Der Eiweißstoffwechsel des Ganglion spirale des Meerschweinchens

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Zur Entwicklungsstörung des Labyrinthes und des Felsenbeines

Zusammefassung Die klinische Diagnose einer Labyrinthmißbildung stützt sich auf die röntgenologische Untersuchung. Die Prüfung der cochleären und vestibulären Funktionen deutet nur auf das Vorhandensein einer Entwicklungsstörung hin. Die Kenntnis der normalen Entwicklung ist notwendig, um die krankhaften Abweichungen von den normalen Vorgängen nach Form und Zeitpunkt der Störung zu verstehen. Die eigenen Beobachtungen sind im wesentlichen zwei verschiedene Typen von Labyrinth-hypoplasie, die sich in dem Entwicklungsgrad der Pyramide unterscheiden. Die Pyramide entwickelt sich aus dem Mesoderm durch Ossifikationsimpulse, die von der Cochlea ausgehen, während die Pars mastoidea des Os temporale aus dem vestibulären Anteil des Labyrinthes entsteht. Eine Hemmung der Labyrinthentwicklung, die sich auf die Gestaltung dieser Hauptanteile des Os temporale so entscheidend auswirkt, muß nach Kenntnis der normalen Entwicklungsvorgänge bereits innerhalb des 2. Embryonalmonats stattgefunden haben. Die Diskussion der zahlreichen Möglichkeiten exogener und endogener Art läßt uns für unsere Fälle annehmen, daß das Störgeschehen Ausdruck einer endogen bedingten Situation ist. Die Formanalyse einer Entwicklungsstörung des Labyrinthes, insbesondere die Erforschung des spätesten Zeitpunktes der Einwirkung einer mißbildenden Störung, wird unter Heranziehung der Tatsachen der normalen Embryologie wesentlich erleichtert. Dagegen bleibt das Bemühen um die Auffindung der Ursachen der Entwicklungsstörung im Einzelfalle häufig noch eine Vermutung.Mit 10 Textabbildungen     

Verlaufsformen der Präkanzerosen des Mundes und des Kehlkopfes

Zusammenfassung Auf Grund von teils 12jähriger laufender Beobachtung von Leukoplakien des Mundes und des Kehlkopfes kann über ihren Verlauf folgendes gesagt werden:Nur ein kleiner Teil der Leukoplakien verschwindet auf Beseitigung der nachweislich ursächlichen äußeren oder inneren Noxe.Die Mehrzahl der Leukoplakien ist Ausdruck von zur Zeit noch schwer faßbaren Veränderungen des Organismus, des Stoffwechsels, der hormonalen und neuro-vegetativen Steuerung, des Wechselspiels von Abnutzung und Regeneration und so fort, insgesamt von Faktoren, die auch für die menschliche Carcinogenese von Bedeutung sind.Ein gewisser Prozentsatz ist Teilerscheinung einer Erkrankung der äußeren Haut.Alle Leukoplakien endogenen Ursprungs, wie wir in Ermanglung präziser Kenntnisse der Ätiologie sagen, sind durch örtliche Maßnahmen fast nie befriedigend zu behandeln. Sie neigen zu flächenhafter Ausdehnung, unter Umständen zu multiplem Auftreten, bei operativer Beseitigung zu Rezidiven.Die Röntgen- oder Radiumbestrahlung bringt Leukoplakien nur vorübergehend zur Rückbildung.Nach Exstirpation eines aus einer Leukoplakie hervorgegangenen Tumors bleibt die Neigung zur atypischen Verhornung des einmal erkrankten Schleimhautabschnittes unverändert bestehen und kann, sofern der Patient es zeitlich erlebt, zur Bildung weiterer Tumoren führen. Wird die Geschwulst allein oder zusätzlich röntgenologisch behandelt, kommt die Verhornungstendenz ebenfalls früher oder später wieder zur Geltung, zuweilen in verstärkter Form und ebenfalls mit Neigung zu neuerlicher Tumorbildung.Auf Grund dieser Beobachtungen, von denen einzelne angeführt wurden, ergibt sich die Annahme, daß eine bestimmte Gruppe von Leukoplakien bereits Ausdruck einer ausgeprägten Tumordisposition sind.Die Möglichkeit neuraler Einflüsse wird dabei kurz gestreift.Mit 7 TextabbildungenHerrn Prof.Unterberger zum 65. Geburtstag gewidmet.     

Tuberkulöse Osteomyelitis des Klivus mit Beteiligung des Nasopharynx

Involvement of the skull base is rare in tuberculosis. We report here the case of a 28-year-old female patient with an osteolytic process of the clivus with compression of the brain stem and involvement of the nasopharynx. She reported suffering from headaches for the last 6 months, and diplopia had occurred 1 week before her diagnosis as a result of paresis of the VIth cranial nerve on the right side. A biopsy was obtained endoscopically via a transnasal approach, revealing a granulomatous inflammation with acid-fast rods and thus confirming the diagnosis of a tuberculoma. When the biopsy was taken there was no evidence of any further tuberculomas in this patient. The clinical picture, diagnosis, and treatment of tuberculosis of the skull base and nasopharynx are discussed and the literature on this rare clinical entity is reviewed with reference to this patient's case report.     

Ultraschall des Larynx, Hypopharynx sowie des oberen ?sophagus

Sonography is an integral part of the routine diagnosis of diseases of the head and neck area. Ultrasound plays an important role in particular in the diagnosis, treatment and follow-up of head and neck cancer. Sonographic imaging of the larynx, hypopharynx and upper esophagus is often difficult due to the anatomical conditions. Therefore, CT and MRI are performed as the imaging techniques of first choice for diseases of these organs. In addition to the well-established transcutaneous ultrasound, endoscopic endoluminal ultrasound has developed as a promising new technique in recent years. Hollow organs can be displayed in high resolution transcutaneously and endoluminally. Thus, the attending otolaryngologist can use endoscopy and ultrasonography for accurate surgical planning. The aim of the present paper is to present the possibilities and limitations of ultrasonography of the larynx, hypopharynx and upper esophagus.     

Das Hinterkopftrauma vom Standpunkt des Otologen und des Militärarztes

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Synchrones Schwannom des N. vagus und des zervikalen sympathischen Grenzstrangs

Schwannomas are rare neural sheath tumors which are generally benign. Up to 45% of all schwannomas originate in the head and neck region. In the parapharyngeal space (PPS) they may arise from any of the lower cranial nerves IX, X, XI and XII or from the cervical sympathetic chain. We report a unique case of a synchronous schwannoma of the vagal nerve and the cervical sympathetic chain in a patient without neurofibromatosis.     

S2k-Leitlinie „Diagnostik und Therapie des Schnarchens des Erwachsenen“

These guidelines aim to facilitate high quality medical care of adults with snoring problems. The guidelines were devised for application in both in- and outpatient environments and are directed primarily at all those concerned with the diagnosis and therapy of snoring. According to the AWMF three-level concept, these represent S2k guidelines. A satisfactory definition of snoring does not currently exist. Snoring is the result of vibration of soft tissue structures in narrow regions of the upper airway during breathing while asleep. Ultimately, these vibrations are caused by the sleep-associated decrease in muscle tone in the area of the upper airway dilator muscles. A multitude of risk factors for snoring have been described and its occurrence is multifactorial. Data relating to the frequency of snoring vary widely, depending on the way in which the data are collected. Snoring is usually observed in middle-aged individuals and affected males predominate. Clinical diagnosis of snoring should comprise a free evaluation of the patient’s medical history. Where possible this should also involve their bed partner and the case history can be complimented by questionnaires. To determine the airflow relevant structures, a clinical examination of the nose should be performed. This examination may also include nasal endoscopy. Examination of the oropharynx is particularly important and should be performed. The larynx and the hypopharynx should be examined. The size of the tongue and the condition of the mucous membranes should be recorded as part of the oral cavity examination, as should the results of a dental assessment. Facial skeleton morphology should be assessed for orientation purposes. Technical examinations may be advisable in individual cases. In the instance of suspected sleep-related breathing disorders, relevant comorbidities or where treatment for snoring has been requested, an objective sleep medicine examination should be performed. Snoring is not—at least as we currently understand it—a disease associated with a medical threat; therefore there is currently no medical necessity to treat the condition. All overweight patients with snoring problems should strive to lose weight. If snoring is associated with the supine position, positional therapy can be considered. Some cases of snoring can be appropriately treated using an intraoral device. Selected minimally invasive surgical procedures on the soft palate can be recommended to treat snoring, provided that examinations have revealed a suitable anatomy. The choice of technique is determined primarily by the individual anatomy. At an appropriate interval after the commencement or completion a therapeutic measure, a follow-up examination should be conducted to assess the success of the therapy and to aid in the planning of any further treatments.     

S1-Leitlinie „Diagnostik und Therapie des Schnarchens des Erwachsenen“

Due to the frequency of this phenomenon and the often considerable distress caused to the affected person, competent advice, diagnosis and treatment of snoring in adults is of particular importance. The aim of this guideline is to promote high-quality medical care for patients affected by this problem. According to the three-level concept of the AWMF, it corresponds to an S1 guideline. Prior to any therapeutic intervention, relevant sleep medical history, clinical examination, as well as a mandatory objective diagnostic measure are performed. Snoring is only treated if the patient asks for it. In general, invasive methods should be viewed critically and the patient should be advised correspondingly. In the case of surgical therapy, minimally invasive techniques are preferred. Reducing body weight (in the case of overweight snorers), abstinence from alcohol, nicotine and sleep medication, as well as maintaining a healthy sleep-wake cycle can be recommended from a sleep-medicine perspective, although convincing clinical studies are not yet available. Since evidence for the effectiveness of muscle stimulation or various methods for toning and training of the muscles of the floor of mouth is not available, these methods are not recommended. Snoring can be successfully treated with the use of an intraoral device; however, careful patient selection is important. Avoiding a supine position during sleep can be helpful in some cases. Only limited data is available on the success rates of the surgical approaches and long term data is often lacking, and not all techniques have been sufficiently evaluated from a scientific point of view. Nasal surgery is only indicated if the patient suffers from nasal obstruction. Extensive data supports the effectiveness of laser-assisted resection of excessive soft palate tissue (laser-assisted uvuloplasty, LAUP). In principle, however, such resections can be performed using other techniques. Placebo-controlled studies were able to prove the effectiveness of radiofrequency surgery of the soft palate. A reduction in snoring could also be achieved in many cases by means of soft palate implants with minimal post-operative morbidity. The indication for tonsillectomy and uvulopalatopharyngoplasty should be made cautiously due to the comparatively high morbidity associated with these procedures.     

Physiologie des oberen Ösophagussphinkters

The upper esophageal sphincter (UES) forms a barrier between the pharynx and the esophagus. When opened, the UES allows the food bolus to pass into the esophagus, as well as permitting emesis and eructation. The basal sphincter tone constitutes a barrier function which serves to prevent reflux and passive aerophagia in the case of deep breathing. Basal sphincter tone is dependent on several influencing factors; during swallowing, sphincter opening and closure follow a complex multiphase pattern. This article presents an overview of the current understanding of UES physiology.     

Augmentation des Nasenr��ckens

The present article describes the anatomy, surgical technique and outcomes for nasal dorsal augmentation. The various materials available for augmentation are outlined, including polytetrafluoroethylene (PTFE), autogenous costal cartilage graft and irradiated costal cartilage. In addition, appropriate surgical guidelines for successful augmentation are given. The correct height of the nasal dorsum is determined according to the position of the nasion and the nasal tip, whereby the desired height may also be influenced by the sex of the patient as well as his/her notion of an aesthetic ideal. Access is chosen according to the extent of the planned correction; external access is advisable in the case of extensive correction. Osteotomies should only be undertaken where unavoidable, e.?g. in the case of concomitant nasal misalignment. Patient results, complications and future directions are presented.     

Störungen des Gehörs und des Geruchs bei endokraniellen Erkrankungen

Ohne Zusammenfassung     

Mißbildungen des Ohres

Zusammenfassung Es wird über eine bisher nicht beobachtete Mißbildung des Gehörorgans bei einem vermutlich eineiigen Paarling berichtet, die das äußere, das mittlere und das innere Ohr betrifft samt der Innervation, allerdings etwas seitenverschieden. Innenohr und Labyrinth bestehen beiderseits nur aus einem bläschenförmigen, kaum andeutungsweise differenzierten Raum, die Nn. cochleae, vestibuli und facialis fehlen. Drei weitere, anhangsweise mitgenannte Beobachtungen betreffen Mißbildungen der medialen Paukenwand, teils mit, teils ohne solche des äußeren Ohres, bei normal entwickeltem Innenohr und Labyrinth. Auf Mißbildungen der Labyrinthfenster können der mißgebildete Hammer und Amboß hinweisen. Bei der operativen Therapie sollte dies beachtet werden.Mit 2 Textabbildungen     

Pfählungsverletzung des Halses

In comparison to the United States or South Africa, penetrating injuries of the neck are rare in Europe. Most of these traumas are due to sharp perforation mechanisms. We report on a 43-year-old man who was admitted to the emergency room because of an impressive transcervical penetrating neck trauma inflicted by a chisel. He survived the trauma since the chisel missed all important structures of the neck. The diagnostic strategy to evaluate the dimension of the trauma was primarily based on endoscopic and surgical exploration.     

Luftnot durch ein spontanes Hämatom des Oropharynx und des Larynx unter Marcumar-Therapie

A patient with a history of tachycardiac atrial fibrillation and pulmonary embolism was admitted to the emergency unit with acute shortness of breath. The patient was on coumarin medication. Pulmonary embolism, heart failure, or pulmonary edema could be ruled out. Laryngoscopy revealed a huge hematoma of both valleculae extending to the lateral pharyngeal wall and the epiglottis. The epiglottic cartilage was displaced to the posterior pharyngeal wall. The INR was > 6. Prothrombin complex, vitamin K1, corticoids, and fresh frozen plasma were administered immediately. The patient was monitored--without tracheotomy--in the intensive care unit and received oxygen. In a patient with dyspnea, impaired ventilation has to be considered besides impaired perfusion or diffusion.     

Einfl��sse des Wasserstrahljets auf die Histomorphometrie und Funktion des N.?facialis

Background

Initial results on the application of the water-jet in a parotidectomy setting in an animal study demonstrate that there are morphologic changes which do, and some which do not, affect the clinial function of the facial nerve due to the different jet sizes and operating pressures used. In a further study the histomorphometric data of the facial nerve dissected by the water-jet should be evaluated and correlated to the different sizes of jet and operating pressures.

Material and methods

In total, 102 nerves (in 14 beagles) which had been dissected by water-jets of different sizes and operating pressures were evaluated. After an observation period of 21?days, including documentation of the clinical function of the facial nerve, the nerves were dissected. The number of nerve fibers and the diameter of the different nerve fibers were then evaluated.

Results

All nerve fibers dissected with jet sizes of 120 and 150???m showed an identical cumulative frequency of fiber diameters. All nerve fibers dissected with a water-jet of 200???m showed morphologic and clinical abnormalities and??in terms of nerve fiber diameters??clear differences to the nerve fibers dissected with 120- or 150-??m jets. Altogether, there is a decrease in fiber diameter along the nerve course.

Conclusion

Our data show a shift of larger diameters of the nerve trunk to smaller diameters in the terminal nerve fibers. This phenomenon has not been described in the literature to date and is probably not due to the water-jet. Additionally, our data show that 22% of the original nerve fiber damaged by the water-jet is sufficient to preserve the nerve??s clinical function.     

Fernmetastasierung von Plattenepithelkarzinomen des oberen Aerodigestivtrakts Der Einfluß klinischer Tumorparameter und des Krankheitsverlaufs

Screening for distant metastases from head and neck tumors is still controversial. In the present study, the records of 1087 patients with newly diagnosed squamous cell carcinomas of the upper aerodigestive tract were reviewed retrospectively to determine clinical factors influencing the incidence and location of distant metastases. Overall, 130 patients (12.0%) developed clinical evidence of metastatic disease, 17 of whom (1.6%) had metastases at the time of initial presentation. The rate of distant metastases significantly increased with the initial stage of tumors (P < 0.00001) and the occurrence of local and/or regional recurrences (P < 0.00001) or of second primaries below the clavicles (P < 0.0005). The locations of primary cancers as well as histopathologic grading were not independent risk factors for the development of distant metastases. They mainly reflected different frequency distributions of stages. The lungs, liver and bones were the most common sites of metastatic disease, being involved in 68.5%, 23.8% and 20.0% of cases, respectively. Our findings show that at the time of initial presentation chest X-ray alone appears to be sufficient to exclude distant metastases from tumors classified as T1-3 NO. Further screening comprising abdominal ultrasound, bone scanning and/or CT scans of the thorax is particularly indicated for patients with advanced-stage disease, local and/or regional recurrences and second primaries below the clavicles. However, the individual decisions should consider whether the detection of distant metastases will significantly affect clinical management.     

Über periodische Veränderungen des Flimmerepithels der Luftwege durch Reizung des vegetativen Systems

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