Cochlear and middle ear implants: advances for the hearing impaired

We have entered into an era of surgical audiology with cochlear and middle ear implants. With both devices there are distinct phases of patient management--patient selection, surgery, programming and rehabilitation. These phases and issues relating to the implants themselves are considered in this article.     

Increased height and bulk in antisocial personality disorder and its subtypes

Research suggests that those with antisocial tendencies are larger than controls, but studies have not assessed this association in antisocial personality disorder (APD) or its hypothesized sub-types (i.e. adolescence-limited, late-onset). Height, weight, body mass index, bulk, and psychosocial adversity were assessed in 44 controls, nine adolescent-limited antisocials, 21 APDs, and 13 late-onset antisocials from the community. Adult antisocial individuals, regardless of age of onset, were significantly taller and had greater body bulk than controls. Although groups tended to differ on weight, they did not differ on body mass index. In addition, APDs and adolescent-limited individuals reported greater psychosocial adversity than the other groups. Adversity did not account for height or bulk differences. Results suggest prior findings on height and bulk may apply to APD and support differentiating adolescent-limited and life-course persistent subgroups.     

Childhood adversity in alcohol- and drug-dependent women presenting to out-patient treatment

Eighty alcohol- and/or drug-dependent women who were consecutive admissions to a representative out-patient alcohol and drug service in Christchurch were interviewed with the aim of establishing the extent of exposure to childhood adversity including childhood sexual, physical and emotional abuse and parental problems. The results show that a sizeable percentage of the women came from backgrounds characterized by parental conflict and alcohol and drug problems. Within their first 15 years 51% were subjected to sexual abuse involving attempted or completed oral, anal or vaginal intercourse and 39% were exposed regularly to physical abuse perpetrated by their parents or main parental figures. Over half reported experiencing emotional abuse rated as being 'very distressing' and two-thirds had been exposed to 'very distressing' parental problems. The main implication for clinical practice arising from the results of this study is the need for the development of a broader approach to alcohol and drug service provision. In order to achieve positive treatment outcomes, alcohol and drug services may need to routinely screen and plan treatment for childhood adversity and associated problems in all clients presenting for alcohol and drug treatment.     

Developmental aspects of gastroschisis

The development of gastroschisis was studied experimentally as well as clinically, particularly concerning the characteristic fibrous coating of the protruding bowel loops, associated intestinal atresia, and postoperative hypoperistalsis without intestinal obstruction. Experimental investigation was carried out in the chicken embryo. The clinical study was a joint one, involving a total of 50 patients with gastroschisis seen at the Sophia Children's Hospital, Rotterdam, and the Royal Hospital for Sick Children, Glasgow, between 1972 and 1985. Some patients were followed antenatally. The results, correlating with previous experiments, were compared with data from the literature. The fibrous coating of the protruding bowel loops appeared to be a late occurrence and directly related to changes of the amniotic fluid secondary to the onset of renal function. Associated intestinal atresia and postoperative hypoperistalsis in the absence of an obstruction both appeared to be due to another late gestational event, consisting of ischemic changes of the bowel wall secondary to the compression of bowel loops and mesentery in the small abdominal wall defect.     

Bilateral nephrectomy before transplantation: indications, surgical approach, morbidity and mortality

Forty patients with end-stage renal failure, who had undergone simultaneous bilateral native nephrectomy before a subsequent renal transplant operation, were reviewed with particular reference to the indications and surgical approach for bilateral nephrectomy and to the complications of the procedure. The main indications for bilateral nephrectomy are hypertension resistant to medical therapy, persistent symptomatic renal infection, severe renal protein loss and occasionally polycystic kidneys or bilateral renal tumours. In this consecutive series of 40 patients both kidneys were removed because of chronic pyelonephritis with reflux (n = 28), glomerulonephritis with reflux (n = 9) and uncontrolled hypertension (n = 3). Surgical morbidity was less in patients who had bilateral nephrectomy performed through bilateral vertical lumbotomy incisions. There was no surgical mortality.