The prevalence of human papillomavirus in paediatric tonsils in Southwestern Ontario.

OBJECTIVE: To determine the prevalence of human papillomavirus in paediatric tonsils in Southwestern Ontario, Canada. MATERIALS AND METHODS: Patients aged 0-18 years undergoing tonsillectomy were recruited. Two specimens (left and right tonsils) were collected from each participant. Tonsillar DNA was analysed using quantitative polymerase chain reaction to determine the presence of human papillomavirus subtypes 6, 11, 16 or 18. RESULTS: A total of 102 patients, aged 1-18 years (mean age of 5.7 years), were recruited. Ninety-nine surveys were returned. There were 44 females (44.4 per cent) and 55 males (55.6 per cent). Forty patients (40.4 per cent) were firstborn children and 73 (73.7 per cent) were delivered vaginally. Six mothers (6.1 per cent) and one father (1.0 per cent) had prior known human papillomavirus infection, and one mother (1.0 per cent) had a history of cervical cancer. All tonsil specimens were negative for human papillomavirus subtypes 6, 11, 16 and 18. CONCLUSION: No human papillomavirus subtypes 6, 11, 16 or 18 were found in paediatric tonsil specimens from Southwestern Ontario.

Safety of nasal stenting in pharyngeal flap surgery for pediatric velopharyngeal dysfunction.

INTRODUCTION: The pharyngeal flap procedure is an effective surgery for velopharyngeal dysfunction (VPD) yet carries approximately a 3.2% post-operative airway obstruction risk. Life threatening airway compromise occurs in first 24 h post-operatively. Nasopharyngeal airway has been shown to decrease these complications but its routine use is not commonplace. At our centre, surgical technique involves routine placement of bilateral nasopharyngeal airway referred to as nasal stenting. Our objective was to demonstrate safety of nasal stenting for children with VPD undergoing pharyngeal flap surgery. METHODS: A retrospective review of pediatric patients aged 1 through 18 years at the time of VPD diagnosis, who underwent superiorly based pharyngeal flap surgery at London Health Sciences Centre (LHSC), was conducted. Patients were admitted to a regular ward with bihourly oxygen saturation checks. Nasal stents were removed on post-operative day two. Demographic data along with patient outcomes and perioperative complications were collected and analyzed. RESULTS: Eighty-five pediatric patients underwent superiorly based pharyngeal flap surgery at LHSC from November 2004 through February 2017 that met inclusion criteria. Mean age at the time of surgery was 11.0 years, whereas average age at diagnosis was 8.7 years. The majority of patients (60.0%) had history of cleft palate repair. Only 28.2% had additional comorbidities, the most common being Pierre-Robin Sequence. Average length of hospital stay was 2.7 days. No patients required admission to an intensive care unit. Surgical complication rate was 8.2%. No post-operative airway obstruction events were encountered. Two patients (2.3%) underwent pharyngeal flap reversal for obstructive sleep apnea and one for persistent nasal obstruction. Five (5.9%) minor stent-related complications were captured. Two patients developed self-limiting epistaxis. Two patients had partially extruded stents prior to their removal. One patient developed nasopharyngeal port granuloma which resolved with a course of intranasal corticosteroids. CONCLUSION: Nasal stenting for pharyngeal flap surgery is safe. Stent related complications were minor and did not influence length of hospital stay. A prospective study to determine if routine stenting would lead to decreased serious airway complications is warranted.

Hollow Multi-Shelled Structural TiO2-x with Multiple Spatial Confinement for Long-Life Lithium-Sulfur Batteries.

TiO2-x with well-controlled hollow multi-shelled structures (HoMSs) were designed and synthesized, via a sequential templating approach (STA), to act as sulfur carrier materials. They were explored as physico-chemical encapsulation materials. Particularly, the sulfur cathode based on triple-shelled TiO2-x HoMSs delivered a specific capacity of 903 mAh g-1 with a capacity retention of 79 % at 0.5 C and a Coulombic efficiency of 97.5 % over 1000 cycles. The outstanding electrochemical performance is attributed to better spatial confinement and integrated conductivity of the intact triple-shell that combine the features of physico-chemical adsorption, short charge transfer path along with mechanical strength.

Perioperative Teaching and Feedback: How are we doing in Canadian OTL-HNS programs?

BACKGROUND: Discrepancies between resident and faculty perceptions regarding optimal teaching and feedback during surgery are well known but these differences have not yet been described in Otolaryngology - Head and Neck Surgery (OTL-HNS). The objectives were thus to compare faculty and resident perceptions of perioperative teaching and feedback in OTL-HNS residency programs across Canada with the aim of highlighting potential areas for improvement. METHODS: An anonymous electronic questionnaire was distributed to residents and teaching faculty in OTL-HNS across Canada with additional paper copies distributed at four institutions. Surveys consisted of ratings on a 5-point Likert scale and open-ended questions. Responses among groups were analysed with the Wilcoxon-Mann Whitney test, while thematic analysis was used for the open-ended questions. RESULTS: A total of 143 teaching faculty and residents responded with statistically significant differences on 11 out of 25 variables. Namely, faculty reported higher rates of pre and intra-operative teaching compared to resident reports. Faculty also felt they gave adequate feedback on residents' strengths and technical skills contrary to what the residents thought. Both groups did agree however that pre-operative discussion is not consistently done, nor is feedback consistently given or sought. CONCLUSION: Faculty and residents in OTL-HNS residency programs disagree on the frequency and optimal timing of peri-operative teaching and feedback. This difference in perception emphasizes the need for a more structured approach to feedback delivery including explicitly stating when feedback is being given, and the overall need for better communication between residents and staff.

C-class functions with new approach on coincidence point results for generalized [Formula: see text]-weakly contractions in ordered b-metric spaces.

In this paper, by using the C-class functions and a new approach we present some coincidence point results for four mappings satisfying generalized [Formula: see text]-weakly contractive condition in the setting of ordered b-metric spaces. Also, an application and example are given to support our results.

Proteus mirabilis abscess involving the entire neural axis.

Intramedullary spinal cord abscesses are rare and potentially devastating lesions usually associated with other infective processes such as bacterial endocarditis, or pulmonary or urogenital infection. We describe a 2-year-old girl who presented with an infected dermal sinus leading to an intraspinal abscess. This abscess eventually spread and involved the entire neural axis leaving her quadriparetic. Drainage of the abscess resulted in recovery and the child regained normal function of her limbs. To our knowledge this is the first documented case of an intramedullary abscess involving the entire neural axis.

Effect of acute bull exposure around the time of artificial insemination on serum oxytocin and progesterone concentrations and pregnancy rates in dairy cows.

This study examined the effect of acute bull exposure around the time of artificial insemination (AI) on oxytocin and progesterone concentrations, and pregnancy rates in dairy cows. Ninety six dairy cows, stratified according to parity into primiparous and pluriparous, were divided into three groups; short bull exposure (SBE; 10 min, n = 32), long bull exposure (LBE; 4 h, n = 32) or no bull exposure (NBE; n = 32). On day 45 post-partum, all cows were treated with PGF2α on three occasions 11-14 days apart to synchronize oestrus. They were submitted to fixed time AI 80 h after the third PGF2α injection. Cows in the SBE and LBE groups were artificially inseminated 5 min after the introduction of the bull. From a subset of cows (n = 6 per group; three primiparous and three pluriparous), blood samples were collected once every 5 min starting 15 min before AI until 15 min after AI and analysed for oxytocin concentrations. Additional blood samples were collected for measurements of progesterone (P4) concentrations once daily for 4 days starting on the day of AI and once every 3 days thereafter until day 22. The effects of bull exposure, time, parity, difficulty of AI, and pregnancy on oxytocin and P4 concentrations were analysed using the mixed linear model procedure. Mean oxytocin concentrations or change in oxytocin concentrations after bull exposure or AI were not different among groups. Pregnancy rates for the NBE, SBE and LBE groups were 55.5%, 33.3% and 44.4%, respectively, and were not different among groups. In conclusion, acute bull exposure around the time of AI did not affect oxytocin and progesterone concentrations and did not improve pregnancy rates in dairy cattle under these farms conditions.

Comparative analysis of the oil and supercritical CO(2) extract of Schinus molle L. growing in Yemen.

In this study, we report the preliminary data on the chemical composition of Yemeni Schinus molle L. volatile oil obtained by supercritical extraction with carbon dioxide (40°C and 90 bar), SFE, and by hydrodistillation (HD). The composition of the volatile oil has been analysed by GC and GC-MS. The content of the major constituents in the oils from leaves varied in the following ranges: germacrene D 3.7% in SFE and 16.7% in HD; ß-caryophyllene 19.1% in SFE and 13.5% in HD. The amount of monoterpenes constituted 4%, in all the analysed samples, while the number of sesquiterpenes was 44% in supercritical and 67% in HD oil. Some compounds were not identified by GC-MS and it will require further analysis using other analytical techniques.

A new strategy for superior reproductive performance of ewes bred out-of-season utilizing progestagen supplement prior to withdrawal of intravaginal pessaries.

Two experiments were conducted to examine the effect of progestagen supplement 24h prior to intravaginal pessary withdrawal on reproductive performance of seasonal anestrous ewes. Ewes in each experiment were allocated to treatment and control and all were induced to estrus using either intravaginal MAP (Exp. 1; n=24) or CIDR-G (Exp. 2; n=28) pessaries for 12 days. Half of the ewes in each experiment were supplemented 24h before withdrawal of pessaries with either 10mg oral MAP tablets (Exp. 1) or 25mg i.m. progesterone (P(4)) administration (Exp. 2; P(4)-supplement-treated group). Fertile rams were allowed with the ewes at sponge removal (Day 0, 0h) and estrus was monitored at 6-h intervals for 3 days. Blood samples were collected for measurements of P(4) (Exp. 1 and Exp. 2) and LH (Exp. 2). In both experiments, the percent of ewes in estrus was greater (P<0.05) and intervals to estrus were longer (P<0.05) in progestagen-supplement-treated than control ewes. In Exp. 2, the occurrence and magnitude of LH surges were greater (P<0.01) and intervals to onset of LH surge were longer (P<0.01) in P(4)-supplement-treated than control ewes. In Exp. 2, P(4) supplement elevated P(4) levels from 1.8+/-0.1ng/mL on Day -1 to 4.2+/-0.3 on Day 0 (P<0.001). Following pessaries removal, P(4) concentrations fell to basal values on Day 1 in both groups and remained low until Day 5. Then, P(4) concentrations increased and remained elevated through Day 19 in all (100%) progestagen-supplement-treated in Exp. 1 (12/12) and Exp. 2 (14/14) and in only 5/12 (41.7%) and 6/14 (42.9%) control ewes, respectively. These ewes were confirmed pregnant by ultrasonography and lambed on Day 149.2+/-0.2 following Day 0. In conclusion, progestagen supplement 24h prior to removal of pessary can be used successfully to improve reproductive performance of ewes bred out-of-season.

The effect of progesterone and oestradiol benzoate on fertility of artificially inseminated repeat-breeder dairy cows during summer.

An experiment was conducted to examine the effect of progesterone (P(4)) and oestradiol benzoate (ODB) on fertility of repeat-breeder lactating dairy cows during summer. One hundred repeat-breeder lactating dairy cows were randomly allocated to four groups (Tr1, Tr2, Tr3 and C) in a study conducted at a private dairy farm. All cows were injected with 2 mg ODB (day 0), which were at random stages of their oestrous cycles. Cows in Tr1, Tr2 and Tr3 were administered with intravaginal progesterone-releasing devices (controlled internal drug-releasing, CIDR) at the time of ODB injection for 7 days and those in group C were untreated and served as controls. Following CIDR removal, all cows were given an intramuscular injection of 25 mg Prostaglandin (PGF(2 alpha)). Twenty-four hours after the PGF(2 alpha) injection, cows in Tr1, Tr2 and C groups were injected with 1 mg ODB. Cows in Tr3 group were injected with 10 microg gonadotropin-releasing hormone (GnRH) agonist 48 h after CIDR removal. Artificial insemination was performed between 24 and 30 h following the second ODB injection for cows in Tr1 group and at the time of GnRH injection for cows in Tr3 group. Cows in Tr2 and C groups were inseminated at detected oestrus. Plasma P(4) and oestradiol 17beta (E(2)) concentrations were determined for all cows daily from day 0 to day 9. Plasma concentrations of P(4) and E(2) among cows of groups Tr1, Tr2 and Tr3 were increased and reached maximum values within 48 h following administration and were greater (p < 0.001) than those of group C cows. The proportion of cows detected in oestrus based on P4 concentration on day 9 was 88%, 72%, 88% and 60% in groups Tr1, Tr2, Tr3 and C, respectively. Oestrous detection rate differed (p < 0.01) significantly between time-inseminated groups (Tr1 and Tr3) and those inseminated at observed oestrous (Tr2 and C) groups. Pregnancy rates based on ultrasonography performed on day 28 were 52%, 56%, 60% and 40%, and those based on rectal palpation on day 45 were 32%, 44%, 36% and 28% for Tr1, Tr2, Tr3 and C cows (p > 0.1), respectively. Whereas pregnancy rates for cows with four or more previous services in all groups (54.55%) were higher (p < 0.03) than those for cows with three previous services (29.49%). In pregnant cows, mean days from calving to the day of insemination were higher (p < 0.01) among cows with four or more previous services (204 +/- 8.0 days) than those with three previous services (157 +/- 6.0 days). Results indicate that treatment with a combination of ODB and CIDR in repeat-breeder dairy cows causes elevation in plasma concentrations of E(2) and P(4). Oestrous detection rate was better in cows that were primed with P(4) than those without P(4) priming. Cows with four or more previous services had significantly higher pregnancy rates than those with three previous services.

Comparing concurrent versus fixed parameter equating with common items: using the dichotomous and partial credit models in a mixed-item format test.

There has been some discussion among researchers as to the benefits of using one calibration process over the other during equating. Although literature is rife with the pros and cons of the different methods, hardly any research has been done on anchoring (i.e., fixing item parameters to their pre-determined values on an established scale) as a method that is commonly used by psychometricians in large-scale assessments. This simulation research compares the fixed form of calibration with the concurrent method (where calibration of the different forms on the same scale is accomplished by a single run of the calibration process, treating all non-included items on the forms as missing or not reached), using the dichotomous Rasch (Rasch, 1960) and the Rasch partial credit (Masters, 1982) models, and the WINSTEPS (Linacre, 2003) computer program. Contrary to the belief and some researchers' contention that the concurrent run with larger n-counts for the common items would provide greater accuracy in the estimation of item parameters, the results of this paper indicate that the greater accuracy of one method over the other is confounded by the sample-size, the number of common items, etc., and there is no real benefit in using one method over the other in the calibration and equating of parallel tests forms.

A new approach to enhance reproductive performance in sheep using royal jelly in comparison with equine chorionic gonadotropin.

The objective was to compare the effects of royal jelly (RJ) and eCG treatments on reproductive performance of ewes synchronized using intravaginal progesterone-releasing devices. Forty-two cycling Awassi ewes were treated intramuscularly (i.m.) with 15 mg PGF2alpha. On the following day, all ewes were administered with CIDR-G for 12 days and were randomly allocated to three (RJ, eCG and control) groups of 14 ewes each. Ewes in the RJ-treated group received daily i.m. treatments of 400mg RJ during the period of CIDR-treatment. Each ewe in the eCG-treated group received an i.m. treatment of 500 IU eCG at the time of CIDR-G removal (day 0) and no further treatment was given to ewes in the control group. Ewes were exposed to four fertile rams for 72 h, from the time of CIDR-G removal, and checked for breeding marks at 6-h intervals. Blood samples were collected from day -13 until day 0 and thereafter until day 19 for progesterone analysis. Royal jelly treatment resulted in a greater rate of decline and lower (P<0.02) progesterone concentrations between days -10 and 0 than eCG-treated and control ewes. Expression of estrus was similar among the three groups and intervals to onset of estrus were shorter (P<0.01) in RJ-treated (31.3h) and eCG-treated (29.8h) than control (41.3h) ewes. First-cycle pregnancy and lambing rates were greater (P<0.05) in RJ-treated (71.4 and 71.4%) and eCG-treated (85.7 and 78.6%) than in control (42.9 and 35.7%) ewes, respectively. Results demonstrate that the treatments of RJ and eCG in conjunction with CIDR-G were similarly effective in induction of estrus and improvement of pregnancy and lambing rates.

Pre-equating: a simulation study based on a large scale assessment model.

Although post-equating (PE) has proven to be an acceptable method in the scaling and equating of items and forms, there are times when the turn-around period for equating and converting raw scores to scale scores is so small that PE cannot be undertaken within the prescribed time frame. In such cases, pre-equating (PrE) could be considered as an acceptable alternative. Assessing the feasibility of using item calibrations from the item bank (as in PrE) is conditioned on the equivalency of the calibrations and the errors associated with it vis a vis the results obtained via PE. This paper creates item banks over three periods of item introduction into the banks and uses the Rasch model in examining data with respect to the recovery of item parameters, the measurement error, and the effect cut-points have on examinee placement in both the PrE and PE situations. Results indicate that PrE is a viable solution to PE provided the stability of the item calibrations are enhanced by using large sample sizes (perhaps as large as full-population) in populating the item bank.

Effect of progesterone prior to GnRH-PGF2alpha treatment on induction of oestrus and pregnancy in anoestrous Awassi ewes.

An experiment was conducted to examine the effect of progesterone prior to a GnRH-PGF2alpha treatment on oestrus and pregnancy in seasonally anoestrous Awassi ewes. Twenty-four ewes were randomly assigned to three groups to be pre-treated with 60 mg medroxyprogesterone acetate sponges (group A), 600 mg progesterone sponges (group B) or blank sponges (group C) for 4 days. All ewes were injected with 100 microg of GnRH 24 h after sponge removal followed, 5 days later, by 20 mg PGF2alpha injection. Ewes were exposed to three fertile rams at the time of PGF2alpha injection (day 0, 0 h) and were checked for breeding marks at 6-h intervals for 5 days. Blood samples were collected from all ewes 1 day (day -10) prior to sponge insertion, at the time of sponge removal (day -6), 1 day following sponge removal (day -5, at the time of GnRH injection) and at the time of PGF2alpha injection (day 0) for analysis of progesterone. Progesterone concentrations on days -10 and -5 were basal and averaged 0.2 +/- 0.04 and 0.2 +/- 0.2 ng/ml, respectively. Progesterone concentrations on day -6 were elevated only in group B ewes and were higher (p < 0.0001) than those of groups A and C. Progesterone concentrations on day 0 were higher (p = 0.002) in groups A and B than group C. Oestrous responses occurred only in ewes of groups A and B (p > 0.05). Induced oestrus conception rate was greater (p < 0.01) in group A than groups B and C. Ewes returned to oestrus 17-20 days following day 0 were two of eight, six of eight and three of eight of groups A, B and C, respectively, all of which eventually lambed. The overall lambing rate was 82% in progesterone-primed ewes compared with only 38% non-progesterone-primed ewes (p < 0.05). Progesterone priming apparently sensitizes GnRH-PGF2alpha-treated seasonally anoestrous ewes and increases their response in oestrus and pregnancy rates.

Reproductive responses following royal jelly treatment administered orally or intramuscularly into progesterone-treated Awassi ewes.

An experiment was conducted to determine whether natural royal jelly (RJ) paste administered orally or intramuscularly (i.m.) in conjunction with exogenous progesterone is associated with improved reproductive responses in ewes. Thirty 3-6-year-old Awassi ewes were randomly allocated into three (RJ-capsule, RJC; RJ-injection, RJI and control, CON) groups of 10 ewes each. All ewes were treated with intravaginal progesterone sponges for 12 days. Ewes in the RJC and RJI were administered orally or i.m. with a total of 3g of RJ given in 12 equal doses of 250 mg per ewe per day starting at the time of sponge insertion. At the time of sponge withdrawal (day 0, 0 h), ewes were exposed to three rams and checked for breeding marks at 6-h intervals for 3 days. Blood samples were collected from all ewes for analysis of progesterone concentrations. Pretreatment progesterone levels were <0.5 ng x ml(-1) in 16/30 and >1.3 ng x ml(-1) in the remaining ewes indicating luteal function and cyclicity. Similar reproductive responses and progesterone levels occurred in ewes of the RJC and RJI; therefore, data of the two groups were pooled. Following sponge insertion, progesterone levels increased rapidly and reached maximum values of 5.8+/-0.2 ng x ml(-1) within 2 days among ewes of the three groups, and then declined gradually to day 0 values of 1.6+/-0.1 and 1.9+/-0.1 ng x ml(-1) for the RJ-treated and CON ewes, respectively. The rate of progesterone decline was greater (P<0.001) in RJ-treated than in CON. Mean progesterone levels during the 12-day period were lower (P<0.001) in RJ-treated than in CON (2.8+/-0.2 ng x ml(-1) versus 3.3+/-0.2 ng x ml(-1)). Treatment with RJ resulted in greater (P<0.05) incidence of oestrus and shorter (P<0.05) intervals to onset of oestrus than CON. Based upon progesterone levels, ovulation occurred following day 0 in all ewes. Progesterone increased on day 3 in RJ-treated and on day 4 in CON ewes. Progesterone remained elevated through day 18 in 8/20 RJ-treated and 1/10 CON ewes (P=0.09). All pregnant ewes exhibited oestrus 14 h earlier (P<0.02), ovulated approximately 1 day earlier and had higher (P<0.001) luteal phase progesterone levels than non-pregnant ewes. Non-pregnant had higher (P<0.04) body weights than pregnant ewes. In conclusion, results demonstrate that both RJ treatments in conjunction with exogenous progesterone were equally capable of improving oestrus response and pregnancy rate.

Nutritive value of lentil and vetch straws as compared with alfalfa hay and wheat straw for replacement ewe lambs.

The objective of this study was to compare the nutritive value of lentil straw (LS) and vetch straws (VS) with alfalfa hay (AH) and wheat straw (WS). Forty Awassi ewes (body weight (BW)=56.2kg) were assigned randomly to four dietary treatments (10 ewes per treatment) for 6 weeks using a complete randomize design. In each dietary treatment, ewes were fed 550g per day of concentrate mix formulated to supply 40% of the metabolizable energy requirement. After the consumption of the concentrate mix, ewes had ad libtum access to AH, LS, VS, or WS. Forage intake, total dry matter intake (DMI), and organic matter intake (OMI) were higher for AH and LS and lowest for WS. Final weight of ewes fed AH and LS diets were higher (P<0.05) than VS and WS diets. However, ewes fed VS diet gained more weight (2.5kg) than ewes on WS diet (0.2kg). Dry matter digestibility was higher for the AH and LS diets (59.4%), and lowest for WS diet (49.6%). The VS diet had an intermediate value (54.4%). Ruminal passage rate was higher for AH and LS (3.4% per hour) compared with WS (1.9% per hour). Eating time for the AH diet was lowest compared with the rest of the forages. Eating time, expressed as minutes per kilogram NDF intake, was highest for WS and VS diets (680min) compared with AH and LS diets (535min). WS diet required more time for rumination (395min per day) compared to AH, LS, and VS diets. However, ewes on VS diet spent more time ruminating per kilogram NDF consumed (954min) compared with WS, LS, and AH diets (901, 617, and 597min, respectively). These results were significant and demonstrate that the nutritive value of LS is greater than VS and close to the nutritive value of AH. VS nutritive value is slightly greater than WS.

How many procedures to make a breast?

The construction of a new breast after mastectomy involves fashioning the breast mound and creating a projecting nipple and a coloured areola. This should involve three episodes for a patient, but is this the experience of patients embarking on breast reconstruction? We identified 177 patients who had undergone breast reconstruction between 1 September 1997 and 31 March 1999. The clinical records for 164 of these patients were found and the data summarised. The techniques, complications and other ancillary procedures experienced by this group of patients are presented. Multiple procedures are likely to be required to complete breast reconstruction, and the patient should be so counselled from the outset. Particular problems may be encountered with each technique and this should be borne in mind when selecting a procedure for each patient, especially in the context of immediate reconstruction where avoiding any delay to adjuvant treatment is a consideration.

MultiDimensional Voice Program analysis in children with vocal cord nodules.

Computer-assisted voice analysis has recently been introduced as a noninvasive approach to the management of paediatric dysphonia. The aim of this study was to determine which parameters of voice analysis distinguish vocal cord nodules from normal patterns. Following diagnosis by flexible nasolaryngoscopy, 12 male children with vocal cord nodules, aged 7 to 12, underwent voice analysis by MultiDimensional Voice Program (MDVP; Kay Elemetrics, Lincoln Park, NJ, USA). These subjects were divided into two age groups (7-9 years, n = 5; 10-12 years, n = 7) and compared to age-matched controls. Results suggest that across all age groups, subjects with vocal cord nodules had statistically significant (p < .01) elevations in absolute jitter, jitter percent, relative average perturbation, pitch period perturbation quotient, smoothed amplitude perturbation quotient, and fundamental frequency variation. Further studies are required to assess the role of MDVP in the diagnosis of other voice pathologies and the monitoring of voice therapy.

Lemierre syndrome in an immunocompromised patient.

Lemierre syndrome or septic thrombophlebitis of the internal jugular vein is a potentially life-threatening complication. This condition may result from oropharyngeal infection, central venous catheterization, and intravenous drug abuse. Immunocompromised patients and individuals with systemic disease are at higher risk of developing the syndrome. We present here a case of septic jugular vein thrombosis in an adolescent with systemic lupus erythematosus. The etiological factors, pathogenesis, and diagnostic and therapeutic measures are discussed.