Digital filtering and spectral analysis of the low intensity ABR

Spectral analysis along with zero and standard-phase shift digital filtering were performed on evoked potentials recorded from 12 normal hearing subjects. The results indicated a progressive shifting of the mean spectral content of the ABR toward the low frequencies as the stimulus intensity was lowered. Despite this, the effects of zero-phase shift high-pass digital filtering at 100 Hz (36 dB/oct) did not significantly differ between waveforms elicited by a 75 dB nHL, 55 dB nHL, and 35 dB nHL stimulus. The major response frequency of the ABR is related to the distance between the peak (IV/V) and the following major trough (approximates one-half the response period). In waveforms where the major trough occurred before 10 msec, the use of 100 Hz, 36 dB/oct, zero-phase shift high-pass filters produced only a small reduction in response amplitude, even at low stimulus intensity levels. Waveforms which had a major trough (Na1) between 10 to 15 msec were reduced in amplitude by 100 Hz, 36 dB/oct, zero-phase shift high-pass filters (the longer period of the response energy in these waveforms corresponds to a lower energy frequency). However, this trough has a latency that prevents it from being recorded on a 10 msec time base or defined as an ABR. Based on these results, the use of zero-phase shift high-pass filters with a high-pass cutoff frequency that is equal to or less than the resolution of the time base (1/time base) appears to be a desirable method of reducing muscle artifact and other electrical contamination of the ABR.(ABSTRACT TRUNCATED AT 250 WORDS)     

Extramedullary hematopoiesis within the hypotympanicum presenting as a glomus tympanicum

We discuss the case of a 22-year-old black woman who presented with a mass in the left hypotympanicum. Both the pre- and postoperative diagnosis of the lesion was a glomus tympanicum. Histopathologic examination revealed the "tumor" to be a nodule of extramedullary hematopoiesis. Many sickled erythrocytes were also noted within the lesion. A multilingual literature search (English, French, German, Spanish, Portuguese, Italian, and Russian) failed to reveal a documented case of extramedullary hematopoiesis in the hypotympanicum. We assume that the patient's hemoglobinopathy was the cause of her unusual focus of extramedullary hematopoiesis.     

A trial of continuous-infusion vinblastine in refractory endometrial adenocarcinoma

Fourteen patients with refractory or metastatic adenocarcinoma of the endometrium were treated with continuous infusion vinblastine. No patient had a response. One patient had stable disease. Although well tolerated, vinblastine sulfate given by this method has no activity in this malignancy.     

Successful treatment of leptomeningeal relapse of epithelial ovarian cancer

A case of isolated leptomeningeal recurrence of an epithelial ovarian cancer was recently diagnosed and treated successfully with methotrexate placed via an Ommaya reservoir in combination with radiation therapy. A review of the literature revealed no other cases of epithelial ovarian leptomeningeal malignancy similarly treated.     

Yeasts of the genus Candida are the dominant cause of onychomycosis in Libyan women but not men: results of a 2-year surveillance study

BACKGROUND: The reported frequency of recovery of fungi from infected nails varies according to the geographical area. OBJECTIVES: To establish the nature of the causal agents in a sample of the Libyan population presenting with suspected onychomycosis. METHODS: Samples were taken from the infected fingernails of 648 patients attending the Tripoli Medical Centre. RESULTS: Samples from 500 patients proved positive for fungi following culturing, while 476 were potassium hydroxide and culture positive. Of the culture-positive samples, yeasts of the genus Candida (C. albicans, C. parapsilosis, C. glabrata, C. guillermondii and C. tropicalis) were the dominant cause of this condition in women (417 of 434, 96%) but were responsible for only a minority of cases in men (three of 66, 5%). In contrast, dermatophytes (Trichophyton violaceum, T. rubrum, T. mentagrophytes and Microsporum canis) were responsible for this condition in the majority of cases in men (53 of 66, 80%) but only 3% (15 of 434) of cases in women. The mould Aspergillus nidulans was isolated from the nails of 10 (15%) men and two (0.5%) women. CONCLUSIONS: The data obtained in this study reveal an almost total separation of the aetiological agents responsible for onychomycosis based on gender.     

Bilateral subclavian steal syndrome

Background

Bilateral atherosclerotic subclavian artery occlusion is rare.

Aim

To describe the surgical treatment of a patient with symptomatic bilateral subclavian artery occlusion.

Methods

A midline sternotomy and bilateral aorto-subclavian bypass was performed in a male with upper limb, exercise-induced vertigo.

Results

Postoperatively symptomatic improvement paralleled an increase in brachial systolic arterial blood pressure readings.

Conclusion

Bypass grafting is the more durable option for subclavian artery occlusion, as angioplasty with or without stenting is associated with a higher rate of late stenosis.

     

Ovarian Sertoli-Leydig cell tumor: success with salvage therapy

A case of metastatic ovarian Sertoli-Leydig cell tumor is presented. The patient achieved a complete pathologic response with four courses of cisplatin, vinblastine and bleomycin chemotherapy. Recurrence of the tumor was detected with elevated serum alpha-fetoprotein. After surgical debulking, the recurrence was treated with intra-arterial cisplatin and intravenous etoposide with pelvic radiation therapy followed by intravenous doxorubicin and cyclophosphamide. The patient is alive and disease free 75 months after initial diagnosis, 4 years after salvage therapy.     

Use of docetaxel (Taxotere) in patients with paclitaxel (Taxol) hypersensitivity

Anaphylaxis or significant hypersensitivity reaction is one of the most catastrophic potential complications of chemotherapy. There is a 2-5% risk of hypersensitivity with paclitaxel, a commonly used chemotherapeutic agent for various cancers. Three patients, who developed hypersensitivity to paclitaxel infusion, received docetaxel without allergic reactions. Docetaxel may therefore be an alternative treatment for patients with paclitaxel hypersensitivity.