Ototoxic reactions of quinine in healthy persons and patients with Plasmodium falciparum infection

Audiometric changes following quinine administration were studied in healthy Caucasian subjects and patients suffering from falciparum malaria disease. Quinine-dihydrochloride was administered intravenously as a single dose of 300 mg to 12 healthy subjects and as multiple doses of 600 mg in 4 h every 8 h in 10 Plasmodium falciparum malaria patients. The hearing function was monitored by conventional and high frequency audiometry. In nine healthy subjects hearing loss was documented at 2-4 h after infusion of Quinine-dihydrochloride at a mean maximal plasma quinine concentration of only 2 mg/l. In one healthy subject a persistent loss occurred of 20 dB at 14 kHz in one ear. In all malaria patients severe hearing losses and adverse effects related to ototoxicity were documented, but all the audiograms had returned to normal after 1 week and side effects disappeared. This study has shown that ototoxicity induced by quinine is almost completely reversible in healthy volunteers and in malaria patient

The Real Heroine of the Story: Female Rivalry in the Victorian Novel

This thesis seeks to challenge the thinking that led Virginia Woolf to dismiss fictional representations of female rivalry as “simplified, conventionalised”, uncomplicated and uninteresting. Using close readings of novels by Charlotte Brontë, Anne Brontë, George Eliot, Elizabeth Gaskell, Wilkie Collins, Mary Elizabeth Braddon and Ellen Wood, I look at the ways in which female rivalry functions in the Victorian novel; at the tensions and currents of narrative it creates; at its force for forging relational structures between characters; and at its part in the distribution of narrative interest, affect and sympathy. Whether it manifests as maternal rivalry, fledgling professional rivalry, sororal rivalry, or the romantic rivalry so often associated with the nineteenth-century marriage plot, female rivalry is central to Victorian narratives about women because it translates female homosocial bonds into narrative effect. I argue that rivalry is both a structural and thematic concern in narrative. Narrative conditions us to read rivalry. It teaches us to derive meaning through the oppositional frameworks in which it sets characters and their stories up against each other: as foils; as relative points of moral or aesthetic value; as rival points of interest. By encouraging us to read and evaluate narrative elements relative to each other, narrative structures generate rivalry. And rivalry, in its turn, generates narrative. The idea of female rivalry has tended to attract the kind of cultural stigma that Sianne Ngai associates with “ugly feelings”, and feminist debates on the subject have typically attempted to rehabilitate this image. I seek neither to assign negative or positive values to female rivalry, nor to suggest new ways in which to accept it into the fold of feminist criticism. Instead, I want to stake a claim for rivalry’s part in the reading and writing of narrative, and more specifically, for the role female rivalry plays in the formation and the consumption of the Victorian marriage plot

Primary stapes surgery in patients with otosclerosis: prediction of postoperative outcome.

Contains fulltext : 97258pub.pdf (publisher's version ) (Closed access)OBJECTIVES: To evaluate the audiometric results of primary stapes surgery in patients with otosclerosis and to determine predictors of a postoperative air-bone gap (ABG) of 10 dB or less and a postoperative gain in air conduction (AC) exceeding 20 dB. DESIGN: Retrospective cohort study. SETTING: Tertiary referral center in Utrecht, the Netherlands. PATIENTS: Nine hundred thirty-nine patients with otosclerosis who underwent primary stapes surgery between January 1, 1982, and March 1, 2009. INTERVENTION: Primary stapes surgery. MAIN OUTCOME MEASURES: Preoperative and postoperative audiometric results were compared. Logistic regression analyses were performed to evaluate which factors (ie, sex, age at surgery, bilateral otosclerosis, and preoperative 4-frequency [0.5, 1, 2, and 4 kHz] ABG, AC, or bone conduction) independently contributed to the prediction of a postoperative ABG of 10 dB or less and a postoperative gain in AC exceeding 20 dB. RESULTS: A total of 72.1% of patients had a postoperative ABG of 10 dB or less, and 93.8% of patients had a postoperative ABG of 20 dB or less. Age at surgery and preoperative ABG and AC were independent prognostic determinants. A patient older than 40 years with a preoperative ABG of 30 dB or less has a 77.6% chance of achieving a postoperative ABG of 10 dB or less. A patient with a preoperative AC exceeding 50 dB and a preoperative ABG exceeding 30 dB has an 86.2% chance of achieving a postoperative gain in AC exceeding 20 dB. CONCLUSIONS: Following primary stapes surgery, a postoperative ABG of 10 dB or less and a postoperative gain in AC exceeding 20 dB may be predicted with accuracies of 62.1% and 80.1%, respectively. Clinicians can use this information to inform patients more explicitly about expected postoperative audiometric results.1 augustus 201

A nonrandomized comparison of stapes surgery with and without a vein graft in patients with otosclerosis

Item does not contain fulltextOBJECTIVE: To evaluate the effectiveness of primary stapes surgery with and without a vein graft in patients with otosclerosis and to determine the differences in the postoperative gain in air-bone gap (ABG) and air-conduction (AC). STUDY DESIGN: A nonrandomized multicenter clinical evaluation. SETTING: Two tertiary referral centers in The Netherlands and France. PATIENTS: Otosclerosis patients that underwent primary stapedotomy surgery. INTERVENTION: Primary stapedotomy surgery without a vein graft (n = 939, first center) compared with primary stapedotomy surgery with a vein graft (n = 3691, second center). MAIN OUTCOME MEASURES: Preoperative and postoperative audiometric results were compared. An analysis of variance was performed to evaluate differences in postoperative ABG and AC gains between surgeries with and without a vein graft, adjusted for potential confounders. RESULTS: The postoperative ABG was 10 dB or lesser in 72.1% of the patients without a vein graft and in 93.2% of patients with a vein graft. After adjustments for differences at baseline, the mean gain in ABG was 18.6 dB (95% CI, 18.1-19.1) in the group without vein graft, compared with 24.2 dB (95% CI, 23.9-24.6) in the group with vein graft (mean difference, 5.6 dB; 95% CI, 5.0-6.2). The mean gain in AC was 19.5 dB (95% CI, 18.7-20.3) in the group without vein graft, compared with 24.3 dB (95% CI, 23.7-24.7) in the group with vein graft (mean difference, 4.8 dB; 95% CI, 3.8-5.7). CONCLUSION: Patients with otosclerosis undergoing primary stapes surgery may benefit more from a vein graft interposition. LEVEL OF EVIDENCE: 2B

Laser versus conventional fenestration in stapedotomy for otosclerosis: a systematic review

Objectives/Hypothesis To assess hearing results and complications following primary stapedotomy in otosclerosis patients comparing the use of laser and conventional techniques for fenestration. Study Design Systematic literature review. Methods A systematic bibliographic search was conducted in PubMed, Embase, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and Scopus. Studies reporting original data on the effect of laser fenestration, compared to conventional techniques, on closure of air-bone gap in patients undergoing primary stapedotomy were included. Directness of evidence and risk of bias of the selected articles were assessed. Studies with low directness of evidence, high risk of bias, or both were not further analyzed. The absolute risks, risk differences, and 95% confidence intervals were extracted only for studies with moderate to high directness of evidence and moderate to low risk of bias. Results In total, 383 unique studies were retrieved. Eight of these (including 999 procedures) provided high or moderate directness of evidence and carried a moderate risk of bias, and were considered eligible for data extraction. The included studies show no consistent difference in postoperative air-bone gap closure or immediate postoperative vertigo. Conclusions Both footplate fractures and sensorineural hearing loss appear to occur more frequently in the conventional group than in the laser group. Therefore, we prefer laser above conventional methods for footplate fenestration in primary stapedotomy

Vocal efficiency in tracheoesophageal phonation

OBJECTIVE: Voice rehabilitation after total laryngectomy is challenging. In order to investigate and understand the function of the neoglottis sophisticated measurements need to be made. During voice production, aerodynamic energy is transformed into sound energy. In non-laryngectomized patients, the voice production efficiency is called the vocal efficiency. Vocal efficiency is an indication of how efficient the transformation of energy takes place. Vocal efficiency is calculated by dividing the output sound power by the aerodynamic power. PATIENTS AND METHODS: In a group of eight laryngectomees with tracheoesophageal voice, we measured aerodynamic and acoustic quantities and calculated vocal efficiency. We used a computer setup with airflow transducers, pressure transducers, mikrotip transducers and sound intensity measurement to allow calculation of the needed parameters. RESULTS: The tables show the results of the power used and produced in various phonatory tasks. Relatively high levels of aerodynamic power are interpreted as increased effort to speak. CONCLUSION: The aerodynamic power is an indication of the effort needed for voice generation. The efficiency of TE-voice production is lower compared to laryngeal voice production but does show an increase when sound intensity increases, a known phenomenon in healthy laryngeal voice productio