The tendon of the human stapedius muscle was studied in normal post mortem material and in clinical otosclerotic patients, using light and electron microscopy. Cross section profiles of collagen ...fibrils were measured in various regions of the tendon and the amount of elastin was estimated. The normal stapedius tendon consisted of three concentrically arranged portions: A cylindrical central part, a tube-like mid-portion, and a cortical layer. The central part was made up of collagen fibrils with only a few elastic fibers, the mid-portion contained collagen fibrils together with significantly more elastic material, while the cortical layer, again, showed a smaller amount of elastic fibers. Mean diameters of collagen fibrils in the central part of the tendon were 65.12 +/- 11.89 nm, in the intermediate layer 41.00 +/- 9.63 nm, and in the cortical layer 70.28 +/- 19.58 nm. Stapedius tendons from clinically otosclerotic patients, though showing the same construction, were characterized by significantly altered collagen fibrillar diameters (Mann-Whitney U-test). In the central part, mean diameters were reduced to 61.05 +/- 14.70 nm, in the mid-portion increased to 50.90 +/- 10.08 nm, and in the cortical layer reduced to 61.09 +/- 8.49 nm. The changes of collagen cross section profiles estimated for the entire tendon were significant as well: 59.68 +/- 18.74 nm in controls versus 57.82 +/- 12.53 nm in otosclerotic patients. Elastin content in the mid-portion of control stapedius tendons increased with age (13% at 35 years of age to 35% at 70 years of age).
Quality of life after surgical critical illness is an important measure of outcome. The Sickness Impact Profile Score (SIP) has been validated in critically ill patients, but the Modified Short-Form ...(MSF) has not been directly compared with it.
The SIP and MSF-36 were coadministered to 127 patients (surrogates) with a prolonged surgical critical illness at baseline at 1, 3, 6, and 12 months. Reliability, validity, and acceptability were determined for overall and subscores at each time point.
The overall SIP and eight subscores, including physical health and psychosocial health, were all significantly improved at 1 year compared with baseline (p < 0.05). However, the MSF-36 was improved only in health perception (p < 0.05), but pain scores were higher (p < 0.05) than at baseline. Internal consistency of the MSF-36 was poor at 1 and 3 months. Correlation between the tools was excellent at baseline and 1 year but variable in overall and subscores at other time points.
The SIP is more comprehensive, reliable, and acceptable in determining specific quality-of-life abnormalities, but the MSF-36 is easier to administer and correlates well at baseline and 1 year in patients with a prolonged critical illness.
