Routine otorhinolaryngological examination in patients with cystic fibrosis

OBJECTIVES: Data on the prevalence of otorhinolaryngological (ORL) symptoms in patients with cystic fibrosis (CF) are limited. A standard annual examination would be useful for definition of risk factors and/or management alternatives for these symptoms. STUDY DESIGN: Prospective observational study of an unselected group of CF patients. PATIENTS AND METHODS: Between 1997 and 2004, 123 CF patients were routinely examined. The examinations included nasal endoscopy and audiological evaluation. RESULTS: All patients who were approached to take part in the study gave their consent and were extremely cooperative. In 40% of the patients nasal polyps were found endoscopically. In 22% rhinological surgery had already been performed. Of the 123 patients, 13 (12%) showed different grades of sensorineural hearing loss, and all of these patients had received aminoglycoside antibiotics. CONCLUSIONS: CF patients demonstrate a high prevalence of ORL symptoms. Therefore, an annual standard examination would provide data for identifying potential risk factors and for optimizing the management of these symptoms in CF patients.     

Endoskopische Ohrchirurgie – eine Weiterentwicklung der modernen Ohrchirurgie

Wullstein, the founder of modern microscopic ear surgery, already used an oto-endoscope intraoperatively. However, it is only after the recent development of modern video-endoscopy with high definition, 4?k, and 3?dimensional imaging that endoscopically guided surgery of the middle ear is gaining some importance. Key ventilation routes like the isthmus tympani and the epitympanic diaphragma can be visualized far better by using an endoscope rather than a microscope. Going through the external meatus surgery of middle ear pathologies is possible without external incision. This type of primary endoscopic ear surgery has to be distinguished from secondary endoscopic ear surgery, where standard microscopic ear surgery is supplemented by endoscopic surgery. Having to hold the endoscope in one hand, surgery has to be performed single-handed, which is awkward. In case of extensive bone removal or excessive bleeding the view through the endoscope lense is obscured, the endoscope therefore cannot fully substitute the use of the microscope. It is however an interesting adjunct to microscopic ear surgery.     

Retropubic vs. transobturator tension-free vaginal tape for female stress urinary incontinence: 3-month results of a randomized controlled trial

Background

We conducted a prospective randomized controlled noninferiority trial to compare objective and subjective outcomes of retropubic tension-free vaginal tape (TVT) with those of transobturator tape (TVT-O) as primary treatment for stress urinary incontinence (SUI) in women.

Study design

The study was conducted at 25 gynecology units in Austria and Germany; regional and academic hospitals participated. A total of 569 patients were randomly assigned to undergo TVT or TVT-O.

Results

A total of 480 patients (85 %) were examined at 3 months. A negative cough stress test with stable cystometry to 300 ml was seen in 87 % of patients after TVT and in 84 % after TVT-O; 64 % and 59 % of patients, respectively, reported no pad use, and 88 % of patients in both groups considered themselves much or very much better on the Patient Global Impression of Improvement (PGI-I) scale. Quality of life (QoL) as assessed with the SF-12 Health Survey, Kings’ Health Questionnaire, (KHQ), and EuroQol-5D (EQ-5D) was significantly improved in both arms, with no differences between arms. There were no significant differences in postoperative pain or complications.

Conclusions

Results of this trial demonstrate noninferiority between TVT and TVT-O with regard to postoperative continence and QoL and suggest little difference in perioperative problems (ClinicalTrials.gov NCT 00441454).     

Elektronische Erfassung nosokomialer Infektionen bei Halsweichteileingriffen und Stapesplastiken (CISS)

ZusammenfassungHintergrund Nosokomiale Infektionen gelten als häufigste postoperative Komplikation, daher wird im deutschen Infektionsschutzgesetz vom 23.12.2002 eine Erfassung der Infektionsrate nach Operationen gefordert.Material und Methoden Die Stapesplastik und die Strumaoperation werden als HNO-typische Indikatoroperationen vorgeschlagen. Für die Erfassung wurde eine Software (CISS) basierend auf den Programmen MS Word und MS Excel neu entwickelt.Ergebnisse Retrospektiv wurden die Infektionsraten für die 2 Indikatoroperationen über 3 Jahre aufgearbeitet. Die vorliegenden Daten bestätigen die Ergebnisse früherer Studien, dass allein die Surveillance von Infektionen zu einer Senkung der Infektionsrate führt.Schlussfolgerung Die vorgestellte Software erwies sich als geeignet für die Erfassung der Infektionsdaten. Die 2 Indikatoroperationen Stapesplastik und Strumaoperation spiegeln die Infektionsrate einer typischen Hals-Nasen-Ohren-Klinik gut wider.     

Transmission of antibody-induced arthritis is independent of complement component 4 (C4) and the complement receptors 1 and 2 (CD21/35)

The K/BxN murine model of rheumatoid arthritis (RA) is dependent on the specificity of the KRN alpha beta-TCR, to recognize glucose-6-phosphate-isomerase (GPI) on the NOD MHC class II A(g7) allele and production of GPI-specific autoantibodies. Transfer of K/BxN serum into MHC-unrelated and lymphocyte-deficient mice induces RA. To investigate whether K/BxN serum-induced RA involves complement activation and/or the complement receptors (CR) 1 and 2, we analyzed the role of complement C4 and of CR1 and CR2. For this purpose we used C4(-/-) mice impaired in the classical and the lectin complement pathways; Cr2(-/-) mice lacking CR1 and CR2 and, as control strains, BALB/c, C57BL/6, KRN and NOD. RA was assessed by caliper measurement of ankle thickness, clinical index and joint histology. We found that all mouse strains except NOD developed RA. The lack of protection in C4(-/-) mice suggests that antibody-mediated RA is independent of the classical as well as the lectin complement pathways and the split complement product C4b. The lack of protection in Cr2(-/-) mice suggests that absence of CR1 had no significant affect, considering its role in immune complex clearance, inhibition of C3 and C5 convertase and as receptor for C3b/C4b. Also, CR2 lacks a role in disease as analyzed here, in its possible functions as receptor for C3dg, germinal center reaction and activation of alternative pathway on binding iC3. Hence we conclude that the transmission of K/BxN serum-induced RA is independent of the classical and the lectin complement pathways and CR1 and CR2. The crucial role of complement C5, while neither classical nor lectin pathway is necessary, indicates that the alternative complement pathway may have a role in the K/BxN serum-induced RA model.     

Prognostic significance of tumor angiogenesis in epithelial ovarian cancer.

Since angiogenesis is considered essential for tumor growth and the development of metastasis, we assessed the correlation of microvessel density (MVD) with overall survival in patients with epithelial ovarian cancer. Histologic slides were immunostained for CD34-antigen. MVD was determined within each tumor by enumeration under a light microscope at 200x magnification and an examination area of 0.25 mm2. The Cox proportional-hazards model was used for multivariate analysis. In 63 patients with epithelial ovarian cancer the 5-year survival rate (OS-%) was as follows: 55.0% (+/-12.5) in 18 patients whose tumors had an MVD < 10/field, and 23.6% (+/-6.7) in 45 patients whose tumors had an MVD(10/field (log-rank P = 0.038). MVD showed a significant influence on survival in univariate analysis, but failed to attain a significant value after adjustment for established prognostic parameters such as patients' age at diagnosis, stage of disease, and histologic grading. High MVD was significantly associated with advanced patients' age at diagnosis. This and a considerable heterogenity in the vascular architecture of ovarian carcinoma tissue might be the reasons why MVD did not reveal prognostic significance in multivariate analysis. In contrast to a variety of solid neoplasms, MVD does not seem to be a useful predictor of survival in patients with epithelial ovarian cancer.