The efficacy of intratympanic steroid injection for the treatment of idiopathic sudden sensorineural hearing loss.

OBJECTIVE: A systemic steroid is known to have a potential to recover hearing after idiopathic sudden sensorineural hearing loss (ISSHL). However, lately many centres have introduced the use of intratympanic (IT) steroid therapy as an option. We reviewed our experience in the treatment of patients with ISSHL looking at the overall success of using systemic steroid, IT steroid injections as salvage therapy and primary IT steroid injection. METHODS: A retrospective study was conducted on 20 patients who had suffered from ISSHL from January 1, 2012, to December 31, 2017. ISSHL is defined as a rapid decline in hearing over three days or less affecting three or more frequencies by 30dB or greater. Comparison between the mode of steroid therapies and improvement in patients was done. At least 15dB improvement in pure tone audiogram (PTA) was considered as successful therapeutic intervention. RESULTS: Twenty male and female patients who fit the inclusion and exclusion criteria were included. The mean age of the patients was 41.4 years with a range from 13 to 72 years. Ninety percent patients presented with unilateral ISSHL involvement. Eight ears of patients who received systemic steroid therapy alone had improved hearings (75%). Out of seven ears from six patients who received salvage therapy, four ears (57.1 %) had improvement in PTA. Seven ears showed improvement in PTA from a total of eight patients who primarily received IT injections. CONCLUSIONS: IT steroid therapy promises a favourable outcome in the improvement of the hearing, as compared to systemic steroid administration. Its usage is recommended not only for salvage therapy but should be used as primary treatment especially in those with co- morbidities.

Mechanical signatures of microbial biofilms in micropillar-embedded growth chambers.

Biofilms are surface-attached communities of microorganisms embedded in an extracellular matrix and are essential for the cycling of organic matter in natural and engineered environments. They are also the leading cause of many infections, for example, those associated with chronic wounds and implanted medical devices. The extracellular matrix is a key biofilm component that determines its architecture and defines its physical properties. Herein, we used growth chambers embedded with micropillars to study the net mechanical forces (differential pressure) exerted during biofilm formation in situ. Pressure from the biofilm is transferred to the micropillars via the extracellular matrix, and reduction of major matrix components decreases the magnitude of micropillar deflections. The spatial arrangement of micropillar deflections caused by pressure differences in the different biofilm strains may potentially be used as mechanical signatures for biofilm characterization. Hence, we submit that micropillar-embedded growth chambers provide insights into the mechanical properties and dynamics of the biofilm and its matrix.

Alternatives to female sterilization.

With national policies aimed at reaching zero population growth in the shortest possible time, many countries have introduced restrictive legislation and disincentive programs in an attempt to decrease family size norms to 2 or 3 children. As a result, younger women of lower parity are being sterilized, with consequences that will be seen in the years to come. Although female sterilization is usually associated with minimal complications and side effects and is highly effective without continuing motivation or promotion, it has the disadvantage of causing permanent, essentially irreversible sterility. Therefore, it will not be readily acceptable to a large portion of the population. For many women, alternatives must be sought. Reversible methods of female or male sterilization, longacting systemic contraceptives, longacting implants, and immunization against implantation or sperm antigens are potential alternatives, but all are still in experimental stages of development. Intrauterine devices and injectables are the 2 most effective alternatives now available. The use of intrauterine devices with abortion as a backup in case of contraceptive failure ranks high as an alternative to female sterilization.

Falope ring application via culdoscopy.

This report describes a series of 122 women who were sterilized with Falope ring application via culdoscopy and demonstrates the feasibility of the procedure.

Useful ultrasonic parameters pertaining to intra uterine fetal well being and growth retardation.

The true gestational age of the fetus is of great importance especially when there is an apparent discrepancy between the size of the fetus and the period of amenorrhoea. Various Ultrasonic measurements of the fetus have been used at different gestational periods to help arrive at the true gestation and to confirm or exclude intra uterine growth retardation. Recently, dynamic studies on the fetal blood flow through the umbilical artery and also the uterine vessels have provided an additional measurement of the internal milieu. These tests have been found to be extremely useful and of prognostic value even before changes occur in the CTG patterns.

Assisted reproductive techniques--promises and problems.

Assisted reproductive techniques (ART) are procedures in which the oocyte is handled before replacement, either as an oocyte or embryo. The current success rates and pregnancy outcomes of in-vitro fertilisation (IVF), gamete intra-fallopian transfer (GIFT), zygote intra-fallopian transfer (ZIFT), intra-cytoplasmic sperm injection (ICSI), donor oocyte and frozen embryo programmes are reviewed. Some problems associated with assisted reproductive procedures are also discussed.

Pectoralis major myocutaneous flap reconstruction in head and neck surgery--experience with 60 cases.

The aim of this paper is to evaluate the results of the use of the pectoralis major myocutaneous flap for reconstruction in 60 otolaryngology--head and neck patients over a five year period. There were 52 patients with Stage III (30%) and Stage IV (70%) untreated squamous cell carcinomas. Of the eight recurrent tumours, three patients had nasopharyngeal carcinoma with extensive post-radiation neck failures requiring extended neck dissections and flap reconstruction. The oral cavity and oropharynx were the predominant sites for reconstruction accounting for 70% of the operations performed. Twenty-eight patients had composite resections, ten with pectoralis osteo-myocutaneous flap incorporating a vascularised split sternum bone graft and titanium plate fixation for immediate mandibular reconstruction. All 52 patients underwent post-operative radiation. Major necrosis did not occur but minor tip necrosis of the skin island occurred in two cases (3%). The mean hospitalisation was 19 days for all patients and 21 days for patients with composite resections. The pectoralis major myocutaneous flap in our experience is not only a versatile flap but also a very reliable and robust flap for single stage immediate head and neck reconstruction.

Clinical experience in temporomandibular joint arthroscopy.

Clinical experience of arthroscopy in 12 temporomandibular joints with a clinical diagnosis of closed lock was described. There were 10 patients and all were females with a mean age of 31.2 years (range 20 to 59 years). The antero-lateral approach was used for entry into 11 joints. The clinical findings were adhesions (64%), fibrillation (64%), anterior displacement of disc (36%) and scuffing of the articular surface of the glenoid fossa (9%). Two of the joints that had arthrocentesis prior to arthroscopy did not show any different findings from the rest. Of the 8 patients who had pre-arthroscopy pain, 7 patients (88%) had reduction of the symptom. Three patients (38%) had complete resolution of pain. The range of mouth opening (measured as maximal incisor opening) increased in all patients two weeks following arthroscopy. The average change in maximal incisor opening was 40.3% with a range of 22% to 85%. The mean follow-up was 34 months (range 4 to 68 months).

A cadaveric study of the potential damage in arthroscopic examination of the temporomandibular joints.

An arthroscopic study on 22 temporomandibular joints in 13 cadavers was undertaken. Dissections were carried out to correlate the arthroscopic with macroscopic findings in the joints. Iatrogenic damage to the temporomandibular joints and their surrounding tissues was also examined. Correlation between arthroscopy and macro findings was 91.0%. There was no damage to the facial nerve and superficial temporal vessels. Iatrogenic damage to the temporomandibular joint included scuffing of the articular surfaces of the glenoid fossa and articular eminence (31.8%), scuffing of the condylar articular surface (9%), one disc perforation (4.5%) and one perforation of the medial capsule (4.5%). Prevention of iatrogenic injuries is discussed.

Early experience with the copper 7, copper T220C and multiload 250 intrauterine devices.

PIP: A preliminary study was conducted to assess the progress made in the IUD project being carried out at 3 university centers in Kuala Lumpur, Singapore and Medan. The three IUDs studied were the Copper 7 (Cu-7), the Copper T220C, and the Multiload 250 (MLCu250). Due to the fact that the number of acceptors was relatively small, only the first six months of use were analyzed. The study group consisted of 574 parous women who chose the IUD as the sole method of contraception. Insertions were made in the interval period, either 4 weeks following an abortion or 8 weeks after a delivery. Allocation of the device was made on a random basis and all patients had been followed up for at least 6 months or had been terminated from study by August 31, 1977. The age range of acceptors was 19-35 years. The mean parity was 2.6. Of the 572 insertions made, 70 or 12.2% were terminated in the first 6 months of use. The overall continuation rate at 6 months was 87.7/l00 users for a total of 3253 woman-months of use. The removal rate for pain/bleeding was comparable among the three IUDs. The mean of 3.1/l00 users is low in contrast to the rate of 9.9 for the Lippes Loop. The primary differences between the devices was in their rates for expulsion and accidental, but the data is too small at this time for any tests of significance to be meaningful. If present trends continue, the TCU 220C may prove to be the most effective device.^ieng

Folate content and availability in Malaysian cooked foods.

INTRODUCTION: Data on folate availability of Malaysian cooked foods would be useful for estimation of dietary folate intake; however such information is scarce. METHODS: A total of 53 samples of frequently consumed foods in Malaysia were selected from the Nutrient Composition of Malaysian Foods. Folate content was determined using HPLC method hyphenated with a stainless steel C18 column and ultraviolet detector (lambda = 280 nm). The index of folate availability was defined as the proportion of folate identified as monoglutamyl derivatives from the total folate content. RESULTS: Total folate content of different food samples varied from 30-95 microg/100g fresh weight. Among rice-based dishes, the highest and the lowest total folate was in coconut milk rice (nasi lemak) and ghee rice (nasi minyak), respectively. In noodle dishes, fried rice noodle (kuey teow goreng) and curry noodle (mee kari) had the highest folate contents. The highest index of folate availability was in a flat rice noodle dish (kuey teow bandung) (12.13%), while the lowest was in a festival cake (kuih bakul) (0.13%). Folate content was found to be negatively related to its availability. CONCLUSION: This study determined folate content and folate availability in commonly consumed cooked foods in Malaysia. The uptake of folate from foods with high folate content may not be necessarily high as folate absorption also depends on the capacity of intestinal deconjugation and the presence of high fibre in the foods.