Fall eines großen retropharyngealen Lipoms

Ohne Zusammenfassung     

Bakterielle Infektionen der großen Kopfspeicheldrüsen

The parotid gland is most commonly involved in bacterial sialadenitis. Predisposing factors for the ductally ascending infection, are dehydration, xerogenic drugs and salivary gland diseases associated with ductal obstructions or reduced saliva secretion. In the majority of cases the infection is caused by Staphylococcus aureus. However, a variety of other aerobic and anaerobic pathogens may be involved. Besides hydration, elimination of ductal obstruction and stimulation of saliva flow antibiotic treatment according to antibiogram is essential. In selected cases, for instance if a salivary gland abscess develops, surgical treatment may become necessary. Actinomycosis, tuberculosis and atypical mycobacteriosis are rare variations of bacterial sialadenitis which clinically may resemble a salivary gland tumor     

Über große Cholesteatome

Zusammenfassung Beschreibung von zwei großen Cholesteatomen, die vorwiegend in die Felsenbeinpyramide hineingewachsen waren. Die letzte Ursache für dieses eigenartige Wachstum ist uns noch unbekannt. Diagnostisch ähneln derartige Fälle primären Cholesteatomen. Die Ausdehnung dieser Prozesse festzustellen ist weder otoskopisch noch durch klinische Beobachtung allein, sondern nur mit Hilfe des Röntgenverfahrens möglich. Die Operation wird in den meisten Fällen keine Schwierigkeiten bereiten. Die lange Dauer der Nachbehandlung ist gegeben durch die Gräoße der Höhlen, das Starrbleiben der Wände und in einer Verengungstendenz in den lateralen Teilen der Wunde. Eine Fäullung der Höhle mit Kontrastmittel ist nicht empfehlenswert.Herrn ProfessorZange zum 60. Geburtstag.     

Kleine Deletion—große Auswirkung

Zusammenfassung Das velokardiofaziale Syndrom (VCFS) oder Shprintzen-II-Syndrom zeichnet sich v. a. durch Gaumenspalte (69%), Herzfehler (74%), charakteristische faziale Dysmorphien sowie Lernschwierigkeiten (70–90%) aus. Es weist Phänotypüberlappungen mit dem DiGeorge-Syndom (DGS) auf. 1992 wurde nachgewiesen, dass bei Patienten mit VCFS eine partielle Monosomie 22q11 vorliegt. Deletionsbereich und variable Deletionsgröße unterscheiden sich bei vielen VCFS-Patienten nicht von denen der DGS-Patienten. Für den HNO-Arzt ist wichtig, dass bei Auffälligkeiten in Form von Mittelohraffektionen und einer—ggf. auch submukösen—Gaumenspalte auch nach kardialen Erkrankungen gefragt werden sollte. Liegt eine Kombinationserkrankung vor, sollte zu einer humangenetischen Untersuchung des Kindes geraten werden, um dem Verdacht auf das Vorliegen eines velokardiofazialen Syndroms zu bestätigen oder auszuschließen. Nur so kann diese genetisch bedingte Erkrankung frühzeitig erkannt werden.     

Videoendoskopie der gro?en Kopfspeicheldrüsen

Videoendoscopy is a minimally invasive procedure for the diagnosis and therapy of sialopathies of the major salivary glands. The main indication is sialolithiasis of the submandibular and parotid glands. Sialoendoscopy offers, on the one hand, a diagnostic method for radiolucent calculi in particular and, on the other, can be used to simultaneously remove calculi. Furthermore, endoscopy is of high value for the diagnosis and treatment of other salivary gland diseases in which there are pathological changes of the ductal system. For example, regeneration of the gland is now possible in cases of chronic sialadenitis, due to the removal of a sialostenosis. Sialadenectomy can thereby be avoided.     

Die Bedeutung der Rollappenplastik für den Verschluß großer Pharynx-Defekte bei strahlengeschädigtem Gewebe

Ohne ZusammenfassungHerrn Prof. Dr. med.A. Seiffert zum 70. Geburtstag in Verehrung gewidmet.     

Über die Schmerzempfindungen des Ohres bei Einwirkungen großer Lautstärken

Ohne Zusammenfassung     

Lebensqualitätsbelastung von Patienten mit großen Tumoren der Mundhöhle Teil 2: Krankheitsverarbeitung: Coping, Angst und Depressivität

The psychosocial effects of disfigurements and dysfunctions after combined surgical and radio-oncological therapy of patients with large tumors of the oral cavity (n = 50) are investigated in a three-part study. Part 1 compared the "limitations of quality of life" (LQL) of these patients with those of patients after total laryngectomy (n = 34) and with a group of patients "without cancer" (n = 40). This second part records the coping strategies of the three groups of patients and relates them to the following variables: anxiety (STAI), depression (D-S'), despair (H-scale), self-image (GT), locus of control (KKG), intellectual capacity (shortend SPM) and psychosocial burden in early childhood (new questionnaire). The coping strategies of "compliance" and "self-encouragement" were used most often. Patients with a higher psychosocial burden in early childhood often chose defensive strategies (distrust, cognitive avoidance, distraction, reinforced control of emotions). Only few patients used strategies of healthy regression ("coasting values", A. Maslow). It seems that no specific single coping strategy (in particular not the frequently recommended "positive thinking") but an individualized selection of different strategies is of special value to patients. The self-esteem of the patient was identified as a crucial factor in increasing the effectiveness of coping strategies. The surgeon can support patients in their self-esteem by showing a genuine interest not only in their state of health but also in their personal background. The third part of the study is focused on a search for variables which could serve as preoperative indicators of the individual ability to bear the burden of illness and therapy.     

Knochendurchbruch nach außen bei Stirnhöhlenentzündung

Ohne ZusammenfassungMit 1 Textabbildung.Inaug.-Dissertation 1935. Med. Fakultät der Universität Würzburg.     

Radikale Lymphknotenausr?umung und Unterkieferdurchtrennung mit en bloc-Resektion eines Tonsillen- und Gaumentumors

Ohne Zusammenfassung     

Neue Erfahrungen am menschlichen Labyrinth (Ductus reuniens mit Nervenrudimenten und quergestreiften Muskeln,Innervation, Glykogen,Verschwinden des großen Wulstes in der Embryogenese)

Ohne ZusammenfassungMit 5 Abbildungen.     

Lebensqualitätsbelastung von Patienten mit großen Tumoren der Mundhöhle Teil 3: Hinweise zur präoperativen Abschätzung der individuellen therapeutischen Belastbarkeit

A three-part empirical study investigated in detail the effects of illness and therapy on patients with large tumors of the oral cavity (n = 50). Part 1 compared the limitations of quality of life (LQL) of these patients with those of patients after total laryngectomy (n = 34) and with a group of patients "without cancer" (n = 40). Part 2 dealt with the individual coping strategies applied by the patients. The aim of this third part was to evaluate those biopsychosocial variables which could serve preoperatively in determining whether a planned surgical intervention could benefit the patient's quality of life. For this purpose a dependent variable ("subjective burden of illness and therapy") was defined as the weighted sum of 9 scores (including "duration of survival" and LQL). 51 variables (19 medical, 7 demographic and many psychological) were chosen as potentially explanatory variables. 7 of the 8 exploratory variables correlating most strongly with the dependent variable had an emotional content: depressive personality, intensified preoperative anxiety and depression, emotional indifference, reinforced control of emotions, reservation and compulsiveness. The somatic variables with the highest correlations to the dependent variable were "more pronounced preoperative dysfunction" (4th place) and "extent of primary tumor" (9th place). The findings suggested that the primary reason for a delay (postponement of the first medical consultation) often resulting in a poorer prognosis is not the growth of the tumor in the meantime but the fact that the delay represents an existing resignation. This resignation and the reduced self-esteem generally underlying it would then be concomitant causes of poorer courses of the illness. The opportunities for the surgeon to support the patient's self-esteem are discussed.     

Analyse der Abbildungsqualität großer operativer Eingriffe an Kopf und Hals in den G-DRG-Systemen 2004–2007

Background

When the German DRG system was implemented there was some doubt about whether patients with extensive head and neck surgery would be properly accounted for. Significant efforts have therefore been invested in analysis and case allocation of those in this group. The object of this study was to investigate whether the changes within the German DRG system have led to improved case allocation.

Methods

Cost data received from 25 ENT departments on 518 prospective documented cases of extensive head and neck surgery were compared with data from the German institute dealing with remuneration in hospitals (InEK). Statistical measures used by InEK were used to analyse the quality of the overall system and the homogeneity of the individual case groups.

Results

The reduction of variance of inlier costs improved by about 107.3% from the 2004 version to the 2007 version of the German DRG system. The average coefficient of cost homogeneity rose by about 9.7% in the same period. Case mix index and DRG revenues were redistributed from less extensive to the more complex operations. Hospitals with large numbers of extensive operations and university hospitals will gain most benefit from this development.

Conclusion

Appropriate case allocation of extensive operations on the head and neck has been improved by the continued development of the German DRG system culminating in the 2007 version. Further adjustments will be needed in the future.