[Pilot study: Determination of the subjective trunk vertical in upright head position]

BACKGROUND

Consensus has been established that the subjective vertical (SV) is a result of multimodal sensory integration. In order to be able to calculate the vestibulocervical sensory competence for the SV, the isolated subjective trunk vertical axis (STV) was measured under conditions of vertical head fixation.

MATERIALS AND METHODS

Young, healthy volunteers (n = 49) were compared to older, healthy volunteers (n = 50) on a three-dimensionally deflectable (tilt, torsion, pitch) trunk excursion chair in which the volunteer's head remains in an upright position. Another young, healthy group was divided into a placebo (n = 27) and a monophasic cervical transcutaneous electrical nerve stimulation (C-TENS; n = 22) group to examine verticality perception.

RESULTS

In the STV after trunk pitch, age was a significant variable (p = 0.021). The older, healthy group of subjects missed the physical vertical by an average of 1.8° more than the younger group. Only the placebo group showed an average improvement in STV of 4.3° after torsion.

CONCLUSION

Apart from the macular organs the vestibulocervical sensory afference is involved in finding the trunk vertical. A difference in age to the disadvantage of the older healthy subjects was observed, as well as a lack of learning success after applied C‑TENS. The presented pilot study was able to confirm that a correct vertical trunk sensation is caused by vestibulocervical sensory afference in upright head position.

[Direct hearing aid provision by ENT specialists: Recommendations for prevention and treatment of complications after taking ear impressions]

In times of budgeting, rising costs and monetary losses, an increasing number of ENT specialists considers the hearing system sector due to the distinct undersupply and the expected demographic development to be a market of the future and appropriate to enlarge their field of competence. Exact prevalence of direct hearing aid provision by German otorhinolaryngologists as well as its complication rate are not well-known. Retrospectively, all patients were evaluated who presented at our department with complications in the context of outpatient direct hearing aid supply within the last 3 years. Inappropriate fitting contains the danger of malformed or displaced ear impressions with various injury patterns comprising the external auditory canal, tympanic membrane and ossicular chain. Practical advices for prevention of complications include the accurate modeling and placement of sufficient impression pads behind the second bend of the auditory canal, using an adequate type of impression material as well as performing the correct application procedures. Recommendations for diagnostic patterns and treatment of complications after taking ear impressions are presented, the differences between German "traditional" and "direct" hearing aid provision are critically discussed.

High-dose intravenous interferon beta in patients with neutralizing antibodies (HINABS): a pilot study

Background

Neutralizing antibodies (NABs) against interferon beta (IFNβ) are associated with a loss of IFNβ bioactivity and clinical effectiveness. To date, there are no anti-NAB strategies available. The primary objective of this trial was to investigate whether intravenous IFNβ-1b can restore bioactivity in NAB-positive patients with MS.

Methods

NAB-positive patients with MS were treated with 8 MIU IFNβ-1b s.c., 8 MIU i.v., and 16 MIU i.v. Each application was preceded by a wash-out period of 1 week. Blood samples were collected before, 3, 12, and 24 h after each administration. Myxovirus protein A (MxA) RNA and protein levels were determined. The study has been approved by the local ethics committee.

Results

Five patients completed the study. NAB titers ranged from 42 to 4482 neutralizing units. Median MxA protein (1821, range 12–3234) and RNA (2186, range 114–7525) area under the curve levels for the four measurements at each IFNβ injection were significantly higher after i.v. application of 16 MIU as compared with both 8-MIU dosages, which were 743 (0–2709) for MxA protein after 8 MIU i.v. and 254 (0–1200) after s.c., and 1763 (25–7188) for MxA RNA after 8 MIU i.v., and 557 (5–2265) after s.c. applications. NAB titers decreased significantly and transiently after infusion of 16 MIU IFNβ-1b but not after both forms of 8 MIU applications. Typical side effects could be controlled by paracetamol. No allergic reaction was observed.

Discussion

The results indicate that i.v. administration of IFNβ can restore bioavailability of IFNβ in patients with NABs.

Low-frequency distortion product otoacoustic emission test compared to ECoG in diagnosing endolymphatic hydrops

Previous studies assumed that specific audiometric measures like low-frequency biasing were noninvasive and inexpensive techniques for diagnosing endolymphatic hydrops (EH). The aim of this study was to compare the results of low-frequency DPOAE (LF-DPOAE) with those of transtympanic electrocochleography (ECoG) in patients with Menière's disease (MD). The prospective study included 50 patients, 22 to 72 years old, who were diagnosed with Menière's disease according to the criteria laid down by the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) in 1995. LF-DPOAE and ECoG were performed on the same day after standard audiometry. Enlarged amplitude of summation potential to action potential ratio was used as the diagnostic criterion for EH. The results were compared to those of LF-DPOAE. In this audiometric examination we used the modulation index (MI) to detect EH if MI < 0.5. ECoG yielded a result in 46 of the 50 patients examined. An enlarged SP/AP ratio was found in 23 patients (50%). The results of 33 patients could be compared, i.e. assessable results in both tests. The two tests yielded the same results in 13 patients and different ones in 20 patients. ROC analysis and Mann-Whitney statistics showed no significant correlation between the two tests. With ECoG as the gold standard for verifying EH, we found that LF-DPOAE is not yet a suitable method for diagnosing EH.

[Influence of different head-trunk positions to the upbeat-nystagmus]

The neck torsion test (NTT) can be used to evaluate the cervico-ocular reflex (COR). We think there are two main reasons why NRT has failed to gain general acceptance in clinical practice: the test does not fully exploit the somatosensory examination potential, and electronystagmography has been most commonly used but is inferior to videonystagmography for a very low-amplitude nystagmus. These considerations have led us to develop a modified neck torsion test (mNTT) with three-dimensional video-oculographic (3D-VOG) recording. Sensors on the video glasses enable three-dimensional and continuous registration of the head position. Horizontal, vertical and rotatory eye movements are determined in six different head-body positions (right/left head tilt, ante/retroflexion of the head, and right/left body rotation). The basis for assessing the mNTT is described in detail. We used the mNTT to examine prospectively compensated, vestibularly deficient (n = 52), and cervically deficient (n = 93) patients with vertigo against a control group (n = 22). Our results show that upbeat-nystagmus (UBN) significantly differentiated the groups. This occurs most frequently in the tonic analysis phase of head inclination and reclination. UBN is differential-diagnostically discussed on the basis of these examination findings, and its cervical origin is elucidated with the aid of model conceptions. We conclude that our modified NRT is an improved instrument for COR determination. A suspected cervical somatosensory reduction warrants testing particularly for UBN.

[Investigations concerning the head-trunk-coordination]

BACKGROUND

In the assessment of vertigo patients with suspected cervicocephalic somatosensory deficit, the studies published thus far have focused on reflectory systems like the cervico-ocular reflex or the postural systems. Our study examines the cervicocephalic kinesthetic sensibility of head and body coordination. We therefore introduce two preliminary test series: the "subjective zero chin-knee-angle of the occipital joints" and the "saccadic repositioning during trunk rotation".

METHODS

Subjective recordings of dizziness complaints were done using the Dizziness Handicap Inventory.

PATIENTS

The study population consisted of 24 patients with palpatory cervicocephalic somatosensory deficit (group I) and 23 patients with a central vestibular compensated unilateral vestibular deficit (group II). Twenty-two healthy patients served as controls. The aim of the study is to provide a detailed examination of the "subjective zero chin-knee-angle of the occipital joints" as well as a detailed discussion of "saccadic repositioning with trunk rotation" by three-dimensional videooculography (3D-VOG).

RESULTS

We were able to separate patients with a cervicocephalic somatosensory deficit with the first test procedure and differentiate them from groups II and III. The second test procedure shows a significant difference between groups I and III.

CONCLUSION

We conclude from the group difference that the recording of cervicocephalic kinesthetic sensibility is a further indication of disturbed cervical proprioception.

Das Ti-Epiplating-System für die Knochenverankerung von Hörhilfen

The advent of bone-anchored hearing aids with titanium implants has markedly improved patient management. There are two systems on the market for performing the requisite osseointegration. The aim of our study was to evaluate the Ti-Epiplating system, since no data have been published on this in the literature thus far. Between November 2002 and March 2005, we anchored the BAHA snap coupling via the Ti-Epiplating system in 8 patients in a single session. The patients were followed-up at regular intervals to assess clinical and audiometric results and subjective satisfaction. The postoperative hearing threshold with the BAHA was in the former bone conduction range. In the Freiburg speech test, a significant improvement was found for monosyllables (free-field), and the hearing loss for numbers showed a mean reduction from 75 to 30 dB. There has been no implant loss in our collective thus far. Good to very good results were evaluated for the quality of life in the "International Inventory of evaluation of hearing aids" (IIEH). Clinics that use Medicon's osteosynthesis system can safely and reliably achieve inexpensive and audiometrically successful BAHA management by a comparatively simple surgical procedure.

[Is orbital exenteration indicated for extensive primary mucosal melanomas of the sinunasal system?]

Primary mucosal melanomas are most frequently localized in the sinunasal system. Orbital involvement must be excluded in the mostly advanced tumor stage. The aim of our study was to find possible indications for orbital exenteration in the T3-4 sinunasal tumor stage. We evaluated 14 treatment courses at our department from 1988 to 2004. The analysis disclosed orbital involvement in 43 % of the patients. The one patient submitted to orbital exenteration had a survival of only 28 months, which was not relevantly longer than in the other 9 patients with a T3-4 tumor stage (median survival of 27 months) or to the two patients with purely palliative treatment (survival of 10 and 21 months). We conclude that, due to the high generalized metastasis rate, radical surgical procedures can only prolong survival in individual cases of advanced-stage sinunasal tumors. Orbital decompression should be considered with reference to the quality of life.

Snoring noise pollution—the need for objective quantification of annoyance, regulatory guidelines and mandatory therapy for snoring

Habitual snoring without episodes of apnea or hypoventilation and without respiratory related arousals is considered to be annoying and without any need for treatment. However, studies seem to suggest an enormous psychosocial impact of annoyance for the bed partner. Apart from subjective questionnaires there still exists no generally accepted mode of measurement that can describe snoring objectively. We therefore adapted methods developed for environmental medicine and established a new snore score using psycho-acoustic parameters. For quantification of snoring noise we conducted nocturnal measurements in 19 habitual snorers. Free-field snore sounds were acquired with two low-cost non-contact microphones and transferred to a PC (sampling frequency 11 kHz). The data were recorded, analysed and stored automatically using a MATLAB script. Following the analysis of sound characteristics and levels, the score was computed from relevant parameters containing the rating level (L(R)), maximum level, two percentile levels for frequent maxima (L(5)S; L(1)) and snoring time. The determined values substantially exceeded the prescribed limits defined by WHO noise guidelines, and mainly affected the equivalent continuous sound exposure level, rating level and the immission standard values of brief noise peaks, whose maximum was exceeded by up to 32 dB(A). The Berlin snore score illustrated the objective acoustic annoyance on a scale from 0 to 100. It allows inter-individual comparison and objectifies the need for therapy. The clinical applicability of evaluating the reduction of snoring after surgical therapy is discussed exemplarily. The presented measuring method was found to be suitable for quantifying snoring noise and can be easily integrated into existing polysomnographic applications. In the case of habitual snoring with objective evidence of psychosocially disturbing acoustic annoyance, health fund providers should assume the costs of mandatory medical therapy.

[Problems of hyomandibulopexia in patients with OSAS]

In cases of obstructive sleep apnea syndrome (OSAS) with intolerance of n-CPAP (nasal continuous positive airway pressure) treatment, hyoidthyroidpexia (synonym: hyoid suspension) has recently been advocated by some authors as a valuable surgical option. Despite a basically positive assessment, there is a risk of hindrance to the speaking and swallowing function. Moreover, the thyroid cartilage seems to be too weak for fixation of the hyoid with its complex muscular attachments. This reduces the likelihood of achieving positive long-term results. Considering aspects of preserving laryngeal function, we are reporting on 7 patients submitted to a hyomandibulopexia. This intervention counteracts the tendency of the tongue base to collapse by ventrolateral traction on the hypoglossal muscle via the severed greater horn of the hyoid. We have thus far had to correct our surgical procedure three times because of methodological problems in the postoperative phase. Specific problems with surgical materials like steel wire or Goretex are discussed. In conclusion, we explain why we consider a bone anchored Kevlar suture (FASTak of Arthrex) to be suitable for this operation. Considering functional aspects, our polysomnographic and phoniatric follow-up examinations point to a less traumatic surgical procedure with promising treatment results.

Spatial organisation of microbiota in quiescent adenoiditis and tonsillitis

BACKGROUND

The reasons for recurrent adenotonsillitis are poorly understood.

METHODS

The in situ composition of microbiota of nasal (5 children, 25 adults) and of hypertrophied adenoid and tonsillar tissue (50 children, 20 adults) was investigated using a broad range of fluorescent oligonucleotide probes targeted to bacterial rRNA. None of the patients had clinical signs of infection at the time of surgery.

RESULTS

Multiple foci of ongoing purulent infections were found within hypertrophied adenoid and tonsillar tissue in 83% of patients, including islands and lawns of bacteria adherent to the epithelium, with concomitant marked inflammatory response, fissures filled with bacteria and pus, and diffuse infiltration of the tonsils by bacteria, microabscesses, and macrophages containing phagocytosed microorganisms. Haemophilusinfluenzae mainly diffusely infiltrated the tissue, Streptococcus and Bacteroides were typically found in fissures, and Fusobacteria,Pseudomonas and Burkholderia were exclusively located within adherent bacterial layers and infiltrates. The microbiota were always polymicrobial.

CONCLUSIONS

Purulent processes persist during asymptomatic periods of adenotonsillitis. Most bacteria involved in this process are covered by a thick inflammatory infiltrate, are deeply invading, or are located within macrophages. The distribution of the bacteria within tonsils may be responsible for the failure of antibiotic treatment.

Evaluierung eines neuen Lidimplantates zur Therapie des Lagophthalmus

BACKGROUND

Since 1999 the platinum chain is being used as implant to correct lagophthalmos, which promises, due to its flexibility, lower postoperative complications. The lack of mandatory results reported in the literature, prompted us to survey all surgeons using the platinum chain in order to learn of the complications they had experienced.

METHODS

A questionnaire was sent to 30 surgeons to survey results and complications associated with the implantation of the platinum chain to treat lagophthalmos. Complications like contouring, migration and extrusion of the implant occurred.

RESULTS

Complications observed were bulging of the implant in 12 cases (5,7 %), 4 migrations of the implant (1,9 %), in 7 cases a frank extrusion (3,3 %), a ptosis of the upper eyelid in 8 cases (3,8 %), a corneal astigmatism in 3 cases (1,4 %) and in one case an infection of the upper eyelid (0,5 %). In 2 cases (0,9 %) the patients lamented a mechanical irritation of the upper eyelid.

CONCLUSION

Implantation of eyelid weights is a straightforward and reversible procedure for the surgical therapy of lagophthalmos. Through the use of the platinum chain as implant the postoperative complications are to be regarded as small in total. With that the effectiveness of the procedure can be increased compared to rigid gold implants.

[Contouring of a rigid eyelid implant: indication for the replacement with the platinum chain]

BACKGROUND

The resultant lagophthalmos at peripheral facial palsy can lead to keratopathy of varying degrees. In surgical therapy of lagophthalmos some implants to preserve a sufficient eyelid closure have been described. Besides to the use of magnets, silicone slings or palpebral springs the importance of the gold implantation (lidloading), first described by Illig in 1958, has increased. Unfortunately all of these techniques have often shown unwanted side effects. The platinum chain is a new implant which promises, due to its flexibility, lower postoperative complications.

PATIENTS

We present two case reports to show the platinum chain's advantages compared to the older implants. The two patients developed a unsightly contouring (with threatening extrusion) of the rigid gold implant after lidloading. These gold implants were therefore replaced in one step by the platinum chain.

RESULTS AND CONCLUSIONS

The further process was complication-free. In our opinion, in spite of the small case number, the new developed platinum chain can lead to a reduction of postoperative complications after lidloading. In complications with the rigid gold implants, such as contouring or extrusion, these implants can mostly be replaced in one step by corresponding platinum chains.

Ordered Micro/Mesoporous Composite Prepared as Thin Films

A new synthesis method for preparation of thin films and powders consisting of zeolite beta nanocrystals embedded in ordered mesoporous silica matrix is described. The final structures possessing bimodal porosity, i.e., high degree of mesophase order and spatially defined microporous zeolite nanocrystals are obtained via simultaneous solvent evaporation of preformed silica/surfactant/ethanol/nanosized zeolite beta assemblies. The films were characterized with grazing-incident diffraction (GID), nitrogen sorption based on gravimetric measurements with quartz crystal microbalance (QCM) devices, and transmission electron microscopy (TEM). It is shown that the incorporation of beta nanocrystals in the mesoporous silica matrix and the mesophase order itself can be controlled through the variation of the fractional amounts of the zeolite nanoparticles and silica/surfactant solutions. The HR-TEM measurements showed that the nanosized Beta microporous crystals are separated and at the same time connected through an ordered mesostructured matrix.

[The efficiency of spinal manipulation in otorhinolaryngology. A retrospective long-term study]

BACKGROUND

The vertebral genesis of many functional disorders in otorhinolaryngology, such as dizziness, hearing-impairment, ear-pressure, ear-pain, foreign body sensation in the throat and dysphonia, is suggested by the success of spinal manipulative therapy, particularly of the atlanto-occipital joint. Up to now, there are no retrospective investigations which show the duration of the therapeutic effect.

METHODS

We examined 220 patients with cervical otorhinolaryngological disorders (100 patients with dizziness, 49 with hearing impairment, 47 with tinnitus and 24 with dysphonia) after cervical manipulation lasting more than 6 months.

RESULTS AND CONCLUSIONS

The extraordinary satisfaction with the manipulative therapy in 82% of patients with dizziness (46% total relief, 36% high improvement) reflects the high efficiency of this manual therapy. In contrast to these results, only 10% of patients with tinnitus showed an improvement (P<0.001). This retrospective investigation demonstrates that a successful outcome after manual therapy is not based on a "placebo effect".

[Vestibulospinal reactions in cervicogenic disequilibrium. Cervicogenic imbalance]

A functional cervical spine disorder is often the cause for persistent vertigo, which can last months or several years. The existence of cervical vertigo is not generally recognized, mainly because an objectivation of the cervical nystagmus is not easily understood by many examiners. In this study we examine additional parameters, which underline the diagnosis of cervical imbalance. The anamnestic statement of staggering refers to a disturbance of the vestibulospinal reactions. In 67 patients in which cervical imbalance was suspected the vestibulospinal reactions were monitored directly before and after manual therapy of the cervical spine. The cranio-corpo-graphie (CCG) and the posturography were used to monitor the results. A highly significant improvement of pathological vestibulospinal reactions was seen after chiropractic manipulation of the spine. These results show that a functional disorder of the cervical vertebrae influences the vestibulospinal reactions. The pathological deficit of the vestibulospinal reactions is not solely a phenomenon of peripheric labyrinth malfunction, failure in the brainstem or in the area of the cerebellum ("brain stem staggering"), but can also be viewed nearly regularly by cervical disturbance of the equilibrium. The results of the treatment can be observed within a few hours.

[Tonsillectomy with the argon-plasma-coagulation-raspatorium - a prospective randomized single-blinded study]

BACKGROUND

The Argon-Plasma-Coagulation (APC) offers an innovative possibility for the tonsillectomy combined with a high-frequency technology. Aim of our study was to inves-tigate the differences between this high-frequency-technology and the traditional tonsillectomy. No reports exist in the use of the APC in the tonsillectomy.

METHODS

Argon-Plasma-Coagulation tonsillectomy (TE-APC) was compared with the traditional blunt dissection tonsillectomy (TE-trad) with hemostasis by compression and bipolar coagulation. 133 patients were stratified in two age groups in a clinical prospective randomised study.

RESULTS

Average surgical time and blood loss were markedly decreased in the TE-APC group (p<0,01). There was no significant difference between the two techniques concerning postoperative pain, otalgia, and primary or secondary haemorrhage. In the TE-APC group more extensive fibrin layer appeared after surgery. In the TE-APC patients' group, there was a slightly higher consume of analgetics in some postoperative days.

CONCLUSIONS

The one-step dissection and coagulation procedure leads to an almost bloodfree woundground and to a reduction of operation-time. The self-limited and effective coagualative properties of the APC-method leads to a controlled penetration depth. The often associated extensive post operative pain and uncontrolled tissue- damage, known from electrical and lasersurgical techniques, was not found in TE-APC-patients-group.

[Endotracheal intubation with propofol and fentanyl]

The routine use of succinylcholine for endotracheal intubation is being increasingly questioned. Initial studies have suggested that a combination of propofol and alfentanil without a muscle relaxant can provide good intubating conditions. However, most of these initial studies either did not have a double-blind design or did not include a control group with muscle relaxants. In this study, intubation conditions using fentanyl/propofol without a muscle relaxant were compared with the combinations of fentanyl/propofol/succinylcholine and sodium thiopental/succinylcholine. MATERIAL AND METHODS. Following approval from the local ethics committee and written consent, 100 gynaecological patients (ASA I, II) were included in this study. The study was carried out in a double blind, randomized and prospective manner. Black perfusor syringes and extension sets were used, and the drugs administered were diluted to equal volumes. For induction, group 1 (n = 25) received 0.1 mg fentanyl, 1 mg vecuronium, sodium thiopental (demand-adapted) and succinylcholine 1 mg/kg; group 2 (n = 25) received 0.1 mg fentanyl and propofol (demand-adapted); group 3 (n = 25) received 0.2 mg fentanyl and propofol (demand-adapted); group 4 (n = 25) received 0.1 mg fentanyl, 1 mg vecuronium, propofol (demand-adapted) and succinylcholine 1 mg/kg. Each patient was assessed prior to induction with regard to visualization of the pharynx (grade I-IV). Following induction, jaw relaxation (grade I-IV) and the laryngoscopic visualization of the glottis (grade I-IV) were assessed. During the intubation, the position and movements of the vocal cords (grade I-IV) and patient movement during and 1 min following the intubation were assessed. The overall assessment of the intubation was graded (grade I-IV) by the anaesthetist and the anaesthetic nurse. Postoperatively the patients were questioned regarding muscle pain (grade I-IV). Before, during and after endotracheal intubation arterial haemoglobin oxygen saturation, heart rate and arterial blood pressure were monitored. RESULTS. There were no intergroup differences with regard to age, height, weight and preanaesthetic visualization of the pharynx. In group 1 an average of 5.5 +/- 1.2 mg/kg sodium thiopental was required. There were no significant differences in group 2, 3 and 4 with respect to the dose of propofol (2.4, 2.2 and 2.2 mg/kg). No intergroup differences were noted with regard to jaw relaxation, laryngoscopic visualization of the glottis and patients' movements during intubation. Statistically significant intergroup differences occurred with regard to the position and movements of vocal cords during intubation (group 3 worse than groups 1, 2, 4) and the patients' movements 1 min after intubation (group 2 worse than group 3). Significant intergroup differences also occurred with regard to the overall assessment of the intubation by the anaesthetist (group 3 worse than groups 2, 4) and the anaesthetic nurse (group 3 worse than group 4) and the postoperative muscle pain (group 1 worse than groups 2, 3). CONCLUSION. The use of 0.1 mg fentanyl/sodium thiopental/succinylcholine results in no better intubating conditions than 0.1 mg fentanyl plus propofol. Under these conditions, without the use of a muscle relaxant, it is possible to carry out safe endotracheal intubation in cases where no complications are anticipated.

[Single-shot spinal anesthesia versus continuous spinal anesthesia using the CoSPAN catheter]

OBJECTIVE

We compared conventional single-shot spinal anaesthesia (SS) with continuous spinal anaesthesia (CS) in a randomised prospective study.

PATIENTS AND METHODS

Sixty patients undergoing urological surgery received either SS (n = 30) using an atraumatic needle or CS (n = 30) using a CoSPAN catheter. Prior to performing the spinal anesthesia, patients were prehydrated with 250 ml of hydroxyethyl starch 10%. Spinal anaesthesia was performed with the patients in the sitting position at L3-4 interspace. In the CS group CSF was aspirated via the catheter to check its correct position, and initially 0.5 ml of hyperbaric 5% lidocaine were injected. 0.25 ml boli at 5 min intervals were repeated as often as necessary to reach the desired sensory blockade up to the T10 segment. In patients undergoing the single-shot technique 1.5 to 3.5 ml of hyperbaric 0.5% bupivacaine was injected. After performing the block, haemodynamic parameters were assessed for 20 minutes at 2 min intervals, before and thereafter at 5 min intervals. The required time for recovery of motor activity of the legs was assessed postoperatively. The patients were visited on the 1st, 3rd and 5th postoperative day and asked about possible headache.

RESULTS

The CoSPAN spinal catheter was easy to handle. CSF could be aspirated via this catheter within 33.1 +/- 7.6 seconds. The desired maximum cephalad spread (T10) was exceeded by a mean of 0.63 +/- 1.3 segments in the CS group and by a mean of 1.4 +/- 2.6 segments in the SS group. In the SS group a mean volume of hyperbaric 0.5% bupivacaine of 2.59 +/- 0.4 ml was used. In the CS group a mean volume of 1.08 +/- 0.4 ml of hyperbaric 5% lidocaine was necessary. In the SS group, mean arterial blood pressure was found to have significantly decreased to lower than the initial value within the first 20 min after injection at each of the 10 determinations. Maximal decrease of mean arterial pressure to 89.3 +/- 7.7% was registered 14 min after injection. In the CS group, only the measurement 14 min after injection of the initial bolus revealed a significant decrease of the mean arterial blood pressure to 94.2% of the initial value. The mean interval elapsed before motor function of the legs returned after the end of surgery was 67.7 +/- 50 min in the SS group and 26.7 +/- 15.4 min in the CS group. None of the 60 patients complained about postspinal headache.

DISCUSSION

Fractionated injection of the local anesthetic via a spinal catheter was more precise in achieving the desired maximum cephalad spread than SS. The CS group revealed a significantly more stable blood pressure than the SS group. The use of a short-acting local anesthetic for CS provided an earlier postoperative return of motor function of the legs. Postspinal headache appears not to be a clinically relevant problem when 28-gauge spinal catheters are used.

Changes of alkaline phosphatase, inorganic phosphorus and total calcium in sera of 11 to 17 year old healthy adolescents, and their relationship to growth

A semi-longitudinal study in 111 healthy school children, 11 years old, was started in May 1976 to evaluate age-related "normal-ranges" of two so-called "routine" blood parameters during adolescence. Follow-up examinations were performed at one-year intervals until 1982. In this paper growth velocity is described and results of estimations of alkaline phosphatase, inorganic phosphorus (Pi) and total calcium (Ca) are presented and compared with values in the literature. Peak growth velocity in girls (5.94 +/- 1.92 cm/year) occurred between 11 and 12 years, in boys (7.73 +/- 2.4 cm/year) between the age of 12 and 13 years; from the age of 14 years onwards boys were significantly taller than girls. A strong relationship (p less than 0.05) between growth and alkaline phosphatase could be shown throughout the period observed. Alkaline phosphatase activity varied within a wide range and reached mean peak values at the age of 11 years in girls (470.9 +/- 114.8 U/l) and the age of 13 in boys (514.4 +/- 135.7 U/l). Afterwards, alkaline phosphatase activity decreased towards adult levels. Inorganic phosphorus constantly decreased in both boys and girls until the age of 16, while from the age of 16 to 17 years a significant increase could be observed in both sexes. Total calcium values showed a significant increase between 12 and 13 years in boys and between 13 and 14 years in girls; after the age of 14 values decreased significantly in both sexes.(ABSTRACT TRUNCATED AT 250 WORDS)

Lipids, lipoproteins and alpha-tocopherol: relationship and changes during adolescence. A longitudinal study

From May 1976 until June 1982 a longitudinal study in 54 apparently healthy Austrian schoolchildren with a mean age of 11.2 years at their first visit was performed. The aim of this study was to determine if there are any age-related changes in serum lipids, lipoproteins and alpha-tocopherol concentrations during adolescence and whether a permanent relationship between lipoproteins and alpha-tocopherol can be observed. Total cholesterol showed a significant decrease from age 11 to 14 years in boys (from 195.5 +/- 42.2 to 147.9 +/- 40.3 mg/dl) as well as in girls (from 181.9 +/- 29.7 to 144.1 +/- 23.4 mg/dl); thereafter, a slight increase could be shown. Similar changes could be observed for LDL cholesterol. No significant sex differences were found either in total or in LDL cholesterol, whereas in HDL cholesterol concentrations, a decrease in boys between 12 and 14 years (from 58.4 +/- 18.3 to 41.7 +/- 10.8 mg/dl) and an increase in girls from 13 years onwards led to significantly lower values in boys than in girls from the age of 16 years onwards. No consistent changes could be shown for alpha-tocopherol blood levels. Nevertheless, a close relationship between total cholesterol and alpha-tocopherol could be observed during all our investigations (0.4695 less than or equal to 0.7300, p less than 0.05) and, to a lesser degree, between LDL cholesterol and alpha-tocopherol. Significant correlations between alpha-tocopherol and HDL cholesterol and between alpha-tocopherol and triglycerides occurred only occasionally.

[Amniotic fluid circulation with special reference to hydramnios]

The undisturbed circulation of amniotic fluid is the result of an intact cooperation between three compartments: maternal organism, fetus and amniotic cavity. Impairment of one of these compartments can produce a pathological increase of amniotic fluid. This is possible by animal experiment through the way of producing a hypoproteinemia in the maternal organism, comparable with the situation of maternal EPH-gestosis. By increasing the intraamnial osmotic pressure after injection of hyperosmotic solution it is also possible to produce polyhydramnios in the animal experiment. This is corresponding to the clinical situation in maternal diabetes mellitus. In studies of pregnant rabbits, the analysis of ultrastructure of the amniotic epithelium showed some alterations which are compatible with secretory activity of the yolk-sac. The epithelium of the yolk-sac is comparable with the human chorion. The amniotic epithelium has only a function as a semipermeable membrane for the diffusion of amniotic fluid. Morphological examinations of the human placenta and the amniotic sac showed an increase of placental weight in cases of polyhydramnios. There was no increase, however, of the placental surface. Disturbances of circulation in the placental villi were not seen more frequently than in a control group. In cases of polyhydramnios there were more disturbances of villous maturation. The analysis of ultrastructure of the amniotic epithelium and the surface of the umbilical cord showed some possible ways for the increase of amniotic fluid volume.

Effects of the tocolytic agent fenoterol on body weight, urine excretion, blood hematocrit, hemoglobin, serum protein, and electrolyte levels in nonpregnant rabbits

Infusion of an isotonic solution and increasing doses of the beta 2-sympathomimetic agonist fenoterol (0.6, 20, or 80 micrograms/kg/min) into female rabbits led to a reduction in urine excretion and a concomitant dose-dependent increase in body weight. Although an infusion at 2.5 ml/hr of an isotonic solution that contained 0.6 or 20 micrograms/kg/min of fenoterol did not significantly change the hematocrit, hemoglobin, or serum protein levels, they were significantly decreased by a similar infusion that contained 80 micrograms/kg/min of fenoterol and by giving 20 ml/hr of an isotonic solution that contained 0.6, 20 or 80 micrograms/kg/min of fenoterol. The central venous pressure remained unchanged in animals that received 2.5 ml/hr of an isotonic solution alone or in combination with 0.6 to 80 micrograms/kg/min of fenoterol. It was significantly elevated in animals treated with 30 ml/hr at similar doses. These data support our hypothesis that the development of pulmonary edema which has been reported with the use of tocolytic therapy is mainly due to hypervolemia related to the antidiuretic effect of the beta 2-sympathomimetics. The intravascular hypervolemia leads to an increased fluid content of the lung and may explain the development of pulmonary edema.

Fenoterol-induced changes of urine excretion, body weight, blood hematocrit, hemoglobin, total protein values and serum electrolyte levels in pregnant rabbits

Infusion of the beta 2-sympathomimetic agonist fenoterol into pregnant rabbits at a dose of 20 micrograms/kg/min + 2.5 or 30 ml/h isotonic solution significantly reduced urine excretion. Body weight changes of animals infused with 20 micrograms/kg/min fenoterol + 2.5 or 30 ml/h isotonic solution were inversely correlated to the reduction of urine excretion. The urinary potassium excretion per 24 h was not significantly altered after the infusion of fenoterol + 2.5 or 30 ml/h isotonic solution. On the other hand, the urinary sodium excretion per 24 h was significantly decreased in animals infused with 20 micrograms/kg/min fenoterol + 30 ml/h isotonic solution. Infusion of 20 micrograms/kg/min fenoterol + 2.5 ml/h isotonic solution did not significantly change hematocrit, hemoglobin or total protein values. In contrast, increasing the volume of isotonic solution to 30 ml/h resulted in significantly decreased hematocrit, hemoglobin and total protein levels at 6, 12 and 24 h after starting infusion. Serum potassium concentrations were reduced at 2-24 h after infusion of 20 micrograms/kg/min fenoterol + 2.5 or 30 ml/h isotonic solution was started. The serum sodium concentrations did not change significantly during the infusion of 20 micrograms/kg/min fenoterol + 2.5 or 30 ml/h isotonic solution. While in animals infused with isotonic solution alone or with 20 micrograms/kg/min fenoterol + 2.5 ml/h isotonic solution the central venous pressure did not change significantly, it was strongly increased in animals infused with 20 micrograms/kg/min fenoterol + 30 ml/h isotonic solution at 12-24 h after start of infusion. The results of this study are discussed with respect to those obtained from pregnant women under tocolytic therapy and to the possible pathomechanism of the development of pulmonary edema.

[Impulse cytophotometry in neoplasm prevention. The behavior of normal vaginal smears in the impulse cytophotometric histogram]

Evaluation of histograms of normal cervical and vaginal smears, produced by ""rapid flow through'' cytophotometry. Normal cytological cervical and vaginal smears were examined for their appearance in histograms in order to find criteria for the classification of ""normal non-pathological'' cytological slides. Simultaneously, the reliability of the standardized method for preparation of vaginal and cervical smears was checked. The diagrams and data produced by the histograph were also coded on line and analyzed by a computer; thus obtaining an objective mathematical analysis and avoiding errors due to subjective visual analysis of the histograms. The objective interpretation of histograms of normal vaginal smears is an important step to the realisation of automatic pre-screening.