Cochlear audiometry (electro-cochleography) during the neonatal period.
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Biomedical subjects
Publications and source records attributed to A Leiberman.
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A case of multiple, functional bone metastases from a previously operated follicular thyroid carcinoma is reported in an apparently euthyroid patient. Additional uncommon clinical manifestations encountered in this case were: 1) mandibular metastasis mimicking an intraoral arteriovenous malformation, 2) extensive, destructive, and expansive intraspinal metastases in the thoracic vertebral column protruding into the posterior mediastinum and causing severe spinal lesions, and 3) the precipitation of a fatal thyroid crisis following radioactive iodine treatment.
In an ongoing prospective study, IL-1 concentrations were measured in 78 children (aged 3-36 months) with acute otitis media receiving antibiotics. Middle ear fluid IL-1 concentrations were determined using ELISA kits. Ninety-eight middle ear fluid samples were obtained by tympanocentesis at enrollment (day 1) and 43 samples were collected on days 4-5. Ninety-two pathogens were isolated in 77/98 samples obtained on day 1: 55 Haemophilus influenzae, 34 Streptococcus pneumoniae, 2 Moraxella catarrhalis and 1 Streptococcus pyogenes. Among 37 paired samples initially culture-positive, eradication of the pathogen was achieved on day 4-5 in 20 while pathogens were still present in 17. On day 1, IL-1 was detected in 61/77 (79%) culture-positive samples vs 9/21 (43%) culture-negative ones (P = 0.003). The mean +/- SD middle ear fluid concentration of IL-1 on day 1 was significantly higher in culture-positive (316 +/- 508 pg/ml) than in culture-negative samples (111 +/- 245 pg/ml) (P = 0.01). When paired samples were evaluated, IL-1 decreased on days 4-5 in 13/20 (65%) ears where bacterial eradication was achieved, but also in 11/19 (58%) with persistent or new infection. The mean IL-1 concentrations decreased on days 4-5 in the 20 samples from ears where bacterial eradication was achieved (330 +/- 460 vs 118 +/- 294 pg/ml, P = 0.1) but also in the 17 samples where it was not (465 +/- 660 vs 232 +/- 289 pg/ml, P = 0.02). No significant differences were found between day 1 and days 4-5 in the mean IL-1 concentrations measured in patients with H. influenzae vs S. pneumoniae or concomitant H. influenzae and S. pneumoniae. It was concluded that: 1) IL-1 was detected in the middle ear fluid of most patients with acute otitis media; 2) significantly higher IL-1 concentrations were found in patients with culture-positive than in those with culture-negative acute otits media; 3) IL-1 concentrations decreased on days 4-5 of antibiotic therapy, whether the pathogen was eradicated or not.
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Five children with acute pseudomonas mastoiditis were treated and followed up in our medical center during a period of three years. The main clinical features of the disease include predilection for young male infants, a high rate of local aggressiveness, prolonged hospitalization for repeated surgical procedures, and the need for several courses of intravenous specific antimicrobial therapy. Although correctly diagnosed and promptly treated, these patients may be destined to chronic ear disorders.
Oro-nasal distribution of respiratory airflow was determined in 120 'mouth breathing' children by a minimally invasive computer-assisted method that employed a modified CPAP nasal mask/pneumotach and a head-out body plethysmograph. Resulting measurements were reproducible but clinical assessments correlated poorly with these values. Airflow distribution was almost identical in inspiration and expiration. 100% nasal breathing was found over a wide range of nasal resistances, many subjects with lips apart. Overall, the nasal fraction was negatively correlated with resistance and it was increased by topical decongestant. Decreasing nasal resistance with increasing age was confirmed, but corresponding changes in airflow distribution were not demonstrated. Quantitative assessment is advocated in clinical management of 'mouth breathers'.
This study reports the histopathological findings of 14 temporal bones from infants with trisomy 13 syndrome. The most primitive anomalies in the structures of the inner and middle ears in the present series are those of the semicircular canals, particularly of the horizontal canals: flattened horizontal canal cristae, absence or opening of the utricular endolymphatic valve, small facial nerve, and obtuse angle of the geniculate area of the facial nerve. Each ear demonstrated more than one of those anomalies. The anomalies present features similar to those found in the structures of the normal six to ten-week fetus. Many other mild anomalies observed appear to demonstrate features similar to those seen in the same structures in later fetal life. Reviewing these findings, most of the anomalies that were found in the inner and middle ears appear to be the result of poor development of the structures for reasons which are now unclear. In addition, middle ear infection was found in all cases.
Ectopic pituitary adenoma of the sphenoid sinus in a 68-year-old woman is presented. The confusing discrepancy between the imaging features and the mild clinical manifestations of extensive bone destruction of the skull base is emphasized. A definite diagnosis can be established only by histopathological examination supported by immunohistochemical studies.
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