Voice and choral singing treatment: a new approach for speech and voice disorders in Parkinson's disease.

AIM: The aim of this study was to propose a new voice rehabilitation program for Parkinson's Disease (PD) patients based on voice and choral singing treatment (VCST). METHODS: The authors carried out a pilot test-retest non-controlled study with twenty PD patients that voluntarily took part to the speech rehabilitation treatment. Patients underwent 20 hours of speech therapy, two sessions of one hour every week, and 26 hours of choral singing, one session of two hours every week. The speech and choral activity were directed by a speech therapist expert in PD and choral singing. The pre- and post-treatment assessment included neurological and otolaryngological evaluation, voice and speech acoustic analysis, auditory quality of voice analysis, respiratory function evaluation, that were carried out within two weeks before and after VCST. RESULTS: The authors observed a significant improvement (P<0.05) of functional residual capacity (FRC%), maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), maximum duration of sustained vowel phonation (MDPh), prosodia reading a passage, using paired t-test; and of fatigue reading a passage using Wilcoxon Signed Rank Test. No significant difference was found in the other variables. CONCLUSION: VCST for PD patients can improve specific abnormalities with an amusing, agreeable, and collective approach, but a randomized controlled trial (RCT) is necessary to find evidence of efficacy.

Evaluation of anxiety in Parkinson's disease with some commonly used rating scales.

This study assessed the concurrent validity of the State-Trait Anxiety Inventory (STAI), the Hospital Anxiety and Depression Scale (HADS) and the Hamilton Anxiety Scale (Ham-A) for evaluating anxiety in a group of 46 Parkinson's disease (PD) patients. The magnitude of correlations between the scales was high (all p<0.01), indicating a good concurrent validity. The item-by item analysis indicated that the main characteristics of anxiety in PD patients were 'inability to relax', 'restlessness or inability to feel calm' and 'feeling tense'. The association between anxiety, as measured by the HADS-A, with demographic characteristics or clinical features of PD was not significant, supporting existing data suggesting that anxiety in PD is not closely correlated with the severity of motor symptoms or the degree of disability. The HADS-A may be the most appropriate scale for documenting patient-reported anxiety in depression.

Utilización de dos soportes para la inmovilización de la papaína / Use of two supports for inmobilizing papain

Con la intención de preparar suplementos dietéticos de bajo coste, se inmovilizó papaína en carbón activado (CA) y en alúmina, utilizando suero como fuente de proteínas hidrolizadas. Para determinar el índice de inmovilización se cuantifi caron las enzimas no adsorbidas mediante el método de Lowry. Se analizó el efecto del tiempo de contacto y la temperatura, considerándose 30 min. a 25 ºC como la condición óptima para inmovilizar la papaína en ambos soportes. El CA presentó unos índices de inmovilización muy superiores (entre 95% y 99%) a los de la AL (entre 4% y 13%). Para evaluar la capacidad de reutilización de la papaína se midió la actividad residual de la enzima después de haber sido utilizada hasta 20 veces. Para determinar la actividad de la enzima se cuantifi có el índice de exposición de la fenilalanina mediante espectrofotometría de derivada segunda. En este caso, la AL presentó mejores resultados que el CA, ya que la actividad de la papaína seguía siendo la misma después de haber sido utilizada 15 y 5 veces, respectivamente

Papain was immobilized on activated carbon (AC) and on alumina (AL), with the aim of preparing low cost dietary supplements, using whey as hydrolysed protein source. The quantifi cation of the non-adsorbed enzyme, using Lowry’s method was used to determine the immobilization rate. The effect of the contact time and the temperature was tested, and 30 min at 250C was considered the best condition for immobilizing papain in both supports. AC showed much higher immobilization rates (from 95% to 99%) than AL (from 4% to 13%). The reusability of papain was evaluated by measuring the residual activity of the enzyme after it has been used for up to 20 times. The quantifi cation of exposure rate of phenylalanine by second derivative spectrophotometry was used to determine the enzyme activity. In this case, AL showed better results than AC, since the activity of papain remained unchanged after 15 and 5 times, respectively

Proton magnetic resonance spectroscopy during transient global amnesia.

There is uncertainty about the etiology of transient global amnesia and none of the pathogenetic hypotheses proposed so far, i.e. transient ischemia, epileptic discharge and spreading depression of cortical electrical activity, is completely satisfactory. Using water suppressed proton magnetic resonance spectroscopy we studied one patient during a typical episode of transient global amnesia and 2 weeks thereafter in order to investigate the metabolic changes in the hippocampal region. In both hippocampi, spectra of N-acetyl-aspartate, creatine-phosphocreatine, compounds containing choline and lactate failed to show changes consistent with cerebral ischemia, both in the acute phase and in the follow-up. Spreading depression in response to emotional stress seems a likely explanation in this patient, who suffered from migraine in the past.

Large striatocapsular infarcts: clinical features and risk factors.

We defined large striatocapsular infarcts as subcortical softenings of more than 20 mm in diameter involving the territories of the lateral and medial groups of lenticulostriate arteries. The aim of this study of 56 patients was to compare the clinical features and risk factors of these infarcts with those of cortical and lacunar infarcts. On the whole, our data suggest that both the clinical features and risk factors of large striatocapsular infarcts are similar to those of cortical infarcts, but significantly different from those of lacunar infarcts. The clinical manifestations of large striatocapsular infarcts with a maximum diameter of less than 50 mm may sometimes resemble those of lacunar infarcts because neuropsychological disorders are less frequent; however, our study indicates that, even in these cases, cardioembolic sources and artery-to-artery embolism are significantly more frequent in large striatocapsular than in lacunar infarcts, thus suggesting a different pathogenesis.

Transient global amnesia and transient ischemic attack. Natural history, vascular risk factors, and associated conditions.

BACKGROUND AND PURPOSE: The purpose of the present study was to make an attempt to ascertain the etiology of transient global amnesia (TGA), which is still disputed more than 30 years after the first description of this clinical entity. METHODS: In a case-control study, we compared the prevalence of vascular risk factors in 64 TGA patients with 64 first-ever transient ischemic attack (TIA) control subjects and 108 normal community-based control subjects matched for age and sex. We prospectively studied the vascular events and mortality rates of the TGA cases and of the TIA control subjects. Then we compared the outcome of the two groups using actuarial analysis based on survival curves. RESULTS: We did not find evidence of an increased risk of TGA associated with any vascular risk factor. In contrast to TIA control subjects, no TGA patient suffered stroke, myocardial infarction, or TIA during the follow-up period. Migraine was more common in TGA patients than in both normal and TIA control subjects. In three patients (4.5%), the TGA was eventually considered to be of epileptic origin. CONCLUSIONS: The results of our case-control and longitudinal studies point to the conclusion that TGA and TIA do not share the same etiology. Since half of our patients had a precipitating event in their history, it is reasonable to hypothesize that spreading depression may play a role in TGA. The significant positive association between migraine and TGA may support this hypothesis. Epilepsy may mimic TGA in a minority of cases.

Acute encephalopathy and polyneuropathy after disulfiram intoxication.

A chronic alcoholic who had ingested a very high dose of disulfiram (29 g over a 1-week period) without simultaneous alcohol intake developed an acute encephalopathy and a severe flaccid tetraparesis that worsened over the course of several days, even after the intake of the drug had stopped. Recovery was both slow and incomplete. One year after intoxication, the patient still had distal weakness in the arms and legs, and hypesthesia in the hands and feet.

Immediate prognosis of primary intracerebral hemorrhage using an easy model for the prediction of survival.

We reviewed the medical records and CT scans of 138 patients hospitalized for spontaneous supratentorial hemorrhage and conservatively treated. Seventeen clinico-anamnestic variables and five CT desumed findings were collected. Using univariate analysis we found eight significant predictors of 30-day mortality: intraventricular spread (IVS) of blood, volume of the hemorrhage, Glasgow Coma Scale (GCS) score, midline shift, hyperglycemia, pupillary abnormalities, limb paresis and gaze deviation. With multivariate logistic regression analysis we found three independent predictors of 30-day mortality: IVS of blood, volume of the hemorrhage and GCS score. Using these three independent variables we developed an easy model which allows an immediate estimate of the probability of survival with a high degree of sensitivity and specificity.

Increased density in the middle cerebral artery by nonenhanced computed tomography. Prognostic value in acute cerebral infarction.

In order to consider the prognostic value of hyperdensity of the middle cerebral artery (MCA), we studied retrospectively the medical records of 80 consecutive patients with the diagnosis of ischemic stroke who underwent a non-enhanced computed tomography no longer than 24 h after the onset of the symptoms. To determine the mortality and disability, a follow-up of 30 days was obtained. Mortality does not differ significantly in acute ischemic stroke patients with and without increased density of MCA. When disability, calculated with the Rankin scale, is considered, the two groups are different since patients with hyperdensity of the middle cerebral artery (MCA) have a significantly worse outcome. The two groups do not differ for age, sex, the presence of atrial fibrillation, hypertension, diabetes, myocardial infarction and/or angina, and these factors do not influence the prognosis being equally present in the dead and in the survivors. In the multivariate discriminant analysis with stepwise variable selection, the dense MCA sign was significantly correlated either to mortality or to disability, along with atrial fibrillation, age and diabetes. We conclude that the dense MCA sign can be a useful prognostic factor in the early phase of ischemic stroke.