bluuebunny/crossref_metadata_2025 huggingface dataset:
Tolerance of N-Chlorotaurine, a New Antimicrobial Agent, in Infectious Conjunctivitis – A Phase II Pilot Study
Authors: Nagl Markus , Teuchner Barbara , Pöttinger Ernst , Ulmer Hanno , Gottardi Waldemar
Published: April 2003

N-Chlorotaurine (NCT) is an endogenous microbicidal oxidant. This open pilot study (phase IIa) with 9 patients was done to gain first knowledge on the tolerance of NCT in infectious conjunctivitis. By application of 1% NCT 5 times a day, no adverse effects could be observed. All 6 subjects with bacterial conjunctivitis were cured within 3–5 days. Two subjects with epidemic keratoconjunctivitis were treated for 7–10 days and 1 subject with herpes simplex blepharitis for 3 days with no rapid improvement but probable mitigation of inflammation. Therefore, NCT seems to be useful in the treatment of infectious conjunctivitis, and further investigation on its therapeutic efficacy is suggested.
The Apolipoprotein E ε4 Allele Is Unlikely to Be a Major Risk Factor of Age-Related Macular Degeneration in Chinese
Authors: Pang C.P. , Baum L. , Chan W.M. , Lau T.C. , Poon P.M.K. , Lam D.S.C.
Published: April 2003

Apolipoprotein E (ApoE) is a major transporter of lipids and cholesterol in the nervous system. Age-related macular degeneration (ARMD), characterized by drusen containing lipids, was reported to show a lower frequency of the ApoE ε4 allele than control subjects. We sought to examine the association of this polymorphism with ARMD in Hong Kong Chinese. Among 98 ARMD subjects, the frequency of ε4 carriers showed a trend toward a decrease compared to controls, but it was not significant (11.2 vs. 15.0%, p < 0.52). The association of ε4 with an apparent reduced risk of ARMD was reported previously in the exudative form of the disease, however among 39 exudative ARMD patients there was also no significant difference in ε4 frequency (12.8%, p < 0.93). The lack of a statistically significant effect of ε4 may be due to the lower frequency of ε4 in Chinese than Europeans. Thus we cannot exclude a possible effect of this allele on ARMD risk, but we can conclude that this allele is likely not a major factor influencing ARMD risk in the Chinese.
Immediate Increase in Aqueous Humour Endothelin 1 Concentration and Intra-Ocular Pressure after Argon Laser Trabeculoplasty in the Rabbit
Authors: Holló Gábor , Lakatos Péter , Vargha Péter
Published: April 2003

Purpose: To investigate the immediate changes of aqueous humour endothelin 1 (ET-1) concentration and intra-ocular pressure (IOP) after argon laser trabeculoplasty (ALT) in the rabbit. Methods: Standard ALT was performed in one eye of 11 pigmented rabbits. IOP was measured with a Tono-Pen-2 tonometer before treatment, under general anaesthesia. Postlaser IOP measurements followed by aqueous humour aspiration were performed under general anaesthesia 30 and 60 min after treatment in 6 and in 5 animals, respectively. Results: The aqueous humour ET-1 concentration was significantly higher (55.0 pg/ml) after ALT than in the contralateral eyes without laser treatment (8.2 pg/ml, p = 0.001). IOP increased significantly after ALT (p = 0.007) but remained unaltered (p = 0.10) in the contralateral eyes without treatment. No statistically significant difference was found either in postlaser IOP elevation or in interocular ET-1 difference between the groups. Conclusions: The results suggest that in the rabbit the increase in aqueous humour ET-1 concentration after ALT is immediate, detectable even 30 min after the laser treatment, followed by no further increase during the second 30-min period after ALT, and associated with an immediate postlaser IOP elevation within 1 h after ALT. These findings may suggest a similar response to ALT in the human eye, since a similar immediate IOP elevation is frequently observed after ALT in the clinical practice.
Corneal Refractive Changes after Acrysof Lens versus PMMA Lens Implantation
Authors: Müller-Jensen Kei , Barlinn Björn
Published: April 2003

Purpose: Do foldable acrylic lenses yield not only reduced posterior capsular opacification but also significant refractive advantages? Patients and Methods: 147 cataract patients including 47 with spherical corneas and 100 with preoperative astigmatism of 0.8 ± 0.7 dpt were treated in one of two ways: 70 patients received 5.5-mm Acrysof lens implants through 3.2-mm outer and 4-mm inner temporal clear corneal openings (stretch incision); 77 patients received 5-mm PMMA lenses through temporal clear corneal incisions of 4.1-mm outer and 6.5-mm inner diameter incisions. Corneal topography was examined in all patients before the operations as well as 3 days and 6 months after the operations. Results: 6 months after the operations, we observed a surgically induced astigmatism of 0.4 ± 0.2 dpt for the 3.2-mm incisions compared to 0.8 ± 0.7 dpt for the 4.1-mm incisions; evaluation according to Holladay of the preoperative spherical corneas yielded a with-the-wound change of 0.0 ± 0.3 dpt after 3.2-mm incisions versus 0.6 ± 0.7 dpt after 4.1-mm incisions. The difference in astigmatism for the two types of incisions was statistically significant (p = 0.001). Conclusion: Acrysof lens implantation is especially useful for patients with spherical corneas because of avoidance of postoperative astigmatism. The 4.1-mm corneal incision using PMMA lens implants can be used on the steep meridian to reduce preoperative astigmatism.
Connective Tissue Growth Factor in Retrocorneal Membranes and Corneal Scars
Authors: Wunderlich Kerstin , Senn Brigitte C. , Reiser Peter , Pech Michael , Flammer Josef , Meyer Peter
Published: April 2003

We studied the localization and distribution of connective tissue growth factor (CTGF) in corneal scar tissue and membranes using in situ hybridization in 8 corneas from keratoplasty and 4 normal corneas. Identification of the cells was done with immunohistochemistry for SM-α-actin, vimentin, and Lu5. CTGF mRNA was found in activated corneal fibroblasts in 7 of 8 scars, 7 of 8 retrocorneal membranes and 2 subepithelial membranes, whereas the control corneas showed no CTGF mRNA expression. Vimentin was positive in all scars, retrocorneal and subepithelial membranes, SM-α-actin in 7 of 8 scars and 6 of 8 retrocorneal membranes. These results suggest that CTGF plays a crucial role in corneal wound healing and membrane formation.
Changes in Nasal Reactivity in Patients with Rhinitis medicamentosa after Treatment with Fluticasone Propionate and Placebo Nasal Spray
Authors: Graf Peter M. , Hallén Hans
Published: April 2003

Aim of the Study: To study the changes in nasal reactivity in patients with rhinitis medicamentosa during treatment with placebo or fluticasone propionate, in order to better understand the mechanisms of nasal congestion in such patients. Study Design: A parallel, double-blind study. Twenty patients with rhinitis medicamentosa were randomized to either placebo or fluticasone treatment during 14 days. Material and Methods: Nasal mucosa reactivity was studied with a histamine challenge model using three concentrations of histamine to challenge the nasal mucosa (1, 2 and 4 mg histamine/ml). Recordings of the nasal mucosa response were made 5 min after each challenge, using rhinostereometry and acoustic rhinometry, before and after the period of treatment. Results: The fluticasone group had a significantly increased histamine sensitivity after treatment, unlike the placebo group who had an unchanged or slightly decreased histamine sensitivity after treatment. Conclusions: The results of this study support the theory that the nasal obstruction in rhinitis medicamentosa is due to interstitial oedema rather than to vasodilatation. On the first day of vasoconstrictor withdrawal, the inferior concha was congested and oedematous with a limited capacity to respond to histamine challenge. However, after 14 days of treatment with a corticosteroid nasal spray, the oedema was reduced and the increase in histamine sensitivity reflected the persistence of nasal hyperrreactivity. In the placebo group, histamine sensitivity remains unchanged with the measuring technique we used. This probably indicates that oedema was still present after treatment.
Frey’s Syndrome following Submandibular Gland Excision: An Unusual Postoperative Complication
Authors: Teague A. , Akhtar S. , Phillips J.
Published: April 2003

Gustatory sweating and flushing, or Frey’s syndrome, is a fairly common complication following surgery or injury to the parotid gland and is thought to be caused by aberrant nerve regeneration. A similar condition has been reported in the literature following surgery to the submandibular region. Since this was first described in 1934, only 7 subsequent cases of submandibular sweating and flushing have been reported. We present a case of a 52-year-old female who underwent excision of the left submandibular gland as a result of chronic sialadenitis. Twelve months following surgery, symptoms indicative of Frey’s syndrome were experienced in the operative region. A review of the aetiology and treatment of the condition is described.
Clear Cell (Glycogen-Rich) Rhabdomyosarcoma Presenting as Cervical Lymphadenopathy
Authors: Govender Dhirendra , Chetty Runjan
Published: April 2003

A 15-year-old patient is described who presented with cervical lymphadenopathy. A lymph node biopsy confirmed a metastatic neoplasm composed of islands and aggregates of round to polygonal-shaped cells with surrounding hyalinised fibrous stroma. The tumour cells contained a clear glycogen-rich cytoplasm and stained for desmin, muscle-specific actin and sarcomeric actin. Electron microscopy revealed paranuclear thick and thin filaments. These findings confirm striated muscle differentiation and a diagnosis of glycogen-rich clear cell rhabdomyosarcoma. The tumour recurred in a cervical lymph node after 2 years. This is yet another tumour that must be considered in the differential diagnosis of clear cell tumours of the head and neck region.
Vibration-Induced Nystagmus – A Sign of Unilateral Vestibular Deficit
Authors: Hamann Karl-Friedrich , Schuster Elke-Maria
Published: April 2003

Vibrations of 60 Hz and 100 Hz were applied on the mastoid of healthy subjects, patients with unilateral peripheral vestibular lesions, with central lesions of different localizations, and patients with benign paroxysmal positioning vertigo (BPPV). In patients with unilateral peripheral deficit a horizontal nystagmus with a small torsional component beating generally to the not affected side could be observed. This nystagmus did not show adaptation during 40 s. The occurrence was more frequent using 60-Hz stimulations. This vibration-induced nystagmus did never occur in healthy subjects, seldom in patients with central vertigo, and only exceptionally in patients with BPPV. It is concluded that the finding of a vibration-induced nystagmus reflects a side difference of peripheral vestibular excitability.
Pathogenesis of Experimental Aural Cholesteatoma in the Chinchilla
Authors: Imamura Shun-ichi , Nozawa Izuru , Imamura Mayumi , Murakami Yoshihiko
Published: April 2003

Histopathological observation of celloidin serial sections of the chinchilla middle ear after treatment with propylene glycol disclosed the development of severe inflammation of the middle ear mucosa and tympanic membrane, papillary proliferation of the epidermis of the tympanic membrane and external auditory meatus, and retraction and adhesion of the tympanic membrane. The findings for the tympanic membrane, impedance testing and histopathological examination suggested that there were two types of acquired cholesteatoma formation, probably with a difference in the pathogenesis. In one type, the proliferated epidermal layer of the tympanic membrane penetrated into the middle ear cavity making tympanic perforations. In the other type, there was progressive retraction of the tympanic membrane forming a retraction pocket. We discuss the two different patterns of cholesteatoma development.
Epithelial-Myoepithelial Carcinoma:An Unusual Tumor of the Paranasal Sinus
Authors: Sunami Kishiko , Yamane Hideo , Konishi Kazuo , Iguchi Hiroyoshi , Takayama Masahiro , Nakai Yoshiaki , Wakasa Kenichi , Nakagawa Takayuki , Shibata Shigetaro
Published: April 2003

A 65-year old woman presented with nasal obstruction and on examination was found to have a huge mass in the maxillary sinus. This was removed, and histological examination revealed a mixture of trabecular structures consisting of inner dark cells, outer clear cells and solid structures consisting of only clear cells. Immunohistochemical examination showed the clear cells to be positive for α-smooth muscle actin. Ultrastructural examination confirmed the myoepithelial cell origin. The characteristic morphological, immunohistochemical and ultrastructural features aided in the diagnosis of epithelial-myoepithelial carcinoma.
A Rat T-Cell Line That Mediates Autoimmune Disease of the Inner Ear in the Lewis Rat
Authors: Gloddek Bertrand , Gloddek Jutta , Arnold Wolfgang
Published: April 2003

In various patterns of sensorineural hearing loss including Ménière’s disease, which may show improvement in auditory function following immunosuppressive therapy, an isolated autoimmune disease of the inner ear has been postulated. Because of the lack of well-defined diagnostic criteria to identify autoimmune processes within the inner ear and the fact that the human inner ear is one of the few organs of the body not amenable to diagnostic biopsy, there has been great interest in developing animal models that mimic these clinical entities. Previous studies have found evidence that this process might be cell mediated and that the endolymphatic sac functions as an immunodefensive organ for the inner ear. By heterologous immunization of inbred Lewis rats with inner ear tissue, an autoreactive inner-ear-specific T helper cell line was established. After passive transfer of these cells a labyrinthitis was induced in recipient animals. Immunohistochemically, T helper cells were first identified in the cochlea suggesting that this cell type might carry the autoantigenic epitope. Autoantibodies against inner ear tissue were demonstrated in animals with histologically evident labyrinthitis. We conclude that this experimental design can serve as an animal model for cell-mediated autoimmune disease of the inner ear and could be used to explain the etiology of certain types of sensorineural hearing loss such as Ménière’s disease. With this approach the identification of the causative autoantigen should be possible and will lead to the development of appropriate clinical tests to diagnose autoimmune diseases of the inner ear in humans.
Prognostic Factors in Patients with Idiopathic Facial Paralysis (Bell’s Palsy): A Prospective Study
Authors: Prim M.P. , De Diego J.I. , Sanz O.
Published: April 2003

A prospective study was designed in order to objectively quantify the most important prognostic factors of idiopathic facial paralysis (Bell’s palsy). Stepwise logistic regression was applied to data obtained from 178 patients evaluated between April 1994 and September 1995 at La Paz Hospital. Due to statistical requirements, the final number of cases analyzed was 124. In all cases, 28 variables were recorded. The 3 variables selected by the multivariate analysis were: age, maximal stimulation test and treatment employed (prednisone or acyclovir). With these data, a linear discriminant function was obtained with an overall accuracy of 70.8%. The correct prediction rate for complete facial recovery was 82.1% and for absence of complete facial recovery 50.0%.
New Approach for 3D Imaging and Geometry Modeling of the Human Inner Ear
Authors: Vogel Uwe
Published: April 2003

Obtaining high-resolution three-dimensional (3D) geometry data performs a necessary assumption for modeling cochlear mechanics. Preferably this procedure has to be done noninvasively to preserve the original morphology. Depending on the actual application, various levels of spatial resolution and tissue differentiation should be reached. Here a new approach is presented which allows 3D imaging of temporal bone specimens with intact regions of interest and spatial resolution currently in the 10-μm range, but providing capabilities for future enhancements down to the submicron level. The technique is based on microtomography by X-rays or synchrotron radiation respectively. The structural data are reconstructed and converted to geometry data by 3D image processing, and eventually transferred into simulation environments, e.g., Finite Element Analysis, but may also be used for general visualization tasks in research, clinics, and education.
Nonlinear Electroelastic Model for the Composite Outer Hair Cell Wall
Authors: Spector Alexander A.
Published: April 2003

A nonlinear electroelastic model for the composite wall of the cochlear outer hair cell is proposed. The cell wall is modeled as a two-layer shell with elastic connections between the layers: an active layer corresponds to the plasma membrane and a passive layer corresponds to a combination of the cytoskeleton and the subsurface cisternae. As a basis of the constitutive relations, a thermodynamic potential for such a composite wall is developed. Expressions for the components of the active force are obtained in terms of the active strains and the elastic properties of the passive and active layers. An application to the electrical stimulation of the cell under the conditions of the microchamber experiment is given. As a result, active strains, active forces, and mechanical energy stored in each of the two layers are presented as functions of the wall (membrane) potential.
Alteration of the Calcium Content in Inner Hair Cells of the Cochlea of the Guinea Pig after Acute Noise Trauma with and without Application of the Organic Calcium Channel Blocker Diltiazem
Authors: Maurer Jan , Heinrich Ulf-Rüdiger , Hinni MichaelL. , Mann Wolf
Published: April 2003

Calcium ions are known to be important to the process of signal transduction across the apical and basal sides of the inner hair cells. Calcium channel antagonists have been demonstrated by light microscopy to provide protection against acoustic trauma. To evaluate the protective effect of calcium channel blocker on the inner ear cells to noise exposure, the amount of the histochemical reaction products formed in the cytoplasm of the inner hair cells of the guinea pig after application of pyroantimonate was measured by an image processing system connected to an energy-filtering transmission electron microscope (EFTEM). Compared to untreated control specimens (experimental animal group I) the amount of precipitable calcium had clearly increased in the inner hair cells of noise-exposed cochleae 60 h after an acute noise trauma (group III). In addition, small electron- lucent areas could be identified in the cytoplasm of the hair cells probably representing damage to the cellular fine structure. When the calcium channel blocker diltiazem was administered without any additional noise exposure the calcium content was drastically reduced in the inner hair cells (group II), but when the antagonist was given before and after acute noise trauma (group IV), the calcium content in the inner hair cells was nearly compared to the amount determined in the untreated group of animals. The role of diltiazem is discussed in respect of tissue protection and to the maintenance of the calcium-dependent physiological processes in the inner hair cells during signal transduction.
Age-Related Hearing Changes and Effects of Exotoxin on Inner Ear Function in Aging Rat
Authors: Stenqvist Monika
Published: April 2003

Frequency-specific auditory brainstem responses to tone bursts (2–31.5 kHz) and tuning curves were recorded in 8 male rats during their entire life. No significant threshold elevation occurred during the 1st year. Mean age at onset of hearing loss was 20 months, with individual variations ranging from 14 up to 23 months. In most animals, threshold elevations were limited to 20 and 31.5 kHz. At age of 18–23 months, 3 rats were treated with Pseudomonas aeruginosa exotoxin A. After instillation, threshold elevation occurred at all frequencies, followed by near-total recovery at low frequencies, but only partial reversibility at high frequencies. It is concluded that aging-related hearing changes in Sprague-Dawley albino rats start at different ages, particularly comprising high frequencies and encroaching on the middle and low areas with increasing age.
The Biology of Tumor Invasion, Angiogenesis and Lymph Node Metastasis
Authors: Petruzzelli Guy J.
Published: April 2003

It is now well established that the development of cervical metastases, in particular those with extranodal extension of tumor, negatively impacts both regional control and survival of patients with laryngeal carcinoma. This chapter will begin with an introduction of the important molecular events associated with the transition of the squamous epithelium of the upper aerodigestive tract to metastatic squamous cell carcinoma. We will then review the critical cellular events identified as the tumor progresses from an in situ to invasive and finally a metastatic head and neck squamous cell carcinoma. Finally we will review data from our own and other laboratories which are studying the process of new blood vessel growth (angiogenesis) induced by tumor-derived growth factors. As we develop a better understanding of the cellular and molecular mechanisms of metastasis in head and neck squamous cell carcinoma, new therapies effective at preventing the development of secondary tumors can be realized ultimately increasing the patient’s survival.
Biocompatibility Testing of New Polymers in a Moving Implant Bed
Authors: Held M. , Dost P. , Erdtmann M. , Baumann H. , Jahnke K.
Published: April 2003

Total reconstruction of the auricle requires a skilful surgical technique and an appropriate material for the shape-supporting frame. Up to now, there is no such material apart from autologous rib cartilage. The combination of chronic microtraumatisation of adjacent tissue caused by the mobility of an implant bed such as the auricle and the foreign-body reaction to currently available artificial polymers frequently results in extrusion. In our animal model (rats), polymers of different elasticity were implanted in a moving implant bed to analyse differences in foreign-body reaction related to implant elasticity. The results were significantly better for a rather stiff control material (porous polyethylene). A contributing factor may be better fixation of the implant material by tissue ingrowth into its micropores.
Perilymphatic Fistula: Pathophysiology, Diagnosis and Management
Authors: Gacek Richard R.
Published: April 2003

Objective: To define the pathophysiology of perilymphatic fistula (PLF) and suggest guidelines for diagnosis and treatment. Material and Method: Review of the pertinent literature on clinical and basic reactions of the labyrinth to fenestration of the perilymphatic space. Presentation of personal experience with 20 patients explored for PFL. Results: Clinical and laboratory animal experiences indicate that a PLF induces a serous labyrinthitis with both auditory and vestibular symptoms and findings which are variable from patient to patient. Mechanical, barometric or concussive trauma is important in the diagnosis of sudden PLF. Since spontaneous healing of the PLF may occur, a 7- to 10-day period of conservative management is recommended before surgical intervention. Conclusions: PLF is an uncommon cause of hearing loss and vertigo. Strict adherence to criteria of history, functional results and management is recommended.
Rhinocerebral Mucormycosis
Authors: Smilek P. , Čada K. , Wotke J.
Published: April 2003

Recently, the incidence of opportunistic fungal infections has increased due to a rise in conditions with a general impairment of immunity. These are serious disorders that can be diagnosed and treated with difficulty and have an unfavourable prognosis. A case of a 45-year-old diabetic patient with late determination of rhinocerebral mucormycosis of peracute course and fatal termination is presented. The patient was treated with surgery and antibiotics, and the diagnosis was established postmortem. If rhinocerebral mucormycosis is suspected (immunodeficiency, temperatures which do not respond to antibiotic treatment, black crusts in the nose, unilateral headache, symptoms of orbitocellulitis and endocranial complications), a biopsy must be taken from the margin of a necrotic lesion. If non-septated hyphae with rectangular branching are found, it is necessary to start a complete therapy attempting to adjust the general condition, aggressive surgical debridement and the intravenous administration of amphotericin B at a dose of 0.25–0.30 mg/kg/day or the liposomal form of amphotericin B, 3–4 mg/kg/day, at first daily, then every other day.
How Useful Is Corticosteroid Treatment in Cochlear Disorders?
Authors: Lamm Kerstin , Arnold Wolfgang
Published: April 2003

The scientific basis for the administration of corticosteroids classified as glucocorticoids in certain cochlear disorders, such as immune-mediated progressive and idiopathic acute sensorineural hearing loss (SNHL), Ménière’s disease and noise-induced hearing loss (NIHL), was discussed. The current knowledge on the physiological functions of endogenous glucocorticoids and the pharmacological effects of their synthetic analogs was summarized. Emphasis was placed on experimental studies on corticosteroids in the cochleovestibular system and on the therapeutic effects of glucocorticoids on SNHL, Ménière’s disease, NIHL and chronic tinnitus obtained from clinical trials. Glucocorticoids exert numerous profound effects on almost every organ system, including mechanisms involved in anti-inflammatory action and immunosuppression. However, inflammatory tissue alterations are not only elicited by bacterial, viral or other immunopathological processes but also by physically and chemically induced cellular damage, tissue ischemia and hypoxia. Regardless of whether one or more of these insults underlie SNHL, Ménière’s disease and NIHL, glucocorticoids effectively counteract subsequent inflammatory tissue damage in the auditory and vestibular system. This was confirmed in experimental studies on immune-mediated progressive SNHL, and thrombosis-induced and noise-induced cochlear ischemia, hypoxia and hearing loss. Glucocorticoid treatment results of immune-mediated progressive and acute idiopathic SNHL are promising, although placebo-controlled trials on the effect in acute idiopathic SNHL have revealed conflicting data (probably due to the small number of patients). Clinical studies on the effect of systemic glucocorticoid monotherapy on Ménière’s disease and NIHL have not yet been performed. After intratympanic application, relief of vertigo, tinnitus and preservation of hearing in Ménière’s disease was observed in previous studies; however, recently none of these effects have been confirmed in a placebo-controlled trial. Similarly, in contrast to previous reports, chronic tinnitus of various origins did not improve after repetitive glucocorticoid application onto the round window membrane using a micropump connected to an implanted microcatheter.
Middle Ear Cleft: Three Structural Sets, Two Functional Sets
Authors: Ars B.
Published: April 2003

The observation of an interatticotympanic diaphragm in the middle ear (ME) cleft and the functional histology of the mucosa led to a concept of ME morphofunctional partition. There are two separate compartments: an anterioinferior one, principally devoted to the mucociliary clearance function, and a posterosuperior one, more devoted to the gas exchange function. With this concept of partition we are better able to understand the mechanisms involved in the pathogenesis of otitis media. Clinical as well as surgical management is thereby enhanced.
Pressure Regulation due to Displacement of the Pars flaccida and Pars tensa of the Tympanic Membrane
Authors: Decraemer W.F. , Dirckx J.J.J.
Published: April 2003

Static pressure differences across the tympanic membrane occur daily in normally encountered circumstances. This causes displacement of the tympanic membrane and changes in the configuration of the middle ear ossicles. As a consequence, the physiological functioning of the middle ear is altered and the sensitivity of hearing is decreased. Smaller pressure changes are thought to be compensated for thanks to a rapid deflection of the pars flaccida of the tympanic membrane – which, as the name indicates, can be easily deflected – and a resulting change in the middle ear air pressure. Larger pressure changes are balanced when the pressure difference exceeds a certain threshold and the eustachian tube opens for a short time. With a moiré technique we have measured the displacement of the tympanic membrane as a function of transtympanic pressure. These measurements were used to calculate the volume displacement of the two distinct parts of the tympanic membrane, the pars tensa and the pars flaccida. Our full-field method revolutionizes the displacement calculations of the tympanic membrane. Because the technique provides displacement data at all image points, it allows to calculate the volume displacement of the pars tensa and pars flaccida separately. As the middle ear cavity can be modeled as a closed, air-filled cavity the displacement of the tympanic membrane will cause some pressure variation in the middle ear and this will give rise to a partial compensation of the applied transtympanic pressure. We calulated the magnitude of the pressure compensation provided by the pars flaccida on the basis of the experimental volume displacement versus pressure relation. The pressure compensation provided by the pars flaccida is so small and confined to a very small range of excess pressures that this can hardly be the role to be attributed to the pars flaccida. The pressure compensation due to displacement of the entire tympanic membrane within the same pressure range is about 10 times larger, but still quite small (<25%).
Schalldruckpegelmessungen und Impulsdauerbestimmungen handelsüblicher Schreckschusswaffen
Authors: Just T. , Kramp B. , Pau H.W. , Sievert U. , Wild W. , Kunde B. , Schilf M.
Published: April 2003

Fragestellung: Ziel der Untersuchung war es, die Schalldruckpegel einiger im Handel frei erhältlicher Schreckschusswaffen sowie die Impulsdauer unter realen Schiessbedingungen in einer Schiesshalle zu bestimmen. Material und Methoden: Es wurden 6 verschiedene Schreckschusswaffen mit zwei verschiedenen Kalibern untersucht. Um die Schalldruckpegel am rechten Ohr des Schützen zu messen, wurde die Waffe im Abstand von 80 cm im Winkel von 180°, 225° und 135° zum Mikrofon gehalten. Zur Bestimmung der Schalldruckpegel bei direkt vor das Ohr gehaltener Waffe wird die Waffenmündung in der Horizontalebene in Winkeln von 0°, 45° und 90° aus 1,5–2 m Entfernung vor das Mikrofon gehalten. Der Signalverlauf der impulshaltigen Schallereignisse wurde graphisch dargestellt. Ergebnisse und Schlussfolgerungen: Die Schalldruckpegel lagen bei direkt auf das Ohr gerichteter Waffe (0°) aus 1,5 m Entfernung zwischen 155 und 157 dB. Bei der Variation des Winkels von der Waffenmündung zum Ohr (45°, 90°) wurden Spitzenschalldruckpegel über 150 dB gemessen. Die am rechten Ohr des Schützen (180°) gemessenen Spitzenschalldruckpegel lagen zwischen 140 und 150 dB. Die 135°- und 225°-Messungen zeigten eine starke Richtungswirkung der Schreckschusswaffen. Bei Rechtsdrehung in der horizontalen Ebene (135°) ermittelten wir erwartungsgemäss um 1–6 dB höhere Spitzenschalldruckpegel. Die Effektivwerte (quadratische Mittelwerte) des gesamten Impulses waren im Durchschnitt 4–10 dB niedriger als die Spitzenschalldruckpegel. Die Impulsdauer belief sich bei allen Waffentypen auf Werte unter 2 ms. Impulse von handelsüblichen Schreckschusswaffen zeigen also vergleichbar hohe Spitzenschalldruckpegel wie die von Revolvern und Pistolen mit «scharfer» Munition. Knalltraumata dieser Genese können zu einem Hörverlust im Hochtonbereich führen, der langandauernd, sogar bleibend sein kann. In welchem Zeitraum mit Besserungen zu rechnen ist, hängt nicht zuletzt von der Vorschädigung des Ohres sowie von der Entfernung und vom Winkel der Waffenmündung zum Ohr ab.
Halsdissektion: Konzept zur histopathologischen Aufarbeitung
Authors: Danninger R. , Humer U. , Beham A. , Jakse R.
Published: April 2003

Fragestellung: Der histopathologischen Untersuchung entnommener Halsweichteile nach Halsdissektion kommt entscheidende prognostische Bedeutung zu. Einheitliche Untersuchungskriterien und Anleitungen für den Pathologen liegen bisher nicht vor. Mit dem vorgestellten Konzept soll eine praxisnahe, einheitliche Versorgung von Halsdissektionspräparaten gewährleistet werden. Patienten und Methode: Die Halsdissektionspräparate von 38 Patienten mit Malignomen des Kopf-Hals-Bereiches wurden vom Chirurgen auf Korkplatten aufgespannt, die die anatomischen Konturen der seitlichen Halsweichteile aufwiesen. Diese topographische Determination ermöglichte dem Pathologen eine histopathologische Untersuchung entsprechend den zervikalen Lymphknotenregionen (I–VI). Dokumentiert wurden Anzahl und Lokalisation von Lymphknoten und Metastasen, Kapselruptur und karzinomatöse Lymphgefässausbreitung. Ergebnisse: Bei den kompletten Halsdissektionen betrug die Anzahl der histopathologisch entdeckten und untersuchten Lymphknoten im Mittel 36 (21–60), bei den selektiven Lymphknotenausräumungen 16 (1–43). Im Durchschnitt wurden in den Lymphknotenregionen I–VI 4,7 (in I) bis 9.2 (in V) Lymphknoten entdeckt. 137 Lymphknotenmetastasen fanden sich in 28 von 46 Halsdissektionspräparaten (70% in den Regionen II und III); Kapselruptur und Lymphgefässausbreitung kamen gesondert zur Auswertung. Schlussfolgerungen: Anzahl und Lokalisation der Lymphknotenmetastasen konnten durch die von uns vorgestellte Aufarbeitung der Halsdissektionspräparate exakt bestimmt und damit weitere Therapiemassnahmen festgesetzt, wie auch die Prognose des Geschwulstleidens erkannt werden. Unser Konzept erscheint als Standard für die Versorgung und histopathologische Untersuchung von Halsdissektionspräparaten geeignet zu sein. Dadurch können auch Therapieformen und -ergebnisse gleicher Tumorstadien und Histologien – insbesondere die der histopathologischen N-Kategorien – unterschiedlicher Behandlungszentren verglichen werden.
Consultation conjointe médico-psychologique pour les patients souffrant d’acouphènes
Authors: Degive Colette , Kos Maria-Izabel , Archinard Marc , Guyot Jean-Philippe
Published: April 2003

En 1993, une consultation conjointe médico-psychologique a été mise en place pour les patients souffrant d’acouphènes. Dans cette consultation, les problèmes des patients sont abordés de façon spécifique, le but de la consultation étant d’être thérapeutique en elle-même. Le principal travail est d’aider les patients à s’exprimer tant sur la gêne auditive que sur les autres dimensions qui sont venues modifier leur tolérance à l’acouphène. Les motivations des patients à consulter de nombreux spécialistes sont explorées et analysées. Il apparaît que les attentes de chaque consultation réactivent l’angoisse. Chez tous les patients une plainte affective s’exprime derrière la plainte ORL. La présence conjointe des deux thérapeutes, spécialiste ORL et psychologue, permet aux patients d’unifier leur compréhension du phénomène auditif et de la manière dont ils le vivent. A ce jour, 435 consultations conjointes ont été réalisées. Les résultats ont été analysés par une personne non impliquée dans cette consultation et sont publiés dans l’article suivant de E. Perrin et al.
Chondrosarcoma of the Larynx
Authors: Hof J.R. , Kremer B. , Manni J.J.
Published: April 2003

Chondrosarcoma is a rare tumour of the larynx. We present a case report of a patient with laryngeal chondrosarcoma who needed, although it was a low-grade chondrosarcoma, a total laryngectomy due to the localisation and size of the tumour.
Surgical Treatment of Obstructive Sleep Apnea
Authors: Hochban W.
Published: April 2003

Obstructive sleep apnea is a functional disturbance of the upper airways of various origins. This must be respected considering surgical treatment – all the more, an excellent conservative treatment is nasal continuous positive airway pressure. Patients who look for causal treatment alternatives instead of lifelong conservative therapy need further specific diagnostics besides routine polysomnography. Surgical treatment by maxillomandibular osteotomy is indicated in patients with cephalometric evidence of pharyngeal obstruction and retrognathism or dolichocephaly (about 40% of the patients with obstructive sleep apnea). According to own studies, primary maxillomandibular osteotomy is effective in >90% of the cases with a reduction of the respiratory disturbance index to <10/h without further secondary corrections. The remaining 10% of the patients need additional secondary corrections (advancement genioplasty, pharyngeal soft-tissue resections). Treatment success can be reliably prognosticated; the results are stable also at long-term follow-up.
Short- and Long-Term Outcomes of Uvulopalatopharyngoplasty in Nonapneic Snorers and Obstructive Sleep Apnea Patients
Authors: Boudewyns A. , Mariën S. , Wuyts F. , de Backer W. , Van de Heyning P.
Published: April 2003

Objectives: The aim of this study was to investigate the short- and long-term effects of uvulopalatopharyngoplasty (UPPP) on the major outcome parameters in nonapneic snorers and obstructive sleep apnea (OSA) patients. In addition, we investigated which factors affect the long-term subjective benefit perceived by the patient. Methods: A questionnaire on snoring, daytime sleepiness, habits and subjective benefit was mailed to 48 patients treated by UPPP because of nonapneic snoring or OSA. The results of this long-term (28 months) follow-up were compared with pre- and postoperative scores for snoring and daytime sleepiness. Each patient had undergone a polysomnography before and 3.5 months after UPPP (short-term follow-up). Results: Thirty-nine patients (27 nonapneic snorers and 12 OSA patients) returned the questionnaire and were eligible for statistical analysis. A significant improvement in snoring and daytime sleepiness was documented both in short- and long-term outcomes for nonapneic snorers as well as OSA patients without a significant improvement of polysomnography variables. Smoking after surgery was found to adversely affect subjective benefit. Conclusions: UPPP results in long-term improvement of clinical symptoms. This improvement is not necessarily accompanied by a decrease in respiratory disturbance index or an amelioration of sleep quality. Persistent smoking decreases the subjective benefit of surgery.
Biological Basis of the HLA-B8,DR3-Associated Progression of Acquired Immune Deficiency Syndrome
Authors: Candore Giuseppina , Romano Guiseppina Colonna , D’Anna Claudia , Di Lorenzo Gabriele , Gervasi Francesco , Lio Domenico , Modica Maria Assunta , Potestio Marcella , Caruso Calogero
Published: April 2003

The factors influencing the evolution of human immunodeficiency virus (HIV) infection are not fully known, but the host genotype undoubtedly plays a role in determining the outcome of the disease by affecting the immune response to HIV. The role of the host human leukocyte antigen (HLA) genotype in the regulation of susceptibility to HIV infection and expression has been studied extensively in different major risk groups. Certain HLA alleles and haplotypes, being associated with aberrant immune responses independently from HIV infection, have been reported to facilitate the rapid progression of disorders related to HIV infection. Particularly, the association of rapid acquired immunodeficiency syndrome (AIDS) progression with genes from the HLA-B8,DR3 haplotype has been reported by different research groups. It is well known that this haplotype is associated in all Caucasian populations with a wide variety of diseases with autoimmune features and in healthy subjects with a number of immune system dysfunctions, as a reduced production of T helper (Th)1 type cytokine. HIV infection may act on this genetic background triggering immunopathogenetic mechanisms leading to AIDS with a dominant Th2 profile as a common feature.
Induction and Expression of Intestinal Humoral Immunity in HIV-Infected Individuals: Prospects for Vaccination against Secondary Enteric Infections
Authors: Eriksson Kristina , Kilander Anders , Hagberg Lars , Norkrans Gunnar , Holmgren Jan , Czerkinsky Cecil
Published: April 2003

In view of the high incidence and severity of AIDS-related mucosal complications and secondary mucosal infections, we have evaluated the impact of HIV infection on the mucosal humoral immune status. By measuring the number of total and specific antibody-secreting cells in duodenal biopsies, we could show that HIV infection induces a pronounced polyclonal B-cell activation already in the early stages of the disease. Furthermore, we could document normal mucosal B-cell responses following oral vaccination, also in the late stages of the disease, and despite a lack of concomitant systemic responses. The relevance of these observations will be discussed with respect to the possibility of vaccinating HIV-infected individuals against secondary opportunistic infections.
Changes in Matrix Metalloproteinases during the Evolution of Interstitial Renal Fibrosis in a Rat Experimental Model
Authors: González-Avila Georgina , Iturria Cecilia , Vadillo-Ortega Felipe , Ovalle Consuelo , Montaño Martha
Published: April 2003

The aim of the present study was to analyze the matrix metalloproteinase (MMP) activity during the evolution of interstitial renal fibrosis in a rat experimental model of unilateral ureteral obstruction. The interstitial type I collagenase and the gelatinolytic activities were analyzed by radiolabeled substrate degradation. Interstitial collagenase activity was low at all times while gelatinolytic activity increased on day 6 of evolution, with a decrease in activity from this point. The use of organomercurials revealed the presence of latent enzyme in all cases. Normal kidney samples contained MMP-9 in both active and proenzyme forms as revealed by zymography. On day 3 MMP-9 dimers appeared, and increased activity was observed until day 6. A decrease in the gelatinolytic activity was detected from days 9–15 of evolution. This observation was confirmed by Western blot analysis that revealed the presence of proMMP-9 mainly from days 6–12. Tissue inhibitor of metalloproteinase-1 (TIMP-1) was also detected alone and in combination with proMMP-1 and MMP-1, particularly from days 6–15 of evolution. The presence of MMP-9 and MMP-1 was detected in the cytoplasm of cortical tubular cells by immunohistochemistry, with no difference between the experimental and the normal kidneys. There was also an increase in collagen concentration from day 3 after surgery that increased during the entire evolution of the experimental model. This work reveals that the decrease in the MMP-9 and MMP-1 enzymatic activity, due to their interaction with TIMP-1 and to the lack of activation of the latent forms, may participate in the excessive collagen deposit during the evolution of experimental interstitial renal fibrosis.
Expression of VCAM-1 in Lymphocytes during the Process of Apoptosis
Authors: Ishiyama N. , Kitagawa M. , Takahashi H. , Kina T. , Hirokawa K.
Published: April 2003

The administration of corticosteroids induced apoptosis of thymocytes in vivo. Among various adhesion molecules examined, vascular cell adhesion molecule-1 (VCAM-1, CD106) was shown to be strongly expressed in these apoptotic cells. Flow cytometric analysis also showed the expression of VCAM-1 in apoptotic thymocytes. An RT-PCR study demonstrated the expression of VCAM-1 mRNA in thymocytes. Splenic lymphocytes and other lymphoid cell lines also expressed VCAM-1 during the process of apoptosis. VCAM-1 mRNA expression was also observed in RT-PCR performed on these cell lines.
Short-Term Culturing Influences the Number of bcr/abl-Fused Cells Detected by Fluorescence in situ Hybridisation in Bone Marrow Aspirates of CML Patients
Authors: Wilkens Ludwig , Varga Sabine , Werner Martin , Nolte Martina , v. Wasielewski Reinhard , Georgii Axel
Published: April 2003

Fluorescence in situ hybridisation (FISH) has been proven as a helpful tool in diagnosis and monitoring of bcr/abl fusion in chronic myelogeneous leukaemia (CML). Since long-term cultures are known to decrease the number of bcr/abl-fused cells, it is questionable whether similar effects are detectable in short-term cultures, a technique often preceding FISH analysis. Therefore, we evaluated bone marrow aspirates of 10 CML patients at biopsy and after culturing for between 24 and 144 h by FISH. The percentage of bcr/abl-fused cells in FISH varied between 15 and 70% at biopsy. In samples with 15 and 30% of aberrant cells at biopsy, an increase of about 20% per day was seen within the first 48 h. In longer lasting cultures, the percentage of leukaemic cells then asymptotically approached a value of 60–70%. In patients with 38 and 50% of bcr/abl-fused cells at biopsy, an increase of about 20% could be detected in the first 24 h. Then 65–70% of the cells already bore the bcr/abl fusion, and the percentage of leukaemic cells was almost constant for longer lasting cultures up to 144 h. In patients with a percentage of about 70% before culturing, no increase in positive cells was detected. These results emphasize the impact of short-term culturing on the number of bcr/abl-fused cells. In particular, the importance for monitoring CML patients is obvious. Therefore the effect described should be taken into account in order to avoid misinterpretation and incorrect therapy decisions in CML patients.
Induction of Tolerance in Macrophages by Cholera Toxin B Chain
Authors: Burkart Volker , Kim Yoong-Eun , Kauer Manfred , Kolb Hubert
Published: April 2003

Model systems of human type 1 diabetes have revealed an important role of cellular immune reactions involving macrophages and T cells in the destruction of autologous insulin-producing pancreatic β cells. Recently, the cholera toxin B chain (CTB) was found to suppress T cell-dependent autoimmune diseases including autoimmune diabetes of nonobese diabetic mice. Therefore, we tested the hypothesis that CTB exerts much of its immunomodulatory activity by targeting macrophages. These studies are reviewed here. Cells of the human monocyte line Mono Mac 6 were exposed to CTB and subsequently tested for proinflammatory immunoreactivity in response to challenge with endotoxin (LPS from Escherichia coli, 10 ng/ml for 5 h). Incubation of monocytes with CTB (10 μg/ml) suppressed a later proinflammatory response to LPS as demonstrated by suppression of TNFα release from 6.7 ± 0.7 ng/ml in cultures without CTB preexposure to 1.8 ± 1.1 ng/ml in CTB-pretreated cells (p < 0.001). In contrast, the release of IL-10 remained inducible after CTB pretreatment. RT-PCR analysis showed that the suppression of TNFα production occurred at the level of mRNA formation. Control experiments excluded a role of possible contamination of CTB by endotoxin or the intact cholera toxin. Tolerance induction was maximal after 5 h of CTB exposure and persisted for 24 h. The suppressive effect of CTB was dose-dependent and no more recognizable at ≤1 μg/ml. Incubation with IL-10- and TGFβ-neutralizing antibodies during CTB pretreatment prevented tolerization of macrophages. IFNγ (1,200 U/ml) was found to antagonize actions of CTB. In contrast to desensitization by low doses of LPS, tolerance induction by CTB occurred ‘silently’, i.e. in the absence of a measurable proinflammatory response. In view of the potent instructive role of the innate immune system on T cell responses these findings are important in understanding how CTB prevents the development of autoimmune diabetes and improves tolerance to islet autoantigens.