Measurement of hearing aid outcome in the elderly: Comparison between young and old elderly

OBJECTIVE: To evaluate speech performance and subjective outcomes for older individuals who have hearing impairment and use digital hearing aids. The outcomes between young and old elderly users were compared. STUDY DESIGN: Prospective. SUBJECTS AND METHODS: Fifty-nine patients with hearing loss fitted with digital hearing aids were included. They were divided into two groups. Group A consisted of 32 subjects aged 65 to 80 years, whereas group B had 27 subjects older than 80 years. Speech performance and subjective outcomes were measured 4 months after fitting of hearing aids. Hearing Handicap Inventory for the Elderly-Screening Version (HHIE-S), Client Oriented Scale of Improvement (COSI), satisfaction, and usage questionnaires were used as subjective assessments. RESULTS: Improvements in speech performance were not significantly different between these two groups. There were no statistical differences in terms of HHIE-S score reduction, satisfaction rate, daily usage time, and COSI scores between both groups. CONCLUSION: Age by itself is not a limiting factor for older patients with hearing impairment to benefit from digital hearing aids.     

Nephrogenic adenoma associated with cytomegalovirus infection of the ureter in a renal transplant patient: presentation as ureteral obstruction

Nephrogenic adenoma (NA), a rare benign lesion of the urinary tract, is widely accepted to be a metaplastic reaction due to urothelial injury. It mainly occurs in the urinary bladder and rarely in the ureter. Renal transplant recipients are prone to the development of NA. However in those patients, NA was diagnosed exclusively in the bladder. Herein, we present the – to our knowledge – first case of NA involving a transplanted ureter. A 42-year-old female kidney transplant recipient suffered hematuria, oliguria, and acute renal failure and presented with ureteral obstruction and hydronephrosis of the renal transplant. To our surprise, evidence of cytomegalovirus (CMV) infection of the NA was demonstrated using special immunohistochemical staining. The findings in this case raise the possibility that CMV infection, as an irritant of the ureteral epithelium, may be an etiological factor of NA. Received: 5 November 1999 Revised: 7 August 2000 Accepted: 20 November 2000     

Single-centre results of treatment of retroperitoneal and mesenteric cystic lymphangiomas

BACKGROUND: Intra-abdominal cystic lymphangiomas are rare and usually present as benign large cystic masses. The treatment of choice of mesenteric and retroperitoneal cystic lymphangiomas is surgical resection. METHODS: Seventeen adults, 11 male and 6 female, with a median age of 39 years were investigated. Presentation, treatment, and outcomes of the mesenteric and retroperitoneal cystic lymphangiomas were analyzed. RESULTS: The most common symptom was abdominal pain. The median tumour size was 12.0 cm in diameter. Patients with retroperitoneal lymphangiomas were younger (p=0.043). However, 4 out of 8 patients with the mesenteric type required bowel resection (p=0.064). Magnetic resonance imaging allowed a good differentiation of cystic and septal structures. No postoperative complications occurred, but patients with mesenteric types had longer postoperative stays (7.0 vs. 13.5 days; p<0.001). The long-term outcome of both groups was satisfactory. CONCLUSIONS: The surgical results were good with symptom relief. Bowel resection was common in mesenteric cystic lymphangiomas. Because of its higher resolution, magnetic resonance imaging is suggested.     

Skeletal changes after modified intraoral vertical ramus osteotomy for correction of mandibular prognathism.

BACKGROUND: Orthognathic surgery is widely used to correct congenital and acquired dentofacial discrepancies. Various surgical procedures have been advocated for correction of mandibular prognathism. In this study, a modified intraoral vertical ramus osteotomy has been developed for surgical correction of mandibular prognathism. The aim of this study is to identify contributing factors to skeletal change by analysing cephalometric changes after modified intraoral vertical ramus osteotomy. METHODS: Forty-one patients, treated for absolute mandibular prognathism by bilateral modified intraoral vertical ramus osteotomy, were evaluated cephalometrically with reference to the menton point. A set of four standardised lateral cephalograms were obtained from each subject preoperatively (T1) and immediately postoperatively (T2), prior to removal of maxillomandibular fixation (T3), and at 1-year postoperatively (T4). The mean setback of the menton was 12.4 mm in the horizontal direction. Relapse was defined as forward movement of the menton during the 1-year follow-up. RESULTS: The highly significant backward movements in a horizontal direction were observed during the maxillomandibular fixation period (T3-T2). Moreover, highly significant forward movement was observed following the maxillomandibular fixation period (T4-T3). After 1-year follow-up (T4-T2), the mean changes of the menton were 0.1 mm backward in the horizontal direction. CONCLUSIONS: In this series, the mean skeletal change compared with the amount of setback was less than 1% (0.1/12.4 mm) in backward movement. The results suggest that the modified intraoral vertical ramus osteotomy technique is useful and the more stable approach for correction of severe mandibular prognathism.     

Is the corrected-creatinine model for end-stage liver disease a feasible strategy to adjust gender difference in organ allocation for liver transplantation?

BACKGROUND: The Model for End-stage Liver Disease (MELD) scoring system is used for organ allocation in liver transplantation. Female cirrhotic patients have lower glomerular filtration rates (GFR) than males for the same creatinine (Cr) level. Correcting the Cr in females for the same GFR as in males shows that females have lower MELD scores and therefore a lower priority for liver transplantation; however, there has been no outcome data that justifies this modification. METHODS: We investigated 472 cirrhotic patients, comparing the mortality rate between males and females in relation to MELD and corrected-Cr MELD. RESULTS: Compared to females, male patients had a higher MELD (14.5+/-5.5 vs. 13.8+/-5.7) and significantly higher GFR (61.7+/-21.4 vs. 54.7+/-25.6 mlLmin/1.73 m, P=0.0002) because their Cr value was higher (1.4+/-0.4 vs. 1.3+/-0.5 mg/dL, P=0.0002). The corrected-Cr MELD score in females was higher (15.7+/-6.3) compared to the MELD in their original counterpart (P<0.0001) and the males (P=0.060). Female and male patients had a similar 3-month mortality rate (6.7% vs. 6.3%) and MELD (21.9+/-8.6 vs. 21.7+/-8.9) among deceased patients. At 6 months, female patients tended to have a lower mortality (12.5% vs. 14.7%) and a lower MELD (18.9+/-7.7 vs. 19.4+/-8.5) in deceased patients. However, at 9 and 12 months, females had a consistently higher mortality (25% vs. 21.2% and 37.5% vs. 31.3%, respectively) but lower MELD scores than males by 0.3-1 point. CONCLUSIONS: Using corrected-Cr MELD, which would prioritize female patients for liver transplantation, may only be justified in predicting intermediate-term (9- and 12-month), but not short-term (3- and 6-month) mortality.     

A giant non-functional adrenocortical carcinoma presenting with acute kidney injury

Hormonally inactive adrenocortical carcinoma (ACC) is a rare disease where abdominal discomfort and back pain are common presenting symptoms due to mass effect from a large tumor. Acute kidney injury (AKI) from retroperitoneal tumors has rarely been reported. The most common etiologies include venous thrombosis, ureteral compression, or both. Here, we described a man who presented with AKI from a large retroperitoneal tumor, which was finally diagnosed as a non-functional ACC. The inferior vena cava (IVC) was nearly completely compressed by the large retroperitoneal tumor leading to venous outflow obstruction and AKI. After surgical resection, his urine output increased and renal function recovered. Unfortunately, AKI recurred 2 months later due to recurrence of the tumor. Treatment with a tyrosine kinase inhibitor stabilized his tumor size, and hemodialysis was started. IVC-compression-associated AKI can be the presenting scenario for ACC, a rare but prognostically important aggressive neoplasm.     

Ultrastructural localization of human platelet thrombospondin, fibrinogen, fibronectin, and von Willebrand factor in frozen thin section

We have investigated the localization of thrombospondin (TSP), fibrinogen, fibronectin, and von Willebrand factor in human platelets by transmission electron microscopy of antibody-stained ultrathin frozen sections. In negatively stained thin sections, alpha granules were identified on the basis of their smooth, roughly spherical shape, size, single limiting electron-lucent 100 A membrane, and frequent presence of electron-dense nucleoid. In contrast, mitochondria exhibited characteristic double membranes and cristae. Sections were separately stained with affinity-purified polyclonal antibodies to these proteins as well as with three monoclonal anti-TSP antibodies. Antibody specificity was documented in radioimmunoassays, by immunofluorescent cross-blocking, and by staining of bands of appropriate mobility in Western blots of whole platelets. Bound antibody was visualized using a 5-nm colloidal gold-avidin conjugate. In resting cells, staining of virtually all alpha granules was observed for all four proteins. In contrast, consistent staining was absent from other organelles, including plasma membranes, mitochondria, and vacuolar structures that may represent the open canalicular system.     

Fibronectin binding to thrombin-stimulated platelets: evidence for fibrin(ogen) independent and dependent pathways

Plasma fibronectin binds in a specific and saturable manner to thrombin- stimulated platelets. gamma-Thrombin stimulated 80% as much fibronectin binding to platelets as alpha-thrombin with conversion of less than or equal to 1% of platelet fibrinogen to fibrin. Afibrinogenemic and normal platelets bound similar quantities of fibronectin in the presence of calcium or magnesium-ethylene glycol tetra-acetic acid (EGTA). These observations indicate that fibronectin can interact with platelets without involvement of fibrin or fibrinogen. Nevertheless, two different effects of fibrin(ogen) on fibronectin binding were observed. First, exogenous fibrinogen inhibited fibronectin binding to thrombin-stimulated platelets. This inhibition was unidirectional, as fibronectin did not inhibit fibrinogen binding to ADP or thrombin- stimulated cells. Second, formaldehyde-fixed cells with surface- associated fibrin bound significant quantities of fibronectin. This interaction required calcium and did not occur on fixed cells with or without surface-bound fibrinogen. A portion of the ligand bound to fixed cells with surface-associated fibrin was modified to form a derivative with a molecular weight identical to that of the fibronectin subunit cross-linked to the alpha-chain of fibrin. This high mol wt derivative was also observed to a variable extent with living cells in the presence of magnesium or calcium but not in the presence of magnesium-EGTA. Thus, fibronectin binds to platelets by at least two mechanisms: (1) a fibrin(ogen)-independent pathway that requires divalent ions and is inhibited by exogenous fibrinogen; and (2) a fibrin-dependent pathway with an absolute calcium requirement. With nonaggregated, thrombin-stimulated platelets, the former pathway appears to predominate.     

Nuclear thyroid hormone binding activities and serum iodothyronine levels in aging rats

Since aging mammals present a spectrum of physiologic conditions that mimic the hypothyroid state, we measured serum thyroid hormone levels and the maximum binding capacities and affinities of solubilized nuclear thyroid hormone binding proteins from liver, kidney, heart and cerebellum in healthy male and female Wistar rats of various postpubertal ages (3–4, 7–8, 15–17 mo; 12 rats/group). In cross-sectional measurements, serum levels of T₃ increased by about 40% (3 mo to 15 mo) in both males and females; T₄ levels increased in males by 22% but decreased slightly in females. The affinity of T₃ and T₄ binding to nuclear receptors was highly conserved between tissues, male vs female and with age (mean ± SE: T₃ K_d = 0.90±0.4 × 10⁻¹⁰M; T₄ K_d = 6.02±0.28 × 10⁻¹⁰M). However, maximum binding capacity in the heart decreased significantly by 15 mo for T₃ (−60% in male, −46% in female) and T₄ (−58% in males and −45% in females). Cerebellum showed a pattern similar to the heart in loss of binding capacity with males showing a 56% decrease and females showing a 53% decrease in nuclear T₃ binding activity. A trend toward decreased cerebellar T₄ binding in the 3–15 mo period missed significance for males and females. By contrast, hormone binding in liver and kidney generally increased through 15 mo of age for both T₃ and T₄. We conclude that certain tissues containing mitostatic cells (heart and cerebellum) may selectively lose nuclear thyroid hormone receptors during post-pubertal aging.     

Comparison of the GlideScope® videolaryngoscope and the Macintosh laryngoscope for double-lumen tube intubation

Intubation with a double‐lumen tube is important for achieving one‐lung ventilation and facilitating thoracic surgery. The GlideScope^® videolaryngoscope (Verathon Inc., Bothell, WA, USA) is designed to assist tracheal intubation for patients with a difficult airway. We wished to compare the GlideScope and direct laryngoscopy for double‐lumen tube intubation. Sixty adult patients requiring a double‐lumen tube for thoracic surgery and predicted uncomplicated laryngoscopy were randomly assigned to a direct Macintosh laryngoscopy group (n = 30) or a GlideScope group (n = 30). The mean (SD) duration of intubation was longer in the Macintosh group (62.5 (29.7) s) than in the GlideScope group (45.6 (10.7) s; p = 0.007). There was no difference in the success of the first attempt at intubation (26/30 (87%) and 30/30 (100%) for Macintosh and GlideScope groups, respectively; p = 0.112). The incidence of sore throat and hoarseness was higher in the Macintosh group (18 (60%) and 14 (47%), respectively) than in the GlideScope group (6 (20%) and 4 (13%), respectively; p = 0.003 and 0.004). We conclude that double‐lumen tube intubation in patients with predicted normal laryngoscopy is easier using the GlideScope videolaryngoscope than the Macintosh laryngoscope.