Biomedical subjects

M Manrique

Publications and source records attributed to M Manrique.

67 records · Page 4Linked to original sources

PubMedDate not supplied

[Hearing and speech in children under 2 years of age with a cochlear implant].

BACKGROUND: To compare the auditory abilities and speech performance of children with a profound prelingual bilateral hearing impairment, treated with a cochlear implant (CI) before or after 2 years of age. To analyze the complications arising during the selection process of the children, or as a result of the implantation, programming and follow-up. METHODS: Prospective cohort single-subject repeated-measures study of 130 children who received an implant at our center. The children were divided into two age groups: 0-2 (n=36), and 2-6 years of age (n=94). Preoperative evaluation included: 1. History, physical exploration, and ENT examination. 2. Neuropaediatric examination, family evaluation, and psychological assessment. 3. Auditory brainstem responses. 4. High resolution computed tomogram of temporal bones. 5. Counseling and informed consent. The children were evaluated prior to, and each year following, the intervention (for up to 5 years), using closed and open-set logoaudiometric tests, and speech perception tests. Speech was evaluated according to the Peabody Picture Vocabulary and Reynell general oral expression scale. RESULTS: Auditory and speech perception tests improved significantly in all children after CI, regardless of the follow-up time. The infant's performance was better in the group of early implantees. Speech tests showed that the development of children treated before 2 years of age was similar to that of normal children. No additional complications were observed when compared to CI in older children. CONCLUSIONS: When performed before 2 years of age, CI offers a quicker and better improvement of performance, with no increase in complications when compared with a later intervention.

Age Factors↗

PubMedDate not supplied

[Auditory brain stem potentials evoked by electrical stimulation of cochlear nuclei during central auditive implant setting].

INTRODUCTION: The implantation of a stimulator over the surface of the cochlear nuclei can provide a partial auditive capability to patients deaf due to a bilateral lesion of the 8th nerve. Intraoperative monitoring of short latency electrically-evoked potentials is useful to asses the correct positioning of the implant, specially when there are anatomical distortions. PATIENTS AND METHODS: Evoked potentials from two patients with type II neurofibromatosis were recorded during implantation surgery, using a blanker system to eliminate the stimulus artifact. RESULTS: In both cases, two-peak vertex-positive responses were obtained, with latencies between 0.4-0.5 and 1.2-1.4, respectively. This responses are similar to the most frequent response described. DISCUSSION: Intraoperative monitoring of electrically-evoked auditory brainstem responses is a useful technique to confirm the correct positioning of the cochlear stimulator. The study of the morphology of these responses can help to understand the mechanisms involved in the generation by the brainstem of the auditive evoked potentials. More experience on this subject is needed to establish a correlation between intraoperative results and postoperative stimulator function.

Adult↗

PubMedDate not supplied

[General intubation anesthesia in primates for experimental otoneurologic surgery].

INTRODUCTION: We report our experience in anaesthetic and surgical management of primates (M. fascicularis) in an experimental otoneurosurgical procedure. MATERIAL & METHODS: The VIII cranial nerve was bilaterally sectioned in a translabyrinthine approach in 21 adult primates. In 14 animals subsequently, a prototype of auditory brainstem implant was placed unilateraly within the brain stem for surface stimulation of cochlear nuclei. Premedication consisted in an intramuscular mixture of ketamine, midazolam and atropine. Surgical procedure was performed under intubated general anaesthesia, after propofol (1.5 mg/kg) administration and maintained with nitrous oxide and halotane. RESULTS: The mixture of ketamine, midazolam and atropine produced a deep anaesthesia in 4 +/- 1.7 minutes, permitting safe animal handling. Atraumatic nasotracheal intubation without muscle relaxing agents was easily achieved in all animals. Anaesthesia was adequately maintained with nitrous oxide and halotane. Animals did not present any relevant incidents during surgery, and were extubated 10 +/- 2.5 minutes after cessation of gas administration. Post-operatively, no relevant surgical complications occurred. CONCLUSIONS: We report an anaesthetic technique that provides an optimal restrain and anaesthesia for experimental otoneurosurgical procedures with primates. This technique offers a quick recovery and avoids the use of muscular relaxing agents for intubation, and thus could be safely used in other kind of surgical procedures.

Anesthesia, General↗

PubMedDate not supplied

[Selective dorsal rhizotomy as a therapeutic option in spasticity. Indications and results].

AIMS: Spasticity, which is a very frequent sequela of neurological diseases, is useful for compensating for loss of strength and enabling the patient to stand, if it is not excessive. Otherwise, it is contraindicative and requires specific treatment. DEVELOPMENT: Spasticity is a spinal cord dysfunction triggered by the lack of upper motoneuron inhibiting afferents and, hence, its treatment can be centred either on a level above that of the lesion itself, if the descending pathways remain functional, or on the lesion, that is, on the spinal cord, by means of neurostimulation, intrathecal drugs or ablative procedures. Ablative procedures, which are essentially oriented towards reducing the afferents in order to diminish medullar reflex hyperexcitability, are indicated in children with spastic cerebral palsy. Thanks to a rigorous detailed study that is conducted beforehand, selective dorsal rhizotomy (SDR) allows us to determine which groups of muscles must be treated. Based on intraoperative neurophysiological studies and monitoring and the use of microsurgical techniques, the dorsal rhizome turns out to be very selective after the perfect identification of the rootlets that are to be preserved. Following the qualitative and quantitative valuation of diverse parameters, post operative results show significant improvements in the functional performance of the child at one year after the intervention, and these are maintained and increase in the next few years. A strict programme of physiotherapy and rehabilitation is very effective and enables patients to enjoy greater autonomy. CONCLUSIONS: The use of SDR enables us to remove excessive spasticity, correct anomalous postures and reduce collateral pain. Its successful performance is depends on the work of a multidisciplinary team and on the overall approach to the disease in each case.

Humans↗

PubMedDate not supplied

Posterior fossa subdural hematoma.

One case of traumatic posterior fossa subdural hematoma (PFSH) is described. This location represent 1% of the subdural hematomas. Computerized Tomography (CT) was used in the diagnosis and follow-up of the hematoma. The etiology and physiopathology of this process are discussed.

Adult↗

PubMedDate not supplied

Local and serum IgE in patients affected by otitis media with effusion.

Various mechanisms intervene in the etiopathogenesis of otitis media with effusion (OME), but to date it is not clear which mechanism is the most important. We studied twenty children affected with persistent otitis media with effusion (OME) inspite of the indicated treatments, and the possible incidence of atopic features, total serum IgE and in effusion, obtained by myringotomy and aspiration were evaluated. In order to evaluate the presence of atopy, an allergic history and skin tests against the different suspected allergens (inhalants and foods) were realized.

Child↗

PubMedDate not supplied

Cerebral arteriovenous malformations. Comparative results of surgical vs conservative treatment in 112 cases.

A group of 112 patients affected by cerebral arteriovenous malformations is reviewed. Sixty-six per cent of the cases presented with subarachnoid hemorrhage. Epilepsy was the main clinical feature in 20% of the cases. In 45 cases an intracerebral or intraventricular hematoma was diagnosed by CT-scan, angiography or was found during surgery. Seventy cases (62.5%) were operated upon and 42 cases were treated conservatively. In 57 operated cases, total excision of the AVM was confirmed by postoperative angiography. In this group there was no rebleeding during the follow-up period. Other 13 cases were submitted to partial excision of the AVM or clipping of the feeding vessels. In this latter group, 2 patients had later subarachnoidal rebleeding. Operative mortality was 11% in this series. Mortality caused by the AVM in the non-operated group was 20%. Comparing the morbidity in both groups, the operated group had a much better clinical evolution than the non-operated one. Regarding the final clinically results, an abnormal state of consciousness before surgery, a large size of the AVM and the presence of intracerebral hematoma appear to have a bad prognosis significance.

Adolescent↗

PubMedDate not supplied

[Study of the nasopharyngeal microflora obtained by a cotton swab].

Whether or not a representative sample of the nasopharyngeal microflora can be obtained by introducing a cotton swab through the nasal cavity has been evaluated. Also, a correlation between these results and those achieved from the middle ear effusions, has been searched. Ninety adenoidectomy-pending children, fifty of whom also presented otitis media with effusion, were included in the study. The research showed that there were a coincidence (p < 0.001) among the results obtained from the nasal cotton swab, those obtained from cultures of adenoid biopsies and the middle ear effusions.

Adenoids↗

PubMedDate not supplied

[Distortion product otoacoustic emissions in Ménière's disease].

We present the results of the distortion product otoacustic emission testing performed in 24 patients diagnosed of Ménière's disease. Significant differences in the evoked response of both normal and pathologic ears, and a correlation between lesion degree and auditive impairment, were found. On the other hand, response of the normal ears was lower than in a same age, normal-hearing subjects group.

Adult↗

PubMedDate not supplied

[Results of osteointegrated prosthesis of Audiant type].

Patient selection criteria, auditory results, complications, and patient satisfaction as related to implantation of an Audiant prosthesis in 1991-1992 are analyzed. We report our experience with this late-generation prosthesis in three patients compared with an earlier model implanted.

Adult↗

PubMedDate not supplied

[Results of the cochlear transplant program of the University of Navarra].

From October 1989 to the end of 1991, 33 patients have received a Cochlear Implant Nucleus 22 Channel, that have been selected from over 150 patients that consulted the possibility of implantation. A cochlear implant program should count with a group of professionals of diverse areas, that work in coordination without losing contact with the rest of the member of the implant team. Cochlear Implant are considered an efficient technique in the treatment of profound neurosensorial deafness, in Pre and Postlinguistic patients. The results obtained have been better in the last group of patients, but results on the whole are considered satisfactory. In prelinguist there is a progressive positive tendency, therefore a longer amount of time is necessary to define the final results. The therapeutic capacity of this method of treatment is not limited only to the auditory area, but it has effect also in other fields related to communication and the integral development of the patients on whom it is applied.

Adolescent↗

PubMedDate not supplied

[Pockets of tympanic membrane retraction].

The pathogenesis of tympanic retraction pockets is analyzed. Middle-ear pressure and the behavior of the lamina propria and stratified squamous epithelium of the tympanic membrane were considered. Predisposing factors are discussed. Conservative surgical treatment is recommended for retraction pockets that are not adhered to the walls of the middle ear. Radical surgery should be reserved for adhered pockets. The management of mastoid cavities is discussed.

Ear Diseases↗

PubMedDate not supplied

[The nasopharynx in secretory otitis media].

INTRODUCTION: Nasopharyngeal airway obstruction by adenoidal tissue was studied in children with otitis media with effusion compared with children with healthy ears. Adenoidal and nasopharyngeal development with age also were studied. PATIENTS AND METHODS: The study included 44 children with bilateral effusive otitis media and 32 children without ear disease, all of whom were scheduled for adenoidectomy. In a preoperative lateral radiograph of the nasopharyngeal cavity, adenoidal tissue and the nasopharynx were measured. Adenoidal volume and weight were measured after surgery. RESULTS: The group with effusive otitis media had a larger adenoidal volume, smaller nasopharyngeal cavity, and greater nasopharyngeal airway obstruction (all significant differences) than children without ear disease. All the children had an increase in the nasopharyngeal cavity with age and a decrease in adenoidal volume and nasopharyngeal obstruction after the age of seven years.

Adenoids↗