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Biomedical subjects

A Leunig

Publications and source records attributed to A Leunig.

At least 19 recordsLinked to original sources
PubMed2007

[Myxoma and myxoid chondrosarcoma of the nasal septum: two case reports].

Myxoid neoplasms are histopathologically divided into true myxomas and other tumors of myxomatous character. In the region of the nasal septum, this tumor entity is extremely rare. In the following two case reports, the unusual findings of a myxoma and a myxoid chondrosarcoma of the nasal septum are presented and discussed. At first visit, both patients reported a slowly progressing, bilateral nasal obstruction. In nasal endoscopy, both showed a smoothly surfaced, spheroid, soft tissue mass in the dorsal nasal septum. On CT-scans, a displacing growth was described for the first patient; in the second patient, a bony arrosion of the floor of the sphenoid sinus was suspected. Both lesions were surgically completely removed. The histopathological diagnosis was myxoma in the first and myxoid chondrosarcoma in the second patient. An early, locally recurrent tumor in the second patient could also be surgically removed. Both patients have been in full remission for more than a year. In spite of the similar symptoms and clinical findings, histopathologically different myxoid neoplasms of the nasal septum show marked variations in growth and recurrence.

Aged, 80 and over↗
PubMed2007

[Cervical skin emphysema: a rare complication following tonsillectomy].

Emphysema of the subcutis or interstitial compartments of the neck or around the naso- oro- or hypopharynx is caused by a perforation. In most cases, it occurs after surgery in this area; spontaneous emphysema is very rare. The characteristic symptom is crepitation; the extension is best seen on a CT scan. Endoscopic control of the surgical area for other lesions is necessary. An anaerobic, gas producing infection must be ruled out. Antibiotics should be given prophylactically.

Adult↗
PubMed2006

Computer-assisted surgery of the paranasal sinuses: technical and clinical experience with 368 patients, using the Vector Vision Compact system.

INTRODUCTION: This paper presents our experience with a navigation system for functional endoscopic sinus surgery. In this study, we took particular note of the surgical indications and risks and the measurement precision and preparation time required, and we present one brief case report as an example. MATERIALS AND METHODS: Between 2000 and 2004, we performed functional endoscopic sinus surgery on 368 patients at the Ludwig Maximilians University, Munich, Germany. We used the Vector Vision Compact system (BrainLAB) with laser registration. The indications for surgery ranged from severe nasal polyps and chronic sinusitis to malignant tumours of the paranasal sinuses and skull base. RESULTS: The time needed for data preparation was less than five minutes. The time required for preparation and patient registration depended on the method used and the experience of the user. In the later cases, it took 11 minutes on average, using Z-Touch registration. The clinical plausibility test produced an average deviation of 1.3 mm. The complications of system use comprised one intra-operative re-registration (18 per cent) and one complete failure (5 per cent). Despite the assistance of an accurate working computer, the anterior ethmoidal artery was incised in one case. However, in all 368 cases, we experienced no cerebrospinal fluid leaks, optic nerve lesions, retrobulbar haematomas or intracerebral bleeding. There were no deaths. DISCUSSION: From our experience with computer-guided surgical procedures, we conclude that computer-guided navigational systems are so accurate that the risk of misleading the surgeon is minimal. In the future, their use in certain specialized procedures will be not only sensible but mandatory. We recommend their use not only in difficult surgical situations but also in routine procedures and for surgical training.

Adolescent↗
PubMed2006

[Avoiding and dealing with bleeding during endoscopic sinus surgery].

Endoscopic sinus surgery is one of the most frequent surgical ENT-procedures. Bleeding during surgery may increase complications and may have negative effects on surgery and outcome. The present paper describes strategies to prevent and deal with bleeding during sinus surgery. Preoperative conservative treatment of mucosal inflammation as well the use of adrenalin for decongestion may reduce intraoperative bleeding and hence complications.

Anesthesia, Local↗
PubMed2005

[New information on chronic rhinosinusitis and polyposis nasi].

New Information on Chronic Rhinosinusitis and Polyposis Nasi Chronic inflammation of the paranasal sinuses is more common than inflammatory or degenerative diseases of the joints or arterial hypertension. The pathogenesis of chronic rhinosinusitis has still not been completely worked out. It is known that in particular the administration of antibiotics is incapable of healing the condition. Once the diagnosis has been established by an ENT specialist, topical or systemic steroids may be helpful. In most cases, however, it is necessary to combine these substances with surgical treatment. For this purpose, endoscopic sinus surgery is an approach that is capable of providing good long-term results.

Adult↗
PubMed2005

[Adenocarcinoma in the tear sack after endonasal dacryocystorhinostomy].

Primary adenocarcinoma of the nasolacrimal drainage system is a highly uncommon diagnosis, which is presumably derived from malignantly transformed glandular cells that are interspersed amongst the epithelium of the nasolacrimal duct. The patients usually present with unspecific orbital or sinus-nasal symptoms. An appropriate therapeutic regime consists of a preferably early, radical resection and local postoperative radiation therapy. This brief contribution deals with an especially uncommon case of a carcinoma of the nasolacrimal drainage system. On his first presentation, the 62-year old patient complained about right sided epiphora which had been present over the last few weeks. Eight years prior to presentation, he had been treated for a nasolacrimal duct stenosis by endoscopic dacryocystorhinostomy on this side. Diagnostic imaging revealed a soft tissue mass in the right nasolacrimal duct which was removed by a combined extra-endonasal approach. The final histopathological evaluation was adenocarcinoma. Following postoperative radiotherapy, the patient has been free of disease for 42 months. The occurrence of adenocarcinoma of the nasolacrimal drainage system in the setting of previous surgery may provide a new insight into the clinical spectrum of the natural history of this disease.

Adenocarcinoma↗
PubMed2004

[Respiratory sleep disorders: benefit from laser-surgery].

Laser-assisted surgery is a valid option for the treatment of respiratory sleep disorders and complements established therapies. Laser-surgery of the inferior turbinates can improve nasal obstruction and amend or eliminate primary snoring. LAUP is as well an ambulant therapeutic method for snoring, but it is leading to strong post-operative pain and should exclusively be applied to patients with small tonsils or who already underwent tonsillectomy. OSAS can be worsened by LAUP and should therefore be excluded before the operation. In childhood OSAS laser tonsillotomy leads to a distinct improvement of sleep-disordered breathing with normalisation of the sleeping profile; it is less painful than tonsillectomy and a part of the tonsil is left to continue to exercise its function in the immune system.

Adult↗
PubMed2004

[Acute otitis media in childhood].

Because of its distinct anatomy, pathogens can quickly reach the middle ear of a child and cause acute otitis media. Depending on the age of the child, the clinical symptoms can vary from intense earaches, fever, pressure sensation and hearing loss to vomiting, diarrhea and refusal of food by infants. The progression of otitis media through four phases can be observed in an otoscopic examination. To improve Eustachian tube ventilation in uncomplicated cases, nose drops to reduce swelling along with pain therapy are employed first. Antibiotics can be administered to reduce the rate of complications from, for example, mastoiditis, paresis of the facial nerve, and labyrinthitis. In recurrent middle ear infections, an operative therapy should also be considered.

Acute Disease↗
PubMed2004

[Synovial sarcoma of the hypopharynx - two case reports].

BACKGROUND: Synovial sarcoma is a rare soft tissue malignancy that most often occurs in the extremities of young adults. Approximately 3 % of these mesenchymal malignant tumors occur in the head and neck region. Up to now about 100 cases have been published. PATIENTS: We report on two cases of a synovial sarcoma of the hypopharynx. In the first case the patient died 3.5 years after beginning of therapy including all therapeutical efforts (surgery, chemotherapy, radiotherapy). The second patient with a synovial sarcoma of his left hypopharynx and a distant metastasis in his 8th thoracic vertebral body is actually treated by neoadjuvant chemotherapy and included into a clinical study to optimize therapy of advanced soft tissue sarcomas. Further surgical treatment depends on the success of this therapeutic approach. CONCLUSION: Despite multitherapeutic approaches over all 5-year survival rates for advanced synovial sarcomas of the head and neck have moderately improved in the recent decades and an ideal treatment has not yet surfaced. Modification of accepted treatment modalities is discussed and therapy options in controlled clinical studies are described.

Adult↗
PubMed2004

[Potential and limitations of fluorescence diagnosis and photodynamic therapy. Part II: Photodynamic therapy].

In photodynamic therapy, neoplastic issue is damaged and subsequently killed by the targeted illumination of previously photosensitized cells. This review is aimed at a comprehensive, but still easily understandable, presentation of all of the aspects of these methods relevant to ENT-doctors. Initially, an explanation of the clinically relevant difficulties in the therapy of (pre-)malignant lesions of the head and neck region, a historical synopsis of the development of this method and an illustration of the biophysical basics is given. The main part of the publication, however, revolves around the description of the current status of research and a presentation of internationally approved methods. At the end, a short overview of possible future developments in this field is given.

Cell Survival↗
PubMed2003

[Potential and limitations of fluorescence diagnosis and photodynamic therapy. Part I: Fluorescence diagnosis].

Fluorescence diagnostic methods enable tumor visualization via specific excitation of endogenous or exogenous tumor-selective fluorescent markers and subsequent optical measurement of the induced fluorescence signals. In the following review, the reader will be given a clear and extensive understanding of all aspects of these methods relevant for ENT specialists. Apart from a demonstration of the clinical difficulties in the diagnosis of malignant tumors of the upper aerodigestive tract, a historical synopsis of fluorescence diagnosis and an explanation of the biophysical basics, this publication focuses mainly on a detailed discussion of the current status of research and a critical consideration of the commercially available systems for fluorescence diagnosis in ENT oncology. The topic is rounded off by a short account of possible future activities in this field.

Bronchoscopes↗
PubMed2002

[Ho:YAG and diode laser treatment of hyperplastic inferior nasal turbinates].

BACKGROUND: Since the early 80's, chronic nasal obstruction due to hyperplastic turbinates is treated by laser light. Comparative clinical studies were performed to assess the clinical outcome of laser assisted endonasal turbinate surgery in longterm. METHODS: By means of a pulsed Ho:YAG laser emitting light at lambda = 2100 nm (0.8 - 1.2 J/pulse, 4 - 8 Hz), 69 patients suffering from nasal obstruction due to allergic rhinitis (46 %) and vasomotor rhinitis (54 %) were treated under local anesthesia. Furthermore, 50 patients (52 % with allergic rhinitis and 48 % with vasomotor rhinitis) were treated by means of a GaAlAs-diode laser (c. w., lambda = 940 nm, 8 - 10 W). The treatment time took 3 - 10 min/turbinate and nasal packing was not necessary after the laser procedure. The study was conducted by a standardized questionnaire, photo documentation, allergy test, mucociliar function test, rhinomanometry, and acoustic rhinometry. RESULTS: Within 4 weeks after laser treatment, an improvement of nasal airflow correlating to the extent of the ablated turbinate tissue could be determined in more than 80 % of the patients. Rhinomanometry revealed a significant improvement of the nasal airflow 6 months and 1 year after the laser treatment compared to the preoperative data. Side effects like nasal dryness and pain were rare (< 5 %). Diode laser treatment revealed more effective results than Ho:YAG laser treatment, however there was no significant difference between the two investigated groups. Patients suffering from vasomotor rhinitis showed far better results in long term in comparison to allergic rhinitis patients. CONCLUSIONS: Ho:YAG and diode laser treatment can be performed as an outpatient procedure under local anesthesia in a short treatment time with promising results. It could become a time and cost effective treatment modality in endonasal laser surgery.

Adult↗
PubMed2002

[CAS of the paranasal sinuses--technology and clinical experience with the Vector-Vision-Compact-System in 102 patients].

INTRODUCTION: Functional endonasal sinus surgery has gained significant importance in the treatment of chronic inflammatory sinus disease over the past 20 years. Still, the risk of jeopardizing adjacent structures, i. e. the anterior skull base, optic nerve or carotid artery, is increased, especially in revision cases. Several attempts have been made in the past to reduce the risk of iatrogenic injuries due to this kind of surgery and to increase the safety of the procedure, one of them being the introduction and clinical application of image guided and computer assisted surgery (CAS) respectively. A new method of patient registration for the CAS is the non-contact laser registration (z-touch trade mark laser). The main advantage of the laser registration device, is that it is no longer necessary to equip the patient with special markers or with a headset for the registration scan, therefore additional CT scans can be avoided. MATERIAL AND METHODS: In this study we summarize our experience with the Vector Vision compact navigation system. The study population contained 102 patient, treated over a period of 18 months (Sept. 2000 - Dez. 2001). The indications for the CAS were mainly revision operations of recurrent nasal polyps, mucoceles or other chronic rhino-sinus diseases, especially of the frontal sinus. In 35 cases the headset registration was applied, in all other cases we used the z-touch trade mark laser registration. RESULTS: The preoperative planning time was significantly lower for z-touch trade mark laser registration ( 5,2 min) compared to the headset registration ( 20,2 min), the set-up-time in the operation room was nearly the same, 7 min for z-touch trade mark laser registration and 6 min for headset registration. The most important criterion for CAS, of course, is accuracy during surgery; here we also observed an increased accuracy for the z-touch trade mark laser registration. CONCLUSIONS: Our data confirm earlier observations indicating that CAS enhances safety during endoscopic sinus surgery especially in revision cases. In addition it might be a helpful adjunct for the beginner and even advanced surgeon during routine sinus procedures. Nevertheless, CAS should not be misinterpreted as a substitute for thorough and meticulous studying of this delicate area including cadaver studies. Our results further demonstrate that the faster and simple registration method allows us to use the system more frequently, thereby increasing the number of navigated cases. The accuracy we can achieve varies between 0.9 and 2.4 mm, with a mean value of 1,3 in the x- and y-axis and 1,4 in the z-axis. In addition it is also possible to use imaging data sets obtained prior to the intent to operate. This not only reduces the cost for imaging studies, but also minimizes the manpower needed to place the fiducials, organize and perform additional acquisition of images.

Adult↗
PubMed2002

[Fluorescence staining of oral and laryngeal cancer after application of 5-aminolevulinic acid].

BACKGROUND: Cancer of the oral cavity, oropharynx and larynx are the most common malignancies in the head and neck region. The prognosis for the patients concerned is highly dependent on an early detection and fast surgical treatment. Fluorescence guided examinations may serve as a possible diagnostic tool for better demarcation and delimitation of head and neck cancer. Therefore, the presented study was aimed at the detection of a selective Protoporphyrin IX (PPIX) accumulation in malignant oral, oropharyngeal and laryngeal lesions following topical and systemic application of 5-aminolevulinic acid (5-ALA). PATIENTS: We investigated 193 patients with suspected lesions in the oral cavity and oropharynx (n = 126) as well as in the larynx (n = 67). The patients received a varying dose (rinsing 200 mg, inhalation 30 mg, 2,5 - 25 mg/kg BW by mouth) of 5-ALA in aqueous solution. Both fluorescence pictures and macroscopic findings under white light were recorded using a target integrating, color CCD camera. Fluorescence contrasts between tumor and normal tissue were registered by an optical multichannel analyser. RESULTS: Our results have shown that after topical and systemic application of 5-ALA, PPIX fluorescence could be identified within the mucosa of the oral cavity, oropharynx and the larynx of all patients with a duration of up to 48 hours after systemic application. Malignant lesions usually showed higher intensities of PPIX-fluorescence than surrounding innocuous mucosa. A maximum fluorescence contrast between normal tissue and neoplastic lesions was observed at 1.5 hours after topical application and 3 hours after systemic application. CONCLUSIONS: It will be the aim of further investigations to verify the optimal time of incubation and dosing of systemical 5-ALA application to enhance fluorescence contrasts and set the basis for fluorescence guided resections.

Administration, Inhalation↗
PubMed2001

Laser treatment of hyperplastic inferior nasal turbinates: a review.

BACKGROUND AND OBJECTIVE: Since the early 80s various types of lasers have been used for the reduction of hyperplastic inferior nasal turbinates. Up to now many studies have revealed a variety of important information. To summarize these findings and to determine the value of laser treatment of hyperplastic inferior nasal turbinates, a comparative review of the literature was performed. STUDY DESIGN/MATERIALS AND METHODS: The study of the literature revealed that hyperplastic inferior turbinates of more than 2,000 patients have been treated and followed up. Treatment was performed with the CO2 (10,600 nm), diode (805/810/940 nm), Argon-ion (488/514 nm), KTP (532 nm), Nd:YAG (1,064 nm), and Ho:YAG (2,080 nm) laser in more than 20 studies so far. Generally, the authors of the trials used different laser parameters (power, energy) and application modalities (contact, non-contact, interstitial, superficial). To determine the long-term results objective (active anterior rhinomanometry, acoustic rhinometry, mucociliary function tests, allergy tests) as well as subjective parameters (questionnaire) were recorded and evaluated. In some cases morphological changes of the turbinate tissue were studied by light and scanning electron microscopy (SEM). RESULTS: Laser surgery of inferior turbinates can be performed as an outpatient procedure under local anesthesia. Due to a minimally invasive and controllable coagulation and ablation of soft tissue, almost no complications or bleedings were observed during the operation or postoperatively. Depending on the chosen parameters (power, energy) and the application modalities (contact, non-contact, superficial, interstitial) laser treatment of hyperplastic inferior nasal turbinates achieved comparable or better results than most of the conventional techniques for turbinate surgery like conchotomy, electrocautery, cryotherapy, chemical cauterization, and vidian neurectomy. More invasive (radical) operative methods, such as inferior turbinoplasty, submucous turbinectomy, lateral outfracture, partial and total turbinectomy, seemed to be more effective than laser surgery in the long-term. CONCLUSIONS: Laser treatment of hyperplastic inferior nasal turbinates can be considered as a useful, cost-effective, and time-saving procedure for the reduction of hyperplastic inferior nasal turbinates. Short operation time, good results, and minor side effects compared to other surgical methods provide an excellent clinical response of the patients.

Humans↗