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PubMed2006

[Varicella-zoster virus symptoms and polyneuropathy in a patient with human immunodeficiency virus infection not improved until highly active anti-retroviral therapy added to acyclovir therapy].

In March 2003, a 34-year-old man with left facial palsy, dysphagia, and hoarseness treated with acyclovir suffered worsened dermatological and neurological problems. A routine blood test in early April showed the patient to be HIV-antibody positive, so he was transferred to our hospital. Blood analysis showed serum HIV-RNA at 96,000 copies/mL and a CD 4 count of 170/microL. Brain MRI taken on admission showed a T 2 high lesion in their left medulla. Acyclovir was thought to be ineffective due to reduced cell-mediated immunity because of the HIV infection, and HAART therapy was begun. After two months of HAART, skin lesions and the T 2 high lesion in left medulla improred. HIV-RNA became undetectable and the CD 4 count exceeded 500/microL. Intracellular cytokine analysis by flow cytometry showed a shift from Th 2 to Th 1 dominance. The elimination of VZV may thus have been promoted by the combination of acyclovir and HAART.

Acyclovir↗
PubMed2005

Estimation of vocal dysperiodicities in disordered connected speech by means of distant-sample bidirectional linear predictive analysis.

The article presents an analysis of vocal dysperiodicities in connected speech produced by dysphonic speakers. The processing is based on a comparison of the present speech fragment with future and past fragments. The size of the dysperiodicity estimate is zero for periodic speech signals. A feeble increase of the vocal dysperiodicity is guaranteed to produce a feeble increase of the estimate. No spurious noise boosting occurs owing to cycle insertion and omission errors, or phonetic segment boundary artifacts. Additional objectives of the study have been investigating whether deviations from periodicity are larger or more commonplace in connected speech than in sustained vowels, and whether sentences that comprise frequent voice onsets and offsets are noisier than sentences that comprise few. The corpora contain sustained vowels as well as grammatically- and phonetically matched sentences. An acoustic marker that correlates with the perceived degree of hoarseness summarizes the size of the dysperiodicities. The marker values for sustained vowels have been highly correlated with those for connected speech, and the marker values for sentences that comprise few voiced/unvoiced transients have been highly correlated with the marker values for sentences that comprise many.

Adult↗
PubMed1980

Multidimensional analysis of male and female voices.

This paper is a sequel to a study which showed that the dominant dimension for perceptual discrimination among normal voices was the male-female categorization and which also suggested that discrimination within the male-female categories utilized distinct dimenisons. The present study eliminates the male-female axis by treating the gender groups separately and making the within-category dimensions available for more sensitive analysis. The purpose was to determine the number and nature of perceptual parameters needed to explain judgments of voice similarity depending on talker sex and whether the stimulus sample was a sustained vowel or a short phrase. The similarity judgments were submitted to multidimensional analysis via INDSCAL and the resulting dimenisons were interpreted in terms of available acoustic measures and unidimensional voice-quality ratings of pitch, breathiness, hoarseness, nasality, and effort. The decisions of the listerners appeared to be influenced by both the sex of the speaker and the stimulus sample, although fundamental frequency (fo), was important for all judgments. Aside from the fo dimensions, judgments concerning male voices were related to vocal tract parameters, while similarity judgments of female voices were related to perceived glottal/vocal tranct differences. Formant structure was apparently important in judging the similarity of vowels for both sexes while perceptual glottal/temporal attributes may have been used as cues in the judgments of phrases.

Female↗
PubMed1997

Fundamental frequency of phonation and perceived emotional stress.

Nonlinguistic information about the speaker's emotional state is conveyed in spoken utterances by means of several acoustic characteristics and listeners can often reliably identify such information. In this study we investigated the effect of short- and long-term F0 measures on perceived emotional stress using stimuli synthesized with the LPC coefficients of a steady vowel and varying F0 tracks. The original F0 tracks were taken from naturally occurring speech in highly stressful (contingent on terror) and nonstressful conditions. Stimuli with more jitter were rated as sounding more hoarse but not more stressed, i.e., a demonstrably perceptible amount of jitter did not seem to play a role in perceived emotional stress. Reversing the temporal pattern of F0 did not affect the stress ratings, suggesting that the directionality of variations in F0 does not convey emotional stress information. Mean and maximum F0 within an utterance correlated highly with stress ratings, but the range of F0 did not correlate significantly with the stress ratings, especially after the effect of maximum F0 was removed in stepwise regression. It is concluded that the range of F0 per se does not contribute to the perception of emotional stress, whereas maximum F0 constitutes the primary indicator. The observed effects held across several voices that were found to sound natural (three male voices and one of two female ones). An effect of the formant frequencies was also observed in the stimuli with the lowest F0; it is hypothesized that formant frequency structure dominated the F0 effect in the one voice that gave discrepant results.

Affect↗
PubMed1998

Selection and combination of acoustic features for the description of pathologic voices.

The glottal to noise excitation ratio (GNE) is an acoustic measure designed to assess the amount of noise in a pulse train generated by the oscillation of the vocal folds. So far its properties have only been studied for synthesized signals, where it was found to be independent of variations of fundamental frequency (jitter) and amplitude (shimmer). On the other hand, other features designed for the same purpose like NNE (normalized noise energy) or CHNR (cepstrum based harmonics-to-noise ratio) did not show this independence. This advantage of the GNE over NNE and CHNR, as well as its general applicability in voice quality assessment, is now tested for real speech using a large group of pathologic voices (n = 447). A set of four acoustic features is extracted from a total of 22 mostly well-known acoustic voice quality measures by correlation analysis, mutual information analysis, and principal components analysis. Three of these measures are chosen to assess primarily different aspects of signal aperiodicity, while the fourth one indicates the noise content of the signal. All analysis methods lead to the same feature set that consists of a measure of period correlation, jitter, shimmer, and GNE. The two-dimensional projection of this set named "hoarseness diagram" allows a graphical illustration of voice quality that can be easily interpreted.

Adolescent↗
PubMed1986

Inhaled beclomethasone and oral candidiasis.

Two hundred and twenty nine children aged 6 to 15 years attending the asthma clinic at the Royal Hospital for Sick Children, Edinburgh, had throat swabs taken to determine the incidence of candida colonisation of the oropharynx. One hundred children (group A), who were not receiving steroids, were compared with 91 children (group B) receiving less than 500 micrograms of inhaled beclomethasone a day and 38 children (group C) receiving 500 micrograms or more of inhaled beclomethasone a day. Sore throat and hoarse voice were not related to the presence of candida or to treatment with inhaled steroids. The incidence of candida was greater in the groups given treatment with steroids but did not increase at a higher dosage, nor was it related to the type of inhaler used. There was only one case of clinical thrush in all the children studied.

Adolescent↗
PubMed1987

A controlled trial of nandrolone decanoate in the treatment of rheumatoid arthritis in postmenopausal women.

To determine whether an anabolic steroid had any benefit in the treatment of rheumatoid arthritis 47 patients entered a parallel group study. Twenty four received nandrolone decanoate 50 mg intramuscularly every third week for two years and 23 patients received no anabolic steroids. Other therapy was unaltered. Patients attended for clinical and biochemical assessments as well as the objective assessments of elementary body composition by in vivo neutron activation analysis and measurement of the mineral content of the distal femur by single photon absorptiometry on five occasions. A modest clinical deterioration (except for grip strength) was seen in both groups. No significant changes in calcium or alkaline phosphatase were seen. There was no significant change in total body calcium, total body phosphorus, body weight, or bone index/bone width measurements in either group. Significant increases occurred in total body nitrogen, total body potassium, haemoglobin, and packed cell volume (by six months) in the group treated with nandrolone decanoate. Comparison of 10 patients in the group treated with nandrolone decanoate also receiving oral steroid therapy with 14 patients in this group not receiving oral steroid therapy showed no significant differences. The main side effect of nandrolone decanoate was hoarseness. No radiological changes were seen. Nandrolone decanoate, in a dose that produces a significant anabolic effect, has no demonstrable action on bone metabolism in rheumatoid arthritis but may improve the chronic anaemia by six months.

Anabolic Agents↗
PubMed1987

Farber's disease (lysosomal acid ceramidase deficiency).

The patient presented with progressive joint deformity, a hoarse voice, subsequent cachexia, and myoclonic seizures. She was first seen aged 22 months and died aged 6 years. A diagnosis of Farber's disease was made by demonstrating a deficiency of acid ceramidase both in leucocytes and fibroblasts.

Acid Ceramidase↗
PubMed1988

Rational decisions in managing sore throat: evaluation of a rapid test.

Sixty nine general practitioners recorded what they had prescribed for a total of 1189 episodes of sore throat. Antibiotics were prescribed in 763 (64%) episodes and broad spectrum antibiotics in 161 (21%) of these. If there was dysphagia, hoarseness, cervical adenopathy, and inflamed or purulent tonsils a prescription was more likely to be written. An enzyme immunoassay rapid test was evaluated as a means of rationalizing prescribing. Among 23 general practitioners and 250 patients the sensitivity of the test was 63% and the specificity 91.7% compared with 74% and 58% for clinical assessment alone. Test results rarely caused previous prescribing decisions (34 [corrected] (13%) episodes) to be altered. We suggest that the time is not ripe for the use of the enzyme immunoassay rapid test on a wide scale in the routine assessment of sore throats.

Anti-Bacterial Agents↗
PubMed2001

Is voice therapy an effective treatment for dysphonia? A randomised controlled trial.

OBJECTIVES: To assess the overall efficacy of voice therapy for dysphonia. DESIGN: Single blind randomised controlled trial. SETTING: Outpatient clinic in a teaching hospital. PARTICIPANTS: 204 outpatients aged 17-87 with a primary symptom of persistent hoarseness for at least two months. INTERVENTIONS: After baseline assessments, patients were randomised to six weeks of either voice therapy or no treatment. Assessments were repeated at six weeks on the 145 (71%) patients who continued to this stage and at 12-14 weeks on the 133 (65%) patients who completed the study. The assessments at the three time points for the 70 patients who completed treatment and the 63 patients in the group given no treatment were compared. MAIN OUTCOME MEASURES: Ratings of laryngeal features, Buffalo voice profile, amplitude and pitch perturbation, voice profile questionnaire, hospital anxiety and depression scale, clinical interview schedule, SF-36. RESULTS: Voice therapy improved voice quality as assessed by rating by patients (P=0.001) and rating by observer (P<0.001). The treatment effects for these two outcomes were 4.1 (95% confidence interval 1.7 to 6.6) points and 0.82 (0.50 to 1.13) points. Amplitude perturbation showed improvement at six weeks (P=0.005) but not on completion of the study. Patients with dysphonia had appreciable psychological distress and lower quality of life than controls, but voice therapy had no significant impact on either of these variables. CONCLUSION: Voice therapy is effective in improving voice quality as assessed by self rated and observer rated methods.

Adolescent↗
PubMed2000

Corticosteroids for croup.

Croup (laryngotracheobronchitis) is a common childhood respiratory condition, characterised by a harsh, barking cough, a hoarse voice, stridor and variable respiratory distress. Corticosteroids are often used to treat the condition. Four years ago, we concluded that nebulised budesonide improved croup symptoms of stridor and cough (but not necessarily dyspnoea) but that more trials were needed to clarify its role. In this article, we reconsider the place of corticosteroids in croup and assess whether different products offer particular advantages.

Croup↗
PubMed2003

Low pressure giant pulmonary artery aneurysms in the adult: natural history and management strategies.

OBJECTIVE: To describe aspects of the natural history and pathophysiology of giant low pressure pulmonary artery aneurysms and to propose potential surgical strategies. DESIGN: Cross sectional retrospective review. SETTING: Supraregional tertiary referral centre. PATIENTS: All adult patients referred for assessment of giant pulmonary artery aneurysm retrospectively identified from the Mayo Adult Congenital Heart Disease Clinic database. METHODS: Patient data were reviewed from hospital records, including echocardiograms, magnetic resonance images, radiographs, and histology slides. RESULTS: Four patients were identified with a median age of 52 years (range 37-64 years). Presenting symptoms were effort related dyspnoea, chest discomfort, and hoarseness in one patient. All patients had pulmonary regurgitation and clinical evidence of right ventricular enlargement in association with a pulsatile mass at the upper left sternal edge. Transthoracic echocardiography showed the giant pulmonary artery aneurysm involving the main pulmonary artery and proximal branches, and confirmed severe pulmonary regurgitation in all patients. None of the patients had intimal tearing, medial dissection, or pulmonary arterial rupture. The pulmonary valve was replaced to relieve symptoms and preserve right ventricular function. Pulmonary arterial histology showed medial degeneration of elastic fibres with accumulation of basophilic ground substance. CONCLUSIONS: Rupture or dissection of these low pressure aneurysms is rare. The timing of surgical intervention should be determined by changes in right ventricular size and function resulting from pulmonary regurgitation or pulmonary stenosis, and not the size of the aneurysm.

Adult↗
PubMed1981

Fistulous aneurysm of ductus arteriosus.

We present clinical, haemodynamic, and angiographic data on a 48-year-old woman with a fistulous aneurysm of the ductus arteriosus. This is the first reported case of a spontaneous fistulous aneurysm of the ductus arteriosus in an adult in which an antemortem diagnosis was made. This lesion typically presents with shortness of breath, hoarseness caused by recurrent laryngeal nerve paralysis, and chest pain, and poses a critical threat to life because of progressive compression, erosion, and haemorrhage into the oesophagus or tracheobronchial tree. Fistulous aneurysm of the ductus arteriosus should be considered in the differential diagnosis of an enlarging mediastinal mass, especially when a continuous heart murmur is noted. Early definitive diagnosis and surgical repair in adults are essential for survival.

Aortic Dissection↗
PubMed1987

A ruptured large aneurysm of the ductus arteriosus.

A 60 year old man was admitted with acute back pain followed by hoarseness. An aneurysm of the ductus arteriosus Botalli was diagnosed and an operation was recommended because of the high risk of complications such as rupture, embolism, or infection. The patient and his family refused surgery, however. The patient died suddenly of a rupture of the aneurysm a year later; necropsy confirmed the diagnosis. Several diagnostic methods were used and enhanced computed tomography gave the best representation of the aneurysm as it was seen at necropsy. This case indicates that enhanced computed tomography is probably the most useful investigation in patients with this type of aneurysm and it confirms the importance of an aneurysmectomy.

Coronary Aneurysm↗
PubMed1998

A renin secreting ovarian steroid cell tumour associated with secondary polycythaemia.

A 67-year-old woman presented with dry skin, facial hair, hoarse voice, and weight gain. She was hypertensive (168/ 96 mm Hg), her haemoglobin concentration was 19 g/l, and haematocrit was 55.7%. The diagnosis of probable secondary polycythaemia was made. Blood testosterone concentration was 44 nmol/l (normal < 5) and was not suppressed by dexamethasone, suggesting a neoplastic source rather than a pituitary abnormality. Transvaginal ultrasound revealed a hypoechoic solid mass in the left ovary suggestive of a solid ovarian tumour. Hysterectomy and bilateral salpingo-oophorectomy were performed following which testosterone concentration returned to normal. Immunocytochemistry provided evidence of renin synthesis. This is a case of an unusual steroid cell tumour that caused virilisation accompanied by symptoms of secondary polycythaemia presumably as a result of erythropoietin production. This is the second case of a steroid cell tumour with an erythropoietic effect and the first that shows evidence of renin synthesis.

Aged↗
PubMed1987

A girl with the Weaver syndrome.

A female with the Weaver syndrome is reported. In addition to the characteristic manifestations of overgrowth and advanced bone age, the facies were typical, with a broad forehead, hypertelorism, a long philtrum, micrognathia, and large ears. Like most other patients with Weaver syndrome, she was developmentally delayed, hypertonic, and had a hoarse voice. Other clinical features included prominent finger pads, narrow hyperconvex nails, small and narrow chest, unilateral dislocated distal ulna, and abnormal thoracic vertebrae.

Abnormalities, Multiple↗
PubMed2001

Acromicric dysplasia: long term outcome and evidence of autosomal dominant inheritance.

Acromicric dysplasia is a rare bone dysplasia characterised by short stature, short hands and feet, normal intelligence, mild facial dysmorphism, and characteristic x ray abnormalities of the hands. Only a very small number of children with this condition have been reported so far. Here we report on a series of 22 patients including 10 boys and 12 girls with acromicric dysplasia. Length was normal at birth and height fell progressively off the centiles postnatally. The mean adult height was 130 cm (133 cm in males, 129 cm in females). The hands, feet, and limbs were short and OFC was normal. Intelligence was normal and mild dysmorphic features were noted. Other occasional features included well developed muscles, a hoarse voice, generalised joint limitation in some patients, frequent ear, tracheal, and respiratory complication, and spine abnormalities. Long term follow up showed that facial dysmorphism was less obvious in adults and that carpal tunnel syndrome was frequent in older patients. Apart from short metacarpals and phalanges, internal notch of the second metacarpal, external notch of the fifth metacarpal, and internal notch of the femoral heads, there were no major x ray abnormalities. No major complications, such as cardiac disease or major orthopaedic problems, occurred in the course of the disease. The condition appeared to be sporadic in 16 cases but the observation of vertical transmission in three families was consistent with an autosomal dominant mode of inheritance.

Abnormalities, Multiple↗