Early identification and prompt clinical and surgical intervention with mandatory drainage of the middle ear (primary disease), was essential for better outcome.

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One hundred consecutive patients with a clinical suspicion of metabolic inner ear disorder were submitted to a 5-hour glucose tolerance test with simultaneous titration of insulin. It was found that 82% of the patients presented abnormal glucose and/or insulin values. The analysis of the results revealed hypo- or hyperglycemia were present in only 41% of the cases, and that all patients had normal fast values for glucose. Hyperinsulinemia was the most frequent abnormality and was found to constitute the determining factor of the inner ear disorders. 26 of the patients presented Meniere's disease. The pathophysiological model for insulin-induced Meniere's disease is discussed. Follow-up data indicate that these patients respond well to a diet with reduced intake of small molecule carbohydrates.

In 1979, 96 patients who had undergone hemodialysis for a mean of 3 years and 4 months were entered into this study. This follow-up study revealed that the bilateral kidney volume significantly increased over 10 years in 33 male patients. Kidneys were found to have enlarged 2.7 times over the 10-year follow-up period. However, in 24 females kidney volume did not change over 10 years. This paper reports further results in 39 dialysis patients (21 males and 18 females) who were followed from the 10th to 15th year. In male patients, mean volume was 196 ± 218 ml (mean ± SD) at the 10th year and had significantly increased to 225 ± 213 ml at the 15th year (p < 0.02). In female patients, mean kidney volume was 78 ± 51 ml at the 10th year and had increased to 117 ± 91 ml at the 15th year (p < 0.01). The enlargement in kidney volume during the recent 5 years was 1.26 ± 0.39-fold in males and 1.43 ± 0.45-fold in females. These rates did not significantly differ between males and females. During this recent 5-year period, there were no surgical cases due to renal cell carcinoma. Therefore, over the entire patient-time dialysis period, there were 6 renal cell carcinomas in 1,470 patient years. In conclusion, 10- to 15-year follow-up studies of kidney size revealed that the enlargement in the kidney due to acquired cysts persisted in male patients, but the rate of increase slowed after 13.0 years of hemodialysis, while the enlargement in the kidney in female patients became significant at 17.7 years of hemodialysis, revealing the slowly progressive nature of acquired cysts in women.

Sel ective attention is essential for learning how to write and read. Aim: The objective of this study was to examine the process of selective auditory attention in children with learning disabilities. Material and Method: Group I included forty subjects aged between 9 years and six months and 10 years and eleven months, who had a low risk of altered hearing, language and learning development. Group II included 20 subjects aged between 9 years and five months and 11 years and ten months, who presented learning disabilities. A prospective study was done using the Pediatric Speech Intelligibility Test (PSI). Result: Right ear PSI with an ipsilateral competing message at speech/noise ratios of 0 and -10 was sufficient to differentiate Group I and Group II. Special attention should be given to the performance of Group II on the first tested ear, which may substantiate important signs of improvements in performance and rehabilitation. Conclusion: The PSI -MCI of the right ear at speech/noise ratios of 0 and -10 was appropriate to differentiate Groups I and II. There was an association with the group that presented learning disabilities: this group showed problems in selective attention.

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The local use of the trans-retinoic acid is effective in inhibiting the induced formation of cholesteatomas in guinea pigs.

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