Auditory brain- stem responses in neonatal hyperbilirubinemia and effect of therapy

Background: Neonatal hyperbilirubinemia is the most common condition that requires medical attention in newborns. The phenomenon of deposited indirect bilirubin in basal ganglia as well as in the vestibule-cochlear nucleus causes a neurological syndrome called kernicterus as well as sensorineural hearing loss. Currently, the most sensitive means of assessing neurotoxicity may be auditory brain stem evoked response [ABR], which shows the predictable early effects of bilirubin toxicity

Aim: This study aims to determine the effect of neonatal hyperbilirubinemia on auditory brainstem response [ABR] and evaluate the effect of treatment of hyperbilirubinemia on ABR findings

Subjects and Methods: This case-control study was performed on30 neonates with pathologic hyperbilirubinemia as the jaundiced group chosen from Neonatal Intensive Care Unit of AL Zahraa Hospital of Al-Azhar University and 20 healthy neonates as the control group chosen from Maternity department of the same hospital during the period from September, 2011 to August, 2012. ABR was performed on both groups. The evaluated variable factors were latency time, inter peak intervals time

Results: The mean latencies of waves I, III and V of ABR were significantly higher in the pathologic hyperbilirubinemia group as compared with the controls and the mean interpeak intervals [IPI] of waves I-III, I-V and III-V of ABR were significantly higher in the pathologic hyperbilirubinemia group as compared with the controls. A total reversibility to normal thresholds [normal hearing] was displayed by 23 [77.00%] and 25 [83.30%] of jaundiced neonates in the right and left ears respectively, while the remaining 7 [23.00%] and 5 [16.70%] of jaundiced neonates displayed partial reversibility [mild to moderate hearing loss] in the right and left ears respectively [p <0"001]

Conclusions: About 90% of neonates with pathologic hyperbilirubinemia demonstrate ABR changes. Most of these changes [about 77%] revert to normal early after therapy

Open versus arthroscopic technique for anterior cruciate ligament reconstruction with patellar tendon graft. An early results on post-operative pain, rehabilitation and stability

Anterior cruciate ligament [ACL] reconstruction is a common procedure performed by many surgeons, different grafts have been used but the bone- patellar tendon graft has considered the gold standard for many years. The graft can be inserted either arthroscopically assisted with femoral half tunnel created from the joint, thus avoiding the lateral incision or making two tunnels through a mini-arthrotomy and a lateral femoral incision. A great controversy have been claimed for the advantage and the disadvantage of the two procedure as regards early rehabilitation period and stability. A fourty male patients with ACL deficiency were included in a prospective randomized trial comparing the two procedure with a follow up period of one year. The data obtained preoperatively did not show any significant differences between the two groups. At early follow up there was a differences observed with respect to complications and the progress of rehabilitaion. Evaluation at 12 months postoperatively using Lysholm scoring system revealed good to excellent results in 80% of patients in the first group and 70% in the second one. ACL reconstruction reduced anterior tibial translation of the knee significantly at 6 months follow up with a slight increase of degrees of instability at 12 months in both groups. The arthoroscopic single incision technique did show better results as regards early postoperative pain, swelling, range-of motion or any rehabilitational parameters. We conclude that an arthroscopic single incision technique for ACL reconstruction has an advantage over open mini-arthrotomy two incision technique as regards subjective more than objective parameters

Arthroscopic bankart repair using suture anchors with respect to lesion of the middle glenohumeral ligament

Arthroscopic bankart procedures have been well described, and their results have produced a significant improvement over those of open repair or even those of other arthroscopic capsulorraphy techniques. Although injury to the middle glenohumeral ligament [MGHL] was discribed as a part of an avulsion of the entire anterior capsulolabral complex. A retrospective study was made on 42 patients with symptomatic anterior instability of the glenohumeral joint. The mean age was 24 yaers [20-32]. The instability was confirmed from preoperative history, physical examination, and magnetic resonance imaging which was positive in all patients. The arthroscopic findings showed ill-defined MGHL in 10 patients,and a cord like type in 5 patients a band like shaped ligament had been seen in the rest of the patient, associated injury with an anterior inferior glenoid labaral [AIGL] tear in 8 patients. Arthroscopic repair of glenoid labral tear with respect to MGHL using 2-3 suture anchors with a follow up of 2 - years resulted in decreased pain and improved function in all patients.There was no complication nore recurrence of the symptoms of instabity. 40 patients rated satisfactory on UCLA scale, the 2 patients rated unsatisfactory were complaining impingment, improved with arthroscopic subacromial decompression. Surgical arthroscopic repair of glenoid labral tear and avulsions of MGHL provides satisfactory results in a majority of cases

Ear-lobe electro-cochleography [ECochG] in Meniere's disease

Twelve Meniere's disease patients participated in this study and compared with a normal hearing control group. A classical picture of Meniere's disease [vertigo, tinnitus, hearing loss and feeling of pressure in the ear] was present. Pure tone audiometry showed a significant elevation in hearing threshold at all frequencies in comparison with the control group. However, the classic low frequency SNHL of mild to moderate degree with preserved higher frequencies was the hearing threshold configuration. Semicircular canal weakness was documented. Extratympanic noninvasive ECochG using a horizontal recording montage was used with a surface active electrode on the ipsilateral earlobe and a reference electrode on the contralateral one. A low forehead surface electrode served as a base. The ECochG showed enlarged SP and SP/AP ratio than the normal control. SP/AP ratio was 0.248 +/- 0.094 for the control and 0.683 +/- 0.123 for the study group. The sensitivity of ECochG was 90% in the control and 83.3% in the Meniere's groups. Extratympanic earlobe ECochG offers a valuable objective test for the diagnosis of Meniere's disease. It permits a high quality recording with a minimal professional time or patient discomfort

Auditory brainstem response [ABR] findings in post-meningitic children

Auditory brainstem response [ABR] was performed on 39 children after the recovery from meningitis in addition to 20 healthy children served as controls. Hearing loss was detected in the form of sensorineural hearing loss in 16 patients of which ten had bilateral profound hearing loss. A mild conductive hearing loss was present in four patients and 19 patients showed normal hearing. Brainstem abnormalities were present in the form of prolonged latencies of waves I, V, interwave latencies of I-III and I-V. The age of onset of meningitis and associated neurologic complications were not associated with an increased incidence of hearing loss

Effects of elevated serum lipids on the hearing threshold [a conventional extended high frequency audiometry study]

This study was designed to find out if hyperlipidemia can cause hearing affection and to evaluate the sensitivity of extended high frequency audiometry in early detection of hearing impairment. Audiological evaluation in the form of conventional pure tone air and bone conduction hearing threshold at octave frequencies was done. Extended high frequency hearing threshold audiometry measurement in dB-SPL at 9-18 KHz frequencies was also performed. Triglycerides had less damaging effect on hearing than cholesterol, however combined elevation had more drastic insult. LDL/HDL ratio is an important risk factor in hearing affection. LDL/HDL ratio <3 is a low risky affecting hearing at extended high frequencies at and above 11 KHz. LDL/HDL ratio between [3-6] is a moderate risky affecting hearing at and above 8 KHz. LDL/HDL ratio >6 is high risky, affecting hearing at all conventional and extended high frequencies. It was recommended to use extended high frequencies as a sensitive tool to detect early hearing affection in cases of hyperlipidemia. Treatment of hyperlipidemia should begin long before the evidence of diminished hearing in the high frequencies. Diet control should begin early in life as possible

Helicobacter pylori, effect of its eradication on serum gastrin in gastritis and duodenal ulcer patients

It was observed that hypergastrinemia occurs with Helicobacter pylori [H. pylori] infection whether it may play a role in the pathogensis of duodenal ulcer disease or not, still controversial, Aim of the study is to observe the effect of H. pylori infection among duodenal ulcer [DU] and chronic gastritis patients before and after H. pylori eradication and observe the changes in serum gastrin levels and the reflection on the pathological course of gastritis and DU. disease. Out of 380 chronic dyspeptic patients 154 patients were H. pylori positive [40.5%]. DU was detected in 17.5% of H. pylori positive and in 8.8% with H. pylori negative dyspeptic patients. Serum fasting gastrin levels were measured by standard radioimmunoassay techniques, in 45 DU patients [25 patients of them were H. pylori infected] and 40 chronic gastritis patients [20 patients were H. pylori infected] before and one month after H. pylori eradication. In addition to a control group included 15 normal H. pylori negative individuals. H. pylori detection and monitoring was assessed by serologic test [ELISA], bacteriological culture, Clo test [unease test] and histopathological examination [Giemsa stain] before and after therapy. Colloidal bismuth, amoxicillin and metronidazole triple therapy was used for H. pylori eradication. Fasting hypergastrinemia was detected significantly among DU and chronic gastritis H. pylori infected patients [P<0.001], than H. pylori negative comparable groups and normal controls. Reversed hypergastninemia [mean values] were observed significantly [P<0.01], among chronic gastritis and DU, H. pylori infected groups after a month of triple therapy for H. pylori eradication. Successful eradication was achieved in 75% and 88% as detected by ELISA technique, 100% by bacterial culture, 90% and 88% by Clo test and 100% to 92% by histopathological examination among chronic gastritis and DU groups respectively. Although, significant decrease in the mean values of fasting serum gastrin after H. pylori eradication in chronic gastritis patients [P<0.01], the improvement in the grades of gastritis showed insignificant changes [P>0.05]. Also, a significant decrease in the fasting serum gastrin mean values in DU H. pylori infected patients after a month of H. pylori eradication [P<0.01], however, non significant differences were reported between the rates of complete DU healing, partial healing and non healing ulcers among H. pylori negative or positive DU groups [P>0.05]. In These findings suggest that hypergastrinemia is secondary to H. pylori infection and related to mucosal inflammation and play a minor role in inducing duodenal ulcer disease. Although, ELISA test is the most sensitive for H. pylori detection but its reliability in assessing eradication needs a further study. Also, serum gastrin measurement can be used to assess H. pylori eradication