Measuring control of disease in Chronic Rhinosinusitis; assessing the correlation between SinoNasal Outcome Test-22 and Visual Analogue Scale item scores.

BACKGROUND: In chronic rhinosinusitis (CRS), aim of treatment is control of disease. EPOS2020 suggests the use of visual analogue scale (VAS) measurements on several symptoms. We aim to determine if individual VAS items can be replaced by widely used SinoNasal Outcome Test-22 (SNOT-22) items when determining control of disease, to avoid using double measurements and to stimulate its use in clinical practice. METHODS: Analyses were made on correlations between individual SNOT-22 scores and symptom-specific questions from consecutive patients with CRS visiting our tertiary referral rhinologic clinic for the first time. RESULTS: 157 CRS patients were included. Correlations of individual items were strong (r greater than 0.8). Best parity in sensitivity, specificity, positive predicting value, negative predicting value, odds ratio and Receiver Operating Characteristic curves were found in individual item score of VAS greater than 5 and SNOT item-score. This cut off is valid for measuring control of disease, combining several nasal, facial pain and sleep symptoms (controlled, partially controlled and uncontrolled). CONCLUSION: There is strong correlation between individual items measured as SNOT or VAS. For the definition of CRS disease control, as proposed in EPOS2020, the use of symptoms specific SNOT 23 is predictive of VAS greater than 5.

Occupational exposure influences control of disease in patients with chronic rhinosinusitis.

BACKGROUND: Chronic rhinosinusitis (CRS) is a frequent condition that is treated by endoscopic sinus surgery (ESS) when medical treatment fails. Irritating or sensitizing airborne agents can contribute to uncontrolled CRS. A prior study showed a linear correlation between occupational exposure and the number of ESS. METHODS: In this cross-sectional study we tested the hypothesis that occupational exposure is a risk for undergoing ESS. We sent questionnaires enquiring occupational exposure in patients with CRS with nasal polyps (CRSwNP) or CRS without nasal polyps (CRSsNP). An expert assessed blindly the reported work exposures to inhaled agents. The relationship between occupational exposure on undergoing ESS was analysed. RESULTS: Among all patients who underwent ESS (n=343), 30% reported a relevant occupational exposure, which is significantly higher than the 4.8% found among CRS patients that underwent no prior sinus surgery (n=21). Besides occupational exposure, self-reported doctor-diagnosed asthma were independent variables contributing to the chance of undergoing ESS. CONCLUSION: In our study we confirm occupational exposure as a risk factor for uncontrolled CRS, if defined by undergoing ESS. In CRS patients with uncontrolled symptoms, despite maximal conservative therapy, the clinician should explore the possible contribution of occupational exposure.

Early signs and symptoms of intracranial complications of otitis media in pediatric and adult patients: A different presentation?

OBJECTIVES: The aim of this study was to review the clinical presentation and early signs and symptoms of otogenic intracranial complications (OIC) in children and adults. METHODS: retrospective chart review. The medical records of all children and adults admitted in our center with OIC during the period 2008-2017 were reviewed. Data concerning clinical presentation, treatment and outcomes were reviewed and analyzed. RESULTS: We included 47 patients with OIC: 21 children (range 1-13 years) and 26 adults (range 22-71 years). We included more patients with acute otitis media than with chronic otitis media (children 5% adults 19%, all with cholesteatoma). In children; the most common OIC was central cerebral venous thrombosis. In both children and adults; otogenic symptoms such as otalgia and otorrhea were present. Children presented more frequently with headache and nausea. Adults presented more frequently with decreased consciousness. Hearing loss was the most common long-term sequel. Three adults died. CONCLUSIONS: In our series, we found that OIC in children present as 'mimicking meningitis' (e.g. nausea and vomiting). Adults on the other hand have a clinical presentation 'mimicking stroke' (e.g. neurological deficits and decreased level of consciousness). In children, sinus thrombosis was observed more frequently than in adults. Despite the low mortality rate, death still occurs. Long -term sequelae most frequently include hearing loss in children as well as in adults.

[Posttraumatic endophthalmitis : Complication following severe eye injury]. / Posttraumatische Endophthalmitis : Komplikation nach dem Kampf ums Auge.

BACKGROUND: Posttraumatic endophthalmitis is a rare but another extremely threatening complication for quality of vision, which has already been compromised by the trauma after perforating eye injuries. One of the substantial difficulties is the distinction between posttraumatic inflammation and development of a bacterial infection. METHODS: In a hospital-based study 149 consecutive cases of perforating ocular trauma with open injuries to the eye within a 5-year period were retrospectively investigated. The study included assessment of the relationship between the severity of the injury and the risk of posttraumatic endophthalmitis using the ocular trauma score (OTS), the diagnosis, the therapeutic management and the prognosis concerning visual outcome 1 year after the posttraumatic endophthalmitis. RESULTS: In this study posttraumatic endophthalmitis was observed in 8 out of 149 cases (5.4 %) after perforating ocular injuries. Severe injuries had a higher risk of this complication. In comparison to the clinical courses of non-postraumatic endophthalmitis, the visual outcome showed a tendency to be worse after an average of 18 ± 6 months (1.25 vs 1.0 logMAR). In all of the cases the posttraumatic endophthalmitis could be successfully treated with antibiotics and surgery and the already severely limited visual function due to the injury could at least be maintained in most cases. DISCUSSION: Due to the low case numbers statistical evidence of a clear benefit of treatment by a rapidly initiated and intensive individualized surgery following trauma and a pathogen-specific and operative therapy is not possible: nevertheless, such a comprehensive therapeutic approach to posttraumatic endophthalmitis is recommended.

[Long-term course of immunosuppressive therapy of Vogt-Koyanagi-Harada syndrome]. / Langzeitverlauf unter immunsuppressiver Therapie bei Vogt-Koyanagi-Harada-Syndrom.

This article describes the case of a 22-year old female patient, who first presented with holocephalic headaches and bilateral loss in vision. After diagnosis of a complete Vogt-Koyanagi-Harada syndrome, high-dose corticosteroid therapy was initiated. Due to recurrent headaches 6 weeks later, immunosuppressive therapy was initiated with cyclosporine A. Because of an adverse effect (hirsutism) treatment was changed to azathioprine. In a long-term follow-up over 2 years the patient showed stable clinical findings with good visual acuity.

[Ophthalmological alterations at the initial diagnosis of HIV infection]. / Ophthalmologische Veränderungen im Rahmen der Erstdiagnose einer HIV-Infektion.

Acquired immunodeficiency syndrome (AIDS) caused by the human immunodeficiency virus (HIV), is one of the most important infectious causes of death in the twentieth and twenty-first centuries. Ocular manifestations can appear in particular when the CD4 cell count is low. This article presents a case report of a 38-year-old homosexual man in whom HIV microangiopathy retinopathy syndrome (MAPS) was found during the assessment of the initial HIV diagnosis. Typical findings in MAPS are conjunctival and retinal vessel abnormalities, cotton wool spots as well as intraretinal hemorrhages. Loss of vision is a rare complication but MAPS shows an impairment of the immune status and is also associated with a higher mortality.

Uncontrolled allergic rhinitis and chronic rhinosinusitis: where do we stand today?

State-of-the-art documents like ARIA and EPOS provide clinicians with evidence-based treatment algorithms for allergic rhinitis (AR) and chronic rhinosinusitis (CRS), respectively. The currently available medications can alleviate symptoms associated with AR and RS. In real life, a significant percentage of patients with AR and CRS continue to experience bothersome symptoms despite adequate treatment. This group with so-called severe chronic upper airway disease (SCUAD) represents a therapeutic challenge. The concept of control of disease has only recently been introduced in the field of AR and CRS. In case of poor control of symptoms despite guideline-directed pharmacotherapy, one needs to consider the presence of SCUAD but also treatment-related, diagnosis-related and/or patient-related factors. Treatment-related issues of uncontrolled upper airway disease are linked with the correct choice of treatment and route of administration, symptom-oriented treatment and the evaluation of the need for immunotherapy in allergic patients. The diagnosis of AR and CRS should be reconsidered in case of uncontrolled disease, excluding concomitant anatomic nasal deformities, global airway dysfunction and systemic diseases. Patient-related issues responsible for the lack of control in chronic upper airway inflammation are often but not always linked with adherence to the prescribed medication and education. This review is an initiative taken by the ENT section of the EAACI in conjunction with ARIA and EPOS experts who felt the need to provide a comprehensive overview of the current state of the art of control in upper airway inflammation and stressing the unmet needs in this domain.

[Loss of visual acuity after treatment with pipamperone]. / Visusminderung nach Pipamperon-Therapie.

The butyrophenone derivative pipamperone is a neuroleptic agent administered to reduce psychomotor agitation and psychotic conditions in schizophrenic psychoses. Among other things it blocks D2 receptors in the dopamine pathways of the mesolimbic system and therefore reduces excess release of dopamine in the area thought to control psychotic experiences. Dopamine also takes part in signal transduction in the visual process. Loss of visual acuity, color vision, scotoma and electrophysiological alterations were observed under treatment with different groups of neuroleptics which interfere with dopamine metabolism but have not yet been observed after therapy with pipamperone. We present the case of a young women suffering from unilateral loss of visual acuity after treatment with pipamperone.

Relationship between structure and antioxidative properties of some 3-formylchromone derivatives.

Flavonoids, which generally exhibit very good antioxidant properties, contain the chromone unity. The work elucidates the relation between chemical structure of chromones and their ability to scavenge DPPH radicals. The work deals with antioxidative properties of some hydroxy derivatives of 3-formylchromones (without substituent, 6-hydroxy-, 7-hydroxy-, 7,8-dihydroxy-). It was found that the last two derivatives scavenge DPPH radicals, whereas the first two ones do not. It was demonstrated that the presence and location of hydroxyl groups play a crucial role for antioxidative activity of 3-formylchromones. The scavenging of DPPH radicals runs through H(+) abstraction from hydroxyl groups of formylchromones. The DPPH scavenging by 3-formylchromones with hydroxyl group in the 7th position is connected with the formation of more stable form of anion than in the case of 6-hydroxy-3-formylchromone. Calculation heats of formations of studied formylchromone anions confirmed this fact. All studied 3-formylchromones did not scavenge HO( ) radicals, what supports H(+) abstraction mechanism of DPPH scavenging.

Triplet states as non-radiative traps in multichromophoric entities: single molecule spectroscopy of an artificial and natural antenna system.

Energy transfer in antenna systems, ordered arrays of chromophores, is one of the key steps in the photosynthetic process. The photophysical processes taking place in such multichromophoric systems, even at the single molecule level, are complicated and not yet fully understood. Instead of directly studying individual antenna systems, we have chosen to focus first on systems for which the amount of chromophores and the interactions among the chromophores can be varied in a systematic way. Dendrimers with a controlled number of chromophores at the rim fulfill those requirements perfectly. A detailed photophysical study of a second-generation dendrimer, containing eight peryleneimide chromophores at the rim, was performed 'J. Am. Chem. Soc., 122 (2000) 9278'. One of the most intriguing findings was the presence of collective on/off jumps in the fluorescence intensity traces of the dendrimers. This phenomenon can be explained by assuming a simultaneous presence of both a radiative trap (energetically lowest chromophoric site) and a non-radiative trap (triplet state of one chromophore) within one individual dendrimer. It was shown that an analogue scheme could explain the collective on/off jumps in the fluorescence intensity traces of the photosynthetic pigment B-phycoerythrin (B-PE) (Porphyridium cruentum). The different values of the triplet lifetime that could be recovered for a fluorescence intensity trace of B-PE were correlated with different intensity levels in the trace, suggesting different chromophores acting as a trap as function of time.

Activity of some 3-formylchromone derivatives on the induction of chloroplast-free mutants in Euglena gracilis.

The hereditary bleaching test on Euglena gracilis was used for detecting extranuclear mutations. The highest bleaching activity (induction of the chloroplast-free mutants) was shown by the 6-R-3-formylchromones. On the other hand, bleaching-inactive 6-R-3-formylchromone acylhydrazones (derived from gallic and salicylic acids), added at sufficient concentrations in the case of chloroplast mutagenesis in E. gracilis, act as a potent antimutagen. This effect appeared to be a unique feature of chromone derivatives, but was dependent on the type of mutagen. These substances were very effective against the bleaching activity of acridine orange, and were less effective against N-methyl-N'-nitro-N-nitrosoguanidine. The genotoxic effects of these mutagens was reduced, especially during the first stages of induction of this specific cytoplasmic mutation. The experimental study of mutagenicity and antimutagenicty of 3-formylchromone hydrazones was reinforced by data obtained by the semi-empirical AM1 method and lipophilicity values.

Study of diastereomeric thioureas formed with a new chiral derivatizing agent.

(1S,2S)-1,3-Diacetoxy-1-(4-nitrophenyl)-2-propyl isothiocyanate ((S,S)-DANI) was recently introduced as a new chiral derivatizing agent for the enantioseparation of amino compounds. In the present study, diastereomeric derivatives of racemic amino acids were formed with (S,S)-DANI. The thioureas produced were distinguished by means of infrared spectroscopy, theoretical calculations and high-performance liquid chromatography. The differences observed between the corresponding diastereomers by the independent methods are considered to prove the applicability of the new reagent in the field of enantiomer separation.

[Functional scintigraphic blood pool study. A radiologic technic for non-invasive study of pharmacologically induced blood volume fluctuations]. / Die funktionsszintigraphische Bloodpooluntersuchung. Eine radiologische Technik für das nicht-invasive Studium pharmakologisch induzierter Blutvolumenverschiebungen.

After in-vivo labeling of red blood cells with 99mTcO4, the radioactivity of different parts of the body is proportional to the regional blood volume. This technique allows the simultaneous registration of drug-induced changes of the local blood volume. We examined the influence of nitroglycerin on the blood volume distribution in patients with coronary artery disease (n = 10) and chronic heart failure (n = 8). Compared with the controls (n = 8) we observed in the nitroglycerin-groups a significant decrease of blood volume over the heart and the liver, whereas there was an increase of the blood volume over the extremities. It is pointed out that functional whole-body scanning is a useful radiological technique for the non-invasive study of pharmacologically caused changes of the local blood volume in man.

Changes in regional body blood volume caused by nitroglycerin.

Using a method of in vivo labeling of erythrocytes and subsequent whole-body scanning, we investigated the effect of nitroglycerin (NTG) on regional blood pooling in patients with chronic left heart failure (six men and two women). A group of eight patients with coronary heart disease who did not receive any NTG served as controls. These data were compared with the effects of NTG in ten male patients suffering from coronary artery disease. Up to 25 min after sublingual administration of 1.6 mg NTG we observed a significant decrease in radioactivity in the regions of heart, lung, and liver (maximal per hundred 6.0, 6.5, and 4.8 respectively) indicating the reduction in local blood volume. In the abdomen, the arms, and the legs we observed an increase in regional blood volume (maximum 9.7%, 8.3%, and 6.5% respectively). An overall significant change usually began approximately 5 min after NTG and lasted for about 20 min. In contrast to patients with left heart failure, patients with coronary artery disease did not show any significant difference in pulmonary and abdominal regions after NTG. The noninvasive method used allows an immediate determination of drug-induced regional blood volume pooling.

[Diagnosis of myocardial metastases by sectorechocardiography (author's transl)]. / Diagnose von Myokardmetastasen durch Sektorechokardiographie (SE).

A case of myocardial metastases due to a malignant bone tumour was diagnosed by sectorechocardiography. The clinical data and the findings of echocardiography and pathology are presented, the value of echocardiography in the diagnosis of myocardial metastases is discussed.