Functional outcomes after transanal ileal pouch-anal anastomosis for ulcerative colitis: narrative review of the current literature

The transanal approach to ileal pouch-anal anastomosis (Ta-IPAA) for ulcerative colitis was introduced in 2015 and has since been shown to be a safe and feasible technique, although the impact of this approach on patient function remains unclear. A systematic literature review was performed to identify studies exploring functional outcomes and quality of life after Ta-IPAA. Seven papers were identified, which all demonstrated satisfactory functional outcomes after Ta-IPAA as measured by tools such as Cleveland Global Quality of Life (CGQOL), Oresland Score (OS), Pouch Functional Score (PFS), and Inflammatory Bowel Disease Questionnaire (IBDQ). Many gaps in the literature were identified including paucity of follow-up data beyond the 1-year mark, lack of fertility and fecundity assessment as functional outcomes, and limited evaluation of objective physiologic anal sphincter function. The Ta-IPAA therefore shows promise for good functional results in the short-term, although further research will be required to evaluate the stability of function over time as the technique becomes increasingly integrated into modern surgical practice.

The ClosER study: results from a three-year pan-European longitudinal surveillance of antibiotic resistance among prevalent Clostridium difficile ribotypes, 2011-2014

OBJECTIVES

Until the introduction of fidaxomicin, antimicrobial treatment for Clostridium difficile infection (CDI) was limited to metronidazole and vancomycin. The changing epidemiology of CDI and the emergence of epidemic C. difficile PCR ribotype 027 necessitate continued surveillance to identify shifts in antibiotic susceptibility. ClosER, currently the largest pan-European epidemiological study of C. difficile ribotype distribution and antibiotic susceptibility, aimed to undertake antimicrobial resistance surveillance pre- and post-introduction of fidaxomicin.

METHODS

Between July 2011 and July 2014, 39 sites across 22 European countries submitted 2830 C. difficile isolates for ribotyping, toxin testing and susceptibility testing to metronidazole, vancomycin, fidaxomicin, rifampicin, moxifloxacin, clindamycin, imipenem, chloramphenicol and tigecycline.

RESULTS

Ribotypes 027, 014, 001, 078, 020, 002, 126, 015 and 005 were most frequently isolated, and emergent ribotypes 198 and 356 were identified in Hungary and Italy, respectively. All isolates were susceptible to fidaxomicin, with scarce resistance to metronidazole (0.2%, 6/2694), vancomycin (0.1%, 2/2694) and tigecycline (0%). Rifampicin, moxifloxacin and clindamycin resistance was evident in multiple ribotypes. Lack of ribotype diversity correlated with greater antimicrobial resistance. Epidemic ribotypes (027/001) were associated with multiple antimicrobial resistance, and ribotypes 017, 018 and 356 with high-level resistance. Additional factors may also influence local ribotype prevalence.

CONCLUSIONS

Fidaxomicin susceptibility was retained post-introduction, and resistance to metronidazole and vancomycin was rare. Continued surveillance is needed, with more accurate classification and clarification of ribotype subtypes to further understand their role in the spread of resistance. Other factors may also influence changes in prevalence of C. difficile ribotypes with reduced antibiotic susceptibility.

In vitro susceptibility of Clostridium difficile to SMT19969 and comparators, as well as the killing kinetics and post-antibiotic effects of SMT19969 and comparators against C. difficile

OBJECTIVES

SMT19969 is a novel antimicrobial under clinical development for the treatment of Clostridium difficile infection (CDI). The objective was to determine the comparative susceptibility of 82 C. difficile clinical isolates (which included ribotype 027 isolates and isolates with reduced metronidazole susceptibility) to SMT19969, fidaxomicin, vancomycin and metronidazole and to determine the killing kinetics and post-antibiotic effects of SMT19969, fidaxomicin and vancomycin against C. difficile.

METHODS

MICs were determined by agar incorporation. Killing kinetics and post-antibiotic effects were determined against C. difficile BI1, 630 and 5325 (ribotypes 027, 012 and 078, respectively).

RESULTS

SMT19969 showed potent inhibition of C. difficile (MIC90=0.125 mg/L) and was markedly more active than either metronidazole (MIC90 = 8 mg/L) or vancomycin (MIC90 = 2 mg/L). There were no differences in susceptibility to SMT19969 between different ribotypes. Fidaxomicin was typically one doubling dilution more active than SMT19969 and both agents maintained activity against isolates with reduced susceptibility to metronidazole. In addition, SMT19969 was bactericidal against the C. difficile strains tested, with reductions in viable counts to below the limit of detection by 24 h post-inoculation. Vancomycin was bacteriostatic against all three strains. Fidaxomicin was bactericidal although reduced killing was observed at concentrations <20 × MIC against C. difficile BI1 (ribotype 027) compared with other strains tested.

CONCLUSIONS

These data demonstrate that SMT19969 is associated with potent and bactericidal activity against the strains tested and support further investigation of SMT19969 as potential therapy for CDI.

Pan-European longitudinal surveillance of antibiotic resistance among prevalent Clostridium difficile ribotypes

Clostridium difficile infection remains a major healthcare burden. Until the recent introduction of fidaxomicin, antimicrobial treatments were limited to metronidazole and vancomycin. The emergence of epidemic C. difficile PCR ribotype 027 and its potential link to decreased antibiotic susceptibility highlight the lack of large-scale antimicrobial susceptibility and epidemiological data available. We report results of epidemiological and antimicrobial susceptibility investigations of C. difficile isolates collected prior to fidaxomicin introduction, establishing important baseline data. Thirty-nine sites in 22 countries submitted a total of 953 C. difficile isolates for PCR ribotyping, toxin testing, and susceptibility testing to metronidazole, vancomycin, fidaxomicin, rifampicin, moxifloxacin, clindamycin, imipenem, chloramphenicol, and tigecycline. Ninety-nine known ribotypes were identified. Ribotypes 027, 014, 001/072, and 078 were most frequently isolated in line with previous European studies. There was no evidence of resistance to fidaxomicin, and reduced susceptibility to metronidazole and vancomycin was also scarce. Rifampicin, moxifloxacin, and clindamycin resistance (13%, 40%, and 50% of total isolates, respectively) were evident in multiple ribotypes. There was a significant correlation between lack of ribotype diversity and greater antimicrobial resistance (measured by cumulative resistance score). Well-known epidemic ribotypes 027 and 001/072 were associated with multiple antimicrobial resistance, but high levels of resistance were also observed, particularly in 018 and closely related emergent ribotype 356 in Italy. This raises the possibility of antimicrobial exposure as the underlying reason for their appearance, and highlights the need for ongoing epidemiological and antimicrobial resistance surveillance.

The effectiveness of pharmacological approaches in the treatment of alcohol withdrawal syndrome (AWS): a literature review

Mortality statistics for excessive alcohol consumption show no signs of abatement, with a report published in 2011 from the World Health Organization (WHO) estimating that 2.5 million people worldwide died because of their alcohol consumption. Serious physiological, psychological, social and legal problems are thought to affect many more. Alcohol withdrawal syndrome (AWS) is a potentially life-threatening condition that often occurs in those individuals who significantly reduce or stop their intake after a prolonged and excessive period of drinking. Pharmacological treatment of the AWS has traditionally been undertaken by the use of the benzodiazepines, but recent years have witnessed the emergence of several alternatives. The aim of this paper was (1) to review the evidence base supporting the use of various pharmacological agents currently employed to treat AWS, and (2) to consider the efficacy and safety of the emerging alternatives to the benzodiazepines. The Cochrane Database of Systematic Reviews, CINAHL, Embase, PsycINFO, MEDLINE and BNI databases were extensively searched in order to retrieve the maximum number of relevant articles. Reference lists from relevant literature were also used to identify other potential studies for inclusion. All studies concerned with measuring the efficacy and safety of the various pharmacological treatment options for AWS were considered and a total of 63 trials were included in this review. Findings support the use of benzodiazepines as the recommended drug of choice for the treatment of AWS in the absence of adequate evidence to support the use of alternative agents. There is a lack of evidence of a superior pharmacological agent to the benzodiazepines for the treatment of AWS. There are several studies that have shown that there are pharmacological alternatives that could compete or act as an adjunct with the benzodiazepines in terms of high efficacy and safety in the treatment of AWS, but there is a need for further quality research to be carried out before definitive conclusions can be drawn.

Probing the presence of the ligand-binding haem in cellular nitric oxide receptors

BACKGROUND AND PURPOSE

Nitric oxide (NO) acts on receptors coupled to guanylyl cyclase (GC), leading to cGMP accumulation. The NO binding site is a haem group, oxidation or loss of which diminishes NO-stimulated activity. Agonists reportedly engaging both these NO-insensitive forms have emerged. Here we characterize the effect of a prototype compound (BAY 58-2667) and use it to assess the haem status of cellular GC.

EXPERIMENTAL APPROACH

GC activity measurements were made on the purified protein and on rat platelets.

KEY RESULTS

Experiments on purified GC showed that the target for BAY 58-2667 is the haem-free GC, not the haem-oxidized form. The efficacy of BAY 58-2667 was about half that shown normally by NO. In platelets, BAY 58-2667 was a potent GC activator (EC50 approximately 15 nM) but the maximum effect was only about 1% of that achievable with NO. Nevertheless, it was enough to evoke cGMP-dependent protein phosphorylation. Profound (85 %) desensitization of NO-evoked GC activity did not alter the effectiveness of BAY 58-2667. Haem oxidation, however, increased the efficacy of BAY 58-2667 by 22-fold, implying that about half the cellular GC was then haem-free. Oxidation appeared to enhance the rate of haem dissociation from purified GC.

CONCLUSIONS AND IMPLICATIONS

Compounds such as BAY 58-2667 are useful for probing the occupancy of the haem pocket of NO receptors in cells but not for distinguishing oxidized from reduced haem. In vivo, such compounds are likely to be particularly effective in conditions where there is deficient haem incorporation or enhanced haem loss.

Structure of the Neuronal Protein Calexcitin Suggests a Mode of Interaction in Signalling Pathways of Learning and Memory

The three-dimensional structure of the neuronal calcium-sensor protein calexcitin from Loligo pealei has been determined by X-ray analysis at a resolution of 1.8A. Calexcitin is up-regulated following Pavlovian conditioning and has been shown to regulate potassium channels and the ryanodine receptor. Thus, calexcitin is implicated in neuronal excitation and plasticity. The overall structure is predominantly helical and compact with a pronounced hydrophobic core between the N and C-terminal domains of the molecule. The structure consists of four EF-hand motifs although only the first three EF hands are involved in binding calcium ions; the C-terminal EF-hand lacks the amino acids required for calcium binding. The overall structure is quite similar to that of the sarcoplasmic calcium-binding protein from Amphioxus although the sequence identity is very low at 31%. The structure shows that the two amino acids of calexcitin phosphorylated by protein kinase C are close to the domain interface in three dimensions and thus phosphorylation is likely to regulate the opening of the domains that is probably required for binding to target proteins. There is evidence that calexcitin is a GTPase and the residues, which have been implicated by mutagenesis in its GTPase activity, are in a short but highly conserved region of 3(10) helix close to the C terminus. This helix resides in a large loop that is partly sandwiched between the N and C-terminal domains suggesting that GTP binding may also require or may cause domain opening. The structure possesses a pronounced electropositive crevice in the vicinity of the 3(10) helix, that might provide an initial docking site for the triphosphate group of GTP. These findings elucidate a number of the reported functions of calexcitin with implications for neuronal signalling.

Crystallization and preliminary X-ray diffraction analysis of calexcitin from Loligo pealei: a neuronal protein implicated in learning and memory

The neuronal protein calexcitin from the long-finned squid Loligo pealei has been expressed in Escherichia coli and purified to homogeneity. Calexcitin is a 22 kDa calcium-binding protein that becomes up-regulated in invertebrates following Pavlovian conditioning and is likely to be involved in signal transduction events associated with learning and memory. Recombinant squid calexcitin has been crystallized using the hanging-drop vapour-diffusion technique in the orthorhombic space group P2(1)2(1)2(1). The unit-cell parameters of a = 46.6, b = 69.2, c = 134.8 A suggest that the crystals contain two monomers per asymmetric unit and have a solvent content of 49%. This crystal form diffracts X-rays to at least 1.8 A resolution and yields data of high quality using synchrotron radiation.

Modulation of excitability as a learning and memory mechanism: a molecular genetic perspective

Gene targeting has contributed substantially to the investigation of the neurobiological basis of mammalian learning and memory (L&M). These experiments start with an hypothesis as to a mechanism underlying L&M, then genes of interest are manipulated, and the impact on neuronal physiology and L&M is studied. Previous gene targeting studies have focussed mainly on the role of synaptic plasticity in L&M. Some of those reports provide evidence that processes other than, or additional to, long-term potentiation (LTP) are required for L&M. Accordingly, it is possible that altered neuronal excitability is an essential mechanism. The properties of ion channels determine neuronal excitability and so genetic alteration of ion channel properties is an appropriate method for testing whether the modulation of excitability affects L&M. K(v)beta 1.1-deficient mice were the first mutants used to study the role of altered excitability in mammalian L&M. K(v)beta 1.1 is a regulatory subunit with a restricted expression pattern in the brain, and it confers fast inactivation on otherwise noninactivating K(+) channel subunits. In hippocampal pyramidal neurones Kv beta 1.1-deficiency results in a reduced slow after-hyperpolarisation (sAHP), modulation of which is thought to contribute to L&M. The L&M phenotype of the mutants supports this sAHP hypothesis. It is expected that further gene targeting studies on excitability will lead to valuable insights into the processes of L&M.

The distribution of sales revenues from pharmaceutical innovation

OBJECTIVE

This report updates our earlier work on the returns to pharmaceutical research and development (R&D) in the US (1980 to 1984), which showed that the returns distributions are highly skewed. It evaluates a more recent cohort of new drug introductions in the US (1988 to 1992) and examines how the returns distribution is emerging for drugs with life cycles concentrated in the 1990s versus the 1980s.

DESIGN AND SETTING

Methods were described in detail in our earlier reports. The current sample included 110 new drug entities (including 28 orphan drugs), and sales data were obtained for the period 1988 to 1998, which represented between 7 and 11 years of sales for the drugs included. 20 years was chosen as the expected market life for this cohort, and a 2-step procedure was used to project future sales for the drugs--during the period until patent expiry and then beyond patent expiry until the 20-year time-horizon was completed. Thus, the values in the first half of the life cycle are essentially based on realised sales, while those in the second half are projected using information on patent expiry and other inputs.

MAIN OUTCOME MEASURES AND RESULTS

Peak annual sales for the top decile of drugs introduced between 1988 and 1992 in the US amounted to almost $US1.1 billion compared with peak sales of less than $US175 million (1992 values) for the mean compound. In particular, the top decile accounted for 56% of overall sales revenue. Although the sales distributions were skewed in both our earlier and current analysis, the top decile in the later time-period exhibited more rapid rates of growth after launch, a peak that was more than 50% greater in real terms than for the 1980 to 1984 cohort, and a faster rate of expected decline in sales after patent expiry. One factor contributing to the distribution of sales revenues becoming more skewed over time is the orphan drug phenomenon (i.e. most of the orphan drugs are concentrated at the bottom of the distribution).

CONCLUSION

The distribution of sales revenues for new drug compounds is highly skewed in nature. In this regard, the top decile of new drugs accounts for more than half of the total sales generated by the 1988 to 1992 cohort analysed. Furthermore, the distribution of sales revenues for this cohort is more skewed than that of the 1980 to 1984 cohort we analysed in previous research.

Cross validation of a general population survey diagnostic interview: a comparison of CIS-R with SCAN ICD-10 diagnostic categories

BACKGROUND

Comparisons of structured diagnostic interviews with clinical assessments in general population samples show marked discrepancies. In order to validate the CIS-R, a fully structured diagnostic interview used for the National Survey of Psychiatric Morbidity in Great Britain, it was compared with SCAN, a standard, semi-structured, clinical assessment.

METHODS

A random sample of 1882 Leicestershire addresses from the Postcode Address File yielded 1157 eligible adults: of these 860 completed the CIS-R; 387 adults scores > or = 8 on the CIS-R and 205 of these completed a SCAN reference examination. Neurotic symptoms, in the previous week and month only, were enquired about. Concordance was estimated for ICD-10 neurotic and depressive disorders, F32 to F42 and for depression symptom score.

RESULTS

Sociodemographic characteristics closely resembled National Survey and 1991 census profiles. Concordance was poor for any ICD-10 neurotic disorder (kappa = 0.25 (95% CI, 0.1-0.4)) and for depressive disorder (kappa = 0.23 (95% CI, 0-0.46)). Sensitivity to the SCAN reference classification was also poor. Specificity ranged from 0.8 to 0.9. Rank order correlation for total depression symptoms was 0.43 (Kendall's tau b; P < 0.001; N = 205).

DISCUSSION

High specificity indicates that the CIS-R and SCAN agree that prevalence rates for specific disorders are low compared with estimates in some community surveys. We have revealed substantial discrepancies in case finding. Therefore, published data on service utilization designed to estimate unmet need in populations requires re-interpretation. The value of large-scale CIS-R survey data can be enhanced considerably by the incorporation of concurrent semi-structured clinical assessments.

Longer patents for increased generic competition in the US. The Waxman-Hatch Act after one decade

The 1984 Waxman-Hatch Act had two main objectives. Title I was designed to promote price competition by establishing an abbreviated new drug application (ANDA) process for generic market entry. Title II was designed to encourage drug innovation by restoring some of the patent life lost during the lengthy FDA regulatory process. In this paper, we consider whether these twin objectives have been realised during the first decade of the Act's existence. First, we investigate the pattern of generic and brand name prices and market shares for the major products whose patents expired between 1984 and 1993. A regression model indicates that generic competition has been intensifying significantly in recent periods. Major brand name products now typically lose more than half their market share within the first year after patent expiration. In addition, we examine changes in patent protection for new chemical entities introduced over the period 1984 to 1993. For 1991 to 1993 new drug introductions, the average effective patent life was 11.8 years with 2.3 years resulting from Waxman-Hatch extensions. In the final section of the paper, we consider how the US law compares with that in Europe and discuss possible legislative improvements in the 1984 Act.

Longitudinal changes in myocardial basic fibroblast growth factor (FGF-2) activity following coronary artery ligation in the dog

Although fibroblast growth factor has been identified in normal and ischemic myocardium, temporal changes in mitogenic activity due to fibroblast growth factors in ischemic tissue have not been well established, nor has correlation been made with the known early increases in coronary collateral flow. This study sought to measure fibroblast growth factor activity in myocardium after coronary ligation. Accordingly the left anterior descending coronary artery of dogs was ligated and coronary collateral flow measured with radioactive microspheres. The heart was arrested after 2 h (four dogs), 1 week (four dogs), 2 weeks (three dogs), or 8 weeks (four dogs). Just before arrest collateral flow was again measured with radioactive microspheres, and the perfusion territory of the ligated vessel was demarcated with an intracoronary injection of Evans blue. The stained ischemic region was separated into central and peripheral portions. A transmural sample was removed from each portion for quantitation of tissue radioactivity and the rest was used for isolation of fibroblast growth factor and the measurement of mitogenic activity with vascular endothelial cells. To determine which fibroblast growth factor (FGF-1 or FGF-2) was being produced by the myocardium, aliquots of the isolated protein were first treated with specific antibodies to FGF-1 or FGF-2 before being assayed for mitogenicity. Coronary collateral flow did not change between 5 min and 2 h following coronary ligation, but was significantly increased at later time points. The ischemic/normal myocardial basic fibroblast growth factor mitogenic activity ratio in the peripheral ischemic tissue was increased after 2 h of ischemia (1.41 +/- 0.34), but the increase was not significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Virus-like particles in synovial fluids from patients with rheumatoid arthritis

Based on the elevated expression of oncogenes in proliferating transformed-appearing synoviocytes we searched for the possible involvement of a viral agent in the pathogenesis of RA. We report the detection of virus-like particles with retroviral C type morphology in SF, which lack the typical morphologic as well as immunohistochemical features of the human T-lymphotropic and immunodeficiency viruses.

Attributes of tinnitus that may predict temporomandibular joint dysfunction

A collection of 1002 patients with severe tinnitus, drawn from the Tinnitus Data Registry, were retrospectively surveyed to determine which traits or attributes of tinnitus could indicate the possibility of temporomandibular joint dysfunction (TMD) as the cause of tinnitus. The patients were divided into two groups: (1) a TMD group, consisting of 69 patients for whom there was no known cause of tinnitus except for one or more temporomandibular joint (TMJ) indicators, and (2) a comparison group with mixed etiologies (n = 860). Seventy-three patients were eliminated due to excessive complications relating to cause. The two groups were compared seeking those attributes of tinnitus that significantly separated them. No single benchmark standard was discovered that exclusively indicated tinnitus from TMJ origins. However, a total of 10 "TMJ Indicators" were discovered. The data for each of these indicators is presented and discussed. In addition, the attributes that did not significantly separate the two groups are listed. The study concludes with a recommendation for TMJ referral for those tinnitus patients with unknown etiology who demonstrate any three or more of the TMJ indicators.

Attributes of tinnitus and the acceptance of masking

Various characteristics of tinnitus were surveyed to determine whether they were associated with the acceptance of masking, which is used as a relief procedure for tinnitus. The characteristics considered were duration, loudness match, minimum masking level, and residual inhibition. Data for the characteristics of tinnitus were obtained from the Tinnitus Data Registry at the Oregon Hearing Research Center, which contains information on 784 tinnitus patients. The acceptance of masking was determined by each individual patient based on actual tests with wearable masking units. Variations in the individual characteristics listed above were not found to be significantly associated with the acceptance of masking and thus should not be used a priori to deny patients the opportunity for possible relief of their tinnitus. A masking indicator was found to be significantly (P = .03) associated with the acceptance of masking. This masking indicator is obtained by subtracting the loudness match of the tinnitus from the minimum masking level. When the masking indicator was 10 dB or less, the acceptance of masking was in excess of 50%. The data presented may help to dispel some current misconceptions about the masking of tinnitus.

An implantable bone conduction hearing device

A new implantable hearing device that transmits an acoustical signal from an external electromagnetic coil to a small magnet implanted in the temporal bone has been developed and implanted in more than 350 patients. Animal research indicates that the device serves as a high-fidelity sound source throughout the audio range. Especially notable is its high-frequency performance. Human experiments using a body processor indicate that the device compares favorably with conventional bone conduction hearing aids, and patients report excellent sound quality as well as improved ability to understand conversational speech. Further development has resulted in an at-the-ear (ATE) processor. Extensive testing of the ATE unit has revealed that current models provide approximately 10 dB less output than the body processors. Further research and development are continuing to address the need for increased power output from the ATE processor and to eliminate other minor problems.

Conservative treatment of tinnitus in Menière's disease

Menière's disease is a three-symptom malady. Vertigo, hearing loss, and tinnitus, in order of their importance, are the three symptoms. Tinnitus in active Menière's disease is not of major importance to the patient. Tinnitus in "burnt-out" Menière's disease often becomes the primary complaint. In most cases, the tinnitus of burnt-out Menière's disease can be relieved easily by the masking afforded through the use of hearing aids.

A middle ear implantable hearing device for controlled amplification of sound in the human: a preliminary report

Millions of people in the United States suffer from hearing impairment that is not benefited or poorly benefited by surgery or conventional hearing aids. Recently, we introduced an implantable Temporal Bone Stimulator (TBS) designed for those patients having a hearing loss due to external canal conditions; such as, external canal atresia or disease, inoperable ossicular problems, atelectasis or eustachian tube malfunction, and chronic open-cavity mastoid disease. This device requires relatively good cochlear function. However, the electromagnetic application of this device has led to the development of a new device we call the Implantable Hearing Device (IHD). This device stimulates, by an electromagnetic field, an independent electromagnetic sensitive prosthesis attached to the ossicular chain. This direct energy transfer to the ossicular chain provides a high degree of sound amplification and fidelity, thus providing benefit for those with various degrees of sensorineural hearing impairment. Preliminary disclosure of the device design, the animal experimental results, and the data from human testing will be given.

The surgical technique for implantation of the temporal bone stimulator (Audiant ABC)

Microsurgical techniques and modern hearing aids are very limited in providing hearing improvement to patients with a vast number of middle ear and external ear canal conditions. A new electromagnetic temporal bone stimulator (TBS), capable of direct stimulation of the cochlea, has been developed. Nothing is placed in the external ear canal. The internal portion of the device is placed in the mastoid portion of the temporal bone, thus completely bypassing the external canal, the ossicles, and the middle ear. This provides stimulation to the inner ear regardless of the condition of the external canal and the middle ear. Unilateral hearing losses may also be benefited by transfer of energy to the opposite ear. Selection of patients, the surgical technique, and the instrumental armamentarium are discussed. The pitfalls and expected results are described.

Experiences with implantable hearing devices and a presentation of a new device

Following animal experiments, anatomic examinations, and histologic studies, an implantable hearing device was developed. This device, the temporal bone stimulator (TBS), uses an inductive coil without percutaneous connection that transmits bone-conducted vibrations to the inner ear. Ten patients have been implanted and followed by the Central Ear Research Institute. The TBS is effective and may have wide application in producing amplification in good sound fidelity when used in patients who have external canal, middle ear, or eustachian tube disease that is poorly corrected by surgery or conventional hearing aids. The utilization of similar principles of electromagnetic transfer of energy directly to the ossicles appears reasonable and is potentially highly rewarding for those who have sensorineural hearing impairments with thresholds greater than 40 dB. The enormous potential benefits derived from the application of these implantable hearing devices is worthy of the greatest effort in future otologic investigation.

Complement C8 deficiency with recurrent meningococcemia: examination of meningococcal opsonization

A 10 year old girl presented with recurrent febrile episodes over 2 months. A non-typable strain of Neisseria meningitidis was grown from blood cultures on three occasions. She was found to lack functional C8 activity in serum but material with C8 antigenic activity was present. The opsonic activity of the C8 deficient serum for N. meningitidis was equivalent to that of normal controls.

The perceived severity of tinnitus. Some observations concerning a large population of tinnitus clinic patients

Detailed information about tinnitus was obtained from over 1800 patients attending a tinnitus clinic. Patients rated their tinnitus severity on a scale from 1 to 10 and also provided information concerning the quality, duration, localization, and other attributes of their tinnitus. In addition to standard audiometric tests, patients received tests for tinnitus pitch, loudness, maskability, and residual inhibition, and provided a brief medical history. The severity ratings of over 90% were at or above the scale value of 5. There was no correlation between rated severity and the loudness of tinnitus (obtained by a loudness balance procedure using external sounds matching the tinnitus pitch), thus confirming earlier observations. The severity also was not related to the type, quality, or pitch of tinnitus sound heard. However, severity ratings were highly correlated with incidence of sleep disturbance. Additional observations concerning relationships between perceived severity and other patient characteristics are discussed.

Yeast opsonization and phagocytosis studied by a visual assay and measurement of neutrophil chemiluminescence

Yeast opsonization was examined by a visual phagocytic assay which identified intracellular particles by means of staining with reduced nitroblue tetrazolium, and by measurement of the chemiluminescent response of neutrophils to opsonized particles. With both assays optimal opsonization was dependent on the classical complement pathway at lower serum concentrations, however, alternative pathway activity alone was able to opsonic optimally at higher serum concentrations. Examination of the complement pathway and opsonic activity of sera from 17 children with atopic dermatitis revealed 2 subjects with defective alternative pathway lytic activity. There was no significant difference in the opsonic activity between atopic children and control subjects. This investigation does not confirm the suggestion that yeast opsonization is a common defect in atopic individuals and indicates yeast can be opsonized by both classical and alternative pathways.

Decreased neutrophil chemotaxis and chronic granulomatous disease

A case of chronic granulomatous disease associated with decreased neutrophil chemotaxis is described. It is suggested that defective neutrophil motility may be more common than previously recognized in chronic granulomatous disease. However, the presence of a chemotactic defect does not necessarily imply a more severe clinical course.

The characteristics and natural history of tinnitus in Meniere's disease

Four tests for the identification of tinnitus have been presented: pitch, loudness, maskability, and residual inhibition. The typical features of the tinnitus associated with Meniere's disease are as follows: 1. Usually the tinnitus is a low pitched noise. However, in the burned out condition it is often higher in pitch and tonal in quality. 2. The loudness match occurs at very low sensation levels. 3. Masking as a relief procedure is usually easily achieved, requiring only low levels of noise. 4. The masking recommended for relief of tinnitus is found to be acceptable as a substitute for tinnitus. 5. Masking of the tinnitus produces residual inhibition, which frequently is of longer than average duration.

ASBAH-independence

This paper describes the work done by ASBAH in the field of social independence training since November 1977. The aims of the training scheme are to encourage young people toward accepting responsibility for the course of their own lives, and to prepare them to take fuller advantage of the opportunities for further education and training and a wider range of leisure activities. Problems so far encountered - physical, vocational and emotional, are examined and proposals made for further development in this area of work.

Function of the acoustic reflex in discrimination of intense speech

It is known that the middle ear acoustic reflex (AR) alters the transmission characteristics of the auditory system; however, disagreement exists on how these changes may influence the ears; transfer of speech stimuli. In this study, speech with and without a competing message was delivered at supra-AR levels to cat ears that demonstrated an active and a pharmaceutically inactivated middle ear reflex mechanism. Resulting cochlear potentials were tape recorded and subsequently presented to 18 human subjects with normal hearing. Findings suggest word and sentence discrimination is enhanced in the presence of a functioning AR, with implications for hearing aid use and stapedectomy procedure.