[Radiotherapy in scar-induced keloid]. / Strahlentherapie beim Narbenkeloid.

AIMS: In a retrospective study, the results of the excision of keloids in combination with postoperative irradiation were investigated with respect to the cosmetic effect and the recurrence rate. PATIENTS: Between 1978 and 1990, 20 patients aged between 15 and 64 years who, together, had a total of 23 localized keloids, were submitted to prophylactic irradiation following excision of the latter. TREATMENT: Radiotherapy was applied, fractionated, using low-energy (soft) X-rays, the strontium 90 Dermaplatte, or with electrons produced by a linear accelerator. The mean total surface dose applied was 20 Gy. RESULTS: Eighteen patients with 21 keloids were followed-up for a period of between 2 months and 12 years (mean: 33 months). The cosmetic result was good or very good in 17, and unsatisfactory in four of the 21 keloids. Prior to treatment, 18 of the keloids were associated with local complaints; 15 of these cases were symptom-free after treatment. CONCLUSION: With the combination of excision and postoperative irradiation, the results of keloid treatment can be improved, and recurrence largely avoided.

[Antineoplastic effectiveness and unwanted side effects of polychemotherapy of extensive oro- and hypopharyngeal cancers--results of a prospective therapy study with 5-FU/cisplatin versus 5-FU/carboplatin]. / Antineoplastische Wirksamkeit und unerwünschte Nebenwirkungen der Polychemotherapie ausgedehnter Oro- und Hypopharynxkarzinome--Ergebnisse einer prospektiven Therapiestudie mit 5-FU/Cisplatin versus 5-FU/Carboplatin.

60 patients with advanced carcinomas of the oropharynx and hypopharynx underwent chemotherapy, either with 5-FU/Cisplatin (n = 30) or with 5-FU/Carboplatin (n = 30). The remission-rates (complete and partial remissions) were comparable in both groups. The rate of complete remissions, however, was statistically significant higher in the cisplatinum group (6 patients) than in the carboplatinum group (1 patient). 2 patients of the 5-FU/Cis-group and 4 patients of the 5-FU/Carbo-group developed a progressive disease during chemotherapy. Statistically significant differences were found in the nephrotoxic and myelotoxic side effects between both therapy groups: nephrotoxic side effects were more frequent in the 5-FU/Cis-group, whereas myelotoxic side effects occurred mainly in the 5-FU/Carbo-group. The chemotherapy with 5-FU/Carboplatin was better tolerated by the patients than in the 5-FU/Cisplatinum-group. In the 5-FU/Carbo-group especially a lower rate and severity of loss in weight, nausea, vomiting, alopecia and mucositis/stomatitis was observed. No statistically significant differences were found in ototoxic side effects between both groups.

[Follow-up studies and prognostic references for pre- and post-therapy pure tone audiometry and acoustically evoked potentials in sudden deafness]. / Verlaufsuntersuchungen und prognostische Hinweise prä- und posttherapeutischer Tonschwellenaudiogramme und akustisch evozierter Potentiale beim Hörsturz.

In 95 patients with unilateral sudden deafness, pure-tone and speech audiometry was performed before, during and after drug therapy. Auditory brain-stem evoked responses (ABR) were recorded in all cases. Stapedial reflex audiometry and SiSi tests were also performed. The tone-audiometry thresholds for the frequencies 250, 500, 1000, 2000, 4000 and 6000 Hz were analysed, and likewise the ABR latencies for waves I to V and the I-III, III-V and I-V interpeak latencies. 57 patients showed a flat hearing loss before therapy, 31 patients a high tone loss and 7 patients a hearing loss for low frequencies. Recruitment was positive in 77%. After therapy 81% of the patients showed increased pure-tone thresholds of more than 20 dB. In 11 patients ABR showed signs for retrocochlear hearing loss; in 6 patients initially no waves could be reproduced. The tendency for remission was best in patients with flat hearing loss of less than 40 dB and normal or only moderate alterations of the ABR. In patients with severe hearing loss of greater than 40 dB and signs for retrocochlear lesions in ABR, the tendency of remission was worse. In these cases recruitment was mainly negative.

[Value and status of neurologic, serologic, internal medicine and orthopedic studies in routine diagnosis of sudden deafness]. / Aussagekraft und Stellenwert neurologischer, serologischer, internistischer und orthopädischer Untersuchungen in der Routinediagnostik des Hörsturzes.

One hundred and eighteen patients with acute unilateral sensorineural hearing loss were examined. Diagnosis included a neurological, orthopedic, and internal medical examination. Serological tests were performed including influenza-, parainfluenza-, adenovirus-, RS-virus, enterovirus-, morbilli-, varicella- and cytomegalie-virus-KBR, also the serological tests for toxoplasmosis, rheuma, lues, mycosis, and Borrelia. The examinations allowed conclusions to be drawn about a possible etiology in five of the patients only: in one patient it was possible to detect an acute infection with morbilli virus; in two other patients, an acute lues infection was detected. In two other patients, neurological examinations showed symptoms of a brainstem disease. The authors' experience shows that the following examinations are useful in the diagnosis of acute unilateral sensorineural hearing loss: the recording of acoustically evoked brainstem potentials, an otoneurological examination, a neurological examination to detect a possible centrally located reason for the hearing loss, serological examinations for lues, toxoplasmosis, Borrelia, and the virus KBR if there is any suspicion of a previous virus infection. An orthopedic examination should be performed, if functional aspects, especially of the craniocervical segment are under consideration.

[Results of fluorescein nose endoscopy in the diagnosis of cerebrospinal rhinorrhea]. / Ergebnisse der Fluoreszein-Nasenendoskopie bei der Diagnostik der Rhinoliquorrhö.

To establish the diagnosis of cerebrospinal rhinorrhoea 45 patients were examined via intrathecal fluorescein-dye studies. Rhinorrhoea was suspected after head injuries and surgery of the base of the skull. The diagnostic procedure was in accordance with the technique of Messerklinger. In 8 patients a fluorescent secretion was detected and a CSF-leakage operatively proven. The result of the fluorescein tests, the x-ray tomographies and the RIHSA-studies are compared. The fluorescein technique is shown to be a useful diagnostic tool in the diagnosis of cerebrospinal leaks.

[Reconstruction of the auditory canal in the surgery of severe ear abnormalities]. / Gehörgangsrekonstruktion bei der Operation grosser Ohrmissbildungen.

The reconstruction of a completely epithelialized and wide external meatus is a difficult problem in surgery of the congenital atresia of the ear. Different methods are described and compared. By using a split thickness skin graft formed as a bag and adapted to the walls of the new canal better results were obtained than with the other methods. The cases operated on in this way showed less complications as postoperative inflammations and stenosis of the canal. There was no need for surgical revision.

[Preoperative intravenous and intra-arterial cytostatic therapy (VMBP) in carcinoma of the head and neck]. / Präoperative intravenöse und intraarterielle Zytostatikatherapie (VMBP) bei Karzinomen des Kopfes und Halses.

Two groups of patients with carcinomas of the oropharynx and the oral cavity were selected for praeoperative cytostatic therapy. Vincristine, Methotrexate, Bleomycin and Cisplatin were administered intravenously and intra-arterially (VMBP). The remission rates of the tumours (complete and partial remission) were, for intra-arterial application, 81%, and for intravenous application, 66.7%, indicating a possible superiority of intra-arterial therapy. In 10 intra-arterial (47.6%) and in 8 intravenous cases (38.1%), a complete clinical remission was accomplished. This was confirmed by the histological examination of the tumours, where no tumour cells could be recognized.

[Ambulatory combination therapy with cisplatin, bleomycin (DDP-BLM) in recurrence and metastasis of malignant tumors of the head and neck]. / Konzept einer ambulanten Kombinationstherapie mit Cisplatin, Bleomycin (DDP-BLM) bei Rezidiven und Metastasen maligner Tumoren des Kopfes und Halses.

16 patients with recurrent or metastatic carcinomas of the upper respiratory and digestive tract underwent a total of 55 courses of chemotherapy with Cisplatin and Bleomycin. The cytostatic treatment was performed under outpatient conditions. 0.75 mg./kg. Cisplatin was administered at intervals of 5-8 weeks. In addition, 15 mg. Bleomycin was administered weekly. Hydratation and diuresis were forced by 1000 ml. 0,9% NaCl solution and 1000 ml. levulose 5% with potassium substitution and 250 ml. mannitol 10% after an initial injection of 2 ml. Furosemid. The treatment was generally well tolerated. A nausea lasting 1-3 days was observed after Cisplatin application. Remission of tumours, stopping of tumour progression and a reduction of pain was achieved. The "performance status" was maintained. In 6 cases there was no effect.