Evaluation of Hearing Loss in Tympanic Membrane Perforation

To evaluate and analyse the hearing loss in tympanic membrane perforation based on size, site and duration of perforation. The material for this study was comprised of 100 patients of either sex and of age 15 years and above selected randomly. Size of tympanic membrane perforation was assessed under microscope using calibrated wire look. Patients were divided into three groups according to size; group I (0–9 mm²), Group II (9–30 mm²), Group III (≥ 30 mm²); according to site into anterior and posterior group; according to involvement of malleus into malleolar and non malleolar and according to duration into Group A (<1 year), Group B (1–5 years), Group C (≥ 5 years). Hearing loss was measured in each case with pure tone audiometry. Data was analysed statistically using paired t-test. Hearing loss increased as the perforation size increased [I vs. II (t − 4.23, p < 0.001), II vs. III (t − 8.19, p < 0.001), I vs. III (t − 11.68, p < 0.001)]. Hearing loss was more in posterior quadrant perforation than anterior quadrant perforation but difference was not significant statistically (t − 1.15, p > 0.05). Hearing loss was more in malleolar perforation (t − 5.74, p < 0.001). Hearing loss increased as the duration of disease increased [A vs. B (t − 2.01, p < 0.043), A vs. C (t − 5.49, p < 0.001), B vs. C (t − 4.14, p < 0.001)].     

Clinical Profile of Tubotympanic CSOM and Its Management With Special Reference to Site and Size of Tympanic Membrane Perforation, Eustachian Tube Function and Three Flap Tympanoplasty

Otitis media is an important and a highly prevalent disease of the middle ear and poses serious health problem world wide especially in developing countries where large percentage of the population lack specialized medical care, suffer from malnutrition and live in poor hygienic environmental conditions. It has been a general view that the hearing loss increases with the size of the perforation, more so if it is in the posterio inferior quadrant. It was found that the maximum average loss occurred at 250 Hz. The hearing loss is less in small perforations (less than 2 mm diameter) then in larger ones; less in perforations touching the manubrium than in those away from it, and also less in perforations of the anterioinferior quadrant than in those on posterio-inferior quadrant. A normally functioning eustachian tube is also an essential physiologic requirement for a healthy middle ear and normal hearing.     

Myringoplasty: Impact of Size and Site of Perforation on the Success Rate

Myringoplasty aims to reconstruct the tympanic membrane, restoring protection to the middle ear and improve hearing. Success of Myringoplasty in terms of anatomical closure is influenced by many factors. This study focuses on the influence of size and site of tympanic membrane perforation on success rate of Myringoplasty. This is a prospective study of 60 patients who underwent myringoplasty and were then followed up for 6 months from the date of operation. Patients with dry perforation, with good cochlear reserve, intact and mobile ossicular chain, functioning Eustachian tube were selected randomly for the operation. Video Otoendoscopy of all cases with storz 0 degree endoscope were done. All images were recorded on the computer [DELL VOSTRO 3400]. Using ‘Image J’ [version 1.35j] geometrical package, the area of perforation (P) and the entire area of the tympanic membrane (T) were calculated. Then, the percentage area of the perforation [P/T × 100 %] for each ear was obtained. Site of perforation also documented. Success rate for pin-point and small perforations was 100 %, for medium size 80 %, and for large & subtotal perforations 69.2 and 42.9 % respectively. We regard size of the perforation as a major factor that influences success of Myringoplasty. Site of perforation failed to be a statistically significant influencing factor in this study.     

A Study of Closure of Tympanic Membrane Perforations by Chemical Cauterisation

To study the effectiveness of chemical cautery with patching on chronic tympanic membrane perforations of the pars tensa. Thirty-eight patients with dry tympanic membrane perforations due to inflammatory or traumatic etiology were selected after treating the primary etiological factors like septal deviation and allergic rhinitis. Fifty percentage silver nitrate was used to cauterize the margin and the perforation was covered with thin sterile aluminium foil as a patch. A maximum number of five applications were made, and the patients were followed up for the next 5 years. In this series of 38 patients, highest success was noted among those patients with traumatic perforation, while larger perforations were reduced to small pinhole sizes which were successfully closed by myringoplasty. An overall success rate of 73.75% was achieved. This is a time tested useful method which was popularized by Derlacki (1953), to close small to moderate sized tympanic membrane perforation and should be considered as a first line management in the treatment of tympanic membrane perforation prior to any surgical intervention. Apart from being a simple and economical mode of treatment, it is associated with minimal complications. Though various materials have been used to modify this technique, the principle remains the same and the results obtained in this study is comparable with the previous ones.     

Two Cases of Congenital Cholesteatoma of the Tympanic Membrane

Congenital cholesteatoma of the tympanic membrane is rare, and lesions without a history of otitis media or any other adverse events involving the tympanic membrane are extremely rare. We report two cases of this lesion; one was a 3-year-old girl who underwent removal of a cholesteatoma using retroauricular approach and a partial myringoplasty with an underlay technique, and the other was a 2-year-old girl in whom a cholesteatoma was enucleated without grafting. This disease is thought to be of embryonic origin.     

The Surgical Management of Tympanic Membrane Retraction Pockets Using Cartilage Tympanoplasty

Evaluate the surgical treatment of tympanic membrane (TM) retractions with modified cartilage augmentation tympanoplasty. Retrospective review of subjects with Charachon stage II and III TM retractions who underwent modified cartilage augmentation tympanoplasty following excision of the retracted TM segment. Pre and postoperative symptoms and air-bone gaps were recorded. Forty two ears were included in the study. Twenty six ears were of stage II and 16 were stage III retractions. 35 (83 %) ears had ossicular erosion and cholesteatoma was found in 13 (31 %) ears, all in stage III retractions. Follow-up ranged 12–102 months. The air-bone gap (ABG) improved in 29 (76 %) and worsened in seven (19 %). Ears without cholesteatoma had a greater improvement in ABG. The results of our modified cartilage tympanoplasty technique are comparable to the published literature and should provide a safe and acceptable result. The high rate of cholesteatoma found preoperatively in stage III retractions advocates early surgical intervention.     

Atropic Tympanic Membrane and Hearing Assessment

The hearing threshold in atrophic tympanic membrane is assessed in 35 individuals. Assessment of hearing threshold in patients having atrophic tympanic membrane. Prospective clinical study. Tertiary referral centre. Thirty-five patients who had atrophic tympanic membrane in one ear and normal tympanic membrane of the other ear which was used as control, were selected Hearing threshold of patients having atrophic tympanic membrane. Twenty-nine patients with atrophic tympanic membrane had absolutely normal PTA of the ear and the opposite ear with normal tympanic membrane had similar normal PTA. Majority of the patients with atrophic tympanic membrane have normal hearing.     

Minimyringoplasty: Repair of Small Central Perforation of Tympanic Membrane by Fat Graft: A Prospective Study

Ear lobule fat was used as graft material for the closure of small size central perforation of tympanic membrane. We describe this procedure as minimyringoplasty. This study was done over a period of 2 year on fifty properly selected cases. Closure of perforation was found in 92% of cases within 2–3 months of surgery. Hearing gain was 7 dB on an average and morbidity was insignificant in successful cases.     

A Comparative Study of Various Office Procedures for the Management of Small to Medium Size Tympanic Membrane Perforations

A hospital based prospective study to compare and evaluate the efficacy and convenience of various office procedures like chemical cauterization, fat plug myringoplasty and butterfly cartilage tympanoplasty. This interventional, prospective, longitudinal study carried out on 300 patients in the ENT department of a tertiary care medical college hospital in central India between January 2009 and January 2015. The success rate was found to be 94.54, 91.12 and 97% in chemical cauterization, fat plug and butterfly cartilage tympanoplasty respectively (p value 0.246). In all the groups there were significant improvement in terms of hearing in decibels and AB gap postoperatively. No statistically significant association was found in between the failure rates in all the groups. From this study we conclude that all the procedures were simple, rapid, reliable, cost effective, takes less time and minimum hospital stay (day care) than conventional tympanoplasty. We strongly recommend these procedures in place of tympanoplasty in small to medium size central tympanic membrane perforations according to condition and convenience of the patients.     

幽门螺杆菌的免疫外膜蛋白质组学及其与胃部疾病的关系

目的：应用蛋白质组学技术研究幽门螺杆菌（HP）的候选抗原，用于胃部疾病临床诊断、治疗和疫苗开发。方法：选择自胃腺癌患者胃粘膜分离出且经确定的HP菌株（HP161），采用二维凝胶电泳（2-DE）分析外膜蛋白，并通过PDQuest图像分析软件分析蛋白质图谱，进行蛋白斑点检测和分析；收集20例HP感染患者和10例非HP感染相关性胃炎患者血清，采用免疫印迹技术分析HP161的外膜蛋白质与上述血清的反应性。结果：HP161有129个蛋白斑点；被慢性活动性胃炎和胃癌患者血清不同识别的特定抗原有10个；应用胃癌患者血清时，具有免疫反应性，而用胃炎患者血清时则无，等电点范围较宽，分子量多数在31kDa以下。结论：2-DE是研究HP外膜蛋白质组学的重要途径之一，并可能对其进行鉴定作为临床诊断的候选分子；经免疫蛋白组学检测的资料与公共数据库进行对比分析，以有助于寻找更具免疫原性的蛋白质标记物用于诊断分析和疫苗设计。     

Treatment of Large Tympanic Membrane Perforations: Medial to Malleus Versus Lateral to Malleus

The perforation size affects the success of tympanic membrane (TM) reconstruction, in addition to the surgical technique used. Large TM perforations present a surgical challenge. The perforation size has been reported to be a prognostic factor, and poorer results are obtained with large versus small perforations. We aimed to evaluate patients who had undergone tympanoplasty for large perforations at our clinic using either the underlay or over-underlay technique and to compare the results in terms of re-perforation, retraction, lateralization, and improvement of hearing. Of 302 patients with chronic otitis media, 114 who had a perforation that involved over 50 % of the pars tensa were enrolled in the study. The underlay technique was used in 61 patients, and the over-underlay technique in 53 patients. In the underlay group, the preoperative mean perforation size was 30.11 ± 5.35 mm² (range 20.00–52.00 mm²) (n = 61). In the over-underlay group, the preoperative mean perforation size was 31.41 ± 8.65 mm² (range 22.00–48.00 mm²) (n = 53). The graft success rate of tympanoplasty performed using the underlay technique was 89.1 % in 61 patients. Seven (10.9 %) patients had graft failure. The graft success rate with the over-underlay technique in 53 patients was 90.5 %. Five (9.5 %) patients had graft failure in this group. Three graft lateralizations (5.6 %) and two retractions (3.8 %) were observed at 12 months postoperatively in the over-underlay group. However, in the underlay group, no graft lateralization but five retractions (8.2 %) were observed at 12 months. The graft-take rates and hearing improvement results in both groups were successful and compatible with those in the literature.     

Treatment of Tympanic Membrane Retraction Pockets by Excision and Cartilage Tympanoplasty: A Prospective Study

To assess the role of cartilage tympanoplasty in management of retraction pockets of the pars flaccida. This was a prospective study at a tertiary care centre. Twenty patients having grade III or grade IV retraction pockets were included in the study. Retraction pockets were treated by excision and cartilage tympanoplasty. Findings noted on follow-up were recorded and analysed. Graft was taken up in 18 (90%) cases with residual perforation in 2 (10%) cases. Recurrence of retraction pockets was observed in 6 (30%) cases. Hearing was improved up to 15 dB in 16 (80%) cases. It is concluded that grade III and IV retraction pockets can be well managed by excision and cartilage tympanoplasty.     

The selection and strategy in otoendoscopic myringoplasty with autogenous adipose tissue

Purpose

To summarize the experience and explore the clinical application of myringoplasty with autogenous adipose tissue by endotoscope.

Methods

In this study, we retrospectively analyzed 56 cases (64 ears) of otoendoscopic myringoplasty with autogenous adipose tissue performed between January 2006 and April 2007.

Result

All patients were followed up more than 6 months. The global closing rate was 92.19% (59 perforations among 64 total operations), 95.08% (diameter of perforation ≤5 mm), 33.33% (>5 mm).

Conclusion

Otoendoscopic myringoplasty with adipose tissue is a simple and minimally invasive technique for tympanic membrane perforations. With optimal choice at indication and correct treatment to complication, the technique will give the advantages of slighter trauma, simpler procedure, lower cost and reduced complication rate.     

溴氰菊酯对大鼠脑组织线粒体膜电位和膜流动性的影响

背景与目的： 研究溴氰菊酯(Deltamethrin,DM)对大鼠脑组织线粒体膜电位及膜流动性的影响。材料与方法： 成年雄性Wistar大鼠一次性腹腔注射12.5 mg/kg体重DM(溶剂为色拉油),5 h、24 h、48 h、72 h后处死,提取皮层和海马的线粒体,分别测定线粒体膜电位、膜流动性、Na＋-K＋、Ca2＋-Mg2＋-ATP酶和琥珀酸脱氢酶活力。同时设立对照组,只注射色拉油0.5 ml/100 g,5 h后处死大鼠。 结果： 大鼠经DM处理后,5 h、24 h、48 h、72 h组的线粒体膜电位下降,膜流动性降低,Na＋-K＋、Ca2＋-Mg2＋-ATP酶和琥珀酸脱氢酶活力受到抑制,与对照组相比,差异均具有统计学意义(P<0.01),并且与染毒后时间成直线相关关系。 结论： DM能明显损害大鼠脑组织线粒体功能,继而引起线粒体氧化磷酸化障碍。     

Cell Size Following Irradiation in Relation to Cell Cycle

The cell volume of Ehrlich ascites tumour cells was studied following a radiation dose of 5.0 Gy. The cell volume increased 12 to 30 hours after irradiation by about 20 per cent, was normal at about 50 hours, and increased again at 72 hours. In order to explain these changes the composition of the cells in cell cycle was studied. In addition, the cell volume of irradiated cells from the various parts of the cell cycle, separated by centrifugal elutriation, was measured. The changes in the mean cell volume of unseparated cells could be explained by variations in the cell cycle composition of the cell population. Irradiated cells from the various parts of the cell cycle did not deviate from the volume of non-irradiated cells. The cell volume doubled during the cell cycle. This increase was, however, not linear.     

Outcome of Interlay Grafting in Type 1 Tympanoplasty for Large Central Perforation

A prospective, cohort, clinical study was conducted at Dr. D. Y. Patil Hospital, Kolhapur from August 2010 to August 2013. The aim was to evaluate the results of type 1 interlay tympanoplasty with respect to graft uptake, hearing improvement and complications. Total of 100 cases with a mucosal type of chronic suppurative otitis media and a large central perforation (involving more than 50 % of tympanic membrane) were operated for type 1 tympanoplasty where the graft was placed by interlay method (below the fibro-squamous layer and above the mucosal or endothelial layer). Patients were followed up with ear microscopy at each follow up visit and an audiometry at the end of 3rd month. Statistical analysis was done by statcal software using paired t test and two sample t test for proportion. 96 (96 %) cases had a successful graft uptake. The mean pre-operative air-bone gap was 36.42 ± 12.0 dB; whereas the mean post-operative air-bone gap was 9.7 ± 6.71 dB. Except for residual perforation in four patients and partial tympanomeatal flap necrosis in two patients no other complications were encountered. Thus, we conclude that, the interlay tympanoplasty is a safe and effective method of graft placement for large central perforation.     

Comparative study of hearing improvement in type 1 tympanoplasty with and without canalplasty

Introduction

Widening of the external auditory canal is canalplasty. It is an intergral part of tympanoplasty, especially in anterior perforations and gives wide surgical access for proper repair.

Materials and methods

After elevating tympanomeatal flaps the canal is widened using conical cutting and diamond burrs following which entire tympanic annulus is visible and corresponds to an inverted truncated cone.

Results

Canalplasty gives 9 db gain in hearing compared to without canalplasty.

Conclusion

Canalplasty gives better visualization, better graft placement and better post-operative care.     

正常胃粘膜细胞和病变细胞核的DNA含量初步探讨

本文选择49份胃手术标本(包括正常胃粘膜12例、慢性溃疡13例,胃粘膜不典型增生10例和胃管状腺癌14例)为对象,探讨细胞核内DNA含量的变化。采用常规切片,H·E染色、Feulgen反应显示DNA,光镜下分三级,光镜下测核面积,并选新鲜的正常胃粘膜、胃癌各2例应用显微分光光度仪检查。结果发现光镜下各组病变DNA含量分级中,癌>不典型增生>慢性溃疡>正常,具统计学意义;正常胃粘膜和病变细胞核DNA与直径、核面积的平均值,则癌肿表现核大且DNA含量多;正常胃粘膜细胞和病变细胞核DNA含量与核面积的相关,表现DNA Ⅰ级含量与核面积大小呈负相关,DNA Ⅱ、Ⅲ级均呈正相关;显微分光光度仪结果表明,癌细胞的多倍体及不整倍体细胞的百分数占相当数量,其参差不等的结果与镜下所见很吻合。我们认为,细胞化学方法在光镜下测定DNA含量,可以达到半定量的效果。     

Body Size and Menopausal Status in Relation to the Pattern of Spread in Recurrent Breast Cancer

The prognosis and pattern of spread were related to body size and menopausal status in 863 patients with recurrent breast cancer. These patients were all enrolled in the adjuvant protocols of the Danish Breast Cancer Cooperative Group. the pattern of spread was illustrated by the number of metastases, the anatomical location of recurrence, and the rate of progression. Body size was estimated as height, weight, Quetelet index (QI), and body surface area (BSA). the body size was unassociated with both recurrence-free interval (RFI) and survival after recurrence (SAR). the groups of patients with different body size had both the same number and the same location of metastases. the tumour growth rates were estimated as clinical rates of progression (i.e. the time elapsed from a single distant metastasis until dissemination). the progression rate was unaffected by body size. Postmenopausal patients had a significantly shorter RFI and SAR compared to premenopausal patients. the number of metastatic sites, the anatomical location of metastases, and the rate of progression were similar in pre- and postmenopausal patients. the study could not confirm most findings from the literature which report a poor prognosis for patients with large body size. Moreover, the results do not suggest interactions between body size, menopausal status, and the clinical course of recurrent breast cancer.     

Relation Between Tumor Size and Lymph Node Metastasis According to Subtypes of Breast Cancer

PurposeTumor size and lymph node metastasis are important factors that contribute to the progression of breast cancer. We aimed to analyze the relationship between tumor size and lymph node metastasis molecular subtype and examine the effects of nodal metastasis on overall survival (OS).MethodsWe retrospectively reviewed the data of 16,552 patients who underwent breast surgery in Samsung Medical Center between 2000 and 2015. Information on tumor size (largest diameter of the invasive component), number of positive lymph nodes, and molecular subtype were obtained. We constructed a linear regression model to evaluate the relationship between tumor size and lymph node metastasis. To determine the effect of nodal metastasis on OS, we performed a Cox proportional regression analysis with Np/T (number of metastatic lymph nodes [n]/tumor size [cm]).ResultsThis study included 12,007 patients with a median follow-up of 62 months. The linear regression coefficients were 1.043 for luminal A, 1.024 for luminal B, 0.656 for HER2, and 0.435 for triple-negative breast cancer (TNBC) subtypes. No significant difference was observed in the coefficients between the luminal A and B subtypes (p = 0.797), while all other coefficients showed significant difference. After adjusting for other risk factors, the hazard ratio (HR) of Np/T for each subtype was significant for OS: luminal A (HR, 1.134; 95% confidence interval [CI], 1.097–1.171; p < 0.001), luminal B (HR, 1.049; 95% CI, 1.013–1.086; p = 0.007), HER2 (HR, 1.069; 95% CI, 1.014–1.126; p = 0.013), and TNBC (HR, 1.038; 95% CI, 1.01–1.067; p = 0.008).ConclusionThe incidence of lymph node metastasis differed according to molecular subtype. Luminal types have higher incidence of nodal metastasis than HER2 and TNBC. The HR of Np/T was highest in luminal A subtypes and lowest in TNBC subtypes.