"Warning card" as a prevention of prolonged apnea in children.

Human butyrylcholinesterase (EC 3.1.1.8) (BChE) is present in serum mainly as "usual UU" form, but it has also been found in variant forms known as "atypical" BChE. The most important predictive value of BChE phenotype is for anesthetist to prevent prolonged apnea. BChE has an important role in the hydrolysis of neuromuscular relaxant succinylcholine (suxamethonium, scoline) used during anesthesia. In order to detect atypical variants of BChE and give these findings to the anesthetists-surgeons before an operation to avoid the prolonged apnea, we phenotyped 542 sera of children before tonsillectomies. Total BChE activity was measured using butyrylthiocholine as substrate and dibucaine, fluoride, urea and dimethylcarbamate Ro 02-0683 were used as inhibitors. The frequencies of phenotypes in 542 children were: UU, UA, US, SS, AS and AA--92.25%, 7.01%, 0.18%, 0.18%, 0.18%, 0.18% respectively. Once established phenotype of BChE does not change during the lifetime. Therefore the carriers of atypical phenotype of BChE received a "Warning card", which is a permanent warning for succinylcholine application, as well as a sign to the members of the families to test their own phenotype of BChE. In our study three "Warning cards" were given: two to the carriers of atypical phenotype and third to a child presented as SS phenotype with low total activity of BChE. The present study is the first clinical evaluation of this genetic abnormality in the Republic of Croatia.

Diagnostic accuracy of transesophageal echocardiography for detection of atrial masses.

The aim of this study was to assess the diagnostic accuracy of transthoracic (TTE) and transesophageal echocardiography (TEE) for the detection of atrial masses. The authors' own experiences with the use of TTE and TEE images in the assessment of atrial masses are reported. These masses included tumors, thrombi, and valvular vegetations. The study groups consisted of 14 consecutive patients (7 women an 7 men), age range 24-72 (mean age 56.6 < +13.4) years. Eleven patients had left atrial tumor, two patients had atrial thrombi, and one patient had vegetation in left atrium detected with TEE. Eight patients had left atrial myoma, two patients had right atrial myxoma, and one patient had right atrial leiomyosarcoma. There was no false negative and no false positive TEE diagnosis, yielding a 100% sensitivity and specificity of TEE in detecting atrial masses. TEE detected atrial masses in six (43%) patients, provided poor images in five (36%) patients, and failed to reveal atrial masses in three (21%) patients. The TEE diagnosis was confirmed by surgery and pathohistology in all patients. The ability of TEE to visualize both atria with great diagnostic accuracy makes it a very valuable procedure in the assessment of atrial masses.

A comparison of surgery and radiotherapy in the management of advanced pyriform fossa carcinoma.

This retrospective study analyses the outcome of treatment of 61 patients with advanced carcinoma of the pyriform fossa. Thirty-two patients (group 1) underwent surgery and postoperative radiotherapy and 29 patients (group 2) had induction chemotherapy followed by radiotherapy. The local recurrence-free survival at 5 years from the completion of therapy for group 1 was 54%, compared to 61% for group 2. The 5-year neck recurrence-free survival for groups 1 and 2 were 54% and 59%, respectively. The 5-year overall survival rates for groups 1 and 2 were 19% and 14%, respectively. Non-surgical therapy for advanced stage pyriform fossa cancer provides survival comparable with that achieved with the standard approach of surgery and postoperative radiotherapy. We advocate radical irradiation as the method of choice because it provides nodal coverage to the bilateral jugular chains and retropharyngeal nodes, all known to be at risk for metastases, and is associated with lower morbidity compared to surgery. But, however, despite the therapy, the outcome is poor.

Osteoma of the internal auditory canal.

Osteomas of the internal auditory canal, inaccesible to clinical examination, are rare lesions. There are only 14 cases of osteomas and exostoses of the internal auditory canal reported in the international medical literature. A patient with an osteoma of the internal auditory canal is presented, along with differential diagnosis and possible etiologic factors for the lesion. The auditory brainsteam evoked response testing showed increased absolute latencies of 1 wave and discrepancy of the wave morphology due to bony compression of the eight nerve in the internal auditory canal. Computed tomography showed a bony growth in the internal auditory canal. Magnetic response showed no abnormalities. No surgery was performed since the symptoms improved by conservative therapy.

Pilocarpine in the prevention of postirradiation xerostomia.

During radiation therapy to the head and neck region, salivary gland hypofunction commonly develops. The aim of our study was to evaluate whether the sialogogue pilocarpine given during radiation therapy may reduce the severity of xerostomia and salivary dysfunction. Our results showed the pilocarpine-treated group to have a lower frequency of oral symptoms during the treatment than the placebo-treated group. Although salivary flow decreased in all patients, the pilocarpine-treated group had smaller flow reductions. No drug effect was observed in the glands that were completely irradiated. Thus, pilocarpine appeared to stimulate salivary tissues outside the radiation field.

Recruitment in the diagnosis of small PCA tumors.

Acoustic brainstem response (ABR) waveforms were preoperatively analyzed in 86 cases of pontocerebellar angle (PCA) tumors. Absolute (APL) and interpeak latencies (IPL) ipsilateral to the tumor and interaural absolute latency differences of wave V (IAAPLD V) were normal in two patients with small intracanalicular tumors. However, results of latency-intensity studies were abnormal. So, if PCA tumor is suspected, and standard ABRs are normal by usual criteria, the latency-intensity functions should be examined before the test result is reported as negative for an acoustic nerve tumor.

Clinical interpretation of brainstem evoked response audiometry abnormalities in cochlear pathology.

This investigation involved 45 patients with sensorineural hearing loss (SNHL): 24 with Meniere's disease, 18 with acoustic trauma, and 3 with SNHL due to ototoxic drugs. They all underwent pure tone audiometry and standard brainstem evoked response audiometry (BERA). In patients without wave I in auditory brainstem response, electrocochelography (ECochG) was performed. The findings are presented showing that cochlear lesions (beside threshold elevation) cause latency prolongation of wave I, III and V relative to normal latencies at the actual click hearing level. At high stimulation levels, this effect is almost completely compensated for by the fact that cochlear recruiting ears exhibit steeper latency-intensity curves than do normal ears. But, at the same time this pathology does not cause latency prolongation of central conduction time (CCT). Beside this, cochlear lesions will cause, in some cases, deterioration of replicability (poor waveform resolution) of waves preceding wave V. In such cases, the authors strongly recommend electrocochleography (ECochG) to make wave I visible, because they think that it is the best way to verify the diagnosis of cochlear lesion using BERA.

Bilateral Bell's palsy in a pregnant woman.

Bell's palsy is a peripheral facial palsy of unknown etiology. During pregnancy, there is an increased incidence of idiopathic facial paralysis (Bell's palsy). Nevertheless, bilateral facial paralysis in pregnant woman is a rare phenomenon with only a few case reports in medical literature. We report on a patient with bilateral facial paralysis in pregnancy, with a review of the literature and possible etiologic factors. The patient was treated conservatively and the left facial palsy resolved completely, whereas on the right side there was a residual lesion of facial function. The etiology, treatment and prognosis of Bell's palsy in pregnancy remain controversial.

Vertigo as a prognostic factor in sudden hearing loss.

A group of 87 patients suffering from unilateral sudden hearing loss were investigated. They were divided into two groups with and without vertigo, and were evaluated according to the severity of initial hearing loss and shape of tonal audiogram. Twenty-five percent of the patients had accompanying vertigo. Vertigo occurred more often in patients with severe hearing loss in high tone frequencies. Hearing recovery of high tone frequencies was poorer in the patients with vertigo than in those without it, although the initial hearing loss was the same.

Serum total, LDL, HDL cholesterol and triglycerides related to age, gender and cigarette smoking in patients with first acute myocardial infarction.

The aim of this study was to examine relationships between total cholesterol, LDL, HDL cholesterol, triglycerides and age, gender, and cigarette smoking in 190 patients (132 men and 58 women) aged 34-87 years with first AMI. The control group included 103 patients (57 men and 46 women) aged 29-90 years without a history of angina pectoris or AMI. High total cholesterol (over 5.2 mmol/L) was observed in 75% of patients with AMI vs. 48% of patients in the control group (p < 0.001). Patients with AMI had significantly higher total cholesterol and LDL cholesterol levels than controls (p < 0.0001). HDL cholesterol levels were significantly lower among patients with AMI than among the control group patients (p < 0.0001). Serum total cholesterol and LDL cholesterol is higher in patients with AMI up to 60 years old, but lower in patients older than 60 years. Women aged less than 50 years had significantly higher HDL cholesterol (p < 0.001), lower LDL cholesterol (p < 0.001), and lower total cholesterol (p < 0.05) than those over 50 years. Smokers with AMI who smoked over 20 cigarettes per day had significantly higher total cholesterol, LDL cholesterol and triglycerides levels than the non-smokers (p < 0.05). These findings suggest important influences of hyperlipoproteinemia and cigarette smoking upon development of myocardial infarction, especially in younger patients.