Auditory cortical activation in severe-to-profound hearing-impaired patients monitored by SPET

Single photon emission tomography was used to map blood flow increase in temporal and parietal cortex after auditory stimulation in 25 subjects: 10 normal-hearing, 10 severe-profound hearing-impaired and 5 totally deaf. After a 500 Hz pure tone stimulation, a marked perfusion increase was observed, particularly at the level of the contralateral auditory temporal cortex. Blood flow increase in temporal and parietal cortical areas of normal subjects was significantly higher than that observed in severe-to-profound hearing-impaired patients. In all cases, following 500 Hz pure tone acoustic stimulation, the most lateral sagittal slice tomograms (48.75 and 56.25 mm) showed the highest blood flow increase. Statistically significant differences were also observed between normal subjects and hearing-impaired patients in the 48.75 mm sagittal tomogram. In 2 hearing-impaired patients, the single photon emission tomography pattern showed activation of the intermediate sagittal tomogram, suggesting a possible new tonotopic cortical arrangement. No significant activation was present in totally deaf patients. In conclusion, Single Photon Emission Tomography appears to be a useful tool in the evaluation of auditory cortical activation and cortical plasticity, in severe-to-profound hearing-impaired patients. Moreover, it could be a useful test for the study of auditory central pathways.

Balloon kyphoplasty in traumatic fractures of the thoracolumbar junction. Preliminary experience in 12 cases

AIM

The purpose of this study was to assess the effectiveness and safety of Ballon Kyphoplasty as a new method of treatment for traumatic fracture of the thoracolumbar junction.

METHODS

We treated twelve patients 8 patients male and 4 female. The average age was 47,3 years (22-75 years). The interested vertebrae and therefore the procedures have been 13 since in a patient two vertebrae have been treated. In 9 cases the interested vertebra was L1, in 2 cases L2 and one case D11 and D12. Following the classification of Magerl 9 fractures were of A1.2 fractures and one fracture respectively of type A1.3, A2.2, A2.3, A3.1. We have never placed indication to Balloon Kyphoplasty in the fractures of the type B and C, neither in the complete burst fractures (A3.2 and A3.3), neither in the fractures of the A1.1 type. Balloon Kyphoplasty has been carried out using the Kyphon system (Kyphon Inc. Sunnyvale, CA, USA). In the patients older than 50 years (7 cases) we have used polymethylmethacrylate (PMMA), as filling material, while in the patients younger than 50 years (5 in total), we have used Calcibon (Biomet, Inc.Warsaw, Indiana) in 4 cases and in one case a new material called KyphOs (Kyphon Inc. Sunnyvale, CA, USA). These last two types of material are made up of tricalcium phosphate that, although less manageable of the PMMA and less resistant initially, in the time it will be reabsorbed and osteointegrated.

RESULTS

The method demonstrated swift pain relief associated with an evident augmentation in the resistance and restoration of the vertebral body's physiological shape. No patient has worn a postoperative orthesis. In all the cases we obtained an optimal stabilization in the follow-up minimal to 4 months. In no case we observed a structural yielding of the vertebra.

CONCLUSIONS

Kyphoplasty is an effective, alternative, simple and safe treatment of traumatic fracture of the thoracolumbar junction.

Scanning electron microscopy of cochlea in new-born rats exposed to hyperbaric oxygen: preliminary report

The aetiology of hearing loss in new-borns in neonatal intensive care is still debated. While the physiopathology of brain, lung and retina damage related to oxygen supplementation has been widely described, no studies have been carried out to define the relationship between hearing loss and supplementation of oxygen in new-borns. In the present investigation, the cochlear morphology of new-born rats was evaluated by means of scanning electron microscopy in order to assess morphological changes after supplemental oxygen administration. After treatment, electron microscopy revealed many changes in the morphology of outer hair cells, if compared to normal rats of the same age. The results suggest that cochlear changes are similar to those previously observed in other regions and may be related to a vascular mechanism of hypoxia-ischaemia and neovascularization and/or an oxidative stress.

Two proline-rich peptides from pig (Sus scrofa) salivary glands generated by pre-secretory pathway underlying the action of a proteinase cleaving ProAla bonds

The primary structures of two salivary proline-rich peptides (PRP-SP-A, M 6156.0 amu and PRP-SP-B, M 1905.0 amu), from pig (Sus scrofa) were determined. The PRP-SP-B peptide, 21 residues long, overlaps with a sequence repeated 43 times in three deposited cDNAs coding for PRP proteins cloned from porcine parotid glands (Swiss-Prot codes: Q95JC9, Q95JD1, Q95JD0). PRP-SP-A peptide, 56 amino acid residues long, overlaps with the N-terminus repeats of Q95JC9 and Q95JD1 and it is phosphorylated at Ser 12 and 14. The two peptides were found both in whole saliva and in granules from pig parotid glands. The biosynthesis of the two peptides implies the action of a proteinase responsible for Pro downward arrow Ala cleavage in the pre-secretory process.

Statherin levels in saliva of patients with precancerous and cancerous lesions of the oral cavity: a preliminary report

OBJECTIVE

The aim of this study was to measure concentration of human salivary statherin in patients with oral cavity pathologies and salivary gland diseases.

SUBJECTS AND METHODS

Levels of statherin were analysed with High Performance Liquid Chromatography (HPLC) in following groups of subjects: group A: 24 patients with neoplastic diseases of salivary glands, group B: 13 patients with inflammatory lesions of salivary glands, group C: 13 patients with precancerous and cancerous lesions of the oral cavity excluding salivary gland tumors, group D: 20 healthy volunteers (control group).

RESULTS

Our preliminary data indicated a sensible reduction of the statherin level in the saliva of patients with precancerous and cancerous lesions of the oral cavity (group C) compared with the healthy subjects (group D). The statherin levels are not significantly reduced either in the inflammatory (group B) or in the salivary glands tumours (group A), compared with the healthy subjects (group D).

CONCLUSION

Statherin could play a protective effect in oral cavity in association with its other functions.

Tensor veli palatini electromyography with surface electrode applied transnasally

A new technique is proposed for paratubal electromyography, using a surface, non-invasive, electrode applied transnasally under nasopharyngoscope guidance. This electrode records activity of the tensor veli palatini muscle during swallowing. This technique is of interest for two reasons: endoscopic guidance offers the possibility to check correct positioning of the electrode recording at tensor veli palatini muscle level. Introduction of the non-invasive surface electrode is simple and not painful.

Final height in a patient with Laron syndrome after long-term therapy with rhlGF-I and short-term therapy with LHRH-analogue and oxandrolone during puberty

OBJECTIVE

To report our experience on long-term treatment with recombinant-human-IGF-I (rhIGF-I) of a female patient with Laron syndrome (mutation G223G in the GH receptor gene), who received short-term treatment (1 yr) with LHRH analogue at the start of puberty and subsequently with oxandrolone.

CASE REPORT

The patient started IGF-I therapy (dose 40 microg/kg bid for 9 months, 80 microg/kg bid until 13.7 yr of age and 120 microg/kg bid thereafter) when she was 7.6 yr old (height -6 sds), and was treated for 9.4 yr until final height (cm 129.7; -5.5 sds). At first signs of puberty (age 12.7 yr; height 116.3; -5.3 sds), LHRH analogue was started (3.75 mg/28 days) and bone age progressed by 6 months in the 12-month period. Growth velocity decreased in the 6-12th month of combined treatment (0.9 cm/6 months), and treatment was suspended. At age 14.8 (height 124.5; -6.6 sds), oxandrolone was added (0.1 mg/kg/day), but after 12 months (height 128 cm; -5.7 sds) bone age increased from 11.5 to 13.5 yr and the drug was stopped. No side effects occurred during the various treatments. Body segments progressed harmonically: there was a tendency towards improvement in the upper to lower body segment ratio and in cranial growth. Only biiliac diameter did not increase during LHRH treatment. During the 9-yr period, body mass index (BMI), subscapular and triceps skinfold centiles did not show any significant variations.

CONCLUSIONS

Our patient with Laron syndrome after long-term treatment showed a final result below the initial expectations, confirming that IGF-I used with the present schedule is less effective than GH in GH-deficient patients. LHRH analogue therapy at puberty was associated with a slower bone age maturation but with an almost complete arrest of growth. On the contrary, oxandrolone sustained growth but caused an excessive maturation of bone age. Other strategies are necessary to improve final height in these patients.

Use of titanium mesh in comminuted fractures of frontal sinus anterior wall

The personal experience with the surgical treatment of reduction and fixation of comminuted fractures of the anterior wall of the frontal sinus is reported. Cosmetic results were examined with regard to patients' degree of satisfaction on a 0 to 2 scale and nasal function assessed via rhinoscopy and nasal endoscopy during clinical follow-up, in the course of which the integrity and functionality of the supraorbitary and facial nerves were evaluated. All patients were satisfied, on the whole, with the aesthetic result, with 0-degree satisfaction (no deformity compared with their condition prior to the injury). The operations were performed between the 2nd and 7th post-injury day. The importance of the preoperative clinico-radiological work-up is stressed, with particular regard to the detection of simultaneous involvement of the inferior and/or posterior wall, and to the choice of surgical approach. The evolution of the surgical techniques in the treatment of frontal sinus fractures is discussed. With reference to the new means of fixation, in cases of comminuted fractures of the anterior wall, titanium mesh is preferred. In the Authors' opinion it combines excellent fixation with easy adaptability (cosmetic results are good) without requiring in the majority of cases, autologous bone grafts.

Can chronic nasal obstruction cause dysfunction of the paratubal muscles and otitis media? An experimental study in developing Wistar rats

OBJECTIVE

To quantitatively analyze modifications of the paratubal muscles in developing Wistar rats following nasal obstruction.

MATERIAL AND METHODS

Twenty-four Wistar rats were used. Twelve were examined at 6, 8 and 12 weeks after birth and were considered normal controls. The nostrils of the remaining 12 rats were bilaterally obstructed by means of a synthetic resin 28 days after birth. The animals were sacrificed at either 2, 4 or 8 weeks after nostril occlusion. Serial sections were made in the dorsoventral plane and stained with hematoxylin-eosin. Four 5 x 5 microm2 areas, selected within the paratubal muscles, were histologically analyzed and the number of muscular fibers was counted manually.

RESULTS

The number of tensor veli palatini muscle fibers progressively decreased in the obstructed rats compared with age-matched normal controls and in those that had been obstructed for 4 and 8 weeks these reductions were statistically significant.

CONCLUSION

The correct development of the paratubal muscles seems to be linked to physiological nasal breathing and is negatively affected by oral breathing.

[Surgical features on intraoral approach for the management of isolated zygomatic arch fractures]

The Authors report on their experience of 18 patients with isolated fractures of the zygomatic arch who were treated via intraoral approach. The procedures were performed between the 2nd and 8th post-trauma day and the results obtained were evaluated via post-operative CT scan and periodic follow-up visits for six months. In describing the surgical technique, the Authors recommend that the fracture be reduced with the patient's mouth open, in order to overcome the anatomical obstacle constituted by the coronoid process of the mandible and avoid, as far as possible, external approaches and osteosynthesis with screws or miniplates, which often give rise to unaesthetic results and localized pain. In conclusion, this approach is seen to be the method of choice in the treatment of isolated zygomatic arch fractures in that it is simple, effective and substantially free from complications.

Postural control in horizontal benign paroxysmal positional vertigo

Sixteen patients affected by benign paroxysmal positional vertigo of the horizontal semicircular canal (BPPV-HSC) were investigated by means of dynamic posturography (DP) and during bithermal caloric stimulation. Data were compared to data from 40 patients with benign paroxysmal positional vertigo of the posterior semicircular canal (BPPV-PSC) and 20 healthy controls. No postural deficit was observed before or after a liberative Lempert's manoeuvre when patients were compared to control subjects. BPPV-PSC postural scores were significantly impaired compared to scores from the BPPV-HSC group. A residual significant postural impairment was also observed after a successful liberative manoeuvre in the BPPV-PSC group. Electronystagmographic recordings before recovery revealed significant hypoexcitability of the affected ear in 8/16 patients of the BPPV-HSC group. After the liberative manoeuvre, a symmetric bilateral response to caloric stimulation was recorded in all patients. Three main conclusions can be drawn from the present data. First, disorders of the horizontal semicircular canal do not change postural control. Second, dynamic posturography can detect the postural imbalance due to posterior semicircular canal dysfunction even after resolution of paroxysmal vertigo attacks. Third, utricular dysfunction can be ruled out as a cause of the residual postural deficit observed in BPPV-PSC patients. Therefore the recovery delay observed even 1 month after the liberative manoeuvre in the BPPV-PSC-group might be due to the persistence of small amounts of residual debris in the canal, to paralysis of ampullar receptors, or to the time needed for central vestibular re-adaptation.

Association between vitiligo and spondyloarthritis

OBJECTIVE

To establish if spondyloarthritis (SpA) and vitiligo occur together more frequently than by chance.

METHODS

All consecutive patients with SpA seen in a 6 month period were evaluated for vitiligo by an experienced dermatologist. The control group included the 2 consecutive patients without SpA seen after each patient with SpA.

RESULTS

Two hundred thirty-four patients with SpA (131 men, 103 women; mean age 59 +/- 18.3 yrs) were seen in the study period. Of these, 43 had ankylosing spondylitis (AS), 112 psoriatic arthritis (PsA), 14 SpA associated with inflammatory bowel disease, 64 undifferentiated SpA, and one reactive arthritis. The 468 control patients (360 women, 108 men; mean age 68.5 +/- 2 yrs) had various degenerative and inflammatory rheumatic diseases. Eight (3.4%) patients out of 234 with SpA had type A vitiligo. In the control group, 5 (1.06%) out of 468 had type A vitiligo. The difference was statistically significant (p < 0.05). Of the 8 patients with coexisting vitiligo and SpA, 4 had PsA, 2 primary AS, one AS associated with Crohn's disease, and one undifferentiated SpA. Of the 5 patients with vitiligo in the control group, one had rheumatoid arthritis, one S ogren's syndrome, one palindromic rheumatism, one crystal arthropathy, and one osteoarthritis.

CONCLUSION

Our results suggest that vitiligo and SpA do not coexist by chance and that vitiligo should be included in the list of diseases associated with SpA.

The role of cholinergic transmission in outer hair cell functioning evaluated by distortion product otoacoustic emissions in myasthenic patients

Outer hair cells (OHCs) are the source of otoacoustic emissions, following a tropomyosin-miosin-dependent contraction, which are regulated by the olivocochlear bundle via the release of acetylcholine (ACh). ACh acts on ACh receptors (AChR) located on the OHC post-synaptic membrane. In myasthenia gravis (M.G.) neuromuscular transmission is reduced due to the action of AChR autoantibodies. It has previously been shown that M.G. induces a reduction in transient evoked otoacoustic emissions (TEOAEs), which is reversed after administration of a cholinesterase (AChE) inhibitor. Distortion product otoacoustic emissions (DPOAEs) were recorded before and 60 min after oral administration of 60 mg pyridostigmine bromide in 25 patients with normal hearing affected by M.G. The results were compared with those from 25 age-matched normal controls. Mean values of DPOAE amplitude in myasthenic patients were significantly (p < 0.05) lower at all frequencies before drug administration. All patients showed an overall significant (p < 0.05) increase in DPOAE amplitude after drug administration, although without reaching the control values. Such a recovery was more evident and highly significant (p < 0.01) for middle and high frequencies and could be explained by a higher concentration of ACh receptors in the basal and middle cochlear turns. These data seem to confirm the role of ACh in the neurotransmission of the auditory efferent system and may represent a new in vivo model for the investigation of the physiology of this system.

Coexisting Behçet's syndrome and spondyloarthritis

A patient suffering from Behçet's syndrome and undifferentiated spondyloarthritis developed dactylitis and psoriasis over the next three years.

Reduced spontaneous growth hormone secretion in patients with Turner's syndrome

We evaluated growth hormone (GH) secretion in 81 patients with Turner's syndrome (TS) (mean age 10.7+/-3.6 y) with respect to karyotype, auxological characteristics and growth response to GH treatment (1 IU/kg/wk). None of the patients had spontaneous puberty or had started replacement therapy with estrogens. Thirty-nine patients (48%) had monosomia 45X, 29 (36%) structural abnormalities of the X chromosome and 13 (16%) X mosaicism. Before the start of GH therapy, each patient underwent an evaluation of mean nocturnal GH concentration (MGHC) and 75 patients also underwent 2 pharmacological tests. MGHC of the TS patients did not differ from that of 29 prepubertal GH-deficient girls (GH peaks < 8 microg/l after pharmacological tests) and both groups were lower (p < 0.0001 and p < 0.0005, respectively) than MGHCs of 27 short normal girls (GH peak > 8 microg/l). MGHC of the patients with TS was negatively correlated (p < 0.001) with bodyweight excess (BWE) at multiple regression analysis. MGHC of the TS patients with BWE < 20% was significantly higher (p < 0.02) than that of the TS patients with BWE > 20%, but again did not differ from that of the GH-deficient patients and was lower (p < 0.001) than that of the short normal girls. MGHC did not significantly differ between the 3 groups subdivided according to karyotype. Forty-four percent of the TS patients showed GH responses to pharmacological tests < 8 microg/l. Height velocity SDS at first and second year of therapy was not influenced by MGHC levels, chronological or bone age, target height or BWE. In conclusion, spontaneous secretion in our patients with TS was lower than that of the short normal prepubertal girls and did not differ from that of GH-deficient subjects, even if we excluded overweight patients. The level of GH secretion was unable to predict GH response to treatment.

Relationship between chronic nasal obstruction and craniofacial growth: an experimental model

The aim of this paper was to verify if the growth of the nasomaxillary complex can be influenced by a purely functional alteration such as nasal obstruction, which was induced experimentally in a genetically controlled animal model. Sixty albino rats were employed. Twenty of them had the right nostril occluded by a synthetic resin; another twenty had both nostrils occluded; the other 20 were taken as control group. When the growth was completed, the rats were sacrificed and cephalometric analysis was carried out. Both treated groups showed a statistically significant reduction in overall weight and height, in the vertical development of the nasomaxillary complex and in the skullbase longitudinal axis. After discussing the literature on the subject, the authors conclude that normal craniofacial growth in the rat must somehow depend on physiological nasal breathing, which should therefore be considered of crucial importance.

A new instrumentation for posterior stabilization of cervical traumatic instability

BACKGROUND

Twenty-six patients underwent application of a new posterior plating system (CIDEF SYSTEM) for the alignment and the stabilization of C3-C7 cervical unstable fractures from January 1992 to December 1993.

METHODS

The osteosynthesis apparatus employs posterior articular screw fixation and plate application. Indications for surgery were the presence of neurological damage and cervical column instability. Operative techniques included decompressive and exploratory laminectomy in 20 cases and an articular resection in six cases of posterior superior articular fractures. A one-stage operation with an anterior approach, designed to remove anterior compression from herniated discs, or bone fragments, was also performed in four cases. Three cervical motion segments were immobilized in 15 of the treated cases; four in nine; and five in two. All patients were studied pre- and postoperatively with plain radiographs and computed tomography. Pre- and postoperative examinations demonstrated no alteration in neurological status.

RESULTS

At a mean follow-up period of 47 months, no evidence was found of infection, rejection of the materials used, or mechanical failure of the plates and screws; all patients with incomplete lesion showed improvement in neurological function. Four patients tetraplegic at admission expired from systemic complications (one from pulmonary embolism; one from Disseminated Intravascular Coagulopathy; one for sepsis; and one from myocardial infarction). All patients were immobilized for at least 4 months with a Philadelphia collar. No injury to the neural or vascular structures contiguous to the cervical spine has occurred.

CONCLUSIONS

The authors' experience suggests that the new system offers ease and versatility of application, restoration of vertebral alignment, enhanced spinal stability and is useful in the treatment of urgent and rather complex traumatic lesions of the lower cervical spine.