[Independence of retinopathy and optic atrophy in the DIDMOAD syndrome]. / Unabhängigkeit von Retinopathie und Optikusatrophie beim DIDMOAD-Syndrom.

A brother and a sister with DIDMOAD syndrome (diabetes insipidus, diabetes mellitus, optic atrophy, deafness, etc.) are described. The 15-year-old girl was suffering from severe optic atrophy, severe sensorineural hearing loss but only slight diabetic retinopathy. The 16-year-old boy presented with symptoms which were the opposite: slight optic atrophy, slight sensorineural hearing loss but severe diabetic retinopathy. These complementary impairments of neuronal and (diabetic) retinal function suggest that optic atrophy and retinopathy develop independently in DIDMOAD syndrome.

Postoperative recurrent nerve palsy.

During the past seven years, a total of 1,713 patients underwent strumectomy for a variety of causes at the University of Düsseldorf. Unilateral palsies of the recurrent nerve developed in 147 patients. Both vocal cords were paralyzed in 22 patients. Of the 147 patients with unilateral palsies, 53 patients were available for follow-up examination after one year. In 28 of these patients, complete paresis of the vocal cord remained. Twenty-three patients showed complete recovery and normal function of the affected cord. In two patients, reduced but marked mobility of the previously completely paralyzed vocal cord was present. Of the 22 patients with bilateral recurrent nerve palsies, 10 were available for follow-up examination one year later. In three of these patients vocal cord movement was still absent, in three others one vocal cord showed normal function, and in only one patient did both vocal cords reveal normal physiologic mobility. Three other patients demonstrated a reduced but marked mobility of one vocal cord. The results are discussed in relation to the clinical and histologic data.

[Incidence of recurrent nerve palsy after strumectomy. Long term results (author's transl)]. / Zur Problematik postoperativer Rekurrensparesen.

During the last years all 1713 patients which for different causes underwent strumectomy were controlled by the laryngologist before and after the operation. In 147 cases an unilateral recurrent nerve palsy resulted, in 22 patients both vocal cords were paralysed. Out of these 169 patients we could follow up 63 patients, which were examined after one year. In 28 patients with postoperatively complete paresis of one vocal cord 23 showed recovery and normal function while in two patients a markedly reduced motility was present. Out of the 22 cases which postoperatively had both recurrent nerves injured 10 could be checked one year later. In three patients any vocal cord movement was still absent, in three patients one vocal cord showed normal function again and only in one case both vocal cords revealed normal physiological mobility. Three other patients demonstrated a reduced but market mobility of one vocal cord. The results are discussed in relation to the clinical and histological datas.

[The post-operative recurrent laryngeal nerve paralysis and its course (author's transl)]. / Die postoperative Rekurrensparese und ihr Verlauf.

Benign diseases of the thyroid may also be the cause of pre-operative paralysis of the recurrent laryngeal nerves. the frequency of palsies in uncomplicated strumectomies is approximately 4 to 5%. A markedly higher risk exists in endothoracic goitres which must be delivered by thoracotomy, in recurrencies and thyroiditis. Dissection, crush lesions, strain and nerves mistakenly pulled into a ligature are the most frequent causes of injury; haematoma, oedema, heat by diathermy, lesions caused by a scar and a neuritis of the nerve are less common. 30 to 50% of unilateral laryngeal nerve palsies are without symptoms. An exact examination, however, reveals some alterations of the voice. A logopedic treatment combined with electro-therapy accelerates the compensation of the intact vocal cord. In bilateral paralysis of the recurrent laryngeal nerves a tracheotomy is necessary because of respiratory distress. After 6 to 9 months a glottis-widening procedure may be performed since no further recovery can be expected. A unilateral paralysis has a recovery rate of 40%; therefore in 2 to 3% of uncomplicated strumectomies a definite paralysis of the recurrent laryngeal nerve is observed.

[Audiological findings in cases of acoustic neuromas, cerebellopontine angle and brain tumors (author's transl)]. / Audiologische Befunde bei Akustikusneurinomen, Kleinhirnbrückenwinkeltumoren and höher gelegenen Hirntumoren.

The study contributes to improve, audiological diagnostics of central auditory path lesions and attempts, through the comparison of audiological and neurosurgical findings of 15 patients, to refer certain auditory lesions caused by cerebral tumors to topodiagnostically characteristic audiological symptoms. The audiological findings obtained through 7 generally accepted test methods from 6 patients with an acusticus neurinoma indicate a labyrinthine but not a central symptomatic picture while 4 patients with a pontine-angle tumor present a chiefly central hearing defect which, as regards the constellation of findings, clearly differs from the central hearing defect of 3 patients with a pontine tumor. Two patients with tumors in the lateral ventricle area merely show, from the audiological point of view, a lack of contralateral dichotic discrimination.