How to track and register adverse events and incidents related to gastrointestinal endoscopy.

Background and study aims: Gastrointestinal endoscopic procedures have evolved significantly in the last sixty years revolutionising the approach to the diagnostic and therapeutic spheres of medicine. Despite the advantages of using natural orifices to the bowel, adverse events (AE) may occur following endoscopy. Systematic AE registration is an objective in every realm of quality medicine. Despite the obvious advantage as a quality indicator, tracking endoscopy-related AE is not evident. The current study aimed at tracking all AE of all endoscopic procedures during a 3-month period. The three methods used were voluntary reporting by the endoscopist and by the patient in parallel with retrospective data analysis of patients' electronic medical records to allow capture of all AE and comparison of the three methods. Patients and methods: During a 3-month period endoscopists and patients were requested to report any possible AE. At the end of the period, a systematic review of all patient files was performed to track all AE related to the endoscopic procedure or the endoscopyrelated anaesthesia. In total 2668 endoscopic procedures were reviewed. Results: The total AE rate was 1.95%. Only half (51.9%) of all AE were voluntarily reported by endoscopists, the other half were extracted from the electronic medical record. There were no patient-reported AE. Although the majority (66.7%) of unreported AE were mild, these findings illustrate that voluntary AE reporting is unreliable. However, the retrospective tracking process proved to be difficult and time-consuming. Conclusions: The current study highlighted that systematic registration of all endoscopy-related AE is feasible, but challenging because of multiple hurdles. More practical methods are warranted to obtain reliable and long-term data as part of endoscopy quality measures.

Manifestaciones cutáneas del trastorno mieloproliferativo transitorio asociado a síndrome de Down / Cutaneous manifestations of transitory myeloproliferative disorder associated with Down syndrome

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Trigeminal small-fibre function assessed with contact heat evoked potentials in humans.

Contact heat stimuli have been reported to excite mechano-thermal nociceptors and to evoke brain potentials (CHEPs) from the limbs. We investigated whether contact heat evokes reproducible CHEPs from the trigeminal territory and may prove a reliable diagnostic tool in facial neuropathic pain. We applied contact heat stimuli to the perioral and supraorbital regions; CHEPs were recorded from the vertex in 20 controls and 2 patients with facial neuropathic pains, and reflex responses from the orbicularis oculi and masticatory muscles in 5 controls. We studied the correlation between CHEP data and perceptive ratings, site of stimulation, and age. Finally, we compared CHEPs with laser evoked potentials (LEPs). Contact heat stimuli at 51 degrees C evoked vertex potentials consisting of an NP complex similar to that elicited by laser pulses, though with a latency some 100-ms longer. Perioral stimulation yielded higher pain intensity ratings, shorter latency and larger amplitude CHEPs than supraorbital stimulation. CHEP data correlated significantly with age. Contact heat stimuli at 53 degrees C evoked a blink-like response in the relaxed orbicularis oculi muscle and a silent period in the contracted masseter muscle. In patients with facial neuropathic pain the CHEP abnormalities paralleled those seen with LEPs. We were unable to achieve reproducible signals related to C-receptor stimulation by contact heat stimuli at 41 degrees C in the ten subjects in whom they were tested. Contact heat stimulation, as well as laser stimulation, easily yields large-amplitude brain potentials and nociceptive reflexes, both related to the Adelta input. However CHEPs are not suitable for C-fibres potentials recording.

[Universal newborn hearing screening in Cantabria (Spain): results of the first two years]. / Cribado universal de la hipoacusia congénita en Cantabria: resultados de los dos primeros años.

AIMS: We present the results of the first 2 years of universal newborn hearing screening in Cantabria. MATERIAL AND METHODS: We performed a descriptive study of screening with two levels of transient evoked otoacoustic emissions in 8,836 newborns, diagnostic confirmation with auditory brainstem response, and treatment. RESULTS: The coverage of the first two levels of otoacoustic emissions was 98.4 % and 99.5 %. The incidence of risk factors was 3.08 %. A total of 6.7 % of those studied in the first stage were referred to the second, and 0.7 % of those studied in the second stage were referred to testing of auditory brainstem responses. Of the patents referred to the second stage, 97.6 % attended, and of those referred to the third stage 87.1 % attended. The positive predictive value after the second session of otoemissions was 7.9 %, and the false positive rate was 3.3 %. Sensorineural and bilateral hearing loss was diagnosed in 11 children, and permanent unilateral hypoacousia was diagnosed in one child, representing an incidence of 1.38/1,000 newborns. Sixty percent were diagnosed before the age of 3 months and 100 % before the age of 7 months. Fifty percent began treatment before the age of 6 months and 90 % before the age of 1 year. Of three cochlear implants indicated, two were implanted at 11 and 13 months. The cost was 1.3 3 per child screened and 867 3 for each case diagnosed. CONCLUSIONS: All the objectives of the first and second stages of screening were achieved. The continuity index anticipated for the third stage (87.1 vs 95 %) and access to treatment at 6 months (50 % vs 100 %) were less satisfactory, although these results compare favorably with those of previously published studies.

Cribado universal de la hipoacusia congénita en Cantabria: resultados de los dos primeros años / Universal newborn hearing screening in Cantabria (Spain): results of the first two years

Objetivo: Exponer los resultados de los primeros 2 años del cribado universal de la hipoacusia en Cantabria. Material y métodos: Estudio descriptivo del cribado con dos pases de otoemisiones de 8.836 neonatos, de la confirmación diagnóstica con potenciales evocados, y su tratamiento. Resultados: La cobertura de los dos primeros pases de otoemisiones fue del 98,4 y 99,5 %. La incidencia de factores de riesgo fue del 3,08 %. El 6,7 % de los estudiados en el primer nivel se remitieron al segundo, y el 0,7 % de los estudiados en el segundo se remitieron a potenciales. De los remitidos al segundo nivel acudieron el 97,6 %, y de los remitidos al tercer nivel el 87,1 %. El valor predictivo positivo tras el segundo pase de otoemisiones fue del 7,9 %, y los falsos positivos el 3,3 %. Se diagnosticaron 11 hipoacusias neurosensoriales bilaterales y una unilateral de transmisión permanente, lo que da una incidencia de 1,38 por 1.000 recién nacidos. El 60% fueron diagnosticados antes de los 3 meses y el 100% antes de los siete. Respecto al tratamiento, el 50 % lo iniciaron antes de los 6 meses y el 90 % antes del año. De los tres implantes cocleares indicados, dos se realizaron a los 11 y 13 meses. El coste ha sido de 1,3 3 por niño cribado y de 867 3 por caso detectado. Conclusiones: Se han cumplido los objetivos del primer y segundo niveles. No se ha alcanzado el índice de continuidad previsto para el tercer nivel (87,1% frente a 95 %) ni el acceso al tratamiento a los 6meses (50 % frente a 100 %), aunque estos resultados se comparan de forma favorable con otros publicados previamente

Aims: We present the results of the first 2 years of universal newborn hearing screening in Cantabria. Material and methods: We performed a descriptive study of screening with two levels of transient evoked otoacoustic emissions in 8,836 newborns, diagnostic confirmation with auditory brainstem response, and treatment. Results: The coverage of the first two levels of otoacoustic emissions was 98.4 % and 99.5 %. The incidence of risk factors was 3.08 %. A total of 6.7 % of those studied in the first stage were referred to the second, and 0.7% of those studied in the second stage were referred to testing of auditory brainstem responses. Of the patents referred to the second stage, 97.6 % attended, and of those referred to the third stage 87.1 % attended. The positive predictive value after the second session of otoemissions was 7.9 %, and the false positive rate was 3.3 %. Sensorineural and bilateral hearing loss was diagnosed in 11 children, and permanent unilateral hypoacousia was diagnosed in one child, representing an incidence of 1.38/1,000 newborns. Sixty percent were diagnosed before the age of 3 months and 100 % before the age of 7 months. Fifty percent began treatment before the age of 6 months and 90 % before the age of 1 year. Of three cochlear implants indicated, two were implanted at 11 and 13 months. The cost was 1.3 3 per child screened and 867 3 for each case diagnosed. Conclusions: All the objectives of the first and second stages of screening were achieved. The continuity index anticipated for the third stage (87.1 vs 95 %) and access to treatment at 6 months (50 % vs 100 %) were less satisfactory, although these results compare favorably with those of previously published studies

[Program of hearing loss early detection in newborn infants in Cantabria. Results of the first year of activities]. / Programa de detección precoz de la hipoacusia en neonatos en Cantabria. Resultados del primer año de funcionamiento.

AIMS: To report the findings in the first year of follow-up of the Cantabrian Program to screen newborn babies for congenital permanent hearing loss. METHODS: The study population consisted of infants born during a year period in Cantabria (Spain). Universal hearing screening by transient evoked otoacoustic emissions (TEOAE) in 2 stage protocol was performed. Infants with failure scores in these 2 stages and those with risk factors for hearing loss were referred for diagnostic evaluation with auditory brainstem response. Hearing aids were recommended for those infants who had bilateral hearing loss and referrals to infant speech and language rehabilitation. RESULTS: Out of the 4117 eligible babies, 3987 were studied. One hundred and ten (2.6) had risk factors for hearing loss, 3.5% were referred for audiological assessment and 1.2/1000 were diagnosed as having a permanent hearing loss. The false-positive rate was 0.72% after the two-stage screening procedure was performed. Positive predictive value for permanent hearing loss was 10%. CONCLUSIONS: During the first year working with the Cantabrian Screening Program for congenital permanent hearing loss in newborn babies, the most part of the proposed aims have been achieved.

Programa de detección precoz de la hipoacusia en neonatos en Cantabria. Resultados del primer año de funcionamiento / Early hearing loss detection program for newborn babies in Cantabria. First year results

Objetivos: Evaluar los hallazgos obtenidos en el primer año de funcionamiento del Programa Cántabro para la Detección Precoz de la Hipoacusia Neonatal. Métodos: El ámbito de estudio incluyó a todos los recién nacidos en la Comunidad Autónoma de Cantabria (España) entre el 1 de abril de 2001 y 31 de marzo de 2002. El programa se dividió en 4 fases; las 3 primeras son las que se incluyen en este estudio: fase de screening con otoemisiones acústicas automatizadas (OAE), fase de diagnóstico con potenciales evocados auditivos (neonatos con OAE negativas y/o factores de riesgo de hipoacusia) y fase de tratamiento (adaptación de prótesis auditivas y rehabilitación logopédica). Resultados: Durante el periodo de estudio nacieron 4.117 niños, de los que 110 (2,6%) tenían factores de riesgo. Un 0,8 por ciento de los neonatos sin factores de riesgo y un 3,5 por ciento del total de los incluidos en el programa fueron remitidos a la fase de diagnóstico. 3.987 niños (96,8%) completaron el estudio. La incidencia de hipoacusia permanente fue de 1.2/1000. El valor predictivo positivo en los neonatos sin factores de riesgo fue del 10% y el porcentaje de falsos positivos respecto a la población sometida a screening del 0,72%. Conclusiones: En el primer año de funcionamiento del Programa Cántabro de Detección Precoz de la Hipoacusia Infantil se han cumplido la mayor parte de los objetivos de calidad propuestos (AU)

AIMS: To report the findings in the first year of follow-up of the Cantabrian Program to screen newborn babies for congenital permanent hearing loss. METHODS: The study population consisted of infants born during a year period in Cantabria (Spain). Universal hearing screening by transient evoked otoacoustic emissions (TEOAE) in 2 stage protocol was performed. Infants with failure scores in these 2 stages and those with risk factors for hearing loss were referred for diagnostic evaluation with auditory brainstem response. Hearing aids were recommended for those infants who had bilateral hearing loss and referrals to infant speech and language rehabilitation. RESULTS: Out of the 4117 eligible babies, 3987 were studied. One hundred and ten (2.6) had risk factors for hearing loss, 3.5% were referred for audiological assessment and 1.2/1000 were diagnosed as having a permanent hearing loss. The false-positive rate was 0.72% after the two-stage screening procedure was performed. Positive predictive value for permanent hearing loss was 10%. CONCLUSIONS: During the first year working with the Cantabrian Screening Program for congenital permanent hearing loss in newborn babies, the most part of the proposed aims have been achieved (AU)

[Burgdorf and cataracts]. / Burgdorf und seine "Stars".

This contribution recounts the life of Johann Heinrich Jung, also known as Stilling: his curriculum vitae, method of cataract surgery, trips to Switzerland, the cataract operation he performed in Burgdorf in 1802.

[Acute respiratory syndromes caused by viruses in a pediatric department. Clinical and epidemiological studies of a series of cases admitted in the period from February to May, 1979]. / Le sindromi respiratorie acute da virus in un reparto pediatrico. Studi clinico-epidemiologici su una casistica raccolta nel periodo febbraio-maggio 1979.

In the period between February and May 1979, in concomitance with a sharp increase in admittance to the pediatric Division of the Parma General Hospital for acute respiratory infections, we carried out a virologic and serologic investigation on hospitalized children aged 21 days-12 years. The investigation was carried out on 137 patients with respiratory diseases: 33 with bronchiolitis, which occurred mainly (32/33) between February and March in children that were prevalently (30/33) in the first year of life; 27 with upper respiratory tract infections; 54 with mid respiratory tract infections; 23 with pneumonia. Forty-eight controls (without respiratory infections) were also investigated. In the months of February and March there was a high circulation of respiratory syncytial virus (RSV): throughout the entire period there was a lower incidence of Adenovirus infections and more uniformly distributed.

The Cohen syndrome: clinical and endocrinological studies of two new cases.

This report concerns two new cases of the Cohen syndrome and gives further information on the variable phenotypical pattern of the disease. The frequency of major and minor clinical signs is reviewed from all the published reports. Among the minor signs we found previously undescribed skeletal abnormalities in one of our patients. The reported delay onset of puberty, which appears to be a frequent aspect of the syndrome, seems to occur without LH and FSH deficiency, as our patients show.