[Efficacy of botulinum toxin in infantile esotropia]. / Efficacité de la toxine botulique dans l'estropie de l'enfant.

INTRODUCTION AND OBJECTIVE: Botulinum toxin (BT) is used in a variety of therapeutic applications, including the treatment of strabismus. Two injection techniques coexist - transconjunctival injection and open sky injection. The goal of this study was to evaluate the results of BT injections in esotropia in children under 10 years of age and to compare the two techniques. PATIENTS AND METHOD: This is a retrospective, monocentric study, including children who received BT injections to treat their strabismus by the aforementioned techniques between 2014 and 2017. The results of these injections were recorded, and subgroup analyses (injection technique, age, degree of deviation, type of strabismus) were performed. The primary endpoint was the optimal success rate defined as residual strabismus less than or equal to 10 Δ. RESULTS: The study included 68 children with a mean age of 28.9 months and a mean deviation angle of 34.7 Δ. Patients received 1.2 BT injections. The success rate was 38% at 6 months, 35% at 12 months, and 35% at 24 months. There was 33% transient ptosis and 5% consecutive exotropia. There was no evidence of significant difference in success rate between the transconjunctival and open sky injection methods, baseline angles, age of injection, or type of strabismus. CONCLUSION: BT injection is effective and safe in pediatric esotropia, regardless of the injection method.

[IOL choice predictability, 1-year visual outcome, and complications after cataract surgery in children]. / Prédictibilité du choix de l'implant, résultats visuels à 1 an et complications de la chirurgie de cataracte chez l'enfant.

PURPOSE: To measure the refraction 1year after cataract surgery in children as a function of under-correction of the implant power and to evaluate the visual prognosis and possible therapeutic challenges. PATIENTS AND METHODS: We conducted a retrospective study of 28 children (38 affected eyes) who underwent unilateral or bilateral cataract surgery with primary intraocular lens implantation over a one-year period of time. The age at the time of surgery was between 1month and 17years. RESULTS: Ten patients had bilateral cataracts (35%) and 18 patients unilateral (65%). Ten patients were between 0 and 2years of age, 10 patients between 2 and 6years of age, and 8 patients were over 6years old. 72 % of the cataracts were idiopathic. The cataracts were mainly cortico-nuclear (37%). Monocular acuity averaged 0.7 LogMAR (2/10) between 2 and 6years, and 0.2 LogMAR (6.3/10) after 6years. The percentage of under-correction was 31% between 0 and 2years, 12.2% between 2 and 6years, and 2.3% after 6years, for a mean under-correction of 15.2%. The power of the chosen implant after under-correction was 25 diopters on average. One year after surgery, visual acuity averaged 0.2 LogMAR (6.3/10) between 2 and 6years old,and 0.1 LogMAR (8/10) after 6years. The spherical equivalent remained globally stable after surgery (the mean postoperative value was+1.25 diopters). The highest rate of revision surgery occurred in the 0-2year-olds (40%). The most common complication was cellular proliferation (up to 80% of the 0-2year-olds). Only one case of ocular hypertension was noted. DISCUSSION: It is necessary to apply an under-correction of the intraocular lens power, decreasing with the age of the child. The gain in visual acuity is modest, and the main complication is cellular proliferation.

Infection prevention in endoscopy practice: comparative evaluation of re-usable vs single-use endoscopic valves.

Re-usable air/water and suction valves used in endoscopes often demonstrate risk of infection. To the authors' knowledge, the safety and efficacy of re-usable and single-use valves have not been compared to date. As such, a laboratory investigation was undertaken to compare the safety and efficacy of re-usable and single-use valves at 11 Italian endoscopy sites. Safety was evaluated by analysing the rinse liquid of reprocessed re-usable valves ready for use, and efficacy was assessed based on the completion of endoscopic procedures without valve malfunction. This study found significantly lower contamination of single-use valves compared with re-usable valves (0 vs 29.1%, respectively; P=0.007) and similar efficacy (97.6 vs 98.8%, respectively; P=ns). Microbiological analysis of the rinse liquid of reprocessed re-usable valves identified various surviving micro-organisms and highlighted their potential pathogenicity. Such data suggest that sterile single-use valves may be safer than re-usable valves, and have comparable performance.

Newborn hearing screening in the Campania region (Italy): early language and perceptual outcomes of infants with permanent hearing loss.

Hearing loss in children causes a deficit in early perceptive and language skills. The objective of this study was to evaluate early receptive and expressive language outcomes in children with hearing loss, identified by hearing screening, compared to the time of diagnosis. We studied 18 severely hearing impaired children who were divided into two groups according to the time of diagnosis. Evaluation of communicative language ability was carried out at 18 month of age using the "MacArthur Child Development Inventory" questionnaire, while evaluation of acoustic-perceptual abilities was assessed with the Genovese-Arslan protocol every three months following diagnosis. The linguistic communicative and acoustic-perceptual outcomes of hearing impaired children diagnosed before 6 months of age followed those expected for normally hearing children, with a trend of temporal progression of skills that were faster than those of children diagnosed after 6 months of age.

The rs39335 polymorphism of the RELN gene is not associated with otosclerosis in a southern Italian population.

Otosclerosis, the single most common cause of hearing impairment in white adults, is characterised by bone dystrophy localized to the otic capsule and isolated endochondral bone sclerosis with alternating phases of bone resorption and formation. Conductive hearing loss develops when otosclerotic foci invade the stapedio-vestibular joint (oval window) and interfere with free motion of the stapes, but affected subjects frequently develop profound sensorineural hearing loss. The aetiology of otosclerosis is unknown. In the last years, several association studies have been performed and have suggested that single nucleotide polymorphisms in some genes may be implicated in development of otosclerosis. The strongest association has been demonstrated for the reelin gene, located on chromosome 7q22.1, which encodes an extracellular matrix protein. The involvement of reelin in the pathogenesis of otosclerosis is controversial; it was identified in European and North African populations, but was excluded in an Indian population. To analyze the role of reelin in otosclerosis, it has been studied in a case-control analysis for the polymorphism rs39335 in a southern Italy population. In this population, the pathogenic link between the rs39335 variant and otosclerosis was excluded.

Serum factors associated with precancerous colonic lesions in acromegaly.

BACKGROUND: Insulin, 25-hydroxy vitamin D3 [25(OH)D3] and folate have been differently associated with a risk of colonic neoplasms in the general population. Acromegalic patients have an increased risk of colorectal tumors and an association between fasting insulin concentrations and colonic lesions has been reported. However, it is unknown whether insulin, 25(OH)D3, folate, and homocysteine interact to determine the risk of colonic tumors in acromegaly. AIM: To investigate whether serum insulin, 25(OH)D3, folate, and homocysteine concentrations were associated with precancerous colonic lesions in acromegalic patients. MATERIAL AND METHODS: A cohort of 146 consecutive acromegalic patients was evaluated for colonoscopy findings and fasting insulin, 25(OH)D3, folate, and homocysteine levels. A preliminary study was conducted in 9 naïve acromegalic patients to evaluate the effect of somatostatin analogues (SSA) on serum levels of those factors. RESULTS: Insulin reduced during SSA whereas the other factors did not change. In the cohort study, colonic lesions (14 adenomas; 32 hyperplastic polyps) were detected in 46 patients. Fasting insulin, 25(OH)D3, folate, and homocysteine levels did not differ in patients with or without colonic adenomas. High folate levels were associated with a lower risk of developing precancerous colonic lesions at the multivariate analysis, when corrected by age, gender, disease activity and SSA therapy. CONCLUSIONS: Serum insulin, 25(OH)D3 and homocysteine serum concentrations do not seem to influence the development of precancerous colonic lesions in acromegalic patients, while higher folate levels may be associated with a lower risk of colonic lesions.

Comparison of colonoscopy and fecal occult blood testing as a first-line screening of colonic lesions in patients with newly diagnosed acromegaly.

CONTENT: Patients with acromegaly have frequently colonic neoplasms; however, how acromegalic patients should be screened for colonic lesions is still unsettled. AIMS: To compare fecal occult blood testing (FOBT) and colonoscopy in the screening program of patients with acromegaly. DESIGN: Colonoscopy and FOBT were performed at the first diagnosis of acromegaly. SETTING: Tertiary University center. PATIENTS: Eighty-five consecutive patients with untreated active acromegaly submitted to colonoscopy and FOBT. RESULTS: FOBT, which was positive in 16 (18.8%) out of 85 patients, identified 2 patients with colonic adenocarcinoma and 2 with adenoma; the remaining 12 patients had no detectable colonic lesions. Colonoscopy revealed colonic lesions in 29 patients: 3 (3.5%) cancers, 11 (12.9%) adenomas, and 15 (17.6%) hyperplastic polyps. The remaining 56 acromegalic patients had no detectable lesions. A patient with cancer and 9 patients with adenoma were missed if screened only by FOBT. CONCLUSIONS: Colonoscopy is superior to FOBT in detecting colonic lesions at the first diagnosis of acromegaly.

Does the default-mode functional connectivity of the brain correlate with working-memory performances?

The "default-mode" network is an ensemble of cortical regions that are typically deactivated during demanding cognitive tasks in functional magnetic resonance imaging (fMRI) studies. Using functional connectivity analysis, this network can be studied as a "stand-alone" brain system whose functional role is supposed to consist in the dynamic control of intrinsic processing activities like attention focusing and task-unrelated thought generation and suppression. Independent component analysis (ICA) is the method of choice for generating a statistical image of the "default-mode" network (DMN) using a task- and seed-independent distributed model of fMRI functional connectivity without prior specification of node region extent and timing of neural activation. We used a standard graded working-memory task (n-back) to induce fMRI changes in the default-mode regions and ICA to evaluate to DMN functional connectivity in nineteen healthy volunteers. Based on the known spatial variability of the ICA-DMN maps with the task difficulty levels, we hypothesized the ICA-DMN may also correlate with the subject performances. We confirmed that the relative extent of the anterior and posterior midline spots within the DMN were oppositely (resp. positively in the anterior and negatively in the posterior cingulate cortex) correlated with the level of task difficulty and found out that the spatial distribution of DMN also correlates with the individual task performances. We conclude that the working-memory function is related to a spatial re-configuration of the DMN functional connectivity, and that the relative involvement of the cingulate regions within the DMN might function as a novel predictor of the working-memory efficiency.

Cervico-oculo-Acoustic syndrome in a male with consanguineous parents.

BACKGROUND: The cervico-oculo-acoustic syndrome comprises Klippel-Feil anomaly, sensorineural deafness and Duane's retraction syndrome. Polygenic, autosomal dominant, and X-linked inheritance have been hypothesized. The disorder has rarely been reported in males. CASE REPORT: A 42-year-old male, born of consanguineous parents, presented with Duane's syndrome, mixed hearing loss, C2-C3 fusion, neck stiffness, and right facial palsy. A variety of cardiac, neurological and urogenital anomalies occurred in his relatives. The electro-oculographic studies showed impaired abduction and adduction of the right eye and impaired abduction of the left eye. Vergence, vertical eye movements and peripheral vestibular responses were normal. Somatosensory evoked potentials showed absence of the N13 peak and brainstem auditory evoked potentials bilateral delay of the I-III interpeak latencies. CONCLUSIONS: Consanguinity of the patient's parents, not previously reported, suggests autosomal recessive inheritance, but autosomal dominant inheritance is indicated by the family history. The pattern of the oculomotor deficit is consistent with bilateral dysplasia of the abducens nuclei with preserved internuclear neurons in the right abducens nucleus. Neurophysiological investigations revealed lower brainstem and cervical cord involvement.

[Acoustic discomfort in non-industrial indoor environments]. / Discomfort acustico in ambienti confinati non industriali.

The number of working activities carried out in non-industrial indoor environments that can cause acoustic discomfort is so high that it is impossible to deal with all of them here satisfactorily. Therefore, following a briefing discussion of the known effects of noise on man, this paper will review the current legislation regarding the prevention of occupational noise effects in our country today (D.Lgs. 15 Agosto 1991, N. 277), in the light of important changes introduced by the EU directive 2003/10/CE. Finally we will discuss the problems deriving from exposure to noise on subjects working in offices, in schools, in indoor environments for leisure time activities, and in the performance of professional music.

Thrombosis in the portal venous system after elective laparoscopic splenectomy.

BACKGROUND: The occurrence of thrombosis in the portal system is an underappreciated complication of splenectomy. Presenting symptoms are usually mild and nonspecific. The short hospital stay associated with the laparoscopic approach could delay the early diagnosis of this condition unless routine imaging controls are planned after discharge. METHODS: The records of 40 patients who underwent laparoscopic splenectomy at our institution were reviewed for clinical signs of thrombosis in the portal system and associated factors. All patients were also enrolled in a color Doppler ultrasound surveillance program. RESULTS: Nine patients (22.5%) developed thrombosis of the splenic vein, progressing to the portal vein in five cases (12.5%). Six patients (15%) were symptomatic. Thrombosis occurred even as late as 4 months after splenectomy. Spleen weight was the only significant factor predictive of postoperative thrombosis. The combination of splenomegaly and an elevated preoperative platelet count was associated with a 75% incidence of this complication. CONCLUSION: The high risk of thrombosis after the laparoscopic resection of large spleens should prompt strict postoperative imaging surveillance, combined with a more aggressive anticoagulation prophylaxis.

Psychiatric comorbidity in a population of outpatients affected by tinnitus.

The aim of this study was to outline the psychopathological characteristics of a population of outpatients affected by tinnitus and to consider its impact on their mental state and ability to function in major areas of their lives. Seventy-five consecutive tinnitus patients were enrolled on their first visit to the outpatients clinic of the Audiology Department of the 'Federico II' University of Naples, for audiological and psychiatric evaluation. A series of audiometric and vestibular tests was performed for tinnitus rating assessment, and further information was obtained from the patient via a semi-structural interview. For the psychopathological examination, patients underwent the Mini International Neuropsychiatric Interview (MINI), by means of which a multiaxial diagnosis (five axes) was expressed, according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). For a better understanding of the personality aspects, the Minnesota Multiphasic Personality Inventory (MMPI) test was administered to a subgroup of 55 subjects whose cultural background permitted their full cooperation. The results of the study show that 58 subjects (77% of the total) met the criteria for psychiatric disorder diagnosis, according to the DSM-IV system: Axis I comprises anxiety, affective and somatoform disorders and psychoses; Axis II comprises personality disorders. Multiple diagnoses were expressed in some subjects. The findings of the examination via MMPI show a high percentage of depression, hysteria, and hypochondria. Although we are not seeking to establish a cause-effect relationship between the unpleasant experience of tinnitus and psychopathological disorders, our findings are consistent with those of other authors. Tinnitus can indeed have severe consequences for the subject's ability to function in many areas of their life. In this paper, the implications of such results for the diagnosis and therapy of tinnitus are discussed.

Objective pulsatile tinnitus: case report.

Anomalies in the vascular structures of the neck, cranial base, temporal bone, and intracranial circulation may give rise to pulsatile tinnitus. If the anomalous sound is perceived also by others, then it is defined as objective tinnitus. Herein, the case is reported of right pulsatile tinnitus of one year's duration, which appeared after cranial trauma. Magnetic resonance angiography showed that the jugular bulb was dominant on the same side as the tinnitus. The tinnitus was recorded with a high-sensitivity microphone, while otoacoustic emissions were measured by distortion products during follow-up.

Femoral osteotomies.

none.

Functional fields in human auditory cortex revealed by time-resolved fMRI without interference of EPI noise.

The gradient switching during fast echoplanar functional magnetic resonance imaging (EPI-fMRI) produces loud noises that may interact with the functional activation of the central auditory system induced by experimental acoustic stimuli. This interaction is unpredictable and is likely to confound the interpretation of functional maps of the auditory cortex. In the present study we used an experimental design which does not require the presentation of stimuli during EPI acquisitions and allows for mapping of the auditory cortex without the interference of scanner noise. The design relies on the physiological delays between the onset, or the end, of stimulation and the corresponding hemodynamic response. Owing to these delays and through a time-resolved acquisition protocol it is possible to analyze the decay of the stimulus-specific signal changes after the cessation of the stimulus itself and before the onset of the EPI-acoustic noise related activation (decay-sampling technique). This experimental design, which might permit a more detailed insight in the auditory cortex, has been applied to the study of the cortical responses to pulsed 1000 Hz sine tones. Distinct activation clusters were detected in the Heschl's gyri and the planum temporale, with an increased extension compared to a conventional block-design paradigm. Furthermore, the comparison of the hemodynamic response of the most anterior and the posterior clusters of activation highlighted differential response patterns to the sound stimulation and to the EPI-noise. These differences, attributable to reciprocal saturation effects unevenly distributed over the superior temporal cortex, provided evidence for functionally distinct auditory fields.

Quality of life determinants and hearing function in an elderly population: Osservatorio Geriatrico Campano Study Group.

BACKGROUND: Hearing impairment (HI) is a very common condition in elderly people and the epidemiology together with hearing-related problems is still poorly investigated. Moreover, the cognitive status may be impaired in relation to hearing function. OBJECTIVE: The goal of the study was to evaluate: (a) the prevalence of HI in a random sample of elderly people aged 65 and over (n = 1,750) living in Campania, a region of southern Italy; (b) the cross-sectional relationship between hearing function and cognitive status and also depressive symptomatology and disability, and (c) to assess the role of hearing aids on depressive symptomatology. METHODS: Cross-sectional study on a random sample of elderly population. RESULTS: The overall participation rate in the study was 74.8% (n = 1,332, mean age was 74.2 +/- 6.4 years). The prevalence rate of HI (evaluated by questionnaire) was 27.2%, cognitive impairment prevalence (evaluated by the Mini-Mental State Examination (MMSE)) was 27.9%, mean depressive symptomatology score (evaluated by Geriatric Depression Scale (GDS)) was 11.4 +/- 6.6, while disability assessed by Activity of Daily Living (ADL) was present in 7.0% of the whole population. A strong relationship was found between both decreasing hearing function and MMSE decline, independently by the effect of age and education (r = 0.97; p < 0.01). A positive relationship (r = 0.85; p < 0.01) between GDS score and hearing function was also found. Moreover, at an increased level of hearing loss, a lower ADL score was recorded (r = 0.98; p < 0.01). Finally, the use of hearing aids reduced GDS score. In logistic regression analysis, gender, age and educational level indicate that hearing loss risk increased with age (odds ratio 1.60; 95% confidence interval 1.53-1.71), whereas education plays a protective role (odds ratio 0.75; 95% confidence interval 0.72-0.80). CONCLUSION: HI is very prevalent among elderly people and is associated with either cognitive impairment and/or depression and reduction of functional status. This study suggests that hearing aids may protect against cognitive impairment and disability, improving quality of life of aged people. Copyrightz1999S.KargerAG,Basel

Localisation and characterisation of auditory perception through Functional Magnetic Resonance Imaging.

In the last few years, Functional Magnetic Resonance Imaging (fMRI) has been widely accepted as an effective tool for mapping brain activities in both the neurosensorial and the cognitive field. The present work aims to assess the possibility of using fMRI methods to perform a non-invasive evaluation of the human auditory function. To this end the cortical response to different non speech stimuli (pure tones, pulsed tones) was examined for ten subjects with no audiological impairment. Our findings point out some remarkable differences in both the spatial and the temporal features of the primary auditory cortex response to pulsed tones and to pure tones.