Management and outcome of vagus nerve stimulator implantation: experience of an otolaryngeal/neuropediatric cooperation.

OBJECTIVE: Vagus nerve stimulator (VNS) implantation is an established therapy for pharmacoresistant epilepsy that is not amenable to curative epilepsy surgery. Historically, VNS implantation has been performed by neurosurgeons, but otolaryngologist involvement is increasingly common. In this retrospective study, we aimed to evaluate the efficacy and safety of VNS implantation in children and adolescents from the otolaryngologists' perspective. METHODS: This study included children and adolescents who had undergone VNS implantation at the study center between 2014 and 2018. Patient files were analyzed with regards to the durations of device implantation and hospitalization, postoperative complications, and clinical outcome, including seizure frequency, clinical global impression of improvement (CGI-I) score, and quality of life (QoL). RESULTS: A total of 73 children underwent VNS surgery. The median age at implantation was 9.3 ± 4.6 years, and median epilepsy duration before VNS surgery was 6 ± 4 years. Lennox-Gastaut syndrome was the most common syndrome diagnosis (62.3%), and structural abnormalities (49.3%) the most frequent etiology. Operation times ranged from 30 to 200 min, and median postoperative hospitalization length was 2 ± 0.9 days. No complications occurred, except for four revisions and two explantations due to local infections (2.7%). Among our patients, 76.7% were responders (≥ 50% reduction in seizure frequency), 72.1% showed improved CGI-I scores, and 18.6-60.5% exhibited considerable improvements in the QoL categories energy, emotional health, and cognitive functions. CONCLUSION: Our results indicate that VNS implantation is a highly effective and safe treatment option for children and adolescents with AED-refractory epilepsies who are not candidates for curative epilepsy surgery.

HSP27 and 70 expression in thymic epithelial tumors and benign thymic alterations: diagnostic, prognostic and physiologic implications.

Thymic Epithelial Tumors (TETs), the most common tumors in the anterior mediastinum in adults, show a unique association with autoimmune Myasthenia Gravis (MG) and represent a multidisciplinary diagnostic and therapeutic challenge. Neither risk factors nor established biomarkers for TETs exist. Predictive and diagnostic markers are urgently needed. Heat shock proteins (HSPs) are upregulated in several malignancies promoting tumor cell survival and metastases. We performed immunohistochemical staining of HSP27 and 70 in patients with TETs (n = 101) and patients with benign thymic alterations (n = 24). Further, serum HSP27 and 70 concentrations were determined in patients with TETs (n = 46), patients with benign thymic alterations (n = 33) and volunteers (n = 49) by using ELISA. HSPs were differentially expressed in histologic types and pathological tumor stages of TETs. Weak HSP tumor expression correlated with worse freedom from recurrence. Serum HSP concentrations were elevated in TETs and MG, correlated with clinical tumor stage and histologic subtype and decreased significantly after complete tumor resection. To conclude, we found HSP expression in the vast majority of TETs, in physiologic thymus and staining intensities in patients with TETs have been associated with prognosis. However, although interesting and promising the role of HSPs in TETs as diagnostic and prognostic or even therapeutic markers need to be further evaluated.

[A 48-year-old patient with oligoarthritis of the knees, having excluded spondyloarthritis and rheumathoid arthritis]. / 48-jähriger Patient mit Schmerzen und Schwellungen beider Kniegelenke bei Ausschluss einer Spondyloarthritis und einer rheumatoiden Arthritis.

We report the case of a patient with amyloid light-chain (AL) amyloidosis, presenting for more than 1.5 years with oligoarthritis as the only clinical symptom of the underlying disease. Developing further organ symptoms (heart and gastrointestinal tract) led to the definitive diagnosis. Joint involvement due to AL amyloidosis is extremely rare and may mimic rheumatoid arthritis. Arthritis might be the first symptom of the AL amyloidosis. The combination of arthritis and other organ disorders (e.g., proteinuria, heart failure, or diarrhea) should initiate further diagnostic efforts considering AL amyloidosis as a differential diagnosis. The diagnosis will be confirmed by the typical histology of synovia or involved organs including immunohistochemistry for typing amyloid and performing immunoelectrophoresis.

[Early and late results of treating trigeminal neuralgia by Gasserian ganglioglycerolysis using a personal subjective pain measurement scale]. / Wczesne i odlegle wyniki leczenia neuralgii nerwu trójdzielnego gliceroliza zwoju Gassera z zastosowaniem wlasnej skali subiektywnego odczuwania bólu.

The results of treating 61 patients suffering from trigeminal neuralgia by Gasserian ganglioglycerolysis were estimated in the studies. The following features were considered: sex, age, side of pain, duration of symptoms, pharmacological therapy and the course glycerolysis procedure, with attention being paid to whether the CSF outflow is present or not. The ganglionglycerolysis procedure was modified to ensure that the needle is inserted directly in the ganglion, but not into periganglional space. The anesthetic effect was obtained by simultaneous glycerol injection and slow needle withdrawal. The recent and remote results were assessed by implementing own subjective pain sensibility scale, characterizing the therapeutic results and the frequency of disease recurrence.

Adoption of the Uniform Alcoholism Act and the availability of alcoholism treatment programs: a state-by-state examination.

This research examines geographic differences in the availability of alcoholism treatment programs throughout the United States. Using a substantially complete national listing of alcoholism treatment programs, significant differences in treatment availability based upon state, division, and region were found. The variations in treatment availability were strongly related to the adoption of the Uniform Alcoholism Act, with the influence of the UAA being more pronounced in nonmetropolitan areas. Treatment availability was only weakly related to the extent of alcohol-related problems. It is suggested that the UAA may be adopted through the social mandates of metropolitan areas and that nonmetropolitan areas respond with increased treatment availability as a result of the legal mandate of the legislation. It is concluded that without the official redefinition of alcoholism as a condition requiring treatment, the establishment of an adequate treatment capability is severely impaired.

Eyes as the center of focus in the visual examination of human faces.

An experiment was conducted to determine the degree to which individuals focus upon the eye region of others while visually inspecting their faces. Using an eye-tracking camera, 16 male subjects spent approximately 40% of their looking time focused upon the eye region of facial photographs, with each of the remaining parts of the face being looked at less.