Brain abscess mimicking brain tumor

We review our experience with brain abscesses presenting as primary brain tumor over a 5-year period (1983 to 1988). Four of 66 (6%) patients admitted with the diagnosis of primary brain tumor by computed tomographic scans were found at craniotomy to have brain abscesses. Periapical abscesses found after surgery were determined to be the cause of brain abscess in two of four patients. Our experience suggests that periapical abscess may be a more frequent cause of brain abscess than previously thought, and should be considered before surgery in patients with a suspected brain tumor.     

Assessing speech recognition in noise for listeners with a signal processor hearing aid

Hearing aids with signal processors use advanced circuitry to enhance speech recognition in noise. The effectiveness of these processors has not been well established. The purpose of this study was to evaluate performance on a speech recognition in noise task for listeners wearing a Zeta signal processor aid with the processor turned on and with the processor turned off. In addition, comparisons were made to performance while unaided and aided with a conventional hearing aid. A simple adaptive procedure and a psychometric function were the procedures used. Results for normal-hearing subjects indicate performance was usually better without a hearing aid. Performance when aided was similar for the processor on and the conventional aid. Performance in both of these conditions was clearly better than with the signal processor off. Although results for the hearing-impaired subjects varied widely, there was a trend for better performance with the conventional aid and with the signal processor on than for the signal processor off condition.     

Hysteroscopic cannulation and lavage in the treatment of proximal tubal occlusion

In two patients with apparent PTO, as diagnosed by HSG and laparoscopy, tubal patency was restored by hysteroscopic cannulation of the tubal ostia, followed by direct lavage. Tubal resection and reanastomosis/reimplantation may not be necessary for all patients with apparent PTO.     

A new after-care model in geriatrics

78 geriatric patients predominantly suffering from cardiocerebrovascular diseases (stroke, heart insufficiency) and lesions respectively operations of the locomotion system (fractures, arthroses) were admitted in 1987 from acute hospitals for after-treatment (short-term care). 35 (= 45%) of them (average age 80 (61-92) could be discharged after 63.5 days on average, 11 died from intercurrent complications, 9 remained for long-term care as inrehabilitable. Besides other concomiting troubles mainly cardiac and circulation affections were present in the majority of patients. Their identification (a. o. by means of ultrasonic methods) and therapy also means a secondary prevention of cerebral as well as of fall and injuries inducing risk factors. The results confirm the principal rehabilitation chance of multimorbid geriatric patients by use of the diagnostic and therapeutic special potential of geriatrics.     

Use of percutaneous silastic central venous catheters in neonates and the management of infectious complications.

A prospective study of 35 patients in the neonatal intensive care unit was conducted to examine the safety and feasibility of percutaneous Silastic central venous catheters for the provision of prolonged parenteral alimentation. Particular attention was directed to the possibility of maintaining these lines through intercurrent episodes of infection. Catheters were placed in 34 infants (97%). At the time of insertion, 21 patients (62%) weighed less than 1000 gm and 13 patients (38%) weighed less than 750 gm. The average duration of catheterization was 32.0 +/- 18.2 (SD) days; 19 patients (56%) had lines in place for more than 30 days. Mechanical difficulties complicated the course of five patients (15%). Four cases of bacteremia were identified; this represents 3.7 infections/1000 days of catheter use. All infections were caused by methicillin-resistant staphylococci. Two patients required catheter removal to clear their infection, but in two of the four bacteremic patients, the infection was cleared and the line was sterilized by the administration of antibiotic therapy through the central catheter. We conclude that Silastic central venous catheters can be used safely to deliver intravenous nutrition to extremely small preterm infants over a prolonged period of time, and in carefully selected patients, successful treatment of complicating infections may be achieved without catheter removal.