Effects of adaptation of vestibulo-ocular reflex function on manual target localization.

The goal of the present study was to determine if adaptive modulation of vestibulo-ocular reflex (VOR) function is associated with commensurate alterations in manual target localization. To measure the effects of adapted VOR on manual responses we developed the Vestibular-Contingent Pointing Test (VCP). In the VCP test, subjects pointed to a remembered target following passive whole body rotation in the dark. In the first experiment, subjects performed VCP before and after wearing 0.5X minifying lenses that adaptively attenuate horizontal VOR gain. Results showed that adaptive reduction in horizontal VOR gain was accompanied by a commensurate change in VCP performance. In the second experiment, bilaterally labyrinthine deficient (LD) subjects were tested to confirm that vestibular cues were central to the spatial coding of both eye and hand movements during VCP. LD subjects performed significantly worse than normal subjects. These results demonstrate that adaptive change in VOR can lead to alterations in manual target localization.

Adenoid cystic carcinoma of the head and neck: predictors of morbidity and mortality.

OBJECTIVES: To review 160 patients treated at a single institution for adenoid cystic carcinoma during the 20 years between 1977 and 1996, applying a consistent treatment of surgery and postoperative radiation therapy to 140 patients. To analyze factors governing treatment failure, treatment-related morbidity, and mortality. DESIGN: Retrospective review. SETTING: Tertiary referral center. PATIENTS: Seventy-seven males and 83 females aged 13 to 89 years (average age, 49.5 years). RESULTS AND CONCLUSIONS: Combined treatment yielded an 85% locoregional freedom from relapse and disease-specific survival at 5, 10, and 15 years was 89%, 67.4%, and 39.6%, respectively. Thirty-five patients (21.9%) had distant metastases as the only site of failure. Patients treated for paranasal sinus tumor experienced the most treatment-related morbidity vs other sites. Perineural invasion of major nerves, positive margins at surgery, and solid histological features were associated with increased treatment failures. Four or more symptoms present at diagnosis, positive lymph nodes, solid histology, and perineural invasion of major nerves were associated with increased mortality from disease.

Massive splenomegaly in sarcoidosis.

We have presented a case of massive splenomegaly. Our patient was initially thought to have lymphoma, but at operation she was found to have sarcoidosis with splenic involvement. At 2250 g, the spleen was one of the largest recorded in the literature on sarcoidosis. Although the spleen is frequently involved in sarcoidosis, a review of 6074 cases showed that the incidence of actual splenomegaly is only 10%. In 628 of these cases the authors described various degrees of splenomegaly, but the incidence of massive splenomegaly was only 3%. We conclude that sarcoidosis must be considered in the differential diagnosis of splenomegaly.

Correlation of the nerve excitability test and electroneurography in acute facial paralysis.

In a retrospective study of 77 patients with acute facial palsy, the results of the nerve excitability test (NET) and electroneurography (ENoG) were analyzed in order to establish a mathematic correlation and to relate the prognostic NET values to quantitative ENoG results. The two tests are related by exponential functions. Coefficients of correlation were higher for the results between NET and the optimized lead placement (OLP) ENoG compared to NET and standardized lead placement (SLP) ENoG. The highest correlation coefficients were demonstrated when NET was performed over the marginal and zygomatic branches of the facial nerve and OLP ENoG recorded in the nasolabial region. Good prognostic NET threshold differences in patients with a small percentage of intact motor axons, calculated by ENoG, may represent segmental demyelination or the deblocking phase of neuropraxia. The tests are complimentary in establishing the integrity of the facial nerve in acute paralysis.

Effect of influenza vaccination on plasma phenytoin concentrations.

A mean decrease in plasma phenytoin concentrations of 11-14% (p less than 0.005) was observed in seven patients within 4 days after influenza vaccination. Possible mechanisms are discussed.