Pharmacokinetic interaction between voriconazole and methadone at steady state in patients on methadone therapy.

This trial was aimed to estimate the pharmacokinetic interaction between voriconazole and methadone at steady state in male patients on methadone therapy and to characterize the safety and tolerability profile during the coadministration. Twenty-three patients on individualized methadone therapy (30 to 100 mg once daily) were enrolled into this randomized, patient- and investigator-blind, placebo-controlled, parallel-group study. Methadone pharmacokinetic samples were collected from patients receiving methadone alone as the baseline before they were randomized to coadminister either 200 mg voriconazole twice daily (BID) (400-mg BID loading doses on the first day) (n = 16) or matching placebo (n = 7) for the next 5 days.

Effects of ototopic steroid and NSAIDS in clearing middle ear effusion in an animal model.

Objective: A model of otitis media with effusion (OME) has been developed in the Sprague-Dawley (SD) rat. This model was used to study the effects of an ototopic steroid and nonsteroidal anti-inflammatory drug (NSAID) on lipopolysaccharide (LPS)-induced OME.

Study Design: Twenty-six rats were randomized into 4 groups: saline solution, LPS, NSAID + LPS, and steroids + LPS.

Fluorescent retrograde axonal tracing of the facial nerve.

Objective: The objective of this study was to investigate retrograde fluorescent axonal labeling of motor nerves as an aid to surgical dissection in otolaryngology-head and neck surgery.

Methods: Cholera toxin B subunit conjugated to a fluorescent dye was injected into the facial musculature of New Zealand white rabbits. At variable time points after injection, the facial nerves were harvested and analyzed for fluorescence in the peripheral axon.

Differential expression of surfactant protein A in the nasal mucosa of patients with allergy symptoms.

Objective: To characterize surfactant protein A (SP-A) expression in human nasal tissue and correlate differential expression of SP-A with symptoms suggestive of allergic rhinitis.

Design: Allergic rhinitis symptom data were prospectively collected in the form of the Rhinitis Symptom Utility Index, the Rhinoconjunctivitis Quality of Life Questionnaire, and a Visual Analog Scale. Immunohistochemical staining for SP-A was performed on resected nasal tissue.

Submillimetric target-registration error using a novel, non-invasive fiducial system for image-guided otologic surgery.

Objective: Otologic surgery is undertaken to treat ailments of the ear, including persistent infections, hearing loss, vertigo, and cancer. Typically performed on otherwise-healthy patients in outpatient facilities, the application of image-guided surgery (IGS) has been limited because accurate (<1 mm), non-invasive fiducial systems for otologic surgery have not been available. We now present such a fiducial system.

Acellular allograft dermal matrix for tympanoplasty.

Purpose Of Review: Reconstruction of the tympanic membrane is a common procedure in otology today. Many different materials have been used for this purpose, including a wide array of autologous tissues. This article focuses on the use of human acellular allograft dermal matrix (AlloDerm, LifeCell Corporation, Branchburg, New Jersey) in tympanoplasty.

Use of AlloDerm in type I tympanoplasty: a comparison with native tissue grafts.

Objectives: AlloDerm, an acellular human dermis allograft, has been shown to be an effective option as a tympanic membrane (TM) graft in animals and humans and has several potential advantages, including eliminating donor site morbidity, reducing operative time, and preserving native tissues for later use. We compared AlloDerm and native tissue grafts in type I tympanoplasty with regard to operative time, graft success rate, and audiologic outcome.

Study Design: A retrospective chart review of tympanoplasties performed at a major tertiary referral hospital over a 31 month period, starting with the first use of AlloDerm for TM grafting at this institution.

Minimally invasive, image-guided, facial-recess approach to the middle ear: demonstration of the concept of percutaneous cochlear access in vitro.

Hypothesis: Image-guided surgery will permit accurate access to the middle ear via the facial recess using a single drill hole from the lateral aspect of the mastoid cortex.

Background: The widespread use of image-guided methods in otologic surgery has been limited by the need for a system that achieves the necessary level of accuracy with an easy-to-use, noninvasive fiducial marker system. We have developed and recently reported such a system (accuracy within the temporal bone = 0.

In vitro assessment of image-guided otologic surgery: submillimeter accuracy within the region of the temporal bone.

Objectives: Application of image-guided surgery to otology has been limited by the need for submillimeter accuracy via a fiducial system that is easily usable (noninvasive and nonobstructive).

Methods: A dental bite-block was fitted with a rigid frame with 7 fiducial markers surrounding each external ear. The temporal bones of 3 cadaveric skulls were removed and replaced with surgical targets arranged in a bull's-eye pattern about the centroid of each temporal bone.

Primary care approach to hearing loss: the hidden disability.

We report the results of a survey designed to investigate audiologic referral patterns of primary care physicians and, more specifically, their referral of patients for hearing aids and cochlear implants. Three hundred internal medicine and family medicine physicians were identified from a referral basin of a tertiary care center and chosen randomly to be faxed questionnaires concerning their views about patients with hearing loss, hearing loss screening and referral practices, and availability of local resources. Of the 260 physicians who received a questionnaire, 85 (32.

Image-guided surgery: what is the accuracy?

Purpose Of Review: Use of image-guided surgery (IGS) systems in otolaryngology, particularly rhinology, has grown exponentially in recent years. Central to their use is the understanding of the accuracy of each system. The purpose of this review is to discuss the error inherent in all IGS systems.

Cochlear implant fixation using polypropylene mesh and titanium screws.

Hypothesis: Fixation of cochlear implants using prosthetic mesh is an improvement of the traditional fixation methods.

Study Design: A retrospective chart review was performed examining all adult and pediatric patients between 1998 and 2003 who underwent cochlear implantation using polypropylene mesh and titanium screws to fix the cochlear implant internal receiver. Patient age at implantation, postoperative infections, device failures, device migrations or extrusions, cerebrospinal fluid (CSF) leaks, flap complications, epidural hematoma data, and follow-up data were evaluated.

Quality of life in hearing-impaired adults: the role of cochlear implants and hearing aids.

Objective: To compare the quality-of-life (QOL) benefit received from cochlear implants (CIs) and hearing aids (HAs) among hearing-impaired adults.

Study Design: Health-related questionnaire.

Methods: Twenty-seven CI users compared to control group of 54 HA users, both older than 49.

Treatment of benign positional vertigo using the semont maneuver: efficacy in patients presenting without nystagmus.

Objective: To evaluate and compare the efficacy of the Semont liberatory maneuver on "objective" benign paroxysmal positional vertigo (BPPV) defined as vertigo with geotropic nystagmus in Dix-Hallpike positioning versus "subjective" BPPV defined as vertigo without nystagmus in Dix-Hallpike positioning.

Study Design: Retrospective chart review.

Methods: One hundred sixty-two patients with positional vertigo during Dix- Hallpike positioning were identified.

Outcome of cochlear implantation in pediatric auditory neuropathy.

Objective: Auditory neuropathy, characterized by absence or abnormality of auditory brainstem responses and normal otoacoustic emissions, is often associated with particularly poor response to amplification. Outcome data from four such pediatric patients who received cochlear implants are discussed.

Study Design: Four patients from the Carolina Children's Communicative Disorders Program were identified as having received a diagnosis of auditory neuropathy before implantation with a Clarion cochlear implant.

Immunomodulatory and anti-inflammatory activity of Picrorhiza scrophulariiflora.

Extracts of the rhizomes of Picrorhiza scrophulariiflora Pennell (Scrophulariaceae) were investigated for their in vitro and in vivo immunomodulatory properties. Diethyl ether extracts showed potent inhibitory activity towards the classical pathway of the complement system, the respiratory burst of activated polymorphonuclear leukocytes, and mitogen-induced proliferation of T-lymphocytes. Furthermore, such extracts showed anti-inflammatory activity towards carrageenan-induced paw edema.

Cochlear implant performance in senior citizens.

Cochlear implants are indicated for elderly patients with severe-to-profound hearing loss (sensorineural hearing loss >/=70 dB). Their use has been limited, possibly by the misconception that elderly patients will perform poorly. To document the performance of older adults (> or =65 years old), we undertook a retrospective analysis of our postlingually deafened adult patients who underwent implantation with the CLARION Multi-Strategy Cochlear Implant and underwent formal audiologic analysis (sentence recognition [Central Institute for the Deaf, CID] and monosyllabic word recognition (consonant-noun-consonant, CNC)).

Inhibition of T-lymphocyte proliferation by cucurbitacins from Picrorhiza scrophulariaeflora.

Two cucurbitacin aglycons were isolated from the dried rhizomes of Picrorhiza scrophulariaeflora and were identified as 25-acetoxy-2,3, 16,20-tetrahydroxy-9-methyl-19-norlanosta-5,23-dien-22-one (picracin, 1) and 2,3,16,20,25-pentahydroxy-9-methyl-19-norlanosta-5, 23-dien-22-one (deacetylpicracin, 2). Both compounds inhibit mitogen-induced T-lymphocyte proliferation at an IC(50) value of 1 microM.

Nodal volume reduction after concurrent chemo- and radiotherapy: correlation between initial CT and histopathologic findings.

Background And Purpose: The role of concurrent chemoradiation for treatment of head and neck squamous cell carcinoma is expanding. We sought to evaluate the CT appearance of diseased and normal cervical lymph nodes before and after concurrent chemoradiation and to correlate lymph node volume reduction as revealed by CT with histopathologic findings of resected nodes.

Methods: Using concurrent chemoradiation, we treated seven patients with locally advanced head and neck squamous cell carcinoma.

Allergy increases susceptibility to otitis media with effusion in a rat model. Second place--Resident Clinical Science Award 1998.

To investigate the possible relationship between allergy and otitis media with effusion (OME), we investigated the hypothesis that allergen presentation to the middle ear causes functional disruption of the eustachian tube predisposing to the development of OME. Thirteen of 19 Brown-Norway rats were sensitized to ovalbumin, and the remaining 6 served as nonallergic controls. To mimic subclinical exposure to allergen, we transtympanically injected ovalbumin at a dose (0.

Histopathology of solar lentigines of the face: a quantitative study.

Background: Solar lentigines are acquired pigmented lesions on sun-damaged skin that in general have both keratinocytic and melanocytic hyperplasia, but no melanocytic atypia and no nests of melanocytes. Most histopathologic studies of solar lentigines have been limited to sites other than the face and have not included a systematic and quantitative assessment of the diagnostic features.

Objective: Our purpose was to systematically quantitate a variety of histologic parameters that may be useful in the diagnosis of facial solar lentigines.