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Background Bone subtraction radiography allows reading pulmonary changes of chest radiographs more accurately without superimposition of bones. Purpose To evaluate the value of bone subtraction chest radiography using dual energy (DE) bone subtracted lung images compared to conventional radiographs (CR) in adult patients with cystic fibrosis (CF). Material and Methods Forty-nine DE radiographs of 24 patients (16 men) with CF (mean age, 32 years; age range, 18–71 years) were included. Lung function tests were performed within 10 days of the radiographs. Two radiologists evaluated all CR, DE, and CR + DE radiographs using the modified Chrispin-Norman score (CNS) and a five-point score for the confidence. Findings were statistically evaluated by Friedman ANOVA and Wilcoxon matched-pairs test. Results There was significant difference of CNS between CR and DE ( P = 0.044) as well as CR and CR + DE ( P Conclusion DE radiographs are reliable for the evaluation of adult patients with CF in acute exacerbation. For yearly surveillance, CR and DE radiographs may play a limited role. However, in clinical routine, DE radiographs are useful for adult CF patients and may depict more accurately inflammatory changes than CR.

Severe Ménière's disease (MD) may be debilitating and compromising, despite intensive medical treatment. Vestibular neurectomy (VN) is considered an effective surgical treatment for disabling MD. Our aim was to analyse the medium- to long-term outcome after retrosigmoid VN with special regard to vertigo, quality of life (American Academy of Otolaryngology-Head and Neck Surgery criteria), and pure tone average (PTA).Retrospective evaluation of patients with disabling MD treated with retrosigmoid VN at the university hospital of Bern (1992-2009), after unsuccessful attempts at medical treatment. Demographics, clinical signs and symptoms, quality of life, thresholds of hearing, and adverse events were documented at baseline, 1 week, 12 months, and 24 months after surgery.Medium to long-term follow-up data were available from 44 of 78 patients, who had undergone retrosigmoid VN (19 men; mean age, 50.3 ± 11.0 yr). Vertigo disappeared in 34 (77.3%) of 44 patients and improved in 6 (13.6%) of 44 patients. Quality of life significantly improved postoperatively (mean American Academy of Otolaryngology-Head and Neck Surgery, 0.68 ± 1.14 [1 yr] and 0.57 ± 1.19 [2 yr] versus 5.11 ± 0.66). Mean PTA decreased (52.3 ± 19.2 dB versus 56.2 ± 21.6 dB [1 wk] and 60.4 ± 20.5 dB [1 yr]; p0.001). Ten (22.7%) of 44 patients showed improved PTA after VN. These patients had significantly higher baseline PTA (69.4 dB versus 47.9 dB; p = 0.001).Retrosigmoid VN is a valuable and safe surgical option to treat disabling MD that has proved resistant to medical treatments. It may also be indicated for patients with preoperative severely impaired thresholds of hearing, in whom a certain hearing gain may be observed.

Objectives: We aimed to identify clinical characteristics and to assess effectiveness of different initial antibiotic regimens in adult patients with community-acquired pneumonia (CAP) caused by Haemophilus influenzae. Methods: Characteristics were compared between patients with H. influenzae monoinfection versus CAP of other and unknown aetiology enrolled by the German prospective cohort study CAPNETZ. Impact of initial antibiotic treatment on "early clinical response" according to FDA criteria and overall clinical cure were analysed. Results: H. influenzae was found in 176 out of 2790 patients with pathogen detection (6.3%). Characteristics significantly associated with a H. influenzae CAP (p

Mild traumatic brain injury (MTBI) is common; up to 37% of adult men have a history of MTBI. Complaints after MTBI are persistent headaches, memory impairment, depressive mood disorders, and disability. The reported short- and long-term outcomes of patients with MTBI have been inconsistent. We have now investigated long-term clinical and neurocognitive outcomes in patients with MTBI (at admission, and after 1 and 10 years).Patients of a previous study investigating MTBI short-term outcome were prospectively reassessed after ±10 year using the same standardized data entry form and validated questionnaire (Beltztest with Beltz Score [BeSc]) for evaluation of Quality of life (QoL) and neurocognitive outcome (higher scores indicate lower QoL).Eighty-six of 176 patients (49%) could be reassessed (n = 75 lost to follow-up; n = 8 second brain trauma; n = 7 death), 10.4 ± 2 years after initial evaluation. Over time, overall BeSc was significantly increased (5.92 ± 10.3 [admission] vs. 10.7 ± 12.8 [1 year] vs. 20.86 ± 17.1 [10 year]; p0.0001); only 54 of 86 patients (62.8%) presented with a normal BeSc. Long-term complaints were fatigue, insomnia, and exhaustion. Ten of eighty-six patients (11.6%) had intracranial injury (ICI) and initial BeSc was almost twofold higher in patients with ICI than in patients without ICI (10.0 ± 8.4 vs. 5.3 ± 9.6; p = 0.007). This difference was not seen after 1 year or after 10 years (10.3 ± 11.6 vs. 10.3 ± 10.1 and 21.4 ± 17.3 vs. 16.1 ± 16.4, respectively). Eight of eighty-six patients (9.3%) lost their jobs because of persistent complaints after MTBI.BeSc deteriorates over time; our data suggest a decline in general health and QoL in a substantial proportion of patients (37.2%) 10 years after MTBI. Patients without ICI appear to have a better long-term outcome with regard to subjective complaints and QoL.