Aerotitis: cause, prevention, and treatment

Aerotitis, an acute inflammation of the middle ear caused by the difference in air pressure between the airplane cabin and the middle-ear space, is becoming more common in the United States as our society becomes increasingly mobile. We describe a case in which a 33-year-old woman with a resolving upper respiratory tract infection and mildly blocked eustachian tubes flew on a business trip. During ascent, her ears became blocked. This blockage was partially alleviated by a Valsalva's maneuver. On descent, however, her ears became severely blocked, she experienced intense pain, and her tympanic membranes ruptured. She became nauseated and vomited. Her hearing became significantly diminished and she experienced vertigo. On landing, she was taken to a local emergency room and treated with penicillin and antivertiginous medication. Subsequent otologic evaluation revealed severe permanent sensorineural hearing loss. The vestibular symptoms lasted several months. She now requires hearing aids on a permanent basis. Suggestions are presented for prevention and treatment of aerotitis.     

Pathogenesis,clinic, and treatment of ganglion

Summary In clarification of various theories on the pathogenesis of the ganglion, histopathologic examinations indicate that the ganglion develops from connective tissue by myxoid degeneration and disintegration of collagen fibers. Increasing amounts of mucinous fluid accumulate by the progressive liquefaction of collagen fibers and are surrounded by densifying collagen bundles which form a delimiting capsule. In view of the inadequacy of conservative treatment and the shortcomings of excision, the subcutaneous (s.c.) discission of the ganglion with a tenotome is recommended. Of 184 patients treated in this way, 151 displayed full healing, six underwent a successful repetition of the procedure, nine underwent an excision of the recurrent ganglion, and 18 rejected further treatment.

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Zusammenfassung Zur Klärung der verschiedenen Theorien fiber die Pathogense der Ganglien erwiesen histopathologische Untersuchungen, daß das Ganglion aus Bindegewebe durch Zerfall and myxoide Degeneration von Kollagenfasern mit Ansammlung schleimiger Flüssigkeit and Verdichtung der umgebenden Kollagenbündel entsteht. Als Behandlung wird die subcutane (s.c.) Diszission des Ganglion empfohlen. Von 184 derartig behandelten Patienten boten 151 vollständige Heilung dar, sechs unterzogen sich einer erfolgreichen Wiederholung des Verfahrens, neun machten eine sekundäre Exzision mit und 18 lehnten eine weitere Behandlung ab.

     

Rectal prolapse in adults--causes, diagnostic, treatment

Despite progress in modern surgery, the choice of the surgical procedure of rectal prolapse is regarded with controversy. Selection criteria between the abdominal or perineal approach or between rectopexy and resection rectopexy are not yet proven. This article gives a review of the literature about rectal prolapse and an analysis of the outcome of posterior rectopexy and resection rectopexy--partly conventionally and partly laparoscopically--in 25 patients with rectal prolapse III degrees and IV degrees. All except for one patient were examined during a mean follow-up of 5.5 (3.1) years for the rectopexy group and 2.1 (0.7) years for the resection rectopexy group. Recurrence occurred in one patient in each group respectively. There was no significant difference concerning the continence function (p = 0.32) and constipation (p = 0.36) between both groups. No mesh-related complications such as infection, fistula or rectum stenosis were observed. According to the review of the literature and our data, we believe that the choice of the operative procedure for rectal prolapse should be based on individual criteria. Fit patients should be offered laparoscopic procedures such as resection rectopexy and rectopexy without colonic resection.     

Nocturia: etiology, diagnosis, and treatment

Voiding at night, or nocturia, is a common reason for interrupted sleep in the adult population. The condition affects both men and women, with an incidence that increases dramatically with age. Nocturia has a negative impact on quality of life, affecting both morbidity and mortality. Effective diagnosis of the condition is dependent on a clear understanding of its underlying etiology. In general, the causes of nocturia fall into three categories: diurnal polyuria, nocturnal polyuria, and low bladder capacity. In some individuals, however, nocturnal polyuria and low bladder capacity may both contribute to the overall symptomatology of nocturia. Addressing any underlying conditions that contribute to nocturia is the first step in treating the condition. Lifestyle and behavioral changes may provide benefit in some individuals, but for many, the only option is pharmacotherapy. Antimuscarinic agents are first-line therapies for overactive bladder and are often used in the management of nocturia. Pharmacological and physicochemical differences between available antimuscarinic agents, however, translate into different safety and tolerability profiles, which may make some agents more suitable for use in certain populations, including the elderly. Careful selection of the most appropriate antimuscarinic medication is therefore central in optimizing treatment outcomes.     

Inpatient PTSD treatment: A study of pretreatment measures,treatment dropout,and therapist ratings of response to treatment

Pretreatment measures including demographic variables, adjustment index variables and psychological testing variables were studied in relationship to treatment dropout and therapist ratings of overall response to treatment among PTSD veterans in an inpatient PTSD program. Analysis comparing a group of fourteen veterans who dropped out of treatment early and a random sample of fourteen who successfully completed treatment showed no significant differences. Analysis comparing a group of 35 veterans who received the highest therapist ratings on response to treatment with a group of 35 veterans receiving the lowest ratings on response to treatment also showed no significant differences. Analysis of subgroups of patients who had completed the Millon Clinical Multiaxial Inventory (MCMI) and received high versus low therapist ratings showed one significant difference on the hypomania scale. Overall findings on the MMPI and MCMI appeared similar to other investigations of PTSD.     

Running: examination, diagnosis, and treatment

Remember that athletes are a special breed of person. They are usually determined and progressive in their thinking. Athletics is an essential part of their lives, and many cannot do without the activity. Do not deprive them of this opportunity. To simply say "Stop what you are doing and the pain will go away" is not sufficient. You must examine, prod, and badger the athlete for answers. Help the athlete overcome the injury and put him on the right road to recovery. This is an essential part of practice. Not only will the athlete be delighted, but it will give the practitioner immense satisfaction to see the athletes happy and running.     

Pheochromocytoma: evaluation, diagnosis, and treatment

Pheochromocytoma is a catecholamine-producing tumor of the sympathetic nervous system. Signs and symptoms are generally related to catecholamine excess; these include hypertension, sweating, palpitatione, headaches, and anxiety attacks. Abdominal imaging and 24-h urine collection for catecholamines are usually be sufficient for diagnosis. Catecholamine blockade with phenoxybenzamine and metyrosine generally ameliorates symptoms and is necessary to prevent hypertensive crisis during surgery. Standard treatment is laparoscopic adrenalectomy, although partial adrenalectomy is gaining enthusiastic support in familial forms of pheochromocytoma.