Electrophysiological tests of the hearing organ in Hashimoto's disease

Thyroid gland diseases resulting from an autoimmunological process may influence the hearing organ. The aim of this study was to assess peripheral and central parts of the hearing organ in children with Hashimoto's thyroiditis. Thirty children (mean age 14.9 years) with Hashimoto's thyroiditis were examined. Patients were euthyroid, and presented high blood concentration of antithyroperoxidase (ATPO) antibodies. Pure tone audiometry, tympanometry, otoacoustic emissions (DPOAEs), and brain auditory evoked potentials (BAEPs) were performed. None of the patients had any complaints about hearing acuity; pure tone audiometry, tympanometry, and DPOAEs were normal in all patients. There were considerable disturbances in auditory nerve and brainstem neural conduction in BAEPs. There was positive correlation between the blood concentration of ATPOA and the extent of the disturbances in the central part of the hearing organ. One should consider the possible presence of subclinical Hashimoto's encephalopathy affecting the central part of the auditory organ.     

Results of myringoplasty and type I tympanoplasty with the use of fascia, cartilage and perichondrium grafts

Since the publication of Miodoński, Zollner and Wullstein different methods and grafting materials have been promoted in tympanoplasty. The purpose of this study was to demonstrate the anatomical and functional results of tympanoplasty in comparison with the material used. The studies included a selected group of 142 patients who were operated on because of perforation of tympanic membrane. The analysed group consisted of 112 patients when perichondrium and cartilage were used to reconstruct the tympanic membrane. The comparison group consisted of 30 patients when fascia of the musculus temporalis was used to close a defect of the eardrum. In all cases before and after operation there was made tonal audiometry with indication for air and bone conduction within range from 500 to 4000 Hz, verbal audiometry after operation with indication of speech detection and speech reception threshold using mono-syllable NLA-93 test, tympanometry after operation and evaluation of anatomical results after surgery. The comparison of operation results showed that there was no significant difference between the two groups.     

Pharmacokinetic interaction after joint administration of zinc and imipramine in forced swim test in mice

Recent preclinical and clinical data indicate beneficial role of zinc in the antidepressant treatment. To evaluate the mechanism of interaction between zinc and antidepressants, in the present study we examined the brain zinc, imipramine and desipramine concentrations in mice treated with combinations of zinc and imipramine and subjected to the forced swim test. We have chosen doses of zinc (10 mg/kg) and imipramine (15 mg/kg) which we have previously found to be ineffective in the forced swim test when given alone. However, when administered jointly, a significant reduction in the immobility time in this test was demonstrated. In the present study, we demonstrated a significant ca. 60% reduction in the brain desipramine and non-significant reduction (ca. 40%) in brain imipramine concentrations in the group of animals treated with zinc plus imipramine compared with animals treated with imipramine alone. The brain zinc concentration in the zinc plus imipramine group was reduced when compared with the group treated with zinc or imipramine alone. Since there was no increase in brain imipramine/desipramine or zinc brain concentration after combined zinc and imipramine treatment, the data suggest that pharmacodynamic rather than pharmacokinetic interaction between zinc and imipramine is responsible for behavioral effect in the forced swim test.     

Effect of 1,2,3,4,-tetrahydroisoquinoline administration under conditions of CYP2D inhibition on dopamine metabolism, level of tyrosine hydroxylase protein and the binding of [3H]GBR 12,935 to dopamine transporter in the rat nigrostriatal, dopaminergic system

Current concepts of Parkinson's disease (PD) postulate that interaction between neurotoxins and specific genetic background may play an important role in pathogenesis of PD. Therefore, the effect of multiple administration of 1,2,3,4-tetrahydroisoquinoline (TIQ) under conditions of CYP2D blockade on the expression of key markers of PD was studied in the rat striatum (STR) and substantia nigra (SN). TIQ administered alone (50 mg/kg i.p. twice daily for 14 days) markedly decreased the level of tyrosine hydroxylase protein (TH) in the STR; however, this effect was not accompanied by reduction of dopamine (DA) concentration and [(3)H]GBR 12,935 binding to dopamine transporter (DAT). Administration of CYP2D inhibitor, quinine, jointly with TIQ lowered the levels of TH and DA in that structure, but slightly increased DAT binding. In the SN, treatment with TIQ alone did not change TH level although it enhanced DA content and decreased [(3)H]GBR 12,935 binding to DAT in the substantia nigra pars compacta (SNc). Neither the TH level nor DA concentration was affected by the combined treatment, although DAT binding was still reduced in the SN. TIQ did not change the total DA catabolism in the STR, but caused its inhibition in the SN. It strongly depressed the levels of intraneuronal DA metabolite DOPAC and enhanced that of extraneuronal 3-MT in either structure. TIQ more weakly affected the levels of both DA metabolites in the presence of quinine. Our results suggest that endogenous TIQ may act rather as neuromodulator but not as parkinsonism-inducing neurotoxin in the rat brain.     

The influence of metabolic disturbances present in diabetes mellitus type I on vestibulo-spinal reflexes in children and young adults

Diabetic neuropathy encompasses various disturbances concerning somatic and autonomic nervous system and has significant impact on prognosis and course of diabetes mellitus. The aim of the work is an evaluation of vestibulo-spinal reflexes in children and young adults suffering from diabetes mellitus type 1. Material--95 children and young adults aged from 6 to 28 years with diabetes mellitus type 1 diagnosed. The control group consisted of 44 otoneurologically healthy subjects aged from 6 to 28 years. After detailed medical history collection and physical ENT examination stato-posturography was performed in each case. Posturographer PE 62 Model 04 was applied in the studies. Static posturography as well as dynamic one (one leg standing test) was performed in each case. 6 patients belonging to diabetic group complained about vertigo or dizziness. There were worse stabilograms parameters in diabetic group in comparison to control one, statistically significant in younger children. There were better stabilogram parameters in diabetic patients with longer history of the disease. The parameters analysed were significantly worse in the subgroup with not compensated diabetes. The parameters were slightly better in relation to the presence of hypoglycaemic incidents. No apparent differences in stabilograms parameters were present in relation to the presence of diabetic complications. Diabetes mellitus type 1 with slight or without complications does not have significant influence on vestibulo-spinal reflexes and posture stability of the patients. Balance organ disturbances in diabetes mellitus type 1 in children and young adults despite their presence have subclinical course. Perhaps one should consider monitoring of those disturbances in the course of the disease.     

DPOAE otoemission in patients with tinnitus and normal hearing

The goal of our study was analysis of characteristic interrogation, audiometry and distortion products otoacoustic emission in patients with normal hearing and complaining of tinnitus. We examined the group of 24 ill patients with hearing threshold up till 25 dB HL and with tinnitus and the control group of 18 with no audiological complains. All the patients were made tonal audiometry and the discomfort level as well as tinnitus frequency and intensity were evaluated. For each ear separately, we examined DPAOE of DP-gram function with resolving power of half the octave and the fine structure on the level of stimulation L1 = L2 = 70 dB. In the group of patients average time of tinnitus was 1.5 year. Average hearing threshold in patients with tinnitus was 18 dB HL for air conduction and 11 dB HL for bone conduction, average discomfort threshold--93 dB HL. In the control group hearing threshold was comparatively 16 dB and 10 dB HL and average discomfort threshold--95 dB HL. In the tinnitus group 8 patients (21%) complained of hyperacusis. The differences between the two groups in DP-gram were observed mainly in high frequencies (higher than 3000 Hz). In DP-gram fine structure in the group of patients with tinnitus we noted wider span of otoemission decreases (over the octave) compared to control group. In the tinnitus group among 20 examined ears with decreases of otoacoustic emission DP--fine structure only in 6 patients (30%) the frequency of tinnitus given by the patient was overlapping with the frequency for which decreases of otoemission were observed. In both groups we observed decreases of DPOAE for some frequencies but in the patients with tinnitus we noticed the lack of otoacoustic emission in wider span of frequencies, mainly in higher frequencies compared to controls.     

Ectopic thyroid glad--a case report

Authors have described the case of 67 years women with an anterior midline neck tumor. The tumor was surgically excited and the microscope examination revealed thyroid tissue with colloid goiter. One must consider a midline ectopic thyroid gland in the differential diagnosis of masses in the neck.     

Late results of percutaneous balloon mitral commissurotomy in patients with restenosis after surgical commissurotomy compared to patients with 'de-novo' stenosis

BACKGROUND AND AIMS OF THE STUDY: The outcome of percutaneous balloon mitral commissurotomy (BMC) has been reported as poor in patients with prior surgical commissurotomy. The study aim was to evaluate immediate and long-term follow up results of BMC in patients with restenosis after surgical commissurotomy compared to patients with 'de-novo' mitral stenosis. METHODS: Between October 1988 and September 1999, a total of 1,027 patients underwent BMC. Of these patients, 169 (16.5%) were examined at 17+/-7 years (range: 2-33 years) after surgical commissurotomy (group 1), and 858 (83.5%) had de-novo mitral stenosis (group 2). RESULTS: Group 1 patients were older than group 2 patients (49.4+/-9.3 versus 47.3+/-9.6 years; p <0.05), and atrial fibrillation was seen more often in group 1 (53.9% versus 32.4%; p <0.005). Before BMC, mitral valve area (MVA) was similar in both groups (1.18+/-0.27 and 1.15+/-0.26 cm2 in groups 1 and 2 respectively; p = NS); following BMC, MVA was 1.82+/-0.3 and 1.93+/-0.40 cm2 respectively (p <0.05). Four patients (2.4%) from group 1, and 24 (2.8%) from group 2 required mitral valve replacement due to severe regurgitation (p = NS). Annual clinical and echocardiographic evaluation was completed for 950 patients (mean follow up 56.2+/-31.1 months (range: 12-132 months). Cardiac events defined as death, valve surgery or repeat BMC occurred in 16.0% of patients in group 1, and in 9.6% of those in group 2. At follow up of three, five and 10 years, actuarial event-free survival was 85.7+/-2.9%, 79.8+/-3.8% and 65.2+/-7.5% respectively in group 1, and 93.4+/-0.9%, 90.1+/-1.1% and 72.7+/-3.9% respectively in group 2 (log rank test, p = 0.02). Multivariate analysis showed MVA <1.5 cm2 after BMC, mitral regurgitation grade >2/4, Wilkins score >8, and mean transmitral gradient and left atrial mean pressure post BMC to be independent predictors of an adverse event occurring during follow up. CONCLUSION: BMC in patients with restenosis after surgical commissurotomy is an effective method of treatment, and may help to avoid valve surgery in most patients.     

Transcatheter closure of a 16 mm hypertensive patent ductus arteriosus with the Amplatzer muscular VSD occluder.

There is little experience with transcatheter closure of very large, hypertensive patent ductus arteriosus. We present a case of successful closure of a 16 mm ductus with the Amplatzer VSD occluder, a device originally designed for transcatheter closure of congenital muscular ventricular septal defects. To our best knowledge this is the largest ductus ever closed by an interventional technique.