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Otoacoustic emissions constitute a sensitive non-invasive means of auditory exploration of outer hair cells (organ of Corti). The aim of this paper is to situate this method among others in the context of auditory exploration in children, and as regards the future of the exploration of the medial olivocochlear system.
A coding scheme based on Wertsch's (1983) extension of Vygotsky's ideas about adult-child interaction in the zone of proximal development was used to analyze parent-child interaction during exploration. Sixty children, 3 to 6 years old, were videotaped while exploring novel objects in 15-min sessions with their mothers and fathers. Clusters of verbal and nonverbal behavior were used to code how participants defined the situation in each 15-s interval of each session in terms of one of nine categories. When parent-child mismatches occurred, the participants' negotiations of an intersubjective definition were coded, and child and parent questions were coded for complexity, complexity and appropriateness of response, and function. Results indicated that parent and child definitions matched almost 80% of the time, usually around exploration by the child with attention of or collaboration by the adult. Fathers tended to be more didactic than mothers.
Diagnostic imaging and mediastinoscopy have reduced but not eliminated the exploratory thoracotomy in the management of lung cancer patients. Considering all the limits of such diagnostic techniques, an aggressive approach to lung neoplasm imply an increase both in explorative thoracotomies and in radical or palliative intraoperative procedures. Our study includes 55 explorative thoracotomies performed on 206 surgical operations for lung cancer. The patients of E.T.'s group couldn't undergo surgical resection in 28 cases because of direct tumoral mediastinal diffusion, involving cardio-pericardial wall and/or great vessels; in 20 for extensive nodal mediastinal diffusion, in 3 patients for pleural dissemination, and 4 had unresectable chest wall involvement. Postoperative mortality rate was 3.6% vs. 5.5% recorded in resected patients; postoperative morbidity rate was 9%. During explorative operations became possible to define more exactly diagnosis and, through palliative procedures, to improve life quality: in fact we performed tumor histology correction or settlement (12/55 P.ts), pericardiotomy for pericardial effusion (5/55 P.ts), pleurodesis or pleurectomy when pleural effusion was present (16/55 p.ts), intercostal neurolysis in involved chest wall areas (4/55 p.ts).
Blunt traumatic renal injuries seldom (less than 10 per cent) require operation. Improved staging techniques such as CT have been responsible for the decrease in the number of renal explorations. Penetrating renal injuries from knife or gunshot wounds historically have mandated surgical exploration. This practice should be continued unless staging studies confirm that the degree of injury justifies expectant management. In the authors' experience, 42 per cent of stab wounds and 76 per cent of gunshot wounds have necessitated renal exploration.
One hundred and four patients undergoing concomitant cholecystectomy and exploration of the common bile duct were retrospectively reviewed. Exploration of the common bile duct retrieved stones in only 17 patients, all of whom had clearly positive findings from operative cholangiography. Of 87 patients who had negative results 57 underwent exploration of the common bile duct on the basis of clinical factors and 21 on the basis of equivocal cholangiographic findings.
The purpose of this study was to examine the relationship between adolescent pubertal status, the affective quality of family relations, and the early adolescent's exploration of a sense of ego identity. Fifty-one intact families with adolescents in the seventh grade agreed to participate. Each family member completed a battery of questionnaires designed to assess familial adaptation to pubertal growth and identity exploration. The results reveal that the affective quality of parent-adolescent relationships and the pubertal status of the adolescent appear to influence the adolescent's exploration of ego identity. The need to establish the functional significance of familial adaptation to adolescent pubertal growth for identity development is discussed.
In Takayasu's disease full radiological exploration of the arteries requires multiple injections of a contrast medium, and this would be difficult to achieve in the course of one single examination. In the present study, two non-invasive methods--digital angiography and cross-sectional echography--were used comparatively to evaluate arterial lesions in 13 ambulatory patients presenting with this disease. Conventional arteriography had previously been performed in 11 of them. The results obtained with digital angiography were considered satisfactory in 12 patients. All underwent aortic and pulmonary echography. Digital angiography and cross-sectional echography provide full, reliable and non-invasive exploration of the aorta and pulmonary artery. Echography shows abnormal thickness of the vascular walls, but the arterial branches can be explored only by digital angiography. The value of these two non-invasive methods is discussed.
Velocimetric exploration by continuous emission Doppler is still essential for non-invasive evaluation of vertebral circulation but it does not provide morphologic data. Results were compared of exploration with combined continuous emission Doppler and a Duplex examination (sectorial scanning ultrasound imaging coupled with pulsed emission Doppler) and data from arteriography of 186 vertebral arteries in patients, mean age 57 years, admitted for exploration of a cerebral ischemic accident or a cervical murmur. The Duplex examination allowed identification of proximal segment (VI) in 98% of permeable vertebral arteries. The ostium of the vertebral artery was more difficult to visualize because of possible tortuosities, of sometimes a too posterior or intrathoracic localization or of a short neck. Nevertheless the vertebral ostium was identified in 78% of cases on the right and 48% on the left. The Duplex examination demonstrated sensitivity of 72% and specificity of 98% for detection of proximal stenosis of vertebral artery, and its sensitivity was therefore twice as sensitive as continuous emission Doppler for detection of stenoses of less than 50%. The Duplex examination should complete data from continuous emission Doppler by providing an evaluation of vertebral artery diameter and information on presence and characters of an elongation or stenosis. In this way, 9 atheromatous plaques not identified on arteriography were detected by ultrasound imaging. Similarly, the Duplex examination is particularly useful for identification of a hypoplastic vertebral artery, to distinguish the specific lesions of the subclavian artery from those extending onto vertebral ostium, and to characterize ostial lesions when these are accessible to examination.(ABSTRACT TRUNCATED AT 250 WORDS)
One hundred patients who had elective manual exploration of the uterus at the time of delivery were compared with a control group of 100 patients with regard to febrile morbidity and blood loss at delivery. Febrile morbidity was quantitated with the Fever Index, and postpartum blood loss was quantitated by subtracting the two-day postpartum hemoglobin from the admission hemoglobin. The patient population encompassed only normal spontaneous vaginal deliveries without complications. The manually explored group had less febrile morbidity and less blood loss; however, this was not statistically significant. Although this study cannot conclude that routine elective manual exploration of the uterus should be done after expulsion of the placenta, it does demonstrate the safety of the procedure.
Formal exploration of the common bile duct through choledochotomy is a standard surgical technique; however, the prevalence of postoperative morbidity and mortality from intraoperative extraction of stones and debris of the common duct remains significant. From 1982 to present, we performed 25 explorations of the common bile duct entirely through the cystic duct in patients in whom duct size was large enough to permit passage of instrumentation greater than 6.5 millimeters in diameter. All instrumentation, including biliary Fogarty balloon-tipped catheterization and fiberoptic choledochoscopy, was used through the cystic duct without difficulty. No complications of bile leakage or stricture formation were encountered, and all patients are doing well at five and one-half years after surgical treatment without known retained stones. The early community hospital experience of this report supports the view that exploration of the common bile duct through a suitably sized cystic duct is a safe, efficient and effective alternative to choledochotomy for exposure of the common bile duct.
Over a period of 42 years, 581 patients with presumed hyperparathyroidism underwent an initial cervical exploration. Abnormal parathyroid glands were removed from 495 patients (85.2%). There was a greater probability of operative success in women, patients over 50 years of age, and patients with hypercalcemia, hypertension, or nonspecific abdominal pain. There was no association of operative outcome with some of the "classic" manifestations of hyperparathyroidism--peptic ulcer disease, neuropsychiatric symptoms, pancreatitis, bone disease, or urolithiasis. The probability of surgical success improved with time, increasing from 56 per cent in the 1950s to 97 per cent in the present decade. This improvement appears to be related to greater operative experience, since all four parathyroid glands were more likely to be found with increased experience, and there was a strong correlation between finding four parathyroids and achieving persistent normocalcemia. The most common causes of operative failure were inaccurate calcium assays (the patient was not truly hypercalcemic), an inappropriate diagnosis ("normocalcemic hyperparathyroidism"), and surgical inexperience. These three factors accounted for at least three fourths of all negative explorations. More accurate diagnostic studies, and careful exploration by an experienced surgeon should maximize the probability of a successful operation for primary hyperparathyroidism.
Twentytwo parathyroidectomies were performed in a series of about 200 patients. Surgical exploration was performed in less than 5% of patients with slowly progressive uremia, and of patients on maintenance haemodialysis, whereas as many as 15% of patients returning to dialysis after graft failure were operated on. After successful transplantation appoximately 10% of a patients with an initially functioning graft ultimately had a neck exploration. On three occasions this parathyroidectomy was acutely performed. In about one third of the surgically explored cases the parathyroid glands displayed marked assymetry and/or histological features possibly indicative of adenoma formation or "autonomous nodules". The incidence of surgical complications was low and beneficial clinical effect were often encountered. It thus seems possible to defend a liberal attitude towards the performance of parathyroidectomy in patients accepted into a transplantation programme.
Lymphoscintigraphy of lower limbs generally involves bilateral subcutaneous injection of a radioactive colloid into the first or second interdigital space: only the superficial internal saphenous pathway is visualized in this way (superficial lymphoscintigraphy: SL). However, the external saphenous and deep pathways can be explored by an external retromalleolar injection as demonstrated in radiology. Isotopic exploration of the external saphenous pathway and deep lymphatics (deep lymphoscintigraphy: DL) was carried out in 18 patients with arteritis also investigated by SL. The study forms part of a prospective trial of edema developing after femoro-popliteal shunts. The deep lymphatics are correctly and easily visualized, and in about 20% of cases there exist anomalies of distribution of superficial or deep lymphatic flow, morphologic anomalies developing postoperatively in one pathway only, or in both pathways. DL is a simple, reliable method of investigation of deep lymphatics, and complete exploration of lymphatics of lower limbs should include both SL and DL.
The purpose of this research was to develop a model of individuation in family relationships that focuses on communication processes, and to assess the links between them and adolescent identity exploration. Expressions of the 4 dimensions of the model--self-assertion, separateness, permeability, and mutuality--were predicted to be positively associated with identity exploration in adolescents. A sample of 84 Caucasian, middle-class, 2-parent families, each including an adolescent and 1 or 2 siblings, was observed in a Family Interaction Task designed to elicit the expression and coordination of a variety of points of view. Multiple regression analyses revealed differentiated results concerning father-son, father-daughter, mother-son, mother-daughter, and marital relationships as well as both positive and negative contributions of communication variables to identity exploration when verbal ability and sociability were controlled. Results are discussed in terms of recent formulations of the progressive redefinition of the parent-child relationship during adolescence.
Skeletal isotopic exploration is fundamental in patients with prostatic cancer. Bone scintiscan is reliable. Its sensibility can be increased by using new radioactive isotopes and quantitative isotopic explorations. Bone marrow histologic study is indicated in case of a doubtful diagnosis, when there is a discordance between radiological and isotopic exploration.
Because manipulative exploration of objects may be important to the infant's perception and conceptualization of objects, this study compared full-term infants with preterm infants who are considered to be at risk for cognitive deficits. 30 preterms at 9 months, with age corrected for prematurity, and 20 9-month-old full-terms were videotaped while they explored novel objects; the videotapes were scored for behaviors such as looking, handling, mouthing, turning the object around, fingering, transferring from hand to hand, and banging. There were no differences between the preterms and the full-terms. A "low-risk" subgroup and a "high-risk" subgroup of preterms were then compared with each other as well as to the full-terms. The low-risk subgroup was essentially the same as the full-terms. The high-risk preterms, however, fingered, rotated, and transferred the objects less than either the full-terms or the low-risk preterms. There was a relationship between manipulative exploration at 9 months and later cognitive functioning, suggesting that lower levels of manipulation may be one way in which cognitive deficits originate or are maintained.
The authors review their experience with 59 consecutive patients undergoing common duct exploration for calculous biliary tract disease, 33 of whom underwent operative choledochoscopy. It is shown that choledochoscopy is not associated with an increase in the amount of time required to perform cholecystectomy and common duct exploration. It is similarly shown that there is no increase in the incidence of postoperative complications occurring in conjunction with the use of the choledochoscope. Because of the safety of the technique and the subjective satisfaction afforded by its use, the authors, now include choledochoscopy as a routine measure in common duct exploration.
UNLABELLED: Patients with orbital fractures may develop late complications like enophthalmos, orbital dystopia or diplopia, as a result of untreated orbital floor lesions, with herniation of orbital fat. Clinical and radiological findings are not enough for diagnostic and indication of orbital floor repair. PURPOSE: To evaluate the indication of repair of the orbital floor, during the surgical treatment of maxillozygomatic or zygomatic-maxillary compound fractures, by means of systemic exploration and to compare clinical with surgical findings. METHODS: 112 patients with unilateral zygomatic-maxillary compound fracture were submitted to exploration of the orbital floor, during the surgical treatment of the fracture. Open reduction and rigid internal fixation was performed with steel wire or miniplates. An autogenous conchal cartilage graft was used to repair the floor lesion, when there was bone loss of the inferior orbital wall and periorbita discontinuity, with fat herniation. RESULTS: The repair of the orbital floor was indicated in 46.4% of the patients. Early diplopia (before surgery) was observed in 26.6% and enophthalmos in 3.30% of the cases. Among patients with early diplopia, 60% needed repair, while 36.6% of the patients without early diplopia received cartilage graft. No important complications was observed. CONCLUSION: Orbital floor exploration is a complementary maneuver for the treatment of zygomatic-maxillary compound fractures that permits the precise diagnostic of the lesion and the correct indication of repair.