Superior semi-circular canal dehiscence syndrome: quantifying the effectiveness of treatment from the patient's perspective.

BACKGROUND: Superior semi-circular canal dehiscence syndrome is a disorder characterised by auditory and vestibular symptoms that can significantly impact quality of life, and yet it has no disease-specific quality of life instrument. METHOD: Thirty-six patients who underwent transmastoid superior semicircular canal resurfacing and plugging were included from an initial cohort of 60 surgically managed patients. A sub-cohort of 19 consecutive patients completed validated symptom and quality of life questionnaires before and after surgery. Of the 36 patients, 31 participated in a telephone semi-structured interview post-operatively. RESULTS: Following surgery, there was a statistically significant improvement in autophony index score (p = 0.02), symptom severity score (p < 0.001) and sound hypersensitivity (p = 0.01). Thematic analysis of telephone interviews suggested three main symptom themes: auditory hypersensitivity, dysequilibrium, headache and concentration difficulties. Dysequilibrium was found to persist post-operatively. CONCLUSION: Surgery improves overall symptoms and quality of life. However, important symptom themes may be overlooked using the outcome measures that are currently available. A unified disease-specific outcome measure is urgently required to better understand the impact of symptoms and measure treatment effects.

Sinonasal cancer: an overview of the emerging subtypes.

BACKGROUND: Advances in immunohistochemistry have spearheaded major developments in our understanding and classification of sinonasal tumours. In the last decade, several new distinct histopathological entities of sinonasal cancer have been characterised. OBJECTIVES: This review aims to provide a clinical update of the major emerging subtypes for the ENT surgeon and an overview of the management strategies available for this heterogeneous group of pathologies. CONCLUSION: Although rare, knowledge of sinonasal neoplasm subtypes has implications for prognosis, treatment strategies and the development of novel therapeutic targets.

ENT training amongst general practitioners: results from a questionnaire.

OBJECTIVES: To evaluate the level of undergraduate and post-graduate ENT exposure amongst general practitioners and their perceived quality of this training. A secondary aim was to examine whether general practitioners believe ENT department based rotations should remain in the undergraduate curriculum. METHOD: An online questionnaire-based survey was sent to general practices in England. RESULTS: A total of 417 general practitioners completed the questionnaire. Sixty-seven per cent had completed an ENT rotation at medical school whereas 27 per cent had undertaken a postgraduate placement in ENT. Fifty-one per cent had received post-graduate teaching in ENT, mainly in the form of lectures. The majority of general practitioners were not satisfied with their training in ENT at undergraduate and post-graduate levels. Eighty-five per cent of general practitioners believed formal hospital-based ENT training should remain in the undergraduate curriculum. CONCLUSION: General practitioners reported insufficient exposure to ENT during both post-graduate and undergraduate training. Proposals to outsource undergraduate ENT teaching to affiliated departments such as general practice are of concern.

New types of nonclassical iridium carbonyls formed in Ir-ZSM-5: a Fourier transform infrared spectroscopy investigation.

In this work we report some new nonclassical carbonyls of iridium formed after CO adsorption on Ir-ZSM-5 (Ir-MFI). Mainly Ir+ cations were found on sample activated at 523 K and reduced by CO at the same temperature. With CO they formed Ir+(CO)2 gem-dicarbonyls (2104 and 2033 cm(-1)) that decomposed at 673 K without leaving a measurable fraction of monocarbonyls. The dicarbonyl structure was established by 12CO-13CO coadsortpion experiments. In the presence of CO in the gaseous phase and at ambient temperature the Ir+(CO)2 dicarbonyls were converted into Ir+(CO)3 species (2182, 2099, and 2074 cm(-1)). At 100 K these complexes are able to accommodate a fourth CO molecule thus producing tetracarbonyls (2155, 2145, 2125, and 2105 cm(-1)). The results are explained by the high coordinative unsaturation of the Ir+ cations in the ZSM-5 matrix. This is also the reason for the formation of mixed Ir+(H2O)(CO)2 species after CO-H2O coadsorption (2087 and 2015 cm(-1)). Evacuation of the sample at 673 K, followed by treatment with CO at 523 K, generates Ir2+ cations. With CO these cations form another kind of geminal complex, namely, Ir2+(CO)2 species (2173 and 2129 cm(-1)). Here again, the structure was confirmed by 12CO-13CO coadsortpion experiments. These dicarbonyls are decomposed at 573 K (again without producing monocarbonyls) and are able to accommodate additionally neither CO nor water molecules. The results are explained by the smaller cationic radius of Ir2+ (as compared to Ir+), which is associated with a decrease of the number of ligands required for coordinative saturation.

[Intravenous treatment with quamatel in reflux-esophagus and erosive gastritis]. / Intravenozno lechenie s quamatel pri reflux-ezofagit i eroziven gastrit.

Organism's good tolerance toward Ranitidin and Famotidin makes possible an application of doses higher than the ones put into everyday practice. This is a very favorable circumstance considering the fact that according to some authors the decreasing of acidity in oesophagus apparently depends on the applied dose of the medicine. Thus the treatment with famotidin 2 x 40 mg allows an additional decreasing of acidity in lower oesophagus. We investigate the effect of intravenous application of famotidin (quamatel) in dose 2 x 20 mg and 2 x 40 mg as monotherapy in cases of reflux-oesophagitis and erosive gastritis as well as organism's tolerance toward it. There are 23 patients studied--17 men and 6 women, between 18 and 70 years old. The diagnoses are: reflux-oesophagitis--23, chronic erosive gastritis and reflux-oesophagitis--8. The patients are selected according to clinical criteria--scalding and/or pain in the oesophagus accompanied with acidity in the mouth cavity. The diagnoses are put gastoscopically. The results of the intravenous applying of quamatel are accounted in reference to the clinical complaints (scalding and/or pain in the oesophagus, acidity in mouth cavity) as well as to the endoscopic and histologic changes in the oesophagus and stomach mucosa. In patients with chronic erosive oesophagitis the efficiency of treatment was confirmed with complete epithelization of the erosions in 22 of 23. The short-period use of large doses 2 x 40 mg quickly improves the clinic symptoms and decreases the period of epithelization twice. The clinic experience shows that the intravenous form of quamatel remains the most effective in cases of short-term and intensive therapy of erosive gastritis with accomplicated hard and emergency clinical cases when the aim is to be avoided the peroral application of anti-ulcer means. An important advantage of the intravenous treatment with quamatel is its low price.

[Clinical difficulties and errors in making a diagnosis of chronic papillo-odditis]. / Klinichni trudnosti i greshki pri postaviane na diagnozata khronichen papiloodit.

138 patients with chronic papillooditis were investigated, 15 of them in a stage of decompensation. In 83.3% of the cases, the diagnosis was not clinically determined (including 68 of 92 endoscoped before their hospitalization--82.9%). 34 patients were diagnosed as having chronic gastroduodenitis, 15--ulcer, 42--chronic cholecystitis, 11--chronic pancreatitis, 4--cholangitis, 9--postcholecystectomic status. All these diseases developed simultaneously with the papillitis. In a second endoscopic check-up with an examination of papilla Vateri, the patients were in all the cases diagnosed without difficulties and the diagnose was confirmed by biopsy. In 21 patients there was confirmed primary papillooditis and in 127--accompanying disorders: chr. gastroduodenitis--29, chr. atrophic gastritis--18, ulcer--15, chr. cholecystitis--42, postcholecystectomic status--9, choledocholithiasis--14, chr. pancreatitis--11. Most often misdiagnosis occurs if: 1) during the routine endoscopic investigation the endoscopist does not examine papilla of Vater; 2) chr. papillitis exists simultaneously with one of the already mentioned diseases that are easier of approach for diagnostics and explanation of the disorders; 3) the clinical picture of papillitis cannot be differentiated from the one of the basic or accompanying disease; 4) the bile drainage is not prevented; 5) the result of the venous biligraphy does not lead to the diagnosis and ERCP is carried out only in a case of a clinical suspicion.

[Dental changes in patients treated with calcium antagonists]. / Zubni promeni pri bolni, lekuvani s kaltsievi antagonisti.

For a period of 7 years the dental status of 160 patients has been investigated and followed. These patients have been treated with calcium channel blockers and selected in age between 22 and 50 years. Their diagnoses are: m. hypertonicus I-II stage--106, WPW-syndrome--10, stenocardia--18, atrial extrasystolia--26. Duration of treatment--from 1 to 7 years (corinfar, nifedipin, adalat--tabl. 40 mg, taken peroral or chewed, respectively suck; isoptin, verapamil--tabl. 40 mg, diltiazem--tabl. 30 mg, taken peroral. A control group of 60 clinically well people at age from 20 to 48 years was investigated. Under continuous treatment with calcium antagonist (> 1 year) the examined patients are found to have considerable decalcination of the dental enamel and caries more frequent (87.5%) compared to the group of clinically healthy people (65%), also increased number of caries in the same patient in comparison to his dental status before starting the therapy in 108 of 160 (67.5%). The differences in the results are statistically significant (p < 0.001). The number of the discovered caries in patients treated with calcium channel blockers and in the studied groups is also large (4 to 2 on average, i.e. two times more). The results allow to recommend a continuous stomatological control for patients treated with calcium antagonists.

Texturing 3D-reconstructions of the human brain with EEG-activity maps.

A method for representing the results of statistical EEG analysis in a visually comprehensive and concentrated way is presented. It consists of a combination of scattered data interpolation, texture mapping, and volume rendering techniques. First, starting with an EEG study of the proband in question, a smoothly interpolated rectangular map of the EEG findings in the (phi, theta)-domain (phi and theta denote spherical coordinates) is calculated. Then, using the data from an accompanying MRI scan, volume-rendered representations of the brain with a pseudo-colored cortical surface, vividly depicting the precalculated EEG-activities, are produced. Custom-developed software was used for interpolating the EEG maps from the scattered data samples, as well as for mapping and rendering them together with the brain volume data. The algorithm which achieves the scattered data interpolation is a genuine development employing Delaunay triangulation and a modification of the well-known rotation-invariant Phong interpolation. The pictures produced by the presented method are currently being utilized in neurophysiology for detecting correlations between EEG-parameters, cortical morphology, and underlying mental activities.

The reflection of cognitive tasks in EEG and MRI and a method of its visualization.

Up until recently, neurology was dominated by localisatory thinking. Language and other so-called "centers" were considered to be centers of command controlling the respective functions. Today, there is general agreement that, instead, for every brain function numerous brain regions must act together. For the exploration of these manifold topographic cooperations produced by cognitive tasks, coherence of long-term EEG periods proved to be a proficient parameter for the representation of functionally essential connections. Because of the unequivocal meaningfulness of absolute coherence values, instead, only the signs of significant differences between coherence values during cognitive tasks and periods of EEG at rest before and after the task were considered for all possible electrode pairings and charted on schematic maps of the brain. In addition, the signs of significant changes of amplitude were entered. This procedure was performed for each of 6 frequency bands and for the 19 electrodes of the 10/20 system, thus yielding 171 possible plus or minus values for coherence and 19 for amplitude, respectively. The positions of the electrodes were marked by an MRI contrast medium. After the EEG, MRI examination was performed. The MRI data were segmented and the cortex was mapped onto a plane using a method similar to cartography. The exact electrode positions are registered from a similarly obtained map of the scalp and the electrode position pattern is used as basis for the coherence graphs. A detailed map of the cortex based on the segmented MRI data with the electrode positions marked is provided as a reference enabling allocation of the electrodes to the cortical structures. The usefulness of this procedure is demonstrated with a single subject by means of different cognitive tasks including musical thinking.

Influence of measurement inaccuracies on determination of left ventricular mass by M mode echocardiography.

OBJECTIVE: To determine to what extent inaccuracies in measuring the end diastolic diameter of the left ventricle, the interventricular septum, and the posterior wall, by M mode echocardiography influence the left ventricular mass calculated by the Devereux's formula. DESIGN: Mathematical model. RESULTS: Relatively small measurement inaccuracies such as 5%, which are known to be inherent in the echocardiographic method, will result in "changes" of left ventricular mass in the range of 8% to 15%. This is equivalent to expected changes in left ventricular mass seen during treatment. CONCLUSIONS: The use of Devereux's formula to calculate left ventricular mass is limited by measurement inaccuracies in individual patients.

Collagen dysplasia in idiopathic carpal tunnel syndrome.

Surgical biopsies of dissected transverse carpal ligaments of patients with idiopathic carpal tunnel syndrome were examined with an electron microscope revealing collagen fibrils with extremely varying diameters. Morphometric analysis was performed on electron micrographs exhibiting fibrils with a small diameter comparable to that in control tissue as well as fibrils with a far larger diameter than could be observed in control tissue. Morphometric parameters were evaluated in order to analyse the relation between the number of and the area covered by collagen fibrils in the electron micrographs. In control tissue the numerical density per image area was twice the numerical density in carpal tunnel syndrome. However, the area fraction of the electron micrographs occupied by collagen fibrils in carpal tunnel syndrome and controls were equal.

Morphometric analysis of collagen fibrils in idiopathic carpal tunnel syndrome: Part 2.

Morphometric parameters were evaluated in order to analyze the relation between number and covered area of collagen fibrils in normal and carpal tunnel syndrome tissue. This analysis revealed that in normal tissue twice as many collagen fibrils as in pathological tissue occupy an equal area. Taking these facts into account, some hypotheses are advanced.

In vivo study of the influence of adenine and guanosine on the erythrocytes of ACD (pH 5.0 and 5.6) preserved blood.

Data are presented for percentage of recovery, survival time (T1/2) and mode of sequestration of erythrocytes from ACD [disodium citrate 95 mmol/l and glucose (C6H12O6 X H2O)] 152 mmol/l or ACD--adenine or adenine + guanosine (pH ranging from 5.0 to 5.6) preserved blood for 35 days at 4-8 degrees C (277-281 K). With the availability of guanosine in 0.25 mmol/l or 0.5 mmol/l final concentration in ACD + 0.25 or 0.5 mmol/l adenine preserved blood a positive effect can be exerted on erythrocyte 24 hrs recovery and survival time (T1/2). This effect is particularly evident when pH of the preservative solution is raised to 5.6. Final concentrations of 0.25 mmol/l adenine and guanosine in ACD preserved blood (whole or packed erythrocytes, pH 5.6, Hct. 0.73 or 0.61) are sufficient to ensure 35 days of storage at 4-8 degrees C (277-281 K).

Comparative study on the percentage of recovery, survival and mode of sequestration of fresh and frozen preserved (-196 degrees C) human platelets.

Platelet concentrates amounting to 142 X 10(9) +/- 11 X 10(9) cells are prepared by cytopheresis from one liter of blood. Ten of the concentrates are labelled with 51Cr and reinfused autologously. The other ten concentrates are frozen with a controlled rate freezer in a medium containing 10% DMSO and 5% glucose for 7 days at -196 degrees C. The fresh platelets have a 51Cr 24 hrs. recovery of 68 +/- 7% and a survival rate (T 1/2) of 10 +/- 1 days. The frozen preserved platelets have a 51Cr 24 hrs. recovery of 54 +/- 6.1%, a T 1/2 of 8.1 days, and significantly increased liver sequestration. There is a correlation between the reversal reaction in vitro after hypotonic shock and the 51Cr 24 hrs. in vivo recovery of fresh platelets and the 51Cr 1st hr. recovery of frozen platelets.