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1.
Iran J Med Sci ; 49(5): 302-312, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38751872

RESUMO

Background: Antibiotic resistance is a global public health concern that has been exacerbated by the overuse and misuse of antibiotics, leading to the emergence of resistant bacteria. The gut microbiota, often influenced by antibiotic usage, plays a crucial role in overall health. Therefore, this study aimed to investigate the prevalence of antibiotic resistant genes in the gut microbiota of Indonesian coastal and highland populations, as well as to identify vancomycin-resistant bacteria and their resistant genes. Methods: Stool samples were collected from 22 individuals residing in Pacet, Mojokerto, and Kenjeran, Surabaya Indonesia in 2022. The read count of antibiotic resistant genes was analyzed in the collected samples, and the bacterium concentration was counted by plating on the antibiotic-containing agar plate. Vancomycin-resistant strains were further isolated, and the presence of vancomycin-resistant genes was detected using a multiplex polymerase chain reaction (PCR). Results: The antibiotic resistant genes for tetracycline, aminoglycosides, macrolides, beta-lactams, and vancomycin were found in high frequency in all stool samples (100%) of the gut microbiota. Meanwhile, those meant for chloramphenicol and sulfonamides were found in 86% and 16% of the samples, respectively. Notably, vancomycin-resistant genes were found in 16 intrinsically resistant Gram-negative bacterial strains. Among the detected vancomycin-resistant genes, vanG was the most prevalent (27.3%), while vanA was the least prevalent (4.5%). Conclusion: The presence of multiple vancomycin resistance genes in intrinsically resistant Gram-negative bacterial strains demonstrated the importance of the gut microbiota as a reservoir and hub for the horizontal transfer of antibiotic resistant genes.


Assuntos
Microbioma Gastrointestinal , Humanos , Microbioma Gastrointestinal/efeitos dos fármacos , Indonésia , Resistência a Vancomicina/genética , Vancomicina/farmacologia , Vancomicina/uso terapêutico , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Fezes/microbiologia , Masculino , Feminino , Bactérias/efeitos dos fármacos , Bactérias/genética , Bactérias/classificação , Adulto , Genes Bacterianos
2.
Stud Health Technol Inform ; 295: 320-323, 2022 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-35773873

RESUMO

Acute stroke care is a time-critical process. Improving communication and documentation process may support a positive effect on medical outcome. To achieve this goal, a new system using a mobile application has been integrated into existing infrastructure at Hannover Medical School (MHH). Within a pilot project, this system has been brought into clinical daily routine in February 2022. Insights generated may support further applications in clinical use-cases.


Assuntos
Aplicativos Móveis , Acidente Vascular Cerebral , Telemedicina , Documentação , Humanos , Projetos Piloto , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia
3.
Neurology ; 96(3): e343-e351, 2021 01 19.
Artigo em Inglês | MEDLINE | ID: mdl-33144517

RESUMO

OBJECTIVE: To determine whether thrombectomy is safe in children up to 24 hours after onset of symptoms when selected by mismatch between clinical deficit and infarct. METHODS: A secondary analysis of the Save ChildS Study (January 2000-December 2018) was performed, including all pediatric patients (<18 years) diagnosed with arterial ischemic stroke who underwent endovascular recanalization at 27 European and United States stroke centers. Patients were included if they had a relevant mismatch between clinical deficit and infarct. RESULTS: Twenty children with a median age of 10.5 (interquartile range [IQR] 7-14.6) years were included. Of those, 7 were male (35%), and median time from onset to thrombectomy was 9.8 (IQR 7.8-16.2) hours. Neurologic outcome improved from a median Pediatric NIH Stroke Scale score of 12.0 (IQR 8.8-20.3) at admission to 2.0 (IQR 1.2-6.8) at day 7. Median modified Rankin Scale (mRS) score was 1.0 (IQR 0-1.6) at 3 months and 0.0 (IQR 0-1.0) at 24 months. One patient developed transient peri-interventional vasospasm; no other complications were observed. A comparison of the mRS score to the mRS score in the DAWN and DEFUSE 3 trials revealed a higher proportion of good outcomes in the pediatric compared to the adult study population. CONCLUSIONS: Thrombectomy in pediatric ischemic stroke in an extended time window of up to 24 hours after onset of symptoms seems safe and neurologic outcomes are generally good if patients are selected by a mismatch between clinical deficit and infarct. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for children with acute ischemic stroke with a mismatch between clinical deficit and infarct size, thrombectomy is safe.


Assuntos
Embolectomia , AVC Isquêmico/cirurgia , Seleção de Pacientes , Trombectomia , Adolescente , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
4.
Eur Arch Otorhinolaryngol ; 277(7): 1931-1937, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32206871

RESUMO

PURPOSE: To evaluate temporal bone cone-beam CT in patients with idiopathic sudden sensorineural hearing loss (ISSNHL) being treated with primary and secondary intratympanic (IT) triamcinolone and to possibly correlate these results to the clinical outcome. METHODS: Retrospective analysis of patients treated with IT triamcinolone for ISSNHL at our department in 2018. Pre- and post-therapeutic audiologic examinations included four-tone average (FTA) at 0.5, 1, 2 and 3 kHz. Using a clinical questionnaire, pre-therapeutic CBCT scans were re-evaluated looking at items, which might interfere with adequate drug diffusion into the inner ear (e.g. bony overhangs or secondary membranes at the round or oval window). RESULTS: Thirty-one patients were included. Twenty-four (77%; group A) had experienced ineffective systemic steroid therapy before and seven (23%; group B) received primary IT injections. Four group A-patients (21%) and two group B-patients (33%) showed a post-therapeutic FTA improvement of more than 15 dB HL. Bony overhangs at the round window niche (RWN) were present in seven cases (26%), a secondary membrane at the RWN in four (15%) and soft tissue in eight (30%) cases, respectively. CONCLUSION: Most patients present radiological findings in CBCT imaging, which might interfere with drug diffusion through the RW membrane. Interestingly, soft or bony tissue obstructing the RWN or the OWN was found in 50% of patients, who showed improvement of hearing. We conclude that radiologic 'tiny' findings are either clinically irrelevant or improvement in hearing is independent from intratympanic drug delivery.


Assuntos
Perda Auditiva Neurossensorial , Perda Auditiva Súbita , Audiometria de Tons Puros , Tomografia Computadorizada de Feixe Cônico , Dexametasona/uso terapêutico , Glucocorticoides/uso terapêutico , Perda Auditiva Neurossensorial/diagnóstico por imagem , Perda Auditiva Neurossensorial/tratamento farmacológico , Perda Auditiva Súbita/diagnóstico por imagem , Perda Auditiva Súbita/tratamento farmacológico , Humanos , Injeção Intratimpânica , Estudos Retrospectivos , Resultado do Tratamento , Triancinolona/uso terapêutico , Membrana Timpânica/diagnóstico por imagem
5.
Stroke ; 51(4): 1182-1189, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32114927

RESUMO

Background and Purpose- The recent Save ChildS study provides multicenter evidence for the use of mechanical thrombectomy in children with large vessel occlusion arterial ischemic stroke. However, device selection for thrombectomy may influence rates of recanalization, complications, and neurological outcomes, especially in pediatric patients of different ages. We, therefore, performed additional analyses of the Save ChildS data to investigate a possible association of different thrombectomy techniques and devices with angiographic and clinical outcome parameters. Methods- The Save ChildS cohort study (January 2000-December 2018) analyzed data from 27 European and United States stroke centers and included all pediatric patients (<18 years), diagnosed with arterial ischemic stroke who underwent endovascular recanalization. Patients were grouped into first-line contact aspiration (A Direct Aspiration First Pass Technique [ADAPT]) and non-ADAPT groups as well as different stent retriever size groups. Associations with baseline characteristics, recanalization rates (modified Treatment in Cerebral Infarction), complication rates, and neurological outcome parameters (Pediatric National Institutes of Health Stroke Scale after 24 hours and 7 days; modified Rankin Scale and Pediatric Stroke Outcome Measure at discharge, after 6 and 24 months) were investigated. Results- Seventy-three patients with a median age of 11.3 years were included. Currently available stent retrievers were used in 59 patients (80.8%), of which 4×20 mm (width×length) was the most frequently chosen size (36 patients =61%). A first-line ADAPT approach was used in 7 patients (9.6%), and 7 patients (9.6%) were treated with first-generation thrombectomy devices. In this study, a first-line ADAPT approach was neither associated with the rate of successful recanalization (ADAPT 85.7% versus 87.5% No ADAPT) nor with the complication rate or the neurological outcome. Moreover, there were no associations of stent retriever sizes with rates of recanalization, complication rates, or outcome parameters. Conclusions- Our study suggests that neurological outcomes are generally good regardless of any specific device selection and suggests that it is important to offer thrombectomy in eligible children regardless of technique or device selection. Registration- URL: https://www.drks.de/; Unique identifier: DRKS00016528.


Assuntos
Isquemia Encefálica/cirurgia , Revascularização Cerebral/instrumentação , Doenças do Sistema Nervoso/prevenção & controle , Stents , Acidente Vascular Cerebral/cirurgia , Trombectomia/instrumentação , Adolescente , Isquemia Encefálica/diagnóstico por imagem , Revascularização Cerebral/métodos , Criança , Pré-Escolar , Estudos de Coortes , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Feminino , Humanos , Lactente , Masculino , Doenças do Sistema Nervoso/diagnóstico por imagem , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Trombectomia/métodos , Resultado do Tratamento
6.
J Thromb Thrombolysis ; 49(1): 67-74, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31482326

RESUMO

Although intravenous thrombolysis (IVT) with recombinant tissue-plasminogen-activator represents a highly effective treatment in acute ischemic stroke patients, not every patient benefits. We hypothesized that pretreatment levels of mediators of hemostasis (VWF and ADAMTS13) and dimethylarginines (ADMA and SDMA) are associated with early neurological improvement and outcome after IVT in ischemic stroke. Moreover we aimed to investigate the link between ADAMTS13 and markers of inflammation (CRP, IL-6, MMP-9 and MCP-1). In 43 patients with acute ischemic stroke treated with IVT blood samples for determination of the different markers were strictly taken before treatment, as well as at 24 h, 3, 7 and 90 days after symptom onset. Early neurological improvement was assessed using the shift between National Institutes of Health Stroke Scale (NIHSS) at baseline and at 24 h. Outcome at 90 days was assessed using the modified Rankin Scale. The lowest quartile of ADAMTS13 activity was independently associated with less improvement in NIHSS (baseline-24 h) (OR 1.298, p = 0.050). No independent association of ADMA or SDMA levels at baseline with outcome could be shown. Furthermore, IL-6, MCP-1 and CRP levels at 90 days significantly differed between patients with low and high ADAMTS13 activity. Thus, ADAMTS13 might indicate or even influence efficacy of IVT.


Assuntos
Proteína ADAMTS13/sangue , Isquemia Encefálica , Doenças do Sistema Nervoso , Acidente Vascular Cerebral , Terapia Trombolítica , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Isquemia Encefálica/sangue , Isquemia Encefálica/complicações , Isquemia Encefálica/terapia , Proteína C-Reativa/metabolismo , Citocinas/sangue , Feminino , Humanos , Inflamação/sangue , Inflamação/terapia , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/sangue , Doenças do Sistema Nervoso/etiologia , Estudos Prospectivos , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/terapia
7.
Int J Pediatr Otorhinolaryngol ; 113: 102-109, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30173965

RESUMO

OBJECTIVES: Bacterial meningitis can cause a labyrinthitis. Consequences often are intracochlear soft tissue neoformation (cochlear obliteration) or intracochlear osteoneogenesis (cochlear ossification) and deafness. Cochlear implantation becomes challenging and hearing rehabilitation is complicated. This retrospective case-control-study aimed to find correlations between morphologic, electric and functional parameters. METHODS: The study group included children, who lost hearing due to a bacterial meningitis (n = 35 cases). Using preoperative computed tomography and intraoperative findings we grouped into 'unaltered cochleae', 'obliterated cochleae' and 'ossified cochleae'. Control group children suffered from deafness (n = 16) of other aetiology and presented with radiologically unchanged cochleae. Postoperative routine controls documented impedances, stimulation charge and hearing tests a various time points, which all were analysed. RESULTS: Control group patients showed a mean impedance of 6.3 kΩ and the mean charge applied was 19 nC. The study group averaged at 7.9 kΩ and 24.6 nC respectively. Patients with ossified cochleae had increased values of 8.6 kΩ and 29.7 nC. The control group reached a monosyllabic word understanding of 74% and the study group of 58%. Patients with ossified cochleae reached 36%. CONCLUSIONS: Impedances and stimulation charge influence each other. Increased charge is necessary for higher cochlear implant output. Despite higher charges, patients with obliterated and patients with ossified cochleae significantly perform worse in hearing rehabilitation. Reduced audiological outcome in study group patients without morphologic cochlear changes furthermore hints at additional factors besides cochlear tissue neogenesis like postinflammational changes at the neural pathway.


Assuntos
Implante Coclear/métodos , Surdez/cirurgia , Impedância Elétrica , Meningites Bacterianas/complicações , Estudos de Casos e Controles , Criança , Pré-Escolar , Cóclea/diagnóstico por imagem , Cóclea/patologia , Surdez/etiologia , Feminino , Humanos , Lactente , Masculino , Ossificação Heterotópica/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento
8.
Thromb Haemost ; 118(4): 758-767, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29618156

RESUMO

BACKGROUND: Endovascular treatment improves outcome in patients with acute ischaemic stroke due to large vessel occlusion in general. But outcome in some of these patients is jeopardized by recanalization failure or bleeding. OBJECTIVES: This study aimed to determine a possible association of mediators of inflammation and haemostasis (C-reactive protein, interleukin-6, matrix metalloproteinase-9, monocyte chemoattractant protein-1, asymmetric dimethylarginine [ADMA], symmetric dimethylarginine, von Willebrand factor and a disintegrin and metalloproteinase with a thrombospondin type 1 motif 13 [ADAMTS-13]) with the post-intervention grade of reperfusion, complications and clinical outcome in patients who underwent endovascular treatment of ischaemic stroke. PATIENTS/METHODS: Forty-one patients with acute ischaemic stroke due to large vessel occlusion were prospectively enrolled into the study. Peripheral venous blood was taken prior to treatment and 24 hours and 3, 7 and 90 days after symptom onset. The post-intervention grade of reperfusion was determined using the modified Treatment in Cerebral Infarction (mTICI) score. Clinical outcome on day 90 was assessed using the modified Rankin's scale (mRS). RESULTS: Low ADAMTS-13 activity (p = 0.009) and missing of statin therapy (p = 0.038) on admission were independently associated with unfavourable outcome (mRS: 5-6). Patients with unsuccessful reperfusion (mTICI: 0-1) showed higher ADMA levels on admission (p = 0.018). However, this association could not be confirmed in the binary logistic regression analysis. CONCLUSION: Low ADAMTS-13 activity is a predictor of unfavourable outcome in patients with ischaemic stroke undergoing endovascular therapy. Further studies are warranted to elucidate the clinical and potential therapeutic role of ADAMTS-13 in acute ischaemic stroke.


Assuntos
Proteína ADAMTS13/sangue , Isquemia Encefálica/tratamento farmacológico , Procedimentos Endovasculares/métodos , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/tratamento farmacológico , Proteína ADAMTS13/fisiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Hemostasia , Humanos , Inflamação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Traumatismo por Reperfusão , Reprodutibilidade dos Testes , Resultado do Tratamento
9.
Int J Pediatr Otorhinolaryngol ; 78(8): 1320-6, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24882458

RESUMO

OBJECTIVE: As patients with Waardenburg syndrome (WS) represent potential candidates for cochlear implantation, their inner ear anatomy is of high significance. There is an ongoing debate whether WS is related to any inner ear dysplasias. Our objective was to evaluate radiologically the inner ear anatomy in patients with WS and identify any temporal bone malformations. METHODS: A retrospective case review was carried out in a tertiary, referral center. The high resolution computed tomography (HRCT) scans of the temporal bone from 20 patients (40 ears) with WS who were managed for deafness in a tertiary referral center from 1995 to 2012 were retrospectively examined. Measurements of 15 different inner ear dimensions, involving the cochlea, the vestibule, the semicircular canals and the internal auditory meatus, as well as measurements of the vestibular aqueduct, were performed independently by two neuroradiologists. Finally, we compared the results from the WS group with a control group consisting of 50 normal hearing subjects (100 ears) and with previously reported normative values. RESULTS: Inner ear malformations were not found in any of the patients with WS. All measured inner ear dimensions were within the normative values compiled by our study group as well as by others. CONCLUSIONS: Inner ear malformations are not characteristic for all types of WS; however, certain rare subtypes might be related to inner ear deformities. Normative cochleovestibular dimensions that can help in assessing the temporal bone anatomy are provided.


Assuntos
Orelha Interna/anatomia & histologia , Síndrome de Waardenburg/complicações , Adolescente , Estudos de Casos e Controles , Criança , Orelha Interna/diagnóstico por imagem , Feminino , Humanos , Masculino , Estudos Retrospectivos , Osso Temporal/anatomia & histologia , Osso Temporal/diagnóstico por imagem , Tomografia Computadorizada Espiral , Adulto Jovem
10.
Laryngoscope ; 124(3): 751-4, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23832771

RESUMO

OBJECTIVE/HYPOTHESIS: Magnetic resonance imaging of the temporal bone has an important role in decision making with regard to cochlea implantation, especially in children with cochlear nerve deficiency. The purpose of this study was to evaluate the usefulness of the combination of an advanced high-resolution T2-weighted sequence with a surface coil in a 3-Tesla magnetic resonance imaging scanner in cases of suspected cochlear nerve aplasia. STUDY DESIGN: Prospective study. METHODS: Seven patients with cochlear nerve hypoplasia or aplasia were prospectively examined using a high-resolution three-dimensional variable flip-angle turbo spin-echo sequence using a surface coil, and the images were compared with the same sequence in standard resolution using a standard head coil. Three neuroradiologists evaluated the magnetic resonance images independently, rating the visibility of the nerves in diagnosing hypoplasia or aplasia. RESULTS: Eight ears in seven patients with hypoplasia or aplasia of the cochlear nerve were examined. The average age was 2.7 years (range, 9 months-5 years). Seven ears had accompanying malformations. The inter-rater reliability in diagnosing hypoplasia or aplasia was greater using the high-resolution three-dimensional variable flip-angle turbo spin-echo sequence (fixed-marginal kappa: 0.64) than with the same sequence in lower resolution (fixed-marginal kappa: 0.06). CONCLUSIONS: Examining cases of suspected cochlear nerve aplasia using the high-resolution three-dimensional variable flip-angle turbo spin-echo sequence in combination with a surface coil shows significant improvement over standard methods.


Assuntos
Nervo Coclear/anormalidades , Anormalidades Congênitas/patologia , Imagem Ecoplanar/métodos , Perda Auditiva Neurossensorial/diagnóstico , Pré-Escolar , Implante Coclear/métodos , Estudos de Coortes , Anormalidades Congênitas/cirurgia , Imagem Ecoplanar/instrumentação , Feminino , Perda Auditiva Neurossensorial/cirurgia , Humanos , Imageamento Tridimensional , Lactente , Imageamento por Ressonância Magnética/métodos , Masculino , Variações Dependentes do Observador , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Melhoria de Qualidade
11.
Otol Neurotol ; 34(7): 1253-60, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23928521

RESUMO

OBJECTIVE: Hearing rehabilitation of patients with severe inner ear malformations remains controversial. Our objective was to describe the radiologic findings of aplasia of the cochlea (AC) and evaluate the existing therapeutic options in such patients. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary referral center. PATIENTS: Pediatric and adult patients with AC evaluated at our institution from 1995 to 2010. INTERVENTIONS: The precise radiologic findings were identified using high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) scans of the inner ear. In cases of auditory implantation on the AC side, the achieved outcome was recorded using categories of auditory performance (CAP). Related surgical aspects were analyzed. RESULTS: Twenty-three patients (28 ears) with AC were found. In 5 patients AC was bilateral. The remaining unilateral cases had contralateral normal ears (2 patients), cochlea hypoplasia (5 patients), common cavity (6 patients), incomplete partition Type I (4 patients), and atresia of the internal auditory canal (1 patient). Four patients (3 bilateral, 1 unilateral ACs) were treated with cochlear implants in ears with AC, and 1 patient underwent auditory brainstem implantation. All implanted patients achieved speech perception with limited vocabulary (CAP scores between 4 and 5). CONCLUSION: AC is defined as the total absence of the cochlea, with a present, although malformed, vestibule. Although a distinct auditory nerve was not seen in these cases of AC, results following cochlear implantation suggest functional cochlear nerve fibers in the remaining dysplastic inner ear structures. In selected cases, cochlear implantation may be a reasonable option for the habilitation of deafness associated with AC.


Assuntos
Cóclea/anormalidades , Cóclea/diagnóstico por imagem , Transtornos da Audição/etiologia , Transtornos da Audição/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Cóclea/cirurgia , Implante Coclear , Implantes Cocleares , Estudos de Coortes , Meato Acústico Externo/anormalidades , Paralisia Facial/etiologia , Feminino , Lateralidade Funcional , Transtornos da Audição/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador , Lactente , Imageamento por Ressonância Magnética , Masculino , Procedimentos Cirúrgicos Otológicos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
12.
Br J Neurosurg ; 26(3): 397-400, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22348282

RESUMO

OBJECTIVE: Several new shunt technologies have been developed to optimize hydrocephalus treatment within the past few years. Overdrainage, however, still remains an unresolved problem. One new technology which may reduce the frequency of this complication is the use of a programmable shunt assistant (proSA). Inactive in a horizontal position, it impedes CSF flow in a vertical position according to a prescribed pressure level ranging from 0 to 40 cm H(2)O. METHODS: We exposed the proSA valve in an ex vivo protocol to MR systems operating at 3 and 7 Tesla to investigate its MRI safety. RESULTS: Following 3 Tesla exposure, no changes in valve settings were noted. Adjustment to any pressure level was possible thereafter. The mean deflection angle was 23 ± 3°. After exposure to 7 Tesla, however, there were unintended pressure changes, and the mechanism for further adjustment of the valves even disintegrated. CONCLUSION: According to the results of this study, proSA is safe with heteropolar vertical magnet alignment at 3 Tesla. Following 7 Tesla exposure, the valves lost their functional capability.


Assuntos
Derivações do Líquido Cefalorraquidiano/métodos , Hidrocefalia/terapia , Derivações do Líquido Cefalorraquidiano/instrumentação , Desenho de Equipamento , Humanos , Imageamento por Ressonância Magnética/efeitos adversos , Imageamento por Ressonância Magnética/ética , Imageamento por Ressonância Magnética/métodos , Imãs , Segurança do Paciente
13.
Eur Arch Otorhinolaryngol ; 269(4): 1103-10, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21938527

RESUMO

A minimal tip dislocation of the middle ear transducer (MET(®), Otologics Ltd) may result in poor hearing performance. Our objective was to examine if a defined MET dislocation can be diagnosed by high-resolution computed tomography (HRCT) or digital volume tomography (DVT). A human cadaver head was sequentially implanted with different MET tips (incus application) including a ceramic tip (T 1c), a titanium tip (T 1t), a new, thinner titanium tip (T 2), and a spherical titanium tip (Ts). HRCT and DVT studies were performed. Afterward, the tips were pulled back 0.5 mm, so that they were not attached to the incus. HRCT and DVT scans were repeated to identify the dislocation. Using the best plain in HRCT images, the dislocation of the transducer could be measured reliably and reproducibly in half of the cases. In particular, the precise positioning and the dislocation could be identified when T 1t and Ts were implanted, with the Ts showing the best visibility. DVT failed in recognizing the dislocation in all cases. The identification of MET tip's dislocation with HRCT depends on the shape, size, and material of the tip. This knowledge is useful for the design of the implants, as determination of the right position of the middle ear transducer may be proven important for the hearing outcome. In some cases, however, surgical exploration may still be required. Although DVT represents a promising imaging method for the otologists, it can barely help when MET dislocation is suspected.


Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Ossículos da Orelha/diagnóstico por imagem , Orelha Média/diagnóstico por imagem , Perda Auditiva Neurossensorial/cirurgia , Prótese Ossicular , Osso Temporal/diagnóstico por imagem , Transdutores , Cadáver , Ossículos da Orelha/cirurgia , Orelha Média/cirurgia , Perda Auditiva Neurossensorial/diagnóstico por imagem , Humanos , Falha de Prótese
14.
Eur Radiol ; 22(3): 525-32, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21965038

RESUMO

OBJECTIVES: To investigate an extended cohort of patients with incomplete partition (IP) and examine the adequacy of the existing classifications based on radiological criteria and on their implications for cochlear implantation. METHODS: Patients with IP admitted to a tertiary referral centre during the period 2000-2010 were retrospectively examined. The subjects were initially classified into IP-I, IP-II and atypical cases. For cochlear implant recipients relevant aspects were analysed. RESULTS: Eighty-three ears (49 patients) with IP were found, 19 with IP-I, 54 with IP-II and 10 atypical. Thirty-three patients received a cochlear implant (11 with IP-I, 19 with IP-II and three atypical) achieving heterogeneous though mostly promising results. Cerebrospinal fluid gushing was the commonest surgical complication, particularly in cases of IP-I. In general, patients with IP-II performed better than those with IP-I. CONCLUSIONS: Cochlear implantation promises adequate hearing rehabilitation for most patients with IP. As we move from IP-I to IP-II better results and lower risk for gushing shall be expected. Based on radiological findings we suggest a modified classification into IP-I, atypical IP-I (with large vestibular aqueduct (LVA) and better partition), IP-II (Mondini deformity) and atypical IP-IIa (without LVA) and b (without LVA but with semicircular canal dysplasia). KEY POINTS: • Radiological (CT and MR) features are of crucial importance for cochlear implantation • Imaging can identify two types of incomplete cochlear partition and atypical cases • Detailed pre-operative radiological assessment can help predict complications and outcome • A more comprehensive radiological classification of these anomalies is proposed.


Assuntos
Cóclea/anormalidades , Implante Coclear/métodos , Implantes Cocleares , Perda Auditiva Neurossensorial/reabilitação , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
15.
Eur Radiol ; 22(3): 519-24, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21960158

RESUMO

OBJECTIVE: To determine features of hypoplasia and aplasia of the vestibulocochlear nerve (VCN) in combination with inner ear malformations (IEMs). METHODS: Index cases were retrospectively selected from all IEMs collected since 1995. CT and MRI data were reviewed by two neuroradiologists. The number and thickness of visible nerves in the cerebellopontine angle cistern and inside the internal auditory canal (IAC) were analysed. RESULTS: MR images for 176 patients with IEMs were analysed. Labyrinthine aplasia and otocyst deformity showed 100% correlation, and IAC malformations exhibited 92% correlation with VCN aplasia. Cochlear aplasia, complete aplasia of the semicircular canals, severe cochlear hypoplasia, common cavity, incomplete partition type 1 and mild cochlear hypoplasia showed decreasing degrees of correlation with hypoplasia of the VCN. The remaining types of IEM did not demonstrate VCN hypoplasia. CONCLUSIONS: Certain forms of IEM show 100% correlation with hypoplasia or aplasia of the VCN, while others correlate less strongly and some do not usually exhibit VCN hypoplasia. MRI should always be carried out for those forms often correlated with VCN hypoplasia. KEY POINTS: Vestibulocochlear nerve deficiency can be strongly suspected in certain inner ear malformations • Bony cochlear aplasia and cochlear nerve aplasia are strongly correlated • In semicircular canal aplasia, hypoplasia of the vestibular nerve can be found • Before cochlear implantation, the type of any IEM should be fully understood.


Assuntos
Orelha Interna/anormalidades , Nervo Vestibulococlear/anormalidades , Criança , Cóclea/anormalidades , Nervo Coclear/anormalidades , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Estudos Retrospectivos , Canais Semicirculares/anormalidades , Tomografia Computadorizada Espiral , Nervo Vestibular/anormalidades
17.
Neuroradiology ; 53(9): 681-7, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21448638

RESUMO

INTRODUCTION: The aim of this study is to describe the morphology of the rare malformation that is atresia of the internal auditory canal (IAC) and determine the course of the facial nerve in cases of normal facial nerve function. METHODS: Index cases were retrospectively selected from our electronic database in which all inner ear malformations presenting to a tertiary referral center between 1995 and 2010 are collected. Computed tomography (CT) data and magnetic resonance (MR) images were reviewed by two neuroradiologists. An otolaryngologist analyzed the patients' clinical data. RESULTS: Nine ears of six patients (three bilateral, three unilateral) with atresia of the IAC were identified. All patients presented with sensory neural hearing loss. Two of these unilaterally affected patients had facial nerve palsy. In the other seven cases of complete atresia of the IAC, the facial nerve was dislocated in its cisternal segment close to the trigeminal nerve. Where the nerve fibers enter the Gasserian ganglion, the facial nerve takes a sharp lateral turn and enters a minute canal by which it reaches the geniculate ganglion. In the two ears with facial nerve palsy, this pathway could not be identified. CONCLUSIONS: In atresia of the IAC, the facial nerve takes a ventral and superior course, with its own canal starting at the point where the trigeminal nerve enters the Gasserian ganglion. Facial nerve palsy points to absence of this aberrant temporal facial nerve canal.


Assuntos
Orelha Interna/anormalidades , Nervo Facial/anormalidades , Paralisia Facial/etiologia , Perda Auditiva Neurossensorial/etiologia , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Pré-Escolar , Orelha Interna/diagnóstico por imagem , Orelha Interna/patologia , Nervo Facial/diagnóstico por imagem , Nervo Facial/patologia , Paralisia Facial/diagnóstico por imagem , Paralisia Facial/patologia , Feminino , Perda Auditiva Neurossensorial/diagnóstico por imagem , Perda Auditiva Neurossensorial/patologia , Humanos , Lactente , Masculino , Estudos Retrospectivos
18.
Artigo em Inglês | MEDLINE | ID: mdl-21273800

RESUMO

PURPOSE: Aim of this study was to examine any stapes fixation-related clinical, intraoperative and high-resolution computed tomography (HRCT) findings in children undergoing stapedotomy. PROCEDURES: Detailed diagnostic assessment was performed in 12 children (18 ears) who underwent stapedotomy within the period 2005-2008. RESULTS: Ear malformations such as malleus-incus anomalies, malleus-epitympanum fixation and absence of the stapedius tendon, small external auditory canal and auricle malformations were clinically and/or intraoperatively diagnosed. HRCT identified a petrous high jugular bulb and malformed inner auditory canal in 4 ears; however, it failed to recognize ossicular fixation. Systemic anomalies, namely kyphoscoliosis, esophageal atresia and finger malformations were identified in 2 children. Summing up, additional anatomic anomalies were found in 8 patients (66.7%). CONCLUSIONS: Ear malformations may coexist in children with stapes fixation. Ossicular fixation is not easily recognized with HRCT, and therefore, ossicular mobility should always be tested intraoperatively. In a few cases, pediatric stapes fixation can coexist with systemic dysplasias; in such patients, additional referral to geneticists is recommended.


Assuntos
Perda Auditiva Condutiva/diagnóstico por imagem , Perda Auditiva Condutiva/cirurgia , Otosclerose/diagnóstico por imagem , Otosclerose/cirurgia , Cirurgia do Estribo/métodos , Adolescente , Criança , Orelha Externa/anormalidades , Atresia Esofágica/patologia , Feminino , Deformidades Congênitas da Mão/patologia , Humanos , Bigorna/anormalidades , Bigorna/diagnóstico por imagem , Bigorna/cirurgia , Cifose/patologia , Masculino , Martelo/anormalidades , Martelo/diagnóstico por imagem , Martelo/cirurgia , Estudos Retrospectivos , Escoliose/patologia , Estribo/anormalidades , Estribo/diagnóstico por imagem , Tomografia Computadorizada por Raios X
19.
Neuroradiology ; 53(1): 49-61, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20959971

RESUMO

INTRODUCTION: Hypoplastic cochleae are among the inner ear malformations more frequently encountered by radiologists; little detailed information is available on these, however. We present the first large series of hypoplastic cochleae and document imaging findings to better characterize this anomaly radiologically. METHODS: We used our electronic database to search for inner ear malformations described between 1995 and 2009 and extracted 81 ears (of 47 patients) with hypoplastic cochleae out of 289 patients with inner ear malformations. Two neuroradiologists evaluated the available CT and MRI data. Measurements of all inner ear structures were performed. Accompanying findings were listed. RESULTS: Cochlear hypoplasia (58 ears, 32 patients) often involves not only the apical turn being reduced in size but also the basal turn being smaller in length. Additionally, 11 ears (eight patients) of hypoplastic cochleae with only a basal turn and five ears (four patients) of cochleae with only a small bud were identified. Non-classifiable hypoplastic cochleae (seven ears, five patients) were those with either a rudimentary or an absent basal turn or a "dwarf appearance" with no further partition. CONCLUSIONS: The term "hypoplastic cochlea" is very general; a further division into severe and less severe forms based on the length and existence of cochlea turns is possible and can help enhance the comparison of CI outcome data. Measurements can help the less experienced radiologist to detect them more easily.


Assuntos
Anormalidades Múltiplas/classificação , Anormalidades Múltiplas/diagnóstico , Cóclea/anormalidades , Tomografia Computadorizada por Raios X/métodos , Adulto , Cóclea/diagnóstico por imagem , Cóclea/patologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
20.
Neuroradiology ; 52(2): 147-54, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19798492

RESUMO

INTRODUCTION: Inner ear malformations (IEMs) are rare and it is unusual to encounter the rarest of them, namely labyrinthine aplasia (LA) and otocyst deformity. They do, however, provide useful pointers as to the early embryonic development of the ear. LA is characterised as a complete absence of inner ear structures. While some common findings do emerge, a clear definition of the otocyst deformity does not exist. It is often confused with the common cavity first described by Edward Cock. Our purpose was to radiologically characterise LA and otocyst deformity. METHODS: Retrospective analysis of CT and MRI data from four patients with LA or otocyst deformity. Middle and inner ear findings were categorised by two neuroradiologists. RESULTS: The bony carotid canal was found to be absent in all patients. Posterior located cystic structures were found in association with LA and otocyst deformity. In the most severe cases, only soft tissue was present at the medial border of the middle ear cavity. The individuals with otocyst deformity also had hypoplasia of the petrous apex bone. CONCLUSIONS: These cases demonstrate gradual changes in the two most severe IEMs. Clarification of terms was necessary and, based on these findings, we propose defining otocyst deformity as a cystic structure in place of the inner ear, with the cochlea, IAC and carotid canal absent. This condition needs to be differentiated from the common cavity described by Edward Cook. A clear definition of inner ear malformations is essential if outcomes following cochlear implantation are to be compared.


Assuntos
Orelha Interna/anormalidades , Orelha Interna/diagnóstico por imagem , Pré-Escolar , Orelha Interna/patologia , Orelha Média/diagnóstico por imagem , Orelha Média/patologia , Feminino , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Estudos Retrospectivos , Terminologia como Assunto , Tomografia Computadorizada por Raios X
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