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1.
Int J Comput Assist Radiol Surg ; 16(4): 567-578, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33761064

RESUMO

PURPOSE: State-of-the-art medical examination techniques (e.g., rhinomanometry and endoscopy) do not always lead to satisfactory postoperative outcome. A fully automatized optimization tool based on patient computer tomography (CT) data to calculate local pressure gradient regions to reshape pathological nasal cavity geometry is proposed. METHODS: Five anonymous pre- and postoperative CT datasets with nasal septum deviations were used to simulate the airflow through the nasal cavity with lattice Boltzmann (LB) simulations. Pressure gradient regions were detected by a streamline analysis. After shape optimization, the volumetric difference between the two shapes of the nasal cavity yields the estimated resection volume. RESULTS: At LB rhinomanometry boundary conditions (bilateral flow rate of 600 ml/s), the preliminary study shows a critical pressure gradient of -1.1 Pa/mm as optimization criterion. The maximum coronal airflow ΔA  := cross-section ratio [Formula: see text] found close to the nostrils is 1.15. For the patients a pressure drop ratio ΔΠ  := (pre-surgery - virtual surgery)/(pre-surgery - post-surgery) between nostril and nasopharynx of 1.25, 1.72, -1.85, 0.79 and 1.02 is calculated. CONCLUSIONS: LB fluid mechanics optimization of the nasal cavity can yield results similar to surgery for air-flow cross section and pressure drop between nostril and nasopharynx. The optimization is numerically stable in all five cases of the presented study. A limitation of this study is that anatomical constraints (e.g. mucosa) have not been considered.


Assuntos
Endoscopia/métodos , Cavidade Nasal/cirurgia , Septo Nasal/cirurgia , Tomografia Computadorizada por Raios X/métodos , Adulto , Simulação por Computador , Feminino , Humanos , Masculino , Cavidade Nasal/diagnóstico por imagem , Septo Nasal/diagnóstico por imagem , Estadiamento de Neoplasias , Reconhecimento Automatizado de Padrão , Período Pós-Operatório , Respiração
2.
J Psychosom Res ; 140: 110316, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33271403

RESUMO

PURPOSE: The Sino-Nasal-Outcome-Test-22 (SNOT-22) represents the reference questionnaire to assess symptoms, health-related quality-of-life (HRQOL) and treatment-response in patients with chronic rhinosinusitis (CRS). The SNOT-22 has been validated for various languages, yet no validation is available for the German version. Thus, we provide a validation of the SNOT-22 for German. METHODS: In this prospective observational study 139 CRS-patients and 36 control-participants were included. CRS-patients completed the German-SNOT-22 before treatment (T0) and four (T1), twelve (T2) and 48 weeks after inclusion (T3). At T0, Mackay-Naclerio-, Lund-Mackay- and Brief-Symptom-Inventory-18 (BSI-18) scores were collected as external reference for the German-SNOT-22 and its subscales. At T1, T2, and T3 health-transition-items (HTIs) were raised to explore responsivity. Control-participants completed the German-SNOT-22 at T0. Reliability (internal consistency, item-total correlation), validity (concurrent validity, discriminatory validity) and responsiveness (distribution- and anchor-based) were explored for the German-SNOT-22. RESULTS: At T0, the mean German-SNOT-22 total-score for CRS patients was 38.0 (± 20.9) and responded to treatment (T1 = 26.3 ± 19.1; T2 = 25.8 ± 20.6; T3 = 20.5 ± 16.3). For control-participants, the mean total-score at T0 was 15.1 (±10.9). The German-SNOT-22 was reliable (excellent internal consistency α = 0.93; good overall item-total correlations r = 0.39-0.85), valid (significant correlations between Mackay-Naclerio-, Lund-Mackay- and BSI-18 scores, all r > 0.39, p < 0.01) and responsive (significant correlations between HTIs and mean change in German-SNOT-22 total-score F = 9.57, p < 0.001). CONCLUSION: The German-SNOT-22 validated here matches the original SNOT-22. It is a reliable, valid and responsive questionnaire to assess symptoms, HRQOL and treatment-response in CRS-patients. Good psychometric properties were observed.


Assuntos
Psicometria/métodos , Qualidade de Vida/psicologia , Rinite/diagnóstico , Rinite/psicologia , Teste de Desfecho Sinonasal , Sinusite/psicologia , Adolescente , Adulto , Idoso , Doença Crônica , Feminino , Alemanha , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Sinusite/diagnóstico , Adulto Jovem
3.
J Clin Med ; 9(7)2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-32630033

RESUMO

BACKGROUND: Epithelial to mesenchymal transition (EMT) promotes therapy resistance in head and neck cancer (HNC) cells. In this study, EMT was quantified in HNC tumor samples by the cellular co-localization of cytokeratin/vimentin, E­cadherin/ß­catenin and by Slug expression. METHODS: Tissue samples from HNC patients were stained with antibody pairs against cytokeratin/vimentin and E-cadherin/ß-catenin. Epithelial-mesenchymal co-localization was quantified using immunofluorescence multichannel image cytometry. Double positivity was confirmed using confocal microscopy. Slug was semi-quantified by 2 specialists and quantified by bright field image cytometry. RESULTS: Tumor samples of 102 patients were investigated. A loss of E-cadherin positive cells (56.9 ± 2.6% vs. 97.9 ± 1.0%; p < 0.0001) and E-cadherin/ß-catenin double positive cells (15.4 ± 5.7% vs. 85.4 ± 1.2%; p < 0.0001) was observed in tumor samples. The percentage of Slug positive cells was increased in tumor samples (12.1 ± 3.6% vs. 3.2 ± 2.6%; p = 0.001). Ordinal Slug scores judged by two specialists closely correlated with percentage of Slug-positive cells (Spearman's rho = 0.81; p < 0.001). Slug score correlated negatively with the percentage of E-cadherin positive cells (r = 0.4; p = 0.006), the percentage of E-cadherin/ß-catenin positive cells (r = 0.5; p = 0.001) and positively with cytokeratin/vimentin positive cells (r = 0.4, p = 0.003). CONCLUSION: EMT can be assessed in HNC tumor probes by cytokeratin/vimentin co-expression and loss of E-cadherin/ß-catenin co-expression. Slug score provides a convenient surrogate marker for EMT.

4.
Eur Arch Otorhinolaryngol ; 277(5): 1437-1448, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31982945

RESUMO

PURPOSE: Surgical rescue is a treatment option for persistent disease after first-line treatment treatment of head and neck cancer (HNC). METHODS: Patients with persistent HNC treated with rescue surgery between 2008 and 2016 were included. Patients who received a rescue neck dissection (ND only) and who received primary site surgery ± ND were analysed separately (primary site surgery ± ND). RESULTS: During the observation period, 35 patients received ND only and 17 primary site surgery ± ND. No perioperative mortality was observed. In nine patients with ND only and 12 patients with primary site surgery ± ND at least one complication was encountered. 41/52 (79%) patients had a complete response. Median overall survival of patients receiving rescue surgery was 56 months (95% CI 44-69 months). Median overall survival was best for patients with initial laryngeal and oropharyngeal cancer and worst for patients with hypopharyngeal cancer (p = 0.02). Functional deficits following rescue surgery were mainly observed in the domains speech, nutrition, and shoulder/arm mobility. The risk of functional impairment was higher for patients with rescue surgery at the primary tumor site (OR 2.5 ± 2; p = 0.07). CONCLUSION: Rescue surgery offers patients with resectable, persistent disease a realistic chance to achieve long-term survival. Especially patients with laryngeal and oropharyngeal cancer profited from rescue surgery. Rescue neck dissection is an effective and safe procedure. Patients with rescue surgery at the primary tumor site ± ND should expect complications and permanent functional impairment.


Assuntos
Neoplasias de Cabeça e Pescoço , Neoplasias Hipofaríngeas , Neoplasias Laríngeas , Neoplasias Orofaríngeas , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Neoplasias Hipofaríngeas/cirurgia , Laringectomia , Esvaziamento Cervical , Neoplasias Orofaríngeas/cirurgia , Estudos Retrospectivos , Terapia de Salvação
5.
Cancer Microenviron ; 12(2-3): 67-76, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31297730

RESUMO

Epithelial mesenchymal crosstalk (EMC) describes the interaction of the tumor stroma and associated fibroblasts with epithelial cancer cells. In this study we analysed the effects of EMC on head and neck cancer cells. In tumor cell lines EMC was induced using media conditioned from a mix-culture of cancer cells and fibroblasts. Cell proliferation and chemotherapy response were assessed using direct cell counting. Flow cytometry, immunohistochemistry of markers of epithelial-mesenchymal transition (EMT) and subsequent TissueFaxs™ acquisition and quantification and western blot analysis were performed. Holotomographic microscopy imaging was used to visualize the effects of EMC on Cisplatin response of SCC-25 cells. EMC induced a hybrid epithelial-mesenchymal phenotype in SCC-25 cells with co-expression of vimentin and cytokeratin. This hybrid phenotype was associated with chemotherapy resistance and increased proliferation of the cells. The EMC conditioned medium led to an activation of the IL-6/STAT3 pathway with subsequent phosphorylation of STAT3. EMC induced a hybrid epithelial-mesenchymal phenotype in HNSCC cells accompanied by increased therapy resistance and cell proliferation. The IL-6/STAT3 pathway might be one of the major pathways involved in these EMC-related effects.

6.
Rhinology ; 57(5): 367-374, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31210177

RESUMO

BACKGROUND: This randomized clinical trial was designed to evaluate the efficacy and safety of Tavipec® (Spicae aetheroleum), a phytomedicine obtained by steam distillation of the flowering tops of Lavandula latifolia, as compared to placebo in adult patients suffering from acute viral rhinosinusitis. METHODOLOGY: Patients with acute viral rhinosinusitis were randomly assigned to treatment with 2 capsules Tavipec® 150 mg or placebo thrice daily over a period of 7 days in a double-blind, parallel-group design. No additional treatment was admitted. The efficacy endpoints comprised the improvement of the main rhinosinusitis symptoms as per Major Symptom Score (MSS) and Sino-Nasal Outcome Test (SNOT-22) as well as of quality of life (QoL) by global assessment scale, evaluated at baseline, day 5 and day 8, respectively. RESULTS: 288 patients were enrolled and randomized to treatment. At day 8 the patients in the Tavipec® group had a significantly lower MSS compared to placebo and the impact of rhinosinusitis symptoms on QoL was significantly reduced. A significantly higher proportion of Tavipec® treated patients experienced a change in SNOT-22 score greater than or equal to 10 points at day 5 or day 8. No new safety signals were identified. CONCLUSIONS: The treatment with Tavipec® effectively reduced the symptoms of acute rhinosinusitis in adult patients.


Assuntos
Extratos Vegetais , Rinite , Sinusite , Doença Aguda , Adulto , Método Duplo-Cego , Humanos , Extratos Vegetais/uso terapêutico , Qualidade de Vida , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Resultado do Tratamento
7.
AJNR Am J Neuroradiol ; 40(6): 1055-1059, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31122917

RESUMO

BACKGROUND AND PURPOSE: MR imaging has become an important tool for the detection of cholesteatomas of the middle ear. Various diffusion-weighted imaging sequences are available and have shown promising results. This study aimed to evaluate readout-segmented echo-planar DWI for the detection of cholesteatoma and compare the results with surgical validation. MATERIALS AND METHODS: Fifty patients with chronic otitis media (24 females and 26 males; range, 12-76 years of age; mean age, 41 years) who underwent MR imaging before an operation of the middle ear (1-169 days) were included. The MR imaging protocol consisted of axial and coronal readout-segmented echo-planar DWI with b-values of 0 and 1000 s/mm2 and 3-mm slice thickness. The readout-segmented echo-planar diffusion-weighted images were fused with standard T2-weighted sequences for better anatomic assignment. The results of the MR imaging evaluation were correlated with the results from the operation. RESULTS: Readout-segmented echo-planar DWI detected 22 of the 25 cases of surgically proved cholesteatoma. It has an accuracy of 92% (95% confidence interval, 80.8%-97.8%), a sensitivity of 88%, a specificity of 96%, a positive predictive value of 96%, and a negative predictive value of 89%. In 1 case, a positive finding for cholesteatoma with readout-segmented echo-planar DWI could not be proved by histology, and in 3 cases, histology yielded a cholesteatoma that was not detected with MR imaging. CONCLUSIONS: Readout-segmented echo-planar DWI is a promising and reliable MR imaging sequence for the detection and exclusion of cholesteatoma.


Assuntos
Colesteatoma da Orelha Média/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/métodos , Imagem Ecoplanar/métodos , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Adulto Jovem
8.
Eur Arch Otorhinolaryngol ; 276(5): 1355-1365, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30739177

RESUMO

PURPOSE: The sino-nasal outcomes test-22 (SNOT-22) represents the reference questionnaire to assess patients with chronic rhinosinusitis (CRS). As weak correlations between objective CRS parameters and SNOT-22 total score have been observed, factor analyses have aimed to identify underlying factorial structures. However, ambiguous factor loadings and problematic item-domain assignments have resulted. Moreover, such factor analyses have mainly been performed in non-European CRS patients, while European data remain sparse. This study thus sought to address these issues. METHODS: Principal component analysis and confirmatory factor analysis were performed from SNOT-22 questionnaires completed by European CRS patients. Goodness of fit, internal consistencies, and factor loadings were calculated. Item-domain assignment was based on statistical grounds and clinical meaningfulness. Additionally, this study investigated correlations between SNOT-22 domains and external reference criteria, including Lund-Mackay score, Lund-Naclerio score and the brief symptom inventory 18 (BSI-18). RESULTS: One hundred and thirty-four European CRS patients were included. Principal component analysis proposed four SNOT-22 domains ("nasal symptoms", "otologic symptoms", "sleep symptoms", "emotional symptoms"), which explained 63.6% of variance. Observed item-domain-assignment differed from previously proposed item-domain assignments. All factor loadings were > 0.5, except "cough" (0.42) and "facial pain or pressure" (0.49). For confirmatory factor analysis, satisfactory goodness of fit (RMSEA = 0.66; CFI = 0.92; TLI = 0.90) and internal consistencies (Cronbach-α: total score = 0.93; domains = 0.75-0.91) were observed. Significant positive correlations were found between the "nasal symptoms" domain and both the Lund-Mackay score (r = 0.48; p < 0.001) and the Lund-Naclerio score (r = 0.27, p < 0.01). Significant positive correlations were also identified between "emotional symptoms" and BSI-18 total score (r = 0.64, p < 0.001). CONCLUSIONS: Principal component analysis performed for SNOT-22 questionnaires completed by European CRS patients indicated a different item-domain-assignment than previously reported. Confirmatory factor analysis suggested acceptable and clinically plausible psychometric properties for the resulting factorial structure. Significant correlations between the "nasal symptoms" and the "emotional symptoms" domains were observed with objective CRS parameters. The resulting factorial structure with different item-domain assignments may thus be more suitable for European CRS patients.


Assuntos
Pólipos Nasais/diagnóstico , Rinite/diagnóstico , Sinusite/diagnóstico , Adulto , Doença Crônica , Europa (Continente)/epidemiologia , Dor Facial , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/epidemiologia , Pólipos Nasais/fisiopatologia , Análise de Componente Principal , Rinite/epidemiologia , Rinite/fisiopatologia , Sinusite/epidemiologia , Sinusite/fisiopatologia , Inquéritos e Questionários , Avaliação de Sintomas/métodos
9.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30630744

RESUMO

OBJECTIVE: 18F-Fluoro-L-dihydroxyphenylalanine (18F-DOPA) PET offers high sensitivity and specificity in the imaging of non-malignant extra-adrenal paraganglioma (PGL) and pheochromocytoma (PHEO) but lower sensitivity in metastatic disease. These tumours are of neuroendocrine origin and can be detected by 68Ga-DOTA-Tyr3-octreotide (68Ga-DOTA-TOC) PET. Therefore, we compared 68Ga-DOTA-TOC and 18F-DOPA as radiolabels for PET/CT imaging for the diagnosis of metastatic extra-adrenal PGL and PHEO. Combined cross-sectional imaging was the reference standard. METHODS: A total of 6 men and 4 women (age range 22-72 years) with anatomical and/or histologically proven metastatic PGL and PHEO were included in this study. Of these patients, 2 male patients suffered from PHEO, while the remaining 8 patients were diagnosed as metastatic extra-adrenal PGL disease. Comparative evaluation included morphological imaging with CT and functional imaging with 68Ga-DOTA-TOC and 18F-DOPA PET. The imaging results were analyzed on a per-lesion basis. The maximum standardized uptake value (SUVmax) of each functional imaging modality in concordant tumour lesions was measured. RESULTS: Compared with anatomical imaging, the per-lesion detection rate of 68Ga-DOTA-TOC was 100% (McNemar, P<0.01), and that of 18F-DOPA PET was 82.3% (McNemar, P<0.8) in metastatic extra-adrenal PGL and PHEO. Overall, 68Ga-DOTA-TOC PET identified 67 lesions; anatomical imaging identified 62 lesions, and 18F-DOPA PET identified 56 lesions. The SUVmax (mean±SD) of all concordant lesions was 29.3±19.9 for 68Ga-DOTA-TOC PET and 12.3±9.1 for 18F-DOPA PET (Mann-Whitney U test, P<0.0001). CONCLUSION: 68Ga-DOTA-TOC PET offers the highest detection rate in metastatic extra-adrenal PGL and PHEO compared to 18F-DOPA PET and even to diagnostic CT, particularly in bone lesions. Combined functional/anatomical imaging (68Ga-DOTA-TOC PET/CT) enables exact tumour extension to be detected in these rare tumour entities, especially in the case of unclear anatomical correlation.


Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Di-Hidroxifenilalanina/análogos & derivados , Compostos Organometálicos , Paraganglioma Extrassuprarrenal/diagnóstico por imagem , Feocromocitoma/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
10.
Eur Arch Otorhinolaryngol ; 275(5): 1103-1110, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29605865

RESUMO

AIMS: The frequency of the use of intratympanic steroids (ITS) as a treatment for idiopathic sudden sensorineural hearing loss (ISSNHL) in Europe is still unknown and remains a contentious issue amongst otolaryngologists. We undertook a survey of otolaryngologists in Germany and Austria to establish if there is any professional consensus with which to form a protocol for its use. METHODS: A survey of 21 questions was distributed electronically to otolaryngologists in Germany and Austria and data on demographics, indications for intratympanic treatment, procedure, follow-up, and outcomes were analysed. RESULTS: We received 908 responses. 49.1% of otolaryngologists used ITS for ISSNHL. Of those otolaryngologists who use ITS, 73.7% do not use it as primary treatment. 20.6% use ITS in conjunction with oral steroids for primary treatment and only 5.8% use ITS as monotherapy for primary treatment. 90.5% use ITS as salvage therapy. 81.1% do not consider the use of ITS after 2 weeks from the onset of symptoms. 8.3% used a tympanostomy tube and while the most commonly used steroid was dexamethasone at a concentration of 4 mg/ml (61%), a wide variety or other steroids and concentrations were used. CONCLUSIONS: This survey illustrates wide variation of current practice of intratympanic corticosteroid injection for ISSHL in Germany and Austria. In the absence of high-level evidence, knowing what current practice is allows clinicians to assess what they do against what their colleagues are doing, and if they do something very different, make them question their practice. Moreover, the obtained data will help to direct future clinical trials with the aim to compare the outcomes of more commonly used protocols.


Assuntos
Anti-Inflamatórios/uso terapêutico , Dexametasona/uso terapêutico , Perda Auditiva Neurossensorial/tratamento farmacológico , Perda Auditiva Súbita/tratamento farmacológico , Padrões de Prática Médica/estatística & dados numéricos , Áustria , Esquema de Medicação , Alemanha , Humanos , Injeção Intratimpânica , Otolaringologia , Inquéritos e Questionários , Resultado do Tratamento
11.
Rhinology ; 56(3): 209-215, 2018 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-29466477

RESUMO

Mobile health technology is emerging to take a prominent position in the management of chronic diseases. These technologies aim at enhancing patient empowerment via education and self-management. To date, of all the different apps available for patients with sinus disease, none were developed by medical experts dealing with chronic rhinosinusitis (CRS). The European Forum for Research and Education in Allergy and Airway diseases (EUFOREA) has undertaken a multi-stakeholder approach for designing, developing and implementing a tool to support CRS patients in monitoring their symptoms and to provide patients with a digital support platform containing reliable medical information about their disease and treatment options. mySinusitisCoach has been developed by medical experts dealing with CRS in close collaboration with patients, primary care physicians and community pharmacists, meeting the needs of both patients and health care providers. From a research perspective, the generation of real life data will help to validate clinical studies, patient stratification and improve understanding of the socio-economic impact of CRS, thereby paving the way for better treatment strategies.


Assuntos
Aplicativos Móveis , Participação do Paciente , Rinite/terapia , Autocuidado , Sinusite/terapia , Doença Crônica , Humanos , Qualidade de Vida
12.
Allergy ; 73(8): 1597-1608, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29377177

RESUMO

Nasal allergen challenge (NAC) is an important tool to diagnose allergic rhinitis. In daily clinical routine, experimentally, or when measuring therapeutic success clinically, nasal allergen challenge is fundamental. It is further one of the key diagnostic tools when initiating specific allergen immunotherapy. So far, national recommendations offered guidance on its execution; however, international divergence left many questions unanswered. These differences in the literature caused EAACI to initiate a task force to answer unmet needs and find a consensus in executing nasal allergen challenge. On the basis of a systematic review containing nasal allergen challenges of the past years, task force members reviewed evidence, discussed open issues, and studied variations of several subjective and objective assessment parameters to propose a standardized way of a nasal allergen challenge procedure in clinical practice. Besides an update on indications, contraindications, and preparations for the test procedure, main recommendations are a bilaterally challenge with standardized allergens, with a spray device offering 0.1 mL per nostril. A systematic catalogue for positivity criteria is given for the variety of established subjective and objective assessment methods as well as a schedule for the challenge procedure. The task force recommends a unified protocol for NAC for daily clinical practice, aiming at eliminating the previous difficulty of comparing NAC results due to unmet needs.


Assuntos
Comitês Consultivos , Alérgenos/administração & dosagem , Testes de Provocação Nasal/normas , Testes de Provocação Nasal/tendências , Rinite Alérgica/diagnóstico , Administração Intranasal , Assistência ao Convalescente , Anafilaxia , Alemanha , Humanos , Imunoglobulina E/sangue , Mucosa Nasal/imunologia , Obstrução Nasal/imunologia , Testes de Provocação Nasal/métodos , Sprays Nasais , Prurido/imunologia , Testes Cutâneos , Espirro/imunologia
14.
Rhinology ; 54(4): 302-310, 2016 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-27556896

RESUMO

BACKGROUND: Chronic rhinosinusitis (CRS) is a common health problem. If medical treatment fails, endonasal sinus surgery is a valuable treatment option. A thorough postsurgical treatment is needed including, among others, nasal saline irrigations (NSI). In this prospective, controlled, single blinded, randomized trial, we aimed to evaluate efficacy of nasal saline irrigations following endonasal sinus surgery in CRS-patients with nasal polyps. METHODOLOGY: We examined patient's nasal symptoms, general quality of life and postoperative condition of the mucosa. We also investigated whether or not NSI reduced the number of missed workdays after surgery (MWD). Patients were randomized into an irrigation and non-irrigation arm. RESULTS: Following treatment, mean nasal sum-score in the irrigation arm was 4.4 and in the non-irrigation arm it was 6.3. Accordingly, mean general sum-score in the irrigation arm was 2.5 and in the non-irrigation arm 4.8. Thus, nasal irrigation led to a more pronounced improvement of nasal and general symptoms than in the non-irrigation arm. No differences were observed in postoperative condition of mucosa or number of MWD. CONCLUSIONS: Nasal irrigation improves symptoms score after ESS in patients with CRSwNP.


Assuntos
Lavagem Nasal/métodos , Pólipos Nasais/terapia , Cuidados Pós-Operatórios/métodos , Qualidade de Vida , Rinite/terapia , Sinusite/terapia , Administração Intranasal , Adulto , Atrofia , Doença Crônica , Cicatriz , Endoscopia , Epistaxe , Feminino , Humanos , Masculino , Obstrução Nasal , Sais/uso terapêutico , Método Simples-Cego , Cloreto de Sódio/uso terapêutico , Irrigação Terapêutica/métodos , Resultado do Tratamento
15.
Laryngorhinootologie ; 95(7): 497-510, 2016 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-27392191

RESUMO

Presbycusis or age related hearing loss can be defined as a progressive, bilateral and symmetrical sensorineural hearing loss due to age related degeneration of inner ear structures. It can be considered a multifactorial complex disorder with environmental and genetic factors. The molecular, electrophysiological and histological damage at different levels of the inner ear cause a progressive hearing loss, which usually affects the high frequencies of hearing. The resulting poor speech recognition has a negative impact on cognitive, emotional and social function in older adults. Recent investigations revealed an association between hearing impairment and social isolation, anxiety, depression and cognitive decline in elderly. These findings emphasize the importance of diagnosis and treating hearing loss in the elderly population. Hearing aids are the most commonly used devices for treating presbycusis. The technical progress of implantable hearing devices allows an effective hearing rehabilitation even in elderly with severe hearing loss. However, most people with hearing impairments are not treated adequately.


Assuntos
Auxiliares de Audição , Presbiacusia , Surdez , Orelha Interna , Perda Auditiva Neurossensorial , Humanos , Presbiacusia/complicações , Presbiacusia/diagnóstico , Presbiacusia/terapia
16.
Allergy ; 71(7): 967-76, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-26864207

RESUMO

BACKGROUND: The safety and tolerability of a mite allergoid subcutaneous allergen immunotherapy (SCIT) product was previously established. The aim of this study (EudraCT number: 2011-000393-61) was to find the optimally safe and effective allergoid dose by evaluating several dosages in patients with house dust mite (HDM)-induced allergic rhinoconjunctivitis (ARC) using a titrated nasal provocation test (TNPT). METHODS: In total, 290 adult ARC patients (148 females; 142 males) with established HDM allergy and with a positive TNPT were randomized to receive placebo or mite allergoid SCIT 6667, 20 000, 50 000 or 100 000 AUeq/ml for 12 months. Patients were updosed weekly, followed by monthly maintenance dosing. The primary study endpoint comprised the clinical response to TNPT after 12 months of treatment. Secondary endpoints included response to TNPT after 6 months, PNIF measurements, symptom and medication scores during the last 8 weeks of treatment, serum immunoglobulins and safety assessments. RESULTS: After 12 months, a dose-response was observed showing statistically significant improvements in the TNPT with SCIT concentrations of ≥20 000 AUeq/ml, while no significantly different outcomes were reached after 6 months. Specific serum IgG and IgG4 levels were dose dependently increased. In the highest dose group, more treatment-emergent adverse events were observed compared with the lower dose groups. CONCLUSION: In this mite allergoid SCIT dose finding study in HDM-induced ARC, concentrations of ≥20 000 AUeq/ml showed both immunological effects and clinical efficacy in the TNPT compared with placebo. The risk-benefit ratio favours 20 000 AUeq/ml and 50 000 AUeq/ml strengths for further clinical development.


Assuntos
Antígenos de Dermatophagoides/administração & dosagem , Antígenos de Dermatophagoides/imunologia , Conjuntivite Alérgica/imunologia , Conjuntivite Alérgica/terapia , Dessensibilização Imunológica , Pyroglyphidae/imunologia , Rinite Alérgica/imunologia , Rinite Alérgica/terapia , Adolescente , Adulto , Animais , Conjuntivite Alérgica/diagnóstico , Dessensibilização Imunológica/efeitos adversos , Dessensibilização Imunológica/métodos , Feminino , Humanos , Imunoglobulina E/imunologia , Imunoglobulina G/imunologia , Masculino , Pessoa de Meia-Idade , Rinite Alérgica/diagnóstico , Resultado do Tratamento , Adulto Jovem
17.
Cancer Imaging ; 15: 16, 2015 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-26419914

RESUMO

BACKGROUND: Tumor volume may serve as a predictor of response to radiochemotherapy (RCT) in head and neck squamous cell carcinoma (HNSCC). Computer assisted tumor volumetry requires time-consuming slice-by-slice manual or semi-automated segmentation. We questioned how accurately primary tumor and suspect cervical lymph node (LN) volumes can be approximated by the maximum tumor diameters in three dimensions. METHODS: In contrast-enhanced diagnostic CT scans of 74 patients with incident advanced HNSCC, manual slice-by-slice segmentation volumetry of primary tumor, total- and largest suspect cervical LN served as the reference method. In the same scans, maximum orthogonal diameters were measured using the distance measurement tool in standard visualization software in axial and coronal sections. From these diameters, approximate volumes were calculated using the cubic and ellipsoid formula. A second segmentation volumetry was performed in contrast enhanced radiotherapy-planning CT scans obtained prior to primary concurrent RCT 24 days (+/- 13 days) following the initial diagnostic CT scans. Intraclass correlation coefficients and Bland-Altman analyses were used to compare results. RESULTS: Slice-by-slice manual segmentation volumetry of primary and LN volumes revealed a lognormal distribution and ranged from 0 to 86 ml and 0 to 129 ml, respectively. Volume approximations in diagnostic CT scans with the ellipsoid formula resulted in an -8 % underestimation of tumor volumes (95 % CI -14 % to -1 %; p = 0.022) and an -18 % underestimation of suspect cervical LN volumes (95 % CI -25 % to -12 %; p = 0.001). Inter rater intraclass correlation for primaries was 0.95 (95 % CI +0.92 to +0.97; p = 0.001), and intra rater intraclass correlation was 0.99 (95 % CI +0.98 to +0.99; p = 0.001). The cubic formula resulted in pronounced overestimation of primary and LN volumes. Primary tumor volumes obtained by the second segmentation volumetry in radiotherapy-planning CT scans obtained on average 24 days following the initial volumetry resulted in larger primary tumor volumes (mean bias +28 %, 95 % CI +14 % to +41 %; p = 0.001). Tumor volume increase correlated with time between the diagnostic and planning CTs (r = 0.24, p = 0.05) and was approximately 1 % per day. DISCUSSION: Ellipsoid approximations of tumor and lymph node volumes in HNSCC using maximum orthogonal diameters underestimates volumes based on segmentation in multiple slices. Due to time difference and safety margins, segmented volumes in radiotherapy-planning CT scans tend to be larger than in diagnostic CT scans. CONCLUSION: Ellipsoid approximations of tumor and lymph node volumes in HNSCC are easily available from diagnostic CT scans. Volume estimates are applicable over a wide range of tumor and LN sizes and may be useful in clinical decision-making and oncologic research.


Assuntos
Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/patologia , Tomografia Computadorizada por Raios X , Idoso , Carcinoma de Células Escamosas/terapia , Quimiorradioterapia , Feminino , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Linfonodos/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Intensificação de Imagem Radiográfica , Planejamento da Radioterapia Assistida por Computador , Carcinoma de Células Escamosas de Cabeça e Pescoço , Carga Tumoral
18.
Laryngorhinootologie ; 94(7): 467-79; quiz 480-1, 2015 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-26125293

RESUMO

Actinic keratosis is a cutaneous lesion characterized by proliferation of atypical epidermal keratinocytes due to prolonged exposure to exogenous factors such as ultraviolet radiation. AKs are in-situ-squamous cell carcinomas (PEC) of the skin. AK typically presents as erythematous, scaly patch or papule (classic AK), occasionally as thick, adherent scale on an erythematous base. Mostly fair-skinned adults are affected. AKs typically occur in areas of frequent sun exposure (balding scalp, face, "H-region", lateral neck, décolleté, dorsum of the hand and lower extremities). Actinic Cheilitis is the term used for AKs appearing on the lips. The diagnosis of AK is based on clinical examination including inspection and palpation. The typical palpable rough surface of AK often precedes a visible lesion. Dermoscopy may provide additional information. If diagnosis is uncertain and invasion suspected, biopsy and histopathologic evaluation should be performed. The potential for progression to invasive PECs mandates therapeutic intervention. Treatment options include topical and systemic therapies. Topical therapies are classified into physical, medical and combined physical-chemical approaches and a sequential combination of treatment modalities is possible. Topical-physical cryotherapy is the treatment of choice for isolated, non-hypertrophic AK. Topical-medical treatment, e. g. 5-fluoruracil (5FU) cream or Imiquomod or Ingenolmebutat application is used for multiple, non-hypertrophic AKs. For hypertrophic AKs, a dehorning pretreatment with salicinated vaseline is recommended. Isolated hypertrophic AKs often need cryotherapy with prolonged freezing time or several consecutive applications. Sequentially combined approaches are recommended for multiple, hypertrophic AKs. Photodynamic therapy (PDT) as example for a combined physical-chemical approach is an established treatment for multiple, non-hypertrophic and hypertrophic AKs. Prevention includes avoidance of sun and application of sunscreen with high sun protection factor. Regular clinical checkups aid in early recognition of AKs.


Assuntos
Carcinoma in Situ/diagnóstico , Carcinoma in Situ/patologia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patologia , Ceratose Actínica/diagnóstico , Ceratose Actínica/patologia , Neoplasias Induzidas por Radiação/diagnóstico , Neoplasias Induzidas por Radiação/patologia , Carcinoma in Situ/terapia , Carcinoma de Células Escamosas/terapia , Dermoscopia , Humanos , Ceratose Actínica/terapia , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/terapia , Neoplasias Induzidas por Radiação/terapia , Pele/patologia
20.
Sportverletz Sportschaden ; 29(1): 40-5, 2015 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-25710393

RESUMO

BACKGROUND: A high percentage of all sports injuries occur during school sports. The aim of this study was to collect statements and opinions of sports teachers for safety in physical education. METHODS: In a cross-sectional study, 296 teachers (202 with, 94 without a teaching qualification in "exercise and sports") at 77 Tyrolean "New Middle Schools" (former secondary schools) were interviewed. They judged various statements on school sports safety using a 5-point verbal rating scale. RESULTS: Irrespective of gender, teachers with a teaching qualification stated significantly more frequently (p = 0.015) that they have participated in continuing education on accident prevention than had their colleagues without qualification. The same applies to the checking of gymnastic and sports equipment before use (p < 0.001) and warming up at the beginning of the lesson (p < 0.001). Female sports teachers allowed their pupils more often (p = 0.002) to participate without adequate sportswear in physical education than did their male counterparts. Of all respondents, 57 % knew about technical faults in sports halls, which have also been reported to the school administration. In more than half (58 %) of these, reported defects were repaired completely and in one-third (36 %), a partial repair was reported. Participants estimated that the major risk for school sports injuries was due to the low motor skills of the pupils, inhomogeneous groups, large numbers of pupils, outdated sports equipment, and ball games. CONCLUSION: Since about a third of all surveyed teachers had no teaching qualification in exercise and sports, this group should come into the focus of regular continuing education in accident prevention.


Assuntos
Traumatismos em Atletas/etiologia , Traumatismos em Atletas/prevenção & controle , Atitude Frente a Saúde , Docentes , Educação Física e Treinamento , Segurança , Adolescente , Adulto , Traumatismos em Atletas/epidemiologia , Áustria , Estudos Transversais , Feminino , Humanos , Masculino , Educação Física e Treinamento/estatística & dados numéricos , Aptidão Física , Risco , Inquéritos e Questionários , Adulto Jovem
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