Pseudomeningitis secondary to accidental tap of a paraspinal lymphatic vessel.
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Biomedical subjects
Publications and source records attributed to M P Orlando.
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Chronic immunoglobulin administration decreases the incidence of bronchial and pulmonary infections in patients affected by chronic variable immunodeficiency (CVI). In this study, an ENT screening was carried out in 22 patients affected by chronic variable immunodeficiency and treated with chronic immunoglobulin administration. All the patients underwent ENT physical examination, nasal endoscopy by fiberoptics, mucociliary transport test (MTT), anterior rhinorheomanometry (RRM), nasal provocation test with cold water (ANPT), audiometry and impedentiometry, olfactory evaluation, and paranasal sinus X rays. Dysphagia was present in 91% of the patients, nasal secretion and obstruction in 77%, and hypoacusia, tinnitus, and otodinia in 57%. Rhinitis and pharyngitis were observed in 86% of the patients, and serous middle ear effusion in 50%. Confirmed maxillary sinusitis was observed in five patients. Hyposmia was observed in 50% of the patients. MTT was significantly longer in the patients than in the controls (18.0 +/- 10.5 vs. 11.2 +/- 2.4 min; p < .05). Nasal resistance was lower in patients than in controls (0.46 +/- 0.32 vs. 1.11 +/- 0.22 Pa/L.s-1; p < .001). ANPT was positive in 9 patients out of 25 versus 1 control out of 15 (p < .05). Finally, seven patients were affected by transmissive hypoacusia, and one patient by neurosensorial hypoacusia. Our results suggest that chronic immunoglobulin administration in CVI patients is not effective against ENT disorders, probably because of the important role played by nasal hyperreactivity. Frequent ENT examination and early treatment of ENT disorders are therefore suggested in order to prevent chronic disease.
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On the grounds of previous researches on periodicity and virtual pitch, the present paper describes the results of some experiments on pitch extraction in normal ears and in subjects with sensorineural hearing loss of cochlear origin, with harmonic and inharmonic stimuli. The latter stimuli are constituted by complex tones with constant ratios between the frequency of adjacent components; for this reason the term geometric spectrum is used. These stimuli can be considered as an alternative to harmonic stimuli, since inharmonic components play an important role in sound analysis and therefore in the perception of sound. Comparison between the data obtained in experimental measurements from normal and hearing impaired subjects (also in relation to the estimates predicted by a mathematical model for pitch), revealed that pitch extracted by hearing impaired subjects tends to be shifted towards the high frequencies.
Subcutaneous heparin is commonly used as a prophylaxis against deep venous thrombosis in a wide variety of hospitalized patients. As with most medications, heparin has a significant side effect profile; heparin-induced hyperkalemia is an unusual but well described side effect. To increase awareness of heparin-induced hyperkalemia and of those patients at greatest risk, we present two cases of documented hyperkalemia induced by heparin and reconfirmed by drug rechallenge.
The existence of a physiopathologic connection between nose and middle ear is widely accepted so that chronic purulent middle ear effusion (CPMEE) could be expected to be usually associated with nasal chronic disease or impaired function. Nevertheless such association is less frequently observed in clinical practice than one could expect, possibly because of inadequate nasal function evaluation. Thirty-five patients affected by CPMEE were included in this study in order to assess the incidence of nasal disorders. E.N.T. clinical history was obtained and E.N.T. physical examination, nasal endoscopy by fiber optics, anterior rhino-rheo-manometry, non-specific nasal provocation test with histamine, mucociliary transport test, and allergic skin tests were performed. In the clinical history assessment 26 patients were affected by chronic rhinopathies, 16 by chronic pharyngitis, and 20 by frequent headache. At rhinoscopy we registered nasal septum deviation in 24 cases and mean and inferior turbinates hypertrophy in 31 cases. CPMEE and nasal septum deviation or turbinates hypertrophy were more frequently ipsilateral (p < .001 and p < .05, respectively). Total nasal resistance was 0.99 +/- 0.49; it was abnormally high in 11 subjects bilaterally and in 4 subjects monolaterally and increased significantly in 32 patients following nasal provocation test. Mucociliary transport time was longer in CPMEE subjects than in 10 healthy subjects (18 +/- 5 vs 13 +/- 4 min; p < .05). Finally 10 patients presented positive skin tests. On the whole, 96% of non allergic patients included in this study showed signs of non-specific nasal hypersensitivity which could theoretically cause purulent middle ear effusion to chronicize. Indeed recurrent histamine release in response to specific and/or aspecific stimuli could cause the obstruction of the Eustachian tube and consequently inadequate middle ear ventilation.