[Intratympanic injection therapy for therapy refractory acute hearing loss: A safe option for secondary treatment]. / Intratympanale Injektionstherapie bei therapierefraktärem Hörsturz: Eine sichere Therapieoption zur Sekundärtherapie.

BACKGROUND: High-dose corticosteroids are currently recommended for idiopathic sudden sensorineural hearing loss (ISSNHL) treatment. Intratympanic injections (ITI) are of growing importance, especially in cases of therapy resistance. The selection of patients for this procedure in SSNHL has not been adequately examined so far. STUDY DESIGN: A total of 77 patients with ISSNHL after ineffective systemic pretreatment underwent intratympanic administration of dexamethasone and hyaluronic acid. Improvement after treatment was determined by pure tone audiometry for both ears before and of the treated ear after ITI. RESULTS: In this study 34 female and 43 male patients with mean age of 57 years showed a pre-ITI hearing loss of 35 dB in the lower frequencies and 69 dB in the higher frequencies. The mean hearing gain was 10 dB and the response rate was 62%. Absolute hearing gain revealed significant improvements at 500 Hz, 1 kHz and 2 kHz. Under inclusion of contralateral thresholds there were hardly any differences up to 4 kHz. In a detailed analysis of responders moderate improvements could be observed even in higher frequencies. Overall, no relevant adverse events occurred. CONCLUSION: Treatment of ISSNHL resistant to systemic regimens by ITI of steroids provides an option that offers additional prospects of auditory improvement for affected patients. The presented results indicate that these modalities are also valid for patients with pancochlear ISSNHL.

[Antibiotic prophylaxis in dermatologic and soft tissue surgery]. / Perioperative Antibiotikaprophylaxe bei Haut- und Weichteileingriffen.

In Germany, over half a million operations are done in dermatologic surgery in a hospital setting every year, as well as a less well quantified number of procedures in private offices. In spite of this large number, specific guidelines concerning the use of perioperative antibiotics in dermatologic surgery are sparse. In contrast to procedures in general, visceral or gynecological surgery, general guidelines on perioperative antibiotics issued by the Paul-Ehrlich Institutes and the AWMF do not specifically consider dermatologic operations. Several surveys indicate that familiarity with current recommendations on perioperative antibiotics is suboptimal and resulted in a considerable overuse of perioperative antibiotics in dermatologic surgery. Given the increasing antimicrobial resistance among important pathogens and the inherent risks of antibiotic administration, the decision for the use of prophylactic antibiotics should be based on the individual risk profile of the patient and of the surgical procedure. In the following, we will critically discuss the evidence for perioperative antibiotics in dermatologic surgery.

[Minimally invasive treatment of stress urinary incontinence by collagen administration. Comparison between endosonography controlled and transurethral submucous collagen injection]. / Minimal invasive Behandlung der Stressharninkontinenz durch Kollagenapplikation. Vergleich zwischen endosonographisch gezielter und transurethraler submuköser Kollageninjektion.

For many years, injectable substances have been in use for the treatment of incontinence. We examined different methods of injecting glutaraldehyde cross-linked bovine collagen injection for their effectiveness in treatment of genuine stress incontinence. In the first group of patients collagen injection was done under endo-ultrasound guidance. In the second group an endoscopic system was used. There was no major difference in patient selection for the two groups. Incontinence symptoms became less severe in only 5 of 15 (33%) patients in the endo-ultrasound group, who then had moderate stress incontinence. Endoscopic collagen treatment resulted in social continence in 15 of the 22 (68.2%) patients. We conclude that endoscopic collagen is superior to endo-ultrasound-guided collagen injection in the treatment of incontinence.

Snake venom phospholipase A2s (Asp49 and Lys49) induce mechanical allodynia upon peri-sciatic administration Involvement of spinal cord glia, proinflammatory cytokines and nitric oxide

Snakebites constitute a serious public health problem in Central and South America, where species of the lancehead pit vipers (genus Bothrops) cause the majority of accidents. Bothrops envenomations are very painful, and this effect is not neutralized by antivenom treatment. Two variants of secretory phospholipases A2 (sPLA2), corresponding to Asp49 and Lys49 PLA2s, have been isolated from Bothrops asper venom. These sPLA2s induce hyperalgesia in rats following subcutaneous injection. However, venom in natural Bothrops bites is frequently delivered intramuscularly, thereby potentially reaching peripheral nerve bundles. Thus, the present series of experiments tested whether these sPLA2s could exert pain-enhancing effects following administration around healthy sciatic nerve. Both were found to produce mechanical allodynia ipsilateral to the injection site; no thermal hyperalgesia was observed. As no prior study has examined potential spinal mechanisms underlying sPLA2 actions, a series of anatomical and pharmacological studies were performed. These demonstrated that both sPLA2s produce activation of dorsal horn astrocytes and microglia that is more prominent ipsilateral to the site of injection. As proinflammatory cytokines and nitric oxide have each been previously implicated in spinally mediated pain facilitation, the effect of pharmacological blockade of these substances was tested. The results demonstrate that mechanical allodynia induced by both sPLA2s is blocked by interleukin-1 receptor antagonist, anti-rat interleukin-6 neutralizing antibody, the anti-inflammatory cytokine interleukin-10, and a nitric oxide synthesis inhibitor (L-NAME). As a variety of immune cells also produce and release sPLA2s during inflammatory states, the data may have general implications for the understanding of inflammatory pain. © 2003 International Association for the Study of Pain.