Otolaryngology residents' perceptions of endoscopic ear surgery during surgical training.

BACKGROUND: The introduction of endoscopic ear surgery has implications for the training of otolaryngology residents. OBJECTIVES: To report on the status of endoscopic ear surgery and assess the effects of this new technology on otolaryngology training in Singapore, from the residents' perspective. METHODS: An anonymous survey was conducted amongst all Singaporean otolaryngology residents. Residents' exposure to, and perceptions of, endoscopic ear surgery were assessed. RESULTS: Residents from institutions that practise endoscopic ear surgery were more positive regarding its efficacy in various otological surgical procedures. Of residents in programmes with exposure to endoscopic ear surgery, 82.4 per cent felt that its introduction had adversely affected their training, with 88.3 per cent of residents agreeing that faculty members' learning of endoscopic ear surgery had decreased their hands-on surgical load. Both groups expressed desire for more experience with endoscopy. CONCLUSION: The majority of residents view endoscopic ear surgery as an expanding field with a potentially negative impact on their training. Mitigating measures should be implemented to minimise its negative impact on residents' training.

Diagnosing features of Jacobson's nerve schwannoma.

Jacobson's nerve schwannoma is a rare middle ear tumour presenting as a mass along the cochlear promontory. It can be differentiated from other masses along the promontory based on clinical findings, and computed tomography and magnetic resonance imaging features. For small-sized masses, it is possible to differentiate the various middle ear schwannomas from one another. We present the case of a 40-year-old woman with a ten-year history of left hearing loss who was diagnosed with Jacobson's nerve schwannoma.

Measuring caloric response: comparison of different analysis techniques.

INTRODUCTION: Electronystagmography (ENG) testing has been supplanted by newer techniques of measuring eye movement with infrared cameras (VNG). Most techniques of quantifying caloric induced nystagmus measure the slow phase velocity in some manner. Although our analysis is carried out by very experienced assessors, some systems have computer algorithms that have been "taught" to locate and quantify maximum responses. We wondered what differences in measurement might show up when measuring calorics using different techniques and systems, the relevance of this being that if there was a change in slow phase velocity between ENG and VNG testing when measuring caloric response, then normative data would have to be changed. There are also some subjective but important aspects of ENG interpretation which comment on the nature of the response (e.g. responses which might be "sporadic" or "scant"). METHODS: Our experiment compared caloric responses in 100 patients analyzed four different ways. Each caloric was analyzed by our old ENG system, our new VNG system, an inexperienced assessor and the computer algorithm, and data was compared. CONCLUSIONS: All four systems made similar measurements but our inexperienced assessor failed to recognize responses as sporadic or scant, and we feel this is a limitation to be kept in mind in the rural setting, as it is an important aspect of assessment in complex patients. Assessment of complex VNGs should be left to an experienced assessor.

Leprosy: otolaryngologist's perspective.

A patient with hemi-facial erythematous swelling as a result of borderline leprosy and reversal reaction is reported. This uncommon presentation of the disease poses initial diagnostic difficulties to the otolaryngologist. The otolaryngologist must be familiar with otolaryngologic manifestations of leprosy, since early diagnosis and treatment reduces the risk of transmission of the disease and may avoid permanent nerve damage.

Leprosy: otolaryngologists perspective

A patient with hemi-facial erythematous swelling as a result of borderline leprosy and reversal reaction is reported. This uncommon presentation of the disease poses initial diagnostic difficulties to the otolaryngologist. The otolaryngologist must be familiar with otolaryngologic manifestations of leprosy, since early diagnosis and treatment reduces the risk of transmission of the disease and may avoid permanent nerve damage.

Phase I/II trial of dexverapamil plus vinblastine for patients with advanced renal cell carcinoma.

PURPOSE: The reduced cardiac toxicity of the dextro-(d-) stereoisomer of verapamil (dexverapamil; Knoll Pharmaceuticals, Whippany, NJ) warrants its study as a potential multidrug-resistance (MDR) reversal agent. PATIENTS AND METHODS: Twenty-three patients with advanced renal cell carcinoma (RCC) were treated with vinblastine at a dose of 0.11 mg/kg intravenous (IV) bolus injection on days 1 and 2 every 21 days. Dexverapamil was added to subsequent cycles after resistance had been demonstrated. Dexverapamil treatment was begun 18 hours before day 1 of vinblastine administration and was given orally every 6 hours for 12 doses. Patients in group A were treated with a dose of 120 mg/m2, and those in group B were treated with 180 mg/m2 plus dexamethasone; plasma concentrations achieved in patients were correlated with in vitro effects. RESULTS: Toxicities included hypotension, asymptomatic bradycardia, and mild atrioventricular conduction delays, although one patient had dexverapamil discontinued for grade IV congestive heart failure. There were no partial or complete responses. The mean day-1 serum dexverapamil plus norverapamil plasma concentrations were 2,575 ng/mL (range, 697 to 6,015 ng/mL) for group A and 1,654 ng/mL (range, 710 to 4,132 ng/mL) for group B at the time of vinblastine administration. These concentrations were in the range of those that reversed vinblastine resistance in vitro. CONCLUSION: The advantage of dexverapamil as an MDR reversal agent is its potential for achieving desired blood levels with substantially less toxicity than the racemic mixture of verapamil. Based on tolerability, it is a suitable drug for further study in clinical trials of malignancies other than RCC that attempt to achieve MDR reversal. The dose of 120 mg/m2 given orally every 6 hours, with dose escalation based on individual tolerance, represents a feasible schedule to be considered for such studies.

Enhancement of propoxyphene bioavailability by ethanol. Relation to psychomotor and cognitive function in healthy volunteers.

The interaction between a single oral dose of 130 mg propoxyphene and 0.5 g/kg body weight ethanol was investigated in 12 healthy male volunteers by 9 objective performance tests, 8 visual analogue self-rating scales and the measurement of plasma propoxyphene, norpropoxyphene and ethanol concentrations, using a double-blind threeway crossover design. Volunteers were each given one of three treatments, propoxyphene + ethanol, placebo + ethanol and propoxyphene alone, separated by a two week interval. The performance tests were completed before and 1.25 and 4 h after drug intake, and the self-rating scales before and 1.25, 4 and 10 h after it. Ethanol was shown to enhance the bioavailability of propoxyphene by 25% probably by reducing its first-pass metabolism. However, despite this pharmacokinetic effect no pharmacodynamic interaction was found. Subjective ratings disclosed that the effect of ethanol on physical and mental sedation predominated over the effects of propoxyphene.

Cutaneous malignant melanoma and bilateral retinoblastomas: a case report and review of the literature.

Retinoblastoma survivors following successful treatment have a predilection to develop other malignant neoplasms. This report describes a patient with bilateral retinoblastomas diagnosed and treated early in life, who developed cutaneous malignant melanoma 20 years later. In our review of the literature only 5 cases with this association have been reported. We would like to report the sixth case.