The mechanism of speech perception using multichannel cochlear implant

The mechanism of speech perception in patients with Australian multi-channel cochlear implant was investigated. 1) Vowel recognition abilities of patients were sufficient with this implant, whereas, consonant recognition abilities were insufficient. 2) Although the cochlear hair cells were functionally damaged, cochlear nerves had the ability to characterize frequency. 3) The signals from the implanted material were very simple compared to those from normal cochlea, however these patients could understand speech well, perhaps due to aid from the central nervous system.     

Levels of epidermal growth factor in human cord blood.

Levels of epidermal growth factor (EGF) in the cord serum of 13 full-term and 84 preterm infants were measured using a radioimmunoassay. Detectable levels of immunoreactive EGF were present in the cord blood at 23 weeks gestation and rose gradually with increasing gestational age. EGF levels correlated significantly with birth weight and placental weight. In small-for-gestational-age infants with birth weights smaller than 3 SD below the mean, EGF levels were lower than those in appropriate-for-gestational-age infants. These results suggest that EGF may play a role in fetal growth, but low EGF levels may also be the result of growth retardation.     

Laparoscopic approach to ovarian pathology in children and adolescents

Laparoscopic procedures are constantly finding wider application in general and pediatric surgery. The female child and adolescent presenting with suspected acute or chronic ovarian pathology may be an ideal candidate for laparoscopic surgery. From March 1992 to December 1993, six girls aged 7 to 18 years underwent seven laparoscopic operations for ovarian pathology at Childrens Hospital Los Angeles. Clinical presentations included virilization with primary amenorrhea (1), precocious puberty (1), malignant dysgerminoma (second look) (1), and abdominal pain (3). Postoperative diagnoses were dysgerminoma (1), bilateral gonadoblastoma in a 46 XY chromosomal phenotypic femal with dysgenetic gonads (1), negative bipsy (1), serous cystadenoma with acute torsion (1), ovarian cysts (1), and ovarian torsion (1). Operations performed were unilateral salpingo-oophorectomy (1), unilateral salpingo-oophorectomy with contralateral biopsy (2), bilateral salpingo-oophorectomy (1), diagnostic biopsy (2), and ovarian cystectomy with oophoropexy (1). There were no operative complications. One patient underwent two operations, a biopsy followed by unilateral salpingo-oophorectomy. Only one patient required a mini-laparotomy for delivering a large tumor mass. Mean operative time was 138 min, mean hospital stay 2.0 days. We encountered two malignant cases, which were definitively treated by laparoscopic resection. These two patients remained free of disease 12 to 18 months later. The laparoscopic approach to ovarian pathology in children and adoloscents in an effective method for diagnosis as well as definitive therapy. Our initial experience is presented followed by recommendations for clinical practice.     

Enema reduction of intussusception with a small dose of iopamidol may have advantages over barium

Barium enema (B-enema) has been the standard method for hydrostatic reduction of intussusception, although recently air enema has been used due to the lower risk when perforation occurs. Recently, we have administered a small dose of iopamidol during enema reduction (I-enema) in children with intussusception. From November 1989 to December 1993, we treated 50 children with intussusception at Kiyama Hospital. Barium was used in the first half of the period, and iopamidol in the second half. Reduction was successful in 22 of 24 patients with barium (92%) and 23 of 26 with iopamidol (88%); 25 children had the ileocolic type and 25 the ileoileocolic (-cecal) type of intussusception. Operations were carried out in 3 patients from each group. I-enema avoids some of the drawbacks of barium and air enemas. It is a new method of enema reduction, as a contrast medium is injected first. It is possible to obtain a good image of the advanced portion with a small dose of contrast medium, which is important for treatment. For institutions performing B-enemas, I-enemas can be performed easily with the same equipment and technique. It causes less contamination upon leakage than a B-enema, and also has less influence on the intestinal membrane with very few risks if perforation occurs. Better images are obtained than with air. A large dose of contrast medium is not needed, thereby reducing medical expenses to a minimum. Iopamidol can be used safely for enema reduction of intussusception with an expected high success rate.     

Intraoperative peritoneal washing cytology with the rapid immunoperoxidase method using microwave irradiation

The rapid immunocytochemical staining of gastrointestinal cancer-associated antigens, carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19–9), for intraoperative peritoneal washing cytology of pancreatic or biliary carcinoma can be completed in only 25 minutes by using microwave irradiation to accelerate incubation of the primary antibody. Only 3-second irradiation at 500 W for fresh smears produced specific antigen staining of malignant cells similar to that obtained with longer incubation, and the sensitivity of intraoperative cytology was greater than by the conventional staining method. The rapid immunocytochemical staining method of peritoneal washings at laparotomy can provide sensitive information for determining more aggressive therapy for intraperitoneal spread of malignant cells before closing the abdominal wall. © 1995 Wiley-Liss, Inc.     

Clinical Analysis of Intracranial Metastases in Gestational Choriocarcinoma: A Series of 15 Cases

Between 1963 and 1980 we have had experience of 54 patients with gestational choriocarcinoma and 29 are alive, a survival rate of 53.7%. The disease had metastasized to the central nervous system in 15 of these 54 patients, an occurrence rate of cerebral metastases of 27.8%. 13 of these 15 patients have died and 2 are now in a state of remission. Autopsy was performed in 8 cases. The following points are emphasized: cases with the pulmonary disease risk intracranial spread; the serum/cerebrospinal fluid ratio of human chorionic gonadotropin concentrations and computerized tomography are recommended as useful investigations in the diagnosis of CNS disease; decompression surgery in patients with increased intracranial pressure is indispensable; radiotherapy is temporarily effective for brain deposits; powerful systemic chemotherapy using multiple anticancer drugs is suggested to be helpful both in preventing and in treating CNS disease.     

Diagnosis of neuroblastoma metastasis in bone marrow with a panel of monoclonal antibodies

Neuroblastoma, along with rhabdomyosarcoma, Ewing's sarcoma, and acute lymphoblastic leukemia/lymphoma, is one of the small, round-cell tumors of childhood. All of these malignancies show a propensity to metastasize to bone marrow. Occasionally when the clinical picture is unclear and the tumor is particularly anaplastic, it can be difficult to arrive at a diagnosis by conventional histological and biochemical procedures. In the present study, a panel of nine monoclonal antibodies was used to undertake a detailed analysis of seven bone marrows contaminated with tumor cells: six cases of stage IV neuroblastoma, and one case of stage IV-S neuroblastoma. The antibody profiles obtained were compared with those deduced from the studies of over 20 marrows from patients with acute lymphoblastic leukemia. A comparison of these data with those obtained from the studies of rhabdomyosarcoma and Ewing's sarcoma cell lines and tissues suggests that when high levels of tumor cells are present in the marrow, it is possible to obtain a confident diagnosis of either neuroblastoma or acute lymphoblastic leukemia. In addition, the immunocytological identification of neuroblasts in bone marrow enables accurate staging without histological examination.     

Surfactant replacement therapy in neonatal respiratory distress syndrome

We conducted a prospective, randomized, controlled trial comparing the efficacy of two doses of a reconstituted bovine surfactant (Surfactant TA) in premature infants requiring mechanical ventilation shortly after birth for respiratory distress syndrome. Forty-six infants weighing 1000–1499 g were randomized into two groups: a low-dose group (23 infants given a single dose of 60 mg surfactant lipid/kg) and a high-dose group (23 infants given a single dose of 120 mg/kg). The mean (SD) age at which surfactant was given was 5.5 (±1.2) h in the low-dose group and 6.0 (±1.5) h in the high dose group. Both treatments improved oxygenation (increased arterial-alvcolar PO₂ ratio) with decreased mean airway pressure, the high-dose surfactant having a more beneficial effect in prolonging the response. Infants in the high-dose group had significantly less (P<0.05) incidence of both intraventricular haemorrhage and bronchopulmonary dysplasia. This prospective trial documents that a greater benefit can be obtained by increasing the dose of surfactant (120 mg/kg) beyond 60 mg/kg in the treatment of premature infants with severe respiratory distress syndrome (RDS).Abbreviations RDS respiratory distress syndrome - Surfactant TA Surfactant Tokyo-Akita - 5 kDa 5 kilodaltons - ELISA enzyme-linked immunosorbent assay - PDA patent ductus arteriosus - a/APO₂ arterial-alveolar oxygen tension ratio - MAP mean airway pressure - ^99mIc-DTPA 99m technetium diethylenetriamine pentacetate     

Neonatal hemophilia B with intracranial hemorrhage. Case report

It is uncommon for infants with hemophilia to have excessive bleeding during the neonatal period. Even if bleeding occurs, it rarely becomes life-threatening, such as in intracranial hemorrhage (ICH). We here report a case of a 4-day-old boy who had intracranial hemorrhage as the first complication of hemophilia B. Computerized axial tomography (CT scan) and ultrasonography were very useful for early diagnosis. Only a few cases of neonatal hemophilia with intracranial hemorrhage have been reported, but the occurrence of this complication is probably more frequent. We reviewed seven cases (including our case) with intracranial hemorrhage as the first manifestation of neonatal hemophilia. Although these infants showed good prognosis as to survival, permanent residual neurological deficits remained in all of them. It is emphasized that intracranial hemorrhage due to hemophilia may occur in neonates even without a family history. Urgent neuroimaging and coagulation studies are necessary for an early and adequate diagnosis.