[200 free jejunum transplantations: is the great surgical effort worthwhile?]. / 200 freie Jejunumtransplantationen: Lohnt der grosse operative Aufwand?

From 1983 to 1992, 216 free jejunal transplants were performed after resection of malignant tumours for reconstructing the upper oesophageal tract. In two patients reconstruction was performed secondarily and in four cases within the framework of recurrence treatment. In 25 cases the jejunal transplant was sewn in tubular form to the circular insert of the hypopharynx, whereas in the remaining 188 cases the jejunum transplant was sewn as patch. A jejunum transplant was most frequently employed in the tonsillar region (n = 75). Reconstruction of the body of the tongue was performed in 42 cases and of the hypopharynx in 29 cases. Of the 213 patients treated, 175 were irradiated postoperatively. The most severe complications were in 5 cases death from the sequels of the operating, abdominal complications in 15 cases and complete loss of the transplant in 22 cases. Protracted inability to swallow occurred in 15 cases and pneumonia in 16 patients. The five-year survival probability was 39% for the 42 patients suffering from carcinomas of the oral cavity, 53% for the 90 patients with oropharyngeal carcinoma in stage III and 33% in stage IV, as well as 40% with the 29 patients suffering from hypopharyngeal carcinomas. An essential advantage of the free jejunum transplants were the excellent functional reconstruction results. This is demonstrated by examples of various cases. Since the number of treated patients is still too low, it is at present not yet possible to compare this approach with other therapeutic concepts, such as enoral laser surgery resection or radiochemotherapy.

[Critical retrospective evaluation of the treatment of 400 patients with laryngeal cancer]. / Kritische Rückschau auf die Behandlung von 400 Patienten mit Larynxkarzinom.

This retrospective study deals with the outcome of 401 patients with laryngeal carcinoma who were treated between 1975 and 1986 either by operation alone or by operation and irradiation. The patients as a group, the concepts of treatment, and the course of disease as found retrospectively are described. T and N categories are compared with the respective pT and pN categories: T and pT categories corresponded in 83.3% of the cases while there was only a 67.4% correspondence between each N and pN category. The survival rates using the Kaplan-Meier estimation according to the localization and extension of laryngeal tumor, pN category and method of resection are discussed in detail.

[Effect of inhaled environmental pollutants on the mucous membrane of the upper airways]. / Die Wirkung von inhalativen Umweltschadstoffen auf die Schleimhaut der oberen Luftwege.

Diseases of the mucosa of the upper respiratory tract have increased in the last few decades. In epidemiological studies, an increase in the rate of allergies has especially been noticed. The offensive particles from the environment meet human organism in the respiratory mucosa of the nose: the function of the mucosa depends partly on the protective function of the mucus, ciliae and swelling bodies of the mucosa and partly on the abundant number of immunocompetent effector cells in the subepithelial lamina propria. Of central interest are the mast cells, which initiate reactions by means of the exocytosis of mediators: the hyperergic, anaphylactic reaction and the hyper-reflectoric, anaphylactoid reaction. Environmental noxious agents (sulfur dioxide, nitrous oxides, ozone, carbohydrides and dust particles) influence in different ways the pathological reactions of the mucosa: they provoke inflammatory reactions through toxic and chemical-irritative effects. They lead to the initiation and perpetuation of allergies. This happens through the changing spectrum of allergen exposition, through direct changing of the surface and structure of proteins of the allergens and through the strengthening of the humoral and cellular mechanisms, which are part of the initiation and perpetuation of allergies. Environmental noxious agents initiate hyper-reflectoric reactions of the mucosa, which seems to be the most impressive factor causing the change in rhinological diseases nowadays. Environmental noxious agents are partially responsible for the "priming effects."

[Intubation problems of anesthesia in otorhinolaryngology]. / Intubationsprobleme bei Anästhesien in der Hals-Nasen-Ohrenheilkunde.

Many pathological changes in pharynx and larynx can cause problems in endotracheal intubation. Their preliminary signs and symptoms are often uncharacteristic. Thus prophylaxis is not always possible. Some representative diseases of larynx and pharynx are demonstrated by means of endoscopic photographs and by case reports. The photos were taken during endoscopic examinations in an ENT-clinic. The method of anaesthesia used in these cases is described, as well as prophylactic measures to be taken, if a difficult intubation may be expected. Finally, the procedure in case of an unexpected critical intubation is discussed.

[Modification of the microvascular reanastomosed latissimus dorsi flap for reconstruction after extensive maxillary resection]. / Modifikation des mikrovaskulär reanastomosierten Latissimus-dorsi-Lappens zur Rekonstruktion nach erweiterter Oberkieferresektion.

Large defects after extended maxillectomy and orbital exenteration were immediately reconstructed using a modification of the revascularized musculocutaneous latissimus dorsi flap. Three skin islands were transplanted based on the muscular part of the flap. The first island replaced the hard palate, the second the lateral nasal wall and the third was used together with the preserved eyelids to reconstruct an eye socket. The muscular part of the flap was folded spirally so that each skin island reached the site to be reconstructed.

[Free small intestine transplantation in plastic reconstruction of the oral cavity, pharynx and cervical esophagus. Report of experiences following 3 years of use]. / Die freie Dünndarm-transplantation zur plastischen Rekonstruktion von Mundhöhle, Pharynx und zervikalem Osophagus. Erfahrungsbericht nach dreijähriger Anwendung.

Between August 1984 and August 1987 77 free intestinal grafts were transplanted in our Department of otorhinolaryngology using microvascular anastomoses. These reconstructions were necessary after tumour resections in the oral cavity, in the pharynx, and the cervical oesophagus. Patients, operative technique, perioperative treatment, and complications are described. The definition of oncologic results is still problematic. Only trends have been discovered. In conclusion, complications, functional results, and the advantages of free intestinal grafts are discussed.

[Osteosynthesis in cranial and midfacial skull fractures]. / Osteosynthese bei kranialen und mittleren Gesichtsschädelfrakturen.

From 1982 to 1985 65 patients with a fracture of the cranial and middle portion of the visceral skull underwent surgical reconstruction using mini-plate osteosynthesis (Champy set). In this group we can distinguish four typical fractures where plate osteosynthesis with functional stability has proved successful (e.g.: piece fracture of the inferior margin of the orbita, bursting fracture of the zygomatic bone, impression fracture of the anterior wall of the frontal sinus, comminuted fracture of the interorbital region). The technical details of surgery are given special emphasis and possible complications are discussed.

[Pathogenic immune factors in recurrent mucous tympanic effusion in children]. / Pathogene Immunfaktoren beim rezidivierenden schleimigen Paukenerguss des Kindes.

In children with recurrent secretory otitis media (SOM) a mechanical malfunction of the Tuba Eustachii (by adenoids, myogenous palatotubal insufficiency, persistent cartilaginous collapse of the tube) should be taken into consideration as well as immunological factors of the lymphatic structures of the pharynx which may influence the tubotympanal mucosa. The pharyngeal tonsil and the tubotympanal mucosa are part of the immune system of the mucosa which itself has a regulating immunological function and importance as do the central and peripheral lymphatic organs. The lymphatic ring of Waldeyer regulates the reactivity of the tubotympanal mucosa in a similar way as the plaques of Peyer do control and influence immunologically the mucosa of the guts. The importance of persisting infections in the pharyngeal tonsil (by adenovirus, pneumococcus, H. influenzae) as well as the influence of IgG-mediated immune complex reaction for the perpetuation of inflammatory processes of the middle ear mucosa are discussed. The question to which extent the hyperergic immune reaction is pathogenetically involved in the secretory otitis media is thoroughly discussed. Compared to the other immune mechanisms the hyperergic immune reaction is of minor importance and may be considered as a predisposing factor.

[The cervico-cranial syndrome in the practice of the otorhinolaryngologist]. / Das zervikokraniale Syndrom in der Praxis des HNO-Arztes.

The craniocervical syndrome is an entity whose symptoms: vertigo, cephalea, tinnitus, facial pain, otalgia, dysphagia, pain of the carotid artery are thought to be caused by cervical factors. In the majority of cases the cranio-cervical syndrome is caused by a spondylarthrogenic segmental dysfunction whose pathophysiology is explained. In the pathogenesis lesions of the joints of the skull which may be responsible for pain and dysfunction in the segmental areas are of great importance. The neurology of the joints of the skull, as well as the pathological mechanisms of spondylarthrogenic disturbances, responsible for the different kinds of dysfunction of the equilibrium and for cephalea are discussed. The pathophysiological basis of manual diagnosis is explained; also the radiological findings of the upper cervical vertebral column are principally discussed. A short review of therapeutic recommendations is given.

[Hyperreflectoric rhinopathy]. / Die hyperreflektorische Rhinopathie.

Research in molecular biology in the past few years offers new views on vasomotor rhinitis. The key role of mediator substances which contain the mast cell and which, after degranulation, are active immediately by histamine release or act in a delayed manner (eg. leucotriene), is discussed, as well as the "liberofunction" of the neurotransmitter acetylcholine. The contribution to vasomotor rhinitis of other humoral systems, the kinine system and complement factors are also taken into account. The biopharmacological actions of the effector systems of the nasal mucosa (vessels, exocrine glands, nociceptors) are also analyzed. Using clinical examples the differentiation between humoral or neural reflex mediated hyperreflexia is worked out related to the classic triad of sneezing, profuse nasal discharge, nasal obstruction. The causes of vasomotor rhinitis (exogenous endogenous and drugs) are examined in the light of their pathophysiological importance. The differential diagnosis must cover allergic rhinopathy as well as the different kinds of rhinitis medicamentosa, the most important of which are discussed. Drugs which can help are discussed as well as continuous physical therapy.