No abstract

Case reports of 3 patients seen with a bluish mass behind the tympanic membrane are presented. The initial diagnosis was probable glomus tumor. In 1 patient, middle ear exploration confirmed the presence of a high-lying jugular bulb. In the other 2, venography demonstrated that the jugular bulb projected superiorly into the middle ear cavity. In all 3, polytomography demonstrated a dehiscence of the bony septum which normally separates the jugular bulb from the hypotympanum. When a bony dehiscence is seen in the absence of destructive changes, a diagnosis of aberrant jugular bulb is strongly suggested.

Accuracy in the diagnosis of lower extremity deep venous thrombosis (DVT) by physical examination and impedance plethysmography (IPG) is reviewed. Physical examination proved unreliable in distinguishing patients with and without acute disease. Swelling in the leg was, however, more prevalent in patients with DVT. The sensitivity and specificity of IPG were less than those reported by other groups. Venography remains the most reliable diagnostic procedure in our institution.

Patients with immune complex-(IC) mediated diseases frequently have low levels of CR1 on E. The present study was undertaken to determine the role of circulating IC in causing low E-CR1 levels. E-CR1 were enumerated by measuring the binding of anti-CR1 mAb (E11) and rabbit anti-CR1 antibodies (RbaCR1) to E. In addition, the distribution of CR1 among E was assessed by flow cytometry of E stained with E11 and RbaCR1 and by evaluating the binding of E11-coated fluorescent beads (E11-beads) to E. E11-beads bind to clusters of CR1 on E. Five cynomolgus monkeys (CYN) were preimmunized to bovine gamma-globulin (BGG). E-CR1 changes in these animals were assessed: 1) acutely, during the first 60 min after an infusion of BGG and 2) chronically, during daily administration of BGG infusions over 2 wk. Acutely, there was a decrease in the number of E-CR1 as measured by E11 binding to E (E11/CR1). This decrease was not attributable to occupancy of CR1 by IC because the decrease in E11/CR1 number persisted after the IC had been cleared from E. By comparing the E11/CR1 levels in arterial blood to hepatic vein blood (n = 5), or in pulmonary artery blood (n = 1), we determined that the acute decrease in E11/CR1 number did not occur whereas E circulated through liver, spleen, or lung. The decrease in E11/CR1 number required the binding of IC to E because it did not occur after BGG was infused into nonimmunized CYN (n = 2) or into a preimmunized complement-depleted CYN. The decrease in E11/CR1 number was not due to loss of CR1 from E because E11/CR1 number recovered 24 h after infusion of BGG and in addition, enumeration of E-CR1 with RbaCR1 and E11-beads did not reflect a decrease in E-CR1 number. After several daily BGG infusions there was a persistent decrease in E-CR1 levels and that decrease appeared to be mainly the result of loss of CR1 from E because the decrease was confirmed with all methods of E-CR1 measurement and because E-CR1 levels recovered only slowly after BGG infusions were discontinued. Both in vitro and in vivo IC bound preferentially to subpopulations of E, identified by their ability to bind multiple E11-beads and by their high intensity staining with the anti-CR1 antibodies E11 and RbaCR1.(ABSTRACT TRUNCATED AT 400 WORDS)