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1.
Pathologe ; 35(2): 173-6, 2014 Mar.
Article in German | MEDLINE | ID: mdl-24619528

ABSTRACT

This article presents the case of a 43-year-old male patient with recurrent painful swelling of the right submandibular gland. Submandibulectomy was performed. Histological investigations showed an intense granulomatous inflammation with severe destruction of the parenchyma. The inflammatory infiltrate consisted of abscesses with neutrophilic and eosinophilic granulocytes and ill-defined granulomas with multinucleated giant cells. Some of the blood vessels showed evidence of vasculitis. After further clinical and serological investigations with highly elevated levels of cytoplasmic antineutrophil cytoplasmic antibodies (c-ANCA) and antiproteinase-3 antibodies, a rare limited disease of granulomatous polyangiitis (Wegener granulomatosis) was finally diagnosed. Such a manifestation of the disease is exceedingly rare; therefore, only single case reports have so far been described. The certain establishment of the diagnosis seems to be challenging because of the lack of involvement of the respiratory tract and the kidneys. In this case a histological assessment and clinical findings are mandatory for the correct diagnosis.


Subject(s)
Sialadenitis/diagnosis , Sialadenitis/pathology , Submandibular Gland Diseases/diagnosis , Adult , Antibodies, Antineutrophil Cytoplasmic/blood , Autoantibodies/blood , Diagnosis, Differential , Granuloma/pathology , Granuloma/surgery , Humans , Male , Myeloblastin/immunology , Necrosis , Sialadenitis/surgery , Submandibular Gland/pathology , Submandibular Gland/surgery , Submandibular Gland Diseases/pathology , Submandibular Gland Diseases/surgery , Tomography, X-Ray Computed
5.
Eur Arch Otorhinolaryngol ; 256(6): 280-2, 1999.
Article in English | MEDLINE | ID: mdl-10456275

ABSTRACT

Partial laryngeal resection often results in major aspiration problems, making larynx preservation during surgical removal of tumors of the oropharynx and hypopharynx impossible. However, free flaps can be used to reconstruct perilaryngeal tissue, thus preserving the larynx and ensuring a better quality of life for patients. We present the results of forearm free-flap reconstruction of the supraglottis in 22 patients who underwent resections of extended squamous cell carcinomas of the oropharynx and hypopharynx. A total of 9 patients had T3 lesions and 13 had T4 lesions. All patients were additionally treated with radiation therapy alone (to 70 Gy) or in combination with chemotherapy (Cisplatin; 5-fluorouracil). The mean follow-up was 2.4 years. In four patients, tracheostomy could be closed. Five patients suffered from severe aspiration, one of whom had to undergo a laryngectomy. Six patients had mild aspiration and 7 patients had no aspiration, but extensive edema made decanulation impossible. A total of 13 patients were free of disease, 4 patients died of disease, 1 patient died as the result of a second primary cancer and 1 patient died of other causes. Three patients are alive with persistent tumor. Although the majority of patients experienced a better quality of life as a result of larynx preservation, aspiration has remained a problem following treatment.


Subject(s)
Carcinoma, Squamous Cell/surgery , Hypopharyngeal Neoplasms/surgery , Laryngectomy , Oropharyngeal Neoplasms/surgery , Surgical Flaps , Adult , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/radiotherapy , Chemotherapy, Adjuvant , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Hypopharyngeal Neoplasms/mortality , Hypopharyngeal Neoplasms/pathology , Hypopharyngeal Neoplasms/radiotherapy , Male , Middle Aged , Neoplasm Staging , Oropharyngeal Neoplasms/mortality , Oropharyngeal Neoplasms/pathology , Oropharyngeal Neoplasms/radiotherapy , Postoperative Complications/etiology , Postoperative Complications/surgery , Radiotherapy, Adjuvant , Reoperation , Survival Rate
6.
Laryngorhinootologie ; 78(5): 259-62, 1999 May.
Article in German | MEDLINE | ID: mdl-10412135

ABSTRACT

BACKGROUND: Extensive tumors of the oropharynx require an open approach and plastic reconstruction for good oncologic and functional results. PATIENTS AND METHODS: From January 1988 through December 1996 at the Department of Otolaryngology, Head and Neck Surgery, of the University of Würzburg, 62 patients with extensive tumors of the oropharynx underwent surgical treatment (T2 = 6, T3 = 24, T4 = 32). In 40 patients, the resection was performed via a median mandibulotomy approach, in 22 patients using a lateral pharyngotomy. All patients underwent postoperative radiotherapy up to 70 Gy. RESULTS: Using the Kaplan-Meier method, the five-year survival was 80% for T2, 52% for T3, and 22% for T4. Four patients (7%) presented with a second primary carcinoma, and one also had a third carcinoma. Seven patients who died of T3- and T4-tumors had distant metastases, among them 5 patients who were free of local disease. A regular oral diet was possible on average 14 days postoperatively. All patients underwent tracheostomy. Ninety percent of them were decanulated one year postoperatively. CONCLUSIONS: Resection of extensive carcinomas of the oropharynx and microvascular reconstruction produces good oncological and functional results. The best access to extensive tumors is provided by a mandibulotomy. The advantage of this excellent approach outweighs an increasing morbidity in occasional cases.


Subject(s)
Microsurgery , Oropharyngeal Neoplasms/surgery , Surgical Flaps , Combined Modality Therapy , Female , Humans , Lymphatic Metastasis , Male , Middle Aged , Neoplasm Staging , Oropharyngeal Neoplasms/mortality , Oropharyngeal Neoplasms/pathology , Radiotherapy, Adjuvant , Survival Rate
7.
Int J Radiat Oncol Biol Phys ; 44(4): 777-88, 1999 Jul 01.
Article in English | MEDLINE | ID: mdl-10386634

ABSTRACT

PURPOSE: To evaluate therapeutic modalities used at our institutions regarding local control, disease-free survival and actuarial survival in carcinoma of the external auditory canal and middle ear, in an attempt to provide guidelines for therapy. METHODS AND MATERIALS: A series of 27 patients with carcinoma of the external auditory canal and middle ear treated between 1978 and 1997 in our institutions were analyzed with particular reference to tumor size and its relation to surrounding tissues, patterns of neck node involvement, surgical procedures, and radiation techniques employed. Clinical endpoints were freedom from local failure, overall survival, and disease-free survival. The median follow-up was 2.7 years (range 0.1-17.9 years). RESULTS: Treatment by surgery and radiotherapy resulted in an overall 5-year survival rate of 61%. According to the Pittsburgh classification, the actuarial 5-year survival rate for early disease (T1 and T2 tumors) was 86%, for T3 tumors 50%, and T4 stages 41%. Patients with tumors limited to the external auditory canal had a 5-year survival rate of 100%, patients with tumor invasion of the temporal bone 63%, and patients with tumor infiltration beyond the temporal bone 38%. The rate of freedom from local recurrence was 50% at 5 years. Unresectability by dural and cerebral infiltration, and treatment factors such as complete resection or resection with tumor beyond surgical margins are of prognostic relevance. All patients with dural invasion died within 2.2 years. The actuarial 5-year survival rate of patients with complete tumor resection was 100%, but 66% in patients with tumor beyond surgical margins. 192Iridium high-dose-rate (HDR) afterloading brachytherapy based on three-dimensional computed tomography (3D CT)-treatment planning was an effective tool in management of local recurrences following surgery and a full course of external beam radiotherapy. CONCLUSION: Surgical resection followed by radiotherapy adapted to stage of disease and grade of resection is the preferred treatment of cancer of the external auditory canal and middle ear.


Subject(s)
Carcinoma/radiotherapy , Carcinoma/surgery , Ear Canal/surgery , Ear Neoplasms/radiotherapy , Ear Neoplasms/surgery , Ear, Middle/surgery , Adult , Aged , Aged, 80 and over , Brachytherapy/adverse effects , Carcinoma/mortality , Carcinoma/pathology , Disease-Free Survival , Ear Canal/pathology , Ear Neoplasms/mortality , Ear Neoplasms/pathology , Ear, Middle/pathology , Female , Humans , Male , Middle Aged , Neoplasm Staging , Postoperative Complications , Radiotherapy Planning, Computer-Assisted , Survival Rate , Treatment Failure
8.
J Allergy Clin Immunol ; 100(1): 23-9, 1997 Jul.
Article in English | MEDLINE | ID: mdl-9257783

ABSTRACT

BACKGROUND: Short-term immunotherapy (STI) can be beneficial for patients who are noncompliant with long-term specific immunotherapy. OBJECTIVE: The efficacy and tolerance of STI with seven preseasonal injections of molecular standardized allergens from grass and rye pollen has been investigated in a double-blind, placebo-controlled multicenter study with 87 patients at 12 German University hospitals. METHODS: Symptoms of the eyes, nose, and bronchi and use of symptomatic drugs were documented daily in diaries by patients with allergic rhinitis to grass and/or rye pollen and without bronchial asthma. Patients were monitored by skin prick test titration and measurement of levels of specific IgE and IgG4. RESULTS: The median nasal score for the 10 weeks with the strongest symptoms during the grass pollen season was significantly lower (p = 0.014) with 35.0 for STI (n = 41) versus 69.0 for placebo (n = 40); the overall symptom score was 54.0 for STI versus 97.5 for placebo (p = 0.020). Only STI-treated patients exposed to less than 40 pollen grains per cubic meter per week showed a significantly lower nasal symptom score of 39.0 versus 75.0 for placebo (p = 0.006); these patients also had fewer nasal symptoms and less use of topical nasal drugs (p < 0.001). The threshold dose in skin prick tests was significantly higher, being 9.06 histamine equivalent for skin prick test (HEP) for STI-treated patients who received the maximum dose (n = 22) versus 4.33 HEP for placebo (p = 0.005). Specific IgE levels were significantly higher, being 55.9 SU/ml for STI versus 39.2 SU/ml for placebo after seven injections (p = 0.006) and level of specific IgG4 was 5.36% for STI versus 1.28% for placebo (p < 0.001). No severe systemic reactions were observed. CONCLUSION: STI with seven preseasonal injections with molecular standardized allergens is effective and well tolerated.


Subject(s)
Allergens/therapeutic use , Desensitization, Immunologic , Poaceae/immunology , Pollen/immunology , Rhinitis, Allergic, Seasonal/etiology , Rhinitis, Allergic, Seasonal/therapy , Adolescent , Adult , Allergens/adverse effects , Desensitization, Immunologic/adverse effects , Desensitization, Immunologic/methods , Desensitization, Immunologic/standards , Dose-Response Relationship, Immunologic , Double-Blind Method , Female , Histamine H1 Antagonists/therapeutic use , Humans , Immunoglobulin E/blood , Immunoglobulin G/blood , Lolium/immunology , Male , Middle Aged , Prospective Studies , Reference Standards , Rhinitis, Allergic, Seasonal/drug therapy , Time Factors
11.
Acta Neurol Scand ; 89(4): 293-8, 1994 Apr.
Article in English | MEDLINE | ID: mdl-8042449

ABSTRACT

It is still controversial, whether early surgical removal of infectious material and heparin-anticoagulation to reduce vascular complications will improve outcome in acute meningitis. In the present pilot-study 40 patients with acute or delayed post-traumatic or oto-/rhinogenic purulent bacterial meningitis were analysed for neurological outcome by using the Glasgow outcome score (GOS) and the Tuthill functional score; patients were treated either by early surgical revision of the septic focus (Group 1, within 6 days, n = 15), late surgery (Group 2, later than 6 days, n = 19), or no surgery at all (Group 3, n = 6). All patients, independent of surgical approach, received therapeutic heparin-anticoagulation. Patient groups were otherwise comparable for antibiotic treatment, osmotherapy, microbiology, CSF-findings, CT-scans and prognostic factors. Outcome according to GOS was superior in Group 1 compared with Groups 2/3 (non-significant). Although there was no significant difference on admission in the Tuthill functional score, Group 1 achieved a superior final outcome of 96 points compared with Groups 2 and 3, who gained 72 points (p < 0.01). In addition, Group 1 patients had significantly less intracranial complications (8/15 patients versus 21/25 patients in Groups 2/3, p < 0.01) and were dependent upon respirator treatment for fewer days (10.2 days) than Groups 2/3 (12.5 days, non-significant). In 31 patients CSF-leakage was identified: among these, 17 patients had CSF-leakage, which had not been anticipated by clinical/neuroradiological examinations and revealed only by surgery. The overall mortality in this study population was very low (2.5%), therefore, therapeutic heparin seems to represent an additional favorable treatment measure.(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Brain Injuries/surgery , Cerebrospinal Fluid Otorrhea/surgery , Cerebrospinal Fluid Rhinorrhea/surgery , Heparin/administration & dosage , Meningitis, Bacterial/surgery , Adolescent , Adult , Aged , Anti-Bacterial Agents , Brain Injuries/mortality , Cerebrospinal Fluid Otorrhea/mortality , Cerebrospinal Fluid Rhinorrhea/mortality , Combined Modality Therapy , Drug Therapy, Combination/administration & dosage , Female , Follow-Up Studies , Humans , Male , Meningitis, Bacterial/mortality , Middle Aged , Neurologic Examination , Survival Rate , Treatment Outcome
14.
Laryngorhinootologie ; 71(7): 337-40, 1992 Jul.
Article in German | MEDLINE | ID: mdl-1497763

ABSTRACT

We report on the history, clinical findings, diagnostic examinations and the therapy of three patients with a left piriform sinus fistula, probably a fourth pharyngeal pouch. Our patients show recurrent inflammation and abscesses of the left lateral neck. X-ray (gastrografin swallow) showed the fistula originating from the floor of the left piriform sinus. CT-scan was helpful in the previously operated area, although the fistula could be shown by ultrasonic examination. Recurrent abscesses of the lateral neck may be caused by sinus piriform fistula. It is important to search for this rare malformation of the lateral neck.


Subject(s)
Branchioma/surgery , Head and Neck Neoplasms/surgery , Abscess/diagnosis , Abscess/surgery , Adolescent , Adult , Branchioma/diagnosis , Endoscopy , Female , Head and Neck Neoplasms/diagnosis , Humans , Male , Tomography, X-Ray Computed
16.
Arch Otorhinolaryngol ; 245(2): 61-8, 1988.
Article in English | MEDLINE | ID: mdl-3291842

ABSTRACT

Miniplate osteosynthesis is an osteoplastic procedure that achieves secure stabilization of the midface, even following extensive fractures of the midface and the floor of the anterior cranial fossa. This procedure can be considered a satisfactory operative treatment in terms of cosmetic and functional results. Correlative osteology is discussed and clinical experiences are reviewed.


Subject(s)
Bone Plates , Craniotomy/methods , Facial Bones/injuries , Fracture Fixation, Internal/methods , Fractures, Open/surgery , Skull/injuries , Adult , Evaluation Studies as Topic , Facial Bones/surgery , Humans , Postoperative Complications/prevention & control , Skull/surgery , Titanium
17.
Acta Otolaryngol Suppl ; 454: 70-4, 1988.
Article in English | MEDLINE | ID: mdl-3146864

ABSTRACT

The human tonsils are responsible for the final antigen-induced differentiation of B-cells to plasma cells. Their main function could be the expansion of memory IgA-B-cells, allowing J-chain expression and final differentiation under secondary signals. IgA/J+-cells have been shown to migrate into mucosal membranes, allowing a protection against microorganisms. Recurrent tonsillitis obviously interferes with this complex immunological network, possibly resulting in a reduced mucosal protection by IgA. Furthermore, bacterial antigens can initiate the liberation of biochemical inflammatory mediators. Among these, arachidonic acid products can play a key role. They can induce epithelial damage and decreased ciliary function. Furthermore, they influence tonsillar immunological reactions.


Subject(s)
Palatine Tonsil/immunology , Tonsillitis/immunology , Arachidonic Acid , Arachidonic Acids/metabolism , B-Lymphocytes/immunology , Humans , Immunoglobulin A/analysis , Immunoglobulin J-Chains/biosynthesis , Immunoglobulin J-Chains/immunology , Immunoglobulins/biosynthesis , Inflammation/metabolism , Palatine Tonsil/metabolism , Tonsillitis/metabolism
18.
HNO ; 35(3): 106-11, 1987 Mar.
Article in German | MEDLINE | ID: mdl-3583829

ABSTRACT

Mini-plate osteosynthesis is an osteoplastic procedure that achieves secure stabilisation of the midface even in extensive fractures of the midface and the floor of the anterior cranial fossa. This procedure can be considered as a satisfactory operative treatment both from a cosmetic and from a functional point of view. Nevertheless the partial loss of previous mucosa, and the development of granulation tissue and scar tissue can impede ventilation and drainage of the paranasal sinuses and induce recurrent inflammation. In the last five years we have treated 73 patients with extensive fractures of the midface and the anterior skull base, generally with good results. Aspects of the primary operative treatment, complications and post-operative care are discussed.


Subject(s)
Facial Bones/injuries , Fracture Fixation, Internal/methods , Postoperative Complications/therapy , Skull Fractures/surgery , Bone Plates , Humans , Maxillary Fractures/surgery , Nose/injuries , Orbital Fractures/surgery , Paranasal Sinuses/injuries , Surgical Flaps
19.
HNO ; 35(2): 70-7, 1987 Feb.
Article in German | MEDLINE | ID: mdl-3570885

ABSTRACT

The role of barium pharyngograms in the pre- and post-therapeutic evaluation of pharyngeal tumors is described. The intralumenal part of the tumor is well shown by high spatial and contrast resolution of the pharyngeal mucosa. Barium pharyngogram is the only imaging method which can record the course of the swallowing act at the pharyngeal level. Post-operatively, barium pharyngography reliably demonstrates altered pharyngeal morphology; fibrotic stenoses may be distinguished from narrowing due to recurrence. The result of primary radiotherapy is easy to document.


Subject(s)
Pharyngeal Neoplasms/diagnostic imaging , Endoscopy , Humans , Hypopharyngeal Neoplasms/diagnostic imaging , Neoplasm Recurrence, Local/diagnostic imaging , Neoplasm Staging , Pharyngeal Neoplasms/pathology , Pharyngeal Neoplasms/surgery , Pharynx/diagnostic imaging , Postoperative Complications/diagnostic imaging , Tomography, X-Ray Computed
20.
Laryngol Rhinol Otol (Stuttg) ; 65(5): 260-3, 1986 May.
Article in German | MEDLINE | ID: mdl-3736289

ABSTRACT

An "infection allergy" must always be taken into account in children with allergic rhinitis, suffering from adenoids and also from recurrent rhinosinusitis. First of all, it would be necessary to take measures to cure the infection. Brief and mild symptoms only are no indications for hyposensitisation in definitely predominant allergy. Subcutaneous hyposensitisation proves more successful than oral hyposensitisation in children with severe signs and symptoms of allergy.


Subject(s)
Rhinitis, Allergic, Perennial/therapy , Rhinitis, Allergic, Seasonal/therapy , Asthma/therapy , Child , Combined Modality Therapy , Desensitization, Immunologic/methods , Diagnosis, Differential , Humans , Prognosis , Rhinitis, Allergic, Perennial/diagnosis , Rhinitis, Allergic, Seasonal/diagnosis
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