[Surgical Risk Profile and Audiological Outcome in the Elderly after Cochlea-implantation]. / Operatives Risikoprofil und Hör-Spracherfolg bei älteren Cochlea-Implantat-Patienten.

BACKGROUND: The number of elderly patients with indication for cochlear implantation is increasing. Our aim was to investigate whether seniors with cochlea implants differ from younger patients with regard to hearing improvement, surgical complications and rehabilitation. PATIENTS AND METHODS: Patients older than 60 years (ys) having received a cochlea implant in 2007-2012 were included (Group I 60-70 ys; Group II <70 ys). Preoperative risk factors according to ASA-Criteria and postoperative complications were analyzed. Improvements in quality of live were evaluated by questionnaire. Audiological outcome was tested by Freiburger speech test and OLSA sentence test with background noise. Patients with comparable conditions for cochlea implantation between 40 and 59 years of age served as control group (Group K). RESULTS: Patient cohort consisted of 94 patients, 29 of which being older than 70 years. Severe complications were inexistent postoperatively. Gr. II achieved a speech perception for numbers of 95% (65 dB) and 50% (65 dB) for monosyllables. The speech perception in Gr. II was not significantly different from Gr. I or K. According to the quality of life test all groups experienced an improvement in their social life. CONCLUSION: Old age itself is no contraindication to cochlea implantation. It has little influence on the postoperative speech perception even though the learning curve of the elderly rises slower. However, careful assessment with regard to surgical risk factors and expected outcome is necessary.

[Molecular approaches to systemic therapy of adenoid cystic carcinoma of the head and neck area]. / Molekulare Ansatzpunkte für systemische Therapien adenoidzystischer Karzinome im Kopf-Hals-Bereich.

The adenoid cystic carcinoma (ACC) is a neurotropic salivary gland tumor with a high blood-borne metastasis tendency. The treatment of choice for localized disease consists of radical surgical resection and, depending on resection status, adjuvant radiotherapy. Due to the high recurrence rate with limited local therapeutic options and frequent occurrence of distant metastases, one is confronted inevitably with the search for an adequate systemic therapy. ACC shows little response to a variety of chemotherapeutic agents, partial or complete remissions are extremely rare. Beside classical chemotherapies, immunotherapeutics and targeted therapies with more favorable side effect profiles were tested in trials, but due to the small number of patients, a definitive statement on the effectiveness can be hardly made. This results in the need for prospective multicenter studies that allow clear recommendations for systemic therapy of the tumor. The present paper gives an overview of the sub-cellular and genetic characteristics of ACC, which represent possible targets for systemic therapies and have partly already been included in running clinical trials.

Isoniazid, rifampicin and pyrazinamide plasma concentrations 2 and 6 h post dose in patients with pulmonary tuberculosis.

BACKGROUND: Low concentrations of anti-tuberculosis drugs are related to drug resistance and treatment failure. OBJECTIVE: To determine the prevalence of low plasma concentrations of anti-tuberculosis drugs. METHODS: The study was performed among 60 pulmonary tuberculosis (TB) in-patients at a tertiary care university-affiliated hospital in Tehran, Iran. Drug samples were drawn 2 and 6 h post dose for isoniazid (INH), rifampicin (RMP) and pyrazinamide (PZA); related concentrations were determined using high-performance liquid chromatography. Plasma drug concentrations, duration of treatment, age, sex, liver enzyme levels, administered doses and smoking status were evaluated and recorded. RESULTS: Among 60 patients recruited to the study, the mean (±SD) age was 54.2 (±20.9) years; 39 were female. The median peak plasma concentrations (C(max)) of INH, RMP and PZA were respectively 2.5, 4.0 and 43.6 µg/ml; 81% of the patients had drug plasma concentrations lower than the target ranges for at least one administered drug. Respectively 49.1%, 92.5% and 8.7% of the patients had low concentrations of INH, RMP and PZA. CONCLUSION: The results indicate that RMP concentrations are below the reference range in most patients, while PZA is within the target range of the standard doses.

Effect of mycorrhizal fungi on some defense enzymes against Gaeumannomyces gaminis in wheat.

At this research, the effect of mycorrhizal fungi (Glomus etunicatum) On Pero Xidase (POX) and Phenylalanine Ammonia Lyase (PAL) activities and isozymatic pattern against Gaeumannomyces graminis were studied in wheat plants. Seeds were planted in inoculated soils in 4 treatment groups including Control (C), Mycorrhiza (M), Pathogen (P) and Pathogen- Mycorrhiza (PM). Plants were harvested 17 days after inoculation. POX activities in PM group were significantly greater than control group. Significant differences were not observed between P and C groups. POX activities significantly decreased in M group. PAL activities in M group were significantly greater than other groups. PAL activities in P and PM groups were significantly greater than C group. The appearance of new isozyme was induced in PM group. It is highly probable that induced POX isozymic activity and/or appearance of new isozymes may be responsible for elevated POX activity. Present results showed that the isozymatic patterns of POX were changed by inoculation ofmycorrhiza and/or pathogen. The obtained results from this research is agreement with other researches about the enhancing effect of mycorrhizal fungi on PAL activity. The obtained results from the present research, confirm this opinion that defense related proteins is not induced in compatible interactions or is weak.

Relationship between erythrocyte lithium concentration and renal concentrating capacity.

BACKGROUND: Studies investigating possible correlations between plasma lithium concentration, lithium treatment duration, and frequency of lithium administration, and lithium nephrotoxicity have yielded conflicting results. OBJECTIVES: Our main objective was to investigate whether there was any relationship between erythrocyte lithium concentration (ELC) and renal side effects. Another objective of our study was to identify a parameter, which could be estimated inexpensively, for assessing possible renal side-effects of lithium. METHOD: Seventy Iranian inpatients with bipolar disorder entered this case-control study. Medications taken concurrently by the patients were recorded. A direct method of measuring ELC was used in this study. The cases were patients on lithium who had urine specific gravity (SG) of 1.006 or less after 8-10 h water deprivation at night and the controls consisted of patients on lithium with urine SG of 1.011 or more after this period. Blood urea nitrogen, serum creatinine, sodium and potassium and urine SG, sodium, and potassium were measured in all patients during this time. Renal indices were compared by using independent sample t-test at a significance level of a P-value of 0.05 or less. Non-parametric Spearman's rank correlation test was used to investigate the relationship between clinical variables and the indices of renal function. RESULTS: Results revealed that in case group mean serum sodium concentrations were significantly higher (P = 0.008) and mean urine sodium and potassium were significantly lower than those of controls (P = 0.004 and 0.007 respectively). We found no statistically difference in lithium ratios between the two groups. However, ELCs were significantly higher in the cases (P = 0.026). There were no significant correlation between concomitant use of neuroleptics, benzodiazepines or carbamazepine and ELC or lithium renal side-effects. CONCLUSION: This study showed that ELC may reflect lithium renal side-effects better than plasma lithium level.

Possible role of Pi supply in mitochondrial actions of glucagon.

Glucagon is able to diminish the net release of inorganic phosphate (Pi) occurring on incubation of isolated hepatocytes from 48-h-starved rats. Concomitantly the hormone increases the cellular Pi content. This is associated with a rise of Pi in the cytosolic fraction. Other hormonal effectors like phenylephrine, vasopressin and angiotensin II exert a smaller and transient effect as compared to glucagon. It is proposed that this increase in Pi availability to the mitochondria, by favouring substrate level phosphorylation at the succinyl-CoA synthetase step plays a role in the development of the metabolite pattern found in the mitochondrial matrix space after exposure of hepatocytes to glucagon or the above agents. With regard to the glutamate level this view is evidenced by the finding that its hormone-dependent decrease was inversely correlated to the respective increase in the cytosolic Pi concentration. Further evidence is provided by experiments with isolated mitochondria incubated under state-3 conditions at medium Pi concentrations corresponding to those metabolically active in the cytosolic compartment of control and glucagon-stimulated hepatocytes, being 2 mM and 3 mM, respectively. Increasing medium phosphate concentration from 2 mM to 3 mM caused a marked decrease in the level of succinyl-CoA and increased the rates of 2-oxoglutarate utilization and of malate and phosphoenolpyruvate production. Citrulline synthesis also was found to be stimulated at 3 mM Pi. Taken together our results suggest a role of Pi supply in mitochondrial actions of glucagon in intact hepatocytes. Moreover, they could contribute to a better interpretation of glucagon effects on isolated mitochondria from hormone-pretreated liver cells.

Evidence that glucagon stabilizes rather than activates mitochondrial functions in rat liver.

The present study is concerned with the question as to whether the acute treatment of intact rats or hepatocytes with glucagon and dibutyryl cAMP, respectively, leads to a stabilization or an activation of mitochondrial functions, such as state-3 respiration, succinate dehydrogenase activity and pyruvate carboxylase activity. For this purpose, the influence of various parameters of mitochondria preparation (isolation medium, washing steps, storage) as well as of phospholipase A inhibitors (cinchocain, chloroquine) on the expression of the hormone effect was examined. With regard to the above mentioned functions, the values displayed by control mitochondria were found to be considerably higher if mannitol instead of sucrose had been used for isolation. Accordingly, only small effects of hormone treatment became apparent. The addition of cinchocain or chloroquine to the sucrose medium yielded results similar to those obtained with mannitol. Furthermore, the hormone effect on state-3 respiration and succinate dehydrogenase activity was only small if the mitochondria had been prepared faster than usual and had been used without washing. Regarding pyruvate carboxylase, a considerably smaller glucagon effect was observed when it was assayed at 25 degrees C and not (as usual) at 37 degrees C. Our results indicate that glucagon application stabilizes rather than activates mitochondrial functions.