Αρχειοθήκη ιστολογίου

Κυριακή 10 Ιουλίου 2016

The development of the ICF vestibular environmental scale.

The development of the ICF vestibular environmental scale.

J Vestib Res. 2016 Jul 2;26(3):297-302

Authors: Whitney SL, Alghadir A, Alghwiri A, Alshebber KM, Alshehri M, Furman JM, Mueller M, Grill E

Abstract
UNLABELLED: People with vestibular disorders report changes in symptoms based on their environment with many situations increasing their symptoms. The purpose of this paper was to utilize the International Classification of Functioning Disability and Health (ICF) from the World Health Organization (WHO) to describe common environmental triggers for dizziness in persons living with balance and vestibular disorders. A multi-centre cross-sectional study was conducted with four different centres on three different continents, including patients from the United States (Pittsburgh), Germany (Munich), Jordan (Amman) and Saudi Arabia (Riyadh).
SUBJECTS: Three hundred eighty one persons with vestibular disorders participated.
METHODS: A 9-item questionnaire (the Vestibular Environmental Scale) was developed from existing ICF items, which were compared to Dizziness Handicap Inventory (DHI) scores. Sixty-five percent of participants reported that "quick movements in the vicinity" increased symptoms, "crowds" at 45%, and "design of buildings, e.g. narrow hallways, stairs, elevators" at 42%. The "crowds" item was a good positive predictor of psychogenic vertigo (OR 1.8, 95% Confidence Interval 1.03-3.16), while "food" (OR 0.47, 95% Confidence Interval 0.17-1.29) and "light" (OR 0.41 95% Confidence Interval 0.23-0.75) were negative predictors of psychogenic vertigo. There also was a positive correlation between the number of triggers and DHI score (Spearman correlation coefficient 0.47, p < 0.0001). Sixty-eight percent of the subjects reported an increase in symptoms with between 1 and 4 environmental triggers. In our cross cultural sample, environmental triggers affect dizziness in persons living with balance and vestibular disorders. The use of items from the ICF of the WHO may help to promote cross cultural sharing of information in persons with dizziness.

PMID: 27392833 [PubMed - in process]



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Σάββατο 9 Ιουλίου 2016

Comparison between objective and subjective benign paroxysmal positional vertigo: clinical features and outcomes.

Comparison between objective and subjective benign paroxysmal positional vertigo: clinical features and outcomes.

Acta Otolaryngol. 2016 Jul 7;:1-6

Authors: Jung JY, Kim SH

Abstract
CONCLUSIONS: Objective benign paroxysmal positional vertigo (O-BPPV) and subjective BPPV (S-BPPV) have similar demographic and clinical features. Canalith repositioning manoeuvres (CRMs) can be an effective treatment for patients with S-BPPV, and a diagnosis of positional nystagmus is not essential for considering CRMs. This study supports the use of CRMs as the primary treatment for S-BPPV.
OBJECTIVE: To examine differences in demographic and clinical features, as well as treatment outcomes, between O-BPPV and S-BPPV.
METHODS: The medical records of 134 patients with BPPV were reviewed for demographic characteristics, past medical history, associated symptoms, response to CRMs, interval between symptom onset and the first medical visit, and recurrence rate. The O-BPPV group (n = 101) comprised patients who experienced vertigo and accompanying autonomic symptoms, and showed typical nystagmus. The S-BPPV group (n = 33) comprised patients who, when subjected to a provoking manoeuvre, showed all of the classic BPPV symptoms but did not show nystagmus. All patients had at least 3 years of follow-up.
RESULTS: The demographics (age and sex ratio), past medical history, and associated symptoms were not significantly different between the two groups. Posterior semi-circular canal BPPV appeared more than twice as often as horizontal semi-circular canal BPPV in patients with S-BPPV. However, both canals were affected to a similar proportion in patients with O-BPPV, and the difference was marginally significant (p = 0.073). Overall improvement was better in O-BPPV than in S-BPPV; however, there was no significant difference. The total numbers of manoeuvres for recovery and the interval between symptom onset and the first medical visit also did not show any significant inter-group differences. During a 3-year follow-up, the recurrence rate was 13.8% for O-BPPV and 21.2% for S-BPPV.

PMID: 27388229 [PubMed - as supplied by publisher]



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Cerebral Aneurysm from Cardiobacterium hominis Endocarditis.

Related Articles

Cerebral Aneurysm from Cardiobacterium hominis Endocarditis.

Conn Med. 2016 May;80(5):297-300

Authors: Glucksman A, Naut E

Abstract
A 43-year-old male with a history of bioprosthetic aortic valve replacement and tricuspid valve annuloplasty presented with vertigo and was found to have an acute infarct in the left superior cerebellum, as well as a left-middle cerebral artery mycotic aneurysm. Blood cultures grew Cardiobacterium hominis and bioprosthetic aortic valve vegetation was found on transthoracic echocardiogram.

PMID: 27328579 [PubMed - indexed for MEDLINE]



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Παρασκευή 8 Ιουλίου 2016

Influence of supplemental vitamin D on intensity of benign paroxysmal positional vertigo: A longitudinal clinical study.

Influence of supplemental vitamin D on intensity of benign paroxysmal positional vertigo: A longitudinal clinical study.

Caspian J Intern Med. 2016;7(2):93-98

Authors: Sheikhzadeh M, Lotfi Y, Mousavi A, Heidari B, Monadi M, Bakhshi E

Abstract
BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is linked to vitamin D deficiency. This clinical trial aimed to determine the influence of vitamin D supplementation on intensity of BPPV.
METHODS: The study population was selected consecutively and the diagnosis of BPPV was made by history and clinical examination and exclusion of other conditions. Intensity of BPVV was assessed based on VAS score (0-10). Serum 25-hydroxyvitamin D (25-OHD) was measured using ELISA method and levels < 20 ng/ml was considered a deficiency. All patients received rehabilitation treatment using Epley's maneuver one time per week for one month. Serum 25-OHD deficient patients were classified as treated and non-treated groups (rehabilitation with or without 50.000 IU cholecalciferol weekly for two months).The results of treatment were compared with vitamin D sufficient group as control. All patients were followed-up for 6 months.
RESULTS: After two months of treatment, in both vitamin D treated and non-treated groups the intensity of BPPV decreased significantly as compared with control (P=0.001 for both groups) but at endpoint, the intensity of BPPV aggravated and regressed to the baseline value in vitamin D deficient non-treated group (P=0.001) whereas, in vitamin D treated group, improvement of BPPV remained stable and unchanged over the study period.
CONCLUSION: This study indicates that correction of vitamin D deficiency in BPPV provides additional benefit to rehabilitation therapy (Epley maneuver) regarding duration of improvement. These findings suggest serum 25-OHD measurement in recurrent BPPV.

PMID: 27386060 [PubMed - as supplied by publisher]



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[The assessment of sequential treatment for subjective and objective benign paroxysmal positional vertigo].

[The assessment of sequential treatment for subjective and objective benign paroxysmal positional vertigo].

Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016 Mar;30(5):386-8

Authors: Li S, Wang Q, Dong J, Zhou X

Abstract
OBJECTIVE: To compare the effectiveness of sequential treatment for subjective and objective benign paroxysmal positional vertigo(BPPV).
METHOD: The efficacy of sequential treatment for nineteen vertical semicircular canal S-BPPV patients(Group A) and forty-five vertical semicircular canal O-BPPV patients(Group B) who were admitted to our hospital between January 2014 and July 2015 was retrospectively analyzed and compared, treatment of five cases with horizontal semicircular canal S-BPPV was reported here as well.
RESULT: The number of repositioning maneuver for Group A was 2 - 6 times (average: 4. 21±1. 18) while 2 - 3 times (average: 2. 29 ± 0. 46) for Group B. There was significant difference between the two groups(P<0. 01). The effective rate of initial treatment for Group A was 78. 9%(15/19) while 82. 2%(37/45)for Group B. After one weeks treatment, the effective rate for Group A changed to be 89. 5% (17/19)while 88. 9% (40/45) for Group B. Non-significant difference was found in the two groups neither in the initial nor one weeks treatment. On three months' follow-up, one in Group A and two in Group B relapsed, and they were cured after treated in the initial treatment. The recurrence for Group A was 5. 3%(1/19) while 4. 4%(2/45) for Group B and there was non-significant difference. The five cases with horizontal semicircular canal S-BPPV were completely free of disease after undergoing treatment.
CONCLUSION: The sequential treatment is effective for both vertical semicircular canal S-BPPV and vertical semicircular canal O-BPPV, but the former needs more repositioning maneuver times. The repositioning maneuver, combined with drug therapy and head-shake-in-supine-position method is recommended for horizontal semicircular canal S-BPPV.

PMID: 27382683 [PubMed - in process]



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[The treatment of otosclerosis using laser assistedstapedotomy with mini incision in external auditory meatus].

[The treatment of otosclerosis using laser assistedstapedotomy with mini incision in external auditory meatus].

Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016 Mar;30(5):353-6

Authors: Hao X, Chen S, Yu Z, Liang F, Li Y

Abstract
OBJECTIVE: To investigate the feasibility of the treatment of otosclerosis using laser stapedotomywith mini incision in the external auditory meatus.
METHOD: Thirteen patients(15 ears) with otosclerosis evidence onclinic history. They were all operated using the laser assistedstapedotomy by mini incision in external auditory meatus because of the wide straight canal. Laser resection the tendo musculistapedius and anterior and postrior arch, breaking the articulatioincudostapedia, removing the stapes superstructure, making a hole of 6mm diameter in therear of stapes footplate by laser drilling, implanting the corresponding length Piston artificialossicle.
RESULT: All thesurgeries were successful and the operation time was about one hour. There was only one patient manifested vertigo and nausea after the operation. But the symptoms improved three days later after the expectant treatment. Allthe incisions were healed in the externals. There was significant difference between the preoperative and postoperative PTA. The air conduct improved in every frequent and the bone conduct improved in 1 kHz, 2 kHz and4 kHz.
CONCLUSION: Laser assisted stapedotomy by mini incision in the external auditory meatus in patients havingwide straight canal with otosclerosis can shorten the operation time, minimize the tissue damage, fasten the healing of the incision and reduce the complications postoperatively. In addition, the mini incision is beauty and easy to nurse.

PMID: 27382673 [PubMed - in process]



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[Progress in diagnosis and treatment of benign paroxysmal positional vertigo].

[Progress in diagnosis and treatment of benign paroxysmal positional vertigo].

Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016 Mar;30(5):345-8

Authors: Wei X

PMID: 27382671 [PubMed - in process]



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Πέμπτη 7 Ιουλίου 2016

Acoustic–Phonetic Versus Lexical Processing in Nonnative Listeners Differing in Their Dominant Language

Purpose
Nonnative listeners have difficulty recognizing English words due to underdeveloped acoustic–phonetic and/or lexical skills. The present study used Boothroyd and Nittrouer's (1988) j factor to tease apart these two components of word recognition.
Method
Participants included 15 native English and 29 native Russian listeners. Fourteen and 15 of the Russian listeners reported English (ED) and Russian (RD) to be their dominant language, respectively. Listeners were presented 119 consonant–vowel–consonant real and nonsense words in speech-spectrum noise at +6 dB SNR. Responses were scored for word and phoneme recognition, the logarithmic quotient of which yielded j.
Results
Word and phoneme recognition was comparable between native and ED listeners but poorer in RD listeners. Analysis of j indicated less effective use of lexical information in RD than in native and ED listeners. Lexical processing was strongly correlated with the length of residence in the United States.
Conclusions
Language background is important for nonnative word recognition. Lexical skills can be regarded as nativelike in ED nonnative listeners. Compromised word recognition in ED listeners is unlikely a result of poor lexical processing. Performance should be interpreted with caution for listeners dominant in their first language, whose word recognition is affected by both lexical and acoustic–phonetic factors.

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Mandarin Lexical Tone Acquisition in Cochlear Implant Users With Prelingual Deafness: A Review

Purpose
The purpose of this review article is to synthesize evidence from the fields of developmental linguistics and cochlear implant technology relevant to the production and perception of Mandarin lexical tone in cochlear implant users with prelingual deafness. The aim of this review was to identify potential factors that determine outcomes for tonal-language speaking cochlear implant users and possible directions for further research.
Method
A computerized database search of MEDLINE, CINAHL, Academic Search Premier, Web of Science, and Google Scholar was undertaken in June and July 2014. Search terms used were lexical tone AND tonal language, speech development AND/OR speech production AND/OR speech perception AND cochlear implants, and pitch perception AND cochlear implants, anywhere in the title or abstract.
Conclusion
Despite the demonstrated limitations of pitch perception in cochlear implant users, there is some evidence that typical production and perception of lexical tone is possible by cochlear implant users with prelingual deafness. Further studies are required to determine the factors that contribute to better outcomes to inform rehabilitation processes for cochlear implant users in tonal-language environments.

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[The false-negative reasons of positioning test in benign paroxysmal positional vertigo].

Related Articles

[The false-negative reasons of positioning test in benign paroxysmal positional vertigo].

Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016 Jan;30(1):19-21

Authors: Ma X, Si F, Liu Y, Han L, Jing Y, Yu L

Abstract
OBJECTIVE: To analyze the false-negative proportion and reasons of positioning test in benign paroxysmal positional vertigo (BPPV).
METHOD: Sixty-eight cases were reviewed and analyzed during February to April 2009. All patients had typical clinical history of BPPV and diagnosed by positioning test,and all were treated with PRM successfully. If positioning test at the first time were negative, examinations repeated after either head shaking or return visits.
RESULT: Thirteen patients (19.12%) appeared false-negative in positoning test, and 11 cases showed typical nystagmus after head shaking,while 2 cases were diagnosed by return visitis the next day. There were no statistically difference between false-negative group and positive group in age (P > 0.05), gender (P > 0.05), course of disease (P > 0.05) and types of semi-circular canal (P > 0.05).
CONCLUSION: Re-examinations after head shaking or return visits are useful for the diagnosis in the suspected BPPV patients who have negative positioning test.

PMID: 27197448 [PubMed - indexed for MEDLINE]



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[The efficacy of intratympanic dexamethasone injection for the moderate and severe sudden deafness with BPPV].

Related Articles

[The efficacy of intratympanic dexamethasone injection for the moderate and severe sudden deafness with BPPV].

Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015 May;29(10):934-6

Authors: Zhou X, Yu Y, Zhao Y, Wang Y, Liu Z, Liu Q

Abstract
OBJECTIVE: To evaluate the efficacy of intratympanic dexamethasone injection for the moderate and severe sudden deafness with BPPV.
METHOD: A total of 63 patients diagnosed with sudden sensorineural hearing loss with BPPV were treated through OPD. Patients were divided into three groups: 20 cases in intratympanic dexamethasone injection as initial treatment (group A); 18 cases in systemic hormone therapy group (group B); 25 cases in intratympanic dexamethasone injection as salvage treatment (group C). In addition, routine drugs were used to all patients.
RESULT: The overall effective rate of group A, B and C in hearing recovery was 60.0%, 38.9% and 48.0%, respectively: (1) No significant difference of hearing recovery was observed among three groups (P > 0.05); (2) A significant difference of hearing recovery was evidenced between group A and C (P < 0.05); (3) A significant difference of hearing recovery was evidenced between group A and C (P < 0.05); (4) No statistically significant difference was found in the hearing recovery between group B and C (P > 0.05).
CONCLUSION: Our data showed that intratympanic dexamethasone should be used as initial therapy for treating the moderate and severe sudden deafness with BPPV.

PMID: 26596013 [PubMed - indexed for MEDLINE]



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Τετάρτη 6 Ιουλίου 2016

San Diego State Student-City Project Looks To Go International

Jessica Barlow

San Diego State University professor Jessica Barlow is director of the Sage Project

A San Diego State University project that has tackled civic issues in National City and Santee could influence similar projects in other countries through a conference planned this week in Bonn, Germany.

Linguistics professor Jessica Barlow plans to attend the Resilient Cities 2016 conference in Bonn this week, where she will explain how SDSU students helped local cities work on specific issues as part of the Sage Project, which she directs at the school.

“The panel focus will be ‘Innovative and effective ways of sharing knowledge and delivering actionable information to decision-makers,’” Barlow said, reciting the name of the session she’s attending.

While the panel title is a mouthful, the concept is simple, and it’s already catching on.

Some cities don’t have the manpower to handle all the many complex issues facing municipalities, and there aren’t enough staff members to research innovations about traffic, signage, homelessness and other issues. Many major cities do, however, have colleges and universities filled with students looking for real-world projects in their disciplines. The Sage Project connects classrooms with cities and already has worked with San Diego, Tijuana, National City and Santee. Barlow said Lemon Grove will be the Sage Project’s next partner.

The concept began about seven years ago with the Sustainable City Year Program at the University of Oregon.

The Oregon program was replicated across the country in a network called the Educational Partnership for Innovation in Communities, or EPIC.

SDSU became the first California school in the network about three years ago, and seven other California State University schools have joined since then, including San Marcos, Chico, East Bay, Fullerton, Fresno, Monterey Bay and Sonoma State.

Barlow said that around the time the network was being formed, the Pacific southwest office of the Environmental Protection Agency contacted the University of Oregon with an interest in bringing the program to California.

“They said, ‘You’re in luck, because San Diego State has a program,’” Barlow said.

Anthony Socci, senior lead on international climate policy for the EPA’s Office of Global Affairs and Policy, organized a panel that Barlow will be on with other speakers. Among the organizations represented on the panel will be NASA, the National Science Foundation, the United Nations, the United Nations University, the National Science Foundation and the city of Durban in South Africa.

“He wanted to put together a panel about improving ways of sharing knowledge and information among researchers,” Barlow. “We’re going to be talking about new and innovative ways of doing that.”

Equally important as the people on the panel may be those in the audience, which will include mayors, and community and civic leaders from more than 100 countries, she said. People from the World Bank, the United Nations, nonprofits, universities and the National Science Foundation also will be in attendance, she said.

Barlow said cities pay an average of $25,000 for each project that is tackled in partnership with the Sage Project. The cost covers field trips, internships, a paid position to write up a final report and other expenses. She plans to tell other cities not to be scared off by the cost because grants and other sources of funding can be found.

Explaining the name of the Sage Project, Barlow said each member of EPIC names its project after something in its region. Locally, she said, sage has the double meaning of wisdom and the southwest plant.

So far the Sage Project has involved students in 28 different disciplines, including geography, design, environmental engineering, civil engineering, city planning, public administration and public health. One student studying for a professional certificate in the business of craft beer at SDSU worked on a National City study of why the city had no craft beer breweries.

Another project in National City had design and geography students working on signage in the city. While the city didn’t adopt the designs, the work by the students did result in the city getting more than $1 million in grants.

“It’s an example of how a partnership can help move a project forward,” Barlow said about the city’s effort to create a signage system that is efficient and reflects the community’s character.

In another National City project, students studied uses of city-owned land that once was in a redevelopment zone. With funds for redevelopment cut, the city had to submit a long-range property management plan to the state, and Barlow said the students’ work helped the city prepare most of its documents.

Students also have worked with the city of San Diego, and in August a report on the Police Department’s Homeless Outreach Team should be completed, Barlow said.

 

 

written by: Gary Warth

 

 

 

 



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The rhizome of Gastrodia elata Blume - an ethnopharmacological review.

The rhizome of Gastrodia elata Blume - an ethnopharmacological review.

J Ethnopharmacol. 2016 Jul 1;

Authors: Zhan HD, Zhou HY, Du XL, Sui YP, Wang WH, Dai L, Sui F, Huo HR, Jiang TL

Abstract
ETHNOPHARMACOLOGICAL RELEVANCE: Gastrodia elata Blume (Orchidaceae) is commonly called Tian ma in Chinese and mainly distributed in the mountainous areas of eastern Asia, such as China, Korea, Japan and India. It is an extensively used traditional Chinese herbal medicine in the clinical practice of traditional Chinese medicine, to treat headache, migraine, dizziness, epilepsy, infantile convulsion, tetany and so on. The present paper reviews the advancements in investigation of botany and ethnopharmacology, phytochemistry, pharmacology, toxicology and quality control of Gastrodia elata Blume. Finally, the possible tendency and perspective for future investigation of this plant are also put forward.
MATERIALS AND METHODS: The information on Gastrodia elata Blume was collected via piles of resources including classic books about Chinese herbal medicine, and scientific databases including Pubmed, Google Scholar, ACS, Web of science, ScienceDirect databases, CNKI and others. Plant taxonomy was validated by the databases "The Plant List", and "Mansfeld's Encyclopedia".
RESULTS: Over 81 compounds from this plant have been isolated and identified, phenolics and polysaccharides are generally considered as the characteristic and active constituents of Gastrodia elata Blume. Its active compounds possess wide-reaching biological activities, including sedative, hypnotic, antiepileptic, anticonvulsive, antianxietic, antidepressant, neuroprotective, antipsychotic, anti-vertigo, circulatory system modulating, anti-inflammationary, analgesic, antioxidative, memory-improving and antiaging, antivirus and antitumor effects.
CONCLUSION: Despite the publication of various papers on Gastrodia elata Blume, there is still, however, the need for definitive research and clarification of other bioactive compounds using bioactivity-guided isolation strategies, and the possible mechanism of action as well as potential synergistic or antagonistic effects of multi-component mixtures derived from Gastrodia elata Blume need to be evaluated. It is also necessary and important to do more quality control and toxicological study on human subjects in order to maintain its efficacy stable in the body and validate its safety in clinical uses. In addition, more investigations on other parts of this plant beyond the tubers are needed. Further studies on Gastrodia elata Blume will lead to the development of new drugs and therapeutics for various diseases, and how to utilize it better should be paid more attention to.

PMID: 27377337 [PubMed - as supplied by publisher]



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Παρασκευή 1 Ιουλίου 2016

A Geriatric Perspective on Benign Paroxysmal Positional Vertigo.

http:--media.wiley.com-assets-7315-19-Wi Related Articles

A Geriatric Perspective on Benign Paroxysmal Positional Vertigo.

J Am Geriatr Soc. 2016 Feb;64(2):378-85

Authors: Parham K, Kuchel GA

Abstract
Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo in older adults. Beyond the unpleasant sensation of vertigo, BPPV also negatively affects older adults' gait and balance and increases their risk of falling. As such it has a profound effect on function, independence, and quality of life. Otoconia are the inner ear structures that help detect horizontal and vertical movements. Aging contributes to the fragmentation of otoconia, whose displacement into the semicircular, most commonly posterior canals, can produce rotatory movement sensations with head movement. BPPV is more commonly idiopathic in older adults than in younger individuals, can present atypically, and has a more-protracted course and higher risk of recurrence. Medications such as meclizine that are commonly prescribed for BPPV can be associated with significant side effects. Dix-Hallpike and Head Roll tests can generally identify the involved canal. Symptoms resolve as otoconia fragments dissolve into the endolymph, but appropriate canalith repositioning (e.g., Epley maneuver) can expedite recovery and reduce the burden of this disorder. Observations suggesting an association between idiopathic BPPV and vitamin D deficiency and osteoporosis indicate that BPPV may share risk factors with other common geriatric conditions, which highlights the importance of moving beyond purely otological considerations and addressing the needs of older adults with vertigo through a systems-based multidisciplinary approach.

PMID: 26804483 [PubMed - indexed for MEDLINE]



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Πέμπτη 30 Ιουνίου 2016

Minimal Hearing Loss: From a Failure-Based Approach to Evidence-Based Practice

Purpose
A representative sample of the literature on minimal hearing loss (MHL) was reviewed to provide evidence of challenges faced by children with MHL and to establish the need for evidence-based options for early intervention.
Method
Research articles published from 1950 to 2013 were searched in the Medline database using the keywords minimal hearing loss, unilateral hearing loss, and mild hearing loss. References cited in retrieved articles were also reviewed.
Results
In total, 69 articles contained relevant information about pediatric outcomes and/or intervention for unilateral hearing loss, 50 for mild hearing loss, and 6 for high-frequency hearing loss. Six challenges associated with MHL emerged, and 6 interventions were indicated. Evidence indicates that although some individuals may appear to have no observable speech-language or academic difficulties, others experience considerable difficulties. It also indicates that even though children with MHL may appear to catch up in some areas, difficulties in select domains continue into adulthood.
Conclusions
Evidence indicates significant risks associated with untreated MHL. Evidence also demonstrates the need for early intervention and identifies several appropriate intervention strategies; however, no single protocol is appropriate for all children. Therefore, families should be educated about the impact of MHL and about available interventions so that informed decisions can be made.

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Gastric peroral endoscopic myotomy for refractory gastroparesis: results from the first multicenter study on endoscopic pyloromyotomy (with video).

Gastric peroral endoscopic myotomy for refractory gastroparesis: results from the first multicenter study on endoscopic pyloromyotomy (with video).

Gastrointest Endosc. 2016 Jun 25;

Authors: Khashab MA, Ngamruengphong S, Carr-Locke D, Bapaye A, Benias PC, Serouya S, Dorwat S, Chaves DM, Artifon E, de Moura EG, Kumbhari V, Haito Chavez Y, Bukhari M, Hajiyeva G, Ismail A, Chen YI, Chung H

Abstract
BACKGROUND AND AIMS: Gastric peroral endoscopic myotomy (G-POEM) has been recently reported as minimally invasive therapy for gastroparesis. The aims of this study were to report the first multicenter experience with G-POEM and assess the efficacy and safety of this novel procedure for gastroparetic patients with symptoms refractory to medical therapy.
PATIENTS AND METHODS: All patients with gastroparesis who underwent endoscopic pyloromyotomy (G-POEM) at 5 medical centers were included. Procedures were performed following the same principles as esophageal POEM. Clinical response was defined as improvement in gastroparetic symptoms with absence of recurrent hospitalization. Adverse events (AEs) were graded according to the ASGE lexicon.
RESULTS: A total of 30 patients with refractory gastroparesis (11 diabetic, 12 post-surgical, 7 idiopathic) underwent G-POEM. Prior therapies included Botox injection in 12, transpyloric stenting in 3, and PEGJ in 1. Nausea/vomiting were the predominant symptoms in 25 patients. Weight loss was present in 27 patients with an average of 10% of body weight loss. G-POEM was completed successfully in all 30 (100%) patients with mean procedure time of 72 minutes (range 35-223). The mean myotomy length was 2.6±2.3 cm. The mean length of hospital stay was 3.3 days (range 1-12). Two AEs occurred in 2 (6.7%) patients, including 1 capnoperitoneum and 1 prepyloric ulcer and were rated as mild and severe, respectively. Clinical response was observed in 26 (86%) patients during a median follow-up of 5.5 months. Four patients (2 diabetic, 1 post-surgical, 1 idiopathic etiology) did not respond to G-POEM. Repeat GES was obtained in 17 patients, normalized in 8 (47%) and improved in 6 (35%) patients.
CONCLUSION: G-POEM is a technically feasible procedure. This small non-randomized study suggests the effectiveness of G-POEM for the treatment of patients with gastroparesis refractory to medical therapy. It concomitantly results in normalization of GES in a significant proportion of treated patients.

PMID: 27354102 [PubMed - as supplied by publisher]



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[Percutaneous Phil™-Embolization for Preoperative Therapy of Carotid Body Paragangliomas].

[Percutaneous Phil™-Embolization for Preoperative Therapy of Carotid Body Paragangliomas].

Laryngorhinootologie. 2016 Jun 29;

Authors: Psychogios G, Berlis A, Märkl B, Schaller T, Psychogios MN, Zenk J

Abstract
Introduction: Paragangliomas are rare tumors representing a therapeutic challenge. In particular, the surgical removal may lead to life-threatening bleeding. The preoperative percutaneous embolization is an alternative that allows a high closure rate of tumor-feeding vessels in a short intervention time and thus significantly reduces intraoperative bleeding probability. Complete tumor resection is facilitated thereby. The use of a new non-adhesive liquid embolic agent is presented here. Methods: A 50-year old patient presented with 4 cm large paraganglioma of the carotid body (Shamblin II). A percutaneous embolization with 7 ml PHIL™ (injectable precipitating hydrophobic liquid) was performed preoperatively. 24 h later the complete surgical resection of the tumor was performed. Results: A good distribution of the liquid embolic agent could be achieved over the entire tumor. Intraoperative resection of the tumor was much easier and faster due to low bleeding tendency over the entire surface of the tumor. Total blood loss was less than 50 ml. All adjacent nerve and arterial structures could be spared. Postoperative nerve function was normal and the patient was discharged on the 4(th) postoperative day. Conclusion: The combination of percutaneous embolization and surgical resection provides a safe combination in the treatment of advanced carotid body paragangliomas. The use of a novel liquid embolic agent may possibly further optimize the therapy.

PMID: 27355479 [PubMed - as supplied by publisher]



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[Management of Complex Tympanojugular Paragangliomas].

[Management of Complex Tympanojugular Paragangliomas].

Laryngorhinootologie. 2016 Jun 29;

Authors: Harati A, Schultheiß R, Harati K, Rohde S, Weber W, Deitmer T

Abstract
Background: Tympanojugular paraganglioma (TJP) are benign, high vascularized, local destructive tumors. Despite many studies in the literature, the management of particularly complex TJP (e. g., posterior fossa and/or carotid artery invasion) remains controversial. In the current study we present our treatment strategies for complex TJP and long-term results. Patients and methods: Between 2003 and 2013, 17 patients with TJP Fisch types C and D were treated in our institution. Primary symptoms were hearing loss, followed by facial nerve palsy and lower cranial nerve impairments. 2 patients presented with recurrent tumors. Surgical treatment after endovascular tumor embolization was performed in 14 patients. 2 patients were treated by radiation therapy. Results: Gross tumor resection was achieved in 10 patients. A temporary postoperative facial nerve palsy occurred in 2 patients and permanent postoperative vocal cord palsy in 3 patients. During long term follow-up, one patient experienced regrowth of the residual tumor. No tumor progress was observed in both patients treated with radiation therapy. Outcome assessed by Karnofsky scale showed 100% functionality in 12 patients and 90% in 5 patients. Discussion: Surgical treatment of TJP after endovascular embolization is the treatment of choice in young and healthy patients. In older patients with premorbid conditions, radiation therapy is the main treatment option and is associated with high tumor control rates. Precise preoperative staging together with individualize risk-benefit assessment and interdisciplinary treatment strategy are essential for a favorable outcome.

PMID: 27355478 [PubMed - as supplied by publisher]



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[Objective Diagnostics and Therapie of Hearing Loss Several Years after Cochlear Implant].

[Objective Diagnostics and Therapie of Hearing Loss Several Years after Cochlear Implant].

Laryngorhinootologie. 2016 Jun 29;

Authors: Müller A, Feick J, Dziemba OC, Mir-Salim P

PMID: 27355477 [PubMed - as supplied by publisher]



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Simulation in neurology.

http:--production.springer.de-OnlineReso Related Articles

Simulation in neurology.

Neurol Sci. 2015 Oct;36(10):1967-71

Authors: Micieli G, Cavallini A, Santalucia P, Gensini G

Abstract
Simulation is a frontier for disseminating knowledge in almost all the fields of medicine and it is attracting growing interest because it offers a means of developing new teaching and training models, as well as of verifying what has been learned in a critical setting that simulates clinical practice. The role of simulation in neurology, until now limited by the obvious physical limitations of the dummies used to train students and learners, is now increasing since, today, it allows anamnestic data to be related to the instrumental evidence necessary for diagnosis and therapeutic decision-making, i.e., to the findings of neurophysiological investigations (EEG, carotid and vertebral echography and transcranial Doppler, for example) and neuroradiological investigations (CT, MRI imaging), as well as vital parameter monitoring (ECG, saturimetry, blood pressure, respiratory frequency, etc.). Simulation, by providing learners with opportunities to discuss, with experts, different profiles of biological parameters (both during the simulation itself and in the subsequent debriefing session), is becoming an increasingly important tool for training those involved in evaluation of critical neurological patients (stroke, Guillan Barrè syndrome, myasthenia, status epilepticus, headache, vertigo, confusional status, etc.) and complex cases. In this SIMMED (Italian Society for Simulation in Medicine) position paper, the applications (present and, possibly, future) of simulation in neurology are reported.

PMID: 25926070 [PubMed - indexed for MEDLINE]



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