Sensorineural hearing loss caused by NSAID-induced aseptic meningitis

Aseptic meningitis is a rare complication of nonsteroidal anti-inflammatory drug (NSAID) use. Otologic symptoms may include sensorineural hearing loss and tinnitus. A 66-year-old woman sought the care of an otologist for sudden bilateral sensorineural hearing loss and a substantial increase in baseline tinnitus. The patient had previously undergone a left tympanoplasty secondary to cholesteatoma and had been treated for atypical face pain with ibuprofen taken every six hours for three months. Magnetic resonance imaging (MRI) with gadolinium demonstrated abnormal enhancement of the dura mater and the surrounding basal cisterns, with extension of enhancing dura mater into the internal auditory canals. Cerebrospinal fluid examination revealed evidence of aseptic meningitis. An audiogram confirmed new bilateral sensorineural hearing loss. Hearing loss and tinnitus resolved and no abnormalities were observed with MRI when nonsteroidal anti-inflammatory medication was discontinued. Otolaryngologists are well aware of the otologic sequelae in patients with meningitis. However, NSAIDs need to be considered as possible causal agents in the evaluation of meningitis with otologic symptoms.     

Erythema multiforme caused by saquinavir]

A multidisciplinary audit to monitor the introduction of a ward-based urine screening test using Multistix 10 SG was associated with a 40% reduction in the number of culture-negative samples being sent for laboratory testing. Ongoing education and support was provided for nursing staff throughout the process of change.     

Diagnosis of anaphylactic shock caused by antibiotics]

A total of 277 cases with anaphylactic shock due to the use of various antibiotics were analyzed. Anaphylactic shock due to penicillin (38.2 per cent), streptomycin (19.8 per cent), combihation of streptomycin with penicillin (16.9 per cent) or bicillin (15.2 per cent) was most frequent. The causes of the diagnostic mistakes are shown and the clinical signs of the main typical form of the drug anaphylactic shock are descrifed. Four variants of atypical clinical picture of anaphylactic shock, i.e. hemodynamic (collaptoid), asphyctic, cerebral and abdominal were classified. Examples of diagnostic mistakes are presented. It was shown that the drug allergological anamnesis was not always considered in the therapeutic practice.     

Respiratory failure caused by myopathy in severe sepsis]

The peptide hormone relaxin was isolated in good yield from the ovaries of the pregnant rodent Rattus rattus using a simplified purification schedule. It was subjected to comprehensive chemical characterization to confirm both its purity and predicted composition. The peptide was also chemically synthesized by the solid phase procedure. The two chains comprising the hormone were each assembled by the Boc-polystyrene method and, following conventional purification, combined in solution to form the single intramolecular and two intermolecular disulfide bonds. Following purification, the synthetic rat relaxin was fully chemically characterized and shown to be indistinguishable from the native peptide including by secondary structure analysis using circular dichroism spectroscopy. The native and synthetic rat relaxins were shown to be equally biologically active in the in vitro rat uterine relaxation assay and had pEC50 values that were comparable to synthetic human H2 relaxin.     

Diagnosis of infections caused by varicella zoster virus]

Pendred's syndrome is manifested by congenital sensorineural deafness in association with familial goiter due to defective organic binding of iodine in the thyroid gland. The majority of patients with Pendred's syndrome are euthyroid. We report on an unusual case of a patient with Pendred's syndrome presenting with amenorrhea and late-onset hypothyroidism.     

Liver damage caused by sensitivity to anti-inflammatory agents]

Nonsteroidal antiinflammatory drugs may cause hepatic sensibilization and impairment. The incidence of these changes is low and referential data are scarce and related mainly to reaction which clinically corresponds to hepatic or cholestatic reaction. We present a patient who is sensitive to Diclofenac and has hepatic granuloma which developed after the use of the drug. History, clinical presentation, laboratory results, US examination of the liver and pathohistologic analysis of the hepatic biopsy sample enabled us to diagnose hepatitis with granulomatous impairment. Improvement of symptoms and signs of the disease was spontaneous and without administration of glucocorticoid drugs.     

Clinico-radiological correlations in pulmonary pathology caused by immunosuppression]

Lung is the most involved site by infective manifestations in immunodepressed patients. In these patients the variability of pathogenic and opportunistic agents is expressed in the lungs with interstitial and alveolar changes, which are not pathognomonic. CT is the appropriate method to study lung parenchyma. CT by means of fast scans and high resolution algorithms (HRCT) allows an accurate and detailed representation of the lung parenchyma, detecting the secondary lobe, the anatomic and functional unit of the lung and its pathological changes. Our study aim to show the clinical-radiological correlation among the various types pulmonary infections in immunocompromised host.     

Thoughts on carcinogenic pollution caused by ionizing radiation]

The lacrimal secretion in 99 healthy individuals has been measured by Schirmer's method. The established statistical limits of normal lacrimal secretion were tested in 18 patients submitted to geniculate ganglionectomy because of petrosal neuralgia, in 15 patients with traumatic, in 17 patients with idiopathic, and in 10 patients with herpetic facial palsy. A significant bilateral reduction of lacrimation was found to be as indicative for a unilateral interruption of the parasympathetic iaring. Abnormal unilateral and bilateral values of lacrimation were present in 93% of the traumatic, in 53% of the idiopathic, and in 60% of the herpetic facial palsies respectively. There is evidence that a significantly disturbed lacrimal flow has not only topographic, but also prognostic value in facial nerve palsy.