Die Infrarot- und die Videookulographie – Alternativen zur Elektrookulographie?

Neuartige Technologien für die Registrierung von Augenbewegungen werfen die Frage auf, ob sie für die HNO-Heilkunde eine zuverl?ssige und genaue Alternative zur bew?hrten Elektrookulographie darstellen. Ein direkter Vergleich zwischen drei verschiedenen Technologien, n?mlich der Elektrookulographie (EOG), der Videookulographie (VOG) und der Infrarotokulographie (IROG) wurde anhand der mittleren Geschwindigkeit der langsamen Phase (SPV) w?hrend den 4 Routineuntersuchungen der Nystagmographieuntersuchungsbatterie, also dem Blickfolgetest (ETT), der vertikalen und horizontalen optokinetischen Nystagmusprüfung (OKN) und der Drehstuhlprüfung des horizontalen vestibulookul?ren Reflexes (HVOR) durchgeführt. Der ETT gelang mit der VOG, dank der genauen und stabilen Kalibration des Systems, am besten (h?here Mittelwerte und geringe Varianz der SPV). Die Registrierung des horizontalen OKN und HVOR lieferte mit allen 3 Technologien vergleichbare Mittelwerte der SPV, wobei die IROG jedoch eine h?here Varianz aufwies. Die Mittelwerte der SPV beim vertikalen OKN mit der VOG und IROG waren als Folge mangelnder Linearit?t und begrenzten Aufl?sungsverm?gens beider Systeme deutlich niedriger als mit der EOG. Diese Ergebnisse zeigen, da? alle 3 Systeme bei der Registrierung horizontaler Nystagmen vergleichbar sind, w?hrend die Registrierung vertikaler Augenbewegungen trotz der bekannten Nachteile (Rauschen, Vorbereitungszeit, ?nderung der Kalibrierung) am besten mit der EOG gelingt.     

Social, emotional, and behavioral functioning of children with cancer

OBJECTIVE: It was hypothesized that children with cancer would have more social problems and difficulties with emotional well-being than case control, same race/gender, similarly aged classmates. STUDY DESIGN: Using a case controlled design, children with any type of cancer requiring chemotherapy except brain tumors (n = 76), currently receiving chemotherapy, ages 8 to 15, were compared with case control classroom peers (n = 76). Peer relationships, emotional well-being, and behavior were evaluated based on peer, teacher, parent, and self-report, and were compared using analysis of variance and structural equation modeling. RESULTS: Relative to case controls, children with cancer were perceived by teachers as being more sociable; by teachers and peers as being less aggressive; and by peers as having greater social acceptance. Measures of depression, anxiety, loneliness, and self-concept showed no significant differences, except children with cancer reported significantly lower satisfaction with current athletic competence. There were also no significant differences in mother or father perceptions of behavioral problems, emotional well-being, or social functioning. Scores on all standardized measures were in the normal range for both groups. Comparisons of the correlation matrices of children with cancer and to the correlation matrix of the comparison children using structural equation modeling suggested they were not significantly different. CONCLUSIONS: Children with cancer currently receiving chemotherapy were remarkably similar to case controls on measures of emotional well-being and better on several dimensions of social functioning. These findings are not supportive of disability/stress models of childhood chronic illness and suggest considerable psychologic hardiness.     

Effect of dialysate calcium concentrations on intradialytic blood pressure course in cardiac-compromised patients

To prevent hypercalcemia in the treatment of secondary hyperparathyroidism, low calcium (L-Ca) dialysate is advocated. However, changes in ionized calcium (i-Ca) levels have a pivotal role in myocardial contraction and could influence blood pressure stability during dialysis. Recently, our group found in patients with normal cardiac function a significant decrease in blood pressure (decrease in systolic blood pressure [DSBP]: -13 mm Hg and decrease in mean arterial pressure [DMAP]: -7 mm Hg) during dialysis with L-Ca dialysate compared with high calcium (H-Ca) dialysate, and this was mainly related to a decreased left ventricular contractility with use of L-Ca dialysate. On the basis of these data, it could be expected that changes in i-Ca levels during dialysis are of more clinical importance in cardiac-compromised patients (CCpts), New York Heart Association classifications III and IV. In this study, the effects of L-Ca dialysate (1.25 mmol/L) and H-Ca dialysate (1.75 mmol/L) on arterial blood pressure parameters (systolic [SBP], diastolic [DBP], and mean arterial blood pressure [MAP]), heart rate, stroke distance (SDist), and minute distance (MDist) during 3 hours of a standardized ultrafiltration/hemodialysis (UF+HD) in nine CCpts was investigated. i-Ca levels increased significantly with H-Ca dialysate UF+HD, whereas there was no change with L-Ca dialysate. SBP, DBP, and MAP decreased statistically and clinically significantly during UF+HD with L-Ca dialysate and were significantly lower with the use of L-Ca dialysate compared with H-Ca dialysate. SDist and MDist decreased significantly with L-Ca dialysate, whereas there were no changes in SDist and MDist with H-Ca dialysate. The predialysis and postdialysis index of systemic vascular resistance (SVRI) was similar between L-Ca dialysate and H-Ca dialysate use. Between the two groups, there were no significant differences in changes in SVRI. From this study, we can conclude that changes in i-Ca levels are a very important determinant of the blood pressure response during UF+HD in CCpts, and this response is mediated by changes in myocardial contractility.     

A systematic review of the use of aromatherapy in treatment of behavioral problems in dementia

We aimed to fill the literature gap by identifying the clinical benefits of aromatherapy in older adults with dementia, and its efficacy in reducing behavioral and psychological symptoms of dementia (BPSD) based on available randomized controlled trials (RCT). A systematic review of 11 clinical trials shortlisted from electronic databases from 1995 to 2011 was carried out. The RCT showed that aromatherapy had positive effects on reduction of BPSD, improvement in cognitive functions, increasing quality of life, enhancing independence of activities of daily living and so on. However, adverse effects were noted in some studies. Limitations on methodology are discussed and suggestions on directions of further studies are made. It is recommended that aromatherapy shows the potential to be applied as a therapeutic and safe complementary and alternative therapy for the management of BPSD on more evidence collected from better designed RCT. Geriatr Gerontol Int 2012; 12: 372–382.     

准分子激光冠状动脉成形术治疗支架内再狭窄

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介入放射医生在急性缺血性卒中干预中的重要角色

脑卒中是一个全球重大的公共健康问题,取栓治疗为本世纪脑卒中领域最重要的研究进展,而取栓手术必须在严格的时间窗内才能取得良好的结果。这就需要投入非常多的神经介入医师来保证7天全天候的服务,而目前专业的神经介入医师严重不足。介入放射医生本身具有丰富的各种介入器械操作经验,如果再经过简单的神经专业相关培训,完全有能力和神经科医生一起来从事取栓治疗,从而弥补神经介入医生紧缺的现状。为此,美国、欧洲及澳大利亚介入放射协会发布一项关于介入放射医生从事急性脑卒中治疗的联合声明,该声明对人口密度大的我国可能更有指导意义。