[Interdisciplinary management of chronic tinnitus (I)].
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Chronic Disease↗
Biomedical subjects
U Hoppe
Publications and source records attributed to U Hoppe.
Surgical repair of right-atrial aneurysm.
Atrial fibrillation and embolic events are the most common clinical symptoms of congenital right- or left-atrial aneurysms. We report an a case of righ-atrial aneurysm, in a patient with typical history of atrial fibrillation and history of stroke. The aneurysm was resected, but the patient suffered from acute embolic occlusion of the left anterior descending coronary artery on the fourth postoperative day despite of systemic heparinization with 300 IU/kg bw per 24 hours.
Anticoagulants↗
Coenzyme Q10, a cutaneous antioxidant and energizer.
The processes of aging and photoaging are associated with an increase in cellular oxidation. This may be in part due to a decline in the levels of the endogenous cellular antioxidant coenzyme Q10 (ubiquinone, CoQ10). Therefore, we have investigated whether topical application of CoQ10 has the beneficial effect of preventing photoaging. We were able to demonstrate that CoQ10 penetrated into the viable layers of the epidermis and reduce the level of oxidation measured by weak photon emission. Furthermore, a reduction in wrinkle depth following CoQ10 application was also shown. CoQ10 was determined to be effective against UVA mediated oxidative stress in human keratinocytes in terms of thiol depletion, activation of specific phosphotyrosine kinases and prevention of oxidative DNA damage. CoQ10 was also able to significantly suppress the expression of collagenase in human dermal fibroblasts following UVA irradiation. These results indicate that CoQ10 has the efficacy to prevent many of the detrimental effects of photoaging.
Antioxidants↗
[Outcome of hyperbaric oxygen therapy in therapy refractory tinnitus].
Although many studies are available concerning the treatment of sudden deafness using hyperbaric oxygenation, only a few of these deal with tinnitus. The aim of the present study was to evaluate the therapeutic use of hyperbaric oxygenation in cases of tinnitus. A total of 193 patients, having undergone primary intravenous hemorheologic therapy, were treated with hyperbaric oxygenation. Tinnitus was evaluated before, after ten sessions and after 15 sessions using a tinnitus questionnaire. Additionally, an audiometric examination was performed. Measurable improvements of the tinnitus occurred in 22% of the patients, whereas a moderate improvement was seen in 17% of cases. 10.4% showed an excellent improvement and tinnitus disappeared completely in two patients. The improvement rate decreased in those cases where the time from onset of tinnitus exceeded 40 days. In conclusion, hyperbaric oxygenation seems to be a moderately effective additional treatment in the therapy of tinnitus after primary hemorheologic therapy, provided the time from onset of tinnitus is less than 1 month.
Adolescent↗
[Modulation of oxidative stresses in human aging skin].
Oxidative stress (UV irradiation, free radicals) plays a significant role in aging. Coenzyme Q10 (CoQ10) and exogenously applied antioxidants can significantly reduce the formation of oxidative stress with increasing age. In our in vitro and in vivo experiments concerning the parameters of ultraweak photon emission (UPE), intracellular thiol status, mitochondrial membrane potential and cell vitality, we demonstrated a diminished resistance in keratinocytes of old donors against UV irradiation. This reduced epidermal resistance against oxidative stressors, i.e. UV irradiation, can be improved by topical application of CoQ10 and antioxidants like alpha-glucosylrutin (15). Furthermore, our in vivo investigations show that wrinkles around the region of the eyes ("crow feet") could be reduced by long-term application of CoQ10.
Aged↗
Ultraweak photon emission of human skin in vivo: influence of topically applied antioxidants on human skin.
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Adolescent↗
Two ceramide subfractions detectable in Cer(AS) position by HPTLC in skin surface lipids of non-lesional skin of atopic eczema.
The non-involved skin of atopic eczema (NEAE) is characterized by severe dryness and an impaired barrier function of the stratum corneum as indicated by an increased transepidermal water loss. Previous studies have demonstrated that this barrier impairment coincides with marked alterations in the amount and composition of stratum corneum ceramides. The aim of this study was to identify specific alterations in NEAE that may be used in the diagnosis of the atopic eczema. Using a classical procedure for high performance thin layer chromatography we could confirm earlier results: apart from Cer(EOH), which contains omega-hydroxy fatty acid (O) ester-linked to linoleic acid (E) and amide-linked to 6-hydroxy-4-sphingenine (H), the quantities of all ceramide fractions were significantly decreased. Furthermore, Cer(EOH)/Certotal was significantly increased, whereas the percentage of Cer(EOS), which contains sphingosine (S), and Cer(NP), which contains non-hydroxy fatty acid (N) amide-linked to phytosphingosine (P), were significantly decreased. Using a modified procedure for high performance thin layer chromatography we could demonstrate the formation of a double peak in the position of Cer(AS), which contains alpha-hydroxy fatty acid (A), in lipids of NEAE. The subfractions of the double peak comprised 15% and 12% of Certotal. MALDITOF mass spectrometry suggested that the double peak was formed by a homologous series of mono-hydroxylated and mono-unsaturated ceramides of different chain length, e.g., Cer(AS) subfractions containing either (C16,18) or (C22,24,26) alpha-hydroxy fatty acids. In contrast, in normal skin a single peak in Cer(AS) position, which comprised 22% of Certotal, was mainly formed by the long chain subfraction. In some cases this single peak displayed a small shoulder at its right flank, but never showed a clear peak separation when developed with NEAE samples. Furthermore, even in senile xerosis, or in either non-involved skin of psoriasis or seborrhoic eczema, only a single peak occurred in Cer(AS) position. Accordingly, the double peak might be specific for NEAE and turn out to be a marker for atopic eczema.
Ceramides↗
Determination of acute noise effects using distortion product otoacoustic emissions.
Because distortion product otoacoustic emissions (DPOAE) are the product of the effect of two sinus tones on the cochlea, a multitude of combinations regarding the amplitude and the frequency ratio of the primary tones exists. The goal of the present study was to directly compare different stimulus combinations described in the literature in the detection of acute noise trauma using DPOAE. In the present study, 13 volunteers were exposed for 1 h to noise that was equivalent to sound levels in a discotheque. Audiograms and distortion product otoacoustic emissions were measured before and after noise exposure using four different stimulus combinations. For three of these settings, L1 was 65 dB, L1-L2 was 25 dB and f2/f1 was varied and set to 1.22, 1.20 and 1.18. For the fourth setting, L1 was at 65 dB, whereas L1-L2 was at 10 dB (f2/f1 = 1.20). A second group of volunteers (n = 14) was measured using identical time periods and setting, but was not exposed to noise. The comparison of different stimulus combinations showed that the stimulus combination L1 = 65 dB and L1-L2 = 25 dB at f2/f1 = 1.18 was best suited for detecting a difference between noise-exposed and unexposed individuals.
Adult↗
Effect of gentian violet, corticosteroid and tar preparations in Staphylococcus-aureus-colonized atopic eczema.
BACKGROUND: In atopic eczema (AE), skin colonization with Staphylococcus aureus plays a possible role in the pathophysiology of the disease. METHODS: Thirty-eight patients with AE were screened for their cutaneous colonization with S. aureus. The antibacterial and clinical efficacy of topical therapy with the antiseptic dye gentian violet, a potent glucocorticosteroid or a tar solution (liquor carbonis detergens) was evaluated in vivo in 21 patients with a density of >10(4) CFU/cm(2) and in vitro. Skin sites were treated twice daily for 4 days with the active drug or a corresponding control. Quantification of S. aureus was done daily during therapy as well as 3 days thereafter. The severity of the lesions was rated by a regional SCORAD. RESULTS: In gentian-violet-treated skin, bacterial density decreased significantly in lesional (p < 0.001) and unaffected skin (p < 0. 001). Bacterial densities did not decrease during therapy with glucocorticosteroid or liquor carbonis detergens but dropped afterwards. All therapeutics reduced the severity score, reduction being greatest for the glucocorticosteroid and lowest for liquor carbonis detergens. In vitro, a high antibactericidal efficacy was demonstrated only for gentian violet. CONCLUSIONS: Antibacterial therapy with gentian violet not only reduces S. aureus dramatically, but also reduces the severity of the eczema. Reduction of S. aureus after therapy with glucocorticosteroids and LCD seems to be secondary to improvement of the skin condition.
Administration, Topical↗
Semiquantitative chemiluminescent detection of UV-B-induced point mutations in the p53 tumor-suppressor gene.
The technique of allele-specific PCR (AS-PCR) enables the detection of a small number of mutant alleles in a large number of wild-type (WT) alleles. We used the AS-PCR technique and Southern blotting, using a nonradioactive labeled probe to analyze the formation of point mutations in the tumor-suppressor gene p53 of primary keratinocytes after UV-B irradiation. These permanent mutations resulting from CC dimers occur at distinct "hot-spots", one of which is affected in the human keratinocyte cell line HaCaT. This enabled us to establish the method with a defined positive control template, which also allowed semiquantitative determination of the mutation frequency. This, and the determination of the detection limit, was done with the use of serial dilutions of WT genomic DNA from primary keratinocytes with mutant genomic HaCaT DNA in the AS-PCR assay.
Alleles↗
[Johanson-Blizzard syndrome. A complex dysplasia syndrome with aplasia of the nasal alae and inner ear deafness].
BACKGROUND: The Johanson-Blizzard syndrome is a rare autosomal recessive syndrome with ectodermal dysplasia. ENT findings in the syndrome include profound bilateral hearing loss, aplasia of the alae nasi and dental malformations. To date approximately 30 cases have been described. CASE REPORT: We report our findings in a female patient who was born as the second child of consanguine parents. Pregnancy was normal, birth weight 3620 g and body length 52 cm. She was hospitalized immediately after birth because of anal atresia and facial dysmorphism with aplastic alae nasi, mongoloid eye slant and slightly dystopic ears. Bilateral symmetric profound hearing loss was diagnosed by subjective hearing tests and confirmed by auditory evoked brainstem potentials. Otoacoustic emissions were absent. Hearing aids were successfully fitted. Other malformations were a duplex of the uterus and vagina and exocrine pancreatic insufficiency. The anal atresia was corrected surgically. DISCUSSION: In general, the exocrine pancreatic insufficiency in the Johanson-Blizzard syndrome requires careful medical management. The aplastic alae nasi require no specific therapy, while in our case in the hearing loss could be treated with hearing aids.
Abnormalities, Multiple↗
Kinetics of DNA strand breaks and protection by antioxidants in UVA- or UVB-irradiated HaCaT keratinocytes using the single cell gel electrophoresis assay.
The aim of this study was to characterize the genotoxic action of UVA and UVB in human keratinocytes by application of the single cell gel electrophoresis assay (SCGE assay). Dose dependence of DNA damage, the time course of its repair, and the influence of cellular antioxidant status were assessed. Irradiation with UVA or UVB both resulted in a dose-dependent increase in the level of DNA damage. A time course study to evaluate the repair kinetics in keratinocytes irradiated with 5 J/cm2 UVA revealed an immediate occurrence of DNA effects which subsequently disappeared within about 1 h, indicating removal of DNA lesions. This rapid repair of DNA damage is consistent with the observation that 5 J/cm2 UVA did not impair cellular viability. In contrast, exposure to 15 mJ/cm2 UVB resulted in a prolonged repair of DNA damage which lasted about 25 h. Thus, the repair kinetics of UVA- and UVB-induced DNA damage clearly differed from each other, implicating the induction of different types of DNA lesions by UVA and UVB. Neither a pretreatment with Mg-ascorbyl phosphate or D,L-alpha-tocopherol, nor depletion of endogenous glutathione altered cellular sensitivity to UVB. In contrast, the DNA damaging effects of UVA could be counteracted by a pretreatment with these antioxidants. These observations confirm that the UVA-induced effects on DNA are related to radical mediated strand breaks and DNA lesions forming alkali-labile sites. The UVB-induced effects mainly occur as a consequence of excision repair-related strand breaks. The observed repair kinetics of DNA lesions and the influence of cellular antioxidant status may help to elucidate protective mechanisms against the carcinogenic effects of UV radiation present in sunlight.
Antioxidants↗
[Auditory speech-evoked cerebral cortex potentials in patients with stuttering syndromes].
BACKGROUND: The cause of stuttering is unknown. For clinical purposes it proved to be useful to assume a multifactorial genesis with organic psychological and social aspects. A longstanding organic theory focussed on the failure to develop left-hemispheric dominance for speech, whereas others favoured deficits of the speech motor system. Positron emission tomography (PET) studies support organic theories for the development of stuttering. The purpose of this study was to find out whether in stutterers auditory cortical potentials evoked by pure tones, noise and words are different to those of healthy controls. PATIENTS AND METHODS: 10 young adults having suffered from stuttering since infancy were examined. The potentials were measured and analysed as previously described. RESULTS: No correlation of clinical and electrophysiological findings were found. In one case the evoked potentials were normal, in all other patients heterogeneous results were obtained in respect of tone-evoked and both noise- and speech-evoked potentials. Cortical hemispheric differences could be detected. CONCLUSIONS: In agreement with PET findings reported in the literature the data obtained in this study indicate an organic, central nervous cause of stuttering. Obviously both speech motoric components and perception elements are affected. These facts have to be taken into account whenever a psychological cause of stuttering is suspected. Nevertheless, psychosomatic aspects of the disturbances must be considered since they influence the patients' ability to cope with their symptom.
Adolescent↗
Butyrylcholinesterase antisense transfection increases apoptosis in differentiating retinal reaggregates of the chick embryo.
To investigate the roles of the enzymes butyryl- and acetylcholinesterase (BChE and AChE) in retinal proliferation and differentiation, we use reaggregated spheres from retinal cells of the 6-day-old chick embryo, forming cellular and fibrous areas homologous to all layers of a normal retina. Recently, we could suppress BChE expression by transfecting these so-called retinospheroids during their proliferation period with a pSVK3 expression vector containing a 5' fragment of the rabbit BChE gene in antisense orientation. Along with morphological changes, proliferation was significantly decreased. Here, we have studied the effect of antisense BChE suppression during the differentiation period of retinospheroids. As BChE is suppressed, the differentiation of AChE-positive cells is increased, whereas the immunoreactivities for red and green cone-specific opsins are strongly reduced. Concomitantly, the rate of apoptosis as determined by propidium iodide uptake, by increased CPP 32-like caspase expression, and by terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling and DNA fragmentation assays is roughly doubled, predominantly at the expense of degenerating photoreceptor precursors. This is further strong evidence that the proliferation marker BChE regulates an intricate balance between cell proliferation, cell differentiation, and programmed cell death in this in vitro retinal system.
Acetylcholinesterase↗
Induction of IL-15 messenger RNA and protein in human blood-derived dendritic cells: a role for IL-15 in attraction of T cells.
IL-15 is a pleiotropic cytokine with IL-2-like functions. As IL-15 was shown to be mitogenic for T cells, we wondered whether human blood-derived dendritic cells (DC), as the primary stimulators of T cell responses, are able to produce IL-15. To test our hypothesis, DC were grown under serum-free conditions from human peripheral blood using granulocyte-macrophage CSF and IL-4. Cultures were assayed for IL-15 mRNA production at various times by semiquantitative reverse transcription-PCR. Low baseline signals were detected from days 0 to 5 of culture. A significant increase was detected from days 5 to 9 of the culture. When DC were further enriched by immunomagnetic beads to >98% purity as determined by CD83 staining, IL-15 mRNA signals were exclusively found in the CD83+ fraction. This increase in mRNA signals was paralleled by IL-15 protein release from days 9 to 12 as detected by CTLL-2 assay and ELISA. In addition, protein levels were increased >10-fold by adding paramagnetic beads to the cultures, thereby inducing phagocytic activity. Furthermore, DC supernatants were tested for chemokinetic and chemotactic activities for T cells in a checkerboard filter assay. It was shown that supernatants express chemokinetic and chemotactic activity for T cells. This activity was blocked almost completely by addition of an anti-IL-15 mAb. Our data show that human blood DC contain IL-15 mRNA and produce functional protein that is induced in culture. Protein release is triggered by phagocytic activity. Furthermore, DC-derived IL-15 has chemotactic and chemokinetic activities for T cells, suggesting a role for IL-15 as an attractant of T cells during the initial DC/T cell interaction.
Cells, Cultured↗
[Chronic tinnitus in children and adolescents].
BACKGROUND: The problem of tinnitus in adults is reviewed systematically in nearly all standard otolaryngology reference works, whereas textbooks and monographs that focus on pediatric otorhinolaryngology or audiology and hearing in children and adolescents provide only little information concerning the epidemiology, etiology and therapy of tinnitus. The purpose of this study was to evaluate the psychosomatic aspects of chronic tinnitus in this younger age group. A rational diagnostic approach is discussed as to which diagnostic measures are necessary in the pediatric group for deciding which therapeutic option to chose. The therapeutic outcome of tinnitus counselling in non-severe cases and of parenteral lidocaine infusions in cases of a troublesome tinnitus is presented. PATIENTS AND METHODS: From January 1992 to December 1995, 31 children and adolescents in the age range from 6 to 17 years were treated for a chronic tinnitus without a measurable hearing loss. In 20 cases the tinnitus was bilateral; in 11 cases it was unilateral, without side preference. In 24 patients the case history gave no hint of a major annoyance by the tinnitus or significant psychological components. In these cases tinnitus counselling was carried out. In 7 cases-3 girls and 4 boys in the age range from 10 to 17 years-the kind and grade of symptom satisfied the ICD-10 criteria of a depressive episode. These patients were hospitalized for 10 days and a lidocaine infusion therapy (2 mg/kg Xylocain Cor in 500 ml HAES 6%) was performed as treatment for the somatic component of the disorder. Data were analyzed catamnestically using the patients' files. RESULTS: In all cases normal hearing threshold and speech intelligibility were ascertained by pure-tone and speech audiometry. Auditory evoked brainstem potentials gave no further information. The measurement of transient evoked otoacoustic emissions gave no consistent results in either of the two groups. Tinnitus measurement and audiometric masking could only be carried out in patients older than 10 years and showed non-reproducible results. In all cases with no major symptoms tinnitus disappeared. During a follow-up of 12-44 months, 4 cases treated with lidocaine achieved complete remission; in 3 cases the tinnitus eased off to such an extent that it was no longer regarded as annoying. In one girl of the lidocaine group a somatisation disorder developed independently of the tinnitus and was treated by psychotherapy. No side-effects of the lidocaine occurred. CONCLUSIONS: All aspects of chronic tinnitus in children and adolescents can be covered best when regarding this symptom as a psychosomatic disorder. The diagnostic approach in this age group has to include a detailed case history embracing both organic and psychological and social aspects. It should also include pure-tone and speech audiometry. Only in cases with an uncertain hearing threshold auditory evoked brainstem potentials have to be measured. Otoacoustic emissions give no further information about the development and therapeutic outcome of the tinnitus. In this age group tinnitus measurement and masking is of no diagnostic value. In patients with no signs of a hearing loss and no other organic symptoms there is no need for further diagnostic measures such as imaging or serological investigations. In cases with severe annoyance, tinnitus counselling is sufficient therapy. In cases with severe symptoms, lidocaine infusion therapy may be a therapeutic option for the somatic component of the disorder. In adolescents with chronic tinnitus psychotherapy will be necessary only in rare cases. The overall prognosis of this disorder is good.
Adolescent↗
Regulation of cholinesterase gene expression affects neuronal differentiation as revealed by transfection studies on reaggregating embryonic chicken retinal cells.
In the embryonic chicken neuroepithelium, butyrylcholinesterase (BChE) as a proliferation marker and then acetylcholinesterase (AChE) as a differentiation marker are expressed in a mutually exclusive manner. These and other data indicate a coregulation of cholinesterase expression, and also possible roles of cholinesterases during neurogenesis. Here, both aspects are investigated by two independent transfection protocols of dissociated retina cells of the 6-day-old chick embryo in reaggregation culture, both protocols leading to efficient overexpression of AChE protein. The effect of the overexpressed AChE protein on the re-establishment of retina-like three-dimensional networks (so-called retinospheroids) was studied. In a first approach, we transfected retinospheroids with a pSVK3 expression vector into which a cDNA construct encoding the entire rabbit AChE gene had been inserted in sense orientation. As detected at the mRNA level, rabbit AChE was heterologously overexpressed in chicken retinospheroids. Remarkably, this was accompanied by a strong increase in endogenous chicken AChE protein, while the total AChE activity was only slightly increased. This increase was due to chicken enzyme, as shown by species-specific inhibition studies using fasciculin. Clearly, total AChE activity is regulated post-translationally. As an alternative method of AChE overexpression, transfection of spheroids was performed with an antisense-5'-BChE vector, which not only resulted in the down-regulation of BChE expression, but also strongly increased chicken AChE transcripts, protein and enzyme activity. Histologically, a higher concentration of AChE protein (as a consequence of either AChE overexpression or BChE suppression) was associated with an advanced degree of tissue differentiation, as detected by immunostaining for the cytoskeletal protein vimentin.
Animals↗
[Speech-specific cortical potentials--methodologic aspects and initial clinical results].
BACKGROUND: The purpose of this study was to find out whether specific cortical potentials can be evoked and identified after word stimulation. The clinical relevance was to be investigated in patients with aphasic syndromes. MATERIALS AND METHODS: In 20 young adults with no signs of hearing impairment and in patients with manifest aphasic syndromes, word-evoked cortical potentials were compared with those after an equivalent noise stimulus. The test words were selected from the Freiburger Speech Comprehension Test. The duration of the words was between 450 and 640 ms. The stimulus was presented monaurally. The peak level was 70 dB HL. The noise stimulus was produced by modifying a low-band noise. Potentials were measured between the ipsilateral mastoid and the contralateral forehead. Data were analysed offline. RESULTS: In healthy persons, the potentials after word and noise stimulation did not differ until 100 ms after the stimulus onset. After noise stimulation a negative maximum could be seen 100 ms after the stimulus onset, and a positive maximum 200 ms after the stimulus onset. After word stimulation, a positive maximum of higher amplitude than after noise stimulation was measured 150 ms after the stimulus onset, and a negative maximum was measured 270 ms after the stimulus onset. In all test persons the difference curve of word-and noise-evoked potentials revealed a speech-specific component 170 ms (N 170) after the stimulus onset. The single-word analysis showed that the potentials depend on the phonemes of the test word. The potentials do not alter when the stimulus side is changed. In patients with aphasia the potentials depend on the grade of the disturbance of speech perception: global and Wernicke's aphasia show no significant difference of speech-and noise-evoked potentials, whereas in Broca's aphasia a speech specific maximum is apparent. CONCLUSION: The speech-specific component may be regarded as a paradigm of cortical speech detection processes. Electrophysiological speech audiometry by means of word-evoked cortical potentials seems possible and may be used for clinical purposes.
Adult↗