Sequential bilateral cochlear implantation improves working performance,quality of life,and quality of hearing

Conclusions: This prospective study shows that working performance, quality of life (QoL), and quality of hearing (QoH) are better with two compared with a single cochlear implant (CI). The impact of the second CI on the patient’s QoL is as significant as the impact of the first CI. Objectives: To evaluate the benefits of sequential bilateral cochlear implantation in working, QoL, and QoH. Methods: We studied working performance, work-related stress, QoL, and QoH with specific questionnaires in 15 patients with unilateral CI scheduled for sequential CI of another ear. Sound localization performance and speech perception in noise were measured with specific tests. All questionnaires and tests were performed before the second CI surgery and 6 and 12 months after its activation. Results: Bilateral CIs increased patients’ working performance and their work-related stress and fatigue decreased. Communication with co-workers was easier and patients were more active in their working environment. Sequential bilateral cochlear implantation improved QoL, QoH, sound localization, and speech perception in noise statistically significantly.     

Community structure of helminth parasites in two closely related South African rodents differing in sociality and spatial behaviour

To understand the effect of social and spatial behaviour of a host on parasite community organization, we studied species co-occurrence and nestedness of assemblages of gastrointestinal helminths in two closely related rodents, solitary and mobile Rhabdomys dilectus and social and territorially conservative Rhabdomys pumilio, and asked whether helminth communities of the two hosts are characterized by a non-random pattern and whether the occurrence or degree of this non-randomness (a) differs between hosts and (b) is associated with abundance, prevalence and diversity of helminths. We found that although the general pattern of helminth co-occurrence was similar in the two hosts, helminth infracommunities of R. dilectus and R. pumilio differed in the relative frequency of positive and negative pairwise species co-occurrences (only positive in the former and both positive and negative in the latter). Nestedness-related patterns in helminth infracommunities were found in R. pumilio (predominantly anti-nested) but not R. dilectus (predominantly non-nested), whereas the opposite was the case for their component communities (non-nested versus nested, respectively). The level of infection was generally associated with the manifestation of non-randomness in helminth assemblages. Different infection parameters affected different structure patterns in the two hosts. We concluded that community structure of helminths in Rhabdomys spp. results from complex interactions between parasite- and host-associated factors.

     

Walk-rotate-walk test identifies patients responding to Lempert’s maneuver, with benign paroxysmal positional vertigo of the horizontal canal

Two hundred and fifteen patients were diagnosed and treated for benign paroxysmal positional vertigo of the horizontal canal (BPPV-HC). All patients were tested with conventional positional nystagmus tests lying supine and rotating head for geotropic nystagmus, registered with Frenzels glasses, and in 109 cases with ENG. The walk-rotate-walk (WRW) test, developed by one of us (T.R.) and described in the text, was applied to all patients. The immediate good treatment results with Lempert’s maneuver verify the correct diagnosis of BPPV-HC. The WRW test is a more sensitive test for BPPV-HC than earlier positional tests. The unhabituated acute phase of vestibular neuritis shows positive test results and must be eliminated with caloric tests. The WRW test identifies as a dynamic test patients with symptoms of even lesser magnitude, where the compensatory capacity of the equilibrium system suppresses the diagnostic findings with earlier positional horizontal canal tests. Received: 14 December 2000 / Accepted: 5 February 2001     

Effects of combination treatment with ketoprofen 100 mg + acetaminophen 1000 mg on postoperative dental pain: A single-dose, 10-hour,randomized, double-blind,active- and placebo-controlled clinical trial

Background: A combination of analgesic drugs with different pharmacologic properties may be more effective, with fewer adverse events, than either agent used alone.Objective: This study assessed whether the combination of acetaminophen and ketoprofen is more effective and better tolerated than either drug used alone in treating postoperative pain.Methods: This single-dose randomized, double-blind, active- and placebo-controlled study was conducted at the Finnish Student Health Service, Oulu, Finland. Patients aged 18 to 40 years with moderate or severe pain (≥3 on a numerical rating scale [NRS] of 0-10) after surgical removal of impacted third molars were randomly assigned to receive one of the following drugs in single oral doses: ketoprofen 100 mg + acetaminophen 1000 mg, ketoprofen 100 mg, acetaminophen 1000 mg, or placebo tablets. Effectiveness was assessed by the onset of analgesia, pain intensity difference (PID) from baseline, sum of PID (SPID), and duration of analgesic effect. Patients rated pain intensity on the NRS at rest and on dry swallowing. Onset of pain relief was measured using time to PID in ≥1 category at rest or on dry swallowing (PID ≥1). Patients recorded the occurrence of adverse events and the supplemental consumption of rescue medication (ibuprofen).Results: The study included 76 patients, accounting for 78 cases (2 patients were operated on twice and were assessed as 4 individual patients) (59% women, 41% men; mean age, 22.8 years; white race, 100%; and mean weight, 68.3 kg). At 1.5 hours, mean SPIDs at rest and on swallowing were significantly greater in the combination group than in the acetaminophen, ketoprofen, and placebo groups (all, P < 0.05). Mean time to onset of pain relief (PID ≥1) at rest and on swallowing were significantly less in the combination group than the acetaminophen, ketoprofen, and placebo groups (all, P < 0.05). Median time to use of rescue medication was significantly longer in the combination group than in the acetaminophen group (P = 0.006) and the placebo group (P < 0.001) but not the ketoprofen group. At 1.5 hours after administration, maximum sedation scores were not significantly different between the study groups. The prevalences of trismus, bleeding, and edema were not significantly different between the study groups.Conclusions: The results from this study suggest that the combination of ketoprofen 100 mg + acetaminophen 1000 mg provided a significantly more rapid onset of analgesia than either drug given alone in the management of pain after oral surgery in this patient population. Adverse events were not significantly different between the study groups. These results support the clinical practice of combining ketoprofen with acetaminophen for the management of acute pain.     

Functional outcome of distal bypasses for lower limb ischemia.

OBJECTIVES: The purpose of this study was to assess limb salvage and functional outcome in patients who underwent distal reconstructions. DESIGN: Retrospective study. MATERIALS AND METHODS: Fifty-nine consecutive patients underwent 63 femorodistal bypass operations during 1998-2002 at a university hospital. Late functional outcome was assessed using a questionnaire (mean 27 months after the primary operation). RESULTS: At the end of the study, 81% (30/37) of the surviving patients were alive with a viable limb. In all, 90% (27/30) of patients were living in their own homes and 3% (1/30) in a nursing home. Sixty percent (18/30) were able to walk independently. The walking distance was unlimited in 42% (13/31) and limited in 42% (13/31) of the operated limbs. In 16% (5/31) of cases, the treated limbs served only as a support. CONCLUSIONS: According to our results, the functional outcome of distal bypasses seems to be favourable. It is recommended that these operations should be performed even in elderly patients to avoid major amputations and to maintain the independence of the patient.     

Long-term outcome over a decade after first rib resection for neurogenic thoracic outlet syndrome

 Open in a separate windowOBJECTIVESThe aim was to determine long-term outcomes over a decade after first rib resection (FRR) in patients with neurogenic thoracic outlet syndrome (NTOS). A secondary aim was to investigate correlation of residual rib stump with long-term symptoms.METHODSThis ambispective cohort included patients who underwent transaxillary FRRs for NTOS between 1998 and 2007. Short-term outcomes at 3-month clinical follow-up were retrospectively collected from medical records. Patients who agreed to participate in the study were invited to a long-term clinical follow-up in 2019. Disabilities of Arm, Shoulder, and Hand Score and Cervical Brachial Symptom Questionnaire were used. A chest X-ray limited to a clavicular projection was taken, and the length of the residual first rib was measured.RESULTSTwenty patients {mean age 41.8 [standard deviation (SD): 10.3 years]} who underwent 27 FRRs participated in the study. The mean follow-up time was 14.9 (SD: 3.6) years. Excellent or good recovery was noted after 16 (59.3% of operated arms) operations in the short-term follow-up and 22 (81.5%) operations in the long-term follow-up. No reoperations were necessary for residual symptoms. The mean Cervical Brachial Symptom Questionnaire score was 26.7 (SD: 28.2) (maximum 120), and the Disabilities of Arm, Shoulder, and Hand Score was 21.1 (SD: 18.4) (maximum 100) points. Twenty-six patients (96.3%) had a noticeable residual first rib stump. The mean length of the residual first rib was 28.9 (SD: 9.5) mm. More than 30-mm rib stump did not indicate a worse long-term outcome.CONCLUSIONSThis study showed good long-term outcome without symptom recurrence after FRR for NTOS. In most patients, after surgery, quality of life and ability to work improved. Residual rib stump length was not associated with the treatment outcome.     

Long-term outcomes of transaxillary versus video-assisted first rib resection for neurogenic thoracic outlet syndrome

Open in a separate window OBJECTIVESThis study compared the long-term outcomes in terms of clinical examinations and patient-reported outcome measures, between transaxillary and video-assisted thoracoscopic techniques for first rib resection in patients with neurogenic thoracic outlet syndrome.METHODSThe study population comprised patients who underwent first rib resection for neurogenic thoracic outlet syndrome at our institution between 2009 and 2016. All patients were recruited in a follow-up assessment in 2019, and those who agreed to participate were included in this study. Outcomes included examinations at the outpatient clinic and patient-reported outcome measures: Disabilities of Arm Shoulder and Hand Score and Cervical Brachial Symptom Questionnaire. The completeness of the rib resection was assessed on chest X-rays.RESULTS:A total of 60 first rib resections (30 transaxillary + 30 video-assisted fully thoracoscopic approaches) were performed for neurogenic thoracic outlet syndrome in 47 patients between 2009 and 2016. Of these, 32 patients participated in the study including 18 who had transaxillary and 22 who had video-assisted thoracoscopic procedures. The mean follow-up was 5.9 (standard deviation: 2.2) years. The outcome was good or excellent after 15 (83.3%) and 17 (77.3%) procedures in the transaxillary and video-assisted thoracoscopic surgery groups, respectively (P = 0.709). There were no differences in patient-reported outcome measures between the 2 groups. Furthermore, the length of the residual first rib stump was similar in both groups.CONCLUSIONSWe found no differences in the long-term outcomes between the study groups. These results indicate that both transaxillary and purely thoracoscopic approaches offer favourable long-term outcomes following first rib resection in patients with neurogenic thoracic outlet syndrome.     

Enhanced Eating Competence Is Associated with Improved Diet Quality and Cardiometabolic Profile in Finnish Adults with Increased Risk of Type 2 Diabetes

Eating competence (EC) is characterized by positive attitudes towards food and eating, having regular meals, eating a variety of foods, and internally regulated eating. We investigated the associations of changes in EC with changes in lifestyle, anthropometrics and biomarkers of glucose and lipid metabolism in 2291 adults at increased risk of type 2 diabetes as part of the StopDia study conducted in primary healthcare. EC and diet quality were assessed with validated digital questionnaires. During the intervention, the participants received either (1) the digital lifestyle intervention, (2) the combined digital and face-to-face group-based lifestyle intervention, or (3) standard care. EC increased among the participants independent of the intervention type. Increase in EC was associated with an increase in diet quality, high-density lipoprotein (HDL) cholesterol, and with a decrease in body mass index and waist circumference, regardless of baseline EC. Of the subdomains of EC, the contextual skills, food acceptance and eating attitudes were associated with various of these changes. Our results thus suggest that EC could be a potential target in lifestyle interventions aiming to improve the cardiometabolic health of people at type 2 diabetes risk.