[Options for reconstruction after injuries in the head and neck region]. / Rekonstruktionsmöglichkeiten nach Verletzungen der Kopf-Hals-Region.

Reconstruction of lesions in the head and neck region must be both functionally and esthetically adequate, as the exposed anatomic position can easily lead to social stigmatization after injury. Distortion of symmetry, e.g., by a crooked nose, enophthalmos, or a (partial) amputation of the outer ear, is easily visible. On the other hand, limitations to nasal breathing and olfaction or diplopia may significantly reduce quality of life, and restoration of form and function continues to be challenging. This review discusses the treatment options for trauma of the external nose and the lateral midface, including the orbital floor and the auricle.

[Chinese medicine and constructivism-a new way in psychotherapy]. / Chinesische Medizin und Konstruktivismus ­ ein neuer Weg in der Psychotherapie.

BACKGROUND: The background of this study is twofold: basic methodological differences between Western Biomedicine and Classical Chinese Medicine (CCM) and obvious parallels between the methodology of psychotherapy and CCM. OBJECTIVES: Drawing on available investigations on the methodology of CCM, the analysis of structural parallels between CCM and Western psychotherapy tries to enrich the methodological self-conception of psychotherapy in order to provide impulses for the new approaches to psychotherapeutic practice. METHODS: The reciprocal interpretation of CCM about the patient's state draws on a language of metaphors. These metaphors "mediate" between the various positions of the universal interdependency and the human being, who is able to understand the language. The constructive realistic methodology in general and the epistemological method of "alienation" in particular, provide an instrument for the decodification of these metaphors. RESULTS: In the context of CCM, the process dynamics of mental healing are based on hermeneutical principals. Every operation carried out by the CCM therapist is not organ medical in nature but a purely semantic form. These semantic operations aim to provide a meaningful integration of problematical behavior (in terms of meaning) into metaphorically logical structures in order to stimulate a coherent self-understanding of the suffering individual, which is associated with healing effects. In this context, it is crucial for CCM that there is no conceptual division between body and soul with respect to the therapy. This enables a completely different comprehensive treatment of mental problems than biomedicine is able to offer, due to its methodological presuppositions.

Redox-based therapeutics in neurodegenerative disease.

This review describes recent developments in the search for effective therapeutic agents that target redox homeostasis in neurodegenerative disease. The disruption to thiol redox homeostasis in Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis and multiple sclerosis is discussed, together with the experimental strategies that are aimed at preventing, or at least minimizing, oxidative damage in these diseases. Particular attention is given to the potential of increasing antioxidant capacity by targeting the Nrf2 pathway, the development of inhibitors of NADPH oxidases that are likely candidates for clinical use, together with strategies to reduce nitrosative stress and mitochondrial dysfunction. We describe the shortcomings of compounds that hinder their progression to the clinic and evaluate likely avenues for future research. LINKED ARTICLES: This article is part of a themed section on Redox Biology and Oxidative Stress in Health and Disease. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v174.12/issuetoc.

Quality of life after primary septorhinoplasty in deviated- and non-deviated nose measured with ROE, FROI-17 and SF-36.

BACKGROUND: Quality of life measurements are gaining in importance. The present study was conducted with the aim to compare patient satisfaction after septorhinoplasty according to their preoperative nasal deformity. METHODS: The patients completed two disease-specific questionnaires before their surgery: the Functional Rhinoplasty Outcome Inventory (FROI-17), the Rhinoplasty Outcome Evaluation (ROE) and as a general instrument, the Short Form 36 Health Survey (SF-36). The second measurement was taken during an outpatient examination 12 months after their primary septorhinoplasty. Patients were grouped in nasal axis deviation (NAD), nasal hump deformity (NHD) and NAD plus NHD. Additionally the patients with preoperative NAD and NAD+NHD were combined as deviated nose and compared to the non-deviation group. RESULTS: One hundred and two patients (51 male and 51 female) underwent primary septorhinoplasty. The ROE- and the FROI-17 overall score including all three subgroups showed significant postoperative improvements. Regarding the SF-36, the postoperative score improved significantly only in two scales (role-functioning physical and mental health). Looking at the the different QoL questionnaires, there were significant postoperative differences in regards to deviated versus non-deviated nose in the FROI-17 overall- and FROI-17 subscores (nasal and general symptoms) and in three scales of the SF-36 (vitality, social functioning, role-functioning emotional), showing a greater postoperative satisfaction in the deviated-nose patient. CONCLUSION: Patients with and without nasal deviation showed improved QoL after their surgery, as measured with the ROE, the FROI-17 and the SF-36. The patients with a nasal deviation showed a significantly better outcome, as measured with the FROI-17, in comparison with the non-deviated group.

The accuracy of the modified Evans blue dye test in detecting aspiration in head and neck cancer patients.

The purpose of this study was to determine sensitivity and specificity of the modified Evans blue dye test (MEBDT) in tracheostomised patients after treatment of head and neck squamous cell carcinoma (HNSCC). This was a prospective study with 30 consecutive patients. All individuals underwent a MEBDT and a subsequent fiberoptic endoscopic evaluation of swallowing (FEES) immediately after the MEBDT for reconsidering the validity of the MEBDT. Aspiration was present in 20 patients documented by MEBDT and FEES. One patient was judged to aspirate by FEES but not by MEBDT (1 false-negative result). Nine patients showed no aspiration either by MEBDT or by FEES. The sensitivity of the MEBDT protocol in predicting aspiration among individuals in our cohort was 95.24%, the specificity 100%, respectively. The results of the current investigation suggest that the MEBDT is much more sensitive in tracheostomised HNSCC patients than in tracheostomised neurological patients. The MEBDT for tracheostomised HNSCC patients offers a quick and reliable method to identify aspiration risk in cases of severe dysphagia.

Leakage of fluid in different types of tracheal tubes.

The aim of this study was to evaluate leakage of liquids, i.e., water and saliva, past low-pressure cuffs of tracheostomy tubes. Three different types of tracheostomy tubes, TRACOE vario (TRACOE Medical GmbH, Germany), Rüsch Ultra-Tracheoflex (Rüsch GmbH, Germany), and Portex Blue Line Ultra (Smiths Medical, UK) were tested in isolated pig tracheas. Sixty samples (10 tubes each of 7- and 8-mm inner diameter of each type) were used. Four different experiments were devised: type 1 (water and artificial ventilation), type 2 (water and no artificial ventilation), type 3 (saliva and artificial ventilation), and type 4 (saliva and no artificial ventilation). Six milliliters of water or artificial saliva were infused over the cuff and the volume of fluid that leaked past the cuff was measured after 5, 10, and 15 min. Intracuff pressure was also measured three times. The saliva experiments resulted in less leakage than the water experiments. Leakage after treatment with water or artificial saliva is higher without artificial ventilation than with ventilation. The amount of leakage among the tubes with respect to manufacturer showed statistically significant results. However, there were no differences among tracheostomy tubes with respect to internal diameter.

[Evaluation of aspiration protective-covered tracheal cannulas]. / Evaluation des Aspirationsschutzes blockbarer Trachealkanülen.

BACKGROUND: The aim of the study was to evaluate leakage of liquids in terms of water and artificially produced saliva past low-pressure cuffs of tracheal tubes. METHODS: Three different types of tracheal tubes, TRACOE vario, Rüsch Ultra-Tracheoflex, and Portex Blue Line Ultra, were tested in isolated pig tracheas by infusing 6 ml of water or artificially produced saliva over the cuff and measuring the volume of fluid leaking past the cuff after 5, 10, and 15 min. RESULTS: The leakage in the saliva experiments was significantly lower than in the water experiments (p < 0.05). The amount of leakage between the three different types of tubes showed statistically significant (p < 0.05) results. There was no statistically significant difference between tracheal tubes of 7 and 8 mm internal diameter. CONCLUSION: The present laboratory findings suggest that the three tracheal tubes studied will not guard against aspiration of water but they will prevent the leakage of artificial saliva to a great extent.

Prognostic impact of EBV-related LMP-1, histologic type, and environmental factors in nasopharyngeal carcinoma in a German population.

INTRODUCTION: This retrospective study addressed the possible involvement of latent Epstein-Barr virus (EBV) infection, in particular LMP-1 expression, and further exogenous factors, i.e. tobacco, alcohol and occupational hazardous substances, in nasopharyngeal carcinoma (NPC) in a German population. PATIENTS AND METHODS: From 1980 to 2000, 44 patients suffering from histologically confirmed NPC were entered into the study. 33 specimens were available for immunostaining (IHC) to analyze LMP-1 expression. Information about environmental exposures were obtained employing a detailed standardized questionnaire. RESULTS: Outcome of patients with squamous cell NPC (SC-NPC) was significant worse than that of those with non-keratinizing NPC (NK-NPC). Age and tumor size correlated with response to therapy. The group with negative conventional LMP-1 staining showed better overall survival after 5 years compared to the group with positive or marginally positive LMP-1 detection (not significant). Nevertheless, after staining by tyramid-augmented IHC (TSA-IHC), nearly all specimens with negative LMP-1-staining in conventional IHC were found to be clearly positive. All patients with SC-NPC were smokers. The distribution of smokers and non-smokers in the group of NK-NPC was balanced. Comparable to the tobacco observation, there was also a correlation between high alcohol consumption and SC-NPC. CONCLUSION: Prognosis of NPC is mainly dependent on histologic type. Prognostic impact of LMP-1 is still unclear since LMP-1 was detected in all specimens using TSA-IHC. Therefore, TSA-IHC-LMP-1 detection might be interesting for diagnostic specification and development of new therapeutic strategies in NPC.

[Health aspects of diving in ENT medicine. Part I: Diving associated diseases]. / Tauchmedizinische Aspekte in der HNO-Heilkunde1. Teil: Erkrankungen durch den Tauchsport.

There has been a steady increase in the number of recreational scuba divers in the last years, with a growing number of diving associated diseases involving ENT medicine. Disorders of the ears, sinuses and pharynx are those most common in divers. In particular, external otitis and barotrauma of the middle ear are commonly treated by every ENT specialist. They usually do not lead to any permanent complaints. Incidents involving the cochleovestibular system are less common, but can result in deafness, vertigo and tinnitus, and therefore have to be treated appropriately. To treat diving medical disorders, the physician has to have some basic understanding of the physical laws that lead to diving incidents. This article will inform the reader of the forces that are encountered by divers, and then give details of the treatment of acute ENT diseases which result from diving incidents.

[Health aspects of diving in ENT medicine. Part II: Diving fitness]. / Tauchmedizinische Aspekte in der HNO-Heilkunde. 2.Teil: Tauchtauglichkeit.

Diving has become increasingly popular. With the growing number of patients who want to dive, there is an increasing number of divers who require their regular medical examination. As ENT problems are the most common disorders in divers, otorhinolaryngologists regularly have to assess the diver's fitness. It should be noted that an ENT examination does not certify complete fitness to dive! Diving can be resumed 3 months after middle ear surgery, especially after tympanoplastic type I, II and III with insertion of a PORP, when there is regular middle ear ventilation without atrophic scars of the tympanic membrane. Even after stapes surgery, diving can be resumed when there are no signs of vestibular irritation during a provocation test. By 3 months after sinus surgery, the diver should perform a test dive under supervision before fitness to dive can be certified. After inner ear barotrauma, the diver remains fit to dive depending on his hearing ability in the involved ear. After inner ear decompression illness, one should look for a vascular right-to-left shunt before diving can be resumed. These and many more aspects are discussed in this article on how to determine whether a diver with ENT problems is fit to dive.

[Antibiotic impregnation of cartilage implants: diffusion kinetics of fluoroquinolones]. / Antibiotische Imprägnation von Knorpelimplantaten: Diffusionskinetik von Fluorchinolonen.

BACKGROUND: Antibiotic impregnation of cartilage implants may reduce the risk of bacterial infection and subsequent absorption. The aim of this study was to investigate the penetration kinetics of two quinolone antibiotics into fresh cartilage and the concentrations in the core of lyophilized cartilage after rehydration. METHODS: Fresh human costal cartilage was impregnated with ofloxacin and ciprofloxacin (2 mg/ml) for 2, 15 and 90 min. Concentrations were measured in 6 levels (0.5 mm each) from the surface to 3 mm beneath the surface with high performance liquid chromatography (HPLC). Lyophilized human costal cartilage was rehydrated in ofloxacine and ciprofloxacine solutions (2 mg/ml, 0.2 mg/ml and 0.02 mg/ml) for 18 hours and concentrations in the core of the rib segment were measured. RESULTS: Quinolone antibiotics penetrate into cartilage by free diffusion. We found no evidence of significant binding to cartilage. After 2 and 15 min of impregnation, concentrations above the minimal inhibitory concentration (MIC90) for pseudomonas species are found from 0-0.5 mm below the surface of fresh cartilage. After 90 min concentrations above the MIC90 were found 1.0-1.5 mm below surface of the implant. In lyophilized rib grafts which were rehydrated in 1/10 diluted intravenous solutions (0.2 mg/ml), concentrations in the core of the specimen were above MIC90. Differences between the penetration characteristics of ofloxacine and ciprofloxacine were minor. CONCLUSION: Intraoperative impregnation of cartilage implants with ofloxacin or ciprofloxacin probably offers only short-term protection against bacterial infection. Rehydrated rib grafts, however, contain high quinolone concentrations which may be effective even in infected implant beds for several hours.

[An aberrant course of the internal carotid artery through the middle ear]. / Aberranter Verlauf der A. carotis interna durch das Mittelohr.

The presence of the internal carotid artery in the middle ear is a rare but known vascular anomaly. A blue-reddish mass behind the tympanic membrane, hearing loss and a tinnitus that is synchronous with the pulse are the typical symptoms and should lead to a correct diagnosis. The diagnostic procedure includes high resolution CT scans with or without contrast or MRI. Possible methods of therapy include embolization, stent implantation or balloon occlusion of the internal carotid artery but are seldom indicated clinically because of the high rate of side-effects. However, regular followup examinations must be performed.

[The potential uses and limitations of the flexible laryngoscopy under local anesthesia in clinical practice]. / Möglichkeiten und Grenzen der flexiblen chirurgischen Laryngoskopie in Lokalanästhesie.

Microsurgery of the larynx is commonly performed as direct laryngoscopy (DL) under general anesthesia. An alternative in selected cases is flexible laryngoscopy (FSL) under local anesthesia. We used a flexible laryngoscope that contained an additional working tunnel (Olympus ENF Type T3). Local anaesthesia of the larynx was achieved with 1% oxybuprocaine-HCl. Tissue samples were taken under endoscopic view and control. Twenty-five patients were studied and had benign lesions of the larynx or were being followed after treatment for cancer. The examination was tolerated well by all patients. The handling of the endoscope allowed precise targeting and sample taking. Due to the 2.2 mm diameter of the forceps the sizes of the biopsies were also limited. However, nearly all of the biopsies taken allowed sufficient histological examination. The advantage of the FSL was its simplicity and the minor inconvenience for patients. Although true histological results of suspect findings are possible, limitations in examining the hypopharynx prevent true staging of cancer patients. In general, FCL is a worth-while complement to DL.

[Exophytic papillomatous space-occupying lesions of the larynx as a rare manifestation of candidiasis. Diagnostic and therapeutic consequences]. / Exophytisch-papillomatöse Raumforderungen des Larynx als seltene Manifestation einer Candida-Infektion. Diagnostische und therapeutische Konsequenzen.

Laryngeal candidiasis is very rare in the absence of other more proximal diseases in the aerodigestive tract. The lesion shows pseudoepitheliomatous hyperplasia or acanthosis and, given its rarity, may be confused with cancer. In the present paper we report on a 56-year-old male patient who presented with hoarseness. Physical examination of the larynx revealed a hyperplastic lesion involving both vocal cords. The clinical aspect and the risk factor profile of the patient (ten bottles of beer and 40 cigarettes per day) generated the clinical diagnosis of laryngeal cancer. A biopsy was taken. The histopathological examination of the specimen excluded a squamous cell carcinoma; however, it could not provide a clear diagnosis. Laryngeal papillomatosis and tuberculosis, which had been suspected, could be excluded. As the lesion progressed, further biopsies led to the diagnosis of candidiasis. Systemic antimycotic treatment with fluconazol and amphotericin caused a complete remission.

Is monocular perception of depth through the rigid endoscope a disadvantage compared to binocular vision through the operating microscope in paranasal sinus surgery?

Vision through the endoscope is strictly monocular. Perception of depth (stereopsis) during ethmoid surgery through the operating microscope would be expected to be superior due to binocular view. To investigate whether monocularity of the endoscope is a disadvantage in paranasal sinus surgery, we compared stereoacuity in a model of the nasal cavity using a headlamp, an operating microscope, and a 0 degree-Hopkins-endoscope. Twenty volunteers were asked to touch defined points in a spatial model of the nasal cavity. Due to the configuration of the model, which allowed binocular vision of all contact points with headlamp, performance was significantly better than with optical instruments. Manipulations were performed faster with the endoscope than with the microscope. Under microscopic guidance more faults in point sequence were made than with the endoscope. Various monocular phenomena obviously allow sufficient spatial orientation through the endoscope, so that monocularity of the endoscope appears not to be a disadvantage for quick and safe manipulations during functional endoscopic sinus surgery.

[Rest-activity cycle in man]. / Untersuchung des Ruhe-Aktivitäts-Zyklus des Menschen.

An actigraph (ZAK company) is a small device that can be worn on the wrist like a watch. We carried out a study to compare sleep efficiency and total sleep time as determined by actigraphy and polysomnography. The number of body movements per minute is a density function. The integrated function shows a virtually constant gradient in the wake state and a different constant gradient during sleep. The body movement density function per hour provides a useful threshold for correctly differentiating between wake and sleep states. This threshold is defined as the minimum between the two maxima of the bimodal logarithmic body movement density distribution. In the second step we computed a rank scale of the different gradients and approximated the integrated function for every scale element using linear graphs. The points of intersection of the straight lines define the time points for sleep onset and end of sleep. Sleep efficiency is given by SE = 100 (TST-sleep interruption time)/TST. Total sleep time is the interval between sleep onset and end of sleep. Actigraphy is a suitable semi-objective method for estimating sleep efficiency and total sleep time, and--for cost reasons--should be used for screening before approaching a sleep laboratory. Actigraphy carried out over several days shows only small differences in comparison with polysomnography. The estimation of parameters is more accurate the longer the patient wears the actigraph, and a minimum of five days is recommended. Spectral analysis of the intregrated body movement density provides important information for detecting subclinical sleep disorders.

[Detection of rapid eye movement with rapidly adapting neuronal fuzzy systems in imprecise REM syntax]. / Detektion von Rapid-Eye-Movements mit schnell adaptierenden neuronalen Fuzzy-Systemen bei unsicherer REM-Syntax.

Both living beings and artificial neuronal networks are capable of 'learning' and behavioural adaptation. But also the fuzzy program designed to detect rapid eye movements (REM) during sleep and described here, can be provided with a self-learning option that provides important information about REM sleep. The algorithm computes REM on the basis of horizontal and vertical EOG. EEG, EMG and actiography signals are employed to optimize the method and eliminate artefacts. In a second step, the fuzzy system learns to detect REM with the aid of a sample data set and a minimal set of syntax rules. From sample data and the actions and reactions of visual scorers, the program extracts additional rules and information, which are then used to build a complete fuzzy structure. Thereafter, the REM detection program optimizes the fuzzy logic structure, independently of visual monitoring, on its own. A direct comparison of the results of the algorithm in a 10-night analysis with those of two experienced visual scorers revealed a better than 95% agreement. Re-analysis with the algorithm showed a 100% concurrence. Complete visual measurement of the eye movements occurring in a single night requires several hours; this compares with only 15 minutes required by the algorithm.