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The "chained-stimuli" technique for rapid auditory brain stem response (ABR) threshold estimation involves lengthening the averaging time window and presenting a series ('khain") of click stimuli. Each stimulus chain contains, in addition to a silent interval, click stimuli of 10,20, 30, 40, 50, 60, and 70 dB nHL that are separated by 10 msec intervals. Using this method, the single averaged response to the chained-stimulus contains up to seven individual ABRs. The responses elicited by each level of click stimulus within the chain can be analyzed separately. In this study, chained-stimuli ABR threshold estimations for normal hearers were essentially equivalent to those obtained using an automated conventional ABR method. The data for a seven point latency-intensity function using the chained-stimuli technique were obtained in a mean time of only 8 min per ear (Ear Hear 12 4:229-234).

Cytogenetic records were examined from consecutive nononcology blood specimens from 2,821 patients referred for cytogenetic services to Vanderbilt University Medical Center, Nashville, Tenn, from January 1985 to December 1992. We grouped the records according to reasons for referral and diagnoses. The most common reasons for referral were history of multiple abortions/ miscarriages (23.3%), possibility of chromosomal abnormality (18.8%), and possible presence of the fragile X syndrome (15.6%). Overall, 2,418 (85.7%) patients were found to have normal chromosomes, and 403 (14.3%) patients were diagnosed with a cytogenetic abnormality. For example, 20 (5.4%) of the 373 males referred for the fragile X syndrome, or 1.4% of all males (20 of 1,428) excluding those with ambiguous genitalia, were diagnosed with this syndrome while 8 (2.1%) of the 373 males had a chromosome abnormality other than the fragile X chromosome. In addition, 85 (70.2%) of 121 males referred for Down syndrome had this syndrome, and only 53 (40.8%) of 130 females referred for Down syndrome had this diagnosis. This study should assist physicians in middle Tennessee and surrounding areas by increasing their awareness of the types and frequencies of cytogenetic diseases and by providing figures for comparison with other regions of the country. To estimate the types and frequencies of cytogenetic problems that occur in patients referred to a full-service cytogenetics laboratory at a major medical center, we analyzed the laboratory records from consecutive nononcology blood specimens over an 8-year period (1985 through 1992) from Vanderbilt University Medical Center, Nashville, Tenn. The medical literature lacks this type of information, and it should be useful for the local medical community, as well as for comparison with data from other regions of the country. This research study complements an earlier publication on genetic conditions among patients receiving genetic services in middle Tennessee over a comparable 5-year period. 1 MATERIALS AND METHODS Data for this study came from a review of laboratory records from consecutive blood specimens (excluding blood from oncology patients) from 2,821 patients referred for cytogenetic analysis at Vanderbilt University Medical Center from January 1985 to

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Although double-blind experimental designs are considered the gold standard for documenting treatment effectiveness, many treatments for Ménière's disease have not been evaluated using this methodology. Particularly with a disease characterized by exacerbation and remission, carefully controlled, long-term studies are required. The nature of the placebo effect is described in this article, and the concept of debonafide effect introduced. Ideally, patients should be given treatments supported by evidence-based medicine that have the lowest possible risk of side effects. However, risk minimization may dictate using treatments that have not been proven effective and may evoke debonafide effects.