Faculty Bibliography

Although diffuse cervical lymphadenopathy is one of the earliest and most common findings in patients with AIDS, the appropriate diagnostic approach in these patients has yet to be determined. Fine-needle aspiration (FNA) was performed on 26 patients with AIDS in order to evaluate the role of FNA in patients with diffuse cervical adenopathy. Specimens were sent for cytology, bacterial culture, fungal culture, and acid-fast smear and culture. Ten patients had positive findings, including toxoplasmosis, histoplasmosis, tuberculosis, atypical mycobacterium, and methicillin-resistant staphylococcal infection. All patients with either unilateral adenopathy or lymph nodes 3 cm or larger had positive aspirates. A statistically significant difference between patients with lymph nodes smaller than 2 cm and those with nodes larger than 2 cm was found. Fine-needle aspiration of a representative node in patients with AIDS may allow prompt diagnosis of diffuse lymphadenopathy. Rapid initiation of appropriate treatment can lead to symptomatic improvement. The need for excisional biopsy of involved lymph nodes may be obviated. Fine-needle aspiration is recommended as a diagnostic tool in selected patients with diffuse cervical lymphadenopathy and AIDS.

Composite data describing ocular pharmacokinetics are unreliable because of intersubject variation. To address this problem, an animal model was developed in which multiple aqueous samples from single subjects were obtained. Following direct anterior chamber or intravenous administration of amikacin or chloramphenicol, pharmacokinetic analysis of drug concentrations in the serum and anterior chamber was performed by using a nonlinear least-squares regression program. The number of anterior chamber paracenteses performed did not alter the beta elimination rates or percent penetration into the anterior chamber. The aqueous humor and peripheral-compartment terminal slopes were identical. These data indicate that complete ocular concentration-time curves can be obtained without altering antibiotic pharmacokinetics. Following direct injection into the anterior chamber, the elimination rates for both antibiotics followed a one-compartment model, whereas those following intravenous administration best fit an open, first-order, two-compartment model. Following intravenous administration, the anterior chamber elimination rate constants for both drugs were equal to that of the serum and significantly longer than that following direct injection. The elimination rates of both drugs following direct injection were similar. Systemic administration resulted in drug levels in aqueous humor that persisted longer than those following direct injection. Chloramphenicol, a lipophilic compound, gave higher mean concentrations in aqueous humor than did amikacin. Our model provides a new approach which rigorously examines ocular pharmacokinetics and provides data which suggest that for selected compounds the parenteral route of administration is preferable.

The Early Language Milestone Scale, a screening test for language in children from birth to 36 months of age, was applied to the total population of pediatric otolaryngic patients. Ninety-seven percent of the patients were found to have a completed screen. Thirty percent of the patients failed one or more portions of the Early Language Milestone screen. Practice management was modified by the results of the Early Language Milestone in all the patients who failed the screen. The Early Language Milestone was found to be efficient and effective in contributing to the management of the children with pediatric otolaryngic disorders and diseases.

Fluid electrolyte solutions based on mixtures of butyronitrile (PrCN) and ethyl chloride (EtCl) with Bu4NPF6 or Bu4NClO4 as electrolyte freeze below -180-degrees-C and provide excellent media for cryogenic electrochemical experiments. A 1:2 mixture of PrCN and EtCl exhibits the best combination of freezing point and ionic conductivity for ultralow temperature electrochemistry. Diffusion coefficients for bis(pentamethylcyclopentadienyl) iron (Cp2*Fe) are measurable by protential step chronoamperometry down to -160-degrees-C using a conventionally sized electrode, but the resistivity of the solvent mixture is such that potential sweep voltammetry benefits from the use of microdisk (10 and 25-mu-m diam Pt) or microband (0.2-mu-m wide Au) electrodes. Voltammetry at a chemically modified electrode down to -170-degrees-C is presented for the case of thin films of poly-[Os(bpy)2(vpy)2][PF6]2.

The availability and application of miniplate systems for the repair of displaced zygomatic fractures may effect commonly accepted guidelines for fixation of these injuries. A retrospective review of 20 patients at New York University-Bellevue Medical Center was conducted to further delineate issues concerning surgical repair and fixation. Our experience with one- and two-point fixation is evaluated and guidelines are presented

In orthogonal polynomial compression, the short-term speech spectrum is first approximated by a family of orthogonal polynomials. The coefficients of each polynomial, which vary over time, are then adjusted in terms of their average value and range of variation. These adjustments can be used to compress (or expand) temporal variations in the average level, slope, and various forms of curvature of the short-term speech spectrum. The analysis and reconstruction of the short-term speech spectrum using orthogonal polynomials was implemented using a digital master hearing aid. This method of compression was evaluated on eight sensorineurally hearing-impaired listeners. Speech recognition scores were obtained for a range of compression conditions and input levels with and without frequency shaping. The results showed significant advantages over conventional linear amplification when temporal variations in the average level of the short-term spectrum were compressed, a result comparable to that obtained with conventional amplitude compression. A subset of the subjects showed further improvement when temporal variations in spectrum slope were compressed, but these subjects also showed similar improvements when frequency shaping was combined with level-only compression. None of the subjects showed improved speech recognition scores when variations in quadratic curvature were compressed in addition to level and slope compression

Toxic shock syndrome has been associated with rhinologic surgery and medical devices, and it has been linked to a circulating exotoxin of a toxogenic strain of Staphylococcus aureus. One hundred forty patients with rhinosinusitis were studied. Nasal cultures were obtained. The microbiological characteristics are described. The carrier rate for Staphylococcus aureus was 35%. Thirty percent of patients selected for surgery were Staphylococcus aureus carriers. Toxin-capable isolates were identified in 40% of those tested. Users of cocaine, topical decongestants, and steroid sprays had a statistically higher rate of Staphylococcus aureus carriage compared to nonusers. It is hoped that by identifying the population at risk and defining the factors associated with the development of toxic shock syndrome, a cogent policy of prevention can be established

The consultants all agree to treat this patient who has a seemingly poor prognosis. However, they disagree as to the method and order of treatment. A patient's nutritional status is taken seriously by all 3 experts, although no one would delay surgery to correct a patient's weight loss. Drs. Komisar and Miller consider a weight loss of 10% significant and prefer to assess a patient with lymphocyte counts, serum albumin and transferrin levels, and creatinine/height index. Dr. Osguthorope follows serum hemoglobin, transferrin, prealbumin, and albumin levels. All the experts prefer an enteral route for weight gain. With regard to diagnosis, the experts agree that endoscopy plays an important role in tumor staging. Drs. Komisar and Osguthorpe believe that a tracheotomy should be performed prior to endoscopy. Dr. Miller would prefer intubation with an endotracheal tube but if there were any question of safety, he would proceed with a tracheotomy under local anesthesia. Confirming the histology of the pulmonary lesion is important. Dr. Komisar would proceed with flexible bronchoscopy and if tissue could not be obtained with this method he would obtain a fine-needle biopsy. He believes that if the histology matches that of the larynx, the pulmonary lesion is a metastasis. Dr. Osguthorpe would also obtain a needle biopsy of the lung lesion. If no other lesions are seen on the CT, he would consider this a second primary. Dr. Miller states that unless the histologies are different, the question of primary vs metastatic disease is unanswerable.(ABSTRACT TRUNCATED AT 250 WORDS)