[Treatment of fibrous dysplasia]

BACKGROUND

The fibrous dysplasia is a rare disease of bone metabolism. Most common on the extremities, its appearance at the skull base is rare but of importance in clinical otorhinolaryngology. The patients suffer from problems such as cosmetical limitation, recurrent pain and in later phases from functional losses which result from bone dysplasia.

METHODS

Based on the experiences of these cases and the study of the current literature we would like to suggest a stage dependent therapy concept that includes conservativ options as well as surgical methods which are divided into curative and palliative surgical treatments.

PATIENTS

The Department of Otorhinolaryngology in Bochum has been involved in the therapy of eight patients suffering from fibrous dysplasia which have been treated and examined from six to twenty years.

RESULTS

Treatment in fibrous dysplasia can be efficient in increasing quality of life. A complete healing is rare and not the main target of treatment.

CONCLUSIONS

The staged therapy of fibrous dysplasia consists of conservative and surgical treatment and the combination of both. The decision for an individual therapy concept might be difficult and often requires close interdisciplinary cooperation.

Spinocerebellar ataxia type 2. Genotype and phenotype in German kindreds

BACKGROUND

Spinocerebellar ataxia type 2 (SCA2) is an autosomal dominant cerebellar ataxia (ADCA) for which the disease-causing mutation has recently been characterized as an expanded CAG trinucleotide repeat. We investigated 64 families of German ancestry with ADCA and 55 patients with sporadic ataxia for the SCA2 mutation.

RESULTS

Expanded alleles were found in 6 of the 64 families and in 1 patient with sporadic ataxia. This patient had a de novo mutation from an intermediate paternal allele. Length of repeats in 21 patients with SCA2 ranged from 36 to 52 CAG motifs and was inversely correlated with age at onset and progression of the disease. Expanded alleles were unstable during meiosis; paternal transmission especially caused significant anticipation of onset up to 26 years earlier. The SCA2 phenotype differed from those of SCA1 and SCA3 with higher frequencies of slowed ocular movements, postural and action tremor, myoclonus, and hyporeflexia. However, no single feature was sufficient to permit a specific clinical diagnosis.

CONCLUSIONS

Spinocerebellar ataxia type 2 accounts for about 10% of German families with ADCA but may also be present in sporadic ataxia due to de novo mutations. Clinical features are highly variable among and even within families. However, the size of the expanded repeat influences the phenotype and is relevant for course and prognosis of the disease.

Treatment of hypertensive emergency. Comparison of a new dosage form of the calcium antagonist nitrendipine with nifedipine capsules

OBJECTIVE

To present the efficacy and tolerability of a new oral dosage form of the calcium antagonist nitrendipine compared to nifedipine capsules in patients with hypertensive emergency.

DESIGN

Multicenter randomized double blind clinical study.

SETTING

23 study centres (hospitals) in Germany.

PATIENTS

161 patients between 20 and 70 years with acutely elevated blood pressure (systolic 200-250 mmHg, diastolic between 110-140 mmHg) with and without concomitant clinical symptoms.

INTERVENTIONS

Double blind treatment with 10 mg nifedipine or 5 mg nitrendipine. Nifedipine was administered as capsules, nitrendipine was given from a small plastic tube (vial), containing 1 ml alcoholic solution. Every patient received in addition to the test medication a placebo corresponding to the other product. Patients with insufficient treatment after 45 min were given either an additional capsule of 10 mg nifedipine or a further vial containing 5 mg nitrendipine according to their group and maintaining the double dummy procedure.

MEASUREMENTS AND RESULTS

Blood pressure and heart rate were measured repeatedly during 4 h, before and 90 min after beginning of the treatment a 12 channel resting ECG was recorded. At 45 min after administration the blood pressure had fallen significantly from 216.0/117.4 mmHg to 170.0/93.3 mmHg under nifedipine and from 216.9/117.3 mmHg to 177.4/94.4 mmHg under nitrendipine. 61.6% of the nifedipine patients and 58.8% of the nitrendipine patients had already reached blood pressure values < 180/100 mmHg after 45 min and in both groups 83% of these patients were still in this limit at the end of the observation period after 4 h. Tolerability was very good in both groups.

CONCLUSION

The new dosage form of nitrendipine (vial with 1 ml of alcoholic solution) represents an alternative in the treatment of hypertensive emergency.