Pneumopericardium, defined as air in the pericardial cavity, is a rare condition with potentially severe complications and mortality. In the neonatal period, pneumopericardium is associated with prematurity, very low birth weight, and assisted ventilation. We report the occurrence of spontaneous pneumopericardium in a healthy full-term neonate who did not receive any supportive ventilation.

There have been a number of hypotheses regarding abiogenesis, the ‘Metabolism First’ model and the ‘RNA World Hypothesis’ are two such examples. All theories on abiogenesis make a set of unstated assumptions with regard to the elemental make up of life or only apply the theory to a primitive earth model. This paper reviews current knowledge from the myriad of observations from a variety of scientific disciplines and applies generally understood thermodynamic reasoning to explain the formation of molecules known to be used by life. These arguments are used in this paper to construct a set of new hypotheses which govern universal abiogenesis. The intention of this paper is to show by the application of our known laws of science that life is the end sequence of events of the fundamental forces which affect the entire universe. From these events a new hypotheses on abiogenesis can be formulated. The hypotheses proposed by this paper are incorporated in many of the current theories of abiogenesis, either assumed or accepted but very rarely stated or explained. The proposed set of five hypotheses are: (1) any celestial mass that has a body of liquid water and therefore has access to energy will form at least the building blocks of life, if not life itself. (2) The major component of any life form anywhere in the universe will be H2O. (3) Any organism, anywhere in the universe, will be carbon-based. (4) All life in the universe will be composed of nucleic acid based molecules as its code for life. (5) The cell is the universal unit of life. Throughout this paper the background to the formulation of these hypotheses is discussed, as is the explanation of why these hypotheses are universal and not limited to an application of a primitive earth model. This set of hypotheses is also testable as any investigation of a celestial body which contains liquid water (e.g. Europa) will quickly provide evidence to prove or refute the proposed theory.

Certain observations arose from the implementation of multicentre research on ‘ecotherapy’. Very diverse community groups of people with a range of disabilities, undertaking horticulture and nature conservation as a therapeutic and social enterprise, provided an unexpected conception. We coined the term embracement to capture the meaning of an activity we found in many ‘bottom-up’ examples of social inclusion. Self-organizing groups grow by the members’ choosing to embrace a common identity, which included and integrated health, social and environmental dimensions. Embracement is self-directing, spontaneous and collective, with the potential group members being the driving force.

In humans, the neural circuitry underlying facial expressions differs, depending on whether facial expressions are spontaneously (i.e., limbic, subcortical) or voluntarily initiated (i.e., frontal cortex). Previous investigators have suggested that the “masked face” of Parkinson's disease involves spontaneous, but not intentional, facial expressions. In contrast, we hypothesized that intentional facial expressions may be slowed (bradykinetic) and involve less movement, in much the same way that other intentional movements are affected by Parkinson's disease. To test this hypothesis, we used sophisticated computer imaging techniques to quantify dynamic facial movement. Relative to controls, Parkinson patients had reduced facial movement (entropy) and were significantly slowed in reaching a peak expression (i.e., bradykinesia). These findings are consistent with the view that the basal ganglia play a role in affecting intentional facial movements. This possibly occurs because of diminished efficiency and/or activation of face representation areas in the frontal cortical regions (i.e., motor, premotor, and supplementary motor area) or because of movement-based suppression secondary to dopaminergic reduction in frontostriatal pathways. Taken together, the characterization of Parkinson's disease as a model system for the neuroanatomic dissociation between voluntary and spontaneous expressions may be unjustified. (JINS, 2006, 12, 765–773.)

This aim of this study was to determine the effect of anaesthetic agents on stapedius reflex (SR) thresholds and transient evoked otoacoustic emissions (TEOAE). Fifty patients who were scheduled for operation and who had normal hearing were included in the study. All were given midazolam for premedication and propofol for induction. Anaesthesia was maintained in five different ways in each group of 10 patients. Groups I–IV received inhalational anaesthesia: group I received 70 per cent N2O plus 30 per cent O2, group II sevoflurane, group III desflurane and group IV halothane. Group V received total intravenous anaesthesia with propofol plus sufentanil. The SR and TEOAE of the patients were measured four times: on the day before surgery (first measurement), after premedication (second measurement), after induction of anaesthesia (third measurement) and during maintenance of anaesthesia (fourth measurement). Midazolam significantly increased ipsilateral and contralateral SR thresholds and decreased TEOAE wave reproducibility. Propofol significantly increased only the SR thresholds. The other anaesthetic agents significantly increased only the contralateral reflex thresholds. Of these, the highest increase was seen after sevoflurane and the lowest after halothane. The changes in TEOAE wave reproducibility due to anaesthetic agents used for maintenance were not significant. We concluded that midazolam premedication may affect audiological evaluation with SR and TEOAE tests, and sevoflurane should not be used when it is necessary to measure SR under general anaesthesia.

The aim of this study was to investigate otoacoustic emissions in young adults who had a history of otitis media (OM) in childhood and to assess whether a history of OM had an irreversible effect on hearing. We studied 116 cases between 15 and 25 years of age, divided into three groups. Each subject underwent a single examination comprising otoscopy, pure-tone audiometry (PTA), tympanometry, and transient evoked otoacoustic emission (TEOAE) and distortion product otoacoustic emission (DPOAE) testing. Subjects in the first and second groups had normal audiometric hearing thresholds and type A tympanograms. The only difference between the first and second group was the presence or absence of a history of OM. The third group consisted of patients diagnosed as having active OM; these patients had poorer hearing thresholds and type B or C tympanograms. After statistical analysis of TEOAE and DPOAE results (one-way analysis of variance test), significant differences were noted between groups. Otoacoustic emission levels were, unsurprisingly, lowest in the third group, as expected. However, the most striking result in the study was that significantly fewer otoacoustic emissions were detected in subjects with a history of OM than in subjects without a history of OM. These findings suggest that OM in childhood may cause minor but irreversible damage to the middle ear or cochlea. Otoacoustic emissions testing can be used to detect this sub-clinical damage.

The highveld mole-rat Cryptomys hottentotus pretoriae is a social subterranean rodent that exhibits seasonal reproduction. Non-reproductive females remain anovulatory whilst in the confines of the natal colony. However, during the southern hemisphere summer, dispersal of non-reproductive females from the natal colony occurs with subsequent pairing with unrelated males. This study investigates whether the dispersing female highveld mole-rat is an induced or spontaneous ovulator. Eight non-reproductive females were removed from their natal colonies during the breeding season and housed individually for 5 weeks. Urine was collected every second day during the next 5 weeks of isolation. After this initial period, isolated females underwent one of three trials: two females were kept isolated without a male, three females were individually placed in chemical but not physical contact with unvasectomized males, while each of the remaining three females were allowed full contact with a vasectomized male. Urine was again collected every second day for a further 5 weeks, after which the females were killed. Both urinary progesterone profiles and histology of the ovaries revealed that the female highveld mole-rat is an induced ovulator. Females in physical contact with vasectomized males exhibited a significant increase in urinary progesterone concentration as well as the presence of corpora lutea in their ovaries, both indicative of ovulation. The act of coitus is necessary for ovulation to take place even though the males were not capable of fertilization. This is the first time induced ovulation has been shown in bathyergid rodents.

Testing of otoacoustic emissions (OAE) has been successfully applied to study outer hair cell function. We used this methodology to evaluate and compare the effect of topically applied normal saline, and gentamicin- and ciprofloxacin-containing drops into the middle ear of guinea pigs. All three solutions similarly decreased the distortion product OAE (DPOAE) and all three caused an inflammatory reaction in the guinea pig’s middle-ear. OAE failed to detect adequately the ototoxicity of topically administered drops in this animal model because the opening of the bulla affected DPOAE, and both inflamed middle-ear mucosa and osteoneogenesis caused a decrease in DPOAE amplitude.

This is the first report examining the influence of topically used otic drops on inner ear function as demonstrated by OAE.

The possible cochlear toxicity of topically applied povidone-iodine solution was investigated in guinea pigs by measuring transiently evoked otoacoustic emissions (TEOAEs). Seven adult pigmented guinea pigs (14 ears) with a normal acoustic pinna reflex were used. After the baseline TEOAE measurements, 0.1mL of povidone-iodine solution was applied transtympanically into the middle ear in the study group. Saline solution and gentamicin were used as negative and positive control, respectively. TEOAE measurements were repeated on the 10th day, and four weeks after the first application. Tympanometric measurements were also carried out for both ears of all animals at the end of the study. Responses in all ears, which had povidone-iodine applied to them, disappeared in a way similar to those recorded in gentamicin-treated ears. Tympanometric measurements at the end of the study showed ’type A’ tympanograms in all ears of all animals. The present study showed that povidone-iodine could have a cochleotoxic effect in guinea pigs. A study in humans with TEOAE before and after middle-ear surgery, where povidone-iodine can reach into the middle-ear cavity, may be useful for evaluating this result for clinical practice.

The aim of this work was to determine the effect of extracorporeal shock wave lithotripsy (ESWL) on the hearing of both patients and staff members exposed to such treatment. It used different hearing screening instruments, and compared the sensitivity of these instruments for the detection of the earliest change in hearing induced by this procedure.

The results of this study show that ESWL has a potentially hazardous effect on hearing. This effect is subtle, could only be detected by transient evoked otoacoustic emissions (TEOAE), and is manifested in some of the subjects under study as temporary subjective hearing loss and tinnitus, reflecting a state of temporary biomechanical derangement of the outer hair cells. This effect seems to be related to the frequency of exposure to ESWL.

Background and objective The laryngeal tube is a variant of the oesophageal obturator airway. The manufacturer claims that it is an alternative to ventilation with a facemask, laryngeal mask or endotracheal tube. To date, published studies have only involved controlled ventilation. We wished to find out if its use in spontaneous ventilation was equivalent to using the laryngeal mask airway.

Methods We have compared the laryngeal tube with the laryngeal mask in a randomized prospective study involving patients breathing spontaneously under general anaesthesia. Criteria and a scoring system were used for the comparison. A sequential analysis chart with P=0.01 was chosen for each of two anaesthetists.

Results Only seven and 10 pairs of patients were required to indicate that the laryngeal tube was poorer at airway maintenance than the laryngeal mask. Of the 17 patients who had received the laryngeal tube, successful airway maintenance was only possible in seven. In the remaining 10 patients, the laryngeal tube was abandoned and the rescue airway was the laryngeal mask in all cases. All 17 patients randomized to the laryngeal mask were successfully managed.

Conclusions We conclude that the laryngeal tube is not a satisfactory device for management of the airway during spontaneous ventilation.

Five patients of various ages with difficulty in speech discrimination were evaluated. All showed evidence of abnormal auditory brainstem responses (ABRs) beginning with the VIIIth cranial nerve. Broad summating potentials were evoked on their electrocochleograms (EcochGs) and they all exhibited almost normal cochlear outer hair cell function by otoacoustic emissions (OAEs) recordings. Behavioural audiometric testing revealed a mild to moderate elevation of pure-tone threshold in all patients. The shape of their pure-tone losses varied, being predominantly low-frequency in four patients (rising slope pattern) and flat across all frequencies in one patient. Speech intelligibility scores of all patients were poor and out of proportion to what would have been expected if threshold elevation of pure-tone was of cochlear origin (i.e. markedly poor scores on the speech audiogram with good scores on the auditory comprehension test). Patients were neurologically normal when the hearing impairment was first manifested. We suggest that this type of hearing impairment is due to an isolated and sporadic disorder of auditory nerve function. It occurs in isolation and does not seem to be part of a generalized neuropathological process.

Infantile myofibromatosis is a rare benign tumour usually occurring early in infancy. We describe the case of a 10-year-old boy with solitary infantile myofibromatosis in the left lateral orbit floor which regressed spontaneously. Although our patient was older than previously reported cases and showed bony destruction confirmed by computed tomography (CT), this tumour was diagnosed as infantile myofibromatosis based on immunohistochemical findings. The tumour disappeared spontaneously six months after incisional biopsy, that also indicated this tumour was an infantile myofibromatosis.

A prospective study of a method of anaesthetizing children for magnetic resonance imaging was carried out. The end-tidal carbon dioxide, respiratory rate and oxygen saturation of 23 children undergoing magnetic resonance imaging were monitored. The children underwent halothane anaesthesia breathing spontaneously via an endotracheal tube and a modified Bain breathing system.

The children were divided into two age groups. In all groups the end-tidal carbon dioxide and oxygen saturation values remained at or near normal for the duration of the scan. All children were recovered within 10 min and there were no post-anaesthetic problems. We suggest, that in the absence of respiratory problems or a rise in intracranial pressure, this is a safe and appropriate technique for magnetic resonance scanning in the child.

A case of spontaneous rupture of the tympanic membrane during anaesthesia is reported and its possible aetiology discussed.

Spontaneous perforation of the oesophagus is extremely rare in children, as is perforation due to vomiting in pregnancy. We report the case of a 15-year-old in whom vomiting inearly pregnancy resulted in oesophageal perforation with subcutaneous emphysema causing marked facial swelling in the absence of other signs. The more common clinical presentation of spontaneous oesophageal rupture (Boerhaave's syndrome) is discussed.