[20 Years of Bilateral Cochlear Implantation - an Analysis of the Implanted Patients]. / 20 Jahre bilaterale Cochleaimplantation ­ eine Analyse seither implantierter erwachsener Patienten.

Binaural hearing is essential for localization abilities and improves the speech perception in noise. Since 20 years, bilateral cochlear implantation is routinely performed to restore binaural hearing. In this cross-sectional study, we evaluated speech perception in quiet (Freiburger monosyllables, Hochmair-Schulz-Moser (HSM) sentence test, each at 70 dB) and in noise (HSM test, signal-to-noise ratio 10 dB) in 103 out of 165 adult patients who were bilaterally implanted in Würzburg between 1995 and June 2014. In almost half the patients, the second implanted side showed the better speech perception. Compared to the first implanted side, the average monosyllable scores with bilateral implants were improved from 54 to 63% and the HSM scores from 86 to 96%. In noise the speech perception improved from 47 to 65%. The speech perception of the second implanted side was independent of the time interval between the implantation of both sides in this cohort of postlingually deafened patients. This cross-sectional data underline the importance of bilateral cochlear implantation for speech understanding in quiet and even more in noise and thus, for the everyday life. For this, bilateral cochlear implantation should be the generally accepted standard in the treatment of deaf patients.

[Preoperative auditory evaluation and postoperative follow-up in cochlear implantees : The role of objective measures]. / Präoperative audiologische Evaluation und postoperative Verlaufsdiagnostik bei Cochleaimplantatversorgung : Bedeutung objektiver Testverfahren.

The primary diagnostic aim prior to cochlear implantation is establishment of a comprehensive and multidisciplinary diagnosis, in order to subsequently begin therapy as early as possible. Audiological evaluation prior to implantation employs a test battery-approach, including subjective and objective procedures. Objective measures show high reliability and therefore play a major role in the diagnosis of difficult-to-test subjects such as infants and young children. During postoperative follow-up, objective measures offer a valid method for analyzing the effects of different stimuli on the auditory system. Particularly in infants, children, and uncooperative patients, the results of these tests enable the speech processor settings to be optimized, the hearing benefit to be assessed, and treatment to be adapted accordingly. Auditory brainstem responses (ABR) offer an excellent test/retest and inter-/intrarater reliability and validity, and are the most commonly used method for objective hearing threshold estimation and evaluation of the functional integrity of the lower auditory pathway. The use of narrow-band stimuli allows frequency-specific threshold estimation; analysis of stationary auditory steady state potentials (ASSR) adds the advantages of automated objective detection. Electrocochleography and electrically evoked ABR give valuable information in special cases. The use of cortical potentials (CAEP) in response to speech stimuli is quite promising, although the high response variability currently limits this method's clinical application. An audiological test-battery approach combining the results of subjective and objective measures leads to significantly increased reliability of preoperative diagnosis and postoperative follow-up in cochlear implantees.

[Direct Drive Simulation - Sound-Simulation of the Vibrant Soundbridge®]. / Direct Drive Simulation - Klangsimulation des Vibrant Soundbridge®-Hörens.

BACKGROUND: The Direct-Drive-Simulation (DDS) tends to simulate the sound quality of hearing with the active middle ear implant Vibrant Soundbridge(®) (VSB). Up to now a scientific evaluation of the validity is missing. Furthermore, the test procedure has not been described yet. Aim of this study was to evaluate the test validity and to describe the test realization in detail. MATERIAL AND METHODS: 10 patients evaluated their sound impression on scales from 1 to 10 concerning sound quality during DDS, postoperative free field testing at least 3 month after the first fitting of the VSB and in the everyday life situation. 3 patients were implanted bilaterally. Together, 36 data sets could be analyzed. RESULTS: Coupling of the Floating Mass Transducer (FMT), which was placed inside of a silicone probe during DDS was successful in all cases. In 11 out of 13 cases the coupling quality was judged as "good" an only in 2 cases as "medium". None of the patients needed local anesthesia. Comparing the evaluation of the sound impression during DDS preoperatively, and with the implanted VSB in free field testing and in everyday life no significant differences were found. CONCLUSION: The DDS offers the possibility of a realistic preoperative sound simulation of the "VSB-hearing" in case of sensorineural hearing loss. Thus, the test is supposed to facilitate the patient's decision towards possible treatment options. The specialist gets additional information regarding the indication especially when audiologic indication criteria are critical. The DDS should be a basic part of the preoperative diagnostic prior to VSB-implantation.

Estimation of severe drug-drug interaction warnings by medical specialist groups for Austrian nationwide eMedication.

OBJECTIVE: The objective of this study is to estimate the amount of severe drug-drug interaction warnings per medical specialist group triggered by prescribed drugs of a patient before and after the introduction of a nationwide eMedication system in Austria planned for 2015. METHODS: The estimations of interaction warnings are based on patients' prescriptions of a single health care professional per patient, as well as all patients' prescriptions from all visited health care professionals. We used a research database of the Main Association of Austrian Social Security Organizations that contains health claims data of the years 2006 and 2007. RESULTS: The study cohort consists of about 1 million patients, with 26.4 million prescribed drugs from about 3,400 different health care professionals. The estimation of interaction warnings show a heterogeneous pattern of severe drug-drug-interaction warnings across medical specialist groups. CONCLUSION: During an eMedication implementation it must be taken into consideration that different medical specialist groups require customized support.

JADE: a tool for medical researchers to explore adverse drug events using health claims data.

OBJECTIVE: The objective of our project was to create a tool for physicians to explore health claims data with regard to adverse drug reactions. The Java Adverse Drug Event (JADE) tool should enable the analysis of prescribed drugs in connection with diagnoses from hospital stays. METHODS: We calculated the number of days drugs were taken by using the defined daily doses and estimated possible interactions between dispensed drugs using the Austria Codex, a database including drug-drug interactions. The JADE tool was implemented using Java, R and a PostgreSQL database. RESULTS: Beside an overview of the study cohort which includes selection of gender and age groups, selected statistical methods like association rule learning, logistic regression model and the number needed to harm have been implemented. CONCLUSION: The JADE tool can support physicians during their planning of clinical trials by showing the occurrences of adverse drug events with population based information.

The dose-response relationship of acetazolamide on the cerebral blood flow in normal subjects.

BACKGROUND: Acetazolamide (AA) is used to determine the cerebral vasoreactivity (CVR). To investigate whether the usually applied standard dose of 1 g intravenously will guarantee stable test conditions, the dose-response relationship of AA on cerebral blood flow (CBF) and cerebral blood flow velocity (CBFV) in normal subjects was determined. METHODS: In 59 healthy volunteers, rCBF was measured with a (133)Xenon inhalation device, and CBFV of the middle cerebral artery (MCA) by transcranial Doppler sonography. The first CBF measurement was taken at rest, the second 15 min after application of AA at a dosage of 5, 10, 13, 15 and 18 mg/kg of body weight, respectively. The CBFV (n = 52) of the middle cerebral artery on the side of the better temporal window was taken 25 min after application of AA 13 mg/kg. In order to determine the side effects of AA, statements of an additional 172 patients were included. RESULTS: A significant dosage dependence of AA on the CBF (fast flow and initial slope index) exists between 5 and 18 mg/kg intravenously. After AA 13 mg/kg, the fast flow increases from 70.8 +/- 10.8 to 110.1 +/- 13.5 ml/100 g/min, the initial slope index from 46.5 +/- 5.4 to 62.8 +/- 5.8, and the CBFV from 51.5 +/- 8.5 to 85.4 +/- 14.2 cm/s. The CVR of CBF and CBFV ascertained that way shows an age dependence equivalent to the situation at rest. Severity and frequency of side effects are dosage-dependent, significantly in part, but reversible without exception. CONCLUSION: For the determination of CVR of CBF with AA, a dosage related to body weight is required. The usually applied standard dose of 1 g intravenously is not sufficient for standardized test conditions. For evaluation of the results obtained, the apparent age dependence of CVR must be taken into account. Because of the severity of side effects occurring at a higher dose, an AA dosage of 13 mg/kg intravenously is recommended.

[Randomized field study of the etiology of strabismus concomitans]. / Randomisierte Feldstudie über die Atiologie des Strabismus concomitans.

After an introduction to the problems of binocular vision and an overview of the literature, the authors report on the reasons for undertaking this study and on its practical implications. Up to now, no other randomized study has been undertaken to our knowledge on children of this age group in such a large city as Vienna. All children in primary 3 classes in 20 out of the 256 elementary schools were examined ophthalmologically and orthoptically. It was found that hereditary factors are of statistically significant importance. Especially important for the ophthalmologist is also the statistically significant relation between the diagnosis poor range of fusion, poor fixation, incorrect Worth test for distance and/or proximity, and poor or lacking stereoscopic vision with the occurrence of strabism. The authors were astonished to find a remarkably high percentage of exophoria (58%), in contrast to esophoria (16%). It is interesting for prophylaxis and therapy that children originating from families where spectacles are worn, acted more cooperatively and tended to take the orders of the physician more seriously than those coming from families without eye problems. The promotion of genetic research related to squint and more counselling for couples wishing to have children or confronted with risk factor problems would be desirable, as well as the inclusion of more obligatory ophthalmological examinations in the mother-child medical "passport".

Aberration analysis in aerial images formed by lithographic lenses.

A test procedure for the final assembly of lenses that does not need exposed photographic plates is introduced. It is based on the metrological simulation of optical ray tracing. A measuring example illustrates its suitability for ultraviolet optical systems in particular. The measuring apparatus displays the distortion vectors directly in the aerial image, gives a wave-front analysis, and performs an analogous distortion analysis.

Naftidrofuryl in the treatment of mild senile dementia. A double-blind study.

After a wash-out period of four weeks 51 patients with mild to moderate senile dementia were treated with either 600 mg naftidrofuryl (n = 23) daily per os or placebo (n = 28) over an eight-week period. When classified according to Hachinski's score, 24 patients were found to be suffering from senile dementia of Alzheimer's type (SDAT), whereas 27 patients presented with vascular dementia (MID). During wash-out and the treatment period the somatic and social symptoms of the disease were assessed by the AGP score. Cerebral performance was evaluated by a battery of tests measuring memory, concentration, psychomotor coordination and degree of depression. Electrical activity of the brain was estimated by a power-spectral analysis of EEG. In the total study group, the naftidrofuryl group showed a significantly better improvement in the results of the psychometric test battery, which was the primary variable during treatment. A parallel development was to be found in the AGP score and electrical brain function. When results of subgroups were analyzed according to the etiopathogenetic background of patients with SDAT, it was possible to show that naftidrofuryl affected psychopathometry and EEG-parameters while patients with MID responded to naftidrofuryl with changes in AGP score and EEG variables. These findings indicate the importance of etiopathologic features in performing studies with nootropic drugs in obtaining information on possible different actions in patients with different kinds of senile dementia.

The value of cerebral blood flow measurement in carotid surgery.

The considerable risks and high costs associated with carotid surgery have raised the discussion of its expediency. Carotid surgery is only indicated if a source of embolism in the region of the carotid bifurcation has been demonstrated or an endangerment of the blood supply to the brain is certain. Methods to detect a source of embolism with some reliability were not available until the advent of high-resolution Doppler ultrasound and transcranial techniques. The demonstration of an endangerment of the blood supply to the brain requires measurement of the regional cerebral blood flow assessment of the collateral circulations, and determination of the reserve capacity of the cerebral blood system. Diagnostic procedures available for this and their clinical relevance are discussed. Reliable assessment, however, requires functional criteria which still have to be developed.

[Memantine and neurogenic bladder disorders within the bounds of spastic conditions]. / Memantin und neurogene Blasenstörungen im Rahmen spastischer Zustandsbilder.

The action of 1,3-dimethyl-5-aminoadamantane (DMAA, D-145, memantine, Memantine) on neurogenic bladder dysfunction in spastic conditions was investigated. Under memantine treatment micturition was considerably facilitated, and spontaneous, involuntary voiding reduced. Additionally, memantine effected a decrease of residual urine and toned down the vesicular sphincter by simultaneously enhancing detrusor activity. At the same time the patients reported a considerable diminution of spastic hypertonicity and improved mobility of the limb muscles.

[Use of monomeric trains in diagnosis of twins (author's transl)]. / Die Anwendung monomerer Erbmerkmale in der Zwillingsdiagnose.

The principle of estimating the probability of monozygosity based on Bayes' formula is outlined for tweins with unknown parental genotypes. Tables based on Austrian gene frequencies are given for the common blood groups for easy computing of the chance of monozygosity.

[The effect of memantine (dimethylamino-adamantane) on membranes of sensory nerve fibres (author's transl)]. / Die Wirkung von Memantin auf die Membranen sensibler Nervenfaserbündel.

The effect of memantine (dimethylaminoadamantane), a new amantadinederivate with antiparknison-properties was investigated by the help of the sucrose gap method on sensory nerve fibres of the rat In normal Locke-solution memantine 10(-4) M reduced the amplitude of the compound action potential without change of the resting potential, increased the membrane resistance and depressed the repetitive activity elicited by depolarizing rectangular currents. The results of the experiments with changed concentrations of sodium, potassium and chloride ions in the suspensionmedium indicate that the membrane conductance of all three ions was reduced by memantine. Beside the antiparkinson properties these effects as well as those reported by others might be interpreted as a central muscle relaxing action of memantine. The possible implication of the demonstrated membrane effects of the drug is discussed in relation to its action on the dopaminergic transmission in the nigro-striatal system.

The effect of dimethylaminoadamantane on neuronal membranes.

The effect of dimethylaminoadamantane (DMAA), an amantadine derivative with an anti-Parkinson property, on rat sensory nerve fibres was studied with the sucrose gap method. DMAA 10(-4) M in normal Locke solution reduced the spike amplitude without changing the resting potential, increased the membrane resistance and depressed repetitive spike activity elicited by depolarizing currents. From experiments performed with changed concentrations of sodium, potassium, calcium and chloride ions in the suspension medium it appears that the permeability of sodium, potassium and chloride ions is reduced by DMAA. The possible implication of the membrane effects of the drug in its action on dopaminergic transmission in the brain is discussed.