Unclear chronic vertigo syndromes-experiences with an interdisciplinary inpatient diagnostic concept

xlomafota13 shared this article with you from Inoreader Unclear chronic vertigo syndromes-experiences with an interdisciplinary inpatient diagnostic concept Via hno HNO. 2021 May 4. doi: 10.1007/s00106-021-01059-4. Online ahead of print. ABSTRACT Dizziness is a common leading symptom. Especially patients with chronic vertigo syndromes experience a significant impairment in quality of life up to a limitation of their ability to work in the case of employed persons. The consequences are financial and capacitive burdens on the health system due to frequently multiple examinations and sick leave up to occupational invalidity of the affected patient. In 150 patients with chronic vertigo syndromes and an unclear outpatient diagnosis, at least one diagnosis that justified the complaint was made in over 90% of cases on the basis of a structured interdisciplinary inpatient diagnostic concept. Chronic vertigo syndromes are often multifactorial. Psychosomatic (accompanying) diagnoses were found in more than half of the patients. Targeted therapy can only be recommended after establishing a specific diagnosis. This justifies an interdisciplinary inpatient diagnostic concept for persistently unclear cases. PMID:33944963 | DOI:10.1007 /s00106-021-01059-4 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Allogenes und autologes Material führt bei Mastoidhöhlenobliteration zu vergleichbaren Rezidivraten

xlomafota13 shared this article with you from Inoreader Allogenes und autologes Material führt bei Mastoidhöhlenobliteration zu vergleichbaren Rezidivraten Via Laryngo-Rhino-Otologie Laryngorhinootologie DOI: 10.1055/a-1432-3123 Einleitung Bei symptomatischen Mastoidhöhlen nach Ohroperationen besteht die Therapie der Wahl in der chirurgischen Verkleinerung. Hierbei stehen verschiedene Methoden und Materialien zur Obliteration zur Verfügung. Allogenes Material ist leicht verfügbar, kann jedoch zu Wundinfektionen aufgrund von Abstoßungsreaktionen, Granulationen und Entzündungsreaktionen führen, weshalb autologes Material aufgrund seiner guten Biokompatibilität häufig bevorzugt wird. Ziel dieser Studie war es, die Langzeitergebnisse von Patienten nach Mastoidhöhlenobliteration mit allogenem und autologem Material im Hinblick auf das Auftreten von Rezidivcholesteatomen, die Anzahl der Revisionsoperationen und den Einfluss der Operation auf die Lebensqualität zu vergleichen.Methoden Patienten, die sich einer Mastoidhöhlenobliteration mit dem allogenen Material Hydroxylapatit-Matrix (HMM) unterzogen, wurden retrospektiv in die Studie eingeschlossen. In einem prospektiven Studienteil wurden Patienten eingeschlossen, welche sich einer Mastoidhöhlenobliteration mit autologem Rekonstruktionsmaterial (AutoM) unterzogen. Bei allen Patienten wurde neben einer ausführlichen Aktenanalyse eine Reintonaudiometrie durchgeführt und bei der postoperativen Untersuchung das Zürcher Mittelohrinventar (Zurich Chronic Middle Ear Inventory (ZCMEI-21)) zur Erhebung der gesundheitsbezogenen, krankheitsspezifischen Lebensqualität ausgefüllt.Ergebnisse Insgesamt wurden 22 Patienten mit einem durchschnittlichen Alter von 56,9 Jahren (SD 18,7 Jahre) und HMM (mittleres Nachuntersuchungsintervall: 88,3 Monate; SD 21,9 Monate) sowie 25 Patienten mit einem Durchschnittsalter von 52,4 Jahren (SD 13,7 Jahre) und AutoM (mittleres Nachuntersuchungsintervall: 13,5 Monate; SD 9,5 Monate) in die Studie eingeschlossen. Die audiologische Revisionsfreiheit lag nach einem Jahr für HMM bei 100% und für AutoM bei 85%. Die Rezidivfreihe it lag nach einem Jahr für HMM bei 95% und für AutoM bei 100%. Die Gruppen unterschieden sich weder hinsichtlich des postoperativen Hörergebnisses noch der postoperativen Lebensqualität.Diskussion Die Obliteration von Mastoidhöhlen ist eine chirurgische Herausforderung. Es zeigte sich kein relevanter Unterschied zwischen den verwendeten Materialien im Hinblick auf die Rezidivrate, das Hören und die Lebensqualität über den für beide Gruppen beobachteten Zeitraum von 13,5 Monaten. Die oft fehlende subjektive Symptomatik zusammen mit der hohen Rate an Rezidivcholesteatomen und Revisionsindikationen unterstreicht die Notwendigkeit einer regelmäßigen klinischen Nachsorge inklusive der Ohrmikroskopie bei chronischen Mittelohrerkrankungen und lässt regelmäßige Nachuntersuchungen dringend empfehlen. [...] Georg Thieme Verlag KG R� �digerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prevention of cerebrospinal fluid leak after vestibular schwannoma surgery: a case-series focus on mastoid air cells' partition

xlomafota13 shared this article with you from Inoreader Prevention of cerebrospinal fluid leak after vestibular schwannoma surgery: a case-series focus on mastoid air cells' partition Via leak of cerebrospinal fluid Eur Arch Otorhinolaryngol. 2021 May 3. doi: 10.1007/s00405-021-06850-1. Online ahead of print. ABSTRACT BACKGROUND: Petrous bone pneumatization may be related to cerebrospinal fluid (CSF) leak secondary to vestibular schwannoma surgery. OBJECTIVE: To assess the association between petrous bone pneumatization and CSF leak in vestibular schwannoma surgery. METHODS: A retrospective study included 222 consecutive vestibular schwannoma patients treated via a retrosigmoid or translabyrinthine approach in a 17-year period in one University Hospital. Association of CSF leak and petrous bone pneumatization, as seen on CT scans, was assessed on ANOVA and Student's t or Chi-squared test in case of non-parametric distribution. RESULTS: One hundred and 75 resections were performed on a retrosigmoid approach and 47 on a translabyrinthine approach. Mean age was 53.6 ± 12.9 years. Mean follow-up was 5 years 6 months. Twenty-six patients (1 1.7%) showed CSF leak and 8 (3.6%) meningitis. Approach (p = 0.800), gender (p = 0.904), age (p = 0.234), body-mass index (p = 0.462), tumor stage (p = 0.681) and history of schwannoma surgery (p = 0.192) did not increase the risk of CSF leak. This risk was unrelated to mastoid pneumatization (p = 0.266). There was a highly significant correlation between internal acousticus meatus (IAM) posterior wall pneumatization and CSF leak after retrosigmoid surgery (p = 0.008). Eustachian tube packing in the translabyrinthine approach did not decrease risk of CSF leak (p = 0.571). CONCLUSION: Degree of petrous bone pneumatization was not significantly related to risk of CSF leak, but pneumatization of the posterior IAM wall increased this risk in retrosigmoid surgery. Eustachian tube packing in the translabyrinthine approach is not sufficient to prevent postoperative CSF leak. Both approaches had similar rates of CSF leaks, around 12%. PMID:33942123 | DOI:10.1007/s00405-021-06850-1 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The adjunctive use of carbimazole during radioactive iodine treatment reduces the cure rate of Graves' disease

xlomafota13 shared this article with you from Inoreader The adjunctive use of carbimazole during radioactive iodine treatment reduces the cure rate of Graves' disease Via radioactive iodine S Afr Med J. 2021 Feb 1;111(2):176-179. doi: 10.7196/SAMJ.2021.v111i2.14522. ABSTRACT BACKGROUND: Radioactive iodine (RAI) is widely used in the treatment of hyperthyroidism. Adjunctive antithyroid drugs (ATDs) are commonly prescribed to treat the hyperthyroid state before the RAI has taken effect. However, there is no consensus on the use of or timing of adjunctive ATD treatment with RAI. OBJECTIVES: To determine the influence of the ATD carbimazole on the cure rate of RAI t reatment for Graves' disease. METHODS: A retrospective chart review was conducted in the Department of Nuclear Medicine of the Steve Biko Academic Hospital in Pretoria. The cure rate of patients treated with RAI for Graves' disease was analysed. The effect of adjunctive carbimazole treatment with regard to its use and timing with RAI dosing was analysed. The cure rate was determined in patients treated with carbimazole either before RAI or before and after RAI administration. Cure rate was defined by the biochemical thyroid function status (thyroxine (T4), thyroid-stimulating hormone (TSH)) as euthyroid or hypothyroid from 3 months and sustained at 12 months. The need for a second dose of RAI was recorded. RESULTS: RAI treatment was administered to 171 patients with Graves' disease. The cure rate was higher in patients receiving a higher dose of RAI. The overall cure rate increased progressively from 3 months and was 91% at 12 months. The cure rate in 97 patients not rec eiving carbimazole was 98%. The cure rate of the 27 patients on carbimazole treatment given before RAI administration was 81%, and 73% in the 37 patients in whom it was resumed after RAI administration. The overall cure rate was lower in patients who received carbimazole (p<0.001), but especially in patients in whom carbimazole was continued after RAI administration (p<0.001). CONCLUSIONS: Adjunctive carbimazole treatment decreased the RAI cure rate of Graves' disease significantly. PMID:33944730 | DOI:10.7196/SAMJ.2021.v111i2.14522 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Analysis of key genes and related transcription factors in liver fibrosis based on bioinformatic technology

xlomafota13 shared this article with you from Inoreader Analysis of key genes and related transcription factors in liver fibrosis based on bioinformatic technology Via International Journal of Clinical and Experimental Pathology Int J Clin Exp Pathol. 2021 Apr 15;14(4):444-454. eCollection 2021. ABSTRACT OBJECTIVE: To analyze differentially expressed genes (DEGs) related to liver fibrosis, and clarify the key genes and the possible targets in the progression of liver fibrosis. METHODS: Using microarray datasets, GSE38199 was extracted from Gene Expression Omnibus (GEO), and a bioinformatics method was performed to find DEGs and transcription factors related to liver fibrosis. RESULTS: A total of 58 DEGs were screened out according to GEO2R online analysis tool, which included 49 up-regulated and 9 down-regulated genes. These DEGs were mainly involved in formation with the extracellular region and extracellular exosome through gene ontology (GO) enrichment analysis. Kyoto Encyclopedia of Gene and Genome (KEGG) pathway enrichment analysis showed that DEGs mainly participated in the PI3K-Akt signaling pathway, focal adhesion, ECM-receptor interaction, and metabolic pathways. Based on the results of the Protein-Protein Interaction (PPI) network and Molecular Complex Detection (MCODE) analysis, 9 key genes (COL1A1, FBN1, BGN, COL6A3, MMP2, FBLN5, LUM, PDGFRB, LOXL1) were screened out. A total of 30 transcription factors were found according to these 9 key genes, of which 4 transcription factors (Stat3, Trp53, NF-κB1, Sp1) were enriched. CONCLUSION: Stat3, Trp53, NF-κB1, and Sp1 were all related to the development of liver fibrosis, and FBLN5 might be a target for liver fibrosis. PMID:33936366 | PMC:PMC8085816 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Evolution of renal cyst to renal carcinoma: a case report and review of literature

xlomafota13 shared this article with you from Inoreader Evolution of renal cyst to renal carcinoma: a case report and review of literature Via International Journal of Clinical and Experimental Pathology Int J Clin Exp Pathol. 2021 Apr 15;14(4):463-468. eCollection 2021. ABSTRACT BACKGROUND: Renal cyst is a common benign disease which is rare to progress from simple renal cyst to renal cell carcinoma. CASE PRESENTATION: A 62-year-old woman who suffered a simple renal cyst for over 20 years complained intermittent lumbar in recent 2 years. At her latest admission, the cyst lesion displayed enhancement in the cystic wall by CT scan and cystic to partially solid change by ultrasound, so we did a partial nephrectomy and found that the cystic lesion had become a cyst-solid transition. The pathology turned out to be renal clear cell carcinoma. CONCLUSIONS: Although the canceration of a renal cyst is a small probability event, patients with a long history of a cyst, especially those with symptoms, need to seek for medical treatment in time, and if necessary, lesion biopsy or resection may be under consideration. PMID:33936368 | PMC:PMC8085821 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Segmental arterial mediolysis of the middle colic artery: report of a case with special reference to lesions of small arteries and veins

xlomafota13 shared this article with you from Inoreader Segmental arterial mediolysis of the middle colic artery: report of a case with special reference to lesions of small arteries and veins Via International Journal of Clinical and Experimental Pathology Int J Clin Exp Pathol. 2021 Apr 15;14(4):508-513. eCollection 2021. ABSTRACT We report a case of segmental arterial mediolysis (SAM) that involved the middle colic artery, and present some pathologic alterations found in mesenteric small arteries and veins. The patient, a 52-year-old woman, underwent an emergency laparotomy for acute intra-abdominal hemorrhage, and a segment of the transverse colon with hemorrhagic mesocolon was excised. Microscopic examination demonstrated two separate lesions of SAM in the middle colic artery. The involved arterial segments showed a partial to circumferential loss of the media (mediolysis) and intima associated with the formation of a pseudoaneurysm. Smooth muscle cells adjacent to the mediolysis showed various degenerative changes. In addition, we found multiple, tiny foci of degenerative lesions affecting the outer media in the wall of small arteries. Subendothelial vacuoles and nodular intimal pro liferation were also noted in small veins. Whereas SAM chiefly affects large or medium-sized arteries, small blood vessels, including veins, are also affected. The present case is unusual in that degeneration of medial smooth muscle cells was clearly observed in the arterial walls, and the small veins were affected by lesions similar to those in arteries. We suspect that a phenotypic modulation of vascular smooth muscle cells induced by some genetic vulnerability plays a role in the pathogenesis of SAM. PMID:33936374 | PMC:PMC8085823 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.