Throat related symptoms and voice: development of an instrument for self assessment of throat-problems

<p>Abstract</p> <p>Background</p> <p>Symptoms from throat (sensation of globus; frequent throat clearing; irritated throat) are common in patients referred to voice clinics and to ENT specialists. The relation to symptoms of voice discomfort is unclear and in some cases patients do not have voice problems at all. Instruments for patients' self-reporting of symptoms, and assessment of handicap, such as the Voice Handicap Index (VHI), are in common use in voice clinics. Symptoms from throat are however only marginally covered. Purpose: To develop and evaluate an instrument that could make the patients' estimation of symptoms from the throat possible. Further to facilitate the consideration of the relation between throat- and voice problems with the Throat subscale together with a Swedish translation of the Voice Handicap Index. Finally to try the VHI with the Throat subscale: the VHI-T, for test-retest reliability and validity.</p> <p>Methods</p> <p>A subscale with 10 throat related items was developed for appliance with the VHI. The VHI was translated to Swedish and retranslated to English. The questionnaire was tried in two phases on a total of 23+144 patients and 12+58 voice healthy controls. The reliability was calculated with Cronbach's alpha, ICC and Pearson's correlation coefficient. The validity was estimated by independent T-test.</p> <p>Results</p> <p>The difference in VHI-T scores between the patients and the voice-healthy controls was significant (<it>p </it>= < 0,01) and there was a good correlation of the test- retest occasions. The reliability testing of the entire questionnaire showed an alpha value of <it>r </it>= 0,90 and that for the Throat subscale separately a value of <it>r </it>= 0,87 which shows a high degree of reliability.</p> <p>Conclusions</p> <p>For the estimation of self-perceived throat and voice problems the scale on throat related problems together with the present Swedish translation of the Voice Handicap Index, (VHI) the VHI-Throat, proves to be a valid and reliable instrument. The throat subscale seems to help revealing a category of symptoms that are common in our patients. These are symptoms that have not earlier been possible to cover with the questionnaires designed for use in the voice clinic.</p

Interstellar Grains -- The 75th Anniversary

The year of 2005 marks the 75th anniversary since Trumpler (1930) provided the first definitive proof of interstellar grains by demonstrating the existence of general absorption and reddening of starlight in the galactic plane. This article reviews our progressive understanding of the nature of interstellar dust.Comment: invited review article for the "Light, Dust and Chemical Evolution" conference (Gerace, Italy, 26--30 September 2004), edited by F. Borghese and R. Saija, 2005, in pres

Pharmacokinetic comparison of two models of endocarditis prophylaxis with amoxycillin

From studies on prophylaxis against experimental streptococcal endocarditis using amoxycillin in a single dose, it has been deduced that serum concentrations above 0.12 mg/l should be maintained for at least 10 h after antibiotic administration. Since concentrations above this level are reported to occur following an oral dose of 3 g of amoxycillin, this doses for prophylaxis has become widely accepted in USA and the UK, and presently also in Sweden. Nevertheless, in individuals who cannot tolerate a high single dose of amoxycillin, there is need for an alternative dosage regimen. In the present study, we have compared the pharmacokinetics in 12 healthy volunteers, of a single dose of 3 g of amoxycillin with those of 1 g as single dose or combined with 1 g of probenecid. The combination resulted in an AUC twice as large as that achieved after 1 g of amoxycillin, and was slightly, but not significantly, larger than that after 3 g. However, amoxycillin concentrations above 0.12 mg/l were sustained for almost 14 h with the combination as compared to 10.4 hours following 3 g of amoxycillin only (p less than 0.001). Thus, the combination should be a convenient alternative in patients unable to tolerate a higher oral dose of amoxycillin, and in situations when an antibacterial effect of longer duration is desired

Isolation and some properties of an IgG Fc-binding protein from group A streptococci type 15

An IgG Fc-binding protein was isolated from alkaline extracts of group A streptococci type 15 by ion-exchange chromatography and immunosorption on an IgG column. Ample use of protease inhibitors was necessary to achieve successful isolation. 600 micrograms protein was obtained from 60 g bacteria (wet weight). The protein appeared homogeneous on agarose gel and sodium dodecyl sulfate polyacrylamide gel electrophoresis and had an apparent molecular weight of 29,500. It contained appreciable amounts of the amino acids glutamic acid, alanine, leucine, aspartic acid and lysine, but little or no tyrosine, phenylalanine, proline, glucosamine or galactosamine. It precipitated human monoclonal IgG of all four sub-classes in agarose gels as well as polyclonal IgG, IgG Fc and normal human serum. It did not precipitate IgG Fab, IgA, IgM, IgD or free kappa or lambda chains

Demonstration of separate receptors for human IgA and IgG in group A streptococci type 4. Separation of the solubilized receptors from group- and type-specific antigens, lipoteichoic acid and peptidoglycan

The alkaline extract of group A streptococci type 4 was separated by electrophoresis and diffused against 27 normal human sera. One of the precipitates appeared with 85% of the sear. Addition of purified IgA myeloma protein or sera containing IgA M-components to the extract changed the electrophoretic mobility of the precipitate anodically. Purified IgG Fc-fragments or sera containing IgG M-component did not affect the mobility of the precipitate. It was concluded that this precipitate contained the streptococcal receptor for human IgA. A non-precipitating IgG Fc-receptor, with agglutinating capacity for cells coated with human IgG1 but not IgG3, was localized by preparative electrophoresis to the same electrophoretic region as the IgA receptor. The mobility of the IgG receptor remained unaltered on addition of IgA myeloma protein permitting a separation of the two receptors by preparative electrophoresis. The receptors were distinct from the group specific carbohydrate, peptidoglycan and lipoteicholic acid. No M antigen or opacity factor were demonstrated in the extract

Bedside Diagnosis of Mitochondrial Dysfunction After Malignant Middle Cerebral Artery Infarction

The study explores whether the cerebral biochemical pattern in patients treated with hemicraniectomy after large middle cerebral artery infarcts reflects ongoing ischemia or non-ischemic mitochondrial dysfunction. The study includes 44 patients treated with decompressive hemicraniectomy (DCH) due to malignant middle cerebral artery infarctions. Chemical variables related to energy metabolism obtained by microdialysis were analyzed in the infarcted tissue and in the contralateral hemisphere from the time of DCH until 96 h after DCH. Reperfusion of the infarcted tissue was documented in a previous report. Cerebral lactate/pyruvate ratio (L/P) and lactate were significantly elevated in the infarcted tissue compared to the non-infarcted hemisphere (p < 0.05). From 12 to 96 h after DCH the pyruvate level was significantly higher in the infarcted tissue than in the non-infarcted hemisphere (p < 0.05). After a prolonged period of ischemia and subsequent reperfusion, cerebral tissue shows signs of protracted mitochondrial dysfunction, characterized by a marked increase in cerebral lactate level with a normal or increased cerebral pyruvate level resulting in an increased LP-ratio. This biochemical pattern contrasts to cerebral ischemia, which is characterized by a marked decrease in cerebral pyruvate. The study supports the hypothesis that it is possible to diagnose cerebral mitochondrial dysfunction and to separate it from cerebral ischemia by microdialysis and bed-side biochemical analysis