Intratympanic gentamicin in Meniere's disease.

Ninety-three patients with intractable Meniere's disease were treated with gentamicin (Garamycin 40 mg/ml) administered in 1 to 4 transtympanic injections. The patients were tested at frequent intervals and followed up for 2 years. Before treatment all subjects experienced moderate or severe handicap caused by Meniere's disease. Two years after the treatment, rotatory vertigo was abolished in 81% of subjects, Tumarkin attacks were cured in 60%, and work capacity was severely reduced in 10% and moderately reduced in 17% of subjects. The outcome of the caloric responses did not correlate with the outcome of the treatment. In logistic regression analysis poor outcome of treatment correlated with Tumarkin attacks (odds ratio 5.5), severity of vertigo (odds ratio 3.8) and gait disorders (odds ratio 2.9). The mean hearing level was significantly affected by the treatment (before, 59.1 dB HL; after, 67.9 dB HL). Ten treated ears became deafened. During follow-up 44 subjects were subjected to retreatment, usually after 6 months. Intratympanic gentamicin treatment is a relatively safe and effective way to treat Meniere's disease. The authors recommended starting with 2 injections and renewing the injections if relapse occurs.

Cells of the neuronal lineage play a major role in the generation of amyloid precursor fragments in gelsolin-related amyloidosis.

Gelsolin-related amyloidosis or familial amyloidosis, Finnish type (FAF) (OMIM No105120) is a hereditary amyloid disease caused by a mutation in a precursor protein for amyloid (gelsolin) and characterized by corneal dystrophy and polyneuropathy. In vitro expression of the FAF-mutant (Asp187 --> Asn/Tyr) secretory gelsolin in COS cells leads to generation of an aberrant polypeptide presumably representing the precursor for tissue amyloid. Here, we provide evidence that this abnormal processing results from defective initial folding of the secreted FAF gelsolin due to the lack of the Cys188-Cys201 disulfide bond, normally formed next to the FAF mutation site. We compared cells of different tissue origin and discovered a dramatic difference between the amount of cleavage of FAF gelsolin to the amyloid precursor in neuronal and non-neuronal cells. More than half of the mutant gelsolin was cleaved in PC12 and in vitro differentiated human neuronal progenitor cells. In contrast, human fibroblasts and Schwannoma cell cultures showed only a limited capacity to cleave FAF gelsolin, although the cleavage mechanism per se seems to be similar in the various cell types. The present findings of processing and distribution of secreted FAF gelsolin in the neuronal cells emphasize the role of neurons in the tissue pathogenesis of this amyloid polyneuropathy.

Culturing of acoustic neuroma--methodological aspects.

We have been able to culture acoustic neuroma (AN) tissues by taking small tumor pieces during surgery from the cisternal or, preferably, metal part of the tumor where macroscopic tissue degeneration is not prominent. The AN pieces were transported in culture tubes to our cell laboratory where they were sliced and transferred to culture medium. The AN tissue demands a crude culture suspension containing laminin. We have been successful in culturing 15 successive ANs. The cells have different morphological features with characteristics of type Anthony A and B. Four main cell types were recognized: ameboid microglia-like cells, spindle-shaped cells, racket-shaped cells, and kite-shaped cells. However, no immortal cell line could be established. Some of the cultures were viable for up to 4 months.

Effect of intratympanically administered gentamicin on hearing and tinnitus in Menière's disease.

We have examined the effect of intratympanic gentamicin on hearing and tinnitus in 69 patients with intractable Menière's disease. Tinnitus was scored from 1 to 4 depending on its severity. The mean pure tone audiometry level before treatment was 57.5 dB and 1 year after treatment 63.5 dB Five subjects became deaf in the treated ear, and in 13 subjects hearing loss was > 10 dB and in 21 subjects 0 10 dB. In 25 subjects significant improvement (> 10 dB) was gained, and in 5 patients. Tinnitus was significantly reduced after treatment with gentamicin. A total of 66 patients had tinnitus before treatment and tinnitus relief was rated as good. Four percent of the subjects had no tinnitus, 30% had slight tinnitus. 27% moderate tinnitus. 18% severe and 8% handicapping tinnitus.

Intratympanic gentamicin in bilateral Menière's disease.

Treatment of bilateral Menière's disease is a delicate task. Streptomycin has demonstrated its ability to successfully control the vertigo attacks, but in some cases it results in oscillopsia and transforms the periodic attacks to permanent instability. If the site of the active labyrinth can be determined, a more specific treatment can be tried. We have treated 14 patients with intractable bilateral Menière's disease with intratympanic gentamicin (Garamycin, 40 mg/ml) administered initially in either 1, 2, 3, or 4 injections. The patients were tested at frequent intervals and followed up for 2 years. The work capacity, severity of vertigo, and gait difficulties were scored before treatment and during each test occasion. The postural stability was evaluated on a force platform and sway velocity was analyzed. Before treatment, moderate or severe reduction of work capacity was experienced by all of the subjects, which correlated to severity of vertigo and gait problems. Two years after treatment, the vertigo attacks were eliminated in 11 subjects and controlled in three subjects. The work capacity of three subjects was still moderately or severely reduced. This reduction depended on gait disturbance and Tumarkin attacks. The average postural stability returned to pretreatment level 2 years after the treatment was begun. The outcome of the caloric responses did not correlate with the outcome of the treatment. Hearing was not significantly affected by the treatment. Intratympanic gentamicin treatment is a relatively safe and effective way to treat bilateral Meniere's disease when the symptoms can be localized to one ear.

Pain after thoracic surgery.

In order to evaluate postoperative pain treatment following thoracic surgery, 214 medical records of patients who were operated during 1986-1988 were examined. Nurses' comments concerning pain and the amounts of analgesics given during the 2 postoperative days were recorded. The 150 patients who were still alive in December 1989 were sent a postal questionnaire which asked about the pain and the efficacy of pain relief they had received after their operation. They were also asked if they still had pain which they connected to the thoracotomy and if any attempts had been made to treat that pain. The mean consumption of intramuscular oxycodone was 38 mg during the 1st and 33 mg during the 2nd postoperative day. The administration of nonsteroidal anti-inflammatory drugs significantly reduced the opioid consumption on the second but not on the first postoperative day. In 30% of the patients' charts there were no remarks on pain, in 10% there was a mention of no pain, in 40% pain was mentioned and in 20% the patient was reported to have severe pain. During the first postoperative week little pain was experienced by 60% of the patients, considerable pain by 35% and excruciating pain by 5% of the patients being interviewed. The postoperative pain relief was rated as good in 60% of the answers, satisfactory in 38% and poor in 2%. Persistent post-thoracotomy pain lasting for more than 6 months was reported by 44% of the patients, of whom 66% had received treatment for the pain.