[Chronic myeloid leukemia--a rare cause of labyrinth apoplexy]. / Chronische myeloische Leukämie--eine seltene Ursache für den Labyrinthapoplex.

BACKGROUND: Cochleovestibular lesions in patients with acute myeloid leukemia or the blastic phase of chronic myeloid leukemia are usually due to leukemic infiltration, infection or hemorrhage. In contrast, the most likely cause of cochleovestibular lesions in the chronic phase of the chronic myeloid leukemia seems to be disturbed microvascular perfusion and vascular occlusion. CASE REPORT: A 45-year old patient with a chronic myeloid leukemia presented with the sudden onset of profound deafness in his right ear combined with a total loss of vestibular function on the same side. The hemoglobin count was 10.5 g/dl; the white blood cell count 448 x 10(9)/I; the platelet count 71 x 10(9)/I. All of the plasmatic coagulation factors were in the normal range. The patient was treated with cytostatic drugs and responded well (rapid cytoreduction), but the deafness persisted. DISCUSSION: Cochleovestibular lesions in the chronic phase of the chronic myeloid leukemia are very rare. The most likely cause in the case described above seems to be increased blood viscosity due to the high white cell count and alterations in the leukocyte rheology (leukostasis syndrome). CONCLUSION: In patients with leukemia and acute cochleovestibular lesions in contrast to other patients with sudden deafness and/or sudden loss of peripheral vestibular function, a combination of chemotherapy and leukopheresis capable of rapid cytoreduction is necessary, whereas a conventional hemorrheologic therapy seems to be insufficient.

Value of computed tomography in patients with persistent vertigo after stapes surgery.

RATIONALE AND OBJECTIVES: The value of computed tomography was evaluated in 14 patients with persistent vertigo after otosclerosis operation. METHODS: High-resolution computed tomography was performed with 1-mm slice thickness and table feed in the axial and coronal planes. RESULTS: Computed tomography scans showed in 13 case findings that related to symptoms. An air bubble at the end of the prosthesis as a new, indirect sign of a perilymphatic fistula was found in 6 cases. An incorrect position of the stapes prostheses was diagnosed in 7 patients. One patient had recurrence of otosclerosis, and two others developed scarring around the prosthesis. In 1 case, an incus necrosis was found. Some patients showed two signs simultaneously. The computed tomography results were confirmed by retympanotomy in 12 cases. CONCLUSIONS: Computed tomography proved to be a valuable method in the diagnosis of persistent vertigo after otosclerosis operation. The indication for a repeat operation was facilitated by the use of computed tomography.

[Diagnosis in persistent vertigo after stapes surgery]. / Diagnostik bei persistierenden Gleichgewichtsstörungen nach Operationen am Stapes.

One hundred sixty-two otosclerotic patients who underwent a stapedotomy between October 1991 and April 1994 were examined after experiencing postoperative vertigo. Twenty-eight complained of dizziness. In sixteen patients, we observed vertigo and nystagmus only within the first six postoperative days; in these cases, special treatment was not necessary. However, in twelve patients in whom vertigo persisted even after their stay in the hospital, the problem seriously affected their quality of life and their return to work. In these cases, an individualized diagnostic and therapeutic procedure was indicated. Case reports demonstrate the usefulness of several diagnostic methods (analysis of the case history, audiogram, investigation of the vestibular system, and elimination of non-vestibular causes of vertigo. But only high-resolution computed tomography scans of the temporal bone showed definite results. Air bubbles at the end of the prosthesis as indirect sign of perilymphatic fistula, bad position of the piston, new centers of otosclerosis, cicatrices, and in one case fracture of the prosthesis. Ten of the twelve patients required revision surgery. In most patients with persisting vertigo following stapedotomy, revision surgery was justified. However, high-resolution computed tomography is recommended.

[The value of computed tomography in persistent balance disorders following the use of stapes prostheses]. / Stellenwert der Computertomographie bei persistierenden Gleichgewichtsstörungen nach dem Einsatz von Stapesplastiken.

10 of 150 patients had persistent vertigo after implantation of stapes prostheses. These patients were evaluated by high-resolution CT in the axial and coronal plane. Scans showed in all cases findings which related to the symptoms. The CT findings were proved intraoperatively in 9 cases. A new indirect sign of a perilymphatic fistula is described in form of an air bulla at the end of the prosthesis. Retympanotomy could be planned better with the help of HR-CT.

[Changes in vegetative parameters during and after normobaric hypoxic hypoxia in newborn rabbits]. / Veränderungen vegetativer Parameter während und nach normobarer hypoxischer Hypoxie bei neugeborenen Kaninchen.

68 awake spontaneously breathing newborn rabbits were investigated in five series; 43 animals were exposed to a hypoxic atmosphere (FiO2 = 0.05) for 3 h during the 1st day of life. Heart rate, rectal temperature and intracranial pressure were recorded. Arterial blood samples were analyzed for pO2, ASTRUP-values, glucose and lactate content; O2-saturation was calculated. The vegetative situation at the end of the hypoxic period was characterized by low heart rate, low body temperatures (less than or equal to 25 degrees C), reduced glucose concentration and a lactate acidosis, compensated by low pCO2 (less than 2 kPa). At the 2nd posthypoxic day all parameters were normalized. If CO2-gas (FiCO2 = 0.05) is added to the hypoxic atmosphere (normocarbic pCO2-values in the arterial blood), the glucose and lactate content remained on the normal level; the diminution of heart rate and rectal temperature was smaller. Under the conditions of severe hypoxia in contrast to the adult rabbits the newborns are able to maintain their life processes for a longer time, but this fact need not be identical with the prevention of posthypoxic brain damage. In the cases of normocarbic pCO2-values, the hypoxic tolerance was elevated in the way of improved O2-delivery to the tissues.

A follow-up study of perinatally hypoxic rabbits.

Rabbits, surviving a severe 3-hours-lasting hypoxia (FiO2 = 0.05) during the 1st day of life, grew up together with their littermates. In animals aged 10 and 20 days, respectively, the vestibular induced tonic eye deviations were investigated during tilting around the three orthogonal body axes. The spontaneous head-body-motor coordination was analysed by means of a search coil technique in 14 days old rabbits. Perinatally hypoxic rabbits exhibit a compensation of initially reduced torsional tonic eye deviation and an overcompensation of the vertical ones at the 20th postnatal day in comparison to controls. Moreover, we found reduced amplitudes and velocities of spontaneous head saccades in perinatally hypoxic animals 14 days old. We assume a retarded development of the neuronal nets of the brain stem reticular formation in the hypoxic rabbits accompanied by an insufficient visuo-vestibular interaction.