Neurostimulation as a new treatment for severe tinnitus: a pilot study.

BACKGROUND: Tinnitus is an uncomfortable symptom for the patient and an embarrassing one for the consulted physician. So far, there is no treatment that can be considered well established in terms of providing long-term reduction of tinnitus in excess of placebo effects. There is considerable evidence of pathophysiological similarity between tinnitus and chronic pain. Some forms of chronic pain can be treated by neurostimulation. OBJECTIVE: This study was designed to investigate the feasibility of neurostimulation of the cochlear nerve in order to reduce tinnitus. STUDY DESIGN: Pilot study. SETTING: Tertiary referral center. PATIENTS: Five patients with therapeutically refractory tinnitus were selected for this study. INTERVENTION: Placing a stimulation lead around the cochlear nerve through the suboccipital approach and connecting the stimulation lead to a pulse generator. MAIN OUTCOME MEASURES: The patients experienced 1) an absence of major or minor complications, such as death, meningitis, cranial nerve deficit, and vestibular problems; 2) tolerance of the procedure as considered by the patient; 3) relief of tinnitus in at least one patient. RESULTS: Implantation of the neurostimulation system was accomplished in each patient without any difficulty. None of the patients considered the treatment unbearable. No major or minor complications occurred in this study. Subjective tinnitus reduction was accomplished in four patients. CONCLUSION: Our preliminary data show that neurostimulation of the cochlear nerve is feasible, is bearable for the patient, and is a safe treatment modality without major complications. The effects on tinnitus are promising.     

Transjugular intrahepatic portosystemic shunting (TIPS) with balloon-expandable and self-expanding stents: Technical and clinical aspects after 3 1/2 years’ experience

Purpose To evaluate prospectively our experience with transjugular intrahepatic portosystemic shunt (TIPS) using four different metallic stents. Methods Between November 1991 and April 1995, 57 patients (41 men and 16 women; age 35–72 years, mean 54 years) underwent the TIPS procedure. Techniques for portal vein localization before and during TIPS were fluoroscopy, computed tomography (CT) studies, wedged hepatic venography, arterial portography, and ultrasound. After predilation we deployed balloon-expandable (n=48) and self-expanding (n=45) metallic stents. Fifteen patients underwent variceal embolization. Initial follow-up angiograms (mean 6.9 months, range 3–24 months) were obtained in 39 of these patients. Results Fifty-three patients (93%) had successful TIPS placement. The mean decrease in portal pressure was 42.7%. Besides fluoroscopy, the most helpful techniques for portal vein localization were venography and CT. Residual stenosis (n=1) and late shortening (n=4) of Wallstents resulted in shunt dysfunction. The technical problems encountered with the Palmaz stent resulted from its lack of flexibility. We combined balloon-expandable and self-expanding stents in 12 patients. The 30-day and late follow-up (mean 11.9 months) percutaneous reintervention rates were 11.3% and 64.2%, respectively. There were no clinically significant complications related to the TIPS insertions. Conclusion An ideal stent does not exist for TIPS, and the authors recommend combining a Palmaz stent with a flexible self-expanding stent.     

The effect of various thermal processes on the glycemic response to whole grain wheat products in humans and rats

The effects of different thermal processes used to produce ready-to-eat cereals on the glycemic response to whole grain wheat were investigated in rats. The metabolic response to drum dried flour, which constitutes the major component in instant gruel and porridge, was also studied in healthy human subjects. Boiled flour was used for comparison. The degree of starch gelatinization and rate of starch hydrolysis in vitro were also measured. Incompletely gelatinized steam flaked and dry autoclaved products were digested more slowly in vitro and elicited lower glucose responses in rats compared with completely gelatinized drum dried, extrusion cooked or boiled samples. The initial glycemic response in rats was closely related to the rate of starch hydrolysis in the pepsin/alpha-amylase assay (r = 0.91, P less than 0.04). When pepsin was omitted, no significant correlation was obtained. The peak glucose, insulin and C-peptide responses in humans after breakfast meals of porridge prepared from drum dried flour and from boiled flour were similar, whereas the rate of depression of the glucose curve was more rapid after consuming drum dried porridge. It is concluded that the glycemic response to wheat products is affected by the processing conditions used. The more severe the processing conditions, the more rapid the digestion of starch.     

Computer-assisted three-dimensional reconstruction of the hippocampal region based on serial sections

A large series of rabbit hippocampal Neo-Timm stained sections were manually aligned, digitized, and by a modified median filtration noise reduced and reconstructed into a three-dimensional object. From the presented simulated grey tone cuts of this object, the reader may assemble a rabbit hippocampal model, that spatially illustrates its anatomy.     

Boundary Ambiguity in Parents With Chronically Ill Children: Integrating Theory and Research

Abstract: This article integrates theory and research related to boundary ambiguity in parents of children with a chronic health condition. We propose that boundary ambiguity is a risk factor for psychological distress in these parents. Clinical applications and a case example highlight how boundary ambiguity can be assessed and managed in clinical settings by professionals working with parents with chronically ill children. Questions are provided for assessing boundary ambiguity in clinical and research settings, and implications for research are discussed.     

Physical conditioning in the aging adult

The benefits of exercise are well established but the impact of exercise on the older adult is not as clearly defined. Increasing numbers of people in the United States are over 65 years old. Thus health care providers will find themselves often involved with the older adult and will need an understanding of exercise in this age group. This article reviews the known benefits of exercise for the older adult, exercise-related age changes, and how to prescribe exercise for those 65 years and over. Selected case reports are used to provide examples of how specified guidelines can be incorporated into practice.     

Ultrasonographic diagnosis of renal stones

To illucidate the diagnostic accuracy of ultrasound in the detection of renal stones we performed a blind comparative study of ultrasonography and i.v. urography. In 92 kidneys with 58 stones, 10 stones smaller than 6 mm were overlooked by ultrasound, whereas all stones 6 mm or larger were correctly detected. In one case of uric acid stone disease i.v. urography was inconclusive in determining the true nature of a renal pelvic filling defect, whereas ultrasound correctly diagnosed a stone. We conclude that ultrasonography has a place in diagnosis and control of renal stones.     

Assessment of thermal conditions in neonatal care: use of a manikin of premature baby size.

A thermal manikin of the size of a 1 kg premature baby has been constructed. The nonevaporative heat loss from eight different regions and the total heat loss were measured. The measurements of heat loss have high repeatability and the values are in good agreement with measurements of dry heat loss for premature babies, using indirect calorimetry. The heat losses from the manikin in a single-walled, air-heated incubator and on a recently described heated, water-filled mattress have been compared. The total heat loss was found to be 20 to 30 W/m2 with both methods at ambient temperatures between 15 degrees and 25 degrees C. Treatment on a heated, water-filled mattress provides a means of direct conductive heat input to the baby, with a conductive heat transfer coefficient of 0.4 W/degrees C or 21 W/m2 degrees C. The thermal manikin appears to provide an accurate method for assessment of the thermal conditions in neonatal care.