[Fatal complications of otitis 60 years ago]

The temporal bone collection of the ENT Department of the Charité Hospital in Berlin contains 128 cases from 1924 to 1941 of fatal complications of acute otitis media and cholesteatoma. In 1927 alone, one patient died on average every 2 weeks at Charité Hospital from fatal otitic disease. Lesions include labyrinthitis, meningitis, sinus thrombosis and brain abscess. Each case is documented by clinical history, autopsy findings and temporal bone sections. The reasons for the various features of each illness are briefly discussed.

[Indirect azygos vein continuation syndrome with segmental agenesis and saccular aneurysm of the inferior vena cava]

Indirect vena azygos continuation syndrome and aneurysm are rare variations of the inferior vena cava (IVC). In this article we describe the ultrasound, angiographic and CT appearance of a 14-year-old girl with this congenital anormaly of the IVC.

[Doppler ultrasound studies of long-term follow-up of children with hemolytic-uremic syndrome]

AIM

In the present study, we compared the diagnostic value of Doppler sonography with "B-Imaging" in the acute and chronical period of the HUS in children.

METHOD

For this, we analysed the Doppler sonographic measurement (Acuson-128) from 3 patients in the acute stage of the disease and 14 patients after approximately 5 years. All patients examined in the chronic stage of the disease had been treated by peritoneal dialysis in the acute stage. As a control, the Doppler sonographic analysis of the A. renalis was performed in 25 healthy children.

RESULTS

During the acute phase of the HUS, we found a significant increase in both the resistive index (RI) and the pulsatility index (PI). In addition, the diastolic current in the A. renalis was decreased or the blood flow was reversed. The kidney volume as well as the echo was increased in all cases. A recovery of the kidney observed as beginning diuresis coincided with a return to normal parameters in the Doppler sonographic measurement. In patients examined after 5 years, both the RI and the PI value was significantly (p < 0.01) different from the control group. These parameters correlate with the effective renal plasma flow, but not with the glomerular filtration rate.

CONCLUSION

We conclude that in the acute stage of the HUS either "B-Imaging" or duplex sonography yield pathological parameter values. For the observation of the renal symptoms during the chronic phase of the disease, duplex sonography is clearly superior.

Human-papillomavirus DNA in cholesteatomas

Cholesteatoma of the middle ear is a relatively common disorder, often with severe consequences. Histologically, the aggressively growing, bone-destructing form shows papillary growth and koilocytosis, which are characteristic of papillomavirus-induced lesions. A PCR (polymerase chain reaction) method using degenerate primers for the detection of any known or as yet unknown HPV (human papillomavirus) type was applied in screening 51 biopsies from 42 patients. A resulting 36% (16/45) of the cholesteatomas were found to contain papillomavirus DNA, which hybridized under stringent conditions with an HPV-II DNA probe. In 3 cases the presence of HPV-II DNA could be confirmed by sequencing the PCR products. The mere presence of this HPV DNA does not prove an etiological role of this group of viruses in the induction of cholesteatomas. It does, however, identify another group of human proliferative lesions putatively linked to papillomavirus infections.

The effect of activation procedures on neuroleptic-induced akathisia

Two studies have been performed to evaluate the effect of activation tasks on neuroleptic-induced akathisia (NIA). In the first sample (30 patients) we found a consistent increase of symptoms during mental activation while motor activation led to a decrease. In a second study 34 patients with the same diagnosis were evaluated, using slightly different statistical procedures: while the effects of motor activation were corroborated, mental activation did not change NIA. Since mental and motor activation are usually considered to increase tardive dyskinesia and Parkinsonism, these measures might be helpful in differentiating NIA from other antipsychotic-induced movement disorders.

Combination treatment with noradrenalin and serotonin reuptake inhibitors in resistant depression

Eight cases of resistant recurrent depression were treated with a combination of nortriptyline and a new serotonin reuptake inhibitor, with or without concurrent lithium therapy. Significant improvement was seen in all patients where other drug regimes and ECT had been ineffective. No adverse reactions occurred in any of our patients, seven of whom were elderly. The combination treatment was more effective than individual therapies alone.