Solitary rectal ulcer syndrome presenting as polypoid mass lesions in a young girl

Solitary rectal ulcer syndrome (SRUS) is a rare condition in children. We report a case of SRUS in an 8-year old Saudi girl who presented with recurrent rectal bleeding, intermittent mucosal prolapse, and passage of mucus per rectum. Colonoscopy revealed multiple polypoid mass lesions with histopathological features of SRUS. The polypoid variant of SRUS is very rare in children and may be confused with rectal malignant or inflammatory conditions.     

Bilateral hearing loss during vincristine therapy: a case report

Vincristine sulfate is a chemotherapeutic agent used in different cancer therapies. It is also the first choice of treatment for peripheral T-cell lymphoma with cyclophosphamide and adriamycin. Sudden hearing loss during vincristine therapy is a very rare event. This is a case of a 16-year old girl who developed sudden bilateral hearing loss related to vincristine therapy.     

Reversible mechlorethamine-associated hearing loss in a patient with Hodgkin's disease

Mechlorethamine, when administered in massive doses (0.6-1.5 mg/kg) to cancer patients in several early studies, caused severe irreversible hearing loss. There have been no reports of ototoxicity with doses of 0.4 mg/kg or less. The authors describe a 36-year-old man who developed profound sensorineural hearing loss during his first cycle of MOPP chemotherapy for Hodgkin's disease. Cyclophosphamide was substituted for mechlorethamine in subsequent cycles and his hearing deficit resolved. This is the first reported case of reversible ototoxicity associated with currently recommended doses of mechlorethamine.     

Adult T-cell leukemia/lymphoma presenting with bilateral hearing loss

A 44-yr-old Jamaican male who presented only with bilateral hearing loss was found to have hypercalcemia, which, upon further investigation, was found to be due to adult T-cell leukemia/lymphoma (ATLL) syndrome. This is the first case of ATLL presenting with bilateral auditory conduction hearing loss, which responded to combination chemotherapy along with alleviation of other manifestations of ATLL.     

Bilateral transient hearing loss associated with vincristine therapy: case report

Vincristine, adriamycin, and dexamethasone (VAD) chemotherapy protocol is first-choice treatment in newly diagnosed multiple myeloma patients in many centers. Sudden hearing loss associated with vincristine therapy is a rarely observed event in the VAD protocol. We describe a 69-year old male patient diagnosed with multiple myeloma 7 months ago who developed sudden bilateral hearing loss related to vincristine therapy. This uncommon adverse effect of vincristine is discussed and the literature reviewed.     

Sudden hearing loss due to oxaliplatin use in a patient with colon cancer

Oxaliplatin is used to treat advanced colorectal cancer. Platinum-containing chemotherapeutic agents are known to be ototoxic. However, ototoxicity is rare with newer generation platinum-derived agents, such as oxaliplatin. This case report presents a rare case of sudden unilateral sensorineural hearing loss following intravenous (IV) infusion of oxaliplatin in a 64-year-old woman with advanced colon cancer. The hearing loss was severe and did not respond to treatment. To the best of our knowledge, this is the fifth reported case of oxaliplatin ototoxicity. Although oxaliplatin ototoxicity is rare, physicians must be aware of this important adverse effect, and an audiometric evaluation must be performed when necessary. Patients treated with oxaliplatin should be followed closely for early signs and symptoms of hearing loss, and if hearing loss is detected, treatment should be stopped immediately.     

Bilateral adrenal lymphoma presenting as Addison's disease and hypercalcaemia

The adrenal gland is not uncommonly involved in lymphoma. It is rare, however, for adrenal lymphoma to present as Addison's disease. There are only eight reports in the English literature. This paper reports a case of adrenal lymphoma that presented with Addison's disease and hypercalcaemia.     

Bilateral irreversible hearing loss associated with the combination of carboplatin and paclitaxel chemotherapy: a unusual side effect

The regimen with paclitaxel and platinum compound (carboplatin or cisplatin) is the standard chemotherapy for patients with advanced ovarian cancer. Ototoxity for carboplatin and paclitaxel alone or combined is rarely observed. We report the case of a 35-year old female with advanced ovarian cancer who developed sudden bilateral sensorineural hearing loss related to paclitaxel and carboplatin based chemotherapy. This uncommon adverse effect of carboplatin and paclitaxel alone or combined is discussed and the literature reviewed. Hearing monitoring should be mandatory to evaluate the real incidence of clinical and sub-clinical hearing modification induced by carboplatin and paclitaxel based chemotherapy.     

Delayed sodium thiosulfate as an otoprotectant against carboplatin-induced hearing loss in patients with malignant brain tumors.

Carboplatin is effective in the treatment of malignant brain tumors. However, when administered in conjunction with osmotic opening of the blood-brain barrier (BBB), carboplatin is ototoxic. The purpose of this study was to determine whether delayed administration of sodium thiosulfate (STS), given after BBB closure, provided protection against carboplatin ototoxicity. Patients underwent monthly treatment with intra-arterial carboplatin (200 mg/m2/day x 2) in conjunction with osmotic opening of the BBB, for up to 1 year. Audiological assessment was conducted at baseline and within 24 h before each monthly treatment. STS was administered i.v. as one (20 g/m2) or two (20 g/m2 and 16 g/m2) 15-min doses, depending on baseline hearing status. The initial group received the first STS dose 2 h (or 2 and 6 h) after carboplatin (STS2) and a subsequent group received STS 4 h (or 4 and 8 h) after carboplatin (STS4). Audiological data were compared with a historical comparison group (HCG) treated with carboplatin without STS. Spearman correlation coefficients comparing STS 2 (n = 24), STS4 (n = 17), and HCG (n = 19) indicated significantly lower rates of ototoxicity with increased delay in STS (P = 0.0006). On the basis of the analysis of hearing levels, there were significant differences among the two STS groups and HCG at 8000 Hz (P = 0.0010) and at 4000 Hz (P = 0.0075). The log-rank test for time to ototoxicity indicated a significant difference between STS4 and HCG (P = 0.0018). Delayed STS was effective in protecting against carboplatin-induced hearing loss. STS delayed to 4 h after carboplatin significantly decreased time to development of ototoxicity and rate of ototoxicity when compared with HCG.     

Pulmonary tuberculosis presenting as mass lesions and simulating neoplasms in adults

In a review of the chest X-rays and medical records of 597 cases of culture- or biopsy-proven pulmonary tuberculosis (PTB; age range 1.5-72 years), seen over a period of 6 years (1991-97), 26 patients had radiographic patterns unusual for PTB. These patterns were mass-like densities simulating neoplasms, chronic lower lobe airspace opacities without adenopathy, mediastinal adenopathy without parenchymal airspace opacities and bronchopleural fistula without other radiographic abnormalities. The most common of these unusual radiographic patterns was mass-like densities, most of which were initially and mistakenly diagnosed as neoplasms. These masses, seen in 11 adult patients, form the basis of this report. Two children aged 1.5 and 2 years also had tuberculous mass densities initially diagnosed as neurogenic tumour and round pneumonia, respectively. They have been excluded from the present series, and form the subject of another report. The masses were lower lobe predominant and were not usually associated with fibro-productive satellite lesions or with calcification or cavitation. In view of the recent resurgence of PTB and the importance of chest X-rays in its diagnosis and management, this rare radiographic pattern needs to be emphasized.     

Adenocarcinoma of prostate presenting as brain metastasis

The diagnosis of brain metastasis from prostate carcinoma is rarely made antemortem, and has previously been reported only in patients with known extensive metastatic disease of long duration. A case of adenocarcinoma of the prostate presenting as a brain metastasis is described. Current concepts of metastatic spread of prostate carcinoma are reviewed.     

Multiple myeloma presenting as space-occupying lesions of the liver

Initial myeloma presentation as discrete liver nodules is unusual. A 59-year-old man who presented with hepatomegaly and multiple space-occupying lesions in the liver and who was found to have a lambda light chain multiple myeloma with hepatic plasmacytomas is described and a review of liver involvement in multiple myeloma is presented.     

Primary pulmonary tuberculosis presenting as mass lesions and simulating tumours in children

Two cases of primary pulmonary tuberculosis presenting as mass densities and simulating neoplasms in children are reported. This manifestation has not been previously reported in children. It probably represents an unusual immunological response to the mycobacterium.     

Hypertensive retinopathy and sensorineural hearing loss

Objective

To determine the correlation between hypertensive retinopathy (which is the end-organ damage of the vessels due to chronic hypertension) with sensorineural hearing loss.

Methods

Pure tone hearing threshold of 56 hypertensive patients were compared with 56 normal age and sex matched control. Comparisons of pure tone hearing threshold are made among different group (grade) of hypertensive retinopathy patients and control (non-hypertensive patients).

Results

The mean hearing thresholds were higher (worse) in all the frequencies on both sides in the hypertensive study group compared with normal subjects. However it was found to be statistically significant when tested using independent sample test (p < 0.05) on right ear at 2,000 Hz, 4,000 Hz and 8,000 Hz only. The mean hearing threshold is higher in all frequencies in the presence of retinopathy compared to control. However, the difference was found to be only statistically significant in the mean hearing threshold between grade I and control at 4,000 Hz and 8,000 Hz on both sides and at 1,000 Hz and 2,000 Hz on right ear. Hypertensive patient with grade I retinopathy had higher pure tone hearing thresholds at 4,000 Hz and 8,000 Hz compared to hypertensive without retinopathy and normal control.

Conclusions

Hypertensive retinopathy appears to be associated with high frequency sensor neural hearing loss.     

Visual analog scale in hearing loss

Objective

To determine if visual analog scale (VAS) that has been used to measure magnitude of internal states such as pain, mood and various functional capabilities can be applied for patients with hearing loss.

Materials and methods

One hundred and sixty patients, aged 12–80 years with unilateral hearing loss were studied using a VAS (1–10) and pure tone audiometry (PTA) of responses to 500, 1,000 and 2,000 Hz to determine degree and type of hearing loss. The results of both were compared to determine if VAS can be used in measuring hearing loss.

Results

Patients with mild, moderate hearing loss correlate well with corresponding VAS but other degrees of hearing loss (severe and profound) have poor correlation. The best correlation between PTA and VAS were found in conductive type of hearing loss.

Conclusion

This study suggest that there may be a role for VAS in mild and moderate hearing loss. This may be more applicable in rural setting as a screening procedure when audiometry is not available and can enhance clinical hearing assessment especially in mild-to-moderate conductive hearing loss.     

Occupational hearing loss in textile workers

The present investigators measured the noise levels in a large textile factory and auditory thresholds of 500 subjects each in ‘noisy’ and ‘non-noisy’ areas. Fairly high and potentially damaging General Noise Levels were observed in the Textile Industry. Subjective rating of degree of hearing loss did not correlate with the audiometric findings. Hearing conservation programme must be initiated at the earliest to avoid this incurable but preventable hearing loss.     

Congenital hearing loss in venereal disease

A total of 367 cases of deafness from various Deaf schools were studied to detect Congenital Venereal Disease. A complete General medical, Otorhinolaryngological and Venereological examination was done followed by blood VDRL analysis and audiological assessment. Out of 367 cases, 112 cases had definite family history of deafness, 6 gave history of consanguinity and 7 cases had CSOM in either one or both ears. A majority of cases had hearing loss of more than 90 dB at speech frequencies in both ears and only in a small percentage the hearing threshold was 60dB. Of the 367 blood samples tested only one (a female child aged 11 years and whose audiogram showed a flat response of 100 dB in both ears) had a weak reaction at zero dilution to the VDRL test. Congenital syphilis is insignificant as a causative factor of deafness among our children, in contrast with other studies.