Endocrine PBL in the year 2000.

The Southern Illinois University School of Medicine (SIU-SOM) has utilized problem-based learning (PBL) in its curriculum since 1981, when Dr. Howard Barrows joined the faculty. From 1989 to 2000, SIU-SOM implemented two parallel curricula for the basic science years (years I and II), one curriculum being a problem-based learning curriculum (PBLC). An executive decision to design and implement a single curriculum, to begin in Fall 2000, fostered a review of existing pedagogy upon which to base this new curriculum: C2000. The results of this review, which considered formal outcome measures as well as internal review in consideration of the institutional mission, led to PBL becoming the predominant pedagogy for C2000, albeit with some modifications from its PBLC predecessor. C2000, then, represents the third iteration of PBL in use at SIU-SOM, and its design and rationale offer insight for the teaching of Endocrine Physiology in a PBLC.

Stroboscopic signs associated with benign lesions of the vocal folds.

Stroboscopic signs were systematically rated for a group of 80 patients with benign vocal fold lesions, most of whom had either a nodule or a polyp. Each group revealed a characteristic pattern of ranking of signs and exhibited differences of most predominant signs. The results of the ratings were submitted to a multiple discriminant analysis to determine if post hoc stroboscopic ratings could be used to correctly classify patients into one of four diagnostic groups and into one of two treatment groups. All patients except one were correctly classified into the diagnostic groups, and all were correctly classified into the treatment groups. The important signs for classifying patients into the diagnostic groups were roughness of the edge of the affected vocal fold, phase closure pattern, and phase symmetry. The important signs for classifying patients into the treatment groups were roughness of the edge of the affected vocal fold, glottal closure configuration, and vibration characteristics of the affected (or more affected) vocal fold. The results suggest that objective evaluation of stroboscopic examinations can be valuable in correctly diagnosing patients and in selecting the proper treatment regimen for the patient.

The integration of voice science, voice pathology, medicine, public speaking, acting, and singing.

The integration of voice science, voice pathology, medicine, public speaking, acting, and singing has been central to evolution in all fields. The Voice Foundation Symposia have played a seminal and central role in fostering integration among disciplines. The result has been an improvement in the knowledge and practice in each field. And the future promises to be even more informative and exciting.

Successful pregnancy outcome following mid-gestational uterine rupture and repair using Gore-Tex soft tissue patch.

The first reported gestational use of the Gore-Tex soft tissue patch (expanded polytetrafluoroethylene) for uterine repair and support is presented in a pregnant woman whose partially dehisced, congenitally abnormal uterus was operated upon at 19 weeks' gestation. Use of the expanded polytetrafluoroethylene Gore-Tex soft tissue patch for assisted uterine integrity in combination with a program of uterine tocolysis and close maternal/fetal surveillance averted a pregnancy loss.

Computer modeling of human fertility: the impact of reproductive heterogeneity on measures of fertility.

As a result of the paucity of biological markers for both reproductive events and exposure to reproductive toxicants, it is likely that individual members of populations will be misclassified with respect to reproductive performance and xenobiotic exposure. A four-parameter computerized model of fertility (frequency of intercourse, male fecundity, female fecundity, and spontaneous abortion) was developed to explore the effect of misclassification of populations on several measures of fertility. The measures of fertility explored include cumulative percent pregnant, time to pregnancy, cycle specific fertility, and fecundability ratio. The cumulative percent pregnant and time to pregnancy appeared to be insensitive to small changes in reproductive competence. The fecundability ratio decreased in proportion to the size of population exposed to a reproductive toxicant. The three reproductive parameters, time to pregnancy, cumulative percent pregnant, and fecundability, do not appear useful as measures of reproductive heterogeneity in populations. The reproductive heterogeneity of a population was best defined by the change in cycle-specific fertility rate over the period of observation. These simulations suggest that the change in the cycle-specific fertility rate should be evaluated and comparable in all population groups over the period of observation to assure reproductive homogeneity.

Laryngeal behavior during stuttering: a further study.

The purpose of this study was to provide detailed, objective descriptions of stutterers' laryngeal behavior during instances of stuttering within conversational speech. Subjects were 11 adult stutterers who produced stutterings (sound prolongations and sound/syllable repetitions) while their laryngeal behaviors were observed by means of a flexible fiber-optic nasolaryngoscope (fiberscope). Laryngeal behaviors during 86 of the 11 stutterers' stutterings were categorized as adducted, intermediate, or abducted. Results indicate that during sound prolongations the vocal folds were more likely to be adducted and less variable in their movement than during sound/syllable repetitions. Results further indicated that the voicing characteristics of the stuttered sound (voiceless vs. voiced) and the type of stuttering (sound prolongation vs. sound/syllable repetition) interactively influenced laryngeal behavior. It is hypothesized that a complex interaction among the laryngeal, articulatory, and respiratory systems contribute to the occurrence of the inappropriate abductory and/or adductory laryngeal behavior which characterizes prolonged or repeated (stuttered) speech segments.

Evaluating vocal fold function.

In the effort to develop a non-invasive method for the evaluation of the vibratory characteristics of the vocal folds in patients with vocal pathology, some of the newer methods for evaluating vocal function in normal speech are being considered. Inverse filtering of the glottal airflow waveform and ways of measuring vocal fold contact area are described and evaluated for their potential use in the clinic. Knowledge of the vibratory behavior of a patient's vocal folds is important to our understanding of problems such as spastic dysphonia, dysphonia plica and functional aphonia as well as the problems of the professional voice user.

Laryngeal behavior during stuttering.

Laryngeal behavior associated with 101 stutterings (part-work repetitions, sound prolongations, and broken words) produced by a group of 10 stutterers was observed by means of a flexible fiberoptic naso-laryngoscope. Results indicated that 60% of part-word repetitions were different from fluent productions of the same speech segment in terms of laryngeal behavior, and 72% of sound prolongations were similar to fluent productions of the same speech segment. Findings indicate that there are differences in laryngeal behavior among the various types of stutterings.

Fiber-optic video study of the post-laryngectomized voice.

Simultaneous video-fluoroscopy and fiber-optic video laryngoscopy was carried out on a series of eight laryngectomees. Previous concepts supported by an earlier report1 indicated that the folds of the rebuilt cricopharyngeal sphincter were seen to represent the primary source of sound vibration for voice production. Fold vibration was envisioned as an essential for sound production. Present findings present a challenge to the older concept. The fluoroscopic studies showed a considerable variation in the vertical thickness of the sphincteric area--from several millimeters to as many as 10 centimeters. Mucus bubbles in rapid motion were easily visible immediately above the narrowest portion of the reconstructed cervical esophagus. Ingestion of barium only enhanced the visualization of this bubbling. Vibration of a long vertical area of the thin anterior and thicker posterior esophageal walls well above and well below this point was regularly noted. Fiber-optic visualization failed to show actual fold vibration at any time. Momentary opening of the food tract during air injection or intake, immediately prior to the onset of phonation, was seen on many occasions. During phonation, routinely, the anticipated pseudoglottic opening was obscured by bubbles of mucus or barium. These findings suggest that the air, when accumulated below the narrowest spot in the hypopharyngeal-esophageal tract and when forced upward through a narrow opening, sets the accumulated mucus, not the mucous membrane, into vibration; further, that this vibration is of sufficient amplitude to transmit itself to both the anterior wall and the posterior wall of an extensive vertical portion of the neck.

Early diagnostic signs and symptoms of laryngeal disease.

A compilation of late and early symptoms of patients who ultimately were found to have laryngeal disease was carried out. Notation of even minor changes in the indirect laryngoscopic appearance of the same patients was made routinely. Correlation of symptoms with signs has made possible a better understanding of the natural history of certain laryngeal lesions such as contact ulcer, polyps, nodes, dysphonia plica ventricularis as well as some of the pareses, paralyses and fixations. Identical early symptoms and numerous signs have apparently been ignored in subsequently proven cases of cancer of the larynx. The expanded list of symptoms (33 in number) and the detailed list of signs (54 in number) may now assist the Otolaryngologist in earlier diagnosis. Although the reported findings are not specifically diagnostic of cancer of the larynx, they should draw earlier attention to the larynx as the etiological site of such symptoms. Earlier recognition of minor laryngeal changes, as detailed in the text, should lead to earlier biopsy and tissue diagnosis, earlier and more enlightened public awareness, and earlier and, therefore, more effective utilization of present day day modalities in the management of carcinoma of the larynx.