Hearing immaturity found by ABR and its clinical impact on otoneurological evaluation.

Auditory Brainstem Response (ABR) is the most reliable and most frequently used procedure to evaluate audiological conditions in early infancy. However, several reports have demonstrated that developmental change in the central nervous system may affect the results of ABR in audiological evaluations. We examined statistically the reliability of ABR for the diagnosis of profound deafness in early childhood according to our experience over the past 12 years of follow-up in our facility. Subjects included 371 children among 1,041 children who were admitted to Kanariya-Gakuen (institute for pre-school deaf children) from April 1985 to March 1997. These children were examined with ABR to determine their hearing levels. In five cases with an abnormal hearing threshold determined by ABR and other audiological tests, repeated examinations carried out during a 5- to 6-month follow-up period revealed that they had normal hearing. Three of these children had been diagnosed previously with mental retardation and the remaining two were infants < 5 months old. The specificity and sensitivity of ABR were calculated as 97.3% and 100%, respectively. The predictive value of a positive result was 94.7%. There remains the possibility of a false negative for such cases, although the rate seems to be very low (< 0.2%).

[Prognosis for patients with angina pectoris accompanied by chronic renal failure].

Chronic renal failure (CRF) is one of the risk factors of a worse outcome for patients with coronary artery disease. However, few studies have assessed the outcome in such patients. This study investigated the clinical characteristics, treatment modalities, and prognosis for patients with angina pectoris accompanied by CRF and evaluated the validity of current treatment strategy for these patients. A total of 593 patients (248 with stable angina and 345 with unstable angina) admitted to our institution were studied. Renal failure was defined as serum creatinine of > or = 2.0 mg/dl. Patients were divided into 2 groups, with renal failure (46 patients) and without renal failure (547 patients), and the former group was further divided into 2 groups with hemodialysis (26 patients) and without hemodialysis (20 patients). The mean follow-up period was 2.5 +/- 1.2 years and the follow-up rate was 99%. The prevalences of congestive heart failure (26% vs 3%, p < 0.001), hypertension (72% vs 45%, p < 0.005), and multivessel coronary artery disease (65% vs 33%, p < 0.001) were higher in patients with CRF. The left ventricular end-diastolic volume was greater in patients with CRF than in patients without CRF (114 +/- 36 vs 85 +/- 24 ml/m2, p < 0.001). The calcification score of both coronary arteries and abdominal aorta evaluated by electron-beam computed tomography was higher in patients with CRF (2,187 +/- 2,727 vs 631 +/- 841, p = 0.03; 4,091 +/- 3,068 vs 2,191 +/- 2,249, p = 0.02, respectively). In-hospital cardiac mortality was higher in patients with CRF than in patients without CRF (8.7% vs 0.7%, p < 0.001). The cumulative survival was 88% at 1 year and 65% at 3 years in patients with CRF and 99% and 97% in patients without CRF, respectively (p < 0.001). The incidence of re-hospitalization due to congestive heart failure was higher in patients with CRF (19% vs 1.3%, p < 0.0001). The cumulative survival in CRF was 93% at 1 year, 57% at 3 years in the medical treatment group and 87% and 75% in the invasive therapy group, respectively (p = 0.1). Patients with angina pectoris and CRF had a poor prognosis under the current treatment strategy. Newly developed therapeutic strategies, such as rotational atherectomy, minimally invasive direct coronary artery bypass surgery and combinations, will be necessary to improve the long-term prognosis for these patients.

Differing patterns of P-selectin expression in lung injury.

Using two models of acute lung inflammatory injury in rats (intrapulmonary deposition of immunoglobulin G immune complexes and systemic activation of complement after infusion of purified cobra venom factor), we have analyzed the requirements and patterns for upregulation of lung vascular P-selectin. In the immune complex model, upregulation of P-selectin was defined by Northern and Western blot analysis of lung homogenates, by immunostaining of lung tissue, and by vascular fixation of 125I-labeled anti-P-selectin. P-selectin protein was detected by 1 hour (long before detection of mRNA) and expression was sustained for the next 7 hours, in striking contrast to the pattern of P-selectin expression in the cobra venom factor model, in which upregulation was very transient (within the 1st hour). In the immune complex model, injury and neutrophil accumulation were P-selectin dependent. Upregulation of P-selectin was dependent on an intact complement system, and the presence of blood neutrophils was susceptible to the antioxidant dimethyl sulfoxide and required C5a but not tumor necrosis factor alpha. In contrast, in the cobra venom factor model, upregulation of P-selectin, which is C5a dependent, was also dimethyl sulfoxide sensitive but neutrophil independent. Different mechanisms that may explain why upregulation of lung vascular P-selectin is either transient or sustained are discussed.