Evaluation of a "shotgun" regimen for sudden hearing loss.

One hundred nine patients with idiopathic sudden hearing loss were treated with a "shotgun" regimen that included dextran, histamine, Hypaque, diuretics, steroids, vasodilators, and carbogen inhalation. Thirty-three patients received the entire protocol and 76 patients received most, but not all, of the protocol drugs. Some improvement of hearing (greater than 10 dB in pure-tone average) was seen in 52% of patients treated with the complete protocol and in 54% of patients who received the partial protocol. All patients were analyzed for potential prognostic indicators. Patients with thresholds at 8000 Hz better than at 4000 Hz fared better than the group as a whole. Vertigo at the time of onset of hearing loss was a sign of poor prognosis. There was no correlation between hearing improvement and the age of the patient or the sedimentation rate. Most importantly, there was no statistically significant difference in outcome between patients treated with the complete protocol and those who received only part of the protocol. Furthermore, when the effect of each drug was examined individually, there was no significant difference between those patients receiving and not receiving treatment. The results suggest that this "shotgun" approach for treatment of sudden hearing loss offers no better outcome than is reported in the literature for spontaneous recovery.

Acute appendicitis presenting as acute left scrotal pain: diagnostic considerations.

To our knowledge this is the first case of acute perforated appendicitis presenting as acute left scrotal pain described in the literature. In addition, this case involved a unique false positive radionuclide scrotal scan for testicular torsion, which is also reported and discussed for the first time.

Effect of ventilation and perfusion imbalance on inert gas rebreathing variables.

The effects of ventilation-to-perfusion (VA/Qc) maldistribution within the lungs on measured multiple gas rebreathing variables were studied in 14 dogs. The rebreathing method (using He, C18O, and C2H2) allows for measurements of pulmonary capillary blood flow (Qc), diffusing capacity (DLco), lung gas volume, and the combined pulmonary tissue and capillary blood volume (VTPC). VA/Qc imbalance was created by reversibly occluding the right main pulmonary artery or by reversibly obstructing the left main bronchus in eight dogs. Six additional dogs were ventilated with 10 cmH2O positive end-expiratory pressure (PEEP) to create a bimodal distribution of VA/Qc within the lungs. No significant alterations in computed rebreathing variables, except for a small (14%) decrease in DLco, occurred during right main pulmonary artery occlusion, whereas obstruction of the left main bronchus caused parallel decreases (mean of 46%) in all rebreathing variables. Ventilation with 10 cmH2O PEEP for 3 h caused no alterations in VTPC when compared with postmortem determinations of total lung water. Thus marked alterations in distribution of Qc or creation of VA/Qc maldistributions with PEEP caused no significant changes in rebreathing parameters, whereas obstruction of the left main bronchus resulted in decreases in all rebreathing values consistent with the presumed size of the ventilation defect. Thus it appears that rebreathing estimates of VTPC and other rebreathing parameters are accurate in states of moderate VA/Qc maldistribution within the lung.

A regulatory phenotype associated with the en-am 1 mutant of Neurospora crassa.

We have investigated the nature of the en-am1 mutant of Neurospora crassa and have found that it affects the regulation of proline oxidase and utilisation of other nitrogen sources. This mutant is closely linked to the gln gene but not allelic with it. Data from crosses suggest that the two genes he on opposite sides of the in1 gene on linkage group VR.

Analysis of rebreathing measurements of pulmonary tissue volume in pulmonary edema.

A rebreathing method (usood volume (VTPC) was evaluated in 13 dogs. In seven, pulmonary edema was induced by oleic acid injection. Six dogs served as controls. Values of VTPC calculated by three algorithms were compared to postmortem lung water. The first algorithm uses the C18O intercept to determine time 0 and all data to construct the alveolar disappearance curves. The second uses the beginning of inspiration as time 0. The last uses data only during the last third of expiration. The best correlation (r = 0.90) between VTPC and total lung water was obtained utilizing the first algorithm. In the control animals, mean VTPC was 188 ml, and in the edema dogs was 278 ml. Mean VTPC for all dogs was 96 +/- 14% of total lung water using the first algorithm. Another algorithm (J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 44: 782-795, 1978) was evaluated inthe edema dog group. This method gave values of VTPC 53% higher than those obtained by the first algorithm.

Cytochemical and immunologic of women treated for squamous cell carcinoma of the cervix.

A total of 126 individuals were tested for circulating T lymphocyte levels: 10 patients with stage I-III squamous cell carcinoma of the cervix before treatment; 65 women previously treated with radiation for stage I and II squamous cell carcinoma of the cervix; and 51 healthy age-matched controls. Percentages of aneuploid cells and DNA content in vaginal or cervical smears were determined in 94 patients. All patients with squamous cell carcinoma of the cervix had lower ratios and levels of circulating T lymphocytes than healthy controls. Cytologic and cytochemical DNA studies of vaginal and cervical smears revealed that these individuals had high percentages of aneuploid cells in cervical smears as well as high DNA values. Patients with no evidence of dysplasia had increased circulating T lymphocyte levels compared to pretreatment values, a lower number of aneuploid cells, and mean DNA values close to diploid cells. Based on cytologic and quantitative DNA studies of vaginal and cervical smears, postirradiation dysplasia was diagnosed in 17 of 65 women previously treated by radiation for squamous cell carcinoma of the cervix. No difference in the levels of circulating T lymphocytes between women with postirradiation dysplasia and women without this mucosal disorder and no evidence of cancer was found.

Immunocompetence of cancer patients treated with Levamisole.

Nineteen outpatients with malignant melanoma and squamous cell carcinoma of the head and neck, who had surgical resection for complete removal of the tumor and no demonstrable metastases following surgery, were administered Levamisole (p.o., 150 mg per day, two days per week) and maintained on this dose for at least six months. Of this group, drug therapy was discontinued in four patients because of severe "flu-like" syndromes leaving a group of 15 patients for detailed analysis. T-lymphocyte percentages and levels, cAMP levels in the lymphocytes and a battery of skin tests for recall antigens were evaluated following surgery and at various intervals during immunotherapy. Patients who responded well to the treatment showed increased levels of T-lymphocytes and increased cAMP levels, whereas non-responders had low T-cell levels and low cAMP levels. Also positive skin test reactions were observed in most patients who responded well to immunotherapy, although this was the least reliable indicator of patient response. Eight of the nine patients in the melanoma group have responded well clinically, whereas five of the six squamous cell carcinoma patients have developed recurrences.

T-lymphocyte levels in the peripheral blood of patients with cancer of the head and neck.

Percentage and levels of circulating T-lymphocytes were studied in forty-six patients with squamous cell carcinoma of the head and neck before and/or after treatment and compared with control values obtained in fifty-one healthy volunteers. Mean percentages of circulating T-cells and mean T-cell levels in cancer patients prior to treatment were significantly lower than control values. After surgery or radiation therapy the mean percentage of T-cells remained lower in comparison with that of the controls whereas T-cell levels in patients evaluated after surgical treatment increased in comparison with pretreatment values and were not significantly different from those of the controls.