The endoscopic study of human middle ear mucociliary transport.

The mucociliary clearance (MCC) is an important defence mechanism of the middle ear. The mucociliary transport (MCT) is a part of MCC. We measured the duration of MCT and visualised its routes in middle ears of 31 patients (mean age 45 years; range 7-61 years; SD 11.6) with intact tympanic membrane, with ventilated middle ears and without a history of prolonged otitis media. The transition time of indigo carmine dye from the promontory mucosa to the middle ear orifice of the Eustachian tube (ET) was observed with a rigid 30°, 1.7-mm-diameter tympanoscope. The dye took an average of 7 min (range 4.5-15 min; SD 3.4; median 4.5) to reach the ET orifice in 25 (81 %) patients. Three main ciliary pathways were detected: (1) below and parallel to the tensor tympani muscle; (2) downwards, anterior to the round window, and then ascending to the ET; and (3) straight across the promontory.

In-hospital cardiac complications after intracerebral hemorrhage.

BACKGROUND AND PURPOSE: Data on cardiac complications and their precipitants after intracerebral hemorrhage are scarce. We examined the frequency and risk factors for serious in-hospital cardiac events in a large cohort of consecutive intracerebral hemorrhage patients. METHODS: A retrospective chart review of 1013 consecutive patients with nontraumatic intracerebral hemorrhage treated at the Helsinki University Central Hospital (2005-2010). We excluded patients with intraparenchymal hematoma related to sub-arachnoid hemorrhage or intracerebral hemorrhage because of fibrinolytic therapies for acute ischemic stroke or myocardial infarction. Serious in-hospital cardiac event was defined as any of in-hospital poststroke acute myocardial infarction, ventricular fibrillation or tachycardia, moderate to serious acute heart failure, or cardiac death. RESULTS: Among the 948 patients included, ≥1 serious in-hospital cardiac event occurred in 39 (4·1%) patients after a median delay of two-days from stroke onset (acute myocardial infarction in three patients, ventricular fibrillation or tachycardia in three patients, acute heart failure in 36 patients, and cardiac death in three patients). Hospital stay was longer in patients with serious in-hospital cardiac event than in those without (median 12, interquartile range 7-19 vs. 8, 3-14; P = 0·001), with no difference in in-hospital mortality (23·1% vs. 24·3%; P = 0·86). In multivariable logistic regression analysis adjusted for age, gender, and diabetes, atrial fibrillation during hospitalization (odds ratio 6·68 for new-onset atrial fibrillation, 95% confidence interval 2·11-21·18; 4·46 for old atrial fibrillation, 2·08-9·56), and history of myocardial infarction (3·20, 1·18-8·66) were independently associated with serious in-hospital cardiac events. CONCLUSIONS: After intracerebral hemorrhage, 4% of patients suffer an acute serious cardiac complication. Those with history of myocardial infarction or in-hospital atrial fibrillation are at greater risk for such events.

Opinions on alcohol-related issues among professionals in primary, occupational, and specialized health care.

The objective of this study was to analyse differences in health care personnel's knowledge, skills, and attitudes in relation to alcohol-related matters by a postal questionnaire between primary, occupational, and specialized health care. Heavy drinking was considered to be common among patients at all health care levels, and particularly in specialized health care. However, early recognition and treatment of heavy drinkers was considered more appropriate in primary and occupational health care, than in specialized health care. Alcohol consumption was found to be an easy subject to discuss at all health care levels. In addition, 90% (165/183) of the respondents thought that patients had a positive or neutral attitude towards questions on their alcohol consumption. Of the respondents, 32% (58/182) considered discussing alcohol-related matters unacceptable and 81% (121/149) believed that they could not influence patients' drinking using brief intervention; there was no significant difference between different settings. Additionally, motivational skills of doctors and nurses were found to be poor at all health care levels. Our study shows that, although discussing alcohol consumption is easy, better motivational skills and more positive attitudes are needed in primary, occupational, and specialized health care. Professionals need further education at all health care levels, but particularly in specialized health care.

Integrin and dystrophin associated adhesion protein complexes during regeneration of shearing-type muscle injury.

In shearing injury both the myofibres and connective tissue framework are breached and the muscle tendon continuity is disrupted. During regeneration the firm myofibre to extracellular matrix (ECM) adhesion must be re-established. We have analysed the expression of selected molecules implementing this adhesion in regenerating myofibres 2-56 days after transection of rat soleus muscle using quantitative immunohistochemistry and Northern blotting. Beta1 integrin mRNA level and alpha7 integrin and vinculin immunoreactivities were transiently increased in both the intact and regenerating parts of the transected myofibres by day 5-7 with normalization by day 10-14. After day 14, alpha7 integrin and vinculin accumulated at the tips of the regenerating myofibres, indicating formation of new mini-myotendinous junctions (mMTJ). Immunoreactivities for dystrophin and associated proteins as well as merosin appeared in regenerating myotubes by day 3-4 reaching control levels by day 56. Our results suggest that integrin and dystrophin associated molecules are complementary in myofibre-ECM adhesion. During regeneration, ruptured myofibres temporarily reinforce their integrin mediated lateral adhesion until mMTJs are formed. Thereby the load on the newly formed scar and the risk of rerupture are reduced. Dystrophin associated molecules appear later and replace integrin on the lateral aspects, while both complexes are abundant at the mMTJs. These molecular events correspond to our previous results on tensile strength.

Correlation between biomechanical and structural changes during the regeneration of skeletal muscle after laceration injury.

A standardized and reliable model for muscle laceration injuries was developed. The biomechanical and morphological changes during the process of muscle repair after injury were analysed, and the reproducibility of the methods was evaluated. The soleus muscles of Sprague-Dawley rats were completely transected and were allowed to heal for 5, 7, 10, 14, 21, 28, or 56 days, when the muscles either were pulled to failure to measure different parameters of tensile strength or were removed for morphological analysis. During the repair process, the regenerating myofibers penetrated into the connective-tissue scar and formed new myotendinous junctions, thus restoring the functional continuity across the muscle stumps. The muscle atrophied significantly during the recovery period. Mechanical failure occurred in the scar until day 10, and thereafter it occurred within myofibers. Until day 10, the failure load, strain, and specific energy increased to as much as 46, 59, and 36% of the control level, respectively; thereafter, there were only minor changes. Stress (tensile strength per cross-sectional area) reached 86% of the control level by day 21 and further increased to as much as 96% of the control level until day 56. These results indicate that the scar becomes stronger than muscle within 14 days; thereafter, the weakest point is the atrophic muscle. The fact that the stress value was most rapidly normalized suggests that, qualitatively, the regenerated muscle had virtually regained its pretrauma strength by day 56 and that the low values of failure load, strain, and specific energy were mainly due to atrophy of the muscle. Thus, further increase in the tensile strength of the regenerated muscle-tendon unit may require active exercise to reverse muscle atrophy.

Intrapartum rupture of uterus diagnosed by ultrasound: a case report.

A case of ruptured uterine scar of a previous cesarean section diagnosed by ultrasound is presented. Because of the severity of the complication and the great variation of symptoms in connection with it, the authors encourage the use of ultrasound screening in the detection of this rare, but often catastrophic complication.