The impact of maternal serum alpha fetoprotein screening on open neural tube defect births in north-east Scotland

Over the three years period 1980-1982, 18 256 pregnancies in the Grampian Region of N-E Scotland including the islands of Orkney and Shetland were screened for raised levels of maternal serum alpha fetoprotein (MSAFP) in the second trimester. Thirty six cases of fetal open neural tube defect in singletons were detected (18 anencephaly and 18 spina bifida). Four additional cases of open spina bifida were associated with normal MSAFP levels although two of these were detected by amniotic fluid AFP measurement when amniocentesis was carried out because of previous NTD history. A further three cases of open spina bifida and two of anencephaly occurred in unscreened pregnancies. The MSAFP screening programme alone was thus instrumental in reducing the birth incidence of open neural tube defects by 36 out of 45 cases (80 per cent) in singletons.     

Thrombolytic therapy for delayed occlusion of knitted Dacron bypass grafts in the axillofemoral, femoropopliteal and femorotibial positions

Selective intra-arterial streptokinase therapy successfully reopened ten axillofemoral and lower extremity Dacron bypass grafts that had undergone delayed closure from two to 47 months after implantation. In four, completion arteriograms revealed no runoff obstruction acquired since implantation; additional runoff obstruction had developed in the remaining six. All of the grafts without obstruction have remained open from two to 11 months. Three of the six grafts with obstruction have remained open from two and one-half to four months after specific surgical correction of the obstructive lesion. We conclude that intra-arterial streptokinase therapy is an effective means to reopen knitted Dacron grafts that have undergone delayed closure in the axillofemoral and above-knee femoropopliteal positions.     

Adhesion formation after tubal surgery: results of the eighth-day laparoscopy in 188 patients

First-look laparoscopy (FL) on the eighth day after salpingostomy, fimbrioplasty, or adhesiolysis was performed in 188 patients. Behavior of postoperative adhesions and the occurrence of pregnancy after tubal surgery were compared with a similar group of 127 patients in whom no FL was performed. In greater than 50% of the cases (104/188), adhesions were found on the eighth postoperative day around both adnexa or the only remaining adnexum. Adhesions were mainly located between the ampulla and the ovary and between the ovary and the lateral pelvic wall or broad ligament. More than half of the adhesions that were separated at FL did not recur. It was concluded that FL significantly diminished the occurrence of permanent pelvic adhesions. The incidence of ectopic pregnancy after salpingostomy was significantly lower when FL was performed. FL on the eighth postoperative day can be regarded as a well-accepted procedure with few complications.     

Wegener granulomatosis in pediatric patients

Wegener granulomatosis is more easily recognized as a distinct clinical entity than other vasculitides because the initial clinical features frequently include granulomatous vasculitis of the upper and lower respiratory tract and glomerulonephritis. Although the disease has been lethal in the past, prolonged survival and avoidance of end-stage kidney disease can now be expected when cyclophosphamide therapy is introduced early in the course. We report four children with Wegener granulomatosis in whom the initial clinical findings suggested Henoch-Sch?nlein purpura. In two of the patients Wegener granulomatosis was not recognized until after end-stage kidney disease had developed. The course in these patients emphasizes the need for attention to even scant evidence of inflammation of the upper or lower respiratory tract in patients with glomerulonephritis. Appropriate diagnostic studies may then lead to recognition of Wegener granulomatosis and the prompt institution of appropriate treatment.     

Sensory evoked responses in the intensive care unit

Within the past decade, sensory evoked responses (SERs) have been increasingly applied in acute brain injury. In this paper, we present the rationale for this clinical application and discuss principles and practices that are important for successful measurement and interpretation of sensory evoked responses (SERs) in the intensive care unit. Fundamentals of pathophysiology and management of acute brain injury are reviewed. Varied uses of SERs in brain-injured children and adults are illustrated with case reports. Our experience suggests that SER measurement in acute brain injury is clinically challenging yet rewarding. We conclude that, with sufficient preparation, the audiologist can assume an important position on the intensive care unit team in acute management of brain injury.     

Traumatic flap displacement after LASIK

CASE REPORT: We present a case of traumatic displacement of corneal flap in the superior temporal quadrant 13 days after LASIK. The flap was repositioned after gentle irrigation of BSS, cleaned the interface and then drying the flap to verify its stability. In the next day the flap was adhered, clear cornea,smooth and visual acuity without correction was 1.00. DISCUSSION: We should try immediately to reposition the flap after traumatic displacement, as in this case.     

Speech acts and the pragmatic deficits of autism

In a videotaped free-play session with a parent, autistic children were compared with mental-age matched Developmental Language Delay (DLD) children and with normally developing (ND) 2-year-olds in the use of communicative acts by parent and child. Groups were matched for language level. Autistic children had more incidents of no responses, produced less affirming, turn-taking vocalization, and gesture, and were less likely to initiate communication than other children. Parent groups differed only in a greater amount of initiating and use of imperatives by parents of autistic children. Few relations between parent behaviors and child behaviors were found. Nonresponses by all children were concentrated subsequent to parent imperatives and questions, but no group differences were found in the distribution of nonresponses to various parent communicative acts. Results are interpreted to support the hypothesis that autistic children's language can serve a number of useful functions but that their pattern of language functions differs from that of nonautistic language-impaired children and much younger normal children of similar language level.     

Influence of envelope rise time on neural responses in the auditory system of anurans

The influence of envelope rise time on neural responses was investigated in the central auditory pathway of frogs. Single unit and evoked potential recordings were made from the dorsal medullary nucleus (DMN) and thalamus, respectively. It was found that phasic neurons (15% of the population) in the DMN responded preferentially to stimuli with rapid (less than 25 ms) rise times. Acoustically evoked potentials (AEPs) recorded from the thalamus, specifically the Nucleus of Bellonci, also showed more pronounced responses to stimuli with rapid, rather than slower, envelope rise times. Interestingly, the leopard frog mating call, which has a rapid onset, elicited strong neuronal discharge both within the DMN and thalamus. In contrast, the mating call of bullfrogs, a species sympatric with leopard frogs, has a characteristically slow (greater than 100 ms) envelope rise time and elicited little, if any, response. These findings indicate the presence of neural specializations within the frog's auditory pathway for the optimal detection of the conspecific mating call. The relevance of these findings for stimulus coding in the auditory pathway of other vertebrates is discussed.     

Congenital malformations of the ear

Two hundred and two operations on patients with a congenital ear malformation are presented. Special emphasis is placed on those patients seen in the past three years. The goal of surgery is normal, or near normal, hearing in the operated ear. The surgical approach is direct to the middle ear, and the mastoid air cell system is not opened. Temporalis fascia is used for the new tympanic membrane and a center hole split-thickness skin graft is used to line the new ear canal. In the uncomplicated atresia patient, the postoperative speech reception threshold is routinely 15 to 25 dB.