Grade Of Impairment Research Articles

Absence status epilepticus in adults

Absence status epilepticus (ASE) is a type of nonconvulsive status epilepticus, in which varying grade of consciousness impairment lasting more than 15 minutes and are accompanied by constant generalized spike-wave complexes with a frequency of 2.5-4 Hz on the electroencephalogram (EEG). ASE can be observed in various epileptic syndromes, usually detected in children. In some cases, ASE manifests in adulthood as a late complication of idiopathic generalized epilepsy or status for the first time (de novo), without history of epilepsy. A review of reported cases of ASE manifestation in adulthood is presented and two of our own clinical observations of ASE that occurred in adult patients who did not have a previously established diagnosis of epilepsy are discussed. Quite clear clinical and EEG syndromic delineation of ASE in adults and the elderly, high effectivenefe of therapy and good outcome of the disease allow distinguishing recurrent ASE as a separate epileptic syndrome, in contrast to nonconvulsive status epilepticus in other neurological diseases.

Formal help for persons with multiple sclerosis-Background factors associated with usage of personal assistance and home help in Sweden.

Multiple sclerosis (MS) is a chronic neurological disease that may cause several different symptoms, some which may entail the need for help in daily life. The aim of this study was to explore the association between sociodemographic background factors and the use of personal assistance and home help services (home help) among persons with MS in Sweden. The study was based on cross-sectional survey data merged with register data and included 3,863 persons with MS aged 20-51. Binary logistic regression analyses were performed to identify factors associated with the use of personal assistance and home help. The central finding of this study was that grade of impairment, as determined by the Expanded Disability Status Scale for Multiple Sclerosis (EDSS), was the most important variable associated with the use of both personal assistance (p < 0.001, OR 18.83) and home help (p < 0.001, OR 6.83). Living alone and receiving sickness benefit were also both associated with the use of personal assistance (p < 0.001, OR 3.32; p 0.001, OR 3.32) and home help (p 0.004, OR 2.56; p 0.011, OR 2.56). Stating a visible symptom of MS as being the most limiting factor of the disease (p 0.001, OR 2.73) and having a disposable income below the limit for poverty risk (p 0.02, OR 2.16) was associated with the use of personal assistance. Receiving informal, meaning unpaid, help (p 0.049, OR 1.89) was associated with the use of home help. Several background factors were controlled for but were not related to differences in the usage of formal help. The results indicated no significant differences in demographic characteristics that could be linked to unequal distribution. However, differences were found between those using personal assistance and home help. The latter were mainly affected by invisible symptoms, suggesting a plausible influencing factor in the chances of obtaining more comprehensive help in the form of personal assistance. Users of home help were also more likely to receive informal help than users of personal assistance, which may suggest that home help is not sufficient.

Pulmonary impairment independently determines mortality in critically ill patients with acute-on-chronic liver failure.

In ACLF patients, an adequate risk stratification is essential, especially for liver transplant allocation, since ACLF is associated with high short-term mortality. The CLIF-C ACLF score is the best prognostic model to predict outcome in ACLF patients. While lung failure is generally regarded as signum malum in ICU care, this study aims to evaluate and quantify the role of pulmonary impairment on outcome in ACLF patients. In this retrospective study, 498 patients with liver cirrhosis and admission to IMC/ICU were included. ACLF was defined according to EASL-CLIF criteria. Pulmonary impairment was classified into three groups: unimpaired ventilation, need for mechanical ventilation and defined pulmonary failure. These factors were analysed in different cohorts, including a propensity score-matched ACLF cohort. Mechanical ventilation and pulmonary failure were identified as independent risk factors for increased short-term mortality. In matched ACLF patients, the presence of pulmonary failure showed the highest 28-day mortality (83.7%), whereas mortality rates in ACLF with mechanical ventilation (67.3%) and ACLF without pulmonary impairment (38.8%) were considerably lower (p< .001). Especially in patients with pulmonary impairment, the CLIF-C ACLF score showed poor predictive accuracy. Adjusting the CLIF-C ACLF score for the grade of pulmonary impairment improved the prediction significantly. This study highlights that not only pulmonary failure but also mechanical ventilation is associated with worse prognosis in ACLF patients. The grade of pulmonary impairment should be considered in the risk assessment in ACLF patients. The new score may be useful in the selection of patients for liver transplantation.

Oral Submucous Fibrosis: Association of Clinical and Histological Severity with Hearing Loss and Middle Ear Function.

OSMF is a precancerous condition of the oral cavity. Cons umption of Areca nut in quid has been proved to be the most consistent factor. To assess middle ear function in OSMF patients by audiometry and tympanometry. Two Hundred patients of < 40years of age with OSMF were examined and followed by PTA and impedance audiometry. Impaired mobility was seen in 20(10%) ears, and retraction of tympanic membrane was found in 36(18%) ears. Clinical staging was done in four stages. Majority of the patients were males (58%) in the age group of 21-30years belonging to stage III (38%) and IV (26%) respectively. PTA showed varying degrees of hearing loss in 73 (36.5%) ears. In Grade I, mild hearing loss was seen in 10 (35.71%) ears and moderately severe hearing loss was in 5 (11.36%) ears whereas in Grade II mild hearing loss in 11(25%) ears. Grade III and IV showed mild hearing loss in 11(14.47%) and 12 (23.07%) respectively. Tympanometry revealed type A curve in 126 (63%) ears followed by C curve in 50 (25%) and B curve in 24 (12%) ears. In patients of OSMF, there is involvement of palatal/paratubal muscles in the fibrosis process, which causes eustachian tube malfunction leading to disturbed middle ear functions and negative middle ear pressure. Most patients of oral submucous fibrosis showed direct association with grade of hearing impairment and eustachian tube dysfunction. Higher clinical grades, both clinically and histologically showed similar findings thereby we concluded that if the disease is treated early, preventing patients from having higher grades of disease, involvement of ear can be avoided, and patients can be saved from hearing impairment.

Coronary microvascular dysfunction and findings of heart failure with preserved ejection fraction in patients with microvascular angina.

Coronary microvascular dysfunction (CMD) may cause symptoms of myocardial ischemia (microvascular angina [MVA]), but recent studies suggested that it might also contribute to the syndrome of heart failure with preserved ejection fraction (HFpEF). In this study we assessed the relation of CMD with findings of HFpEF in MVA patients. We enrolled 36 consecutive patients with MVA, in whom we assessed: 1) coronary blood flow (CBF) response to adenosine and cold pressor test (CPT) by color-Doppler echocardiography of the left anterior descending coronary artery; 2) complete echocardiographic examination; 3) N-terminal-pro-B-natriuretic peptide (NT-proBNP); 4) grade of dyspnea by the modified Medical Research Scale. Among patients, 15 had definite HFpEF findings (group 1), 12 had equivocal HFpEF findings (group 2) and 9 had no evidence of HFpEF findings (group 3). Group 1 patients were older, had more cardiovascular risk factors and higher NT-proBNP levels (P=0.018), and showed a higher prevalence of diastolic dysfunction. Left ventricle dimensions and systolic function, however, did not differ among groups. Dyspnea was also not significantly different among groups (P=0.19). CBF to adenosine was 1.85±0.47, 1.78±0.40 1.49±0.32 in group 1, 2 and 3, respectively (P=0.13). Similarly, CBF response to CPT was 1.57±0.4, 1.49±0.2 and 1.45±0.3 in the 3 groups, respectively (P=0.74). Both CBF response to adenosine and CPT showed no relation with the severity of dyspnea symptoms. Our data suggest that in patients with MVA there is no relation between the grade of impairment of coronary microvascular dilatation and findings of HFpEF.

Olfactory Dysfunction in Huntington's Disease.

Olfactory dysfunction is a common symptom in patients with neurodegenerative disorders, including Huntington’s disease (HD). Understanding its pathophysiology is important in establishing a preventive and therapeutic plan. In this literature review, we cover the physiology of olfaction, its role in neurodegeneration, and its characteristics in patients with HD. In the general population, olfactory dysfunction is present in 3.8–5.8%and the prevalence increases significantly in those older than 80 years. For HD, data regarding prevalence rates are lacking and the scales used have been inconsistent or have been restructured due to concerns about cross-cultural understanding. Pathogenic huntingtin deposits have been found in the olfactory bulb of individuals with HD, although no studies have correlated this with the grade of olfactory impairment. Olfactory dysfunction is present in both premanifest and manifest patients with HD, showing a progressive decline over time with more severe deficits at advanced stages. No specific treatment for olfactory impairment in HD has been proposed; identifying and avoiding potential medications that cause olfactory dysfunction, as well as general safety recommendations remain the basis of the therapeutic strategy.

A study on stress and resilience among hearing-impaired people during the COVID-19 pandemic.

AimThe aim of the study is to determine the acute stress and psychological resilience level of people with hearing impairment during the COVID‐19 pandemic and to investigate the relationship between the grade of hearing impairment, psychological resilience and perceived stress level in this period.MethodsA cross‐sectional study. A total of 135 hearing‐impaired individuals using hearing aids (study group) and 125 healthy individuals (control group) participated. The Turkish versions of the Acute Stress Symptoms Scale (ASSS) and Brief Resilience Scale (BRS) were applied to all participants. The Turkish version of Amsterdam Inventory for Auditory Disability and Handicap (T‐AIADH) was also applied to the study group in addition to other scales. The presence of any difference between the groups in terms of ASSS and BRS scores was investigated.ResultsThere was a statistically significant difference between the control group and the study group in terms of ASSS results (Z = −4.4, P = .00). No statistically significant difference was found between the control group and the study group in terms of BRS scores (Z = −0.248, P = .804). Furthermore, T‐AIADH scale was observed not to correlate either with ASSS or BRS (P > .05). In the study group, the change in income level after the pandemic, age and sex variables were determined as a significant predictor of ASSS.ConclusionIdentifying risks and protective factors for hearing‐impaired individuals at the early stage of the epidemic is considered to be of critical importance to predict the psychological impact of both the epidemic and the response to the COVID‐19 health crisis and to reduce stress.

Olfactory Performance among Hospital Residents.

Introduction Smell plays an important role in the maintenance of health and quality of life of the general population. Health workers with olfactory impairment may not be able to help diagnose certain diseases, and subsequently increase the risk of hazardous events and mortality among those affected. ‘Odor learning’ requires repeated experiences with different smells to develop a discriminatory ability, and this is a process that takes years. Because of that, physicians of certain medical specialities have better odor detection than others. Objective To study the olfactory performance and associated factors of otorhinolaryngology residents compared with residents of different medical specialities in a representative sample of a tertiary hospital. Methods The University of Pennsylvania Smell Identification Test (UPSIT) was used to compare olfactory performance. Clinical and epidemiological data were collected among 42 hospital residents. Results Otorhinolaryngology residents presented an average UPSIT score of 35.0, and the other residents, a score of 32.8 ( p = 0.02) Of all the residents, 40.5% showed some grade of olfactory impairment. Half of the females students in the first year of residency showed olfactory dysfunction. The multivariate analyses found age ( p = 0.03; 95% confidence interval for β = 0.33) to be an independent predictor of the UPSIT score. Conclusion The present study demonstrated that otorhinolaryngology residents have greater olfactory capacity compared with other residents. Future studies should explore the relevant factors of olfactory impairment and its impact on quality of life in this population.

Comparative analysis of craniotomy methods in severe traumatic brain injury

The goal of research: to improve the results of neurosurgical management in patients with traumatic brain compression by detecting an optimal way of craniotomy.Material and methods. The study includes data of 127 patients with traumatic brain compression. The series consisted of 109 (85.8 %) males and 18 (14.2 %) females out of examined. The patients’ age ranged from 16 to 85 years. The neurosurgical interventions were performed in all patients with traumatic brain compression.Results. The patients with traumatic brain compression regardless of craniotomy method (burr hole surgery, craniectomy, osteoplastic craniotomy) did not experience a statistically significant difference in the outcome. When planning a method of craniotomy in traumatic brain compressio, the grade of consciousness impairment on the Glasgow coma scale, brain contusion foci, acute subdural and intracerebral hematomas, brain compression, patients’ age and brain dislocation syndrome should be considered that predicts an outcome.Conclusion. The results of a burr hole, resection, and osteoplastic craniotomy revealed no significant differences in outcome in patients with traumatic brain injury. Resection craniotomy in traumatic brain injury may be effective enough even in deep coma and dislocation syndrome but in absence of intraoperative brain edema. The absence of brain edema, the moderate coma level are indications for osteoplastic craniotomy.

Effect of Endemic Fluorosis on Cognitive Function of School Children in Alappuzha District, Kerala: A Cross Sectional Study.

Background:Exposure to high fluoride levels in drinking water can lead to a number of adverse effects in children, including cognitive dysfunction. Despite being endemic for fluorosis, studies on its effect on the cognitive function of children are lacking in Kerala.Aims:The aim of this study was to compare the cognitive function of school children with fluorosis with that of normal children and to correlate between the severity of dental fluorosis and cognitive function.Settings and Design:Cross-sectional study, conducted in collaboration with the National Fluorosis Control Programme, among school children in Alappuzha district, Kerala.Methods:Children aged 8–10 years, studying in 2 lower primary schools in Alappuzha district with confirmed fluorosis were selected, and compared with healthy age- and sex-matched children from the same school. Raven's Standard Progressive Matrices and MISIC digit span subtest were used to assess the cognitive function.Statistical Analysis:Continuous variables were assessed by independent samples t test and categorical variables by Chi-square test. The relationship between severity of dental fluorosis and grade of cognitive impairment was assessed using Spearman's correlation.Results:There were 60 children each in fluorosis and control groups. The mean age of the children was 8.95 ± 0.50. Only 15% of the children with fluorosis scored Grade I and II Raven's SPM grades (Intellectually superior/above the average) versus 30% in the control group. None of the children without fluorosis scored Grade V (intellectually impaired) category versus 20% in the fluorosis group. The mean digit span was significantly higher in the control group. A strong positive correlation between severity of dental fluorosis and Raven's SPM grades was found (Spearman's correlation coefficient = 0.740).Conclusions:Fluorosis is associated with impaired cognition in children. There is a positive correlation between severity of dental fluorosis and the grade of cognitive impairment.

Shedding "LIGHT" on the Link between Bone and Fat in Obese Children and Adolescents.

Obesity may affect bone health, but literature reports are contradictory about the correlation of body mass index (BMI) and bone markers. LIGHT, one of the immunostimulatory cytokines regulating the homeostasis of bone and adipose tissue, could be involved in obesity. The study involved 111 obese subjects (12.21 ± 3.71 years) and 45 controls. Patients underwent the evaluation of bone status by quantitative ultrasonography (QUS). LIGHT amounts were evaluated in sera by ELISA, whereas its expression on peripheral blood cells was evaluated by flow cytometry. Osteoclastogenesis was performed by culturing peripheral blood mononuclear cells (PBMCs) with or without anti-LIGHT antibodies. Obese patients showed significant high BMI-standard deviation score (SDS), weight-SDS, and Homeostatic model assessment for insulin resistance (HOMA-IR) that negatively correlated with the reduced Amplitude Dependent Speed of Sound (AD-SoS)-Z-score and Bone Transmission Time (BTT-Z)-score. They displayed significantly higher serum levels of LIGHT compared with controls (497.30 ± 363.45 pg/mL vs. 186.06 ± 101.41 pg/mL, p < 0.001). LIGHT expression on monocytes, CD3+-T-cells, and neutrophils was also higher in obese patients than in the controls. Finally, in PBMC cultures, the addition of anti-LIGHT antibodies induced a significant osteoclastogenesis inhibition. Our study highlighted the high serum levels of LIGHT in obese children and adolescents, and its relationship with both the grade of obesity and bone impairment.

Other-initiation of repair by speakers with mild to severe hearing impairment

ABSTRACT Hearing impairment is a common chronic condition in middle-aged and elderly adults. The number of individuals with hearing impairment is expected to rise because of the longer life expectancies and trends in the population growth. Acquired hearing impairment in adulthood is not just a disorder of the sense of hearing. It is primarily a social disability because its handicapping effect is experienced in interaction with other people. This paper aims to explore how the repair of problems in hearing is initiated by hearing-impaired individuals with acquired mild to severe hearing impairment. By using the method of conversation analysis (CA), this paper examines the occurrence of other-initiations of repair (OIR) and how it is typically resolved in actual mundane interaction. In addition, this paper reveals the challenges and the impact of hearing impairment as the state of hearing deteriorates. This article argues that the frequency of OIR in mild hearing impairment does not differ from normally hearing individuals. However, in a more severe grade of hearing impairment, the OIR sequences are longer, more frequent, multimodal and may require more vigilance from the normally-hearing conversation partner. Implications for counselling are suggested.

Levels of disability and relapse in Bangladeshi MB leprosy cases, 10 years after treatment with 6m MB-MDT

Introduction: Since 1998 the recommended duration of treatment for multi- bacillary (MB) leprosy cases has been 12 months. Further shortening the duration of multi-drug therapy (MDT) for MB cases has been proposed, but evidence regarding long term outcomes is still needed. Disability outcomes are as important for the affected individual as the bacteriological response. Methods: Newly diagnosed MB leprosy cases were recruited from 2 NGO projects in Bangladesh for treatment with 6m MB-MDT, and followed up for 10 years from diagnosis. Their outcomes were compared with those in a similar annual cohort of MB cases from the same projects who were diagnosed during the previous year, treated with 12m MB-MDT, and followed up in the same way. Results: Over a 10 year period there were no differences in outcomes between the 6m MB-MDT group and the control group who received 12m MB-MDT in regard to WHO disability grade or degree of nerve function impairment (NFI). The proportion of subjects ever needing steroids for reaction/neuritis did not differ between regimens. Mean duration of steroid therapy was longer in the 12m group. Only one relapse was diagnosed in 10 years of follow-up. This occurred at 9 years follow up, from a patient in the 6m treatment group. Conclusion: In 2 cohorts of leprosy affected people who were actively followed up, the level of disability and the rate of relapse at 10 years after diagnosis was not significantly different between those receiving either 6m or 12m MB-MDT.

GDF15 reflects beta cell function in obese patients independently of the grade of impairment of glucose metabolism

Background and aimsGrowth differentiation factor 15 (GDF15) is a strong predictor of cardiovascular morbidity and mortality found to be both marker and target of impaired glucose metabolism. GDF15 increases following glucose administration and is up-regulated in obesity and diabetes. We investigate here the relationship between GDF15 and beta cell function. Methods and resultsIn this cross-sectional study we evaluated GDF15 concentrations in 160 obese subjects (BMI 35–63 kg/m2, age 39.4 ± 18.6 years, m/f 38/122) who underwent a 75 g oral glucose tolerance test (OGTT). Based on the OGTT results, the cohort was divided into two groups: 1) normal fasting glucose and normal glucose tolerance (n = 80), 2) impaired fasting glucose, impaired glucose tolerance or type 2 diabetes (n = 80). The relationship of GDF15 to fasting and OGTT-based dynamic insulin sensitivity and insulin secretion parameters was evaluated.GDF15 was higher in the prediabetes and diabetes groups and correlated with HbA1c, glucose, insulin as well as baseline and dynamic indices of insulin sensitivity and estimated beta cell function. Multiple regression analysis revealed that age, waist-to-height ratio, glomerular filtration rate and prehepatic beta cell function, but not the grade of impairment of glucose metabolism, were independent predictors of GDF15. Subgroup analysis showed that of all parameters of glucose metabolism only C-peptide, fasting prehepatic beta cell function and insulinogenic index remained significantly related to GDF15 in both groups. ConclusionWe conclude that in patients with severe obesity, GDF15 strongly relates to beta cell function and should be further investigated as a potential therapeutic target and biomarker guiding treatment options.

The Effect of the Speech Task Characteristics on Perceptual Judgment of Mild to Moderate Dysphonia: A Methodological Study

Objective: To study the differences in perceptual ratings of mild and moderate dysphonia related to the speech task, and their impact on intrarater and interrater reliabilities. Patients and Methods: Voice recordings of 15 outpatients with mild or moderate dysphonia related to laryngopharyngeal reflux were presented to 6 female experienced judges blinded to the clinical state of the patients. From these, the GRBASI (Grade, Roughness, Breathiness, Asthenia, Strain, and Instability) evaluations were performed on connected speech and sustained vowel of the pretreatment voice recordings and absolute agreement, and both intrarater and interrater reliabilities were assessed. Results: The average GRBASI scores were significantly worse when performed on sustained vowel. Intrarater reliability substantially varied according to the judge and the task. Good interrater reliability was broadly found for the evaluations of all GRBASI components irrespective of the speech task. Concerning agreement, we only found absolute agreement between judges for G and R items assessed on text. Conclusion: Average grade of perceptual voice impairment, intrarater reliability, and agreement vary according to the speech task.

Executive Dysfunction Detected with the Frontal Assessment Battery in Alzheimer's Disease Versus Vascular Dementia.

Alzheimer's disease (AD) and vascular dementia (VaD) lead to progressive decline in executive function. We estimated the prevalence of executive dysfunction in AD and VaD patients, investigating cognitive, functional, and clinical correlates and also using a multidimensional approach based on a standardized comprehensive geriatric assessment (CGA). We included 215 patients (115 AD patients and 100 VaD patients) consecutively evaluated with a complete cognitive and affective assessment, a CGA, and the Frontal Assessment Battery (FAB) with six subtests investigating conceptualization, mental flexibility, motor programming, sensitivity to interference, inhibitory control, and environmental autonomy. The prevalence of dysexecutive syndrome screened with a FAB score <12 points was high in both AD (97 patients) and VaD (77 patients) (84.3% versus 77.0%, p = 0.171). AD patients were significantly younger, with higher grade of cognitive impairment and less severe comorbidity and polypharmacy than VaD patients. AD patients showed a significantly higher impairment in FAB total score and five FAB subtests (conceptualization, motor programming, sensitivity to interference, inhibitory control, and environmental autonomy) than VaD patients. These findings were largely confirmed in a sub-analysis conducted subdividing the sample in mild and moderate-to-severe demented patients and suggesting that in moderate-to-severe AD there was higher impairment in FAB total score and four FAB subtests (conceptualization, sensitivity to interference, inhibitory control, and environmental autonomy). Executive dysfunction could be greater in AD patients with moderate-to-severe dementia compared to VaD patients, although our groups were also not matched for age, comorbidity or polypharmacy, which could also exert an effect.

Characteristic of Noise-induced Hearing Loss among Workers in Construction Industries

Noise-induced hearing loss (NIHL) is among the most common occupational disease in industries. This paper investigates NIHL in construction related industries in Malaysia with particular emphasis on its relation with risk factors. The objectives of this research were to (1) quantify the prevalence of NIHL in construction related industries, and (2) assess the relationship between hearing loss and risk factors and it’s characteristic. The study was conducted using 110 NIHL compensation record collected from Social Security Organisation (SOCSO), Malaysia. Risk factors namely area noise, age, temperature, smoking habit, hobby, diabetic and cardiovascular disease were identified and analysed. Results showed that there was no direct relationship between area noise with hearing impairment while there was only low relationship between age and hearing impairment. The range for area noise and age were between 70 to 140 dB(A) and 20 to 70 years, respectively. The other risk factors classified as categorical data and analysed using frequency method. Grade of impairment does not depend solely on area noise but also in combination with age and other risk factors. Characteristic of NIHL prevailed in construction related industries were presented using scatterplots and can serve as a references for future hazard control on site.

The Protective Effect of Sertraline in Preventing Cisplatininduced Ototoxicity in Solid Organ Chemotherapy

Cisplatin, as a platinum-based chemotherapeutic medication, is applied for various types of solid tumors. Regarding the treatment of cancer cells, cisplatin is potentially accompanied with some side effects such as nephrotoxicity, neurotoxicity, and ototoxicity in spite of high efficacy of Cisplatin. The present study aimed to determine whether the use of oral sertraline can contribute to preserve hearing threshold among the patients who receive cisplatin or not. This research has done for one year, along with a 3 months course and follow-up. This is a double-blind, randomized, and placebo-controlled trial study. The study was conducted in Oncology Clinic and Audiology Department of Firoozgar University Hospital in Tehran, Iran. Among 112 patients, 79 patients who were suffering from different types of solid tumors and were candidates for receiving cisplatin for chemotherapy treatment were selected. The grade of hearing impairment and otoacoustic emission in the first day and the last stage of the study was used for data analysis. Among 112 patients, 79 patients were randomly selected to receive either sertraline (50 mg/d) as the case group, or placebo as the control group. Before and after the treatments, the patients were assessed by High-Frequency Audiometry and dpOAE tests. First, the two groups were distributed homogeneously based on sex and age. Based on Common Terminology Criteria for Adverse Events (CTCAE), the Ototoxicity Grade indicated a significantly lower grade of deficits in the Sertraline group (p<0.001), compared to that of the control group. In addition, a significant difference was observed between the two groups regarding the changes in the threshold of dpOAE (p=0.000). The daily consumption of sertraline (50 mg/d) among the adults who were candidates for chemotherapy treatment with cisplatin could result in preserving the hearing threshold significantly.

Fetal intracranial hemorrhage. Prenatal diagnosis and postnatal outcomes

Objective: To present our experience with 14 cases of fetal intracranial hemorrhage (ICH).Methods: Cases of fetal ICH detected in our institution between 2005 and 2016 by ultrasonography. Maternal characteristics, ultrasound and MRI findings, and postnatal outcome were noted.Results: Twelve cases (86.7%) were identified during a third trimester routine scan at a median gestational age of 30.6 weeks. The ICH was classified as Grade 2 in two cases, Grade 3 in three cases, and Grade 4 in nine cases. Nine cases were bilateral and five were unilateral (four left/one right). The 11 MRI available confirmed grade and location and, in six cases (54.5%), added new findings. There were six terminations of pregnancy, one intrauterine fetal death and seven babies born alive. These were followed up for 28 months (range 3–96). Some grade of neurologic impairment was observed in five children (71.4%, one Grade 3/four Grade 4), mainly mild to moderate motor sequelae.Conclusion: Diagnosis of fetal ICH is amenable to antenatal US. Most of the cases identified are of high grade and usually detected during the third trimester. MRI is a valuable complementary tool in evaluating ICH. Conversely to that previously reported, postnatal survival is high but it entails the risk of adverse neurologic outcome in most neonates.

The senile functional evolution of the larynx after supracricoid reconstructive surgery.

Supracricoid partial laryngectomy is a relevant organ-preserving surgical technique used for the treatment of early or locally advanced laryngeal tumors with an oncologic outcome comparable with that of total laryngectomy. This reconstructive surgery is certainly technically feasible also in the elderly, but the problem is postoperatively as the patient may lack the will and strength to be successfully rehabilitated. The goal was to evaluate functional outcomes, in a maximum follow-up period of ten years from the end of the postoperative follow-up, in a cohort of elderly patients to look at the senile evolution of the laryngeal post surgical function comparing the amount of resection and grade of possible impairment of swallowing and phonatory parameters. A group of 33 patients were selected for a retrospective study aimed at evaluating the long-term evolution of laryngeal functionality after surgery, with the baseline at 5 years from the end of follow-up. All the patients had three-monthly visits for a period up to ten years, during which the objective and subjective swallowing and phonatory parameters were recorded, analyzed and, at the end of the study, compared with baseline. The results suggest that long-term post surgical functional problems may develop also in the neolarynx where the effects of the reconstructive surgery, on speech and swallowing, are largely stabilized. The presence of arytenoid resection had significantly impacted on the occurrence of aspiration even if the overall number of dysphagic patients was not statistically significant compared to baseline.