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von Werdt M, Korda A, Zamaro E, Wagner F, Kompis M, Caversaccio MD, Mantokoudis G. The acute vestibular syndrome: prevalence of new hearing loss and its diagnostic value. Eur Arch Otorhinolaryngol 2024; 281:1781-1787. [PMID: 37943315 PMCID: PMC10942940 DOI: 10.1007/s00405-023-08296-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/17/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES To assess the prevalence of new hearing losses in patients with acute vestibular syndrome (AVS) and to start to evaluate its diagnostic value for the differentiation between peripheral and central causes. DESIGN We performed a cross-sectional prospective study in AVS patients presenting to our Emergency Department (ED) from February 2015 to November 2020. All patients received an MRI, Head-impulse test, Nystagmus test and Test of skew ('HINTS'), caloric testing and a pure-tone audiometry. RESULTS We assessed 71 AVS patients, 17 of whom had a central and 54 a peripheral cause of dizziness. 12.7% had an objective hearing loss. 'HINTS' had an accuracy of 78.9% to diagnose stroke, whereas 'HINTS' plus audiometry 73.2%. 'HINTS' sensitivity was 82.4% and specificity 77.8% compared to 'HINTS' plus audiometry showing a sensitivity of 82.4% and specificity of 70.4%. The four patients with stroke and minor stroke had all central 'HINTS'. 55% of the patients did not perceive their new unilateral hearing loss. CONCLUSIONS We found that almost one-eighth of the AVS patients had a new onset of hearing loss and only half had self-reported it. 'HINTS' plus audiometry proved to be less accurate to diagnose a central cause than 'HINTS' alone. Audiometry offered little diagnostic accuracy to detect strokes in the ED but might be useful to objectify a new hearing loss that was underestimated in the acute phase. Complete hearing loss should be considered a red flag, as three in four patients suffered from a central cause.
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Affiliation(s)
- Moritz von Werdt
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, 3010, Bern, Switzerland
| | - Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, 3010, Bern, Switzerland
| | - Ewa Zamaro
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, 3010, Bern, Switzerland
| | - Franca Wagner
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Martin Kompis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, 3010, Bern, Switzerland
| | - Marco D Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, 3010, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, 3010, Bern, Switzerland.
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Mantokoudis G, Zwergal A, Heg D, Kerkeni H, Diener S, Kalla R, Korda A, Candreia C, Welge-Lüssen A, Tarnutzer AA. What neuro-otology specialists need for better care of dizzy patients: a national survey. Front Neurol 2024; 14:1322471. [PMID: 38259654 PMCID: PMC10800397 DOI: 10.3389/fneur.2023.1322471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Background A substantial fraction of dizzy patients are assessed by neurologists and ear-nose-throat (ENT) physicians. With the differential diagnosis being broad and often different specialties involved, we aimed to assess the interaction with generalists from the specialists' perspective to identify limitations and needs and to define strategies for improvement in patient care and education by the specialist. Methods One hundred eleven board-certified neurologists (n = 62) and ENT physicians (n = 49) working in Switzerland participated in an online survey. Here, we focused on limitations faced in the diagnostic workup and treatment of the dizzy patient and potential strategies to improve the standard of care and the interaction between generalists and specialists. Descriptive statistical analyses were performed. We hypothesized that those specialists applying modern concepts in history-taking and bedside examination techniques reach a specific diagnosis more often and request fewer referrals. Results Specialists indicated higher confidence in reaching a specific diagnosis for patients presenting with acute dizziness than episodic/chronic dizziness (80% vs. 60%) at the first consultation. Knowledge of the timing-and-trigger concept [odds ratio (OR) = 0.81 (0.67-0.98), p = 0.034], as well as of subtle oculomotor/vestibular signs [OR = 0.80 (0.68-0.94), p = 0.007] was predictive of the self-reported probability of reaching a specific diagnosis in patients with episodic/chronic dizziness, while no such differences were observed in the care of acutely dizzy patients. Further referrals of acutely dizzy patients were significantly higher in neurologists than in ENT physicians (17% vs. 10%, p < 0.001) and in specialists located in the Latin part of Switzerland [OR = 2.84 (1.63-4.93), p < 0.001], while this was not the case for patients with episodic/chronic dizziness. Identified unmet needs included regular communication between physicians (27%/53%; always/often true) and sufficiently detailed information on the previous workup from the referrals (27%/53%). Specialists expressed most interest in hands-on courses/workshops, webinars, and practical guidelines for education. Conclusion In our survey, bedside state-of-the-art assessments were key in reducing the fraction of unclear dizzy cases. Several gaps were identified that should be addressed. Specifically, referring physicians should provide more comprehensive details regarding urgency, prior diagnostics, and treatment. Specifically, when promoting the knowledge of neurologists and ENT physicians, this should be preferentially done by offering a combination of hands-on courses and webinars.
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Affiliation(s)
- Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Zwergal
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, Munich, Germany
- Department of Neurology, LMU University Hospital, Munich, Germany
| | - Dik Heg
- CTU Bern, University of Bern, Bern, Switzerland
| | - Hassen Kerkeni
- Department of Neurology, Lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Suzie Diener
- Practice Neurology St. Gallen, St. Gallen, Switzerland
| | - Roger Kalla
- Department of Neurology, Lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, Lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Claudia Candreia
- Department of Otorhinolaryngology, Head and Neck Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Antje Welge-Lüssen
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Basel, Basel, Switzerland
| | - Alexander Andrea Tarnutzer
- Neurology, Cantonal Hospital of Baden, Baden, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Michailidou E, Korda A, Wyss T, Bardins S, Schneider E, Morrison M, Wagner F, Caversaccio MD, Mantokoudis G. The value of saccade metrics and VOR gain in detecting a vestibular stroke. J Vestib Res 2024; 34:49-61. [PMID: 38160379 DOI: 10.3233/ves-230083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
OBJECTIVE A normal video Head Impulse Test is the gold standard in the emergency department to rule-in patients with an acute vestibular syndrome and a stroke. We aimed to compare the diagnostic accuracy of vHIT metrics regarding the vestibulo-ocular reflex gain and the corrective saccades in detecting vestibular strokes. METHODS Prospective cross-sectional study (convenience sample) of patients presenting with acute vestibular syndrome in the emergency department of a tertiary referral centre between February 2015 and May 2020. We screened 1677 patients and enrolled 76 patients fulfilling the inclusion criteria of acute vestibular syndrome. All patients underwent video head impulse test with automated and manual data analysis. A delayed MRI served as a gold standard for vestibular stroke confirmation. RESULTS Out of 76 patients, 52 were diagnosed with acute unilateral vestibulopathy and 24 with vestibular strokes. The overall accuracy of detecting stroke with an automated vestibulo-ocular reflex gain was 86.8%, compared to 77.6% for cumulative saccade amplitude and automatic saccade mean peak velocity measured by an expert and 71% for cumulative saccade amplitude and saccade mean peak velocity measured automatically. Gain misclassified 13.1% of the patients as false positive or false negative, manual cumulative saccade amplitude and saccade mean peak velocity 22.3%, and automated cumulative saccade amplitude and saccade mean peak velocity 28.9% respectively. CONCLUSIONS We found a better accuracy of video head impulse test for the diagnosis of vestibular strokes when using the vestibulo-ocular reflex gain than using saccade metrics. Nevertheless, saccades provide an additional and important information for video head impulse test evaluation. The automated saccade detection algorithm is not yet perfect compared to expert analysis, but it may become a valuable tool for future non-expert video head impulse test evaluations.
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Affiliation(s)
- Efterpi Michailidou
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Thomas Wyss
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Stanislav Bardins
- Institute of Medical Technology, Brandenburg University of Technology Cottbus - Senftenberg, Cottbus, Germany
| | - Erich Schneider
- Institute of Medical Technology, Brandenburg University of Technology Cottbus - Senftenberg, Cottbus, Germany
| | - Miranda Morrison
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Franca Wagner
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Marco D Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
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Nikles F, Kerkeni H, Zamaro E, Korda A, Wagner F, Sauter TC, Kalla R, Morrison M, Mantokoudis G. Do monosymptomatic stroke patients with dizziness present a vestibular syndrome without nystagmus? An underestimated entity. Eur J Neurol 2024; 31:e16066. [PMID: 37738525 DOI: 10.1111/ene.16066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND PURPOSE Vestibular symptoms are common in emergency department (ED) patients and have various causes, including stroke. Accurate identification of stroke in patients with vestibular symptoms is crucial for timely management. We conducted a prospective cross-sectional study from 2015 to 2019 to determine stroke prevalence and associated symptoms in ED patients with vestibular symptoms, aiming to improve diagnosis and outcomes. METHODS As part of the DETECT project, we screened 1647 ED patients with acute vestibular symptoms. Following a retrospective analysis of 961 head and neck magnetic resonance imaging (MRI) scans, we included 122 confirmed stroke cases and assessed them for vestibular signs and symptoms. RESULTS Stroke prevalence in dizzy patients was 13% (122/961 MRI scans). Most patients (95%) presented with acute vestibular symptoms with or without nystagmus, whereas 5% had episodic vestibular syndrome (EVS). Nystagmus was present in 50% of stroke patients. Eighty percent had a purely posterior circulation stroke, and nystagmus was absent in 46% of these patients. Seven patients (6%) had lesions in both the anterior and posterior circulation. Vertigo was experienced by 52% regardless of territory. CONCLUSIONS A stroke was identified in 13% of ED patients presenting with acute vestibular symptoms. In 5%, it was EVS. Most strokes were in the posterior circulation territory; vertigo occurred with similar frequency in anterior and posterior circulation stroke, and absence of nystagmus was common in both.
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Affiliation(s)
- Florence Nikles
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Hassen Kerkeni
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Ewa Zamaro
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Franca Wagner
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Thomas C Sauter
- Department of Emergency Medicine, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Roger Kalla
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Miranda Morrison
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
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Zwergal A, Mantokoudis G, Heg D, Kerkeni H, Diener S, Kalla R, Korda A, Candreia C, Welge-Lüssen A, Tarnutzer AA. What is the current status of care by neuro-otology specialists in Switzerland-A national survey. Front Neurol 2023; 14:1322330. [PMID: 38130837 PMCID: PMC10733682 DOI: 10.3389/fneur.2023.1322330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023] Open
Abstract
Background Vertigo and dizziness are frequent presenting symptoms in the emergency department and in outpatient centers. While the majority of dizzy patients are evaluated by primary care physicians, specialists are often involved in the diagnostic workup. We aimed to gain more insights into the role of specialists in the care of dizzy patients. Materials and methods Board-certified neurologists and ear-nose-throat (ENT) physicians working in Switzerland were invited to participate in an online survey. Descriptive statistical analyses were performed, and prospectively defined hypotheses were assessed using correlation analyses. Results All 111 participating specialists (neurologists = 62; ENT specialists = 49) were familiar with testing for posterior canal benign paroxysmal positional vertigo (BPPV), and 66% regularly applied provocation maneuvers for suspected lateral canal BPPV. Reposition maneuvers for posterior (99%) and lateral (68%) canals were frequently performed. ENT physicians were familiar with lateral canal BPPV repositioning maneuvers significantly more often than neurologists (84 vs. 56%, p ≤ 0.012). Specialists strongly agreed that performing the head impulse test (86%) and looking for deficient eccentric gaze holding (82%) are important. Compared to neurologists, significantly fewer ENT physicians indicated ordering brain MRI in acutely dizzy patients (OR = 0.33 [0.16-0.067], p = 0.002) and physical therapy in patients with acute (50 vs. 20%, p = 0.005) or episodic/chronic dizziness (78 vs. 50%, p = 0.003). Conclusion We found substantial differences in the care of dizzy patients by neurologists and ENT physicians. This underlines the need for a standardized, guideline-oriented diagnostic workup and treatment across specialties. Dedicated training for performing lateral canal BPPV repositioning maneuvers should be prioritized for neurologists. Similarly, physical therapy should be considered more often by ENT physicians.
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Affiliation(s)
- Andreas Zwergal
- German Center for Vertigo and Balance Disorders, LMU University Hospital, LMU Munich, Munich, Germany
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dik Heg
- Clinical Trials Unit Bern, University of Bern, Bern, Switzerland
| | - Hassen Kerkeni
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Suzie Diener
- Practice Neurology St. Gallen, St. Gallen, Switzerland
| | - Roger Kalla
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Claudia Candreia
- Department of Otorhinolaryngology, Head and Neck Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Antje Welge-Lüssen
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Basel, Basel, Switzerland
| | - Alexander A. Tarnutzer
- Neurology, Cantonal Hospital of Baden, Baden, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Michailidou E, Rüegg PO, Karrer T, Korda A, Weder S, Kompis M, Caversaccio M, Mantokoudis G. Hearing Results after Transmastoid Superior Semicircular Canal Plugging for Superior Semicircular Canal Dehiscence: A Meta-Analysis. Audiol Res 2023; 13:730-740. [PMID: 37887846 PMCID: PMC10604912 DOI: 10.3390/audiolres13050065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/01/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVE The transmastoid plugging of a superior semicircular canal is considered a safe and effective technique for the management of superior semicircular canal dehiscence (SSCD). The aim of this meta-analysis is to assess the postoperative hearing outcomes after the transmastoid plugging of the superior semicircular canal. Search method and data sources: A systematic database search was performed on the following databases until 30 January 2023: MEDLINE, Embase, Cochrane Library, Web of Science, CINAHL, ICTRP, and clinicaltrials.gov. A systematic literature review and meta-analysis of the pooled data were conducted. We also included a consecutive case series with SCDS for those who underwent transmastoid plugging treatment at our clinic. RESULTS We identified 643 citations and examined 358 full abstracts and 88 full manuscripts. A total of 16 studies were eligible for the systematic review and 11 studies for the meta-analysis. Furthermore, 159 ears (152 patients) were included. The postoperative mean air conduction threshold remained unchanged (mean difference, 2.89 dB; 95% CI: -0.05, 5.84 dB, p = 0.58), while the mean bone conduction threshold was significantly worse (mean difference, -3.53 dB; 95% CI, -6.1, -0.95 dB, p = 0.9). CONCLUSION The transmastoid plugging technique for superior semicircular canal dehiscence syndrome, although minimally worsening the inner ear threshold, is a safe procedure in terms of hearing preservation and satisfactory symptom relief.
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Affiliation(s)
- Efterpi Michailidou
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
| | - Pascal Oliver Rüegg
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
| | - Tanya Karrer
- Medical Library, University Library of Bern, University of Bern, 3010 Bern, Switzerland
| | - Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
| | - Stefan Weder
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
| | - Martin Kompis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
| | - Marco Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, 3010 Bern, Switzerland
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Zwergal A, Mantokoudis G, Heg D, Kerkeni H, Diener S, Kalla R, Korda A, Candreia C, Welge-Lüssen A, Tarnutzer AA. What is the current status of primary care in the diagnosis and treatment of patients with vertigo and dizziness in Switzerland? A national survey. Front Neurol 2023; 14:1254080. [PMID: 37745663 PMCID: PMC10513417 DOI: 10.3389/fneur.2023.1254080] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
Background Vertigo and dizziness are among the most frequent presenting symptoms in the primary care physicians' (PCPs) office. With patients facing difficulties in describing their complaints and clinical findings often being subtle and transient, the diagnostic workup of the dizzy patient remains challenging. We aimed to gain more insights into the current state of practice in order to identify the limitations and needs of the PCPs and define strategies to continuously improve their knowledge in the care of the dizzy patient. Materials and methods Board-certified PCPs working in Switzerland were invited to participate in an online survey. A descriptive statistical analysis was performed, and prospectively defined hypotheses were assessed using regression analyses. Results A vast majority of participating PCPs (n = 152) were familiar with the key questions when taking the dizzy patient's history and with performing provocation/repositioning maneuvers when posterior-canal benign paroxysmal positional vertigo (BPPV) was suspected (91%). In contrast, strong agreement that performing the alternating cover test (21%), looking for a spontaneous nystagmus with fixation removed (42%), and performing the head-impulse test (47%) were important was considerably lower, and only 19% of PCPs were familiar with lateral-canal BPPV treatment. No specific diagnosis could be reached in substantial fractions of patients with acute (35% [25; 50%], median [inter-quartile range]) and episodic/chronic (50% [40; 65.8%]) dizziness/vertigo. Referral to specialists was higher in patients with episodic/chronic dizziness than in acutely dizzy patients (50% [20.3; 75] vs. 30% [20; 50]), with younger PCPs (aged 30-40 years) demonstrating significantly increased odds of referral to specialists (odds ratio = 2.20 [1.01-4.81], p = 0.048). Conclusion The assessment of dizzy patients takes longer than that of average patients in most primary care practices. Many dizzy patients remain undiagnosed even after a thorough examination, highlighting the challenges faced by PCPs and potentially leading to frequent referrals to specialists. To address this, it is crucial to promote state-of-the-art neuro-otological examination and treatment techniques that are currently neglected by most PCPs, such as "HINTS" and lateral-canal BPPV treatment. This can help reduce referral rates allowing more targeted treatment and referrals.
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Affiliation(s)
- Andreas Zwergal
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig Maximilian University Hospital, Munich, Germany
- Department of Neurology, Ludwig Maximilian University Hospital, Munich, Germany
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dierik Heg
- Clinical Trial Unit Bern, University of Bern, Bern, Switzerland
| | - Hassen Kerkeni
- Department of Neurology, Lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Suzie Diener
- Practice Neurology St. Gallen, St. Galen, Switzerland
| | - Roger Kalla
- Department of Neurology, Lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, Lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Claudia Candreia
- Department of Otorhinolaryngology, Head and Neck Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Antje Welge-Lüssen
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Basel, Basel, Switzerland
| | - Alexander A. Tarnutzer
- Neurology, Cantonal Hospital of Baden, Baden, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Mantokoudis G, Zwergal A, Heg D, Kerkeni H, Diener S, Kalla R, Korda A, Candreia C, Welge-Lüssen A, Tarnutzer AA. Needs and supporting tools for primary care physicians to improve care of patients with vertigo and dizziness: a national survey. Front Neurol 2023; 14:1254105. [PMID: 37706010 PMCID: PMC10495563 DOI: 10.3389/fneur.2023.1254105] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/14/2023] [Indexed: 09/15/2023] Open
Abstract
Background The diagnostic workup and treatment decisions for vertigo or dizziness in primary care can be challenging due to the broad range of possible causes and limited time and expertise of physicians. This can lead to delays in treatment and unnecessary tests. We aimed to identify the unmet needs of primary care physicians (PCPs) and strategies to improve care for dizzy patients. Materials and methods An online survey was conducted among board-certified PCPs in Switzerland to explore needs in caring for dizzy patients and potential educational approaches. Results Based on responses from 152 participating PCPs, satisfaction and confidence were higher in diagnosing (82%) and treating (76%) acute dizziness compared to episodic/chronic cases (63 and 59%, respectively). Younger PCPs had lower diagnostic yield and confidence. Areas for improvement in specialist interactions included communication between physicians (23%/36%; always/often true), shorter waiting times for consultations (19%/40%), more detailed feedback (36%/35%), and consistent patient back referrals (31%/30%). PCPs expressed interest in hands-on courses, workshops, practical guidelines, web-based algorithms, and digital tools such as printed dizzy diaries and apps for follow-up. Conclusion Enhanced dialog between PCPs and specialists is crucial to address the most common unmet needs. Reducing waiting times for referrals and providing clear instructions to specialists for triage are essential. The findings from this survey will guide the development of tools to improve the diagnosis and treatment of dizzy patients. Younger PCPs, who face higher diagnostic uncertainty, should be prioritized for educational approaches such as hands-on courses, workshops, and practical recommendations.
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Affiliation(s)
- Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Zwergal
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, Munich, Germany
- Department of Neurology, LMU University Hospital, Munich, Germany
| | - Dierik Heg
- CTU Bern, University of Bern, Bern, Switzerland
| | - Hassen Kerkeni
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Suzie Diener
- Practice Neurology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Roger Kalla
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Claudia Candreia
- Department of Otorhinolaryngology, Head and Neck Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Antje Welge-Lüssen
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Basel, Basel, Switzerland
| | - Alexander Andrea Tarnutzer
- Neurology, Cantonal Hospital of Baden, Baden, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Comolli L, Korda A, Zamaro E, Wagner F, Sauter TC, Caversaccio MD, Nikles F, Jung S, Mantokoudis G. Vestibular syndromes, diagnosis and diagnostic errors in patients with dizziness presenting to the emergency department: a cross-sectional study. BMJ Open 2023; 13:e064057. [PMID: 36963793 PMCID: PMC10040076 DOI: 10.1136/bmjopen-2022-064057] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 03/14/2023] [Indexed: 03/26/2023] Open
Abstract
OBJECTIVES We aimed to determine the frequency of vestibular syndromes, diagnoses, diagnostic errors and resources used in patients with dizziness in the emergency department (ED). DESIGN Retrospective cross-sectional study. SETTING Tertiary referral hospital. PARTICIPANTS Adult patients presenting with dizziness. PRIMARY AND SECONDARY OUTCOME MEASURES We collected clinical data from the initial ED report from July 2015 to August 2020 and compared them with the follow-up report if available. We calculated the prevalence of vestibular syndromes and stroke prevalence in patients with dizziness. Vestibular syndromes are differentiated in acute (AVS) (eg, stroke, vestibular neuritis), episodic (EVS) (eg, benign paroxysmal positional vertigo, transient ischaemic attack) and chronic (CVS) (eg, persistent postural-perceptual dizziness) vestibular syndrome. We reported the rate of diagnostic errors using the follow-up diagnosis as the reference standard. RESULTS We included 1535 patients with dizziness. 19.7% (303) of the patients presented with AVS, 34.7% (533) with EVS, 4.6% (71) with CVS and 40.9% (628) with no or unclassifiable vestibular syndrome. The three most frequent diagnoses were stroke/minor stroke (10.1%, 155), benign paroxysmal positional vertigo (9.8%, 150) and vestibular neuritis (9.6%, 148). Among patients with AVS, 25.4% (77) had stroke. The cause of the dizziness remained unknown in 45.0% (692) and 18.0% received a false diagnosis. There was a follow-up in 662 cases (43.1%) and 58.2% with an initially unknown diagnoses received a final diagnosis. Overall, 69.9% of all 1535 patients with dizziness received neuroimaging (MRI 58.2%, CT 11.6%) in the ED. CONCLUSIONS One-fourth of patients with dizziness in the ED presented with AVS with a high prevalence (10%) of vestibular strokes. EVS was more frequent; however, the rate of undiagnosed patients with dizziness and the number of patients receiving neuroimaging were high. Almost half of them still remained without diagnosis and among those diagnosed were often misclassified. Many unclear cases of vertigo could be diagnostically clarified after a follow-up visit.
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Affiliation(s)
- Lukas Comolli
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Ewa Zamaro
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Franca Wagner
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Thomas C Sauter
- Department of Emergency Medicine, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Marco D Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Florence Nikles
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Simon Jung
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
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Wyssen G, Morrison M, Korda A, Wimmer W, Otero-Millan J, Ertl M, Szukics AA, Wyss T, Wagner F, Caversaccio MD, Mantokoudis G, Mast FW. Measuring the Influence of Magnetic Vestibular Stimulation on Nystagmus, Self-Motion Perception, and Cognitive Performance in a 7T MRT. J Vis Exp 2023. [PMID: 36939227 DOI: 10.3791/64022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Strong magnetic fields induce dizziness, vertigo, and nystagmus due to Lorentz forces acting on the cupula in the semi-circular canals, an effect called magnetic vestibular stimulation (MVS). In this article, we present an experimental setup in a 7T MRT scanner (MRI scanner) that allows the investigation of the influence of strong magnetic fields on nystagmus as well as perceptual and cognitive responses. The strength of MVS is manipulated by altering the head positions of the participants. The orientation of the participants' semicircular canals with respect to the static magnetic field is assessed by combining a 3D magnetometer and 3D constructive interference in steady-state (3D-CISS) images. This approach allows to account for intra- and inter-individual differences in participants' responses to MVS. In the future, MVS can be useful for clinical research, for example, in the investigation of compensatory processes in vestibular disorders. Furthermore, it could foster insights into the interplay between vestibular information and cognitive processes in terms of spatial cognition and the emergence of self-motion percepts under conflicting sensory information. In fMRI studies, MVS can elicit a possible confounding effect, especially in tasks influenced by vestibular information or in studies comparing vestibular patients with healthy controls.
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Affiliation(s)
- Gerda Wyssen
- Department of Psychology, University of Bern; Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine;
| | - Miranda Morrison
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, University Hospital Bern and University of Bern
| | - Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, University Hospital Bern and University of Bern
| | - Wilhelm Wimmer
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, University Hospital Bern and University of Bern; Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern
| | - Jorge Otero-Millan
- Herbert Wertheim School of Optometry and Vision Science, University of California
| | | | - Andreas A Szukics
- Department of Psychology, University of Bern; Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine
| | - Thomas Wyss
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, University Hospital Bern and University of Bern
| | - Franca Wagner
- University Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern; Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine
| | - Marco D Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, University Hospital Bern and University of Bern; Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, University Hospital Bern and University of Bern; Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine
| | - Fred W Mast
- Department of Psychology, University of Bern; Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine
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Kerkeni H, Zee DS, Korda A, Morrison M, Mantokoudis G, Ramat S. Corrective saccades in acute vestibular neuritis: studying the role of prediction with automated passively induced head impulses. J Neurophysiol 2023; 129:445-454. [PMID: 36651642 DOI: 10.1152/jn.00382.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
When the demands for visual stabilization during head rotations overwhelm the ability of the vestibuloocular reflex (VOR) to produce compensatory eye movements, the brain produces corrective saccades that bring gaze toward the fixation target, even without visual cues (covert saccades). What triggers covert saccades and what might be the role of prediction in their generation are unknown. We studied 14 subjects with acute vestibular neuritis. To minimize variability of the stimulus, head impulses were imposed with a motorized torque generator with the subject on a bite bar. Predictable and unpredictable (timing, amplitude, direction) stimuli were compared. Distributions of covert corrective saccade latencies were analyzed with a "LATER" (linear approach to threshold with ergodic rate) approach. On the affected side, VOR gain was higher (0.47 ± 0.28 vs. 0.39 ± 0.22, P ≪ 0.001) with predictable than unpredictable head impulses, and gaze error at the end of the head movement was less (5.4 ± 3.3° vs. 6.9 ± 3.3°, P ≪ 0.001). Analyzing trials with covert saccades, gaze error at saccade end was significantly less with predictable than unpredictable head impulses (4.2 ± 2.8° vs. 5.5 ± 3.2°, P ≪ 0.001). Furthermore, covert corrective saccades occurred earlier with predictable than unpredictable head impulses (140 ± 37 vs. 153 ± 37 ms, P ≪ 0.001). Using a LATER analysis with reciprobit plots, we were able to divide covert corrective saccades into two classes, early and late, with a break point in the range of 88-98 ms. We hypothesized two rise-to-threshold decision mechanisms for triggering early and late covert corrective saccades, with the first being most engaged when stimuli are predictable.NEW & NOTEWORTHY We successfully used a LATER (linear approach to threshold with ergodic rate) analysis of the latencies of corrective saccades in patients with acute vestibular neuritis. We found two types of covert saccades: early (<90 ms) and late (>90 ms) covert saccades. Predictability led to an increase in VOR gain and a decrease in saccade latency.
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Affiliation(s)
- Hassen Kerkeni
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - David S Zee
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Miranda Morrison
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Stefano Ramat
- Laboratory of Bioengineering, Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
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Korda A, Wimmer W, Wyss T, Michailidou E, Zamaro E, Wagner F, Caversaccio MD, Mantokoudis G. Artificial intelligence for early stroke diagnosis in acute vestibular syndrome. Front Neurol 2022; 13:919777. [PMID: 36158956 PMCID: PMC9492879 DOI: 10.3389/fneur.2022.919777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Measuring the Vestibular-Ocular-Reflex (VOR) gains with the video head impulse test (vHIT) allows for accurate discrimination between peripheral and central causes of acute vestibular syndrome (AVS). In this study, we sought to investigate whether the accuracy of artificial intelligence (AI) based vestibular stroke classification applied in unprocessed vHIT data is comparable to VOR gain classification. Methods We performed a prospective study from July 2015 until April 2020 on all patients presenting at the emergency department (ED) with signs of an AVS. The patients underwent vHIT followed by a delayed MRI, which served as a gold standard for stroke confirmation. The MRI ground truth labels were then applied to train a recurrent neural network (long short-term memory architecture) that used eye- and head velocity time series extracted from the vHIT examinations. Results We assessed 57 AVS patients, 39 acute unilateral vestibulopathy patients (AUVP) and 18 stroke patients. The overall sensitivity, specificity and accuracy for detecting stroke with a VOR gain cut-off of 0.57 was 88.8, 92.3, and 91.2%, respectively. The trained neural network was able to classify strokes with a sensitivity of 87.7%, a specificity of 88.4%, and an accuracy of 87.9% based on the unprocessed vHIT data. The accuracy of these two methods was not significantly different (p = 0.09). Conclusion AI can accurately diagnose a vestibular stroke by using unprocessed vHIT time series. The quantification of eye- and head movements with the use of machine learning and AI can serve in the future for an automated diagnosis in ED patients with acute dizziness. The application of different neural network architectures can potentially further improve performance and enable direct inference from raw video recordings.
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Affiliation(s)
- Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Wilhelm Wimmer
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
- Hearing Research Laboratory, ARTORG Center, University of Bern, Bern, Switzerland
| | - Thomas Wyss
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Efterpi Michailidou
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Ewa Zamaro
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Franca Wagner
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Marco D. Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
- *Correspondence: Georgios Mantokoudis
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Korda A, Wimmer W, Zamaro E, Wagner F, Sauter TC, Caversaccio MD, Mantokoudis G. Videooculography “HINTS” in Acute Vestibular Syndrome: A Prospective Study. Front Neurol 2022; 13:920357. [PMID: 35903121 PMCID: PMC9314570 DOI: 10.3389/fneur.2022.920357] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/02/2022] [Indexed: 11/23/2022] Open
Abstract
Objective A three-step bedside test (“HINTS”: Head Impulse-Nystagmus-Test of Skew), is a well-established way to differentiate peripheral from central causes in patients with acute vestibular syndrome (AVS). Nowadays, the use of videooculography gives physicians the possibility to quantify all eye movements. The goal of this study is to compare the accuracy of VOG “HINTS” (vHINTS) to an expert evaluation. Methods We performed a prospective study from July 2015 to April 2020 on all patients presenting at the emergency department with signs of AVS. All the patients underwent clinical HINTS (cHINTS) and vHINTS followed by delayed MRI, which served as a gold standard for stroke confirmation. Results We assessed 46 patients with AVS, 35 patients with acute unilateral vestibulopathy, and 11 patients with stroke. The overall accuracy of vHINTS in detecting a central pathology was 94.2% with 100% sensitivity and 88.9% specificity. Experts, however, assessed cHINTS with a lower accuracy of 88.3%, 90.9% sensitivity, and 85.7% specificity. The agreement between clinical and video head impulse tests was good, whereas for nystagmus direction was fair. Conclusions vHINTS proved to be very accurate in detecting strokes in patients AVS, with 9% points better sensitivity than the expert. The evaluation of nystagmus direction was the most difficult part of HINTS.
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Affiliation(s)
- Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Wilhelm Wimmer
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
- Hearing Research Laboratory, ARTORG Center, University of Bern, Bern, Switzerland
| | - Ewa Zamaro
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Franca Wagner
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Thomas C. Sauter
- Department of Emergency Medicine, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Marco D. Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
- *Correspondence: Georgios Mantokoudis
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Morrison M, Korda A, Wagner F, Caversaccio MD, Mantokoudis G. Case Report: Fremitus Nystagmus in Superior Canal Dehiscence Syndrome. Front Neurol 2022; 13:844687. [PMID: 35614919 PMCID: PMC9124807 DOI: 10.3389/fneur.2022.844687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/17/2022] [Indexed: 11/21/2022] Open
Abstract
Superior canal dehiscence syndrome (SCDS) is a structural bony defect of the roof of the superior semi-circular canal into the middle cranial fossa and is responsible for the creation of a third window, which alters the dynamics of the inner ear. During humming, vibratory waves entering the vestibulum and cochlea are re-routed through the dehiscence, leading to stimulation of the otolithic and ampullary vestibular organs. This is responsible for the torsional-vertical nystagmus known as “fremitus nystagmus”. In this case report, we video-document a rare case of fremitus nystagmus and its resolution after plugging of the superior semi-circular canal.
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Affiliation(s)
- Miranda Morrison
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and the University of Bern, Bern, Switzerland
| | - Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and the University of Bern, Bern, Switzerland
| | - Franca Wagner
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and the University of Bern, Bern, Switzerland
| | - Marco Domenico Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and the University of Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and the University of Bern, Bern, Switzerland
- *Correspondence: Georgios Mantokoudis
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Abstract
OBJECTIVES Clinicians performing a horizontal head impulse test (HIT) are looking for a corrective saccade. The detection of such saccades is a challenge. The aim of this study is to assess an expert's likelihood of detecting corrective saccades in subjects with vestibular hypofunction. DESIGN In a prospective cohort observational study at a tertiary referral hospital, we assessed 365 horizontal HITs performed clinically by an expert neurootologist from a convenience sample of seven patients with unilateral or bilateral deficient vestibulo-ocular reflex (VOR). All HITs were recorded simultaneously by video-oculography, as a gold standard. We evaluated saccades latency and amplitude, head velocity, and gain. RESULTS Saccade amplitude was statistically the most significant parameter for saccade detection (p < 0.001).The probability of saccade detection was eight times higher for HIT toward the pathological side (p = 0.029). In addition, an increase in saccade amplitude resulted in an increased probability of detection (odds ratio [OR] 1.77 [1.31 to 2.40] per degree, p < 0.001). The sensitivity to detect a saccade amplitude of 1 degree was 92.9% and specificity 79%. Saccade latency and VOR gain did not significantly influence the probability of the physician identifying a saccade (OR 1.02 [0.94 to 1.11] per 10-msec latency and OR 0.84 [0.60 to 1.17] per 0.1 VOR gain increase). CONCLUSIONS The saccade amplitude is the most important factor for accurate saccade detection in clinically performed head impulse tests. Contrary to current knowledge, saccade latency and VOR gain play a minor role in saccade detection.
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Affiliation(s)
- Athanasia Korda
- University Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - John Patrick Carey
- Department of Otorhinolaryngology, Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ewa Zamaro
- University Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Domenico Caversaccio
- University Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- University Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Mantokoudis G, Korda A, Zee DS, Zamaro E, Sauter TC, Wagner F, Caversaccio MD. Bruns' nystagmus revisited: A sign of stroke in patients with the acute vestibular syndrome. Eur J Neurol 2021; 28:2971-2979. [PMID: 34176187 PMCID: PMC8456911 DOI: 10.1111/ene.14997] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 06/24/2021] [Indexed: 11/29/2022]
Abstract
Objective Gaze‐evoked nystagmus (GEN) is a central sign in patients with the acute vestibular syndrome (AVS); however, discriminating between a pathological and a physiologic GEN is a challenge. Here we evaluate GEN in patients with AVS. Methods In this prospective cross‐sectional study, we used video‐oculography (VOG) to compare GEN in the light (target at 15° eccentric) in 64 healthy subjects with 47 patients seen in the emergency department (ED) who had AVS; 35 with vestibular neuritis and 12 with stroke. All patients with an initial non‐diagnostic MRI received a confirmatory, delayed MRI as a reference standard in detecting stroke. Results Healthy subjects with GEN had a time constant of centripetal drift >18 s. VOG identified pathologic GEN (time constant ≤ 18 s) in 33% of patients with vestibular strokes, specificity was 100%, accuracy was 83%. Results were equivalent to examination by a clinical expert. As expected, since all patients with GEN had a SN in straight‐ahead position, they showed the pattern of a Bruns’ nystagmus. Conclusions One third of patients with AVS due to central vestibular strokes had a spontaneous SN in straight‐ahead gaze and a pathological GEN, producing the pattern of a Bruns’ nystagmus with a shift of the null position. The localization of the side of the lesion based on the null was not consistent, presumably because the circuits underlying gaze‐holding are widespread in the brainstem and cerebellum. Nevertheless, automated quantification of GEN with VOG was specific, and accurately identified patients in the ED with AVS due to strokes.
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Affiliation(s)
- Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David S Zee
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ewa Zamaro
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas C Sauter
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Franca Wagner
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco D Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Morrison M, Korda A, Zamaro E, Wagner F, Caversaccio MD, Sauter TC, Kalla R, Mantokoudis G. Paradigm shift in acute dizziness: is caloric testing obsolete? J Neurol 2021; 269:853-860. [PMID: 34191079 PMCID: PMC8782777 DOI: 10.1007/s00415-021-10667-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 12/03/2022]
Abstract
Objective Cold and warm water ear irrigation, also known as bithermal caloric testing, has been considered for over 100 years the ‘Gold Standard’ for the detection of peripheral vestibular hypofunction. Its discovery was awarded a Nobel Prize. We aimed to investigate the diagnostic accuracy of Caloric Testing when compared to the video head impulse test (vHIT) in differentiating between vestibular neuritis and vestibular strokes in acute dizziness. Design Prospective cross-sectional study (convenience sample). Setting All patients presenting with signs of an acute vestibular syndrome at the emergency department of a tertiary referral center. Participants One thousand, six hundred seventy-seven patients were screened between February 2015 and May 2020 for Acute Vestibular Syndrome (AVS), of which 152 met the inclusion criteria and were enrolled. Inclusion criteria consisted of a state of continuous dizziness, associated with nausea or vomiting, head-motion intolerance, new gait or balance disturbance and nystagmus. Patients were excluded if they were younger than 18 years, if symptoms lasted < 24 h or if the index ED visit was > 72 h after symptom onset. Of the 152 included patients 85 completed testing. We assessed 58 vestibular neuritis and 27 stroke patients. Main outcome measures All patients underwent calorics and vHIT followed by a delayed MRI which served as a gold standard for vestibular stroke confirmation. Results The overall sensitivity and specificity for detecting stroke with a caloric asymmetry cut-off of 30.9% was 75% and 86.8%, respectively [negative likelihood ratio (NLR) 0.29] compared to 91.7% and 88.7% for vHIT (NLR 0.094). Best VOR gain cut-off was 0.685. Twenty-five percent of vestibular strokes were misclassified by calorics, 8% by vHIT. Conclusions Caloric testing proved to be less accurate than vHIT in discriminating stroke from vestibular neuritis in acute dizziness. Contrary to classic teaching, asymmetric caloric responses can also occur with vestibular strokes and might put the patient at risk for misdiagnosis. We, therefore, recommend to abandon caloric testing in current practice and to replace it with vHIT in the acute setting. Caloric testing has still its place as a diagnostic tool in an outpatient setting. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10667-7.
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Affiliation(s)
- Miranda Morrison
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, 3010, Bern, Switzerland
| | - Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, 3010, Bern, Switzerland
| | - Ewa Zamaro
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, 3010, Bern, Switzerland
| | - Franca Wagner
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Marco D Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, 3010, Bern, Switzerland
| | - Thomas C Sauter
- Department of Emergency Medicine, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Roger Kalla
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, 3010, Bern, Switzerland.
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Korda A, Zee DS, Wyss T, Zamaro E, Caversaccio MD, Wagner F, Kalla R, Mantokoudis G. Impaired fixation suppression of horizontal vestibular nystagmus during smooth pursuit: pathophysiology and clinical implications. Eur J Neurol 2021; 28:2614-2621. [PMID: 33983645 PMCID: PMC8362184 DOI: 10.1111/ene.14909] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 12/27/2022]
Abstract
Background and purpose A peripheral spontaneous nystagmus (SN) is typically enhanced or revealed by removing fixation. Conversely, failure of fixation suppression of SN is usually a sign of a central disorder. Based on Luebke and Robinson (Vision Res 1988, vol. 28 (8), pp. 941–946), who suggested that the normal fixation mechanism is disengaged during pursuit, it is hypothesized that vertical tracking in the light would bring out or enhance a horizontal SN. Methods Eighteen patients with acute vestibular neuritis were studied. Eye movements were recorded using video‐oculography at straight‐ahead gaze with and without visual fixation, and during smooth pursuit. The slow‐phase velocity and the fixation suppression indices of nystagmus (relative to SN in darkness) were compared in each condition. Results During vertical tracking, the slow‐phase velocity of horizontal SN with eyes near straight‐ahead gaze was significantly higher (median 2.7°/s) than under static visual fixation (median 1.2°/s). Likewise, the fixation index was significantly higher (worse suppression) during pursuit (median 48%) than during fixation (median 26%). A release of SN was also suggested during horizontal pursuit, if one assumes superposition of SN on a normal and symmetrical pursuit capability.
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Affiliation(s)
- Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - David S Zee
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas Wyss
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Ewa Zamaro
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Marco D Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Franca Wagner
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Roger Kalla
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
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Mantokoudis G, Wyss T, Zamaro E, Korda A, Wagner F, Sauter TC, Kerkeni H, Kalla R, Morrison M, Caversaccio MD. Stroke Prediction Based on the Spontaneous Nystagmus Suppression Test in Dizzy Patients: A Diagnostic Accuracy Study. Neurology 2021; 97:e42-e51. [PMID: 33986142 PMCID: PMC8312858 DOI: 10.1212/wnl.0000000000012176] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/26/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Failure of fixation suppression of spontaneous nystagmus is sometimes seen in patients with vestibular strokes involving the cerebellum or brainstem; however, the accuracy of this test for the discrimination between peripheral and central causes in patients with an acute vestibular syndrome (AVS) is unknown. METHODS Patients with AVS were screened and recruited (convenience sample) as part of a prospective cross-sectional study in the emergency department between 2015 and 2020. All patients received neuroimaging, which served as a reference standard. We recorded fixation suppression with video-oculography (VOG) for forward, right, and left gaze. The ocular fixation index (OFI) and the spontaneous nystagmus slow velocity reduction was calculated. RESULTS We screened 1,646 patients reporting dizziness in the emergency department and tested for spontaneous nystagmus in 148 patients with AVS. We analyzed 56 patients with a diagnosed acute unilateral vestibulopathy (vestibular neuritis) and 28 patients with a confirmed stroke. There was a complete nystagmus fixation suppression in 49.5% of patients with AVS, in 40% of patients with vestibular neuritis, and in 62.5% of patients with vestibular strokes. OFI scores had no predictive value for detecting strokes; however, a nystagmus reduction of less than 2 °/s showed a high accuracy of 76.9% (confidence interval 0.59-0.89) with a sensitivity of 62.2% and specificity of 84.8% in detecting strokes. CONCLUSIONS The presence of fixation suppression does not rule out a central lesion. The magnitude of suppression was lower compared to patients with vestibular neuritis. The nystagmus suppression test predicts vestibular strokes accurately provided that eye movements are recorded with VOG. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that in patients with an AVS, decreased fixation suppression recorded with VOG occurred more often in stroke (76.9%) than in vestibular neuritis (37.8%).
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Affiliation(s)
- Georgios Mantokoudis
- From the Department of Otorhinolaryngology, Head and Neck Surgery (G.M., T.W., E.Z., A.K., M.M., M.D.C.), University Institute of Diagnostic and Interventional Neuroradiology (F.W.), Department of Emergency Medicine (T.C.S.), and Department of Neurology (H.K., R.K.), Inselspital, University Hospital Bern and University of Bern, Switzerland.
| | - Thomas Wyss
- From the Department of Otorhinolaryngology, Head and Neck Surgery (G.M., T.W., E.Z., A.K., M.M., M.D.C.), University Institute of Diagnostic and Interventional Neuroradiology (F.W.), Department of Emergency Medicine (T.C.S.), and Department of Neurology (H.K., R.K.), Inselspital, University Hospital Bern and University of Bern, Switzerland
| | - Ewa Zamaro
- From the Department of Otorhinolaryngology, Head and Neck Surgery (G.M., T.W., E.Z., A.K., M.M., M.D.C.), University Institute of Diagnostic and Interventional Neuroradiology (F.W.), Department of Emergency Medicine (T.C.S.), and Department of Neurology (H.K., R.K.), Inselspital, University Hospital Bern and University of Bern, Switzerland
| | - Athanasia Korda
- From the Department of Otorhinolaryngology, Head and Neck Surgery (G.M., T.W., E.Z., A.K., M.M., M.D.C.), University Institute of Diagnostic and Interventional Neuroradiology (F.W.), Department of Emergency Medicine (T.C.S.), and Department of Neurology (H.K., R.K.), Inselspital, University Hospital Bern and University of Bern, Switzerland
| | - Franca Wagner
- From the Department of Otorhinolaryngology, Head and Neck Surgery (G.M., T.W., E.Z., A.K., M.M., M.D.C.), University Institute of Diagnostic and Interventional Neuroradiology (F.W.), Department of Emergency Medicine (T.C.S.), and Department of Neurology (H.K., R.K.), Inselspital, University Hospital Bern and University of Bern, Switzerland
| | - Thomas C Sauter
- From the Department of Otorhinolaryngology, Head and Neck Surgery (G.M., T.W., E.Z., A.K., M.M., M.D.C.), University Institute of Diagnostic and Interventional Neuroradiology (F.W.), Department of Emergency Medicine (T.C.S.), and Department of Neurology (H.K., R.K.), Inselspital, University Hospital Bern and University of Bern, Switzerland
| | - Hassen Kerkeni
- From the Department of Otorhinolaryngology, Head and Neck Surgery (G.M., T.W., E.Z., A.K., M.M., M.D.C.), University Institute of Diagnostic and Interventional Neuroradiology (F.W.), Department of Emergency Medicine (T.C.S.), and Department of Neurology (H.K., R.K.), Inselspital, University Hospital Bern and University of Bern, Switzerland
| | - Roger Kalla
- From the Department of Otorhinolaryngology, Head and Neck Surgery (G.M., T.W., E.Z., A.K., M.M., M.D.C.), University Institute of Diagnostic and Interventional Neuroradiology (F.W.), Department of Emergency Medicine (T.C.S.), and Department of Neurology (H.K., R.K.), Inselspital, University Hospital Bern and University of Bern, Switzerland
| | - Miranda Morrison
- From the Department of Otorhinolaryngology, Head and Neck Surgery (G.M., T.W., E.Z., A.K., M.M., M.D.C.), University Institute of Diagnostic and Interventional Neuroradiology (F.W.), Department of Emergency Medicine (T.C.S.), and Department of Neurology (H.K., R.K.), Inselspital, University Hospital Bern and University of Bern, Switzerland
| | - Marco Domenico Caversaccio
- From the Department of Otorhinolaryngology, Head and Neck Surgery (G.M., T.W., E.Z., A.K., M.M., M.D.C.), University Institute of Diagnostic and Interventional Neuroradiology (F.W.), Department of Emergency Medicine (T.C.S.), and Department of Neurology (H.K., R.K.), Inselspital, University Hospital Bern and University of Bern, Switzerland
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Gebhart I, Götting C, Hool SL, Morrison M, Korda A, Caversaccio M, Obrist D, Mantokoudis G. Sémont Maneuver for Benign Paroxysmal Positional Vertigo Treatment: Moving in the Correct Plane Matters. Otol Neurotol 2021; 42:e341-e347. [PMID: 33165161 PMCID: PMC7880166 DOI: 10.1097/mao.0000000000002992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS We aimed to investigate the effect of the head excursion angle on the success of the Sémont Maneuver (SM). BACKGROUND SM is performed with the head turned by 45 degrees toward the unaffected ear. In clinical routine, it is unlikely that physicians can turn the head to a position of exactly 45 degrees. Moreover, it is unclear how possible deviations from 45 degrees would affect the outcome with SM. METHODS We used an in vitro model (upscaled by ×5) of a posterior semicircular canal with canalithiasis to study head excursion angles (0-75 degrees) and minimum waiting times in SM. Additionally, we measured actual head excursion angles performed by trained physicians during SM on a healthy subject. RESULTS Successful canalith repositioning to the utricle was possible at head excursion angles between 21 and 67 degrees. Waiting time increased from 16 to 30 seconds with increasing deviation from 45 degrees. Angles larger than 67 degrees or smaller than 21 degrees did not lead to successful repositioning even after a waiting period of 5 minutes. Physicians set head excursion angles of 50 degrees ±SD 4.8 degrees while performing the SM. CONCLUSION Angular deviations up to ±20 degrees from the ideal SCC plane (45 degrees) still allows for successful SM. Although the tested physicians tended to underestimate the actual head excursion angle by 5 degrees (and more), the success of SM will not be affected provided that the waiting time is sufficiently long. Further, the results suggest that the Brandt-Daroff maneuver is a form of habituation training rather than a liberatory maneuver.
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Affiliation(s)
- Isabel Gebhart
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern
| | - Carina Götting
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern
| | - Sara-Lynn Hool
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern
| | - Miranda Morrison
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern
| | - Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern
| | - Marco Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern
| | - Dominik Obrist
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern
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Korda A, Sauter TC, Caversaccio MD, Mantokoudis G. Quantifying a Learning Curve for Video Head Impulse Test: Pitfalls and Pearls. Front Neurol 2021; 11:615651. [PMID: 33551973 PMCID: PMC7862580 DOI: 10.3389/fneur.2020.615651] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/29/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: The video head impulse test (vHIT) is nowadays a fast and objective method to measure vestibular function. However, its usability is controversial and often considered as a test performed by experts only. We sought to study the learning curve of novices and to document all possible mistakes and pitfalls in the process of learning. Methods: In a prospective cohort observational study, we included 10 novices. We tested their ability to perform correctly horizontal head impulses recorded with vHIT. We assessed vHITs in 10 sessions with 20 impulses per session giving a video instruction after the first session (S1) and individual feedback from an expert for session 2 (S2) up to session 10 (S10). We compared VOR gain, the HIT acceptance rate by the device algorithm, mean head velocity, acceleration, excursion, and overshoot between sessions. Results: A satisfying number of accepted HITs (80%) was reached after an experience of 160 vHITs. Mean head velocity between sessions was always in accepted limits. Head acceleration was too low at the beginning (S1) but improved significantly after the video instruction (p = 0.001). Mean head excursion and overshoot showed a significant improvement after 200 head impulses (p < 0.001 each). Conclusions: We showed that novices can learn to perform head impulses invHIT very fast provided that they receive instructions and feedback from an experienced examiner. Video instructions alone were not sufficient. The most common pitfall was a low head acceleration.
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Affiliation(s)
- Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Thomas C Sauter
- Department of Emergency Medicine, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Marco Domenico Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
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Lädrach C, Zee DS, Wyss T, Wimmer W, Korda A, Salmina C, Caversaccio MD, Mantokoudis G. Alexander's Law During High-Speed, Yaw-Axis Rotation: Adaptation or Saturation? Front Neurol 2020; 11:604502. [PMID: 33329363 PMCID: PMC7719745 DOI: 10.3389/fneur.2020.604502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/02/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: Alexander's law (AL) states the intensity of nystagmus increases when gaze is toward the direction of the quick phase. What might be its cause? A gaze-holding neural integrator (NI) that becomes imperfect as the result of an adaptive process, or saturation in the discharge of neurons in the vestibular nuclei? Methods: We induced nystagmus in normal subjects using a rapid chair acceleration around the yaw (vertical) axis to a constant velocity of 200°/second [s] and then, 90 s later, a sudden stop to induce post-rotatory nystagmus (PRN). Subjects alternated gaze every 2 s between flashing LEDs (right/left or up/down). We calculated the change in slow-phase velocity (ΔSPV) between right and left gaze when the lateral semicircular canals (SCC) were primarily stimulated (head upright) or, with the head tilted to the side, stimulating the vertical and lateral SCC together. Results: During PRN AL occurred for horizontal eye movements with the head upright and for both horizontal and vertical components of eye movements with the head tilted. AL was apparent within just a few seconds of the chair stopping when peak SPV of PRN was reached. When slow-phase velocity of PRN faded into the range of 6-18°/s AL could no longer be demonstrated. Conclusions: Our results support the idea that AL is produced by asymmetrical responses within the vestibular nuclei impairing the NI, and not by an adaptive response that develops over time. AL was related to the predicted plane of eye rotations in the orbit based on the pattern of SCC activation.
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Affiliation(s)
- Claudia Lädrach
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital Bern, Bern, Switzerland
| | - David S Zee
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Thomas Wyss
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital Bern, Bern, Switzerland
| | - Wilhelm Wimmer
- Hearing Research Laboratory, ARTORG Center, University of Bern, Bern, Switzerland
| | - Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital Bern, Bern, Switzerland
| | - Cinzia Salmina
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital Bern, Bern, Switzerland
| | - Marco D Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital Bern, Bern, Switzerland
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George A, Ajwani S, Bhole S, Dahlen HG, Reath J, Korda A, Ng Chok H, Miranda C, Villarosa A, Johnson M. Knowledge, attitude and practises of dentists towards oral health care during pregnancy: A cross sectional survey in New South Wales, Australia. Aust Dent J 2017; 62:301-310. [DOI: 10.1111/adj.12505] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2017] [Indexed: 01/23/2023]
Affiliation(s)
- A George
- Collaboration for Oral Health Outcomes, Research Translation and Evaluation (COHORTE) Research Group; Western Sydney University, South Western Sydney Local Health District, Ingham Institute Applied Medical Research, University of Sydney; Liverpool New South Wales Australia
| | - S Ajwani
- Sydney Local Health District Oral Health Services, Sydney Dental Hospital, University of Sydney; Sydney New South Wales Australia
| | - S Bhole
- Sydney Local Health District Oral Health Services, Sydney Dental Hospital/University of Sydney; Sydney New South Wales Australia
| | - HG Dahlen
- School of Nursing and Midwifery; Western Sydney University/Ingham Institute Applied Medical Research; Parramatta New South Wales Australia
| | - J Reath
- Peter Brennan Chair of General Practice, School of Medicine, Western Sydney University; Campbelltown New South Wales Australia
| | - A Korda
- Obstetrics and Gynaecology, School of Medicine, Western Sydney University; Campbelltown New South Wales Australia
| | - H Ng Chok
- Centre for Nursing Research and Practice Development; Western Sydney University/Nepean Blue Mountains Local Health District; Penrith New South Wales Australia
| | - C Miranda
- College of Professional Psychology; Crows Nest New South Wales Australia
| | - A Villarosa
- COHORTE Research Group; Western Sydney University/South Western Sydney Local Health District/Ingham Institute Applied Medical Research; Liverpool New South Wales Australia
| | - M Johnson
- Faculty of Health Sciences; Australian Catholic University, Ingham Institute Applied Medical Research; Sydney New South Wales Australia
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Garcia-Martinez V, Lopez Sanchez C, Hamed W, Hamed W, Hsu JH, Ferrer-Lorente R, Alshamrani M, Pizzicannella J, Vindis C, Badi I, Korte L, Voellenkle C, Niculescu LS, Massaro M, Babaeva AR, Da Silva F, Woudstra L, Berezin A, Bae MK, Del Giudice C, Bageghni SA, Krobert K, Levay M, Vignier N, Ranieri A, Magenta A, Orlandi A, Porro B, Jeon ES, Omori Y, Herold J, Barnett GA, Grochot-Przeczek A, Korpisalo P, Deffge C, Margariti A, Rong W, Maring JA, Gambardella J, Mitrofan CG, Karpinska O, Morbidelli L, Wilkinson FL, Berezin A, Kostina AS, De Mey JGR, Kumar A, Lupieri A, Pellet-Many C, Stamatiou R, Gromotowicz A, Dickhout A, Murina M, Roka-Moiia YM, Malinova L, Diaz-Canestro C, Vigliarolo T, Cuzzocrea S, Szantai A, Medic B, Cassambai S, Korda A, Revnic CR, Borile G, Diokmetzidou A, Murfitt L, Budko A, Fiordelisi A, De Wijs-Meijler DPM, Gevaert AB, Noriega De La Colina A, Benes J, Guillermo Solache Berrocal GSB, Gafarov V, Zhebel VM, Prakaschandra R, Stepien EL, Smith LE, Carluccio MA, Timasheva Y, Paci M, Dorofeyeva NA, Chimed CH, Petelina TI, Sorop O, Genis A, Parepa IR, Tscharre M, Krestjyaninov MV, Maia-Rocha C, Borges L, Sasonko ML, Kapel SS, Stam K, Sommariva E, Stojkovic S, O'reilly J, Chiva-Blanch G, Malinova L, Evtushenko A, Skopal J, Sunderland N, Gegenava T, Charnaia MA, Di Lascio N, Tarvainen SJ, Malandraki-Miller S, Uitterdijk A, Benzoni P, Ruivo E, Humphrey EJ, Arokiaraj MC, Franco D, Garcia-Lopez V, Aranega A, Lopez-Sanchez C, Franco D, Garcia-Lopez V, Aranega A, Garcia-Martinez V, Tayel S, Khader H, El-Helbawy N, Tayel S, Alrefai A, El-Barbary H, Wu JR, Dai ZK, Yeh JL, Sanjurjo-Rodriguez C, Richaud-Patin Y, Blanco FJ, Badimon L, Raya A, Cahill PA, Diomede F, Merciaro I, Trubiani O, Nahapetyan H, Swiader A, Faccini J, Boya P, Elbaz M, Zeni F, Burba I, Bertolotti M, Capogrossi MC, Pompilio G, Raucci A, Widmer-Teske R, Dutzmann J, Bauersachs J, Donde K, Daniel JM, Sedding DG, Simionescu N, Sanda GM, Carnuta MG, Stancu CS, Popescu AC, Popescu MR, Vlad A, Dimulescu DR, Sima AV, Scoditti E, Pellegrino M, Calabriso N, Carluccio MA, Storelli C, De Caterina R, Solodenkova KS, Kalinina EV, Usachiova MN, Lappalainen J, Lee-Rueckert MDEC, Kovanen PT, Biesbroek PS, Emmens RWE, Van Rossum AC, Juffermans LJM, Niessen JWM, Krijnen PAJ, Kremzer A, Samura T, Berezina T, Gronenko E, Kim MK, Park HJ, Bae SK, Sorriento D, Ciccarelli M, Vernieri E, Campiglia P, Trimarco B, Iaccarino G, Hemmings KE, Porter KE, Ainscough JF, Drinkhill MJ, Turner NA, Hiis HG, Cosson MV, Levy FO, Wieland T, Macquart C, Chatzifrangkeskou M, Evans A, Bonne G, Muchir A, Kemp E, Avkiran M, Carlomosti F, D'agostino M, Beji S, Zaccagnini G, Maimone B, Di Stefano V, De Santa F, Cordisco S, Antonini A, Ciarapica R, Dellambra E, Martelli F, Avitabile D, Capogrossi MC, Scioli MG, Bielli A, Agostinelli S, Tarquini C, Tarallo V, De Falco S, Zaninoni A, Fiorelli S, Bianchi P, Teruzzi G, Squellerio I, Turnu L, Lualdi A, Tremoli E, Cavalca V, Lee YJ, Ju ES, Choi JO, Lee GY, Lim BK, Manickam MANOJ, Jung SH, Omiya S, Otsu K, Deffge C, Nowak S, Wagner M, Braun-Dullaeus RC, Kostin S, Daniel JM, Francke A, Subramaniam S, Kanse SM, Al-Lamee K, Schofield CJ, Egginton S, Gershlick AH, Kloska D, Kopacz A, Augustyniak A, Dulak J, Jozkowicz A, Hytonen J, Halonen P, Taavitsainen J, Tarvainen S, Hiltunen T, Liimatainen T, Kalliokoski K, Knuuti J, Yla-Herttuala S, Wagner M, Weinert S, Isermann B, Lee J, Braun-Dullaeus RC, Herold J, Cochrane A, Kelaini S, Bojdo J, Vila Gonzalez M, Hu Y, Grieve D, Stitt AW, Zeng L, Xu Q, Margariti A, Reglin B, Xiang W, Nitzsche B, Maibier M, Pries AR, Vrijsen KR, Chamuleau SAJ, Verhage V, Metz CHG, Lodder K, Van Eeuwijk ECM, Van Dommelen SM, Doevendans PA, Smits AM, Goumans MJ, Sluijter JPG, Sorriento D, Bova M, Loffredo S, Trimarco B, Iaccarino G, Ciccarelli M, Appleby S, Morrell N, Baranowska-Kuczko M, Kloza M, Ambrozewicz E, Kozlowski M, Malinowska B, Kozlowska H, Monti M, Terzuoli E, Ziche M, Mahmoud AM, Jones AM, Wilkinson JA, Romero M, Duarte J, Alexander MY, Kremzer A, Berezina T, Gronenko E, Faggian G, Kostareva AA, Malashicheva AB, Leurgans TM, Nguyen TN, Irmukhamedov A, Riber LP, Mcgeogh R, Comer S, Blanco Fernandez A, Ghigo A, Blaise R, Smirnova NF, Malet N, Vincent P, Limon I, Gayral S, Hirsch E, Laffargue M, Mehta V, Zachary I, Aidonidis I, Kramkowski K, Miltyk W, Kolodziejczyk P, Gradzka A, Szemraj J, Chabielska E, Dijkgraaf I, Bitsch N, Van Hoof S, Verhaegen F, Koenen R, Hackeng TM, Roshchupkin DI, Buravleva KV, Sergienko VI, Zhernossekov DD, Rybachuk VM, Grinenko TV, Furman N, Dolotovskaya P, Shamyunov M, Denisova T, Reiner M, Akhmedov A, Keller S, Miranda M, Briand S, Barile L, Kullak-Ublick G, Luscher T, Camici G, Guida L, Magnone M, Ameri P, Lazzarini E, Fresia C, Bruzzone S, Zocchi E, Di Paola R, Cordaro M, Crupi R, Siracusa R, Campolo M, Bruschetta G, Fusco R, Pugliatti P, Esposito E, Paloczi J, Ruivo E, Gaspar R, Dinnyes A, Kobolak J, Ferdinandy P, Gorbe A, Todorovic Z, Krstic D, Savic Vujovic K, Jovicic D, Basta Jovanovic G, Radojevic Skodric S, Prostran M, Dean S, Mee CJ, Harvey KL, Hussain A, Pena C, Paltineanu B, Voinea S, Revnic F, Ginghina C, Zaglia T, Ceriotti P, Campo A, Carullo P, Armani A, Coppini R, Vida V, Olivotto I, Stellin G, Rizzuto R, De Stefani D, Sandri M, Catalucci D, Mongillo M, Soumaka E, Kloukina I, Tsikitis M, Makridakis M, Varela A, Davos C, Vlachou A, Capetanaki Y, Iqbal MM, Bennett H, Davenport B, Pinali C, Cooper G, Cartwright E, Kitmitto A, Strutynska NA, Mys LA, Sagach VF, Franco A, Sorriento D, Trimarco B, Iaccarino G, Ciccarelli M, Verzijl A, Stam K, Van Duin R, Reiss IKM, Duncker DJ, Merkus D, Shakeri H, Orije M, Leloup AJ, Van Hove CE, Van Craenenbroeck EM, De Meyer GRY, Vrints CJ, Lemmens K, Desjardins-Creapeau L, Wu R, Lamarre-Cliche M, Larochelle P, Bherer L, Girouard H, Melenovsky M, Kvasilova A, Benes J, Ruskova K, Sedmera D, Ana Barral ABV, Martin Fernandez M, Pablo Roman Garcia PRG, Juan Carlos Llosa JCLL, Manuel Naves Diaz MND, Cesar Moris CM, Jorge B Cannata-Andia JBCA, Isabel Rodriguez IR, Voevoda M, Gromova E, Maximov V, Panov D, Gagulin I, Gafarova A, Palahniuk H, Pashkova IP, Zhebel NV, Starzhynska OL, Naidoo DP, Rawojc K, Enguita FJ, Grudzien G, Cordwell SJ, White MY, Massaro M, Scoditti E, Calabriso N, Pellegrino M, Martinelli R, Gatta V, De Caterina R, Nasibullin TR, Erdman VV, Tuktarova IA, Mustafina OE, Hyttinen J, Severi S, Vorobyov GG, Sagach VF, Batmyagmar KH, Lkhagvasuren Z, Gapon LI, Musikhina NA, Avdeeva KS, Dyachkov SM, Heinonen I, Van Kranenburg M, De Beer VJ, Octavia Y, Van Geuns RJ, Van Den Meiracker AH, Van Der Velden J, Merkus D, Duncker DJ, Everson FP, Ogundipe T, Grandjean T, De Boever P, Goswami N, Strijdom H, Suceveanu AI, Suceveanu AP, Mazilu L, Tofoleanu DE, Catrinoiu D, Rohla M, Hauser C, Huber K, Wojta H, Weiss TW, Melnikova MA, Olezov NV, Gimaev RH, Khalaf H, Ruzov VI, Adao R, Mendes-Ferreira P, Santos-Ribeiro D, Rademaker M, Leite-Moreira AF, Bras-Silva C, Alvarenga LAA, Falcao RSP, Dias RR, Lacchini S, Gutierrez PS, Michel JB, Gurfinkel YUI, Atkov OYU, Teichert M, Korn C, Mogler C, Hertel S, Arnold C, Korff T, Augustin HG, Van Duin RWB, De Wijs-Meijler DPM, Verzijl A, Duncker DJ, Merkus D, D'alessandra Y, Farina FM, Casella M, Catto V, Carbucicchio C, Dello Russso A, Stadiotti I, Brambilla S, Chiesa M, Giacca M, Colombo GI, Pompilio G, Tondo C, Ahlin F, Andric T, Tihanyi D, Wojta J, Huber K, O'connell E, Butt A, Murphy L, Pennington S, Ledwidge M, Mcdonald K, Baugh J, Watson C, Suades R, Crespo J, Estruch R, Badimon L, Dyachenko A, Ryabukho V, Evtushenko V, Saushkina YU, Lishmanov YU, Smyshlyaev K, Bykov A, Popov S, Pavlyukova E, Anfinogenova Y, Szigetfu E, Kapornai B, Forizs E, Jenei ZS, Nagy Z, Merkely B, Zima E, Cai A, Dworakowski R, Gibbs T, Piper S, Jegard N, Mcdonagh T, Gegenava M, Dementieva II, Morozov YUA, Barsanti C, Stea F, Lenzarini F, Kusmic C, Faita F, Halonen PJ, Puhakka PH, Hytonen JP, Taavitsainen JM, Yla-Herttuala S, Supit EA, Carr CA, Groenendijk BCW, Gorsse-Bakker C, Panasewicz A, Sneep S, Tempel D, Van Der Giessen WJ, Duncker DJ, Rys J, Daraio C, Dell'era P, Paloczi J, Pigler J, Eder A, Ferdinandy P, Eschenhagen T, Gorbe A, Mazo MM, Amdursky N, Peters NS, Stevens MM, Terracciano CM. Poster session 2Morphogenetic mechanisms290MiR-133 regulates retinoic acid pathway during early cardiac chamber specification291Bmp2 regulates atrial differentiation through miR-130 during early heart looping formationDevelopmental genetics294Association of deletion allele of insertion/deletion polymorphism in alpha 2B adrenoceptor gene and hypertension with or without type 2 diabetes mellitus295Association of G1359A polymorphism of the endocannabinoid type 1 receptor (CNR1) with coronary artery disease (CAD) with type 2 diabetes mellitusCell growth, differentiation and stem cells - Vascular298Gamma-secretase inhibitor prevents proliferation and migration of ductus arteriosus smooth muscle cells: a role of Notch signaling in postnatal closure of ductus arteriosus299Mesenchymal stromal-like cells (MLCs) derived from induced pluripotent stem (iPS) cells: a promising therapeutic option to promote neovascularization300Sonic Hedgehog promotes mesenchymal stem cell differentiation to vascular smooth muscle cells in cardiovacsular disease301Proinflammatory cytokine secretion and epigenetic modification in endothelial cells treated LPS-GinfivalisCell death and apoptosis - Vascular304Mitophagy acts as a safeguard mechanism against human vascular smooth muscle cell apoptosis induced by atherogenic lipidsTranscriptional control and RNA species - Vascular307MicroRNA-34a role in vascular calcification308Local delivery of a miR-146a inhibitor utilizing a clinically applicable approach attenuates neointima formation after vascular injury309Long noncoding RNA landscape of hypoxic endothelial cells310Specific circulating microRNAs levels associate with hypertension, hyperglycemia and dysfunctional HDL in acute coronary syndrome patientsCytokines and cellular inflammation - Vascular313Phosphodiesterase5A up-regulation in vascular endothelium under pro-inflammatory conditions: a newly disclosed anti-inflammatory activity for the omega-3polyunsaturated aatty acid docosahexaenoic acid314Cardiovascular risk modifying with extra-low dose anticytokine drugs in rhematoid arthritis315Conversion of human M-CSF macrophages into foam cells reduces their proinflammatory responses to classical M1-polarizing activation316Lymphocytic myocarditis coincides with increased plaque inflammation and plaque hemorrhage in coronary arteries, facilitating myocardial infarction317Serum osteoprotegerin level predictsdeclined numerous of circulating endothelial- derived and mononuclear-derived progenitor cells in patients with metabolic syndromeGrowth factors and neurohormones - Vascular320Effect of gastrin-releasing peptide (GRP) on vascular inflammationSignal transduction - Heart323A new synthetic peptide regulates hypertrophy in vitro through means of the inhibition of nfkb324Inducible fibroblast-specific knockout of p38 alpha map kinase is cardioprotective in a mouse model of isoproterenol-induced cardiac hypertrophy325Regulation of beta-adrenoceptor-evoked inotropic responses by inhibitory G protein, adenylyl cyclase isoforms 5 and 6 and phosphodiesterases326Binding to RGS3 and stimulation of M2 muscarinic acetylcholine receptors modulates the substrate specificity of p190RhoGAP in cardiac myocytes327Cardiac regulation of post-translational modifications, parylation and deacetylation in LMNA dilated cardiomyopathy mouse model328Beta-adrenergic regulation of the b56delta/pp2a holoenzyme in cardiac myocytes through b56delta phosphorylation at serine 573Nitric oxide and reactive oxygen species - Vascular331Oxidative stress-induced miR-200c disrupts the regulatory loop among SIRT1, FOXO1 and eNOS332Antioxidant therapy prevents oxidative stress-induced endothelial dysfunction and Enhances Wound Healing333Morphological and biochemical characterization of red blood cell in coronary artery diseaseCytoskeleton and mechanotransduction - Heart336Novel myosin activator, JSH compounds, increased myocardial contractility without chronotropic effect in ratsExtracellular matrix and fibrosis - Vascular339Ablation of Toll-like receptor 9 causes cardiac rupture after myocardial infarction by attenuating proliferation and differentiation of cardiac fibroblasts340Altered vascular remodeling in the mouse hind limb ischemia model in Factor VII activating protease (FSAP) deficiencyVasculogenesis, angiogenesis and arteriogenesis343Pro-angiogenic effects of proly-hydroxylase inhibitors and their potential for use in a novel strategy of therapeutic angiogenesis for coronary total occlusion344Nrf2 drives angiogenesis in transcription-independent manner: new function of the master regulator of oxidative stress response345Angiogenic gene therapy, despite efficient vascular growth, is not able to improve muscle function in normoxic or chronically ischemic rabbit hindlimbs -role of capillary arterialization and shunting346Effect of PAR-1 inhibition on collateral vessel growth in the murine hind limb model347Quaking is a key regulator of endothelial cell differentiation, neovascularization and angiogenesis348"Emerging angiogenesis" in the chick chorioallantoic membrane (CAM). An in vivo study349Exosomes from cardiomyocyte progenitor cells and mesenchymal stem cells stimulate angiogenesis in vitro and in vivo via EMMPRINEndothelium352Reciprocal regulation of GRK2 and bradykinin receptor stimulation modulate Ca2+ intracellular level in endothelial cells353The roles of bone morphogenetic proteins 9 and 10 in endothelial inflammation and atherosclerosis354The contribution of GPR55 to the L-alpha-lysophosphatidylinositol-induced vasorelaxation in isolated human pulmonary arteries355The endothelial protective ACE inhibitor Zofenoprilat exerts anti-inflammatory activities through H2S production356A new class of glycomimetic drugs to prevent free fatty acid-induced endothelial dysfunction357Endothelial progenitor cells to apoptotic endothelial cell-derived microparticles ration differentiatesas preserved from reduced ejection fractionheart failure358Proosteogenic genes are activated in endothelial cells of patients with thoracic aortic aneurysm359Endothelin ETB receptors mediate relaxing responses to insulin in pericardial resistance arteries from patients with cardiovascular disease (CVD)Smooth muscle and pericytes362CX3CR1 positive myeloid cells regulate vascular smooth muscle tone by inducing calcium oscillations via activation of IP3 receptors363A novel function of PI3Kg on cAMP regulation, role in arterial wall hyperplasia through modulation of smooth muscle cells proliferation364NRP1 and NRP2 play important roles in the development of neointimal hyperplasia in vivo365Azithromycin induces autophagy in aortic smooth muscle cellsCoagulation, thrombosis and platelets368The real time in vivo evaluation of platelet-dependent aldosterone prothrombotic action in mice369Development of a method for in vivo detection of active thrombi in mice370The antiplatelet effects of structural analogs of the taurine chloramine371The influence of heparin anticoagulant drugs on functional state of human platelets372Regulation of platelet aggregation and adenosine diphosphate release by d dimer in acute coronary syndrome (in vitro study)Oxygen sensing, ischaemia and reperfusion375Sirtuin 5 mediates brain injury in a mouse model of cerebral ischemia-reperfusion376Abscisic acid: a new player in cardiomyocyte protection from ischaemia?377Protective effects of ultramicronized palmitoylethanolamide (PEA-um) in myocardial ischaemia and reperfusion injury in vivo378Identification of stem cell-derived cardiomyocytes using cardiac specific markers and additional testing of these cells in simulated ischemia/reperfusion system379Single-dose intravenous metformin treatment could afford significant protection of the injured rat kidney in an experimental model of ischemia-reperfusion380Cardiotoxicity of long acting muscarinic receptor antagonists used for chronic obstructive pulmonary disease381Dependence antioxidant potential on the concentration of amino acids382The impact of ischemia-reperfusion on physiological parameters,apoptosis and ultrastructure of rabbit myocardium with experimental aterosclerosisMitochondria and energetics385MicroRNA-1 dependent regulation of mitochondrial calcium uniporter (MCU) in normal and hypertrophied hearts386Mitochondrial homeostasis and cardioprotection: common targets for desmin and aB-crystallin387Overexpression of mitofusin-2 (Mfn2) and associated mitochondrial dysfunction in the diabetic heart388NO-dependent prevention of permeability transition pore (MPTP) opening by H2S and its regulation of Ca2+ accumulation in rat heart mitochondria389G protein coupled receptor kinase 2 (GRK2) is fundamental in recovering mitochondrial morphology and function after exposure to ionizing radiation (IR)Gender issues392Sex differences in pulmonary vascular control; focus on the nitric oxide pathwayAging395Heart failure with preserved ejection fraction develops when feeding western diet to senescence-accelerated mice396Cardiovascular markers as predictors of cognitive decline in elderly hypertensive patients397Changes in connexin43 in old rats with volume overload chronic heart failureGenetics and epigenetics400Calcium content in the aortic valve is associated with 1G>2G matrix metalloproteinase 1 polymorphism401Neuropeptide receptor gene s (NPSR1) polymorphism and sleep disturbances402Endothelin-1 gene Lys198Asn polymorphism in men with essential hypertension complicated and uncomplicated with chronic heart failure403Association of common polymorphisms of the lipoprotein lipase and pon1 genes with the metabolic syndrome in a sample of community participantsGenomics, proteomics, metabolomics, lipidomics and glycomics405Gene expression quantification using multiplexed color-coded probe pairs to determine RNA content in sporadic cardiac myxoma406Large-scale phosphorylation study of the type 2 diabetic heart subjected to ischemia / reperfusion injury407Transcriptome-based identification of new anti-inflammatory properties of the olive oil hydroxytyrosol in vascular endothelial cell under basal and proinflammatory conditions408Gene polymorphisms combinations and risk of myocardial infarctionComputer modelling, bioinformatics and big data411Comparison of the repolarization reserve in three state-of-the-art models of the human ventricular action potentialMetabolism, diabetes mellitus and obesity414Endothelial monocyte-activating polypeptide-II improves heart function in type -I Diabetes mellitus415Admission glucose level is independent predictor of impaired left ventricular function in patients with acute myocardial infarction: a two dimensional speckle-tracking echocardiography study416Association between biochemical markers of lipid profile and inflammatory reaction and stiffness of the vascular wall in hypertensive patients with abdominal obesity417Multiple common co-morbidities produce left ventricular diastolic dysfunction associated with coronary microvascular dysfunction, oxidative stress and myocardial stiffening418Investigating the cardiovascular effects of antiretroviral drugs in a lean and high fat/sucrose diet rat model of obesity419Statins in the treatment of non-alcoholic steatohepatitis (NASH). Our experience from a 2-year prospective study in Constanta County, Romania420Epicardial adipose tissue as a predictor of cardiovascular outcome in patients with ACS undergoing PCI?Arterial and pulmonary hypertension423Dependence between heart rhythm disorers and ID polymorphism of ACE gene in hypertensive patients424Molecular mechanisms underlying the beneficial effects of Urocortin 2 in pulmonary arterial hypertension425Inhibition of TGf-b axis and action of renin-angiotensin system in human ascending aorta aneurysms426Early signs of microcirculation and macrocirculation abnormalities in prehypertension427Vascular smooth muscle cell-expressed Tie-2 controls vascular tone428Cardiac and vascular remodelling in the development of chronic thrombo-embolic pulmonary hypertension in a novel swine modelBiomarkers431Arrhythmogenic cardiomyopathy: a new, non invasive biomarker432Can circulating microRNAs distinguish type 1 and type 2 myocardial infarction?433Design of a high-throughput multiplex proteomics assay to identify left ventricular diastolic dysfunction in diabetes434Monocyte-derived and P-selectin-carrying microparticles are differently modified by a low fat diet in patients with cardiovascular risk factors who will and who will not develop a cardiovascular event435Red blood cell distribution width assessment by polychromatic interference microscopy of thin films in chronic heart failure436Invasive and noninvasive evaluation of quality of radiofrequency-induced cardiac denervation in patients with atrial fibrillation437The effect of therapeutic hypothermia on the level of brain derived neurotrophic factor (BDNF) in sera following cardiopulmonary resustitation438Novel biomarkers to predict outcome in patients with heart failure and severe aortic stenosis439Biological factors linking depression and anxiety to cardiovascular disease440Troponins and myoglobin dynamic at coronary arteries graftingInvasive, non-invasive and molecular imaging443Diet composition effects on the genetic typing of the mouse ob mutation: a micro-ultrasound characterization of cardiac function, macro and micro circulation and liver steatosis444Characterization of pig coronary and rabbit aortic lesions using IV-OCT quantitative analysis: correlations with histologyGene therapy and cell therapy447Enhancing the survival and angiogenic potential of mouse atrial mesenchymal cells448VCAM-1 expression in experimental myocardial infarction and its relation to bone marrow-derived mononuclear cell retentionTissue engineering451Advanced multi layered scaffold that increases the maturity of stem cell-derived human cardiomyocytes452Response of engineered heart tissue to simulated ischemia/reperfusion in the presence of acute hyperglycemic conditions453Serum albumin hydrogels prevent de-differentiation of neonatal cardiomyocytes454A novel paintbrush technique for transfer of low viscosity ultraviolet light curable cyan methacrylate on saline immersed in-vitro sheep heart. Cardiovasc Res 2016. [DOI: 10.1093/cvr/cvw149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tooher J, Thornton C, Makris A, Korda A, Ogle R, Horvath J, Hennessy A. PP102. Hypertension in pregnancy and long term cardiovascular mortality outcomes. Pregnancy Hypertens 2012; 2:295. [DOI: 10.1016/j.preghy.2012.04.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Tooher J, Chiu C, Thornton C, Lupton S, O’Loughlin A, Makris A, Hennessy A, Lind J, Korda A, Ogle R, Horvath J. PP033. High blood pressure in pregnancy: an indicator of future health outcomes. Pregnancy Hypertens 2012; 2:260. [DOI: 10.1016/j.preghy.2012.04.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Korda A, Wróbel Z, Gwardiak K. An efficient route from trifluoroacetates to water soluble free amines using Diaion HP-20. Amino Acids 2005; 30:95-8. [PMID: 16049641 DOI: 10.1007/s00726-005-0228-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Accepted: 05/28/2005] [Indexed: 11/29/2022]
Abstract
A series of polybasic lysine and ornithine derivatives were synthesised as trifluoroacetate salts. Attempts to prepare their free amines according to standard methodology were not successful due to the excellent water solubility of these compounds. Free amines were however efficiently obtained if the column with Diaion HP-20 adsorbent was loaded with the trifluoroacetate and 1% NaHCO(3) aq was passed, followed by elution of free amine with methanol.
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Affiliation(s)
- A Korda
- Institute of Organic Chemistry, Polish Academy of Sciences, Warsaw, Poland.
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Korda A, Guns P, Crauwels H, Hove C, Holvoet P, Bult H. Abstract no.: 6 Endothelium-dependent relaxation by purinergic receptors in the aorta of apolipoprotein E-deficient mice. Fundam Clin Pharmacol 2005. [DOI: 10.1111/j.1472-8206.2004.00286_6.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Manning J, Korda A, Benness C, Solomon M. The association of obstructive defecation, lower urinary tract dysfunction and the benign joint hypermobility syndrome: a case-control study. Int Urogynecol J 2003; 14:128-32. [PMID: 12851757 DOI: 10.1007/s00192-002-1025-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2001] [Accepted: 12/14/2002] [Indexed: 11/25/2022]
Abstract
It has been suggested that, apart from obstetric trauma, chronic straining at stool may also result in pudendal nerve damage, contributing to the etiology of genuine stress incontinence (GSI). The benign joint hypermobility syndrome (BJHS) has been associated with rectal as well as uterovaginal prolapse, suggesting that connective tissue abnormalities may also be implicated. This study was undertaken in order to further investigate whether - and if so, why - an association may exist between symptoms of obstructive defecation, lifetime constipation, chronic heavy lifting and lower urinary tract (LUT) dysfunction. Cases were female patients referred for urodynamic assessment with symptoms of LUT dysfunction. Controls were age-, sex- and postcode-matched community controls. Both cases and controls were assessed using a detailed questionnaire that also asked about symptoms of BJHS. Cases were also divided into their urodynamic classification of LUT dysfunction. All symptoms of obstructive defecation (52.3% vs 33.6%, P=0.00003), as well as chronic straining at stool (38.6% vs 23.4%, P=0.0005), were significantly more common in women with LUT dysfunction than in community controls. BJHS, chronic heavy lifting and a history of uterovaginal prolapse were significantly associated with patients with LUT and obstructive defecation compared to those with LUT dysfunction alone. Overall, symptoms of obstructed defecation were not more prevalent in any one urodynamic diagnostic group than in others. However, childhood constipation and current constipation were significantly more prevalent in women with voiding dysfunction than in those with other urodynamic diagnoses (16.7% vs 5.5%, P = 0.0030 and 13.0% vs 5.7%, P = 0.017). We concluded that women with LUT dysfunction are more likely to have symptoms of obstructive defecation than are community controls. Connective tissue disorders such as BJHS may be an important factor in this association.
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Affiliation(s)
- J Manning
- Urogynaecology Unit, Royal Prince Alfred Hospital, Australia
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Abstract
BACKGROUND Urinary and fecal incontinence in females are both common and distressing conditions. Because common pathophysiologic mechanisms have been described, an association between the two would be expected. The aim of this study was to determine whether patients with lower urinary tract dysfunction have concomitant fecal incontinence when compared with age and gender matched community controls and, second, to determine whether they have predisposing factors that have led to lower urinary tract symptoms and concomitant fecal incontinence. METHODS A case-control study was performed by means of detailed questionnaire and review of investigation results. One thousand consecutive females presenting for urodynamic investigation of lower urinary tract dysfunction, were compared with 148 age and gender matched community controls. RESULTS Frequent fecal incontinence was significantly more prevalent among all cases than among community controls (5 vs. 0.72 percent, P = 0.023). Occasional fecal incontinence was also more prevalent (24.6 vs. 8.4 percent, P < 0.001). Fecal incontinence was not significantly more prevalent among females with genuine stress incontinence (5.1 percent) when compared with females with detrusor instability (3.8 percent) or any other urodynamic diagnosis. Symptoms of fecal urgency and fecal urge incontinence were significantly more prevalent among those with a urodynamic diagnosis of detrusor instability or sensory urgency than among females with other urodynamic diagnoses or community controls. Multivariate analysis comparing cases with fecal incontinence with other cases and also with community controls did not indicate that individual obstetric factors contributed significantly to the occurrence of fecal incontinence in these patients. CONCLUSIONS There is an association between genuine stress incontinence, lower urinary tract dysfunction, and symptoms of fecal incontinence, but the exact mechanism of injury related to childbirth trauma is questioned.
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Affiliation(s)
- J Manning
- Urogynaecology Unit, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
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Abstract
Our aim was to evaluate a new minimally invasive device for the treatment of genuine stress incontinence in women by both objective and subjective measures of outcome. Fifteen women with Type I or Type II urinary stress incontinence were treated with a new per vaginal bone anchor device designed to fix periurethral tissues to the pubic bone. No patients had significant operative morbidity. After 6-13 months a follow-up questionnaire and repeat urodynamic testing was performed for all the women. Subjectively 73% of patients had improvement in symptoms and on urodynamic testing 53% of patients were cured.
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Affiliation(s)
- A MacGibbon
- Department of Gynaecology and Urogynaecology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Szászi K, Korda A, Wölfl J, Paclet MH, Morel F, Ligeti E. Possible role of RAC-GTPase-activating protein in the termination of superoxide production in phagocytic cells. Free Radic Biol Med 1999; 27:764-72. [PMID: 10515580 DOI: 10.1016/s0891-5849(99)00126-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The mechanism leading to the termination of superoxide production of phagocytes is poorly understood. The aim of the present study was to investigate the involvement of the active (GTP-bound) form of the GTP-binding proteins in maintaining continuous electron transport through the reduced nicotinamide adenine dinucleotide phosphate (NADPH) oxidase complex. Activation of the enzyme was carried out under in vitro conditions and a shift from the active to the inactive form of the GTP-binding protein was attained (i) by addition of an excess of GDP to the assembled enzyme complex or (ii) by variation of the Rac-GTPase activating (Rac-GAP) capacity of the constituents of the cell-free system. Significant inhibition of O2*- production was observed when guanine dinucleotides were added after the assembly of the active enzyme complex. The effect was specific for GDP and GDP,S whereas ADP, CDP and UDP were ineffective. GTP was significantly less efficient in inducing superoxide production in a cell-free system containing endogenous GAP activity than in a system devoid of GAP activity. It is suggested that the active, GTP-bound form of Rac is required for sustained catalytic function and Rac-GAP proteins are involved in the downregulation of the oxidase.
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Affiliation(s)
- K Szászi
- Department of Physiology, Semmelweis University of Medicine, Budapest, Hungary
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Abstract
The efficacy of a series of dinitroaniline herbicide derivatives for the treatment of Cryptosporidium parvum infections has been studied. The lead compounds oryzalin (compound 1) and trifluralin (compound 2) have low water solubility (<3 ppm) which was alleged to be a major contributor to their poor pharmacokinetic availability. Derivatives of compounds 1 and 2 were synthesized. In these derivatives the functionality at the C-1 amine position or the C-4 position was substituted with groups with various hydrophilicities to determine if a direct relation existed between water solubility and overall activity. The chlorinated precursors of these derivatives were also examined and were found to be less active in the C. parvum assays, a result in direct contrast to earlier work with Leishmania. Enhanced water solubility alone did not overcome the drug availability problem; however, several candidates with similar activities but with toxicities lower than those of the lead compounds were produced.
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Affiliation(s)
- J W Benbow
- Department of Chemistry, Lehigh University, Bethlehem, Pennsylvania 18015, USA.
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Korda A, Santas P, Tenente A, Santas R. Petroleum hydrocarbon bioremediation: sampling and analytical techniques, in situ treatments and commercial microorganisms currently used. Appl Microbiol Biotechnol 1997; 48:677-86. [PMID: 9457796 DOI: 10.1007/s002530051115] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The sampling and analytical methods, along with available microorganisms, used for in situ hydrocarbon bioremediation are reviewed. Each treatment method is briefly described and its advantages and limitations pertaining to potential applications are evaluated. Bioremediation provides cost-effective, contaminant- and substrate-specific treatments equally successful in reducing the concentrations of single compounds or mixtures of biodegradable materials. In situ treatments rarely yield undesirable byproducts, but precautions and preliminary baseline tests are always recommended. Sampling methods should adhere to good laboratory and field practices and usually do not require highly trained personnel. Analytical methods vary in sensitivity, cost, duration of sample analysis and personnel training required. Voucher specimens of bacterial strains used in bioremediation exist in various repositories (e.g. ATCC, DSM, etc.) or are commercially available, and are usually covered by patent rights. Each one of these strains may yield spectacular results in vitro for specific target compounds. However, the overall success of such strains in treating a wide range of contaminants in situ remains limited. The reintroduction of indigenous microorganisms isolated from the contaminated site after culturing seems to be a highly effective bioremediation method, especially when microorganism growth is supplemented by oxygen and fertilizers.
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Affiliation(s)
- A Korda
- Oiko Technics Institute, Athens, Greece
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Brieger G, Ditton J, Korda A. Insertion of a permanent electrode for intractable detrusor instability. Aust N Z J Obstet Gynaecol 1995; 35:107-8. [PMID: 7771987 DOI: 10.1111/j.1479-828x.1995.tb01847.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- G Brieger
- Department of Gynaecology, King George V Hospital, Camperdown, New South Wales
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Peat B, Korda A, Boogert A, Anderson J, Thornton S. Transvaginal ultrasound for the detection of urethral diverticula at urodynamic assessment. Int Urogynecol J 1992. [DOI: 10.1007/bf00455085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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37
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Abstract
In a study of 190 patients with genuine stress incontinence, 91 patients were of normal weight, 66 overweight and 33 obese as determined by their Body Mass Index at the time of operation which was either a colposuspension (143) or a silastic sling insertion (47). Body mass index was found to significantly alter the outcome.
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Affiliation(s)
- G Brieger
- Department of General Gynaecology and Gynaecological Urology, King George V Memorial Hospital, Sydney, Camperdown, NSW
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38
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Korda A. re Elevation of the vagina during colposuspension: the use of Deaver retractor. BJU Int 1990. [DOI: 10.1111/j.1464-410x.1990.tb07216.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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39
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40
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Abstract
A total of 1,012 patients referred to 4 urodynamic centres were questioned, and subsequently investigated. Coital incontinence was present in 192 of the 839 (23%), who were sexually active. Ninety-five patients (49%) had the urodynamic diagnosis of genuine stress incontinence, alone or in association with cystocoele or interstitial cystitis. Fifty-one (26.6%) had urodynamically proven detrusor instability with or without interstitial cystitis. Forty-five (23.4%) had dual pathology as the final urodynamic diagnosis.
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41
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Abstract
Between June 1, 1983 and June 30, 1988, 174 patients with stress incontinence were treated with a colposuspension operation; 144 patients were cured, 30 remained wet. Sixteen patients who remained wet had detrusor instability; 9 of these were cured by anticholinergic medications. Of 25 patients who had dual pathology 19 were cured. Seventy nine patients had urinary tract infections. Two patients had ureteric obstruction due to kinking; it is postulated that this can be an infrequent and sometimes unavoidable complication.
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Affiliation(s)
- A Korda
- Department of Obstetrics and Gynaecology, Royal Prince Alfred Hospital, Sydney
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42
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Abstract
Between September 1, 1985 and December 31, 1987, 54 patients with stress urinary incontinence were treated with a reinforced silastic sling using an abdominovaginal approach; 42 patients were cured, two improved and nine were the same or worse. Five patients who are continent required periodic intermittent self-catheterization. Eight patients developed detrusor instability postoperatively. One patient had to have the sling removed due to a persistent sinus. Fifteen patients had to have the sling adjusted.
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Affiliation(s)
- A Korda
- Department of Obstetrics and Gynaecology, Royal Prince Alfred Hospital, Sydney
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43
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Tyrlik S, Korda A, Poppe L, Rockenbauer A, Györ M. EPR spectra of products of the reaction of di-η5-cyclopentadienyl(diethylalanedi-μ-chloro)titanium(III) with C1 compounds. J Organomet Chem 1987. [DOI: 10.1016/0022-328x(87)85193-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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44
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Korda A, Krieger M, Hunter P. The use of prolonged bladder distension in the treatment of intractable urinary incontinence in females with detrusor instability. Aust N Z J Obstet Gynaecol 1987; 27:155-7. [PMID: 3675443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Fifty patients suffering from detrusor instability who failed to respond to anticholinergic treatment were treated with prolonged bladder distension. Twelve months after treatment 9 were symptom free, 15 improved and 26 remained symptomatically unchanged. Extraperitoneal bladder rupture occurred in 2 patients.
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Affiliation(s)
- A Korda
- King George Vth Hospital, Camperdown, Sydney
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45
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Abstract
In a study of 566 patients with urinary incontinence the presenting symptom or combination of symptoms were shown to have limited diagnostic predictive value as measured by urodynamic diagnostic criteria.
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Affiliation(s)
- A Korda
- King George V Hospital, Camperdown, Sydney, New South Wales
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46
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Horvath JS, Phippard A, Korda A. Clonidine hydrochloride-A safe and effective antihypertensive agent in pregnancy. Int J Gynaecol Obstet 1987. [DOI: 10.1016/0020-7292(87)90222-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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47
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Korda A, Hunter P. Modern evaluation of the incontinent woman. Aust Fam Physician 1986; 15:1409-11. [PMID: 3800760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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48
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Horvath JS, Phippard A, Korda A, Henderson-Smart DJ, Child A, Tiller DJ. Clonidine hydrochloride--a safe and effective antihypertensive agent in pregnancy. Obstet Gynecol 1985; 66:634-8. [PMID: 3903581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A prospective, double-blind, randomized controlled trial was carried out, comparing alpha-methyldopa and clonidine hydrochloride in 100 pregnant women with hypertension. There was no difference in hypotensive effect or reported maternal side effects with either agent. There was one neonatal loss in each group (98% survival). Neither drug caused clinically significant hypotension nor rebound hypertension in the neonates. Clonidine hydrochloride, like methyldopa, appears to be a safe antihypertensive agent in pregnancy.
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49
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Horvath JS, Korda A, Child A, Henderson-Smart D, Phippard A, Duggin GG, Hall BM, Tiller DJ. Hypertension in pregnancy. A study of 142 women presenting before 32 weeks' gestation. Med J Aust 1985; 143:19-21. [PMID: 4010599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This study evaluates the outcome of 142 consecutive pregnancies in women in whom hypertension was diagnosed before 32 weeks' gestation and who were managed by a team comprising obstetricians, physicians and perinatologists. Arterial pressure was lowered to 140/90 mmHg or lower with clonidine hydrochloride or methyldopa therapy to which, in most cases, a vasodilator, hydralazine or diazoxide was added. The outcome of patients who were managed by the multidisciplinary team from the clinical onset of their disease was compared to the outcome of those who were transferred after the onset of hypertension from other centres. A greater perinatal mortality rate was found among the infants of patients with pre-eclampsia and patients with essential hypertension in pregnancy when the mothers were referred late for management. Reasons for the difference in pregnancy outcome are not clear. Possible explanations are discussed which emphasize the need for further study to establish optimal management of this common complication of pregnancy.
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50
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Gjurić M, Korda A, Gjurić Z. [Changes in the structure of skiing injuries in Yugoslavia]. Lijec Vjesn 1984; 106:411-3. [PMID: 6503592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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