Cholesteatoma in children

Cholesteatoma in children falls into two main categories: congenital and acquired. Though they present in different ways, both are potentially destructive lesions that are managed surgically. The goals of treatment are to eradicate keratinizing squamous epithelium from the temporal bone and to preserve or restore hearing. These children need to be followed closely by the pediatric otolaryngologist to prevent and control recurrent disease.     

Cholesteatoma of the cerebellopontine angle

Congenital cholesteatoma is the third most common tumor found in the cerebellopontine angle. It must be differentiated from acoustic neuromas, meningiomas, metastatic tumors, arachnoid cysts and lipomas. Symptoms include hemifacial spasm, progressive facial paralysis, hearing loss, tinnitus, vertigo, pain and otorrhea. Radiologic and magnetic resonance imaging frequently can be useful to establish a preoperative diagnosis. The treatment of choice is total removal of the lesion. Complete removal with preservation of normal structures is the most difficult and technically exacting procedure performed by the neurotologic surgeon. The clinical features and results from a series of 19 cases, nine of which extended into the cerebellopontine angle, are discussed.     

Psychiatry today

A COMMON SITUATION: Primary care physicians often provide care for schizophrenic patients. The main approaches include drug regimens, psychotherapy and psychosocial support. DRUG THERAPY: Neuroleptics should be given in single drug regimens in a continuous protocol for long periods. Side effects, particularly neurological effects, can be countered with antiparkinson medication. The aim is to reach the best possible balance between the therapeutic effect and side effects. PSYCHOTHERAPY: The general practitioner does not necessarily use sophisticated psychotherapeutic protocols but rather relies on a certain number of attitudes aimed at helping the patient accept the medications and control the main pathological mechanisms the schizophrenic state as expressed in the relationship with the health care provider. PSYCHOSOCIAL SUPPORT: A series of assistance measures (allocations for handicapped adults, adapted housing, protection of property) often involve a team of workers who should all take part in the therapeutic strategy.     

Clinical andrology today

Of a group of 860 men who attended a private infertility clinic in Western Australia, 80 (9.3%) presented with vasectomy-related infertility. Of these men, 73 (91%) requested treatment due to re-marriage. The median age of the men was 42.5 years and their present partners were approximately 10 years younger. The median vasectomy interval in the men in this study was 9 years. Treatment of vasectomy-related infertility included vasectomy reversal procedures, donor insemination and both in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). It is suggested that care must be taken in counselling such patients prior to a vasectomy. The cryopreservation of semen prior to vasectomy would also make much of this type of infertility treatment unnecessary.     

Reinforcement today.

The discovery of facts and practices concerning reinforcement in the past 25 years "have increased our power to predict and control behavior and in so doing have left no doubt of their reality and importance." In the acquisition of a bowling response in pigeons 3 points are relevant: (a) The temporal relationships between behavior and reinforcement are very important. (b) Behavior was set up through successive approximations. (c) Behavior gradual "shapes up" by "reinforcing crude approximations of the final topography instead of waiting for the complete response." The maintenance of behavior through various schedules of reinforcement is discussed. "The world in which man lives may be regarded as an extraordinarily complex set of positive and negative reinforcing contingencies… . In any social situation we must discover who is reinforcing whom with what and to what effect." The modern study of reinforcement is: (a) difficult and relatively expensive; (b) usually single-organism research, in which a statistical program is "unnecessary" and "wrong"; (c) not theoretical. "The new principles and methods of analysis which are emerging from the study of reinforcement may prove to be among the most productive social instruments of the twentieth century." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing bioethics today

Our society clearly needs to set limits on health care. The United States health care delivery system is the fourth largest economy in the world, yet its inflation continues to grow at twice the normal rate of other products and services. The inefficiencies are built in in such a way that while intensive care beds are plentiful, and very expensive, 37 million Americans cannot gain access to health care because they are either uninsured or underinsured. It is estimated that this figure will approach 39 million by the end of the decade. Since many of these individuals are young, the problem, it is said, has no real practical consequences because the young are relatively healthy. Yet evidence exists that the uninsured and underinsured receive poorer care than covered individuals. This and other inequities in the system have led many thinkers like Leonard Fleck to ask how just we must be in society. The answer to this question would presumably help us determine the lengths we must go in correcting the inequities. Even if the peace-dividend emerges from the new political events around the world, and we are able to spend more of our money on health care, our resources are not a bottomless pit. If need alone drives the system, just performing open-heart surgery on everyone who needs it would cost more than the annual budget itself. Virtually everyone agrees, then, that escalating health care costs are a moral problem because justice is involved, a political problem because public interest is involved, and that limits must be set that are moral and public.     

Cholesteatoma in children. Apropos of 110 cases

It has been considered that thromboxane A2 (TXA2) is involved in the development of bronchial hyperresponsiveness (BHR), a characteristic feature of asthma. To ensure the involvement of TXA2 in BHR of asthma, effects of a 1-week treatment with two orally active TXA2 antagonists, BAY u 3405 and S-1452, on BHR were examined in 10 and 13 patients with stable asthma, respectively, in two consecutive double-blinded, randomized, placebo-controlled, two-phase crossover studies. Provocative concentration of methacholine causing a 20% fall in FEV1 (PC20-FEV1) with BAY u 3405 (0.78 (GSEM, 1.50) mg/ml) was significantly greater than the value with placebo (0.65 (GSEM, 1.46) mg/ml) (ratio 1.23 times, 95% CI 1.01 to 1.46: P = 0.0401). PC20-FEV1 was also significantly increased with S-1452 (0.43 (GSEM, 1.39) mg/ml) compared with placebo (0.29 (GSEM, 1.27) mg/ml) (ratio 1.75 times, 95% CI 1.05 to 2.45: P = 0.0189). Baseline pulmonary function was not altered by these treatments. These results may ensure that TXA2 is significantly involved in the BHR of asthma while the degree of contribution may be small.     

Gestalt psychology today.

The background of gestalt psychology is traced and relationships of gestalt psychology to physics are indicated. The notion of insight is reformulated. Certain trends in American psychology are not fully approved: "I doubt whether it is advisable to regard caution and a critical spirit as the virtues of a scientist, as though little else counted… . Too many young psychologists, it seems to me, either work only against something done by others or merely vary slightly what others have done before." Human experience in the phenomenological sense requires study. A gestalt view of motivation is presented "in terms of… forces which operate between certain perceptual processes and processes in another part of the brain, where a need may be physiologically represented." With de?mphasis on differences in Behaviorist and Gestalt schools and more emphasis on positive contributions of each, constructive work can be accomplished together. "It would be an extraordinary experience—and one good for psychology." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reading instruction today.

Most current instructional programs provide considerably more decoding instruction than they did 20 yrs ago, but the debate over the degree of emphasis that should be placed on decoding is still alive. Some argue that instruction that stresses decoding leads to higher scores on word recognition tests in the early grades; others point out that such instruction does not lead to higher comprehension scores. But it must be kept in mind that other factors—social, philosophical, political—tend to influence decisions about reading instruction as much as do theory and experimentation. The new interest in reading comprehension and instruction in the middle years (Grades 4–6) may draw attention away from this perennial debate for a while. A brief review of reading instruction in the past decades is presented, and current achievements in the areas of reading theory and reading instruction are discussed. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Endometrial cancer treatment today

In industrialized countries, for the past few years, the decreasing prevalence of dental caries is due to the improvements of oral hygiene, alimentary prevention and water and salt fluoridation. The dental caries are promoted by the consumption of sucrose when it is too high and/or too frequent between meals. The well cooked sucrose-containing starch - are more cariogenic than sucrose alone. Prevention aims first at high consumers of cariogenic foods and at subjects who are genetically predisposed to dental caries.     

American Democracy today.

Suggests that American policy has been shaped more by anticommunism than by any other factor. When the mood and character of the nation are shaped by what is hated instead of by what is valued, the vision, goals, and direction of the country begin to decline. (0 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cholesteatoma of the cerebellopontine angle. A case report

In this paper are recalled the most important features of this sinusal condition, its behaviour, complications and so on. Regarding the management the A. recall to the classic surgery, well done, orderly and systematically planed, which give him always good outcomes. By the way accordingly to the promising it could be, he refers to endoscopic functional sinusal approach.     

Care of wounds today

Fifty three (45 males, 8 females) patients with primary meylodysplastic syndrome were seen between January 1990 and June, 1996. Fifteen (28%) patients had refractory anaemia (RA), 9 (17%) refractory anaemia with ring sideroblast (RARS), 21 (40%) refractory anaemia with excess blasts (RAEB), 5 (9%) refractory anaemia with excess blasts in transformation (REABt) and 3 (6%) had chronic myelomonocytic leukemia (CMML). The mean age for the whole cohort was 59 years. Patients with RAEB and RAEBt were significantly younger than other FAB types with a mean age of 53.5 and 45 years respectively. Among the FAB types RAEB appeared to be over represented. Symptomatic anaemia (66% cases) was the major cause to seek medical attention. The commonest laboratory findings was anaemia; Hb < 8 g/dl in 31 (59%) patients. Only two patients had Hb > 12 g/dl at presentation. Twenty four (45%) patients had normocytic anaemia, mainly in RAEB group (61%). Macrocytosis was a dominant finding in patients with RA (53%) and RARS (53%). Bicytopenia (72%) was a more common finding than pancytopenia (8%). Bone marrow was normocellular in 32 (60%) patients and hypoplastic in 11 (21%). Dyserythropoiesis predominantly affected RA (80%), RARS (55%) and RAEB (43%) groups. Bilineage dysplasia (21%) was commoner than trilineage dysplasia (19%). Increased bone marrow fibrosis was seen in about half of the available trephines, mainly in RAEB patients. Median survival of patients was ten months with a follow up duration of 2-55 months. Four patients transformed to acute leukemia (M1 or M2) and died subsequently. However, infection was major complication and cause of death (10 cases). The preponderance of younger people to acquire the disease (especially the RAEB and RAEBt variants), the emergence of RAEB as the major group of MDS and increased prevalence of hypoplastic MDS point towards non-therapeutic genotoxin (s) in the causation of disease. Shortened survival and low rate of acute transformation points that patients did not withstand cytopenias and died earlier.