Prediction of successful hearing aid treatment in first-time and experienced hearing aid users: Using the International Outcome Inventory for Hearing Aids.

OBJECTIVE: Primarily to understand whether clinically relevant factors affect the International Outcome Inventory (IOI-HA) scores and to examine if IOI-HA scores improve when renewing the hearing aids (HA) for experienced users. Secondly, to estimate the overall HA effectiveness using the IOI-HA. DESIGN: A prospective observational study. STUDY SAMPLE: In total, 1961 patients with hearing loss were included. All patients underwent a hearing examination, were fitted with HAs, and answered the IOI-HA. Factor analysis of IOI-HA separated the items into a Factor 1 (use of HA, perceived benefits, satisfaction, and quality of life) and Factor 2 (residual activity limitation, residual participation restriction and impact on others) score. RESULTS: Degree of hearing loss, word recognition score, motivation, HA usage time, tinnitus, asymmetry, and sex were significantly associated with total IOI-HA, Factor 1, or Factor 2 scores. The seven IOI-HA items increased on average by 0.4 (p < 0.001) when renewing HAs. The total median IOI-HA score at follow-up was 29 (7) for experienced (n = 460) and first-time users (n = 1189), respectively. CONCLUSIONS: Degree of hearing loss, word recognition score, motivation, tinnitus, asymmetry, and sex may be used to identify patients who require special attention to become successful HA users.

Dural venous sinus thrombosis in anaplastic astrocytoma following concurrent temozolomide and focal brain radiotherapy plus bevacizumab.

Malignant gliomas have long been a therapeutic dilemma in neuro-oncology, with a poor overall prognosis. Standard treatment, consisting of primary resection, followed by radiation therapy and temozolomide, has improved prognosis. Recently, studies have looked at the addition of bevacizumab (Avastin), a humanized murine IgG1 monoclonal antibody against vascular endothelial growth factor-A, to conventional regiments. Bevacizumab gained US FDA approval for single agent use in recurrent glioblastoma in 2009. Known side effects of bevacizumab include increased risk of arterial and venous thromboembolism, as well as hemorrhage. With emerging data for the use of bevacizumab in malignant gliomas, the extent of risks such as bleeding and thrombosis in patients with primary brain tumors treated with bevacizumab remains unknown. Here, we present only the second reported case of dural venous sinus thrombosis during treatment with bevacizumab and the first reported case for a primary glioma treated with temozolomide, radiation, and bevacizumab.

Technique for neurosurgically relevant CT image transfers using inexpensive video digital technology.

OBJECTIVE: To examine and document neurosurgically relevant CT image transfers using inexpensive video digital technology. METHODS: Thirty abnormal CT scans were evaluated on a personal computer monitor following their digital image creation and transfer by electronic mail (e-mail). These were compared with the radiologist's interpretation of a hard copy of the CT scan originals. Any change in diagnosis based on the CT scan or e-mail image was assessed after completion of the comparison. RESULTS: A total of 30 CT scans were successfully transferred and reviewed. On only one image was there disagreement between the neurosurgeon's and the radiologist's interpretations of the image. This resulted in a change in the radiologist's diagnosis after digital image transfer occurred and the neurosurgeon diagnosed an isodense subdural hematoma, which was later confirmed at the time of surgical decompression. CONCLUSIONS: A hand-held, inexpensive digital camera may serve neurosurgeons as a helpful alternative to expensive, labor-intensive teleradiology systems. It should be considered as an adjunctive option for small community-based hospitals unable to financially support more sophisticated teleradiology techniques, which have been shown to provide a significant benefit in the management and outcome of head trauma patients.

[Determination of core body temperature. A comparison of esophageal, bladder, and rectal temperature during postoperative rewarming]. / Bestimmung der Körperkerntemperatur. Ein Vergleich von Osophagus-, Blasen- und Rektaltemperatur während der postoperativen Wiedererwärmung.

OBJECTIVE: The data of 60 postoperatively sedated and ventilated patients were studied for analysis of oesophageal, bladder, and rectal temperatures. The purpose of the investigation was to clarify whether changes of oesophageal temperature are adequately reflected by bladder and rectal temperatures and whether the rate of rewarming has an influence on the accuracy of the latter two sites. METHODS: For temperature recording, a Hi-Lo Temp esophageal stethoscope (Mallinckrodt Medical), a Foley FC400-18 catheter temperature sensor (Respiratory Support Products, Mallinckrodt Medical), and a rectal temperature probe N401 (YSI) were used. Each probe and matching recording unit was calibrated over a range of 30-40 degrees C against a reference quartz thermometer (Hewlett packard Model 2801 A) in a thermostated water bath before the investigation. Five measuring points distributed over the whole period of rewarming were evaluated. Patients were assigned to groups with slow and fast rewarming, respectively. Agreement between the methods of measurement was assessed as described by Bland and Altman. Furthermore, differences between the oesophageal and bladder or rectal temperature were checked at each measuring point for statistical significance using the t-test. RESULTS: In regard to oesophageal temperature, the bladder and rectal temperatures had biases of -0.01 degree C and -0.03 degree C, respectively. Limits of agreement (+/- s) were +/-0.68 degree C and +/-0.82 degree C, respectively. The bias of the bladder temperature was independent of the rate of rewarming (Fig. 3). The bias of the rectal temperature, however, differed in regard to the rewarming rate, being +0.06 degree C in the group with slow rewarming and -0.13 degree C in the group with fast rewarming (Tables 1 and 2, Fig. 1 and 2). These differences were significant for the measuring points 4 and 5 (Fig. 4). CONCLUSIONS: Bladder and rectal temperatures can accurately indicate the oesophageal temperature with a very small bias in postoperatively sedated and ventilated patients. Since the rate of rewarming influences the accuracy of rectal temperature readings, monitoring of bladder temperature seems to be more favourable in the postoperative period.

[The comparative effectiveness of different infusion and blood warming methods]. / Experimentelle Untersuchung zur Effektivität verschiedener Infusions- und Blutwärme-verfahren.

UNLABELLED: Heat loses during surgery occur mainly to the environment and due to infusions and irrigations. Infusions given at room temperature account for a great deal of the total heat deficit during major operations, e.g., the infusion of 53 ml/kg 20 degrees C fluid leads to a loss of 1 degree C in mean body temperature. Hence, heating i.v. fluids will add to the effect of other measures aimed at reducing heat loss to the environment. We investigated the efficacy of different warming methods for i.v. fluids in an experimental model by measuring the temperature at the end of the delivery line. METHODS: The following in-line warmers were studied: Hotline HL-90 and System H-250/heat exchanger D-50 (Level 1 Technologies, Marshfield, USA), Astotherm IFT 260 (Stihler Elektronic GmbH, Stuttgart, Germany), RSLB 30 H Gamida (Productions Hospitalieres Francaises, Eaubonne, France), Bair Hugger 241/Modell 500 Prototype (Augustine Medical, Eden Prairie, USA). They were compared with pre-warming infusions (39 degrees C) only using the Clinitherm S (Labor Technik Barkey GmbH, Bielefeld, Germany) and pre-warming with "active insulation" of the delivery line using the Autotherm/Autoline system (Labor Technik Barkey GmbH, Bielefeld, Germany). We investigated the influence of four variables on the efficacy of warming: (1) flow rate (50-15,000 ml/h); (2) ambient temperature (20 degrees C and 25 degrees C); (3) infusion bag temperature (6 degrees C, 20 degrees C, and 39 degrees C); and (4) length of infusion system downstream from the heat exchanger. Fluid temperatures were measured using thermistors of 1 mm diameter (Modell YSI 520, Yellow Springs Instruments Co., Yellow Springs, USA) incorporated into 3-way stopcocks. Temperatures were recorded using Hellige temperature monitors (Hellige GmbH, Freiburg im Breisgau, Germany) and the signals were collected at 10 Hz through an AD converter and averaged over 1 min. Flows were calculated by timed collection into calibrated cylinders; 10 to 12 different flow rates were taken to define one temperature/ flow plot. Effective warming was defined as a temperature > 33 degrees C at the end of the infusion line. RESULTS: At high flow rates (> 2,500 ml/h) using 20 degrees C fluids at 20 degrees C ambient temperature, the H-250/D-50 system gave the highest temperatures throughout the range and showed effective warming from 1,300 ml/h on over the entire range tested (35 degrees C at 17,000 ml/h) compared to the RSLB 30 H Gamida system (3,000-18,000 ml/h) (Fig. 2). This difference in performance was almost abolished with fluids at 6 degrees C (Fig. 4). Similar efficacy could be reached by using prewarmed infusions that gave effective warming at > 2,000 ml/h and reached 39 degrees C at 13,000 ml/h. Prewarmed infusions could be used effectively down to > 80 ml/h applying "active insulation" (Autotherm/Autoline) to the whole infusion system. The Hotline HL-90 (50-4, 700 ml/h) appeared to be the most effective in-line warmer in the low (< 250 ml/h) and middle (250-2,500 ml/h) flow range, followed by the Astotherm IFT 260 (400-4,000 ml/h), but only if used with a length of 40 cm down-stream from the heat exchanger (Fig. 1). Increasing this distance to 145 cm markedly reduced its efficacy below the range of 2,000 ml/min (1,200- 3,000 ml/h) (Fig. 5). The Bair Hugger 241 Prototype showed a narrow effective range (700-1,300 ml/h) that could be extended beyond 1,300 ml/h by the use of prewarmed infusions (Figs. 1 and 3). The performance for 6 degrees C solutions and ambient temperatures of 25 degrees C are given in Fig. 4 and Table 1. CONCLUSIONS: The importance of infusion warming increases with the amount of fluid given.(ABSTRACT TRUNCATED)

The difficult diagnosis of subdural empyema: report of three cases and review of the literature.

Subdural empyema remains a frequently misdiagnosed clinical entity. This article presents three cases of subdural empyema and a review of recent literature.

Tonsillar ectopia and Chiari malformations: monozygotic triplets. Case report.

A unique case of monozygotic triplets, each of whom exhibits variable degrees of tonsillar ectopia, is reported. Patient X presented with a Chiari I malformation and associated syringomyelia; examination of patients Y and Z showed 4 mm and 2.5 mm of tonsillar ectopia, respectively. No such case has been reported in the literature. The discussion defines the current magnetic resonance criteria for diagnosis of hindbrain malformations and addresses the question of whether these disorders represent a spectrum or separate disease entities, with specific emphasis on genetic predisposition. Due to the 100% concordance in this case the presence of a common hereditary factor in the etiology of these malformations is highly suggested.

Congenital cystic supratentorial hemangioblastoma. Case report.

The first documented case of congenital supratentorial hemangioblastoma is presented, occurring in a 3-week-old infant. Extensive review of the literature revealed approximately 83 cases of supratentorial hemangioblastoma; however, only one of these occurred in the first year of life, and that case was not presented in detail.

Seventeen level laminectomy for extensive spinal epidural abscess: case report and review.

Several studies have suggested that non-operative treatment be employed for spinal epidural abscesses involving a considerable length of the vertebral column. The reasons for this have not been clearly stated in the literature, however, nor has the critical number of vertebral levels been specified. Presumably, this is related to the morbidity of extensive laminectomy, but we began to question this assumption because of advances in surgical instrumentation combined with frequent reports of irreversible disease progression while on appropriate antibiotics. In this article, we present a case of an extensive spinal epidural abscess managed surgically with no associated morbidity. In addition, we present a review of the literature concerning spinal epidural abscess.

Neurologic deficits restored after elective posterior fossa decompression.

Arnold Chiari malformation is a condition in which the contents of the posterior fossa are herniated below the level of the foramen magnum, and it occurs in three basic forms. Patients with this condition frequently have obstructive hydrocephalus which requires a ventriculo-peritoneal shunt. This article describes the case of a infant female patient with Arnold Chiari Type I, who suffered an episode of acute hydrocephalus and neurologic deterioration after ventriculo-peritoneal shunt malformation. A shunt revision did not reverse her neurologic deficits, so a posterior fossa decompression was performed which did improve her condition.

Intraoperative use of rtPA for subarachnoid hemorrhage.

Intraoperative thrombolysis with recombinant tissue plasminogen activator (rtPA) was performed in 15 patients with aneurysmal subarachnoid hemorrhage. All patients had significant basal cistern blood accumulation seen on CT scans preoperatively. The patients underwent surgery within four days of subarachnoid hemorrhage with aneurysm clipping in all patients. Postoperatively, transcranial doppler examinations demonstrated reduction in the development of vasospasm to a greater degree in patients treated with rtPA than a similar group of patients managed without the rtPA treatment. Eighty percent of patients receiving intracisternal rtPA had fair to good results compared with 78% of a similar group of patients who underwent surgery shortly after subarachnoid hemorrhage and were not given rtPA. Intracisternal rtPA remains an adjunctive treatment of questionable benefit in the management of patients with aneurysmal subarachnoid hemorrhage.

Giant posterior inferior cerebellar artery aneurysm associated with foramen magnum syndrome.

The case of a giant distal posterior inferior cerebellar artery (PICA) aneurysm which caused foramen magnum syndrome is presented. A 67-year-old male was referred for evaluation of a posterior fossa mass lesion on MRI scan. Craniotomy was performed which revealed a giant and completely thrombosed aneurysm of the distal PICA, which was subsequently excised intact. This report adds giant aneurysm of the PICA to the list of posterior fossa lesions reported which cause foramen magnum syndrome.

P relaxation responses associated with n(2)/o(2) diffusion in soybean nodule cortical cells and excised cortical tissue.

N(2)-fixing Bradyrhizobium japonicum nodules and cortical tissue derived from these nodules were examined in vivo by (31)P nuclear magnetic resonance (NMR) spectroscopy. Perfusion of the viable nodules and excised cortical tissue with O(2) followed by N(2) or Ar caused a loss of orthophosphate (Pi) resonance magnetization associated with the major portion of acidic Pi (delta 0.9 ppm, pH 5.5) residing in the cortical cells. Resumption of O(2) perfusion restored approximately 80% of the intensity of this peak. Detailed examination of the nuclear relaxation processes, spin-lattice relaxation time (T(1)), and spin-spin relaxation time (T(2)), under perfusion with N(2) or Ar as opposed to O(2), indicated that loss of signal was due to T(1) saturation of the acidic Pi signal under the rapid-pulsed NMR recycling conditions. In excised cortical tissue, Pi T(1), values derived from biexponential relaxation processes under perfusing O(2) were 59% 3.72 +/- 0.93 s and 41% 0.2 +/- 0.08 s, whereas under N(2) these values were 85% 7.07 +/- 1.36 s and 15% 0.39 +/- 0.07 s. The T(1) relaxation behavior of whole nodule vacuolar Pi showed the same trend, but the overall values were somewhat shorter. T(2) values for cortical tissue were also biexponential but were essentially the same under O(2) (38% 0.066 +/- 0.01 s and 63% 0.41 +/- 0.08 s) and N(2) (39% 0.07 +/- 0.01 s and 61% 0.37 +/- 0.01 s) perfusion. Soybean (Glycine max) root tissue as well as Pi solutions exhibited single exponential T(1) decay values that were not altered by changes in the perfusing gas. These data indicate that oxygen induces a change in the physical environment of phosphate in the cortical cell tissue. Although under certain conditions oxygen has been observed to act as a paramagnetic relaxation agent, model T(1) experiments demonstrate that O(2) does not significantly influence Pi relaxation in this manner. Alternatively, we suggest that an increase in solution viscosity brought on by the production of an occlusion glycoprotein (under O(2) perfusion) is responsible for the observed relaxation changes.

Treatment of giant intracranial aneurysm with carotid ligation, saphenous vein bypass graft.

Giant intracranial aneurysms pose difficult problems for neurosurgeons. This article describes the technique of extracranial-intracranial saphenous vein bypass graft and carotid artery ligation as treatment to remove a giant intracranial aneurysm.

The efficacy of methylprednisolone in reducing flap edema.

It has been suggested that systemic steroids reduce postoperative flap edema. This has been poorly documented by several reports based on subjective clinical observations. In an effort to provide quantitative data on methylprednisolone and edema, a flap edema model in the rat was developed based on the inferior epigastric vessels. Significant edema developed after 48 hours. Differing intraoperative doses of methylprednisolone were studied, producing a dose-response curve. A single low dose of intraoperative steroid is effective in reducing flap edema; previously recommended doses are probably excessive.

Pneumococcal meningitis due to psoas abscess.

We have described a patient who had meningitis from local extension of a primary pneumococcal abscess of the psoas muscle. With open surgical drainage and high-dose penicillin therapy, the patient did well and was discharged without neurologic sequelae.