Thoracoscopic pneumonectomy in a 4 year-old-child with destroyed lung following viral pneumonia. / Tiroidectomía transoral endoscópica con abordaje vestibular (TOETVA): una nueva opción para el tratamiento de pacientes pediátricos.

Pediatric pneumonectomies are exceptional nowadays, being reserved for cases with destroyed lungs with frequent exacerbations and reinfections and only two cases of thoracoscopic pneumonectomy have been previously published. We present the case of a 4-year-old patient with no relevant history who developed complete atelectasis of the left lung (LL) after influenza A pneumonia, followed by secondary recurrent infections. A year later a diagnostic bronchoscopy without alterations was performed. A complete loss of volume and hypoperfusion of the LL (right lung perfusion 95%, LL perfusion: 5%) with bronchiectasis and hyperinsufflation and herniation of the right lung into the left hemithorax was observed in a pulmonary perfusion SPECT-CT. After unsuccessful conservative management and recurrent infections a pneumonectomy was indicated. The pneumonectomy was performed through a five-port thoracoscopy. The dissection of the hilum was made using hook electrocautery and sealing device. The left main bronchus was sectioned with an endostapler. There were no intraoperative complications. An endothoracic drain was removed the first postoperative day. The patient was discharged on the fourth postoperative day. The patient has not presented any complications 10 months after surgery. Although pneumonectomy is an exceptional surgery in children, it can be performed by minimally invasive surgery with success and safety in centers with extensive experience in pediatric thoracoscopic surgery.

Hoy en día, las neumonectomías pediátricas son algo excepcional. El procedimiento se reserva para aquellos casos en los que los pulmones están destruidos y presentan exacerbaciones y reinfecciones frecuentes, con tan solo dos casos de neumonectomía toracoscópica publicados hasta la fecha. Presentamos el caso de un paciente de 4 años sin antecedentes de interés que desarrolló atelectasia completa del pulmón izquierdo (PI) tras neumonía por gripe A, seguido de infecciones secundarias recurrentes. Un año después, se le practicó broncoscopia diagnóstica, sin que esta mostrara alteraciones significativas. Tras realizársele un SPECT-CT de perfusión pulmonar, se evidenció pérdida completa de volumen e hipoperfusión del PI (perfusión del pulmón derecho: 95%; perfusión del pulmón izquierdo: 5%), con bronquiectasia e hiperinsuflación y herniación del pulmón derecho hacia el hemitórax izquierdo. Tras fracasar el manejo conservador y registrarse infecciones recurrentes, se estableció la indicación de neumonectomía. La neumonectomía se llevó a cabo mediante toracoscopia por cinco puertos. La disección del hilio se realizó mediante gancho de electrocoagulación y dispositivo de sellado. El bronquio principal izquierdo se seccionó con endograpadora. No se registraron complicaciones intraoperatorias. El drenaje endotorácico se retiró al día siguiente de la intervención, mientras que el paciente fue dado de alta a los cuatro días, sin que haya presentado complicaciones transcurridos 10 meses desde la cirugía. Aunque la neumonectomía es una intervención excepcional en niños, puede llevarse a cabo de manera exitosa y segura por cirugía mínimamente invasiva en centros con amplia experiencia en cirugía toracoscópica pediátrica.

Neumonectomía toracoscópica en un niño de 4 años con el pulmón destruido tras neumonía vírica / Thoracoscopic pneumonectomy in a 4 year-old-child with destroyed lung following viral pneumonia

Hoy en día, las neumonectomías pediátricas son algo excepcional. Elprocedimiento se reserva para aquellos casos en los que los pulmones estándestruidos y presentan exacerbaciones y reinfecciones frecuentes, con tansolo dos casos de neumonectomía toracoscópica publicados hasta la fecha.Presentamos el caso de un paciente de 4 años sin antecedentes deinterés que desarrolló atelectasia completa del pulmón izquierdo (PI) trasneumonía por gripe A, seguido de infecciones secundarias recurrentes.Un año después, se le practicó broncoscopia diagnóstica, sin que estamostrara alteraciones significativas. Tras realizársele un SPECT-CT deperfusión pulmonar, se evidenció pérdida completa de volumen e hi-poperfusión del PI (perfusión del pulmón derecho: 95%; perfusión delpulmón izquierdo: 5%), con bronquiectasia e hiperinsuflación y hernia-ción del pulmón derecho hacia el hemitórax izquierdo. Tras fracasar elmanejo conservador y registrarse infecciones recurrentes, se establecióla indicación de neumonectomía.La neumonectomía se llevó a cabo mediante toracoscopia por cincopuertos. La disección del hilio se realizó mediante gancho de electro-coagulación y dispositivo de sellado. El bronquio principal izquierdose seccionó con endograpadora. No se registraron complicaciones in-traoperatorias.El drenaje endotorácico se retiró al día siguiente de la intervención,mientras que el paciente fue dado de alta a los cuatro días, sin que hayapresentado complicaciones transcurridos 10 meses desde la cirugía.Aunque la neumonectomía es una intervención excepcional enniños, puede llevarse a cabo de manera exitosa y segura por cirugíamínimamente invasiva en centros con amplia experiencia en cirugíatoracoscópica pediátrica.(AU)

Pediatric pneumonectomies are exceptional nowadays, being re-served for cases with destroyed lungs with frequent exacerbations and einfections and only two cases of thoracoscopic pneumonectomy havebeen previously published.We present the case of a 4-year-old patient with no relevant his-tory who developed complete atelectasis of the left lung (LL) afterinfluenza A pneumonia, followed by secondary recurrent infections.A year later a diagnostic bronchoscopy without alterations was per-formed. A complete loss of volume and hypoperfusion of the LL(right lung perfusion 95%, LL perfusion: 5%) with bronchiectasisand hyperinsufflation and herniation of the right lung into the lefthemithorax was observed in a pulmonary perfusion SPECT-CT. Afterunsuccessful conservative management and recurrent infections apneumonectomy was indicated.The pneumonectomy was performed through a five-port thoracos-copy. The dissection of the hilum was made using hook electrocauteryand sealing device. The left main bronchus was sectioned with an en-dostapler. There were no intraoperative complications.An endothoracic drain was removed the first postoperative day. Thepatient was discharged on the fourth postoperative day. The patient hasnot presented any complications 10 months after surgery.Although pneumonectomy is an exceptional surgery in children,it can be performed by minimally invasive surgery with success andsafety in centers with extensive experience in pediatric thoracoscopicsurgery.(UA)

A frequency comb stabilized Ti:Sa laser as a self-reference for ion-trap experiments with a 40Ca+ ion.

In this study, we report on the stabilization of a continuous-wave Ti:Sa laser to an optical frequency comb. The laser is emitting at 866 nm to address one of the transitions required for Doppler cooling of a single 40Ca+ ion in a linear Paul trap (2D3/2 ↔P1/22). The stabilized Ti:Sa laser is utilized to calibrate an ultra-accurate wavelength meter. We certify this self-reference laser source by comparing the results from monitoring the laser-cooled 40Ca+ ion in the linear Paul trap, with those obtained when a HeNe laser is used for calibration. The use of this self-reference is compatible with the simultaneous use of the comb for precision spectroscopy in the same ion-trap experiment.

Telorragia: revisión de la literatura a propósito de dos casos / Telorrhagia: literature review on two cases

La telorragia es infrecuente en la edad pediátrica y un signo de alarma en la edad adulta. Estos pacientes se remiten a la consulta de Cirugía para valorar intervenciones agresivas por la amenaza de la malignidad. Sin embargo, su principal etiología es la ectasia ductal mamaria, un proceso benigno y autorresolutivo. Se presentan dos pacientes varones de 4 y 5 meses con telorragia. Una vez realizadas la exploración, la ecografía y la citología, se descartó un proceso maligno y se resolvió con manejo conservador en un periodo de 12 meses. A continuación, se realiza una revisión de la literatura incluyendo los pacientes pediátricos (0-16 años) con telorragia monosintomática. Encontramos un total de 59 casos publicados. Es más frecuente en varones (1,5:1) y el 74% de los casos ocurren en el primer año de vida. En los estudios revisados se realizan diversas pruebas complementarias (cultivo, citología, analítica hormonal) pero solo parece aportar información de utilidad la ecografía, que se encuentra alterada en un 69,2% de los pacientes. El abordaje terapéutico clásico ha sido la resección quirúrgica de la glándula mamaria, pero en la literatura más reciente se ha demostrado que, ya que se trata de una patología limitada en el tiempo, el manejo conservador es el más adecuado. Se reserva la cirugía para los casos con diagnóstico dudoso o persistentes. La recidiva es infrecuente (9,8%). Conclusiones: pese a ser un síntoma alarmante, la telorragia en lactantes debe de manejarse de forma conservadora evitando las intervenciones quirúrgicas agresivas, que podrían condicionar secuelas posteriores (AU)

Nipple discharge in children is uncommon, whereas it is considered a warning sign in adulthood. Hence these patients are referred to the Paediatric Surgeon to assess whether it is necessary to perform aggressive procedures to avoid the risk of malignancy. However, the most common ethology is ductal ectasia, a benign and self-limited process.We present two cases of a 4 and 5-month-old male patients with bloody nipple discharge. Once malignancy was ruled out by physical examination, ultrasound and cytology, a conservative approach was adopted and the symptoms disappeared over a period of 12 months. Then we conducted a systematic review including pediatric patients (0-16 years) with monosymptomatic bloody nipple discharge.We found a total of 59 cases published. It is more prevalent in male patients (1,5:1) and 74% present before the age of 12 months. In the articles reviewed several tests are mentioned (secretion culture, cytology, hormonal blood test) but only ultrasound provided useful information, showing altered results in 69.2% of the patients. The classical therapeutic approach was breast surgical resection but in more recent reports ductal ectasia has been shown to be a self-limited pathology. Therefore, conservative treatment is now advocated while surgery is reserved for persistent symptoms or cases where there is a diagnostic doubt. Relapse is infrequent (9.8%).Conclusions: despite of being a disturbing sign, bloody nipple discharge in infants should be managed conservatively, avoiding aggressive surgical procedures that might cause permanent consequences. (AU)

Quartz resonators for penning traps toward mass spectrometry on the heaviest ions.

We report on cyclotron frequency measurements on trapped 206,207Pb+ ions by means of the non-destructive Fourier-transform ion-cyclotron-resonance technique at room temperature. In a proof-of-principle experiment using a quartz crystal instead of a coil as a resonator, we have alternately carried out cyclotron frequency measurements for 206Pb+ and 207Pb+ with the sideband coupling method to obtain 21 cyclotron-frequency ratios with a statistical uncertainty of 6 × 10-7. The mean frequency ratio R¯ deviates by about 2σ from the value deduced from the masses reported in the latest Atomic Mass Evaluation. We anticipate that this shift is due to the ion-ion interaction between the simultaneously trapped ions (≈100) and will decrease to a negligible level once we reach single-ion sensitivity. The compactness of such a crystal makes this approach promising for direct Penning-trap mass measurements on heavy and superheavy elements.

A quartz amplifier for high-sensitivity Fourier-transform ion-cyclotron-resonance measurements with trapped ions.

Single-ion sensitivity is obtained in precision Penning-trap experiments devoted to light (anti)particles or ions with low mass-to-charge ratios, by adding an inductance coil to an amplifier connected to the trap, both operated at 4 K. However, single-ion sensitivity has not been reached on heavy singly or doubly charged ions. In this publication, we present a new system to reach this point, based on the use of a quartz crystal as an inductance, together with a newly developed broad-band (BB) amplifier. We detect the reduced-cyclotron frequency of 40Ca+ ions stored in a 7-tesla open-ring Penning trap. By comparing the detected electric signal obtained with the BB amplifier and the fluorescence signal obtained by collecting the photons emitted by a trapped ion cloud, we show a detection limit below 110 ions. Adding the crystal, the electrical signal increases by a factor of about 30 at room temperature, which combined with the measured equivalent resistance and voltage noise, proves the feasibility of the system to reach single-ion sensitivity at 4 K.

[Cognitive neurorehabilitation: the foundations and applications of neurologic music therapy]. / Neurorrehabilitacion cognitiva: fundamentos y aplicaciones de la musicoterapia neurologica.

INTRODUCTION: Music is the result of a perception in the brain involving a number of cortical and subcortical areas in both brain hemispheres. Increased knowledge about brain plasticity and the numerous neuroimaging studies conducted in recent years have made it possible to further our understanding of the processing of musical stimuli in the brain. This has led to an interest in analysing and studying its application in the non-invasive treatment of certain dysfunctions or diseases with the aim of helping to achieve an improved quality of life. AIM: To outline the foundations and applications of the musical techniques that are used in cognitive neurorehabilitation. DEVELOPMENT: Following an initial summary of the processing of musical stimuli in the brain, the study goes on to explain the foundations of different techniques, as defined by neurologic music therapy, that are used efficaciously in cognitive neurorehabilitation. Sounds, which are the raw material of music, maintain a temporality and a sequencing that are a useful aid in the formation of temporal patterns of the cognitive functions, and constitute an assembly or framework that facilitates the learning of sequential information processing, such as memory. CONCLUSIONS: The techniques used in neurologic music therapy, which in recent years are being applied for cognitive neurorehabilitation, are not invasive and offer promising results that, together with further research, should be taken into account to be implemented alongside the conventional therapies of cognitive neurorehabilitation and stimulation.

TITLE: Neurorrehabilitacion cognitiva: fundamentos y aplicaciones de la musicoterapia neurologica.Introduccion. El conocimiento de la plasticidad cerebral y los numerosos estudios con neuroimagenes de los ultimos años han permitido un avance en la comprension del proceso cerebral de los estimulos musicales. Ello ha propiciado el interes para analizar y estudiar su aplicacion en el tratamiento no invasivo de determinadas disfunciones o enfermedades con el fin de contribuir a una mejora de la calidad de vida. Objetivo. Exponer los fundamentos y aplicaciones de las tecnicas musicales que se utilizan para la neurorrehabilitacion cognitiva. Desarrollo. A partir de un resumen inicial del proceso cerebral de los estimulos musicales, se exponen los fundamentos de diversas tecnicas, tal como define la musicoterapia neurologica, que se utilizan de forma eficaz en la neurorrehabilitacion cognitiva. Los sonidos, que constituyen la materia prima de la musica, mantienen una temporalidad y una secuenciacion que son utiles para ayudar a la formacion de patrones temporales de las funciones cognitivas y conforman un ensamblaje o armazon que facilita el aprendizaje de los procesos secuenciales de informacion, como por ejemplo, la memoria. Conclusiones. Las tecnicas usadas por la musicoterapia neurologica, que en los ultimos años se aplican en la neurorrehabilitacion cognitiva, no son invasivas y aportan resultados esperanzadores; con una mayor investigacion, deberian considerarse para su implantacion junto a las terapias convencionales de estimulacion y neurorrehabilitacion cognitiva.

Can positron emission tomography support the characterization of immune-mediated inner ear disease? / ¿Puede la tomografía por emisión de positrones ayudar en la caracterización de la enfermedad inmunomediada del oído interno?

INTRODUCTION: To evaluate the utility of 18F-FDG PET/TC as an imaging tool for the characterization of immune-mediated inner ear disease (IMIED), providing measurements of the inner ear region activity as well as detecting possible involvement of other organs. MATERIAL AND METHODS: The study included 28 patients with IMIED and 4 sex-matched and age-matched control subjects with no history of ear disease. Eighteen patients were considered to be suffering from primary IMIED and 10 patients from secondary. PET/CT scans with 18F-FDG were performed to assess systemic involvement as well as inner ear region activity. Interpretation of PET/CT scans was performed independently by 2nuclear medicine physicians blinded to clinical history. In order to assess inter-rater agreement before performing the analysis of the inner ear, different Bland & Altman plots and the intraclass correlation coefficients were estimated. RESULTS: Different metabolically active foci findings were reported in 13 patients. Four patients diagnosed as primary IMIED showed thyroid and aorta activity. Regarding the inner-ear semiquantitative analysis, the inter-rater agreement was not sufficiently high. Comparisons between groups, performed using Mann-Whitney test or Kruskal-Wallis tests, showed no differences. CONCLUSIONS: The study showed 18F-FDG PET/TC could be an important tool in the evaluation of IMIED as it can support the characterization of this entity providing the diagnosis of unknown or underestimated secondary IMIED. Nevertheless, we consider PET is not an adequate tool to approach the inner ear because of the small size and volume of the cochlea which makes the assessment very difficult.

Eosinophilic esophagitis: an underdiagnosed cause of dysphagia and food impaction to be recognized by otolaryngologists.

Eosinophilic esophagitis (EoE) is a recently recognised pathologic entity whose prevalence has risen significantly since first being described in 1993. Defined as a chronic, local immune-mediated disease with predominant eosinophil infiltration, it is nowadays the leading cause of dysphagia and food bolus impaction in children and young adults. Genetic and environmental risk factors, and especially food antigens, trigger the disease and are in the focus of investigation as avoidance can cure three quarters of patients. The most common antigen involved is milk, followed by egg and gluten. These patients frequently come undiagnosed to the otolaryngologist with complaints of dysphagia and recurrent non-sharp food impactions, although pharyngolaryngeal reflux symptoms and other airway complaints could also be a first sign. Delayed diagnosis and treatment can produce fibrostenosis of the esophagus that greatly impairs patients' quality of life.In-office transnasal esophagoscopy with esophageal biopsy offers a unique opportunity to promptly diagnose and follow-up these patients, without causing the morbidity of repeated sedations and reducing exploration overload in gastroenterology departments. The search for food-antigen triggers, response evaluation to swallowed steroids, or proton pump inhibitors (PPIs) make multiple endoscopies and biopsies necessary every 6 to 8 weeks.There are three first-line interchangeable treatments with the same recommendation: PPIs, dietary allergen elimination and topical swallowed steroids. The choice should be discussed with the patient on an individual basis.The objective of this article is to raise awareness of this condition, update otolaryngologists with the new EoE consensus, and highlight the need for biopsy in patients with dysphagia to rule out EoE.

Intratympanic gadolinium magnetic resonance imaging supports the role of endolymphatic hydrops in the pathogenesis of immune-mediated inner-ear disease.

OBJECTIVE: To evaluate the presence of endolymphatic hydrops in patients with immune-mediated inner-ear disease. METHODS: The presence of endolymphatic hydrops was prospectively evaluated in 17 patients clinically diagnosed with secondary (n = 5) or primary (n = 12) immune-mediated inner-ear disease, who attended the ENT department of a tertiary care centre for evaluation or treatment over the previous year. All patients underwent magnetic resonance imaging of the temporal bone. RESULTS: Intratympanic gadolinium three-dimensional magnetic resonance imaging diagnosed hydrops in 11 of 12 patients with primary immune-mediated inner-ear disease (92 per cent). Of these, seven patients (64 per cent) presented only cochlear (n = 5) or predominantly cochlear (n = 2) hydrops. A positive magnetic resonance imaging result was observed in only one of five patients with secondary immune-mediated inner-ear disease (20 per cent). CONCLUSION: This study confirms the presence of endolymphatic hydrops in immune-mediated inner-ear disease patients. The virtual absence of hydrops in patients with secondary immune-mediated inner-ear disease is remarkable, although firm conclusions cannot be drawn; this should be explored in a multicentre study with a larger sample of patients. A different immune reaction without development of endolymphatic hydrops should not be ruled out in secondary immune-mediated inner-ear disease patients.

Diagnosis of endolymphatic hydrops by means of 3T magnetic resonance imaging after intratympanic administration of gadolinium. / Diagnóstico del hidrops endolinfático mediante resonancia magnética de 3T tras administración de gadolinio intratimpánico.

OBJECTIVE: To detect and graduate endolymphatic hydrops or endolymphatic space dilations in patients with suspected Meniere's disease or immune-mediated inner ear disease by magnetic resonance imaging. MATERIAL AND METHODS: A prospective study was performed including all the patients with clinical suspicion of Meniere's disease or immune-mediated inner ear disease treated at the Otolaryngology department during a one year period. In all cases, magnetic resonance imaging (MRI) was performed in a 3T scanner. IR sequence was performed after 24 to 28h prior intratimpanic injection of gadolinium on both ears. Two neurorradiologist graduated endolymphatic space volume as agreed on normal, moderate and significant in the obtained images. RESULTS: The presence of hydrops was documented by MRI in six patients with definite or probable Meniere's disease. In two of the four cases without vertigo hydrops was not demonstrated. In the other two cases with a high clinical suspicion of immune-mediated disease but with negative autoimmune tests hydrops was proved. There was only disagreement on cochlear hydrops presence on two patients. CONCLUSION: The detection of endolymphatic hydrops in patients with definite or probable Meniere's disease served to confirm the final diagnosis. Moreover, hydrops was detected in patients with suspected immune-mediated inner ear disease, which could have an impact on the diagnosis and treatment of these patients. Therefore, we suggest that this test could be included for the diagnosis of these inner ear diseases.

In vitro and in vivo effects of lutein against cisplatin-induced ototoxicity.

INTRODUCTION: Cisplatin is a commonly prescribed drug that produces ototoxicity as a side effect. Lutein is a carotenoid with antioxidant and anti-inflammatory properties previously tested for eye, heart and skin diseases but not evaluated to date in ear diseases. AIM: To evaluate the protective effects of lutein on HEI-OC1 auditory cell line and in a Wistar rat model of cisplatin ototoxicity. MATERIALS AND METHODS: In vitro study: Culture HEI-OC1 cells were exposed to lutein (2.5-100 µM) and to 25 µM cisplatin for 24h. In vivo study: Twenty eight female Wistar rats were randomized into three groups. Group A (n=8) received intratympanic lutein (0.03 mL) (1mg/mL) in the right ear and saline solution in the left one to determine the toxicity of lutein. Group B (n=8) received also intraperitoneal cisplatin (10mg/kg) to test the efficacy of lutein against cisplatin ototoxicity. Group C (n=12) received intratympanic lutein (0.03 mL) (1mg/mL) to quantify lutein in cochlear fluids (30 min, 1h and 5 days after treatment). Hearing function was evaluated by means of Auditory Steady-State Responses before the procedure and 5 days after (groups A and B). Morphological changes were studied by confocal laser scanning microscopy. RESULTS: In vitro study: Lutein significantly reduced the cisplatin-induced cytotoxicity in the HEI-OC1 cells when they were pre-treated with lutein concentrations of 60 and 80 µM. In vivo study: Intratympanic lutein (1mg/mL) application showed no ototoxic effects. However it did not achieve protective effect against cisplatin-induced ototoxicity in Wistar rats. CONCLUSIONS: Although lutein has shown beneficial effects in other pathologies, the present study only obtained protection against cisplatin ototoxicity in culture cells, but not in the in vivo model. The large molecule size, the low dose administered, and restriction to diffusion in the inner ear could account for this negative result.

Hearing threshold levels for an otologically screened population in Spain.

OBJECTIVE: The aim of the present study was to provide thresholds data as a function of age for an otologically normal population in Spain, compared to the current ISO 7029 (2000) standard. DESIGN: A prospective study in an otologically screened population. STUDY SAMPLE: Data was collected from 1175 otologically-normal persons aged between 5 and 90 years. Inclusion criteria involved those listed in ISO 389-1 (1998) and the 8253-1 (2010). Suitability for inclusion was evaluated through interview, based on a questionnaire, and physical examination. RESULTS: The hearing thresholds decreased slightly from 125 to 2000 Hz. From 2000 Hz onwards the thresholds increased; this increase being more pronounced with increasing frequency and age. No statistically significant sex differences were found. The hearing threshold levels in the present study were higher (poorer) than the ones provided by ISO 7029 (2000). CONCLUSIONS: Results from this study suggest that the thresholds listed in ISO 7029 (2000) may be too restrictive, and could be useful in formulating the ISO 7029 update.

Earphones in extended high-frequency audiometry and ISO 389-5.

OBJECTIVE: To determine common reference equivalent threshold sound pressure levels (RETSPL) for the earphones used in the extended high-frequency (EHF) range, as different earphones are commercially available, but there are not RETSPLs for each model. DESIGN: Hearing threshold sound pressure levels were measured up to 20 kHz for the Sennheiser HDA 200 audiometric earphone, and were compared to the ISO 389-5 (2006) norm and other investigations using that earphone and different ones. STUDY SAMPLE: A total of 223 otologically-normal subjects (aged 5-25 years old) participated in the hearing determination. RESULTS: The results are in good agreement with previous studies of hearing thresholds using the same and other earphones. CONCLUSIONS: The results of the present investigation are relevant for the international standard for the calibration of audiometric equipment in the 8 to 16 kHz frequency range, ISO 389-5. The data may be used for a future update of the RETSPL for circumaural and insert audiometric earphones.

Extended high-frequency (9-20 kHz) audiometry reference thresholds in 645 healthy subjects.

OBJECTIVE: The aim of the present study was to study patterns in the extended spectrum of the human hearing (0.125 to 20 kHz) in order to obtain reference thresholds. Then, we compare our values with existing results at extended high-frequencies (8 to 20 kHz) in an attempt to establish new standards for potential international adoption. DESIGN: A prospective study in a group of otologically healthy subjects. STUDY SAMPLE: A total of 645 subjects aged between 5 and 90 years were recruited. Pure-tone thresholds were determined for conventional and extended high-frequencies. RESULTS: There was an increase in the hearing thresholds as a function of frequency and age. For the 20 to 69 years old group, thresholds were lower in females than in males, especially at 12.5 and 16 kHz. Our threshold values are comparable to those presented in previous studies that used different instrumentation and populations. CONCLUSIONS: When comparing different studies the hearing thresholds were found to be similar. Therefore, it would be possible to establish international standard thresholds.

Effect of intratympanic dimethyl sulphoxide (DMSO) in an in vivo model of cisplatin-related ototoxicity.

Although dimethyl sulfoxide (DMSO) is one of the most common solvents employed in otoprotection studies, its effect on the inner ear remains unknown. Only a few in vitro studies have addressed the effect of DMSO in cochlear cells. Up to the date, no in vivo functional studies have been reported. To determine the effect of intratympanic DMSO application in the inner ear, and to evaluate its effect in combination with cisplatin in Wistar rats, twelve Wistar rats were randomly assigned into two groups. Group A received intratympanic 1 % DMSO in both ears. Group B received intraperitoneal cisplatin (10 mg/kg) and intratympanic 0.5 % DMSO in the right ear and saline solution in the left ear. Functional changes were evaluated with Auditory Steady-State Responses before and 5 days after the procedure. Morphological changes were studied by means of confocal laser scanning microscopy following the removal of the temporal bones and cochlear dissection. Hearing threshold levels in group A did not show any statistically significant changes after the treatment. In group B, significant differences between pre- and post-treatment were found, with no statistically significant variations between right (DMSO) and left ear (saline solution). We suggest that DMSO could be safely used to dissolve hydrophobic compounds in otoprotection studies without interfering with the cochlear damage produced by cisplatin.

[Utility of radioguided surgery in splenosis]. / Utilidad de la cirugía radioguiada en la esplenosis.

Splenosis is a common finding after traumatic rupture of the spleen or therapeutic splenectomy, defined as a heterotopic autotransplantation of the spleen in peritoneal cavity and surface. In splenectomized patients due to hematologic disease, splenosis can lead to disease recurrence. We present a case of splenosis in a patient with idiopathic thrombocytopenic purpura who relapsed after splenectomy. For its localization, conventional imaging and scintigraphy with (99m)Tc-denatured red cells was performed, and at least five splenic foci were observed. Given the difficult intraoperative localization of these nodules, radioguided surgery was performed, with excellent localization and removal of all known nodules and multiple peritoneal implants of millimeter size that were not previously observed. We conclude that radioguided surgery is an excellent tool for locating foci of peritoneal splenosis, which have difficult access, thus avoiding early recurrence of the disease.

[Laparoscopic cholecystectomy: what we can learn about]. / Colecistectomía laparoscópica en niños y adultos: lo que podemos aprender.

BACKGROUND: Laparoscopic cholecystectomy (LC) is a very usual procedure within adult population, but not as frequent in childhood. The aim of this study was to assess the outcome of LC in children compared with those performed in adulthood. MATERIALS AND METHODS: We reviewed 39 consecutive patients who underwent LC between 2003 and 2013 at our Department and a similar sample of patients from 18 to 40 years of age from the General Surgery Department. RESULTS: 39 children and 40 adults fulfilled criteria to be included in the study. The most frequent indication was cholelithiasis in both groups. The mean operating time was significantly higher among children (127 min, adults 71 min, p < 0.01) but we didn't find differences neither in conversion nor in complication rates (children 5% and 7.7%, adults 2.5% and 15% respectively). In regard to preoperative factors, only male gender was correlated to a higher complication rate (p 0.037). On the other hand we found out that, in absence of complications, both the average length of stay (children 2.1 days, adults 0.5 days) and mean time to first feeding (children 21 hours, adults 8 hours) were significantly higher among children (p < 0.01). CONCLUSIONS: 1) LC in childhood is a safe procedure that does not imply more morbidity than the same intervention in adults, even though a more prolonged operating time. 2) We believe that our longer hospital stay is due to certain lack of confidence with the technique and, in the future, the trend should be bent on encouraging a shorter time to first feeding and an earlier discharge.

Total transvaginal mesh (TVM) technique for treatment of pelvic organ prolapse: a 5-year prospective follow-up study.

INTRODUCTION AND HYPOTHESIS: To evaluate clinical effectiveness and complication rates at 5 years following the total Trans Vaginal Mesh (TVM) technique to treat pelvic organ prolapse. METHODS: Prospective, observational, multi-centre study in patients with prolapse of stage II or higher. RESULTS: Of the 90 women enrolled in the study, 82 (91%) were available for the 5-year follow-up period. At the 5-year endpoint, success, defined as no surgical prolapse reintervention and leading edge <-1 (International Continence Society [ICS] criteria) or above the level of the hymen, was 79% and 87% respectively. A composite criterion of success defined as: leading edge above the hymen (<0) and no bulge symptoms and no reintervention for prolapse was met by 90%, 88% and 84% at the 1-, 3-, and 5-year endpoints respectively. Quality of life improvement was sustained over the 5 years. Over the 5-year follow-up period, a total of only 4 patients (5%) required re-intervention for prolapse, while a total of 14 patients (16%) experienced mesh exposure for which 8 resections needed to be performed. Seven exposures were still ongoing at the 5-year endpoint, all asymptomatic. Only 33 out of 61 (54%) sexually active patients at baseline remained so at 5 years. De novo dyspareunia was reported by 10%, but no new cases at the 5-year endpoint. One patient reported de novo unprovoked mild pelvic pain at 5 years, 5 reported pains during pelvic examination only. CONCLUSIONS: Five-year results indicated that TVM provided a stable anatomical repair. Improvements in QOL and associated improvements in prolapse-specific symptoms were sustained. Minimal new morbidity emerged between the 1- and 5-year follow-up.

Young systemic lupus erythematosus patients with no hearing involvement: 10-year follow up.

OBJECTIVE: To evaluate patients with systemic lupus erythematosus and normal hearing over 10 years, compared with healthy controls. METHODS: Thirty patients diagnosed with systemic lupus erythematosus were evaluated in a prospective, descriptive study. Eight patients fulfilled the inclusion criteria, i.e. normal otoscopy, normal hearing, normal imaging and disease duration of less than one year. Eleven healthy companions of ENT patients were recruited as controls. RESULTS: At study commencement, the mean patient age was 32.75 years (range, 15-49 years) and there were no statistically significant audiometric differences between patients and controls. No statistically significant audiometric changes were found either within or between the patient and control groups at 10-year follow up. CONCLUSION: These results supply no evidence for progressive hearing loss in systemic lupus erythematosus patients with no hearing involvement at study commencement. Therefore, we recommend audiometric tests only for systemic lupus erythematosus patients complaining of hearing loss, or for other clinical purposes. It is conceivable that asymptomatic hearing loss could be observed over a more extended follow-up period (i.e. more than 10 years).