Resection via median sternotomy in patients with lung cancer invading the main pulmonary artery

BACKGROUND

Conventional pneumonectomy via posterolateral thoracotomy is not always possible in cases with T4 tumour with widespread pulmonary artery invasion. Our objective is to present our surgical experiments in cases with a hilar mass who were thought to have pulmonary artery invasion, in whom we performed intrapericardial pneumonectomy through median sternotomy.

METHOD

Nine cases who had undergone intrapericardial pneumonectomy via median sternotomy were included in this study and evaluated retrospectively. These cases were thought to have right or left pulmonary artery invasion in preoperative evaluation.

RESULTS

Two cases had right and seven cases left pneumonectomy. Based on TNM classification, two patients were Stage IIB, two Stage IIIA and five Stage IIIB in postoperative histopathological examination. Either right or left main pulmonary artery invasion was seen in IIIB cases while invasion was limited to the pericardium in the others. Lymph node involvement was detected in seven cases while six cases were N1, and one case was N2. There was no operative mortality.

CONCLUSION

Standard posterolateral thoracotomy might not be possible in all cases, particularly in patients with hilar tumours invading the main pulmonary artery. In such patients an intrapericardial approach with median sternotomy provides an easier and safer alternative while making it possible to have wider lymph node dissection. Furthermore, if necessary, hemi-clamshell incision can easily be added to this approach.

Plasma visfatin concentrations in subjects with type 1 diabetes mellitus

BACKGROUND/AIMS

Visfatin is a recently discovered adipokine, and its circulating concentrations have not been adequately studied in type 1 diabetes mellitus (DM). Therefore, this study was designed to examine plasma visfatin levels in type 1 diabetic patients and to determine the relationships between visfatin and duration of diabetes, body mass index, glycemic control, insulin dosage and lipid profile.

METHODS

Forty-eight patients with type 1 DM and 26 healthy controls were investigated.

RESULTS

Type 1 diabetic patients had significantly low visfatin levels compared with controls (18.8 +/- 1.7 vs. 20.2 +/- 0.3 ng/ml; p < 0.0001). Visfatin levels were comparable between patients with a short duration of diabetes (<10 years) and patients with a long duration of diabetes (>or=10 years) (18.9 +/- 1.7 vs. 18.2 +/- 2.0 ng/ml; p > 0.05). There was a significant correlation between visfatin and hemoglobin A1c (HbA1c) even after the adjustment for age, sex, body mass index and duration of diabetes (r = -0.48, p = 0.005) in the patient group. Multivariate analysis showed that significant determinants of visfatin concentrations were HbA1c and duration of diabetes (r(2) = 0.27).

CONCLUSION

These data emphasize that plasma visfatin concentrations are lower in patients with type 1 DM and related to glycemic control reflected by HbA1c.

Validity of the Italian adaptation of the Tinnitus Handicap Inventory; focus on quality of life and psychological distress in tinnitus-sufferers

The aim of this study was to determine the validity of the Italian translation of the Tinnitus Handicap Inventory (THI) by Newman et al. in order to make this self-report measure of perceived tinnitus handicap available both for clinical and research purposes in our country and to contribute to its cross-cultural validation as a self-report measure of perceived severity of tinnitus. The Italian translation of the Tinnitus Handicap Inventory (THI) was administered to 100 outpatients suffering from chronic tinnitus, aged between 20 and 82 years, who attended the audiological tertiary centres of the University Hospital of Modena and the Regional Hospital of Treviso. No segregation of cases was made on audiometric results; patients suffering from vertigo and neurological diseases were excluded. Pyschoacoustic characteristics of tinnitus (loudness and pitch) were determined and all patients also completed the MOS 36-Item Short Form Health Survey to assess self-perceived quality of life and the Hospital Anxiety and Depression Scale as a measure of self-perceived levels of anxiety and depression. The THI-I showed a robust internal consistency reliability (Cronbach's alpha = 0.91) that was only slightly lower than the original version (Tinnitus Handicap Inventory-US; Cronbach's alpha = 0.93) and its Danish (Cronbach's alpha = 0.93) and Portuguese (Cronbach's alpha = 0.94) translations. Also its two subscales (Functional and Emotional) showed a good internal consistency reliability (Cronbach's alpha = 0.85 and 0.86, respectively). On the other hand, the Catastrophic subscale showed an unacceptable internal consistency reliability as it is too short in length (5 items). A confirmatory factor analysis failed to demonstrate that the 3 subscales of the THI-I correspond to 3 different factors. Close correlations were found between the total score of the Italian translation of the Tinnitus Handicap Inventory and all the subscales of the MOS 36-Item Short Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale scores indicating a good construct validity. Moreover, these statistically significant correlations (p < 0.005) confirmed that the self-report tinnitus handicap is largely related to psychological distress and a deterioration in the quality of life. On the other hand, it was confirmed that the tinnitus perceived handicap is totally independent (p > 0.05) from its audiometrically-derived measures of loudness and pitch thus supporting previous studies that focused on the importance of non-auditory factors, namely somatic attention, psychological distress and coping strategies, in the generation of tinnitus annoyance. Finally the results of the present study suggest that the THI-I maintains its original validity and should be incorporated, together with other adequate psychometric questionnaires, in the audiological examination of patients suffering from tinnitus and that psychiatric counselling should be recommended for the suspected co-morbidity between tinnitus annoyance and psychological distress.

Profile Analysis and Growth Curve for Body Mass Index of Broiler Chickens Reared Under Different Feed Restrictions in Early Age

Abstract. The purpose of this study is to investigate the effect of different feed restrictions which were applied in early period on change of Body Mass Index of Ross 308 broiler chickens. For this aim we used to two different statistical methods, namely Profile analysis and Growth curves. The daily body weight and weekly body length change of chickens was collected from 7 days of age to 42 days of age. Profile analysis was used to compare differences among the groups and the Gompertz growth function was regressed from these data to estimate the growth parameters. The group profiles were not found parallel in terms of Body Mass Index (P<0.001) as a result of the Profile analysis. Therefore once concludes that the difference in Body Mass Index (BMI) of the animals between weeks depends on feeding regime (profiles are not parallel). The value of A and b parameter values were 0.02368 and 0.83436 for ad libitum group (AD), 0.02216 and 0.75251 for 20 % feed restriction based on ad libitum group (YK), 0.02235 and 0.79656 for HG group, respectively. Inflection point (k) for HG group was fount smaller than that of the AD and YK groups. All parameter estimates and growth characteristics for chickens based on Gompertz growth model were significant (P<0.05).

Cochlear microphonic potential recorded by transtympanic electrocochleography in normally-hearing and hearing-impaired ears

The cochlear microphonic is a receptor potential believed to be generated primarily by outer hair cells. Its detection in surface recordings has been considered a distinctive sign of outer hair cell integrity in patients with auditory neuropathy. This report focuses on the results of an analysis performed on cochlear microphonic recorded by transtympanic electrocochleography in response to clicks in 502 subjects with normal hearing threshold or various degrees of hearing impairment, and in 20 patients with auditory neuropathy. Cochlear microphonics recorded in normally-hearing and hearing-impaired ears showed amplitudes decreasing by the elevation of compound action potential Cochlear microphonic responses were clearly detected in ears with profound hearing loss. After separating recordings according to the presence or absence of central nervous system pathology (CNS+ and CNS-, respectively), cochlear microphonic amplitude was significantly higher in CNS+ than in CNS- subjects with normally-hearing ears and at 70 dB nHL compound action potential threshold. Cochlear microphonic responses were detected in all auditory neuropathy patients, with similar amplitudes and thresholds to those calculated for normally-hearing CNS- subjects. Cochlear microphonic duration was significantly higher in auditory neuropathy and normally-hearing CNS+ patients compared to CNS- subjects. Our results show that: 1. cochlear microphonic detection is not a distinctive feature of auditory neuropathy; 2. CNS+ subjects showed enhancement in cochlear microphonic amplitude and duration, possibly due to efferent system dysfunction; 3. long-lasting, high frequency cochlear microphonics with amplitudes comparable to those obtained from CNS- ears were found in auditory neuropathy patients. This could result from a variable combination of afferent compartment lesion, efferent system dysfacilitation and loss of outer hair cells.

Bilateral complete avulsion of ocular globes in a Le Fort III maxillofacial fracture: a case report and review of the literature

PURPOSE

The purpose of this paper is to demonstrate a case of bilateral complete avulsion of the globes following maxillofacial trauma.

METHODS

A 23-year-old man with bilateral complete globe avulsion following a maxillofacial trauma. Both globes were luxated out of the orbit and suspended on the skin of the upper lid below the brows. No direct or indirect light reflexes or any eye movements could be noted. Computerized tomography showed complete lacerations of both optic nerves at a level just anterior to the optic canal. There were also multiple fractures corresponding to Le Fort III fracture with Le Fort II components. The brain parenchyma was normal with an exception of brain edema. As the globes were unsuitable for repositioning, both were enucleated. The maxillofacial fractures were immobilized with plates and screws. Although the patient gained consciousness with normal vital signs in the early postoperative period, he died on the ninth day due to Pseudomonas aeruginosa infection, despite invasive antibiotic treatment.

DISCUSSION

The optic nerve and the globes are very resistant to mild and moderate trauma. The avulsion of the nerve at the canalicular or more posterior level may demonstrate central nervous system complications resulting in life-threatening conditions. The most critical issue in complete globe avulsions with a transected optic nerve is to rescue the vision. In total transected optic nerves the final eyes could only have had cosmetic benefits. In spite of promising experimental research on optic nerve regeneration, there are unknowns, such as the methods to eliminate the risk of anterior segment ischemia and phthisis bulbi.

CONCLUSIONS

Globe avulsions with a complete optic nerve cut remain a challenging problem. More research is required to better understand the pathophysiology of optic nerve repair.

Method for the deconvolution of auditory steady-state responses

The potential evoked by a 'train' of N equally spaced auditory clicks, with an inter-click period shorter than the duration of the response to an isolated click, is said to be a steady-state response (SSR). Extracting the individual responses evoked by the clicks of the train during steady state can be key to understanding of the neurophysiological mechanisms underlying SSR generation. In the literature, this task has been dealt with only under the (unwarranted) assumption that the response of the system does not vary during the presentation of the clicks, i.e. no neurophysiological adaptation is present. In this work, a new, non-parametric algorithm is proposed that, relaxing the time-invariance hypothesis, allows the extraction from the SSR of the N waveforms individually evoked by the N clicks of the train. The performance of the approach is evaluated on simulated SSRs and on real data recorded from the temporal cortex of awake rats. Results show that the method is able to detect and assess possible adaptation of the neurophysiological system in the generation of SSRs.

Long-term effectiveness of steroid injections and splinting in mild and moderate carpal tunnel syndrome

To evaluate the long-term efficacy of non-surgical treatment methods for mild and moderate carpal tunnel syndrome, 120 patients with clinical symptoms and electrophysiologic evidence were included in a prospective, randomized and blinded trial: 60 patients were instructed to wear splints every night, 30 received injections of betamethasone 4 cm proximal to the carpal tunnel, and 30 received injections distal to the carpal tunnel. After approximately 1 year (mean, 11 months; range, 9-14), 108 patients were available for final evaluation. We assessed clinical symptom severity and performed detailed electrophysiologic examinations before and after treatment. Splinting provided symptomatic relief and improved sensory and motor nerve conduction velocities at the long-term follow-up when the splints were worn almost every night. Proximal and distal injections of steroids were ineffective on the basis of both clinical symptoms and electrophysiologic findings.

Multifocal intradiploic cavernous hemangioma of the skull associated with nasal osteoma

OBJECTIVE

To present a 42-year-old female patient with multifocal cavernous hemangioma of the skull associated with nasal osteoma.

DESIGN

A case report. INTERVENTION METHODS: X-rays, computerized tomography, magnetic resonance imaging, and histopathology were used to achieve the diagnosis of this rare entity. The multiple cavernous hemangiomas were resected en-bloc and a curettage biopsy was obtained from the nasal osteoma.

RESULTS

The patient healed well after the operation. No recurrences of the cavernous hemangiomas were observed after one-year follow-up.

CONCLUSION

Multifocal cavernous hemangiomas are rare benign lesions of the calvarium, arising from the intrinsic vasculature of the bone. Although they are benign, radiological findings are not always characteristic and their multiple presentation may easily make surgeons consider the other malignancies of the skull in the differential diagnosis. Histopathologic confirmation of the tumor is the definitive method for diagnosis. The treatment of choice is early en bloc resection of the tumour where it is possible.

The relationship between tumor necrosis factor (TNF)-alpha and survival following granulocyte-colony stimulating factor (G-CSF) administration in burn sepsis

Blood levels of tumor necrosis factor (TNF)-alpha were determined in 78 patients with burn sepsis. Of these patients, 51 were managed with additional administration of granulocyte colony-stimulating factor (G-CSF) in addition to routine treatment procedures (group A), while 27 received only routine treatment (group B). G-CSF was administrated for at least nine and at most 14 days; doses were gradually decreased in each 3 day period. On the 1st, 4th, 7th, 10th and 15th days, blood levels of TNF-alpha were determined. We sought to determine whether TNF alpha levels had a prognostic value in the management of burn induced sepsis that was treated with G-CSF. In our study, patients with gradually decreasing TNF-alpha levels in the second 3 day period, were strong candidates for survival, because TNF-alpha levels decreased little in nonsurvivors but decreased greatly in survivors. The survival rate was 42/51 (82.3%) in group A and 9/27 (33.3%) in group B. In conclusion, G-CSF had positive effects on survival, and TNF-alpha was a predictor of prognosis in burn-induced sepsis.

Electrocochleography potentials evoked by condensation and rarefaction clicks independently derived by a new numerical filtering approach

The cochlear microphonic potential (CM) and the compound action potential (CAP) cannot be measured separately but only in combination. In the literature their individual estimates are conventionally recovered by the so-called CM cancellation technique. This method averages the potential obtained in response to rarefaction and condensation clicks under the assumption that changing the polarity of the clicks only affects the CM sign and does not alter the CAP in any way. However, both theory and evidence suggest that these hypotheses can be critical. In addition, recent contributions in the electrocochleography (ECochG) literature suggested that assessing the influence of stimulus polarity on the evoked CAP may constitute an indicator of clinical usefulness which the CM cancellation method cannot supply. In this work we propose a new algorithm to estimate the cochlear potentials evoked from positive clicks, CAP+ and CM+, and those evoked from negative clicks, CAP- and CM-, by processing the same kind and amount of data employed in the CM cancellation method. The application to real data taken from 3 subjects exhibiting quantitatively and qualitatively different ECochG responses at various levels of stimulation intensity is presented. In addition, simulated problems where the true CAP and CM are known are studied to permit a fair assessment of the proposed technique. Results suggest that the new algorithm is potentially able to point out small differences between CAP+ and CAP-. This encourages its further employment on a larger scale.

The symbiotically essential cbb(3)-type oxidase of Bradyrhizobium japonicum is a proton pump

Purified cbb(3)-type oxidase of Bradyrhizobium japonicum was reconstituted into phospholipid vesicles. Tight vesicles were obtained as shown by the disturbance of deltapH with CCCP and the membrane potential with valinomycin, which led to a six-fold increase in cytochrome c oxidase activity. The vesicles were thus suitable for proton translocation experiments. In the presence of valinomycin, a pulse with reduced cytochrome c caused an acidification with a subsequent alkalinization, whereas the same pulse caused only an alkalinization in the presence of valinomycin plus CCCP. We conclude that the cbb(3)-type oxidase of B. japonicum is a proton pump.

Compound action potential and cochlear microphonic extracted from electrocochleographic responses to condensation or rarefaction clicks

In electrocochleography (ECochG) compound action potential (CAP) and summation potential (SP) are usually separated from the cochlear microphonic (CM) by the CM cancellation technique consisting in averaging the responses evoked by rarefaction and condensation clicks. With the aim of analysing the ECochG responses evoked by monophasic clicks, we developed a numerical method based on the theory of optimal filtering, which makes no assumptions about the unknown potentials. The application of the filtering technique to the ECochG recordings obtained from 6 normally hearing children and 10 children with cochlear hearing loss allowed us to perform CAP extraction in cases where CM was not cancelled by the conventional method. Differences in SP amplitude and polarity were found between rarefaction and condensation click-evoked responses in cochlear hearing losses.

Global problem of drug-induced hearing loss

Clinically used drugs and chemical agents may potentially cause adverse effects to the human auditory and vestibular systems. Many of them, such as aminoglycosides and cisplatin, can play a critical role in the treatment of serious or life-threatening diseases; others, like loop diuretics or salycilates, offer such important therapeutical effects compared to the ototoxic side effects that the ototoxicity risk can be considered to be of minor importance. The problem of ototoxic side effects is more acute in developing countries, where highly effective and low-cost drugs are more easily prescribed without adequate monitoring. Medical awareness of doses, forms of administration, populations at risk, and possible synergism is necessary in order to develop appropriate care in the prescription of drugs with ototoxic side effects. Relatively recent issues such as risk-benefit analysis, patient-informed consent, and quality-of-life considerations, particularly when life expectancy can be low, are also to be considered. At present, a uniform method of monitoring for all potentially ototoxic therapeutics does not seem reasonable or practical. It is recommended, however, that individual auditory function be noted for a particular drug being employed. Protocols and exams should be easy, quick, sensitive, reliable, and as objective as possible. Benefits of audiological monitoring include the opportunity to change the patient's treatment course, improvement of patient and family awareness of the impact of hearing impairment, and timely prescription of amplification devices. Finally, particular attention should be paid to high-risk populations such as neonatal intensive care unit patients.

Cx26 deafness: mutation analysis and clinical variability

Mutations in the gap junction protein connexin 26 (Cx26) gene (GJB2) seem to account for many cases of congenital sensorineural hearing impairment, the reported prevalence being 34-50% in autosomal recessive cases and 10-37% in sporadic cases. The hearing impairment in these patients has been described as severe or profound. We have studied 53 unrelated subjects with congenital non-syndromic sensorineural hearing impairment in order to evaluate the prevalence and type of Cx26 mutations and establish better genotype-phenotype correlation. Mutations in the Cx26 gene were found in 53% of the subjects tested, 35.3% of the autosomal recessive and 60% of the sporadic cases in our series. Three new mutations were identified. The hearing deficit varied from mild to profound even in 35delG homozygotes within the same family. No evidence of progression of the impairment was found. Alterations of the Cx26 gene account for a large proportion of cases of congenital non-syndromic sensorineural deafness, so it seems appropriate to extend the molecular analysis even to subjects with mild or moderate prelingual hearing impairment of unknown cause.

[Acoustic distortion products otoacoustic emissions (DPOAE) in neonatal screening]

The purpose of the work was to determine the feasibility of direct nursery DPOAE testing in a universal hearing screening, evaluate the results and calculate the reliability of this test vs. Auditory Brainstem Responses (ABR). To this purpose DPOAE (sweep and I/O test) were performed on 500 children born between January and August 1996 at the Civil Hospital of Mestre, Italy. All the children were examined in the nursery, no matter what the risk factors or specific motivations. Besides determining whether the examination could be performed, its specificity and sensitivity, the time required and any variation depending on the day of testing were also evaluated. In a high percentage of cases (11.2%) it proved impossible to perform the test. In addition, when compared to ABR, the percentage of false positives was rather high (16.2%) and specificity was 84%. As conceived, the test requires 6'09" per ear. Comparison of the differences in results according to day of execution did not appear significant although there was a lower percentage of false positive after the third day of life. DPOAE can be measured in the nursery. The high number of false positives and the frequent need to repeat the measurements, however, increase the amount of time required for this test, thus voiding any time savings over an ABR screening: a test which is rather lengthy by provides a high degree of specificity.

Overproduction of the Bradyrhizobium japonicum c-type cytochrome subunits of the cbb3 oxidase in Escherichia coli

We report on a system to improve expression of mature c-type cytochromes in Escherichia coli. It is based on the use of plasmid pEC86 that expresses the E. coli cytochrome c maturation genes ccmABCDEFGH constitutively, whereby the production of both endogenous and foreign c-type cytochromes was increased substantially. The periplasmic soluble domains of the c-type cytochrome subunits FixO and FixP of the Bradyrhizobium japonicum cbb3 oxidase could be expressed in E. coli only when pEC86 was provided in a degP-deficient strain. This shows that a stimulation of heme attachment by the Ccm maturase system combined with the diminished proteolytic activity in the periplasm can increase c-type cytochrome yields.

Audiological management of noise induced hearing loss

Noise-induced hearing loss (NIHL) has no specific of exclusive audiological signs. The disorder is identified on the strength of a high probability conclusion and as a result of an exclusion process. Because of frequent legal purposes, audiometrical data measured and analyzed have furthermore to be as accurate and reliable as possible. The paper outlines the whole procedure involved in the audiological assessment of noise-induced hearing loss considering different stages for: suspicion and identification, hearing threshold measurement, etiological and differential diagnosis, apportionment.