Postauricular myocutaneous flap in otologic surgery

Management of a large mastoid defect resulting from skull base operations or extensive surgical procedures because of chronic ear disease continues to challenge the otologic surgeon. Various local muscle or periosteal rotation flaps have been used to help reduce the size of the postoperative mastoid cavity. With these techniques there are problems with flap retraction and epithelization that may result in delayed healing or chronic drainage. Closure of the ear canal and tissue obliteration of the mastoid results in a maximal conductive hearing loss. A postauricular myocutaneous flap based on the occipital artery and sternocleidomastoid muscle has been used effectively to reconstruct mastoid defects after both surgical procedures for chronic ear disease and skull base operations. The skin muscle flap reduces the mastoid cavity and promotes rapid healing of the surgical defect. Although postauricular myocutaneous flaps have been found to be reliable, their viability may be compromised by arterial embolization used in larger glomus tumors. Indications for and creation of a postauricular myocutaneous flap, with results in 18 cases, are presented. (Otolaryngol Head Neck Surg 1998;118:743-6.)     

Transtelephone Monitoring for Pacemaker Follow-Up 1981–1994

Transtelephone monitoring (TTM) is capable of detecting pacemaker pulse generator malfunction, battery depletion, and lead failure. The accuracy of TTM was analyzed by a review of Montefiore Medical Center records between October 1981 and March 1994. Each group of transmissions from a single patient, starting with implant and ending with a pacemaker operation, was defined as a closed cycle (CLOSE), if undergoing continuing follow-up at the time of analysis, as a continuing cycle (CONT), and if a cycle had ended with death or loss to follow-up, an open cycle (OPEN). TTM records of 2,632 patients were analyzed, providing 3,291 cycles. There were 731 CONT, 433 CLOSE, and 2,127 OPEN cycles; 331 procedures were indicated by TTM. of which 279 were impending depletion, 30 sudden depletion, and 22 lead malfunctions. Of the 102 procedures not indicated by TTM, 85 were for nonurgent reasons (recall: 41; DDD upgrade: 16; patient/MD request: 28) and 17 for urgent reasons. In patients followed by TTM who had a lead problem, 22 were detected by TTM before clinical manifestations and 16 were not. There were no cases in which TTM follow- up did not detect battery depletion. The total number of TTM contacts, available for 3,094 cycles, was 88,654 (range, 1–163, median 19), of which 0.4% yielded a procedure. During the same period, 75% of all secondary interventions during the first 2 years occurred during the first 2 months after implant because of lead malfunction, with a subsequent SI rate of 0.005 per month for the third through the twenty-fourth months.     

Reduced attention-related negative potentials in schizophrenic adults

Event-related potentials were recorded from outpatient adult schizophrenics receiving maintenance doses of neuroleptics and from normal control subjects during performance of a reaction time task and a complex visual discrimination task, the Span of Apprehension. Difference potentials were computed to isolate endogenous activity associated with the processing demands of the Span task. Schizophrenics produce significantly less early endogenous negative activity than do normal subjects. This processing-related negativity reflects pattern matching activity to an attentional trace during the serial scan of the visual icon. We previously reported an identical reduction in processing-related negativity in childhood-onset schizophrenia, suggesting that this deficit is age independent. Both frontal contingent negative variation and an early frontal P3 were larger in the schizophrenics than in normal subjects, suggesting an inappropriate mobilization of nonspecific attentional resources. A later posterior P3 was significantly smaller in schizophrenics than in normal subjects.     

Acoustic Stimuhtion-induced Fetal Response Compared to Traditional Nonstress Testing

Eighty-eight nonstress tests (NSTs) were obtained on gravid women between 27 and 44 weeks' gestation to compare the results of a three-second acoustic stimulus with a traditional NST. Length of testing time was significantly decreased with the use of acoustic stimulation. Consequently, nursing time and equipment use were also considerably lessened per test. Previous studies indicated that the predictive value of the acoustic stimulation test is comparable or better than the traditional NST.     

HALOTHANE ADSORPTION COMPLICATING THE USE OF SODA-LIME TO HUMIDIFY ANAESTHETIC GASES

If tbe anaesthetic circle system is arranged to increase thehumidity of fresh anaesthetic gases by placing the carbon dioxideabsorbent canister between the fresh gas inlet and the patient,drying of the soda-lime can occur. Very dry soda-lime adsorbssignificant quantities of halothane. Using fresh soda-lime,effluent halothane concentration reached 50% of the input concentrationin 35 s, but this time increased to 500s when dry soda-limewas used The use of dry soda-lime can result in a slow inhalationinduction or in the release of adsorbed halothane during a subsequentanaesthetic.     

Computed Tomographic Localization of Malposition of Pacing Electrodes: The Value of Cardiovascular Computed Tomography

Three patients with uncertain pacemaker electrode position on plain film radiography were studied with fast cine cardiovascular computed tomography (CT) imaging. The value of this new technique in determining the position of pacing electrodes is discussed.