Demographic analysis of benign paroxysmal positional vertigo as a common public health problem

Background: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular problem. However, demographic analysis is few. Aim: The aim of this study was to document the demographic data of patients with BPPV regarding distribution of gender, age, associated problems, most common form, symptom duration, severity of nystagmus and cure rate. Subjects and Methods: A total of 263 patients with video‑nystagmography confirmed BPPV were enrolled in this retrospective study (2009‑2013). The data were collected in Anadolu Medical Center. Distribution of gender, age and affected side were reviewed. Associated problems were noted. Patients were analyzed according to the canal involvement, age, duration of symptoms, duration of nystagmus and recurrence. Mean values and standard deviations were calculated. One‑way ANOVA test was used for the analysis of the data (Statistical Package for the Social Sciences 17.0 version, IBM, Chicago, III, USA). Statistical significance was set at P < 0.05. Results: Women were affected more frequently than men (1:1.5). Comparative analysis of average age between the two gender groups was not statistically significant (P = 0.84). BPPV was common at middle age group. The incidence of affected side was not significant (P = 0.74). Posterior canal‑BPPV (PC‑BPPV) was the most leading one (129/263; 49%) followed by lateral canal (LC)‑canalolithiasis (60/263; 22.8%), LC‑cupulolithiasis (38/263; 14.5%) and superior canal‑BPPV (9/263; 3.4%). 55.1% of patients were defined as idiopathic (145/263). Associated problems were migraine (31/263; 11.8%), trauma (19/263; 7.2%), inner ear disorders (18/263; 6.8%) and other systemic problems (50/263; 19.1%). 72.6% of patients had symptoms <2 months (191/263). 23,6% of patients had intensive nystagmus lasting more than a minute regardless of canal involvement (62/263). 33% of patients required two or more maneuvers for the relief of symptoms (87/263). Conclusion: Symptoms are prone to recur in those of traumatic origin, associated inner ear problems and systemic disorders. As the prognostic factors are illuminated, preventive measures will be more effective and more patients will be cured properly.Keywords: Benign paroxysmal positional vertigo, Nystagmus, Semicircular cana

The nature of fibrous dysplasia

Fibrous dysplasia has been regarded as a developmental skeletal disorder characterized by replacement of normal bone with benign cellular fibrous connective tissue. It has now become evident that fibrous dysplasia is a genetic disease caused by somatic activating mutation of the Gsα subunit of G protein-coupled receptor resulting in upregulation of cAMP. This leads to defects in differentiation of osteoblasts with subsequent production of abnormal bone in an abundant fibrous stroma. In addition there is an increased production of IL-6 by mutated stromal fibrous dysplastic cells that induce osteoclastic bone resorption

A new model for the characterization of infection risk in gunshot injuries:Technology, principal consideration and clinical implementation

<p>Abstract</p> <p>Introduction</p> <p>The extent of wound contamination in gunshot injuries is still a topic of controversial debate. The purpose of the present study is to develop a model that illustrates the contamination of wounds with exogenous particles along the bullet path.</p> <p>Material and methods</p> <p>To simulate bacteria, radio-opaque barium titanate (3-6 μm in diameter) was atomized in a dust chamber. Full metal jacket or soft point bullets caliber .222 (n = 12, v₀= 1096 m/s) were fired through the chamber into a gelatin block directly behind it. After that, the gelatin block underwent multi-slice CT in order to analyze the permanent and temporary wound cavity.</p> <p>Results</p> <p>The permanent cavity caused by both types of projectiles showed deposits of barium titanate distributed over the entire bullet path. Full metal jacket bullets left only few traces of barium titanate in the temporary cavity. In contrast, the soft point bullets disintegrated completely, and barium titanate covered the entire wound cavity.</p> <p>Discussion</p> <p>Deep penetration of potential exogenous bacteria can be simulated easily and reproducibly with barium titanate particles shot into a gelatin block. Additionally, this procedure permits conclusions to be drawn about the distribution of possible contaminants and thus can yield essential findings in terms of necessary therapeutic procedures.</p

Immunologic abnormalities and surgical experiences in recurrent facial nerve paralysis

WOS: 000177918000028PubMed: 12218633Objective: To document immunologic findings in patients with recurrent facial paralysis (RFP) and to compare the results of the surgery with the results of medical treatment. Study Design: Retrospective case review. Setting: Tertiary care referral center. Patients: Nine patients with RFP were reviewed. Intervention: Patients underwent nonspecific antibody detection, protein electrophoresis (in blood and cerebrospinal fluid [CSF]) and oligoclonal band determination for immunoglobulin G, A, and M (in CSF). The extended subtotal facial nerve decompression via the transmastoid and transattic route was performed in four patients. Five patients received medical treatment only (steroids, vitamin 13). Results: Two patients had the complete and four patients had the oligosymptomatic form of Melkersson-Rosenthal syndrome. The other three patients were diagnosed with idiopathic RFP. Serum immunoglobulin G was high in seven of nine patients (77%). CSF protein electrophoresis demonstrated an elevated albumin fraction in six of nine patients (66%). CSF immunoglobulin G was high in four of nine patients (44%). The oligoclonal band in CSF was negative in all patients. Mean follow-up time was 5.2 +/- 2.6 years and 3 +/- 1.5 years for surgically treated patients and medically treated patients, respectively. None of the patients who underwent the surgery demonstrated recurrence. Although marked recovery was observed in patients who had received medical treatment, three of them had recurrence during the follow-up period. Conclusion: Serologic test results have demonstrated immune system involvement in cases of idiopathic RFP and in cases of Melkersson-Rosenthal syndrome, providing no distinction between the two. There was no sign substantiating local antibody production in CSF, which implies that the elevated antibodies in CSF were peripheral in origin. Although the serologic test results were not conclusive for a specific diagnosis, they support an immune-mediated pathogenesis. Despite the small number of patients who underwent the extended transmastoid facial nerve decompression, our follow-up data were suggestive for the prevention of recurrences

Acoustic impedance study of peritubal myoclonus

WOS: 000177014200007PubMed: 12206259An audible clicking sound coexistent with the contractions of the peritubal muscles is thought to be an isolated form of palatal myoclonus that presents with myoclonal contractions of the soft palate, larynx, pharynx and, sometimes, cervicofacial area. Acoustic impedance measurements, by demonstrating the relation between the muscle contract ions and the clicking noise, represent one of the ways in which the diagnosis can be confirmed. This paper reports the impedance changes following various maneuvers and simultaneous electromyography recordings in four patients with peritubal myoclonus and confirms the accuracy and simplicity of these tests. The pathology of peritubal myoclonus and its treatment options are discussed

Facial nerve paralysis due to chronic otitis media

WOS: 000176943300034PubMed: 12170164Objective: To present the characteristics of facial paralysis caused by chronic otitis media. The role of cholesteatoma. bony dehiscence, the duration of the disease, and the results of surgical therapy in facial paralysis were reviewed. Study Design: Retrospective case review. Setting: Tertiary care referral center. Patients: A total of 24 patients (6 women, 18 men: age range. 17-74 yr) with facial paralysis were included in the study. Intervention: Canal wall down mastoidectomy was performed in 14 patients (58.3%), modified radical mastoidectomy was performed in seven patients (25%), and intact canal wall mastoidectomy was performed in three patients (16.7%). All patients had decompression of the fallopian canal from the geniculate ganglion to the stylomastoid foramen without opening the epineural sheath. Results: Eighteen patients (75%) had gradual onset of facial paralysis. The most common associated symptom with facial paralysis was vertigo in six patients. Twelve patients (50%) had no associated symptoms. Facial paralysis was the sole complication in 2 1 patients (87.9%), Three patients had multiple complications, Labyrinthitis was the most common associated complication. Facial paralysis was associated with congenital cholesteatoma in one patient. Four-teen patients (58.3%) demonstrated dramatic recovery within 3 months after surgery. Intraoperatively. cholesteatomas were found in 17 of the patients (70.8%). The fallopian canal was intact in four patients (none of them had a cholesteatoma), and 20 patients had bone destruction or dehiscence (three patients had no cholesteatoma). The tympanic segment was the most common site of involvement in 14 patients (58.3%). Conclusion: A middle ear cholesteatoma was present in the majority of patients with facial paralysis caused by chronic otitis media, Gradual onset of facial paralysis was the most frequent pattern, Facial paralysis presented poor prognosis regardless of the presence of a cholesteatoma, There was no statistical difference among the results of surgical techniques