Cochlear implantation in children younger than 2 years old

PURPOSE: This study recorded and compared the flexural elastic moduli and moduli of rupture of four materials (Provipont DC resin, Triad provisional restorative material, Jet acrylic resin, and a 50:50 mixture of Jet acrylic resin and orthodontic resin) used to make provisional restorations. MATERIAL AND METHODS: Thirty-nine identical 63 x 10 x 3 mm specimens were made from each of the four materials. After 24 hours, 30 days, and 60 days of water storage at 37 degrees C (13 specimens each), standard three-point bend tests were conducted on an Instron universal testing machine at a crosshead speed of 0.5 cm/minute. Stress strain curves were generated, and values for the flexural elastic moduli and moduli of rupture were calculated. Data were subjected to two-way and one-way analyses of variance (alpha = 0.05). RESULTS: Provipont DC resin exhibited significantly higher flexural elastic moduli and moduli of rupture values at the 24-hour test time. However, Provipont DC resin exhibited the greatest decrease in these values over time.     

Transitional cell bladder carcinoma in patients younger than 40 years of age

OBJECTIVE: The clinical and pathological characteristics of bladder cancer in young patients were analyzed to determine if patients with bladder cancer under the age of 30 have a better prognosis than older adults and if transitional cell carcinoma of the bladder in patients aged 30 to 40 years has a similar behaviour to that observed in the higher risk population. METHODS: A retrospective review of transitional cell carcinoma of the bladder in patients less than 40 years old that had been treated between January, 1993 to August, 1997 was undertaken. RESULTS: We found 8 patients (5 men and 3 women) with urothelial tumor, accounting for an incidence of 4%. Four cases were diagnosed and staged TaG1, 2 T1G1 and 2 T1G2. Recurrence was observed in one case (12.5%) and progression in none. CONCLUSIONS: Transitional cell carcinoma of the bladder in patients under the age of 40 is usually associated with low grade and low stage tumors. The foregoing finding is certainly observed in those aged less than 30 years old. Bladder cancer is relatively rare in this age group, although we have found a higher incidence than that reported elsewhere. Treatment and follow-up depend on tumor grade and stage, regardless of age.     

The evaluation of breast masses in women younger than forty years of age

BACKGROUND: Breast masses in young women are common, but carcinoma is rare. This study was undertaken to determine how often a complaint of mass was found to represent a dominant mass and to define the role of breast imaging and fine-needle aspiration cytology (FNA) in the evaluation of clinically nonworrisome masses. METHODS: A retrospective review was made of 605 patients younger than 40 years of age with a breast mass between February 1994 and February 1996. RESULTS: Dominant masses were confirmed by surgeon examination in 36% of 484 self-detected masses compared with 29% of physician-detected masses (difference not significant). With pathologic confirmation, 29% of self-detected masses had a dominant mass compared with 19% of physician-detected masses (P = .02). Carcinoma was present in 5% of both groups and not predicted by family history. Imaging studies were not useful in patients with normal examinations but were more likely to identify dominant masses in patients with an examination described as benign (P < .001). FNA did not identify any cancers in normal or benign examinations. CONCLUSIONS: Self-examination is as reliable as a general physician examination in detecting breast masses. When an examination by an experienced surgeon is normal, imaging studies and FNA are low yield. When the examination is equivocal, directed ultrasonography is a useful adjunct.     

Overgrowth and outcome after femoral shaft fracture in children younger than 2 years

Twenty-one children younger than 2 years with a fractured femur were evaluated retrospectively to determine limb overgrowth, efficacy, and outcome after treatment with immediate spica casting. All children had spica casts placed without general anesthesia within 24 hours of admission. Followup averaged 51 months (range, 24-110 months). Average shortening in the spica cast at initial application was 0.5 cm (range, 0-1.8 cm). The average length of hospitalization was 2.2 days. Three patients went home the same day, and seven were discharged after a single overnight stay in the hospital. No patients underwent closed manipulation or a cast change for malalignment of the fracture. Child abuse was identified as the mechanism of injury in eight of 12 (67%) children younger than 1 year of age and in only one of nine (11%) children between 1 and 2 years of age. Leg lengths were determined by measurement with tape and graduated blocks. At followup, the average limb length inequality was 0 cm, with an average net growth of 0.5 cm (range, -0.5-1.8 cm). Only one child had a limb length inequality of more than 1 cm as measured with tape (20 months of age), and no child had a limb length inequality of more than 1 cm as measured with blocks. No child or parent reported any residual pain, limp, or limitation of activity. The results of this study suggest that overgrowth does occur in children younger than 2 years. Additionally, immediate spica casting with early discharge to home is associated with few complications, no functional limitations, and minimal limb length inequality.     

Outpatient adenotonsillectomy. Is it safe in children younger than 3 years?

OBJECTIVE: To evaluate the safety of ambulatory adenotonsillectomy in children younger than 3 years. MATERIALS AND METHODS: The records of 102 children younger than 3 years who underwent adenotonsillectomy as an outpatient procedure were reviewed during a 3-year period. RESULTS: Ten patients (10%) required overnight hospital admission for an average of 1.4 days. Nine patients were admitted directly from the day-stay unit and 1 patient was admitted 48 hours after surgery. The reason for hospital admission was poor oral intake. None of the patients had postoperative bleeding or respiratory problems or required intensive care unit admission. CONCLUSION: The safety of ambulatory adenotonsillectomy depends on judicious selection criteria and can be performed in children younger than 3 years.     

Inhalation therapy in children younger than 2 years. II. The practice

Effective inhalation of drugs, even by small children under 2 years, is often faster, simpler, cheaper and better with metered dose inhalers with small antistatic (metal) inhalation chambers than with nebulisation. This is also true during considerable bronchial obstruction. It is mandatory that the inhalation chamber has a small dead space and well functioning valves opening at low flows. Effective dosing in small children is enhanced by more doses, given separately, while choosing the highest dose per spray available. Important factors determining bronchial deposition in small children are breathing frequency, tidal volume and the degree of bronchial obstruction and nasal obstruction, since inhalation goes primarily through the nose. If well-performed medication with a small inhalation chamber is clinically ineffective, it is better to start systemic medication, e.g. a corticosteroid, or even to consider artificial ventilation, rather than to try nebulisation. Better effective deposition is possible with inhalation of drugs in hydrofluoroalkane (HFA) aerosols, which will replace chlorofluorocarbon (CFC) aerosols in the near future.     

Neuro-psychological development of vision in children older than 6 years of age

In snails maintained at 20 degrees C rediae of Fasciola hepatica merge from sporocysts from 11 days after infection onwards. The number of mother rediae rises steadily thereafter until at least 40 days after infection. Daughter rediae are seldom observed in mother rediae dissected from snails maintained at 20 degrees C. Their production can, however, be stimulated by subjecting the snail host to starvation, to low, and to high temperature shocks. The parasite is susceptible to stress from immediately after infection for about 16 days, when maintained at 20 degrees C. In general, the more extreme the shock, the greater is daughter redial production. Increasing the length of the period of stress from 12 h up to 9 days does not increase the production of daughter rediae, nor does repeated on/off cold shocks or continuous maintenance at 10 degrees C. Daughter rediae develop more rapidly than cercariae and leave the mother rediae several days earlier. There is no evidence that presence of daughter rediae coincides with the suppression of cercarial production. The findings are discussed with reference to possible mechanisms by which parasite development might be controlled.     

Long-term follow-up after endoscopic sphincterotomy for bile duct stones in patients younger than 60 years of age

PURPOSE: To study the clinical histories and courses of six patients with choroidal neovascularization secondary to endogenous Candida albicans chorioretinitis. METHODS: The medical records, fundus photographs, and fluorescein angiograms of six patients who developed C. albicans chorioretinitis secondary to candidemia and who subsequently developed choroidal neovascularization in one or both eyes were reviewed. RESULTS: The six patients ranged in age from 18 to 79 years. Four were women and two men; all but one showed evidence of bilateral chorioretinal scarring secondary to C. albicans chorioretinitis. All patients had been treated successfully with systemic antifungal therapy (amphotericin B). Two weeks to two years after the chorioretinitis, choroidal neovascularization developed in one eye (four cases) or both eyes (two cases). The neovascularization on initial examination was subfoveal in four eyes, extrafoveal in three eyes, and juxtafoveal in one eye. Laser photocoagulation was used in four of the eight involved eyes. In these cases, the active choroidal neovascularization was brought under control. In one eye, the patient had submacular surgery for excision of the choroidal neovascular membrane. Final visual acuities ranged from 20/20 to 20/200 in treated eyes and from 20/50 to 20/400 in untreated eyes. CONCLUSION: Choroidal neovascularization is a potential cause of late visual loss in patients who have had C. albicans sepsis and endogenous C. albicans chorioretinitis. Eyes that have chorioretinal scarring from C. albicans chorioretinitis should be watched for the development of choroidal neovascularization. Laser photocoagulation or perhaps surgical excision of the neovascular complex may be of benefit in selected cases.     

Surgical treatment of Graves' disease in patients younger than 18 years

Eighty-two children and adolescents (18 males, 64 females; median age 14 years) surgically treated for Graves' disease at a single institution between 1979 and 1993 were retrospectively reviewed. Most of the patients (74%) coming to thyroidectomy had been treated medically for a period ranging from 2 to 80 (median 15) months. Bilateral subtotal thyroid resection was the most frequently performed procedure (86%). Postoperatively, no permanent recurrent laryngeal nerve palsy or permanent hypocalcemia occurred. Operative mortality was zero. With a median follow-up of 8.3 years, recurrent hyperthyroidism occurred in five patients (6%), one of whom required reoperation. Most children and adolescents with Graves' disease can be rendered euthyroid by nonsurgical treatment options. However, prolonged and ineffective medical treatment should be avoided in these patients who are in the formative years of their lives. Surgical treatment, when indicated and employed, offers young patients with Graves' disease a safe, rapid, definitive, cost-effective treatment with a high success rate.     

Comparison of outcome of primary PTCA for acute myocardial infarction in patients younger and older than 70 years of age

BACKGROUND: The Primary Angioplasty in Myocardial infarction Study Group reported that the benefit of primary PTCA was observed mainly among patients who were classified as "not low risk" including those over age 70, with anterior infarction and heart rate > 100 bpm. The present study compares procedural success rate and in-hospital and one-month clinical outcome of primary PTCA in acute myocardial infarction patients < 70 and > or = 70 years of age. METHODS AND RESULTS: During 1995 121 patients with acute myocardial infarction underwent primary PTCA within 6 hours of symptoms onset or within 24 hours in case of evidence of ongoing ischemia. Eighty-two patients (Group I) were < 70 (mean age 56 +/- 9) and 39 patients (Group II) were > or = 70 (mean age 75 +/- 3). In group II there was a trend, although not significant, toward a higher prevalence of prior angina and infarction. Multivessel disease was more frequent in group II than in group I (69% vs 48%; p = 0.041). Ejection fraction was markedly depressed in both groups (38 +/- 10% in group I vs 34 +/- 11% in group II). Ejection fraction < or = 30% and shock on admission were more frequent in group II (39% vs 15% and 36% vs 21%, respectively). Optimal angiographic success (< or = 30% stenosis associated with TIMI grade 3 flow) was achieved in 77% of group II and in 98% of group I (p = 0.00059). The in-hospital mortality rate was 26% in group II and 1.2% in group I (p = 0.000042). Shock on admission and PTCA failure predicted high mortality rates. There was no difference between the two groups as regards to non-fatal reinfarction, recurrent ischemia, life-threatening arrhythmias, severe heart failure, revascularization procedures. There were no strokes. At one-month follow-up, recurrence of ischemia or positive response to stress test were more frequent in group II (24% vs 8%; p = 0.039). CONCLUSIONS: In patients with acute myocardial infarction < 70 years of age primary coronary angioplasty is associated with low rates of mortality and cardiac events. Mortality rate remains high in patients over age 70, especially when shock is present on admission or PTCA falls.     

Clinicopathologic characteristics of primary liver cancer in patients younger than 35 years

To investigate clinicopathologic characteristics of primary liver cancer (PLC) in young adults, 77 patients younger than 35 years were compared with 603 patients older than 35 years during the same period. In the young patients, PLC showed a low incidence of PLC detected at mass survey (young 15.6% versus older 28.7%, P < 0.05); a low incidence of hepatitis history (young 36.8% versus older 66.3%, P < 0.01); a high incidence of positive hepatitis B virus surface antigen (HBsAg) (young 79.2% versus older 67.6%, P < 0.05); a low incidence of associated cirrhosis (young 64.9% versus older 90.7%, P < 0.01); larger tumor size (PLC > 5cm; young 87.0% versus older 73.0%, P < 0.01); a more advanced stage of the disease in TNM classification (stage III; young 29.9% versus older 18.2%, P < 0.05). It is suggested that hepatitis B virus (HBV) may play an important role in the development of PLC without associated liver cirrhosis in the young patients. A close periodic surveillance of young adults with a positive HBsAg is important to detect PLC at an early stage.     

Structural analysis of memory traces in children from 4 to 10 years of age.

In 2 experiments, items from 4 (or 8) semantic categories were presented in 4 (or 8) colors located at 4 (or 8) spatial positions. In a recall task, a total of 48 4-, 7-, and 10-yr-olds were given semantic, color, and locational cues. The probability of successful cued recall to each type of cue and cue combination was used to estimate the proportion of memory traces that contained the various types of information. Although recall increased with age, the relative effectiveness of the 3 types of cues did not, and the estimated proportion of memory traces for the set of items that contained semantic information was higher than the estimated proportion having color and locational information. Retention of one type of cue information was not independent of retention of other types of cue information; Ss of all ages tended to retain either none or more than 1 of the 3 kinds of information. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Renal transplant in patient older than 65 years of age

OBJECTIVE: To analyze the outcome of renal transplantation in patients more than 65 years old. METHODS: From 1991 to 1997, 83 renal transplants were performed in patients aged over 60 years at our institution; 20 of these patients were more than 65 years old. The control group comprised graft recipients under than age from the 477 cases that had undergone transplantation during the period 1980-1996. Graft donor selection was done according to standard practice. The immunosuppression protocol changed over time; 5 patients received triple therapy and another 15 patients received quadruple sequential immunosuppression therapy. RESULTS: The mean age of the recipients was 66.8 years (range 65-72); 9 patients required dialysis after renal transplantation. Patients aged over 65 years had a 94% survival at 6 months, 88% at 12 months, and 88% at 48 months, whereas the survival rates for the control group were 96%, 95% and 87% for the respective time periods. Graft survival was 95% at one month, 90% at 3 months and 74% at 48 months versus 93%, 87% and 78% for the control group. CONCLUSION: Patients more than 65 years old with chronic renal failure and who are on dialysis can benefit from renal transplantation.     

Neuroblastoma in children under than 1 year of age

OBJECTIVE: Our objective was to carry out a prospective multicenter study of neuroblastoma patients diagnosed between 0 and 12 months of age. PATIENTS AND METHODS: Diagnostic procedures included histology, catecholamine excretion, bone marrow cytology and MIBG-scan. Staging was evaluated according to the INSS classification. After 1992, Simada criteria were used and also N-myc amplification, DNA index and P-glycoprotein determinations in tumoral tissue. The surgical technique employed and complications derived from it were also evaluated. The patients were treated according to stage with multicenter Spanish protocols N-I-87 and N-II-92. Overall survival and event free survival were calculated by actuarial methods. RESULTS: Between October 1987 and June 1992, a total of 140 infants less than one year of age were registered and diagnosed of neuroblastoma, representing 40% of all neuroblastoma cases. Median age was 0.3 years and 73% were less than 6 months of age at diagnosis. The most frequent stage was 1 (35%) followed by 4-S (20%). The frequency of unfavorable prognostic factors was the following: LDH (21%), NSE (14%), ferritin (18%), Shimada (7%), DNA (35%), NMA (3%), TrakA (23%), P-glycoprotein (19%). Surgery was performed in 133 children: total resection was reported in 94 and > 90% in another 22 cases. Complications attributed to surgery occurred in 12% of the cases. Chemotherapy was given in 73 cases and radiotherapy in 7. The five year total survival is 91% and the event free survival 88%. Survival by stages: Stage 1 = 91%, stage 2A = 88%, stage 2B = 100%, stage 3 = 84%, stage 4 = 56% and stage 4-S = 100%. CONCLUSIONS: 1) The majority of neuroblastoma cases in infants less than one year old are diagnosed before six months of age. 2) For this age group stages 1 and 4-S are the most frequently observed. 3) Unfavorable biological factors are less frequent than for children over one year of age and are associated with disseminated disease (advanced stage). 4) The outcome is excellent, except for stage 4 patients. The cases in stage 1 and 2 may be treated by surgery alone. Chemotherapy may be of benefit for stage 3 patients.     

Prevalence of Cyclospora species and other enteric pathogens among children less than 5 years of age in Nepal

Stools from 124 Nepalese children aged 6 to 60 months with diarrhea were examined for organisms of the coccidian genus Cyclospora and for other enteric pathogens. Enterotoxigenic Escherichia coli, Giardia Lamblia, Campylobacter species, Cyclospora species, and Cryptosporidium species were the most common pathogens identified. Cyclospora species were detected in none of 74 children < 18 months of age compared with 6 (12%) of 50 children > or = 18 months of age (P = 0.004).     

Aortic valve replacement in patients older than 75 years of age

From 1988 to 1992, 16 patients older than 75 years underwent AVR (14 cases) or AVR+MVR (two cases). All patients were followed up for an average of 2.4 years after the operation and follow-up totaled to 38 patient-years. There were no hospital death and one late death. The survival rate was 93.8% through 1 to 5 years and 15 patients are now in NYHA class I or II. The problems of AVR for elderly patients were calcification and small annulus. Decalcification using CUSA was effective technique and supraannular fixing of bioprosthetic valve avoided from aortic annular enlargement. The improved quality of life after AVR supports the aggressive surgery in elderly population.