Simultaneous, unilateral plugging of superior and posterior semicircular canal dehiscences to treat debilitating hyperacusis.

OBJECTIVE: To describe a case of bilateral superior and posterior semicircular canal dehiscences, and the use of a unilateral transmastoid approach to address both right-sided defects simultaneously. CASE REPORT: In a patient with right-sided hyperacusis, bilateral dehiscence of both the superior and the posterior semicircular canals was identified, located adjacent to the common crus, together with a right-sided, anterosuperiorly positioned sigmoid sinus and a high-riding jugular bulb. Results for audiography and cervical vestibular evoked myogenic potential testing were consistent with right-sided semicircular canal dehiscence. At surgery, a right-sided transmastoid approach provided access to plug both defects simultaneously, following posterior mobilisation of the sigmoid sinus. The patient's hyperacusis was completely resolved, with a 10-30 dB improvement in his right ear air conduction hearing, without decrement in bone conduction. CONCLUSION: In properly selected patients, a transmastoid approach can be used to effectively manage superior semicircular canal dehiscence and posterior semicircular canal dehiscence simultaneously. Pre-operative computed tomography is recommended to evaluate the dehiscence sites and to identify complicating vascular anatomy.

Interleukin-4 affects phenotype and proliferative response of peripheral blood lymphocytes from glioblastoma patients after specific or nonspecific in vitro stimulation.

Immunosuppressive events are often observed in glioblastoma-bearing patients. We tested the response of circulating lymphocytes from glioblastoma patients to low concentrations of interleukin (IL)-4 and IL-2 after lectin activation or specific in vitro stimulation by autologous tumor cells. In the presence of IL-2, IL-4 up-regulates the proliferation rate of phytohemagglutinin (PHA)-P-stimulated glioblastoma patients' peripheral blood lymphocytes (PBL)s. Allogeneically- and syngeneically-stimulated PBLs of these patients present an increased proliferation rate in the presence of IL-4. This specifically stimulated lymphocyte population presents a very low proportion of CD8+ cells. This proportion is slightly increased in the presence of IL-4. Our results indicate that the glioblastoma cell-imposed inhibition on T-cells can be partly overcome by low concentrations of IL-4 during in vitro stimulation. Our experiments also demonstrate that glioblastoma-bearing patients' PBLs constitute a good model in which to study the effects of IL-4.

A new technique for two-hand bag valve mask ventilation.

A method of bag valve mask ventilation (BVM) in which the resuscitator compresses the self-inflating bag between the open palm and body was compared with both standard single resuscitator and two-resuscitator BVM ventilation. Eighteen subjects ventilated a modified recording manikin using each method in random order. The tidal volume (VT) was greater with the open palm (mean 684 (SD 182) ml) than standard single resuscitator ventilation (mean 520 (152) ml). The difference was greater in the nine subjects with small hands (mean 196 (103) ml). VT was less than with two-resuscitator ventilation (mean VT 953 (236) ml).

Pictorial keys to the main species and species groups within the Simulium damnosum Theobald complex occurring in West Africa (Diptera: Simuliidae).

The purpose of this paper is to provide a relatively simple means for recognizing the six main vector species or species groups of the Simulium damnosum Theobald complex that can be distinguished primarily to assist non-specialists, technicians and field personnel who have to handle many specimens in a relatively short period of time.

A case of bilateral gynandromorphism in Simulioum soubrense Vajime and Dunbar (Diptera: Simuliidae).

A bilateral gynandromorph of Simulium soubrense Vajime and Dunbar, one of the vector species of the S. damnosum Theobald complex, is described as part of a continuing study of the morphology and taxonomy of the West African vectors of onchocerciasis.