Abstract P2-10-12: How well predict the 2011 St Gallen early breast cancer surrogate phenotypes metastatic survival?

BACKGROUND: The five prognostic surrogate phenotypes, defined by the 2011 St Gallen consensus, predict metastatic relapse following early breast cancer treatment (Brouckaert et al Ann Oncol 2012). It is unknown to what extent these surrogate phenotypes defined on the primary tumor predict metastatic survival (MS) in a cohort of consecutive women with metachronous metastases.

PATIENTS & METHODS: All 4318 patients with primary operable breast cancer, diagnosed between 01–01-2000 and 31–12-2009 and treated in our center were prospectively entered in our institutional database. We included 345 patients with a (distant) metastatic relapse during their follow-up. We observed metastatic survival as the time between the diagnosis of the relapse and death. Tumor subtype was defined according to the 2011 St Gallen recommendations in 5 groups: luminal A (ER+/HER2−, grade 1–2), luminal B1 (ER+/HER2−, grade 3), luminal B2 or luminal-HER2 (ER+/HER2+), HER2-like (ER−/HER2−) and triple-negative. We focused on the value of the primary tumor subtype as a major prognostic determinant, but also assessed age at diagnosis, tumor size, lymph node involvement, tumor subtype, PR-status, primary detection (screening vs. palpation), histology, adjuvant therapy, distant-metastasis free interval (DMFI), first-line metastatic hormonal therapy, recurrence sites (isolate or multiple) and metastasis detection (clinical vs. biochemical).

RESULTS: In our cohort, we recorded a median metastatic survival (MS) of 22.3 months (95% CI: 19.7–25.6) and a 5-year survival probability of 15%. Significant differences in median MS were noted when considering the primary tumor subtype (cf. table).

We observed an independent prognostic effect for multiple recurrence sites (HR = 1.78, 95% CI 1.37–2.32), first-line metastatic hormonal therapy (HR = 0.30, 95% CI 0.18–0.49), DMFI (HR = 0.92 CI 0.85–0.98) and, finally, primary tumor subtype.

Abstract P6-05-05: Triple receptor comparison between primary breast cancer and metachronous or synchronous liver metastasis

Background: Decisions about systemic treatment in women with metastatic breast cancer are currently based on the presence of estrogen receptors (ER), progesterone receptors (PR) or Human Epidermal growth factor Receptor 2 (HER2 receptors) in the primary tumor. Recently, several studies have reported significant discordances in ER, PR and HER2 status between the primary tumor and metastatic lesions and this may vary by metastatic site. Prognostic implications remain unclear although alterations in ER, PR and/or HER2 can influence metastatic management. This study represents one of the largest studies evaluating how frequent receptor discordances occur in liver metastasis, whether this alters therapeutic options and impacts prognosis.

Patients and methods: 246 breast cancer patients with histological confirmed liver metastasis were analyzed in this retrospective study. Immunohistochemistry (IHC) and/or FISH were used to determine ER, PR and HER2 receptor status. We excluded patients when comparison between receptors of primary tumor and metastasis was impossible due to missing data (n = 85), when liver metastasis did not originate from breast cancer (n = 36) and when pathology was obtained from autopsy specimens (n = 38).

Results: 87 patients had matched tissue samples of primary tumor and liver metastasis with possible comparison of at least one of the receptors. Table 1 summarizes changes in ER, PR, HER2 between primary and metastatic lesion. Discordance in receptor status was associated with shorter time to death (63.3 months) compared to the concordant group (75.5 months).

Abstract P6-07-29: Independent prognostic value of age depends on breast cancer subtype

Background: Whether age is an independent prognostic factor in early breast cancer remains controversial. Different cut-off values have been suggested in different studies and few studies assessed its value in triple negative breast cancer and other phenotypes.

Methods: We included all primary operable breast cancer patients from our prospectively managed database in UZ Leuven, Belgium. We excluded male patients, patients treated elsewhere first, patients treated with primary systemic treatment first. We assessed the effect of age as a continuous and categorical variable for distant metastasis free interval (DMFI), locoregional free interval (LRRFI) and breast cancer specific survival (BCSS) in multivariable analysis (correcting for phenotype, tumor size, nodal status, chemo−, endocrine−, radiotherapy, type of breast and axillary surgery). We assessed the effect of age for DMFI, LRRFI and BCSS in basal-like breast cancer and other phenotypes.

Results: We included 4318 patients with a mean/median age of 58/ 57 years (1170 patients were younger than 50 years) and with a median follow-up of 6,0 years. Multivariate analysis confirmed age as an independent prognostic variable for LLRFI (HR1.91; 95% CL:1.33–2.74; p = 0.0005), DMFI (HR:1.77; 95% CL:1.33–2.36; P < 0.0001) and BCSS (HR:2.35; 95% CL:1.66–2.74; P < 0.0001). The optimal cut-off value is 41years for LLRFI and BCSS and 44 years for DMFI. We did not find an independent prognostic value for age in triple negative breast cancer regarding DMFI and LRRFI. Results for other subtypes are subject to currently ongoing analyses.

Conclusions: Overall, young age in primary operable breast cancer patients is an independent prognostic value for DMFI, LRRFI and BCSS after adjusting for known prognostic factors. In triple negative breast cancer, age did not retain independent prognostic value for DMFI and LRRFI.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-07-29.

Applying the 2011 St Gallen panel of prognostic markers on a large single hospital cohort of consecutively treated primary operable breast cancers

BACKGROUND

Many easily measurable and readily available factors are now established as being prognostic in primary operable breast cancer. We here applied the 2011 St Gallen surrogate definition for breast cancer subclassification using tumor grade instead of Ki67.

PATIENTS AND METHODS

Four thousand three hundred and eighteen consecutive patients who had surgery for primary operable breast cancer (1 January 2000 and 31 December 2009) in UZ Leuven excluding primary metastastic male breast cancers and those receiving neoadjuvant therapy. Five different surrogate phenotypes were created using the combined expression of estrogen receptor, progesterone receptor, human epidermal growth factor receptor-2 together with tumor grade. Disease-free interval (DFI), distant metastastis-free interval (DMFI), locoregional relapse-free interval (LRRFI), breast cancer-specific survival (BCSS) and overall survival (OS) were calculated.

RESULTS

Surrogate phenotypes present with significant differences in DFI, DMFI, LRRFI, BCSS and OS. 'Luminal A' tumors presented with the best outcome parameters but the effect weakened at longer follow-up.

CONCLUSIONS

The four surrogate markers, agreed upon by the 2011 St Gallen consensus, defined five prognostic surrogate phenotypes in a large series of consecutively treated breast cancer patients. Their prognostic value changed with longer follow-up. The added value of gene expression profile over classical pathological assessment remains to be defined.

Stellate ganglion block for the management of hot flashes and sleep disturbances in breast cancer survivors: an uncontrolled experimental study with 24 weeks of follow-up

BACKGROUND

We studied the stellate ganglion block (SGB) recently suggested for the treatment of severe vasomotor symptoms and sleep disturbances in breast cancer survivors. Following an initial pilot study, which focused on the acceptability and safety of SGB for this important problem, we evaluated its short- and long-term efficacy.

MATERIALS AND METHODS

Postmenopausal breast cancer survivors with severe vasomotor symptoms resistant to standard nonhormonal pharmacological intervention were eligible. Diaries were used to measure daily hot flash scores (frequency and intensity) and sleep quality (Pittsburgh Sleep Quality Index) during scheduled visits at baseline, 1, 4, 12 and 24 weeks following the SGB. Efficacy data were analyzed using longitudinal regression models.

RESULTS

Thirty-four patients participated and none refused the SGB procedure. Most patients received more than one SGB. The pilot study found SGB to be safe. In the main study, hot flash scores were reduced from baseline by 64% [95% confidence interval (CI) -74% to -49%] and 47% (95% CI -62% to -27%) at weeks 1 and 24, respectively. The odds ratio of better sleep quality relative to baseline was 3.4 at week 1 (95% CI 1.6-7.2) and 4.3 at week 24 (95% CI 1.9-9.8).

CONCLUSION

In the short term, SGB appears to be an effective treatment with acceptable morbidity for some breast cancer survivors with therapy-resistant vasomotor symptoms and/or sleep disturbances. Although sleep quality was maintained out to 24 weeks the efficacy of SGB for hot flashes was reduced over time. A randomized controlled trial is needed to confirm these findings.

Specific inhibition of carbonic anhydrase IX activity enhances the in vivo therapeutic effect of tumor irradiation

BACKGROUND AND PURPOSE

Carbonic anhydrase (CA) IX expression is increased upon hypoxia and has been proposed as a therapeutic target since it has been associated with poor prognosis, tumor progression and pH regulation. The aim of this study was to evaluate the antitumor activity of a high CAIX-affinity indanesulfonamide (11c) combined with irradiation, compared with the general CA inhibitor acetazolamide (AZA).

MATERIAL AND METHODS

HT-29 carcinoma cells with or without (genetic knockdown, KD) CAIX expression were incubated with 11c/AZA under different oxygen levels and proliferation, apoptosis and radiosensitivity were evaluated. 11c/AZA was administered intravenously (1×/day; 5 days) to tumor-bearing mice and tumor irradiation (10 Gy) was performed at day 3 of the injection period. Tumor growth and potential treatment toxicity were monitored (3×/week).

RESULTS

Treatment with 11c/AZA alone resulted in tumor regression, which was further increased in CAIX expressing cells by combining 11c with irradiation. AZA demonstrated also an additional effect in the KD tumors when combined with irradiation. CAIX inhibition in vitro significantly reduced proliferation and increased apoptosis upon hypoxia exposure without affecting intrinsic radiosensitivity.

CONCLUSIONS

Specific inhibition of CAIX activity enhanced the effect of tumor irradiation and might, therefore, be an attractive strategy to improve overall cancer treatment.

Abstract P4-08-09: The Prognostic Importance of “Detection Mode” and “Palpability” in Primary Operable Grade 2 Breast Cancers

Background: Histologic grade 2 breast cancer may benefit most from molecular classification for prognosis. We studied the prognostic value of ‘detection mode’ and ‘palpability’ together with other prognostic variables in a consecutive series of grade 2 lesions.

Patients and methods: We used follow-up data from new diagnosed and primary operable grade 2 breast cancers from UH Leuven (January 2000 - May 2005). Endocrine, chemo-and radiotherapy were given when indicated. The first appearing breast cancer related event (BCRE) was calculated as local (local, regional or contra-lateral) or metastatic (metastatic if both appeared together). These prognostic variables were assessed: age at diagnosis (per decade increase), tumor size (per cm increase), screening (yes/no), palpability (yes/no), lobular type (yes/no), chemotherapy (yes/no), endocrine therapy (yes/no), lymph node status (0, 1, 2-4, >4), combined expression of IHC-measured ER (pos = any expression), PgR (pos if any expression) and HER-2 (positive = IHC2/3+ and FISH pos), architectural, nuclear and mitotic score. Univariable and multivariable proportional hazards Cox regression using the Firth's penalization method to reduce bias in the parameter estimates were used.

Results: Of the 1013 patients in the dataset, 14 had missing values (1.4%). With a median follow-up of 80 months, we observed 116 BCRE (11.6%); 43 local and 73 metastatic. In univariable analysis, screen detected cancers showed better (HR 0.63, 95% CI 0.42-0.93) and palpable cancers worse prognosis (HR 1.96, 95% CI 1.13-3.71) than non-screen detected and non-palpable cases respectively. The beneficial univariable effect of screening weakened in the multivariable analysis (HR 0.83, 95% CI 0.52-1.31) as 582/602 (97%) of non-screen detected cancers were palpable vs 227/397 (57%) for screen-detected cancers. If palpable was omitted from the multivariable model the HR of screening decreased to 0.68 (95% CI 0.44-1.03) thereby approximating its univariable result. Conclusion: Overall, palpability is more strongly related to prognosis, but detection method also has an effect even though we do not have enough events to show this with a convincing level of reliability.

Increased stability of mercapto alkane functionalized Au nanoparticles towards DNA sensing

The use of gold nanoparticles (GNPs) in bioassays is often hampered by their colloidal stability. In this study, gold nanoparticles coated with different mercapto alkanes were investigated towards their stability. Hereto, the effects of the alkane chain length (5-11 methylene groups), the type of functional end-group (-OH or -COOH) and the amount of incorporated poly-ethylene oxide units (none, 3 or 6) on the GNP stabilization was evaluated. Based on these results, an optimal mercapto alkane (HS(CH(2))(11)PEO(6)COOH) was selected to increase the colloidal stability up to 2 M NaCl. Furthermore, it was proved that this mercapto alkane is ideally suited to enhance the stability of DNA functionalized GNPs in high electrolytic hybridization buffers. The effectiveness of these DNA functionalized GNPs was demonstrated in a sandwich assay using a surface plasmon resonance biosensor. The superior stability of these nanoparticles during hybridization may lead to enhanced biosensor technologies.

High resolution micro-CT scanning as an innovative tool for evaluation of the surgical positioning of cochlear implant electrodes

X-ray microtomography (micro-CT) is a new technique allowing for visualization of the internal structure of opaque specimens with a quasi-histological quality. Among multiple potential applications, the use of this technique in otology is very promising. Micro-CT appears to be ideally suited for in vitro visualization of the inner ear tissues as well as for evaluation of the electrode damage and/or surgical insertion trauma during implantation of the cochlear implant electrodes. This technique can greatly aid in design and development of new cochlear implant electrodes and is applicable for temporal bone studies. The main advantage of micro-CT is the practically artefact-free preparation of the samples and the possibility of evaluation of the interesting parameters along the whole insertion depth of the electrode. This paper presents the results of the first application of micro-CT for visualization of the inner ear structures in human temporal bones and for evaluation of the surgical positioning of the cochlear implant electrodes relative to the intracochlear soft tissues.

Hantavirus Puumala infection as a cause of fever of unknown origin in a child

Hantavirus infection due to Puumala virus causes nephropathica epidemica, a disorder characterized by fever, haematological abnormalities, mild renal dysfunction and ophthalmological abnormalities. The prevalence in most European countries is low, but the virus can be endemic. In children, hantavirus infection is rare. This paper describes a young girl diagnosed with hantavirus infection. The patient presented with high fever, proteinuria, haematuria and eye lesions, but other typical hallmarks of the disease, such as thrombocytopenia and renal dysfunction, were absent. This case report demonstrates the need to consider the diagnosis of hantavirus infection in children with prolonged fever of unknown origin. The diagnosis is based on serological tests.

New developments in cochlear implants

Essential to improve the performance with cochlear implants is a better control of the electrode-nerve interface. The long-term stability of the electrode characteristics has to be guaranteed. Most important herein is to have a low and stable electrical impedance and to prevent fibrosis. Results of electrode coating and fibrosis-inhibiting products are described. To assess the properties of the electrode-nerve interface such as stimulation threshold, spatial selectivity and channel interaction, the electrically evoked compound action potential is measured. The measurement paradigm and the first results are described. Models of auditory nerve response to electrical stimulation can be used as a tool for cochlear implant fitting. A simple model is proposed and its predictions are compared with measured responses.

The LAURA Pediatric Cochlear Implant Program in Antwerp: what have we learnt in 5 years?

The LAURA Cochlear Implant Program at the University of Antwerp was initiated 5 years ago. Up to now 50 children have received the LAURA cochlear implant (Philips Hearing Implants). Our accumulated experience in selecting the patients, counselling their parents, implanting and fitting the device allowed us to gradually modify the inclusion/exclusion criteria for cochlear implantation and achieve very rewarding results. The most important change was the gradual shift towards a younger age at implantation, our youngest implantee being 11 months old. In this paper we describe the rationale for this change, as well as the prerequisites for a successful pediatric cochlear implant program.

Developments in speech processing for cochlear implants

The status of speech processing for cochlear implants is reviewed. Points of interest to enhance further speech intelligibility based on improved signal processing, are discussed.

Growth factors in tympanic membrane perforations

OBJECTIVE

Little is known about the arrested healing of chronic central tympanic membrane perforations and the mechanism involved in this process. Some authors have traced the failure to a growth factor deficiency at the perforation margin. In addition, recently, several growth factors have been tried out to improve tympanic membrane (TM) closure in animals. The authors sought to determine the expression of some well-known growth factor peptides in normal human TM and in TMs with a chronic central perforation.

MATERIALS AND METHODS

Total TM specimens were obtained from patients with a normal TM (N = 10) soon after death and from patients with a chronic perforation (N = 20) undergoing myringoplasty with use of an allograft TM. Formaldehyde solution-fixed TMs were analyzed after immunohistochemical staining using highly purified monoclonal antibodies to determine whether epidermal growth factor receptor (EGF-r), transforming growth factor-alpha (TGF-alpha), basic fibroblast growth factor (b-FGF), or transforming growth factor-beta 1 (TGF-beta 1) was expressed in the TMs.

RESULTS

The distribution pattern for EGF-r, TGF-alpha, and b-FGF was similar in perforated and nonperforated TMs. In contrast to this, TGF-beta 1 staining was markedly different in perforated and nonperforated TMs. No or minimal TGF-beta 1 was observed in normal TMs, whereas TGF-beta 1 staining was prominent in perforated membranes, mostly at the perforation border.

CONCLUSIONS

The authors experimental findings imply that EGF-r, b-FGF, and TGF-alpha expression are not significantly different in TMs with and without a central chronic perforation. However, for TGF-beta 1, the authors found an increased staining pattern in perforated TMs when compared with that of normal TMs, and staining at the fibrotic and scarred perforation margin was pronounced. Based on these findings, the authors speculate on the possible role of TGF-beta 1 in the development of the fibrotic scar at the perforation margin explaining the deficient healing pattern of tympanic membranes in chronic otitis media. Possible clinical implications for the future, including growth factor therapy, are discussed.

Comparisons between stress incontinence in women and sphincter mechanism incompetence in the female dog

In dogs, sphincter mechanism incompetence most often affects middle-aged spayed bitches and is more prevalent in docked animals, certain breeds and in dogs over 30 kg in weight. It results in urinary leakage, mainly when the animal is recumbent and relaxed. In humans, stress incontinence occurs most often in post-menopausal women who are multiparous, have had difficult deliveries and are obese. They also leak urine, but most often when active stressors increase abdominal pressure. Both women and bitches have shorter functional urethras and lower maximal urethral pressures. In women, the compliance and cross-sectional area of the urethra are increased and power generation is substantially weakened. Many women and most bitches have an intrapelvic bladder neck and a short urethra. Owing to hormonal deficiencies they have an impaired capacity to seal the lumen of the urethra and the urethral sphincter is less sensitive to sympathomimetics. In women partial denervation of the pudendal nerve is also a contributory factor.

A multi-channel simultaneous data acquisition and waveform generator system designed for medical applications

To meet the needs of our research programmes on auditory prostheses for the totally deaf, a 15-channel data acquisition and waveform generator system with flexible triggering, pacing and linking was developed. It allows both synchronous and asynchronous operation at high speed. Each channel of the system, which is controlled by a simple personal computer, has an on-board microcontroller, a 512 kWord signal memory, a voltage input and both voltage and current outputs. The system includes a master pacer and trigger unit with elaborate hardware and software triggering options. This paper describes the system hardware and the software used to control it. Finally, some of its application are demonstrated. The flexibility of the system makes it widely applicable in the field of biomedical engineering.

Contribution of endoscopy to early diagnosis of hypertrophic pyloric stenosis

The diagnostic accuracy of ultrasonography and gastrointestinal endoscopy was compared in 63 infants who were operated on for infantile hypertrophic pyloric stenosis. Endoscopy was far more accurate than ultrasonography, the diagnosis being made in 97 and 81% of the cases, respectively. The difference between the techniques was even more obvious in the younger patients and in those with a short history of vomiting. The ability to detect coexistent or other causes of vomiting with endoscopy appeared advantageous. The endoscopic procedure is easily done without general anesthesia and was without complications in our series. We recommend endoscopy as an important tool in very young patients with few clinical signs other than vomiting, allowing for appropriate treatment without delay.

Antithrombin-Gly 424 Arg: a novel point mutation responsible for type 1 antithrombin deficiency and neonatal thrombosis

Inherited type 1 antithrombin (AT) III deficiency is characterized by a decrease of immunoreactive and functional protein levels to about 50%. The disorder is associated with a significantly increased risk of thromboembolism. We have investigated the molecular basis of type 1 AT deficiency in a Belgian family. The diagnosis of the disease was primarily made in a newborn girl with unusually severe thrombotic complications. Using the polymerase chain reaction and single-strand conformation polymorphism analysis, followed by direct sequencing of AT gene fragments, we identified a novel point mutation in exon 6. We detected a G to C substitution in the first position of codon 424 leading to a glycine to arginine substitution. The modification at this highly conserved position in the serine protease inhibitor gene family probably leads to an unstable mutant-gene product. The mutation creates a unique restriction site for the enzyme Hha I in exon 6. This change permitted a rapid and accurate screening of the kindred with identification of the molecular defect in five other family members.

The nutritional value of a whey hydrolysate formula compared with a whey-predominant formula in healthy infants

Forty-five healthy infants were included in a double-blind randomized prospective study comparing the nutritional value of two formulas. One group received a whey-predominant formula (n = 20); the other group received a whey hydrolysate formula (n = 25). Four infants of the whey hydrolysate group were dropped because they refused the formula. Although the mean daily volume intake was smaller with the whey hydrolysate formula compared with the whey-predominant formula (p < 0.001), the weight gain in the two groups after 13 weeks was identical (27.2 g/day in both groups; the mean difference in weight gain between the groups after 13 weeks was only 8 g). Length gain at 13 weeks was 10.4 cm in the whey-predominant formula group and 10.8 cm in the whey hydrolysate formula group (p = NS). After 13 weeks, blood was sampled for hemoglobin, hematocrit, red blood cell count, white blood cell count, lymphocytes, glycemia, proteins, albumin, prealbumin, calcium, phosphorus, urea, creatinine, iron, iron-binding capacity, zinc, and vitamins A and E. Except for the iron-binding capacity, zinc, urea (in plasma as well as in urine) (all three were higher in the whey hydrolysate group), no significant differences were found. According to these results, exclusive feeding of the whey hydrolysate formula from birth to 3 months of age to healthy infants appears to result in an adequate nutritional status, as assessed at 3 months of age.

Myocardial infarction in a neonate with hereditary antithrombin III deficiency

We report the case of a newborn girl with antithrombin III deficiency type 1. The clinical features of a hypercoagulable condition that lead to this rare diagnosis differed from the reports in the literature, since the primary thromboembolic incident resulted in neonatal myocardial infarction, which is in itself a rare condition during the first days of life.

The prevalence of Helicobacter pylori-positive serology in asymptomatic children

Epidemiologic data are presented about the prevalence of Helicobacter pylori positivity as determined by serology in a large series of asymptomatic children (n = 466). Serology is now generally accepted as a valid noninvasive screening method for the detection of Helicobacter pylori infection. Blood samples were taken from 466 apparently healthy children (ages 2-14 years) who were admitted to our pediatric 1-day clinic for elective surgery. The children originated from different ethnic backgrounds. All were born in Belgium and have been living there ever since. Thirty-four (7.3%) had positive titers for Helicobacter pylori. There was a significant increase in the number of positive patients with advancing age (5.4% in the age group 2-8 years and 13.4% in the age group 8-14 years; p < 0.001). We also found a significant difference in the prevalence of Helicobacter pylori positivity between Caucasian Belgian children and non-Caucasian children of different ethnic backgrounds. This relatively high prevalence of positive serology in asymptomatic older children (13.4%) should be considered in studies on the incidence or causative role of Helicobacter pylori in children with chronic abdominal complaints.

Asymptomatic autoimmune chronic active hepatitis in a male adolescent

We report a 12-year-old boy presenting with smooth muscle antibody-positive auto-immune chronic active hepatitis. Suspicion of the diagnosis arose after a routine blood test which revealed abnormal liver function tests. In spite of the presence of cirrhosis and patchy necrosis on liver biopsy, our patient never showed any clinical feature of impaired liver function. This observation demonstrates that auto-immune hepatitis may exist for a long time before clinical symptoms appear and probably explains why some cases of auto-immune hepatitis finally present as fulminant liver failure.

A digital speech processor and various speech encoding strategies for cochlear implants

We distinguish two main categories in the speech decoding strategies: those based on feature extraction and those based on time information of the filtered incoming signal. In the first group only those electrode pairs corresponding to the localisation of the four or more, maximum spectral peaks or the formants of the speech signal are stimulated. The second category is essentially based on the timing information that is included in the filter outputs of the filtered speech signal. The Laura implant has the capability to be programmed to the different decodings-strategies. To understand the potential possibilities the main features of the implant are discussed.

[Helicobacter pylori infections in children]

In our patient population with chronic aspecific abdominal complaints Helicobacter pylori gastritis is no rarity. This entity has been diagnosed in 10 children out of 48 (mean age: 8 years 11 months) who underwent an endoscopy of the upper gastrointestinal tract. After treatment with amoxicillin and colloidal bismuth subcitrate during a period of 2 weeks the complaints disappeared and an eradication was obtained in 7. Histology of the antral mucosa demonstrated a type B chronic active gastritis in all patients. A Helicobacter pylori specific serology was positive in all 10 patients. This test was also positive in 17 out of 35 asymptomatic first degree family members; this is an illustration for the high family prevalence of Helicobacter pylori.

Lack of ciprofloxacin ototoxicity after repeated ototopical application

The possible side effects of ototopically applied ciprofloxacin on inner ear function were investigated. The hearing function of pigmented guinea pigs was evaluated by daily frequency-specific evoked response audiometry after repeated application of the drug to both ears. Ciprofloxacin appeared to have no statistically significant effect on the hearing thresholds of the experimental animals.

Acoustic simulation experiments with preprocessed speech for an 8-channel cochlear implant

A speech processor for simulation of preprocessed speech in cochlear implantation has been developed. An acoustic simulation of spectrally reduced speech was presented to 169 normally hearing subjects. Several perceptual tests with 9 different filter conditions were carried out. The intelligibility of sentences and the discrimination of phonemes in nonsense syllables were measured. It was established that even within one test session, an important learning effect occurred.

Ultrasonography of liver haemangioma. A report of 35 patients totalizing 53 lesions

During the last two years a total of 53 liver angiomas in 35 patients were examined by sonography. The angiomatous nature of these lesions was proven by angiography, CT, laparotomy, laparoscopy or autopsy. In this material the most striking sonographic data are the reflective character of the angiomas (94%), the subcapsular location (70%), the small size under 2 cm. (32%) and the multiplicity (35%). 90% of the lesions larger than 3 cm. tend to display polylobular contours.

Distortion products f1 + fh and 2f1 + fh in the inner ear

The ear introduces spectral components which are not present in the stimulating sound. These components are commonly attributed to nonlinearities in the inner ear. In this paper it is shown that the sum product of f1 + fh and cubic sum product 2f1 + fh, perceptively measured, do behave as predicte d by the conventional distortion theory of a power series nonlinearity and that they are most likely masked by the d.c. component generated by the same nonlinearity. We present a model in an attempt to explain the data.