Assessment of deafmute patients: a study of ten years

Present prospective study was conducted on 350 patients presenting with chief complaints of impaired hearing and delayed speech from 1996–2006. The aim of the present study was to find out the prevalence of deafmutism in our area, the aetiology of childhood deafness and to ascertain the role of acoustic reflex test (ART) for hearing screening considering brain stem evoked response audiometry (BSERA) as gold standard. A detailed history, clinical and other relevant systemic examination and investigations were done to find out the cause. All patients were subjected to ART test and BSERA. Male to female ratio was 2.1:1. Prevalence was found to be 5.59 per one lac population in our district. The commonest age of presentation was in the second decade. The causes for childhood deafness were genetic (15.8%), embryopathies (10%), perinatal (10.8%) and postnatal problems (12.5%). In 50.6% cases it was aediopathic. Congenital syndromic abnormalities were found in 5.4% patients. In BSERA 21% patients were found to have residual hearing varying from 60 dB to 100dB. The positive predictive value of ART was found to be low (10.4%). Hence it was recommended that ART should not be used as screening tool for childhood deafness.     

Neurilemmoma of cervical sympathetic chain

Neurilemmoma of the cervical sympathetic chain is a rare nerve tumour. Less than 40 confirmed cases have been reported in the literature.1 2 Sometimes they can he mistaken as carotid body tumour but usual presentation of these lesions is an asymptomatic neck mass. Because of the rarity of the tumour we report another case of neurilemmoma arising from cervical sympathetic chain in a 19 years old male.     

Subdural evacuating port system (SEPS)—Minimally invasive approach to the management of chronic/subacute subdural hematomas

Objective

The population suffering from chronic/subacute subdural hematomas (SDHs) generally includes elderly patients with co-morbidities; therefore the success of less invasive surgical techniques has been of long standing interest. The optimum treatment option for chronic/subacute SDH has not been well established. We report our retrospective outcomes of SDH drainage through a subdural evacuating port system (SEPS).

Patients and methods

Fifty-two consecutive adult patients with chronic/subacute SDH treated with SEPS (total 64 procedures), over a period of 3 years (June 2006–June 2009), were included. 9/52 patients had SEPS performed for bilateral SDHs. Three patients had SEPS placed for recurrent SDH. This retrospective study was approved by the Institutional Review Board of SUNY Upstate Medical University and Crouse Hospital.

Results

Overall 38/52 patients (73%) showed clinical improvement, 10/52 patients (19%) did not show any clinical improvement and 4/52 (8%) patients became clinically worse after the SEPS placement during initial hospitalization. 41/52 patients, treated initially with SEPS were followed as outpatients. 32/41 patients improved, returning to baseline neurological status, 5/41 patients improved, but still had some residual symptoms. The remaining 4/41 patients, presented with recurrent symptoms and had recurrent SDH on CT scans. During the in-hospital post-SEPS period, 8 SDH had >75% decrease, 17 SDH had between 50 and 75% decrease, 23 SDH had between 25 and 50% decrease and 14 procedures had <25% decrease in maximal width of the SDH on postoperative scans. Outpatient follow up CT scans after SEPS placement were available for 46/64 procedures. At final outpatient follow up, 33/46 SDHs showed >75% decrease in maximal thickness, 4/46 SDH showed between 50 and 75% and 2/46 SDH showed between 25 and 50% decreases in maximal width of chronic SDH. However, in 7/46 patients, SDH re-accumulated (i.e. increased in thickness) as outpatients, after initial response to treatment on post-operative in-hospital CT scans.

Conclusion

SEPS is an effective, relatively safe and convenient treatment strategy with low invasiveness; among management options of chronic/subacute SDH.     

Endodontic Management of a Maxillary First Molar with Two Palatal Canals with the Aid of Spiral Computed Tomography: A Case Report

This case report presents the endodontic management of a maxillary first molar with 2 palatal canals with separate orifices and apical foramen. The diagnosis was confirmed with the help of spiral computed tomography. This article discusses the variations in the canal morphology and the use of latest adjuncts in successfully diagnosing and negotiating them.     

Teratomas of the Tongue Present at Birth

A large teratoma of the tongue, present at birth, was successfully removed at 32 h of age. It contained immature neural tissue consisting of a loose neurofibrillary matrix with primitive neurons, rossettes, and papillary tissue. Serum alpha fetoprotein was present at 8 days of age, as reported in some patients with malignant teratomas. Our case, however, had no histologic evidence of malignancy, no serum alpha fetoprotein at 7 months of age, and no recurrence at 1 years. The four glossal tumors reported in the literature, including one with immature neural elements, were all present at birth. In 1 case, another teratoma of the tongue was found 5 months after removal of the congenital one. It may not have been a recurrence, as the mass was located in a different area of the tongue. It appears that congenital teratomas of the tongue do not behave in a malignant fashion, at least in the 5 known cases.     

Effects of Calcium Modulation on Percutaneous Absorption of a Model Drug

Purpose. To investigate the effect of modulation of the calcium gradient in the skin on the percutaneous absorption of nicotinic acid (NA). Methods. A skin model with an altered calcium gradient was produced by pretreatment with A23187 (25 g/ml). The immunohistochemistry was used to evaluate the change in phosphoprotein Elk-1. ATR-FTIR spectroscopy was employed to investigate the changes in lipid conformation in the skin. The permeation profiles of the model drug were studied and the distribution profile of the model drug in the skin layer was evaluated using the cryostat micro-sectioning method. Results. The immunohistochemistry demonstrated that modulation of the calcium gradient increased phosphorylated Elk-1 in the dermis. The FTIR study showed a shift of the asymmetric stretch peak, implying an increase in lipid fluidity in the epidermis. The amount of NA permeated through the A23187-pretreated skin was significantly lower than that of the control (2.2714 ± 0.6040 vs. 3.1895 ± 0.2456 g/cm²/h). The Cryostat micro-sectioning study showed that there are concentration gradients of the model drug across the skin layers with a higher gradient in the control than in the A23187-pretreated skin. Conclusions. The alteration in the calcium gradient significantly decreased the permeation rate of a hydrophilic drug, such as nicotinic acid.     

Current concepts in the pharmacotherapy of benign prostatic hyperplasia

Benign prostatic hyperplasia is a major men's health issue, with approximately 80% of all men developing this condition within their lifetime. A variety of oral treatments is available, including alpha-adrenoceptor antagonists (alpha-blockers), 5alpha reductase inhibitors, aromatase inhibitors and phytotherapy. A large number of alpha-blockers can be administered, but no single agent has demonstrated a clear superiority over the other drugs. 5alpha Reductase inhibitors have demonstrated similar efficacy in larger volume prostates but most evidence suggests that there is no benefit in combining them with alpha-blockers. The use of phytotherapy is not entirely novel but requires further long-term evaluation before it can be endorsed for clinical use in benign prostatic hyperplasia.