Efficacy of tPBM on ADHD symptoms and Executive Function Deficits in Adults with high-functioning Autism Spectrum Disorder

Introduction

Executive function (EF) deficits are often associated with Autism Spectrum Disorder (ASD), even in the absence of Attention Deficit Hyperactivity Disorder (ADHD) diagnosis. To date, no approved medication treatments exist for EF deficits associated with ASD.

Objectives

To assess the efficacy of transcranial photobiomodulation (tPBM) on EF in adults with ASD.

Methods

Adults (18-59) with high-functioning (HF)-ASD received twice a week tPBM for 8 weeks in an open-label single group design. ASD and EF deficits were assessed by clinician-rated Clinical Global Impression Scale and patient-rated scales of Behavior Rating Inventory of Executive Function-Adult (BRIEF-A).

Results

Eleven participants were enrolled. Ten participants completed the study. Nine participants who completed the study had comorbid ADHD diagnosis. All 10 participants were included in efficacy analyses of EF deficits. Statistically significant improvements in executive function deficits were found in BRIEF-A total score and in subdomains of Inhibition, Emotional Control, Planning and Organization, Organization of Materials, Behavioral Regulation, Metacognitive Index and Global Executive Control. All participants were found to have mild to moderate improvement in their ADHD symptom severity per clinician rated CGIs. Statistically significant improvements in ADHD symptoms were noted in self-rated scales. No adverse events required changes in tPBM protocol.

Conclusions

tPBM is a safe and feasible treatment approach that has the potential to treat core features of ASD. Further research is necessary and warranted.

Disclosure

This work is funded by Alan and Lorraine Bressler Clinical and Research Program for Autism Spectrum Disorder and the MGH Pediatric Psychopharmacology Council Fund.

Obstructive sleep apnea syndrome in the pediatric age: the role of the otorhinolaryngologist

OBJECTIVE

Obstructive sleep apnea (OSA) is the primary indication for tonsillectomy, one of the most common pediatric surgical procedures, commonly performed in association with adenoidectomy. The objective of this review article is to evaluate the role of the otorhinolaryngologist in pediatric OSA.

MATERIALS AND METHODS

A literature review has been performed on the following topics: peculiarities of sleep-disordered breathing in pediatric age; discrimination of sleep disorders; adenotonsillar hypertrophy; surgical techniques; adjuvant surgical procedures.

RESULTS

The role of the otorhinolaryngologist in pediatric OSA is important for the evaluation of the upper airways and of essential biometric and polysomnographic data and for indication and execution of appropriate surgical treatment. In the majority of healthy children, adenotonsillectomy for OSA results in a dramatic improvement in respiratory parameters as measured by polysomnography. When post-surgical residual OSA occurs, it is essential to monitor patients by means of drug-induced sleep endoscopy (DISE).

CONCLUSIONS

Otolaryngologic assessment is of paramount importance to correctly classify a child with OSA. Correct inspection of the upper airway and quantification of the quality of sleep through polysomnography lead to the right therapeutic choice. Knowledge of different surgical techniques helps to deal with residual OSA after studying the obstruction sites by drug-induced sedation endoscopy.

Nares patients have more respiratory infections than allergic subjects

Respiratory infections (RI) represent a frequent challenge for physicians. Allergic patients could present higher susceptibility to contract RI than non-allergic subjects. Non-allergic rhinitis with eosinophils (NARES) has been little investigated. This preliminary study was performed to evaluate the number and duration of RI and their sequelae in NARES and allergic patients, and non-allergic healthy subjects. Forty healthy non-allergic subjects (22 males, mean age 29 years), 40 patients with allergic rhinitis (AR) (19 males, mean age 35), and 40 NARES patients (18 males, mean age 34) were evaluated. The considered parameters were: nasal eosinophils, total number, duration in days of RI, and RI severity. NARES patients had more eosinophils than AR patients and normal controls (p<0.01); RI duration was longer in NARES patients than in AR ones (p<0.05) and controls (p<0.01); RI were more severe in NARES patients than in AR ones (p<0.05) and controls (p<0.01); pneumonia and asthma were more frequent in both NARES and AR patients than controls (p<0.05 and p<0.01). In conclusion, this preliminary study shows that NARES may induce more severe respiratory infections than allergic rhinitis.

May nasal hyperreactivity be a sequela of recurrent common cold?

Respiratory viral infections may worsen bronchial hyperreactivity. However, there is no data on the possible role of recurrent infectious rhinitis in nose hyperreactivity. This study was therefore designed to investigate whether subjects suffering from recurrent common cold have nasal hyperreactivity, assessed by histamine nasal challenge. This study included a group of 40 patients (19 males, mean age 34.1 years) with history of at least five episodes of common cold in the previous year, but without documented allergy, and twenty healthy subjects (8 males, mean age 32.3 years) were enrolled as control group, all of whom were non-allergic. Nasal provocation test with histamine was performed in all subjects. Nasal provocation test with histamine induced a 200% increase in nasal resistance after provocation in 24 (60%) patients suffering from recurrent viral rhinitis. No normal subject had an increase >180% in nasal resistance. There was a significant difference between the patient group and the control group (p<0.05). In conclusion, this study shows that nasal hyperreactivity might be a sequela of recurrent common cold. Further studies should be conducted to confirm this preliminary finding.

Survival Time of Nasal Mucous Membrane Ciliated Cells: A Preliminary Study of Cytological Examination by Phase-Contrast Microscopy

The observation of the ciliated cell dynamics by phase-contrast microscope has allowed a profound study of some parameters of the cellular components. The aim of this preliminary study is to assess the surviving time of ciliary cells using the phase-contrast microscope. Nasal cytology was carried out on 50 healthy volunteers. The ciliary beat time was assessed by a video-camera connected with a PC. The time of ciliary beat persistence was extraordinarily long (mean 210 minutes, with range 74–1260). The ciliary activity remained valid as rhythm, synchronism and metachronality. In conclusion, this preliminary study demonstrated that cilia has an energetic autonomy of great importance, able to allow a valid functional activity also in the case of partial sufferance of the cellular unit.

[Clinical evaluation of the efficacy of Salsomaggiore (Italy) thermal water in the treatment of rhinosinusal pathologies]

OBJECTIVES

Aim of the research was to demonstrate the efficacy of a treatment with thermal water as nasal spray (Salsomaggiore Italy) vs saline on chronic rhinosinusitis with/out nasal polyps.

MATERIALS AND METHODS

55 patients affected by chronic rhinosinusitis with/out I degree nasal polyposis randomised into two groups were enrolled. 30 patients of the study group were treated with thermal water nasal spray 4 times/day for 4 weeks. 25 patients of the control group were treated, with the same protocol, with saline. At the beginning and at the end of the study, in all the subjects the clinical history, objective examination and the instrumental analysis of nasal functions by active anterior rhinomanometry, mucociliary transport (MCT) time determination and nasal cytology were performed.

RESULTS

At the end of the treatment patients in the study group showed an improvement statistically significant, with respect to the control group, of headache, rhinorrea and hiposmia. Significant differences were also observed between the study and control group concerning objective examination (nasal mucosa appearance and crusts) and instrumental analysis (rhinomanometric values and mucociliary transport times). Nasal cytology (epithelial and goblet cells, neutrophils, eosinophils, bacteria) improved in both groups without any statistical difference.

CONCLUSIONS

Thermal water (Salsomaggiore Italy) nasal spray showed a greater efficacy with respect to saline in the treatment of patients affected by chronic rhinosinusitis.

Acetyl-l-carnitine feeding to unloaded rats triggers in soleus muscle the coordinated expression of genes involved in mitochondrial biogenesis

The expressional profile of mitochondrial transcripts and of genes involved in the mitochondrial biogenesis pathway induced by ALCAR daily supplementation in soleus muscle of control and unloaded 3-month-old rats has been analyzed. It has been found that ALCAR treatment is able to upregulate the expression level of mitochondrial transcripts (COX I, ATP6, ND6, 16 S rRNA) in both control and unloaded animals. Interestingly, ALCAR feeding to unloaded rats resulted in the increase of transcript level for master factors involved in mitochondrial biogenesis (PGC-1alpha, NRF-1, TFAM). It also prevented the unloading-induced downregulation of mRNA levels for kinases able to transduce metabolic (AMPK) and neuronal stimuli (CaMKIIbeta) into mitochondrial biogenesis. No significant effect on the expressional level of such genes was found in control ALCAR-treated rats. In addition, ALCAR feeding was able to prevent the loss of mitochondrial protein content due to unloading condition. Correlation analysis revealed a strong coordination in the expression of genes involved in mitochondrial biogenesis only in ALCAR-treated suspended animals, supporting a differentiated effect of ALCAR treatment in relation to the loading state of the soleus muscle. In conclusions, we demonstrated the ability of ALCAR supplementation to promote only in soleus muscle of hindlimb suspended rats an orchestrated expression of genes involved in mitochondrial biogenesis, which might counteract the unloading-induced metabolic changes, preventing the loss of mitochondrial proteins.

Tissue-Specific Effect of Age and Caloric Restriction Diet on Mitochondrial DNA Content

The effect of age and caloric-restriction (CR) diet on mitochondrial DNA (mtDNA) content in different rat tissues was investigated. A decrease of the mtDNA content occurs with aging in liver and soleus muscle, whereas there is no age-related significant change of mtDNA content in brain. CR fully reverses the age-dependent loss of mtDNA in liver and soleus, whereas it results in a significant increase of mtDNA amount above the value of aged ad libitum fed rats in brain. These results further support the tissue-specific effect of CR, likely because of the different dependence of tissues on external nutrient uptake.

Hippocampal upregulation of the cyclooxygenase-2 gene following neonatal clomipramine treatment (a model of depression)

Although a putative role has been attributed to inflammation in the pathogenesis of depressive disorders, the relationship of prostaglandins, known mediators of inflammation, and depression has not been elucidated. Clomipramine is an antidepressive drug with a pro-depressive paradoxical effect in adult rats when administrated neonatally. Using this effect as a model of depression, we investigated the differential expression of the cyclooxygenase (COX-2) gene in rat brains. Rats injected neonatally with clomipramine showed depressive-like symptoms in adulthood, as well as decreased levels of the brain-derived neurotrophic factor (BDNF) and a quantitative differential expression of the COX-2 gene (Real Time PCR) and protein (immunohistochemistry) in the hippocampus. As evidenced, the relationship between a key enzyme in the prostaglandin synthesis and biological and behavioral depression-like changes opens an interesting line of investigation regarding the molecular bases of depression and its potential treatment through immunomodulatory drugs.

The psychotic spectrum: validity and reliability of the Structured Clinical Interview for the Psychotic Spectrum

This study evaluates the validity and the reliability of a new instrument developed to assess the psychotic spectrum: the Structured Clinical Interview for the Psychotic Spectrum (SCI-PSY). The instrument is based on a spectrum model that emphasizes soft signs, low-grade symptoms, subthreshold syndromes, as well as temperamental and personality traits comprising the clinical and subsyndromal psychotic manifestations. The items of the interview include, in addition to a subset of the DSM-IV criteria for psychotic syndromes, a number of features derived from clinical experience and from a review of the phenomenological descriptions of psychoses. Study participants were enrolled at 11 Italian Departments of Psychiatry located at 9 sites and included 77 consecutive patients with schizophrenia or schizoaffective disorder, 66 with borderline personality disorder, 59 with psychotic mood disorders, 98 with non-psychotic mood disorders and 57 with panic disorder. A comparison group of 102 unselected controls was enrolled at the same sites. The SCI-PSY significantly discriminated subjects with any psychiatric diagnosis from controls and subjects with from those without psychotic disorders. The hypothesized structure of the instrument was confirmed empirically.

Measurement of the 4,834-bp mitochondrial DNA deletion level in aging rat liver and brain subjected or not to caloric restriction diet

Several studies have demonstrated an age-related accumulation of the amount of a specific 4834-bp mitochondrial DNA (mtDNA) deletion in different tissues of rat (liver, brain, and skeletal muscle). We investigated the influence of a caloric restriction diet (CR) on a selected age-associated marker of mtDNA damage, as the 4834-bp deletion, using quantitative real-time PCR. The mtDNA deleted level has been determined with respect to the mitochondrial D-loop level, using specific primers and TaqMan probes for each target. In liver we found an age-related increase of the deletion level (twofold) that was reversed and brought back to the adult level by a CR diet. On the contrary, in the brain the age-related increase of the deletion level (eightfold) was not affected by CR at all. The different effect of the CR on the deletion level in liver and brain might be a further element supporting the tissue-specificity of the aging process.

Sex- and age-related differences in major depressive disorder with comorbid anxiety treated with fluoxetine

OBJECTIVE

To examine sex- and age-related differences of treatment outcome in a cohort of outpatients with major depressive disorder (MDD), with and without comorbid anxiety, treated with fluoxetine.

METHODS

Outpatients with a SCID-diagnosis of MDD aged 18 to 65 years were treated openly with fluoxetine (20 mg/day) for 8 weeks. The 17-item Hamilton Depression Rating Scale (HAM-D-17) was administered at baseline, and at weeks 2, 4, 6 and 8. Remission of MDD was defined as a HAM-D-17 score < or =7 at week 8. Rates of remission and change of depressive symptoms of MDD were compared among women aged < 45 years and > or =45 years. The analyses were then repeated in men. The presence of comorbid anxiety disorders was included in the prediction model for change of depressive symptoms of MDD across age and sex.

RESULTS

176 women and 153 men were included in this analysis. Remission of MDD occurred in 57.1% and 50% of younger and older women respectively. Similar rates were present in men (57.2% and 49.1%, respectively). Age did not predict remission of depression or change of depressive symptoms of MDD, in both women and men. Anxious and non-anxious subtypes of depression did not present sex- or age-related differences in treatment outcome.

CONCLUSION

In this cohort of outpatients with MDD, we observed no sex- or age-related differences in response to an 8-week treatment with the SSRI fluoxetine. Similarly, there were no age-related differences among women with anxious and non-anxious subtype of depression.

[Assessment of asbestos exposure via mineralogical analysis of bronchoalveolar lavage fluid]

BACKGROUND

Mineralogical analysis of bronchoalveolar lavage fluid (BALF) by electron microscopy could be the most suitable method for assessing asbestos exposure. However, it has been claimed that there is not a standardized or systematic approach to the subject of mineralogical analysis.

OBJECTIVES

The aim of the study was to evaluate mineralogical analysis of BALF by transmission electron microscopy (TEM) as biomarker of asbestos fibre load.

METHODS

BALF was examined in 193 exposed workers (189 men and 4 women) and in 84 patients (65 men and 19 women) who underwent diagnostic fibreoptic bronchoscopy for various clinical purposes. Asbestos bodies (AB) in BALF were counted with a phase contrast microscope, while fibres were counted and analysed by TEM.

RESULTS

Fibre counting by TEM showed a significant difference in the two populations (two tailed Mann-Whitney U test, p=0.0044), since it was positive in all exposed subjects. Only 75.1% of the exposed population was positive for asbestos bodies (AB). Subjects who had been exposed over a long time period had higher concentrations of fibres than subjects who had been exposed more recently probably because of higher exposure in the past.

CONCLUSIONS

The study confirms the results of a previous study on a limited number of subjects. Fibre concentrations in BALF can be considered as a reliable biomarker of past asbestos exposure even after many years after cessation of exposure.

Perilymphatic gusher in stapedectomy: demonstration of a fistula of internal auditory canal

Gusher is a very rare phenomenon, generally associated with congenital stapes fixation or otosclerosis in adult age, that may present during stapedectomy. A sudden perilymph flow occurs following platinotomy, due to congenital malformation (abnormally wide cochlear aqueduct or internal auditory canal fistula), that causes an abnormal connection between subarachnoid and perilymphatic spaces. This report deals with a case of bilateral gusher, occurring during stapedectomy, caused by an osseous fistula between bottom of internal auditory canal and the osseous labyrinth later observed at computed tomography scan. The usefulness of a radiologic examination is stressed for a correct therapeutic approach in the even contralateral ear stapedectomy.

Toxic epidermal necrolysis treated with intravenous high-dose immunoglobulins: our experience

BACKGROUND

Toxic epidermal necrolysis (TEN) is a rare severe acute exfoliative drug-induced skin disorder which has recently been ascribed to alterations in the control of keratinocyte apoptosis, mediated by an interaction between the cell surface death receptor Fas and its respective ligand. A therapeutic approach with intravenous immunoglobulins (IVIG) associated with pulse methylprednisolone, based on the inhibition of Fas-mediated keratinocyte death by naturally occurring Fas-blocking antibodies included in human immunoglobulin preparations, has produced good preliminary results.

OBJECTIVE

To analyse the efficacy of IVIG in the treatment of TEN.

PATIENTS

Nine patients with erythematous body surface area ranging from 38 to 85% and dermo-epidermal detachment from 4 to 37% were treated.

RESULTS

Eight patients were healed and 1 died of septic shock and multiple organ failure. Interruption of further epidermal detachment occurred after an average of 4.8 days from the onset of IVIG therapy. Complete wound healing occurred after an average of 12 days. Concerning complications, 3 out of 8 surviving patients had acute respiratory failure requiring mechanical ventilation and 1 acute renal failure was treated with dialysis. Late sequelae were limited to dyschromia and nail dystrophies. No hypertrophic scars were observed.

CONCLUSION

IVIG therapy represents a safe and valid approach for TEN.

Fig leaf tanning lotion and sun-related burns: case reports

A sun tan is considered a symbol of well-being in our society, but incorrect methods of sun exposure can create serious problems. We present two cases of severe sun-related burns caused by fig leaf decoction used as home-made tanning lotion. Twenty four-thirty six hours after application and sun exposure, patients developed a phytophotodermatitis characterised by erythema, and blister formation involving all the photoexposed areas (45-70% BSA). Their general conditions became rapidly critical and they were admitted to our Burn Centre. The patients were discharged after 11 and 26 days, respectively. Haemolytic anaemia and retinal haemorrhages presented as systemic complications due to the furocoumarins present in the fig leaf decoction.

[Bilateral semicircular canal pathology]

The authors report 12 cases of bilateral cupulolithiasis found in 142 subjects diagnosed as having benign paroxysmal positional vertigo. A case history was taken for these patients (4 males, 8 females; average age 28 years) and 10 reported a previous cranial trauma while the remainder did not refer any previous condition of note. All patients had normal cochleovestibular test results and showed no signs of concomitant internal and/or central pathologies. The Hallpike maneuver was able to evoke an intense symmetrical paroxysmal vertigo and this was often accompanied by neurovegetative phenomena while paroxysmal nystagmus always appeared. The patients were treated with a rehabilitative technique: the Brandt-Daroff was preferred as it is better tolerated. Within 15 days all patients had full remission of symptoms and at 6 months after treatment there have been no signs of recurrence. The conclusion is, thus, drawn that while the technical characteristics of the Sémont maneuver make it suitable only for use as rehabilitation in unilateral benign paroxysmal positional vertigo, this experience indicates that the Brandt-Daroff technique is better suited for the bilateral forms of this disorder.

[Corticosteroid therapy in the prevention of recurrent post-surgical nasal polyposis]

The purpose of this study was to evaluate, in a group of 30 patients, the results of a medical treatment combining an oral corticosteroid (Deflazacort) with a drug applied topically (Beclomethasone dipropionate) following a well-defined protocol, in the prevention of recurrent post-surgical nasal polyposis. In the follow-up at 6, 12 and 24 months, the possible recurrence of polyposis was evaluated as well as the nasal blockage and the olfactory function. After six months the disease recurrence was observed in 33% of the cases, always in its early stages, whereas after one year the percentage rose to 50% (15 patients, of whom only 3 displayed a severe form with considerable reduction of nasal ventilation). At 24 months recurrence was observed in 57% of the patients. However most cases did not show any sign of further progression. Throughout the entire follow-up period under observation only 6 patients (20%) had a severe recurrence which therefore required a revision surgery. The comparison with a control group not undergoing medical therapy after surgery highlighted the significance of the results obtained. Consequently the therapeutic protocol adopted proved to be reliable due to the very high tolerability in all cases and to the high percentage of good or very good short and medium term results observed. No clinical side effects of any importance were observed during the study.

[Muco-ciliary transport in chronic inflammatory pathology of the middle ear]

The Authors have studied the behaviour of nasal mucociliary transport (MCT) in the chronic phlogistic pathology of the middle ear, in subjects suffering from simple and cholesteatomatous otitis. In both groups the duration of MCT was longer than a control group of normal subjects; instead no significant difference was observed either between the two kind of pathologies nor between the two different phases of the otitis (quiescence and breakthrough). The Authors conclude therefore that, in the recurrent phlogistic pathology of the middle ear, the function of MCT must be carefully studied, possibly corrected if damaged, to prevent the evolution in the breakthrough.

[Effect of physical exercise on nasal resistance in normal subjects and in patients with vasomotor rhinopathy]

The study has evaluated the behaviour of the nasal resistances, studied using Anterior Active Rhinomanometry, after physical exercise, in normal subjects and in allergic and non allergic vasomotor rhinopathics. The results, in accordance with the literature, show a reduction of nasal resistances in all subjects, particularly in the rhinopathics, immediately after the effort and a return to the starting values after a rest period of 30 minutes. Among vasomotor patients, only the non-allergic group has shown very significant variations in the resistances, because in these subjects there is almost always an exaltation of the neurovegetative system, which we did not observe in the allergic subjects in the intercritical phase. The effort test is therefore, among the aspecific tests of nasal reactivity useful, perhaps, more to therapy than to diagnostic aims.

[Nasal provocation test with hyperosmolar solutions: normal values]

Hyperosmolar solutions have recently been introduced as test-substances in the nasal provocation of vasomotor rhinitis subjects. In order to establish a norm, the test was carried out in 40 subjects without nasal pathologies, stimulating with solutions at increasing level of concentrations of NaCl (0.9% - 1.8 - 3.6% - 5.4% - 7.2% - 9%). In all subjects an increase in nasal secretion was verified in proportion to the concentration of the solutions and this increase was statistically significative, with respect to the base, from the concentration 3.6% (p less than 0.001) on words. The statistical analysis has not, however, evidenced any significant differences in secretion between male or female subjects. As far as the variation of nasal resistance is concerned, the rhinomanometric registration has revealed that the hypertonic solutions modify such resistances in a rather casual, absolutely irregular and unimportant way. These results lead to believe that the test is extremely useful in the study of the secretion component of vasomotor rhinopathy.

Erythrocyte fatty acids, plasma lipids, and cardiovascular disease in rural China

Cardiovascular disease (CVD) mortality (coronary heart disease, hypertensive heart disease, and stroke), plasma lipids, and red blood cell fatty acid composition were examined in an ecologic study in 65 rural counties in the People's Republic of China. Means of plasma total cholesterol, triglyceride, low-density-lipoprotein (LDL) cholesterol, and high-density-lipoprotein (HDL) cholesterol concentrations were substantially lower and the ratio of HDL cholesterol to total cholesterol was higher in this Chinese population than in Western populations. Mortality rates for CVD in China were well below Western values. Within China neither plasma total cholesterol nor LDL cholesterol was associated with CVD. A strong inverse correlation between red blood cell oleate concentrations and CVD was observed. However, red blood cell oleate concentrations were not associated with plasma cholesterol but were strongly negatively associated with arachidonate concentrations, suggesting potential diminution of CVD by oleate through reduced platelet aggregability. The results indicate that geographical differences in CVD mortality within China are caused primarily by factors other than dietary or plasma cholesterol.

[Changes in nasal resistance as a result of posture in normal subjects]

The variations of nasal resistance, after lateral right, lateral left and supine recumbency have been studied in 20 normal subjects. These variations were in order of constant succession by rhinomanometry. In lateral right recumbency (first recumbency), the mean increase of nasal resistance in lower nasal cavity was 35%; on the contrary in the following recumbency the increase was twice as large as the first one. In supine recumbency the results were abnormal. In fact, with respect to the same nasal cavity, some of our subjects showed a congestion, while some showed a decongestion. It may be concluded that utilization of postural tests, like index vasomotor reactivity, must keep the increase of nasal resistance in normal subject, following postural variations in mind, in order to express a judgement of significative pathological difference.

[Obstructive apnea syndrome during sleep in children: diagnosis and treatment]

Marked adeno-tonsillar hypertrophy is certainly the most common respiratory disturbance found among children. Most particularly obstructive sleep apnea (OSA) leads to serious, at times fatal, consequences on the cardio-respiratory apparatus. Thus opinion in the literature unanimously holds that said syndrome is one precise indication for tonsillectomy and/or adenotomy. The present case study was performed on 19 children, age range 21 months to 6 years, with serious obstructions of the respiratory tract due to tonsillar or adeno-tonsillar hypertrophy (14 cases) or to isolated adenoid hypertrophy (5 cases). The sample was divided into 4 groups, taking into consideration the severity of the nighttime sleep obstruction and the type of obstruction. Polygraphy performed during sleep recorded objective OSA in 10 subjects with tonsillar or adeno-tonsillar hypertrophy, but no case was recorded in any subject with solely adenoid hypertrophy. The severity of the obstruction was likewise shown, judged both on the basis of frequency and duration of the pauses as well as on the cardio-respiratory complications, especially in the smallest children (less than 3 years). Furthermore, in the most serious cases significant hematological alterations were recorded. Tonsillectomy, performed in 9 of the 10 children with OSA, completely resolved the sleep disturbances and improved, or normalized, the broncho-pneumonic picture as well the hematological findings in those cases where preoperative complications were present. Even for those children who did not manifest OSA, tonsillectomy and/or adenotomy led to a more uniform rhythm and quality of their sleep.(ABSTRACT TRUNCATED AT 250 WORDS)

[Carbachol nasal provocation test in vasomotor and polyposis rhinopathy]

A group of 117 subjects suffering from vasomotor rhinopathy (33 with nasal polyposis) were studied with the nasal provocation test with carbacholine in order to evaluate aspecific nasal reactivity. The results obtained by quantifying the variations in nasal secretions and rhinomanometric resistance after application of the test substance indicate the following: a marked hypersecretory response and obstruction in 80% of the vasomotor rhinitis cases; a more marked aspecific reactivity in perennial allergic rhinitis sufferers than in those with seasonal atopic rhinopathy; a lack of statistical significance between the group of those with atopic polyposis and those with a negative skin test. The authors conclude by confirming the usefulness of the test for aspecific reactivity in the diagnosis of vasomotor rhinopathy and propose its use for better screening those patients to undergo specific hyposensitivity therapy.

Cholesteatoma surgery: open vs closed tympanoplasty

The purpose of this report is to compare closed tympanoplasty (canal wall up) and open tympanoplasty (canal wall down) performed in ears with extensive cholesteatoma operated on and followed up during the past 11 years. The study has demonstrated that there are no significant differences between open and closed tympanoplasties in terms of both postoperative subjective problems and auditory results. The only definite difference relates to recurring cholesteatoma: canal wall-up operations are complicated by recurrence of cholesteatoma in a not insignificant number of ears and require a planned two-stage procedure in all the cases. By contrast, the postoperative clinical course of open tympanoplasties has been only rarely affected by cholesteatomatous complications. It is concluded that reduction of cholesteatoma recurrence to the greatest degree possible necessitates removal of the canal wall. Open tympanoplasty is an effective alternative for closed tympanoplasty in all cases in which there is a contraindication to preserving the canal wall and in all patients whose medical or social conditions prevent scheduling an operation in more stages.

Improved diagnostic procedures in allergic RAST negative rhinitis

Patients affected by cutinegative, RAST negative, chronic hyperreactive rhinitis showed in 15/28 cases positive intradermal tests, nasal provocation test and RAST on nasal fluids. In 13/28 cases high IgE on nasal samples could be observed and seldom were the intradermal tests positive, but in no case were the nasal provocation or nasal RAST positive. Delayed and late positive provocation tests showed different features from early reactions. Criteria of positivity and checks during provocation tests look critical. The occurrence of sinusitis and polyposis can change clinical features. Mediators released from tissues lead to bronchial hyperreactivity.

The effect of dietary imbalances on the activation of benzo[a]pyrene by the metabolizing enzymes from rat liver

Male Sprague-Dawley rats (70-80 g) were fed ad libitum a standard control diet (22% casein, 5% lard), or a high lipid diet (30% lard) or a low protein diet (6% casein) or a standard diet containing 50 ppm phenoclor DP6. After 6 weeks on these diets, the cytochrome P-450 microsomal content, the benzo[a]pyrene monooxygenase (BaP-MO) and the epoxide hydrolase (EH) were assayed. The formation of mutagenic B(a)P metabolites which covalently bind with DNA was compared. The activity of BaP-MO and of EH were increased by the high lipid diet (+27% and 106% respectively) and by the phenoclor DP6 treatment (+63% and 400% respectively), compared to the standard diet. In animals fed a low protein diet the BaP-MO was decreased (-34%) and the EH activity was strongly increased (+262%) compared to those fed a standard diet. All experimental diets increased both the activation of BaP to metabolites able to bind DNA and the mutagenicity of BaP versus TA98 Salmonella typhimurium strain. It was concluded that dietary imbalances can be considered as a factor in chemical carcinogenesis.

Relationship of cigarette smoking and social class to birth weight and perinatal mortality among all births in Britain, 5-11 April 1970

The joint associations of maternal cigarette smoking and social class on perinatal outcome were studied in the 1970 British birth cohort (British Births). Whereas smoking was much more frequent among women in social classes III, IV, and V, there was little difference in the birthweight decrement associated with smoking across class. Perinatal mortality, however, was increased only among smokers in the manual social classes. Thus whereas the offspring of more privileged smokers were not protected from intrauterine growth retardation, they did not suffer from increased perinatal mortality. Observations of other populations suggest a possible nutritional mediation of this protective effect.

[Stapedial reflex under auditory masking of bone canal: 1- The effect of white noise on threshold values]

The authors have studied the behaviour of the A.R. threshold under bone way masking sent to the vertex. The masking caused changings of the recorded track; a change of the compliance was observed in the 60% of the subjects and a rythmic waving of the (isoelectric) line was observed in 40% of the subjects. Upon these changes the A.R. were recorded for the tone test sent at similar values (almost equal) at those recorded without any kind of masker, even if a threshold shift sometimes big, existed because of the high intensity of the masking noise. The authors are making further researches to explain the meaning of these changes.

Newborn neurologic maturity relates more strongly to concurrent somatic development than gestational age

The nineteen-item assessment of newborn neurologic maturity developed by Koenigsberger was applied to 682 infants born to women enrolled in a randomized controlled trial of nutritional supplementation in a poor, urban, black, clinic population. The total score of the neurologic scale, four clusters of items derived from principal component factor analysis followed by a varimax rotation, and the four clusters taken simultaneously (using Cohen's method of set correlation) were related to the conceptional age, weight, length, and head circumference of the infants. Taken in any of these ways, neurologic maturity was more strongly related to somatic development than to conceptional age. Although these results are consistent with a set pattern and order of neurologic development, they are incompatible with such a pattern following a rigid and universal time scale. Rather, at all stages of conceptional age, there appears to be a range of neurologic maturity, related more strongly to concurrent somatic development than to the child's conceptional age.

[Remote masking as a test of cochlear conductive hearing losses (author's transl)]

The authors studied the remote masking (RM) in patients with Menière's disorder during the hearing loss fluctuations produced either by the disorder or by the glycerol test (Klockhoff). The RM was recorded for pulsed tones of 250, 500 and 1 000 Hz; the masker was a continuous narrow-band noise centered at 3 000 Hz, with 305 Hz (2 875-3 180 Hz) bandwidth, delivered at an overall level of 98 dB SPL. The results showed that the RM decreases during the acute phase, i.e. when the hearing loss increases, and, increases if the glycerol tests do not significantly modify the RM value. They seem to confirm the hypothesis that the RM may be due to a mechanical effect in the internal ear and suggest the possibility of using the RM as a test of end-organ rigidity.