Hemodiafiltration for vancomycin overdose in a neonate with end-stage renal failure

We describe continuous venovenous hemodiafiltration (CVVHD) with a high-flux membrane as a novel treatment modality for vancomycin overdose associated with renal insufficiency. CVVHD was used in a 6-day-old male with a solitary hypodysplastic kidney, suspected sepsis, and anuric renal failure who subsequently received an accidental tenfold overdose of vancomycin. We furthermore present evidence for the importance of countercurrent dialysis in addition to continuous hemofiltration for optimal vancomycin removal.

Efficacy of a recombinant fowl pox-based Newcastle disease virus vaccine candidate against velogenic and respiratory challenge

A fowl pox-based recombinant virus TROVAC-NDV (vFP96.5) was developed expressing the fusion and hemagglutinin-neuraminidase glycoproteins from a velogenic strain of Newcastle disease virus (NDV). Studies in specific-pathogen-free birds indicated that inoculation of a single dose of the recombinant led to the induction of significant levels of hemagglutination-inhibiting antibody that were maintained to 8 wk postinoculation. Further, the recombinant induced protective immunity against a combined intramuscular velogenic NDV challenge and respiratory NDV challenge. In commercial broiler chickens that were inoculated in the presence of maternally derived NDV immunity, the level of the NDV-specific humoral response was dampened, but significant levels of protection against both a lethal intramuscular NDV challenge and a fowl poxvirus challenge were obtained.

Four cases of acoustic neuromas with normal hearing

In 95 percent of the cases, patients with acoustic neuromas will have some magnitude of hearing loss in the affected ear. This paper reports on four patients who had acoustic neuromas and normal hearing. Results from the case history, audiometric evaluation, auditory brainstem response (ABR), electroneurography (ENOG), and vestibular evaluation are reported for each patient. For all patients, the presence of unilateral tinnitus was the most common complaint. Audiologically, elevated or absent acoustic reflex thresholds and abnormal ABR findings were the most powerful diagnostic tools.

Intersubject variability of real-ear sound pressure level: conventional and insert earphones

Measures of the sound pressure level (SPL) near the eardrum were determined at discrete frequencies between 500 and 4000 Hz on 50 ears using TDH-39P and ER-3A earphones with the attenuator of an audiometer fixed at 90 dB HL. Results revealed significant differences in the measured SPL between the two earphones at all test frequencies. Results also revealed large intersubject differences in the SPL measured near the eardrum for both earphones. The results of this study highlight the large intersubject variability associated with measuring the SPL at the eardrum and point out the difficulty in accurately predicting individual performance from averaged group data.

High-frequency thresholds: circumaural earphone versus insert earphone

Benefits of high-frequency audiometry in monitoring hearing sensitivity of patients administered ototoxic medications are well established. High-frequency thresholds have been reported to be variable, due in part to small differences in the placement of the earphone diaphragm over the opening of the ear canal. Reliability may be improved by using insert earphones (ER-2) when obtaining high-frequency thresholds. The purposes of this study were to determine high-frequency threshold test-retest reliability using Koss HV/1A+ and ER-2 earphones and to determine if significant differences are present between high-frequency thresholds obtained using these two earphones. Results obtained on 40 ears of 20 normal hearing adults revealed that differences between the test and retest thresholds for each earphone were not significant. Intrasubject threshold differences between the test and retest thresholds for each earphone were, for the most part, within +/- 10 dB at all test frequencies. Further, significantly greater intensity was required to measure threshold when using the ER-2 earphone when compared to the Koss HV/1A+ at all test frequencies.

High-frequency thresholds: sound suite versus hospital room

Benefits of high-frequency audiometry in monitoring hearing sensitivity of patients administered ototoxic medications are well established. Thresholds obtained within a sound suite have been proven reliable. It may, however, often be necessary for the audiologist to evaluate the patient at bedside. The primary purpose of this study was to determine if significant differences are present between high-frequency thresholds measured in a sound suite versus thresholds measured in a hospital room. In addition, the test-retest reliability of high-frequency thresholds was determined when measured in a hospital room. For 25 normal hearing subjects, results revealed that significant differences were not observed between thresholds measured in a sound suite versus those measured in a typical hospital room. In addition, differences between the initial and repeated thresholds obtained in the hospital room were not significant, and the differences were, for the most part, within +/- 10 dB at all test frequencies.

Reliability and intersubject variability of the real ear unaided response

Intratester test-retest reliability of the real ear unaided response (REUR) was determined on 49 ears using the Frye 6500 real ear analyzer. Results revealed mean differences of less than 1 dB for repeat measurements at seven test frequencies between 250 and 4000 Hz. The average peak resonant frequency of the repeated measure was within 16 Hz of the initial measure. In addition, the intersubject variability of the amplitude of REUR was quite large. A range of 7 dB was found at 250 to 500 Hz with the range expanding to 15 to 20 dB at 2000 to 4000 Hz. Also, the peak resonant frequency varied between 2100-4800 Hz. These results are discussed in terms of those dispensers who use the REUR to "custom" order hearing aids.

Intratester test-retest reliability of insertion gain measures

Intratester test-retest reliability of insertion gain was determined on 28 subjects using the Frye 6500 real-ear analyzer. Results revealed mean differences of less than 1 dB for repeat measurements at six test frequencies between 250 and 4000 Hz. Also, over 80% of the repeat measures were within +/- 3 dB of the first measure. The results of this study are compared with previous studies of intratester reliability of insertion gain measures.

Use-effectiveness and analysis of satisfaction levels with the Billings Ovulation Method: two-year pilot study

A 2-year study of 135 women using the Billings Ovulation Method as their method of family planning is reported. There were 1381 exposure cycles during the 1st year and 580 during the 2nd year. The total conception rates were 1.303 for the 1st year and 1.896 for the 2nd year. If one subtract the user failures from these rates, the biologic failure rates are 0.072 for the 1st year and 0.517 for the 2nd year. The continuation rate is 51.8%. An analysis of satisfaction levels is presented with a discussion of possible underlying emotional factors.