Isaac Eliachar

Auditory Brainstem Evoked Potentials in Insulin-dependent Diabetics with and without Peripheral Neuropathy

Auditory Brainstem Evoked Potentials (ABEP) were recorded from 33 insulin-dependent diabetes mellitus (IDDM) patients (17 with diabetic peripheral neuropathy and 16 without) as well as from 20 normals. Pure-tone audiometry, speech reception threshold and discrimination were also evaluated. Sub-clinical pure-tone threshold elevation was observed for IDDM patients with neuropathy. Pure-tone thresholds of IDDM patients without neuropathy were not significantly different from those of normals. ABEP abnormality (at 10/sec click rate) was observed in 31% of IDDM patients with neuropathy, rising to 44% when 55/sec click rate measures were included. Abnormalities included bilateral and symmetrical peak-latency prolongations for all waves, greater for the later waves, and prolongation of V-I and V-III interpeak latency differences, all at 10/sec, and only prolonged peak latency for I at increased rate. Abnormalities coincided with microangiopathy and peripheral neuropathy. The incidence of ABEP abnormality for IDDM patients without neuropathy was only 12%, unilateral and sporadic in nature. As a group, IDDM patients with neuropathy had significantly prolonged IV and V peak-latencies, compared with the normals, or with the IDDM patients without peripheral neuropathy. In contrast, IDDM patients without neuropathy resembled the normals in all respects. ABEP have proven useful in understanding the variety of pathologies underlying the clinical manifestation of diabetes.

Hyoid bone fracture with pharyngeal lacerations

Four cases of hyoid bone fracture with laceration of the pharynx are presented. The emergency treatment must aim at an exploration of the neck in an attempt to suture the lacerations of the pharyngeal mucosa. The fractured hyoid bone may be left untouched in most cases. The most common causes of fractures of the hyoid bone were previously considered to be violent strangulation and hanging. In the last two decades, however, road accidents seem to have become the most important cause in patients who survive the initial impact of collision. The biodynamics of injury to the pharynx and larynx in road accidents have been adequately described by Nahum and Siegel (1967). The concluded that the driver was the most frequent victim and the steering wheel was the object with which the neck most commonly collides. It is very easy to miss a fractured hyoid bone during the urgent admission of a patient injured in a traffic accident, since the more dramatic injuries are treated first and a treacheostomy is often performed to provide an airway.

Primary hydatid cyst of the maxillary sinus

An unusual case of hydatid cyst of the maxillary sinus compressing the orbit is presented. No similar report has appeared in world literature.

Assessment of Long-Term Middle Ear Ventilation

Pathologic changes of the middle ear cavity are almost invariably caused by eustachian tube malfunctions which are either permanent, fluctuating or recurrent. The process may deteriorate from middle ear effusion to atelectasis of the middle ear, adhesive otitis, and can potentially end in cholesteatoma. Close association with eustachian tube malfunction is common in the following conditions: cleft palate, allergy, obstructive lymphoid hypertrophy, hypoimmune state, etc. Negative intratympanic air pressures typify the above conditions, leading to the progressive pathology of the ear drum and cavity. Localized atelectatic retraction pockets signal the alarm of impending irreversible complications. They may be localized in any part of the eardrum, predominantly in the posterosuperior quadrant. Inpocketed by the continuous vacuum, these invaginations may fill with trapped epithelial debris. Re-establishment of adequate middle ear ventilation is the key in every attempt to arrest and reverse this pathology. Cl...

Plastipore in reconstruction of the laryngo-tracheal complex.

The feasibility of using plastic material in the reconstruction of the damaged laryngotracheal complex was studied. In 6 dogs, large segments of larynx and trachea were removed and replaced by Plastipore sheets covered on the inside by free skin or mucosa grafts. It was demonstrated that the skin and mucosa covering the Plastipore--and resurfacing the airways lumen--remained viable. However, there appeared to be inadequate incorporation of the Plastipore into the tissue, probably due to the small pore size. Larger size pores may increase the likelihood that the Plastipore will become firmly embedded in the tissue environment.

Combined treatment of concurrent laryngeal and tracheal stenosis.

This report describes a one-stage combined surgical procedure for laryngeal and tracheal stenosis presenting concurrently. The technique links together three new procedures. Autogenous hyoid bone transposition on a muscle pedicle for reconstruction of the larynx, together with implantation of a silicone T-tube in conjunction with a custom-carved silicone stent, for maintenance and resurfacing of both strictures. This technique has produced satisfactory results in four cases. In two of the patients there is sufficient follow-up to indicate the efficacy of this method.

Familial Combined Hyperlipidemia and Otosclerosis—The Occurrence in a Large Kindred

The occurrence of otosclerosis and hyperlipidemia in four generations of a single family is described. The lipid abnormality fulfilled the characteristics of combined familial hyperlipidemia. Whereas a genetic linkage between combined hyperlipidemia and otosclerosis is feasible, our study indicates that both conditions are inherited through autosomal but unlinked genes.