A planimetric study of therapy-dependent development of temporal bone pneumatization in secretory otitis media

The present study is based on the results of a planimetric investigation of temporal bone pneumatization in 43 children. Radiological and clinical follow-up studies 10 years after therapy for secretory otitis media indicate an adaptation in the size of pneumatization to an almost normal area. The increase shows that a myringotomy is sufficient in cases of serous effusion, whereas a mucous fluid requires long-term middle ear ventilation. Received: 5 August 1999 / Accepted: 3 December 1999     

Effect of platelet-activating factor on secretion of mucous glycoprotein from chinchilla middle ear epithelial cells in vitro

Platelet-activating factor (PAF) is a naturally occurring phospholipid that acts as a pleiotropic mediator and mediates cell-cell reactions under physiological and pathological conditions. Recently, it has been shown that PAF is a strong secretagogue of mucous glycoprotein in the airways, suggesting its role in mucous glycoprotein secretion and the pathogenesis of otitis media with effusion. In the current study, we examined the effect of PAF on mucous glycoprotein secretion in cultured chinchilla middle ear epithelial cells. PAF at 1 M significantly stimulated mucous glycoprotein secretion from cultured chinchilla middle ear epithelial cells. This action was concentration-dependent, with secretions reaching near maximum when the cells were incubated with PAF at 100 M. In a time-dependent study, PAF demonstrated an initial rapid stimulation of mucous glycoprotein secretion, followed by a gradual increase thereafter. A six-fold increase was seen in the first 2 h compared with controls. Cycloheximide, a protein synthesis inhibitor, demonstrated an inhibitory effect on PAF-stimulated mucous glycoprotein secretion in this study. These findings suggest that PAF plays an important role in the pathogenesis of otitis media with effusion by stimulating mucous glycoprotein secretion in vitro.Supported by NIH grant P0I-D000133 from the National Institute on Deafness and Other Communication Disorders.     

Epidemiology of chronic suppurative otitis media and deafness in a rural area and developing an intervention strategy

Of 613 children evaluated in a village in Haryana 94 (15.3%) were observed to have chronic suppurative otitis media (CSOM). Fifty eight (61.7%) children had hearing impairment. CSOM contributed to 71.6% of the hearing impaired (58/81). On analysis of association of CSOM with literacy and socio-economic status of mothers, and age, sex, and upper respiratory tract infections (URI) in children positive correlation was observed only with URIs (P<0.001). Literacy and socio-economic status of the mothers did not correlate significantly with knowledge about treatment seeking, and ear cleaning practices, probably due to the narrow range of incomes and literacy levels. An intervention program consisting of play, demonstrations, health charts and slogans, and aural cleaning and antibiotic drops was introduced.     

Cardiac effects of contrast media in MR angiography: evaluation in an experimental model of myocardial ischemia

RATIONALE AND OBJECTIVES: The authors evaluated the cardiac tolerability of paramagnetic contrast agents for magnetic resonance (MR) angiography in an in vitro model of ischemic rat heart. MATERIALS AND METHODS: The left anterior descending coronary artery was temporarily occluded in a perfused rat heart model to induce cardiac ischemia and reperfusion. A dose of 0.4 mL of gadobenate dimeglumine, of gadopentetate dimeglumine, or of D-mannitol was injected directly into the aorta both during the ischemia and during the reperfusion period. The left ventricular pressure and heart rate were recorded. RESULTS: Myocardial ischemia resulted in decreased cardiac activity, with a reduction in left ventricular pressure and heart rate. A further decrease in cardiac activity was temporarily induced by injection of contrast medium during both the ischemic and early reperfusion phases. Less marked responses were induced by a hyperosmolal solution of mannitol. CONCLUSION: These results suggest that the transient cardiac effects induced by bolus injection of paramagnetic contrast medium may be regarded as the combined effects of the osmotoxicity of the contrast medium solution and the chemotoxicity of the contrast medium molecule.     

Time-resolved MR angiography of the upper abdomen: initial clinical experience

In this study, thirty-eight patients with a variety of upper abdominal diseases were examined with three-dimensional time-resolved MR angiography (7 sec/data set). Visualisation of arterial and venous anatomy was excellent in the majority of patients. Moreover, subtraction images could be calculated and organ perfusion could be assessed. It is concluded that this technique opens new perspectives for a comprehensive evaluation of vascular and parenchymal disease. Received: 14 April 1998; Revision received: 23 October 1998; Accepted: 9 November 1998     

Benign and malignant hepatocellular tumors: evaluation of tumoral enhancement after mangafodipir trisodium injection on MR imaging

The aim of this work was to study the ability of mangafodipir trisodium (Mn-DPDP)-enhanced MR imaging in differentiating malignant from benign hepatocellular tumors. Eleven patients with pathologically proved hepatocellular carcinomas, six with focal nodular hyperplasias, and one with a single hepatocellular adenoma were examined by spin-echo and gradient-echo T1-weighted sequences before, 1 h after, and 24 h after intravenous injection of Mn-DPDP (5 μmol/kg). Quantitative analysis including enhancement and lesion-to-liver contrast-to-noise ratio, and qualitative analysis including the presence of a central area and a capsule were done on pre- and post-Mn-DPDP-enhanced images. Enhancement was observed in all the tumors with significant improvement (p < 0.05) in contrast-to-noise ratio 1 h after, and 24 h after intravenous injection of Mn-DPDP. There were no significant differences in the mean enhancement and the mean contrast-to-noise ratio (CNR) between benign and malignant tumors. No enhancement was seen within internal areas observed in 7 hepatocellular carcinomas, and in 5 focal nodular hyperplasias, and within capsules which were observed in 9 hepatocellular carcinomas. In our study, Mn-DPDP increased CNR of both benign and malignant tumors but did not enable differentiation between benign and malignant tumors of hepatocellular nature. Received: 7 October 1997; Revision received: 25 February 1998; Accepted: 10 July 1998     

Do we need to treat otitis media?

Otitis media is a common pediatric problem. It is well established that over half of infants and children with acute otitis media may have spontaneous recovery. Since it is difficult to predict the course (self-limited versus serious disease) all the children with acute suppurative otitis media need to be treated with antibiotics. Amoxicillin is still the initial antibiotic of choice. There are several alternate antibiotics available with activity against beta-lactamase positive bacteria. These agents have no advantage over amoxicillin in infections due to penicillin resistant pneumococci. Recent use of beta-lactam antibiotics and/or attendance in a day care where there is frequent use of antibiotics are predisposing factors for penicillin resistant pneumococcal infection. In such cases after tympanocentesis, higher dose of amoxicillin, clindamycin or intramuscular ceftriaxone should be considered. Secretory otitis media does not need to be treated with antibiotics unless the patient is in high risk group. Prophylactic use of antibiotics should be actively discouraged. Influenza and pneumococcal vaccination (2 years or older) should be encouraged in children with recurrent episodes of acute otitis media. Breast feeding should be encouraged.     

慢性中耳炎活动期听力重建的研究

目的 :探讨慢性化脓性中耳炎活动期听力重建的可能性。方法 :对 34例慢性中耳炎患者于活动期行鼓室探查 ,取出锤、砧骨 ,开放鼓峡 ,行鼓室成形术。其中 ,2 3例用自体听骨重建听骨链 (自体听骨组 ) ,1 1例用人工钛听骨重建听骨链 (人工钛听骨组 )。结果 :34例术后 3个月平均气导听力提高 1 5～ 30dBHL。术后 1年 ,自体听骨组 2 3例中 ,6例听力下降至术前水平 ,其中 1例穿孔 ;人工钛听骨组 1 1例中 ,1例听力明显下降 ,移植物完整 ,位置正常。 34例听力提高 (1 5dB以上 )率为 79.4 % (2 7/ 34) ,其中人工钛听骨组听力提高率为 90 .9% (1 0 /1 1 ) ,未见排斥 ;自体听骨组为 73.9% (1 7/ 2 3)。人工钛听骨组听力提高明显优于自体听骨组 ,差异有极显著性意义 (P <0 .0 1 )。结论 :慢性化脓性中耳炎活动期行鼓室成形听力重建是可行的 ;彻底开放鼓峡 ,清除上鼓室、鼓窦入口病灶 ,选择良好的听骨赝复物 ,是手术取得成功的关键     

Influence of prednisolone on the secretion of mucin from the HT29‐MTX cell line

Influence of prednisolone on the secretion of mucin from the HT29‐MTX cell line Glucocorticoids have been used in the treatment of otitis media with effusion with promising but inconsistent results. The HT29‐MTX cell line is a completely differentiated and almost exclusively mucus‐secreting goblet cell line. To assess the potential of steroids in suppressing mucin secretion, we have studied the response of this cell culture to prednisolone. Confluent cell cultures were trypsinized, subcultured in six‐well plates and incubated with five doses of prednisolone from 10^?3 M to 10^?11 M and over a varying time course from 6 to 36 h. Analysis was performed using a monoclonal mouse antibody to human gastric mucin by dot‐blot ELISA. Prednisolone caused a consistent reduction in mucin production from this cell line. Increasing concentrations of prednisolone resulted in increasing suppression of MUC5AC secretion. There is a dose‐dependent suppression of mucin secretion by prednisolone, with a maximum effect of 21% over control seen at the highest steroid concentration used.