Michel dysplasia

A case is reported in whom there was a unilateral complete arrest of differentiation of the otocyst associated with an ipsilateral mild hemifacial hypoplasia and auricular abnormalities. The patient’s tympanic membrane and VII nerve function were normal and a normal ossicular mass was identified on CT Scan. This case illustrates that development of the middle ear cavity (exclusive of structures on the medial wall), external ear canal and VII nerve can be independent of development of the inner ear and that a unilateral absence of otic capsule differentiation can take place without severe associated abnormalities.     

MRI of Recurrent Cystic Mesothelioma: Differential Diagnosis of Cystic Pelvic Masses

A case of recurrent cystic pelvic mesothelioma in a woman who developed pelvic fullness, frequent urination, and pressure sensation in the lower abdomen with interesting magnetic resonance imaging findings is presented. The differential diagnosis of cystic pelvic masses is briefly discussed.     

Combined Cisplatin and Carboplatin Chemotherapy for Treatment of Advanced Epithelial Ovarian Cancer

Purpose. The primary goal of this trial was to evaluate the clinical activity and the toxicity of a combination of cisplatin and carboplatin for women with advanced-stage epithelial ovarian cancer. Patients and methods. Fifty-one consecutive evaluable patients with untreated stage III and IV epithelial ovarian cancer received 360 mg/m² carboplatin on Day 1 and 50 mg/m² cisplatin on Day 2 administered intravenously every 28 days for six cycles. Drug doses were adjusted for hematologic toxicity based on nadir counts during the prior therapy course. Dose levels included 300-400 mg/m² carboplatin and 50-75 mg/m² cisplatin. Second-look surgery was optional. Endpoints were clinical response, surgical response, progression-free survival, and survival. Results. Of 8 patients with measurable disease, 3 (37.5%) had a clinical compete response, and 3 (37.5%) had a clinical partial response, for an overall clinical response rate of 75%. Of 39 patients who began chemotherapy with abnormal serum levels of CA 125, 31 (79%) achieved normalization of CA 125 at the completion of chemotherapy. Thirteen patients underwent second-look laparotomy. Of these, 7 (54%) had a pathological compete response, and 2 (15%) had a partial response. The median progression-free survival was 14 months, and the overall median survival was 32.5 months. Neutropenia and thrombocytopenia were the main dose-limiting toxicities. In addition, 9 patients developed grade 2 and 3 developed grade 3 ototoxicity. Conclusion. This regimen is very active against advanced-stage epithelial ovarian cancer. The degree of ototoxicity observed is worrisome, but such toxicity may be ameliorated by limiting the dose of cisplatin and increasing the dose of carboplatin.     

Tamoxifen therapy of epithelial ovarian cancer

The activity of the antiestrogen tamoxifen was evaluated in 23 patients with epithelial ovarian carcinoma. All patients had received cytotoxic chemotherapy. The patients were given daily doses of 20 or 40 mg tamoxifen orally for a minimum of eight weeks. No objective tumor regressions were noted. In 19 patients disease remained stable for a median duration of 17 weeks (range: eight to 47 weeks). Estrogen and/or progesterone levels available for six patients did not correlate with stability of disease. The authors conclude that tamoxifen does not induce objective response in patients with epithelial ovarian carcinoma who have been treated with cytotoxic chemotherapy. However, in the current study about 80% of such patients had short-lived objective stabilization of their disease.     

High-pass digital filtration of the 40 Hz response and its relationship to the spectral content of the middle latency and 40 Hz responses

This study analyzed the effects of high-pass filtration on the 40 Hz response using zero and standard phase shift digital filtration. Filtration effects were compared to the spectral content of the middle latency response (MLR) and 40 Hz response. The spectral composition of the MLR was found to contain major response energy at 10 and 40 Hz. The major energy of the 40 Hz response was at 40 Hz with minor peaks every 40 Hz above the fundamental frequency. The elimination of the 10 Hz response energy in the 40 Hz response was due to cancellation caused by phase differences which occurred in the production of a steady state potential. The reduction was confirmed by the minor amplitude effects created by zero-phase-shift high-phase filtration (cutoff frequency 30 Hz with 36 dB/oct slopes) on the 40 Hz response as compared to the MLR. The only beneficial effect of high-pass filtration was the elimination of the mild undulation of the unfiltered waveform. The major effect of phase-shift high-pass filtration on the 40 Hz response was the displacement of the high frequency ABR from the peak to the descending slope and finally to the trough of the MLR. Shifting of the ABR from the peak of the MLR resulted in amplitude loss which may affect response identification at threshold. The authors recommend minimal high-pass filtration (i.e., less than 12 dB/oct slope and a cutoff frequency less than or equal to 15 Hz) when recording the 40 Hz response. The spectral analysis of the evoked response may be able to predict the optimal rate for eliciting a steady state response in divergent subject populations.     

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.