Number, distribution, and morphologic particularities of encapsulated proprioceptors in pig extraocular muscles.

PURPOSE: To analyze qualitatively and quantitatively the total complement of encapsulated proprioceptors (Golgi tendon organs [GTOs] and neuromuscular spindles) in pig extraocular muscles (EOMs). METHODS: EOMs of four pigs of different ages were prepared for light microscopic histochemical and immunohistochemical analysis and for transmission electron microscopy. RESULTS: GTOs and muscle spindles were numerous in pig EOMs. GTOs were found to be distributed in aponeurotic expansions of the distal and proximal EOM tendons, being more numerous in the distal aponeurosis than in the proximal aponeurosis. The total number of GTOs was higher in the recti EOMs (100-128) than in the oblique EOMs (45-61). Spindles were distributed over the entire muscle length. In each EOM the number of muscle spindles (142-333) exceeded those of GTOs. The morphology of the GTOs was variable. In addition to collagen bundles, approximately one third of the GTOs contained intracapsular muscle fibers that resembled the multiply innervated fiber type. Intracapsular muscle fibers entered the poles of the GTOs and either terminated inside the receptors in collagen bundles or exited the GTOs at the opposite poles. Nerve terminals were numerous in each GTO and established intimate contacts with collagen fibrils. CONCLUSIONS: Most structural particularities formerly observed in GTOs of rhesus monkey and sheep EOMs are also present in GTOs of pig EOMs. The high number of GTOs with their typical nerve terminals indicates functional importance. During muscle activity, afferent signals from GTOs and muscle spindles may provide sufficient information about eye position.

Clinical and economic outcomes in the hypertension and COPD arms of a multicenter outcomes study.

OBJECTIVE: To evaluate the impact of pharmaceutical care on selected clinical and economic outcomes in patients with hypertension or chronic obstructive pulmonary disease (COPD) in ambulatory care settings. DESIGN: Clinic patients with hypertension or COPD were randomly assigned to a treatment group (pharmaceutical care) or a control group (traditional pharmacy care) over a six-month period. Clinical pharmacists and pharmacy residents conducted the protocols. There were 133 evaluable patients (63 treatment and 70 control) in the hypertension study arm and 98 evaluable patients (43 treatment and 55 control) in the COPD study arm. SETTING: 10 Departments of Veterans Affairs medical centers and 1 academic medical center. INTERVENTIONS: Patient-centered pharmaceutical care model (employing standardized care) implemented by clinical pharmacy residents. MAIN OUTCOME MEASURES: Patient knowledge, medication compliance, and health resource use. RESULTS: The hypertension treatment group had a significantly greater reduction in systolic blood pressure from visit 1 to visit 5 than did the control group. In the COPD study arm, trends were positive in the treatment group for patients ratings of symptom interference with activities and dyspnea measures. There was a significant difference between the hypertension treatment and control group for compliance. There were no significant changes in compliance scores in the COPD study arm. Mean number of hospitalizations and other health care provider visits was higher for the hypertension control group. For patients with COPD, hospitalizations increased in the control group, and the number of other health care provider visits was higher in the control group. CONCLUSION: Pharmacists' participation in a pharmaceutical care program resulted in disease state improvement in ambulatory patients with hypertension and COPD.

Development, implementation, and evaluation of a multicenter pharmaceutical care outcomes study.

OBJECTIVES: To: (1) develop a pharmaceutical care multicenter outcomes research project using clinical pharmacy residents and preceptors; (2) develop two research protocols to document pharmacists' impact on clinical, economic, and humanistic outcomes of therapy; (3) develop and implement a data collection process and methodology for outcomes research; (4) evaluate the effectiveness of the multicenter outcomes research process; and (5) prepare clinical pharmacy preceptors and residents to conduct outcomes research. DESIGN AND SETTING: Two research protocols were developed, each a randomized, parallel, open-label evaluation of patients at 10 Department of Veterans Affairs and 1 university medical center. One protocol focused on patients with chronic obstructive pulmonary disease (COPD) and the other on patients with hypertension. The study evaluated pharmacists' management of these two patient groups. PATIENTS AND OTHER PARTICIPANTS: 133 patients with hypertension and 98 patients with COPD; 33 pharmacy directors and preceptors; 45 pharmacy residents. MAIN OUTCOME MEASURES: Clinical, economic, and humanistic outcomes of pharmacists' interventions. The processes of developing a multicenter outcomes study were evaluated, including the data collection process. RESULTS: The two study protocols and an educational program for study participants were developed. A data collection process was developed and implemented, with the paper process being successful and the computer data collection process not implemented due to time constraints. Overall, the multicenter outcomes research process was successful. CONCLUSION: The study provides a framework of processes and sites for the future development of other outcomes research studies. Clinical, economic, and humanistic outcomes are reported in Parts 2 and 3.

Humanistic outcomes in the hypertension and COPD arms of a multicenter outcomes study.

OBJECTIVE: To evaluate the effects of pharmaceutical care on selected humanistic outcomes in patients with hypertension or chronic obstructive pulmonary disease (COPD). DESIGN: Clinic patients with hypertension or COPD were randomly assigned to a treatment group (pharmaceutical care) or a control group (traditional pharmacy care) over a six-month period. Clinical pharmacists and pharmacy residents conducted the protocols. There were 133 evaluable patients (63 treatment, 70 control) in the hypertension study arm and 98 evaluable patients (43 treatment, 55 control) in the COPD study arm. The Pharmaceutical Care Questionnaire evaluated patient satisfaction with care. Tests specific to the disease states assessed disease and disease management knowledge. Quality of life (QOL) was evaluated using the Health Status Questionnaire 2.0 (HSQ 2.0) in the COPD arm; in the hypertension arm, the Hypertension/Lipid TyPE Specification Form 5.1 was used. SETTING: Ambulatory care centers of 10 Department of Veterans Affairs (DVA) medical centers and 1 university medical center. INTERVENTIONS: Patient-centered pharmaceutical care model (employing standardized care) implemented by clinical pharmacy residents. MAIN OUTCOME MEASURES: Satisfaction with pharmaceutical care, disease and disease management knowledge, and QOL. RESULTS: Statistically significant differences in most satisfaction items were found, with treatment patients expressing greater satisfaction. Treatment groups in both arms strongly agreed that pharmacists helped them with confidence in use of their medication and understanding of their illness, gave complete explanations about their medications, made them feel that their care was a priority, and followed up on their questions and concerns. In the hypertension arm, treatment patients demonstrated significant increases in knowledge scores. Trends in QOL were positive for both hypertension groups, with a significant decrease found in number of treatment patients reporting problems with sexual function. In the COPD arm, improvement trends were significantly stronger for treatment patients. CONCLUSION: Although patients were not dissatisfied with traditional pharmacy care, they were more satisfied overall with the pharmaceutical care model.

[Value of free, microvascular anastomosis of a small intestine transplant in reconstructive surgery following resection of T4 tumors of the upper aerodigestive tract]. / Die Wertigkeit des freien, mikrovasculär anastomosierten Dünndarminterponates in der Wiederherstellungschirurgie nach Resektion von T4-Tumoren des oberen aerodigestiven Traktes.

The jejunal graft with microsurgical vascular anastomoses is now recognised as one of the most reliable methods for reconstructing large and various defects of the upper aero-digestive tract. After resection of T4-tumours and reconstruction of phonation, deglutition and aesthetics 50% of our patients could be resocialized within the first postoperative month.

[A new method of surgical voice rehabilitation: microsurgical jejunum transplantation]. / Neue Methode zur chirurgischen Stimmrehabilitation: Mikrochirurgische Jejunum-Transplantation.

A new method of surgical rehabilitation of the voice is being presented. A shunt is introduced between the trachea and the hypopharynx or the entrance to the oesophagus, by the use of a jejunal graft which is sutured isoperistaltically. By microsurgical anastomoses the jejunum is revascularized by the cervical vessels. Seven patients, having undergone total laryngectomy because of carcinoma of the larynx, have been treated by this procedure. In one case a venous thrombosis developed and the graft had to be resected. The other patients regained a voice, able to meet all requirements of daily life. The voice shows a remarkable low phonatory pressure, a good modulation capacity and a phonatic duration of up to 20 seconds.

[Reconstruction of defects following pharyngolaryngectomy with free transplanted jejunum]. / Rekonstruktion von Defekten nach Pharyngo-Laryngektomie mit frei transplantiertem Jejunum.

We report 10 patients undergoing pharyngo-laryngectomy in whom the pharyngeal defect was reconstructed with a free jejunal graft. This method is technically demanding. The advantages are excellent healing due to the excellent blood supply of the edges of the graft, and the almost unlimited supply of jejunum. The use of this method is justified by the immediate restoration of deglutition.

Jejunal grafts for reconstructing a phonatory neoglottis in laryngectomized patients.

After laryngopharyngectomy and reconstruction of the upper digestive tract, a free jejunal graft can be anastomosed in an isoperistaltic direction end-to-end to the trachea and the hypopharynx in order to form a shunt for vocal rehabilitation. Following placement of the shunt, no special care is required nor does any patient show any aspiration. Because of a low-flow resistance of the shunt, patients so treated possess long-lasting phonation with loud and modulated voices.

[A new procedure for reconstruction of the voice--neoglottis of small intestine]. / Ein neues Verfahren zur Wiederherstellung der Stimme--Die Neoglottis aus Dünndarm.

The fundamental concept in vocal rehabilitation after laryngectomy is the tracheo-hypopharyngeal shunt. The usual contemporary methods possess numerous disadvantages. In order to improve the results a syphon-fashioned shunt with free transplanted jejunum between the tracheal stump and the hypopharynx is created (stimulated by K. Ehrenberger). Aspiration can be avoided by means of the autonomic peristalsis of the implant. The procedure has been performed in 7 cases. One developed necrosis of the loop. The other patients possess a clear voice.

[Late results of corrective surgery of prominent auricles]. / Spätergebnisse der Korrektur abstehender Ohrmuscheln.

In 87 persons who had to undergo plastic surgery of the auricle an evaluation was carried out of the motives for undergoing such surgery, on the one hand, and of the late results of the success of surgical intervention, on the other. The motives for undergoing surgery clearly suggest a significant psychological component, so that the intervention must most likely be regarded as a psycho-prophylactic measure. As concerns the results, it is striking that the evaluation given by the patients has been better (subjective evaluation) than that given by the doctors (objective evaluation), the subjective evaluation sometimes differing from the objective one.

The blood vessels of the limbus spiralis.

The capillaries of the spiral limbus in the cochlea of the laboratory rat were investigated under light and electron microscopy. A stereological examination of the capillary volumes of specimens injected with horseradish peroxidase was performed. The volume of capillaries amounted to 2.87%, and, as such, is very high. The ultrastructure of the capillaries showed continuous endothelial cells and basal laminae, discontinuous pericytes and varying relations towards the surrounding tissue. Morphological criteria, such as microvilli and plasmalemmal vesicles, suggest a significant transendothelial transport. The causes for the abundance of vessels in the spiral limbus are discussed: the transport of oxygen to the perilymph and the need of substances for the formation of the tectorial membrane seem to be important factors. The transport processes are obviously controlled by the endothelial cells as well as by the spiral limbus cells.

[Streptomycin-induced damage of the spiral ganglion]. / Zur Steptomycinschädigung des Ganglion spirale.

The neuronal density in the spiral ganglion was investigated in normal and in streptomycin-intoxicated guinea pigs. Streptomycin was administered in a dose of 250 mg/kg for 21 days. 6 weeks after the streptomycin exposure a histological examination revealed a decrease in ganglion cell density in the spiral ganglion, with maximum loss in the apical portion of the ganglion. As mechanisms of the ototoxic effect, a secondary degeneration of spiral ganglion cells after hair cell loss or a primary neurotoxic degeneration are discussed.

[Injuries of the oesophagus (author's transl)]. / Verletzungen der Speiseröhre.

34 cases of perforation of the oesophagus are reported, partly treated at the surgical and partly at the E.N.T. department. Air emphysema of the throat or of the mediastinum and/or escape of the contrast medium was observed in all patients. The main cause of perforation was endoscopic examination. The patients partly underwent conservative and partly surgical therapy, both groups showing similar mortality rates. Small perforations in the upper third of the oesophagus can be treated conservatively, whereas perforations in the lower two thirds, especially with involvement of the pleura, pericardium or peritoneum, need rapid surgical intervention, as the prognosis improves in relationship to the rapidity with which treatment is instituted following perforation.

[Vascularization of the ganglion spirale cochleae of the rat (author's transl)]. / Vaskularisation des Ganglion spirale cochleae der Ratte.

Investigation into the vascularization of the Ganglion spirale of the rat showed an irregular, loose network of capillaries, with a somewhat denser vacularization of the marginal areas of the ganglion; the horseradish peroxidase benzidine test according to Sugar was used to demonstrate the vessels. At least of the blood supply of the ganglion is effected via the vessels which run parallel to the nerve fibres through the osseous canals from the modiolus into the Rosenthal canal. The density of vascularization of the Ganglion spirale is surprisingly small, namely 1.89% by volume. The comparative figure for the Ganglion spirale, also measured by means of stereological methods, is approximately 6.8% by volume, whilst the vessels in the Nervus cochlearis occupy 2.1% by volume. The vascularization density of the ganglion corresponds roughly to that of the Cortex cerebri. Electro-microscopical tests have shown that there are unfenestrated capillaries with a small number of pinocytotic vesicles. Possible conclusions as to the permeability of the capillaries are discussed in the paper. The blood supply of the Ganglion spirale has so far received only little attention. In the case of internal ear diseases of vascular genesis, attention is mainly given to changes in the vessels of the lateral wall of the cochlea. Experimental findings, however, show the high sensitivity of the nervous apparatus of the cochlea in the case of disturbed blood supply.

[Speech discrimination and dynamic compression. A comparative study with hearing aids (author's transl)]. / Sprachdiskrimination und Dynamikkompression (Eine vergleichende Untersuchung mit Hörgeräten).

A hearing aid with dynamic compression and the very same one without dynamic compression were used for an examination of 13 patients with recruitment who were hard of hearing with respect to sound perception. The maximum degree of speech discrimination possible to be reached was determined. Although in general the hearing aid with dynamic compression yielded better results, the differences between the two aids were, however, small and showed a high scattering range. Thus, we have to draw the conclusion that the lacking 100% speech discrimination in the case of recruitment-positive disorders with respect to sound perception is not due to distorted sound volume dynamics.

[The capacity to destinguish changes in the intensity as a function of volume and frequency (author's transl)]. / Das Intensitätsunterscheidungsvermögen in Abhängigkeit von Lautstärke und Frequenz

Békésy audiometry equipment was used for investigations carried out in 15 test persons to study the intensity differentiation threshold. We tried to find the degree of intensity required to recognize given dB changes in the intensity. The results achieved very well coincide with those established by other authors. It was possible to statistically prove the volume dependence of the intensity differentiation threshold, it was, however, not possible to establish any frequency dependence. The relations of our result with the SISI test are under discussion.

[Cytostatic therapy in oto-rhino-laryngology (author's transl)]. / Zytostatika bei Tumoren im HNO-Bereich

The report covers the therapeutic results achieved after using cytostatic drugs in 104 patients treated at the 1st Oto-Rhino-Laryngological Univ. Hospital, Vienna, between 1967 and 1975. The breakdown according to the tumor histology shows that squamous cell carcinomas accounted for the highest per centage, i.e. 53%; laryngeal tumor prevails according to the tumor localization. In 42 patients it was not possible to positively influence the disease; 45 patients showed a disruption or a slowdown of the progress of the disease; in 17 patients all measurable criteria of the disease receded (classification according to Karnofsky). Even if the average survival time after the commencement of the therapy amounted to only about 6 months, it was nevertheless possible to positively influence the progress of the disease by means of cytosatic therapy.

On the acetylcholinesterase activity in the vestibular ganglion of the rat.

Acetylcholinesterase was demonstrated in the ganglion cells of the vestibular ganglion of the rat with Karnovsky's method. The acetylcholinesterase content was evaluated after a 24 hours incubation time by means of a three-grade scale. The cell size was determined by a particle size analyser. No correlation between the two values could be established. A comparison with the spiral ganglion showed a slightly lower acetylcholinesterase content in the vestibular ganglion. The content of acetylcholinesterase in the vestibular ganglion cells seems to be lower than in the spinal ganglion cells.