Safety of electronic molecular resonance adenoidectomy.

Adenoidectomy is one of the most frequent operations in children. In order to reduce hospital stay costs, today, this procedure is performed as day surgery. Even though adenoidectomy is not considered risky, some minor complications may occur, the most important being bleeding (0.5-8% incidence). The surgical technique used can influence considerably postoperative pain and time to recovery. This aspect is essential in the management of day surgery patients, for whom the need of safe and rapid maneuvers associated with early recovery determines the choice of the surgical procedure. Recently, we developed a surgical technique based on the use of an electronic molecular resonance tool associated with bendable suction electrocautery. This study was carried out on 600 patients, divided into two groups, the first undergoing ablation using the molecular resonance tool and the second undergoing curette adenoidectomy. The two groups were homogeneous for age, sex, surgical indications, and grade of adenoid hypertrophy. The following parameters were considered: duration of surgery, importance of intraoperative bleeding, time to cicatrization, incidence of bleeding complications. Duration of surgery and intra- and postoperative bleeding were much lower in the first group than in the group undergoing traditional adenoidectomy. In addition, rhinopharyngeal complete cicatrization, defined as absolute absence of pseudomembrane, was much quicker in the first group, as assessed by postoperative endoscopy. Another major advantage offered by the molecular resonance tool is the accuracy of surgery performed under visual control in a practically bloodless field. To sum up, this method, thanks to its technical features and safety, is particularly indicated in children and in patients with coagulation disorders.

Acute mastoiditis: a 10 year retrospective study.

This retrospective study reviews our experience in the management of acute otomastoiditis over 10 years. During the study period we identified 40 cases in children aged 3 months-15 years with a peak incidence in the second year of life. Sixty per cent of them had a history of acute otitis media (AOM). All the children were already receiving oral antibiotic therapy. Otalgia, fever, poor feeding and vomiting were the most common symptoms, all the children had evidence of retroauricolar inflammation. Computerized tomography (CT) and magnetic resonance imaging (MRI) were used to support the diagnosis and to evaluate possible complications. Streptococcus pneumoniae was the most common isolated bacterium. All the patients received intravenous antibiotics, 65% of children received only medical treatment, 35% also underwent surgical intervention. Mean length of hospital stay was 12.3 days. Cholesteathoma was diagnosed in one child. We conclude from our study that acute otomastoiditis is a disease mainly affecting young children, that develops from AOM resistant to oral antibiotics. Adequate initial management always requires intravenous antibiotics, conservative surgical treatment with miryngotomy is appropriate in children not responding within 48 h from beginning of therapy. Mastoidectomy should be performed in all the patients with acute coalescent mastoiditis or in case of evidence of intracranial complications.

[Therapeutic use of a peptide fraction derived from bovine factor VIII in epistaxis in children]. / Utilizzaione terapeutica di una frazione peptidica derivata dal fattore VIII bovino nelle epistassi in età pediatrica.

The results obtained in patients suffering from essential epistaxis in paediatric age using a peptide fraction derived from the enzymatic hydrolysis of bovine factor VIII (VUEFFE-Baldacci) are reported. Carbazochrome sodium sulphate was employed for comparison purposes. Vueffe is effective in reducing haemorrhagic episodes without modifying the laboratory parameters investigated.

[The influence of click polarity and stimulation rate on the auditory evoked response in relation to age]. / Influenza della polarità dei clicks e della frequenza di stimolazione sulle risposte acustiche evocate (ABR) in rapporto all'età.

In order to study the changes which occur in phase of the click stimulus and its relation to the stimulus repetition rate on the auditory brainstem response (ABR) as a function of age, the Authors recorded the ABR from the scalp's surface of 10 newborns and 40 infants, 3 months, 6 months, 1 year and 3 years old as well as from 10 normal adults. The stimulus was a square wave of 0.1 msec duration and 90 dBHL level. The stimulus equipment was calibrated twice under visual inspection to ensure that the C and R clicks resulted in an initial membrane deflection toward and from the ear drum respectively. No significant differences could be found for the latencies and amplitude in the C-R comparison. However, the mean values of the complete group of test subjects showed most intraindividual stability for the conventional click stimulation. The latency of the ABR with excitation of the cochlea seemed to be mainly determined by the internal oscillation sequence in the cochlea and not by the stimulus polarity. The amplitudes and latencies of the ABR components tend to decrease when the stimulus rate increases and the age decreases. The importance of the stimulus characteristics is discussed and some suggestions for clinical use of ABR are made.

[Development of auditory evoked potentials of the brainstem in relation to age]. / Evoluzione dei potenziali evocati uditivi del tronco in rapporto all'età.

In order to study the various changes which occur in the waveform, latency and amplitude of the auditory brainstem evoked response (BSER) as a function of age, the authors recorded the BSER from the scalp's surface of 20 newborns and 50 infants, 3 months, 6 months, 1 year and 3 years old as well as from 20 normal adults. The data obtained show that the most reliable waves during the first month of life are waves I, III, V, which is often present even when other vertex-positive peaks are absent. The latencies of the various potential components decreased with maturation. Wave V, evoked by 90 dB sensation level clicks, changed in latency from 7, 12 msec at 1-4 weeks of age to 5,77 msec at 3 years of life. The auditory processes related to peripheral and central transmission were shown to mature at differential rates during the first period of life. By the 6th month, in fact, wave I latency had reached the adult value; in contrast, wave V latency did match that of the adult until approximately 1 year old. One obvious explanation for the age-related latency shift is progressive myelination of the auditory tract in infants, for this is know to occur. The authors conclude that the clinical application of this technique in paediatric patients couldn't provide reliable informations about auditory brain stem activity regardless of evaluation of the relationship between age and characteristics of BSER.

Resistant and relapsing neuroblastoma: improved response rate with a new multiagent regimen (OC-HDP) including high-dose cisplatinum.

From September 1984 to July 1985, 11 children from 6 months to 6 years of age were treated with a three-drug regimen (OC-HDP), including vincristine, cyclophosphamide, and cisplatinum 200 mg/m2 given as five dose-fractions over 5 days. Nine had resistant and two relapsed neuroblastoma. Nine children had previously been treated with cisplatinum at conventional doses; nine had not received cyclophosphamide and ten had not received vincristine. Nine of eleven patients had a good response to treatment; six are presently alive in continuous complete remission 11-23 months (median 13 months) after diagnosis. Toxicity was moderate: no child showed either severe myelotoxicity or clinical or laboratory evidence of nephrotoxicity. No child had clinically significant ototoxicity. In six children audiometry showed hearing loss for high frequencies after the third cycle of treatment. It is concluded that OC-HDP regimen could be considered as a first-line treatment for advanced neuroblastoma.

Comparison of cefatrizine and erythromycin for pediatric ear, nose, and throat infections.

A comparison was made of cefatrizine in dosages of 75 mg/kg/day administered once daily or twice daily and erythromycin in a mean daily dosage of 50 mg/kg given in three divided doses for the treatment of acute infections of the ear, nose, and throat in children. Temperature was recorded twice a day during therapy. At the end of treatment, a clinical evaluation of cure, improvement, or failure was made, based on defervescence and abatement of symptoms. All ten children given cefatrizine once daily were cured (P less than or equal to 0.05), as were eight of ten given cefatrizine twice daily and four of ten given erythromycin. The remaining eight patients were improved. One patient given cefatrizine had diarrhea, which appeared on the fifth day of treatment. No other side effects were observed. Cefatrizine appeared to be similarly effective whether given once a day or twice a day; further trials are warranted to confirm the efficacy of once-daily treatment with this cephalosporin.

High-dose cisplatin and etoposide in advanced malignancies of childhood.

Thirty-two children with poor-prognosis solid tumors were treated with a combination of high-dose cisplatin (CDDP) (200 mg/m2 over 5 days) and VP16. In the 30 children evaluable for antitumor effect, there were 7 complete, 12 partial, and 3 minor tumor responses. Wilms' tumor and rhabdomyosarcoma responded best. There were no therapy-related deaths. Severe neutropenia (PMN less than 500/mmc) developed after 29 out of the 45 evaluable courses and lasted a median of 8 days; during periods of neutropenia 8 episodes of fever occurred, 1 of which was caused by streptococcal sepsis. Platelet levels were depressed to less than 50,000/mmc after 17/45 cycles and this thrombocytopenia lasted a median of 8 days. No neurological toxicity occurred. One case developed acute renal failure. A hearing deficit for high frequencies was documented in 14/22 patients evaluated after the first cycle and in all cases after the subsequent cycles; the deficits correlated with the total dose of CDDP administered. High-dose cisplatin and VP16 is an effective association in children with advanced cancer, but cumulative dosage is limited by ototoxicity.

[Evaluation of auditory function in homozygous beta-thalassemia]. / Valutazione della funzione uditiva nella beta-talassemia omozigote.

We examined the auditory function of 29 subjects affected by homozygous beta-thalassemia, managed with an high transfusion scheme and regularly treated with 40-60 mg/kg/day of desferrioxamine. A group of 29 healthy subjects is studied as control. We found conductive hearing defect in 8 thalassemics (6 bilateral) and sensory-neural hearing loss at high frequencies in 4. Thalassemic patients showed more auditory impairment than controls, an higher incidence of tonsillar hypertrophy, adenotonsillitis and submandibular lymph-node enlargement.