Otosclerosis: mid-term results of cochlear implantation

INTRODUCTION

Constant histological changes in otosclerosis lead to progressive hearing loss which may end up in a profound hearing loss and then be treated by means of cochlear implants. These progressive changes could be followed by changes in cochlear implants fitting and speech discrimination results over the years.

OBJECTIVES

The aim of the study is to correlate the progressive histological changes to the cochlear implant clinical outcomes (fitting and speech discrimination results). Also main complications (facial nerve stimulation and difficulties at insertion) and new complications will be discussed.

DESIGN

A 5-year prospective case-control study was performed in order to compare cochlear implant results in otosclerosis patients to those in a matched-pair control group.

MATERIALS AND METHODS

Fifteen otosclerosis patients were followed throughout the study. Preoperatively temporal bone high-resolution computed tomography, electrically evoked auditory brainstem responses and speech discrimination tests were performed in order to select the patients to be implanted.

RESULTS

Not only difficulties with electrode guide insertion were reported, but also difficulties with fitting over the years, due to increasing difficulties to spread the electrical stimuli, which provokes increasing thresholds, maximum comfort levels and charges needed to stimulate hearing cells in basal and medial turn electrodes (p < 0.05), which required deactivating some basal and medial turn electrodes in order to improve cochlear implant effectiveness. The results demonstrated no statistical differences in speech discrimination in otosclerosis patients compared to the control group (p > 0.05). Several complications were reported: facial nerve stimulation (7.14%) and sudden episodes of tinnitus and headaches (14.28%).

CONCLUSIONS

Although progressive histological changes in otosclerosis lead to increasing thresholds, maximum comfort levels and charges needed to stimulate hearing cells, speech discrimination results support the cochlear implantation in otosclerosis.

Periodontal and oral microbiological status of an adult population undergoing haemodialysis: a cross-sectional study

OBJECTIVES

The aim of this cross-sectional study was to evaluate the periodontal status and oral microbiological patterns of a population with end-stage renal disease (ESRD), undergoing haemodialysis (HD).

DESIGN

This was a cross-sectional study, involving 52 patients from the Nephrology Department and 52 matched control subjects.

MATERIALS AND METHODS

The subjects had a periodontal clinical examination; subgingival plaque samples were taken and analysed using a semiquantitative polymerase chain reaction (PCR) test to detect Porphyromas gingivalis, Tannerella forsythia, Prevotella intermedia, Prevotella nigrescens and Actinobacillus actinomycetemcomitans. Subgingival plaque and saliva samples were studied for Candida and Enterobacteriaceae.

MAIN OUTCOME MEASURES

Most of the 104 subjects had some degree of loss of periodontal attachment (LPA) > or =3 mm [11 (10.5%) had severe LPA; 16 (15.4%) moderate LPA; and 64 (61.5%) mild LPA]. Only 13 subjects (12.5%) presented good periodontal health.

RESULTS

No statistically significant differences were found between the HD patients and the control group regarding bleeding index, number of teeth, or percentage of LPA > or =3 mm. However, a statistically significant difference was seen in the degree of oral hygiene.

CONCLUSIONS

On the basis of the findings presented here, we cannot associate ESRD with more severe periodontal destruction. Although HD patients presented a higher number of periodontopathic microorganisms than the matched controls, a prolonged duration of HD did not bear a statistically significant relationship with the percentage of sites with LPA > or =3 mm, specific microbiota or composition of biofilm.

[Acute obstructive renal failure secondary to retroperitoneal mass]

The acute renal failure is a grave pathology, of rapid establishment and relatively frequent in the hospital environment. We can describe three etiological groupS, which are responsible for it, amongst which are emphasized the pre-renal reasons. The obstructive pathology, of minor incidence, increases with the age. It is described the case of a 67-yr-old patient who was admitted in the Nephrology Service because of abrupt decline of the renal function. Among the initial symptoms, he presented arterial hypertension (190/90) and preserved diuresis. Blood analysis: urea 199 mg/dl, creatinine 7.7 mg/dl, without proteinuria. Sonography reported a bilateral ureteral hydronephrosis with simple cyst of possible ischemic origin. In view of the absence of previous biochemical data of renal failure, we considered possible reasons which start with an acute pattern. In initial evaluation, pre-renal etiology was not seen (high blood pressure, right cardiac systole function). The absence of prostatic syndrome and sonography discovery did not justify a diagnosis of urinary tract obstruction. Finally, abdominal-pelvic scan showed a periaortic retroperitoneal mass which included both ureters and appeared to trigger the obstruction. Combined efforts were pursued with the Urology Service, which implanted a bilateral "double J" catheter and later operated surgically on the patient, carrying out an alternating ureterolysis of both ureters. The biopsy manifested a retroperitoneal fibrosis, and the renogram showed a residual renal function of 20% in the right kidney and 80% in the left kidney. Due to the failure of the previous measures and as a last therapeutic recourse when one year had passed from the diagnosis, a continuous regimen with tamoxifen (anti-estrogen drug) in dose of 20 mg/dl each 12 hours was started, which began a progressive remission in the size of the observed mass by scan (CT) and magnetic resonance (MR). The treatment was completed during 12 months and in this time, the levels of blood urea nitrogen and creatinine were reduced gradually too. Finally, at the end of the treatment, the magnetic resonance demonstrate the complete disappearance of the fibrosis.

Primary systemic amyloidosis presenting as a colonic stricture: successful treatment with left hemicolectomy followed by autologous hematopoietic stem-cell transplantation: report of a case

Intestinal tract involvement by primary systemic amyloidosis is frequent but usually asymptomatic. Ischemic colitis caused by amyloid infiltration of wall blood vessels can occasionally be observed. We report a 62-year-old female with primary systemic amyloidosis who presented with intestinal obstruction caused by ischemic stricture of the sigmoid colon, secondary to submucosal amyloid deposition. The patient was successfully treated with surgical resection followed by high-dose chemotherapy and hematopoietic stem-cell transplantation. The clinical manifestations and differential diagnosis of gastrointestinal involvement of primary systemic amyloidosis, as well as its current treatment, are discussed.

Subtype distribution among intravenous drug users with chronic type C hepatitis in southern Spain

The hepatitis C virus (HCV) subtype distribution among intravenous drug users (IVDU), and patients without this risk of acquiring HCV infection, was evaluated. The patients included in the study were 51 with chronic type C hepatitis (36 IVDU and 25 coinfected by HIV-1), and 31 on haemodialysis. Genotyping was performed on 71 viraemic patients, with the following distribution: 25.4%, 1a; 54.9%, 1b; 8.5%, 3a; 7%, mixed (1a, 1b; 3a, 1a; 3a, 1b; 2 x 3a, 2a); 1.4%, 4; and 2.8%, non-typeable. When subtypes were related to IVDU practice, the statistical significance was p < 0.01 for subtypes 1a (48.5% vs 7.5%, for IVDU and non-IVDU, respectively) and 1b (16.1% vs 85.1%). No relation between HIV-1 coinfection and subtype distribution was observed among IVDU patients. The results suggest that among young IVDU of Southern Spain the emerging HCV subtype is 1a.

Prevalence and viral persistence of TT virus in patients on hemodialysis

The aim of this study was toevaluate the prevalence of TT virus (TTV) in 107 hemodialysis patients and 100 healthy individuals. Sixteen percent of hemodialysis patients and 2% of the control population were TTV positive (P<0.001). Sex, time on dialysis, transfusions, and alanine aminotransferase levels were not related to the presence of TTV DNA. TTV was more frequent in patients 50 to 70 (12/51) years of age and persisted in the serum of six of nine patients 8 months later. TTV was found in peripheral blood mononuclear cells of all patients with chronic infection, and sequence variation was noted in the peripheral blood mononuclear cells of two patients. No relationship between TTV infection and hepatitis was observed. Viral persistence and nonparenteral transmission may be possible in patients on hemodialysis.

Evaluation of two reverse transcription polymerase reaction assays (GEN ETI-K HGV RNA and LCx GBV-C assay) for the detection of GB virus C/hepatitis G virus RNA in clinical samples

Our study evaluates the analytical performance of two amplification methods in the detection of GB Virus C/Hepatitis G Virus, GEN ETI-K HGV RNA (GEN) and the LCx GBV-C Assay (LCx). GB Virus C RNA was detected by at least one test in 58/315 samples (18.41%). Fifty-five samples (17.46%) were positive by the GEN method and 51 samples (16.19%) by the LCx method. The same rate of detection was found for 71 haemodialysis patients and 18 non-A non-E hepatitis. Method based differences in prevalence were observed for patient samples from the general population, 8/106 (7.55%) positive by GEN vs 7/106 (6.60%) by LCx; and HIV infected patients, 26/98 (26.53%) vs 23/98 (23.46%). For chronic type C hepatitis 10/22 (45.5%) were positive by both methods, with two samples discordant. Overall, discordance was observed for ten samples, with seven positive only by the GEN ETI-K HGV RNA, and three positive only by the LCx GBV-C Assay. An additional evaluation of serial samples, from chronic type C hepatitis patients under interferon treatment, revealed three samples which were positive only by the GEN method. Results were 100% concordant for patients under haemodialysis and for non-A non-E hepatitis, 95.9% in the HIV positive group, 90.9% in the chronic type C hepatitis group, and 97.1% in the general population group. Overall, a 97.2% of concordance was found between methods. Both tests have a similar diagnostic performance, though in our opinion, LCx GBV-C Assay better suits the requirements of a clinical microbiology diagnostic laboratory.

A seroepidemiological study of human immunodeficiency virus infection in northeast Zaire

To evaluate the incidence of human immunodeficiency virus type 2 infections in an endemic African area, we have studied 134 patients from Northeast Zaire. Sera were tested for HIV-1 and HIV-2 antibodies to asses cross-reactivity or a possible double infection. Sixty five (48.5%) serum samples were reactive for HIV-1 and six (4.5%) for HIV-2 using specific Western blots. The enzyme immunoassays used to detect HIV-2 showed cross-reactivity with HIV-1 in 17 samples (16.5%). Tests based upon synthetic peptides corresponding to specific from human immunodeficiency viruses confirm their ability to discriminate antibodies directed against both viruses in 42/47 samples (89.4%); in 5/47 (10.6%) this test could not distinguish double infection from cross-reactivity. We suggest that the high number of sexual partners may be responsible for HIV transmission in our study group.