Cochlear implantation in auditory neuropathy spectrum disorders: role of transtympanic electrically evoked auditory brainstem responses and serial neural response telemetry.

OBJECTIVE: To evaluate the utility of pre-operative transtympanic electrically evoked auditory brainstem responses and post-operative neural response telemetry in auditory neuropathy spectrum disorder patients. METHODS: Four auditory neuropathy spectrum disorder patients who had undergone cochlear implantation and used it for more than one year were studied. All four patients underwent pre-operative transtympanic electrically evoked auditory brainstem response testing, intra-operative and post-operative (at 3, 6 and 12 months after switch-on) neural response telemetry, and out-patient cochlear implant electrically evoked auditory brainstem response testing (at 12 months). RESULTS: Patients with better waveforms on transtympanic electrically evoked auditory brainstem response testing showed superior performance after one year of implant use. Neural response telemetry and electrically evoked auditory brainstem response measures improved in all patients. CONCLUSION: Inferences related to cochlear implantation outcomes can be based on the waveform of transtympanic electrically evoked auditory brainstem responses. Robust transtympanic electrically evoked auditory brainstem responses suggest better performance. Improvements in electrically evoked auditory brainstem responses and neural response telemetry over time indicate that electrical stimulation is favourable in auditory neuropathy spectrum disorder patients. These measures provide an objective way to monitor changes and progress in auditory pathways following cochlear implantation.

An unusual case of ear mould impression material as a foreign body in the middle ear: case report.

BACKGROUND: The occurrence of retained ear mould impression material is rare and can lead to complications. The current case report describes one such complication, where the silicone impression material used to take the impression of the ear canal flowed into the middle ear through the pre-existing tympanic membrane perforation. Five days later, the patient presented with worsened hearing and blood-tinged discharge from the ear. Ear microscopy revealed a greenish foreign body in the middle ear. CASE REPORT: The foreign body was removed by tympanotomy and the perforation repaired using a temporalis fascia graft. A hearing aid was prescribed after ensuring that the perforation had healed. CONCLUSION: It is essential that the audiologist perform a basic otological examination before prescribing a hearing aid and preparing an ear mould. A clinical approach algorithm for audiologists, for prior to taking an impression, is suggested.

Apolipoprotein E polymorphism and its relation to plasma lipids in coronary heart disease.

BACKGROUND: The present investigation is aimed at examining the Apolipoprotein E (APOE) genotypic influence on coronary heart disease (CHD) risk in northwest India (Punjab), where this disease is emerging as a major threat to public-health care system. MATERIALS AND METHODS: The present study comprised of angiographically diagnosed coronary heart disease patients (n = 193) and controls (n = 150) of Punjab. Genetic polymorphism of APOE gene was investigated by polymerase chain reaction (PCR), and its association with lipid levels was evaluated. RESULTS: The allele frequencies of epsilon2, epsilon3, and epsilon4 were 0.054, 0.795, 0.151; and 0.077, 0.856, 0.067 in patients and controls respectively. The bearers of E3/E4 genotype had threefold higher propensity of developing CHD in this population (OR, 3.04; CI, 1.55-6.25; P < 0.001), which exacerbated (OR, 4.18; CI, 2.03-9.27; P < 0.001) after correcting for age, sex, BMI, and lipid-lowering drugs. Lower HDL-C levels and higher LDL-C levels were found to be correlated with E3/E4 genotype (P < 0.01). Other concomitants like body mass index (BMI), total cholesterol (TC), and triglyceride (TG) levels did not show up as genetic determinants in this part of the region. CONCLUSIONS: A significant association (P = 0.016) of epsilon4 allele, especially E3/E4 genotype, with CHD was observed, along with HDL-C and LDL-C concentrations, in the population of northwest India.

Electronic structure of Mn-doped ZnO by x-ray emission and absorption spectroscopy.

We report an investigation of Mn-doped ZnO pellets with diluted Mn concentration by soft-x-ray emission and absorption spectroscopy. We have compared the electronic structure of two samples with different Mn concentration and different magnetic properties at room temperature: ferromagnetism in one case (Zn(0.98)Mn(0.02)O) and no magnetic order in the other (Zn(0.96)Mn(0.04)O). The results show that most of the Mn ions of the ferromagnetic sample are in the divalent state. For the nonmagnetic sample, a larger contribution of higher oxidation Mn states is present, which can be correlated to the suppressed ferromagnetism. The presence of oxygen atoms bonded to Mn ions and hybridized Mn 3d-O 2p states has been detected in both compounds. The partial density of states in the valence band has been measured with x-ray emission spectroscopy and the Mn 3d states have been found inside the bandgap of ZnO.

Xanthogranulomatous cholecystitis (XGC): a clinicopathological study of 21 cases.

Xanthogranulomatous Cholecystitis (XGC) is an uncommon inflammatory disease. In a retrospective analysis of 159 cholecystectomy specimens revealed 21 cases of diffuse and focal XGC with an overall incidence of 13.2 per cent. The age distribution was identical to those of traditional chronic cholecystitis with female predominance (M:F ratio 1:4). Gallstones were seen in 15 cases with marked thickening of the gall bladder on ultrasonography. In one case it falsely diagnosed as carcinoma on ultrasonographic examination, however, histopathologically it was turned out to be XGC. One case of XGC was associated with adenocarcinoma of gall bladder. The incidence of diffuse XGC was 5.66 per cent, whereas incidence of focal XGC was 7.54 per cent amongst chronic cholecystitis.

Neoplasms of Hair Follicle.

The present paper deals with clinico-pathological analysis of 22 cases of hair follicle neoplasm, representing 23.4% of skin appendage tumours. The mean age was 32 years, M : F ratio was 1:1. Histopathologically, there were 15 cases of pilomatrixoma, 5 cases of trichoepithelioma and 2 cases of trichelemmoma.

Basal Cell Epithelioma (A Clinico-pathological Study of 172 Cases).

The present paper deals with a clinico-pathological analysis of 172 cases of basal cell epithelioma representing 28% of the total skin cancer case. 1.44% of the total malignant tumours, 1% of the total tumours and 0.24% of the hospital admissions. M:F ratio was 1.26:1. The mean age was 54.06 years with the maximum number of cases in the fifth decade., Most (94%) of the lesions were seen on the head and neck region. Histopathologically it showed solid (60.5%), adenoid cystic (15,7%), keratotic (9.3%), pigmented (6.4%), basi-squamous (3.5%) and morphoea patterns (2.3%). Perineural lymphatic invasion was seen in 52% of the adenoid cystic basal call epithelioma. Amyloid (12.8%) and amyloid like deposits (29.65%) were seen in 42% of the case. Amyloid deposits were seen as lichen amyloidosis in 10.46% cases and in or around the tumour cell masses in 16.8% cases. It appeared as structureless homogeneous eosinophilic material and showed congophilia with apple green birefringence on polarising microscopy. It was found to be KMN04 sensitive (AA type protein- secondary amyloidosis). Amyloid like deposits appeared as less homogeneous,, basophilic, fractured material which showed non-specific congophilia with apple- green birefringence and stained with acid orcein stain indicating degenerated collagen (elastoid-degeneration).

Neoplasms of Sweat Gland.

Fifty cases of sweat gland tumours seen during a. period of 27 years, accounted for 54.34% of skin appendages tumours. There were 47 sweat glands, tumours and 3 malignant, seen in the 21- 40 years age group. M : F ratio was 1:1 Histopathol4caUy, there were 13 cases of eccrine, acrospiroma, 11 cases each of syringocystadenovaa papiuiferum and chondroid syringoma, 5 cases of eccrine, spiradenoma, 3 cases of dermal cylindrom and 2 cases each of hidradenoma papilliferum and eccrine pogrom. Three cases of malignant sweat gland tumours included 2 cases of sweat gland-carcinoma and 1 case of primary mucmous carcinomas of skin.

Gastric secretion in cirrhosis and non-cirrhotic portal fibrosis.

Studies on basal and pentagastrin-stimulated gastric secretion were carried out in 20 patients with cirrhosis, 20 with non-cirrhotic portal fibrosis (NCPF) and 20 control subjects. There was no significant difference in the basal volume and acid output between the three groups. However, maximal volume and acid output were significantly lower in patients with cirrhosis and NCPF compared with the control group. There was no correlation between the acid secretion and the degree of hepatocellular dysfunction in patients with cirrhosis. Moreover, the gastric hyposection was as marked in the patients with NCPF as in those with cirrhosis, although the former did not suffer from any hepatic decompensation. It is concluded that gastric hyposecretion is not due to a derangement of hepatocyte function but may be secondary to portal hypertension and collateral circulation.

Significance of eosinophil and mast cell counts in rectal mucosa in ulcerative colitis. A prospective controlled study.

Eosinophil and mast cell counts were done in 44 patients with active ulcerative colitis, 10 patients with ulcerative colitis in remission, and 44 matched subjects with functional bowel disorder. Mean (+/- SD) rectal eosinophil counts (EC) per unit area were significantly high (P less than 0.01) in active ulcerative colitis (5.80 +/- 5.49) as compared with inactive disease (2.81 +/- 2.19) or controls (3.01 +/- 1.67). Eosinophil count was not significantly different in the acute stage between responder (6.36 +/- 5.95) and nonresponders (5.1 +/- 5.84) to medical treatment and was thus of little discriminatory and prognostic value. Mean (+/- SD) EC was reduced from 6.36 +/- 5.95 to 3.91 +/- 3.19 in responders after four weeks of medical treatment. There was little change in the EC with treatment in nonresponders. No correlation was seen between tissue eosinophils and clinical severity of ulcerative colitis. Mast cell count was not significantly different between patients with active ulcerative colitis, inactive disease, and controls and thus had little diagnostic or prognostic value. It can be concluded therefore, that EC in the rectal mucosa indicated activity but not severity of ulcerative colitis. A reduction in EC possibly indicated remission. Rectal EC, however, cannot correctly prognosticate the treatment response and outcome of the disease.

Idiopathic Calcinosis of the Scrotum.

Idiopathic calcinosis of scrotum is a rare condition of unknown aetiology. It is often misdiagnosed as multiple sebaceous cysts. Three, cases of idiopathic calcinosis of scrotum characterised by multiple hard nodules, variable in size and shape, discharging chalky white material over the scrotal skin are described. Histopathology showed irregular masses of calcium in the subepithelial area, with foreign body granulomatous reaction.