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In this study, we compared the orthographic and semantic preferences of healthy adults and age and gender matched adults with aphasia, an acquired language disorder. Previous research in word retrieval and word associations has addressed semantic and phonological connections, but it has not as often included analyses of orthographic skills. We matched (on age and gender) 10 neurotypical adults and 11 older adults with aphasia and administered to both groups a lexical discrimination task requiring them to select, from 18 choices, those words that were most different from three words (daughter, laughter, son). Among the choices were foil words (e.g., daughter), orthographic similarities (laughter) and semantic similarities (son). Results revealed that individuals with aphasia focused on orthographic differences, while healthy adults chose semantic differences. Further studies should further explore this orthographic focus to develop treatment strategies, using behavioral and objective measures, for word-finding deficits in aphasia.

Precise preoperative characterization of urethral stricture is important for surgical planning. A period of urethral rest by a suprapubic cystostomy tube may aid in stricture characterization and affect the surgical approach. In this study fellowship trained reconstructive urologists compared the radiographic characterization of anterior urethral strictures before and after a period of urethral rest. We then determined how this changed the planned operative approach.We queried our prospectively maintained urethroplasty database at our institution for men with an anterior urethral stricture who underwent retrograde urethrogram and voiding cystourethrogram before and after preoperative suprapubic cystostomy tube placement. A total of 29 men were identified for analysis. To minimize responder fatigue 20 pairs of radiographs were selected at random. All images before and after suprapubic tube placement were interpreted in random order by 11 fellowship trained reconstructive urologists. Interpretation included stricture length, diameter, location and surgeon operative plan. Preplacement and post-placement results were compared. Post-placement stricture length was also compared to intraoperative length. ICC was used to evaluate homogeneity among the urologists. Linear regression analysis was performed to determine the association of post-radiographic length after tube placement with intraoperative stricture length.Imaging agreement among interpreting urologists was satisfactory (ICC 0.72). There was no statistically significant difference in stricture length before vs after suprapubic tube placement. Of the images 23% were considered obliterative before tube placement while 58% were obliterative after placement (p = 0.0005). Mean ± SD post-placement radiographic and intraoperative stricture length was 3.0 ± 2.6 and 3.8 ± 3.3 cm, respectively (p0.0001). Deviation between the radiographic and intraoperative lengths increased with stricture length (slope 0.26, p = 0.0023). The surgeon operative plan changed 47% of the time, including to an excision approach in 37% of cases.Despite optimal urethral imaging with a suprapubic tube in men with high grade stricture reconstructive urologists underestimated length by an average of almost 1 cm. This underestimation was less for shorter strictures and it increased with stricture length. In addition, a period of urethral rest resulted in more frequent stricture obliteration, which was associated with a change in the planned operative approach about half of the time. If urologists do not place a suprapubic cystostomy tube prior to urethroplasty for high grade stricture, the operative plan should account for the stricture being tighter than it may appear.

Introduction Penile prosthetic devices are the gold standard treatment of medication-refractory erectile dysfunction. Inflatable penile prosthetic (IPP) devices have been available and used for more than four decades. Oftentimes, medical conditions causing erectile dysfunction also cause penile shortening, causing decreased patient quality of life. Aim To identify and review all available penile lengthening procedures that can be performed at time of IPP insertion. Methods An extensive, systematic literature review was performed using PubMed searching for key terms penile lengthening, inflatable penile prosthesis, penile girth, corporoplasty, glans augmentation, and penile enhancement ; all articles with subjective and/or objective penile length outcomes were reviewed. Main Outcome Measures A review of various techniques for penile length and girth preservation and enhancement during penile prosthesis insertion. Results Several advanced and novel techniques were found for penile length preservation and enhancement at time of IPP insertion, including the sub-coronal IPP insertion technique, and adjuvant maneuvers during insertion, such as the sliding technique, modified sliding technique, multiple slice technique, and circumferential incision and grafting. Other adjuvant techniques that can enhance perception of increased length include ventral phalloplasty, suprapubic lipectomy, and suspensory ligament release. Further enhancement can be obtained using augmentation corporoplasty and glans augmentation with hyaluronic acid and other fillers. The different techniques vary in complexity and could require specialized training and experience. Maximum length gain appears to be limited by the length of the neurovascular bundles. Conclusion Overall, surgical penile lengthening procedures at time of IPP insertion appear safe and effective for treatment of patients with penile shortening and severe erectile dysfunction. These therapies can significantly improve patient self-esteem and quality of life in properly selected patients. Tran H, Goldfarb R, Ackerman A, Valenxuela RJ. Penile Lengthening, Girth and Size Preservation at the Time of Penile Prosthesis Insertion. Sex Med Rev 2017;5:403–412.

We evaluated the short and long-term surgical outcomes of urinary diversion done for urinary adverse events arising from prostate radiation therapy. We hypothesized that patient characteristics are associated with complications after urinary diversion.We performed a retrospective cohort study of 100 men who underwent urinary diversion (urinary conduit or continent catheterizable pouch) due to urinary adverse events after prostate radiotherapy from 2007 to 2016 from 9 academic centers in the United States. Outcome measurements included predictors of short and long-term complications, and readmission after urinary diversion of patients who had prostate cancer treated with radiotherapy. The data were summarized using descriptive statistics and univariate associations with complications were identified with logistic regression controlling for center.Mean patient age was 71 years and median time from radiotherapy to urinary diversion was 8 years. Overall 81 (81%) patients had combined modality therapy (radical prostatectomy plus radiotherapy or various combinations of radiotherapy). Grade 3a or greater Clavien-Dindo complications occurred in 31 (35%) men, including 4 deaths (4.5%). Normal weight men had more short-term complications compared to overweight (OR 4.9, 95% CI 1.3-23.1, p=0.02) and obese men (OR 6.3, 95% CI 1.6-31.1, p=0.009). Hospital readmission within 6 weeks of surgery occurred for 35 (38%) men. Surgery was needed to treat long-term complications after urinary diversion in 19 (22%) patients with a median followup of 16.3 months.Urinary diversion after prostate radiotherapy has a considerable short and long-term surgical complication rate. Urinary diversion most often cannot be avoided in these patients but appreciation of the risks allows for informed shared decision making between surgeons and patients.

Objective To examine population-based practice patterns and outcomes related to urethroplasty for urethral stricture management. Methods We conducted a retrospective study of adult males with urethral stricture disease treated from January 2001 to June 2015 using the Clinformatics Data Mart Database. Treatment was defined as urethral dilation, direct visualized internal urethrotomy, and urethroplasty. We then examined anterior or posterior urethroplasty outcomes defining failure as any subsequent procedure specific to urethral stricture disease occurring >30 days after urethroplasty. We used multivariable and time-to-event analysis to examine factors associated with failure. Results We identified 75,666 patients treated for urethral stricture disease, with 420 and 367 undergoing anterior and posterior urethroplasty, respectively. Urethroplasty utilization doubled from 2005 to 2015. One- and 5-year failure rates for anterior and posterior urethroplasty were 25% and 18%, and 40% and 25%, respectively, with median times to failure of 5.1 and 4.1 months. Failures were salvaged primarily with direct visualized internal urethrotomy, with salvage urethroplasty in 19% and 12% of anterior and posterior repairs, respectively. Conclusion Despite increasing population-based urethroplasty utilization over the past decade in our insured cohort, we found higher rates of salvage treatments than reported by high-volume and expert surgeon reports. Further efforts appear warranted to balance workforce expertise and quality of urethroplasty care to meet increasing urethral stricture population needs.

Prostate cancer is a common cancer in elderly men and in some will prove fatal. Standard treatments for localised disease include surgery ( radical prostatectomy), radiotherapy and active monitoring. New emerging therapies are being evaluated with the aim of reducing the complication rate associated with standard therapies, as well as developing an effective treatment. One such modality is cryotherapy, a procedure that introduces probes directly into the prostate tumour and kills the malignant cells by a freezing process.This review aims to evaluate the relative clinical and economic benefits of cryotherapy compared to standard therapies for the primary treatment of localised prostate cancer.Our search strategy included an electronic search of MEDLINE from 1996 to December 2006, plus EMBASE (Excerpta Medica Database), the Cochrane library, ISI Science Citation Index, Database of Abstracts and Reviews of Effectiveness (DARE), and LILACS to identify all relevant published randomised trials of cryotherapy for localised prostate cancer. Cancerlit and HealthSTAR databases were searched to their final date. Handsearching of relevant journals was undertaken.Only published randomised trials comparing the effectiveness of cryotherapy with radical prostatectomy, radiotherapy or active monitoring for the primary treatment of men with localised prostate cancer were eligible for inclusion in this review.Data were extracted from eligible studies, and included study design, participants, interventions and outcomes. Primary outcome measures were biochemical disease-free survival, disease-free survival and treatment-induced complications. Secondary outcomes included disease-specific survival, overall survival, quality-of-life outcome measures and economic impact measures.There were no randomised trials found comparing cryotherapy with other therapies for the primary treatment of localised prostate cancer. All studies identified were case series. To indicate the level of the available evidence, studies that evaluated cryotherapy as a primary therapy, using transrectal ultrasound guidance and urethral warming in at least 50 patients with localised prostate cancer, and a minimum of one year follow up, were reviewed. Eight case series were identified that complied with these criteria; two were retrospective. The patients recruited (n = 1483) had an age range from 41 to 84 years, stages T1 = 0 to 43%, T2 = 24 to 88%, T3 = 1 to 41%, and T4 = 0 to 14%. The mean preoperative PSA level ranged from 9.7 to 39 ng/mL, with Gleason scores7 and ranging from 6 to 37%. One additional study that compared cryotherapy (total cryotherapy and standard cryotherapy with urethral preservation) with radical prostatectomy was also identified and reviewed. In this study the success rates, defined as a post-treatment PSA of 0.2 ng/mL or less, were reported as 96% for total cryotherapy, 49% for standard cryotherapy and 73% for radical prostatectomy. Four studies did not monitor the temperature of the cyro-procedure and reported 17 to 28% of patients had a positive biopsy following cryotherapy with a mean PSA nadir of 0.55 to 1.75 ng/mL (median 0.4 to 1.85 ng/mL). The other four studies used thermocouples to monitor the temperature of the cryo-procedure and reported progression-free survival rates of 71 to 89% with 1.4 to 13% of patients having a positive biopsy post-cryotherapy. At 5 years, overall survival was reported as 89 to 92% in two studies, and disease-specific survival as 94% in one study. The major complications observed in all studies included impotence (47 to 100%), incontinence (1.3 to 19%), and urethral sloughing (3.9 to 85%), with less common complications of fistula (0 to 2%), bladder-neck obstruction (2 to 55%), stricture (2.2 to 17%) and pain (0.4 to 3.1%). Most patients were sent home the following day (range 1 to 4 days).Cryotherapy offers a potential alternative to standard therapies for the primary treatment of localised prostate cancer. However, the poor quality of the available studies makes it difficult to determine the relative benefits of this modality. Randomised trials are needed to fully evaluate the full potential of cryotherapy in men with this disease. Patients selecting cryotherapy as their therapeutic option should be made fully aware of the reported efficacy, complications and the low-grade evidence from which these data are derived.

I woke up at 6:00 am on Wednesday, June 12, 2013, unable to converge the visual signals from my left and right eyes. This diplopia was accompanied by vertigo, and I listed to the left when attempti...

To determine urodynamic studies (UDS) findings in adult cerebral palsy (CP) patients. CP patients may suffer from voiding dysfunction. UDS in children with CP has consistently shown an upper motor neuron bladder with detrusor-sphincter dyssynergia.We included adult CP patients seen at Gillette Transitional Urology Clinic who underwent UDS for voiding dysfunction between 2011 and 2014. Descriptive statistics were used to characterize findings.There were 49/211 CP patients who underwent UDS. Average age was 30 years; 55% were men. Ninety-eight percent had moderate to severe CP. UDS was initiated for irritative symptoms in 55%, obstructive voiding symptoms in 25%, hydronephrosis in 18%, and other reasons in 2%. Incontinence was reported in 57%. Detrusor-sphincter dyssynergia was seen in 12%, detrusor overactivity in 30%, and detrusor leak point pressure (DLPP)40 cmH2O in 51%. Median compliance was 18 mL/cmH2O (0.78-365). Maximum cystometric capacity (MCC) was 80-1400 mL and was300 mL in 27%. Sixteen percent had an MCC300 mL and a compliance20 mL/cmH2O. Twelve percent had an MCC300 mL and a DLPP40 cmH2O.UDS findings in symptomatic adult CP patients are varied. Fifty-one percent had upper motor neuron bladder findings, similar to that seen in the pediatric literature, but 6% had large flaccid bladders. Half of the patients had concerning findings, such as compliance20 or DLPP40 cmH2O. Our results emphasize the need to thoroughly investigate voiding dysfunction in those with CP. Further characterization of this population is needed to correlate these UDS findings with clinical outcomes.

Hypertrophy occurs in urinary bladder wall smooth muscle (BSM) in men with partial bladder outlet obstruction (PBOO) caused by benign prostatic hyperplasia (BPH) and in animal models of PBOO. Hypertrophied BSM from the rabbit model exhibits down-regulation of caveolin-1, a structural and functional protein of caveolae that function as signaling platforms to mediate interaction between receptor proteins and adaptor and effector molecules to regulate signal generation, amplification, and diversification. Caveolin-1 expression is diminished in PBOO-induced BSM hypertrophy in mice and in men with BPH. The proximal promoter of the human and mouse caveolin-1 (CAV1) gene was characterized, and it was observed that the transcription factor GATA-6 binds this promoter, causing reduced expression of caveolin-1. Furthermore, caveolin-1 expression levels inversely correlate with the abundance of GATA-6 in BSM hypertrophy in mice and human beings. Silencing of GATA6 gene expression up-regulates caveolin-1 expression, whereas overexpression of GATA-6 protein sustains the transcriptional repression of caveolin-1 in bladder smooth muscle cells. Together, these data suggest that GATA-6 acts as a transcriptional repressor of CAV1 gene expression in PBOO-induced BSM hypertrophy in men and mice. GATA-6-induced transcriptional repression represents a new regulatory mechanism of CAV1 gene expression in pathologic BSM, and may serve as a target for new therapy for BPH-induced bladder dysfunction in aging men.

Fibromuscular dysplasia (FMD) is a well-known disease, but its diagnosis can be challenging. Typically, the symptomatic FMD are reported by young and middle aged people with high blood pressure refractory to medical treatment. We present a rare case of a young, healthy, and normotensive patient who presented with pain secondary to renal infarction, without any prior signs or symptoms or history of hypertension. This presentation of FMD has not been previously described. The typical but subtle angiographic findings of the macro-aneurysmal FMD as well as the successful endovascular treatment are discussed herein. The macro-aneurysmal form of FMD should be considered in the differential diagnosis of acute renal infarction in young and middle aged patients even if they do not have a history of hypertension.

Cerebral palsy is characterized by motor impairment following injury to the developing brain. Neurogenic lower urinary tract dysfunction is estimated to affect at least a third of children with cerebral palsy. However there are limited data as patients transition to adulthood. We sought to describe the symptoms, sequelae and management of neurogenic lower urinary tract dysfunction in adults with cerebral palsy.We retrospectively reviewed the charts of adult patients with cerebral palsy between 2011 and 2014. Patients with prior bladder reconstruction or catheterization based bladder drainage were excluded from study. Cerebral palsy severity was determined using GMFCS (Gross Motor Function Classification System). A conservative evaluation and treatment paradigm was used. Noninvasive treatments were encouraged. Specifically clean intermittent catheterization, which is often not feasible, is avoided unless urinary retention, hydronephrosis or refractory lower urinary tract symptoms develop.There were 121 patients included in final analysis. Median age was 25 and 61 patients (50%) had GMFCS level V. Noninvasive management failed in 28 of 121 patients (23%) as defined by hydronephrosis in 9, persistent urinary retention in 10 and refractory lower urinary tract symptoms/incontinence in 9. Urethral clean intermittent catheterization was poorly tolerated. Of all patients 25% showed evidence of urolithiasis during the study period. Surgical intervention was rare and associated with significant morbidity.Adults with cerebral palsy may present with variable signs and symptoms of neurogenic lower urinary tract dysfunction. Conservative treatment was successful in more than 75% of patients. Clean intermittent catheterization was poorly tolerated in patients in whom conservative treatment failed. Surgical intervention was rarely indicated and it should be reserved for select individuals.

The purpose of this study was to assess the diagnostic accuracy of 18F-fluorodeoxyglucose with positron emission tomography and computed tomography (FDG–PET–CT) to predict nodal metastases in patients with bladder cancer (BC) scheduled to undergo radical cystectomy (RC). We retrospectively reviewed records of patients diagnosed with BC and scheduled to undergo RC at our center from January 2011 through February 2015, who also underwent FDG–PET–CT at the time of diagnosis. All patients underwent RC and an extended pelvic lymph node dissection as the reference standard. The primary endpoints were the sensitivity, specificity and overall accuracy of FDG–PET–CT in detecting lymph node metastasis. We also examined its accuracy in identifying distant metastasis. In addition, we conducted a protocol-driven systematic review and meta-analysis of accuracy of FDG–PET–CT for preoperative staging of BC, as compared to CT alone, as reported in individual studies. To assess the methodological quality of eligible studies, we used the QUADAS-2 tool (a revised tool for the Quality Assessment of Diagnostic Accuracy Studies) and pooled diagnostic accuracy measures using Meta-DiSc statistical software. For detecting nodal metastases in 78 patients, the sensitivity of FDG–PET–CT was 0.56 (95 % CI 0.29–0.80) and the specificity, 0.98 (95 % CI 0.91–1.00). Pooled sensitivity and specificity for detecting lymph node metastasis were 0.57 and 0.95, respectively. Positive likelihood ratio was 9.02. All lesions that were suspicious for distant metastasis were found to be positive on biopsy. FDG–PET–CT was more accurate than CT alone in staging BC in patients undergoing surgery. Standardization of FDG–PET–CT protocol and cost-effectiveness analysis are required before widespread implementation of this technology.

INTRODUCTION AND OBJECTIVES: Patients with neurological conditions often suffer from severe debilitating lower urinary and bowel dysfunction in addition to their physical disabilities. However, only the bladder has received the attention of medical providers with neurogenic bowel being poorly understood and characterized. The primary aim in this study was to determine the level of severity and impact on quality of life of bowel dysfunction in a population with neurogenic bladder using validated surveys and to determine those patient variables that correlate with worse bowel symptoms. Our second aim was to determine if the severity of bowel dysfunction correlates with the severity of bladder dysfunction. METHODS: This is a cross-sectional analysis of a prospective institutional Neurogenic Bladder Database from 2010e2013. RESULTS: Among the 175 patients 60.6% had traumatic SCI and 18.3% MS. Fecal Incontinence Severity Index (FISI) scores were a median of 18.0 1.39 (moderate). Neurogenic Bowel Dysfunction (NBD) score, which is specific to patients with neurological disease, were a median of 11.0 0.63 (moderate). NBD Scores were worse in those patients with SCI and myelomeningocele compared to other diseases (P1⁄40.020), in younger patients (p1⁄40.020) and in the SCI group those with higher levels of injury (p1⁄40.0046). Based on the Bristol stool scale 65% of patient had abnormal stool consistency, mostly constipation. None of the FISI, Bristol or NBD scores correlated significantly with SF12 quality of life measures. None of the urodynamic findings correlated with any of the bowel symptom scores. However, both of the bladder symptom scores Michigan Incontinence Symptom Index (MISI)(p1⁄40.05) and the AUA-SI (p1⁄40.03) correlated with FISI severity and the NBD score correlated with the M-ISI (~ n1⁄40.29, p1⁄40.02). Those patients with abnormal stool consistency on the Bristol reported more urgency and stress incontinence on M-ISI. CONCLUSIONS: Bowel dysfunction is very common among patients with neurogenic bladder. Those patients with worse bladder symptoms also suffered from worse bowel dysfunction although the severity of bowel dysfunction did not correlate with overall quality of life or urodynamic measures.

Reports of the MIT protocol developed in the 1970s by the Boston group [2,3] emphasized that it was a language training program that used operant conditioning principles to treat adults with moderate nonfluent (Broca’s-type) aphasia. The authors reported success in increasing the expressive abilities of some individuals with aphasia for whom other clinical approaches had failed. The authors described MIT as a programmed approach with two levels of increasing difficulty, each level consisting of several steps. Short phrases or sentences were imbedded in simple, non-distinct melody patterns.

Why do people diet? The proximate cause of dieting is a desire to lose weight, but, because there are different ways by which a person becomes heavier than he wants to be, the ultimate causes of the choice to diet vary. Using a simple, graphical model grounded in the physiology of weight determination, we explore some theoretical and empirical implications of dieting’s different causes. The model determines desired weight, generates propositions about "optimal overweightedness," and shows how different causes of dieting can be usefully analyzed.

Behavior theory has fallen from favor as a foundation for aphasia rehabilitation. Once a robust basis for experimental and clinical examination of communication disorders in adults, behavior modification has been largely absent in the literature of the past 25 years. This paper advocates a return to the application of a behavioral framework for the treatment of aphasia, with particular attention to the principles of reinforcement, and punishment, including overcorrection. It also advocates a return to such programs of instruction as melodic intonation therapy and to the application of contemporary alternate augmentative communication systems (AAC). The language of sets provides an overall framework for approaching aphasia therapy. Key Words: Programmed instruction, aphasia, rehabilitation, behavioral speech interventions Introduction Behavior theory presents a set of principles by which a person's performance can be observed, analyzed and modified to support the development of socially valued adaptive skills. These principles are rules or laws which describe behavior and its relationship to environmental consequences and motivating stimuli. It is important for speech-language pathologists (SLPs) to understand behavioral principles, because clinical treatment involves the modification of communicative behavior. When clinical treatment is effective, there is behavioral change. Principles of behavior modification have been described as they relate to aphasia rehabilitation (Brookshire, 1969; Goldfarb, 1981; Holland, 1970; Holland & Harris, 1968). These principles refer to a Skinnerian or operant model, not a Pavlovian or reflexive model. Systematic reinforcement of operant behaviors can lead to new responses that expand a person's interactive repertoires communicatively, socially, and verbally. New reflexes cannot be learned, but operant procedures can be used to inhibit or shape infantile oral reflexes, such as suckling and biting, which may be exhibited following brain damage in adults. While there was a flurry of activity in operant-based aphasia research more than 25 years ago (Albert, Sparks, & Helm, 1973; Brookshire, 1968; Goldfarb & Scharf, 1980; Keenan, 1966; Keith & Darley, 1967; Rosenberg & Edwards, 1965; Sarno, Silverman, & Sands, 1970; Tikofsky & Reynolds, 1962; 1963), there has been much less recent interest. One recent non-language study (Goldenberg, Hodges, Hershe, & Jinich, 1980) reported efficacy of operant conditioning in reducing fecal incontinence in 12 patients (ages 12-78 years) with medical and surgical conditions using biofeedback. An auditory language comprehension program for persons with severe aphasia (Bastiaanse, Nijboer, & Taconis, 1993) was applied in a case study involving a participant who learned to discriminate a target word from one, two, and then three distracters. Two other studies used filmed or videotaped programmed instruction to examine reading recognition and comprehension (Di Carlo, 1980) and comprehension of indirect requests such as "can" and "should" (Levey & Goldfarb, 2003) with participants who had aphasia. However, the generalizability of recent studies is limited due to the small number of subjects and low statistical power. Consequences of Ignoring Behavioral Principles SLPs with a limited understanding of applied behavior analysis (ABA) are at risk for attempting to modify maladaptive communicative behavior ineffectively. Consider the following vignette: Several adults with aphasia are seated in a small group during a speech-language therapy session. One of the adult clients points to the door and says, "Go, go." When this request is ignored by the SLP, the client repeats the gesture and the utterance with greater intensity. Without turning to the client, the SLP says, "Just a minute, I'm helping John now." The client then unlocks his wheelchair and rolls back and forth, ramming the chairs of other group members. …

A probe technique requiring convergent and divergent semantic behavior and representing five levels of communicative responsibility served as the research tool. Stimuli were presented to adults identified as having Alzheimer disease or multi-infarct dementia. Within each group differences were observed on the semantic task (convergent and divergent) and on communicative responsibility. Group characteristics are compared with data previously published in 1994 on aphasic and schizophrenic adults responding to the same stimuli.

Speech-language pathologists tend to rely on the noninstrumental swallowing evaluation in making recommendations about a patient’s diet and management plan. The present study was designed to examine the sensitivity and specificity of the accuracy of using the chin-down posture during the clinical/bedside swallowing assessment. In 15 patients with acute stroke and clinically suspected oropharyngeal dysphagia, the correlation between clinical and videofluoroscopic findings was examined. Results identified that there is a difference in outcome prediction using the chin-down posture during the clinical/bedside assessment of swallowing compared to assessment by videofluoroscopy. Results are discussed relative to statistical and clinical perspectives, including site of lesion and factors to be considered in the design of an overall treatment plan for a patient with disordered swallowing.

This study investigated noun-verb retrieval patterns of 30 adults with chronic undifferentiated schizophrenia and 67 typical adults, to determine if schizophrenia affected nouns (associated with temporal lobe function) differently from verbs (associated with frontal lobe function). Stimuli were homophonic homographic homonyms, balanced according to frequency of occurrence, where NV, NV, or N approximately V. Systematicity effects, in which systematic noun and verb meanings are transparently related (e.g., "drain"), and unsystematic noun and verb meanings appear to be unrelated (e.g., "seal"), were also examined. Adults with schizophrenia overselected nouns, in both phrase and sentence tasks. Typical participants strongly preferred verbs in the phrase task, but nouns in the sentence task. Frequency of occurrence yielded statistically significant effects in control, but not in experimental groups. Effects of systematicity were statistically significant in some, but not all tasks and conditions. Age of typical participants was not significant.Readers will be introduced to (a) evidence of noun-verb organization in the brain; (b) evidence of ambiguous noun-verb preference to differentiate the language of schizophrenia from the language of typical adults; and (c) evidence of ambiguous noun-verb preference to differentiate the language of schizophrenia from fluent aphasia.

Semantic judgment tasks, based on antecedent pronouns and on word order, were presented to 16 aphasic adult subjects. Responses on the elicited imitation task were better than on comprehension tasks, a finding which parallels the language-acquisition behavior of children. Addition of features to a basic judgment of animate vs inanimate did not affect subjects' performance.

As the population of older adults increases, there is a corresponding increase in the number of individuals with communication disorders resulting from brain damage. The purpose of this article was to describe the effects of aphasia and dementia on language and communication, and to suggest support systems for improving communication and maximizing residual language abilities. For both these disorders, we address the psychosocial environment, the roles of professionals and caregivers, individual versus group therapy, and support groups. Finally, we report on 2 specific support groups, one for aphasia and one for Alzheimer's dementia, with which the authors have been involved for many years.

This study asked whether aphasic adults show different noun/verb retrieval patterns based upon their clinical categorization as fluent or nonfluent. Participants selected either the noun or the verb meaning of target words, as presented in three contexts. The framework was that nouns (associated with temporal lobe function) are processed, stored, and retrieved separately from verbs (associated with frontal lobe function), implying separate status in the mental lexicon. Stimuli were homophonic homographs, words that are spelled and pronounced the same but which have different meanings (in this case, noun and verb meanings). Another contrast was the putative difference between systematic pairs (e.g., "kiss" and "farm"), in which noun and verb meanings are transparently related, and may be stored as a unit, and unsystematic pairs (e.g., "squash" and "sink"), in which noun and verb meanings are apparently unrelated, implying discrete storage. Results demonstrated significant interactions between fluent and nonfluent participants, suggesting that, as expected, fluent aphasic adults have more difficulty with nouns, nonfluent aphasic adults have more difficulty with verbs. There was no effect of systematicity. Contrary to expectations, verbs proved less vulnerable, rather than more vulnerable, to aphasic impairment.

Summary.-This study examined the judgments and response latencies of 10 parcicipants with aphasia and 10 participants without aphasia for responses to indirect requests. Modals such as colt and should were drawn from 5 indirect request categories. There was a signiEicant diHerence in judgment errors and response latency between participants with and without aphasia. There were no significant merences between aphasic participants' judgments for literal versus nonliteral contrasts. There was a significant effect among the modals and among the categories of indirect requests. Response latency reflected aphasic participants' understanding of these indirect requests. Indirect requests represent sentences that do not &redy convey a speaker's meaning or intent. In contrast to a direct request for action, e.g., "Pass the bread," indirect requests convey a request for action while tahg the form of a question, e.g., "Can you pass the bread?" or a statement, "That cookie sure looks good." Consequently, a listener must evaluate what is said versus what is being conveyed or meant by a speaker (Grice, 1975). Searle (1975) posited that an indirect request requires at least five steps to understand that (a) a question has been asked regarding the listener's ability to perform a requested action, (b) a speaker has a particular goal in mind, (c) a speaker knows that the listener can and wd perform the action, (d) a speaker is not producing a question, and (e) a speaker is requesting that an action be performed. These steps may add to the processing time required to understand a speaker's utterance, in contrast to the time required to process a direct request. Pragmatics refers to the system that combines che form of language (phonology, morphology, and syntax) and the content of language (semantics) into functional and socially appropriate comprehension. It involves eye contact with the listener, topic maintenance, turn-taking, modulation of loudness, proper decorum in the communicativesetting, facial and bodily gestures that reflect the mood, proper use of register, and the provision of information to the listener (Prutting & Kirchner, 1987). Aphasic adults with left brain damage tend to have verbal pragmatic deficits (such as problems

A probe technique requiring convergent and divergent semantic behavior and representing five levels of communicative responsibility served as the research tool. Stimuli were presented to 29 aphasic adults (13 Broca's, 7 Wernicke's, and 9 anomic), 26 adults with chronic undifferentiated schizophrenia, and 32 normal elderly control subjects. Within each group significant differences were observed on the semantic task (convergent and divergent) and on level of communicative responsibility. Among subjects with aphasia, differences appeared to relate more to severity than type. Differences between unclassified aphasic and “schizophasic” groups occurred only when multiword responses were required. We conclude that continued use of the term “schizophasia” may be unwarranted and that the linguistic behaviors we observed in aphasia and the language of schizophrenia may contribute to differential diagnosis.

Caveolin-1 is a structural and functional protein of caveolae that function as signaling platforms to mediate interaction between receptor proteins and adaptor and effector molecules to regulate signal generation, amplification, and diversification. Hypertrophied bladder smooth muscle (BSM) from the rabbit model of partial bladder outlet obstruction (PBOO) and men with benign prostatic hyperplasia (BPH)-induced PBOO shows a downregulation of Caveolin-1 and caveolar structural alteration. Here we report that caveolin-1 expression is diminished in PBOO-induced BSM hypertrophy in mice and in men with BPH. We characterized the proximal promoterof the human and mouse caveolin-1 gene and found that the transcriptionfactor GATA-6 binds this promoter, causing reduced expression of caveolin-1. Furthermore, we demonstrate that caveolin-1 expression levels inversely correlate with the abundance of GATA-6 in BSM hypertrophy in mice and humans. Importantly, silencing of GATA-6 gene expression up-regulates caveolin-1 expression, whereas overexpression of GATA-6 protein sustains the transcriptional repression of caveolin-1 in BSM cells. Together, our data suggest that GATA-6 acts as a transcriptional repressor of caveolin-1 gene expression in PBOO-induced BSM hypertrophy in men and mice. The GATA-6-induced transcriptional repression represents a new regulatory mechanism for caveolin-1 gene expression in pathologic BSM. Regulating the GATA-6 transcriptional regulation may serve as a target for new therapy for BPH-induced bladder dysfunction in aging men. Supported by O’Brien Urology Center Grant P50 DK052620

A word association test was administered to a group of 32 aphasic adults and to a control group of 32 normal adults similar in age, sex, and education. Word stimuli were balanced according to frequency of occurrence in written English language usage (frequent, infrequent), word length (short, long), abstraction level (low, medium, high), and grammatical class (noun, verb, adjective). Stimuli were presented auditorily at normal speed (equivalent to 10 phonemes per sec) and at half speed (equivalent to 5 phonemes per sec) speech. When word stimuli were presented at half speed (slower), the aphasic adults but not the controls produced significantly more paradigmatic (same grammatical class) responses. Twenty aphasic subjects and twenty controls supplied association responses to words presented tachistoscopically at fixation speed (equivalent to 250 msec) and at sweep speed (equivalent to 10 msec). When word stimuli were shown for a longer time, the aphasic adults but not the controls produced significantly more paradigmatic responses. Also analyzed were paradigmatic responses to the word association test produced in relation to frequency of occurrence, word length, levels of word abstraction, and grammatical class.

A program of Melodic Intonation Therapy (MIT) was adapted as a home training procedure to enable a severely affected aphasic adult to respond to 52 simple questions bearing relevance to his daily life. MIT involves embedding short phrases or sentences in a simple, non-distinct melody pattern. As the patient progresses through the program, the melodic aspect is faded and the program eventually leads to production of the target phrase or sentence in normal speech prosody. The present procedure consisted of three levels of training designed to advance the subject from an initial level of intoning responses in a simple melody to producing the responses in normal speech prosody. The subject's wife was trained to administer MIT both in the clinical and home settings. Considerable improvement was obtained in imitation and in context related responses to questions. These findings lend support to the proposal that the music dominance to the right hemisphere assists, and perhaps diminishes the language dominance of, the damaged left hemisphere. The limitations of use of Melodic Intonation Therapy were discussed.

A word association test was administered to a group of 316 undergraduate students. Word stimuli were balanced according to frequency of occurrence in written English language usage (frequent, infrequent), word length (short, long), abstraction level (low, medium, high), and grammatical class (noun, verb, adjective). Responses were analyzed according to a syntactic classification system. The factorial nature of the word list used enhances its value as a research tool.