Cell-mediated and humoral immune responses after vaccination of human volunteers with the live vaccine strain of Francisella tularensis.

The specific humoral and cell-mediated immune responses of human volunteers vaccinated with the Francisella tularensis live vaccine strain (LVS) were evaluated. In the search for an optimal antigen to measure the immunogenicity of the vaccine in an enzyme-linked immunosorbent assay, we tested irradiation-killed LVS, an aqueous ether extract of the LVS (EEx), lipopolysaccharide (LPS) from LVS, and a virulent strain (SCHU4). Volunteers were immunized with LVS by scarification. Immunoglobulin G (IgG) responses to LVS and LPS gave the highest background titers when tested with sera from unimmunized volunteers, whereas IgA, IgG, and IgM background titers to EEx and SCHU4 were low. Vaccination caused a significant rise (P < 0.01) in IgA, IgG, and IgM titers to all antigens tested, except for the IgG response to LPS. Eighty percent of vaccinated volunteers developed a positive IgG response to EEx 14 days postvaccination, while 50% were positive to LVS. By day 14 after vaccination, 70% of immunized volunteers exhibited a positive response to EEx in an in vitro peripheral blood lymphocyte proliferation assay. EEx, a specific and sensitive antigen for evaluating immune responses of vaccinated volunteers, may be a superior antigen for the diagnosis of tularemia.

Anterior cricoid split for subglottic stenosis.

Subglottic stenosis is a common problem that often results from ventilatory support necessary in the premature infant. Previous methods of treatment include tracheostomy with dilatation of the stenosis, steroid injections, and procedures to stent the trachea. Results of these methods have been unsatisfactory because of the multiple procedures needed to obtain an adequate airway as well as the high mortality from long-term tracheostomy in infants. In the past 2 years, seven infants have undergone an anterior cricoid split for tight subglottic stenosis and airway obstruction. Of the seven patients, six were premature, five of whom required ventilatory support ranging from 4 to 30+ days. Each child presented in respiratory distress with symptoms present in five children from 1 to 11 months (mean 3.8) after birth. Bronchoscopy identified the site of obstruction in each case as subglottic, with a narrow lumen, usually less than 2.5 mm in diameter. Anterior cricoid split was performed at ages ranging from 2 to 11 months (mean 5.0). All children were extubated at 10 to 14 days and subsequently discharged home asymptomatic; none required postoperative tracheostomy. Complications developed in five children, including atelectasis, otitis media, phlebitis, and tracheocutaneous fistula in two, one of whom required operative closure. One child was rebronchoscoped at 3 weeks postoperatively for bronchospasm, which resolved on aminophylline. The subglottic trachea was normal. At follow-up ranging from 2 to 21 months (mean 8.3), no child has symptoms referrable to the subglottic region. In one patient, a brief period of respiratory distress recurred 3 months postoperatively due to tracheomalacia.(ABSTRACT TRUNCATED AT 250 WORDS)

Complications associated with the surgical treatment of cholesteatoma.

The surgical complications associated with a cholesteatoma are predictable preoperatively depending upon the location of a cholesteatoma. If the patient has an attic cholesteatoma the surgeon can anticipate postoperatively a dry ear, minimal chance of a persistent or recurrent cholesteatoma, a satisfactory hearing restoration, and, although a mastoidectomy is usually necessary, the size of the mastoid cavity in an adult can be extremely small. If a patient has a middle ear cholesteatoma the surgeon can anticipate postoperatively a relatively high incidence of moist ears, persistent or recurrent cholesteatoma, and an unsatisfactory hearing result. However, rarely will the creation of a mastoid cavity be necessary as rarely will mastoidectomy be required. Although most of the children "before puberty" in the study had middle ear cholesteatomas, all children, regardless of the location of cholesteatoma, had a higher incidence of surgical failure than did adults.

Complications associated with the surgical treatment of cholesteatoma.

The surgical complications associated with a cholesteatoma are predictable preoperatively depending upon the location of a cholesteatoma. If the patient has as attic cholesteatoma the surgeon can anticipate postoperatively a dry ear, minimal chance of persistent or recurrent cholesteatoma, satisfactory hearing restoration, and, although a mastoidectomy is usually necessary, the size of the mastoid cavity in an adult can be extremely small. If a patient has a middle ear cholesteatoma the surgeon can anticipate postoperatively a relatively high incidence of moist ears, persistent or recurrent cholesteatoma, and an unsatisfactory hearing result. However, seldom will the creation of a mastoid cavity be necessary as rarely will mastoidectomy be required. Although most of the children before puberty in the study had middle ear cholesteatomas, all children--regardless of the location of cholesteatoma--had a higher incidence of surgical failure than did the adults.

Motivation in hearing aid acceptance.

Patient case histories are presented in an attempt to pinpoint possible motivational factors affecting the acceptance of a hearing aid. Personality profiles were constructed on three representative patients through the use of an in-depth interview as well as three personality scales: the 16PF Multiphasic Personality Scale; the Crowne-Marlowe Social Desirability Scale; and the Attitude Toward Disabled Persons Scale. The very preliminary results indicate at least some face validity to the assertion that unsuccessful hearing aid wearers are measurably different from successful wearers and that these differences may be used to predict success of failure for future patients.

Management of the mastoid air cell system in chronic otitis media.

The influence of the Mastoid Air Cell System in Chronic Otitis Media is subject to much speculation. Does a mastoidectomy influence the surgical results following chronic inflammatory ear surgery? An understanding of the pathology associated within the mastoid air cell system is necessary before a discussion of the need for a mastoidectomy can be presented. Most mastoid air cell systems are sclerotic in chronic otitis media patients. The report summarizes one author's experiences with the influence of mastoidectomy upon surgical reconstruction for chronic inflammatory diseases of the ear. Emphasis is directed toward the eustachian tube rather than the mastoid air cell system.

First branchial cleft syndromes and associated congenital hearing loss.

We have recently encountered three cases of first branchial cleft syndromes, two of which had prominent hearing losses. The cases are described, and the literature pertaining to first branchial cleft syndrome is reviewed. Because of the frequent coexistence of various congenital anomalies, we feel that the prevalence of congenital otologic problems associated with a first branchial cleft syndrome may be greater than has previously been suspected.