Ecological and evolutionary drivers of phenotypic and genetic variation in the European crabapple [Malus sylvestris (L.) Mill.], a wild relative of the cultivated apple.

BACKGROUND AND AIMS: Studying the relationship between phenotypic and genetic variation in populations distributed across environmental gradients can help us to understand the ecological and evolutionary processes involved in population divergence. We investigated the patterns of genetic and phenotypic diversity in the European crabapple, Malus sylvestris, a wild relative of the cultivated apple (Malus domestica) that occurs naturally across Europe in areas subjected to different climatic conditions, to test for divergence among populations. METHODS: Growth rates and traits related to carbon uptake in seedlings collected across Europe were measured in controlled conditions and associated with the genetic status of the seedlings, which was assessed using 13 microsatellite loci and the Bayesian clustering method. Isolation-by-distance, isolation-by-climate and isolation-by-adaptation patterns, which can explain genetic and phenotypic differentiation among M. sylvestris populations, were also tested. KEY RESULTS: A total of 11.6 % of seedlings were introgressed by M. domestica, indicating that crop-wild gene flow is ongoing in Europe. The remaining seedlings (88.4 %) belonged to seven M. sylvestris populations. Significant phenotypic trait variation among M. sylvestris populations was observed. We did not observe significant isolation by adaptation; however, the significant association between genetic variation and the climate during the Last Glacial Maximum suggests that there has been local adaptation of M. sylvestris to past climates. CONCLUSIONS: This study provides insight into the phenotypic and genetic differentiation among populations of a wild relative of the cultivated apple. This might help us to make better use of its diversity and provide options for mitigating the impact of climate change on the cultivated apple through breeding.

[Quality in the appraisal of head and neck sonography results in university hospitals-a random sample]. / Qualität in der Befundung von Kopf- und Halssonographien an Universitätskliniken ­ eine Stichprobe.

BACKGROUND: Ultrasound diagnostics are widely used and are standard for radiologists, otolaryngologists, and oral and maxillofacial surgeons in the diagnostic work-up of various pathologies. There is agreement that digital documentation is urgently needed at present to improve and standardize the quality of sonographic documentation. There are more and more publications on the implementation of standardized documentation of findings in imaging diagnostics, including head and neck sonography. OBJECTIVE: The present work aims to determine the quality of routine head and neck sonography findings on a random basis, according to the criteria of the Bavarian Association of Statutory Health Insurance Physicians (KVB) at a selection of German university otolaryngology departments (ENT). MATERIALS AND METHODS: A total of 70 randomly selected anonymized written findings including image documentation from seven ENT departments were retrospectively analyzed by an experienced KVB examiner concerning fulfilment of KVB criteria. The data were evaluated descriptively. RESULTS: Of the 70 reports, 69 were eligible for evaluation. The average documentation completeness was 80.6%. A total of 9 findings were correctly documented in full (13%). The documentation completeness of the individual departments was sorted in ascending order from 68.1% to 93%. With 88.5% vs. 75%, the hospitals with a structured report showed a higher level of completeness. In 75% of the cases the hospitals with structured reports also had digital solutions for reporting and image archiving. CONCLUSION: In general, there is potential for optimization regarding the completeness and quality of routinely prepared head and neck sonography findings at the selected university ENT departments. The implementation of structured reporting masks and the conversion of analogue documentation into digital solutions as well as digital networking with the hospital information systems, picture archiving and communication systems should be promoted. Supervision by senior doctors is required to ensure the quality of findings of inexperienced colleagues and to help to achieve standards in reporting.

Modifications to a Vitis Shoot Tip Cryopreservation Procedure: Effect of Shoot Tip Size and Use of Cryoplates.

BACKGROUND: Cryopreservation has been considered a preferred method for the long-term storage of plant germplasm, especially to efficiently conserve and maintain the genetic integrity of genebank materials. Droplet-vitrification (DV) procedures have been developed to cryopreserve Vitis shoot tips from in vitro-grown plants. OBJECTIVE: This research focused on optimizing shoot tip sizes for DV and the feasibility of using cryo-plates for Vitis cryopreservation. MATERIALS AND METHODS: Uniform shoot tips were obtained from nodal sections cultured from in vitro-grown stock plants of Vitis aestivalis and Vitis jacquemontii (PI 135726). Shoot tips were precultured for 3 days on medium containing 0.3 M sucrose, salicylic acid, glutathione (reduced form), and ascorbic acid. They were cryopreserved using either DV on aluminum foil strips or by placement in calcium alginate gel in the wells of aluminium cryo-plates (V cryo-plate method). Shoot tips were then treated with loading solution followed by PVS2 treatment prior to liquid nitrogen (LN) exposure. Shoot tips were warmed in unloading solution and placed on recovery medium. The effect of extraction or non-extraction of the cryopreserved shoot tips from alginate beads was also tested. RESULTS: The highest regrowth levels of cryopreserved shoot tips were obtained using 1 mm shoot tips and a PVS2 exposure for 90 min at 0°C with the DV method on aluminum foil strips or by using 30 min of PVS2 at 22°C using V cryo-plates. CONCLUSION: Shoot tip size is an important factor in the cryopreservability of Vitis shoot tips; 1 mm shoot tips were the most successful for the DV cryopreservation method that was tested. In addition, the V cryo-plate cryopreservation technique described herein can be easily executed and results in high regrowth levels (≥70%) with quality plants obtained from cryo-exposed shoot tips, making it a practical and promising Vitis cryopreservation methodology.

Patient's perspective on long-term complications after superficial parotidectomy for benign lesions: Prospective analysis of a 2-year follow-up.

OBJECTIVE: Evaluation of patients' perspective on long-term complications after superficial parotidectomy for benign lesions. DESIGN: A prospective nonrandomized controlled multicenter study. SETTING: Three university-based tertiary referral centers (Departments of Otorhinolaryngology of Cologne, Jena and Giessen; all in Germany). PARTICIPANTS: 130 adult patients, who underwent a primary superficial parotidectomy for benign tumors of the parotid gland, were consecutively included from 09/2010 to 05/2012. 61 patients completed every follow-up examination. MAIN OUTCOME MEASURES: Complications were evaluated using the validated German-language questionnaire Parotidectomy Outcome Inventory 8 at six, 12 and 24 months after surgery. Pain intensity was assessed on a numeric rating scale (NRS) at each follow-up visit. RESULTS: At 6 months after surgery, 90% characterized hypoesthesia as the most disturbing problem, followed by fear of revision surgery (57%) and scar (56%). Facial palsy (14%) posed the minor problem. Hypoesthesia improved significantly during the follow-up period (all P < .05), but still posed a problem for 78% of the patients after 2 years. Pain, which initially bothered 53% of the patients, significantly decreased, whereas impairment due to Frey's syndrome significantly increased during the follow-up (6 vs 24 months; P = .002 and P = .001, respectively). Scar, substance loss, xerostomia, facial palsy, and anxiety affected patients with unvarying severity during the 2 years (all P > .05). CONCLUSIONS: From patients' perspective, sensation loss posed the major subjective problem after superficial parotidectomy. Appearance of the scar, and fear of revision surgery impaired more than 50% of the patients in their daily life without significant improvement during the 2 years postoperatively. Although superficial parotidectomy is a highly standardized and safe procedure, limited parotidectomy for proven benign parotid salivary gland neoplasms is more likely to result in patients with minimal or no displeasing complications.

Successful Cryopreservation of Vitis Shoot Tips: Novel Pre-treatment Combinations Applied to Nine Species.

BACKGROUND: Secure back-up of Vitis genetic resource collections requires cryopreservation methods that give long-term survival of clonal germplasm having diverse genetic backgrounds. OBJECTIVE: This work sought to increase survival of Vitis shoot tips exposed to liquid nitrogen using combinations of pretreatments and cryoprotection procedures. The new procedure should give high survival of shoot tips from a wide range of Vitis species. MATERIALS AND METHODS: In vitro plants from nine Vitis species were used as source material for nodal sections. Shoot tips were then excised from nodal sections that were grown on medium containing benzyladenine, salicylic acid, glutathione, and ascorbic acid. The shoot tips were treated with loading solution, and then half-strength PVS2 for 30 minutes, prior to full-strength PVS2 treatments for between 60 and 90 minutes prior to liquid nitrogen (LN) exposure. RESULTS: Shoot tip regrowth levels were highest 90 minutes in PVS2+LN and ranged from 24-43% and averaged 35±2% across the nine Vitis species. CONCLUSION: The pretreatment, cryopreservation, and recovery methods yielded successful regrowth for multiple Vitis species using a droplet-vitrification procedure.

Inpatient treatment of patients with acute idiopathic peripheral facial palsy: A population-based healthcare research study.

OBJECTIVES: To determine the inpatient management for patients with acute idiopathic facial palsy (IFP) in Thuringia, Germany. DESIGN: Population-based study. SETTING: All inpatients with IFP in all hospitals with departments of otolaryngology and neurology in 2012, in the German federal state, Thuringia. MAIN OUTCOME MEASURES: Patients' characteristics and treatment were compared between departments, and the probability of recovery was tested. RESULTS: A total of 291 patients were mainly treated in departments of otolaryngology (55%) and neurology (36%). Corticosteroid treatment was the predominant therapy (84.5%). The probability to receive a facial nerve grading (odds ratio [OR=12.939; 95% confidence interval [CI]=3.599 to 46.516), gustatory testing (OR=6.878; CI=1.064 to 44.474) and audiometry (OR=32.505; CI=1.485 to 711.257) was significantly higher in otolaryngology departments, but lower for cranial CT (OR=0.192; CI=0.061 to 0.602), cerebrospinal fluid examination (OR=0.024; CI=0.006 to 0.102). A total of 131 patients (45%) showed a recovery to House-Brackmann grade≤II. A pathological stapedial reflex test (Hazard ratio [HR]=0.416; CI=0.180 to 0.959) was the only independent diagnostic predictor of worse outcome. Prednisolone dose >500 mg (HR=0.579; CI 0.400 to 0.838) and no adjuvant physiotherapy (HR=0.568; CI=0.407 to 0.794) were treatment-related predictors of worse outcome. CONCLUSIONS: Inpatient treatment of IFP seems to be highly variable in daily practice, partly depending on the treating discipline and despite the availability of evidence-based guidelines. The population-based recovery rate was worse than reported in clinical trials.

[Rehabilitation of facial palsy and vertigo in patients with vestibular schwannoma]. / Rehabilitation bei Fazialisparese und Schwindel bei Patienten mit Vestibularisschwannom.

BACKGROUND: Facial palsy and vertigo, as symptoms of vestibular schwannoma (VS) or consequences of its therapy, have a significant impact on patients' quality of life. OBJECTIVE: This review analyzed current literature on the topic and deduced recommendations for rehabilitation of facial palsy and vertigo. METHODS: The present review describes a PubMed-based search of the literature of the past 10 years. RESULTS: There is no evidence-based drug therapy for the treatment of acute facial palsy after VS surgery. Several surgical procedures for facial nerve reconstruction, muscle transfer, and static techniques have been established. Physiotherapeutic movement therapy, optimally with biofeedback, seems to improve facial function in patients with post-paralytic syndrome. Botulinum toxin injections are the method of choice for synkinesis treatment. For treatment of acute and chronic vertigo in patients with VS, the same antivertiginous drugs as for other vertigo patients are used. If the patient shows retained vestibular stimulation function, preoperative intratympanic gentamycin therapy followed by compensation training is a promising approach to decreasing postoperative vertigo. Good vestibular rehabilitation comprises intensive and regular movement training, preferably with real-time feedback and therapy control. CONCLUSION: There are several conservative, surgical, or combined conservative-surgical treatment options for individualized facial nerve rehabilitation of VS patients, as confirmed by clinical studies. In cases of acute vertigo, standard antivertiginous pharmacotherapy is indicated. In cases of acute and also of chronic vertigo, intensive balance and movement training relieves complaints.

[Validation of the German Version of the Sunnybrook Facial Grading System]. / Validierung einer Deutschen Version des Sunnybrook Facial Grading Systems.

Background: The Sunnybrook facial grading system (SFGS) is frequently applied to evaluate facial function in patients with facial palsy, but still now there is no validated German version of this evaluation sheet. Methods: The original English version of the SFGS was translated and validated in accordance with international standards. The interrater reliability from 5 raters (speech therapy students) and the intrarater reliability from repeated ratings at 2 time points using video tapes of 18 patients with different types of facial palsy were analyzed by calculating the intraclass correlation coefficient (ICC) and other reliability measures. Results: ICC for the interrater reliability for the 4 components of the SFGS, resting symmetry, symmetry during voluntary movements, synkinesis, and the composite score were ICC 0.845; 0.903; 0.731 and 0.918, respectively, for the first evaluation and ICC 0.881; 0.932; 0.818 and 0.940, respectively, for the second evaluation. The mean intrarater reliability for the 4 SFGS scores was ICC=0.791; 0.906; 0.770 and 0.905. Discussion: There is now a valid German version of the SFGS available that can be used even by novices. The German version is suitable for evaluation of facial palsies in clinical routine and studies to allow a better comparability of German patients with results of the international literature.

[One Year Treatment of Nose Bleeding in the ENT Emergency Departments of East Thuringia]. / Ein Jahr Epistaxisbehandlung in den Notfallambulanzen der Ostthüringer HNO-Kliniken.

Objective: Aim of the study was to analyse the medical care situation of patients suffering from epistaxis in everyday clinical practice in ENT emergency departments. Material and Methods: In the year 2009, 690 patients with 862 occurrences of epistaxis sought help in the 2 East Thuringian ENT emergency departments in Jena and Gera (60% male, average age: 60 years). The patients' characteristics were evaluated retrospectively with a focus on comorbidity, long-term medication and treatment measures. Results: The incidence of epistaxis treatment in the ENT emergency departments was 121 28 per 100 000 habitants of East Thuringia. Die Inzidenz für die Epistaxisbehandlung in den Notfallambulanzen der Ostthüringer Kliniken lag bei 121 28 pro 100 000 Einwohner Ostthüringens The most common comorbidity was hypertension (68% of all patients). 27% of all patients were taking antiplatelet drugs and 19% anticoagulants. We identified the 3-fold combination of a medication with anticoagulant and antiplatelet drugs (p=0.015), Morbus Osler (p=0.011) and thrombocytopaenia (p=0.009) as independent risk factors for recurrent epistaxis. The therapeutic measures the patients led to success rates of more than 90%. Conclusion: The actual ENT emergency treatment of epistaxis seems to be efficient. The escalation of anticoagulant long-term drug therapy has resulted in more admittance to the inpatient sector. More analyses of medical care situations and factors have to be carried out to develop a patient stratification for the daily clinical practice as well as a general guideline for the management of epistaxis.

[Electromyographic Analysis of Neck Muscles at a Simulated Rear-end Impact in Healthy Subjects]. / Elektromyografische Analyse der Halsmuskulatur bei simulierter Heckkollision an gesunden Probanden.

BACKGROUND: Despite the introduction of safety belts and head restraints, severe neck injuries still occur in traffic accidents. Whether there are anthropometric factors or muscular properties, that affect the reflex times during a rear-end collision, and if they have predictive value for the expected trauma, should be reviewed in this investigation. METHODS: In 32 male volunteers anthropometric data and the maximal strength of their cervical musculature were measured. Thereafter, the volunteers were subjected to a simulated rear-end collision with a speed of 2 km/h. The impending crash was not announced to the subjects during the first test run. The situation was repeated several times to test the effect of warning. During the investigation, the muscle activity of neck and shoulder muscles was derived with surface electromyography (EMG). RESULTS: There was a strong correlation between the reflex time of the anterior neck muscles and the strength of that muscle group (r=-0.75; r²=0.57). In addition, the neck length correlated to the reflex time (r=-0.67; r²=0.45). The warning provided for the volunteers influences the EMG as well. The reflex times of the subjects were shorter (p Alle statistischen Berechnungen wurden mit IBM SPSS Statistics (Version 18; IBM Inc., Armonk, USA), sowie dem Programm Excel, (Microsoft, Redmond, USA) vorgenommen. Die Reflexzeiten wurden den anthropometrischen Daten, sowie der Muskelkraft gegenübergestellt und nach Pearson korreliert. Als eine angemessene Korrelation wurde das Quadrat des Korrelationskoeffizienten bei Werten r²>0,4 festgelegt. Außerdem wurden die Mediane der Reflexzeiten, der verschiedenen Kollisionssituationen miteinander verglichen. Das Signifikanz-Niveau wurde auf p<0,05 festgelegt. 0.05), when they knew about the impending collision. CONCLUSION: A high force capacity of anterior neck muscles has preventive value to reduce the consequences of whiplash accidents. The use and development of early warning systems in cars should be supported.

[Surgical Simulation Models for Sialendoscopy]. / Trainingsmodelle für die Sialendoskopie.

OBJECTIVE: Different simulation models are in use to teach the technique of sialendoscopy. Only a few reports in literature deal with this topic with no comparison having been published, yet. We therefore asked sialendoscopy training course participants about our applied models by using a questionnaire. Material und Methods: A tube-, a pepper-, a porcine kidney-, and a pig head-model were developed as training models and used during 6 consecutive practical sialendoscopy courses from 2012 to 2014. Participants were asked to answer a questionnaire specifically designed to assess the value of the different training models. RESULTS: All respondents (n=61) rated all training models positively. However, porcine kidney- and pig head-models were described to be superior, especially with respect to realistic simulation. Intubation of the papilla can be practised sufficiently only in the pig head-model. The tube- and peppers-models have the advantage of being less expensive, easier to handle and cleaner. CONCLUSIONS: The models described are all useful in learning the sialendoscopy technique. However, they have distinct advantages and disadvantages making a combination of different models useful.

[Facial Disability Index and Facial Clinimetric Evaluation Scale: validation of the German versions]. / Facial Disability Index und Facial Clinimetric Evaluation Skala: Validierung der Deutschen Versionen.

BACKGROUND: A validated instrument to measure patient-related outcome and quality of life in facial palsy is not available in German language. METHODS: 2 appropriate questionnaires, the Facial Clinimetric Evaluation (FaCE) scale and the Facial Disability Index (FDI) were translated and validated according to international guidelines. The internal consistency of both German versions was assessed. The results of FaCE and FDI were correlated with results of the SF-36, the House-Brackmann scale and the Stennert index. RESULTS: 122 facial palsy patients with a median duration of 4.7 months were included. FaCE and FDI showed good to very good psychometric characteristics with Cronbach's alpha values between 0.667 and 0.907. Both questionnaires were able to distinguish different degrees of facial palsy. The comparison to the SF-36 shows the highest correlation with the subscale social function. DISCUSSION: The German versions of the FDI and FaCE are valid and should now be applied more frequently to assess the disease-specific quality of life in patients with facial palsy.

Chronic vocal cord palsy in Thuringia, Germany: a population-based study on epidemiology and outcome.

Although surgical treatment of patients with chronic vocal cord palsy (VCP) is an integral part of clinical routine of otorhinolaryngologists, there is nearly no population-based data published on incidence and efficiency of this surgery country-wide or nation-wide. 1430 patients with chronic VCP were treated in a department of otorhinolaryngology between 2005 and 2010 in Thuringia, Germany. VCP was unilateral and bilateral in 63 and 18%, respectively. The affected side was not documented in 20%. Iatrogenic lesions of the recurrent nerve (42%) and neoplastic infiltration (27%) were the leading etiologies. 192 patients (13%) received surgical treatment. 31% of patient needed more than one surgery. The rate of surgeries was higher for bilateral VCP (p < 0.0001). Vocal cord augmentation was the most frequent surgery for unilateral VCP and posterior cordectomy for bilateral VCP. The complication rate was high (16%), but not different between unilateral and bilateral VCP (p = 0.108). The risk for tracheostomy was higher in the bilateral VCP group (p < 0.0001). Voice improvement was better after treatment of unilateral VCP (p < 0.0001). Breathing improvement was more frequent after bilateral VCP (p = 0.028). Dysphagia did not improve significantly. The rate of better voice, breathing, and swallowing function was higher in patients treated surgically than without surgery (all p < 0.0001). The rate of patients admitted for treatment of vocal fold palsy was 9.9/100,000 habitants. The surgical rate of VCP was 1.38/100,000 habitants. This population-based analysis shows that surgery for VCP is performed with higher incidence than expected effectively, but with relevant risks in daily routine of otorhinolaryngologists.

[EMG biofeedback training at home for patient with chronic facial palsy and defective healing]. / EMG Biofeedback Training zuhause zur Therapie der Defektheilung bei chronischer Fazialisparese.

BACKGROUND: There is no standard for the adjuvant treatment of patients with chronic facial palsy and defective healing. There is a lack of standard for mimic training programs with biofeedback technique. The advantages of modern EMG based biofeedback training have not been evaluated yet. MATERIAL AND METHODS: After detailed instruction 8 patients with facial palsy tested several types of electrodes and different EMG biofeedback programs without and with electrostimulation for selected mimic muscle activation, muscle relaxation, coordinated movements with the healthy contralateral side, as well as synchronous activation and relaxation of synkinetic muscle pairs at home. Feasibility, practical handling, training intensity and compliance were evaluated. RESULTS: Because of the mobility of the facial skin connected to the mimic muscles and the smallness of the muscles on the other hand, only one type of electrodes and one size was suitable. A step-wise treatment algorithm for the use of the different EMG biofeedback program was developed supporting the patient to specifically exercise deficits of defective healing at home. CONCLUSION: The proposed standardized algorithm to treat facial defective healing with EMG biofeedback is the basis for the evaluation of its efficacy in a subsequent clinical trial.

Feasibility of 6-month maintenance cetuximab after adjuvant concurrent chemoradiation plus cetuximab in squamous cell carcinoma of the head and neck.

BACKGROUND: Close resection margins < 5 mm (CM) or extra capsular extent at the lymph nodes (ECE) impair the prognosis of patients with squamous cell cancer of the head and neck (SCCHN) scheduled for adjuvant radiochemotherapy. We conducted a multicenter phase II study to investigate toxicity and efficacy of additional cetuximab administered concomitantly and as maintenance for the duration of 6 months following adjuvant radiochemotherapy., Ppreliminary results on feasibility and acute toxicity on skin and mucosa are presented in this article. METHODS: Patients with SCCHN following CM resection or with ECE were eligible for the study. In all, 61.6 Gy (1.8/2.0/2.2 Gy, days 1-36) were administered using an integrated boost intensity-modulated radiotherapy (IMRT) technique. Cisplatin (20 mg/m(2), days 1-5 and days 29-33) and 5-fluorouracil (5-FU) as continuous infusion (600 mg/m(2), days 1-5 + days 29-33) were given concurrently. Cetuximab was started 7 days prior to radiochemotherapy at 400 mg/m(2) followed by weekly doses of 250 mg/m(2). Maintenance cetuximab began after radiochemotherapy at 500 mg/m(2) every 2 weeks for 6 months. RESULTS: Of the 55 patients (46 male, 9 female, mean age 55.6, range 29-70 years) who finished radiochemotherapy, 50 were evaluable for acute toxicity concerning grade III/IV toxicities of skin and mucosa. Grade 3-4 (CTC 3.0) mucositis, radiation dermatitis, and skin reactions outside the radiation portals were documented for 46, 28, and 14 % of patients, respectively. One toxic death occurred (peritonitis at day 57). Cetuximab was terminated in 5 patients due to allergic reactions after the first application. In addition, 22 % of patients discontinued cetuximab within the last 2 weeks or at the end of radiochemotherapy. Of patients embarking on maintenance treatment, 80 % were still on cetuximab at 3 months and 63 % at 5 months. Concurrent and maintenance treatment with cetuximab could be administered as scheduled in 48 % of patients. CONCLUSION: Adjuvant radiochemotherapy with concomitant and maintenance cetuximab is feasible and acute toxicities are within the expected range. Compliance within the first 3-5 months is moderate.

Postural responses without versus with acute external cervical spine fixation: a comparative study in healthy subjects and patients with acute unilateral vestibular loss.

Using a diagnostic prospective cohort single center study design, the influence of a cervical collar on standing balance during dynamic postural perturbations in healthy adults and patients with acute unilateral vestibular dysfunction was measured in 31 healthy subjects and 27 patients with acute unilateral vestibular loss. The main outcome measures were completed standard protocols on the Sensory Organization Test (SOT) and Motor Control Test (MCT) of the NeuroCom Equitest(®) computerized posturography platform measured without and with acute cervical fixation, respectively. Paired t test showed no significant difference during the six conditions of neither the SOT scores nor analyzing the SOT strategies or during the MCT between the non-fixed and fixed neck in healthy subjects and in the patients (all p > 0.05). Older healthy subjects showed decreased SOT scores but equal MCT results. The age effect was more dominant in the patients when wearing the collar. Gender had no influence whether in healthy individuals nor in patients. In almost all conditions of the SOT but only in some MCT subtests patients had significantly lower scores than healthy subjects without collar and with collar (all p < 0.05). In conclusion, the SOT but only some subtest of the MCT could clearly distinguish between healthy adults and patient with acute unilateral vestibular loss. Equilibrium scores did not change significantly when the cervical spine was fixed with a collar. Acute fixation of the neck with a collar seems not to affect standing balance, even not when vestibular, visual and/or somatosensory input are also reduced.

[Emotional impact of facial palsy]. / Emotionale Auswirkungen einer Fazialisparese.

Facial palsy is not only a movement disorder but leads also to an emotional and communicative disorder in chronic stage but also in some patients already during the acute phase of the disease. The present review describes the current knowledge of the neurobiological and psychological fundamentals on the relation of facial movement and its emotional context. So far there is not much knowledge on the impact of a facial palsy on the interaction between facial movement, emotional processing and communicative skills of the patient. The emotional contagion seems to be reduced in patients with facial palsy. The ability to express emotions seems also to be reduced. Moreover, the patients feel to be perceived negatively. In fact, most of the expressions of patients with facial palsy are allocated with a negative affect even when the patients are smiling. Patients with facial palsy react with negative stress, anxiety and depression. The patients avoid social contacts. In turn, this reinforces the communicative disorder. The otorhinolaryngologist can use the Facial Disability Index as a simple questionnaire to detect such dysfunctions. Diagnostics that are necessary to develop a therapy program are presented in this review. Standardized therapy concepts that are not only treat the movement disorder but also the emotional context is missing so far. Finally, the review will give an outlook on potential therapy strategies.

[Progressive hoarseness]. / Progressive Heiserkeit.

A 31-year-old female teacher presented with a 6-month history of progressive hoarseness. The rigid laryngeal endoscopy showed corresponding transversal cream-yellow nodular lesions in the submucosal space of the middle third of both vocal folds. These are characteristic for bamboo nodes which are rare and strongly associated with autoimmune disease. In the present case a hitherto undiscovered Sjögren syndrome was diagnosed. After surgical excision, local steroid therapy and voice training a considerable voice improvement could be achieved.

[Estimation of postoperative pain after tonsillectomy in adults using QUIPS: an instrument to improve postoperative pain management]. / Verbesserung der Schmerztherapie nach Tonsillektomie bei Erwachsenen durch Schmerzmessung mit QUIPS ("Qualitätsverbesserung in der postoperativen Schmerztherapie").

BACKGROUND: Tonsillectomy leads to strong postoperative pain. Pain management often is not optimal after tonsillectomy. To date, there exists no clear guideline for pain management after tonsillectomy. METHODS: In a prospective study 65 tonsillectomy patients were examined at the first postoperative day within the QUIPS project. This allowed a standardised assessment of patients' characteristics, pain parameters, outcome and process parameters. The influence of these parameters on the patients' postoperative pain was estimated with univariate and multivariate statistic analysis. RESULTS: All patients report of constant slight pain during the first postoperative day after tonsillectomy. Although maximal pain intensity was moderate, overall, patients were satisfied with the pain management. Pain management did not result in relevant side effects. Younger patients suffered significantly more from maximal pain than older patients. The same was obvious for patients who needed pain killers already prior to surgery. Perioperative antibiotic treatment and specific counselling about the possibilities of postoperative pain management reduced pain intensity highly significant in univariate and multivariate analysis. Patients receiving opioids on the ward postoperatively had significantly less pain. DISCUSSION: QUIPS is a very good tool to evaluate the quality of postoperative pain management in one's own hospital. Next step, a detailed comparison to the best practise of other hospitals participating at QUIPS will follow in order to improve and standardize pain management for adult tonsillectomy patients.