Hearing improvement achieved by different cochlear implantation techniques on the same and contralateral ears.

The authors have performed cochlear implantation since 1985. Different implantation techniques have been used: extracochlear, round window and intracochlear implantation combined with different receivers. Right at the beginning, the 8-channel extra-cochlear implant produces good results due to the gradually increasing current needed to obtain the same effectivity (transduction energy). However, no great differences can be observed in speech reception whether round window or intracochlear implants be used. In addition to audiological results, we briefly outline surgical implantation techniques and implant fixation methods and summarize the outlook for long-term cochlear implantation. Six months after operation, contralateral hearing was observed. The hearing presented itself at one or two frequences.     

Randomized European multicenter trial of surfactant replacement therapy for severe neonatal respiratory distress syndrome: single versus multiple doses of Curosurf.

There is now convincing evidence that the severity of neonatal respiratory distress syndrome can be reduced by surfactant replacement therapy; however, the optimal therapeutic regimen has not been defined. This randomized European multicenter trial was designed to determine whether the beneficial effects of a single large dose of Curosurf (200 mg/kg) in babies with severe respiratory distress syndrome (arterial to alveolar oxygen tension ratio approximately 0.10) could be enhanced by using multiple doses of surfactant. Preterm neonates (birth weight 700 to 2000 g) with severe respiratory distress syndrome requiring artificial ventilation with fraction of inspired oxygen greater than or equal to 0.6 were randomized into two groups at an age of 2 to 15 hours. Both groups received the usual dose of Curosurf (200 mg/kg) immediately after randomization. In neonates randomized to receive multiple-dose treatment, two additional doses of Curosurf (100 mg/kg each) were instilled into the airways (12 and 24 hours after the initial dose) provided that the patients still needed artificial ventilation with fraction of inspired oxygen greater than 0.21. In both groups (single dose: n = 176, multiple doses: n = 167) there was a rapid improvement in oxygenation as reflected by a threefold increase in arterial to alveolar oxygen tension ratio within 5 minutes after surfactant instillation (P less than .001), and peak inspiratory pressure and mean airway pressure could be reduced significantly during the first 6 hours after surfactant treatment. In addition, ventilatory requirement (peak inspiratory pressure, ventilatory efficiency index) was reduced in the multiple-dose group 2 to 4 days after randomization (P less than .05 to .01).(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparison of an elemental with a hydrolysed whey formula in intolerance to cows' milk

In a double blind study, 40 infants with cows' milk intolerance of various causes were randomised to receive a nutritionally complete formula in which nitrogen was supplied either as whey hydrolysate or amino acids. The median age of infants was 10 weeks (range 36 weeks' gestation to 108 weeks' postnatal age). After a median follow up period of 25 weeks there was no significant difference in dietary intake between the formulas. Twenty four weeks after entry, weight and weight for length improved equally on both formulas. Plasma albumin improved significantly on the hydrolysed whey formula but not in the amino acid group. Both milks were palatable and normal intakes of formula were maintained. Biochemical and haematological indices remained within normal limits. There was no difference in stool frequency and vomiting between the two formulas. Two infants developed a probable allergic colitis while receiving hydrolysed whey. Amino acid formula may have a role in the management of atopic infants with severe cows' milk intolerance who have already reacted to whey or casein hydrolysate formula.     

The Significance of Mild Squamous Atypia on Cytology

Summary: Between January, 1991 and February, 1993 inclusive, 396 Papanicolaou smears were reported to show Mild Squamous Atypia with or without Human Papilloma Virus (MSA ± HPV). All women with MSA ± HPV smears were routinely recalled for colposcopy. To determine the significance of MSA ± HPV on routine smear screening, the records of all patients were reviewed.
Three hundred and thirty-seven women (85.1%) attended the colposcopy clinic and are the subjects analyzed for this report. The remaining 59 (14.9%) failed to attend. Intraepithelial neoplasia was found in 61 patients (18.1%), of whom 27 (8.0%) had a high grade lesion (CIN 2 or 3 or GIN 2). No patient had invasive cancer of the cervix. Only 1 of the 45 pregnant women had a significant lesion.
It is concluded that all asymptomatic women with MSA ± HPV on cervical smear may be managed in accordance with the current NH and MRC recommendations (1) and have a repeat smear in 6 months and colposcopy if the abnormality persists at 12 months.     

Polymorphonuclear leukocyte function in term and preterm newborn infants

Bacterial infections are a major problem in the care for newborn infants. In search for immunological deficits we investigated phagocytosis and killing of staphylococci using polymorphonuclear leukocytes (PMN) isolated from 2 ml of venous blood. Phagocytosis of PMN from preterm (n = 10) and newborn infants (n = 9; mean birth weights 1,949 and 3,523 g, respectively) was not different from that of adult PMN (n = 14). Killing capacity of PMN from preterm infants was markedly impaired compared to term newborn infants and to adult PMN. We found similar rates of superoxide anion production and similar times for activation in response to phorbolmyristate acetate stimulation. Our study gives further evidence that PMN from term newborn infants have normal phagocytotic and bactericidal capacity. In PMN from preterm newborn infants, however, the bactericidal capacity is diminished similar to newborn infants under stress as described earlier by others.     

Prenatal diagnosis of classical phenylketonuria by linked restriction fragment length polymorphism analysis

Since the isolation of a recombinant containing a cDNA sequence for human phenylalanine hydroxylase (hPH) (Woo et al., 1983; Speer et al., 1986) prenatal diagnosis by linked restriction fragment length polymorphism (RFLPs) has become possible for families in which phenylketonuria (PKU) occurs (Lidsky et al., 1985a). We describe here the application of a Hind III three-allele RFLP in a single family, which allowed the prenatal diagnosis of an affected fetus.     

Phagocytic activities in neonatal monocytes

Monocytes play an essential role in cellular host defense as circulating phagocytes, as well as precursors of macrophages. We investigated the principal phagocytic activities in monocytes from cord blood of term infants by analysing adherence, random migration, chemotaxis, bactericidal activity, phagocytosis-associated chemiluminescence, production of superoxide anion (O ₂ ^– ) and generation of hydrogen peroxide (H₂O₂). All phagocytic functions of monocytes from neonates were shown quantitatively to be comparable to those of cells from healthy adult volunteers. The increased susceptibility of the human neonate to serious systemic infections cannot be related to an abnormality in monocyte function.Abbreviations FMLP formyl-methionyl-leucyl-phenylalanin - PMA phorbol myristate acetate - CL chemiluminescence - O₂ superoxide anion - H₂O₂ hydrogen peroxide - CGD chronic granulomatous disease - HBSS Hank's balanced salt solution - HSA human serum albumin - SOD superoxide dismutase - KRP-D Krebs Ringer phosphate buffer with dextrose     

Elastase-alpha 1-proteinase inhibitor: an early indicator of septicemia and bacterial meningitis in children

In 26 infants and children with septicemia or bacterial meningitis, significantly elevated plasma levels of elastase-alpha 1-proteinase inhibitor (E-alpha 1-PI) were present at time of recognition of infection, even in those patients with neutropenia (range of reference values: 25 to 190 micrograms/L, n = 142; patients: 444 to 2049 micrograms/L, n = 26). After initiation of therapy, normalization of E-alpha 1-PI levels was observed in all patients who recovered from infection. In addition, 18 of 19 children with bacterial meningitis had increased cerebrospinal fluid concentrations of E-alpha 1-PI above the range of normal (range of reference values: 0 to 39 micrograms/L, n = 62; patients: 30 to 3490 micrograms/L, n = 19); concentrations of E-alpha 1-PI in bacterial meningitis were significantly increased when compared with those in aseptic meningitis (range 25 to 194 micrograms/L; n = 15). In 30 patients with local bacterial infections (pneumonia, urinary tract infections, etc.), E-alpha 1-PI was also elevated. These data suggest that E-alpha 1-PI is a sensitive indicator of systemic and local bacterial infection in childhood.     

Reduction in the minimum candidate interval in the dominant-intermediate form of Charcot-Marie-Tooth neuropathy to D19S586 to D19S432

As part of an on-going genomic screen of unlinked Charcot-Marie-Tooth disease type 2 (CMT2) families, we identified 11 regions in the genome with lod scores ≥1.0. One of these regions was near the recently identified CMTDI1 locus on 19q. We show evidence of linkage of DUK 1118 to this region and our data reduce the minimum candidate interval for CMTDI1 to the 9-cM interval spanned by D19S586 and D19S432.We also demonstrate that five additional CMT2 families are unlinked to 19q markers, providing further evidence of CMT2 heterogeneity. Electronic Publication     

Evaluation of a self-management programme for congestive heart failure patients: design of a randomised controlled trial

Background  

Congestive heart failure (CHF) has a substantial impact on care utilisation and quality of life. It is crucial for patients to cope with CHF adequately, if they are to live an acceptable life. Self-management may play an important role in this regard. Previous studies have shown the effectiveness of the 'Chronic Disease Self-Management Program' (CDSMP), a group-based cognitive behavioural programme for patients with various chronic conditions. However, the programme's effectiveness has not yet been studied specifically among CHF patients. This paper presents the design of a randomised controlled trial to evaluate the effects of the CDSMP on psychosocial attributes, health behaviour, quality of life, and health care utilisation of CHF patients.