Diagnosis and treatment of the short-arm type posterior semicircular canal BPPV.

INTRODUCTION: The Epley maneuver is useful for the otoconia to return from the long arm of the posterior semicircular canal into the utricle. To move otoconia out of the posterior semicircular canal short arm and into the utricle, we need different maneuvers. OBJECTIVE: To diagnose the short-arm type BPPV of the posterior semicircular canal and treat them with bow-and-yaw maneuver. METHODS: 171 cases were diagnosed as BPPV of the posterior semicircular canal based on a positive Dix-Hallpike maneuver. We first attempted to treat patients with the bow-and-yaw maneuver and then performed the Dix-Hallpike maneuver again. If the repeated Dix-Hallpike maneuver gave negative results, we diagnosed the patient with the short-arm type of BPPV of the posterior semicircular canal and considered the patient to have been cured by the bow-and-yaw maneuver; otherwise, probably the long-arm type BPPV of the posterior semicircular canal existed and we treated the patient with the Epley maneuver. RESULTS: Approximately 40% of the cases were cured by the bow-and-yaw maneuver, giving negative results on repeated Dix-Hallpike maneuvers, and were diagnosed with short-arm lithiasis. CONCLUSION: The short-arm type posterior semicircular canal BPPV can be diagnosed and treated in a convenient and comfortable manner.

Diagnosis and treatment of the short-arm type posterior semicircular canal BPPV / Diagnóstico e tratamento da VPPB de braço curto do canal semicircular posterior

Abstract Introduction The Epley maneuver is useful for the otoconia to return from the long arm of the posterior semicircular canal into the utricle. To move otoconia out of the posterior semicircular canal short arm and into the utricle, we need different maneuvers. Objective To diagnose the short-arm type BPPV of the posterior semicircular canal and treat them with bow-and-yaw maneuver. Methods 171 cases were diagnosed as BPPV of the posterior semicircular canal based on a positive Dix-Hallpike maneuver. We first attempted to treat patients with the bow-and-yaw maneuver and then performed the Dix-Hallpike maneuver again. If the repeated Dix-Hallpike maneuver gave negative results, we diagnosed the patient with the short-arm type of BPPV of the posterior semicircular canal and considered the patient to have been cured by the bow-and-yaw maneuver; otherwise, probably the long-arm type BPPV of the posterior semicircular canal existed and we treated the patient with the Epley maneuver. Results Approximately 40% of the cases were cured by the bow-and-yaw maneuver, giving negative results on repeated Dix-Hallpike maneuvers, and were diagnosed with short-arm lithiasis. Conclusion The short-arm type posterior semicircular canal BPPV can be diagnosed and treated in a convenient and comfortable manner.

Resumo Introdução A manobra de Epley é útil para o retorno da otocônia do braço longo do canal semicircular posterior para o utrículo. Diferentes manobras são necessárias para mover a otocônia para fora do braço curto do canal semicircular posterior e para dentro do utrículo. Objetivo Diagnosticar a VPPB do tipo braço curto do canal semicircular posterior e tratá-la com a manobra de incline and balance. Método Foram diagnosticados 171 casos como VPPB de canal semicircular posterior com base na manobra de Dix-Hallpike positiva. Primeiro tentamos tratar os pacientes com a manobra de incline and balance e, em seguida, executamos a manobra de Dix-Hallpike novamente. Se a repetição da manobra de Dix-Hallpike desse resultados negativos, diagnosticávamos o paciente como VPPB do canal semicircular posterior do tipo braço curto e considerávamos que ele ou ela havia sido curado pela manobra de incline and balance; caso contrário, provavelmente o paciente apresentava VPPB do canal semicircular posterior do tipo braço longo e tratávamos o paciente com a manobra de Epley. Resultados Aproximadamente 40% dos casos foram curados pela manobra de incline and balance, com resultados negativos nas manobras de Dix-Hallpike repetidas, e foram diagnosticados com litíase de braço curto. Conclusão A VPPB de canal semicircular posterior do tipo braço curto pode ser diagnosticada e tratada de maneira conveniente e confortável.

The Distinct Effects of Estrogen and Hydrostatic Pressure on Mesenchymal Stem Cells Differentiation: Involvement of Estrogen Receptor Signaling.

This study aimed to investigate the differential and synergistic effects of mechanical stimulation and estrogen on the proliferation and osteogenic or chondrogenic differentiation potential of bone marrow mesenchymal stem cells (BMSCs) and the roles of estrogen receptor (ER) in them. BMSCs were isolated and cultured using the whole bone marrow adherence method, and flow cytometry was used to identify the surface marker molecules of BMSCs. Cells were pre-treated with 1 nM 17ß-estradiol or 1 nM of the estrogen receptor antagonist tamoxifen. Then, the cells were stimulated with hydrostatic pressure. Assessment included flow cytometry analysis of the cell cycle; immunofluorescent staining for F-actin; protein quantification for MAPK protein; and mRNA analysis for Col I, OCN, OPN and BSP after osteogenic induction and Sox-9, Aggrecan and Col-II after chondrogenic induction. Hydrostatic pressure (90 kPa/1 h) and 1 nM 17ß-estradiol enhanced the cellular proliferation ability and the cytoskeleton activity but without synergistic biological effects. Estrogen activated ERKs and JNKs simultaneously and promoted the osteogenic differentiation, whereas the pressure just caused JNK-1/2 activation and promoted the chondrogenic differentiation of BMSCs. Estrogen had antagonism effect on chondrogenic promotion of hydrostatic pressure. Mechanobiological effects of hydrostatic pressure are closely associated with ERα activity. MAPK molecules and F-actin were likely to be important mediator molecules in the ER-mediated mechanotransduction of BMSCs.