[Thyroid medicine for ENT physicians]. / Schilddrüsenmedizin für HNO­Ärzte.

Diseases of the thyroid gland are frequent incidental findings during ultrasound examination of the neck. They affect nearly one third of the normal population. Treatment is not always indicated; however, laboratory diagnostic measures must be initiated to specify the disease. The primary indications for consulting a thyroid specialist are thyroid nodules, goiters, autonomy of the thyroid gland, autoimmune diseases, Graves' disease, and Hashimoto thyroiditis. The aim of this review is to provide an overview of the most important thyroid diseases and their treatment options.

Differential chemokine expression patterns in tonsillar disease.

Expression profiles of CXC- and CC-chemokines in various forms of tonsillar disease were studied to evaluate whether certain chemokines play a predominant role in a specific subset of tonsillar disease. Total RNA was isolated from 89 biopsies (21 hyperplastic palatine tonsils, 25 adenoids, 16 chronic inflammatory palatine tonsils and 27 chronic inflammatory palatine tonsils with histological prove of acute inflammation), reverse transcribed and subjected to PCR amplifying IL-8, Gro-alpha, eotaxin-1, eotaxin-2, MCP-3, MCP-4 and RANTES. 2% agarose gel electrophoresis revealed a predominance of IL-8 in the chronic inflammatory palatine tonsil group compared to tonsillar hyperplasia. Furthermore, eotaxin-2 was strongly overexpressed in adenoid samples compared to chronic inflammatory specimens. Our data suggest that the majority of diseases related to adenoid formation are mediated via an eotaxin-2 expression, whereas chronic inflammatory tonsillitis is associated with IL-8 upregulation. These data imply that adenoids are related to a Th-2, and chronic inflammatory tonsillitis to a Th-1 based immune response.

Assessment of skills using a virtual reality temporal bone surgery simulator.

Surgery on the temporal bone is technically challenging due to its complex anatomy. Precise anatomical dissection of the human temporal bone is essential and is fundamental for middle ear surgery. We assessed the possible application of a virtual reality temporal bone surgery simulator to the education of ear surgeons. Seventeen ENT physicians with different levels of surgical training and 20 medical students performed an antrotomy with a computer-based virtual temporal bone surgery simulator. The ease, accuracy and timing of the simulated temporal bone surgery were assessed using the automatic assessment software provided by the simulator device and additionally with a modified Final Product Analysis Scale. Trained ENT surgeons, physicians without temporal bone surgical training and medical students were all able to perform the antrotomy. However, the highly trained ENT surgeons were able to complete the surgery in approximately half the time, with better handling and accuracy as assessed by the significant reduction in injury to important middle ear structures. Trained ENT surgeons achieved significantly higher scores using both dissection analysis methods. Surprisingly, there were no significant differences in the results between medical students and physicians without experience in ear surgery. The virtual temporal bone training system can stratify users of known levels of experience. This system can be used not only to improve the surgical skills of trained ENT surgeons for more successful and injury-free surgeries, but also to train inexperienced physicians/medical students in developing their surgical skills for the ear.

[Infraorbital lesion after scuba diving with chronic sinusitis: diagnosis and treatment of reverse block]. / Infraorbitalisläsion nach Sporttauchen bei chronischer Sinusitis: Diagnostik und Therapie der Umkehrblockierung.

A 32-year-old diver repeatedly reported pain in the right side of the face after diving. He felt strong pain on pressure over the right face combined with hypaesthesia of the infraorbital nerve. In addition, he reported nasal breathing obstruction and problems regulating pressure in the middle ear. ENT consultation revealed a septal deviation to the right side of the nasal cavity. CT diagnosis showed the typical picture of chronic pansinusitis with total transfer of the right frontal sinus, subtotal transfer of the right ethmoid and subtotal transfer of the right maxillary sinus. Following successful functional sinus surgery (FESS), combined with septal surgery, the patient was able to dive again symptom-free.

[Acute hearing loss from scuba-diving holidays: diagnosis and treatment of barotrauma of the inner ear]. / Akute Hörminderung während des Tauchurlaubs: Diagnostik und Therapie des Innenohrbarotraumas.

A 35-year-old diver noticed hearing loss and tinnitus after his diving holiday. He presented to the Lübeck clinical practice for divers, and we found vascular injections on the eardrum. Audiometry showed a high-degree hearing loss of 40-60 dB. Under the assumption of a perilymphatic fistula, we performed a tympanoscopy with covering of the oval and round windows. Bone-conduction hearing improved immediately postoperatively to 25 dB. A postoperative rheological infusion treatment was given. After 6 months the diver was assessed fit to dive with almost normal inner ear function.

[A rare cause of facial asymmetry: nasoalveolar cyst: a clinical report]. / Seltene Ursache einer fazialen nasalen Asymmetrie: Die nasoalveoläre Zyste: Eine Fallbeschreibung.

UNLABELLED: Nasoalveolar cysts are rare nonodontogenic cysts that develop from the soft tissue in the mucobuccal area of the nasal ala. Their origin is a residuum of the nasolacrimal canal. CLINICAL CASE: A 45-year-old woman had been aware of a painless tumor at the base of the nose and in the region of the left nasal ala for several months. We diagnosed a nasolabial cyst, which was extirpated in toto through a combined transvestibular-transnasal approach.

[Application of skin adhesives in head and neck surgery: analysis of cosmetic results, applicability and cost-effectiveness of cyanoacrylate-based adhesives]. / Einsatz von Hautklebern in der Kopf-Hals-Chirurgie: Analyse von kosmetischen Ergebnissen, Anwendbarkeit und Wirtschaftlichkeit cyanoacrylatbasierter Klebstoffe.

BACKGROUND: In this work cyanoacrylate-based skin adhesives used in Germany for skin closure in head and neck surgery are compared with respect to ease of application, cost-effectiveness and cosmetic results. PATIENTS AND MATERIALS: We compared 25 wounds sealed with a skin adhesive with 25 suture-sealed wounds. RESULTS: Bonding of surgical wounds with glue had a high level of acceptance in all patients. The tedious, time-consuming and sometimes painful postoperative removal of many sutures in patients is omitted. Patients can shower soon afterwards without additional protection as the adhesive provides a waterproof barrier. Problems of wound healing can immediately be detected through the transparent skin adhesive. Cosmetic long-term results of skin closure by adhesives are comparable to suture-sealed wounds. CONCLUSIONS: The adhesives available on the market differ mainly in the form of the applicator, the viscosity on application, as well as the strength after hardening. The application is easy to implement and significantly faster than conventional suturing. Apart from the cost savings of materials compared to the use of skin sutures and investment of Steri-Strips, expensive anesthesia and surgical time can also be saved.

[Obstructive sleep apnea in patients with Parkinson's disease--report of two cases and review]. / Obstruktive schlafapnoe bei patienten mit m. Parkinson--fallbericht und übersicht.

BACKGROUND: The use of continuous positive airway pressure (CPAP) is well established in treatment of moderate and severe obstructive sleep apnea syndrome (OSAS). The judgement of clinical symptoms like daytime sleepiness and hypersomnolence with loss in concentration is complicated in patients with diagnosis of Morbus Parkinson (MP) because the disease itself and pharmacologic therapy may mimic clinical features of OSAS. PATIENTS AND METHODS: Diagnostic pathways and differential diagnostic considerations are demonstrated in two case reports of patients with MP and OSAS. The cases are discussed within the framework of literature concerning sleep disturbances and MP. RESULTS: In both cases respiration could be treated effectively by continuous positive airway pressure (CPAP). Patients clearly responded to therapy and regained more daytime activity. The medication for MP was satisfactory. CONCLUSIONS: The evaluation and treatment of daytime sleepiness in patients with MP and obstructive sleep apnea need an interdisciplinary framework with a practitioner, a neurologist, and a sleep expert. Associated symptoms as increased nycturia, hypokinesia, restless-leg-symptoms, and depression as well as the effects of medication may mimic details of concomitant sleep apnea. Therefore, sleep diagnostic evaluation is recommended to rule out sleep apnea as a frequent cause for hypersomnolence.

A new central supply system as alternative source for bicarbonate dialysate.

Bicarbonate dialysis is mandatory for high efficiency treatment. In most cases bicarbonate is delivered either as prepacked powder or as a stable liquid concentrate in 6-10 I plastic containers. With a newly designed central supply system (CSS) using 800 I tanks of custom-made sterile and pyrogen free concentrates, we investigated the risk of bacterial contamination of dialysate in a 30-bed dialysis unit. During three months, samples of reverse osmosis (RO) water, concentrates and dialysate were taken every two weeks. Colony forming units (CFU) were counted after 48 h incubation. Further samples were taken during nine months of continuous use of the CSS without further intermittent disinfection. None of the samples had greater than 10/ml CFU. Pseudomonas, corynebacteria and enterobacter were the predominant species. In summary, this CSS proved reliable in providing bacteriologically safe bicarbonate dialysate as defined by international standards (CFU less than 200/ml). It significantly reduces costs, workload and environmental pollution by plastic waste.

Teicoplanin: renal tolerance and pharmacokinetics in rats.

The nephrotoxicity and pharmacokinetics of teicoplanin were studied in an experimental rat model. Nephrotoxicity was assessed by measuring urinary excretion of tubular cells and malate dehydrogenase. The experiments revealed that 1 mg/kg or more of teicoplanin daily resulted in an increase of excretion rates of tubular cells. Similarly to vancomycin, teicoplanin is accumulated in the kidneys. Nephrotoxicity induced by teicoplanin can be reduced by coadministration of fosfomycin and D-glucaro-1.5-lactam, and enhanced by administration of tobramycin. We conclude that renal function should be monitored closely during teicoplanin therapy.