In Vitro Investigation of the Dependency Between Abutment Length and Implant Stability Quotient (ISQ) for Stability Measurements on Bone Anchored Hearing Implant Systems.

HYPOTHESIS: The investigation aimed at measuring the relation between abutment length and Implant Stability Quotient (ISQ) for stability measurements on two types of bone-anchored hearing implant systems. BACKGROUND: Measuring bone-anchored hearing implant stability using the ISQ has the inherent limitation that the measurement is dependent on the length of the abutment used on the implant. This dependency has not earlier been analyzed in depth. Therefore, ISQ measurements for different abutment lengths cannot be directly compared if a patient needs a change of abutment or when evaluating different patients in a scientific setting. METHODS: The dependency of ISQ on abutment length for Cochlear BI300 (Cochlear Nordic AB, Mölnlycke, Sweden) and Ponto Wide Implant (Oticon Medical AB, Askim, Swden) was measured using a temporal bone model and a plaster model. ISQ at abutment level was compared with the corresponding ISQ at implant level and results were analyzed by multiple linear regression. RESULTS: The ISQ dependency on abutment length was -3.5 ISQ/mm (95% CI: -3.7 to -3.4) (Cochlear BI300 implant) and -2.9 ISQ/mm (95% CI: -3.0 to -2.7) (Oticon Wide Implant). CONCLUSION: The dependency of ISQ on abutment length for two types of bone-anchored hearing implant systems has been established empirically. This knowledge enables clinicians to continue monitoring the ISQ for a patient after a change of abutment and enables researchers to compare ISQ between patients in a clinical study.

Bone Anchored Hearing Implant Surgery: 1 Year Follow-Up Data Shows No Effect of Hydroxyapatite Coating on Soft Tissue Reaction After Loading at 1 Week.

OBJECTIVE: To assess postoperative skin complications around a bone anchored hearing implant (BAHI) abutment coated with hydroxyapatite and loaded after 1 week. DESIGN: Single center, prospective cohort study of 25 adults with expected normal skin and bone quality. INTERVENTION: Implantation of the Baha BA400 hydroxyapatite coated implant system using a linear incision technique without soft tissue reduction. Abutments with lengths of 8 mm (n = 9), 10 mm (n = 11), and 12 mm (n = 5) were used. The implants were loaded after 7 days (n = 23), 8 days (n = 1), and 12 days (n = 1). MAIN OUTCOME MEASURES: Soft tissue evaluation (Holger's score, skin overgrowth, pain, numbness) at 7 (±2), 14 (±3), and 30 (±7) days and 3 months (±14 days), 6 months (±14 days), and 12 months (±30 days). The results were compared with a historic control group. RESULTS: Twenty five patients were included, 23 could be followed up for 1 year. In 93.8% of the visits, patients had a Holger's score less than or equal to 1. One patient needed revision surgery due to skin overgrowth. 18.8% of the patients experienced mild pain during follow-up, primarily during the first month. Sensibility loss was very limited. Compared with similar patients having the smooth titanium abutment (loaded at 2 wk), there was a slightly increased level of short-term soft tissue reaction. CONCLUSION: The study shows a small, non-detrimental, negative effect on short-term soft tissue status after loading of the implant at 7 days. No positive effect from the hydroxyapatite coating could be demonstrated for the long-term soft tissue status.

Successful Loading of a Bone-Anchored Hearing Implant at 1 Week After Surgery.

OBJECTIVE: To assess implant stability and safety of loading a bone-anchored implant 1 week after surgery. The patients were loaded at 1 week for fast rehabilitation and ease of logistics. DESIGN: Single center, prospective cohort study of 25 adults with expected normal skin and bone quality. INTERVENTION: Implantation of the Baha BA400 implant system using a linear incision technique without skin thinning. Abutment lengths of 8, 10, and 12 mm were used. MAIN OUTCOME MEASURES: Implant stability quotient (ISQ) 0, 7, 14, 30 days and 3, 6, and 12 months postoperatively. RESULTS: Twenty-five patients were included, 23 could be followed up for 1 year. Mean ISQ was increasing throughout the observation period with no sign of adverse influence from the early loading. No implants were lost or clinically unstable. Individual ISQ curves fall in two categories-continually increasing ISQ or increasing ISQ with initial dip. ISQ for patients in the initial dip group eventually increased despite the early and continued loading. CONCLUSION: Loading of the implant system under study 1 week after surgery have been successful for 25 patients with expected normal bone quality followed up for 1 year. No implants were lost. All individual ISQ were increasing throughout the study period. The early loading of the implant under study does not seem to influence the osseointegration.

[The need for clinical examination in penetrating neck trauma]. / Værdi af klinisk observation vedpenetrerende halstraume

In this case report we present a 52-year-old male with a sharp, penetrating neck trauma. We discuss the need for surgical neck exploration and the use of ultrasound and CT-scans when evaluating the extent of the injury.

Bone-anchored Hearing Implant Surgery: Randomized Trial of Dermatome Versus Linear Incision Without Soft Tissue Reduction--Clinical Measures.

OBJECTIVE: Assessment of differences in soft tissue healing and long-term issues between two techniques for bone-anchored hearing implant (BAHI) surgery. STUDY DESIGN: Single-center, randomized, nonblinded study using balanced randomization (1:1). SETTING: Tertiary referral center in the Central Denmark Region. PATIENTS: Forty-seven adults with normal skin quality. INTERVENTION: Operation with a BAHI system with randomization to 1) dermatome technique with soft tissue removal and 2) linear incision with no soft tissue reduction. OUTCOME MEASURES: Holgers' score, pain, and sensibility loss assessed at 0, 3, 7, 10, 14, and 21 days and 1, 3, 6, and 12 months postoperatively. Implant loss. RESULTS: Forty-nine patients were randomized (linear incision, n = 25; dermatome, n = 24). Forty-seven patients were analyzed (linear incision, n = 25; dermatome, n = 22). Differences in proportions for grouped data (outcome 0 and outcome >0) for the total of all visits were Holgers' Index: 0.13 (p = 0.0004; 95% confidence interval [95% CI], 0.058-0.21); sensibility loss: 0.50 (p = 2.2 · 10; 95% CI, 0.42-0.58); pain: 0.096 (p = 0.006; 95% CI, 0.026-0.17). Soft tissue reactions and pain were most prominent in the early postoperative period, whereas issues with sensibility loss subsided throughout the 1-year follow-up period. No implants were lost. CONCLUSION: In a randomized trial for BAHI surgery, the linear incision with no subcutaneous reduction had a faster healing time and inflicted less pain and sensibility loss than the dermatome technique. The long-term soft tissue problems were similar in the two groups, thus favoring the linear incision, which is less invasive.

Successful loading of a bone-anchored hearing implant at two weeks after surgery: randomized trial of two surgical methods and detailed stability measurements.

OBJECTIVE: To assess early implant stability of a bone-anchored hearing implant in detail; safety of loading the implant 2 weeks after surgery; and whether surgical methods influence stability. STUDY DESIGN: Single-center, randomized, nonblinded study using balanced randomization (1:1). SETTING: Tertiary referral center in the Central Denmark Region. PATIENTS: Forty-seven adults with normal skin and bone quality. INTERVENTION: Implantation of the BAHA BIA300 system with randomization to a dermatome technique with soft tissue removal or linear incision with no soft tissue reduction. MAIN OUTCOME MEASURES: Implant Stability Quotient (ISQ) at 0, 3, 7, 10, 14, and 21 days and 1, 3, 6, and 12 months postoperatively. OTHER OUTCOME MEASURES: Implant loss. RESULTS: Forty-nine patients were randomized (linear incision, 25; dermatome, 24). Forty-seven patients were analyzed (linear incision, 25; dermatome, 22). Mean ISQ value was 59.5 at implantation, increasing to 60.5 at 14 days. No stability dip was observed in the early osseointegration period. After loading at 14 days, stability was increasing with a nonsignificant ISQ-dip at 21 days. At 1-year follow-up, mean ISQ was 65.78 (linear incision) and 65.77 (dermatome) (mean difference, 0.010; 95% confidence interval, -2.17 to 2.19). One patient operated on with the dermatome technique had transplant necrosis. No implants were lost. CONCLUSION: In the study population comprising healthy adults with estimated normal bone quality, early implant stability showed no initial stability dip and the implant was safely loaded 2 weeks after surgery. The surgical methods had no influence on implant stability.

Evaluation of round window accessibility to cochlear implant insertion.

Emphasis on hearing preservation has led to recognition of the round window membrane (RWM) as a portal for the cochlear implant electrode array. The St Thomas' Hospital (STH) classification was devised to evaluate the accessibility of RWM electrode insertion. The objectives of this study were: (1) to prospectively evaluate the STH classification in selecting the appropriate cochlear insertion route in "RWM-intentioned" cases, and (2) to ascertain if RWM accessibility differs from adults to children. This was a prospective cohort study of consecutive patients (adult and paediatric) undergoing cochlear implantation at a specialist auditory implant centre. Visibility of the RWM was graded according to the STH classification after an "optimal" posterior tympanotomy had been performed and any overhang of the bony round window niche removed without breaching the RWM. Most adult (89 %) and paediatric (78 %) cases had more than 50 % of the RWM exposed (Types I and IIa). Cases having less than 50 % of RWM exposed (Types IIb) or none exposed (Type III) were twice as common in children (p = 0.004). 96 % of Type I and 63 % of Type IIa cases underwent RWM insertion through a membranous cochleostomy. 71 % of Type IIb necessitated an extended membranous cochleostomy. All Type III cases required a conventional bony cochleostomy. When more than 50 % of RWM was visible (Types I and IIa), 88 % underwent a membranous cochleostomy. For "RWM-intentioned" cases, the STH classification can be a sensible method of relating RWM visibility/accessibility to the optimal route for insertion. This study also demonstrates that RWM insertion is more challenging in children.

Round window electrode insertion potentiates retention in the scala tympani.

CONCLUSIONS: The round window membrane (RWM)-intentioned approach is superior to the traditional bony cochleostomy (BC) approach in obtaining electrode placement within the scala tympani (ST). OBJECTIVE: Cochlear implant outcome is influenced by several factors, including optimal placement and retention of the electrode array within the ST. The present study aimed to assess whether the RWM route is superior to a traditional BC for placement and retention of the electrode array in the ST. METHODS: This was a prospective consecutive non-randomized comparison study. All patients were implanted with the Advanced Bionics 1J electrode array. The RWM approach (n = 32) was compared with a traditional BC group (n = 33). The outcome measure was the electrode position as judged within the scalar chambers at four points along the basal turn using postoperative computed tomography (CT). RESULTS: When the mean position scores were compared, the RWM-intentioned group had significantly more electrodes directed towards the ST compartment than the BC group (p < 0.001). The RWM electrodes achieved 94% ST retention compared with 64% for the BC group (p < 0.05). All electrodes stayed in the ST in the RWM group, whereas in the BC group 9% crossed from the ST to the scala vestibuli.

[Salmonella Enteritidis is a rare cause of neck abscesses]. / Salmonella Enteritidis er en sjælden årsag til absces på halsen.

A case of a neck abscess caused by Salmonella Enteritidis in a 48 year-old diabetic patient is presented. Salmonella neck abscesses are rare and often occur in association with infection in other parts of the body. The condition is treated with drainage and antibiotics. It should be included in the differential diagnosis of abscesses of the head and neck - especially in immunosuppressed patients.

[Spontaneous subcutaneous facial emphysema]. / Spontant subkutant facialt emfysem.

In this case we report how a previously healthy 35-year-old man developed a spontaneous monosymptomatic facial emphysema. The emphysema was found in large parts of deep and superficial compartments of the facial muscles, intraorbital to the optical nerve and along the blood vessels to the larynx level. The reason for this was never determined, but the differential diagnostics include allergic reaction, oesophagus/larynx rupture, infection, fracture of the facial bones, trauma or self-inflicted damage. The patient's symptoms receded over a course of four days to complete recovery.

Squamous cell carcinoma of the nasal vestibule 1993-2002: a nationwide retrospective study from DAHANCA.

BACKGROUND: A retrospective nationwide study of cancer of the nasal vestibule was conducted to evaluate classification systems and prognostic factors for treatment outcome. METHODS: Patients treated between 1993 and 2002 at head and neck oncology centers in Denmark were included. RESULTS: The 5-year results were locoregional control 67%, overall survival 50%, cancer-specific survival 74%. Cancer-specific survival according to Wang classification was 83%, 63%, and 39% for T1, T2, T3, respectively (p < .000). Regarding T1 tumors, 5-year locoregional control for surgery, surgery + radiotherapy (RT), or RT was 94%, 87%, or 61%, respectively (p < .000). Fifty-four Gray in 18 fractions was found comparable with 66 Gy in 33 fractions regarding T1 tumors. CONCLUSION: This national survey is the largest series of nasal vestibule cancer ever published. Wang classification is more prognostic and easier to use than the Union Internationale Contre le Cancer 2002. Surgery or hypofractionated RT can be used for T1 lesions, whereas larger lesions should be treated with combined approach.

Energy restriction prevents the development of type 2 diabetes in Zucker diabetic fatty rats: coordinated patterns of gene expression for energy metabolism in insulin-sensitive tissues and pancreatic islets determined by oligonucleotide microarray analysis.

Energy restriction (ER) causes metabolic improvement in the prediabetic and diabetic state. Little information exists on the mechanism of action of ER, for example, on the changes at the transcriptional gene level in insulin-sensitive tissues. To gain further insight, we have investigated changes in gene expressions in skeletal muscle, liver, fat, and pancreatic islets after ER in male Zucker diabetic fatty rats. Eighteen Zucker diabetic fatty rats were divided at the age of 7 weeks into a control group (ad libitum diet) and an ER group (30% ER compared with the control group). Blood glucose, weight, and food intake were measured weekly. After 5 weeks, blood samples, and skeletal muscle, liver, visceral fat (epididymal fat pads), and islets tissue were collected. Gene expression was quantified with high-density oligonucleotide, microarray GeneChip technology. ER ameliorated the development of hyperglycemia, increased the levels of plasma insulin, and reduced plasma total cholesterol and the glucagon-insulin ratio (P < .05). In skeletal muscle, the expression of 55 genes increased and 245 decreased involving genes related to glucose metabolism (eg, phosphorylase kinase, pyruvate dehydrogenase kinase 4), lipid metabolism (eg, carnitine palmitoyltransferase 1, fatty acid transporter), and signaling pathways (eg, mitogen-activated protein kinases, protein kinase C). In the liver, the expression of 123 genes increased and 103 decreased involving genes related primarily to lipid metabolism. In pancreatic islets, the expression of 110 genes increased and that of 127 decreased, whereas in visceral fat, the expression of 279 genes increased and that of 528 decreased. ER counteracts the development of diabetes and causes changes in the expression of multiple genes involved in glucose and lipid metabolism in skeletal muscle, liver, and pancreatic islets, which may play an important role for the prevention of diabetes.

Can stevioside in combination with a soy-based dietary supplement be a new useful treatment of type 2 diabetes? An in vivo study in the diabetic goto-kakizaki rat.

The diterpene glycoside stevioside (SVS) and soy bean protein isolate have both been shown to have beneficial effects in diabetes treatment. As they each show different benefits we investigated whether the combination of both substances shows an improvement in the treatment of diabetes in Goto-Kakizaki (GK) rats. Over the course of 4 wk, the rats were fed with the following four test diets (n = 12 per group): 1. Standard carbohydrate-rich laboratory diet (chow), 2. chow + SVS (0.03 g/kg BW/day), 3. 80% SPI + 20% chow and 4. 80% SPI + 20 % chow + SVS (0.03 g/kg BW/day). At the end of the course conscious rats underwent an intra-arterial glucose tolerance test (IAGTT) (2.0 g glucose/kg BW). Compared to normal chow diet, stevioside in combination with SPI shows the following beneficial effects in GK rats with mild type 2 diabetes: 1. a 56% reduction in plasma glucose (p < 0.001), 2. a 118% increase in first-phase insulin (p < 0.005), 3. a 20% reduction in glucagons (p < 0.05), 4. a 28% reduction in total cholesterol (p < 0.001), 5. a 13% reduction in FFA (p < 0.01), 6. a 49% reduction in TG (p < 0.001) and 7. a 11% reduction in the systolic blood pressure (p < 0.001). In conclusion, the combination of stevioside and SPI has synergistic positive effects on the characteristic features of the metabolic syndrome, i.e. hyperglycemia, hypertension and dyslipidemia.

Prevention of hyperglycemia in Zucker diabetic fatty rats by exercise training: effects on gene expression in insulin-sensitive tissues determined by high-density oligonucleotide microarray analysis.

Exercise training (ET) causes metabolic improvement in the prediabetic and diabetic states. However, only little information exists on the changes to ET at the transcriptional level in insulin-sensitive tissues. We have investigated the gene expression changes in skeletal muscle, liver, fat, and pancreatic islets after ET in male Zucker diabetic fatty (ZDF) rats. Eighteen ZDF rats (7 weeks old) were divided in a control and ET group. Exercise was performed using a motorized treadmill (20 m/min 1 hour daily for 6 days a week). Blood glucose, weight, and food intake were measured weekly. After 5 weeks, blood samples, soleus muscle, liver, visceral fat (epididymal fat pads), and islet tissue were collected. Gene expression was quantified with Affymetrix RG-U34A array (16 chips). Exercise training ameliorates the development of hyperglycemia and reduces plasma free fatty acid and the level of glucagon-insulin ratio (P < .05). In skeletal muscle, the expression of 302 genes increased, whereas that of 119 genes decreased. These changes involved genes related to skeletal muscle plasticity, Ca(2+) signals, energy metabolism (eg, glucose transporter 1, phosphorylase kinase), and other signaling pathways as well as genes with unknown functions (expressed sequence tags). In the liver, expression of 148 genes increased, whereas that of 199 genes decreased. These were primarily genes involved in lipogenesis and detoxification. Genes coding for transcription factors were changed in parallel in skeletal muscle and liver tissue. Training did not markedly influence the gene expression in islets. In conclusion, ET changes the expression of multiple genes in the soleus muscle and liver tissue and counteracts the development of diabetes, indicating that ET-induced changes in gene transcription may play an important role en the prevention of diabetes.