Middle ear adenoma: a case report with ultrastructural findings

A 56-year-old woman presented with unilateral tinnitus and hearing loss for 18 months. A middle ear mass was detected clinically. At operation, the tumour was found to have eroded the stapes. The light and electron microscopic features of the tumour were those of a middle ear adenoma. This rare benign tumour has an excellent prognosis. Erosion of an ossicle has not been previously associated with this tumour. Benign adenomatous tumours arising from middle ear mucosa are rare (Mills and Fechner, 1984). The term adenoma of middle ear was proposed by Hyams and Michaels (1976), and their review of 20 cases emphasized the benign behaviour of these tumours. We report a case of middle ear adenoma in which ossicular erosion occurred.     

Surface coil magnetic resonance imaging of the normal larynx

The use of specialized surface coils has made it possible to obtain high-signal, high-resolution magnetic resonance (MR) images of the neck. We describe the normal anatomy of the larynx imaged with surface coils and a technique adapted from respiratory gating to reduce motion from swallowing and coughing. Compared with computed tomography, MR has superior discrimination of tissues that on computed tomography appear to be of similar density. The intrinsic laryngeal muscles and carotid sheath are well seen. Multiplanar imaging capability allows easy distinction of false and true cords and optimal evaluation of the preepiglottic and paralaryngeal spaces. Computed tomography is easier to perform than MR and is superior to MR in depicting the laryngeal cartilages. However, with improved technology, MR may become the imaging modality of choice in evaluation of the larynx and adjacent hypopharynx and subglottic regions.     

Changing etiology and outcome of neonatal septicemia in Riyadh, Saudi Arabia

To study the etiology of neonatal septicemia and factors associated with outcome, all charts of neonates with bacteremia and clinical sepsis admitted to a neonatal unit in Saudi Arabia, from 1 November 1980 to 31 October 1984 were reviewed. The results were compared to a previous study period in the unit (1 November 1976-31 October 1980). Septicemia was diagnosed on 50 occasions in 49 neonates. The incidence of neonatal sepsis among patients born in the hospital was 2.5/1,000 live births. Mortality from sepsis was 33% and was associated with neutropenia in 63%. The most commonly isolated bacteria were E. coli, Klebsiella and Staphylococcus aureus. Salmonella enteritidis serotypes were isolated in 4% of the cases. Group B streptococci (GBS) were isolated, for the first time, from blood of 3 neonates. Salmonella species were less frequently and GBS more often isolated than previously. GBS have now appeared as etiologic organisms in neonatal sepsis also in Saudi Arabia. Salmonella septicemia remains more common in Saudi Arabia than in the West.     

Septic atrial thrombosis. A potentially lethal complication of Broviac catheters in infants

Even though the use of Silastic catheters for long-term parenteral nutrition has decreased the incidence of catheter-related thrombosis and infection, these serious complications still occur. We describe three infants with septic atrial thrombosis secondary to use of Broviac catheters. One of the infants had pulmonary embolism and Budd-Chiari syndrome. The use of echocardiography in the diagnosis of this potentially fatal complication and aggressive treatment--which included open heart removal of thrombi--are discussed. The three infants recovered fully from this complication.     

MOLECULAR EPIDEMIOLOGY AND CANCER PREVENTION: Protection by green tea, black tea, and indole-3-carbinol against 2-amino-3-methylimidazo[4,5-f]quinoline-induced DNA adducts and colonic aberrant crypts in the F344 rat

Male F344 rats were exposed for 8 weeks to extracts of greentea (2% w/v) or black tea (1% w/v), or to 0.1% dietary indole-3-carbinol(I3C). In weeks 3 and 4 of the study, rats were given 2-amino-3-methylimidazo[4,5-f]-quinoline (IQ) every other day by oral gavage (50 mg/kgbody wt) in order to induce aberrant crypt foci (ACF) in thecolon. Compared with controls given IQ alone, all three inhibitorsreduced the number of total aberrant crypts per colon, and greentea and I3C inhibited significantly the mean number of ACF (P< 0.05). Rats pre-treated with green tea, black tea, or I3Cand given a single p.o. injection of 50 mg IQ/kg body wt 24–48h before sacrifice had reduced levels of IQ-DNA adducts in theliver, and excreted lower amounts of IQ and other promutagensin the urine and feces. Inhibitors also reduced the excretionof IQ-sulfamate in the urine, but increased the relative amountsof IQ-5-O-sulfate and IQ-5-O-glucuronide. Western blotting togetherwith assays for 7-ethoxyresorufin O-deethylase and methoxyresorufinO-demethylase established that I3C preferentially induced cytochromeP4501A1 over 1A2, consistent with the altered profile of urinarymetabolites. However, both teas caused slight induction of cytochromeP4501A2 versus 1A1, which would be predicted to enhance theactivation of IQ. Thus, green tea and black tea are likely toprotect against IQ-DNA adducts and ACF by mechanisms other thaninduction of cytochromes P450, such as inhibition of enzymeswhich activate IQ or the scavenging of reactive intermediates.     

Failure of intraventricular gammaglobulin and alpha interferon for persistent encephalitis in congenital hypogammaglobulinaemia.

A boy with congenital hypogammaglobulinaemia died at the age of 12 years after a viral meningoencephalitis of two and a half years duration due to an untypable picornavirus. He had received intravenous immunoglobulin every four weeks from the time of the start of immunoglobulin replacement treatment at the age of 3 years. The encephalitis did not respond to high dose intravenous gammaglobulin (2500 g during 22 months). The virus could not be isolated during the administration of intraventricular immunoglobulin (38.15 g) and intraventricular recombinant alpha interferon (121 X 10(6) units), but recurred rapidly each time intraventricular treatment was stopped. Further modes of treatment are still required for prevention and treatment of this disorder.     

Making growth visible in the community

Parents have always been concerned with the growth of their children. Over the last half century health workers have also become intimately concerned with growth, but have unfortunately mystified this and made it difficult for parents and the community to understand. Asking the mother to keep the home based record has done relatively little to increase her understanding, perhaps because she does not understand the methods of weighing used, much less the reason and rational for it. New methods of weighing and measuring children are described in this article which may lead to greater community understanding and concern for the growth of their children. Eventually their introduction may lead to increased numerical literacy by parents and communities. Just as maternal literacy has been shown to be related to improved child survival, so it is proposed that the introduction of greater numerical literacy will also have a significant effect in improving the growth and survival of children and furthering community development.     

Quantification of cardiovascular instability in premature infants using spectral analysis of waveforms

Spectral analysis was applied to blood pressure and cerebral blood flow velocity recordings in premature infants with respiratory distress in order to quantify respiration-induced cardiovascular variability. Aortic blood pressure was transduced via an umbilical arterial catheter and cerebral blood flow velocity measured in the anterior cerebral artery using a 10 MHz continuous wave Doppler velocimeter in 16 infants less than or equal to 32 wk gestational age. Spectral analysis of the resulting waveforms revealed heart rate and respiratory rate components whose relative amplitudes (heart rate/respiratory rate amplitude ratio) represent an index of that component of variability induced by respiratory events. The mean (heart rate/respiratory rate amplitude) ratio was 47.2 in spontaneously breathing infants and rose to 165.9 in infants who were ventilated during muscle paralysis (p = 0.0003). Cerebral blood flow velocity recordings showed R components in only 22 of 38 simultaneous recordings. This method can be used to quantify respiration-induced cardiovascular variability and its response to therapy, and may provide a means of identifying infants at risk from brain injury due to an inability to regulate cerebral blood flow.     

New England Maternal PKU Project: prospective study of untreated and treated pregnancies and their outcomes

Four women with classic phenylketonuria (blood phenylalanine greater than 1200 mumol/L) were given a phenylalanine-restricted diet; three also received L-tyrosine supplements. Biochemical measures of nutrition were normal except for iron deficiency anemia, and in one woman folate deficiency. One pregnancy in which treatment began before conception and another treated from 8 weeks gestation, both with blood phenylalanine levels maintained at 120 to 730 mumol/L, resulted in normal newborn infants whose postnatal growth and development have also been normal. A third pregnancy, treated from 6 gestational weeks, was marked by poor dietary compliance until the middle of the second trimester; fetal microcephaly was identified by ultrasonography at 28 weeks but not at 21 weeks. The child has microcephaly and motor delay. The fourth pregnancy, not treated until the third trimester, produced a child with microcephaly, mental retardation, hyperactivity, and neurologic deficits. It is likely that fetal damage from maternal phenylketonuria can be largely and perhaps entirely prevented by dietary therapy, but therapy must begin before conception for the best chance of a normal infant.