[Iatrogenic thrombosis of the jugular vein. A case report]. / Iatrogene Jugularisthrombose. Ein Fallbericht.

We report on a 52-year-old female patient who developed a thrombophlebitis with consecutive thrombosis of the internal jugular vein 14 days after hemicolectomy and prolonged central venous catheterisation. The tip of the polyethylene catheter was placed in the internal jugular vein. The pathophysiology of the thrombotic inflammation can be related to local alterations of the vessel wall due to mechanical irritation as well as hyperosmotic solutions on one side and bacterial infection on the other. The life threatening complications such as septicaemia, diffuse embolisation of other organs and the development of superior vena cava syndrome can be prevented only by instantaneous surgical removal of the jugular vein. Additionally, antibiotic and highdose heparine therapy are necessary. A review of the literature supports our experience.

[Experimental stapesplasty with the CO2 laser]. / Experimentelle Stapesplastik mit dem CO2-Laser.

Perforation of the footplate in otosclerosis can be performed accurately, when the large and high energetic CO2 laser focus is reduced to 0.5 mm in diameter by an aluminium diaphragm. The operation was performed on three dogs. BAEPs were evoked by bone-conducted acoustic stimuli. Hearing threshold was unchanged immediately after operation as well as after 2 and 6 weeks postoperatively. The new method has still to be performed in man.

Clinical evaluation of 40-Hz middle-latency responses in adults: frequency specific threshold estimation and suprathreshold amplitude characteristics.

40-Hz responses were evaluated for objective threshold estimation and frequency specificity at 500, 1,000, 2,000, and 4,000 Hz and compared to normal middle-latency response (MLR) recordings. Disturbing influences were examined. Stimulus-intensity-dependent amplitude characteristics were investigated. 30 adults with normal hearing and 45 with sensorineural hearing loss were included. On the whole, 40-Hz responses gave better threshold estimation than MLR as compared with pure-tone audiograms. In about 80%, deviation was less than 10 dB. For both the 40-Hz method and the MLR, myogenic potentials and changes in the level of vigilance are disturbing influences which cause amplitude variations. Amplitude-intensity functions can be described and their possible contribution to an objective identification of recruitment was examined. Additionally, an improvement of threshold estimation was achieved by narrow-band filtering of the response curve around 40 Hz.

[Tinnitus therapy with lidocaine and tocainide]. / Tinnitus-Therapie mit Lidocain und Tocainid.

A randomised clinical cross-over study was performed to evaluate the therapeutic value of lidocaine, tocainide infusion and oral application of tocainide against placebo in the treatment of tinnitus. 40 patients with sensory hearing loss of different origin and otherwise not treatable constant tinnitus were included. Lidocaine infusion showed a tinnitus suppression of more than 50 per cent in about 70 per cent of patients; in comparison, tocainide infusion in 55 per cent of the patients. Oral tocainide therapy was successful only in about 35 per cent of patients. This fact depends partially on the high proportion of side effects. Therefore, tocainide therapy should be used in such patients only, who suffer severely from their tinnitus. Patient selection can be done by the lidocaine test. Oral tocainide therapy is advisable only if the lidocaine test result is positive. The methodical problems in the assessment of the value of drugs in tinnitus treatment are discussed: Evaluation and elimination of placebo effects and spontaneous fluctuations of tinnitus intensity, as well as selection of patients included in the study.

[Effect of membrane-effective drugs (anti-arrhythmia agents) on acoustically evoked brain-stem potentials]. / Der Einfluss membranwirksamer Medikamente (Antiarrhythmika) auf die akustisch-evozierten Hirnstammpotentiale (BERA).

Lidocaine, Mexiletine, Procainamide, and Phenytoin were administered intravenously to anaesthesized rabbits. BERA alterations showed two different patterns. If the intoxication dose was exceeded, amplitude depression, threshold elevation, desynchronization, and severe cumulative prolongation of all latencies and interpeak latencies appeared. Below this dose Lidocaine and Mexiletine induced a single, reversible, dose related, cumulative prolongation of all latencies and interpeak latencies. Procainamide induced counterrelated shiftings of interpeak latencies I-III and III-V, whereas Phenytoin showed no influence. One should, therefore, take into account these effects when BERA is used clinically, since otherwise serious errors can occur. On the other hand, there are diagnostic and therapeutic aspects for the tinnitus patient.

[A nasopharynx electrode for BERA potential derivation]. / Die Nasopharynxelektrode zur BERA-Ableitung.

A harpoon-shaped electrode was positioned to the nasopharynx through the nose for registration of BERA-potentials. The amplitudes of peak IV and V increase without changes of latencies. Potential IV is clearer for evaluation of the central conduction time in cases with a single IV/V-complex. Mechanisms of amplitude pattern changes are discussed.

[Neuro-otologic early symptoms of Camurati-Engelmann disease]. / Neurootologische Frühsymptome der Camurati-Englemann-Krankheit.

Camurati-Engelmann disease is a rare generalized progressive bone affection which causes combined hearing loss, facial palsy and vestibular dysfunction. Differential diagnosis against bone affections is possible because of typical x-ray findings, pseudo mixed hearing loss, myopathy and growth disorders.

[Acoustic inner ear trauma by impedance measurement. Acute acoustic trauma?]. / Akustisches Innenohrtrauma bei Impedanzmessung. Akutes Schalltrauma?

We report on two patients with sudden hearing loss occurring immediately after registration of an acoustically elicited acoustic reflex with pure tones of 500, 1000, 2000, and 4000 cps and 125 dB HL. Aetiology and patho-physiology of this form of acute acoustic trauma are discussed. An obvious destruction of middle ear structures or the membrane of the round and oval window can be excluded. Assuming pre-existing disposition, e.g. distortion of microcirculation in the cochlea, the acoustic stimulus is merely the trigger for the imminent sudden hearing loss. Therefore, we suggest to limit the stimulus power to 105 dB HL. In every case one should keep in mind the possible danger of this examination and perform a benefit-risk calculation in every patient.

[Indications for tympanotomy in "sudden deafness" and round window membrane rupture (author's transl)]. / Operationsindikation bei Fensterruptur und Hörsturz.

An operative exploration of the middle ear should be undertaken when deafness ins complete, when vestibular signs are present and when the patient asks for immediate medical care. The closure of the round window with soft tissue or fascia graft should be done within an few days after the event of "sudden deafness". We do not use an infusion therapy or blockade of ganglion stellatum in these cases and those of head trauma, because we saw no hearing gain after later operative intervention.

[Ichthyosis hystrix gravior typus Rheydt: an otologic-dermatologic syndrome (author's transl)]. / Ichthyosis hystrix gravior Typus Rheydt: Ein otologisch-dermatologisches Syndrom.

A case of congenital ichthyosis hystrix gravior combined with non-progressive inner ear hearing loss bordering on deafness is reported. None of the syndromes of keratinization disturbances combined with hearing loss of the inner ear known up to now is comparable. The patient was examined by the dermatologic and otorhino-laryngologic clinics. The findings were presented at the "Südwestdeutschen Dermatologen-Kongress in Heidelberg 1976". Particular otologic findings were a non-progressive inner ear hearing loss bordering on deafness, a fungus-covered cell detritus in the cartilaginous part of the external ear canal, and hyperkeratosis of the auricula. Specific dermatologic findings were skin hyperkeratoses most prominent on face and extremities. In it's ultrastructure, this type is basically different from all other types of inherited ichthyoses that have been studied by electron microscopy. Combined with a lack of normal tonofilaments, an unusual synthesis of large amounts of mucous granules is present under the large spines that is not normally found in healthy skin. No other members of the family are affected.

[A "hairy polyp" of the throat causes larynx occlusion in a newborn (author's transl)]. / Ein pendelnder "behaarter Rachenpolyp" als Ursache für einen plötzlichen Verschluss des Larynx bei einem Neugeborenen

A case of "polyp with hair" in the throat is reported. It's occurence is extremely seldom. It is the simplest form of an epignathus. The birth defect is considered as an uncomplete dual formation, it is more often found in female than in male newborns. The left palate is the preferred place of occurence. Because it is anchored with a pedicle, the tumor may change it's position resulting in an occlusion of the larynx, as it was in this case. Recurrence after surgery is not known.

[A dangerous perforating injury of the soft palate in childhood (author's transl)]. / Eine gefährlich Pfählungsverletzung des weichen Gaumens im Kindesalter

Perforating injuries of the soft palate in childhood are generally uncomplicated. Such simple injuries may however be accompanied by far reaching consequences. A resulting thrombosis of the A. carotis interna in a child after a perforating injury of the soft palate showed how difficult diagnosis may be. Perforating injuries of this type are relatively common, complications are relatively rare. Furthermore the injury may be followed by a lengthy symptom-free interval. No further diagnostic procedure seems necessary during this interval than clinical examination. The belated appearance of central symptoms comes at a time where all to often diagnosis and therapy can not influence the final outcome.

[Adenocarcinoma of the paranasal sinuses in woodworkers, an occupational disease? (author's transl)]. / Ein berufsbedingtes Nasennebenhöhlen-Adenokarzinom bei Tischlern

A 59-year-old carpenter, 44 years in his profession had an adenocarcinoma of the ethmoids. Similar cases have been described previously in foreign literature. This disease has been accepted as an occupational disease in England. The question is whether this disease, provoked by fine wood-dust may be observed in Germany too; whether the chemical wood ingredients and those being produced during fine-sanding may be carcinogenic. In gaschromatograms the wood ingredients have been demonstrated using oak and beech wood. It is proposed that comparable cases be collected in Germany in order to have a sufficient number of cases for a statistic base. This would make it possible to add this disease to the German list of occupational diseases.