Feasibility of neonatal hearing screening program with two-stage transient otoacoustic emissions in Turkey

BACKGROUND: The objective of this study was to investigate the incidence of hearing loss in neonates and evaluate the feasibility of a two-stage Transient Evoked Otoacoustic Emission (TEOAE) screening test. Maternal concerns about hearing screening were also studied. METHODS: Neonatal intensive care patients and well babies were screened using a two-stage TEOAE test, which was followed by an Auditory Brainstem Response (ABR) test for those babies who failed the first test twice. RESULTS: In total, 711 neonates were screened. At the end of the two TEOAE tests, the cumulative pass rate was 99.3% and false-positive rate was 0.3%. Five neonates (0.7%) were referred for the ABR test. Sensorineural hearing loss was found in three of them (0.4%). Of these three neonates, one was from the well baby nursery and two were from the NICU population. Families generally welcomed the screening program, with no refusals. Positive test results have not caused important maternal concerns. CONCLUSIONS: Congenital hearing impairment is a prevalent disease in Turkey. The two-stage TEOAE program is suitable for the neonatal hearing screening program. In general, hearing screening tests do not cause notable maternal concerns.     

Endocardial Electrogram Analysis after Intramyocardial Injection of Mesenchymal Stem Cells in the Chronic Ischemic Myocardium

Background: Cell injection therapies have been introduced for the treatment of patients with coronary heart disease. However, intramyocardial injection of bone marrow (BM)-derived cells may generate proarrhythmogenicity.
Methods: Two weeks after the placement of a circumflex artery-ameroid constrictor, 21 pigs received mesenchymal stem cells (MSC, n = 9), mononuclear (BM)-derived stem cells (MNC, n = 6), and placebo (n = 6) using a electromechanical mapping (EMM)-guided percutaneous transendocardial injection catheter. At week 6, EMM was repeated and the injected areas were analyzed in detail to evaluate local bipolar electrogram fragmentation, duration, and amplitude. Myocardial fibrosis was evaluated by a quantitative histological analysis.
Results: At week 6, the injection of MSC or MNC did not increase local electrogram fragmentation (MSC group: 1.4 ± 0.3 vs. 1.3 ± 0.2; MNC group: 1.4 ± 0.2 vs. 1.3 ± 0.2; P = NS), prolong electrogram duration (MSC group: 27.1 ± 7.8 ms vs. 23.7 ± 2.0 ms; MNC group: 27.8 ± 3.5 ms vs. 26.8 ± 5.6 ms; P = NS), or decrease bipolar voltages (MSC group 2.7 ± 0.9 mV vs. 2.8 ± 1.0 mV; MNC group 2.0 ± 1.0 mV vs. 1.7 ± 0.4 mV). From week 2 to week 6, mean left ventricular ejection fraction increased in the MSC group (37.9 ± 4.2% vs. 45.9 ± 2.2%; P = 0.039) only. Histological analysis of the ischemic regions revealed 17.6 ± 5% myocardial fibrosis in the MNC group vs. 13.6 ± 3.4% MSC vs. 28.7 ± 8.7% in the control group (P = 0.038 and P = 0.013). No death occurred in any animal after the injection procedure.
Conclusion: Intramyocardial injection of MSC or MNC do not increase fragmentation and duration of endocardial electrograms in the injected ischemic myocardium but attenuate ischemic damage and therefore may not create an electrophysiological substrate for reentry tachycardias     

Is there a possible correlation between chromosomal variants and spermatogenesis?

AIM: Heterochromatin polymorphism is considered a variant of a normal karyotype but is more frequent in infertile men. The aim of this study was to evaluate the correlation between heterochromatic variants and male infertility and to discuss the possible mechanisms of how heterochromatic polymorphism might affect spermatogenesis. METHODS: Cytogenetic analysis was undertaken in 210 infertile males who had been taken into assisted reproductive techniques and in 183 men with proven fertility. Additionally, C-banding was performed in men with heterochromatin polymorphism. Sperm fluorescence in situ hybridization (FISH) was applied in 54 men with normal karyotype presenting either normal or abnormal sperm parameters as well as in 8 men with heterochromatin polymorphism. The outcomes of assisted reproductive techniques were compared between infertile men with normal karyotype and men with heterochromatin polymorphism. RESULTS: The incidence of heterochromatin polymorphism was higher in infertile men. The most frequent chromosome involved in heterochromatin polymorphism was chromosome 9. Sperm FISH analysis revealed an increased rate of aneuploidy in men with heterochromatin polymorphism. Laboratory and clinical outcomes in assisted reproductive techniques were compromised in men with heterochromatin polymorphism. CONCLUSIONS: An increased rate of heterochromatin polymorphism in infertile males seems to be more than an incidental finding, and must not be considered as a normal variant. Polymorphic heterochromatin may have deleterious effects on the genetic constitution of spermatozoa. More attention must be directed to infertile men with heterochromatin polymorphism.     

Complications of central venous catheterization in critically ill children

BACKGROUND: Placement of central venous catheter is essential in the management of critically ill children. The purpose of the present paper was to evaluate the success rate, mechanical and thrombotic complications and risk factors associated with these complications from different central venous access sites in critically ill children. METHODS: A prospective study was undertaken from February 2000 to March 2005 of 369 central venous catheterizations in children in a pediatric intensive care unit. RESULTS: The veins most frequently used were femoral vein (45%), subclavian vein (32.2%), and internal jugular vein (22.8%). Mean +/- SD duration of catheterization was 9.5 +/- 6.5 days. The procedure was performed under emergency conditions in 18% of patients with an overall success rate of 92.4%. The success rate was significantly lower in younger patients with subclavian catheterization. Insertion-related complications were noted, including 33 arterial punctures (8.9%), 27 cases of malposition (7.3%), 19 hematomas (5.2%), 12 cases of minor bleeding (3.3%), and three cases of pneumothorax (0.8%), and they were more common in the subclavian vein than in the internal jugular and femoral vein. Multiple attempts and failed attempts significantly correlated with higher incidence of complications. Maintenance-related complications included obstruction (n = 26; 7%), accidental removal (n = 14; 3.8%), central venous thrombosis (n = 8; 2.2%), subcutaneous extravasation (n = 14; 3.8%), dislodgment (n = 1; 0.25%), and extravascular infusion (n = 1; 0.25%). The frequency of catheter maintenance-related complications was significantly higher in femoral catheterizations and increased significantly with an increase in the duration of catheterization. A total of five serious complications were seen (pneumothorax in three, dislodgment in one and extravascular infusion in one) in the present series. CONCLUSIONS: Central venous catheterization in critically ill children is a relatively safe procedure, with a 1.3% rate of serious complications and no mortality. It seems safer to choose initially the femoral or internal jugular vein instead of the subclavian vein because of high success rate without serious insertion-related complications.     

Effect of periprostatic nerve blockade before transrectal ultrasound-guided prostate biopsy on patient comfort: A randomized placebo controlled study

BACKGROUND: In the present study, we assessed the efficacy and morbidity of periprostatic local anesthesia before transrectal ultrasound (TRUS)-guided biopsy of the prostate. METHODS: From August 2001 to February 2002, 98 patients underwent TRUS-guided prostate biopsy at the Department of 2nd Urology, Ankara Numune Education and Research Hospital, Ankara, Turkey. Ninety patients who fulfilled the inclusion criteria were randomized into three groups of 30 patients each. Group 1 received no local anesthesia, while group 2 received a periprostatic saline injection 5 min before the biopsy and group 3 received periprostatic local anesthesia with 1% lidocaine. Pain-scale responses were analyzed for each aspect of the biopsy procedure using a visual analog scale. RESULTS: There were no differences in pain scores between the three groups during digital rectal examination, intramuscular injection and probe insertion. Mean pain scores during needle insertion in groups 1, 2 and 3 were 5.65 +/- 2.35, 6.25 +/- 2.04 and 3.16 +/- 2.14, respectively. There was no significant difference between the pain scores of groups 1 and 2, whereas pain scores decreased significantly in group 3. CONCLUSION: Periprostatic local anesthesia before prostate biopsy is a safe and easy method to increase patient comfort during the procedure.