Immunosuppressant neurotoxicity in liver transplant recipients. Clinical challenges for the consultation-liaison psychiatrist.

Neuropsychiatric problems are common among liver transplant recipients, and immunosuppressant neurotoxicity is an important etiologic factor in the posttransplant period. Four typical cases of immunosuppressant neurotoxicity are presented from the clinical experience of the University of California, Los Angeles-Dumont Liver Transplant program. All patients presented with acute behavioral symptoms and received urgent psychiatric consultation; each proved to be suffering from a variant of immunosuppressive-related neurotoxicity. Correlative neuroimaging studies and descriptions of clinical course are included. Psychiatrists are urged to become familiar with the signs, symptoms, differential diagnosis, neuroimaging findings, and management of immunosuppressive neurotoxicity and secondary psychiatric disorders in solid organ recipients.

Extra-high-frequency noise remotely masks and alters temporal integration at lower frequencies.

A quasi-free-field technique was used to assess the effects of extra-high-frequency-band masking on detection threshold of middle and high (1-7 kHz) frequencies. At an SPL of 60 dB, the 10- to 20-kHz masker produced a slight amount of masking. Increasing the masking level by another 5 dB produced a disproportionate increase of the detection thresholds. This increase was greatest in response to 4- and 5-kHz stimuli, and was detected with both constant and pulsed tones. Decreasing the bandwidth of the masker reduced the magnitude of the effect, but not the frequency-specific pattern of the remote masking. Extra-high-frequency masking also increased the amount of temporal integration at middle and high frequencies. The data are discussed in reference to peripheral and central neural changes associated with sensorineural hearing loss.

Extra-high-frequency auditory thresholds: fine structure, reliability, temporal integration and relation to ear canal resonance.

Three trained subjects were repeatedly tested for detection of auditory thresholds at 27 frequencies, from 2 to 18 kHz. A double-blind procedure was used with the method of adjustment, and the quasi-free-field delivery system of Osterhammel et al. [Scand. Audiol. 6:91-95, 1977] was used to monaurally stimulate the ear. A very reliable series of high- and low-threshold changes, termed the fine structure of the extra-high-frequency audiogram, was observed from 8 to 16 kHz. All 6 ears had a major low-threshold region at or near 13.5 kHz, and up to 3 other replicable sensitive frequencies along this one octave range. Thresholds were invariant over 3 conditions of stimulus presentation (constant tone; 500 ms duration, 25 ms rise and decay, 1 s interstimulus interval; and 100 ms duration, 1.5 ms rise and decay, 200 ms interstimulus interval). As the duration of the tone was decreased from 100 to 5 ms, temporal integration (an average of approximately 2.5 dB threshold increase as the duration was halved) was noted. Although temporal integration was slightly less at higher frequencies, the shape of the audiograms remained essentially unchanged as the stimulus duration was decreased to 5 ms. There was no consistent relationship between the maximally sensitive high frequencies and the amount of temporal integration. But there was a general association between the maximally sensitive high frequencies and the resonant frequency characteristics of that particular ear.