The potential risk of carotid injury in cochlear implant surgery.

BACKGROUND: The advent of cochlear implantation has revolutionized the options afforded to the deaf population. With the increase in the prevalence of this procedure have come larger experiences in the associated technical challenges and complications. RESULTS: We present the evaluation and management of a patient with an unusual complication of improper placement of the implant electrode into the carotid canal and its management. We discuss the anatomy of the carotid artery and its proximity to the cochlea to emphasize the potential risk to this large vessel. CONCLUSIONS: Damage to the carotid canal and the carotid artery is a potential risk of cochlear implant surgery. When available, we recommend intraoperative electrical testing of the cochlear implant be performed. If there is doubt as to the placement of the electrode, a radiograph should be obtained before the patient is taken out of the operating room to avoid this complication.

Landscape ecology of arboviruses in southern California: temporal and spatial patterns of vector and virus activity in Coachella Valley, 1990-1992.

Consistent temporal and spatial patterns in the activity of Culex tarsalis Coquillett and western equine encephalomyelitis (WEE) and St. Louis encephalitis (SLE) viruses were delineated that were useful in developing a stratified surveillance program. Vernal increases in Cx. tarsalis abundance typically were associated with flooding of saline marshes along the north shore of the Salton Sea and were followed 6-8 wk later by the onset of WEE and SLE virus activity. Viruses then spread to managed marsh (duck club) and agricultural habitats in the Whitewater Channel flood plain and, depending upon the intensity of amplification, to agricultural and residential areas in the more elevated northwestern portion of the valley. Mean annual Cx. tarsalis abundance was correlated inversely with elevation and distance from the Salton Sea. Abundance was greatest at managed marsh habitats. Although spatially correlated with vector abundance among sites, virus transmission rates to sentinel chickens were asynchronous temporally with vector abundance. Seroconversion rates were related to flock location but not flock size (10 versus 20 chickens). Human cases were not detected during the study period, despite elevated transmission rates of both WEE and SLE viruses to sentinel chickens positioned in peridomestic habitats.

Mosquito and arbovirus ecology in southeastern California, 1986-1990.

Mosquito abundance and western equine encephalomyelitis (WEE) and St. Louis encephalitis (SLE) virus activity were monitored in five valleys in southeastern California from June 1986 through April 1990 to study virus overwintering and possible dissemination from south to north along geographically defined corridors. Culex tarsalis Coquillett predominated in CO2 trap collections and was the only species repeatedly infected with WEE and SLE viruses. Abundance peaked during April-May and August-October. WEE virus infections in Cx. tarsalis generally were detected after the spring peak and were followed approximately 1 mo later by seroconversions in sentinel chickens. SLE virus infections occurred later in the summer but before the fall peak in Cx. tarsalis abundance. Peak Cx. tarsalis abundance occurred when monthly temperatures averaged 25 degrees C, whereas virus infections generally were detected most frequently when temperatures exceeded 29 degrees C. Although the spring increase in Cx. tarsalis abundance occurred earlier in southern valleys, the onset of virus activity was variable among valleys and did not follow a south to north progression.

Antibodies to sulfated glycolipids in Guillain-Barré syndrome.

Sera from 53 patients with acute Guillain-Barré syndrome (GBS), 15 patients with chronic inflammatory demyelinating polyneuropathy (CIDP), 13 patients with other neurological diseases (OND) and 31 healthy controls were tested for IgM and IgG antibodies to sulfoglucuronyl paragloboside (SGPG) and sulfatide by both an ELISA and a thin-layer chromatogram-overlay technique. Although the mean levels of anti-SGPG or anti-sulfatide antibodies in GBS patients were not elevated compared to controls, the occurrence of anti-SGPG antibodies was more frequent in GBS patients than in controls (P less than 0.02). Acute GBS patients with antibodies to SGPG or sulfatide were clinically indistinguishable from other GBS patients. Our data suggest that elevated levels of antibodies to SGPG could be important in the pathogenesis of neuropathy in some GBS patients.