[Surgical therapy of blepharospasmus gravis]. / Die operative Therapie des Blepharospasmus gravis.

Blepharospasm is a rather rare disease characterised by cramps of the orbicularis oculi muscle. The quality of life of patients suffering from this illness is often severely reduced. The therapeutic approaches reported in the literature have so far not been satisfactory in most cases. In the mid'-seventies a new operative technique has been introduced by Walser and modified by Behbehani. This procedure consists of the dissection of the zygomatico-temporal branch of the facial nerve. In the present paper the author reports on his own experience with this special method as well as the long-term results in 19 patients that have been followed up over a period of 3 months up to 14 years after operation. Surgery was carried out bilaterally in 19 cases, while 5 patients were operated on one side only. After resection of the nerve, blepharoplasty of the upper lid was performed. The therapeutic value of the technique is discussed and compared with the appropriate literature.

Thorotrast-induced oro- and hypopharyngeal fibrosis with recurrent bleeding.

Thorium dioxide, widely used as a contrast material, is a producer of alpha particle radiation. This is well demonstrated by autoradiography. The case described illustrates that life-threatening, thorium dioxide-induced pharyngeal haemorrhage may occur even with an occluded carotid artery. The radiation exposure caused an intense foreign body reaction with a marked cell-deficient fibrosis. The alpha particles are well demonstrated by autoradiography. In addition, we were able to show a defect in the wall of the carotid artery due to the Thorotrast injection, which was closed by cell-depleted connective tissue. As the radioactivity of the nuclides of thorium dioxide peaks 30-40 years after its first application, the morbidity will increase and the disease has to be taken into careful consideration in head and neck tumour lesions.

[The disease picture of severe blepharospasm, the cause and a new kind of treatment with long-term results]. / Das Krankheitsbild des Blepharospasmus gravis, Ursache und neuartige Behandlung mit Langzeitergebnissen.

The etiology of essential blepharospasm is extraordinarily manifold and still not clarified in many instances. The therapeutic possibilities are equally manifold and not always satisfactory. A new method of surgical intervention consists in the dissection of the zygomaticotemporal nerve shortly after its separation from the stem of the facial nerve. In 10 cases with particularly severe blepharospasm, a permanent therapeutic result which was satisfactory in every respect was achieved in collaboration with an otorhinolaryngologist. For the ophthalmologist and otorhinolaryngologist a knowledge of the various therapeutic possibilities is important in order to adjust treatment accordingly.

[Invasive aspergillosis of the head and neck]. / Invasive Aspergillose im Kopf-Hals-Bereich.

Aspergillosis of the paranasal sinuses after invasion of the neighbouring orbit and/or the sella turcica may simulate a malignant tumour. Exploratory excisions usually lead to the diagnosis of a chronic sinusitis. With the aid of special staining methods as well as cultural and serological tests the diagnosis of an aspergilloma can be established.

[Clinical relevance of protease inhibitors in nasal secretions]. / Zur klinischen Relevanz von Proteasenhemmstoffen im Nasensekret.

The normal human nasal mucous membrane is protected against negative effects of proteases by special inhibitors. This inhibitor pool consists of both secretory-specific and humoral inhibitors. A method is presented to determine the function of protease inhibitors in nasal secretion. Investigations have been carried out on secretions of healthy subjects, as well as patients suffering from sinusitis. The differences are illustrated. The results enable an evaluation of the degree of infection; the course of the disease can be documented. A possibility of producing synthetic inhibitors for therapy is discussed.

[Differential diagnosis of allergic and vasomotor rhinopathy. Value of individual diagnostic possibilities]. / Zur Differentialdiagnose der allergischen und vasomotorischen Rhinopathie. Wertigkeit der einzelnen Diagnostikmöglichkeiten.

History, examination, x-rays and blood tests are usually not very helpful in distinguishing between vasomotor and allergic rhinitis. The best methods are skin-tests and investigations which test the reaction of the nasal mucosa directly. Nasal provocation has so far been the best method of differentiating an allergic from non-allergic rhinitis. The estimation of IgE-concentration in nasal secretion is a promising new method. IgE values over 10 I.U. are found in persons with allergic rhinitis. The IgE-values are lower than 10 I.U. in more than 90% of non-allergic subjects. Estimation of IgE-concentration in nasal secretions seems to be as good as the nasal provocation test but easier.

[Experiences with solvent-dried fascia lata in surgical interventions in otorhinolaryngology]. / Erfahrungen mit lösungsmittelgetrockneter Fascia lata bei operativen Eingriffen im Hals-Nasen-Ohrenbereich.

Basing on our good experiences with dehydrated solvent-dried human dura we applied, during the last two years, dehydrated solvent-dried fascia lata in our clinic. Fascia lata is more flexible in comparison to the stiff dura. In 225 cases we collected experience with the new dehydrated solvent-dried human fascia lata: 103 patients with frontobasal fractures and rhinoliquorrhoea 83 patients with tympanoplastics for mastoid lining 5 patients with laterobasal fractures 11 patients with septum perforations 21 patients with blow-out fractures 2 patients with facial paralysis. Fascia lata was fixated by human fibrin adhesive. The dehydrated human solvent-dried fascia lata showed the same good results as the group of patients where we used autologous fascia lata.

[Diagnostic value of nasal secretions, current state: normal values. 1]. / Nasensekretdiagnostik, aktueller Stand: Normalwerte. Teil 1.

Separation of pure nasal secretions has been very difficult until now. Therefore, examinations were performed only with a small number of patients. Employing a new method to separate pure nasal secretions it is now possible to perform routine examinations. In this paper the protein composition and electrolyte patterns of normal human nasal secretion is reported. The amount of nasal secretion depends from the location and region of human nasal mucosa. The average amount is between 135 and 75 microliters. The protein concentration shows a very wide variation in the normal secretion between 200 and 3500 mg%. The average concentration in the upper nasal meatus is 950 mg%, in the lower nasal meatus 1100 mg%. Selective glycoprotein stainings show that the main part of nasal secret proteins are glycoproteins. The electrolyte concentrations were calculated for sodium 90-148 mval, potassium 6-28 mval and calcium 2-3.5 mval.

[Comparative cytologic studies of human nasal secretions (differential smears of secretions in patients following laryngectomy and patients with rhinitis sicca in comparison with healthy subjects)]. / Vergleichende zytologische Untersuchungen des menschlichen Nasensekretes (Sekretdifferentialausstriche bei Patienten nach Laryngektomie und Patienten mit Rhinitis sicca im Vergleich zu Gesunden).

Using a new method, exfoliative cytologic examinations were performed in patients after laryngectomy and in patients with rhinitis sicca in comparison to normal nasal mucosa. In patients after laryngectomy an increased rate of nasal secretion can be seen. In the nasal smear the main fraction of cells are ciliated epithelial cells. Contrariwise, in patients with rhinitis sicca many squamous epithelial cells can be found. The new method enables the preparation of quantitative cytograms.

[Quantitative exfoliative cytologic studies of the human nasal mucosa]. / Quantitative exfoliativzytologische Untersuchungen der menschlichen Nasenschleimhaut.

A new method for collecting nasal secretions yields quantitative cytological results of human nasal secretions. The new results are compared with the conventional methods for obtaining nasal smears by cotton or replica technique. The best staining method is a modified May-Grünwald stain. With the new method, a large area of nasal mucosa is examined contrary to the previous methods where punctual examinations only were possible. Moreover, because the total number of cells can be counted, accurate quantification of individual cell fractions and differentiation of the nasal smears can be effected.

[Functional results in unilateral auditory canal atresia]. / Funktionelle Ergebnisse bei einseitiger Gehörgangsatresie.

42 patients with unilateral congenital atresia of the ear were examined postoperatively. The results were as follows: 1. Tympanoplasty type III, stapes elevation by autologous ossicula, gave the best results on the average. 2. The discrimination tests gave poorer results than had been expected from the pure-tone threshold audiograms. 3. As a result of the operation, only one-third of the patients obtained a sense of hearing which made them fit for social contacts; hence, the indication for surgery should be examined critically before any action is taken.

[Rhinobasale mucormycosis (author's transl)]. / Rhinobasale Mukormykose.

A case of mucormycosis in a 82-year old woman is reported. In spite of an early diagnosis, a surgical intervention and the antimycotic treatment with Miconazol-Sodium (Daktar [R]) and Amphothericin B "Squibb" (R) could only prolonge the bad prognosis of this infection. The pathogenesis, the typical, in most cases letal fungal infection and its therapy is discussed.