Biomedical subjects
Publications and source records attributed to J Doménech.
A case of palmar dislocation of the metacarpophalangeal joint of the thumb is presented. The interposition of the dorsal capsule and the extensor tendons made open reduction necessary.
Josamycin is an antibiotic macrolide similar to erythromycin, with some differences in its biologic behaviour. There have been no reports of ototoxic effects caused by this drug, but its similitudes with erythromycin have prompted us to undertake a study about its possible cochleo-toxicity. Most trials of this kind have been carried out using conventional audiometry (up to 8,000 Hz), thus not being able to detect threshold shifts above this frequency. Ototoxic lesions usually begin in the upper frequency limit. Twenty-eight patients without previous auditory impairment were studied with conventional (up to 8,000 Hz) and high-frequency audiometry (up to 20,000 Hz) before and after oral treatment with josamycin during eight days. No significant differences were found in auditory thresholds registered before and after treatment in any of the patients. These results suggest that josamycin is devoid of any cochleo-toxic effect in all the frequencies that a normal subject can hear.
Tympanoplasty can cause a sensorineural hearing loss by a mechanism of acoustic trauma. Although this lesion appears to be relatively infrequent in clinical practice, we believe that its low apparent incidence is caused when clinicians fail to assess the auditory frequencies above 8000 Hz. Twenty-four patients with normal bone-conduction audiometric thresholds scheduled for tympanoplasty were assessed with an electro-stimulation, bone-conduction high-frequency audiometer which can measure hearing frequencies up to 20 kHz before and after surgery. A measurable hearing loss was found in the upper limits of the audible frequencies in 9 patients (37.5%), and was considered important in 4 of them (16.7%). This hearing loss was recorded above the upper frequency limit of conventional audiometers. The findings in this study indicate that drilling of the temporal bone can impair the hearing level in the high frequencies in a significant number of patients. High-frequency audiometry is a very sensitive tool to assess any damage caused to the inner ear by surgical procedures carried out in the middle ear and temporal bone.
Necrotizing (malignant) external otitis is a severe infection caused by Pseudomonas aeruginosa which occurs mainly in elderly diabetics or in immuno-depressed patients (Chandler, 1968). The management of this condition requires the association between an aminoglycoside antibiotic and an antipseudomonal beta-lactamic, given parenterally during a 4 to 6 week period. Sometimes it is necessary to continue the therapy for months until there is no evidence of residual disease (Strauss et al., 1982). Ciprofloxacin is a quinolone with antipseudomonal activity which can be taken orally, and it is a useful alternative to the current treatment. The authors report a case of necrotizing external otitis which was successfully treated with ciprofloxacin.
Progressive hearing loss after cisplatin therapy is relatively frequent, specially in older patients, but it is less common in children and in acute form. The case of a 17-year-old patient with an intracranial tumor who suffered sudden deafness after a single course of cisplatin is presented. This patient had a previously documented very good hearing up to 20 kHz. Although it has been suggested that children with irradiated brain tumors may have an increased susceptibility to cisplatin-induced hearing loss, in this case the patient had not been subjected to radiotherapy.
It is possible that, when the labyrinth is opened in stapedectomy, some form of alteration may occur within it, even if it is not detected postoperatively by routine audiometry. Injuries against the inner ear usually impair the hearing at the highest frequencies. We can assess bone-conduction hearing up to 20 kHz by means of a high-frequency audiometer. Twenty-five patients were examined with conventional and high-frequency audiometry (HFA) before and after successful stapedectomy. Conventional audiometry showed a good postoperative improvement in the low and middle frequencies. HFA showed a lowering of the auditory thresholds above 8 kHz in 20 patients (83.4%), which was not evident with conventional audiometry because it occurred above its upper frequency limit. HFA is a very valuable means of assessing the results of ear surgery, and can be used to compare different surgical techniques.
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The time course of biophasic amounts of two nonsteroid antiinflammatory drugs (naproxen and oxyphenbutazone) after an intravenous dose of both drugs in rats (5 and 20 mg/kg, respectively) and their relationships with the drug amounts in central and peripheral compartments as defined through blood level data obtained after the same intravenous dose of the drug, are described. To assess the first point, the carrageenin-induced rat paw edema method is employed. Through previously established dose-response curves obtained after administration of different i.v. doses, the conversion of responses to biophasic amounts is achieved by means of the corresponding model equations. To calculate kinetic parameters through the fitting of the concentration-time data, a least-squares method based on the Marquardt algorithm is used on a computer. It can be concluded that the biophasic compartment cannot be identified as the "central" or the "peripheral" kinetic ones, being, however, the output biophasic rate constant not significantly different from the terminal disposition rate constant, beta or lambda 2.
The absorption of metoprolol from the stomach, small intestine and colon of anaesthetized rats has been evaluated using an in situ technique. Absorption rates were measured in terms of the rate of disappearance of metoprolol fumarate from the lumen between 5 and 30 min after dosing. Adsorption was estimated from the initial rapid fall in luminal content within the first 5 min after drug administration. The rate of drug absorption from the stomach was low or negligible. In the small intestine, the absorption rate constants, ka, at pH 6.2 and 7.5 were 0.66 and 0.81 h-1, respectively. In the colon, the rate of drug absorption at pH 7.5 was faster (ka = 1.21 h-1) than in other segments of the gut. Drug adsorption in the stomach amounted to 11% of the administered dose. In the small intestine adsorption was greater (16-22%), presumably because of the larger surface area in this segment of the gut, but in the colon adsorption was negligible.
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The prognostic value of tinnitus about the occurrence of hypoacusia in a patient undergoing an ototoxic treatment is not know. Ninety-five patients treated with cisplatinum, a cocleotoxic drug, have been studied to evaluate the percentage of patients with tinnitus, to assess the characteristics of these tinnitus and to know if there is a relationship between its occurrence and the degree of hearing loss that appears after treatment. Thirty-six patients (37.9%) had tinnitus, and there was not a statistically significant relationship between this symptom and the hearing loss. Therefore, tinnitus cannot be used as a prognostic factor for hypoacusia in patients undergoing treatment with cisplatinum.
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Laryngeal trauma can cause severe, life-threatening damage in the upper respiratory tract. Management of trauma presents difficulties with respect to airway control and the procedural decisions are challenging. We studied 12 patients treated at our hospital after laryngeal trauma of various degrees of severity. Respiratory failure detected in some cases was critical from the moment of trauma, whereas other patients were asymptomatic at first but experienced progressive respiratory failure over the next few hours. We looked at the method applied to gain initial control of the upper airway and also considered the laryngeal lesions themselves, associated lesions and established treatment. We then looked for relationships between these and evolution and laryngeal sequelae 6 months after trauma. In agreement with other studies we found that the severity of sequelae depends on the severity of the lesion incurred and on how early treatment is established. The choice of whether to use orotracheal intubation or tracheotomy to control the upper airway was less important, as that decision would depend largely on severity of the lesion, although orotracheal intubation is recommended whenever possible.