Hearing rehabilitation with single-stage bilateral vibroplasty in a child with Franceschetti syndrome.

Hearing is of utmost importance for normal speech and social development. Even children who have mild or unilateral permanent hearing loss may experience difficulties with understanding speech, as well as problems with educational and psycho-social development. The increasing advantages of middle-ear implant technologies are opening new perspectives for restoring hearing. Active middle-ear implants can be used in children and adolescents with hearing loss. In addition to the well-documented results for improving speech intelligibility and quality of hearing in sensorineural hearing loss active middle-ear implants are now successfully used in patients with conductive and mixed hearing loss. In this article we present a case of successful, single-stage vibroplasty, on the right side with the fixation of the FMT on the stapes and PORP CLiP vibroplasty on the left side in a 6-year-old girl with bilateral mixed hearing loss and multiple dyslalia associated with Franceschetti syndrome (mandibulofacial dysostosis). CT revealed bilateral middle-ear malformations as well as an atretic right and stenotic left external auditory canal. Due to craniofacial dysmorphia airway and (post)operative, management is significantly more difficult in patients with a Franceschetti syndrome which in this case favoured a single-stage bilateral procedure. No intra- or postoperative surgical complications were reported. The middle-ear implants were activated 4 weeks after surgery. In the audiological examination 6 months after surgery, the child showed 100% speech intelligibility with activated implants on each side.

Assessment of pulmonary air trapping and obstruction in expiration: an experimental MRI study.

PURPOSE: The aim of this experimental study was to evaluate the potential of a simple expiration technique by means of magnetic resonance imaging (MRI) in an animal model to detect pulmonary air-trapping areas after artificial bronchial obstruction. MATERIAL AND METHODS: Sixteen pigs were evaluated by means of a modified T1-weighted FLASH with fat saturation in respiratory arrest (TR=4.6 ms, TE=1.8 ms, alpha=10 degrees, S.D.=3-5 mm). A measurement of the signal intensity (SI) in the peripheral lung tissue was made in both inspiration and expiration before and after inhalation of 2 ml of 0.5% acetylcholine to simulate a bronchial obstruction. A final measurement of the lung SI was also made after bronchospasmolytic induction through salbutamol (beta2-mimetic bronchodilator). RESULTS: In expiration, a mean SI increase in peripheral lung tissue of about 183% was seen in comparison to inspiration (mean SI increase of 11-32). After inhalation of 0.5% acetylcholine, the expirational signal increase in peripheral lung tissue was only 114% of the original SI. The expirational signal homogeneity decreased after inhalation of acetylcholine. After inhalation of salbutamol, the lung tissue signal elevation in expiration was 193%. CONCLUSION: We interpret the low expiratory signal elevation after acetylcholine inhalation as a result of an air-trapped bronchial constriction in certain areas. The simple expiratory technique in an animal model showed that it is suitable to demonstrate obstructive air trapping using MRI.

Pulmonary resorption of inhaled gadobutrol in an animal model: usage to determine lung diffusion in MRI examinations.

The aim of this study was to examine a pulmonary gadobutrol resorption after inhalation. An examination of 16 young swine, which were given different amounts of gadobutrol through inhalation, was performed. A measurement of the signal elevation in peripheral lung tissue as well as in the thoracic aorta was made using a T(1)-weighted FLASH-3D sequence in a 1.5 T magnetic resonance imaging (MRI) machine. Twenty minutes after gadobutrol application, a steep signal elevation in the aorta was reported, as well as a plateau phase after 45 min. The signal elevation in peripheral lung tissue after inhalation increased to a mean of 33.9%. The concurrent signal elevation of the abdominal aorta was 137.4%. The evaluation of an intravascular signal elevation after gadobutrol inhalation opens the possibility to evaluate and obtain lung diffusion with MRI.

Severe head trauma in children: cranial computer tomography and clinical consequences.

BACKGROUND: We investigated the prognostic and therapeutic implications of cranial computerized tomography (CCT) examinations after severe head trauma in children. MATERIALS AND METHODS: The CCT scans from 248 children (aged 0.1-14 years) during the course of treatment after severe head trauma were assessed. The initial CCT findings, the frequency of CCT examinations and the schedule as well as duration of treatment were registered. The neurological outcome was examined both 1 month and 1 year after the trauma. RESULTS: Approximately one-third (29%) of the children who suffered from severe head trauma showed no changes in the CCT. Furthermore, 40.3% of the children showed a singular finding in the CCT, whereas 30.6% of all children had a combined injury pattern. One year after trauma, we found no impairment of consciousness in children without pathological CCT findings, as well as in cases with isolated epidural and subdural haemorrhage. Children with massive generalized brain oedema had the poorest prognosis (37% died, 25% had impairment of consciousness). The outcome of children with parenchymal and ventricular bleeding was also unfavourable (23.1% and 33.3% neurological findings). Patients with focal oedema likewise had impairment of consciousness. An average number of 3.0 CCT per child was performed but numbers in single cases varied greatly (1-13 scans per individual). CONCLUSIONS: The initial CCT was of importance regarding further therapy, especially for children in need of surgical treatment. In the other cases, there was no direct impact from CCT findings on treatment procedures in the paediatric intensive care unit. The initial CCT was related to the prognosis, which can be poor even if there are only minimal changes in CCT, such as focal oedema or isolated ventricular bleeding.