Cirrhotic Cardiomyopathy and Cardiac Failure after Liver Transplantation: A Case Series.

Preoperative cardiac functional assessment has been a long-debated topic in liver transplantation. Debate continues to exist regarding the use of invasive cardiac studies, and the utility of each prior to transplant. Despite the debate, a 7% mortality can be attributed to significant cardiac events. We present a case series of 3 patients who underwent orthotopic liver transplantation and developed significant cardiac dysfunction postoperatively. All preoperative cardiac assessments in each patient were normal with no hemodynamically significant abnormalities. Interestingly enough, each patient developed cardiac failure due to completely different diagnoses.

Impact of human immunodeficiency virus on 2-year revision rates following lumbar fusion for degenerative spinal conditions: a retrospective cohort study.

BACKGROUND: To our knowledge, no studies exist that evaluate the impact of human immunodeficiency virus (HIV) on long-term revision rates following lumbar fusion. This study aims to understand how HIV impacts 2-year revision rates and 90-day postoperative complication rates following primary lumbar fusion for degenerative spine conditions. METHODS: Data collection was done using PearlDiver Patient Records Database, a national insurance database from 2010-2019. Patients who underwent primary lumbar fusion for degenerative diseases were divided into a cohort of patients that are HIV positive (HIV), have asymptomatic HIV (AHIV), acquired immune deficiency syndrome (AIDS), and HIV-negative at the time of their procedure. Univariate and multivariable regression analyses were performed to determine rates of revision surgery, surgical site infection (SSI), neurological complications, sensory deficits, bowel/bladder dysfunction and myelopathies within two years of surgery as well as 90-day postoperative complications. RESULTS: In total, 216,587 patients were included in this study. Of these, 631 patients (0.29%) had HIV including 502 patients (0.23%) with asymptomatic HIV and 129 patients (0.06%) with AIDS. Relative to the control cohort, patients with HIV had no difference in odds of two-year revision surgery, SSI, neurological complications, sensory deficits, bowel/bladder dysfunction and myelopathies. Patients with HIV did have increased odds of postoperative pneumonia (OR 1.592; 95% CI: 1.048-2.314; P=0.021). AIDS patients had greater odds of respiratory complications (OR 2.585; 95% CI: 1.075-5.264; P=0.017) and septic complications (OR 2.702; 95% CI: 1.122-5.514; P=0.013) 90-day postoperatively. CONCLUSIONS: Our study found that HIV positive status did not significantly affect two-year revision rates compared to the control group. However, there is a higher rate of pneumonia and respiratory complications among HIV positive patients. Before deciding to proceed with surgical intervention in HIV positive individuals, surgeons must carefully consider each patient's specific diagnosis, comorbidities, and risk factors.

[Traffic medicine expert opinions in otorhinolaryngology: current aspects]. / Verkehrsmedizinische Begutachtung in der HNO-Heilkunde : Aktuelle Aspekte.

According to German law granting of driving licenses depends on the proof of an adequate driving capability. The corresponding guidelines are at present in the process of being revised. At the moment bilateral deafness and high-grade hearing loss (> or = 60% in pure tone audiometry) are not exclusion criteria for driving licenses grades A, B and C, while driving licenses grade D and licenses for public transport are generally excluded. In the forthcoming revised edition of the guidelines it has been suggested that the latter group will also not be excluded. The regulations concerning dizziness are wide-sweeping at the moment as no driving license will be granted if dizziness is present but will be more specific in the next issue. In particular a division will be made between single axle and two axle vehicles. An expert assessment about driving suitability can only be made by a certified specialist with qualifications in traffic medicine.

[Nasal surgery in patients with systemic disorders]. / Rhinochirurgie bei Systemerkrankungen.

Systemic disorders represent a heterogenous group of diseases which can primarily manifest at the nose and sinuses as limited disease or secondarily as part of the systemic involvement. Rhinologists therefore play an important role in the diagnostic but also therapeutic process. Although therapy of systemic disorders is primary systemic, additional nasal surgery may become necessary. Surgical procedures include sinus surgery for the treatment of complications of the orbit and the lacrimal duct, septorhinoplasty due to saddle nose deformity and closure of septal perforation. Since many systemic disorders represent very rare diseases, recommendations are based on the analysis of single case reports and studies with a limited number of patients. Even though data is still limited, experiences published so far have shown that autogenous cartilage or bone transplants can be used in nasal reconstruction of deformities caused by tuberculosis, leprosy, wegener's granulomatosis, sarcoidosis and relapsing polychondritis. Experiences gained from these diseases support our observation that well-established techniques of septorhinoplasty can be used in systemic disorders as well. However, reaching a state of remission is an essential condition before considering any rhinosurgery in these patients. Under these circumstances revision surgery has to be expected more frequently compared to the typical collective of patients undergoing septorhinoplasty. These observations in part may also be useful for the treatment of nasal septal perforations since implantation of cartilage- or bone grafts represents an essential step in the closure of septal perforations. Apart from the treatment of orbital complications, sinus surgery has been proven beneficial in reducing nasal symptoms and increasing quality of life in patients refractory to systemic treatment.

[Vertigo and disturbance of balance concerning medico-legal principles]. / Schwindel und Gleichgewichtsstörungen nach den neuen "Versorgungsmedizinischen Grundsätzen".

The evidence of social rights for compensation and the rights of severely disabled persons has changed since January 1 (st) 2009. Now these rights have the status of laws. Furthermore the scale of disability (incapacitation) will now used as a scale of conditions due to injury. And the new scale contains a reflection on specific origins of the traumatisation.

Utilization of Intraoperative TEE to Assess Supraventricular Tachycardia-Inducing Right-Sided Cardiac Compression by the Liver, Post-Liver-Transplantation Status.

This unique and interesting case report involves a patient who recently underwent a combined liver and kidney transplant (due to autosomal dominant polycystic kidney disease) and subsequently suffered from episodes of supraventricular tachycardia (SVT) secondary to the new liver graft compressing the right atrium and ventricle. After this was diagnosed, the patient underwent operative plication of the right hemidiaphragm. Intraoperative transesophageal echocardiography was used to demonstrate cardiac compression from the liver and demonstrate resolution of compression after plication of the hemidiaphragm.

Effect of prednisolone on cytokine synthesis in nasal polyps.

To investigate steroid effects on eosinophils and their associated cytokines in nasal polyps, we sampled nasal polyp tissue from 20 subjects during routine surgery. Freshley removed polyps were cut into small pieces and incubated in culture medium for 24 h in different concentrations of prednisolone (10(-2)-10(-6) mol/L). Cell viability was assessed by means of trypan dye exclusion of the supernatants. The number of eosinophils was quantified by means of cytocentrifuge smears stained by May-Giemsa-Grunwald stain. The cytokine protein content of interleukin-5 (IL-5), IL-3, and granulocyte-macrophage colony-stimulating factor (GM-CSF) was measured by ELISA technique in supernatants and in homogenates of nasal polyp tissue. Our results revealed a significant reduction in the number of eosinophils and total number of vital cells at concentrations of 10(-3) and 10(-2) mol/L. GM-CSF and IL-5 protein levels were significantly reduced in supernatants and in homogenates after treatment with prednisolone, whereas IL-3 synthesis was not diminished. Corticosteroid effects known to inhibit synthesis of eosinophil-associated cytokines could be measured in terms of a significant decrease in IL-5 and GM-CSF protein level as well as in a decrease in the number of vital cells.

Pituitary gonadotropin inhibition by a highly active analog of luteinizing hormone-releasing hormone.

Chronic treatment with highly active analogs of luteinizing hormone (LH)-releasing hormone (LH-RH) induces "paradoxical" antifertility effects. Intact male rats, a reduction in testosterone production is observed after the administration of [D-Ser(But)6]-LH-RH(1-9)ethylamide (burserelin, Hoe 766), 50 ng/day subcutaneously for 4 weeks. In castrated male rats treated with the same dose of analog, plasma LH levels were reduced from days 14 to 28 and plasma follicle-stimulating hormone (FSH) levels were reduced from days 21 to 28 of treatment. Pituitary LH and FSH concentrations were also decreased. The plasma prolactin level was reduced at 14 days of treatment. The hypothalamic LH-RH content remained unchanged and the adrenal corticosterone content was lowered. These findings indicate a direct inhibitory effect of the analog on gonadotropin secretion in the absence of the gonads, and may explain some paradoxical antifertility effects observed with high doses of LH-RH analogs which exceed the physiologic dose range.

Arteriovenous malformations of the transverse dural sinus.

Clinical, radioanatomical, and therapeutic aspects of dural arteriovenous malformations in the region of the transverse sinsu are discussed on the basis of seven personal observations and the analysis of 72 reported cases. Common symptoms are headache and troublesome tinnitus aurium. More serious neurological deficiencies may occur as a result of distrubance in cerebral hemodynamics. A complete neuroradiological investigation is essential for adequate treatment. Most frequent arterial feeders are the occipital, tentorial, and middle meningeal arteries. Ligation of the occipital artery is not sufficient in most cases. Operative isolation of the transverse sinus by craniotomy and dural section is considered by far the most successful treatment and should be performed whenever ligations fail or are not indicated.

Cortical reorganization in patients with high frequency cochlear hearing loss.

Animal research has shown that tonotopic representation in the auditory cortex is not statically fixed in the adult organism but can be altered after deafferentation. The present study examines the plasticity of the human auditory cortex in patients with high frequency cochlear hearing loss by means of magnetoencephalographic measurements. The data show that the cortical map can reorganize such that cortical neurons deprived of their usual most sensitive afferent input now respond to tone frequencies adjacent to the frequency range of the partial hearing loss. The results suggest that deafferentation due to cochlear damage in adults may lead to functional reorganization of auditory cortical structures.

Optic nerve decompression in the comatose and conscious patients after trauma.

OBJECTIVE: To investigate the efficacy of early optic nerve decompression in comatose and conscious patients with indirect traumatic optic neuropathy. STUDY DESIGN: Retrospective analysis of 65 optic nerve decompressions. METHODS: The total collective of optic nerve decompressions comprised 65 patients treated within the period between February 1987 and December 1998. Thirteen of these 65 patients (average age, 32 y) were comatose and required critical care treatment, so visual acuity could not be measured. The indication for surgical decompression in all patients was based on the ophthalmological examination and the finding on computed tomography (CT) scan of a lesion inside the optic nerve canal or the orbit apex, respectively. RESULTS: In the comatose patients the time interval between trauma and surgery was 16.1+/-12.1 hours (mean +/- standard deviation). During the subsequent postoperative examinations (on average, 12.3 mo postoperatively) five patients showed a normal visual acuity (20/20), two patients a visual acuity of 20/30 and 20/50, and one a visual acuity of 20/200. Three patients (three eyes) remained amaurotic. Two patients died of the general and severe consequences of injury. The beneficial visual acuity results achieved within the group of comatose patients were equivalent to those achieved within the group of patients who were conscious during the preoperative examination. The success rate, defined as an improvement of three lines with a final visual acuity of at least 20/1000, was 57.7% versus 61.5%. CONCLUSION: The results confirm our concept of early decompression of the optic nerve, based on close interdisciplinary cooperation and the ophthalmological findings.

A pilot study of autofluorescent endoscopy for the in vivo detection of laryngeal cancer.

OBJECTIVES: To determine the advantage of autofluorescent endoscopy for the identification of laryngeal cancer. STUDY DESIGN: This is a prospective, multicenter clinical study. We investigated whether autofluorescent endoscopy using the Lung Imaging Fluorescent Endoscopy (LIFE)-Lung System (Xillix, Olympus) is capable of identifying early cancer of the larynx, especially in comparison with conventional white-light endoscopy and microscopic laryngoscopy. Benign lesions as well as microinvasive and invasive squamous cell carcinoma of the larynx were investigated. For logistic reasons and because of the pilot character of this study, the number of patients was limited. METHODS: Sixteen patients having 24 laryngeal lesions of both benign or malignant character were subsequently examined by autofluorescent endoscopy, white-light endoscopy, and microscopic laryngoscopy. Based on optical appearance, and for each method separately, the lesions were classified as malignant or not. The visual results were documented and histologically verified. RESULTS: The sensitivity of autofluorescent endoscopy for laryngeal cancer detection was more than 90% and therefore higher than that of white-light endoscopy and microscopic laryngoscopy. However, as far as laryngeal cancer is concerned, the specificity of autofluorescent endoscopy was very low. Many of the false-positive results were due to inflammation, hypervascularization, and edema. CONCLUSION: Autofluorescent endoscopy is advantageous only in the hands of an experienced ENT specialist. Although it does not replace the combination of white-light endoscopy and a critical evaluation of the clinical symptoms of the individual disease, it can profitably complement them. Autofluorescent endoscopy can help in determining whether microscopic laryngoscopy performed with general anesthesia should be recommended urgently to the patient. Microscopic laryngoscopy remains the best method for the identification of malignant lesions, if it is combined with obtaining taking multiple biopsy specimens. Confirmation of the results of this pilot study with a larger series of patients is desirable.

Efficacy of botulinum toxin A for treatment of upper esophageal sphincter dysfunction.

OBJECTIVES: To investigate the efficacy of botulinum toxin A (BTA)-induced chemodenervation of the upper esophageal sphincter (UES) in patients with dysphagia and UES dysfunction. STUDY DESIGN: Prospective clinical trial in 10 selected patients with pure UES dysfunction. METHODS: In each patient 30 units of BTA were injected into the UES under brief general anesthesia. Videofluoroscopic swallowing study (VSS) was done and a clinical symptom score was determined before and after treatment. RESULTS: On VSS relative opening of the UES improved in all patients (mean +/- SD: 47 +/- 14% before versus 71 +/- 24% after treatment; P < .01). Hypopharyngeal retention or laryngeal penetration of barium was significantly reduced in four of seven patients. Clinical symptom scores improved in all patients. One patient was free of symptoms, mild dysphagia persisted in six patients, and moderate dysphagia persisted in three patients. CONCLUSIONS: Our results support the use of BTA in selected patients with pure UES dysfunction. Its efficacy is limited by the possibility of a persistent structural stenosis of the UES and the risk of BTA diffusion into the larynx or hypopharynx.

[Early experience with repeated determinations of 131-I-hipuran clearance-equivalent during pregnancy ]. / Erste Erfahrungen mit der wiederholten Bestimmung der 131J-Hippurat-Clearanceäquivalente während der Gravidität.

Serial observations of ureteric and renal function during pregnancy were carried out by using isotope clearances; renal scintigraphy was performed for the first examination and isotope nephrography subsequently. The results of both types of examination are tabulated. It is shown that these procedures provide the necessary information on renal and ureteric function, given the indications which we have listed. The information concerns both kidneys or can be confined to a single kidney.

[Estimation of 131I hippuran clearance during pregnancy (author's transl)]. / Bestimmung der 131J-Hippuratclearance im Verlaufe der Schwangerschaft.

Changes in 131I hippuran clearance were estimated by a non-catheter method, as well as total clearance and clearance of each kidney, in 43 women at various stages of pregnancy and in 13 non-pregnant women who were not using hormonal contraceptives. The results are demonstrated in graph form. The methods used are described in detail. The procedure for determining clearance in separate kidneys is indicated. It was found that clearance values increased up to the 35th and 36th weeks of pregnancy. The difference between the sides that were found corresponds with the previously known difference in the function of the right and left kidneys and ureters.

[Sequential scintigraphy in the investigation of changes in renal function during pregnancy (author's transl)]. / Sequenzszintigraphische Untersuchungen über die Veränderungen der Nierenfunktion in der Schwangerschaft.

Changes in renal function during pregnancy were studied by sequential scintigraphy in 16 women with normal kidneys. The examinations were carried out during the first and third trimesters. Time activity curves were obtained by a computer-assisted storage and analysis procedure, using a "region of interest" technique for renal parenchyma and renal pelvis. The study included topographic changes and the evaluation of 13 semi-quantitative parameters related to the renal parenchyma and of nine parameters related to the renal pelvis. The results were demonstrated graphically. The predominantly rightsided changes in renal function during the third trimester are discussed in relation to the relevant literature.

[A comparison of isotope nephrographic examinations during pregnancy and hormonal contraception (author's transl)]. / Vergleichende isotopennephrographische Untersuchungen während der Schwangerschaft und bei hormonaler Kontrazeption

Renal function was investigated by isotope nephrography in 31 pregnant women with normal kidneys during various phases of pregnancy, and in 137 women on continuous contraceptive steroids (up to eight years). The semi-quantitative parameters of zum Winkel were used. It was found that the use of oral contraceptives did not lead to any change in renal function, whereas with advancing pregnancy there was distinct excretion delay on the isotope nephrogram. The results are discussed in the light of the relevant literature. Isotope nephrography appears to be a satisfactory screening test for evaluation of renal function on each side.

Decompression of the orbit and the optic nerve in different diseases.

During the past six years, visual loss in 60 patients was caused by infectious processes and mucoceles of the ethmoid region, benign paranasal tumours, endocrine ophthalmopathies, head trauma etc. Comparison of preoperative and postoperative visual function in 48 cases treated by decompression of the orbit and in 12 cases treated by decompression of the optic nerve demonstrated visual improvement of 68 percent on average. Surgically, we preferred the transethmoidal route and in some cases the lateral osteoplastic approach. With regard to the success of the surgical therapy, a correlation between the time of manifestation of the visual loss and the time of surgery was found. The results mainly depended on the underlying diseases.

Olfactory function after functional endoscopic sinus surgery for chronic sinusitis.

One hundred and fifteen patients suffering from chronic sinusitis were observed to analyse the prevalence of olfactory dysfunction and the influence of FESS. Pre-operative questionnaires were supplemented by examination of olfactory thresholds and discrimination. Pre-operatively, 58% of the collective were aware or complained of any olfactory deficit. However, the olfactory tests demonstrated that of the collective 52% were hyposmic and 31% anosmic. Eight per cent of the hyposmic patients presented with an isolated reduction of their ability to discriminate odours. Post-operative improvements were found in 70%. Normosmia was post-operatively achieved in 25% of the hyposmic patients, but only in 5% of the anosmic patients. Olfaction changed to the worse in 8% after FESS. Therefore, the prevalence of olfactory dysfunction in chronic sinusitis is pre-operatively higher, and the rate of improvement is lower than generally assumed. The extent of sinus disease as measured by the degree of intranasal polyposis correlates with olfactory dysfunction. Resections of the middle turbinate may have a negative effect on olfaction, due to damage to the olfactory fila or alteration of the normal aerodynamic pattern within the olfactory cleft. However, this hypothesis is based on a few observations and needs to be verified by further investigations.