Hearing preservation in unilateral acoustic neuroma surgery

This paper reviews the principal English literature on hearing preservation in unilateral acoustic neuroma surgery. Seventeen case reports and 13 surgical series are included. In addition, we report ten cases of our own, two with successful hearing preservation. The purpose of this report is to study feasibility, success rate, and associated problems. Previous reports have been compared in terms of criteria that we have selected. A classification system similar to Silverstein's is used. The total number of cases under review is 621, with 221 reported successes. Cases limited to those having a unilateral acoustic neuroma, with valid supportive audiometry, were 394, with 131 successes. The approximate overall rate of success is 33%. There are five cases of hearing preservation with unilateral acoustic neuromas 3 cm or larger when supporting audiometric data are available, the largest being "4-5 centimeters." Problems included mixing of unilateral acoustic neuromas with other types of tumors and failure to include comprehensive data, particularly audiometry. We conclude 1) that hearing preservation is a reasonable goal in unilateral acoustic neuroma surgery, although the number of available candidates is relatively small and 2) that intelligent selection of patients and high quality surgical technique are the keys to success.     

Inhibitation of pro-inflammatory cytokine gene expression and papilloma growth during murine multistage carcinogenesis by pentoxifylline

Topical application of 12-O-tetradecanoylphorbol-13-acetate(TPA) to the dorsal epidermis of Sencar mice induces synthesisof pro-inflammatory cytokines, including interleukin-1     

Gene expression and cellular sources of inducible nitric oxide synthase during tumor promotion

The present studies examined the temporal sequence of induciblenitric oxide synthase (iNOS) gene expression and the cellularsources of iNOS protein and of 3-nitrotyrosine, as a markerof production of nitric oxide-derived reactive nitrogen intermediatesduring murine multi-stage carcino-genesis. Levels of iNOS mRNAin dorsal skin isolated from acetone-treated female Sencar micewere 2.5-fold higher than iNOS gene expression detected in cutaneoustissue isolated from Sencar mice at 1,3,6,10,16 and 22 weeksafter exposure to a single topical application of 25 nmol 7,12-dimethylbenz[     

Potency following conformal neutron/photon irradiation for localized prostate cancer

: To assess the effect of conformal neutron/photon irradiation with or without neoadjuvant hormonal therapy on posttreatment potency.

: Seventy-six patients with localized adenocarcinoma of the prostate, Stage T1 or T2 N0 Mo, Gleason score ≤7, were enrolled on a prospective Phase II study. Each patient received 9–10 Neutron + 38 Photon Gy. Twenty-eight patients received neoadjuvant hormonal therapy in conjunction with radiation therapy. Potency was assessed prior to starting treatment and was assessed at each subsequent follow-up visit.

: Fifty-two of 75 patients (70%) were potent at the start of therapy. Thirty-eight of 52 (73%) had functional erections and 14 of 52 (27%) had erections termed nonfunctional, which were of insufficient strength for intercourse. After treatment, 35 of 52 (67%) retained potency. Twenty-nine of 38 (76%) with functional erections pretreatment maintained this ability. Only 6 of 14 patients (43%) with nonfunctional erection pretreatment maintained their level of potency. Neoadjuvant hormonal therapy did not impact on the ability to maintain erections. Sixty-five percent of those patients receiving hormones retained erectile function, while 69% of those who did not receive hormones maintained erectile function. Age was not a significant factor in posttreatment potency, although a trend towards potency in younger patients was observed . (p = 0.74).

: The majority (67%) of patients maintained their level of erectile function following conformal sequential neutron photon irradiation. This comparable to that achieved with photon irradiation alone. No significant change in potency was seen with neoadjuvant hormonal therapy or with increasing patient age.     

Surfactant treatment and incidence of intraventricular haemorrhage in severe respiratory distress syndrome.

As part of a multicentre study of porcine surfactant administration in respiratory distress syndrome, 29 babies weighing 2000 g or less were studied in the neonatal intensive care unit of the Royal Maternity Hospital, Belfast. Fourteen babies of a mean gestational age of 28.1 weeks were randomly allocated to the treatment group (200 mg/kg phospholipid given intratracheally) and 15 babies of a mean gestational age of 28.7 weeks formed the control group. All babies had severe respiratory distress syndrome (oxygen requirement over 60%, mechanical ventilation, and age 15 hours or less). Almost immediate improvement in oxygenation was seen in the treated group so that oxygen concentrations could be reduced and remained significantly lower than those of control babies for the first seven days of life. Alveolar-arterial oxygen gradients were also significantly different for the first five days after treatment. More babies in the treatment group survived (79% v 40%) but the difference was not significant. The incidence of pneumothorax and of intraventricular haemorrhage, however, was significantly lower in treated babies compared with controls. For babies weighing less than 1200 g the risk of developing or extending intraventricular haemorrhage after entry to the study was also reduced in the treatment group (29% v 100%).     

Injuries in youth football

The injury experience of 5,128 boys (8 to 15 years of age, weight 22.5 to 67.5 kg [50 to 150 lb]) participating in youth football revealed an overall rate of significant injury of 5%, with 61% classified as moderate and 38.9% as major injuries. No catastrophic injuries occurred, and it was rare for a permanent disability to result from any injury. The upper extremity was most likely to be injured, and fractures were the most common injury to occur. The rate, site, and type of injuries experienced by the pre- and early adolescent players differed from the pattern for older players at higher levels of competition. Variables related to an increased risk of injury included participation in the older and heavier divisions, heavier weight, and involvement in contact activities. Factors associated with the occurrence of an injury were evaluated and provided areas for future study for the prevention of injuries. The medical care received by youth football participants was appropriate, although improved sideline surveillance for injured players is required.     

Severe neonatal respiratory distress syndrome treated with the isolated phospholipid fraction of natural surfactant

Ten newborn infants (795-1680 g) with severe respiratory distress syndrome (RDS) were treated with the isolated phospholipid fraction of bovine or porcine surfactant, which was administered via the airways (dose 200 mg/kg), at a median age of 10.5 h. Before receiving surfactant, all the infants were on artificial ventilation (FiO2 0.6-1.0). Within 2 h after surfactant replacement, the arterial-to-alveolar PO2 ratio increased from 0.1 to 0.35. There was a concomitant improvement in lung aeration on the chest roentgenograms and a significant reduction in the right-to-left shunt. Four patients died of cerebral hemorrhage; two of them also had a patent ductus arteriosus. One surviving infant developed bronchopulmonary dysplasia, and another succumbed 8 months later to the sudden infant death syndrome. No antibodies against surfactant were detected in the sera of the survivors. Since our results show a significant improvement in lung function after replacement therapy, the efficacy of this new surfactant preparation should be further tested in randomized clinical trials.     

Amphotericin B dosage for disseminated candidiasis in premature infants

Amphotericin B (Amp-B) serum concentrations were determined in five infants with disseminated candidiasis. All patients had positive blood cultures for Candida and one patient had Candida albicans meningitis. Amp-B sterilized the blood and the cerebrospinal fluid within four to nine days. Total doses of Amp-B varied from 11.6-62.3 mg. There was no laboratory or clinical evidence of renal toxicity. Two infants died of causes unrelated to disseminated candidiasis. Disseminated candidiasis in premature infants was treated successfully with 0.5 mg/kg doses of Amp-B, but further studies with more evaluable cases are needed to confirm the correct dose.     

External cephalic version at term: is a tocolytic necessary?

This prospective investigation evaluates the benefit of a beta-mimetic tocolytic for external cephalic version. From July 1, 1984 to May 15, 1987, 58 patients who had breech presentations between 37-41 weeks' gestation were considered for external cephalic version. The patients were randomly assigned to one of two groups: tocolytic or no tocolytic. An ultrasound examination, serum alpha-fetoprotein (AFP), Kleihauer-Betke test, and nonstress test (NST) were performed before and after the attempt at version. A version was not attempted if there was evidence of intrauterine growth retardation (IUGR), oligohydramnios, or a nonreactive NST. Patients in the tocolytic group received 200 micrograms/minute of ritodrine hydrochloride for 20 minutes via continuous intravenous infusion before a version was attempted. Twenty of the 30 patients (66.7%) in the tocolytic group and 19 of the 28 patients (67.8%) in the no-tocolytic group had successful versions, a nonsignificant difference. The nine patients with unsuccessful version attempts in the group without a tocolytic then received intravenous ritodrine and underwent a second attempt. Only one of these nine attempts was successful. There were no serious maternal or fetal complications associated with the attempts at version. In our patient population, use of a tocolytic did not significantly increase the probability of a successful version.     

Defective haemochorial placentation as a cause of miscarriage: a preliminary study

The morphology of the placental bed in idiopathic sporadic and recurrent miscarriages was studied and the findings correlated with the fetal chromosomal pattern where possible. Defective development of haemochorial placentation, which was not necessarily linked with fetal chromosomal abnormality, was seen in association with some miscarriages. These preliminary results, not previously demonstrated, strongly support the concept that miscarriages and pregnancies complicated by pre-eclampsia and/or small-for-gestational-age infants may be a continuum of disorders with a similar pathology in the placental bed.