Validation of the LittlEARS((R)) Auditory Questionnaire in children with normal hearing.

OBJECTIVES: With more children receiving cochlear implants during infancy, there is a need for validated assessments of pre-verbal and early verbal auditory skills. The LittlEARS Auditory Questionnaire is presented here as the first module of the LittlEARS test battery. The LittlEARS Auditory Questionnaire was developed and piloted to assess the auditory behaviour of normal hearing children and hearing impaired children who receive a cochlear implant or hearing aid prior to 24 months of age. This paper presents results from two studies: one validating the LittlEARS Auditory Questionnaire on children with normal hearing who are German speaking and a second validating the norm curves found after adaptation and administration of the questionnaire to children with normal hearing in 15 different languages. METHODS: Scores from a group of 218 German and Austrian children with normal hearing between 5 days and 24 months of age were used to create a norm curve. The questionnaire was adapted from the German original into English and then 15 other languages to date. Regression curves were found based on parental responses from 3309 normal hearing infants and toddlers. Curves for each language were compared to the original German validation curve. RESULTS: The results of the first study were a norm curve which reflects the age-dependence of auditory behaviour, reliability and homogeneity as a measure of auditory behaviour, and calculations of expected and critical values as a function of age. Results of the second study show that the regression curves found for all the adapted languages are essentially equal to the German norm curve, as no statistically significant differences were found. CONCLUSIONS: The LittlEARS Auditory Questionnaire is a valid, language-independent tool for assessing the early auditory behaviour of infants and toddlers with normal hearing. The results of this study suggest that the LittlEARS Auditory Questionnaire could also be very useful for documenting children's progress with their current amplification, providing evidence of the need for implantation, or highlighting the need for follow-up in other developmental areas.

Otoacoustic emissions analysers for monitoring aminoglycosides ototoxicity.

OBJECTIVES: Aminoglycosides (AG) are widely prescribed despite their notorious toxicity. These antibiotics cause irreversible hearing loss, starting with high frequencies and progressing toward conversational frequencies (0.5-2 kHz), by destroying the acoustic hair cells in the inner ear. The integrity of these cells could be analysed by recording faint sounds that they produce otoacoustic emissions (OAE). The aim of the present study was to monitor and to characterise the acoustic toxicity of the AG using an OAE analyser. METHOD: We performed a prospective study of 49 patients receiving gentamicin (G), during 2007-2008. We made serial OAE recordings with an ILO 92 analyser (1-8 kHz) on at least 3 occasions: at the start, during treatment and after the cessation of G therapy (1-6 months). The recordings were performed at the patient's bedside and did not require the active participation of the patient. The method is fast, non-invasive, accurate and does not request an ENT specialist. We included patients presenting OAE. Ototoxicity was defined using adapted ASHA (American Speech Hearing Association) criteria. RESULTS: We studied 49 patients (24/25 female/male), mean age of 37.24 (3-70 years old), who received G for 4-42 days: less than 10 days--24 patients and more than 10 days--25 patients. Hearing impairment was observed in 10 patients (20.4%) and appeared during the therapy or in the next 3 months, with a loss of one or 2 high frequencies that occurred unilaterally in 9 out of 10 cases. The acoustic damage correlates with the length of G treatment. We did not find a statistical correlation between the degree of impairment and the age, regimen or addition of another ototoxic drug, although the hearing loss was slightly higher in those with concomitant exposure. CONCLUSION: OAE monitoring of AG treatment is a very useful way for detecting and preventing acoustic toxicity, because it could warn about hearing loss before damage of the conversational frequencies. The accuracy is similar to the classical methods, but it is faster and easier to perform.

[Consideration regarding 20 antireflux laparoscopic operations for hiatal hernia]. / Consideratii în legatura cu 20 operatii antireflux efectuate pe cale laparoscopica pentru hernia hiatala.

AIM: To evaluate the clinical, therapeutical and evolutive aspects of the patients with hiatal hernia with laparoscopical approach. MATERIALS AND METHODS: Retrospective analysis of 20 patients diagnosed with hiatal hernia and operated, laparoscopical, between 13.01.1999-10.04.2002. RESULTS: At 18 cases (90%), were sliding hiatal hernia and at 2 cases (10%), were paraesophageal hiatal hernia. There were performed laparoscopical: 1 (5%) Dor anterior hemi-fundoplication, 4 (20%) Rosetti fundoplication, 3 (15%) Toupet posterior hemi-fundoplication and 11 (55%) Nissen fundoplication. For the dissection, the ultrasound scissors (Ultra-Shears) was used and for the suture of the both diaphragmatic crus and the wrap, the Endo-Stitch. There were reported 1 (5%) optional conversion and 3 cases (15%) with bleeding solved by clipping and hemostatic suture. No postoperative complications, deaths intra and postoperative were reported. The average duration of the intervention decreased in time, due to the experience, from 180 to 60 minutes, but in accordance with the complexity of the procedure (Nissen-Toupet-Dor). At 2 (10%) cases with Nissen fundoplication was reported a transitory dysphagia, which was remitted between 1-2 months. We noticed a decreasing of the duration of hospitalisation for the antireflux laparoscopical interventions, compared with the classic methodes. CONCLUSIONS: There is a tendency of the laparoscopical approach of hiatal hernia to come the standard in the GERD, due to his minimal invasive character, significantly reducing costs and good postoperative results.

[Intraoperative diagnosis of common biliary duct using laparoscopic ultrasonography]. / Diagnosticul intraoperator al litiazei de cale biliara principala prin ecografie laparoscopica.

THE AIM: Of the study is to show the advantages and limits of laparoscopic echography in exploration and diagnosis of common biliary duct lithiasis, as it is evidenciated in the experience of our surgical department. MATERIAL AND METHODS: Between 31.03.1997-31.12.2002 we have made 878 laparoscopic interventions to patients with hepatho-biliary pathology. We made a prospective study and performed 116 laparoscopic ultrasonography examinations for exploration of the liver and bile ducts. We used an Aloka SSD 2000 device with a linear laparoscopic flexible transductor. RESULTS: We obtained a very good visualization in 97 cases (83.6%) and medium visualization in 19 cases (16.4%). The medium time of the examination was 10 minutes (variations between 5-20 minutes). We discovered pathological modifications in principal bile duct and cystic using color Doppler examination in acute and chronic inflammatory lesions with important anatomical modifications. CONCLUSIONS: 1. laparoscopic ultrasonography it is an ideal technique in common bile duct lithiasis diagnosis, with 90-98% precision. 2. intraoperative ultrasonography does not need preliminary dissection of cystic and offers the possibility of exploration of the liver and pancreas. 3. it needs a learning curve and collaboration between surgeon and ultrasonography specialist.

[Mechanical suture in colorectal surgery]. / Sutura mecanica în chirurgia colorectala.

THE OBJECT: Of this work was the study of using, as well as the utility of the mechanical sutures in colorectal surgery; because of the special caution needed to be taken for any colonic or rectal suture, more than any other digestive segment. The frequency of the postoperative fistulas after the suture and anastomosis is higher at this level and so it increases the period and costs of the hospitalization. MATERIAL AND METHOD: We studied the possibilities of performing and evolution of 64 mechanical sutures for 19 patients, with colorectal pathology, hospitalized in our department from july 1999 to december 2000. RESULTS: We performed 64 mechanical sutures, as followed: 47 in open surgery and 17 in laparoscopic. From all these, 56 was bowel sutures, 8 of them were vascular (in laparoscopic, for cutting the most important vascular pedicles). We did 18 anastomosis: 15 in open and 3 in laparoscopic surgery. It was 2 postoperative fistulas from all 56 intestinal sutures (3.57%). We haven't any intra or postoperative bleeding from the vascular anastomosis. It was 3 intraoperative bleeding from the intestinal anastomosis, and only 1 case of postoperative bleeding (5.26% of the cases: 1.56% of all mechanical sutures). In only one case, the mechanical suture couldn't be initially done, but it succeeded after the removing of the segment of the bowel involved. CONCLUSIONS: Mechanical sutures offers a high level of safety to the colorectal anastomosis. It provides a very good vascularization to the anastomosis and decreases the time needed for performing the suture or anastomosis, versus manual sature. Also, for the patients with rectal ampular neoplasm, it creates the possibility of anal sphincter preservation by making a low colorectal anastomoses--which is difficult by manual suture.

[Intraoperative ultrasonography during laparoscopic surgery]. / Ecografia intraoperatorie în chirurgia laparoscopica.

AIM: Of this study is the introduction and the results evaluation of laparoscopic ultrasonography performed. MATERIAL AND METHOD: We realize a prospective study about laparoscopic ultrasonography performed in 37 cases with laparoscopic surgical treatment. The Aloka SSD 2000 mobile scanner is used. This system make possible the use of an linear-array transducer, with mechanical flexibility and availability of Doppler analysis. Most frequently we used intraoperative ultrasonography in laparoscopic cholecystectomy as an alternative for cholangiography to exclude CBD pathology. Because of various surgical pathology with laparoscopic approach, the laparoscopic ultrasonography utilization range was vastly. RESULTS: In all the cases we could performed the laparoscopic ultrasonography. In 6 of 27 cases with laparoscopic cholecystectomy we found pathological disorders of bile ducts. CBD with diameter found between 5-12 mm. We properly saw the distal segment of CBD in 23 cases (89.2%), and common hepatic duct in 26 cases (97.3%). The quality of visualization was very good in 21 cases (83.8%) and moderate in 6 cases (16.2%). We easy identify CBD stones and we successfully used Doppler color mode in differentiating vascular from non-vascular from non-vascular structures. Laparoscopic ultrasonography performed in a case with left colon cancer excluded liver metastasis and lymph nodes metastasis. CONCLUSIONS: 1. Laparoscopic ultrasonography combines the advantages of diagnostic laparoscopy and intraoperative contact ultrasonography; 2. Laparoscopic ultrasonography is a simple and very efficient intraoperative examination procedure; 3. Laparoscopic ultrasonography is the technique to choose in CBD intraoperative exploration; 4. Laparoscopic ultrasonography improve abdominal malignancy exploration, thus modifying therapeutic decisions; 5. Color Doppler mode guides the surgeon's steps in difficult directions.

[Mechanical suture in classic and laparoscopic general surgery]. / Sutura mecanica în chirurgia generala clasica si laparoscopica.

AIM: Of this working is the study of employment the mechanical suture in general surgery classic and laparoscopic. MATERIAL AND METHOD: We analysed the possibility of accomplishment and postoperatory evolution of 104 mechanical sutures performed in 24 patients, with diverse surgery pathology, operated in Department of General Surgery, between January 1999 and January 2000. RESULTS: Mechanical sutures allowed us to minimize the duration of surgical interventions and to perform some difficult anastomotic assembles (sometimes including creation of organ substitute). We had only two postoperatory fistulas and two postoperatory haemorrhages from anastomotic area (both cases because of bad closing of clips, through tissue excess between anvil and cartridge of the stapler). CONCLUSIONS: There are certain advantages in using mechanical sutures (versus manual sutures) consisting in decreasing of time period, both in operation itself and in hospitalization, despite their high level cost.

[Definition of normal criteria of provoked otoacoustic emission in the newborn infant]. / Définition des critères de normalité d'une oto-émission acoustique provoquée chez le nouveau-né.

Evoked otoacoustic emissions (EOE) were recorded with ILO88 in a group of 254 neonates (n = 508 ears) in order to determine the normative data. In this study, it was found that: (i) the mean EOE amplitude was 20.2 dB SPL, (ii) the EOE amplitude of the right ear was significantly higher than those of the left ear, (iii) the mean time necessary to record EOE in both ears was around three minutes, and (iv) EOE spectrum was large (mean = 638-5,611 Hertz). These data permit to precise the clinical interest of EOE for screening auditory function in neonates.

Congenital adrenal hyperplasia with female pseudohermaphroditism in a 26-year-old patient.

The paper presents the case of a 26-yr-old patient admitted for intersexuality. Clinical examination shows statural deficit, female phenotype, melanoderma, glabrous tegmina except for the pubic area presenting horizontally inserted pilosity, labioscrotum devoid of contents, pseudomicropenis with hypospadias. The Barr cytogenetic test is positive (56%) and hormone assay shows plasma cortisol at the lower limit and adrenal androgenic hormones and their metabolites in excess, suppressible by dexamethasone. The patient had a history of repeated admissions to intensive care units for severe dehydration, vomiting, diarrhea and collapse.

Room air ventilation for total intravenous general anaesthesia.

The use of room air alone to ventilate patients who were anaesthetized with total intravenous anaesthesia, including morphine 2 mg.kg-1, was studied in ten patients. The were scheduled for gastrectomy for peptic ulcer or stomach carcinoma. The patient's minute-ventilation was measured the day previous to surgery; this, together with a frequency of 14 c.min-1, was used to preset the ventilator. Alveolar ventilation, end-expiratory CO2, arterial blood gases and acid-base balance were monitored throughout the procedure. The blood oxygen level was found to remain similar to the reference value; there was a moderate hypocapnia, a low end-expiratory CO2 and minimal changes in acid-base balance. No pulmonary complication was encountered in the postoperative course. These results showed that room air could be used in unusual circumstances for healthy patients for whom a total intravenous anaesthetic technique has been chosen.