[Pressure-related dysphonia, recurring pneumonia and supraglottic tumor]. / Belastungsabhängige Dysphonie, rezidivierende Pleuropneumonie und supraglottische Raumforderung.

Urbach-Wiethe syndrome (hyalinosis cutis et mucosae) is an autosomal-recessive inherited disease. It often presents with typical symptoms such as skin lesions (especially in the face and neck area), dyspnea, and maldigestion. Hoarseness is a leading symptom in young children. These manifestations are caused by the assimilation of glycoproteins in mesenchymal tissue. Our case report shows that hoarseness does not necessarily appear only in children, but can also appear later. Furthermore, the assimilation of glycoproteins in the supraglottic area may also cause dysphonia. Due to the varied features of this disease, interdisciplinary check-ups are necessary at regular intervals.

[PET/CT imaging in head and neck tumors]. / PET-CT-Bildgebung bei Kopf-Hals-Tumoren.

AIM: To evaluate the usefulness of combined PET/CT examinations for detection of malignant tumors and their metastases in head and neck oncology. METHODS: 51 patients received whole body scans on a dual modality PET/CT system. CT was performed without i.v. contrast. The results were compared concerning the diagnostic impact of native CT scan on FDG-PET images and the additional value of fused imaging. RESULTS: From 153 lesions were 97 classified as malignant on CT and 136 on FDG/PET images, as suspicious for malignancy in 33 on CT and 7 on FDG-PET and as benign in 23 on CT and 10 on FDG-PET. With combined PET/CT all primary and recurrent tumors could be found, the detection rate in patients with unknown primary tumors was 45%. Compared to PET or CT alone the sensitivity, specifity and accuracy could be significantly improved by means of combined PET/CT. CONCLUSION: Fused PET/CT imaging with [F18]-FDG and native CT-scanning enables accurate diagnosis in 93% of lesions and 90% of patients with head and neck oncology.

Craniometaphyseal dysplasia as a rare cause of a severe neonatal nasal obstruction.

We report on a 2-year-9-month-old boy with the typical features of craniometaphyseal dysplasia with hyperostosis and sclerosis of the cranial vault and mild splaying of the metaphyses. The boy already presented during the neonatal period with the unusual clinical picture of breathing and feeding problems due to severely enlarged and ossified inferior nasal conchae causing obstruction of the nasal lumen.

[Ultrasonic diagnosis of goiter of the tongue base]. / Die sonographische Diagnose von Zungengrundstrumen.

Lingual goitre was found in two adolescents suffering from mild dysphagia. Since there were typical changes in lingual sonomorphology, sonographic evaluation was easy to perform. Lingual thyroid was less echogenic than normal thyroid tissue. Ultrasound may support the decision of the initial treatment and is useful to guide further therapy.

[A difficult intubation in a case of endolaryngeal paraganglioma]. / Erschwerte Intubation bei endolaryngealem Paragangliom.

In a female patient aged 71, a tumor of unknown histology almost completely occupied the whole of the supraglottic space. Because of the valve-like behaviour of the tumor, the patient could not be ventilated by mask. Therefore, preoxygenation and preservation of spontaneous breathing were essential. Anaesthesia was induced by titration of etomidate, and no muscle relaxant or opioid was administered. The patient was successfully intubated by means of direct laryngoscopy. In all probability the blind nasal technique or the use of a fiberoptic device would not have been helpful, because the tumor had to be luxated before the endotracheal tube could be placed. Figure 1 shows the tumor (a) with a diameter of approximately 3 cm, which has displaced the epiglottis (b) to the left. A part of the endotracheal tube is visible at the bottom left. The spiral tube had to be replaced by a tube suitable for laser surgery. After resection (see Fig. 2) the coagulated tumor base (a) and the right vocal cord (b) can be seen with the laser tube still in place. Postoperatively extubation was possible. The histological examination revealed a paraganglioma without signs of malignancy. Apart from occlusion of the upper airway, the main danger stems from the considerable vascularization of such a paraganglioma. Not only the surgical procedure, but also minor manipulations during the endotracheal intubation may cause significant blood loss. In a small percentage of cases hormone-mediated cardiocirculatory complications may occur. If a difficult intubation is expected because of an endolaryngeal tumor, management should be based on the diagnostic findings and the planned surgical procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

[High-resolution computed tomography in diseases of the inner ear]. / Hochauflösende Computertomographie bei Erkrankungen des Innenohres.

High-resolution CT of the petrous bone was carried out in 259 patients with clinically diagnosed abnormalities of the inner ear; in some the lesions were bilateral. In 62 patients (approximately 20%), the scans showed findings which related to the signs and symptoms. Patients with hearing loss and vestibular neuronitis showed no abnormalities. Amongst the remaining patients, the most common findings were acoustic neuromas (17 cases), cochlear otospongiosis (14 cases), malformations (13 cases) and tumours or cholesteatomas of the labyrinth (13 cases) as well as single rare isolated lesions.

[Chondroma of the larynx--case report and differential diagnosis in CT]. / Chondrom des Larynx--Falldarstellung und Differentialdiagnose in der CT.

The characteristic features of chondroma and chondrosarcoma of the larynx (less than 1% of laryngeal tumors) are discussed in a case report. Laryngoscopy (rounded, smooth tumor, covered by normal mucous membrane) and HR-CT of the larynx (swelling of the cartilages, calcifications in 80% of cases) give a characteristic view of the tumor, so that, by synopsis of both, a definite diagnostic statement concerning the kind of tumor is possible. However, carcinoma of the larynx with invasion of the cartilage, laryngeal manifestation of multiple chondromatosis and calcification after severe trauma have to be differentiated from cartilaginous tumors of the larynx. The adequate therapy of chondroma and low-grade chondrosarcoma consists of partial laryngectomy and reconstruction of the air passages. High-grade chondrosarcoma should be treated with radical laryngectomy.

[Computed tomography in the preoperative diagnosis of malignant laryngeal tumors]. / Die Computertomographie in der präoperativen Diagnostik von malignen Larynxtumoren.

The pre-operative laryngoscopic and CT findings in the larynx in 50 patients with malignant laryngeal tumours were compared. Laryngoscopy showed an accuracy for T-staging of 78.6% and CT an accuracy of 80%. In addition, CT complemented the endoscopic findings by demonstrating the depth of tumour invasion. The changes in individual anatomical portions of the larynx were compared, using both methods. CT and palpation showed equal specificity for lymph node staging, but CT is markedly superior in sensitivity.

[Dacryocystography in the digital subtraction technic]. / Dakryozystographie in digitaler Subtraktionstechnik.

Dacryocystorhinostomy is well established as a common surgical approach to the treatment of obstructive epiphora. The importance of a radiological procedure for pre-operative diagnosis and postoperative follow-up is emphasised. Routine imaging (dacryocystography) of the nasolacrimal system is made difficult by the high contrast between bone and air in the sinuses and pharynx, by overlapping structures, and by the very small size of those structures that are of interest. Digital subtraction technique provides significantly improved visualisation even of poorly contrasted structures of the lacrimal system (i.e. canaliculi lacrimales), overcoming limitations imposed by inherently high object contrast. Representative case reports such as pre- and postsaccal stenosis and functional obstruction are presented. Digital subtraction dacryocystography is an important nonvascular application of digital imaging technology.

[Radiation therapy of nasopharyngeal carcinoma. Retrospective study for the assessment of long-term results]. / Strahlentherapie des Nasopharynxkarzinoms. Folgestudie zur Beurteilung der Langzeitergebnisse.

During the years from 1967 to 1986, 90 patients with nasopharyngeal carcinomas were irradiated at the Radiologic Hospital of Bonn University. The median overall survival time was 4.3 years which corresponded to 23% of the statistical life expectancy of the patients. 66% were still alive after two years and 46.5% after five years. Compared to the overall group, the prognosis was significantly worse in case of highly differentiated, keratinizing squamous cell carcinomas, penetration of the primary tumor into the base of the skull, or certain symptoms as ophthalmo-neurologic troubles, headaches, loss of body weight, night sweat, or fever. After partial tumor excision performed prior to irradiation or complete remission following to radiotherapy, the therapy results were better than the average with median survival times of about eleven years.

[High-resolution computed tomography in malformations of the cochlear and vestibular organs]. / Hochauflösende Computertomographie bei Missbildungen des Gehör- und Gleichgewichtsorganes.

Twenty-one patients with congenital deformities of the petrous bones were examined by high resolution computed tomography. This allows an accurate description of the extent of the malformation in all parts of the cochlear and vestibular organs; only localised changes in the auditory ossicles, such as fixation of the stapes and changes in the soft tissue portions of the labyrinth, cannot be shown. Improved demonstration of soft tissues while using less radiation makes high resolution CT preferable to conventional polytomography. It is also easier to perform and provides axial projections which are essential for the elucidation of malformations of the middle and inner ear.

[Malignant tumors of the mouth and pharynx--MR tomography with surface coils]. / Malignome der Mundhöhle und des Pharynx--MR-Tomographie mit Oberflächenspulen.

The place of MRT, using surface coils, has been evaluated retrospectively in 27 patients with clinically confirmed malignant tumours of the mouth and pharynx. The extent of the tumour and its relationship to neighbouring structures is well demonstrated. The resolution obtainable by using surface coils is almost as good as that of CT. Soft tissue contrast is better in showing the spread and size of the tumour. A disadvantage of MRT is the inability in most cases to demonstrate bone destruction. Differentiation between residual tumour, recurrence and scarring is possible only occasionally. Quantitative MRT may be expected to lead to improved diagnosis during the course of following up.

[High-resolution computed tomography of peripheral facial paralysis]. / Hochauflösende Computertomographie bei peripherer Fazialisparese.

High resolution computer tomographic examinations of the petrous bones were performed on 19 patients with confirmed peripheral facial nerve paralysis. High resolution CT provides accurate information regarding the extent, and usually regarding the type, of pathological process; this can be accurately localised with a view to possible surgical treatment. The examination also differentiates this from idiopathic paresis, which showed no radiological changes. Destruction of the petrous bone, without facial nerve symptoms, makes early suitable treatment mandatory.

[High-resolution computed tomography in the diagnosis of bone-destroying processes of the external ear]. / Die hochauflösende Computertomographie in der Abklärung knochendestruierender Prozesse des äusseren Ohres.

Eleven patients with known malignant tumours of the outer ear and three patients with otitis externa maligna were examined by high resolution CT. CT provided accurate information concerning soft tissue infiltration into the parotid or subtemporal tissues, and of the bony destruction in the mastoid, meatus and tympanic cavity. Absolute differentiation between a malignant tumour and otitis cisterna maligna is not possible, not even by high resolution CT.

[Yeast fungus flora in tumor irradiation of the upper aerodigestive tract]. / Untersuchungen zur Sprosspilzflora während Tumor-Bestrahlungen im oberen Aerodigestivtrakt.

The microflora of the oral cavity and pharynx were examined in 28 patients undergoing radiotherapy for cancer of the upper aerodigestive tract. We found no correlation between yeast flora and mucositis: early mucositis occurred between 10 and 20 gy. independent of the concentration of yeast. During radiotherapy the number of patients with detectable yeasts rose from 12 to 22 of the 28. There was a tenfold increase of mean values for yeasts during irradiation, whereas the normal flora (eg. streptococci) remained unchanged. The value of an antifungal local therapy for the prevention of yeast-induced complications is discussed.

[Osteoma of the temporal bone as a rare differential diagnosis of a retroauricular tumor]. / Das Osteom der Schläfenbeinschuppe als seltene Differentialdiagnose eines retroaurikulären Tumors.

Extracanalicular osteomas of the temporal bone represent a rare differential diagnosis of osseous tumours in the ear region in contrast to the common finding of exostoses of the external auditory canal. Basing on a report on a retroauricular osteoma of the squama of the temporal bone treated in the authors' ENT clinic, the morphological and clinical characteristics of this tumour are discussed.

[Paraganglioma of the nasal cavity]. / Das Paragangliom der inneren Nase.

Extraadrenal paragangliomas are very rarely located in the nose and the nasal sinus. Histological and clinical findings of this tumour are discussed.

[Vessel damage caused by the administration of intra-arterial methotrexate? Fluorescence angiography and histologic findings]. / Gefässschäden bei intraarterieller Methotrexatapplikation? Fluoreszenzangiographische und histologische Befunde.

During a 7 days course of intraarterial methotrexate therapy in patients with certain head and neck tumours, we could demonstrate changes in the blood supply of the tympanic membranes as well as in the tumours themselves by the fluorescence angiography technique. Chemotherapy generally was followed by an operation, the material of which histologically showed varying degrees of vascular occlusions, which we ascribe to the high concentration of methotrexate. The drug given into the external carotid artery reached not only the tumour-supplying vessels but also more peripheral branches such as the arteries of the tympanic membrane. This could explain the observed vascular changes. We conclude that the high concentration of methotrexate achieved by intraarterial therapy may cause vascular occlusions. Therefore, this kind of chemotherapy should be used for a limited time only, because later the penetration of the drug may be inhibited.

[Photodocumentation of intra-arterial infusions using fluorescein]. / Photodokumentation des intraarteriellen Infusionsgebietes unter Zusatz von Fluoreszein.

Intra-arterial chemotherapy was given to 12 patients with Head and Neck tumours with the aim of selective perfusion of the tumour area, usually located in the area of supply of the lingual and/or facial artery. A catheter was inserted retrograde into the external carotid artery. The skin or mucous membrane area thus selectively infused by the antineoplastic drug and fluorescein solution could be controlled and documented using an excitation- and barrier filter. Serial photographs were used to demonstrate the higher fluorescence in the perfused area during the intra-arterial infusion lasting 60 or 90 minutes. The use of a balloon catheter increased the selectivity of the fluorescent region. At the end of the infusion the fluorescence disappeared rapidly. From our findings we conclude that it is possible to produce a selective higher concentration of a substance in the tumour during the intra-arterial infusion.