[A rare pathology of the petrous part of the temporal bone: adenoma of the middle ear]. / Eine seltene Pathologie des Felsenbeins: Das Adenom des Mittelohres.

Adenomas are very rare tumors of the middle ear. They are benign neoplasms originating from the glandular components of the mucous membrane of the middle ear. The middle ear adenoma was first described by Hyams and Michaels in 1976, which was named an adenomatous tumor. This article reports the case of a 50-year-old female patient, who presented with recurrent right-sided dull otalgia and pulse synchronous tinnitis, which began 1 year prior to presentation, with the suspected diagnosis of a glomus tympanicum tumor. Following the otorhinolaryngological examination and imaging an unclear mesotympanal space-occupying lesion was detected. A transmeatal endoscopic complete removal of the tumor was carried out. The histopathological investigations enabled the diagnosis of an adenoma of the middle ear. Adenomas are a rare differential diagnosis of tumors of the middle ear. In cases with a suitable localization an adequate exposure and removal of this rare tumor can be achieved by a transmeatal endoscopic access.

[Value of informed consent in tympanoplasty and FESS procedures]. / Zum Erinnerungsvermögen an das präoperative Aufklärungsgespräch bei HNO-Patienten.

BACKGROUND: More than one third of all lawsuits against surgeons include statements of insufficient or lacking preoperative informed consent which is mandatory in the german jurisprudence. Almost nothing is known about the postoperative patient's memory of risk factors which were explained prior to typical surgical procedures in ENT. METHODS: The objectives of this prospective study in 201 patients were to elucidate the actual clinical routine of obtaining informed consent for tympanoplasty (n=105) and FESS procedures (n=89), collect information on active and passive recall 6 weeks, 6 months and 1 year post-operatively, and to investigate whether patient age, sex, education, the time from obtaining consent to interview, recurrent vs. non-recurrent procedures, would influence the patient's recall capabilities. RESULTS: In clinical routine, obtaining informed consent included 5 main items for tympanoplasty and 5 for FESS procedures made by the physician. Of the patients, 18.9% recalled actively and 65.3% passively. They named 1.5 items on average, with "deafness" as the leading complication in tympanoplasty and "amaurosis" in FESS procedures. Patient's memory was depending on the time from obtaining consent to interview and education exclusively. CONCLUSION: In conclusion, the quantity of patient/physician interaction does not guarantee an increased effect on patient's recall. Improving patient interaction may reduce the probability of imminent accusations.

Reversible scaling of dihedral angle barriers during molecular dynamics to improve structure prediction of cyclic peptides.

Peptide cyclization or chemical cross-linking has frequently been used to restrict the conformational freedom of a peptide, for example, to enhance its capacity for selective binding to a target receptor molecule. Structure prediction of cyclic peptides is important to evaluate possible conformations prior to synthesis. Because of the conformational constraints imposed by cyclization low energy conformations of cyclic peptides can be separated by large energy barriers. In order to improve the conformational search properties of molecular dynamics (MD) simulations a potential scaling method has been designed. The approach consists of several consecutive MD simulations with a specific lowering of dihedral energy barriers and reduced nonbonded interactions between atoms separated by three atoms followed by gradually scaling the potential until the original barriers are reached. Application to four cyclic penta- and hexa-peptide test cases and a protein loop of known structure indicates that the potential scaling method is more efficient and faster in locating low energy conformations than standard MD simulations. Combined with a generalized Born implicit solvation model the low energy cyclic peptide conformations and the loop structure are in good agreement with experiment. Applications in the presence of explicit water molecules during the simulations showed also improved convergence to structures close to experiment compared with regular MD.

[Skin prick test results in snoring and sleep apnea patients]. / Pricktest bei Schnarchern und Schlafapnoe.

BACKGROUND: In allergic rhinitis, nasal obstruction is a typical symptom. Reduced nasal ventilation is thought to be one causal factor for sleep breathing disorders. Whether or not snoring individuals with or without sleep apnea show more frequent or stronger reactions in skin prick tests (SPT) compared to non-snorers has not been investigated yet. METHOD: SPT on 20 most frequent allergens and standardized questionnaires of 412 patients of either sex who received a polysomnography at the sleeplab of the ENT department, University of Würzburg, Germany, were analysed retrospectively. In 351 patients (85 %), data were complete. According to their polysomnography, patients were grouped into snorers (n = 248, 71 %) and non-snorers (n = 103, 29 %) or apnea (apnea-hypopnea-index > 10; n = 171, 49 %) and non-apnea patients (n = 180, 51 %). Average occurrence or strength of skin reactions was compared between these groups. RESULTS: Except plantain (7 % vs. 1 %) and beech (10 % vs. 3 %), there were no statistical increases in the average occurrence or strength of SPT results in snoring individuals. Apnea patients did not show more frequent or stronger allergic skin reactions than non-apnea patients. Three patients suffering from allergic rhinitis by house dust mites were treated with citerizin 10 mg and allergen exposition prophylaxis. Three months after onset of therapy in all three patients, a reduction of snoring was polysomnographically observed. Snorers or apnea patients complaining sneezing, reduced nasal ventilation at night, hyperlacrimation or rhinorrhea showed significant higher numbers of allergic skin reactions for rye, gras and house dust mites compared to patients without these symptoms. CONCLUSIONS: The results reveal that only snorers or apnea patients with specific symptoms for allergic rhinitis should be tested by SPT. A general SPT-screening seems not to be indicated. Snoring and apneas in patients with allergic rhinitis due to house dust mites can be eliminated or reduced by an oral antihistaminic treatment.