Temporal resolution and pitch discrimination in music education: novel data in children.

BACKGROUND: Rehabilitation of hearing and listening difficulties through neuroplasticity of the auditory nervous system is a promising technique. Evidence of enhanced auditory processing in adult musicians is often not based on clinical auditory processing tests and is lacking in children with musical education. PURPOSE: The aim of this study is to investigate the temporal resolution and frequency discrimination elements of auditory processing both in adults and children with musical education and to compare them with those without any musical education. METHODS: Participants consisted of ten children without musical training and ten children with musical training with mean age 11.3 years and range 8-15 years as well as ten adults without musical education and ten adults with musical education with mean age 38.1 years and range 30-45 years. All participants were tested with two temporal resolution tests (GIN:Gaps-In-Noise and RGDT:Random Gap Detection Test), a temporal ordering frequency test (FPT:Frequency Pattern Test), and a frequency discrimination test (DLF: Different Limen for Frequency). RESULTS: All test results revealed better performance in both children and adults with musical training for both ears. CONCLUSION: A positive effect of formal music education for specific auditory processing elements in both children and adults is documented. Larger samples, longitudinal studies, as well as groups with impaired hearing and/or auditory processing are needed to further substantiate the effect shown.

On the Difference of Scoring in Speech in Babble Tests.

Hearing is a complex ability that extends beyond the peripheral auditory system. A speech in noise/competition test is a valuable measure to include in the test battery when attempting to assess an individual's "hearing". The present study compared syllable vs. word scoring of the Greek Speech-in-Babble (SinB) test with 22 native Greek speaking children (6-12-year-olds) diagnosed with auditory processing disorder (APD) and 33 native Greek speaking typically developing children (6-12-year-olds). A three-factor analysis of variance revealed greater discriminative ability for syllable scoring than word scoring, with significant interactions between group and scoring. Two-way analysis of variance revealed SinB word-based measures (SNR50%) were larger (poorer performance) than syllable-based measures for both groups of children. Cohen's d values were larger for syllable-based mean scores compared to word-based mean scores between groups for both ears. These findings indicate that the type of scoring affects the SinB's resolution capacity and that syllable scoring might better differentiate typically developing children and children with APD.

Safety and effectiveness of peroral endoscopic myotomy in patients on antiplatelet or anticoagulant therapy: an international multicenter case-control study.

BACKGROUND AND AIMS: The risk of bleeding and thromboembolic events in patients undergoing peroral endoscopic myotomy (POEM) who are receiving antithrombotic therapy is unknown. Our primary aim was to assess the safety of POEM in this patient subset. Secondary outcomes were rates of clinical success, GERD, and procedure-related outcomes. METHODS: This was an international, 1:1, case-control study performed at 10 centers using prospectively maintained databases. All consecutive patients who underwent POEM before November 2019 were considered for inclusion. Cases were patients on antiplatelet and/or anticoagulant therapy. Controls not receiving antithrombotics were matched for age and esophageal motility disorder. Primary outcomes were major bleeding and thromboembolic events on postprocedural day 30. RESULTS: Of 2895 patients who underwent POEM, 126 cases (103 on antiplatelets, 35 anticoagulants, 12 both) and 126 controls were enrolled. The rate of major bleeding was higher for the antithrombotics users (5.6% vs 0.8%, P = .03). Anticoagulants and clopidogrel were temporarily interrupted in all cases. Aspirin was continued in 40.5% of users without increasing the bleeding risk. One thromboembolic event occurred in each group (0.79%; P = 1.00). No POEM-related deaths were noted. Rates of clinical success (91.7% vs 96% in controls, P = .20), postprocedural GERD, and technical-related outcomes were similar in both groups. Antithrombotic management was heterogeneous, and guidelines were not adhered to in 23.8% of cases. CONCLUSIONS: POEM is safe and effective in patients receiving antithrombotic therapy although it is associated with a greater risk of major bleeding.

Multicenter Evaluation of Clinical Efficacy and Safety of Per-oral Endoscopic Myotomy in Children.

OBJECTIVES: Per-oral endoscopic myotomy (POEM) is a recommended treatment modality for achalasia, but there is little published data for its use in children. The objective of the present study was to evaluate whether POEM is clinically effective and safe for children. METHODS: International multicenter retrospective study conducted in 14 tertiary centers that included consecutive children who underwent POEM between January 2012 and August 2018. Outcomes, such as clinical response were assessed whenever available. Adverse events and factors associated with clinical failure were also investigated. RESULTS: A total of 117 patients (mean ±â€ŠSD age: 14.2 ±â€Š3.7 years) underwent POEM for achalasia (type I, n = 36; type II n=66; type III, n=8). Among these, 30 (26%) were pretreated (botulinum injection and/or pneumatic dilatation). Mean ±â€ŠSD baseline Eckardt score was 7.5 ±â€Š2.0. Clinical success was achieved in 90.6% of cases (95%CI [83.8%;95.2%]) in the intention-to-treat analysis. The mean ±â€ŠSD Eckardt score post-POEM was 0.9 ±â€Š1.2 (P < 0.001). The mean duration of follow-up time 545 days (range: 100-1612). A total of 7 adverse events occurred (4 mucosotomies, 2 subcutaneous emphysema, 1 esopleural fistula). Gastroesophageal reflux symptoms were seen in 17 patients (15%); missing data for 10 patients (9%). There was a trend towards more frequent clinical failure in achalasia associated with genetic disorders (40% vs 8%, P = 0.069). CONCLUSIONS: POEM in pediatric patients appears to be effective and safe, although there was a trend towards more frequent clinical failure achalasia associated with genetic disorders. Further studies are needed to assess the long-term outcomes, especially the consequences of GERD.

Auditory Processing Disorder as the Sole Manifestation of a Cerebellopontine and Internal Auditory Canal Lesion.

BACKGROUND: Clinical importance of auditory processing disorder (APD) testing is often overlooked and regarded with skepticism given the challenging interpretation of results and the current growing debate of its nature and clinical entity. PURPOSE: Presentation of this case is highly educational as APD is the single clinical manifestation of a large cerebellopontine and internal auditory canal lesion. RESEARCH DESIGN: A case report. DATA COLLECTION AND ANALYSIS: The patient underwent a standard audiological evaluation with normal results. She was referred for APD evaluation. The APD test battery consisted of speech in babble (SinB), dichotic digits (DD), frequency and duration of pattern sequence testing, Random Gap Detection Test, and gaps in noise. These were followed by otoacoustic emissions testing, auditory brainstem responses (ABR) and magnetic resonance imaging (MRI). RESULTS: Her auditory processing results showed deficits in SinB and DD limited to the right ear as well as deficits in temporal processing. Both verbal and nonverbal tests exhibited deficits strictly limited to the right ear, which was in accordance with what she was experiencing as reduced loudness for the incoming sounds on the right ear. This less costly evaluation revealed that there was good reason to assess electrophysiologically the auditory system. ABR showed an abnormal waveform with either missing or severely prolongated wave V (depending on stimulus polarity). Otoacoustic emissions were normal. MRI was then implemented revealing a large cerebellopontine and internal auditory canal lesion. CONCLUSIONS: This clinical case stresses the importance of testing for APD with a psychoacoustical test battery despite current debate of lack of a gold standard diagnostic approach to APD. In this case, APD diagnosis led to a cerebellopontine lesion identification with extension to the right internal auditory canal. This rare cause of APD demonstrates the efficiency of the current diagnostic test battery in revealing lesional causes of central APD.

Splenic irradiation as palliative treatment for symptomatic splenomegaly due to secondary myelofibrosis: a multi-institutional experience.

PURPOSE: To evaluate the impact of splenic irradiation as a palliative treatment for symptomatic splenomegaly due to secondary myelofibrosis. METHODS: Seventeen patients with chronic myelogenous leukemia and 3 with idiopathic polycythaemia presented with splenomegaly, splenic pain and anemia. Due to symptomatic splenomegaly, despite first-line treatment, the patients underwent splenic irradiation. Two patients received two different schedules of external radiotherapy (580 cGy in 5 fractions and 600 cGy in 6 fractions). Eight patients received 980 cGy in 14 fractions. Ten patients received two courses of 360 cGy in 6 fractions, 3 months apart. Median follow-up was 12 months post irradiation. RESULTS: The patients showed excellent response to treatment one month post-radiotherapy, while treatment was well tolerated without severe toxicity. The dimensions of the spleen decreased significantly. Pain-related Visual Analogue Score (VAS) regressed after completion of irradiation. During 12-month follow-up all patients maintained the benefit of radiotherapy. CONCLUSION: This study indicates that splenic irradiation could be a safe and effective palliative treatment for symptomatic splenomegaly due to secondary myelofibrosis.

Portal vein thrombosis in a patient with HCV cirrhosis and combined hemophilia A and thrombophilia V Leiden.

UNLABELLED: The relation of hemophilia A with thrombophilia V Leiden is extremely rare in the literature. Furthermore, hemophiliac patients have an increased risk of severe life-threatening hemorrhage, blood transfusions, and therefore hepatitis transmission, mainly hepatitis C (HCV). AIMS AND METHODS: We present a 54-year-old male with a 5-year history of decompensated liver cirrhosis on the grounds of HCV hepatitis, hemophilia A, and thrombophilia V Leiden. He was admitted to our department because of severe abdominal distension, resembling 'tense ascites' despite the use of diuretics. Clinical examination showed shifting dullness and a protuberant abdomen, while hematological and blood chemistry results revealed thrombopenia (platelets: 77000/mL) and hypoalbuminemia. Repeated abdominal paracentesis (under factor VIII administration) failed to remove ascitic fluid, while abdominal echosonography and computed tomography revealed severe edema of mesenterium and intraabdominal viscus and the absence of free ascitic fluid, atrophic cirrhotic liver, and splenomegaly. Moreover, abdominal doppler echosonography revealed signs of portal hypertension, previous portal vein thrombosis, and revascularization of the portal vein. Gastroscopy showed esophageal varices grade II, without signs of bleeding. A-FP and all other laboratory examinations were normal. RESULTS: Our patient was intravenously treated with albumine and diuretics (furosemide) with mild improvement of his abdominal distension. During his hospitalization he presented an episode of spontaneous bacterial peritonitis and hepatic encephalopathy, which were successfully treated with lactulose clysmas and ciprofloxacine. He was discharged in a good general condition. CONCLUSION: According to our case we consider the false clinical picture of 'tense ascites' of our patient as a rare clinical presentation of decompensated liver cirrhosis, with severe edema of mesenterium and viscus, on the grounds of preexisting portal vein thrombosis, in a patient with combined hemophilia A and thrombophilia V Leiden.

Evaluation of cardiotoxicity five years after 2D planned, non-simulated, radiation therapy for left breast cancer.

INTRODUCTION: Radiation treatment has been associated with radiation induced cardiotoxicity, especially with older, long-outdated, techniques. Such complications include pericarditis, myocardial fibrosis, valvular injury, ischemic heart disease, and myocardial infarction. AIM: To assess the effect of outdated breast radiation therapy (RT) - using a diagnostic CT scanner in the absence of a CT simulator - on cardiac function in women with stage II left breast cancer. PATIENTS AND METHODS: Sixty-two women under 65 with stage II left breast cancer who received post-operative RT using a diagnostic computed tomography scanner were studied between 1997 and 2001. Participants underwent a clinical interview, ECG, and echocardiography before and 6 months and 5 years after RT. RESULTS: There was no serious cardiotoxicity at 6 months and 5 years after radiotherapy. A 23% increase in hypertensive patients, and a slight decrease (2.3%) in ejection fraction was observed after 5 years, with 3 patients (5%) developing abnormalities. Two patients presented abnormal electrocardiographic findings within 6 months of RT. CONCLUSION: Our study showed that RT for left breast cancer was not associated with significant alteration in heart morbidity or mortality within 5 years of treatment, despite the lack of a simulator.

Radiotherapy plus either transdermal fentanyl or paracetamol and codeine for painful bone metastases: a randomised study of pain relief and quality of life.

OBJECTIVE: To compare the effects of providing analgesia with either transdermal fentanyl (TTS-fentanyl) or paracetamol and codeine (P/C) in addition to radiotherapy in patients with metastatic bone pain. METHODS: In a prospective study, 26 patients with radiologically confirmed bony metastases received radiotherapy (R/T). They were randomised to receive either 500 mg paracetamol and 30 mg codeine four times per day (P/C group), or transdermal fentanyl patches delivering 25 microg fentanyl/h (TTS-fentanyl group). Pain was assessed using visual analogue pain ratings (VAS) and the Greek Brief Pain Inventory (G-BPI) questionnaire administered before R/T and after 3 months. RESULTS: Data were available from 24 eligible patients. Use of TTS-fentanyl was associated with significantly superior pain relief. Mean VAS fell from 7.0 to 1.1 with TTS-fentanyl and from 8.3 to 4.3 with P/C, p< 0.01. The TTS-fentanyl group also showed significantly greater improvements of important G-BPI domains including global quality of life, pain, and physical, cognitive, and role functioning, than the P/C group (p< 0.01). Four patients receiving TTS-fentanyl and three receiving P/C reported severe nausea/vomiting. CONCLUSIONS: Transdermal fentanyl combined with R/T was more effective in reducing metastatic bone pain and resulted in greater improvements in quality of life than paracetamol and codeine.

Octreotide for palliative treatment of hepatic metastases from non-neuroendocrine primary tumours: evaluation of quality of life using the EORTC QLQ-C30 questionnaire.

BACKGROUND AND AIM: While octreotide has been used in palliative treatment of hepatocellular carcinoma and neuroendocrine tumours with good results, little is known about the possible role of this in palliative treatment of hepatic metastases. MATERIAL AND METHODS: We present our experience from the use of octreotide in palliative treatment of symptomatic liver metastases in 16 patients (11 males, five females, age ranged 43-69 years) with proven hepatic metastases from different primary tumours (six with non-small lung cancer, four with colon carcinoma, two with primary pancreatic head carcinoma, two with prostate cancer and two with adenocarcinoma of the stomach). All patients were administered 20 mg long-acting octreotide IM (octreotide LAR) once the first day, octreotide SC 0.5 mg three times daily on days 2-14 and then 20 mg long-acting octreotide IM every month. Quality of life was assessed by using the European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30). Tumour response was evaluated by using ultrasonography. RESULTS: One month after baseline, octreotide resulted in significant (P < 0.01, Wilcoxon test) improvement and stabilization of all major related EORTC QLQ-C30 parameters such as global quality of life, pain, fatigue, insomnia, appetite loss as well as physical, emotional, cognitive, social and role functioning. Except for mild hyperglycaemia in six out of 16 patients and mild gastrointestinal complications in one patient, no other severe side effect due to octreotide was reported. Two patients died two months after the initiation of the study due to generalized metastatic disease, while the remaining 14 patients were still alive seven months after the initiation of the study. The hepatic metastases were stabilized and no new lesions were detected by ultrasonography. CONCLUSIONS: Although further studies are warranted, we consider the use of octreotide a good alternative in palliative treatment of symptomatic liver metastases in patients with end-stage malignant disease.

Helicobacter pylori infection in upper gastrointestinal bleeding in patients with hereditary hemorrhagic disorders.

BACKGROUND: In patients with hereditary bleeding disorders, upper gastrointestinal bleeding presents a life-threatening complication, while the role of Helicobacter pylori (H. pylori) infection in this group of patients has not been fully clarified in the literature. The aim of the present study was to evaluate the role of H. pylori infection and of dental status in upper gastrointestinal bleeding in patients with hereditary hemorrhagic disorders (HHD). METHODS: Thirty-seven patients with HHD (18 patients with and 19 without a history of upper gastrointestinal bleeding) and 26 control patients without HHD, who were admitted to our hospital for elective gastroscopy due to dyspeptic symptoms, were included in the study. Endoscopy was performed on all patients with gastrointestinal bleeding and on controls. ELISA was used to detect IgG, anti-CagA, and IgA antibodies to H. pylori in the serum and saliva of patients and controls. Moreover, dental status was examined using the decayed/missing/filled teeth index (DMFT) in all subjects. The chi(2)-test was used for statistical analysis. RESULTS: Some 64.8% of the patients and 65.4% of the controls had H. pylori IgG antibodies in serum (P>0.1, NS) while 54.05% of the patients and 34.6% of controls were anti-CagA-positive in serum (P=NS). However, 83 and 26.3% of the HHD patients with and without gastrointestinal bleeding, respectively, were serum anti-CagA-positive (P<0.01) while 72 and 58%, respectively, were serum IgG-positive (P=NS). H. pylori antibodies in saliva and the DMFT calculated index did not differ between the two subgroups. Subsequently, all serum anti-CagA-positive HHD patients received 1-week of triple H. pylori eradication therapy with omeprazole, clarithromycin, and amoxicillin orally. During a 2-year follow-up, none of these patients reported upper gastrointestinal bleeding. CONCLUSIONS: Although no statistically significant difference in H. pylori infection was found between HHD and controls, the CagA strain appeared more frequently in those HHD patients with a history of upper gastrointestinal bleeding. Given our results and the limited data available in the literature, we would recommend anti-CagA screening and therapy to all patients with HHD. However, further studies with a longer follow-up and a greater number of patients are necessary.