Complications of acute otitis media in children

The clinical picture and the treatment of acute otitis media (AOM) and its complications have changed during the past decades. The availability of antibiotics has decreased the incidence of complications of AOM significantly. The treatment of complications of AOM is conservative in most cases. Mastoidectomy is needed when abscess-forming mastoiditis or intracranial complications develop. Although intratemporal and intracranial complications of AOM are rare today, they still cause morbidity, and need prompt treatment. Occasionally, permanent damage of the ear leads to hearing loss, vertigo, and sometimes, facial weakness. Antibiotic treatment has decreased the mortality associated with the complications of AOM, but it is still high in countries with developing health care systems. Early diagnosis and effective treatment of the complications are the bases for a good prognosis.     

Cerebral PET imaging and histological evidence of transglutaminase inhibitor cystamine induced neuroprotection in transgenic R6/2 mouse model of Huntington's disease

To investigate efficacy of cystamine induced neuroprotection, we conducted PET imaging studies of cerebral glucose metabolism with [(18)F]FDG (2-deoxy-2-[(18)F]fluoro-d-glucose) and striatal dopamine D2 receptor function with [(11)C]raclopride in R6/2 transgenic Huntington mice. In the control mice, exponentially decreasing glucose utilization was observed in the striatum N(str) [SUV]=(41.75+/-11.80)(58,str)*exp(-(0.041+/-0.007)*t [days]); cortex N(cort) [SUV]=24.14+/-3.66)(58,cort)*exp(-(0.043+/-0.007)*t [days]); and cerebellum N(cer) [SUV]=(34.97+/-10.58)(58,cer)*exp(-(0.037+/-0.008)*t [days]) as a function of age starting at 58 days. Given that the underlying degeneration rate in the cystamine treated mice is similar to that observed in control animals, the protection coefficient (beta) calculated from the equation N(t)=N(58)*exp(-(1-beta)*k*t) was 0.133+/-0.035 for the striatum; 0.122+/-0.028 for the cortex and 0.224+/-00.042 for the cerebellum with a dose of 100 mg/kg. The 50 mg/kg cystamine dose provided significant protection only for the striatum and only minor protection was obtained using lower doses. Striatal binding potential of [(11)C]raclopride was 1.059+/-0.030 in the control mice, and enhanced in the cystamine treated animals in a dose dependent manner up to 1.245+/-0.063 using the 100 mg/kg dose. Histological analysis confirmed cystamine induced neuroprotection of striatal and cortical neurons and Nissl staining revealed that formation of cellular inclusions was reversed in a dose dependent manner. Cerebral imaging and histological evidence support the use of cystamine as a neuroprotective agent for Huntington's disease (HD) pathology.     

Early percutaneous endoscopic gastrostomy nutrition in head and neck cancer patients

OBJECTIVE: Many head and neck cancer patients suffer from poor nutrition. Nutrition is a problem during and after therapy, especially when it consists of extensive surgery, intensive (chemo)radiotherapy or their combination. Additional enteral nutrition has been provided by means of either nasogastric tube feeding, surgical gastrostomy, radiologic percutaneous gastrostomy or percutaneous endoscopic gastrostomy (PEG). Because of the straightforward, easy technique involved and its low complication rate, PEG has become established as the primary route of nutrition in these patients. Previously, the aim of assisted enteral nutrition was to compensate for already existing malnutrition; nowadays, an additional purpose is to diminish or prevent the development of malnutrition. The main objective of this study was to evaluate the safety of pre-treatment PEG in a sample of patients with an upper aerodigestive tract area malignancy treated in a tertiary referral centre. MATERIAL AND METHODS: A total of 79 patients with an upper aerodigestive tract area malignancy were treated with a total of 80 PEGs during the period 1997-2001. RESULTS: Most of the PEGs (62/80; 77.5%) were performed by an otolaryngologist. An open gastrostomy was needed in five cases because of unsuccessful gastroscopy due to oesophageal stricture (n=4) or severe trismus (n=1). Both acute and late complications were minor and the respective complication rates (1/80; 1.3% and 12/80; 15%) were low. In addition, all complications were easily managed and did not seriously affect the actual treatment. CONCLUSIONS: A major advantage of having the PEG performed by the otorhinolaryngologist was the possibility to combine it easily with other necessary procedures, such as panendoscopy, tracheostomy and additional biopsy. In addition, the timing of the procedure was easy to schedule.     

Intraluminal radiotherapy in esophageal cancer. An update

Oesophageal cancer is severe illness leading usually to death. Radical surgery is the most successful treatment but most patients are not operable at the time of diagnosis. For these patients external beam radiotherapy with or without concurrent chemotherapy offers the best choice for cure or palliation. In patients with advanced oesophageal cancer, intraluminal brachytherapy has been proposed as an additional method to increase local control. Between 1989-2002, 49 patients with inoperable oesophageal cancer were treated with combined external and intraluminal radiation therapy in Turku University Central Hospital. The external radiation was performed with a median total dose of 40 Gy given in 20 fractions. On the average a week after the external radiation a median total dose of 10 Gy intraluminal radiation therapy was given in 4 fractions. The intraluminal brachytherapy could be performed without technical difficulties and no major complications were seen. In many cases (twenty out of 49 patients, 41%), the symptoms could be relieved immediately and in most cases the progression of the disease could be delayed. The one and two year survival rates were 30% and 18%, respectively. All patients alive at two years can be considered as long-time survivors. Median follow-up was 86 months. Intraluminal brachytherapy is a safe and efficient treatment modality which offers a potential means of cure for selected patients with oesophageal cancer.     

Activation in the anterior left auditory cortex associated with phonological analysis of speech input: localization of the phonological mismatch negativity response with MEG

The spatio-temporal dynamics of cortical activation underlying auditory word recognition, particularly its phonological stage, was studied with whole-head magnetoencephalography (MEG). Subjects performed a visuo-auditory priming task known to evoke the phonological mismatch negativity (PMN) response that is elicited by violations of phonological expectancies. Words and non-words were presented in separate conditions. In each of the 318 trials, the subjects first saw a word/non-word (e.g., 'cat') that was soon followed by a prime letter (e.g., 'h'). Their task was to replace mentally the sound of the first letter of the word/non-word with the prime letter, thus resulting in a new word/non-word (e.g., 'hat'). Finally, an auditory word/non-word either matching or mismatching with the anticipated item was presented. In most subjects, a PMNm followed by a later, N400m-like negativity was obtained in the left hemisphere to the mismatching auditory stimuli. A similar response pattern was obtained in the right hemisphere only in a few subjects. Source localization of the N1m, an index of acoustic analysis, and the PMNm and N400m-like responses was performed using L1 minimum-norm estimation. In the left hemisphere, the PMNm source for the words was significantly more anterior than the source of the N400m-like response; for the non-words, the PMNm source was significantly more anterior than the sources of the N1m and the N400m-like response. These results suggest that the left-hemisphere neuronal networks involved in sub-lexical phonological analysis are at least partly different from those responsible for the earlier (acoustic) and later (whole item) processing of speech input.     

Method-dependent characteristics of carbohydrate-deficient transferrin measurements in the follow-up of alcoholics

AIMS: There are only limited data comparing the diagnostic characteristics of carbohydrate-deficient transferrin (CDT) measurements in assays for excessive alcohol consumption under controlled conditions. METHODS: We compared different CDT assays and the conventional laboratory markers of ethanol consumption, gamma-glutamyl transferase (gamma-GT) aspartate aminotransferase (AST) and mean corpuscular volume (MCV) in the assessment and follow-up of 36 alcoholics (31 men, five women, mean age 44 years), who were admitted for detoxification. Detailed interviews to assess the amount of alcohol consumption were carried out for each patient. A hospital follow-up with supervised abstinence for 8 +/- 4 days (range 5-19 days) was carried out for 17 patients. Controls were 30 apparently healthy individuals (22 men, eight women, mean age 49 years), who had no history of hazardous drinking. RESULTS: At the time of admission, the %CDT method, which excludes the trisialotransferrin isoform from the measurement, yielded elevated values in 69% of the patients, compared to 61% for CDTect. The corresponding sensitivities for gamma-GT, AST and MCV were 61, 56 and 47%, respectively. The self-reported alcohol consumption for a period of 1 month prior to admission showed a stronger correlation with the %CDT results (r = 0.59, P = 0.0003) than with the CDTect results (r = 0.36, P = 0.04), GT (r = 0.40, P = 0.02) or AST (r = 0.35, P = 0.05). During follow-up with supervised abstinence the mean %CDT values were found to show a slower rate to normalization (mean 14 +/- 4 days) than the CDT values measured with the CDTect method (mean 10 +/- 5 days) (P < 0.05). CONCLUSIONS: The data indicate distinct differences and method-dependent rates of normalization in CDT assays, possibly reflecting different degrees of transferrin desialylation in the alcoholics. The present findings should be considered in studies on alcohol markers for monitoring abstinence.     

Effect of mandibular setback surgery on the posterior airway size

Treatment of dentofacial deformities with jaw osteotomies has an effect on airway anatomy, and therefore, mandibular setback surgery has the potential to diminish airway size. The purpose of this study was to evaluate the long-term effect of mandibular setback surgery on the airway size. The material consisted of pre- and postoperative (minimum 1 year) lateral radiograms of 22 individuals (18 females and 4 males) with a mean age of 30 years, who had undergone mandibular setback surgery to correct skeletal Class III discrepancies. Hard and soft tissue points were digitized with a Numonics Accugrid digitizer and analyzed with Xmetrix software. A paired t test was used to evaluate the difference between pre- and postoperative measurements. In addition, Pearson's coefficient correlation was calculated to reveal the possible association between the skeletal change in relation to the change in airway size. The mean value for the initial SNA was 81.3 degrees, 85.4 degrees for SNB, 36.9 degrees for S-Na/MP, and for the posterior airway, 10.5 mm and 12.0 mm retropalatinally and retrolingually, respectively. At the postoperative evaluation, SNB was 80.7 degrees, S-Na/MP 41.0 degrees, and the posterior airway retropalatinally 8.3 mm and retrolingually 9.8 mm. Statistical analysis revealed a highly significant correlation between the change in the ANB angle and in the S-Na/MP angle versus the change in the upper airway size, both retropalatinally and retrolingually. Mandibular setback surgery with posterior rotation may gradually result in increased upper airway resistance in cases where neuromuscular adaptation is insufficient to compensate for the reduction in the airway size. Therefore, large anteroposterior discrepancies should be corrected by combined maxillary and mandibular osteotomies.     

Diagnostic characteristics of different carbohydrate-deficient transferrin methods in the detection of problem drinking: effects of liver disease and alcohol consumption

AIMS: Due to methodological heterogeneity, conflicting views have been expressed on the validity of CDT measurements in the detection of alcohol misuse. METHODS: We compared the characteristics of the conventional CDTect method and the Axis turbidimetric CDT assays in the assessment of 62 alcoholics, who were either with (n = 33) or without (n = 29) liver disease, as analysed by combined clinical, laboratory, and morphological indices. Controls were 45 healthy volunteers who were either social drinkers or abstainers. RESULTS: In the total sample of alcoholics, the sensitivity of the %CDT method, which excludes the trisialotransferrin isoform from the measurement, was 63% for men and 46% for women, as compared to 65% and 36% of CDTect, respectively. Both of these methods showed higher sensitivities than the %CDT-TIA method, which reacts with trisialotransferrin (32% and 25%, respectively). The assay specificities were 100% for men and 91% for women with %CDT, and 96% and 87% with the CDTect, respectively. The correlation between the CDTect and %CDT method was higher in men (r = 0.86) than in women (r = 0.57). The presence of liver disease was found to influence the results of the CDTect method, such that the highest CDT concentrations were observed in patients with mild to moderate liver disease, especially among women, whereas the %CDT method was less sensitive to the effect of liver pathology. The self-reported alcohol consumption from the 4 weeks prior to sampling showed a higher correlation between the %CDT results (r = 0.64, P < 0.0001) than with the CDTect results (r = 0.40; P < 0.01). CONCLUSIONS: The data indicate that the new %CDT method offers advantages over the previous versions of the CDT methods. The improved characteristics may be most useful in assays for excessive alcohol consumption in female alcoholics, patients with liver disease, and in patients with abnormal serum transferrin concentrations.