To analyse the possible factors contributing to spontaneous cerebrospinal fluid (CSF) rhinorrhea and to assess the outcome of Transnasal endoscopic repair at our centre. Retrospective case series of patients with spontaneous CSF rhinorrhea at our institution from Jan 2006 to May 2010. 7 patients were diagnosed with spontaneous CSF rhinorrhea. 5 of the 7 patients were obese, middle aged females managed with Transnasal endoscopic repair with fascia lata auto graft. Successful repair of CSF rhinorrhea was achieved in all the patients with a single endoscopic procedure; no patient required a revision procedure. Spontaneous CSF rhinorrhea is a rare condition seen mostly in middle aged obese females with the anterior part of the cribriform plate being the most common site of leak. HRCT paranasal sinus (1 mm cuts) was an effective modality of investigation in our study with ancillary investigations been CT Cisternography, CSF analysis and MRI for inactive leaks. In the absence of a large breech of the skull base, endoscopic repair of CSF rhinorrhea carries a high success rate with a high safety margin and very low morbidity rate.

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Application of a continuous positive transpulmonary pressure by producing a continuous negative chest wall pressure (CNP) was utilized in the treatment of 49 infants with severe hyaline membrane disease (HMD). In 23 infants in whom spontaneous alveolar ventilation was adequate, CNP was associated with an average elevation in arterial Po2 of over 40 mm Hg while inspired oxygen concentration remained unchanged. Alveolar-arterial O2 tension difference (A-aDo2) decreased significantly. All of these infants survived. In 26 infants with severe alveolar hypoventilation, CNP was used in conjunction with artificial ventilation. Arterial Po2 increased significantly and A-aDo2 decreased. Twelve of these infants survived (46%). The overall survival rate was 71.5%. CNP appears to be an important adjunct to the therapy of severe HMD.

The course of 50 p a t i e n t s (34 male, 16 female) who received 56 courses of chlorambucil together with prednisone (1.5-2mg/kg/d) f o r s t e r o i d responsive b u t f r e q u e n t l y r e l a p s i n g o r s t e r o i d dependent nephrotic syndrome has been evaluated over a period of 0.3-15 y r s (mean 3.2 y r s ) . A l l b u t 2 (both < 4 y r s o l d a t time of therapy) had remissions l a s t i n g longer than t h a t induced by s t e ro i d s alone. Only 8 p a t i e n t s experienced a r e l a p s e 0.3-5 y r s a f t e r t h i s therapy, 6 of whom had d i s e a s e < 3 y r s a t t h e time o f t r e a tment. Of 6 who received second courses of chlorambucil, 5 responded with remissions c u r r e n t l y l a s t i n g 0.3->5 yrs; one f a i l e d t o respond t o both high dose courses. L i f e t a b l e a n a l y s i s shows t h e chlorambucil response t o be more p e m n e n t than t h a t reported with cyclophosphamide. Actuarial a n a l y s i s of two dose schedules o f chlorambucil (< 0.3mg/kg/d o r < 14mg/kg t o t a l dose vs. > 0.3 mg/kg/d o r > 14mg/kg t o t a l dose) shows low dose treatment t o be a s e f f e c t i v e a s higher doses; a t 5 y r s . 85% o f low dose and 77% o f high dose p a t i e n t s were still i n remission. Immediate s i d e e f f e c t s were n o t dose r e l a t e d and included herpes z o s t e r ( 3 ) . s e i z u r e s ( 2 ) , and g a s t r i c symptoms ( 2 ) . The r e s u l t s suggest: 1 ) c o n t i n u a l use o f h i g h dose chlorambucil i s unwarranted; 2) i n terms o f immediate response, immediate t o x i c i t y and long-term e f f e c t , chlorambucil has advantages over cyclophosphamide. by Thos. L. Nelson.) University of C a l i f o r n i a , I r v i n e . Department of Peds., I r v i n e , CA. NEUROLOGYAuditory evoked brainstem and slow c o r t i c a l potentials(AEBP) (SCP) were studied i n 4 pretenn i n f a n t s w i t h g e s t a t i o n a l ages(GA) l e s s than 28 weeks. Weights ranged from 560-850 gms. AEBP were measured a s responses t o a u d i t o r y c l i c k s a t sound i n t e n s i t i e s of 25,45h 65 dBSL.75 dBSL c l i c k s were used i n two i n f a n t s . 10 c l i c k s per s e c were presented monaurally and responses t o 2048 c l i c k s were amplified and computer averaged. 256 c l i c k s a t a r a t e of l / s e c a t 65 dBSL were averaged f o r t h e SCP. No AEBP were obtained i n 3 i n f a n t s a t 25 and 26 weeks GA a t 25, 45 h 65 dBSL. One i n f a n t a t 26 weeks had only 2 i d e n t i f i a b l e waves, 1 h IV-V. An i n c r e a s e t o 75 dBSL r e s u l t e d i n t h e appearance of BP i n 2 i n f a n t s . 65 dBSL c l i c k s however r e s u l t e d i n SCP with a negative-going def l e c t i o n between 100 and 200 msec. 2 of t h e i n f a n t s developed c l e a r l y defined waves 2-3 weeks l a t e r a t 65 dBSL. The b a s i s f o r t h i s threshold d i f f e r e n c e is unclear, but may be due t o t e c h n i c a l f a c t o r s favoring t h e l a r g e r amplitudes i n CP (1-1hV) over BP (<0.5pV), d i f f e r e n t r...