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C Walch

Publications and source records attributed to C Walch.

33 records · Page 2Linked to original sources
PubMed1999

Plasma adrenaline concentrations during functional endoscopic sinus surgery.

OBJECTIVES/HYPOTHESIS: Vasoconstrictors (i.e., epinephrine) are routinely applied before functional endoscopic sinus surgery (FESS) but may have significant cardiac side effects. The controversy concerning clinical application of adrenaline is discussed. STUDY DESIGN: In a prospectively controlled study of 51 patients undergoing FESS we evaluated the absorption of adrenaline from standard cotton pledgets and submucous infiltration and the incidence of related side effects during surgery. Additionally, a control group of 12 patients undergoing tonsillectomy was investigated. METHODS: Plasma adrenaline concentrations were measured 1) before anesthesia, 2) after intubation, 3) after nasal packing with adrenaline soaked pledgets (adrenaline 1:1000) and submucous infiltration with 2 mL lidocaine with adrenaline 1:100,000 in each side, and 4) at end of surgery. The catecholamines were determined with a Merck-Hitachi Catecholamine Analyzer, model II (Merck, Darmstadt, Germany). Pulse, electrocardiogram (ECG), and blood pressure were monitored. RESULTS: In the FESS group, we found a remarkable decrease in systolic (S) as well as diastolic blood pressure (D) (P < .001), whereas the heart frequency was unaffected during surgery. All patients in the adrenaline group showed significant increase in plasma adrenaline (AD) concentrations in the third and fourth sample (P < .001). The control group, however, showed a significant rise in blood pressure only at beginning of surgery (P < .001) with cardiac pulse and plasma adrenaline concentrations unaffected by surgery or anesthesia. The often described severe side effects of adrenaline in combination with general anesthesia were not seen in any of our patients. CONCLUSIONS: Although systemic absorption of locally injected vasoconstrictors occurs, adrenaline-related side effects during FESS are extremely rare when the patient is monitored exactly.

Anesthesia, General↗
PubMed1999

Possibilities and limitations of endoscopic management of nasal and paranasal sinus malignancies.

Over the last decade, the use of rigid endoscopes in surgery of tumorous lesions of the nose, paranasal sinuses, nasopharynx and anterior skull base has extended and diversified. Endoscopic surgical approaches for malignant lesions are very controversially discussed as of today, yet. From 1989-1999 we have treated 43 patients with invasive/destructive tumors of the paranasal sinuses and the anterior skull base strictly endoscopically, transnasally. These included 5 patients with juvenile angiofibromas and 36 patients with various malignant tumors, one with a large invasive macroadenoma of the pituitary and one case of a craniopharyngeoma. The age range was 3 months to 82 years. Whereas the very first patients were approached endoscopically in a palliative intention, we have started endoscopic surgery for selected malignancies with curative intention in the last years. Histologically, patients with various carcinoma differentiation were operated (n = 18), as well as patients with malignant melanoma (n = 5), esthesioneuroblastoma (n = 8), clivus chordoma (n = 3), immature teratoma (n = 1) and leiomyosarcoma (n = 1). Our first results appear to indicate, that outcome is at least equal to standard external approaches, however with excellent functional terms and significantly better overall quality of life. The limitations result from the anatomical spread of the tumor, when extensive infiltration of orbit, dura/brain and other vital structures exist. However, in experienced hands, endoscopic surgery in this region can be rather radical, bone and even dura of the anterior skull base can be resected as can the periorbit, and all structures reconstructed in the same session. Endoscopic techniques lend themselves very well to cooperation with neighbouring specialities like neurosurgery. In individual cases, gamma-knife therapy has proven an extremely helpful adjunctive. With this combined approach, all 8 patients with esthesioneuroblastoma are alive and free of disease with a mean observation time of 37.2 months. We will therefore continue to use this procedure in selected cases as a reliable alternative to external approaches in the future. However we recommend, that these techniques are only applied at centers, where all other surgical approaches can be performed, should need for this arise.

Endoscopy↗
PubMed1998

Cavernous haemangioma in the infraorbital nerve canal--an unusual expansion in the maxillary sinus.

A patient with a four-week history of hypaesthesia and recurrent swelling of the cheek in the left infraorbital region presented with a computed tomography (CT) scan demonstrating an expansion in the infraorbital nerve canal, thought to be a neuroma. The tumour was surgically removed without complications and no bleeding. Histopathological investigation showed a partially thrombosed cavernous haemangioma. To our knowledge, after reviewing the literature, this is the first report of a cavernous haemangioma in the infraorbital nerve canal.

Facial Neoplasms↗
PubMed1998

Endoscopic optic nerve decompression: the Graz experience.

Recommendations for management of traumatic injuries to the optic nerve in the literature include expectant management, medical therapy, surgical treatment, and medical therapy combined with surgical decompression. Traditional surgical approaches to optic nerve decompression (OND) are a neurosurgical or craniotomy approach, extranasal transethmoidal approach, transorbital approach, transantral approach, and intranasal microscopic approach. Recent advances in instrumentation and surgical techniques have made an endoscopic approach to OND possible. Since 1991 endonasal endoscopic decompression of the optic nerve has been the surgical approach of choice in patients requiring OND in the authors' hospital. The endoscopic method offers many advantages over the traditional approaches. Decreased morbidity, preservation of olfaction, rapid recovery time, more acceptable cosmetic results with no external scars, no risk of injury to the developing teeth in children, and less operative stress in a patient who may have multisystem trauma are only some of the benefits associated with the endoscopic OND. The authors' technique of endonasal endoscopic approach to OND, medical management, and indications for surgery and the results in 22 patients undergoing this procedure are discussed.

Adolescent↗
PubMed1997

[Sarcoidosis of the paranasal sinuses as the etiology of therapy refractory dacryocystitis].

BACKGROUND: Sarcoidosis is a chronic systemic disease of unknown etiology characterized by non-caseating granulomatous inflammation of various organs. The clinical findings when nasal mucosa is involved include nasal crusting, epistaxis, pain and/or anosmia, nasal polyps, or submucosal nodularity. CASE REPORT: We describe a case of sarcoidosis of the paranasal sinuses. In a 33-year-old man, the first symptom was therapy resistant putrid dacryocystitis. Further there had been symptoms of chronic sinusitis. A CT scan revealed swelling of the mucosa in the anterior ethmoid, frontal recess, and maxillary sinus. As the disease obviously affected the region of the nasolacrimal duct with consecutive stenosis of this canal, we opted for endoscopic sinus surgery. A few days after this endoscopic procedure, the dacryocystitis had healed. RESULTS: The histopathological examination showed the typical picture of sarcoidosis that had its primary manifestation in the paranasal sinuses. According to these findings further explanation of the patient was necessary. The diagnosis of sarcoidosis was confirmed by lavage and biopsy material of bronchoscopically suspect lung areas. Consequently, the patient underwent a long-term corticoid therapy and today, 10 months after the surgical intervention, the patient is free of symptoms. Follow-up endoscopy of the paranasal sinuses showed no further pathological findings. CONCLUSION: Our case demonstrates that the first manifestation of sarcoidosis can be in the paranasal sinuses.

Adult↗
PubMed1997

[Fine needle capillary cytology versus fine needle aspiration cytology--a comparison of quality between puncture techniques in the ENT area].

BACKGROUND: Needle aspiration is currently a widely used technique in the diagnosis of unclear lesions in the head and neck region. We present a modified technique of fine needle biopsy in ENT, "fine needle capillary technique". The basics of this technique were developed by Zajdela and coworkers (1987) as a cytological method of fine needle biopsy in benign and malignant mammary tumors. Fine needle capillary technique does not require aspiration of cell samples via negative pressure created by a syringe. A thin 25 G needle (outer diameter 0.50 mm, length 25 mm) is introduced into the lesion with one hand. The cells are detached by the cutting edge of the needle and are conducted into the lumen by capillary force. The needle is removed and the cellular material is expelled onto a glass slide, spread, and immediately fixed. METHOD: In a series of 166 patients with unclear lesions in the head and neck region, we compared the fine needle capillary technique with the classic fine needle aspiration technique in each patient. Regarding quality and assessment of the cytological smear the fine needle capillary technique proved clearly superior in most of the cases. Lymph nodes, tumors of the salivary glands, thyroid glands, branchiogenic cysts, one atheroma, one lipoma, and one skin metastasis of a squamous cell carcinoma were punctured. RESULTS: In our study fine needle capillary technique showed a very good quality of the cytological smear in 24.7% of all cases, while fine needle aspiration technique reached 12.1% only. A good quality was obtained in 51.2% with fine needle capillary technique and in 51.8% with fine needle aspiration technique, poor quality in 24.1% with fine needle capillary technique and in 36.1% with fine needle aspiration technique. Nondiagnostic cytology was obtained in 21.7% with fine needle capillary technique and in 32.5% with fine needle aspiration technique. Both techniques together showed insufficient material in 10.8%. The quality of the cytological smear in each region was always better with fine needle capillary techniques than with fine needle aspiration technique except five punctures of the submandibular gland. Of 166 patients 113 (68.1%) underwent surgery, and a correlation of the cytologic report to the surgical specimen showed agreement in 95.7% with fine needle capillary technique and in 90.5% with fine needle aspiration technique. In 17.7% with fine needle capillary technique and in 25.7% with fine needle aspiration technique it was not possible to compare the cytological smear with the histological results because of poor quality of the cytological smear. In four cases (4.3%) with fine needle capillary technique the cytological diagnosis was wrong. With fine needle aspiration technique, a wrong diagnosis occurred eight cases (9.5%). CONCLUSIONS: Fine needle capillary technique offers several advantages. Without aspiration trauma to cells and tissues is reduced. Less blood in the samples results in higher quality of the cytological smear. These circumstances make it easier for the pathologist to comment the cytological findings. The handling of the needle is practiced with a wrist movement and not from the shoulder joint as in aspiration method using the Cameco syringe holder. This allows for a more sensitive puncture technique touching the lesion during sampling with the finger tips. The puncture causes less pain than the aspiration technique. Our results demonstrate that fine needle capillary technique is the better method of fine needle biopsy in the head and neck region.

Biopsy, Needle↗
PubMed1996

Choristoma of the middle ear.

Choristoma is a mass of tissue histologically normal for an organ or part of the body other than the site at which it is located. A rare case of ectopic salivary gland choristoma in the middle ear is described in a 4-year-old boy whose only symptom was a 50 dB conductive hearing loss in the presence of a normal tympanic membrane.

Audiometry↗
PubMed1996

Retro- and para-pharyngeal ganglioneuroma.

A patient with slight dysphagia and dyspnoea on exertion was referred to us. We diagnosed a large retro- and para-pharyngeal ganglioneuroma. The mass was surgically removed in toto. The case is presented and the features are discussed.

Ganglioneuroma↗
PubMed1996

[H.E.L.P. therapy (heparin-induced extracorporeal LDL precipitation) in sudden deafness].

BACKGROUND: The H.E.L.P. (Heparin-induced extracorporal low-density lipoprotein precipitation) system selectively eliminates fibrinogen, LDL (low-density lipoprotein) cholesterol, triglycerides, and LP (a) (lipoprotein a) from the blood plasma by means of extracorporal circulation. The reduction of these macromolecules immediately improves the hemorheological situation and leads to a significant decrease of plasma viscosity and red cell transmission time (RCTT), which correlates to the deformation of red blood cells. There are no known contraindications for this therapy. PATIENTS: Sudden hearing loss patients who present to our hospital are admitted for up to ten days. All patients undergo the same standardized imaging studies and examinations, consisting of audiological tests, X-rays and CT of the base of the skull, X-rays of the cervical vertebral column, neurological and internal examination, blood tests, and CSF aspiration. Patients with no obvious etiology for their hearing loss and no improvement of their hearing after two weeks of treatment with intravenous vasodilators and corticosteroids were referred for the H.E.L.P. protocol. RESULTS: We report on five patients with idiopathic sudden hearing loss who following the H.E.L.P. protocol showed complete remission or evident improvement of hearing after H.E.L.P. therapy. CONCLUSIONS: Heparin-induced extracorporal LDL (low-density lipoprotein) precipitation (H.E.L.P.) improves the blood flow and the microcirculation and therefore could be a new and effective method for the treatment of sudden hearing loss.

Audiometry, Pure-Tone↗
PubMed1995

[A rare case of malignant otitis external in a non-diabetic patient].

One case of malignant external otitis in a non-diabetic patient is presented. Malignant external otitis is a rare but severe bacterial infection, caused by Pseudomonas aeruginosa, predominantly in elderly diabetic patients. The process starts in the external auditory canal and after crossing the cartilaginous-osseus junction invades the connective tissue, cartilage, bone, and nerves of the temporal bone and the surrounding parts of the base of the skull. The clinical syndrome is a severe, painful inflammation of the external auditory canal with edematous obstruction of the external canal and typical granulation tissue in the canal wall. Diagnostic criteria are pain, edema, exudate, granulations, microabscess, diabetes, old age, identification of Pseudomonas aeruginosa, and even cranial nerve involvement. Further important criteria are failure of local treatment and a positive Tc-99 scan demonstrating osteomyelitis of the temporal bone as a sign of connective tissue, cartilage, and bone invasion. In most cases there is also a positive radiograph or HR-CT of the base of the skull. Except for sequestrations, surgical treatment in malignant external otitis is impractical because of the deep penetration into the base of the skull and the lack of demarcation lines in this diffuse pathological process. Nowadays long term i.v. antibiotic therapy is preferred. In our case we applied Ceftazidim (Fortum) 2 g for 12 weeks twice a day. After this period the patient was completely cured. Our case demonstrates that malignant external otitis should be considered even in non-diabetic patients.

Aged↗
PubMed1989

Effect of early visual pattern deprivation on development and laminar distribution of cholinergic markers in rat visual cortex.

In order to evaluate the role of cholinergic cortical mechanisms in the shaping of visual cortical plasticity in more detail the present paper summarizes recent studies on the laminar distribution of muscarinic acetylcholine receptors, choline acetyltransferase, and sodium-dependent high-affinity choline uptake sites during postnatal ontogenesis of the visual cortex of monocularly derived rats using autoradiographic techniques as well as quantitative biochemical methods after separating the different cortical layers by a cryocut technique. The data are correlated to the laminar distribution of cholinergic fibers within the visual cortex as studied by the immunohistochemical visualization of choline acetyltransferase. The laminar distribution of cholinergic receptor binding in the visual cortex changes during ontogenesis. In adult rats, the highest muscarinic acetylcholine receptor density is found in layer I. The activity of the choline acetyltransferase is rather uniformly distributed in all cortical layers. Adult activity values are reached at the age of 25 days. In adult rats the enzyme activity is highest in layer V. In all visual cortical layers the highest 3H-hemicholinium-3 binding to choline uptake sites during the postnatal period studied is already detectable at the age of 10 days, then binding decreases sharply until day 25 at which age it nearly equals the value found in the adult brain. Binding sites exhibit highest density in layers I and IV of the adult rat visual cortex. Monocular deprivation resulted in significant changes in all three parameters studied with different cortical laminae preferentially affected. The data suggest that the normal laminar development of the modulatory function of cholinergic transmission in the rat visual cortex depends on the presence of physiological light stimulation.

Aging↗
PubMed1989

Laminar pattern of cholinergic and adrenergic receptors in rat visual cortex using quantitative receptor autoradiography.

The laminar distribution of muscarinic acetylcholine receptors, including the M1-receptor subtype, of beta-adrenergic receptors, and noradrenaline uptake sites, was studied in the adult rat visual, frontal, somatosensory and motor cortex, using quantitative receptor autoradiography. In the visual cortex, the highest density of muscarinic acetylcholine receptors was found in layer I. From layer II/III to layer V binding decreases continuously reaching a constant binding level in layers V and VI. This laminar pattern of muscarinic receptor density differs somewhat from that observed in the non-visual cortical regions examined: layer II/III contained the highest receptor density followed by layer I and IV: lowest density was found in layer V and VI. The binding profile of the muscarinic cholinergic M1-subtype through the visual cortex shows a peak in cortical layer II and in the upper part of layer VI, whereas in the non-visual cortical regions cited the binding level was high in layer II/III, moderate in layer I and IV, and low in layer VI. Layers I to IV of the visual cortex contained the highest beta-adrenergic receptor densities, whereas only low binding levels were observed in the deeper layers. A similar laminar distribution was found also in the frontal, somatosensory and motor cortex. The density of noradrenaline uptake sites was high in all layers of the cortical regions studied, but with noradrenaline uptake sites somewhat more concentrated in the superficial layers than in deeper ones. The distinct laminar pattern of cholinergic and noradrenergic receptor sites indicates a different role for acetylcholine and noradrenaline in the functional anatomy of the cerebral cortex, and in particular, the visual cortex.

Animals↗
PubMedDate not supplied

Meeting minority health needs through special MCH projects.

The maternal and child health programs of the Public Health Service have always been directed to minority populations; however, the recent surges of immigrants from Asian and Central American countries have caused the agency to appraise its efforts to meet the special health needs of these people. Through grants for special projects of regional and national significance (SPRANS), the Office of Maternal and Child Health is funding projects to break down language, culture, and access barriers to health services for pregnant women, infants, and children. Recent and current SPRANS projects have taken innovative approaches to solving the special health problems of the minority populations. They range from a breastfeeding initiative in the Commonwealth of the Northern Mariana Islands to an areawide genetic service program in the Virgin Islands. Examples of projects that have been conducted are presented.

Asia↗