granules prepared from bison neutrophils had potent direct killing action on the Gram-negative bacteria Escherichia coli but failed to kill the Gram-positive bacteria Staphylococcus aureus and, at intermediate doses, actually had a permissive effect for this bacteria. Thus, bison neutrophils have potent host defense capabilities similar in quality to those of bovine neutrophils; however, unique differences are present, which may allow bison neutrophils to respond to the distinct immunological challenges that bison encounter.

Technology applications in intervention for preschool-age children with language disorders.

Preschool-age children are capable of using computers and benefiting from developmentally appropriate software. Computer technology has been used successfully in therapy for young children with speech and language disorders; however, the clinician is a crucial factor in such success. Clinicians choose communication goals and appropriate software, plan precomputer activities, provide appropriate models and opportunities during the computer activity, and provide postcomputer activities that ensure the generalization of new skills. In this article, we discuss and illustrate the characteristics of developmentally appropriate computer-based activities and the role of clinicians in planning and implementing these activities for young children.

Isolation of bovine neutrophils with biomagnetic beads: comparison with standard Percoll density gradient isolation methods.

A prerequisite for studies on bovine neutrophils is a reliable method of neutrophil isolation from blood to obtain highly purified cell populations that are functionally active. Since current techniques of neutrophil isolation fall short of these requirements, we have developed a newer and more effective technique for isolation of bovine neutrophils that utilizes biomagnetic beads coated with a monoclonal antibody that recognizes an abundant surface antigen on bovine neutrophils to purify these cells. Comparison of the purity and viability of bovine neutrophils isolated by a conventional method (continuous Percoll density gradient) with this new method showed that neutrophils isolated with biomagnetic beads were higher in purity and had an increased yield. In addition, cells isolated with biomagnetic beads demonstrated normal or even improved function in assays of chemotaxis, phagocytosis, degranulation, and respiratory burst activity. Finally, bovine neutrophils isolated using this method showed an overall lower level of spontaneous apoptosis, which correlates well with the high level of viability observed in the purified cell preparations. Thus, this method represents a significant advance over current methods for isolating bovine neutrophils and would be widely applicable to labs studying the biochemistry and signal transduction pathways in these cells.

Inhibition of GTP binding to Rac2 by peroxynitrite: potential role for tyrosine modification.

Peroxynitrite is a potent oxidant generated by the reaction of nitric oxide (*NO) and superoxide anion (O2*-), and both can be produced in inflammatory tissues. In the present studies, we analyzed the effects of peroxynitrite treatment on the GTP-binding activity of Rac2, a low molecular weight GTP-binding protein important in regulating a number of cellular functions. Using a fluorescent analog of GTP (methylanthraniloyl guanosine triphosphate or mant-GTP) as a reporter group, we found that treatment of Rac2 with peroxynitrite inhibited the binding of mant-GTP to Rac2 in a dose-dependent manner. Peroxynitrite was also able to react directly with free mant-GTP, resulting in a significant decrease in mant-GTP fluorescence; however, the mechanism of peroxynitrite-mediated damage to mant-GTP was different than with Rac2. In the case of mant-GTP, protection from peroxynitrite-mediated oxidation was observed in the presence of the free radical scavengers, mannitol and DMTU. In contrast, DMTU was unable to prevent peroxynitrite-mediated inhibition of mant-GTP binding to Rac2. Instead, our data demonstrates a role for peroxynitrite-mediated tyrosine modification in the inhibition of mant-GTP binding to Rac2, and we were able to demonstrate the formation of a significant level of nitrotyrosine formation in Rac2 exposed to peroxynitrite. Thus, our studies support the premise that oxidative modification of key cellular proteins, such as Rac2, plays an important role in the cytotoxic effects observed for peroxynitrite and other reactive oxidants.

Surfactant-spreading and surface-compression disturbance on a thin viscous film.

Spreading of a new surfactant in the presence of a pre-existing surfactant distribution is investigated both experimentally and theoretically for a thin viscous substrate. The experiments are designed to provide a better understanding of the fundamental interfacial and fluid dynamics for spreading of surfactants instilled into the lung. Quantitative measurements of spreading rates were conducted using a fluorescent new surfactant that was excited by argon laser light as it spread on an air-glycerin interface in a petri dish. It is found that pre-existing surfactant impedes surfactant spreading. However, fluorescent microspheres used as surface markers show that pre-existing surfactant facilitates the propagation of a surface-compression disturbance, which travels faster than the leading edge of the new surfactant. The experimental results compare well with the theory developed using lubrication approximations. An effective diffusivity of the thin film system is found to be Deff = (E*gamma)/(mu/H), which indicates that the surface-compression disturbance propagates faster for larger background surfactant concentration, gamma, larger constant slope of the sigma*-gamma* relation, -E*, and smaller viscous resistance, mu/H. Note that sigma* and gamma* are the dimensional surface tension and concentration, respectively, mu is fluid viscosity, and H is the unperturbed film thickness.

Priming of human neutrophils by peroxynitrite: potential role in enhancement of the local inflammatory response.

Peroxynitrite is a potent oxidant generated from the reaction of nitric oxide (NO) and superoxide anion (O2-), both of which can be produced in inflammatory tissues. In these studies, we analyzed what direct effect peroxynitrite had on neutrophil (PMN) function. We found that peroxynitrite was an effective priming agent for PMNs, as demonstrated by enhanced O2- production on subsequent activation with low doses of PMA or N-formyl-methionine-leucine-phenylalanine (fMLF), changes in the expression of PMN surface markers (L-selectin, Mac-1, flavocytochrome b, and fMLF receptor), and increased intracellular calcium levels. Analysis of the mechanism of PMN priming by peroxynitrite demonstrated that peroxynitrite resulted in minimal oxidation of protein sulfhydryl groups and subsequent protein cross-linking. In contrast, treatment of PMNs with peroxynitrite resulted in significant nitration of tyrosine residues on neutrophil proteins. In addition, inhibition of tyrosine nitration with a pyrrolopyrimidine antioxidant blocked the majority of peroxynitrite-induced priming effects, further suggesting that PMN priming was mediated primarily by nitration of tyrosine residues on PMN proteins. The ability of peroxynitrite to serve as an effective priming agent for PMNs at sites of inflammation may play a key role in modulating the host-defense process.

Platelet-activating factor induces a concentration-dependent spectrum of functional responses in bovine neutrophils.

We characterized the dose response of bovine neutrophils to platelet-activating factor (PAF) with respect to the following functions: calcium flux and membrane potential changes, actin polymerization, degranulation, and the production and/or priming of the oxidative burst. PAF at very low concentrations (10(-10) and 10(-9) M) caused changes in intracellular calcium and membrane potential in bovine neutrophils, whereas moderate PAF concentrations (> or = 10(-7) M) resulted in increased actin polymerization. Degranulation responses to PAF were more complex: low concentrations (10(-9) M) caused secretory granule degranulation, moderate doses (> or = 10(-7) M) caused specific granule degranulation, whereas azurophil degranulation only occurred at high (10(-5) M) PAF concentrations. Treatment of bovine neutrophils with PAF at concentrations > or = 10(-7) M also caused up-regulation of the adhesion molecules Mac-l and L-selectin. PAF stimulation resulted in a very weak [compared to phorbol myristate acetate (PMA)] oxidative burst in bovine neutrophils, and only at high (10(-6) M) concentrations. Unlike human neutrophils, bovine neutrophils were poorly primed by PAF treatment. Only high concentrations of PAF (10(-5) M) caused an increased rate of PMA-stimulated superoxide production, although lower doses of PAF did reduce the lag time preceding the PMA-induced oxidative burst. The overall pattern that can be inferred is that lower concentrations of PAF promote neutrophil sensitivity and interaction by selective degranulation, up-regulation of adhesion molecules, and increased actin polymerization. In contrast, higher PAF concentrations can promote, albeit weakly, more direct bactericidal responses, such as the release of reactive oxygen species and granule enzymes. The ability of PAF to modulate a graded response in bovine neutrophils would allow the cell to respond proportionally to the severity of a stimulus.

U-101033E (2,4-diaminopyrrolopyrimidine), a potent inhibitor of membrane lipid peroxidation as assessed by the production of 4-hydroxynonenal, malondialdehyde, and 4-hydroxynonenal--protein adducts.

4-Hydroxy-2-nonenal (4-HNE) and malondialdehyde (MDA) are major lipid peroxidation products generated by free radical attack on membranes and appear to contribute to the cytotoxic effects of oxidative stress by a mechanism involving adduct formation with cellular proteins. In the present studies, we investigated the relationship between lipid peroxidation and eventual inactivation of plasma membrane proteins using a model system consisting of purified red blood cell membranes and Fe2+/EDTA. Using this system, we also analyzed the ability of a novel antioxidant, U-101033E (2,4-diaminopyrrolopyrimidine), to inhibit lipid peroxidation and associated protein damage. Our results demonstrated that significant levels of MDA and 4-HNE are generated in this model system, and that both aldehydes are capable of cross-linking membrane proteins. In addition, we used a monoclonal antibody to demonstrate the presence of 4-HNE-protein adducts in this system. The generation of 4-HNE-protein adducts closely paralleled the time course of lipid peroxidation and membrane protein cross-linking, suggesting that 4-HNE may contribute to membrane protein cross-linking. Analysis of U-101033E in this system showed that this antioxidant inhibited lipid peroxidation, prevented the appearance of 4-HNE-protein adducts, and strongly reduced membrane protein cross-linking, with an EC50 of 0.5 microM. We also show that these antioxidant effects were not due to the scavenging of superoxide anion. Thus, these studies demonstrate the potential usefulness of U-101033E for treating certain disease processes where lipid peroxidation plays a role in disease pathogenesis.

The nos (nitrous oxide reductase) gene cluster from the soil bacterium Achromobacter cycloclastes: cloning, sequence analysis, and expression.

The nitrous oxide (N2O) reductase (nos) gene cluster from Achromobacter cycloclastes has been cloned and sequenced. Seven protein coding regions corresponding to nosR, nosZ (structural N2O reductase gene), nosD, nosF, nosY, nosL, and nosX are detected, indicating a genetic organization similar to that of Rhizobium meliloti. To aid homology studies, nosR from R. meliloti has also been sequenced. Comparison of the deduced amino acid sequences with corresponding sequences from other organisms has also allowed structural and functional inferences to be made. The heterologous expression of NosD, NosZ (N2O reductase), and NosL is also reported. A model of the CuA site in N2O reductase, based on the crystal structure of this site in bovine heart cytochrome c oxidase, is presented. The model suggests that a His residue of the CuA domain may be a ligand to the catalytic CuZ site. In addition, the origin of the spectroscopically-observed Cys coordination to CuZ is discussed in terms of the sequence alignment of seven N2O reductases.

Analysis of activation-induced conformational changes in p47phox using tryptophan fluorescence spectroscopy.

Activation of the neutrophil NADPH oxidase requires translocation of cytosolic proteins p47(phox), p67(phox), and Rac to the plasma membrane or phagosomal membrane, where they assemble with membrane-bound flavocytochrome b. During this process, it appears that p47(phox) undergoes conformational changes, resulting in the exposure of binding sites involved in assembly and activation of the oxidase. In the present study, we have directly evaluated activation-induced conformational changes in p47(phox) using tryptophan fluorescence and circular dichroism spectroscopy. Treatment of p47(phox) with amphiphilic agents known to activate the NADPH oxidase (SDS and arachidonic acid) caused a dose-dependent quenching in the intrinsic tryptophan fluorescence of p47(phox), whereas treatment with a number of other amphiphilic agents that failed to activate the oxidase had no effect on p47(phox) fluorescence. In addition, the concentration range of activating agents required to induce changes in fluorescence correlated with the concentration range of these agents that induced maximal NADPH oxidase activity in a cell-free assay system. We next determined if activation by phosphorylation caused the same type of conformational changes in p47(phox). Protein kinase C phosphorylation of p47(phox) in vitro resulted in comparable quenching of fluorescence, which also correlated directly with NADPH oxidase activity. Finally, the circular dichroism (CD) spectrum of p47(phox) was significantly changed by the addition of SDS, whereas treatment with a non-activating detergent had no effect on the CD spectrum. These results support the conclusion that activation by amphiphilic agents results in changes in the secondary structure of p47(phox). Thus, our studies provide direct evidence linking conformational changes in p47(phox) to the NADPH oxidase activation/assembly process and also further support the hypothesis that amphiphile-mediated activation of the NADPH oxidase induces changes in p47(phox) that are similar to those mediated by phosphorylation in vivo.

Speech and language production at age 2: evidence for tradeoffs between linguistic and phonetic processing.

The purpose of this study was to explore how 2-year-old children manage the relationship between phonetic production and production of word combinations in their spontaneous speech. The subjects were 5 normally developing 2-year-olds who were participants in an ongoing longitudinal study of speech and language acquisition. Three measures were used to estimate phonetic production skills in the children's spontaneous speech samples. These included a measure of the accuracy of consonant production (Percentage of Consonants Correct), and two estimators of phonetic complexity (phonetic products for utterance and word length units). Regression analyses were used to determine the relationship between complexity of word combinations, as measured by length of utterance in morphemes and a propositional complexity analysis, and utilization of phonetic production skills. The results revealed modest tradeoffs between complexity of word combinations and accuracy of consonant production for 2 of the 5 children. The results also showed tradeoffs between complexity of word combinations and phonetic complexity of individual lexical items (phonetic product for words) for 4 of the 5 children. As the complexity of these 4 children's multiword combinations increased, the phonetic complexity of individual lexical items decreased. These results are consistent with synergistic theories of language acquisition and language processing that emphasize dynamic tradeoffs in interactions among language processing levels in a limited capacity production system.

Reading assessment post head injury: how valid is it?

The purpose of this study was to identify the passage dependency for three reading tests applied to the closed head injured (CHI) population and to determine whether reading the passage resulted in improved accuracy in responding to passage-related questions. Based on the performance of 10 CHI adults, passage dependency was low for all three tests. Only the Reading Comprehension Battery for Aphasia scores improved significantly when the subjects read the passages prior to responding. The results parallel those found with aphasic subjects and raise questions concerning the validity of these tests in assessing communication dysfunction post-CHI.

Estudo comparativo entre válvulas biológicas e válvulas mecânicas nas posiçöes mitral ou aórtica até 14 anos / Biological and mechanical prothesis in mitral and aortic valve at 14 years

Foram estudados 1222 pacientes, submetidos a troca valvar simples, sendo 652 mitrais (Mi) e 570 aórticas (Ao). os paciente foram classificados por sexo, idade e etiologia. No grupo Mi. receberam 126 próteses mecânicas, como segue: 49 Björk-Shiley (B-S); 71 Liliehei-Kaster (L-K); 6 Hall-Kaster (H-K) e 526 próteses de pericárdio bovino IMC (PBIMC). O seguimento pós-operatório foi de 95% a 100%. A mortalidade hospitalar foi de 21% para a L-K e 9,5% para a PBIMC. A incidência de trombose e tromboembolismos em eventos por 100% pacientes-ano foi de 7,7; 5,6; 6,7 e 1,0 para: B-S, L-K, H-K e PBIMC, respectivamente. A incidência de calcificaçäo e roturas foi de 1,8 por 100 pacientes-ano para a PBIMC, e näo ocorreu nas próteses mecânicas. Solamente os pacientes com próteses mecânicas foram anticoagulados. O grupo Ao totalizou 336 próteses mecânicas (92B-S, 111L-K, 133H-K) e 234 PBIMC. O seguimento pós-operatório foi de 97% a 100%. A mortalidade hospitalar foi de 5,5% para o grupo das mecânicas e 2,6% para o das biológicas. A incidência de trombose e tromboembolismo em eventos por 100 pacientes-ano foi de 3,0 para B-S, 2-3 para L-K, 2,5 para H-K e 0,3 para PBIMC. Calcificaçäo, roturas e falhas mecânicas foram de 0,54 eventos por 100 pacientes-ano para PBIMC e de 0,38 eventos por 100 pacientes-ano para H-K. No grupo mecânico, os pacientes receberam aspirina e dipiridamol e 30% recebveram anticoagulante oral. Os autores concluíram que a sobrevida, de um modo geral, näo está relacionada ao tipo de prótese empregada. A incidência de trombose e tromboembolismo é mais elevada com válvulas mecânicas, e a taxa de complicaçöes é mias baixa com válvulas biológicas. a anticoagulaçäo oral é obrigatória para as próteses mecânicas na posiçäo Mi, mas näo és essencial nao posiçäo Ao. As biopróteses näo necessitam de anticoagulantes. Por estes motivos, os autores empregam, de rotina, próteses mecânicas para a posiçäo Ao, a menos que existam contra-indicaçöes, e biopróteses para a posiçäo Mi

Seguimento de 9 anos da bioprótese valvular cardíaca de pericárdio bovino IMC-Biomédica: estudo multicêntrico / Nine year follow-up of the bovine pericardial prosthetic valve IMC-Biomedica: a multicentric study

De dezembro de 1977 a novembro de 1986, foi usado o bioenxerto valvular cardíaco de pericárdio bovino IMC-Biomédica na posiçäo mitral, em 798 pacientes, com idade média de 42 anos. Os 722 pacientes sobreviventes foram observados por um período de até 9 anos, representando 27036 meses, ou 2253 anos. O estudo indicou um índice de sobrevida de 66% para os adultos e 69% para os jovens, sendo de 94% e 80% o índice de sobrevida para os adultos e jovens, respectivamente, com pós-operatório de 5 anos. A freqüência das complicaçöes diante da amostra analisada foi: 0,4% de rotura do tecido; 0,4% de vazamento paravalvular; 2,7% de acidente vascular cerebral; 3,2% de endocardite infecciosa; 4,4% de calcificaçäo. A curva atuarial de calcificaçäo entre os anos de 1978 e 1982 (Grupo I) mostrou 94% doa adultos e 12% dos jovens livres dessa complicaçäo. Por outro lado, de 1982 a 1986 (Grupo II), esseíndice subiu para 99,0% entre os adultos e 92,0% para os jovens. Deste modo, concluímos que a nossa opçäo pela bioprótese de pericárdio bovino foi apropriada, visto que 96% dos pacientes estiveram livres de complicaçöes fatais relacionadasa à bioprótese, o que significa que, em 9 anos, o potencial da bioprótese foi apenas de 4%

Seguimento de 9 anos da bioprótese valvar cardíaca de pericárdio bovino IMC Biomédica / 9 years follow-up of cardiac valvar bioprosthesis with bovine pericardium IMC Biomédica

De dezembro de 1977 a novembro de 1986 foi usado o bioenxerto valvar cardíaco de pericárdio bovino "IMC-Biomédica" na posiçäo mitral, em 798 pacientes, com idade média de 42 anos. Os 722 pacientes sobreviventes foram observados por um período de até 9 anos, representando 27.036 meses ou 2.253 anos. O estudo indicou um índice de sobrevida de 66% para os adultos e 69% para os jovens, sendo de 94% e 80% o índice de sobrevida para os adultos e jovens, respectivamente, com pós operatório de até 5 anos. A freqüência das complicaçöes diante da amostra analisada foi: 0,4% rotura do tecido, 0,4 escape paravalvar, 2,7% acidente vascular cerebral, 3.2% endocardite infecciosa, 4.4% calcificaçäo. A curva atuarial de calcificaçäo entre os anos de 1978 e 1982 (Grupo I) mostrou 94% dos adultos e 12% dos jovens livres dessa complicaçäo. Por outro lado, de 1982 a 1986 (Grupo II) esse mesmo índice subiu para 99.0% entre os adultos e 92.0% para os jovens. Dese modo concluímos que a nossa opçäo pela bioprótese valvar de pericárdio bovino foi apropriada, visto que 96% dos pacientes estiveram livres de complicaçöes fatais relacionadas a bioprótese, o que significa que em 9 anos o potencial da bioprótese foi apenas de 4%

Cognitive strengths and weaknesses in language-impaired children: one more look.

The hypothesis-testing abilities of 15 language-impaired and 15 normally developing children matched for mental age were investigated using discrimination-learning tasks. The subjects in both groups were presented with two sets of discrimination-learning problems. One set of problems featured explicit input concerning the correct response choice. The other set of problems featured nonexplicit input. The results revealed both differences in the performance of the MA-matched and language-impaired children and differences in performance on the two types of problems. The children in both groups solved more of the explicit input problems than the nonexplicit input problems. In addition, the MA-matched children performed significantly better than the language-impaired children, particularly on the nonexplicit problems. The findings suggested that the language-impaired children exhibited deficits in solving discrimination-learning problems. The deficits exhibited by the language-impaired children seemed related to deficits in their ability to encode information.

Word, syllable, and sound awareness in language-disordered children.

The present investigation evaluated language-disordered children's metalinguistic awareness of words, syllables, and sounds. Subjects were 15 language-disordered children matched for mental age to 15 normally developing children and for language age to another 15 normally developing children. In the first task, children were asked to divide sentences, bisyllabic words, and monosyllabic words into smaller units. In the second task, children were asked several questions designed to assess their word awareness. The language-disordered children performed significantly poorer than both groups of normally developing children in dividing sentences and words. The language-disordered children also did not show the same level of responses to the word-awareness questions as the normally developing children. These findings indicate that language-disordered children's metalinguistic deficit is not limited to difficulty making grammatical judgments. Importantly, these disordered children's lack of word, syllable, and sound awareness places them significantly at risk for future academic difficulties, in particular, learning how to read.

The elicited language inventory and the influence of contextual cues.

The Elicited Language Inventory (ELI) (Carrow, 1974b) was administered in standardized fashion and in a modified procedure with contextually supported cues to eight language-delayed and eight normal-speaking children in Brown's (1973) Stage II of morphological development. Additionally, grammatical morpheme use under the two ELI presentation conditions was compared with use of the same morphemes in spontaneous speech for two language-delayed and two normal-speaking subjects. Results of both comparisons favored modified use of the ELI with contextually cued items when sampling children's expressive speech. A significantly greater number of morphemes was imitated and provided in obligatory contexts under modified ELI conditions. Significantly fewer total errors were produced by all subjects when ELI items were presented with contextual cues. Moreover, children's performance on contextually cued ELI items was a significantly better predictor of their grammatical morpheme use in spontaneous speech than performance on the standard version of the ELI. Except for total errors, subject group differences were not significant; however, the older language-delayed children performed consistently better than the stage-matched normal-speaking children on all imitative response measures.