Extended phenotype and clinical subgroups in unilateral Meniere disease: A cross-sectional study with cluster analysis.

OBJECTIVES: To define clinical subgroups by cluster analysis in patients with unilateral Meniere disease (MD) and to compare them with the clinical subgroups found in bilateral MD. DESIGN: A cross-sectional study with a two-step cluster analysis. SETTINGS: A tertiary referral multicenter study. PARTICIPANTS: Nine hundred and eighty-eight adult patients with unilateral MD. MAIN OUTCOME MEASURES: best predictors to define clinical subgroups with potential different aetiologies. RESULTS: We established five clusters in unilateral MD. Group 1 is the most frequently found, includes 53% of patients, and it is defined as the sporadic, classic MD without migraine and without autoimmune disorder (AD). Group 2 is found in 8% of patients, and it is defined by hearing loss, which antedates the vertigo episodes by months or years (delayed MD), without migraine or AD in most of cases. Group 3 involves 13% of patients, and it is considered familial MD, while group 4, which includes 15% of patients, is linked to the presence of migraine in all cases. Group 5 is found in 11% of patients and is defined by a comorbid AD. We found significant differences in the distribution of AD in clusters 3, 4 and 5 between patients with uni- and bilateral MD. CONCLUSIONS: Cluster analysis defines clinical subgroups in MD, and it extends the phenotype beyond audiovestibular symptoms. This classification will help to improve the phenotyping in MD and facilitate the selection of patients for randomised clinical trials.

Familial clustering and genetic heterogeneity in Meniere's disease.

The aims of this study were to estimate the prevalence of familial cases in patients with Meniere's disease (MD) and to identify clinical differences between sporadic and familial MD. We recruited 1375 patients with definite MD according to the American Academy of Otolaryngology-Head and Neck Surgery criteria, obtaining the familial history of hearing loss or episodic vertigo by direct interview or a postal survey in 1245 cases in a multicenter study. Familial clustering was estimated by the recurrence risk ratio in siblings (λs ) and offspring (λo ) using intermediate and high prevalence values for MD in European population. A total of 431 patients (34%) reported a familial history of hearing loss or recurrent vertigo and 133 patients had a relative with possible MD. After clinical reevaluation, 93 relatives in 76 families were diagnosed of definite MD (8.4%), including three pairs of monozygotic twins. λs and λo were 16-48 and 4-12, respectively. We observed genetic heterogeneity, but most families had an autosomal dominant inheritance with anticipation. No clinical differences were found between sporadic and familial MD, except for an early onset in familial cases. We may conclude that MD has a strong familial aggregation and that sporadic and familial MDs are clinically identical.

Complications of chemical face peeling as evaluated by a questionnaire.

Seven-hundred and ninety-four questionnaires were returned, and 74 percent of the plastic surgeons reported the use of phenol for chemical face peeling. They reported pigmentation difficulties as the most common local complication, with scarring being reported by 21 percent of the plastic surgeons. Of the plastic surgeons reporting, 87 percent did not encounter any systemic complications and 13 percent noted cardiac complications, with tachycardia being the most frequent. The surgeon must be reminded that phenol is a toxic material that is absorbed into the bloodstream and is capable of producing cardiac complications. Therefore, slow and cautious application of the chemical to the skin is advisable in order to prevent such complications. The use of a cardiac monitor is highly recommended as a precautionary diagnostic aid. This procedure has gained popularity and is used by 74 percent of present-day plastic surgeons. Despite the fact that complications can occur, the procedure is still valuable for certain conditions of the skin that cannot be managed successfully by standard surgical procedures. Chemical face peeling, although unsound pharmacologically, will produce beneficial results in indicated cases if it is used judicially.

[Age influence in otoacoustic emissions for hearing loss screening in infants]. / Influencia de la edad en las otoemisiones acústicas para el screening de hipoacusia infantil.

OBJECTIVE: To determine the most favorable age for detection of otoacoustic emissions in newborns and for repeated testing. METHODS: Observational, retrospective, descriptive study in 2,567 newborns. RESULTS: The incidence of any degree of hearing loss was 7 per thousand newborns. It was proportionately higher in the group that did not have otologic risk factors The distribution of otoacoustic emissions by age groups followed a significant linear trend in the first month of life. The time lapse to obtain a positive result on the second otoacoustic emission test was 6 days from the first one. CONCLUSIONS: Otoacoustic emission screening should be performed in all newborns as late as possible after birth (from the first 48 hours after birth), but before hospital discharge for the test to be effective and efficient. A repeat test, if required, must be performed at least six days after failing the first one.

Present day status of the chemical face peel.

A phenol chemical face peel restores a clean, youthful appearance by removing the fine wrinkles of the tired, aged face. This procedure has the additional advantage of decreasing the rate of appearance of precancerous and probably early cancerous lesions of the photoaged skin of the face. Knowledge of the history, theory, histology, and technique are made current. A comprehensive review demonstrates that pigmentary changes, third degree scarring, and cardiac arrhythmias appear to be the main complications. The technique is safe and effective if used in a judicious manner.

Midvastus approach in total knee arthroplasty: a description and a cadaveric study determining the distance of the popliteal artery from the patellar margin of the incision.

Total knee arthroplasty (TKA), one of the most efficacious procedures in orthopedics, requires complete exposure of the knee joint for precise instrumentation. Although most orthopedic surgeons agree that TKA is easily performed using a medial parapatellar approach, a large segment of the patellar blood flow is disrupted by this exposure. The southern or subvastus approach addresses these concerns; however, the procedure has the disadvantage of inadequate exposure in certain patients. A compromise between these two approaches, a midvastus approach, has been described. To decrease potential neurovascular injury, this cadaveric study of the midvastus approach determines the proximity of the incision to the popliteal vascular bundle and addresses the innervation pattern of the vastus medialis oblique. A midvastus arthrotomy was performed on 19 female and 15 male adult cadaveric knees. The midpoint of the superior pole of the patella and the superomedial patellar prominence were marked. After determining the midpoint between the 2 previously mentioned landmarks, an incision was made from that point paralleling the fibers of the vastus medialis oblique medially to the popliteal vascular bundle. The length of the incision was measured three times using calipers; measurements were averaged for each individual specimen, then by gender, and, finally, overall. Ninety-five percent confidence intervals were determined. Differences were assessed by an independent t-test with an alpha level of significance at .05. In addition, the terminal branches of the femoral nerve innervating the vastus medialis oblique were dissected in 5 cadavers. The femoral nerve branched extensively to innervate the vastus medialis oblique. The average distance between the patella and the popliteal vessels was 8.8 +/- 1.4 cm. The average distance in males, 9.5 +/- 1.4 cm, was significantly greater than the distance in females, 8.3 +/- 1.2 cm (P < .02). The distance appeared proportionate to the size of the extremity. The midvastus approach is a viable alternative for primary TKA in selected patients who are not obese and who have not had previous arthrotomy or osteotomy. The average distance (8.8 cm) and corresponding range (6.5 cm minimum to 12.3 cm maximum) are sufficient to suggest a maximal safe distance for sharp dissection of 4.5 cm from the patellar margin in an adult. For additional exposure, the muscle can be safely split further with blunt dissection.

Influencia de la edad en las otoemisiones acústicas para el screening de hipoacusia infantil / Age influence in otoacoustic emissions for hearing loss screening in infants

Objetivo: Determinar cuál es la edad más adecuada en el recién nacido para la detección de Otoemisiones y el tiempo medio necesario para la normalización en las repeticiones, Método: Estudio observacional, retrospectivo y descriptivo sobre 2.567 recién nacidos. Resultados: La prevalencia de hipoacusia de cualquier grado fue del 7 por mil (mayor proporcionalmente en el grupo sin factores de riesgo otológico: 5 frente al 2 por mil con factores positivos). Los resultados por grupos de edad siguieron una tendencia lineal significativa en el primer mes. La segunda Otoemisión se positivizó transcurridos 6 días desde la realización del primer test. Conclusiones: Las Otoemisiones deben hacerse a todos los recién nacidos lo más tardíamente posible antes del alta hospitalaria (a partir de las primeras 48 horas) para que la prueba sea rentable. Si es necesaria la repetición se hará al menos seis días después del fallo en la primera prueba (AU)

OBJECTIVE: To determine the most favorable age for detection of otoacoustic emissions in newborns and for repeated testing. METHODS: Observational, retrospective, descriptive study in 2,567 newborns. RESULTS: The incidence of any degree of hearing loss was 7 per thousand newborns. It was proportionately higher in the group that did not have otologic risk factors The distribution of otoacoustic emissions by age groups followed a significant linear trend in the first month of life. The time lapse to obtain a positive result on the second otoacoustic emission test was 6 days from the first one. CONCLUSIONS: Otoacoustic emission screening should be performed in all newborns as late as possible after birth (from the first 48 hours after birth), but before hospital discharge for the test to be effective and efficient. A repeat test, if required, must be performed at least six days after failing the first one (AU)