Mental distress and quality of life in the hard of hearing

OBJECTIVE: This study aims to compare levels of psychological distress and the quality of life in the hard of hearing with levels reported by the signing deaf, and the hearing population. METHOD: A total of 373 members of the Hard of Hearing Association completed the brief WHO's Quality of Life, 12-item General Health Questionnaire and Brief Symptom Inventory, and provided details about their initial and current deafness. RESULTS: The hard of hearing have worse social relationships than the signing deaf, and are disadvantaged relative to the hearing in all areas measured. Quality of life is related to the level of satisfaction with the hearing achieved by hearing aids. CONCLUSION: General psychiatrists need to be aware that patients who are hard of hearing may be even more isolated than deaf people in a signing community. Hard of hearing patients with unsatisfactory hearing aids can be greatly assisted by cochlear implants.     

The Austrian Competence Network on Mastocytosis (AUCNM): a partner and part of the European ECNM network

Mastocytosis is a group of rare diseases characterized by abnormal expansion and accumulation of tissue mast cells in various organ systems. The disease can be divided into cutaneous and systemic variants. Although considered a rare pathologic condition, more and more patients are currently diagnosed as suffering from mastocytosis. The increasing incidence is best explained by enhanced awareness and improved diagnostics in the Western world. This has in turn created a need to establish optimal facilities for the diagnosis, management, and therapy of patients with mastocytosis. In 2002, the European Competence Network on Mastocytosis (ECNM) was established, with the aim to provide all available information to doctors and patients, and to improve management and therapy of mastocytosis in Europe. Within the ECNM, Centers of Excellence and Reference Centers have been defined and inaugurated. In addition, several countries established a local network of competence within the ECNM. In 2011, the Austrian Competence Network on Mastocytosis (AUCNM) was inaugurated. The AUCNM serves as an integral part and essential partner of the ECNM. In the current article, the structure, aims, achievements, and ongoing projects of the AUCNM are presented.     

Arthroskopisch assistierte Frakturversorgung am distalen Radiusende

After establishment of wrist arthroscopy the positive experiences gained for arthroscopically assisted treatment of fractures especially around the knee joint were transferred to the stabilization of distal intra-articular radius fractures. Simultaneous osteosynthesis by the use of external fixators and K-wires (ARPEF) was pushed into the background due to the rapid development of osteosynthesis techniques, especially of stable angle plating systems. Arthroscopic experience in acute wrist trauma helps to focus on early diagnosis of concomitant carpal injuries, because lesions of intercarpal ligaments and the triangular fibrocartilage complex (TFCC) highly influence the final functional outcome even in cases of exact anatomic reduction of the radius fracture. Most of the concomitant injuries can be treated very early by minimally invasive techniques, so it is advisable to carefully look for corresponding signs. Therefore, wrist arthroscopy represents an important tool for early diagnosis in acute trauma and possibly minimally invasive treatment of carpal injuries and markedly contributes to an improvement of final functional results of distal intra-articular radius fractures.     

Laparoscopic versus open incisional hernia repair

BACKGROUND: To analyze hospital resource utilization for laparoscopic vs open incisional hernia repair including the postoperative period. METHODS: Prospectively collected administrative data for incisional hernia repairs were examined. A total of 884 incisional hernia repairs were examined for trends in type of approach over time. Starting October 2001, detailed records were available, and examined for operating room (OR) time, cost data, length of stay (LOS), and 30-day postoperative hospital encounters. RESULTS: Of the total, 469 incisional hernias were approached laparoscopically (53%) and 415 open (47%). Laparoscopic repair had shorter LOS (1 +/- 0.2 days vs 2 +/- 0.6 days), longer OR time (149 +/- 4 min vs 89 +/- 4 min), higher supply costs (2,237 dollars +/- 71 dollars vs 664 dollars +/- 113 dollars), slightly lower total hospital cost (6,396 dollars +/- 477 dollars vs 7,197 dollars +/- 1,819 dollars), and slightly more postoperative hospital encounters (15% vs 13%). Use of laparoscopy increased over time (37% in 2000 vs 68% in 2004). CONCLUSIONS: Laparoscopic incisional hernia repair is becoming increasingly popular, and not at increased cost to the health care system.     

An innovative and reliable way of measuring health-related quality of life and mental distress in the deaf community

Abstract Background Structured assessment of quality of life and mental distress in deaf people is difficult for various reasons. This paper describes the development and reliability of an interactive computer-based assessment package for measuring quality of life and psychological distress in the deaf population. Methods The Brief version of the WHO Quality of Life (WHOQOL) Questionnaire, the 12-item General Health Questionnaire (GHQ-12) and the Brief Symptom Inventory (BSI) had been translated into sign-language and videotaped. A total of 236 members of the deaf community in Upper Austria participated by responding to a programme consisting of self-administered written and videotaped test-items presented to them on a notebook computer. The reliability of the various assessments was established on this large community sample. Results When reliability of the versions for the deaf was compared with that of written versions of the same measures in general population samples, it was found to be somewhat lower, although still in an acceptable range, for the WHO-QOL and the GHQ-12. For the BSI, the reliability was even higher than that of the general population. Conclusions For deaf individuals whose preferred communication is sign language, quality of life and mental distress can be effectively and reliably assessed with the use of carefully translated and adapted common instruments.     

Immunohistochemical analysis of neural cell adhesion molecules. Differential expression in small round cell tumors of childhood and adolescence.

The neural cell adhesion molecule (NCAM) was discovered in a search for cell surface antigens of chicken neurons that contribute to cell adhesion and pattern formation during development. Homologous adhesion molecules have been identified in several species, including humans. In this immunohistochemical study, the authors examine the role of human NCAM in tumor diagnosis. The authors used a monoclonal antibody (MAb), 5.1H11, to examine NCAM immunoreactivity in frozen sections of more than 450 tumors, including more than 80 small round cell tumors (SRCT) of childhood and adolescence (neuroblastomas, Ewing's sarcomas [ES], peripheral neuroepitheliomas [PN], primitive neuroectodermal tumors [PNET], esthesioneuroblastomas, malignant ectomesenchymoma, medulloblastomas, small cell osteosarcomas, mesenchymal chondrosarcomas, embryonal rhabdomyosarcomas, and lymphomas). The authors show that 1) neuroblastomas and primary brain tumors are NCAM+; 2) ES, most PN/PNETs, and melanomas are NCAM-; 3) embryonal rhabdomyosarcomas and various other sarcomas are NCAM+; 4) neuroendocrine tumors are NCAM+; 5) subsets of carcinomas of kidney, ovary, lung and other organs are NCAM+; and 6) lymphoid tumors are NCAM-. Tests with normal fetal and adult tissues indicate that these findings reflect only in part the NCAM phenotypes of corresponding normal tissues. Notably the NCAM- phenotype of ES and PN/PNET is not explained by current histogenetic models for these tumors, which suggest a primitive neuroectodermal origin. Finally the authors show that NCAM expression among SRCT has an inverse relationship with the expression of p30/32MIC2, a cell surface antigen of ES and PN/PNET detected with MAb HBA71. These results suggest that immunohistochemical assays for NCAM and p30/32MIC2 expression may aid in the further characterization of SRCT of childhood and adolescence.     

Anatomical and safety considerations in establishing portals used for wrist arthroscopy

Eight portals are used for wrist arthroscopy, five for the radiocarpal joint and three for the midcarpal space. These portals pass between important vessels and cutaneous nerves and the extensor tendons underlying the extensor retinaculum and permit access to the common pathologies of the wrist joints. The portals can be safely established making precise use of the external landmarks and are associated with little soft tissue damage and few complications when performed gently and through the dorsal side of the wrist. Clin. Anat. 12:179–185, 1999. © 1999 Wiley‐Liss, Inc.     

Surface rendering of three-dimensional myocardial SPECT: Clinical usefulness compared with bull’s-eye and conventional tomograms

Background

A prospective study was conducted to evaluate the clinical usefulness of three-dimensional (3D) surface-shaded maps for routine practice of myocardial perfusion single-photon emission computed tomography (SPECT) by comparison with 2D slices and 2D bull’s-eye qualitative analysis.

Methods and results

Angiograms were performed on 201 consecutive patients, 155 with coronary artery disease (CAD) and 46 with no significant CAD. One-day ²⁰¹Tl stress/rest-reinjection protocol was performed in 110 patients, and 1-day ^99mTc-sestamibi or tetrofosmin stress/rest protocol was performed in 91. The stress protocol was either exercise or dipyridamole (0.56 mg/kg) infusion. Three-dimensional surface maps were obtained by using a threshold for the transaxial data at 50%, 55%, 60%, 65%, and 70% of the maximum pixel value in the first 60 patients. Interpretation of 3D maps was based on the presence of a complete (transmural-looking) perfusion hole within the myocardial wall; doubtful patterns were considered pathologic or normal. Good diagnostic values were found for the 50% to 60% thresholds, but the 60% setting showed the best concordance with multislice and bull’s-eye analysis; higher values drastically degraded the specificity. Considering doubtful patterns as normal clarified interpretation and led to a small loss in sensitivity but high gain in specificity. Applied to the whole population, the 3D maps using a 60% threshold provided similar diagnostic value to detect CAD as did conventional and bull’s-eye analysis. Moreover, the 3D maps showed a trend toward higher specificity and a proportionally smaller decrease in sensitivity (sensitivity: 92.9%, 90.3%, 89.7%; specificity: 45.6%, 50.0%, 58.7% for tomograms, bull’s-eye analysis, and 3D maps, respectively), especially for the detection of left anterior descending and right CAD. multivessel disease was detected in an identical manner. Three-dimensional maps might improve detection of perfusion defects in the basal regions. However, 3D maps were found to be less sensitive than slices and particularly bull’s-eye analysis for the reversibility of stress defects.

Conclusions

Three-dimensional surface display of myocardial perfusion is a valuable independent tool for determining presence, extent, and location of CAD. It can convey useful first-look information to the referring physician, especially through a cine-rotational motion (as done in our practice through use of a floppy disk).     

MR findings and treatment of four patients with cervical spinal cord injuries

We report the value of magnetic resonance imaging (MRI) in the assessment of cervical spine injuries with neurological deficit and the implications such information might have in the management of acute spinal cord injuries. Four cases are presented that were neurologically classified according to the 5-step Frankel scale. Three patients presented with an intramedullary hemorrhage. One of these patients showed additional mild compression of the spinal cord due to a retropulsed bony fragment, and one an epidural hematoma without any evidence of spinal cord compression. The fourth patient had compression of the spinal cord secondary to bony fragments from a burst fracture. We carried out two decompressions of the spinal cord by removing the disc and bony fragments. In addition, we performed two interbody fusions. In one patient we applied a halo vest, and in one case surgical intervention was not necessary after MRI assessment.

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Die magnetresonanztomographie und behandlung von vier patienten mit zervikaler rückenmarkverletzung

Zusammenfassung Das Ziel dieses Kasuistik ist es, anhand von 4 Fallbeispielen zervikaler Rückenmarkverletzungen die möglichen therapeutischen Konsequenzen zu erläutern, die sich aus der Magnetresonanztomographie ergeben. Die neurologischen Defizite wurden nach der 5stufigen Frankel-Klassifikation eingeteilt. Bei 3 Verletzten wurden intramedulläre Hämatome dargestellt, wobei zusätzlich eine Kompression von außen in Form eines Knochenfragments und einmal ein epidurales Hämatom ohne Kompression bestanden. Ein Patient wurde wegen neurologischer Ausfälle von einem auswärtigen Krankenhaus direkt der Magnetresonanztomographie zugewiesen, wobei sich als Ursache eine Spinalkanalstenose bei einer Berstungsfraktur zeigte. Therapeutisch war 2mal eine Rückenmarkdekompression mit ventraler Spondylodese und einmal die Montage eines Halofixateurs erforderlich. Bei einem Patienten konnte aufgrund der Magnetresonanztomographie auf jegliche chirurgische Intervention verzichtet wurden.

Dedicated to Prof. Dr. Leo Kronberger to his 65th birthday