MIDDLE EAR RECONSTRUCTION – OUR EXPERIENCE

A comparative study of ossicular reconstrution using four different graft material was carried out on 40 patients as a second stage procedure from July 1989 to June 1991. The graft materials used were : aulologus ossicular bone graft, allogeneic ossicular bone graft, autologus cartilage and bio-compatible materials. All patients were observed for a period ranging from one to two years. Extrusion of ossicular graft was prevented by use of a lace of cartilage between the ossicular graft and neotympanic membrance. Satisfactory results were obtained with cartilage graft in 6%, allogeneic ossicles 70%, autologus ossicular graft 80% and bio-compatible materials 33.3%.KEY WORDS: Ossiculoplasty, Autologus and allogeneic ossicular graft, Total ossicular replacement prosthesis, Partial ossicular replacement prosthesis     

Elevated pretreatment levels of soluble CD8 and Beta-2-microglobulin as indicators of relapse in breast-cancer patients

We measured soluble CD8 ((S)CD8) and microglobulin (beta-2M) in 128 breast cancer patients and in 200 controls by the ELISA method. Patient groups were: Group A-new patients; Group B-patients on follow-up; Group C-patients with metastases. The mean (S)CD8 and beta-2M were significantly higher in patients than in controls ((S)CD8 p<0.01, beta-2M p<0.0001). Both for (S)CD8 and beta-2M, groups A and C had high levels which differed significantly from Group B ((S)CD8 p<0.04; beta-2M p<0.0001). A significant correlation between (S)CD8 and B-2M was observed (r=0.379: p=0.0001). Twenty patients relapsed. In 14/20 (70%) an initial high (S)CD8 and in 10/20 (50%), high beta-2M was observed. High initial CD8 and beta-2M were able to identify 80% of relapsed patients. High (S)CD8 and beta-2M levels are indicative of tumor bulk and are able to identify patients at.     

Rehabilitation in Older Coronary Patients

Modern medicine dictates a more active therapeutic approach in the geriatric population. This review summarizes relevant data on cardiac rehabilitation in patients aged 65 years or older. The cardiovascular risk factors in the elderly are similar to those in younger people; thus, treating hypertension or hypercholesterolemia, cessation of smoking, and changing of life style and proper diet are recommended regardless of age. Cardiovascular function gradually declines with age, and the incidence of atherosclerotic heart disease increases. Rehabilitation programs for elderly patients with postmyocardial infarction should be specifically designed, particularly for exercise training. Special attention should be paid to warm-up and cool-down periods, upgrading the intensity of exercise, and programming the muscular conditioning component. On the whole, cardiac rehabilitation in the elderly is cost-effective. It should consider the individual's general health, risk factor profile, cardiac status, and mental response.     

ROLE OF DIRECT BONDING MOLAR TUBES IN FIXED APPLIANCES BY BEGG'S TECHNIC

Use of direct bonding molar tubes saves chair side time in orthodontic treatment. It eliminates the need of painful procedure of tooth separation, and discomfort during band adaptation is avoided. By use of direct bonding tubes, oral hygiene improves and danger of decalcification of enamel is avoided.KEY WORDS: Dental bonding, Orthodontic appliances     

LEUKAEMIC INVOLVEMENT OF CENTRAL NERVOUS SYSTEM

Eighty two patients of leukaemia consisting of 25 cases of acute lymphocytic leukaemia, 38 cases of acute myeloid leukaemia, 14 cases of chronic myeloid leukaemia and 5 cases of chronic lymphocytic leukaemia were evaluated for central nervous system (CNS) involvement. Speech disorders, cranial nerve palsies, encephalopathy, ataxia, intracranial haemorrhage, peripheral neuropathy and spinal cord involvement were the main neurological findings detected in 23 (28.1%) cases. All except one were subjected to autopsy after death. Leukaemic infiltrations (36.6%) and intracranial haemorrhage (26.8%) were the prominent CNS autopsy findings. In addition, demyelination with astrocytosis (9.7%) and gliosis (2.4%) were seen. In all, 45 (54.9%) of the patients showed CNS involvement at autopsy. Thus a large number of CNS lesions were missed clinically and detected only on autopsy.KEY WORDS: Intracranial haemorrhage, Leukemia, Metastasis     

CARDIOVASCULAR RISK FACTOR CLUSTERING AND CORONARY ARTERY DISEASE : A 4-YEAR FOLLOW UP STUDY OF 257 SERVICE PERSONNEL

Two hundred and fifty seven service personnel with established diagnosis of (a) silent ischaemia (40.47%) (b) Q-infarction (25.68%) and (c) non-Q-infarction (33.85%) along with 50 age-matched controls were subjected to stress tests before and after identification and control of risk factors. Lack of exercise (63.0%), dietetic indiscretion (47.4%) and cigarette smoking (40.4%) were the main risk factors. Hypercholesterolaemia (22.1%), alcohol over-indulgence (17.1%), positive family history (16.3%), diabetes mellitus (9.7%) and hypertension (6.2%) were other contributing factors. Clustering or multiplicity of risk factors was seen in 61.1% cases. All patients were advised for control of risk factors along with necessary specific therapy wherever indicated. Initial stress test was positive in 83.3% of the total and on repetition, after 4 years, the positivity dropped to 45.9% with a rate of improvement of 44.9%. Patients with silent ischaemia showed the maximum improvement (57.8%) following the risk factor intervention. Only 4 cases (1.56%) showed deterioration with reinfarction during the 4-year follow up.KEY WORDS: Coronary disease, Risk factors, Prevention and control     

Prognostic factors for local control of early glottic cancer: the Rabin Medical Center retrospective study on 207 patients

Purpose: Different radiation therapy schedules and devices have been used over the last 20 years at Rabin Medical Center in patients with early glottic cancer. The aim of the present retrospective analysis was to identify the subgroup of patients at high risk of failure of radiation treatment.

Materials and Methods: Between 1974 and 1994, 207 patients with squamous cell carcinoma of the glottis, 182 Stage T1 and 25 Stage T2, underwent definitive radiation therapy. During this period, treatment was administered with different radiation devices (⁶⁰Co or 6-MV X ray), using different dose/fraction protocols (1.8 or 2 Gy per day, 5 or 6 fractions per week), total doses (42–77.4 Gy), overall radiation times, and delays. These treatment variables, in addition to certain patient and tumor characteristics, were correlated with local control at a median follow-up of 57 months (range 18–265 months).

Results: The 5-year local control rates for T1 and T2 tumors were 88% and 73%, respectively. Univariate analysis showed that smoking, diabetes mellitus, anterior commissure involvement, T stage, and extension of tumor to one third or more of the vocal cord were highly significantly correlated with decreased local control. None of the treatment variables, including dosage at which complete tumor regression was noted, were found to be predictive. By multivariate analysis, only anterior commissure involvement was found to be highly significant (risk ratio 1.9, 95% CI 1.2–3.0, p = 0.027), and T stage was borderline significant (risk ratio 1.6, 95% CI 1.0–2.5, p = 0.054).

Conclusion: This study suggests that only two tumor characteristics are predictive of local failure of early glottic cancer: anterior commissure involvement and T stage. Treatment variables apparently do not influence local control.     

Esophageal Perforation After Transesophageal Echocardiogram

Esophageal rupture after transesophageal echocardiogram (TEE) is a rare but life-threatening complication. Risk factors for perforation include spasm or hypertrophy of the cricopharyngeal sphincter, cervical arthritis, forward and left lateral bending of the distal esophagus, and esophageal disease such as inflammation or neoplasm. We present the case of a 80-year-old woman who developed perforation of her esophagus after TEE. Prior irradiation to the chest due to treatment for breast cancer and subsequent fibrosis probably contributed to this complication. Physicians referring patients for a TEE and physicians performing this procedure should be aware for the risk of perforation. The identification of risk factors and gentle maneuvering of the probe may prevent this severe, life-threatening complication.     

Change in Attitude Toward Electroconvulsive Therapy: Effects of Treatment, Time Since Treatment, and Severity of Depression

Attitudes toward electroconvulsive therapy (ECT) of patients with major depressive episodes who are treated with ECT were evaluated before the beginning of treatment, 1 to 2 days after completion of the 12th treatment, and 6 months after the termination of the series using a questionnaire (adapted from Freeman and Kendall, 1980). Attitudes toward ECT become more positive after treatment, and remain so at the 6-month follow-up. Attitude changes correlate with changes in depressive symptoms and with subjective side effects during treatment. Patients who had a prior course of ECT had more knowledge of ECT but not a more positive attitude.