Functional MR imaging of the auditory cortex with electrical stimulation of the promontory in 35 deaf patients before cochlea implantation

BACKGROUND AND PURPOSE: Promontory testing is used for preoperative assessment of the auditory pathway before cochlear implantation. This method depends on patient cooperation and cannot be used in children or disabled persons. Promontory stimulation during functional MR imaging (fMRI) provides a new and objective method to test the integrity of the auditory pathway. To evaluate the method, we performed this prospective study in deaf adult patients. METHODS: fMRI of the auditory pathway with electrical stimulation of the promontory was performed in 35 profoundly deaf patients, bilaterally in seven. For safe stimulation inside the MR environment, a specially designed nerve stimulator was used. We acquired nine sections parallel to the sylvian fissure by using an echo-planar pulse sequence (1.5 T). To evaluate the number of pixels in the auditory cortex, areas were counted and the minimum confidence level (p(st) value) was determined. The auditory pathway was called intact when the minimal p(st) value was 10(-5) or when the minimal p(st) value was 10(-4) in at least five activated pixels. RESULTS: Images in 85% of patients reporting an auditory sensation showed activation of the contralateral auditory cortex. In the group of patients reporting no hearing sensation, images in 75% did not show activation. CONCLUSION: This method can prove the intactness of the auditory pathway and help the surgeon in decision making before cochlear implantation. However, a negative finding should not be interpreted as indicating a nonfunctioning auditory pathway. Additional technical refinements and experience are needed to further improve this method.     

Preoperative albumin and surgical site identify surgical risk for major postoperative complications

BACKGROUND: Although malnutrition contributes to morbidity, studies of pre- and postoperative nutrition often include well-nourished patients unlikely to benefit from therapy and usually do not stratify by the site of surgical pathology. This study evaluates whether perceived preoperative markers of nutritional status recorded in charts correlates with postoperative complications and resource use in patients who receive no preoperative nutrition support and reinterprets the results of several conflicting randomized, prospective studies in this context. METHODS: This is a retrospective cohort study of 526 surgical patients who had preoperative serum albumin levels measured and were undergoing elective esophageal, gastric, pancreaticoduodenal, or colon surgery between 1992 and 1996 who could have received preoperative nutrition but did not. RESULTS: Most medical records contained inadequate analysis of preoperative nutritional status, but preoperative albumin correlated inversely with complications, length of stay, postoperative stay, intensive care unit (ICU) stay, mortality, and resumption of oral intake. Patients undergoing esophageal or pancreatic procedures sustained a significantly higher complication rate at most albumin levels, whereas colonic surgery resulted in lower complication rates at the same albumin levels. Resource use (eg, length of stay and ICU stay) related to these complication rates; esophageal and pancreatic procedures used the most resources and colon procedures used the fewest at most albumin levels. This lack of appreciation for nutritional risk and operative site can explain discrepancies in outcome noted in several randomized, prospective nutritional studies and must be applied to the design and implementation of new studies. CONCLUSIONS: Elective, non-emergent esophageal and pancreatic procedures performed in patients who could have had surgery delayed for preoperative nutrition, but did not, result in higher risk than colon surgery at any given level of serum albumin below 3.25 g/dL. Patient populations in trials should be stratified by operative site and by markers of nutritional status. Degree of hypoalbuminemia and other potential markers of nutritional status may explain many of the discrepancies between trials of nutrition support. Preexisting hypoalbuminemia in patients undergoing elective surgery remains underappreciated, unrecognized, and untreated in many hospitalized patients.     

Toward a communicative perspective of collaborating in research: the case of the researcher-decision-maker partnership

In the shift to a post-industrial order, the production and use of knowledge is gaining greater importance in a world beyond science. Particularly in the health sciences, research foundations are emphasising the importance of translating research results into practice and are experimenting with various strategies to achieve this outcome, including requiring practitioners to become part of funded research teams. In this paper, we present a case of a partnership between researchers and decision-makers in Canada who collaborated on an investigation of implementing change in health care organisations. Grounded in this case and recent empirical work, we propose that such research collaborations can be best understood from a communicative perspective and as involving four key elements: relational stance that researchers and decision-makers assume toward each other; purpose at hand that situates occasions for developing and using knowledge; knowledge-sharing practices for translating knowledge; and forums in which researchers and practitioners access knowledge. Our analyses suggest that partnerships are most effective when researchers see the value of contextualising their work and decision-makers see how this work can help them accomplish their purpose at hand.     

Results of suture anchor repair of anteroinferior shoulder instability: a prospective clinical study of 85 shoulders

The results of an open Bankart procedure with use of suture anchors were evaluated in 85 shoulders in 83 patients. The mean age was 30 years (range, 16-59 years). The mean number of preoperative dislocations was 18.5. Patients were evaluated prospectively by the Rowe score. Eighty-five shoulders were followed for 1 year and seventy-seven for at least 2 years. The mean follow-up was 3.5 years (range, 1-8.3 years). The Rowe score increased from 30 to 92 points. An excellent or good result was found in 81 of 85 shoulders after 1 year and in 68 of 77 shoulders after 2 years. Seven redislocations occurred, four due to a new trauma. Two patients had recurrent subluxations, one due to a new trauma.     

Stereotactic radiosurgery and fractionated stereotactic radiotherapy in the treatment of uveal melanoma

Uveal melanoma is the most common primary intraocular malignant tumor. Radiation therapy has now replaced enucleation as the treatment of choice, with radioactive eye plaques and proton therapy being the two most studied radiotherapy modalities. More recently, stereotactic radiosurgery and fractionated stereotactic radiotherapy have emerged as promising, non-invasive treatments for uveal melanoma. This review summarizes the available literature on these newer treatment modalities.     

Multiple site analytical evaluation of a portable blood gas/electrolyte analyzer for point of care testing

OBJECTIVE: To evaluate the analytical performance of the SenDx 100 portable blood gas and electrolyte analyzer (SenDx Medical, Carlsbad, CA). DESIGN: Accuracy was evaluated by correlation of whole blood patient samples with the Nova Stat Profile 5 (Nova Biomedical, Waltham, MA) and the Ciba Corning 865 (Chiron Diagnostics, Medford, MA). Precision was evaluated using quality control materials (RNA Medical, Acton, MA). SETTING: Critical care laboratories and operating rooms in two institutions. MEASUREMENTS AND MAIN RESULTS: Precision studies performed at three different concentration levels for each analyte demonstrated intra-assay precision of < or =2.5% coefficient of variation and interassay precision of < or =4.0% coefficient of variation in all cases. Analysis of patient specimens in general showed good to excellent correlation to reference analyzers. Regression variables are tabulated. CONCLUSIONS: The SenDx 100 portable blood gas and electrolyte analyzer is a simple and easy to use analyzer demonstrating acceptable performance compared with reference methods.     

Untersuchung zur Validität der Computer-wachstumsvorhersage

Zusammenfassung Die vorliegenden Untersuchungen wurden durchgeführt, um die Genauigkeit der vonRicketts und Mitarbeitern entwickelten kommerziellen Computer-Langzeitvoraussage des kraniofazialen Wachstums im retrospektiven Vergleich zu überprüfen und um der Frage nachzugehen, ob mit der lateralen Fernröntgenaufnahme die Wachstumsveränderungen innerhalb des Gesichtsschädels mit hinreichender Genauigkeit vorhergesagt werden können. Dazu wurden die Ergebnisse der Wachstumsvorhersagen von 70 Fällen unterschiedlicher Dysgnathiearten mit dem tatsächlich eingetretenen Schädelwachstum metrisch, angulär und mittels Überlagerung verglichen. Die Wachstumsvorhersage erfolgte für einen Zeitraum zwischen 5 und 7 Jahren und schloß in allen Fällen das puberale Wachstum ein. Zusammenfassend ergibt sich für die Wertigkeit der kommerziellen Wachstumsvorhersage, daß deren Aussage im Einzelfall genauso unsicher bleibt wie bei anderen Methoden und damit kein Vorteil gegenüber den bisher bekannten Prognosemethoden zu erkennen ist.

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Summary These investigations were used to test the exactness of the commercial computer-long range forecast of facial-cranial growth, developed byRicketts and his colleagues. This was conducted through a retrospective comparison. Another question we wished to follow was whether the changes of growth within the facial complex could be predicted through a lateral cephalometric radiograph with sufficient accuracy. In order to do this, results taken from the growth forecasts of seventy cases with different malocclusions were compared to the natural growth of the skull. These comparisons were achieved through metric measurements, angular measurements and superimpositions. The growth forecast covered a period of five to seven years and included adolescent growth in all cases. We found the validity of the commercial growth forecast to be as equally uncertain in the individual case as in other methods. Therefore, there is no advantage of this method compared to the present known methods of prediction.

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Résumé Ces recherches avaient pour but de tester par une comparaison rétrospective, l'exactitude de la prévision de croissance crânio-faciale à long terme élaborée parRicketts et ses collaborateurs et indiquée par un ordinateur commercial. Puis elles voulaient déterminer si à l'aide de la téléradiographie sagittale, on peut prévoir de façon suffisamment exacte les changements de croissance de la face. Dans ce but, l'auteur a comparé par rapport à la croissance réelle qui s'était produite, les prévisons de croissance de 70 cas présentant diverses dysgnathies en analysant des études métriques, angulaires et par superposition. La prédiction de croissance fut déterminée pour une durée allant de 5 à 7 années et comprenait toujours la croissance pubertaire. En résumé, il résulte que la valeur de la prédiction de croissance d'un ordinateur commercial reste très incertaine dans un cas individuel, autant qu'avec d'autres méthodes et qu'on ne peut lui reconnaître par là aucun avantage, par rapport aux autres méthodes de pronostic déjà connues.

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Mit 10 Abbildungen und 7 Tabellen

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Herrn Prof. Dr.E. Hausser zum 70. Geburtstag gewidmet.

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Wesentliche Teile sind der Dissertation, Würzburg 1980, entnommen.     

Herrn Prof. Dr. Edmund Bredy zum 65. Geburtstag

Ohne Zusammenfassung