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Aims: The observation that low total cholesterol predicted poor survival in patients with chronic heart failure, has questioned the beneficial effect of lipid-lowering in this population. This study investigated the relation between lipoprotein concentrations and the levels of interleukin (IL)-6, tumour necrosis factor (TNF)-alpha and the soluble TNF-alpha receptors in patients with chronic heart failure due to coronary artery disease (CAD) or idiopathic dilated cardiomyopathy (IDCM)., Methods and Results: Seventy-one patients with chronic heart failure due to CAD (n=36) or IDCM (n=35) were enrolled. Plasma concentrations of lipoproteins, IL-6, TNF-alpha, soluble TNF-alpha receptor 1 (sTNFR1) and 2 (sTNFR2) were measured. Total cholesterol/HDL-cholesterol (CHOL/HDL) correlated with levels of TNF-alpha (r=0.24, P=0.035), sTNFR1 (r=0.32, P=0.008) and sTNFR2 (r=0.37, P=0.002). In the CAD group, CHOL/HDL and triglycerides (TG) correlated with sTNFR2 (r=0.48, P=0.005 for CHOL/HDL, r=0.40, P=0.015 for TG). No relation was found between lipoproteins and cytokines or sTNF-alpha receptors for IDCM patients (P>0.1)., Conclusions: An atherogenic lipid profile favoured the inflammatory process in patients with heart failure due to CAD. No relation between lipoproteins and cytokines was detected in case of IDCM.

Unlabelled: Target-controlled infusion (TCI) of rocuronium can be used to maintain a stable blood concentration (Cp). At steady-state, the pharmacokinetics (PK) are compensated for by TCI, and a stable effect can be observed. The theoretical Cp may represent effect-site concentration (EC). We used the EC-effect relationship to study pharmacodynamics (PD) in infants, children, and adults. After giving their written, informed consent, 14 infants, 23 children, and 21 adults scheduled for elective surgical procedures received 3 to 6 ascending Cp targets of TCI rocuronium according to PD data. Just before each increase of TCI, venous blood samples were taken to measure Cp. Neuromuscular block was evaluated acceleromyographically. Individual effect data and measured Cp were fitted to the Hill equation. Maximum block during TCI targets-1000, 1300, and 1600 ng/mL-was smaller in children in comparison with infants and adults. The concentration in the effect compartment associated with a 50% drug effect (EC(50)) was significantly smaller in infants (mean [SD]) (652 [215] ng/mL) than in adults (954 [276] ng/mL) and was the largest in children (1200 [295] ng/mL). Calculated mean EC(90) values were 1705, 2230, and 2035 ng/mL, respectively, in infants, children, and adults. TCI rocuronium established steady-state PK/PD at different TCI targets and allowed us to define PK/PD relationships in a standardized way. Steady-state TCI rocuronium revealed the most potency of rocuronium in infants and the least in children., Implications: Target-controlled infusion (TCI) of rocuronium in infants, children, and adults was used to analyze the pharmacokinetic/pharmacodynamic relationship. Steady-state TCI rocuronium revealed the most potency of rocuronium in infants and the least in children.

In this study, the effect of age, sex, and disorder on the vocal performance of 230 children 6 to 11 years of age was investigated by means of the voice range profile (VRP). Ninety-four control children and 136 children with disorders were studied. The VRPs were quantitatively described by frequency and intensity characteristics, as well as by morphological characteristics. Significant differences between healthy children and children with disorders were found. Age has a different effect in girls than in boys regarding vocal performance. Most of the characteristics for the healthy girls change gradually over the period from 6 to 11 years. For the healthy boys, however, two age groups can be identified: one below and one above 8 years of age. It is hypothesized that the androgen dehydroepiandrosterone (DHEA) and its sulfate may play a role in this phenomenon.

In 76 teachers with persisting voice problems, the maintaining factors and coping strategies were examined. Physical, functional, psychological and socioeconomic factors were assessed. A parallel was drawn to a psychological cascade model designed for patients with chronic back pain. The majority of the patients were found to be in a deadlocked situation (phase 1 of the cascade model), for which the combination of externalization and unawareness of the situation is the main risk factor. Subjective rating of the voice problem was assessed by the Voice Handicap Index (VHI) and a visual analogue scale (VAS). Patients in phase 1 of the cascade model showed higher VHI and VAS scores compared with the other patients. For a high VHI score, the combination of socioeconomic factors and being in phase 1 was the most important risk factor. Socioeconomic factors were the most important risk factors for a high VAS score. We introduce the term 'chronicity', which means that the problems are maintained, the patient finds himself in a deadlocked situation, and is sliding down into a chronic disease. 'Chronicity' is essentially different from 'chronic', which refers only to the duration of the disease. We consider maintaining factors and (inadequate) coping factors, which consist of emotional/psychological, physical and socioeconomic aspects, as indicators for chronicity., (Copyright 2003 S. Karger AG, Basel)

The authors report a prospective five-year follow-up study of 52 patients who had arthroscopic subacromial decompression for advanced (stage II: type 1 and 2) rotator cuff disease. All patients were assessed preoperatively, at six months and at five years postoperatively using the Constant-Murley score and the revised American Shoulder and Elbow Surgeons (ASES) score. From six months until five years postoperatively, 45 (out of 52) patients showed a further progressing improvement and relief of symptoms. This is established by a significant (p < 0.001) increase of the mean Constant-Murley score from 76.4 at six months postoperatively to 84.9 at five years postoperatively.

Knowledge of the exact distance between the utricles is important in new vestibular tests, such as the unilateral centrifugation (UC) test for the unilateral examination of the utricles. During this test, subjects are rotated at constant velocity and simultaneously laterally displaced along an interaural axis so that one labyrinth becomes aligned with the axis of rotation. When the axis of rotation crosses precisely through one labyrinth, only the opposite labyrinth is stimulated. To achieve this setup, precise knowledge of the interutricular distance is needed. The purpose of this study is to investigate the correlation between the interutricular distance (IUD), measured on T2-weighted magnetic resonance images, and specific external measures of head dimensions such as distance nasion-inion, intermastoid distance (IMD), distances between the temporomandibular joints and between the lateral margins of the orbits. Data have been collected in a series of 50 subjects (25 men and 25 women). On MR images we found a mean IUD of 7.22 cm (SD = 0.42 cm). There was a strong correlation between the IUD measured on MR images and the intermastoid distance. A linear combination of the IMD, nasion-inion distance and height of the subjects could predict the IUD very satisfactory (R = 0.85, adjusted R2=0.723). We also determined a measure of eccentricity of the vestibular labyrinths. The 95% prediction interval for the asymmetry appeared to be less than 4.3%.

Utricular sensitivity and preponderance of the right or left utricle can be assessed by means of the unilateral centrifugation test. In this test, subjects are rotated about an earth vertical axis at a velocity of 400 degrees per second. During the ongoing rotation, the subject is gradually translated 4 cm first to the right, and then to the left, along an interaural axis, to a position at which one utricle becomes aligned with the axis of rotation, and at this point is subjected only to gravitational forces. At this eccentric position, the contralateral utricle is exposed to the combination of gravity and a centrifugal acceleration of 0.4g, corresponding to an apparent roll-tilt of 21.7 degrees. This stimulus induces ocular counterrolling (OCR), which is measured on-line using three-dimensional video-oculography (VOG). We observed that ocular counterrolling appears as a linear function of the gravito-inertial acceleration tilt of the head centre (GIA(HC)) during the lateral translation. We present a theoretical model for this linear relationship that contains two parameters: 1) the slope of the linear regression is a measure for the utricular sensitivity and 2) the intercept of the linear regression is a measure of the preponderance of the right or left utricle. The strength of the model is supported by data obtained from 28 healthy subjects and 14 patients with unilateral vestibular deafferentiation (UVD) due to acoustic neuroma surgery.

The main purpose of the present acoustical study was to delineate further the changes in nasal resonance in childhood and young adulthood. An additional objective was to collect reference nasal resonance scores for normal Flemish-speaking children. Scores were recorded with a Nasometer while 33 children produced sounds and read three standard passages. We compared the nasal resonance data from the children with those of 58 adults that had been obtained in a previous study. Age had a significant effect on three sounds and two texts. The results indicated that young Flemish adults had higher nasal resonance scores than children, particularly when the reading stimuli included nasal consonants for which a co-ordinated opening and closing function of the velopharyngeal mechanism was required. These results reflect anatomical changes and differences in speech programming associated with growth.

Normative voice range profiles (VRPs) are calculated for a group of untrained boys and girls between 6 and 11 years based on 35 and 39 recordings, respectively. All individuals had healthy voices. These normative VRPs contain 95% prediction intervals (PI) for both frequency and intensity. They are based on a series of mathematical transformations of the original individual VRPs in order to maintain in the normative VRPs the typical oval VRP shape including the dip between modal and falsetto register. The presented normative VRPs are directly applicable in the clinical practice of otolaryngologists and speech-language pathologists.

The voice quality of 86 occupational voice users, i.e., students of a high school for audiovisual communication, was assessed by means of a multidimensional test battery containing: the GRBAS scale, videolaryngostroboscopy, maximum phonation time, jitter, lowest intensity, highest frequency, dysphonia severity index (DSI), and voice handicap index (VHI). In a questionnaire on daily habits the prevalence of smoking, eating habits, and vocal abuse were recorded. A comparison of the voice characteristics of the future occupational voice users with a control group revealed significant differences. The results of the VHI and the DSI of these students revealed significantly worse scores than the score of a control group characterized by no vocal complaints. Moreover, the questionnaire on daily habits showed that the future elite vocal performers and professional voice users take less precautions for the care of their voices. These findings support the importance of a good balanced vocal coaching.

The main purpose of this study was to measure and compare the effect of an unilateral cleft lip and palate (UCLP) and a bilateral cleft lip and palate (BCLP) on overall speech intelligibility, nasalance and nasality. An additional objective was to compare the nasalance and nasality patterns of cleft palate children with the available normative data for normal children. The subjects were 37 children with an UCLP (19/37) or a BCLP (18/37) with normal cognitive and motor functions and normal hearing levels. All subjects had a non-syndromic cleft, followed the same surgical protocol and did not undergo secondary pharyngeal surgery. To measure and compare the effect of cleft type, objective and subjective assessment techniques were used. For the objective assessment of nasal resonance the nasometer and the mirror-fogging test were used. Nasalance scores were obtained, while patients produced sounds, read three standard passages or repeated sentences focusing on specific consonants. A perceptual evaluation of speech, the Gutzmann (1913) test and the tests of Bzoch (1989) were used as subjective assessment techniques. The perceptual assessment of the overall speech intelligibility was based on the spontaneous speech and reading or repeating of the nasometric sentences. These samples were judged by three speech pathologists using a 4-category nominal scale. A subjective test (Morley, 1945) was used to evaluate the velopharyngeal mechanism. The findings of the present study show no statistically significant differences for nasalance values, nasality and overall speech intelligibility between the UCLP and BCLP children. Significant differences were found between the data of the normal group and the cleft palate children. These differences included nasalance values as well as nasality data and overall speech intelligibility., (Copyright 2002 S. Karger AG, Basel)

Normative voice range profiles (VRP) are calculated for a group of male and female teachers, based on 43 and 46 recordings, respectively. All individuals had healthy voices. These normative VRPs contain 95% prediction intervals for both frequency and intensity. They are based on a series of mathematical transformations of the original individual VRPs in order to maintain in the normative VRPs the typical oval VRP shape, including the dip between modal and falsetto register. The normative VRPs presented are directly applicable in the clinical practice of otolaryngologists and speech-language pathologists.

Objective: To report the clinical, auditory, and vestibular characteristics of a nonsyndromic otovestibular dysfunction in a large Belgian family caused by a missense mutation of the DFNA9 gene: COCH., Study Design: Retrospective study of the clinical, audiologic, and vestibular data of 60 genetically affected cases., Setting: Tertiary referral center., Patients: All members of a Belgian kindred who carry the genetic (P51S) defect linked to the inherited hearing and vestibular impairment., Interventions: Diagnostic otologic, audiometric, and vestibular analysis and imaging., Main Outcome Measures: Pure tone audiometry, supraliminary audiometry. and vestibular investigation., Results: The autosomal dominant inherited impairment was characterized by peripheral degeneration of the inner ear, leading to total deafness and bilateral vestibular areflexia., Conclusions: The genetically affected persons of a Belgian family shared a progressive sensorineural hearing loss starting between the third and sixth decade. Vestibular symptoms started at about the same age as the hearing loss. The vestibular symptoms consisted of instability in darkness, a tendency to fall sideways, light-headiness, a drunken feeling, and attacks of vertigo. Most of the patients reported tinnitus, and half of them reported pressure in the ears. Clinically, 9 of the 60 patients met the criteria for definite Ménière's disease, and another 13 and 17 patients met the criteria for probable or possible Ménière's disease, respectively. All 9 were older than the age of 35, but only 1 was older than 55 years, so more than 30% of the patients were between 35 and 55 years old. A specific pattern could be recognized in the evolution of the otovestibular impairment. Under the age of 35 years, almost all the affected family members had normal hearing, whereas above the age of 55 years, the hearing loss was at least moderate, and vestibular hypofunction occurred. In between, there was a transition period of two to three decades, when deterioration of the cochleovestibular function occurred, with a temporary audiometric and vestibular asymmetry.

Objective: The purpose of this study was to obtain normative nasalance scores for adult subjects speaking the Flemish language. Additional objectives of the study were to determine if speaker sex played a role in differences in nasalance scores and if significantly different nasalance scores existed for Flemish compared with other languages or dialects., Design: Nasalance scores were obtained while young Flemish adults read three standard nasalance passages. These passages were an oronasal passage (a text that contained the same approximate percentage of nasal consonants as found in the standard Dutch speech), an oral passage (a text that excluded nasal consonants), and a nasal passage (a reading text loaded with nasal consonants)., Participants: Subjects included 58 healthy young Flemish adults with normal oral and velopharyngeal structure and function, normal hearing levels, normal voice characteristics, and normal resonance and articulation skills., Methods: The Nasometer (model 6200) was used to obtain nasalance scores for the three reading passages. These three reading passages were designed specifically for use with the nasometer. The nasalance data were analyzed for sex dependence, using Student's t test for each reading passage. This same test was used for comparison of our data with data of other languages., Results: Normative nasalance data were obtained for the oronasal text (33.8%), the oral text (10.9%), and the nasal text (55.8%). Female speakers exhibited significantly higher nasalance scores than male speakers on the passages containing nasal consonants (normal text, p = .001; nasal text, p = .042). Furthermore, statistically significant cross-linguistic nasality differences were observed. The English and Spanish languages were found to have more nasalance than the Flemish language. For the North Dutch and Flemish languages, this cross-linguistic phenomenon was absent., Conclusion: These normative nasalance scores for normal young adults speaking the Flemish language provide important reference information for Flemish cleft palate teams. Sex-related differences and cross-linguistic differences were shown.

Electrocochleographic recordings of action and summating potentials are widely used in the electrophysiological assessment of endolymphatic hydrops (ELH). Increased amplitudes of the summating potential (SP) in response to tone burst stimuli are indicative of positive ELH. This study reports the effect of repetition rate of tone burst stimulation on the SP amplitude. Using transtympanic electrocochleography (ECochG), the SP in response to 1 kHz tone bursts was recorded in both a Ménière and a non-Ménière population. Absolute values of the SP were systematically higher in the Ménière group. Moreover, in the Ménière and non-Ménière groups, the response amplitudes of the SP at a repetition rate of 8.4 tone bursts/s were only 66 and 32%, respectively, of the maximal response amplitude which was obtained at the rate of 37.4 tone bursts/s. Additionally, in normal guinea pigs chronically implanted with a round window electrode, the SP was recorded to 0.5-16 kHz tone burst stimulations presented at 100 dB SPL with the same different repetition rates. Similar enhancement of the SP amplitude was observed from 8.4 to 37.4 stimuli/s, whatever the frequency. This effect is interpreted as an increased asymmetry of vibration of the cochlear partition, whose mechanical operating point would not return to the normal resting position at high repetition rates, since it is permanently shifted in ELH.

The response of the vestibular system after acoustic neuroma surgery was investigated in nine patients. The otolith system was studied by means of ocular counterrolling, assessed by video oculography. Horizontal vestibulo-ocular reflex (VOR) function was tested by the sinusoidal harmonic acceleration test using electronystagmography. The results were compared with those obtained from a normal control population. The response to slow rotation tests was symmetric, but the gain was significantly reduced when compared to the normal population. Phase lag was significantly increased. No difference in ocular torsion was observed with lateroflexion of the head to the ipsilateral side in comparison with lateroflexion to the contralateral side. Moreover, the overall ocular counterrolling was well within normal limits. We conclude that the semicircular canal response differs from the otolith response. The component of the torsional VOR mediated by otolith stimulation appears to be more robust than the horizontal VOR mediated mainly by the horizontal semicircular canal system. Ocular counterrolling induced by lateroflexion does not reveal abnormalities in patients with surgically produced unilateral peripheral loss.

The aims of this study were, firstly, to provide a formula (neurogenic index) based on MR characteristics used in daily routine for predicting whether a soft tissue tumor is neurogenic or not, secondly, to test prospectively the performance of this formula, and thirdly, to compare this performance with that of radiologists experienced in MR imaging of soft tissue tumors. Retrospectively, MR images of 70 neurogenic and 70 non-neurogenic soft tissue tumors were evaluated in random order by two teams of two observers each. A neurogenic index (NI) was calculated based on those MR parameters that showed no or minor interobserver variability. Subsequently, three investigators in concert used the NI in a validation group of 15 neurogenic and 22 nonneurogenic soft tissue tumors. The same team, based on their own experience, tried to differentiate in the same validation group neurogenic from non-neurogenic soft tissue tumors. This was expressed in a subjective score (SS). Sensitivity, specificity, and predictive values were calculated. NI comprised spread (intra- or extracompartmental), distribution, fluid-fluid levels, homogeneity on T2-weighted images (WI), highest signal intensity (SI) on T1WI, lowest SI on T2WI, and delineation on T2WI. In the validation group, NI had a sensitivity of 88.6%, a specificity of 52.0%, a positive predictive value (PPV) of 54.1%, and a negative predictive value (NPV) of 84.6% for neurogenic tumors. The subjective score SS was superior and had a sensitivity of 93.3%, a specificity of 77.2%, a PPV of 73.7%, and a NPV of 94.4%. Our NI was less accurate than the SS; however, the low number of false-negative diagnoses for neurogenic tumors warrants continued efforts in development of neural networks.

Objective: To measure the effect of 4 different matching strategies on the accuracy of computer navigation on the face and within the nose and rhinopharynx., Design: Survey., Setting: Laboratory study., Subjects: Six human cadavers studied within 24 hours of death., Interventions: A commercially available navigation system with infrared optical tracking was used for computer navigation on the face and within the nose of the subjects after matching with external fiducials or with 3 different configurations of anatomical landmarks. Navigation errors were measured and correlated to matching strategies and compared through statistical analysis., Results: Matching with external fiducials on the face results in smaller navigation error than matching with anatomical landmarks. The configuration of matching strategies with anatomical landmarks also significantly determines the accuracy of computer navigation, especially when different locations of accuracy measurement are considered., Conclusion: Statistically significant findings have shown that the choice of a matching strategy is a major factor in the accuracy of computer navigation for ear, nose, throat surgery. Arch Otolaryngol Head Neck Surg. 2000;126:1462-1466

Background/aims: The major complication of extracapsular cataract extraction (ECCE) is posterior capsule opacification (PCO). Posterior continuous circular capsulorhexis (PCCC) seems to be very promising in preventing PCO. This study was aimed at determining if the PCCC area changes as a function of time and if pearl formation could influence it., Methods: 24 eyes of 23 patients underwent ECCE with PCCC. Retroillumination photographs were taken at 6 months and then yearly. To measure the PCCC area, the computerised program EPCO (evaluation of posterior capsule opacification) was used. The ratio of the PCCC area in relation to the IOL surface was calculated for the different time stages and the presence of pearl formation was noted. Firstly, proportional changes in diameter were compared in PCCC areas measured after 6 months and after 1 year (group I, n=13) and after 1 year and 2 years (group II, n=14). Secondly, PCCC areas were compared between two time stages in patients with (group III, n=19) and without pearl formation (group IV, n=8)., Results: No statistically significant difference was found in diameter change in either group. The PCCC area remains stabile between 6 months to 1 year and 1 year to 2 years. No differences are found between eyes with or without pearl formation., Conclusions: The PCCC area remains stable as a function of time and is not influenced by pearl formation.

Objective: To compare the outcome of emergency and elective haemorrhoidectomy., Design: Retrospective study., Setting: Teaching hospital, Belgium., Subject: 104 patients who had haemorrhoidectomy for acutely ulcerated or strangulated haemorrhoids, and 545 who had elective haemorrhoidectomy., Results: Early complications (26/104, 25%), reoperation (7/104, 7%) and late anal stenosis (7/104, 7%) were more common after emergency than elective haemorrhoidectomy, for which the corresponding figures were 74/545 (3.6%), 9 (1.7%) and 1/545 (0.2%). Late outcome was similar for the two groups., Conclusions: Emergency haemorrhoidectomy is indicated for the treatment of the acute complications of haemorrhoids.

Objective: To report the otologic and audiometric characteristics of a nonsyndromic postlingual sensorineural hearing impairment in a Belgian family linked to DFNA10., Study Design: Retrospective study of the otologic and audiometric data of 17 genetically affected persons., Setting: Tertiary referral center., Patients: All members of a Belgian kindred who carried the haplotype linked to the inherited hearing impairment of DFNA10., Interventions: Diagnostic otologic and audiometric analysis., Main Outcome Measures: Pure-tone audiometry., Results: To find the frequencies that were most affected by the genetic defect, the excess hearing loss of the 17 patients was calculated per frequency in comparison with the respective p50 and p95 thresholds of the normal population., Conclusions: The genetically affected persons of a Belgian family shared a progressive symmetric sensorineural hearing loss that started in the first to fourth decade. Thirty-five percent of the affected family members had tinnitus, and only one patient had very mild vestibular complaints. At onset, hearing losses were mainly situated at the midfrequencies. With increasing age, all frequencies became affected. The hearing loss was initially mild, with a spontaneous evolution to a moderate or severe hearing impairment. The progression of the hearing loss for the pure-tone average (between 0.5 and 4 kHz) was 1.08 dB/year for this family, compared with 0.50 dB/year and 0.35 dB/year at the 95th and 50th percentiles of the normal population, respectively.

This study provides normative data from computerized electronystagmography (ENG) testing of 40 healthy subjects with an average age of 45 years. The clinical test protocol comprises an extensive vestibular examination with oculomotor, positional, rotary chair and caloric tests. The results show that with a computerized ENG set-up considerable variabilities of 22% for rotary chair asymmetry and 19% for caloric labyrinth asymmetry remain.

The vocal quality of a patient is modeled by means of a Dysphonia Severity Index (DSI), which is designed to establish an objective and quantitative correlate of the perceived vocal quality. The DSI is based on the weighted combination of the following selected set of voice measurements: highest frequency (F(0)-High in Hz), lowest intensity (I-Low in dB), maximum phonation time (MPT in s), and jitter (%). The DSI is derived from a multivariate analysis of 387 subjects with the goal of describing, purely based on objective measures, the perceived voice quality. It is constructed as DSI = 0.13 x MPT + 0.0053 x F(0)-High - 0.26 x I-Low - 1.18 x Jitter (%) + 12.4. The DSI for perceptually normal voices equals +5 and for severely dysphonic voices -5. The more negative the patient's index, the worse is his or her vocal quality. As such, the DSI is especially useful to evaluate therapeutic evolution of dysphonic patients. Additionally, there is a high correlation between the DSI and the Voice Handicap Index score.

Perceptual evaluation of 14 pathological voices was performed by 29 listeners using the GRBAS scale. To evaluate scale effects on the judgments, 2 versions of the scale were presented: the original 4-point scale and a visual analog scale. Each listener used the same voice samples for both versions of the scale with an interval of 2 weeks. Agreement was found to be higher with the original 4-point scale than with the visual analog version for all scale items G, R, B, A and S. Although a visual analog scale seems to enable a finer judgment of voice quality, this study showed that, with increased freedom of judgment, the interrater agreement decreased considerably. Therefore, we recommend the use of the original 4-point version of the GRBAS scale.

Introduction: The effect of the antiangiogenic agent suramin on the healing of colonic anastomoses was studied in a rat model., Methods: Rats underwent an end-to-end colonic anastomosis and its healing was tested by measuring bursting pressure, hydroxyproline content and number of newly formed vessels. For the bursting pressure experiment suramin was given intraperitoneally in a dose of 200 mg/kg (maximal tolerable dose) and 100 mg/kg. Hydroxyproline content and vessel density were only tested at 100 mg/kg since the toxicity at this dose was lower whereas bursting pressure was still diminished., Results: There were no deaths. On the fourth day after operation bursting pressure in the control group was significantly higher than that in rats treated with suramin 200 mg/kg (P = 0.006) and 100 mg/kg (P = 0.002). Rupture occurred at the anastomotic line. On day 7, this difference was not statistically significant. Four days after the operation, the hydroxyproline content and vessel density were significantly below that in control segments (hydroxyproline: 10.3 versus 7.8 microg per mg dry weight; vessel content: 85.7 versus 49.6 vessels per x 100 field for control and suramin-treated rats respectively). On the seventh day no difference in hydroxyproline levels was seen but the vessel density was still diminished significantly (P = 0.04)., Conclusion: Experimentally, suramin significantly inhibits and delays healing of colonic anastomoses. Presented in part to the XXXII Congress of the European Society for Surgical Research in Corfu, Greece, May 1997

We report the genetic analysis of one large Belgian and two small Dutch families with autosomal dominant non-syndromic progressive sensorineural hearing loss associated with vestibular dysfunction. Linkage studies in the Belgian family mapped the disease to the DFNA9 locus on chromosome 14. Mutation analysis of the COCH gene, which is responsible for DFNA9, revealed a missense mutation changing a highly conserved residue. One of the patients, who had an earlier age of onset in comparison with most of the affected family members, was shown to be homozygous for the mutation. After the mutation was found in the Belgian family, we discovered that the same missense mutation was also present in two Dutch families with similar cochleo-vestibular symptoms. In all three families with hearing loss and imbalance problems, >25% of the patients showed additional symptoms, including episodes of vertigo, tinnitus, aural fullness and hearing loss. Clinically, these symptoms are consistent with the criteria for Menière's disease. The importance of genetic factors in Menière's disease has been suggested on many occasions, but this study is the first report of a mutation in a gene leading to the symptoms of Menière's disease in a significant portion of the carriers. The COCH gene may be one of the genetic factors contributing to Menière's disease and the possibility of a COCH mutation should be considered in patients with Menière's disease symptoms.

Mesna (Mistabron) is a mucolytic substance that is also used for chemically assisted dissection during cholesteatoma surgery. The present animal study aims to evaluate its possible ototoxic side effects. To this end, the right tympanic cavity of 9 guinea pigs was filled with either 20% mesna or 10% neomycin (serving as a positive control), while the left tympanic cavity was filled with saline (serving as a negative control). One week after administration, the inner ears were dissected out and further processed for morphological evaluation by means of either interference contrast microscopy or scanning electron microscopy. No macroscopic signs of middle ear inflammation were observed in any of the ears treated. Whereas damage was obvious in all neomycin-treated specimens, the morphology of both saline- and mesna-treated inner ears was unaffected. These findings led us to conclude that, at least on a morphological basis, no indications are at hand to assume ototoxic effects of this mucolytic substance due to a single application during cholesteatoma surgery.

The influence of two static head positions on the horizontal nystagmus induced by sinusoidal rotational stimulation in a group of 24 healthy subjects was investigated. The rotation test was performed with the subject's head in the primary position (upright) and with the head 30 degree pitched down. Computerized electronystagmography was used to measure the maximum slow component velocity of the horizontal nystagmus and to calculate gain, phase and asymmetry. The vestibulo-ocular reflex (VOR) gain obtained during rotation with the head in the primary position was significantly higher than with the head bent 30 degree forward. No other significant differences were found.

The present prospective study, based on a series of 12 male patients managed with supracricoid partial laryngectomy with cricohyoidoepiglottopexy (SCPL-CHEP), was designed i) to compare the perceptual and acoustic parameters before surgery and at 6 months after sugery, ii) to evaluate the evolution of the perceptual and acoustic parameters between 6 and 18 months postoperatively, and iii) to determine the correlations between the perceptual and acoustic parameters preoperatively and at 18 months postoperatively. The roughness was found to be significantly worsened after SCPL-CHEP. The jitter, shimmer, noise-to-harmonic ratio, and degree of voiceless increased significantly after SCPL-CHEP. Neither acoustic nor perceptual parameters varied significantly between 6 and 18 months postoperatively. Preoperatively, a strong statistical correlation was found between grade, roughness and strain and all acoustic parameters but F0. Breathiness was statistically correlated with all acoustic parameters but jitter. Postoperatively the only statistical correlation noted was between roughness and F0.

The aim of the study was to develop a scoring system for outcome classification at the start of prehospital first tier resuscitation for patients with cardiac arrest from ventricular fibrillation (VF). We studied a consecutive sample of 100 out-of-hospital cardiac arrest patients, presenting with VF of presumed cardiac etiology on arrival of the first tier (in a two-tiered urban Emergency Medical Services system). The number of patients discharged was 29 ('survivors') and 71 died ('non-survivors'). The electrocardiography (ECG) tracings recorded during resuscitation using a semi-automatic defibrillator were retrospectively analysed. For each patient, VF amplitude in mV (VF&#95;a) and the number of base-line crossings per second (VF&#95;blc) were calculated. Fisher's linear discriminant analysis was applied to discriminate between survivors and non-survivors using the variables VF&#95;a, VF&#95;blc and age. Patients were classed as potential survivors or non-survivors using a survival index = 0.6*(VF&#95;a) + 0.4*(VF&#95;blc)-4.0. If for a given patient the survival index is < 0, he is classified in the non-survivor group, if the survival index is > 0, he is classified in the survivor group. Using this index 79% of the survivors and 70% of the non-survivors could be classified correctly. Adding age to the formula increased the correct classification of survivors to 86 and 73% for the non-survivors. The survival index provides a research tool for the discrimination between potential survivors and non-survivors, which opens the possibility for the development of alternative treatment protocols in cardiac arrest.

Perceptual evaluation was performed by means of the GRBAS scale for a series of nine pathological voice samples that were presented twice to a group of 23 judges, consisting of experienced and inexperienced otolaryngologists (ENTs) and speech-language pathologists (S/LPs). The time interval between ratings was 14 days. Test-retest reliability was moderate. The best agreement between the observers was obtained for the G (grade) parameter and the worst for the S (strained) parameter. Considering the medians of the GRBAS ratings, no significant influence was measured for level of experience or professional background. Yet, based on means, the results show that professional background has a greater impact on perceptual rating than experience.

A review of the literature on selective vestibular neurectomy for Meniere's disease is presented. The procedure is placed in historical context and current refinements of the technique are highlighted. In particular, the different methods of evaluating results on vertigo, hearing, tinnitus, aural pressure and imbalance are summarised. The controversy over the indication, timing and outcome measures for selective vestibular neurectomy is discussed. In experienced hands there appears to be a low complication rate, emphasising the value of this procedure in relieving intractable vertigo when a destructive procedure is indicated.

The statolith ocular reflex induced by whole body roll was assessed in 10 patients with Meniere's disease who had undergone a standard vestibular test battery. Normal eye torsion was noted in 4 patients despite the presence of severe symptoms, and a caloric hyporeflexia in one patient. Eye torsion was diminished in one direction of body roll in 4 patients and in both directions of body roll in 2 patients. An abnormal asymmetry of eye torsion (> 16%) was found in the case of body roll towards the normal ear irrespective of whether a caloric asymmetry was found. An abnormal asymmetry of the statolith ocular reflex seems to indicate the side with the functional hearing loss. The results suggest that Meniere's disease might involve pathology of the statolith system. However, the absence of abnormal eye torsion does not imply normal vestibular function.

This review describes the practicalities of using both the inner Ear Profile to define hydrops labyrinthi, and the American Academy of Otolaryngology and Head and Neck Surgery (AAO-HNS) guidelines to define Meniere's disease. The requirement for standardisation is stressed since either system alone may be inadequate. It is suggested that the Inner Ear Profile could be adapted to the AAO-HNS criteria to create a unified method of evaluation.

This paper reviews the literature on instrumentation settings used for transtympanic (TT-ECOG) an extratympanic electrocochleography (ET-ECOG). There is wide variation regard to the applied stimulus, the settings and interpretation of ECOG results. For most physicians, the presence of endolymphatic hydrops is indicated either by the summating/action potential (SP/AP) ratio for click stimuli or the SP amplitude after tone bursts. Different upper limits have been proposed to discriminate hydropic from non-hydropic ears. Based upon a meta-analysis and classification criteria obtained from multivariate statistics, the authors propose that an SP/AP ratio with click stimulation > 0.35 using TT-ECOG, or > 0.42 using ET-ECOG, is indicative of hydrops. With tone burst stimulation set at a repetition rate of 30-40 stimuli per second, a SP of < -2 microV using TT-ECOG for at least one frequency within the range 0.5-8.0 kHz is considered pathologic.

Phonetography has been defined by SCHUTTE and SEIDNER in 1983. Nevertheless publications on phonetography go back to the thirties. Due to publications in the last decade and the development of computer phonetography this testing method has been used for various purposes in voice evaluation. This article gives a historical background, with the different ways of phonetogram recording and describes variables who have their effect on phonetogram results and interpretation. Secondly the range of application with normative and reference phonetograms is discussed.

The consent about the necessity of perceptual evaluation in the assessment of patients with voice disorders is almost unanimous. This is not the case with regard to the method or scale. This article gives an outline of historical backgrounds and presents a survey of contemporary perceptual rating scales. Reliability and influencing factors are discussed and recommendations are made with respect to clinical use.

A new structural model is described for the tension-radius relationship of blood vessels, taking into account their mechanically important constituents: collagen, elastin and smooth muscle. The model has four characteristic parameters: EC, the Young's modulus of the collagen fibres; ESE, the Young's modulus of the combined smooth-muscle/elastin network; epsilon mu, the amount of strain at which the high stiffness region on the tension-radius curve is reached, and eta an indicator for the degree of collagen fibre stretching. The structural stiffness of the wall constituents is reflected by EC and ESE whereas the global stiffness of the entire blood vessel is described by epsilon mu and eta. All these elasticity parameters are pressure independent, in contrast to generally quoted values for the incremental modulus or vascular compliance which are strongly pressure dependent. Hence, an objective comparison of the mechanical properties for various types of blood vessel, based on the present model parameters, has been made possible. The model was successfully fitted to tension-radius data of 65 human aortas, age range 30-88 years, with moderate or severe atherosclerosis. The structural as well as the global stiffness changes with age, e.g. collagen stiffness shows a ninefold increase over 60 years. Global stiffness depends on atherosclerosis.

For many years, the high prevalence of the fragile X syndrome was thought to be caused by a high mutation frequency. The recent isolation of the FMR1 gene and identification of the most prevalent mutation enable a more precise study of the fragile X mutation. As the vast majority of fragile X patients show amplification of an unstable trinucleotide repeat, DNA studies can now trace back the origin of the fragile X mutation. To date, de novo mutations leading to amplification of the CGG repeat have not yet been detected. Recently, linkage disequilibrium was found in the Australian and US populations between the fragile X mutation and adjacent polymorphic markers, suggesting a founder effect of the fragile X mutation. We present here a molecular study of Belgian and Dutch fragile X families. No de novo mutations could be found in 54 of these families. Moreover, we found significant (P < 0.0001) linkage disequilibrium in 68 unrelated fragile X patients between the fragile X mutation and an adjacent polymorphic microsatellite at DXS548. This suggests that a founder effect of the fragile X mutation also exists in the Belgian and Dutch populations. Both the absence of new mutations and the presence of linkage disequilibrium suggest that a few ancestral mutations are responsible for most of the patients with fragile X syndrome.

Intima formation in vessels, spontaneous or experimentally induced, is generally characterized by the presence of longitudinally oriented smooth muscle cells (LSMC). During an experiment of neo-intima induction in carotid arteries in rabbits, by application of a non-constrictive silastic cuff, a study was performed to investigate the presence of LSMC in the systemic and pulmonary circulations, in both elastic and muscular arteries. Three patterns could be distinguished: intimal cushions in muscular arteries, single or small groups of LSMC in the intima in elastic and larger muscular arteries, and intra-medially located layers or columns of LSMC in the aorta, the pulmonary artery, at the bifurcation of the aorta and around orifices of branches. In order to understand this peculiar orientation a biomechanical approach was used: this showed that near the lumen the circumferential stress is 4.5 times higher than the longitudinal. Because the cell surface of the smooth muscle cells exposed to this stress per unit vessel length is much less in the longitudinal than in the circular direction we conclude that the LSMC align in the direction which allows them to cope most effectively with the mechanical stresses.