La evaluación del procesamiento auditivo central: el test de dígitos dicóticos / Central auditory processing assesment: the dichotic digit test

El test de dígitos dicóticos es una técnica conductual no invasiva que evalúa el procesamiento auditivo central responsable de los mecanismos auditivos de integración binaural. Consiste en la presentación simultánea en ambos oídos de dígitos del uno al nueve de forma aleatoria agrupados en bloques de uno, dos y tres pares. Se aplica en el diagnóstico audiológico de los trastornos del procesamiento auditivo central tanto en contextos educativos como clínicos. En la presente investigación se ha estudiado el efecto del oído estimulado, la edad y la dificultad de los ítems en una muestra de 127 participantes con edades comprendidas entre los 6 y 72 años de edad. En general, los resultados ponen de manifiesto una ventaja significativa de las puntuaciones obtenidas por el oído derecho. Se obtuvieron peores puntuaciones y un incremento en las diferencias interaurales con el aumento de la dificultad de los ítems y la edad. El efecto de la edad sobre el porcentaje de aciertos queda descrito mediante una función de regresión curvilínea. Se presentan los valores de normalidad en función de la edad para la muestra estudiada

The central auditory processing mechanism of binaural integration can be assessed through behavioural noninvasive procedures such as the dichotic digit test. This procedure consists of simultaneous presentation of digits to the two ears in an unpredictable presentation in groups of one, two and three pairs of items. The dichotic digit test is commonly used in the diagnosis of central auditory processing disorders in the educational setting and in the clinical audiological practice. In the present study the effect of age, ear and difficulty were studied in a group of 127 participants aged from 6 to 72 years old. Results showed a right ear advantage of scores obtained by the right ear in all subjects. As age and difficulty increase worse scores were obtained. The effect of age over the items recognitions were described by a curvilinear regression function. Normative values are obtained according to the age of the subjects who took part in the present study

[Fitting hearing aids in early childhood based on auditory evoked potentials in steady states]. / La adaptación audioprotésica pediátrica precoz a partir de registros de potenciales evocados auditivos de estado estable.

The purpose of the Newborn Hearing Screening Program is to achieve early. Identification and appropriate intervention for hearing loss. Hearing aids are the most frequent intervention for deafness. Paediatric specific clinical protocols for fitting hearing aids always recommend accurate characterisation of hearing thresholds in newborns. In this sense, electrophysiological procedures are specially indicated in determined hearing sensibility from the first age of life since it is an objective and reliable procedure. 20 normal hearing subject and 17 hearing loss subjects participated in this study. Auditory Steady State Responses (ASSR) were obtained from all of them. Hearing aid fitting was established from the electrophysiological responses. Dynamic range, gain, compression ratio and maximum output of the hearing aid were obtained from the intensity amplitude function of the ASSR. The procedure discussed in this study is specially indicated in newborns and very young children in which other test are not suitable.

Thyroid fine needle aspiration: the morphological features on ThinPrep slide preparations. Eighty cases with histological control.

This study had several purposes: to define cytomorphological features of thyroid cells that might be modified by alcohol fixation; to optimize May-Grünwald-Giemsa (MGG) staining on ThinPrep(R) (TP; Cytyc Inc., Bexborough, MA, USA) slides and to compare the diagnostic accuracy of slides prepared by a liquid-based method with those obtained by conventional technique. This study included 120 cases of ultrasound-guided fine needle aspiration (FNA) of the thyroid and 55 FNAs performed on surgically resected thyroid specimens. Histological control was available in 80 cases. In the first group of 120 FNAs, a split-sample technique was used for the TP. Three screenings were performed: first, an individual screening of the conventional smears (CS) and of the TP, a second screening to compare cells observed on the TP with the histological control and a third screening to assess the previously defined diagnostic criteria. Twenty-seven TP cases (22%) were considered unsatisfactory for diagnosis compared with 10 in CS (8%). The high rate of unsatisfactory cases with TP is likely to be due to the use of the split-sample technique. The sensitivity was 94% for CS and 81% for TP. The specificity was 67% and 60% for CS and TP, respectively. Two occult papillary carcinomas were missed by both methods. As for the MGG staining, the modified technique used for TP resulted in the same quality as the standard procedure. Conversely, TP did however induce uncommon morphological features. In this study, sensitivity and specificity levels are higher for CS than for TP; the difference may be explained by the fact that the methanol fixative used for TP induces some cytological alterations, especially in oncocytic tumours and lymphocytic thyroïditis.

Características acústicas y aplicacione audiológicas del promedio del espectro del habla a largo plazo / Acoustic characteristics and audiological applications of the Long Term Average Speech Spectrum

El promedio del espectro del habla a largo plazo (PEHLP) es una medida de las características acústicas del habla a través de técnicas de análisis espectofráficas. El PEHLP tiene varias aplicaciones en audiología clínica entre las que destacan la medida de la inteligibiidad del habla, la determinación de la prescripción de la ganancia en la adaptación audioprotésica y la orientación de objetivos en la intervención logopédica de las dislalias audiógenas. En el presente estudio se registró el PEHLP en un grupo de sujetos adultos hablantes de español en dos posiciones diferentes de registro. Los resultados obtenidos indican diferencias significativas en función del sexo dependiendo de la banda de frecuencia del espectro del habla. Los registros del PEHLP en español son similares a los llevados acabo en otras lenguas. Los resultados son similares a los llevados a cabo en otras lenguas. Los resultados sugierenel uso de fórmulas de prescripción de la ganancia audioprotésica que tengan en cuenta e PEHLP. Esto facilitaría la verificación del audífono y posterior tratamiento logopédico especialmente la de niños hipoacúsicos con diálisis audiógenas derivadas de una pobre amplificación (AU)

Factors of increase in serum triglyceride-rich lipoproteins in uremic rats.

The possible mechanisms of the increase in serum triglycerides (TG) and TG-rich lipoproteins were studied in chronically uremic (U) rats by comparison with either ad-lib fed control (C) rats or diet-restricted (DR), sham-operated pair-fed control rats. A first series of animals was studied in the fed state and a second series after a 16-hr fast. In U animals the concentration of serum TG and TG-rich particles was lower than that of C rats in the fed state but significantly higher than that of C and DR rats after a 16-hr fast. Serum glucose and lactate concentrations in the fed or fasted state were unchanged by uremia. Serum insulin concentration was significantly decreased in U rats as compared to C and DR rats in both series. The fast did not increase the concentration of serum nonesterified fatty acids (NEFA) in U or DR animals to the same extent as in C rats, whereas the serum concentration of beta-hydroxybutyrate (BOB), which was higher than that of C rats in the fed state, was significantly lower after a 16-hr fast. In U animals, as compared to control rats of either series, a significant decrease of epididymal lipoprotein lipase (LPL) activity was observed during both nutritional states when expressing the enzymic activity per number of cells. In conclusion, our data provide evidence against hepatic over-production of TG-rich lipoproteins in rats with chronic renal failure and strongly point to an LPL-mediated defect of their peripheral catabolism, probably related to the insulin deficiency state.

[Retrospective study of 56 congenital diaphragmatic hernias. Prognostic factors, therapeutic deductions]. / Etude rétrospective de 56 hernies diaphragmatiques à révélation néo-natale. Facteurs pronostiques, déductions thérapeutiques.

Fifty-six neonates were treated for congenital diaphragmatic hernia (48 left and 8 right) in our intensive care unit from 1972 to 1980. Because of the high mortality, we studied the factors which could predict the outcome. Early onset of symptoms (before the 2nd hour of life) and low post-ductal shunt (PAO2/FiO2 less then 15) after the 3rd postoperative hour appear to be signs of poor prognosis. Our present attitude is early surgical procedure, controlled ventilation with a FiO2 1 with Pancuronium, prevention of pneumothorax and different use of pulmonary arterial vasodilatators.

Demonstration of T lymphocytes in leprous granuloma using the acid alpha naphtyl acetate esterase activity. An attempt at quantitative analysis.

In nine leprosy patients (1 TT, 1 BT, 4 BL and 3 LLp), esterase positive lymphocytes (T Lymphocytes) were studied in frozen sections of skin biopsies by alpha naphtyl acetate esterase pH 5.8 method (ANAE) Four patients had never been treated previously and five patients exhibited clinical and bacteriological evidence of relapse for inadequate therapy at first biopsy. There was an increase in ANAE (+) lymphocyte density in granulomas when second biopsies were done after efficient treatment, evaluated by bacillary index for the eight bacilliferous patients, and clinical improvement. The significance of T cells in granulomas is discussed.

[Pulmonary infections caused by Pneumocystis carinii]. / Les infections pulmonaires à Pneumocystis carinii.

The following topics are discussed: 1. Pneumocystis carnii: appearance, antigenic structure, pathogenicity...; 2. Human pneumocytosis: clinical, diagnostic, prognostic and therapeutic aspects; 3. Pneumocystis carnii and the pneumocystoses: coexistence, theoretical and practical consequences, difficulties in interpretation of bronchiolo-alveolar lavage.

Susceptibility of mice to bacterial infections after chronic exposure to cadmium.

Susceptibility to bacterial infections after chronic exposure to cadmium was studied in mice. Cadmium chloride was injected intraperitoneally three times a week for 4 weeks. After this treatment, mice displayed splenomegalia, hyperplasia of the B-dependent areas of spleen. Virulence of bacteria considered as usually having extracellular sites of multiplication (Klebsiella pneumoniae, Pseudomonas aeruginosa), or intracellular (Listeria monocytogenes), was determined. Only L. monocytogenes showed an increased virulence in cadmium-treated mice.

[Results of a protocol for etiologic diagnosis of pneumopathies on immunosuppressed children (author's transl)]. / Résultats d'un protocole d'enquête étiologique des pneumopathies chez les enfants immunodéprimés.

A protocol for etiologic diagnosis has been used on 40 immuno suppressed children with pulmonary infiltrate. The purpose of this protocol is to permit an early etiologic diagnosis, concomitant infections by several pathogen agents being frequently seen. An endobronchial brushing is first performed; the results being obtained between 24 to 48 hours. If the results are negative and the patient's condition worsens we propose an open lung biopsy. Thus pathogenic agent has been established in 24 cases, in 17 cases by endobronchial brushing, in 3 cases by open lung biopsy and in 2 cases by endobronchial brushing and open lung biopsy. In 3 cases several opportunistic organisms were responsible of the pneumopathy. Pneumocystis carinii is the most often established (19 cases); it was also present in one out of 6 post mortem examinations. In 14 cases the pneumopathy occured in children treated for acute leukemia; Pneumocystis was the organism responsible in 6 of them; the evolution was favorable in 13 of the 14 cases. One patient died from a pulmonary infection by the measles virus.

Diagnosis of pneumocystis carinii pneumonia using an endobronchial brushing technique. A report on twenty-one cases in immunocompromised children.

By examining the endobronchial brushings from 65 infants and children with interstitial pneumonia--characterized by a severe hypoxia and diffuse lung infiltrates--we have detected the cysts of pneumocystis carinii in 17 of 21 subsequently confirmed cases. The rapid diagnosis and subsequent specific treatment have allowed the recovery of 18 of these children. The particular significance of this article is the youth of the patients, whose ages ranged from 4 months to 15 years.

[Neonatal hernias of the dome of the diaphragm. Why a gloomy prognosis?]. / Les hernies de la coupole diaphragmatique néo-natales. Pourquoi un pronostic si sombre?

The prognosis is neonatal hernias of the dome of the diaphragm remains extremely gloomy. Associated malformations, prematurity or dysmaturity, cannot explain it. The surgeon is now faced with conditions diagnosed in the labour room, which he previously never saw (and which therefore did not figure in his statistics). Those forms in which the lung gas exchange area is reduced are above all those in which there is a syndrome of persistence of foetal circulation. The association of drugs from the alphalytic group (tolazoline) and curarising agents (pancuronium) is often effective without having completely resolved the problem.

[Pneumocystis carinii pneumonia in chronically immunosuppressed patients. Apropos of 33 cases]. / Pneumonie à Pneumocystis carinii dans les maladies chroniques immunodéprimantes. A propos de 33 observations.

The availability of drugs that are active against Pneumocystis carinii has renewed interest in and underlined the difficulties of the early diagnosis pneumocystis pneumonia. A retrospective study of 33 cases was undertaken to define the optimal management. It is necessary to take into consideration the high mortality of the untreated condition and the risks of investigation and of treatment. Pneumocystis pneumonia affects only those patients who are immunologicaly incompetent, particularly those with defects of cellular immunity. Early symptoms are common but they are insidious. Indirect immunofluorescent tests were positive in 75% of our cases and were useful as screening tests. However it is necessary to identify the parasite (in our cases it was detected in 29 patients) and this requires invasive techniques such as lung puncture, lung biopsy or bronchial brushing. The best method for the rapid diagnosis of pneumocystis is endobronchial brushing, because it is simple, effect and has few complications.

[Congenital syphilis, malnutrition and Pneumocystis carinii pneumonia]. / Syphilis congénitale, dénutrition et pneumopathie à Pneumocystis carinii.

A Korean child aged six months with congenital syphilis and malnutrition developed pneumocystis carinii pneumonia. He recovered after treatment with trimethoprin/sulphamethoxazole with assisted ventilation. There was no evidence of immune deficiency. The role of congenital syphilis and malnutrition predisposing the baby to this infection is discussed.