Posttraumatische Amaurose nach komplexer frontobasaler Fraktur

Background

Whether surgical nerve decompression is indicated for the treatment of posttraumatic reduced vision with optic nerve compression in the bony canal has been a subject of controversy for decades. On balance, the recent literature suggests that this procedure is indeed indicated, as a supplement to high-dosed cortisone therapy. The risk of surgery-related side effects is usually rated low in the literature.

Case Report

We report on a woman patient in whom craniocerebral trauma involved a fracture of the left optic canal with unilateral loss of vision. In the decompression operation, intraoperative symptoms gave rise to the suspicion of an arteriovenous fistula, which had not been revealed by computer tomography and which was seen as sufficient grounds for discontinuing the procedure. In addition to a carotid artery–sinus cavernosus fistula (CCF Barrow type A), subsequent angiography revealed a dissected aneurysm at the branching of the occluded ophthalmic artery.

Discussion and Conclusions

In decisions on whether surgical relief of pressure on the optic canal is indicated after trauma-related visual loss, the possibility of secondary lesions near the tip of the orbita and the optic canal must be taken into account. These are not always revealed by computer tomography. The indications should be critically weighed up in each individual case, with additional imaging examinations, such as MR-angiography, CT-angiography, or conventional angiography, performed as needed. The options and indications for imaging are discussed. The procedure can by no means be rated as “minimally invasive”, as is postulated by some authors.     

Rekonstruktion des Speiseweges durch Anteile des Larynx und der Halstrachea nach Resektion des Hypopharynx und des Halsoesophagus wegen eines ausgedehnten Carcinoms mit Halslymphknotenmetastasen

Ohne Zusammenfassung     

Diagnostisches und therapeutisches Vorgehen beim spontanen Emphysem der Halsweichteile und des Mediastinums

BACKGROUND: Emphysema without any etiological indices from the history represents a diagnostic and therapeutic challenge. PATIENT COLLECTIVE: Over the last 5 years, we treated four patients (three male, one female; aged 3-29 years) with cervical and/or mediastinal emphysema of unknown cause. RESULTS: Two young men with cervical emphysema were observed and received prophylactic antibiotic treatment. After involution of the emphysema, we performed an endoscopy which revealed no abnormalities. A female patient and a 3-year-old boy had a history of coughing and a query history of foreign body ingestion before the appearance of the emphysema. The immediate endoscopies were without pathologic findings. All patients recovered completely without any complications or recurrences. CONCLUSIONS: If there is no indication for a foreign body or a trauma in the history or in radiological imaging, endoscopy of the airways and the upper digestive tract should follow when the emphysema has subsided. The aim is to avoid any further spread of the emphysema and of pathogens. If there is a history of a foreign body or trauma, an immediate endoscopy is indicated.     

Versuche zur Reinnervation des Abduktormuskels nach Recurrenslähmung durch Einpflanzen freier Nerventransplantate zum Nervus phrenicus

Ohne Zusammenfassung     

Inzidenz des Frey-Syndroms nach Parotidektomie

Background

Frey??s syndrome (FS) is defined as facial sweating due to gustatory stimuli following surgery or trauma of the parotid gland. Concomitant symptoms may occur in the area of the auriculotemporal nerve: swelling, facial flushing, and paresthesia. A misguided re-innervation of perspiratory glands by secretory parasympathetic fibres is likely responsible in the pathogenesis. The reported incidence in the literature varies considerably from 1.7% to 97.6%. The present study aims to clarify the incidence of FS.

Patients and methods

A questionnaire was sent to 221 consecutive patients who underwent parotidectomy between 07/2005 and 07/2008. No selection for type of parotidectomy or histological result was made. Patients were invited to undergo a follow-up examination including Minor??s iodine starch test.

Results

A total of 135 of 221 (61%) questionnaires were available for evaluation. In all, 82 patients took part in the follow-up, with a follow-up period of 2.8 years (15?C51 months). According to the questionnaire, 54% of patients claimed to be free of symptoms. Sweating following gustatory stimuli was reported by 23% of patients. Of the 82 Minor??s tests performed, 62.2% were positive. All patients with subjective presence of FS had a positive Minor??s test. In 27%, Minor??s test was positive although patients did not suffer from facial sweating subjectively (??subclinical FS??). In all, 39% had no subjective complaints and Minor??s test was also negative. Cases with a positive Minor??s test showed no statistically significant relation to the patients?? age, gender or to the histological diagnosis or type of parotidectomy.

Conclusion

The clinical incidence of FS in our study is 23%, although a positive Minor??s iodine starch test was observed in 62% of cases. Therefore, it seems justifiable to differentiate between a symptomatic or clinical FS and a merely asymptomatic or subclinical FS. No correlation was observed between epidemiological factors and the occurrence of FS.     

Raumforderung des Halses nach Tracheotomie

The patient presented here suffered from a tumor of the frontal part of the neck and from position-dependent dyspnea. He had a history of tracheostomy following vascular surgery; the tracheostomy did not close spontaneously, so it needed to be sutured. The tracheostomy channel seemed to have developed spontaneous epithelization. After its closure, an epidermoid cyst developed from the epithelium. This cyst was the cause of the patient’s symptoms, and it was surgically removed.     

Rekonstruktion des Larynx nach Teilresektion

Ohne Zusammenfassung     

Die Feinstrukturdarstellung des Corti-Organs des Meerschweinchens nach Silberkontrastierung

Zusammenfassung Es wurde die Silberkontrastierung des Corti-Organs des Meerschweinchens mittels Thiosemicarbohydracid-Protargol-Reaktion untersucht. Die Versilberung erfolgte am Ultradünnschnitt mit Araldit-eingebetteten Cochleae. Unter den beschriebenen Versuchsbedingungen konnte eine feingranuläre Silberimprägnation erzielt werden, die ein für die Beurteilung der submikroskopischen Strukturen ausreichendes optisches Auflösungsvermögen erreichen läßt. Die Versilberung fiel an den verschiedenen Zellelementen unterschiedlich intensiv aus, am stärksten waren das Plasmalemm, Lysosomen, Golgi-Apparat, Kernmembranen und Mitochondrien imprägniert.

---

Demonstration of fine structure of the guinea pig organ of Corti after electron microscopic silver staining

Summary The study is concerned with the electron microscopic silver staining of the guinea pig organ of Corti. Cochleas of guinea pigs were fixed with 1.5% glutaraldehyde-paraformaldehyde and embedded in araldite. Ultrathin sections previously incubated with thiocarbohydrazide were stained with a solution of Protargol. This silver proteinate reaction resulted in a fine granular impregnation by metallic silver, not restricting the electron microscopic resolution severely. Advantageously the silver staining may be checked light microscopically, and this gives access to a direct correlation between light and electron microscopic findings.Several constituents of the cells of the organ of Corti were stained with different intensity by this method. The most intense staining has been seen at the plasmalemma, nuclear membrane, lysosomes, Golgi apparatus, and mitochondria. The basal cell membrane of supporting cells and the plasmalemma of tympanal lining cells reacted discontinously. A moderate staining was found at filaments and in the ground substance of the basilar membrane.Insufficient knowledge of groups active in this method inhibits a precise histochemical interpretation of the silver staining.

     

Rekonstruktion des Larynx nach Teilresektion

Ohne Zusammenfassung     

Die Behandlung des Hemispasmus facialis durch Stichelung des Nerven

Ohne Zusammenfassung     

Rekonstruktion des Pharynx und des cervikalen Oesophagus durch Transposition des Magens

Summary A series of poly- and one-staged surgical procedures are at our disposal to reconstruct the esophageal passage following resection of the pharynx and the cervical esophagus. One stage procedures combining safe techniques and a short hospitalization period will be preferred. Since reconstruction of the esophageal passage by transposition of the stomach and carrying out a pharyngo-gastrotomy meets these requirements we performed in collaboration with the thoracic surgeon on several patients. Reconstructions are possible even including the oro- and mesopharynx. The method is demonstrated, advantages and disadvantages in comparison with other procedures are discussed. The possibility of surgical rehabilitation of the voice is given.     

ENG-Untersuchungen des Spontannystagmus nach einem Vestibularausfall

Ohne Zusammenfassung     

Rekonstruktionsverfahren zum Wiederaufbau des Hypopharynx nach Tumorexstirpation

Die funktionellen Ergebnisse nach Rekonstruktion der Hypopharynxhinterwand bezeichneten Steinhart und Iro als zufriedenstellend. Nur in einem Fall bestand noch nach 12 Monaten eine Aspiration und eine deutliche Einschr?nkung der oralen Nahrungsaufnahme.     

Die Grenzmarkierung von Malignomen des Mundrachens durch Tätowierung und ihre Bedeutung für die radikale Operation nach Vorbestrahlung

Ohne Zusammenfassung     

Thiersch'sche Transplantation nach der Aufmeisselung des Warzenfortsatzes

Ohne Zusammenfassung     

Zur Beeinflussung des Bakterienwachstums durch alloplastische Knochenersatzmaterialien

Hintergrund: Alloplastische Werkstoffe werden üblicherweise auf ihre Toxizit?t hin, ihr Verhalten im tierischen Organismus sowie in der Zellkultur auf ihre Eignung als Knochenersatzmaterial überprüft. Speziell Mittelohrimplantate, die durch rezidivierende Infektionen besonders beansprucht sein k?nnen, sollten erg?nzend im bakteriell kontaminierten Milieu getestet werden.