PubMed Health⌕ Search

Biomedical subjects

C Milewski

Publications and source records attributed to C Milewski.

At least 19 recordsLinked to original sources
PubMed2002

[Skin prick test results in snoring and sleep apnea patients].

BACKGROUND: In allergic rhinitis, nasal obstruction is a typical symptom. Reduced nasal ventilation is thought to be one causal factor for sleep breathing disorders. Whether or not snoring individuals with or without sleep apnea show more frequent or stronger reactions in skin prick tests (SPT) compared to non-snorers has not been investigated yet. METHOD: SPT on 20 most frequent allergens and standardized questionnaires of 412 patients of either sex who received a polysomnography at the sleeplab of the ENT department, University of Würzburg, Germany, were analysed retrospectively. In 351 patients (85 %), data were complete. According to their polysomnography, patients were grouped into snorers (n = 248, 71 %) and non-snorers (n = 103, 29 %) or apnea (apnea-hypopnea-index > 10; n = 171, 49 %) and non-apnea patients (n = 180, 51 %). Average occurrence or strength of skin reactions was compared between these groups. RESULTS: Except plantain (7 % vs. 1 %) and beech (10 % vs. 3 %), there were no statistical increases in the average occurrence or strength of SPT results in snoring individuals. Apnea patients did not show more frequent or stronger allergic skin reactions than non-apnea patients. Three patients suffering from allergic rhinitis by house dust mites were treated with citerizin 10 mg and allergen exposition prophylaxis. Three months after onset of therapy in all three patients, a reduction of snoring was polysomnographically observed. Snorers or apnea patients complaining sneezing, reduced nasal ventilation at night, hyperlacrimation or rhinorrhea showed significant higher numbers of allergic skin reactions for rye, gras and house dust mites compared to patients without these symptoms. CONCLUSIONS: The results reveal that only snorers or apnea patients with specific symptoms for allergic rhinitis should be tested by SPT. A general SPT-screening seems not to be indicated. Snoring and apneas in patients with allergic rhinitis due to house dust mites can be eliminated or reduced by an oral antihistaminic treatment.

Adolescent↗
PubMed2001

Combined intra-operative monitoring of hearing by means of auditory brainstem responses (ABR) and transtympanic electrocochleography (ECochG) during surgery of intra- and extrameatal acoustic neurinomas.

BACKGROUND: Although being established as a standard procedure in intra-operative monitoring in acoustic neurinoma surgery, auditory brainstem responses (ABR) represent a far-field technique bearing some technical limitations. This prospective study was designed to evaluate electrocochleography (ECochG) as a supplementary tool for hearing preservation. METHOD: 84 patients with unilateral intra-/extrameatal acoustic neurinomas (extrameatal diameter: 5-55 mm) preserving serviceable hearing, were operated on using a combined (neuro-/otosurgical) suboccipital approach. ECochG was recorded simultaneously to ABR following transtympanic insertion of a steel needle electrode into the promontory under otoscopic view. FINDINGS: Serviceable hearing (Class 1-3 according to Gardner/Robertson) was preserved in 43 out of 84 patients (51.2%), of whom 40 showed both ECochG and ABR being preserved. All 24 patients with loss of both modalities became deaf. Hearing preservation was observed in 4 out of 12 patients with preserved ECochG but loss of ABR (waves III-V). The reverse was observed in 2 cases with postoperative deafness. While both ECochG and ABR amplitudes were significantly correlated with pre- and postoperative hearing, latencies of ECochG summating (SP) and action potential (AP) proved to be more reliable indicators for preserved hearing than ABR (peak I/III/V) latencies. The predictive value of baseline ABR amplitudes for postoperative hearing, however, was superior to ECochG parameters. Only in large neurinomas (extrameatal diameter: >2 cm) tumour size was found to be a significant predictor for the preservation of hearing. Apart from three cases with postoperative otoliquorrhea and one further case presenting with local bleeding within the external acoustic meatus, no side effects were observed. CONCLUSIONS: In combination with ABR monitoring, ECochG proved to be a useful supplementary tool for hearing preservation in acoustic neurinoma surgery. It is particularly helpful during electrocautery and drilling, since no averaging is required. Special applications are: (1) small tumours with good serviceable hearing; (2) and/or a large intrameatal portion; (3) cases with lost or endangered contralateral hearing (e.g. bilateral acoustic neurinomas), when the preservation of poor or even non-functional hearing is desirable.

Adult↗
PubMed2001

Intra-operative electromyographic monitoring of the lower cranial motor nerves (LCN IX-XII) in skull base surgery.

The functional preservation of lower (motor) cranial nerves (LCN) is endangered during skull base surgery. Intra-operative EMG monitoring of the LCN IX-XII was investigated in 78 patients undergoing 80 operations on various skull base tumors with regard to technical feasibility and clinical efficacy. Ongoing 'spontaneous muscle activity' (SMA) and 'compound muscle action potentials' (CMAP) following supramaximal bipolar stimulation were intra-operatively recorded applying needle electrodes into the soft palate (CN IX: n=76), the vocal cord (CN X: n=72), the trapezius muscle (CN XI: n=18), and the tongue (CN XII: n=71). From 24/22/8 cases with LCN IX/X/XII deficits (despite monitoring) only 5/6/4 remained unchanged (3-6 months postoperative). An irreversible plegia of the LCN IX/X/XII occurred in three (1/1/1) patients. In 7/6/1 patients postoperative (3-6 months) LCN IX/X/XII function was better than preoperatively. In all patients accessory nerve function remained unchanged. 'Pathological' SMA of the LCN IX/X/XII occurred in 12/16/8 cases, but in only 6/5/3 cases corresponded to postoperative LCN deficits. Corresponding 'pathological' SMA patterns were found in 18/17/5 out of 24/22/8 cases with postoperative LCN IX/X/XII dysfunction. Reproducible CMAP of LCN IX/X/XI/XII could be recorded in 59/56/11/32 patients. Approximate 'normal' values were calculated and compared to (very few) data so far given in the literature. Electromyographic monitoring proved to be a safe tool for the intra-operative identification and localization of the LCN contributing to their anatomical and functional preservation. The predictive value of standard neurophysiological parameters for functional outcome, however, is limited.

Adolescent↗
PubMed2000

Quantitative parameters of intraoperative electromyography predict facial nerve outcomes for vestibular schwannoma surgery.

OBJECTIVE: Facial nerve monitoring is an established method that is routinely used during cerebellopontine angle tumor surgery. The aim of this study was to determine quantitative electromyographic (EMG) parameters that were predictive of facial nerve outcomes. METHODS: In 137 patients with intra-/extrameatal vestibular schwannomas, the most proximal (the exit from the brainstem) and distal (the fundus of the internal auditory canal) parts of the facial nerve were stimulated after total tumor removal. A quantitative analysis of absolute values and ratios (proximal/distal) of evoked EMG parameters (amplitude, latency, and duration) was performed, and parameters were correlated with postoperative (1 and 6 wk and 6 mo) facial nerve function (FNF). RESULTS: Absolute values of EMG amplitudes were statistically correlated with FNF (P < 0.05). Amplitude ratios (proximal/distal) demonstrated an even greater predictive power. The risk of exhibiting facial palsy 6 months after surgery increased from 1.6% (amplitude ratio of >0.8) to 75% (ratio of <0.1). For EMG latencies, only the ratios revealed a significant correlation with FNF. The latency ratio-dependent risk of facial palsy after 6 months increased from 2.9% (ratio of <1.05) to 33% (ratio of >1.35). The durations of the muscle responses were not significantly correlated with clinical outcomes. CONCLUSION: The predictive power of the amplitudes and latencies of electrically evoked muscle responses could be improved by calculating proximal/distal ratios. The proximal/distal amplitude ratio proved to be the most powerful parameter for intraoperative assessment of postoperative FNF.

Adult↗
PubMed2000

Acoustic neuroma surgery as an interdisciplinary approach: a neurosurgical series of 508 patients.

OBJECTIVES: To evaluate an interdisciplinary concept (neurosurgery/ear, nose, and throat (ENT)) of treating acoustic neuromas with extrameatal extension via the retromastoidal approach. To analyse whether monitoring both facial nerve EMG and BAEP improved the functional outcome in acoustic neuroma surgery. METHODS: In a series of 508 patients consecutively operated on over a period of 7 years, functional outcome of the facial nerve was evaluated according to the House/Brackmann scale and hearing preservation was classified using the Gardner/Robertson system. RESULTS: Facial monitoring (396 of 508 operations) and continuous BAEP recording (229 of 399 cases with preserved hearing preoperatively) were performed routinely. With intraoperative monitoring, the rate of excellent/good facial nerve function (House/Brackmann I-II) was 88.7%. Good functional hearing (Gardner/Robertson 1-3) was preserved in 39.8%. CONCLUSION: Acoustic neuroma surgery via a retrosigmoidal approach is a safe and effective treatment for tumours with extrameatal extension. Functional results can be substantially improved by intraoperative monitoring. The interdisciplinary concept of surgery performed by ENT and neurosurgeons was particularly convincing as each pathoanatomical phase of the operation is performed by a surgeon best acquainted with the regional specialties.

Adolescent↗
PubMed1999

[Interesting case no. 20--corpus alienum colli].

We report about a 39-year-old man who presented at the department of ENT Würzburg suffering from a suspicious abscess or tumor of the right neck. Computed tomography and X-ray of the neck did not clarify the entity of the process sufficiently. The emergency surgical exploration of the neck showed an unexpected result: a compress which was forgotten during strumectomy 20 years ago.

Adult↗
PubMed1999

Technical developments in intra-operative monitoring for the preservation of cranial motor nerves and hearing in skull base surgery.

Although EMG recordings from mimic muscles have become the standard for intra-operative facial nerve monitoring, few data are available concerning other motor cranial nerves (MCN). Auditory brainstem responses (ABR) are a proven tool for intra-operative hearing preservation, but have their limitations, suggesting the application of supplementary methods. This paper describes new developments of MCN and cochlear nerve monitoring in skull base surgery. Up to 2 x 8 EMG channels were recorded after bipolar stimulation of MCN using concentric coaxial probes. A special software enabled event-dependent registrations of all signals exceeding a definable threshold level. Selective recordings from masticatory muscles (N.V) were obtained using rectangular Teflon-insulated needle electrodes. For oculomotor (Nn.III/ VI) nerve recordings bipolar needle electrodes were precisely placed by orbital ultrasound guidance. Lower cranial nerves were monitored inserting needle electrodes into the soft palate (N.IX), tongue (N.XII) and vocal muscles (N.X) during laryngoscopy using a special applicator. For ABR recordings, click stimuli (95 dB HL) were applied monaurally through insert earphones. Electrocochleography was simultaneously recorded as a near-field potential without averaging after promontory (transtympanic) electrode placement using otomicroscopy. Regarding the ABR biosignal, a characteristic response pattern was detected following bipolar electrical stimulation of the auditory nerve possibly useful for its intra-operative identification.

Cochlear Nerve↗
PubMed1998

[Role of perimatrix fibroblasts in development of acquired middle ear cholesteatoma. A hypothesis].

The epithelial pathogenesis of acquired cholesteatoma has been widely accepted, but clinical and experimental data have not been able to answer questions like: How does a cholesteatoma start or grow or how is bone resorption of conducted? From our own experiments and literature a new hypothesis of cholesteatoma origin and growth is drawn. Three prerequisites are necessary for development: (1) the unique anatomical situation at the ear-drum (two different epithelial layers close together); (2) chronic destruction of the submucosal tissue in the middle ear (infection, inflammation); (3) wound healing (proliferation phase). Destruction of the submucosal space by middle ear infection and cell necrosis starts the wound healing cascade. In wound healing generally the connective tissue fibroblasts and macrophages play a pivotal role. Cytokines of the wound healing thought to promote the re-epithelization of the mucosal defect and scar tissue development act upon the intact squamous cell layer of the outer surface of the ear-drum at the same time. Thereby a proliferation of the undamaged epithelial layer is induced. Cholesteatoma matrix is always surrounded by a layer of connective tissue, the perimatrix. Persistence of the inflammation causes permanent wound healing in the perimatrix, proliferation of the fibroblasts (granulation tissue) and proliferation of the epithelium (matrix). It is speculated that by virtue of wound healing cytokines of fibroblasts and macrophages are the driving forces of cholesteatoma origin, growth and bone destruction.

Bone Resorption↗
PubMed1998

[Basic fibroblast growth factor (b-FGF) in the perimatrix of cholesteatoma].

UNLABELLED: The growth of a cholesteatoma requires angioneogenesis in the connective tissue of the perimatrix. Angioneogenesis is also needed for wound healing as a host response to tissue injury. Normal wound repair is conducted through a wide number of growth factors. Basic fibroblast growth factor (b-FGF) plays a pivotal role in wound repair. This cytokine exerts its effects through stimulation of a wide range of target cells. B-FGF is chemotactic and mitogenic for fibroblasts, endothelial cells and keratinocytes. In addition, b-FGF can stimulate the production of collagenase and plasminogen activators to enhance fibroblast proliferation and angioneogenesis. Its necessity for normal wound repair has been confirmed by several workers. METHOD: In order to demonstrate angioneogenesis in the cholesteatoma perimatrix the distribution of b-FGF as the pivotal cytokine of the process was investigated in the perimatrix of 18 cholesteatoma specimens. RESULTS: B-FGF could be observed in 12 of 18 specimens (66%) in close approximation to histological signs of inflammation and wound healing. Areas with b-FGF also exhibited proliferation of the covering squamous epithelium. Cholesteatoma matrix tissue without inflammation or any sign of wound healing did not express b-FGF (6 of 18). CONCLUSION: Histological changes and distribution pattern of b-FGF in the perimatrix of cholesteatoma in the present study indicate that the perimatrix cells and substances of the wound healing cascade may play an important role in cholesteatoma development, angiogenesis and growth.

Cholesteatoma, Middle Ear↗
PubMed1996

[Endonasal endoscopic ethmoidectomy in acute therapy refractory sinusitis].

BACKGROUND: Acute sinusitis usually requires conservative treatment with antibiotics and decongestion nose drops. However, a certain number of cases do not respond to that treatment. Because functional endoscopic endonasal sinus surgery (FESS) has been proven to be a valuable tool in treatment of all kind of chronic sinus diseases, it was adopted for acute complicated sinusitis. METHODS: Between 1990 and 1993, ethmoidectomy was performed in 43 patients with acute inflammatory sinus disease in whom conservative treatment had failed (frontal sinusitis n = 11, max. sinusitis n = 10, isolated ethmoiditis n = 5, orbital complications of sinusitis n = 10, sphenoidsinusitis n = 2, acute pyomucocele n = 5). Coronal CT scan revealed mucosal pathology of the ethmoid region in 41 cases. None of the patients had intranasal polyposis. Complete ethmoidectomy was performed under general anesthesia using an endoscope and the transnasal route. RESULTS: All patients had relief of their symptoms within the first two postoperative days. One patient with a mucocele and two patients with orbital complications following osteoplastic procedures required revision surgery for removal of screws and plates from previous surgery. None of the patients developed recurrent symptoms of acute complicated sinusitis within the mean postoperative observation period of nine months. CONCLUSION: FESS should early be considered as a possible treatment of acute sinusitis and its complications if conservative treatment fails.

Acute Disease↗
PubMed1996

[Tragus perichondrium-cartilage island transplant in middle ear surgery. Method and results after 5 years].

Temporalis fascia remains the most widespread material for reconstructing the tympanic membrane in tympanomastoid surgery. If total or partial ossicular replacement prostheses are needed or pathology of the eustachian tube causes ventilation impairment, a more rigid transplant material is required. Between 1989 and 1994 perichondrium-cartilage composite grafts were used in a series of 597 cases of tympanomastoid surgery performed at the University ENT Clinic of Würzburg. The graft was taken from the tragus and prepared as a cartilage island with perichondrium attached to one side, the perichondrium-cartilage island transplant (PCI). If reconstruction of the ossicular chain was necessary, glass ionomer cement protheses (IONOS) were used. Closure of the tympanic membrane could be achieved in 90% of all cases. In those cases where ossicular chain reconstruction was postponed to a second procedure, closure of the drum was achieved in 96%. The audiological results of the different type III procedures were evaluated. By using the PCI technique a favorable closure of the air-bone gap to 10-25 dB was achieved, even in cases with advanced ear pathology technique and results are presented in detail.

Audiometry, Pure-Tone↗
PubMed1995

Management of the open labyrinth.

Labyrinthine fistulas occur in approximately 5% of cholesteatoma cases, but the management of this difficult problem remains controversial. This study assessed the preoperative presentation and outcome in 37 patients operated on for cholestatoma complicated by labyrinthine fistula. Therapy involved removing the matrix from each fistula and reconstructing the bony wall of the labyrinth with bone dust, fibrin glue, and perichondrium. Corticosteroids were added to the management protocol in more recent cases. A fistula classification scheme was introduced to standardize the reporting of the extent of labyrinthine involvement and results of treatment. The most common preoperative symptoms, sensorineural hearing loss and vertigo, were notably lacking in more than 30% of patients. The fistula test was positive in only 32% of cases. Corticosteroids were seen to have a beneficial impact on postoperative outcome in those cases involving injury to the membranous labyrinth or removal of perilymph.

Bone Transplantation↗
PubMed1995

[Possibilities for preserving hearing in labyrinth fistulas of different degrees of severity].

The labyrinthine fistula continues to be one of the most common complications in ears with cholesteatoma. Fifty-one patients with labyrinthine fistula were identified in a series of 1243 cases with cholesteatoma operated upon between 1989 and 1993 at the University ENT Clinic Wuerzburg. The surgical management concept comprised of removing the cholesteatoma matrix, categorizing the fistula type, and immediate covering of the labyrinthine capsule defect with bone dust, perichondrium and fibrin glue. The classification system of the fistulae used in the study used the depth of labyrinthine involvement as a criterion and also took into account the possibility of intentional or accidental damage to the labyrinth during surgical manipulation (Fig. 1). From 1991 on, patients were treated with 500 mg of Presnisolon 21 hydrogen succinate in a single intravenous dose, at the time the fistula was corrected. The postoperative hearing results were graded based on the extend of preservation of inner ear function at or near the preoperative level. None of the patients who had corticosteroid therapy suffered a profound sensory neural hearing loss (Fig. 2, 3), whereas five ears without steroids and a deep fistula lost function completely. The study concluded that corticosteroids have a beneficial impact on postoperative outcome in cases with severe injury to the membranous labyrinth.

Adult↗
PubMed1993

[Risk of endocrine activation in interventions of paragangliomas in the head-neck area].

The intracytoplasmatic glycolytic enzyme neuron-specific enolase (NSE) can be found in cells of endocrine tissue and their derived tumours. The enzyme is not secreted but released if cells are destroyed, i.e. continuously in malignant tumours. The serum level of neuron-specific enolase (NSE) has been used as a marker for small cell carcinomas of the lung, glioblastomas and malignant phaeochromocytomas. In this investigation blood samples were taken prior to and following surgical manipulation of the tumour in 21 patients with paragangliomas of the head and neck region and 6 controls. 22 serum samples were obtained before angiography and two hours after angiography, 41 before surgery, during surgery and after surgery. The serum level of NSE was measured by NSE-RIA test (Diagnostics, Uppsala). In all tumour specimens NSE could be demonstrated by the immunohistological PAP method (Abb. 1). Only two patients had preoperatively elevated serum-NSE levels. An arterial venous shunt had been detected by angiography in one of these patients. No significant effect on NSE serum level could be produced in the majority of patients by an angiography with embolisation or surgical manipulation of the tumour (Fig. 1, 2). A reduction in serum NSE level was observed postoperatively in both cases mentioned before. None of the 6 controls showed any significant change in serum NSE level (Fig. 3). It can be concluded from this study that embolisation does not lead to direct or indirect cell destruction through ischaemia. Manipulation of the tumour does not destroy a significant number of cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Composite graft tympanoplasty in the treatment of ears with advanced middle ear pathology.

In ears with advanced pathology, the functional and anatomical results of surgery are compromised by such factors as total perforation, tympanosclerosis, atelectasis, suppuration, or previous surgery. Perichondrium cartilage composite grafts (PCCGs) were used for membrane grafting in 550 such cases over a period of 5 years. In all, 197 tympanoplastic procedures of type I (25% with previous surgery) and 353 of type III (47% with previous surgery) were carried out. The graft was obtained from the tragus and/or the concha. Two slightly different surgical techniques of grafting were used. Closure of the eardrum perforation was successful in 92% of the procedures. An air-bone gap of less than or equal to 30 dB was obtained in 92.4% of tympanoplasty type I procedures and in 79% of tympanoplasty type III procedures. The conclusion drawn from the results is that PCCG is a reliable graft in cases of advanced destruction of the middle ear.

Cartilage↗
PubMed1993

[Morphology and clinical aspects of paragangliomas in the area of the head-neck].

Clinical data and tumor specimens from 63 patients were investigated, and included 22 glomus caroticum tumors and 41 tumors of the tympano-jugulare region. All specimens could be differentiated by their histological growth patterns into four categories. The clinical data revealed that 45% of the female patients with paragangliomas suffered from goitre, one of whom died in thyrotoxic crisis after surgery. Two patients died from sequelae of other serious diseases. In general, postoperative morbidity was solely caused by cranial nerve palsies depending on tumor extent. From the data presented, a conclusion is drawn that serious concurrent diseases are the limiting factor for surgery. Early detection is the best way to reduce postoperative morbidity if total removal of the tumor is required.

Adult↗