Is secretory otitis media a single disease entity?

The outcome of 809 children who had middle ear effusion (MEE) was correlated with their age and medical history and the bacteriologic and cytologic findings of the MEE. Three groups emerged. Group A (n = 384) had a medical history of relatively recent acute otitis media (AOM) with a peak prevalence of 2.6 years of age, and its MEE was hypercellular (mostly polymorphonuclear leukocytes) with a 24% rate of positive bacteriologic culture. In contrast, the peak prevalence of group B (n = 280) was approximately 5 years of age. Its MEE followed no otologic medical history and was bacteriologically sterile with relatively few cells (mostly lymphocytes typical of viral infections). Group AB (n = 145) resembled group B except that they had a history of AOM some years before hearing loss onset. Altogether, the clinical features of group A are statistically distinguishable from those of groups B and AB in most respects. These findings explain the bimodal peak prevalence distribution that was found in many available epidemiological studies of secretory otitis media (SOM) and that was also seen in our data. It appears that SOM should neither be termed nor treated as an otitis media, but as a sequela of either bacterial AOM (group A) or of insidious, asymptomatic, probably viral otitis media (groups B and AB). Our data do not support antibiotic treatment for SOM (otitis media with effusion)--especially not in chronic cases.     

Quality of life following surgery for anterior skull base tumors

OBJECTIVES: To evaluate patients' quality of life (QOL) after surgical extirpation of anterior skull base tumors, to elucidate different QOL domains, and to define possible predictors of functional outcome postoperatively. DESIGN: Retrospective survey. SETTING: University-affiliated medical center. PARTICIPANTS: Sixty-nine patients (76 consecutive cases) who underwent subcranial surgery between 1994 and 2002 for extirpation of anterior skull base tumors. MAIN OUTCOME MEASURE: A multidimensional, disease-specific questionnaire with 39 items was used. Six relevant domains of QOL were assessed: role of performance, physical functioning, vitality, pain, specific symptoms, and impact on emotions. RESULTS: The response rate for completing the questionnaire was 98% (40/41) after excluding patients who died (n = 13), were lost to follow-up (n = 10), and were operated on within 3 months of commencement of the study (n = 5). Thirty patients (74%) reported a significant improvement or no change in overall QOL within 6 months after surgery. The worst impact of surgery on the patients' QOL was on their financial status and emotional state. The most influential factor on QOL was malignancy leading to a significant decrease in the overall score. Radiotherapy, old age, comorbidity, and wide resection also significantly worsened QOL scores of specific domains. CONCLUSION: After subcranial extirpation of anterior skull base tumors, the overall outcome of the patients is good. Old age, malignancy, comorbidity, wide resection, and radiotherapy are negative prognostic factors for these patients' QOL.     

Age dependencies of 90Sr incorporation in dental tissues: comparative analysis and interpretation of different kinds of measurements obtained for residents on the Techa River

Human teeth have been considered as dosimeters for decades. Methods include the in vivo measurement of 90Sr/90Y in teeth with a tooth-beta counter, the radiochemical determination of 90Sr in whole teeth, and the measurement of dose in teeth by use of electron paramagnetic resonance. Presented in this paper are results of 2,514 tooth-beta counter measurements, 334 radiochemical measurements, and 218 electron paramagnetic resonance measurements for residents living in settlements along the Techa River. All three kinds of measurements indicate a sharp peak that corresponds to the uptake of 90Sr by tooth tissue. The results can be interpreted in terms of an intake function for 90Sr only if the period of calcification of each individual tooth is considered--such detail on a tooth-by-tooth basis is presented in this paper. The conclusion is reached that the tooth-beta counter data are the most reliable in terms of reconstruction of 90Sr intake; this is due in part to the fact that the tooth-beta counter measures four teeth (all at position 1) with essentially the same time periods of mineralization and because there are a large number of tooth-beta counter measurements. The main utility of electron paramagnetic resonance measurements is considered to be the validation of estimates of external dose; but for this purpose teeth with 90Sr taken up into enamel must be avoided.     

Age and gender affect the relation between methylenetetrahydrofolate reductase C677T genotype and fasting plasma homocysteine concentrations in the Framingham Offspring Study Cohort

The C677T variant of methylenetetrahydrofolate reductase (MTHFR), a key enzyme in the remethylation of homocysteine to methionine, is a frequent genetic cause of mild hyperhomocysteinemia among individuals with low folate status. However, little is known about the influence of subject characteristics, such as age and sex, on the relation between the C677T MTHFR polymorphism and fasting plasma total homocysteine (tHcy) concentrations. The aim of the present study was to explore the influence of age and gender, together with folate status, on the association between the C677T polymorphism and tHcy concentrations. The C677T genotype was determined for 1820 participants from the fifth examination of the Framingham Offspring Study. Mean age of the participants was 56 y (range 28-82 y). The allelic distribution was not different from the Hardy-Weinberg equilibrium, with a TT frequency comparable in men and women (14%). Geometric mean tHcy was 15% higher in men than in women (P < 0.001), and women had significantly higher plasma folate levels (P < 0.001). Geometric mean tHcy was significantly higher in TT participants (P = 0.001) than in participants with the CC and CT genotypes among those with plasma folate <12.5 nmol/L, but not among those with higher folate status. Because of a significant age and sex interaction (P = 0.02), we further stratified the low folate group by age and sex, and observed that the association between genotype and tHcy was confined to men <55 y old (P < 0.001). Our results suggest that age and sex modify the contribution of the MTHFR C677T mutation to fasting tHcy concentrations.     

Increasing diagnostic yield in allergic fungal sinusitis

Diagnosis of allergic fungal sinusitis (AFS) in patients who present with rhinosinusitis and polyposis is based upon certain clinical, histopathological and mycological histopathological criteria are the demonstration of fungal hyphae in allergic mucin and absence of tissue invasion in the excised polyps. Previous reports have indicated difficulty in demonstrating fungal hyphae on histological examination in up to 75 per cent of cases. Analysis of a series of 25 patients with AFS, suggested methods to ensure demonstration of fungal hyphae and thus increase diagnostic yield in cases with suspected AFS. criteria. Specific diagnostic     

Idiopathic lymphoepithelial cyst of the parapharynx masquerading as peritonsillar abscess

We present a case of a 38-year-old man who was referred to us with a right-sided quinsy. However he was found to have a large lympho-epithelial cyst in his right parapharynx mimicking the signs of a quinsy to the unsuspecting eye. We describe this case to illustrate an unusual cause of a swelling of the lateral pharyngeal wall.     

Expanded polytetrafluoroethylene reinforcement material in glaucoma drain surgery

PURPOSE: To determine whether a synthetic material, expanded polytetrafluoroethylene (E-PTFE), can be used successfully as a reinforcement material over the tubes of glaucoma drainage implants. METHODS: Patches of E-PTFE were sutured over the tubes of Baerveldt glaucoma drains implanted in the eyes of New Zealand white rabbits. Two material thicknesses were tested: 0.5 mm in four eyes and 0.25 mm in five eyes. Rabbit donor scleral patches were used in five eyes as the control. Total ocular health and intraocular pressure were monitored every 2 weeks after the procedure. Six months after implantation, the eyes were harvested and analyzed histologically. RESULTS: Two of the four eyes that received 0.5-mm thick E-PTFE patches showed some conjunctival melting over the anterior corners of the material close to the limbus. All five eyes that received 0.25-mm thick E-PTFE patches showed a healthy cellular wound healing response and no conjunctival melting. Cellular infiltration and collagen deposition in the E-PTFE materials showed integration of the patch material into the surrounding tissue. In the control eyes, marked thinning and resorption of the donor sclera immediately above the drainage tube was noted. CONCLUSION: Thin (0.25 mm) E-PTFE patches were well tolerated in all rabbit eyes tested. Thin E-PTFE should be investigated further as a functional alternative to donor sclera for reinforcement in glaucoma drain surgery.     

Inhibition of thrombin by iopromide in vitro

Iopromide is a nonionic, iodinated, monomeric, radiographic contrast agent used in various indications, including coronary angiography and visceral and peripheral arteriography. Nonionic contrast media have been postulated to increase thrombogenicity when compared with ionic contrast media. The goal of this study was to characterize the interaction of iopromide with thrombin, specifically to determine the rate, extent, specificity, and reversibility of the thrombin inhibition by iopromide, the integrity of the thrombin-iopromide complex, and the inhibitory potency of iopromide using a validated assay methodology. Iopromide was mixed with purified thrombin or pooled serum from healthy male and female donors. The final concentrations of iopromide in the presence of estimated physiologic concentrations of thrombin (1 nmol/L) were 0-184 mmol/L. After incubation for defined time intervals, the activity of thrombin was determined by adding substrate and measuring the absorbance of the generated chromophores at 405 nm. The possible inhibition of the protease trypsin by iopromide was investigated to evaluate the specificity of thrombin inhibition by iopromide. Iopromide was compared with Thromstop, a known thrombin inhibitor, to assess the relative potency of iopromide. The inhibition of thrombin by iopromide was immediate, rapidly reversible, and proportionate to the iopromide concentrations. The minimum inhibitory concentration of iopromide was 50 mmol/L. At the highest iopromide concentration tested, 184 mmol/L, the mean inhibition of thrombin activity was 44.5%. The mean concentration of iopromide associated with a 50% inhibition was 206 mmol/L. The inhibitory potency of iopromide was 4 x 10(6) times smaller than that of Thromstop. The inhibition of thrombin by iopromide is specific, because trypsin was not inhibited by iopromide. The results indicate that in vitro iopromide at clinically relevant concentrations partially inhibits thrombin activity. However, the in vitro model used does not consider other factors that may be relevant for the overall coagulation response in vivo.