The Role of Mastoidectomy in Draining Ventilation Tubes

OBJECTIVES

To discuss the indication for performing a mastoidectomy with catheter placement in patients with chronic tympanostomy tube otorrhea.

METHODS

The Medical Literature Analysis and Retrieval System Online was searched via PubMed for relevant articles using serous mastoiditis, mastoidectomy, chronic otorrhea, tube otorrhea, tympanostomy tubes, and biofilm as keywords.

RESULTS

Further understanding of the pathophysiology of otorrhea and the development of ototopical fluoroquinolones have made a draining tympanostomy tube more manageable. Nevertheless, chronic otorrhea refractory to an otolaryngologist's traditional treatment algorithm still occurs and may benefit from a mastoidectomy with antibiotic irrigation using a catheter in certain cases. We theorize that resolution of otorrhea results from this technique by decreasing the burden of diseased mucosa and providing a larger concentration or dose of antibiotic to the middle ear cleft through the antrum. High-resolution images of the technique and catheter placement are included in this review.

CONCLUSIONS

Despite being an uncommon management strategy, the literature suggests an indication for performing a mastoidectomy in a small percentage of patients with a chronically draining tympanostomy tube.

Correlating regional emergency epistaxis visits with internet search activity

PURPOSE

To investigate the correlation between internet search activity and epistaxis-related Emergency Department visits.

MATERIALS AND METHODS

Data from Google Trends were obtained (www.google.com/trends) for the search term "nosebleed" in Erie County, Pennsylvania during a five-year period. All epistaxis-related CPT code events were obtained from one hospital in this county during the same period. Google total counts were cross tabulated with the following month's ED visits. Graphical analysis and correlation were used to assess the relationship between ED visits and search engine activity.

RESULTS

A strong positive correlation was observed between epistaxis-related ED visits and search engine activity for the term "nosebleed" (r = 0.655).

CONCLUSION

Search engine activities for the term "nosebleed" correlates strongly with epistaxis-related ED visits. This study demonstrates the usefulness of utilizing Google Trends search data to assess regional disease burdens, which may provide a means for epidemiological study that is quicker than conventional methods.

Passifloricins, polyketides alpha-pyrones from Passiflora foetida resin

Three polyketides alpha-pyrones, named passifloricins, were isolated from Passiflora foetida resin; their structures and relative configurations were assigned through 2D NMR spectroscopic analyses. These types of compounds were not detected in other passion flowers.

Misleading serum free thyroxine results during low molecular weight heparin treatment

Measured free thyroxine concentrations in serum increase markedly after intravenous heparin administration, but the effect of heparin administered subcutaneously has not been adequately documented. We found in vitro increases of up to 63% in measured FT4 after a single dose of subcutaneous heparin (enoxaparin, 2000 units) in nine healthy volunteers, and the magnitude of these increases was correlated with initial serum triglyceride concentrations (r = 0.93, P <0.005) and in vitro free fatty acid release (r = 0.88, P <0.005). In 10 cardiac inpatients receiving repeated doses of enoxaparin (2000 units twice daily), measured FT4 increased by up to 171% in specimens taken 2–6 h after injection. When specimens were obtained 10 h after injection, the effect appeared to be minimized, with in vitro increases of <40%, but such increases may still be sufficient to cause interpretative errors. If FT4 estimation is absolutely necessary in patients receiving enoxaparin, specimens should be taken ≥10 h postdose and analyzed within 24 h.

Danielone, a phytoalexin from papaya fruit

A new phytoalexin was induced and isolated from papaya fruit slices treated with copper salts; its structure was established as 3',5'-dimethoxy-4'-hydroxy-(2-hydroxy)acetophenone. This compound showed high antifungal activity against Colletotrichum gloesporioides, a pathogenic fungus of papaya.

Unambiguous 13C NMR assignment of acnistins and absolute configuration of acnistin A

Carbon and proton atoms were fully assigned in this new type of withanolide by HMQC and HMBC experiments. The absolute configuration of acnistin A was determined by X-ray diffraction. Proton and 13C NMR measurements are particularly useful in identifying members of this group of natural products.