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Biomedical subjects

R Mösges

Publications and source records attributed to R Mösges.

At least 19 recordsLinked to original sources
PubMed2007

[The RHINASTHMA-Quality of Life Scale German Adapted Version: validation of a new disease specific quality of life scale for patients suffering from allergic rhinitis and bronchial hyperreactivity].

BACKGROUND: In 2003 Baiardini et al. presented the RHINASTHMA questionnaire, which measures the impairment of quality of life in patients with rhinitis and asthma and takes the "united airway disease" model into its account. The aim of our study was to create a valid version of this questionnaire adapted for use with German-speaking subjects. METHODS: Datasets recorded for 85 patients were analysed for sensitivity, reliability and validity of the new questionnaire. For this purpose, as well as the symptom scores, disease-specific and generic quality of life questionnaires were also used as a measure of validity. RESULTS: A correlation analysis and Cronbach's alpha indicated that the RHINASTHMA scale is satisfactory from the aspect of reliability. Good validity was also shown in terms of discrimination and agreement for all items and scores. In addition, all the observed parameters reacted sensitively to clinical improvements of the health status. CONCLUSION: The RHINASTHMA questionnaire makes it possible to determine how badly the quality of life is impaired by rhinitis and asthma, based on the paradigm of "united airway disease".

Adolescent↗
PubMed2004

[Gastroesophageal reflux disease and chronic sinusitis].

BACKGROUND: It is increasingly suggested that there may be a connection between gastrooesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR) and chronic sinusitis. We therefore wished to establish whether the literature contains sufficient evidence to support this assumption. MATERIAL AND METHODS: We performed a search in Medline (PubMed) and EMBASE with the key words "GERD, GER, reflux, sinusitis, chronic sinusitis". The literature obtained was assessed with regard to the reported results and their evidence levels. The level of evidence was classified according to the usual levels I - IV, only levels Ia or Ib being considered sufficient evidence for a knowledge gain confirmed by therapeutic trials. RESULTS: A total of 77 references were found in Medline and 142 in EMBASE. A large number of these were narrative review articles addressing the connection between GERD or sinusitis and asthma or GERD or sinusitis and chronic cough. Only 12 papers and one case report dealt more or less directly with the question of a connection between chronic sinusitis and reflux. None of the studies could be classed as evidence level I (randomised controlled trials), ten were classed as level III studies, one as level IIb and one as level IV. DISCUSSION AND CONCLUSIONS: The existing studies do not allow us to pinpoint LPR (and even less so GERD) as a clear-cut factor in the aetiopathogenesis of chronic sinusitis. However, despite all their deficiencies and limitations the studies nevertheless do show that reflux into the pharynx and nasopharynx is possible. This reflux (= LPR) can lead to chronic inflammation which can be successfully treated with antireflux therapy with proton pump inhibitors. Quantification of the association is not currently possible. An above-average proportion of the patients with chronic rhinosinusitis appear to have GERD/LPR. However the prevalence of GERD in the population is generally high. It has not yet been established with sufficient certainty whether the LPR must be regarded as a causative factor, whether it exacerbates or chronifies the disease or whether it is merely an epi-phenomenon which does not require specific treatment. To answer this important question we need prospective randomised controlled studies which will provide evidence of sufficient quality. These should be conducted with the help of standardised documentation.

Adolescent↗
PubMed2003

[The Cologne internet-manual of pain therapy--33 months online, experiences and evaluation].

OBJECTIVE: The improvement of ambulant treatment for patients with chronic headache or cancer pain. METHODS: Distribution of accepted guidelines and standards by means of the internet in order to make this knowledge known among general practitioners and to give patients better access to this information. RESULTS: We have built an internet manual about the treatment of chronic headache and cancer pain. About 9100 readers accessed the manual during a period of 33 months. The manual has been completely downloaded 279 times. Physicians and patients very often used search engines to access the manual in their search for information about headache. The terms "migraine" and "tension type headache" were looked up the most. CONCLUSIONS: It is worthwhile editing medical information for use on the internet and thus making it available to the public.

Ambulatory Care Facilities↗
PubMed2003

[Cluster-immunotherapy in seasonal allergic rhinitis: safety aspects of induction therapy with depot allergoids (Purethal)].

BACKGROUND: Specific immunotherapy (SIT) represents the only specific treatment that can be offered to allergic patients apart from allergen avoidance. SIT has been widely used in pollen allergic rhinitis. Clinical efficacy has been demonstrated in several controlled clinical trials and depends on the specific allergen the individual patient is sensitive to, the quality and total amount of allergen applied, and the SIT schedule. In classic SIT, gradually increasing dosages of the allergen extract are injected subcutaneously. Several dosage schedules for subcutaneous SIT can be applied. In Cluster-SIT, 2 - 3 injections per day of treatment are given once a week during induction treatment. PATIENTS: In this study, we investigated 64 patients (33 female, 31 male) from 18 to 54 years (26.9 +/- 5.1 years) in terms of side-effects of Cluster-SIT during induction treatment. RESULTS: The total amount of enlarged local reactions (> grade 1) was n = 77 or 15.2 % of all injections. Of these, 68 (88 %) were classified as immediate reactions, 8 (11 %) were late phase reactions and 1 (1 %) was immediate as well as late phase reaction. Of all enlarged local reactions, 48 (62 %) were grade 1 reactions, 13 (17 %) were grade 2 reactions, 13 (17 %) were grade 3 reactions and 1 (1 %) was a grade 4 reaction. The total amount of systemic reactions was n = 22 or 4.3 % of all injections. Of these, 19 (86 %) were classified as immediate reactions, 3 (14 %) were delayed reactions. Of all systemic reactions, 18 (82 %) were grade 1 reactions and 4 (18 %) grade 2 reactions. Grade 3 or grade 4 reactions did not occur. There were no differences in gender or age regarding the occurrence of side effects (all p > 0.05). CONCLUSIONS: Frequency and severity of adverse side effects in Cluster-SIT correspond to those in other dosage schedules. On behalf of security aspects, Cluster-SIT could become an interesting alternative dosage schedule for dose increase during SIT. Furthermore, in Cluster-SIT with allergoids, induction treatment can be carried out in two treatment days of approximately 2.5 hours each.

Adolescent↗
PubMed2003

Effects of dimethindene maleate nasal spray on the quality of life in seasonal allergic rhinitis.

OBJECTIVE: To determine if the H1-receptor antagonist dimethindene maleate (DMM), topically applied, is able to improve the quality of life (QoL) in patients with seasonal allergic rhinitis better than placebo. METHODS: The study was a multi-centre, randomised, placebo-controlled, double-blinded phase III trial including 157 patients. Two parallel groups received either DMM nasal spray or placebo for 2 weeks. Patients answered 5 QoL questionnaires (Rhinoconjunctivitis QoL Questionnaire (LQ-AR), Munich Life Dimension List (MLDL), Profile of Mood States (POMS), 2 Visual Analogue Scales (VAS-QoL, VAS-GES)) on days 1, 4, 8, and 15. RESULTS: QoL improved significantly in all scales and groups. Statistically significant differences between groups were achieved in the sub-scales LQ-AR Eye Symptoms and Daily Activities, MLDL Total, POMS Depression and Energy, VAS-QoL and VAS-General Health. All differences favoured the DMM group and were present initially but disappeared in visit 4, except MLDL Total and POMS Energy. Almost all other scores had a better tendency of DMM. CONCLUSION: A significant improvement of QoL was found in both groups. Only weak differences between groups (in favour of DMM) were found. There are several reasons explaining this outcome, mainly the rainy weather during the study period (mean weather index 10-20% less sunny than in previous seasons).

Administration, Intranasal↗
PubMed2001

Effect of treatment with Ginkgo biloba extract EGb 761 (oral) on unilateral idiopathic sudden hearing loss in a prospective randomized double-blind study of 106 outpatients.

OBJECTIVE: Test of dose-response relationship for Ginkgo biloba extract EGb 761 (oral) in outpatients with acute idiopathic sudden sensorineural hearing loss (ISSHL) of at least 15 dB at one frequency within the speech range occurring less than 10 days before study inclusion. DESIGN: Multicentre, randomized, double-blind phase III study comparing dosages of 120 mg twice daily and 12 mg twice daily over 8 weeks. MAIN ENDPOINT: Recovery (in dB) of the auditory threshold from the initial measurement to the value on the last day of treatment, averaged over those frequencies from 0.25, 0.5, 1, 2, and 3 kHz for which the initial hearing loss amounted to 15 dB or more compared to the level on the opposite side. PATIENTS: 106 patients with an average age of 44+/-16 years and with hearing loss at affected frequencies 26 dB +/- 9 dB included between December 1995 and July 1997. RESULTS: Large majorities of both treatment groups recovered completely. In exploratory analyses of the 96 patients included according to the protocol, patients given the higher dose had less risk of not recovering well (< or =10 dB residual hearing loss) (one-sided Fisher test: P = 0.0061), especially if they had no tinnitus (n = 44, P = 0.00702). CONCLUSION: A higher dosage of EGb 761 (oral) appears to speed up and secure the recovery of ISSHL patients, with a good chance that they will recover completely, even with little treatment. This was already observed after one week of treatment. We find it justified to treat patients who have unilateral ISSHL of less than 75 dB and neither tinnitus nor vertigo with 120 mg oral EGb 761 twice daily.

Acute Disease↗
PubMed2001

Generic or disease-specific quality of life scales to characterize health status in allergic rhinitis?

BACKGROUND: In patients with allergic rhinitis (AR), various instruments have been validated for the measurement of quality of life (QOL), which may be greatly reduced. However, it is not clear which QOL instruments should be used for the different types of AR and whether they are sensitive to treatment. METHODS: The QOL of patients suffering from symptomatic seasonal AR (sSAR) (before and during treatment with a topical or systemic antihistamine), symptomatic perennial AR (sPAR), and asymptomatic seasonal AR (aSAR) was determined with the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) as disease specific and with the Munich Life Dimension List (MLDL) and the Visual Analogue Scale for Quality of Life (VAS-QOL) as generic QOL instruments. RESULTS: The different forms of AR were associated with typical QOL patterns. In sSAR, we found severe limitation of the global QOL, reduced global life satisfaction, high ranking of practical problems, high limitation of activity, and a high degree of disturbance in all subscales of the RQLQ. In sPAR, there were moderate limitation of the global QOL, normal global life satisfaction, high ranking of practical problems, moderate limitation of activity, and a high degree of disturbance by common symptoms. Under antihistamine treatment, both systemic and nasal, a significant improvement of QOL parameters was found, reaching the levels of patients with aSAR after 2 weeks. CONCLUSION: QOL instruments can distinguish the impairment resulting from sSAR from that of sPAR and are sensitive to treatment with topical and systemic antihistamines. However, as the RQLQ was not designed to measure the short-term variations of disease status that appear in SAR, it may not demonstrate the rapid improvement of QOL under antihistamine treatment.

Adult↗
PubMed2000

["Notebook computer" in combination with WWW-technology in multicenter clinical trials and for chronic patient care].

Our purpose was to determine conditions, under which the use of hand-held computers in the diagnosis and therapy of patients with chronic diseases seems to be handy. Two scenarios are presented showing the employment of these computers in a doctor's office and in multicenter clinical trials. Security-related aspects involved in transferring medical data via the internet are discussed.

Chronic Disease↗
PubMed1999

A new method for the placement of brachytherapy probes in paranasal sinus and nasopharynx neoplasms.

PURPOSE: In afterloading therapy, the exact placement of the applicator is crucial for the result of radiotherapy. A deviation of few millimeters from the target leads to a significant reduction of radiation energy to the tumor. METHODS AND MATERIALS: We present a new method using a computer-assisted device for three-dimensional placing of afterloading probes based on CT scans that allows for the exact placement. RESULTS: Target points have been reached with an accuracy of 0.6 mm. Since 1991 we have used this technique for 24 clinical applications in 11 patients with recurrent neoplasms in the region of the paranasal sinuses and nasopharynx for palliative treatment. CONCLUSIONS: The presented method is a reliable and precise procedure for the positioning of afterloading probes, avoiding the inaccuracy of the traditional methods.

Adult↗
PubMed1999

Sequential therapy with azelastine in seasonal allergic rhinitis. Deutsche Rhinitis Studiengruppe (German Rhinitis Study Group).

A sequential therapy treatment with azelastine (Allergodil) in seasonal allergic rhinitis is introduced. In the critical early stage, treatment begins with a combination of azelastine tablets (azelastine hydrochloride, CAS 79307-93-0) and azelastine nasal spray (azelastine, CAS 58581-89-8), and after five days only the nasal spray is administered. This sequential therapy model aims at achieving the quickest and most complete effect without reducing the tolerability. The investigation was carried out as a randomized, controlled double-blind phase IV study of parallel group design with 300 patients during 14 days. In the first five days, one group was given one puff (0.14 mg) of azelastine nasal spray twice daily and one 2 mg tablet of azelastine at night. The other group received nasal spray and a placebo tablet. Beginning on day six, both groups received nasal spray only. Both treatments proved to be effective; the combination therapy, however, was significantly more effective beginning as early as the first treatment. The superiority of the combination therapy increased until day five. Thereafter, the two curves grew closer together; however, the superiority of the combination treatment remained. The tolerability of both treatments was similar.

Adolescent↗
PubMed1998

Development of computer-aided surgery for otorhinolaryngology.

Computer-aided surgery (CAS) describes a method that allows intraoperative navigation in the surgical field based on digital image data such as computed tomography, magnetic resonance imaging, and others. A computer processes the image data in real time and is intraoperatively connected to a measuring system for coordinate determination. CAS has been used in ENT surgery since 1986, and we developed several generations of CAS systems. A passive robot arm was employed in the first approach. Then electromechanical and infrared optical coordinate-measuring devices followed. CAS was applied to several fields of otorhinolaryngologic surgery, including the paranasal sinuses, the orbit, the rhino- and otobasis, and others. CAS was found to be particularly useful for acoustic neuroma removal, paranasal sinus surgery in cases of massive disease or revision surgery, decompression of the orbit or optic nerve, extraction of deep-seated foreign bodies, stereotaxy-like biopsies, and educational purposes. CAS in its current state of development is a useful tool that can be applied routinely; however, further technical developments are necessary.

Diagnostic Imaging↗
PubMed1998

Clinical validation of a new olfactory test.

A new approach to clinical olfactometry is presented using nasal sprays. A special dosage valve was used to standardize an aerosol size to 40 microns. For evaluation a 6 x 6 matrix (substance/olfactory quality) with verbal associative clues was used according to test psychological findings. Validation took place in three steps after determining smell-associated thresholds in preliminary examinations. Recognition of different aromas administered either by spraying into the open mouth from a distance of 5 cm using nasal sprays or sniffing opened bottles was compared in 50 subjectively normosmic subjects. Findings showed that the correspondence between the two procedures was relatively high, with global identification of odorous substances as high as 98.4% in the spray test. The number of substances used was next reduced to those six substances providing the most reproducible results in an investigation with 56 normosmic and 55 hyposmic subjects. Verbal associative clues were also tested. In a last step 50 patients with hyposmia of various origin and 110 normosmic subjects were tested, allowing previous results to be reproduced regardless of the cause of hyposmia. The spray test was shown to be easily performed and was suitable as a screening test, with a sensitivity of 88% and a specificity of 100%.

Administration, Intranasal↗
PubMed1998

[Computer-assisted surgery in the ENT specialty. Developments and experiences from the first decade].

BACKGROUND: Computer-Assisted-Surgery (CAS) names a method that allows intraoperative navigation in the surgical field based on digital image data like CT, MRT, MRA, DSA and others. A computer processes the image data in real time and is intraoperatively connected to a measuring system for coordinate determination. CAS is used in ENT surgery since 1986. The authors developed several generations of CAS systems. METHODS: In a first approach, a passive robot arm was applied. Self-developed electromechanical and infrared optical coordinate measuring devices followed. RESULTS: CAS was applied to several fields of otorhinolaryngologic surgery including the paranasal sinuses, the orbit, the rhinobasis and otobasis and other. CAS was found to be useful for surgery of acoustic neuromas, the paranasal sinuses in cases of massive disease or revision surgery, decompression of orbit or optiv nerve, extraction of deep seated foreign bodies, stereotaxy-like biopsies, for educational purposes and others. CONCLUSIONS: CAS in its current state of development is a useful tool that can be routinely applied. However, further technical development is necessary.

Computer Systems↗
PubMed1997

The computer-assisted localizer, a navigational help in microneurosurgery.

The computer-assisted-localizer (CAL) achieves a direct linkage between preoperative radiological images and individual intraoperative anatomical findings. Experiences with our system demonstrate that CAL improves the intraoperative orientation and facilitates the neurosurgical procedure. The system described here consists of a mechanical articulated robot arm with six degrees of freedom and a three-dimensional image processor. After calibration, the displayed image dynamically pointed out the exact intraoperative localization in three perpendicular sectional views. Meanwhile, CAL was successfully used in 73 selected microneurosurgical procedures.

Adult↗
PubMed1996

Endoscopic surgery of the rhinobasis with a computer-assisted localizer.

The endoscope is useful for the diagnosis and surgical therapy of diseases of the nose, the paranasal sinuses and its neighboring regions, and allows for microinvasive, functional approaches. The reduced invasiveness of therapeutic procedures is sometimes accompanied by insufficient clearness of the surgical field, however. This significant problem is solved by the computer-assisted-surgery (CAS) system, an intraoperative localizer. It allows continuous orientation based on three-dimensional reconstructed preoperative CT scans with superimposed positioning of the endoscope. We have now adapted CAS for endoscopic sinus surgery, which meant that a variety of visualization methods were tested. A conventional straightforward endoscope was used in combination with, or as, the localizing probe. A dual-display technique was adjusted to video-endoscopic procedures: the information of the localizer is displayed on one monitor while the video-endoscopic picture is viewed on a second screen. In addition, a single-display technique with both images on one monitor was developed. It proved to be the most promising way of combining endoscopy and intraoperative CT-image-guided localization.

Endoscopes↗