Incidence of congenital CMV in children at a hearing rehabilitation center.

OBJECTIVE: To evaluate the incidence of children with congenital CMV (cCMV) infection in a hearing rehabilitation center. METHODOLOGY: This was a retrospective review of 309 children followed in a rehabilitation center for mild to total sensorineural hearing loss (SNHL). Seventy-five children had dried blood spots that we retrieved and retrospectively analyzed for the presence of CMV DNA by real time PCR. The children were born in Belgium after January 1996. The etiology of the SNHL was investigated for each child. RESULTS: The CMV DNA was detected in the dried blood spots for 8 of the 75 children tested (10.6%) by real time PCR. In three children, an alternative etiology of SNHL was suspected before the cCMV infection was diagnosed. CONCLUSIONS: The incidence of children infected with cCMV in a hearing rehabilitation center is high (10.6%). The detection of CMV DNA in dried blood spots is useful and improves the etiological diagnosis of SNHL.

Clinical findings and PDS mutations in 15 patients with hearing loss and dilatation of the vestibular aqueduct.

Following systematic skull imaging of hundred and sixty seven individuals attending a medical referral centre for the deaf in Brussels, Belgium, fifteen patients (9 per cent) aged between two and 25 years were diagnosed with dilatation of the vestibular aqueduct. Careful audiological study, with a baseline assessment then longitudinal follow up, indicated mild to profound deafness with a progressive course (i.e. an average loss of 3.3 dB per year) and frequent dizziness. Sequencing of PDS was performed in all individuals. Alterations of this gene (either homozygous, heterozygous or compound heterozygous base changes) were found in 53 per cent of patients with a large vestibular aqueduct. Four new mutations (two missense, a splice site and a four base pair insertion) were described. We were unable to confirm a correlation between homozygosity, heterozygosity and a Pendred or deafness-only phenotype.

[Hearing screening of newborns. Preliminary results]. / Le dépistage auditif des nouveau-nés. Résultats préliminaires.

Since 1976, an hearing screening is organized at the Clinic Edith Cavell. The testing was based on a behavioral technique of Veit-Bizaguet and, since 2001, the otoacoustic emissions are realised. The National Institutes of Health (1993) recommends universal newborn hearing screening of all newborns before 3 months of age and identification and treatment before 6 months of age. Indeed, detection of hearing loss and early intervention allow a better access to the language and consequently an easier schooling and social integration. This article shows the results of the screening from february at the end of December 2002. These data are compared with those of the literature.

[Cochlear implantation, new prosthetic alternative in the management of the profoundly deaf child]. / L'implant cochléaire, nouvelle alternative prothétique dans la prise en charge de l'enfant sourd profond.

Cochlear implants are new medical devices. In contrast to acoustic hearing aids which work by amplification, cochlear implants directly stimulate the hearing neurons via electrode implanted in the cochlear tympanic ramp. They are indicated in case of profound hearing deficiency or in cases of bilateral cophosis, congenital or acquired. Implanted early, they allow deaf children to improve their speech comprehension and their verbal expression considerably, thereby favouring social integration. A concurrent system of support including the use of visual-manual means of communication nevertheless remains vital for the first years. The frequency and duration of such support varies according to the individual.

Investigation of two new [99mTc]Tc-HEDP preparations that can be expected to give a better lesion-to-normal-bone uptake ratio when used as bone scanning agents.

Two new potential bone scanning agents have been prepared and characterized. One of the agents, Tc(Sn,pH 12)-HEDP, is prepared at pH 12 (and subsequently neutralized). The other agent, Tc(Fe)-HEDP, is prepared by reducing [99mTc]TcO4- by a mixture of Fe(II) and Sn(II). From ion exchange chromatography on Aminex A-28 it appeared that the proportion of early eluting components of the two new agents is larger than that of the usual agent, Tc(Sn,pH 7.4)-HEDP. The stabilities on storage, and in serum, of the three agents appeared to be equally good. The adsorption on tri-calciumphosphate of Tc(Fe)-HEDP and Tc(Sn,pH 7.4)-HEDP was determined at several values of concentrations of Sn(II) and HEDP. Further, the influence of the pH (1-12) during reduction of [99mTc]TcO4- by Sn(II) on the adsorption of the agent on tri-calciumphosphate (at a fixed pH of 7.4) was investigated. It appeared that the adsorption of Tc(Sn,pH 12)-HEDP and Tc(Fe)-HEDP is less than that of Tc(Sn,pH 7.4)-HEDP. It is argued that this result points to a better efficiency in lesion detection of the two new agents, compared to the usual one.

The adsorption of 99mTc(Sn)-diphosphonate complexes on tri-calciumphosphate: the influence of preparation conditions, ligand-type, incubation media and adsorption conditions. The reversibility of the adsorption.

The influence of several variables on the adsorption of 99mTc(Sn)-diphosphonate complexes on tri-calciumphosphate was determined. The composition of the incubation medium influenced the percentage adsorption: with Hank's balanced salt solution (a medium frequently used for bone cell cultures) and Tris buffer lower percentage adsorption was obtained than with physiological saline as the incubation medium. The influence of addition to the incubation medium of some ions and neutral species, some of which occur in bone fluid, is very specific. Addition of Sn(II) or Mg(II) (a component of HBSS) reduces the amount of adsorption. Addition of Ca(II) and Al(III) had no effect. Addition of sodium-citrate and MDP to the medium and an increase of the pH of the medium decreased the percentage adsorption. The ligand that was used in the preparation of the complex mixture influences the percentage adsorption considerably. The Sn(II) concentration used during the preparation of the 99mTc(Sn)-MDP and 99mTc(Sn)-MHDP complexes showed no definite influence on the percentage adsorption. The pH and ligand concentration, used in the preparation, however, did effect the percentage adsorption. It was concluded that the 99mTc(Sn)-disphosphonate mixtures are part reversibly and part irreversibly bound to tri-calcium-phosphate.

[Asthma: psychosomatic disease in children and adults (scientific and literary review of the literature)]. / L'asthme: maladie psychosomatique de l'enfant et de l'adulte (revue de littérature scientifique et littéraire).

The personality of the asthmatic child, and his relation with his mother-characterized by an absence of normal separation and individuation-is examined through scientific and literary sources. The familial milieu and various behavioral attitudes of the asthmatic patient are also considered. Various therapeutic approaches are discussed.

[Malaria and pregnancy. Report of a case of congenital Plasmodium falciparum malaria]. / Paludisme et grossesse. A propos d'une observation de paludisme congénital à Plasmodium falciparum.

We report a case of congenital malaria due to a chloroquine-resistant strain of Plasmodium falciparum acquired in Mali. Ours is the first report of chloroquine-resistant congenital malaria in this part of Africa. We recall the various pathophysiologic, diagnostic and therapeutic features of this disease that should be considered in every neonate born to a mother who may have malaria. Although such cases are infrequent, we also discuss the very serious problems, mainly therapeutic, that they raise in several countries where they are endemic (South-East Asia and Africa particularly).

Improvement of the reproducibility of ion-pair HPLC of 99mTc(Sn)EHDP complexes and the influence of the Sn(II) concentration on the composition of the reaction mixture.

The use of a non-volatile modifier and the simultaneous exclusion of oxygen by flushing with helium in ion-pair HPLC of 99mTc(Sn)EHDP-complexes prevents spurious oxidation during the separation process. It thus enables the omission of the reducing agent from the eluent solution and the determination of the labelling percentage from the TcO4(1)-peak. In addition, retention times become more reproducible.

The binding of 99mTc(Sn)-MDP complexes to human serum albumin and other blood proteins determined with gel chromatography and ultrafiltration.

The binding of 99mTc(Sn)-MDP to human serum albumin and other blood proteins was investigated by gel chromatography and ultrafiltration. During gel chromatography dissociation of the 99mTc(Sn)-MDP-protein complex occurs: thus, it is not a suitable technique for the determination of protein binding. The values found with ultrafiltration have to be corrected for non-ultrafiltrable TcO2.nH2O. From the corrected values it can be concluded that binding of 99mTc(Sn)-MDP to blood proteins does not play a role in the biodistribution.

Anion exchange chromatography of 99mTc(Sn)-MDP complexes: influence of eluent composition, determination of void volume and charge of the main component.

99mTc(Sn)-MDP complexes have been prepared by reduction of 99mTcO4- by Sn(II) in the presence of MDP. These complexes were separated on an anion exchange column. The necessity of the addition of the ligand and the reducing agent to the eluent to avoid decomposition during chromatography is demonstrated. For the main component that is found at pH 5 the ionic charge was calculated according to the method of Wilson and Pinkerton [Anal. Chem. 57,246 (1985)] and the method of Russell and Bishoff [Int. J. Appl. Radiat. Isot. 35,859 (1985)]. With the first method a charge of -4.2 +/- 0.3 was obtained, with the second a charge of -5.1 +/- 0.6. An accurate method to determine the void volume of the ion exchange column is described.

Effect of the composition of the eluent in the chromatography of 99mTc-diphosphonate complexes.

When the ligand and the reducing agent are added to the eluent used in the separation of 99mTc-diphosphonate complexes by column chromatography, a significant increase in recovery is obtained. The addition of the ligand and the reducing agent also influences the shape of the chromatogram.

99mTc bone scanning agents--IV. Chemical characterization of 99mTc(Sn)-pyrophosphate complexes.

Various reaction mixtures for the preparation of 99Tc(Sn)-pyrophosphate were investigated by means of gel chromatography. All components were radioactively labeled. The most likely composition of the complexes, which also appear in "no carrier added" preparations, was determined. At pH 7 one complex is found with the composition TcPyp2. Two complexes are found at pH 4: TcPyp and TcPyp2. Further, at pH 7 a polymeric technetium compound is found not containing tin or pyrophosphate.

[Sensitivity and specificity of blood amylase, amylase and creatinine clearance ratio and urinary amylase/urinary creatinine ratio in the diagnosis of acute pancreatitis]. / Sensibilité et spécificité de l'amylasémie, du rapport des clairances d'amylase et de créatinine et du rapport amylasurie/créatininurie pour le diagnostic des pancréatites aiguës.

The sensitivity and specificity of amylasemia, the ratios of amylase/creatinine clearance and amylasuria/creatininuria were determined in four groups of patients: a control group (n = 43), patients with acute pancreatitis detected on computed tomography (n = 30, 25 cases of alcoholic pancreatitis), patients with an acute surgical abdomen without pancreatitis (n = 25), and patients with renal failure (n = 20). Sensitivity was defined for the acute pancreatitis group and specificity for the other groups. When amylasemia was greater than 20 UI/dl and the amylasuria/creatininuria ratio greater than 100, sensitivity was 98 per cent. The specificity of these two results in patients with an acute surgical abdomen was 98 per cent. When the ratio amylase/creatinine clearance ratio was greater than 4 sensitivity was 73 per cent and specificity in patients with acute surgical abdomen was 75 per cent. These two values were lower than those of the two preceding tests (p less than 0.01). Sensitivity of the association of an amylasemia greater than 13 UI/dl (m + 2SD) with a clearance ratio greater than 4 was 73 per cent. The amylase/creatinine clearance ratio did not seem to be reliable since its change was delayed with respect to the increase of amylasemia and amylasuria. This ratio has a poor specificity as it increased when the clearance of creatinine decreased in the group with an acute surgical abdomen associated with functional or organic renal failure. In these two groups, the correlation between the amylase/creatinine clearance ratio and creatininemia was significant. This suggested that the clearance of creatinine fell more rapidly than the clearance of amylase as renal failure increased.

The usefulness of fructosamine determination in diabetic patients and its relation to metabolic control.

In 116 diabetics and 101 control subjects, we measured both HbA1 and fructosamine values, neither could definitely separate the 2 populations. We observed an excellent correlation between both variables and between each of them and various other parameters of metabolic control. It appeared that the correlation with recent (4 weeks) diabetes control was better with fructosamine than with HbA1 levels. The opposite was true when a 8 week period was considered. The presence of diabetic complications did not modify the fructosamine levels. These results confirm the value of fructosamine measurement in the evaluation of recent diabetes control, but clearly, HbA1 determination remains the best parameter of long-term glycemic control.