Quality of life after endoscopic skull base surgery with a nasoseptal flap: a systematic review.

BACKGROUND: The past two decades have seen a widespread adoption of endoscopic skull base surgery with the use of nasoseptal flaps. Attention has been diverted in recent times to evaluate the quality of life of these patients. OBJECTIVE: This systematic review aimed to evaluate the available literature to compare the quality of life after endoscopic skull base surgery with or without nasoseptal flaps. METHODS: This systemic review was conducted using PubMed, Embase and Cochrane Library databases for literature published after 2009. RESULTS: The majority of studies concluded that there was no statistically significant difference in the quality of life associated with the use of nasoseptal flaps. Post-operatively, more extensive surgery, peri-operative radiotherapy, smoking and younger age were associated with poorer quality of life. CONCLUSION: While the use of nasoseptal flaps can have negative effects on patients' quality of life in terms of sinonasal symptoms, this systematic review found no difference in quality of life associated with the use or non-use of a nasoseptal flap.

Cochlear duct length-one size fits all?

OBJECTIVE: Recent studies demonstrated the utility of high-resolution computed tomography (HRCT) scans in measuring basal cochlear length and cochlear insertion depths. These studies showed significant variations in the anatomy of the cochlea amongst humans. The aim of our study was to investigate for gender and racial variations in the basal turn length of the human cochlea in an Asian population. METHOD: HRCT temporal bone data from year 1997 till 2012 of patients with normally developed cochleae who reported with otologic disease was obtained. Reconstruction of the full basal turn was performed for both ears. The largest distance from the midpoint of the round window, through the midmodiolar axis, to the lateral wall was measured (distance A). Length of the lateral wall of the cochlea to the first turn (360°) was calculated and statistically analyzed. RESULTS: HRCT temporal bone data from 161 patients was initially obtained. Four patients were subsequently excluded from the study as they were of various other racial groups. Study group therefore comprised of 157 patients (314 cochleae). Mean distance A was statistically different between the two sides of the ear (right 9.09mm; left 9.06mm; p=0.0069). Significant gender and racial differences were also found. Mean distance A was 9.17mm in males and 8.97mm in females (p=0.0016). The racial groups were Chinese (39%), Malay (38%) and Indian (22%). Between racial groups, mean distance A was 9.11mm (Chinese), 9.11mm (Malays) and 8.99mm (Indians). The mean basal turn lengths ranged from 19.71mm to 25.09mm. With gender factored in, significant variation in mean basal turn lengths was found across all three racial groups (p=0.04). CONCLUSION: The view of the basal turn of the cochlea from HRCT is simple to obtain and reproducible. This study found significant differences in basal cochlear length amongst male and female Asian patients, as well as amongst various racial groups. This has implications for cochlear electrode insertion as well as electrode array design.

Serotonergic function in major depression and effect of sertraline and paroxetine treatment.

We investigated platelet [14C]serotonin (5-HT) uptake and lysergic acid diethylamide [N-methyl-3H] ([3H]LSD)- and phenyl-6'-paroxetine ([3H]paroxetine) binding in 30 patients with major depression at baseline and after 6 months of treatment with either paroxetine or sertraline. The study was of a double-blind design. Baseline data was compared with an age- and gender-matched group of healthy volunteers. Baseline Vmax was significantly lower in patients than in controls. Bmax for [3H]paroxetine binding were similar in patients and controls, but patients who suffered their first depression had significantly lower Bmax for [3H]paroxetine binding than patients who had suffered multiple depressions. Twenty-three patients (76%) (13 in the paroxetine group and 10 in the sertraline group) responded to treatment as judged by a 50% or more reduction in Montgomery-Asberg Depression Rating Scale (MADRS) scores after 6 months of treatment. There were no significant differences between the paroxetine and sertraline treated groups. Both paroxetine and sertraline caused a significant reduction in Vmax and a significant increase in Km. There was a strong correlation between Km and plasma drug concentration in patients who experienced their first depression but not in patients who had suffered multiple episodes. Bmax for [3H]paroxetine binding increased after paroxetine treatment while the opposite occurred after sertraline treatment. There was a significant interaction between the impact of drug and earlier depressions. All patients included in the study had been drug free for at least 2 months. Earlier antidepressant treatment may have long withstanding effects on the serotonin uptake machinery but it cannot be excluded that the sensitivity of the uptake mechanism may become more resistant to change in patients with recurrent depressive episodes.

Mortality in 497 patients with affective disorders attending a lithium clinic or after having left it.

The impact of lithium prophylaxis on mortality has been studied in 497 patients, 405 bipolars and 92 unipolars, who attended the same out-patient lithium clinic for up to 30 years. In order to avoid preselection, no minimum period of lithium treatment was required in our study. Of a total of 6014 patient-years, 4330 were spent in regular contact with the study clinic. General mortality due to natural causes was not significantly increased; among cardiovascular diseases, only pulmonary embolism showed an excess mortality. No patients died of lithium intoxication or chronic renal insufficiency. Patients were divided into three groups: Group A, 277 patients, attended the study clinic until death or the end of the study, Group B, 86 patients, left the clinic but continued to take lithium, and Group C, 134 patients, both left the clinic and stopped taking lithium. Among bipolars, the suicide rate compared to the general population was in excess in all three groups. Among unipolars, suicides occurred only after the patients had left the study clinic and stopped taking lithium. A special analytical method was used for intergroup comparisons of suicide rates. Bipolars in Group A attending the study clinic regularly had a suicide rate of 3.5 per 1000 patient-years. The rate increased to 6.3 or by 80 % if patients had left the clinic and did not take lithium any longer as in Group C. The suicide rate in Group C increased by 45% compared to Group B, patients who left the clinic but continued to take lithium. Our results support the hypothesis that lithium has a significant antisuicidal effect in bipolars as well as in unipolars. The suicide mortality can be further reduced by regular attendance in a specialised mood disorder clinic.

Increased platelet 5-HT2 receptor binding after electroconvulsive therapy in depression.

We investigated the effect of electroconvulsive treatment (ECT) on platelet 14C-serotonin uptake, 3H-paroxetine binding and 5-HT2 receptors in 12 patients (10 women and 2 men) unresponsive to pharmacological treatment. The mean numbers of ECTs given was 6.1 +/- 1.5. Mean treatment days was 14.6 +/- 3.8. Mean percent reduction in MADRS scores was 80.7 +/- 19.7 (p < 0.002). The number of 5-HT2 receptors increased significantly and uniformly after ECT (p = 0.011). There was no correlation between the degree of increase in 5-HT2 receptor densities and the reduction in MADRS scores after ECT. There was no difference in mean Bmax for platelet 3H-paroxetine binding before and after ECT. Bmax increased in six patients and decreased in six patients. The study shows an increase in platelet 5-HT2-receptor densities in depression after repeated ECT. Recognizing the similarities between 5-HT2 receptors in platelets and cerebral cortex, it seems reasonable to assume that a similar upregulation of cortical 5-HT2 receptors occurs after ECT.

Impaired neuropsychological performance in euthymic patients with recurring mood disorders.

BACKGROUND: Both patients suffering from schizophrenia and patients suffering from recurring mood disorder show cognitive impairments as established by a variety of neuropsychological tests. The aim of the present study was to investigate the neuropsychological performance of euthymic patients who had recurring mood disorder and the possible relationship between episodes of hospitalization and cognitive impairments. METHOD: Twenty-six euthymic patients with a DSM-III-R recurring mood disorder diagnosis were investigated by using the Synonym Reasoning and Block-Test Battery and a part of the Halstead-Reitan Test Battery. RESULTS: An overall lowered performance in the test results was found. There was a significant positive relationship between four different tests and the number of hospitalization episodes; the patients with impaired cognitive functioning had significantly more hospitalization episodes than patients with normal cognitive functioning. CONCLUSION: The results suggest that a subgroup of patients with recurring mood disorder are defined by more relapses and episodes of hospitalization and show cognitive dysfunctions even when euthymic.

Unplanned returns to the accident and emergency department--why do they come back?

An audit of unplanned returns by patients to the Accident and Emergency Department was carried out recently in Toa Payoh Hospital. This was done for a period of eleven months for the year 1994. A total of 166 unplanned patient returns were studied. We analysed the reasons for their return, whether there were any differences between the diagnoses made initially and at the return visit, and the outcome of these return visits. It was found that more than two-thirds of patients (72.3%) returned because of a failure to improve from their initial condition even after treatment given by the Emergency Department doctors. The six most common illnesses for which there were failure to improve were asthma, epigastric pains (including gastritis and peptic ulcer disease), gastroenteritis and food poisoning, renal and ureteric colic, minor head injury and backache. Another 14.5% of patients were found to have wrong or missed diagnoses at the initial visit, the two most important of which were appendicitis and bleeding from the gastrointestinal tract. It is hoped that such an audit will serve to identify areas for improvement in patient care. It can also be a useful tool for measuring and improving the performance of individual Emergency Room doctors, or a group of doctors.

Shwachman syndrome: CT and MR diagnosis.

The MR and CT features of the pancreas are described in an 18-year-old woman. Lipomatosis of the pancreas found on MR and CT and the clinical findings pancytopenia, short stature, and recurrent infections are typical for Shwachman syndrome.

Insulin-like growth factors and insulin-like growth factor binding proteins in cerebrospinal fluid and serum of patients with dementia of the Alzheimer type.

After acid gel-chromatography cerebrospinal fluid and serum levels of immunoreactive insulin-like growth factor 1 and 2 (IGF-1 and IGF-2) were determined in patients with dementia of the Alzheimer type (AD) and in healthy subjects. The AD CSF levels of immunoreactive IGF-1 did not differ from the subjects but the levels of immunoreactive IGF-2 was significantly elevated in both serum and CSF in the AD patient group. Additionally immunoreactive IGF-1 in AD serum was found to be significantly elevated. To characterize the CSF IGF binding protein activity (IGFBP), ligand blotting was performed on whole CSF from AD patients and subjects. The results demonstrate two major forms of IGFBP in CSF with approximate molecular weights of 33 KDa and 30 KDa. The two IGFBP forms are suggested to represent IGFBP-2 and IGFBP-6. A highly significant increase in both the IGFBPs was observed in the CSF of the AD patients compared to the healthy subjects.

Current status of filariasis in Malaysia.

The Filariasis Control Program was established more than 30 years ago in the country and the disease is still a public health problem in some states. Since 1983, a total of 17 filariasis control teams were formed throughout the country to carry out filariasis control work. The teams conduct house and population censuses, nocturnal mass blood surveys and treatment of microscopically confirmed cases. Individual case follow-up is being carried out after 3-5 months while the locality is resurveyed after about 2-3 years. During the years 1988 to 1990, there appeared to be a decreasing trend in the number of filariasis cases detected countrywide. In 1991, brugian filariasis accounted for 92% of the cases detected. The microfilaria rate (MFR) also showed a decreasing trend countrywide for the years 1988 (0.57%) to 1990 (0.35%) but there was an increase in 1991 although it remained well below the 5% MFR targeted in the program objective, In 1991, the filariasis control teams and the district multi-purpose teams collected a total of 167, 151 blood slides out of which 871 were found to be positive for microfilaria. To determine the true endemicity of filariasis in the country, the malaria district multi-purpose teams are also utilized to assist in probe surveys in new areas of the district. Two species of filarial worms, namely Brugia malayi and Wuchereria bancrofti, and the mosquito vectors belonging to the Anopheles and Mansonia genera are involved in the transmission of filariasis in Malaysia. Monkeys and domestic cats are the reservoir hosts for the subperiodic strain of B. malayi.

Value of indium-111 tropolonate autologous granulocyte scintigraphy in the assessment of inflammatory bowel disease.

Indium-111 autologous leucocyte scanning is a non-invasive and reliable technique for the detection of abdominal abscesses. In the past decade several papers have been published concerning the use of this technique in the assessment of inflammatory bowel disease (IBD) with variable results. We conducted a prospective study of 62 patients with IBD attending the Leiden University Hospital, to assess the diagnostic value of indium-111 tropolonate autologous granulocyte scanning. Fifty-one patients had Crohn's disease (CD) (30 with involvement of the small bowel, 18 the colon only, and 3 patients had both localizations), and 11 had ulcerative colitis (UC). Twenty-one of 26 patients with evidence of active disease of the small intestine had a true-positive scan (sensitivity, 80%). However, accurate assessment of localization and extent of disease were often difficult. The other five patients had a false-negative scan. Seven patients had a true-negative scan. No false-positive scans were found. Thus, the diagnostic accuracy for small-intestinal Crohn's disease was 85%. In contrast, of 32 patients with colonic disease (CD and UC), 26 had a true-positive scan corresponding in localization and extent with standard investigations, 3 patients had a false-negative scan (sensitivity, 90%), and 3 had a true-negative scan (diagnostic accuracy, 91%). The patients' acceptability of this procedure was definitely superior to that for radiology and endoscopy. In conclusion, this technique has a definite place in evaluating localization and extent of active colonic disease and in severely ill patients in whom invasive techniques are contraindicated.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunoreactive somatomedin B is increased in serum in patients with major depressive disorder.

Serum levels of immunoreactive somatomedin B (RIA-B) were investigated in patients with major depressive disorder both in the acute state and during remission at 8 h and 22 h and at 22 h after the dexamethasone suppression test. Elevated levels of RIA-B at 8 h and at 22 h after the dexamethasone suppression test were found consistently in the patient group compared with the healthy controls. No indication was obtained that the patients' clinical condition or depressive symptomatology as revealed by their CPRS score, psychotropic medication or TSH, prolactin, melatonin or cortisol levels was significantly related to the RIA-B levels.

Insulin-like growth factors and somatomedin B in the cerebrospinal fluid of patients with dementia of the Alzheimer type.

Cerebrospinal fluid levels of radioreceptor assayable insulin-like growth factors (RRA-IGFs) and immunoreactive somatomedin B (SMB) (RIA-B) were determined in apparently healthy individuals and in patients with dementia of the Alzheimer type (AD). The CSF levels of RIA-B and RRA-IGFs did not alter from the healthy controls. After being acidified, the CSF from the controls and from the presenile ADs were separated over a G-50 fine Sephadex . The RRA-IGFs activity eluted in three peaks. The results indicate that the major constituent of CSF RRA in both AD patients and controls is an IGF binding protein. The two minor peaks eluted at approximately 9 K and 6 K, corresponding to the elution positions of "big" IGF-2 and IGF-2.

Immunoreactive somatomedin B in the human foetus and in women during pregnancy.

Immunoreactive somatomedin B (RIA-B) was identified in foetal organ extracts, amniotic fluid and foetal serum in the second trimester. After separation using a G-200 neutral Sephadex column, the RIA-B activity in the cytosol prepared from foetal organs eluted after the void volume, suggesting the dominance of activity with the molecular weight of approximately 200 K. In contrast, the majority of the RIA-B activity in amniotic fluid eluted around the elution volume, suggesting dominance of activity with a molecular weight of approximately 5 K. Cord blood RIA-B levels were examined and found to be significantly lower than adult levels. A significant correlation between cord blood RIA-B levels, and neonatal weight was found. A longitudinal study during pregnancy showed that RIA-B is increased in both healthy women and in women suffering from hypopituitarism suggesting a pituitary-independent production of RIA-B during pregnancy.