Simultaneous Radiological and Fiberendoscopic Evaluation of Swallowing ("SIRFES") in Patients After Surgery of Oropharyngeal/Laryngeal Cancer and Postoperative Dysphagia.

To compare the results of a simultaneously performed videofluoroscopic swallowing study and fiberendoscopic evaluation of swallowing in patients with dysphagia after surgery and radiotherapy for oropharyngeal or laryngeal cancer. This prospective study included 31 patients who were examined simultaneously with a standardized protocol. The fiberendoscopic and videofluoroscopic swallowing loops were independently scored by two otorhinolaryngologists/phoniatricians and two radiologists. The presence of penetration/aspiration, the amount of pharyngeal residues and the position of the bolus head when triggering of pharyngeal swallow begins were evaluated. Generalized linear models were used to model the impact of rater, method, bolus and quantities as well as specified moderation effects on scorings. In addition, post hoc Wilcoxon tests were used. Rater agreement was assessed using weighted kappas and their 95% confidence intervals. A total of 202 swallow sequences in 29 patients was evaluated. Interrater agreement was substantial to excellent for both methods (weighted k = 0.979-0.613). Significant differences between both methods were found when assessing the penetration-aspiration scale (p = 0.001, tendency of higher scores by videofluoroscopic (median = 2.59) as opposed to fiberendoscopic (median = 2.14) and the residue severity scores in the valleculae (p = 0.029) and the sinus piriformes (p = 0.002) with larger residues scored by fiberendoscopic evaluation of swallowing. No significant differences were found regarding the time point of triggering (p = 0.273). Simultaneous evaluation of swallowing with FEES and VFSS showed significantly different results in symptomatic patients after tumor operation and radiotherapy.

[Increased possibility for HIV-associated retinal microangiopathy syndrome in patients with concomitant hepatitis C infection]. / Höhere Wahrscheinlichkeit eines HIV-assoziierten retinalen Mikroangiopathie-Syndroms bei Patienten mit zugleich bestehender Hepatitis-C-Infektion.

BACKGROUND: The etiology of HIV-related retinal microangiopathy syndrome is yet unknown. Several authors postulate direct endothelial-cell infection, an immunocomplex vasculitis caused by HIV-related hypergammaglobulinemia or an increased serum concentration of endothelin as its origin. PATIENTS: 118 patients infected by HIV-1 have been examined (CDC I: 1; CDC II: 42; CDC III: 7; CDC IV: 68). 49 out of them were also infected by hepatitis-C-virus (CDC I: 0; CDC II: 16; CDC III: 4; CDC IV: 29). RESULTS: 26 out of 49 patients with hepatitis-C-co-infection showed HIV-related retinal microangiopathy syndrome (CDC I: 0/0; CDC II: 8/16; CDC III: 2/4; CDC IV: 16/29). In 69 patients without hepatitis-C-infection, HIV-related retinal microangiopathy syndrome was found five times (CDC I: 0/1; CDC II: 2/26; CDC III: 0/3; CDC IV: 3/39). CONCLUSION: Co-infection with hepatitis-C-virus is supposed to enhance the development of retinal microangiopathy syndrome in patients infected by HIV-1.

[Current results of nitrogen cryotherapy in eyelid basaliomas]. / Bisherige Ergebnisse der Stickstoff-Kryotherapie bei Lidbasaliomen.

By means of long-term follow-ups of large numbers of patients it has been established that nitrogen cryotherapy for lid basaliomas produces very good results with regard to the cure rate, as well as having considerable advantages over other treatment methods. In contrast to other authors we did not employ the spray method, but a very high-performance nitrogen cryo unit with a closed probe. Experimental measurements showed that this unit is capable of generating at least the same temperatures as with the spray method. The cryoapplication technique is described. The cure rate and causes of recurrence in the first series in the total of 84 patients treated from 1979 to 1983 were evaluated by long-term follow-up. If cryobiological principles are observed and the recommended application technique is adhered to, the same cure rate can be achieved as with the spray method and other forms of treatment. There are considerable functional and cosmetic advantages, also as regards the patency of the lacrimal ducts.

[Diagnostic ultrasonography and X-ray computer tomography in space-occupying orbital lesions--a joint effort (author's transl)]. / Zusammenwirken von Ultraschalldiagnostik und Röntgen-Computertomographie bei raumfordernden Orbitaprozessen.

Diagnostic ultrasonography (A-and B-scans) and X-ray computer tomography are completely different in their physical bases. The yield, therefore, different informations in the examination of space-space-occupying lesions in the orbit. The informations which can be recorded from normal and pathologic tissues in the orbit are described in this paper. The value, but also the limitations, of the various diagnostic methods are demonstrated in clinical cases. The reliable diagnosis of unilateral, progressive pseudoprotrusion in high myopia by ultrasound exophthalmometry is described. Facilities and diagnostic value of ultrasonography and X-ray computer tomography in the localisation of orbital tumours and in the determination of their relationship to the orbital walls are discussed. The diagnostic management in intermittent exophthalmos, in orbital abscess and in Grave's disease is reported. The complete ophthalmic examination is followed by ultrasound exophthalmometry and--if indicated--A- and B-scan ultrasonography of orbital tissues. Computed X-ray tomography is indicated in all tumour-suspicious lesions within the orbit. The results of diagnostic ultrasonography and computed X-ray tomography may complete each other in a very helpful manner. The combined evaluation yields better results than the use of only one of these methods. In orbital varices we recommend, to supplement ultrasonography by venography and eventually arteriography. In diagnoses of orbital abscesses resulting from paranasal sinusitis it may usually suffice to combine ultrasound diagnosis with native X-ray examinations. Good interdisciplinary cooperation in diagnosis and therapy is mandatory in all patients with space-occupying orbital lesions.

[The tensile strength of human zonule and its alteration with age (author's transl)]. / Die Reissfestigkeit der menschlichen Zonula und ihre Abhängigkeit vom Lebensalter.

A series of 91 cryoextractions was performed on autopsy material. The scleral section was placed near to the chamber angle and was nearly circumferential (about 330 degrees). Cornea and adjacent sclera could be flapped over this way, and did not interfere with a straightforward lens extraction. The pupil was medically dilated. A cryoprobe was fixed to a specially constructed scale, and frozen to the anterior pole of the lens. Its weight was counterbalanced by a plastic water container at the other end of the scale. The extraction was performed by filling additional water into the counterbalancing container. The statistical evaluation of the results showed a very significant dependence of the average tensile strength on age. However, a considerable standard deviation was found throughout all ages. The nutritional state of the autopsy bodies and the time interval between death and start of the measurement had no significant influence. The differences between right and left eyes were also not significant, as could be expected. The methodological error remained small. Age proved to be an unreliable indicator for the tensile strength of the zonule. All results apply to clear lenses. We known from clinical experience that the tenacity of the zonule may also be different in the various types of cataract.

[Changes in the indications and techniques in the surgery of retrobulbar orbital tumours (author's transl)]. / Wandel der Indikationen und der Technik in der Chirurgie retrobulbärer Orbitatumoren.

In the past 3 decades, surgery of retrobulbar tumours was mainly done by neurosurgeions (transfrontal orbital approach) or ENT surgeons (transethmoidal approach), especially in Europe. More recently, especially in USA this has changed and the majority of these cases, in an increasing number of hospitals, are now treated by a modified Krönlein operation, usually performed by ophthalmic surgeons. In this paper we tried to elucidate the background of this development. Ultrasound exophthalmometry (Fig. 3), ultrasound A- and B-scans of the orbital tissues (Fig. 4 and 5) and computerized axial X-ray-tomography of the orbits (Fig. 6) improved the preoperative diagnoses markedly. In the most cases it is now possible to decide preoperatively on the existence, size and location (and sometimes even on the nature) of a spaceoccupying lesion in the orbit. The technic and the instruments for Krönlein's operation have been improved (Krönlein-Berke, Fig. 8-11). The oscillating saw (Stryker) facilitates the resection of the bone, and microsurgical technics are now preferred for removal of the tumour from the orbit. The modified Krönlein operation is also recommended for orbital decompression in severe endocrine exophthalmos, provided the lateral orbital wall is removed to the described extent.

[On the proof of late sequelae of bulbal and orbital contusion (author's transl)]. / Zum Nachweis von Spätfolgen einer Contusio bulbi (et orbitae).

Contusion cataracts may develop long time after injury, without visible lens changes in the interval. The lens opacities appear like those known in senile cataracts if the eye was injured after the 45th year of age. Demonstration of other traumatic changes becomes then very important for the evaluation of the role of the accident as a cataract cause. As late sequelae of eye (and orbit) contusion, enophthalmos and supersensitivity of the pupil to adrenergic drugs can be found. Ultrasound exophthalmometry proved to be more accurate for checking the former than Hertel's optical exophthalmometry alone. The pupil was studied by the reaction following local instillation of one drop of 1% adrenaline solution (comparison with other eye). The results found in 2 patients are described.

[Unrecognized paralyses of accommodation and their importance in diagnostics and expertise (author's transl)]. / Unerkannte Akkommodationslähmungen und ihre Bedeutung für die Diagnostik und die Begutachtung.

Paralyses of accommodation are safely diagnosticizable even in patients over 45 years of age provided there is no complete presbyopia. The identification can be a key to diagnosing the entire disease pattern. In one case a suspected Adie's syndrome with amblyopia and without any connection with internment and damage due to malnutrition was identified as ophthalmoplegia interna with partial atrophy of the n. opticus, most probably caused by malnutrition encephalopathy or encephalitis. In another patient, a bilateral isolated accommodation paralysis indicated damage of the accommodation center during concussion of the brain (possibly only a functional damage).

[Checking and clinical application of time gain compensation (TGC) in diagnostic ultrasonography (author's transl)]. / Prüfung und klinische Verwendung laufzeitabhängiger Verstärkungsregelung in der Ultraschalldiagnostik.

The usefulness of TGC depends on the scanning technique. The A- and B-scan echograms of the orbit can show much more detailed information of the orbital structures, if TGC and a corresponding scanning technique are applied. The sound beam should be directed preferably through the center of the eyeball to keep the length of vitreous within the sound beam constant. The external eye muscles, orbital fat and optic nerve can much better be identified and localized. Radiolucent orbital foreign bodies (wood splinters) were experimentally examined and could also be shown much better using TGC. The TGC characteristic must be measured for reproducible adjustments. The scale readings of the apparatus are insufficient. Even in apparatus supplied with an indication of the TGC characteristic on the screen checking of the real TGC characteristic proved necessary. A simple measurement technique, easily applicable under hospital conditions is described. It is based on a test reflector made from material for soft corneal contact lenses (testreflector W 38, Poly-HEMA, 38% water content.

[Echography of the vitreous body in case of aphakia and malignant aphakic glaucoma (author's transl)]. / Glaskörperechographie bei Aphakie und malignem Aphakieglaukom

The senile destructions of the vitreous body which can be seen with the slit-lamp (formation of visible fibres, vacuoles and posterior vitreous detachment) cause, if sufficiently advanced, small echoblips visible at echographic examination. We reexamined aphakic patients who had no complications during cataract cryo-extraction. In aphakic eyes without postoperative vitreous prolapse into the anterior chamber the echograms usually consisted of uninterrupted series of small amplitude echoes in the vitreous area. In aphakic eyes with postoperative vitreous prolapse into the anterior chamber echo-free parts were found in the vitreous area and also parts showing closer placing of vitreous echoes. The echo-free parts may represent fluid-filled vacuoles. In malignant aphakic glaucomas, which could not be controlled otherwise, we succeeded inaspirating aqueous humour from these echo-free parts by punction. Echography facilitated, in this way, the punction of the trapped aqueous. Echography of the senile vitreous destructions approaches the limits of present ultrasonographic facilities; artefacts may occur, and technical improvements are desirable and possible.