Transcanal cochlear implantation under monitored anesthesia care.

OBJECTIVE: Given the associated risk of general anesthesia in elderly patients with cardiovascular disease, the authors set out to determine the feasibility of transcanal cochlear implantation under local anesthesia with monitored anesthesia care. METHODS: A 70-year-old man with a history of coronary artery bypass grafting, diabetes mellitus, and an American Society of Anesthesiologists Class III cardiac status underwent cochlear implantation under local with monitored anesthesia care. RESULT: With the described technique and regimen of intravenous remifentanil and dexmedetomidine, the patient tolerated the 60-minute procedure without tachycardia, hyper- or hypotension, or cardiac ischemia. CONCLUSION: Cochlear implantation using the pericanal electrode technique performed under local anesthesia with monitored anesthesia care is possible in patients at risk for undergoing general anesthesia for cochlear implantation.     

Influence of urbanization of the western coast of the United Arab Emirates on trace metal content in muscle and liver of wild Red-spot emperor (Lethrinus lentjan).

We hypothesized that increased ambient concentrations of metals, as a consequence of escalating urbanization and industrialization of the Gulf region will respond in increased contamination of edible fish species. In this study, we report concentrations of chromium, manganese, cobalt, copper, zinc, arsenic, cadmium, mercury and lead in meat and liver of wild Red-spot emperor (Lethrinus lentjan) from three sampling points at the UAE coast. Analysis was performed by the ICP-MS/microwave digestion. Our study has shown that meat and liver metal content was significantly higher in areas with higher industrial activity, although metal values did not exceed permitted levels of fish for human consumption.     

Bilateral choanal atresia and paranasal sinus hypoplasia in an adult patient with hypogammaglobulinaemia

We present an unusual case of a young female patient presenting with bilateral choanal atresia, which was probably acquired, associated with nasal and paranasal sinus hypoplasia and hypogammaglobulinaemia.     

Endonasal carbon-dioxide laser assisted dacryocystorhinostomy verses external dacryocystorhinostomy

This is a prospective, non-randomized study to evaluate and compare the results, morbidity and surgical time for endonasal carbon-dioxide laser assisted dacryocystorhinostomy and external dacryocystorhinostomy. 70 consecutive patients of chronic dacryocystitis with nasolacrimal duct obstruction were selected for the study. 36 patients under went endonasal CO2 laser assisted dacryocystorhinostomy and 34 had external dacryocystorhinostomy. Selection of the type of operation was left to the patient's choice. All the patients had preoperative counseling and both the procedures were explained in detail with their advantages and disadvantages. Patients not willing for the external incision were selected for endonasal laser assisted dacryocystorhinostomy and others were operated via external approach. Silicone tubes were put in all the patients for three months after surgery. The final follow up was 12 months after the removal of silicone tubes. The patency of the lacrimal passage was confirmed by irrigation, and patients were questioned about their symptoms. The success rates, 12 months after removal of silicone tubes were 100% in endonasal CO2 laser assisted dacryocystorhinostomy and 88.24% in external dacryocystorhinostomy. The surgical time of endonasal laser assisted dacryocystorhinostomy was 38 minutes as compared to 62 in external dacryocystorhinostomy. Complication rate in both groups was almost equal. Thus, we came to the conclusion that Endonasal CO2 laser assisted dacryocystorhinostomy is a better surgical option to external dacryocystorhinostomy in cases of chronic dacryocystitis with nasolacrimal duct obstruction, with shorter surgical time.     

Congenital anomalies among infants of diabetic mothers: a study of 466 cases at King Fahd Hospital of the University, Al-Khobar.

The purpose of the study was to determine the incidence of congenital anomalies among infants of diabetic mothers and compare this with the normal obstetric population in our hospital. Among 17 463 patients delivered at the King Fahd Hospital of the University, Al-Khobar, Saudi Arabia between January 1987 and December 1992 there were 466 diabetic mothers who delivered 466 singleton births. The incidence of diabetes was 2.6%. Among those 466 diabetic patients there were 132 with clinical diabetes which was present before pregnancy and which required insulin treatment during pregnancy and 334 with gestational diabetes. There were 14 lethal congenital anomalies among the infants of diabetic mothers (3%) compared with 69 anomalies in general obstetric population (0.4%). The difference = was very highly significant P = 0.001. Ten anomalies were responsible for 10 stillbirths and the other four anomalies resulted in four neonatal deaths. The most common anomalies were those of the central nervous system and multiple fetal anomalies, followed by cardiovascular system, renal and chromosomal anomalies. All those anomalies occurred in the infants whose mothers had clinical diabetes.     

Loss of the nocturnal dip and increased variability of blood pressure in normotensive patients with noninsulin-dependent diabetes mellitus

Summary. Eleven normotensive diabetics with noninsulin-dependent diabetes mellitus (NIDDM) (mean age 52.5 SD 8.2 years) and 11 controls (mean age 47.4 SD 8.9 years) had their ambulatory blood pressure and heart rate recorded non-invasively by the Oxford Medilog System in standard hospital conditions. The results were averaged as hourly means of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), and heart rate (HR) for the 24-h period and similarly for the ‘awake’ period (14.16 h) and the ‘asleep’ period (8–10 h). Hourly means for diabetics and controls showed no differences in blood pressure and heart rate over the 24 h. During sleep, control subjects showed a significant drop in SBP (P < 0.001), DBP (P < 0.001), MAP (P < 0.001) and HR (P < 0.001). However, this nocturnal dip in blood pressure could not be demonstrated in the diabetic group. Blood pressure variability was significantly increased in diabetics compared to controls during waking hours (P < 0.01). These results indicate that in noninsulin-dependent diabetics during sleep there is loss of the nocturnal dip of BP seen in normal subjects, and they have increased BP variability. These may be contributing factors to the development of hypertension and the accelerated target organ damage (TOD) seen in diabetes.,     

Effect of testosterone and anabolic steroids on the size of sebaceous glands in power athletes

The effect of testosterone and anabolic steroids on the size of sebaceous glands was studied by means of interactive morphometry in skin biopsies of power athletes. The subjects used self-administered high doses of testosterone and anabolic steroids during a 4-week strength training period. After 4 weeks' use of hormones, the area of sectioned sebaceous glands enlarged significantly by a factor of 89.2% (p less than 0.005). The number of cells in the so-called differentiating cell pool (DCP) and in the undifferentiated cell pool (UCP) also increased significantly (p less than 0.025, p less than 0.05, respectively). The size of the area occupied by UCP cells increased significantly (p less than 0.05). The study suggests that high doses of testosterone and anabolic steroids lead to an enlargement of sebaceous glands in male power athletes.