Analysis of taste function in patients before and after cochlear implant surgery.

BACKGROUND: Cochlear implantation (CI), the standard therapy for rehabilitation of severe to profound sensorineural hearing loss, exhibits taste dysfunction as a possible postoperative complication. This study aimed to investigate possible postoperative changes in taste and in addition baseline taste function in CI candidates. METHODOLOGY: We included 61 patients (32 male, 29 female) planned to undergo CI surgery and 23 healthy controls (8 male, 15 female). Gustatory function was measured using a chemosensory quasi-threshold test (taste strips) and electrogustometry (EGM). To exclude possible effects of olfaction on taste, olfactory function was tested by means of the Sniffin Sticks odor identification test. Furthermore, the density of fungiform papillae (fPAP) was analyzed. Measurements were taken pre- and 2-4 weeks postoperative. RESULTS: Preoperative taste function and fPAP density was reduced in CI patients compared to controls. The fPAP density correlated significantly with the total taste score, EGM scores and age. Postoperative taste function decreased significantly, whereas EGM scores and fPAP density did not significantly change. Also baseline olfactory function in CI candidates was decreased, whereas no significant change of olfactory function was found post-surgery. CONCLUSION: CI candidates exhibited taste and olfactory dysfunction already preoperatively. Furthermore, a significant decrease in taste scores after CI surgery was detected.

Percutaneous biopsy of the liver as a procedure for outpatients.

Hepatic biopsy was performed in 107 outpatients and 68 inpatients in the last 18 months at this hospital. Only 1 patient had a complication; he bled from the biopsy site, The minimal cost saved per patient was $153.00. Biopsy of the liver in outpatients is both safe and economical.

Mallory-Weiss syndrome. Characterization of 75 Mallory-weiss lacerations in 528 patients with upper gastrointestinal hemorrhage.

Seventy-five Mallory-Weiss lacerations were visualized endoscopically in 58 of 528 patients evaluated acutely for upper gastrointestinal bleeding. The Mallory-Weiss mucosal laceration is more common than generally recognized, is usually associated with hiatal hernia and a prodrome of retching or vomiting, and the ingestion of alcohol or acetylsalicyclic acid, or both. The lacerations are most commonly gastric and are associated with other mucosal lesions which may in fact be the instigating cause of the retching and vomiting. Although blood loss may be considerable, 90% or more patients with this lesion can be managed nonsurgically with appropriate blood component replacement and occasional use of systemic pitressin. There was one fatality in this series of 58 patients with Mallory-Weiss lacerations.

Pericarditis: complication of esophageal sclerotherapy. A report of three cases.

Three patients developed acute pericarditis while undergoing esophageal sclerotherapy for bleeding varices. One patient required pericardiocentesis and the other 2 patients had spontaneous resolution of the pericarditis. This previously unreported complication of sclerotherapy must be considered in the differential diagnosis of those patients who develop postsclerotherapy chest pain.

Cardiopulmonary manifestations of schistosomiasis.

Three major schistosome species infect hundreds of millions of people worldwide. The majority of these infections are asymptomatic, but significant morbidity and mortality can occur as a consequence of ongoing egg deposition in host tissues. Acutely, transient chest radiographic abnormalities and nonspecific influenza-like symptoms can occur, including cough. The most common chronic pathological sequelae of schistosomiasis are those of portal hypertension with Schistosoma mansoni or S. japonicum, and genitourinary tract obstruction with S. haematobium. In less than 5% of infections, schistosomal egg obstruction of the lung vasculature results in pulmonary hypertension and cor pulmonale. Limited data suggests that cardiopulmonary schistosomiasis is seen most often in S. mansoni infections. Hepatic fibrosis and portal hypertension appear to be a prerequisite to the development of schistosomal cor pulmonale caused by this species. The premortem diagnosis of cardiopulmonary schistosomiasis depends on the detection of viable schistosomal ova in stool or urine along with evidence of characteristic hepatic fibrosis and pulmonary hypertension. Although treatment with praziquantel can effectively eradicate all schistosomal infections with minimal toxicity, cardiopulmonary manifestations are not likely to be reversible given the chronic fibrotic tissue changes that are present.

Achalasia in monozygotic twins.

The familial occurrence of achalasia has been previously recorded and a genetic origin for the disease has been postulated. We present the first case of achalasia in monozygotic twins and suggest that concordance for the disease is consistent with a genetic factor in the etiology of achalasia.

Amebic liver abscess: a 15-year experience.

Amebic liver abscess is increasingly common in the United States, particularly in the West and Southwest, due to increased immigration from Southeast Asia, Mexico, and Central America. The presentation, course, and treatment of 50 patients treated for amebic liver abscess at a county-community hospital in San Jose, California, between 1974 and 1988 is reviewed. The typical patient is an immigrant, usually a Hispanic male, 20-40 yr old, who presents with fever, right upper quadrant pain, leukocytosis, abnormal serum transaminases and alkaline phosphatase, and a defect on hepatic imaging study. Available serologic testing (i.e., indirect hemagglutinin antibody) is sensitive and confirms the diagnosis. Most patients respond rapidly and completely to oral metronidazole. The data, compared with other studies, indicate no major change in presentation or management, except for decreasing need to aspirate the abscess for diagnosis.

Pseudo-obstruction of the bowel. Therapeutic trial of metoclopramide.

A patient with chronic idiopathic pseudo-obstruction is reported and the results of a double blind therapeutic trial of metoclopramide are described. Within the limits of this trial metoclopramide was ineffective by all clinical criteria.

Bleeding after liver biopsy.

During nine years 3,080 liver biopsies were carried out and bleeding occurred in 22 of the patients (0.7 percent). Transfusions were given to 17 of these patients and laparotomies were done to control the bleeding in six. All survived. Bleeding was evident within three hours in 19 patients, but occurred from 3 to 13 days after biopsy in the remaining three. Pain requiring analgesic medication and a fall in blood pressure were the usual indications that major bleeding had occurred. Relative contraindications to biopsy (particularly a prolonged prothrombin time) were present in 10 of the 22 bleeding patients and in only 2 of the 41 nonbleeding controls (P<0.001). We believe that some of the bleeding episodes could have been prevented with more careful attention to the indications and contraindications to biopsy, and more rigorous correction of recognized clotting abnormalities.

Gastrointestinal tuberculosis: an eighteen-patient experience and review.

The diagnosis of gastrointestinal tuberculosis (GITB) is often delayed, increasing the morbidity associated with this treatable condition. In this case series, the clinical presentations and outcomes of 18 patients with GITB are reviewed. Our aim was to elucidate the presenting signs and symptoms of GITB so as to help physicians improve their ability to make this diagnosis. Cases were gathered retrospectively over an 8-year period from Santa Clara Valley Medical Center, San Jose, California. Sources of information included patient records from our TB clinic and our hospital from 1989 to 1997. Of the 18 patients, 16 had a definitive diagnosis of GITB made from histology and/or culture from an abdominal source. In the remaining two patients, a presumptive diagnosis of GITB was made based on the co-occurrence of abdominal signs and symptoms, response to antituberculous therapy, and Mycobacterium tuberculosis identified at a nonabdominal site. The most common clinical presentation was a triad of abdominal pain, fever, and weight loss. This triad was present in 8 of 18 patients. Seven patients presented with two of these signs and symptoms, two had abdominal pain alone, and one presented with other symptomatology. Time to diagnosis ranged from 2 days to 11 months, with a mean time to diagnosis of 50 days. These findings suggest that the diagnosis of GI and hepatic TB is often delayed. Possible reasons for delay include nonspecific signs and symptoms and failure to consider TB in the initial differential diagnosis. Once diagnosed, the outcome of GITB in this series was favorable.

Portal hypertension associated with hepatocellular carcinoma with cirrhosis.

Portal hypertension associated with hepatocellular carcinoma in the absence of cirrhosis of the liver has not been clearly recognized in the past. While the incidence of this association is unknown, its occurrence does not appear to be rare. This case report describes a 49-year old male with hepatocellular carcinoma, ascites and measured portal hypertension but no cirrhosis of the liver. The portal hypertension was secondary to microscopic invasion of central veins and small portal veins. Hepatocellular carcinoma in the absence of cirrhosis should be added to the differential diagnosis of portal hypertension.

Isoniazid-associated hepatitis--serum enzyme determinations and histologic features.

A prospective study of 208 patients treated for up to 12 months with isoniazid (INH((R))) for tuberculosis prophylaxis was made. Levels of serum glutamic oxaloacetic acid transaminase (SGOT) became elevated in 20 percent of the adults followed and in 30 percent predominantly nonspecific symptoms developed, in 11 percent simultaneously with SGOT elevation; SGOT levels became elevated in two of 33 children and 1 was symptomatic. Mild SGOT elevations in asymptomatic adults were self-limited; however, a small percentage of symptomatic adults showed prolonged SGOT elevation for months after INH was completed. Results of liver biopsy studies in the early stages of SGOT elevation generally showed portal and periportal lymphocytic infiltrations with lesser numbers of plasma cells, neutrophils and eosinophils.

Marked hypergastrinemia in gastric outlet obstruction.

We report a 45-year-old woman with chronic peptic ulcer disease and multiple episodes of bowel obstruction, who was admitted with gastric outlet obstruction. Because of gastric hypersecretion, a diagnosis of Zollinger-Ellison syndrome was suspected and an initial serum gastrin of 1,251 pg/ml supported this diagnosis. Subsequent evaluation failed to reveal a gastrinoma. A repeat serum gastrin level after 14 days of continuous nasogastric decompression was 43 pg/ml, suggesting that the initial hypergastrinemia was due to antral distention. It is important to consider the possibility of gastric outlet obstruction as a stimulus for serum gastrins in the range previously considered diagnostic for the Zollinger-Ellison syndrome.

Gastric bezoar caused by lecithin: an unusual complication of health faddism.

We discovered an unusual bezoar in a previously healthy man who had been ingesting large amounts of a vegetable-derived oil touted to contain lecithin, which he purchased from health food stores in the belief that it had beneficial effects in lowering cholesterol levels and improving memory. The large intragastric mass, composed of fatty acids and lecithin, led to considerable morbidity, including abdominal pain, early satiety, and significant weight loss, and required surgical removal.

Perforation of an adenocarcinoma of the small bowel affected by regional enteritis.

This report is of a patient with long-term small bowel regional enteritis who presented with a perforation of an adenocarcinoma involving a diseased portion of ileum. Adenocarcinoma of the small bowel is rare. The incidence of small bowel adenocarcinoma may be higher in patients with regional enteritis, but a definite relationship cannot be established on the basis of data presently available. Small bowel adenocarcinoma in regional enteritis usually presents with obstructive symptoms.

Hepatitis B viral markers in severe viral hepatitis: influence of steroid therapy.

In our double-blind randomized trial of methylprednisolone vs. placebo in severe viral hepatitis, 16 patients with hepatitis B (8 on steroid, 8 on placebo) were followed for at least 4 weeks. Four of the eight patients receiving methylprednisolone eventually died and all patients on placebo survived. Despite marked reduction in serum IgG in steroid-treated patients, the decline in HBsAg titer and disappearance of Dane particle markers was the same in both treatment groups. A nonspecific depression of anti-HBc was noted in patients given steroid. There is no evidence that corticosteroid therapy accelerates viral replication when the acute hepatitis is severe.

Pharyngeal/upper esophageal sphincter pressure dynamics in humans. Effects of pharmacologic agents and thermal stimulation.

Extensive physiological studies of swallowing have been carried out in laboratory animals; however, similar studies in humans have been limited by available technology. In this study we describe the use of a solid-state circumferential sphincter transducer to define manometric characteristics of the human pharynx and upper esophageal sphincter (UES). Effects of pharmacologic agents and thermal stimulation are also described. We studied nine normal volunteers on three separate days. All studies were done in the upright position and consisted of a station pull-through of the UES and six wet swallows with the sphincter transducer in the most proximal segment of the UES and a posteriorly oriented single transducer 5 cm proximal in the pharynx. Baseline studies preceded all drug studies. Effects of bethanechol were studied on day 1, cold stimulation and benzonatate on day 2, edrophonium and atropine on day 3. The UES resting pressure showed large intrasubject day-to-day variations; however, mean values did not differ. There were no effects on UES relaxation or swallow coordination with any of the pharmacologic agents, although benzonatate produced multiple pharyngeal contractions.