Characterization of Gene Expression in the Rat Brainstem After Neonatal Hypoxic-Ischemic Injury and Antioxidant Treatment.

The perinatal brainstem is known to be very vulnerable to hypoxic-ischemic events which can lead to deafness, swallowing dysfunction, and defective respiratory control. The aim of the present work was to evaluate the potential neuroprotective effects of nicotine, melatonin, resveratrol, and docosahexaenoic acid on the expression of a panel of genes in the brainstem following hypoxic-ischemic damage. Quantitative PCR was used to examine gene expression 3 and 12 h after the damage, and immunohistochemistry was employed to evaluate neurons, astrocytes, and synaptic vesicles 24 h post insult. We found that the expression of some immediate-early genes, as well as that of inflammatory genes TNF-α, COX2, and caspase 3, was upregulated in response to the insult. Twenty-four hours after the damage, the percentage of NeuN and synaptophysin immunolabeled cells was found to be reduced while GFAP expression was upregulated. No differences were observed in ROS gene expression following treatments.

Usefulness of rhinomanometry in the identification and treatment of patients with obstructive sleep apnoea: an algorithm for predicting the relationship between nasal resistance and continuous positive airway pressure. a retrospective study.

OBJECTIVES: We tried to assess the relationship between nasal resistance measured by rhinomanometry and the pressure used in CPAP. DESIGN: Retrospective medical case series review, January 2004 to December 2014. SETTING: Tertiary care academic medical centre. PARTICIPANTS: Thirty-eight patients (m = 56.55 years; male = 90.5%) with CPAP settings ≤8 and 39 patients (m = 57.49 years; male = 74.9%) with pressure settings ≥12. MAIN OUTCOME MEASURES: Study variables were BMI, neck circumference, Epworth Sleepiness Scale score, nasopharyngeal examination and computerised anterior active rhinomanometry, sitting and supine, in basal conditions and after intranasal administration of oxymetazoline (0.05%). Nocturnal polysomnography was performed to calculate the apnoea-hypopnoea index without and with CPAP to analyse the effectiveness of the treatment. RESULTS: BMI and resistance in supine position after vasoconstriction at 150 Pa were useful variables to predict the pressure setting that should be used. We obtained an equation to calculate the probability that a patient requires a pressure >12 cm H2 O as a function of their BMI and total nasal airflow at 150 pascal in supine position after vasoconstriction. CONCLUSIONS: Rhinomanometry is useful to predict the impact of structural nasal modifications on the positive pressure to support decision-making in relation to surgery.

Inflammatory myofibroblastic tumor of the temporal bone: a histologically nonmalignant lesion with fatal outcome.

INTRODUCTION: Inflammatory myofibroblastic tumor (IMFT) of the temporal bone is an unusual but distinct clinicopathologic entity. CASE REPORT: We report the case of a 75-year-old patient with an IMFT located in the temporal bone. Symptoms included VI, X, XI, and XII cranial nerves palsies. Computed tomography and magnetic resonance images are described. The lesion was locally aggressive and outcome was fatal. IMFT was identified by analysis of postmortem specimen with histopathologic and immunohistochemical confirmation. DISCUSSION: IMFT can be locally destructive lesions. Involvement of the skull base and cervical spine is indistinguishable from an aggressive infection or a malignant tumor and can be fatal as in our case report. The difficulties in establishing clinicopathologic diagnosis, radiological imaging characteristics, and treatment are discussed.

Preliminary study of the lymphatic drainage system of the nose and paranasal sinuses and its role in detection of sentinel metastatic nodes.

CONCLUSIONS: The normal nasal lymphatic drainage runs via the facial vessels into the neck lymphatic nodes of levels I-II and this drainage pattern was found in our patients with sinonasal tumors. We found only one true-positive sentinel lymph node (SLN). Our pathological material was very limited and so further investigations are required before any valid conclusions can be drawn concerning the clinical value of SLNs in nasal tumors. Objectives. To detect the lymph collection route of the nasal fossae and paranasal sinuses and to identify the first echelon in the tumor metastatic cascade in order to prevent the risk of occult metastases in N0 necks in patients with primary head and neck squamous cell carcinoma (SCC). MATERIAL AND METHODS: Our control group comprised 30 patients (20 females; age range 19-50 years) suffering from chronic otitis media who had an anatomically normal nose and a cNO neck on palpation. The pathological group comprised 6 patients (2 females; age range 40-85 years) suffering from sinonasal tumors: 3 SCC, 1 recurrent melanoma, 1 ameloblastoma and 1 inverted papilloma. All had a clinically staged cNO neck on palpation and CT. In the control group, lymphoscintigraphy was carried out by means of unilateral injection of radioactive gold into the head of the inferior turbinate. The tracer was identified using a gamma camera 3 and 6 h after the injection. In the pathological group the chosen tracer was technetium, which was administered 1 day prior to surgery by means of injections into the heads of the inferior and middle turbinates, into the nasal septum and into the retromaxillary gingival mucosa. The tracer was identified transcutaneously using a navigator probe in the gamma camera at 15 min, 30 min and 1 h post-injection. A mark was drawn on the skin corresponding to the hot spot of the SLN. The study was repeated 30 min before surgery. The neck incision was selected according to the location of the SLN. A hand-held gamma probe was used in the operating theatre to detect in situ the radioactivity of the surgical excisional nasal area and the cervical SLN. Once the SLN was excised its radioactivity was confirmed ex situ, taking into account that the activity counts were at least three times greater than background. Postoperatively, all SLNs were histopathologically examined and cytokeratin staining was carried out immunohistochemically using the monoclonal antibody cocktail AE1/AE3. Results. In the control group, intense activity at the injection tracer site and lower activity in the submandibular area (level I) were detected in 26.6% of cases. Nasal radioactivity persisted for 6 h post-injection and submandibular radioactivity increased, also reaching the area corresponding to neck node level II (70%). In two cases (6.6%), radioactivity was observed in the retropharyngeal nodes. In the pathological group, the SLN was found in the submandibular area (level I) in three cases, and in the ameloblastoma patient three SLNs were found at levels I-II. Three cases were false positives, and no metastases were detected using any of the histopathological procedures. The only one true positive corresponded to a female with an SCC of the maxillary infrastructure with invasion of the gingival mucosa. The histopathological code was 1 and a metastasis was detected on hematoxylin-eosin examination. In the other two cases no SLNs were detected.

Auditory function recovery following acoustic overstimulation.

OBJECTIVE: To examine electrophysiological data from auditory brainstem responses (ABRs) and distortion product otoacoustic emissions (DPOAEs) in chickens following acoustic overstimulation. MATERIAL AND METHODS: A total of 15 white 15-day-old Leghorn chickens were used. The animals were anesthetized with Equithensin, and placed with their heads in a special holder. Click stimuli were generated by a Nicolet CA1000 device and ABRs were recorded subcutaneously using three stainless-steel electrodes. An ILO 92/DP analyzer was used to determine DPOAEs. The noise was generated by a Promax GB 212 device. The acoustic exposure was provoked with a 2-kHz pure tone at 120 dB SPL for 24 h. ABRs and DPOAEs were determined before and immediately post-exposure and 5, 15, 21 and 30 days after the traumatic exposure. RESULTS: In our control DPgram response, the maximum amplitudes (dB SPL) occurred at 1, 1.5, 2, 3 and 4 kHz and the minimum amplitudes at 0.7, 5 and 6 kHz. Immediately following acoustic overstimulation an amplitude loss in all frequencies was detected (p < 0.001). Five days after noise exposure only the amplitude loss at 3 kHz remained. Three waves with positive and negative peaks appeared in our control ABR recordings. An important threshold shift was detected in the ABR response immediately after acoustic overstimulation. Its complete recovery occurred 15 days after the acoustic trauma. CONCLUSION: Recovery of the DPgram response was detected 5 days after acoustic overstimulation, whereas the normal ABR threshold appeared on the 15th day.

Distortion-product otoacoustic emissions study of the noise-induced toughening effect in rats.

OBJECTIVE: To compare the toughening effects in rats induced by pure tones and a broadband noise (BBN). MATERIAL AND METHODS: Sprague-Dawley female albino rats (n = 148; 8-10 weeks old) were used. Three experimental groups were established as follows. Toughening only: 38 rats, divided into 3 subgroups, were exposed to different conditioning sounds (2 and 4 kHz and a BBN of 0.25-6 kHz, respectively) at 75-85 dB sound pressure limit (SPL) for 8 h/day for 10 days. Acoustic trauma only: 54 rats, divided into 3 subgroups, were exposed to different conditioning sounds as above for 24 h at 100-110 dB SPL. Toughening plus acoustic trauma: 56 rats, divided into 3 subgroups, were exposed to different conditioning sounds as above, followed 8 h later by traumatic exposure to the conditioning sound at 110 dB SPL for 24 h. 2f1-f2 distortion-product (DP) otoacoustic emission measurements were obtained from the right ear of each animal pre-exposure, immediately post-exposure and after 8 h of the traumatic or conditioning exposure. RESULTS: In our control DPgram response, the maximum amplitude occurred at the highest frequencies (2, 3, 4, 5 and 6 kHz). No statistical differences between the control DPgram and the DP toughening (2 and 4 kHz and BBN)responses were found. Only 2 and 4 kHz frequencies induced a protective effect against traumatic sound exposures to the same frequencies, and this finding was statistically significant. CONCLUSION: The toughening phenomenon induced using 2 and 4 kHz pure tones and BBN in rats does not modify the DPgram response. Nevertheless, only 2 and 4 kHz frequencies induce a protective effect against traumatic sound exposures to the same frequencies.

[Comparative study of the use of manual and mechanical suturing in the closure of the mucosal defect in total laryngectomy]. / Estudio comparativo entre el empleo de la sutura manual y la sutura mecánica en el cierre del defecto mucoso en la laringectomía total.

With the present study we try to achieve an objective confirmation of the efficacy given by the mechanical suture in the closing of the pharyngeal defect following a total laryngectomy against the conventional manual suture with absorbable material. Therefore we have studied three random groups of patients: in the first one we include those who had a manual suture (n = 50), in the second one those who had performed a mechanical suture with closed technique (n = 38) and in the third one those who had a mechanical suture with an open technique (n = 12). We have checked that mechanical suture with a closed technique improves significantly the surgical length (212 minutes), the beginning of the oral feeding (10.73 days) and the time of in-hospital stay (13.5 days). Mechanical sutures with a closed technique also reduce the rate of complications such as fistulae (5.26%), infection (0%) and haemorrhage (0%).

Estudio comparativo entre el empleo de la sutura manual y la sutura mecánica en el cierre del defecto mucoso en la laringectomía total / Comparative study between the use of manual versus mechanical sutures in the closing of the mucous defect following a total laryngectomy

Con el presente estudio se pretende realizar una confirmación objetiva de la eficacia de la sutura mecánica en el cierre del defecto faríngeo tras laringectomía total, frente a la sutura convencional manual con material reabsorbible. Para ello hemos estudiado tres grupos aleatorios de pacientes: en el primero incluimos aquellos a los que se realizó sutura manual del defecto postlaringectomía total (n=50), en el segundo aquellos en los que se practicó sutura mecánica con técnica cerrada (n=38), y en el tercero aquellos a los que se realizó sutura mecánica con técnica abierta (n=12). Hemos comprobado que el empleo de la sutura mecánica con técnica cerrada mejora significativamente los tiempos de intervención (212 minutos), inicio de la ingesta oral (10,73 días) y estancia hospitalaria (13,5 días) respecto a los otros tipos de sutura. Así mismo, este tipo de sutura mecánica disminuye la incidencia de complicaciones como faringostomas (5,26%), infección (0%) y hemorragia (0%) (AU)

With the present study we try to achieve an objective confirmation of the efficacy given by the mechanical suture in the closing of the pharyngeal defect following a total laryngectomy against the conventional manual suture with absorbable material. Therefore we have studied three random groups of patients: in the first one we include those who had a manual suture (n = 50), in the second one those who had performed a mechanical suture with closed technique (n = 38) and in the third one those who had a mechanical suture with an open technique (n = 12). We have checked that mechanical suture with a closed technique improves significantly the surgical length (212 minutes), the beginning of the oral feeding (10.73 days) and the time of in-hospital stay (13.5 days). Mechanical sutures with a closed technique also reduce the rate of complications such as fistulae (5.26%), infection (0%) and haemorrhage (0%) (AU)

[Intramuscular epithelioid hemangioma of the parapharyngeal space]. / Hemangioma epitelioide intramuscular del espacio parafaríngeo.

A clinical case of epithelioid hemangioma of the scalene muscle that occupied the parapharyngeal space is reported. The patient was a 34 year old man with a 2-month history of sensation of pharyngeal foreign body and mild dysphagia. The exploration revealed a tumor of the posterior and lateral wall of the oropharynx that extended from the rhinopharynx to the hypopharynx. The diagnostic sequence included CT, MRI, Doppler echography, and arteriography, which identified a right post-styloid tumor located behind and medial to the jugular vein, internal carotid artery, and vagal nerve, but did not affect arterial blood flow. The patient underwent surgical treatment consisting of lateral cervicotomy, tumor excision, and histological study.

[study of acoustic trauma in hunters using otoacoustic emission recording]. / Estudio del trauma acústico en los cazadores mediante el registro de las otoemisiones acústicas.

Transitory otoacoustic emissions (TOAE) were analyzed in 48 ears of male hunters (age range: 30-45 years: mean age: 37 years) and in a population with normal hearing. All the ears had TOAE. The incidence of TOAE for the 1, 2, 3, 4, 5 and 6 KHz frequential bands was significantly lower in hunters than in the normal subjects (p < 0.001). The mean amplitude of TOAE was significantly lower in hunters (9.2 dB SPL) than in the control group (16 dB SPL; p < 0.001). The amplitude of the TOAE for the frequencies 1, 2, 3, 4, 5 and 6 KHz was significantly lower in hunters than in controls (p < 0.001).

[The study of ototoxicity in Gallus domesticus by recording distortion products]. / Estudio de la toxicidad auditiva en el Gallus domesticus mediante el registro de los productos de distorsión.

Distortion products (DP) were recorded and a morphological cochlear study was made of a sample of 60 ears from chickens (Gallus domesticus. Leghorn breed) and the ages of 15, 23, 29 and 60 days, after intoxication by intramuscular gentamicin injection (40 mg per kg weight and day for 8 days). Spontaneous or transitory otoacoustic emissions were not obtained in any case. DP recordings showed a 2F1-F2 response in every frequency band ranging from 0.7 to 6 KHz. The DP incidence shifted with the age of the chickens and differed significantly (p < 0.001) in the groups of 29 and 60 day-old chickens (m = 100%) and in the 29-day-old (m = 64%) and 60-day-old (m = 62%) intoxicated chickens. We found no significant differences in DP amplitude in subpopulations. In the intoxicated groups, the proximal segment of the ototic membrane disappeared in the macula lagenae and a loss of contact with the hair cells appeared. Degenerative vacuolar phenomena were observed in the support cells and cellular loss in the spiral ganglion.

[The influence of contralateral acoustic stimulation on distortion products]. / Influencia de la estimulación acústica contralateral en los productos de distorsión.

The suppressor effect of contralateral broad-band white noise stimulation at 60 dB SPL on distortion-product otoacoustic emissions (DPOAEs) from 40 human ears was examined. The sample was composed of 9 females and 11 males, age 21-28 years. All the ears had DPOAEs. The 2-6 kHz bands had an incidence of 100%, but 0.7 kHz was found in only 27%. Eighty-eight percent of the frequency points recorded had an amplitude of more than 3 dB SPL over background noise. Nevertheless, DPOAE amplitude decreased for frequencial bands 1 to 6 kHz when contralateral acoustic stimulation was employed. However, these differences were only statistically significant for 1.5, 2 and 3 kHz frequencies. No significant differences were found between the ears of a subject or between sexes.

A contribution to the structural pattern differences between the apical and basal spiral ganglions in mammals.

The purpose of this paper was to establish a mammalian comparative study between the neuronal spaces of the upper versus the basal cochlear turns. We studied with light microscopy i) Webster albino rat embryos at various gestational days (GD), and a postnatal (PN) series; ii) kittens 3 weeks old; iii) pigmented guinea pig embryos and also PN specimens; iv) diverse human fetuses. As from the 16th GD, the apical spiral ganglion primordium of the rat appears as a spherical cluster of cells immersed in the mesenchymal modular tissue whereas the basal spiral primordium displays a pyramidal shape with its apex towards the auditory receptor. Both ganglions keep this shape until the rat becomes adult. This structural pattern also appears in the cat, guinea pig and in human material. This morphological model enables a radial stratification of the peripheral and central auditory nerve projections. A thin uni- or bicellular connective layer covers the tympanic scala side of the apical spiral ganglion as from 8 hours after birth in the rat. No gap is detected in this layer which is: mesenchymal in the embryonic and fetal stages (rat, guinea pig, human), connective in PN rat and kitten, and osseous in PN guinea pig and in the human neonate.

[Parameters of normalcy in transient otoacoustic emissions]. / Parámetros de normalidad de las otoemisiones acústicas transitorias.

The incidence, amplitude and frequency spectrum of transitory otoacoustic emissions (TOAE) were analyzed in a sample of 232 normal hearing ears, after click stimulation to determine normal parameters. 116 subjects, 58 female ranging in age from 18 to 30 years, mean age 23.1 years, and 58 male were from 18 to 32 years, mean 23.7 years, were included in this study. TOAE were normal in all ears, 132 (57%) ears had TOAE at all frequencies between 0.5 and 5 kHz. The mean amplitude of TOAE was 16 dB SPL (SD 3.77) and the highest amplitude was elicited at 1-2 kHz frequency. The intensity of stimulation correlated directly with evoked response amplitude and the subject's age correlated inversely with the incidence and amplitude of TOAE.

[Standard parameters of distortion products]. / Parámetros de normalidad de los productos de distorsión.

In this study we have analyzed the incidence, range, frequency spectrum and threshold of distortion products in a sample of 232 normal hearing person. 116 younger adults, 58 female ranging in age from 18 to 30 years (mean age 23.1) and 58 males ranging in age from 18 to 32 (mean age 23.7) were included in the study. In all the ears studied, the presence of distortion products in a normal ear were found with regularity in the frequency region between 700 to 6,000 Hz. Higher incidence occurred in younger people and women but was not statistically notable. There is a direct correlation between distortion products amplitude and its primary intensity. Distortion products amplitude increases progressively from low (770 Hz) to high frequencies (6,000 Hz). The amplitude of distortion products and its mean value is higher in women, in all frequencies, except in the 700 to 1,000 Hz region. Input/output function had a mean of 50 dB SPL at 1 kHz, 43.8 at 2 kHz, 38.4 at 4 kHz and 33.5 at 6 kHz.

[Normalcy parameters of spontaneous otoacoustic emissions]. / Parámetros de normalidad de las otoemisiones acústicas espontáneas.

In the present study we analyze the spontaneous otacoustic emissions (SOAEs) in a sample of 232 hearing-preserved ears. The examination was performed in people of the same gender aged 18 to 32 years (mean age 23.35) and always in the ear of the same side. We have found that the incidence of the SOAEs was 42.6% of the ears and 53.5% of the individuals, being modified by sex, age and audiometric threshold. Incidence in females was 58.62% and in males 26.72%. Mean age of the group presenting SOAEs was 22.68 years, while in the group without SOAEs was 23.85% years. The audiometric threshold in patients with SOAEs was lower (7.27 dB HL) that in those ears without SOAEs (8.17 db HL). Other parameters studied were the number of peaks, the intensity and the frequency of spontaneous otacoustic emissions. The number of peaks of the SOAEs varied from 1 to 12 (mean 3.1). Women showed higher number of peaks than men did. The intensity was ranged between 3 and 51 db SPL (mean 20.1 db SPL). The frequency spectrum presented a range from 488 to 6,103 hertzs, with a higher incidence (48.5%) in the frequency bands of 1,000 and 2,000 Hz. All these data were statistically significant.

Morphologic and morphometric study of human spiral ganglion development.

A light microscopic study of the spiral ganglion was done in human embryos and fetuses measuring 45, 50, 60, 74, 90, 134, 270 mm crown-rump length (crl), and in a one-day-old neonate. Morphometric evaluations of i) cell and nuclear area, ii) nuclear area/cell area ratio, iii) ganglion area, iv) cell concentration/surface unit, and v) distance between the first neuron and the receptor were made, and the results statistically evaluated. In earlier stages of development, spiral ganglion primordia appeared as a cluster of neuroblasts and some schwannoblasts immersed in the mesenchymal tissue, close to the ductus cochlearis. A honeycomb pattern in the spiral ganglion neurons was observed in the basal turn of a 74 mm crl fetus. In later stages, the basal turn of a 90 mm crl fetus showed a spatial organization. Peripheral and central fibers of the acoustic nerve appeared stratified in early periods of development (45 mm crl embryo). From this stage on, both phenomena progress apicalwards until the neonatal period. A significant decrease in the nuclear area/cell area ratio was observed from the 134 mm crl fetus (17 weeks) to the neonatal stage in all turns. This led to a significant increase in cellular area from the 270 mm crl fetus (32 weeks) to the neonate, with no significant variation in nuclear area. The distance from the primordium of the organ of Corti to the spiral ganglion in the interval between 45 and 74 mm crl showed a significant increase in all turns.(ABSTRACT TRUNCATED AT 250 WORDS)

[Correlation of auditory brainstem evoked potentials and pure tone audiometric thresholds]. / Correlación umbral potenciales evocados auditivos troncoencefálicos (ABR), umbrales audiometría tonal liminar.

This work is on relation existing between the objective threshold of auditory brainstem responses in adults and those existing in the different frequencies of audiometry pure-tone, in order to make the audiometry from the objective threshold of the ABR, from the subjective threshold to the click, and the type of hearing loss in question. Such results can be transferred to children, and starting from the ABR in children we could guess their probable audiometric profiles. On that purpose we have studied the auditory brainstem responses and the pure-tone audiometry in 168 ears suffering from hearing-loss, both conductive and sensory neurals with and without recruitment, with different degrees of hearing losses and audiometric profiles. The results have confirmed the relation existing between the threshold of evoked brainstem responses and those of high frequencies, 2,000, 4,000 and 8,000 herzs. We have also proved that the threshold ABR has a predicting value on the audiometry of patients, and that the difference between the objective threshold ABR and the subjective one represents the inclination degree of the pure tone audiometry, which considerably reduces the great variability presented by the prediction of thresholds of low tones starting from ABR.

[Auditory screening in public schools in Bilbao]. / Screening auditivo en colegios públicos de Bilbao.

In this work we present a hearing screening practised to 2802 six years children, attending to Public Schools in Bilbao area, during 1988, 1989 and 1990. We used the screening audiometry as method, placing the normality level in 30 dB H1 ISO. We obtained a prevalence of 6.6% and a 7.6% of false positives. Transmission hearing losses represent almost 70% and levels of low and moderate hearing loss were the most frequent, reading 88.6%. We also confirmed as parameters that contribute to hearing loss detection, the level and bilaterality of hearing loss, being language delay one of the most frequent reasons of suspicion. We also discovered that the vast majority of hearing losses that cause invalidation, deep and severe, have a perinatal origin, so early screenings would enable and early diagnostic and many benefits. In spite of all the screenings mant hearing losses are not detected, but they are moderate and can never cause incapacitation, being of little hearing relevance.

[Diagnostic value of auditory brainstem evoked potentials (ABP) in high risk premature and newborn infants]. / Valor diagnóstico de los potenciales evocados auditivos troncoencefálicos (ABR) en prematuros y neonatos de alto riesgo.

In this work we have studied 37 children, both preterm and term, belonging ti high risk group of contracting hearing loss, in order to confirm the predictability of ABR in the diagnostic of the congenital hearing losses during the prenatal period and so make possible their immediate and proper rehabilitation. With this purpose we have studied parameters such as threshold, latency of waves and intervals. We have discovered that in preterm children, owing to reasons such as answers of little amplitude, movements of the children and difficulty to determine the gestational age, the parameters of normality are only the existence or not of waves, discarding the value of the threshold and the latency of waves. We have had to wait for 40 weeks to obtain ABR similar to the ones in adults, in which the threshold, latency of waves and intervals are certain to predict hearing. In spite of it all we have to agree that ABR are the best hearing test at those ages. We must not forget that normal ABR could include lesions in the upper part of hearing pathway.