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Biomedical subjects

L L D'Antonio

Publications and source records attributed to L L D'Antonio.

At least 19 recordsLinked to original sources
PubMed2004

Health related quality of life in patients with Parkinson's disease two years following posteroventral pallidotomy.

BACKGROUND: There has been a new emphasis on the use of health related quality of life (HRQOL) measures for translating how a patient's response to treatment is experienced by the patient. The purpose of this study was to describe patient reported HRQOL two years after surgery in subjects who underwent posteroventral pallidotomy (PVP) for the treatment of Parkinson's disease (PD) and a subset of these same subjects four years following PVP. METHOD: A consecutive series of 52 subjects who were evaluated previously, prior to and at 4 months following PVP [3], received long term follow-up using mailed questionnaires. Twenty seven subjects (52% of the original sample) provided 2 year follow-up data and 15 of these subjects (29%) provided 4 year follow-up data. Severity of disease and subject reported HRQOL were evaluated. FINDINGS: Immediately following surgery, there was a sharp decrease in all measures of severity of disease. While there were differing patterns of increasing severity of disease among the measures following the immediate postoperative assessment, all of the measures remained better than the pre-surgery values. The data showed a pattern of marked improvement in HRQOL at 4 months following PVP. Over the 2 years following surgery, there was a gradual deterioration toward preoperative levels that nevertheless remained better than preoperative HRQOL. For the group with data at 4 years following surgery, there was no significant further deterioration in HRQOL between 2 and 4 years, with the 4 year data also remaining better than the preoperative HRQOL reports. CONCLUSIONS: In spite of advanced severe PD and advanced age, subjects in this study reported better HRQOL at 2 years following PVP than they reported at entry into the study prior to surgery. Additionally, the 15 patients who were available for follow-up at 4 years also reported better HRQOL than they experienced prior to the surgery.

Adult↗
PubMed2001

Analysis of speech characteristics in children with velocardiofacial syndrome (VCFS) and children with phenotypic overlap without VCFS.

OBJECTIVE: To address two questions of theoretical importance regarding the profile and course of communication impairment associated with velocardiofacial syndrome (VCFS): (1) do speech characteristics of children with VCFS differ from a group of children with some of the phenotypic characteristics of VCFS who do not have the syndrome, and (2) do younger children with VCFS demonstrate speech patterns that differ from older children with VCFS? DESIGN: Prospective, cross-sectional study comparing two groups of children at two age levels. PATIENTS: Thirteen children with VCFS and eight children with some of the phenotypic features of VCFS who did not have the syndrome. Children ranged in age from 3 to 10 years. MAIN OUTCOME MEASURE: (1) Broad phonetic transcription of speech yielding measures of number of consonant types, Percent Consonant Correct, and percentage of glottal stops used; and (2) composite ratings of velopharyngeal function made from perceptual, aerodynamic, and endoscopic evaluations. RESULTS: Younger children with VCFS demonstrated greater speech impairment than older children with VCFS or the children without VCFS, such as smaller consonant inventories, greater number of developmental errors, greater severity of articulation disorder, and higher frequency of glottal stop use. The relationship between ratings of velopharyngeal function and the speech variables analyzed was not straightforward. CONCLUSIONS: Some young children with VCFS demonstrated speech impairment that is qualitatively and quantitatively different from older children with VCFS or children without VCFS. This finding supports the hypothesis that some children with VCFS demonstrate a profile of speech production that is different from normal but also may be specific to the syndrome.

Age Factors↗
PubMed2000

Changes in health related quality of life in patients with Parkinson's disease with and without posteroventral pallidotomy.

Traditional clinical outcome measures for the treatment of Parkinson's disease (PD) have focused on motor function and activities of daily living. However, in the past decade there has been a new emphasis on the use of health related quality of life (HRQOL) measures for translating how a patient's response to treatment is experienced by the patient. The purpose of this study was to describe patient reported HRQOL in subjects who underwent Posteroventral pallidotomy (PVP) for the treatment of PD compared with a similar group of subjects who did not undergo surgery (non-PVP). A consecutive series of patients who underwent PVP (n = 52) was compared prospectively with a similar group of patients, who received adjustments to medications without surgery (n = 45). Severity of disease and self reported HRQOL were evaluated at two time periods. Time 1 data were collected within one week prior to surgery for the PVP group or when subjects received medication adjustments for the non-PVP group. Time 2 data were collected 4 months later. Results showed that the severity of disease improved from Time 1 to Time 2 for both groups. HRQOL improved significantly for the PVP group (p = 0.001) but not for the non-PVP group (p > 0.29). Changes in HRQOL were most strongly related to the improvement in severity of disease in the "off" state. The results of this study suggest that PVP is associated with significant improvements in clinical and patient reported outcomes four months following surgery compared with a similar group of patients who did not undergo surgery. Additionally, the results suggest that the difference in perceived outcome between the groups is due in part to the improvement in the levodopa "off" periods which occurred for the PVP group but not for the non-PVP group.

Adult↗
PubMed2000

Radiographic and aerodynamic measures of velopharyngeal anatomy and function following Furlow Z-plasty.

Recent studies have shown that the Furlow double-opposing Z-plasty has several advantages that make it an attractive procedure for cleft palate repair and treatment of velopharyngeal insufficiency in selected cases. The anatomic changes associated with this procedure have never been documented prospectively. The purpose of this study was to describe radiographic dimensions of the velopharynx and aerodynamic measures of velopharyngeal function in a group of patients before and after Furlow Z-plasty for the treatment of velopharyngeal insufficiency. Twelve consecutive patients with cleft palate and velopharyngeal insufficiency, ranging in age from 3 to 19 years, were selected as candidates for Furlow Z-plasty based on perceptual, endoscopic, and radiographic findings. Eight patients had repaired cleft palate with a residual muscle diastasis and four patients had unrepaired submucous cleft palate. Subjects received aerodynamic and cephalometric assessments before and after Z-plasty. Cephalometric x-rays were measured for velar length, thickness, and pharyngeal depth. Mean nasal airflow during pressure consonants (Vn) was calculated from pressure/flow studies, and patients were categorized as having complete closure (<10 cc/sec Vn) or incomplete closure (>10 cc/ sec Vn). After Z-plasty, there was a significant increase in velar length (p = 0.002) and velar thickness (p = 0.001). After surgery, patients with complete velopharyngeal closure had significantly greater velar length than the incomplete closure group (p = 0.05) with nearly twice the increase in length. Similarly, following surgery, the complete closure group had significantly greater thickness than the incomplete closure group (p = 0.01), with a greater postoperative increase in velar thickness (p = 0.005). Finally, there was a significant negative correlation between percent increase in length and percent increase in thickness for patients in the complete closure group (r = -0.91, p = 0.03). Findings demonstrate that following Furlow Z-plasty, patients with cleft palate and velopharyngeal insufficiency obtained significant increases in velar length and thickness. Greater velar length and greater velar thickness both were associated with complete velopharyngeal closure. Patients in the complete closure group tended to demonstrate large percent gains in either length or thickness or moderate gains in both. Patients in the incomplete closure group tended to demonstrate relatively small percent gains in both dimensions. Results suggest there may be important anatomic features (such as pharyngeal depth/velar length ratio) that can be evaluated before surgery to predict which patients may be most likely to benefit from Furlow Z-plasty as a form of treatment for velopharyngeal insufficiency.

Adolescent↗
PubMed1999

Early speech and language development in children with velocardiofacial syndrome.

Speech-language impairment is one of the most common clinical features in velocardiofacial syndrome (VCFS). This report describes the speech and language development of four children with VCFS studied longitudinally from 6 to 30 months of age and compares their performance with three groups of children: (1) normally developing children, (2) children with cleft lip and palate, and (3) children with isolated cleft palate. The data show that young children with VCFS show a receptive-expressive language impairment from the onset of language. Further, speech and expressive language development were severely delayed beyond a level predicted by their other developmental or receptive language performance. The children with VCFS showed severe limitations in speech sound inventories and early vocabulary development that far exceeded those shown by the children with cleft lip and palate and children with isolated cleft palate. This study indicates that young children with VCFS emerge from a critical speech and language learning period with severe limitations in their communicative abilities. Further studies are required to describe the later course of these early speech and language impairments and to explore the relationship to learning disabilities described for older children with VCFS. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 88:714-723, 1999.

Abnormalities, Multiple↗
PubMed1998

Relationship between quality of life and depression in patients with head and neck cancer.

OBJECTIVE: This study describes the relationship between health-related quality of life (HRQOL) and depression in patients following major surgery for head and neck cancer. DESIGN: Cross-sectional study using medical chart review, patient interview, and test administration. METHOD: Fifty patients were evaluated 6 months to 6 years following surgery using one global HRQOL measure (The Functional Assessment of Cancer Therapy-General [FACT-G]); three disease-specific measures of HRQOL (the HN module of the FACT [FACT-HNS], The University of Washington Quality of Life Scale [UWQOL], and The Performance Status Scale for Head and Neck Cancer); and one measure of depression (The Beck Depression Inventory [BDI]). RESULTS: The study population showed a high occurrence of depressive symptoms (22%). A negative correlation existed between the BDI and HRQOL as measured by the FACT-G (r = -0.49, P < .001) and the UWQOL (r = -0.44, P = .003). When somatic symptoms of depression were removed, the BDI remained correlated with HRQOL and was most highly correlated with the Emotional Well-Being (EWB) subscale of the FACT-G (r = -0.42, P = .003). There was no correlation between clinician judgments of EWB and any patient-rated measures of HRQOL or depression. CONCLUSIONS: Results demonstrate an inverse relationship between patient-reported HRQOL and depression. The lack of correlation between physician and patient ratings of HRQOL and EWB stresses the importance of obtaining patient ratings in addition to traditional clinician ratings when assessing outcomes. Finally, the multidimensional construction of the FACT with its specific subscales may make it a useful clinical tool for assessing patient status and augmenting patient interviews.

Adult↗
PubMed1998

Evaluation of pharyngeal and laryngeal structure and function in patients with oculo-auriculo-vertebral spectrum.

OBJECTIVE: This study described the occurrence and expression of pharyngeal and laryngeal anomalies in a population of patients with oculo-auriculo-vertebral spectrum (OAVS). DESIGN: Cross-sectional study using chart review, physical examination, and endoscopic evaluation of the pharynx and larynx, and perceptual and aerodynamic evaluation of speech for assessment of vocal tract function. SETTING: Academic tertiary referral center. PATIENTS: Chart review of 41 patients with a diagnosis of OAVS and clinical evaluation of 23 of the patients identified in the initial chart review, ranging in age from 9 months to 17 years. MAIN OUTCOME MEASURES: Data from chart review pertaining to airway and speech symptoms. Physical examination and endoscopic studies of pharyngeal and laryngeal structure and function and perceptual and aerodynamic evaluation of speech, resonance, and voice. RESULTS: Chart review showed a high occurrence of indicators of pharyngeal and laryngeal abnormalities such as velopharyngeal inadequacy and airway obstruction. Clinical evaluations documented a variety of abnormalities in pharyngeal and laryngeal structure and function as well as impairment in speech articulation, resonance, and voice. Presence and severity of pharyngeal and laryngeal abnormalities were not correlated with the severity of expression of the spectrum based on mandibular morphology. CONCLUSIONS: Oculo-auriculo-vertebral spectrum appears to be associated with a high occurrence of structural and functional abnormalities of the pharynx and larynx that may contribute to increased risk of airway obstruction, communication impairment, and morbidity.

Adolescent↗
PubMed1997

Secondary cleft deformities.

Cleft palate fistulas are an unfortunate complication that may follow repair of a cleft palate. The presenting symptoms may be variable, and a full evaluation is necessary to identify which symptoms are directly attributable to the fistula. A multidisciplinary approach is recommended when formulating a treatment plan, which takes into consideration symptomatology, speech, growth, dentition, aesthetics, and individual medical and psychosocial needs.

Cleft Palate↗
PubMed1996

The Performance Status Scale for Head and Neck Cancer Patients and the Functional Assessment of Cancer Therapy-Head and Neck Scale. A study of utility and validity.

BACKGROUND: The goal of this investigation was to examine the relationship between, and application of, two disease specific quality of life (QL) measures currently being employed for head and neck cancer patients: the Functional Assessment of Cancer Therapy-Head and Neck Scale (FACT-H&N) and the Performance Status Scale for Head and Neck Cancer Patients (PSS-HN). METHODS: The FACT-H&N and PSS-HN were administered to 151 head and neck cancer patients with a range of disease sites, treatment status (on vs. off treatment), and treatment modalities (surgery, radiation, and chemotherapy). RESULTS: FACT-H&N subscale and total scores and PSS-HN subscale scores proved sensitive to patients groups (showed significant and clinically meaningful differences) on the basis of treatment status (on vs. off treatment) and global performance status (Karnofsky scores). The pattern of correlations between FACT-H&N and PSS-HN subscales supported the scales' construct (convergent vs. divergent) validity. The strongest and most significant associations were observed between PSS-HN Normalcy of Diet and Eating in Public, and the head and neck subscale (HNS) of FACT-H&N, both of which were designed to measure the unique problems of head and neck cancer patients. More modest associations were observed between subscales measuring physical and functional areas of performance, social functioning, and emotional well-being. CONCLUSIONS: The FACT-HNS was found to be reliable and valid when applied to head and neck cancer patients. It clearly adds information to that collected by the parent (core) instrument. The PSS-HN also provides unique information, independent of that provided by the Karnofsky or the FACT-H&N. This study supported the multidimensional nature of QL for head and neck cancer patients, and thus the importance of assessing disease specific concerns in addition to general health status when assessing functional and QL outcome.

Adolescent↗
PubMed1996

Quality of life and functional status measures in patients with head and neck cancer.

OBJECTIVE: To assess the relationship among three validated head and neck-specific measures of functional status and a general measure of quality of life in patients with head and neck cancer. DESIGNS: Cross-sectional study using medical chart review, patient interview, and test administration. SETTING: Academic tertiary referral center. PARTICIPANTS: Fifty adults patients 3 months to 6 years after major surgery for head and neck cancer. MAIN OUTCOME MEASURE: Scores from a general measure of quality of life (the Functional Assessment of Cancer Therapy), a subscale specific to head and neck cancer, the University of Washington Quality of Life Questionnaire, and the Performance Status Scale for Head and Neck Cancer Patients. RESULTS: The disease-specific measures of functional status correlate well with one another. However, there were low correlations between the Functional Assessment of Cancer Therapy and the disease-specific measures, indicating that general and disease-specific instruments contribute unique information about quality of life. CONCLUSION: A general measure of quality of life augments information obtained by disease-specific instruments by interpreting functional status in the broader scope of the patient's life.

Activities of Daily Living↗
PubMed1996

Tonsillectomy in children with or at risk for velopharyngeal insufficiency: effects on speech.

Recent case reports have challenged the notion that tonsillectomy is contraindicated in patients with or at risk for velopharyngeal insufficiency. The purpose of this study was to quantify the effects of tonsillectomy (with or without adenoidectomy) on perceptual speech characteristics, aerodynamic measures, and endoscopic descriptions of velopharyngeal function in a clinical population. Fifteen children 4 to 10 years of age received preoperative and postoperative evaluations. Perceptual speech characteristics improved or remained the same for most variables. There was no statistically significant difference between preoperative and postoperative ratings of hypernasality or frequency and severity of nasal emission. However, ratings of voice quality (pitch and breathiness) were significantly improved after surgery. Aerodynamic measures showed improvement or no change in velopharyngeal function for 12 of 15 children. Endoscopic assessment showed improvement or no change in velopharyngeal closure for 7 of 11 children tested. Cross-method analysis indicated that no single subject showed deterioration in velopharyngeal function in all three measures. The data from this investigation do not support the assumption that tonsillectomy is contraindicated for all children with or at risk for velopharyngeal insufficiency.

Child↗
PubMed1996

Factors related to quality of life and functional status in 50 patients with head and neck cancer.

Quality of life (QOL) and functional status (FS) have become important outcome measures in cancer therapy. Valid and reliable instruments recently have been developed for examining QOL and FS in patients with head and neck (HN) cancer. The present study evaluated the relationships of QOL and FS to physical and psychological variables assumed to affect QOL and FS. Fifty patients were evaluated up to 6 years after HN cancer surgery using one general QOL instrument and three HN-specific instruments. Analysis of variance showed physical variables such as tumor site to be related to HN-specific scores, while psychosocial variables such as marital status were related to general QOL scores (P < or = .05). Several relationships were seen between physical or psychosocial variables and FS or QOL measures; however the relationships were not as strong or direct as expected.

Adult↗
PubMed1995

Quantitative measures of laryngeal function following Teflon injection or thyroplasty type I.

Laryngeal/voice function was evaluated in six patients with unilateral true vocal fold paralysis following treatment with Teflon injection (TEF) compared to six patients treated with thyroplasty type I (THY). Auditory perceptual, aerodynamic, and endoscopic assessments were conducted. Three judges rated nine voice characteristics. Aerodynamic measures included estimated subglottal pressure, airflow, and laryngeal resistance. Two judges rated laryngeal characteristics from flexible fiberoptic assessment. The THY group had significantly better voice quality and better quantitative aerodynamic findings compared to the TEF group. The TEF group also was more likely to have an irregular vocal fold edge, an irregular glottal closure pattern, a higher occurrence of hyperfunction and hypertrophy of the false vocal folds, edema, and erythema of the paralyzed folds. Results suggest that THY was associated with more favorable measures of laryngeal/voice function than TEF. It is likely that the poorer perceptual, aerodynamic, and endoscopic findings associated with TEF injection may be due to violation of the true vocal fold cover, particularly increased true vocal fold mass and stiffness.

Adult↗
PubMed1995

Parent questionnaire for screening early language development in children with cleft palate.

This study investigated the efficacy of a parent questionnaire as a component for screening early language development of children 16 to 30 months of age with cleft lip and palate. Thirty nonsyndromic children with cleft lip and palate and 30 children without clefts received the MacArthur Communicative Development Inventory: Toddler (CDI: Toddler), administered by a pediatrician. In addition, a speech-language screening was performed by a speech-language pathologist. Results of the two assessments indicated that the CDI:Toddler was a valid screener of language development when compared with a comprehensive speech-language screening. Language and speech characteristics of the subject populations are discussed. In particular, differences between the cleft and noncleft groups demonstrated evidence of delays in expressive language development in the children with cleft lip and palate.

Age Factors↗
PubMed1994

Sphincter pharyngoplasty: a preoperative and postoperative analysis of perceptual speech characteristics and endoscopic studies of velopharyngeal function.

Perceptual speech and endoscopic evaluations were videotaped preoperatively and postoperatively for 20 patients who underwent sphincter pharyngoplasty. Randomized videotapes of these evaluations were rated by clinicians experienced in assessment of patients with velopharyngeal dysfunction. Results of perceptual speech ratings showed that nasal resonance following sphincter pharyngoplasty improved in 79 percent of patients (p = 0.006), frequency of nasal emission decreased in 74 percent (p = 0.018), and severity of emission decreased in 79 percent (p = 0.006). Rating of the overall change in speech quality was not statistically greater than chance (p = 0.41). Thirty percent of patients were judged to be hyponasal postoperatively, while none had been preoperatively. Results of endoscopic evaluations showed that 75 percent of patients had a quantitative decrease in orifice size (p = 0.013). Despite improved velopharyngeal function, 65 percent of patients were still considered candidates for additional surgical management postoperatively. While sphincter pharyngoplasty resulted in improved perceptual speech characteristics and velopharyngeal function, only 18 percent of patients showed complete resolution of hypernasality and nasal emission, and only 35 percent demonstrated complete velopharyngeal closure postoperatively.

Adolescent↗
PubMed1993

Successful nasoendoscopic and aerodynamic examinations of children with speech/voice disorders.

An 8-year retrospective analysis of aerodynamic and nasoendoscopic examinations of children with a variety of speech and voice disorders shows that these examinations can be completed with a high rate of success. Moreover, the examinations were achieved with relative ease in children as young as 2 years old. Several clinicians were involved in the examinations, illustrating the viability of the methods. It is suspected that the failures to complete the examinations relate more to the examiners' methods and skills than to the child's tolerance of the instrumentation.

Adolescent↗
PubMed1993

Results of a survey of cleft palate teams concerning the use of nasendoscopy.

A national survey was conducted concerning methods used for the evaluation of velopharyngeal function with emphasis on the role of nasendoscopy. Forty-five percent of questionnaires were returned. Ninety percent of the responding teams indicated that nasendoscopy was available. Sixty-one percent agreed that endoscopy was an important clinical tool and not solely a research tool. The majority (59%) considered 3 to 5 years of age to be the youngest, appropriate age for referral. Ninety percent agreed that nasendoscopy was indicated for difficult diagnostic problems and 41% reported endoscopic studies were appropriate for all patients for whom secondary palatal management is planned. The results of this survey suggest that endoscopic assessment of velopharyngeal function is used routinely as an adjunct to the perceptual evaluation of speech and has become the standard of care among cleft palate teams for difficult diagnostic cases. However, the data also indicate that increased availability does not necessarily assure optimal use.

Attitude of Health Personnel↗