[Type and extent of preoperative imaging before radical prostatectomy]

BACKGROUND

According to current guidelines, in cases of newly diagnosed prostate cancer the type and extent of imaging to be performed should be based on the patient's risk profile. We investigated the rate of computed tomography (CT), magnetic resonance imaging (MRI), and bone scintigraphy carried out before radical prostatectomy (RP) depending on the individual risk profile.

PATIENTS AND METHOD

Between 1 January 2006 and 31 December 2007, a total of 1,018 consecutive patients who had not received neoadjuvant hormone therapy were treated with RP in our department. We determined the preoperative rates of CT, MRI, and bone scintigraphy by reviewing the medical charts. The patients were stratified according to the D'Amico criteria into low-risk, intermediate-risk, and high-risk groups.

RESULTS

Of the 1,018 subjects, 493 (48%) were classified as low-risk, 403 (40%) as intermediate-risk, and 122 (12%) as high-risk patients, respectively. The rate of preoperative abdominal CT/MRI and bone scintigraphy was 17 and 23% in the low-risk group, 25 and 39% in the intermediate-risk patients, and 39 and 57% in the high-risk group.

CONCLUSION

The rate of preoperative CT and bone scintigraphy is extremely high in the low-risk group. In contrast the rate in the high-risk patients more likely appears to be too low. The discrepancy between the rates of preoperative imaging subject to the patient's risk profile shows that precisely formulated guidelines addressing this issue are needed.

[Selection criteria for the expected management of localised prostate cancer]

Prostate cancer harbours the possibility of overtreatment more than any other malignant disease. Due to its slow growth, expected management is an established therapeutic option in newly diagnosed carcinomas. Improved diagnostic methods and the widespread use of PSA lead to earlier diagnosis of cancers that would not adversely affect the life expectancy of the patient, even when they were left untreated. Several statistical models have been published to identify such insignificant cancers; however, all such nomograms suffer from limited sensitivity and specificity. For the indication of expected management, comorbidity and life expectancy must be considered using risk scores and life tables. In general, expected management is a suitable option for elderly patients with low grade cancers. Young patients and those with intermediate or high-grade cancers are most likely to benefit from active local treatment.

An exploratory investigation of the effect of arsenic trioxide on anti-Gal antibody production in baboons

BACKGROUND

Arsenic trioxide (As2O3) is an anticancer drug that has been reported to induce apoptosis and inhibit differentiation in human plasmacytoma and normal plasma/B cells without significant myelosuppression. We assessed the ability of As2O3 as single therapy or in combination with an anti-CD20 monoclonal antibody (mAb) and whole body irradiation (WBI) to deplete B and plasma cells, both in vitro and in vivo, and to reduce the level of anti-alphaGal1-3Gal antibody (anti-Gal Ab) in baboons.

METHODS

In vitro the effect of As2O3 on antibody secretion (anti-Gal IgM, total IgG and IgM) was measured by enzyme-linked immunospot assay (ELISPOT). Its inhibition of proliferation of baboon splenocytes and the NCI-H929 human plasmacytoma cell line was measured by tritiated thymidine uptake. In vivo: all baboons (n=7) had undergone splenectomy. The effects of As2O3 (0.18 to 0.36 mg/kg) on B/plasma cell depletion and anti-Gal Ab production were assessed in three baboons. For comparison, three baboons received either WBI (2 x 150 cGy) or anti-CD20 mAb (20 mg/kg x 4 doses), or both WBI and anti-CD20 mAb. A final baboon received As2O3 + WBI (150 cGy) + anti-CD20 mAb. Anti-Gal Ab levels were measured daily by ELISA. Depletion of B cells from blood and bone marrow (BM) was monitored by flow cytometry and by histology of lymph nodes (LN). Autopsy was performed in three baboons.

RESULTS

In vitro: As2O3 (at 5 x 10-6 mol/l) reduced anti-Gal IgM and total IgM secretors by 76% (P=0.53) and 95% (P < 0.001), respectively, but did not reduce total IgG secretors. As2O3 inhibited in a dose-dependent manner the proliferation of activated splenocytes and of the NCI-H929 plasmacytoma cell line; complete inhibition was achieved at a dose of 1 x 10-5 mol/l. In vivo: As2O3 was found to be toxic at the doses given and was associated with the deaths of two of the four baboons that received it. Daily intravenous therapy with As2O3 alone reduced B cells (CD20+) in the blood (by 50 to 90%), BM (40%) and LN (20 to 30%), but anti-Gal Ab levels were not significantly decreased. Anti-CD20 mAb therapy alone or WBI alone depleted B cells by 100% in the blood and BM, and 80 to 100% in the LN. The combination of anti-CD20 mAb + WBI led to depletion of B cells in blood, BM and LN for 3 months, but reduction of anti-Gal Ab remained marginal. The combination of As2O3 + anti-CD20 mAb + WBI did not reduce anti-Gal Ab levels further. At autopsy in the latter baboon, B cells remained present in Peyer's patches and tonsils.

CONCLUSIONS

In vitro: As2O3 reduced B/plasma cell numbers and suppressed IgM secretors, but not IgG secretors. In vivo: As2O3 was not as effective as either anti-CD20 mAb or WBI in depleting B/plasma cells, and was largely ineffective in reducing anti-Gal Ab levels. Its administration was associated with considerable toxicity. Autopsy in one baboon suggested that B cells in Peyer's patches and tonsils may be resistant to therapy and remain a source of continuing production of anti-Gal Ab.

Cochlear implantation of Danish prelingually deaf children

The aim of the study was to review the indications, techniques and results of cochlear implant (CI) treatment with the Nucleus CI multi-channel electrode for the first children operated on in Denmark. The study material comprised 16 children (5 girls, 11 boys). Their median age at the time of CI operation was 27 months. Anacusis was caused by pneumococcal meningitis in 31% of the children in this relatively young prelingual material. Obliteration of the cochlea was found in two children, indicating the need for surgery as soon as possible after the verification of post-meningitis, total deafness. There were no technical difficulties with operating on the youngest children in the congenital group and the age of 2 years is optimal for implantation. These preliminary results have contributed definitively to an increase in the number of cochlear implantations being carried out in young prelingually deaf Danish children.

Annexin VI stimulates endocytosis and is involved in the trafficking of low density lipoprotein to the prelysosomal compartment

Annexins are calcium-binding proteins with a wide distribution in most polarized and nonpolarized cells that participate in a variety of membrane-membrane interactions. At the cell surface, annexin VI is thought to remodel the spectrin cytoskeleton to facilitate budding of coated pits. However, annexin VI is also found in late endocytic compartments in a number of cell types, indicating an additional important role at later stages of the endocytic pathway. Therefore overexpression of annexin VI in Chinese hamster ovary cells was used to investigate its possible role in endocytosis and intracellular trafficking of low density lipoprotein (LDL) and transferrin. While overexpression of annexin VI alone did not alter endocytosis and degradation of LDL, coexpression of annexin VI and LDL receptor resulted in an increase in LDL uptake with a concomitant increase of its degradation. Whereas annexin VI showed a wide intracellular distribution in resting Chinese hamster ovary cells, it was mainly found in the endocytic compartment and remained associated with LDL-containing vesicles even at later stages of the endocytic pathway. Thus, data presented in this study suggest that after stimulating endocytosis at the cell surface, annexin VI remains bound to endocytic vesicles to regulate entry of ligands into the prelysosomal compartment.

[Cochlear implantation in children. The first Danish results]

The aim of this study is to review indication, technique and results of cochlear implant (CI) treatment with Nucleus CI-multi-electrode of the first ten children operated in Denmark (five children with congenital deafness and five with acquired prelingual deafness due to meningitis). In the literature, the importance of early referral and operation at the age 2-3 (4) years for congenital deafness and as soon as possible on suspicion of acquired deafness (meningitis) is stressed. A short survey of our indications, technique and rehabilitation is presented. The results of treatment after 11-44 months' use of CI are that one child has language almost matching age, four use words and short sentences accompanied by support signing, three have sound reaction and say single words without sentence building, but of these two children have only used CI for a very short time and are improving. Two meningitis sequelae cases had cochlear ossification, which made the implantation difficult. Both patients had to be operated, and one of them is not using the processor.

Cerebrospinal fluid loss and threshold changes. 1. Hearing loss in the contralateral ear after operation for acoustic neuroma: an analysis of the incidence, time course, frequency range, size and pathophysiological considerations

In a prospective study, 60 patients who underwent surgery for unilateral acoustic neuromas had the hearing on the contralateral ear tested before and several times after surgery. In 40 patients, a threshold increase was found during the following 9 days. The changes were greatest in the low frequencies immediately after surgery, but after 1 week the treble also became involved. After 3 months, the hearing was normalized. The elder patients more than 50 years of age were more often affected, whereas sex, tumor size, surgical approach or duration of surgery had no influence. The pathophysiological mechanisms are discussed and an intracochlear fluid dysfunction caused by the loss of cerebrospinal fluid is suggested.

The effect of neonatal universal hearing screening in a health surveillance perspective--a controlled study of two health authority districts

The contribution describes the effect of a neonatal hearing screening program in terms of estimated prevalence rate of congenital hearing impairment and age at identification in two five-year cohorts born between 1990 and 1994 as a function of health authority districts (HADs). In addition, identically defined five-year birth cohorts from 1970 to 1974 and 1980 to 1984 living in the same HADs evaluated previously are used in the analysis, offering longitudinal data. In 1990 a non-targetted neonatal hearing screening program based on EOAE was introduced in the County-HAD, whereas the City-HAD continued its child hearing health surveillance program unchanged. Assuming an unchanged prevalence estimate of 1.5 per 1000 of congenital or early acquired (i.e. neonatal period) hearing disability, i.e. > or = 25 dB HL for the better ear at 0.5-4 kHz in both HADs, an underestimate of 68 per cent in the City and of 20 per cent in the County, respectively, was found at the time of data collection (January 1995). Significant longitudinal improvements in the early identification from the 1970-1974 cohort compared to the 1980-1984 cohort has been demonstrated, but the improvement in the proportion of children identified as a function of both 6 and 12 months of age in the 1990-1994 cohort is significantly greater, showing a median age at identification of 11 months in the County-HAD. The cross-sectional and longitudinal comparisons between the HADs imply that a neonatal universal hearing screening program with a 20 per cent coverage may add significantly to the early identification of children with early-onset hearing impairment.

Transthoracic needle biopsy with a coaxially placed 20-gauge automated cutting needle: results in 122 patients

PURPOSE

To determine the utility of coaxial transthoracic needle biopsy (TNB) with use of a 20-gauge automated cutting biopsy needle in the diagnosis of thoracic lesions.

MATERIALS AND METHODS

A retrospective review was performed in 122 patients. Computed tomography was used to guide coaxial TNB, which was performed with aspirating (n = 87) and automated cutting (n = 99) needles. The sensitivities for malignant and benign lesions were determined, with a comparison of the relative yields from the two techniques.

RESULTS

The overall diagnostic yield for coaxial TNB was 88%. For malignancy the sensitivity was 95%, whereas a specific benign diagnosis was obtained in 91%. Although no difference was found for fine-needle aspiration versus core biopsy of malignant lesions (92% vs 86%), a statistically significant difference was found for benign lesions (44% vs 100%, P<.05). Pneumothorax occurred in 54%.

CONCLUSION

Coaxial TNB performed with an automated cutting needle helps provide a diagnosis in the majority of patients with focal chest disease and is particularly useful in the diagnosis of benign lesions.

Regional cerebral activation during auditory stimulation in patients with cochlear implants

OBJECTIVE

To evaluate a possible change in the regional cerebral blood flow (rCBF) in the language-related cortical areas of the brain during stimulation of a cochlear implant.

METHODS

The rCBF was measured by single-photon emission tomography and inhalation of Xenon Xe 133, providing information on the regional functional level of the brain. A supplementary single-photon emission tomographic scan was also performed, using technetium Tc 99m hexamethylpropyleneamineoxime as a flow marker. The rCBF was measured during rest (baseline) and during auditory stimulation by presenting white noise and running speech to the ear with the implant.

PATIENTS

Five deaf patients who had undergone intracochlear or extracochlear implantation surgery.

RESULTS

As in subjects with normal hearing, notable activation was not found in the relevant primary auditory cortex on stimulation with white noise. Two of the patients with implants had an increase in the rCBF in the relevant contralateral hemisphere on stimulation with running speech, but in the other three patients, a notable increase was not detected. This lack of increase in the rCBF on speech stimulation was consistent with the lack of speech recognition experienced by the subjects when using the implant. In one subject, the implant had a beneficial effect on speech understanding that was associated with a significant increase in the cerebral blood flow in the Broca's speech area and Wernicke's second speech area.

CONCLUSIONS

Although the results are preliminary, the single-photon emission tomographic technique may be useful when evaluating the function of a cochlear implant. The method may also help select patients and/or ears for cochlear implantation. Four of five patients had functional defects of auditory relevant cortical areas, suggesting that their deafness might be associated with central impairment in addition to their cochlear defects.

Implantation of electromagnetic ossicular replacement device

Semi-implantable hearing aids consisting of permanent middle ear implanted magnet, either partial ossicular replacement prostheses (PORP's) or total ossicular replacement prostheses (TORP's) driven by an electromagnet placed in the ear canal have been tested on six patients undergoing surgery for chronic otitis. The surgical and audiological problems are described. The audiological results were excellent in all six cases. A functional gain of 40-70 dB can be obtained for entire frequency range of the audiogram.

A rare case of carpal dislocation

We present a rare case of carpal perilunate fracture-dislocation, with volar displacement of the distal carpal row and a proximal row location of the triquetrum. A pre-existing abnormal radio-luno-capitate alignment might have contributed to both the unusual volar direction and the difficulty encountered in its treatment, which caused us to perform a radiocarpal K-wire transfixation.

[Reversible hearing loss in the contralateral ear after surgery of acoustic neurinoma]

In a prospective study of 12 patients undergoing operation for acoustic neuromas, the hearing on the contralateral ear was tested before and systematically after operation. In 11 cases a perceptive loss of at least 20 dB was found at one or more frequencies during the first two postoperative weeks. The maximal average threshold decrease was 16.5 dB in the treble and 19.6 in the low frequencies. After three months the hearing had normalized in all cases. The loss of cerebrospinal fluid during operation diminishes the CSF pressure, which is then transmitted to the perilymph via the cochlear aqueduct, producing a transitory perilymphatic hypotonia and a relative endolymphatic hypertension mimicking an endolymphatic hydrops.

[Hearing loss after spinal anesthesia. An audiological controlled trial]

Audiological tests were conducted on 34 patients before and after undergoing an operation in spinal anaesthesia. One of these patients developed a considerable unilateral hearing loss in the low-frequency range, which persisted until an epidural blood-patch was given. Unexpectedly, we also found a general small but significant threshold shift at 500 Hz, which has never before been described in the literature. The biological mechanism is discussed, and the results suggest that the explanation of the hearing loss could be a condition similar to endolymphatic hydrops, resulting from perilymphatic hypotension due to loss of liquor during and after the spinal anaesthesia.

[Congenital hearing disability among children in Copenhagen]

The survey describes the detection, identification and aetiology of congenital/early acquired (i.e. neonatal period) hearing disability in a well-defined cohort of children, living in the Copenhagen area (Copenhagen City and County). The effect of intervention programmes is also mentioned. The children's age at identification can be considered as an evaluation of the quality of hearing screening aimed towards the detection of children with congenital/early acquired hearing disability, while the results of the aetiological evaluation reflects the quality of the diagnostic evaluations performed within paediatric audiology. The prevalence rate of 1.5/1000 of congenital/early acquired hearing disability for children born during 1980-1990 is unchanged in comparison to the period 1970-1980. An improvement in the detection of children with congenital/early acquired hearing disability is found, the identification is, however, still delayed in both children at risk and not-at-risk of hearing disability. The parents are most frequently the first to raise suspicion of their child's hearing disability, but very seldom apply to the audiological department without a referral from the primary health care sector. A change in the aetiology of congenital/early acquired hearing disability has taken place within 1980-1990, which can be ascribed to the reduced frequency of foetal rubella infection, while the frequency of inherited hearing disability has increased. The outcome of intervention programmes, evaluated by means of type of school, education, and employment situation is briefly described in relation to the social consequences of a hearing disability.

Preliminary results and considerations in hearing screening of newborns based on otoacoustic emissions

Many factors may determine the success of a screening programme based on the presence of evoked otoacoustic emissions (EOAEs), including age at test, stimulus used, examiner experience and method of data evaluation. This short report summarizes our experience based on pilot trials of a screen in the whole population of newborns using EOAEs. Optimal test time is when babies are at least 24 h old. Meticulous training of examiners and ultimately automatic evaluation of recordings is essential. Based on visual evaluation of responses to click stimuli at peak-equivalent sound pressure levels of 72.5 and 60.5 dB, 95.5% of babies passed the screen on at least one ear. However, we could only identify an EOAE in 81% of the waveforms for the 60.5 dB stimulus, and only 73% of the non-linear components derived by combining responses to the two stimuli contained an identifiable EOAE. At the present time, examination of both linear and non-linear components is indicated.

The bone-anchored hearing aid. Osseointegration and audiological effect

The results of treatment of the first 12 Danish patients with the Brånemark titanium implant system and the bone-anchored hearing aid (BAHA) are reported. All implants were osseointegrated, judged by 99mTC-scintigraphy, X-ray examination and clinical examination. Skin reactions were few, transient and short lasting. The patients experienced the BAHA to be superior to both conventional BC hearing aids and AC hearing aids in practically all respects. Speech discrimination scores in quiet and in noise were similar for the 3 types of hearing aids.

Transforming growth factor-beta improves healing of radiation-impaired wounds

Exogenously applied TGF-beta 1 has been shown to increase wound strength in incisional wounds early in the healing process. An impaired wound healing model was first established in guinea pigs by isolating flaps of skin and irradiating the flaps to 15 Gray in one fraction using a 4-MeV linear accelerator. Incisions made 2 d after irradiation were excised 7 d later, and showed decreased linear wound bursting strength (WBS) as compared to non-irradiated control wounds on the contralateral side of each animal (p = 0.001). The effect of TGF-beta on healing of radiation-impaired wounds was studied using this model. Skin on both left and right sides of guinea pigs was irradiated as above. A linear incision was made in each side. Collagen with either 1, 5, or 20 micrograms of TGF-beta was applied to one side prior to closure with staples, whereas the contralateral side received saline in collagen. Wounds given either 1 or 5 micrograms of TGF-beta were found to be stronger than controls at 7 d (p less than 0.05), whereas those receiving the higher 20-micrograms dose were weaker than controls (p less than 0.05). Thus, TGF-beta in lower doses improved healing at 7 d but very large amounts of the growth factor actually impaired healing. In situ hybridization done on wound samples showed increased type I collagen gene expression by fibroblasts in wounds treated with 1 micrograms TGF-beta over control wounds. These results indicate that TGF-beta improved wound healing as demonstrated by increased WBS. This improvement is accompanied by an up-regulation of collagen gene expression by resident fibroblasts.

Low-frequency hearing loss after spinal anesthesia. Perilymphatic hypotonia?

Audiological tests were conducted on 34 patients before and after undergoing an operation under spinal anesthesia. One of these patients developed a considerable unilateral hearing loss in the low-frequency range, which persisted until an epidural blood-patch was given. Unexpectedly, we also found a general small significant threshold shift at 500 Hz, which has never before been described in the literature. The biological mechanism is discussed and the results suggest that the explanation of the hearing loss could be an endolymphatic hydrops resulting from perilymphatic hypotonia due to loss of liquor, during and after the spinal anesthesia.

Hearing decrease after loss of cerebrospinal fluid. A new hydrops model?

In a prospective study of 12 patients undergoing operation for acoustic neuromas the hearing on the contralateral ear was tested before and systematically day by day after operation. In 11 cases a perceptive loss of at least 20 dB was found at one or more frequencies during the first 2 postoperative weeks. A maximal average threshold decrease of 16.5 dB was found in the treble (2.4, 8 kHz average), while a tendency of a more pronounced decrease of 19.6 dB was seen in the low frequencies (125, 250, 500 Hz average). After 3 months the hearing had normalized in all cases. The explanation for the transitional loss supports the present theory: The loss of cerebro-spinal fluid during operation diminishes the CSF pressure. This decrease is transmitted to the perilymph via the cochlear aqueduct producing a transitory perilymphatic hypotonia, which in turn hydromechanically results in a relative endolymphatic hypertension mimicking an endolymphatic hydrops thus representing a human hydrops model.

[Bone-anchored hearing aids. Preliminary results]

The bone conduction hearing aid is employed for patients who cannot tolerate treatment with air conduction hearing aids and for whom operation cannot offer permanent improvement of hearing. Conventional bone conduction hearing aids are, however, uncomfortable to wear, amplification is frequently less effective and sounds are often distorted. A new type of bone conduction hearing aid, the bone-anchored hearing aid (BAHA) is presented. In this, sound is transferred directly to the cranium via a percutaneous titanium implant. The results of treatment of the first six Danish patients are presented after a therapeutic period of 8-24 months. The subjective effect of treatment was satisfactory in all of the patients. They all employed their BAHA all day and found that the effect was better than the effect of air conduction hearing aids and conventional bone conduction hearing aids on practically all points. Speech discrimination investigations in quiet and noisy surroundings confirmed the subjective assessment although the differences between BAHA and the two other types of hearing aids were not as great as the patients subjective impressions. The bone-anchored hearing aid, BAHA, should, in our opinion, become the bone conduction hearing aid of the future for patients who have a permanent need for this. It represents considerable progress in treatment of a group of patients for whom treatment has hitherto been difficult and unsatisfactory.

Otospongiosis and sodium fluoride. A clinical double-blind, placebo-controlled study on sodium fluoride treatment in otospongiosis

The effect of sodium fluoride treatment in patients with otospongiosis has been evaluated in a prospective clinical double-blind, placebo-controlled study of 95 patients. The results showed a statistically significant greater deterioration of hearing loss in the placebo group than in the group actively treated with 40 mg of sodium fluoride daily. These results support the view that sodium fluoride can change otospongiotic, active lesions to more dense, inactive otosclerotic lesions.

Age-related hearing difficulties. II. Psychological and sociological consequences of hearing problems--a controlled study

71 individuals aged 70-75 years, whose audiological profile has been described in part I' of the study, were subjected to an extensive psychological questionnaire to evaluate the influence of hearing impairment on the psychological and sociological profile and general behaviour. The subjects consisted of three groups: first-time applicants for hearing-aids, re-applicants, and a control group not complaining of hearing problems. Neither hearing deterioration in general, as measured by hearing handicap and communication handicap, nor noise-induced hearing impairment was correlated to social class. The general activity level and the intellectual capacity were independent of hearing level, but a significant correlation was found between activity level and intellectual capacity. Also social class was correlated to activity level and intellectual level. Thus, a highly active life was correlated to preserved intellect and higher social class. Most of the elderly regarded themselves as being active, but this did not correlate with the objective activity score. Decreased activity was not correlated to hearing problems, but rather to physical limitations, decreased number of interests, tiredness. Self-perception was not influenced by the degree of hearing handicap and a stable mood and an optimistic attitude predominated. Only 14% experienced a depressed mood, and this state seemed to be linked to deteriorated hearing.

Age-related hearing difficulties. I. Hearing impairment, disability, and handicap--a controlled study

The study compares the audiological profile of a group of first-time applicants for hearing aids, a group of re-applicants and a group of non-complainers, aged 70-75 years (n = 71). In spite of overlap in range, a significant difference in thresholds and discrimination was found. The lip-reading capacity was well preserved in the elderly, but showed a significant correlation to the general health condition. The audiological benefit of hearing-aids did not increase with early fitting. General satisfaction with life was independent of satisfaction with hearing; two thirds of the patients were satisfied with their aids and used them regularly. The rest were dissatisfied and used them less than once a week. The aids were most systematically used to watch TV. Pure-tone average and handicap scaling were compared as guidelines for hearing-aid fitting. The most powerful tool to identify those in need of hearing-aids was handicap scaling based on interviews concerning self-assessed hearing difficulties.

Hearing problems and the elderly

Hearing problems have a profound influence on the lives of the elderly. The ability to communicate is frequently a deciding factor in determining a person's autonomy, independence, and overall well-being and happiness. In the works of Ralph Naunton, in the introduction to the report, "Society is ill-informed about the importance of speech communication and about the devastating effects of communication difficulties, and it is ill-informed about the cost effectiveness of providing communication aids to the elderly and about the cost to society and to the individual of not providing them." This report was written for health and social workers, politicians, planners, and others who care for the elderly. The purpose of the report is to provide insight into some of the most important questions concerning hearing problems of the elderly, to show what can be expected from the rehabilitative audiological services, and to make a case for more attention to the hearing problems of elderly persons. The report is organized around these 13 topics: Which criteria should be used in defining the population of elderly persons with hearing problems? How should hearing loss be described by different professions? Evaluation of present services; Do hearing thresholds differ among those having or applying for a hearing aid and those who do not have a hearing aid? Is early fitting of a hearing aid important for a positive result of hearing aid treatment? Can hearing loss provoke or promote senility? Are hearing and quality of life related factors in old age? Crises in the lives of the elderly provoked by hearing problems; Hearing problems and social class; Is audiovisual perception in the elderly a function of age? Qualitative aspects of hearing problems and influence of tinnitus on hearing; Services which should be available today for the elderly person with a hearing problem; How can we most effectively communicate the available knowledge to the elderly, to the relevant authorities, and to any other group which can be active in relieving hearing problems in the elderly? The report includes a reference list on each of the topics discussed as well as an extensive list of reading that should be useful for further study.

Otospongiosis and sodium fluoride. A blind experimental and clinical evaluation of the effect of sodium fluoride treatment in patients with otospongiosis

The effect of sodium fluoride treatment in patients with otospongiosis has been evaluated blindly in a morphological and microchemical element analysis of otospongiotic specimens together with a prospective clinical double-blind, placebo-controlled study. The results show that using the calcium/phosphorus ratio as an indication for bone maturity, the sodium fluoride treatment can stabilize otospongiotic lesions in retaining calcium relative to phosphorus. The clinical double-blind, placebo-controlled study of 95 patients showed a statistically significant worse deterioration of the hearing loss in the placebo group than in the active treated (40 mg sodium fluoride daily) group, supporting the view that sodium fluoride can change otospongiotic, active lesions to more dense, inactive otosclerotic lesions. We have postulated in the past that the actual mechanism of the cochlear loss is toxic enzymes produced by histiocytes at the periphery of the microfoci, and it may be that sodium fluoride has some effect on these enzymes.

Microdissection, cytocochleogram and transmission electron microscopy: a technique for a comprehensive evaluation of human cochlear pathology

A technique combining microdissection with cytocochleogram and TEM is described as a tool for studying human cochlear pathology. It is recommended in cases well studied from a clinical point of view and with a short time interval between death and fixation.

Hearing disability and communication handicap for compensation purposes based on self-assessment and audiometric testing

It is reasoned that for compensation or epidemiological studies an evaluation of hearing disability and the concomitant handicap must include the ability to perceive visual cues. A scaling procedure for hearing- and audiovisual communication handicap is presented. The procedure deviates in two ways from previous handicap assessments: (1) It is based on individual self-assessment of semantic speech perception but can be implemented by means of professional audiological test procedures. (2) The system does not make use of pure-tone auditory thresholds as a predominant audiological principle, but is based on speech perception. The interrelationship between auditory and audiovisual handicap is evaluated. A total score including audio- and audiovisual perception handicap is proposed and a suggestion for disability percentages is presented.

Adolescent smokers and nonsmokers: profiles and their changing structure

The status of smoking among tenth-graders in Jerusalem high schools as part of a smoking prevention program was examined. Two consecutive cohorts of 792 and 771 subjects were given questionnaires on two occasions: at the onset of the study (fall 1980 for the first cohort and fall 1981 for the second), and either 2 years (first cohort) or 1 year (second cohort) later. Based on the theory that smoking relates to counterconformity entailing rebelliousness and conformity to a nonconformist peer culture, subjects were asked about their behaviors and cognitions concerning school, home, peers, drinking, and smoking. It was reasoned that no single variable can predict, let alone explain, the onset and continuation of smoking and that the various factors that relate to smoking and distinguish between smokers and nonsmokers (a) constitute a systematic and coherent syndrome of counterconformity variables, which (b) reinforce each other, and (c) that over time, smoking and counterconformity come to affect each other reciprocally. These hypotheses were supported by the data. Smokers were found to differ from nonsmokers in a number of ways that were all related to counterconformity. Truancy and an inability to resist peer pressure to smoke, manifestations of two aspects of this syndrome, were the best predictors of smoking for both sexes, both cohorts, and both measuring occasions. With time, personal rebelliousness tended to become a weaker predictor, while social interaction variables became relatively stronger. The intercorrelations among the nonsmokers who became smokers were the highest, as predicted. The nature of the syndrome, its changing structure, and implications for prevention are discussed.