Unilateral deafness with subsequent vertigo.

The association between the characteristic clinical picture of endolymphatic hydrops and pre-existent profound sensori-neural hearing loss of long duration, has not been previously reported. Several cases are reported to illustrate this clinical syndrome. Labyrinthectomy was found to be curative. A plea is made for better recognition of this clinical entity.     

Preoperative vs postoperative radiation therapy for extremity soft tissue sarcoma: controversy and present management

PURPOSE OF REVIEW: The 5-year results of the Canadian multicenter prospectively randomized phase III trial that compared preoperative with postoperative radiotherapy for patients with extremity soft tissue sarcomas were recently presented at the 2004 meeting of the American Society of Clinical Oncology. These latter findings serve as an impetus for this current review to assess the optimal sequencing of adjuvant radiotherapy for such patients undergoing limb-preserving surgery. RECENT FINDINGS: The recent studies, including the 2004 American Society of Clinical Oncology presentation, described in this paper show no significant rise in the incidence of long-term side effects, such as delayed wound healing and subcutaneous tissue damage, in patients with extremity soft tissue sarcomas who receive once-daily preoperative irradiation followed by limb-preserving surgery. Postoperative radiotherapy may be best reserved for patients who are most likely to undergo a wide local excision with adequate (>10 mm) tumor-free margins (such as low-grade lesions in the lower extremities). There is an increasing use of neoadjuvant chemoradiation in this group of patients, especially for high-grade and large lesions. SUMMARY: Further investigations regarding the preoperative management of extremity soft tissue sarcomas are continuing in an attempt to optimize the survival and functional status of these patients, while minimizing the permanent side effects resulting from such treatment.     

How ready are colleges for an environmental approach that utilizes campus/community coalitions?

While there is optimism about an environmental management approach that utilizes campus-community coalitions to reduce levels of high-risk drinking, the readiness of schools to implement such an approach is unknown. We surveyed 100 colleges regarding their readiness based on eight factors: existence of a task force to address alcohol use on campus; the inclusion of the college/university President; inclusion of a community representative; frequent meetings; external funding to address alcohol use; previous environmental training; changes implemented as a result of environmental training; and a plan to institute environmental training in the future. Having an alcohol task force or coalition (57%) was associated with participation by the president and/or community representative on the task force, having extramural funding to address high-risk drinking, training in environmental management, implementation of changes after the training, plans for future training, school size, Greek organizations on campus, and being a state university.     

Tamoxifen Therapy for Breast Cancer and Endometrial Pathology

Background

Tamoxifen, used as adjuvant therapy for carcinoma breast in postmenopausal women to prevent relapse has estrogenic effect on the endometrium.

Methods

104 patients on tamoxifen for more than six months were subjected to a clinical examination and transvaginal sonography. Patients with endometrial thickness > 8 mm were further evaluated by hysteroscopy and endometrial biopsy.

Results

35(34%) patients were symptomatic. The average endometrial thickness was 11.2 mm which correlated with duration of tamoxifen use. 27(48%) patients had abnormal hysteroscopic findings. 35 (63%) of endometrial biopsies revealed abnormal endometrium. One case of endometrial carcinoma was diagnosed. The results were statistically analysed. There is a significant association between symptomatic status and endometrial thickness and duration of tamoxifen use.

Conclusion

All patients on long term tamoxifen should be annually screened for endometrial pathology.Key Words: Tamoxifen, Endometrium, Transvaginal sonography     

Developing a decision instrument to guide computed tomographic imaging of blunt head injury patients

BACKGROUND: Computed tomographic (CT) head scanning of blunt trauma patients is expensive, delays care, and necessitates radiation exposure, while detecting intracranial injuries in a minority of patients. Clinical characteristics may be able reliably identify patients who do not have intracranial injuries and consequently, do no require imaging. METHODS: Physicians assessed blunt trauma patients undergoing imaging for the presence or absence of specific criteria. Recursive partitioning was used to identify criteria that predict intracranial injuries with high sensitivity. RESULTS: Intracranial injuries were found in 917 of 13,728 enrolled patients (6.7%). Injuries were rare among patients under age 65 who had no evidence of skull fracture, scalp hematoma, neurologic deficit, abnormal alertness, abnormal behavior, coagulopathy, or persistent vomiting. These characteristics would have identified 901 injury cases (sensitivity 98.3% [CI: 97.2-99.0]), while classifying 1,752 patients (12.8%) as "low risk." CONCLUSIONS: Clinical characteristics can reliably identify patients who are unlikely to have intracranial injuries and who do not require CT imaging.     

Erring on the side of Theresa Schiavo: reflections of the special guardian ad litem

THE SCHIAVO CASE Four commentators discuss what made it so difficult, why it was more complex than most realized, and what we should do differently.     

Caliber of the lumen of the eustachian tube pre-isthmus in infants and children

We measured the eustachian tubes in temporal bones taken from infants and children. These specimens included eustachian tubes from 35 normal temporal bones and 13 temporal bones containing acute and secretory otitis media. All temporal bones were serially sectioned for histological studies. The lumen of the third portion of each eustachian tube (i.e., the pre-isthmus or the physiological isthmus) was measured with the aid of a grid mounted on a microscope. These measurements showed: (1) the eustachian tube lumen grows and enlarges to a small degree with age; (2) each age group has a considerable variation in the size of the lumen which is compatible with natural biological distribution; (3) no statistical differences were found in the size of the pre-isthmus lumina of those eustachian tubes from temporal bones showing acute or secretory otitis media when compared with the lumina of eustachian tubes in non-pathological ears.     

Continuous monitoring of cervical dilatation during labour by ultrasonic transit-time measurement

Instrumentation for continuously measuring cervical dilatation during labour based upon measuring the transit time of a short pulse of ultrasound across the intracervical space is described. 1 mm × 1 mm × 5 mm ultrasonic transducers are attached to diametrically opposite sides of the cervical rim by spring-loaded clips, and their separation increases as the cervix dilates. The velocity of ultrasound in the intracervical space has been determined to be 1·48 mm/μs, making it possible to convert the transit-time measurements between the transducers to displacement. Samples are taken once a second, allowing a continuous recording to be made throughout labour. Examples of cervical dilatation recordings from primigravid and multiparous patients are presented.