Auditory discrimination training for tinnitus treatment: the effect of different paradigms.

Acoustic deprivation, i.e. hearing loss, is responsible for a cascade of processes resulting in reorganisation of the cortex. Tinnitus mechanisms are explained by synchronization of the neural spontaneous activity and might be related to cortical re-mapping. Auditory discrimination training (ADT) has demonstrated in both animals and humans to induce tonotopical changes in the auditory pathways through neural plasticity. We hypothesize that ADT could have some effect on tinnitus perception. The objective of this study is to compare the effect on tinnitus following two paradigms of ADT. Only patients from 20 to 60 years of age were recruited. Inclusion criteria were pure tone tinnitus of mild or moderate handicap according to the Tinnitus Handicap Inventory score (<56). ADT patients were randomized in two groups: SAME (ADT in the same frequency of tinnitus pitch, 20 patients) and NONSAME (ADT in the frequency one-octave below tinnitus pitch, 21 patients). Groups of pair of tones (70% standard tones ST, 30% deviant tones ST + 0.1-0.5 kHz) were randomly mixed for 20 min/day during 1 month. Patient had to mark when the two sounds of the pair were similar or different. Control group included 26 patients from the waiting list (WLG). Patients were also divided according to the trained frequency and the deepest hearing-impaired frequency. Outcome parameters were set up according to the answer to the question "is your tinnitus better, same, or worse with the treatment?" (RESP), the tinnitus handicap inventory (THI) and the visual analogue scale from 1 to 10 on tinnitus intensity (VAS). Tinnitus improved in 42.2% of the patients (RESP). VAS and THI scores were reduced but only THI differences were statistically significant (P = 0.003). ADT patients improved significantly compared with WLG in RESP and THI scores (P < 0.01). Training frequencies one-octave below the tinnitus pitch (NONSAME) decreased significantly THI scores compared with patients trained frequencies similar to tinnitus pitch (SAME, P = 0.035). RESP and VAS scores decreased more in NONSAME group though differences were not significant. We did not find any differences when comparing the group training the deepest hearing-impaired frequency and the group who trained other frequencies. Auditory discrimination training significantly improved tinnitus handicap compared to a waiting list group. Those patients who trained frequencies one octave below the tinnitus pitch had better outcome than those who performed the ADT with frequencies similar to the tinnitus pitch (P = 0.035).

Cortical reorganisation and tinnitus: principles of auditory discrimination training for tinnitus management.

Scientific evidence has proved reorganisation processes in the auditory cortex after sensorineural hearing loss and overstimulation of certain tonotopic cortical areas, as we see in auditory conditioning techniques. Acoustic rehabilitation reduces the impact of these reorganisation changes. Recent theories explain tinnitus mechanisms as a negative consequence of neural plasticity in the central nervous system after a peripheral aggression. Auditory discrimination training (ADT) could partially reverse the wrong changes in tonotopic representation and improve tinnitus. We discuss different studies and their efficacy on tinnitus perception and annoyance. Indications, method, dose and sound strategy need to be implemented.

Auditory discrimination therapy (ADT) for tinnitus management.

Auditory discrimination training (ADT) designs a procedure to increase cortical areas responding to trained frequencies (damaged cochlear areas with cortical misrepresentation) and to shrink the neighboring over-represented ones (tinnitus pitch). In a prospective descriptive study of 27 patients with high frequency tinnitus, the severity of the tinnitus was measured using a visual analog scale (VAS) and the tinnitus handicap inventory (THI). Patients performed a 10-min auditory discrimination task twice a day during one month. Discontinuous 4 kHz pure tones were mixed randomly with short broadband noise sounds through an MP3 system. After the treatment mean VAS scores were reduced from 5.2 to 4.5 (p=0.000) and the THI decreased from 26.2% to 21.3% (p=0.000). Forty percent of the patients had improvement in tinnitus perception (RESP). Comparing the ADT group with a control group showed statistically significant improvement of their tinnitus as assessed by RESP, VAS, and THI.

Macro-orchidism: light and electron microscopic study of four cases.

A hormonal and quantitative light microscopy study of one man with macro-orchidism associated with mental retardation and fragile X chromosome (case no. 1) and three men with idiopathic macro-orchidism (cases no. 2 to 4) is reported. Hormonal study revealed slightly increased follicle-stimulating hormone serum levels in cases no. 1 to 3. The testes from cases no. 1 (orchidoepididymoectomy specimen) and 2 (testicular biopsy) presented interstitial edema and three different tubular patterns that were arranged in a mosaic-like manner. Type I tubules had an increased diameter (less than 220 microns), dilated lumen, and thin seminiferous epithelium usually consisting of Sertoli cells, spermatogonia, primary spermatocytes, and sometimes a few spermatids. Type II tubules had a normal diameter (180 to 220 microns) and germ cell development varied between complete spermatogenesis and Sertoli-cell-only tubules. Type III tubules had decreased diameter (less than 180 microns), atrophic seminiferous epithelium, and thickened tunica propria. The appearance of the nuclei of the Sertoli cells in the three types of tubules could be either mature or immature. Some of the mature Sertoli cells presented a granular cytoplasm. A few of these granular cells grouped together, forming nests that protruded into the tubular lumen. The testicular biopsies from cases no. 3 and 4 only presented type II tubules that contained both mature and immature Sertoli cells. Quantitative study revealed that the large testicular size was principally due to an increased tubular length in all four cases. Although the seminiferous tubule lesions and interstitial edema suggest an obstructive process, the testicular excretory ducts (studied in case no. 1) appeared normal or only slightly dilated. It is possible that the seminiferous tubule lesions (dilated lumen and germ cell depletion) might be secondary to the Sertoli cell lesions (granular cytoplasm and nuclear immature-like pattern.

[Recurrent pneumonia secondary to idiopathic bronchomalacia]. / Neumonías recurrentes secundarias a broncomalacia idiopática.

Bronchomalacia in adults develops secondary to bronchial disease processes (chronic bronchitis, tuberculosis, neoplasm) or to lesions resulting from prolonged intubation, surgery, trauma, or lung transplantation. We report the case of an 84-year-old woman with no history of any of the aforementioned associations in whom we detected severe idiopathic bronchomalacia of the main left bronchus. The identified lesion caused recurrent pneumonias leading to death. We show images obtained by bronchoscopy, revealing the severity of the lesion and its functional repercussions.

[Infection of sternal wound in heart surgery: analysis of 1000 operations]. / Infección de la herida esternal en la cirugía cardíaca: análisis de 1.000 intervenciones.

BACKGROUND: Sternal wound infection (SWI) is the most important complication in cardiac surgery. The aim of this study was to describe the frequency and clinical and microbiological features of this complication. METHODS: All the cases of SWI which were observed in the authors' hospital in the first 1,000 cardiac surgery operations performed with extracorporeal circulation were retrospectively reviewed. The cases were identified through the Infectious Diseases and Cardiac Surgery Department files and were classified according to the depth of the infection. During the study period neither the prophylaxis against infection nor the surgical techniques were modified. RESULTS: Forty-three patients (4.3%) presented SWI. Fourteen were superficial infections and 29 were deep infections of which 9 were classified as osteomyelitis and 20 as mediastinitis. A progressive decrease was observed in the proportion of SWI over time parallel to an increase in the number of operations performed. Staphylococcus aureus was the agent most frequently isolated (60.4%). Gram-positive aerobic cocci were found in 66.7% of the total number of isolations, being most frequent in the deep infections (83.3% of the isolations). The gram-negative aerobic bacilli were isolated more frequently in the superficial infections than in the deep infections (57.8% v.s. 16.7% of the isolations, respectively p < 0.01). In patients with SWI the predictive value of the positive blood cultures for the diagnosis of mediastinitis was 83.3%, with a sensitivity of 50% and specificity of 91.3%. Three patients with deep infection developed chronic complications and another three died (mortality by mediastinitis 15.0%). The mean postoperative stay was 52 days for the patients with deep infection and 39 days for those with superficial infection (p = NS). CONCLUSIONS: The percentage of surgical wound infection during the study period showed a trend to a decrease parallel with an increase in the number of operations. The gram-positive bacteria were responsible for most of the SWI. Although the depth of SWI is difficult to clinically predict, the presence of bacteremia suggests the existence of mediastinitis. Despite their lesser clinical importance, the superficial infections carry a long postoperative stay.

Auditory discrimination therapy (ADT) for tinnitus managment: preliminary results.

CONCLUSION: This clinical assay has demonstrated the efficacy of auditory discrimination therapy (ADT) in tinnitus management compared with a waiting-list group. In all, 43% of the ADT patients improved their tinnitus, and its intensity together with its handicap were statistically decreased (EMB rating: B-2). OBJECTIVE: To describe the effect of sound discrimination training on tinnitus. ADT designs a procedure to increase the cortical representation of trained frequencies (damaged cochlear areas with a secondary reduction of cortical stimulation) and to shrink the neighbouring over-represented ones (corresponding to tinnitus pitch). STUDY DESIGN: This prospective descriptive study included 14 patients with high frequency matched tinnitus. Tinnitus severity was measured according to a visual analogue scale (VAS) and the Tinnitus Handicap Inventory (THI). Patients performed a 10-min auditory discrimination task twice a day for 1 month. Discontinuous 8 kHz pure tones were randomly mixed with 500 ms 'white noise' sounds through a MP3 system. ADT group results were compared with a waiting-list group (n=21). RESULTS: In all, 43% of our patients had improvement in their tinnitus. A significant improvement in VAS (p=0.004) and THI mean scores was achieved (p=0.038). Statistical differences between ADT and the waiting-list group have been proved, considering patients' self-evaluations (p=0.043) and VAS scores (p=0.004). A non-significant reduction of THI was achieved (p=0.113).

Immunohistochemical and semiquantitative study of the apical mitochondria-rich cells of the human prepubertal and adult epididymis.

An immunohistochemical and semiquantitative study of the apical mitochondria-rich cells (AMRC) in the caput, corpus and cauda of the human epididymis from the fetal period to adulthood was performed on autopsy specimens from normal males without testicular or associated pathology. The immunohistochemical pattern of AMRC differed from that of the principal cells (PC). AMRC showed a more intense immunoreaction to several keratin types (AE1 and AE3 keratin complexes, and keratins 18 and 19) and to oestradiol-related protein receptors than did PC. In addition, immunostaining with antibodies to epithelial membrane antigen was intense in PC and weak in AMRC. Two immunohistochemical types of basal cells were observed: one was similar to the AMRC and the other to PC. PC and AMRC were already present in fetuses of 24-27 wk gestation. Basal cells were only occasionally observed at this age, but became much more numerous in the 28-33 wk fetuses. No changes in the immunohistochemical patterns of any of these cell types were found during infancy and adulthood. The numbers of PC per unit length of basement membrane were very similar in the 3 epididymal regions and at all ages studied. In all age groups, the number of AMRC decreased from caput to cauda epididymis. In the caput and corpus, the number of AMRC rose during the fetal period and the first 6 months after birth and thereafter decreased progressively during infancy and adulthood.

Testosterone immunoexpression in human Leydig cells of the tunica albuginea testis and spermatic cord. A quantitative study in normal foetuses, young adults, elderly men and patients with cryptorchidism.

A semi-quantitative study of the extra-parenchymal Leydig cells in the tunica albuginea testis and spermatic cord was performed on histological sections immunostained with anti-testosterone antibodies in the testes and spermatic cords obtained from human foetuses, adults and elderly men without testicular or related diseases (autopsy specimens), as well as from adult men with cryptorchidism (surgical specimens). The albugineal Leydig cells appeared in small groups in the vicinity of blood vessels. The Leydig cells of the spermatic cord usually appeared inside or around nerve trunks. The percentages of testes and spermatic cords with extra-parenchymal Leydig cells were higher in the cryptorchid testis group than in the normal male groups. The number of Leydig cells per mm2 in the tunica albuginea testis was higher in normal adult males than in foetuses. This number decreased in elderly men and increased markedly in cryptorchidism. The number of Leydig cells per mm2 in the spermatic cord was also higher in normal adults than in foetuses and it did not change with either advancing age or cryptorchidism. In foetuses, the percentage of cells intensely immunostained by anti-testosterone antibodies in the tunica albuginea and spermatic cord did not differ significantly from that found in the testicular parenchyma, whereas in the other three groups (adult, elderly, and cryptorchid men) the percentages of these cells in the tunica albuginea and spermatic cord were significantly lower than in the testicular parenchyma.

Enzymohistochemical and immunohistochemical study of the human efferent ducts.

An enzymohistochemical and immunohistochemical study of the efferent ducts was performed in normal adult men. The epithelium consists of two types of columnar cells: principal cells (PCs) and ciliated cells (CCs), and is surrounded by a lamina propria (LP) with cells arranged circularly (LPCs). Enzymohistochemical study revealed more intense activity of succinic dehydrogenase, NADP, and ATPase in the CCs than in the PCs. The LPCs also showed an intense reaction for NADP and ATPase. Acid phosphatase activity was only intense in the apical cytoplasm of PCs. Immunohistochemical study revealed that antibodies to oestradiol receptor-related protein (ER-D5) immunostained the PCs and CCs intensely and the LPCs weakly. AE1/AE3 antibodies (which stain keratins nos. 1-8 and 14, 15 and 19) immunostained the PCs intensely, but was negative in both CCs and LPCs. Antibodies to keratin Ks.4.62 (which stain keratin no. 19) immunostained PCs and CCs but not LPCs. Epithelial membrane antigen antibodies (EMA) immunostained the adluminal surface and apical cytoplasm of PCs. Anti-vimentin antibodies immunostained the cytoplasm of PCs and CCs weakly as well as isolated cells in the LP. Antibodies to desmin immunostained most LPCs. Antibodies to collagen IV immunostained the basal lamina and many extracellular spaces in the LP, mainly around the LPCs. The differences between the enzymohistochemical and immunohistochemical patterns of the efferent ducts and those of the epididymis may help to explain functional differences along the epididymis.

The apical mitochondria-rich cells of the mammalian epididymis.

The morphology and function of the apical mitochondria-rich cells in the mammalian ductus epididymidis epithelium are revised. These cells are similar in all mammalian species studied. Apical mitochondria-rich cells are scarce (1-5 cells/100 principal cells) and are mainly found in the initial epididymal segments. Their morphology varies from slender cells that extend from the basal lamina to the epididymal lumen, to round cells that protrude into the lumen and are not in contact with the basal lamina. Their cytoplasm is more electron-dense than that of principal cells and contains more mitochondria which, in some species, are surrounded by rough endoplasmic reticulum cisternae. The adluminal cytoplasm displays a few short microvilli and contains many acid phosphatase positive vesicles. Apical mitochondria-rich cells differ from the principal cells in some histochemical features such as: (a) different lectin-staining pattern; (b) more intense reaction to the enzymatic activities: carbonic anhydrase, Ca(2+)-ATPase, peanut-agglutinin-sialidase, NADP dehydrogenase, succinate dehydrogenase, alpha-galactosidase and beta-galactosidase; (c) more intense immunoreaction to several cytokeratin types and to estradiol-related receptor protein; (d) weaker immunoreaction to epithelial membrane antigen and to retinol-binding protein. Although the function of the apical mitochondria-rich cells is still unknown, the following possible functions have been suggested: holocrine secretion; cooperation with the principal cells in epididymal reabsorption of testicular fluid; and acidification of epididymal fluid. Experimental results suggest that differentiation and maintenance of apical mitochondria-rich cells are not under androgen control and that these cells are sensitive to estrogen stimulation.

Quasiperiodic Bloch-like states in a surface-wave experiment.

Bloch-like surface waves associated with a quasiperiodic structure are observed in a classic wave propagation experiment which consists of pulse propagation with a shallow fluid covering a quasiperiodically drilled bottom. We show that a transversal pulse propagates as a plane wave with quasiperiodic modulation, displaying the characteristic undulatory propagation in this quasiperiodic system and reinforcing the idea that analogous concepts to Bloch functions can be applied to quasicrystals under certain circumstances.