A retroperitoneal tumor as a late complication of the use of bone wax.

Ordinary bone wax was used to stop bleeding from the iliac crest after procurement of autogenous bone graft harvesting. This gave rise to a large, symptomatic retroperitoneal tumor, which had to be removed operatively 19 years later. Microscopically, a bone wax granuloma was diagnosed. As far as the authors know this is the first case reported with such late and severe clinical complications after the use of bone wax.

[Video-fluoroscopy in a graduated diagnostic program in oral cavity and pharyngeal carcinoma]. / Die Videofluoroskopie im diagnostischen Stufenprogramm von Mundhöhlen- und Pharynxkarzinomen.

The role of videofluoroscopy in the preoperative evaluation of 38 carcinomas of the oral cavity and oro-/hypopharynx is described. The analysis compared videofluoroscopy with CT and endoscopic assessment, since videofluoroscopy is the only imaging method that can record dynamic motility changes during deglutition. The intraluminal part of the tumour is well visualised by high contrast resolution of the pharyngeal mucosa. The extent of tumorous infiltration can be evaluated via indirect criteria such as leaking, vallecular asymmetry, impaired epiglottic movement with insufficient vestibular closure, pharyngeal wall rigidity, and laryngeal aspiration. Carcinoma of the oral cavity and piriform sinus often do not cause functional swallowing impairments that can be detected by videofluoroscopy. However, in case of carcinoma at the base of the tongue region as the major driving force in bolus movement, videofluoroscopic assessment yields important additional information supplementing CT and endoscopic findings.

[Rehabilitation of deglutition in patients with pharyngeal carcinoma]. / Rehabilitation der Schluckfunktion bei Patienten mit Pharynxkarzinomen.

Surgical treatment of pharyngeal carcinoma implies different reconstructive procedures. Despite primary healing, in some cases cicatricial shrinkage occurs, resulting in dysphagia. Of 113 patients with carcinoma of the oro- and hypopharynx in the last 4 years, 35 patients were studied in a specific follow-up examination. Deglutition was evaluated via subjective responses to a questionnaire. Reproducible information was gained by videofluoroscopy and manometry of the pharyngo-esophageal segment. To assess deglutition, an arbitrary number scale was established with 7 for excellent and 1 for poor deglutition. After local tumour excision, partial and total pharyngectomy, pharyngolaryngectomy and additional myocutaneous grafting, the deglutition index ranged from 5.8 to 4.5 showing more striking differences in the time required for eating. Manometric analysis showed pressure peaks 10 times lower (3.5 hPa) than in normal subjects with prolongation of each swallow. Videofluoroscopy reveals even slight motility disturbances after ablative pharyngeal surgery. Typical findings are presented. The swallowing function after pharyngeal tumour operations requires the reconstruction of both the horizontal (oral) and vertical (pharyngeal) phase of deglutition. Since the base of the tongue seems to be the major driving force in bolus movement, it is not the extension of resection but the availability of remaining contractile tissue in the neopharynx, especially in the base of the tongue region, that determines the postoperative rehabilitation of deglutition.

[Angiography findings before and following transplantation of free myocutaneous flaps]. / Angiographische Befunde vor und nach Transplantation freier myokutaner Lappen.

Prerequisite for successful split-skin flap transplants of myocutaneous flaps is the presence of adequate adjacent afferent and efferent vessels, thus making an arteriography of the receiving region mandatory during surgery preparation. In 20 or 29 patients in whom a split myocutaneous flap was transplanted to the lower leg, angiography revealed 22 pathological or other therapyrelevant findings. Besides the afferent vessels it is basically necessary to visualise the peripheral efferent pathways in order to prevent that vascular anastomosis to the split-skin flap obstructs the blood supply of the leg.

[Neurologic complications in hereditary multiple exostoses]. / Neurologische Komplikationen bei hereditären multiple Exostosen.

Based on the radiological and clinical findings in two patients suffering from hereditary multiple cartilaginous exostoses, the importance of identification and x-ray confirmation of neurological signs within the framework of the overall disease patterns is shown. This is a rare complication, bat it is highly important for the patient. Early clarification is imperative; if surgical intervention is not instituted directly, a closely meshed control network is considered mandatory to prevent severe irreversible neurological deficits.