[Laryngeal lead shot injury: therapy and follow-up]. / Laryngeale Schrotschussverletzung : Therapie und Verlauf.

Laryngeal shot injuries are rare. The case of a 65-year-old man who suffered from an injury with lead pellets is reported. After exploration with removal of the pellet from the lateral cricoarytenoid muscle, an immobility of the vocal fold developed, accompanied by impaired vocal function. Despite persisting immobility of the vocal fold, after 12 weeks voice compensation was achieved by voice therapy.

[MR-guided laser-induced thermotherapy in tumors of the head and neck region: initial clinical results]. / MR-gesteuerte laserinduzierte Thermotherapie bei Tumoren in der Kopf-Hals-Region: Erste klinische Ergebnisse.

PURPOSE: To analyse the value of MR-guided laser-induced thermotherapy (LITT) for palliative treatment of recurrent tumours of the head and neck region. MATERIAL AND METHODS: 8 patients with recurrent tumours of the head and neck region (squamous cell carcinomas n = 6, pleomorphic adenomas n = 2) underwent MR-controlled LITT. A 7 French laser applicator was inserted under local anaesthesia into the centre of the recurrent tumour. A Nd:YAG laser with a wavelength of 1064 nm was used. Therapy was monitored on-line using special MR thermosequences. RESULTS: Preinterventional contrast-enhanced MRI revealed a recurrent tumour of the head and neck region for all eight patients. All patients tolerated the procedures well under local anaesthesia, with no clinically relevant side effects. The MR thermosequences depicted up to 15 mm diameter areas of less signal near the laser tip. Postinterventional contrast-enhanced MRI revealed hypovascularized areas due to the resulting coagulative necrosis. Coagulative necrosis of 4 cc to 28 cc occurred in all patients, and a reduction of clinical symptoms was achieved in five. CONCLUSION: The results obtained indicate that minimal invasive LITT can be a therapeutic alternative for palliative treatment of head and neck tumours.

Fine-structural investigations of the effect of nCPAP-mask application on the nasal mucosa.

The treatment success of nasal continuous positive airway pressure (nCPAP)-therapy is dependent, on the one hand, on the achieved relief of complaints and, on the other hand, on long-term patient compliance and avoidance of compliance-related complaints. Next to the problem of mask application, nasal complaints comprise the most frequently reported side-effects and are among the primary factors causing nCPAP-therapy to be discontinued prematurely. To assess the morphological changes in the nasal mucosa during nCPAP-therapy, we excised specimens of nasal mucosa tissue from 10 patients with obstructive sleep apnoea syndrome (OSAS) before and 3-10 months after establishing nCPAP-mask compliance. The specimens were examined by electron microscopy. In all these patients compliance with the CPAP-mask marked the initial part of therapy. In addition, mucociliary clearance was assessed by the saccharin test before and after therapy. In all patients the nasal epithelium underwent fundamental changes upon CPAP-therapy, which became manifest as modifications in the shape of epithelial cells, conglutination and clumping of the microvilli, and the appearance of immunocompetent cells. Once patients were nCPAP-mask compliant, mucociliary clearance was distinctly prolonged in all cases. A successful therapeutic concept should provide normalization of room temperature and air humidity once nCPAP-mask compliance has been achieved and include regular assessment of the condition of the mucosa in the upper respiratory tract. Only by these measures can nasal complications be countered or given therapy at an early stage.

[The basement membrane in diseases of the vocal cords: electron microscopy and immunomorphologic findings]. / Die Basalmembran bei Erkrankungen der Stimmlippen: Elektronenmikroskopische und immunmorphologische Befunde.

The basement lamina of the epithelium of the true vocal cords of 34 inpatients suffering from chronic laryngitis, Reinke's oedema and squamous cell carcinoma have been investigated with the electron and immunofluorescence microscope. In chronic laryngitis, the lamina fibroreticularis is thickened (due to collagen type VII), corresponding to the clinical finding. In this layer mobile cells of the connective tissue can be found. In cases of Reinke's oedema it is the lamina densa which might be thickened. In this disease, also lamina densa-like material can protrude into the lamina fibroreticularis, and the number of anchoring filaments is increased. In squamous cell carcinoma we found the basement lamina irregularly arranged and folded. The lamina densa was always interrupted by numerous small gaps and in some areas the basement membrane could not be identified over a long distance. Lamina densa-like material was also found between the tumour cells within the epithelium. With the immunofluorescence microscope this material was proven as laminin, collagen type IV and heparan sulfate proteoglycan. Our investigation shows that malignant as well as benign lesions of the true vocal cords are characterised by distinct fine structural findings even concerning the basement lamina.

[Clinical aspects and therapy of esophageal candidiasis]. / Klinik und Therapie der Candidamykose des Osophagus.

In 14 patients with candida infection of the oesophagus, the clinical, radiologic and endoscopic findings are described. It is pointed out that candida mycosis of the oesophagus may occur primarily and without underlying disease. The authors report on the therapy of candidiasis.

[Metastasis to the ENT area]. / Metastasierung in den HNO-Bereich.

We report three patients with metastases to the ENT-region mimicking a primary malignant tumour. A 36-year-old woman presented with vertigo, sudden hearing loss, partial facial palsy and headaches. CT scan suggested a meningioma or an acoustic neuroma. Histological examination of the neoplasm removed surgically showed a metastasis from an amelanotic melanoma. A 38-year-old woman with nodules in the tongue had dysphagia. The history revealed that she had been treated successfully with chemotherapy for a carcinoma of the uterine cervix one year ago. Histological examination of a tongue biopsy showed a metastasis from the uterine carcinoma. The primary tumour was in complete remission. The third patient was treated for recurrent epistaxis. Physical examination showed a tumour in the right nasal cavity. A CT scan showed a tumour of the ethmoid cells and of the maxillary sinus, protruding into the nose. Histology and immunohistology proved a metastasis from a primary carcinoma of the liver. Ultrasound and CT scan of the liver confirmed the diagnosis.

[Clinical aspects of acute epiglottitis in adults]. / Zur Klinik der akuten Epiglottitis Erwachsener.

During the last three years, 79 adults suffering from acute epiglottitis have been treated in the ENT departments of the university hospital Rudolf Virchow, Berlin, 36 women (41 years of age as an average) and 43 men (average age 39 years). Acute epiglottitis developed either all of a sudden, within hours, or gradually, within days. All patients complained of dysphagia and pain in the throat; dyspnea could be observed in 20%. During examination, we could see an inflamed, thickened epiglottis with edema of the arytenoid cartilages. 55 patients reported an infection of the upper airway prior to the onset of symptoms of acute epiglottitis, epiglottic abscess developed in 11 adults. The inflammation responded satisfactorily to conservative antibiotic management (broad spectrum penicillin). Only one patient had to undergo intubation, none of the adults required tracheotomy.

[Lymphadenitis toxoplasmotica--a zoonosis]. / Die Lymphadenitis toxoplasmotica--eine Zoonose.

Between 1975 and 1985, 49 in-patients suffering from Toxoplasmosis of head and neck lymph nodes, have been treated chirurgically at the ENT clinics of the universities of Cologne and Homburg/Saar. In the collective there are as much men as women. The patients have an average age of 30 years, the anamnesis is about 3 months. The patients were complaining of swellings of lymph nodes of the angle of mandible or of the submandibular region, but without fever or other signs of infection. Typically, the lymph nodes were not fixed but mobile, hard and indolent. Blood parameters and electrolytic levels are not pathologically changed. The patients do not feel sick in general. The diagnosis is to be confirmed by serological investigations, supported by lymph node histology (Lymphadenitis Piringer-Kuchinka). In the present study, three acute cases of Toxoplasmosis with high serological titers could be diagnosed. The differential diagnosis of the lymphadenitis toxoplasmotica will be discussed.

[Sleep apnea syndrome in children: indications for tonsillectomy]. / Das Schlaf-Apnoe-Syndrom bei Kindern: Eine Indikation zur Tonsillektomie.

Laryngo-tracheo-bronchoscopy on a 2 year old boy with the sleep apnea syndrome showed no anatomic abnormalities and no signs of upper airway obstruction. After tonsillectomy the infant revealed an improvement in sleep pattern, and 1 1/2 years later, the syndrome has been relieved completely. In our opinion, the sleep apnea syndrome is an indication for tonsillectomy.

[Localized amyloidosis of the ENT area]. / Die lokalisierte Amyloidose im HNO-Bereich.

Although amyloidosis is in general a systemic disorder, it may occur as an isolated lesion, especially in the head and neck. The actual classification of amyloidosis is dependent on the biochemical nature of its protein deposits. In the present report, the symptoms and diagnosis of localized amyloidosis are discussed with special regard to histological findings.

[Epithetical management of tumor-induced facial defects]. / Zur epithetischen Versorgung tumorbedingter Gesichtsdefekte.

Defects of the face are mostly due to operations of tumours of the head. In the present study, indications for epistheses are discussed and the possibilities of episthetical treatment are reported. In 54 own cases different methods of attachment for epistheses are described with special reference to the possibility of fixation with adhesives. Moreover, making of epistheses is described as well as the handling of these artificial parts by the bearer. Advantages and disadvantages of epistheses are pointed out.

[Madelung's lipomatosis of the neck--expression of an alcohol-induced endocrine disorder?]. / Der Madelungsche Fetthals--Ausdruck einer alkoholinduzierten endokrinen Störung?

An uncommon case of a patient with Madelung's disease (Launois-Bensaude disease, multiple symmetrical lipomatosis) is reported. Moreover, the patient suffered from alcoholic hepatomegaly, an atrophic right kidney, Dupuytren's contracture of both hands, hyperuricemia and psoriasis. The etiology of Madelung's disease is discussed.

[Myoepithelial carcinoma (malignant myoepithelioma) of the salivary glands. A case report]. / Das myoepitheliale Karzinom (malignes Myoepitheliom) der Speicheldrüsen. Eine Falldarstellung.

We report the rare development of a myoepithelial carcinoma in a pleomorphic adenoma involving the minor salivary glands in the buccal mucosa of a 78-year-old female. Tumor presented as a small asymptomatic left buccal mass. The initial dominant component of the neoplasm was a pleomorphic adenoma, while the minor component was a myoepithelial carcinoma. Recurrences of tumor after 2 and then 5 years were excised. Histopathological examination of the last tissue removed showed a pure myoepithelial carcinoma of the minor salivary glands without evidence for a pleomorphic adenoma. The clinical features, therapy, diagnosis, histopathology and literature are reviewed.

[Concentration levels of thyroxine binding globulin and thyroxine in the blood of euthyroid children. Reliability and diagnostic value of the T4/TBG quotiens--establishing reference values]. / Verhalten der Konzentration von Thyroxin-bindendem Globulin (TBG) und Thyroxin (T4) im Serum euthyreoter Kinder Wertigkeit und Aussagekraft des T4/TBG-Quotienten - Aufstellung von Referenzbereichen.

The most important transportprotein for thyroxine (T4) is the thyroxine-binding globulin (TBG). This protein and T4 were determined using the radioimmunoassay method in bloodserum of 443 euthyreotic children. The age-specific analysis showed high TBG and T4 concentrations in the postnatal phase, nearly constancy between 1. and 9. years with concentrations in the upper physiological range of adults, elevation of the values in the age of 10/11. years and definite attainment of the normal range for adults at 12/13. years. The importance of the T4/TBG quotient for thyroid gland diagnostics was discussed.

[Esthesioneuroblastoma: diagnostic conformation by immunohistology and electron microscopy]. / Asthesioneuroblastom: Diagnosesicherung durch Immunhistologie und Elektronenmikroskopie.

The aesthesioneuroblastoma (olfactory neuroma) is a rare neuroepithelial tumour of the nasal cavity, the clinical symptoms of which become manifest very late in most patients. In general, with the light microscope used routinely (fixation of the specimens with formaldehyde, staining with haematoxylin-eosine) a malignant round cell neoplasia can be recognised without further differentiation. To ensure the diagnosis of an aesthesioneuroblastoma, immunohistological techniques (vimentin, S-100 protein, neurofilaments, neuron-specific enolase) are undoubtedly necessary. In some cases of unclear findings the electron microscope might be used to prove an aesthesioneuroblastoma. The immunohistological and electron microscopic features of aesthesioneuroblastoma are demonstrated and problems of histological differential diagnosis are discussed.

[Pre-irradiation and surgery of patients with squamous cell carcinoma of the oral cavity and oropharynx: the results of a 1973-1984 study]. / Vorbestrahlung und Operation von Patienten mit einem Plattenepithelkarzinom der Mundhöhle und des Oropharynx: Ergebnisse einer Studie 1973 bis 1984.

In collaboration with the Radiotherapeutic Hospital, 87 patients with squamous cell carcinomas of the oral cavity and the oropharynx were treated by combined pre-irradiation and surgical intervention at the University ORL Hospital of Cologne. The study was supposed to improve the five-year survival of patients suffering from advanced carcinomas of the head and neck area. The male and female patient's ratio was 4.5 to 1. Half of the patients had squamous cell carcinomas of the oropharynx, 21 patients had tumors of the floor of the mouth, and another 21 had tumors of the anterior two thirds of the tongue. The tumor and lymph node status was classified according to the UICC regulations (1979). In the pre-irradiation, 40 to 50 Gy were applied to the primary tumor and the regional lymph nodes. Surgery was executed generally four weeks after pre-irradiation. The tumor remission following to pre-irradiation was very good. 27% of the patients showed little or moderate post-operative disturbances in wound healing. An osteoradionecrosis was found in 4.6%. Almost 25% of the patients developed local recurrences. The cumulated five-year survival of all patients is 32%. In dependence on TNM stages, the three-year survival rates are as follows: stage I and II 80%, stage III 44%, and stage IV 40%.

[The use of antibiotics and chemotherapeutic agents during pregnancy]. / Bemerkungen zum Einsatz von Antibiotika und Chemotherapeutika in der Schwangerschaft.

Physicians engaged in all general and specialist fields of medicine may at times be confronted with the necessity of prescribing an antibiotic or chemotherapy for pregnant patients. This article gives ample advice on the therapy with antibiotics and chemotherapeutic agents during pregnancy.

[Tuberculosis of the cervical lymph nodes: report of 193 cases]. / Halslymphknotentuberkulose: Bericht über 193 Fälle.

193 patients suffering from tuberculosis of the cervical lymph nodes are analysed. All cases were examined with respect to sex, age, nationality and typical findings of blood parameters. The diagnostic and therapeutic proceedings are elucidated. Histological diagnosis should be done, but micro-biology is only significant in a few cases. Tuberculosis of lymph nodes of neck should be considered in obscure swellings of the neck.

[Spiral CT: differential diagnosis of cervical swelling. Initial clinical results]. / Spiral-CT: Differentialdiagnose zervikaler Schwellungen. Erste klinische Ergebnisse.

Spiral CT examinations were performed pretherapeutically in 27 patients in whom cervical lymph node enlargement had been suspected. The M/Q quotient known from sonography and MR can also be employed in CT by means of coronary and sagittal reconstruction. This improves CT differentiation between reactively changed and metastatically infiltrated lymph nodes in tumour patients. Hence, CT diagnosis can now make use of a highly sensitive and highly specific criterion for diagnosing lymph nodes. Another diagnostic improvement is that vascular infiltrations by lymph node metastases can now be visualised or excluded more readily. Spiral CT is also suitable in tumorous and non-tumorous processes for an accurate assessment of the extension of e.g. retropharyngeal abscesses or laryngoceles.

[Arteria lusoria--a rare cause of dysphagia]. / Die Arteria lusoria--seltene Ursache einer Dysphagie.

A rare case of a 29-year old woman with aberrant right subclavian artery (A. lusoria) causing dysphagia is presented. This abnormality is generally silent and often an incidental x-ray finding. By means of a median thoracotomy the anomalous vessel was divided at its point of origin and an anastomosis to the ascending aorta with a graft was performed.