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Biomedical subjects

F Bootz

Publications and source records attributed to F Bootz.

At least 91 records · Page 5Linked to original sources
PubMed1994

[Melanoma metastasis in the oropharynx].

Malignant melanomas of the upper respiratory tract are rare tumors but even rarer are their metastases in this region. Between 2% and 3.6% of malignant melanomas of the head and neck occur in the upper respiratory tract. We report a case history of a 48-year-old patient who underwent excision of a superficial spreading melanoma (tumor-thickness, 2 mm) from his trunk and later radical dissections of metastases in his axilla and groin. Chemotherapy with DTIC, an alpha-interferon, was performed. During follow-up, CT-scan demonstrated a 1 cm asymptomatic metastasis in the nasopharynx. Nasal endoscopy confirmed the CT finding as a dark tumor mass in the mucosa of the roof of the nasopharynx, close to Rosenmüller's fossa. Tumor was excised by a temporary split of the soft palate.

Chemotherapy, Adjuvant↗
PubMed1993

[Differential indications of free and pedicled transplants in reconstructive surgery in the head and neck area].

Since the microvascular tissue transfer has been introduced in the reconstructive surgery of the head and neck the question arises repeatedly which free transplant should be favoured and which advantages exist to pedicled flaps. Based on our experiences in 243 reconstructions we discuss the advantages and disadvantages of different operative techniques and their differential indications. Using free as well as pedicled flaps, reconstructions can be performed individually and the decision for a transplant depends on localisation, size and depth of the defect. In contrast to conventional techniques, like the deltopectoral flap, which we performed a decade ago, both new principles allow a one-stage procedure, which reduces the period of hospitalisation and improves the quality of life for the patients. The advantages of free tissue transfer can be seen especially in the reconstruction of the upper digestive tract after laryngopharyngectomy. The existing form of the jejunum segment like a tube allows an easy one-stage reconstruction, as well as better functional and aesthetic results. The radial forearm flap is a nearly ideal transplant in the anterior oral cavity because of the mechanical stability. In contrast the jejunum patch is more vulnerable and less qualified especially when fitting a prosthesis. In the posterior oral cavity we prefer the jejunum patch because it allows more mobility of the tongue. Deep defects, for instance after glossectomy, should be reconstructed with a free latissimus-dorsi-flap or a pedicled myocutaneous pectoralis major flap. In contrast to free tissue transfer, pedicled flaps have the advantage that the difficult technique of microanastomosis is avoided, which reduces the complication rate and the operation time.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Immediate management of rupture and soft tissue injuries in the area of the head-neck].

Most injuries to the head and neck region are accompanied by trauma to the soft tissue. The management of the wound depends on whether it is a superficial or a penetrating trauma. Penetrating traumas may injure bloodvessels, nerve structures and the upper aerodigestive tract. The initial evaluation of a patient with a neck wound should proceed with the basic rules of trauma management (Airway, Bleeding, Circulation). It is suggested, that all wounds deep to the platysma should be explored. Penetrating injuries through the airway should be considered in cases of hoarsness, dyspnea or direct visualization of the airway. In case of dyspnoe the patient should be intubated. In an unstable airway a tracheotomy must be considered. Injuries to the airway demand special care and immediate reconstruction since otherwise it can lead to permanent damage. Hemorrhage and hematoma are the most common symptoms of penetrating neck injuries. Poor initial control of bleeding is the most common cause of death. Uncontrolled clamping of vessels in the neck should be avoided since it can lead to damage of uninvolved structures especially nerves. The neck is divided into 3 zones. Zone I is the area below the sternal notch, Zone II lies between the sternal notch and the angle of the mandible. Zone III is the area above the angle of the mandible. Zone I and III injuries are evaluated with angiography. Zone II injuries are evaluated by surgery. Therapy of Zone I and III is difficult and needs mandibulotomy or resection of the clavicle to gain exposure to the vessels.(ABSTRACT TRUNCATED AT 250 WORDS)

Craniocerebral Trauma↗
PubMed1993

[Methods for surgical closure of pharyngo-cutaneous fistulas after laryngectomy].

Salivary fistulas after laryngectomy and radiotherapy can be treated with different reconstructive procedures if spontaneous closure fails to occur. In small fistulas local supraclavicular flaps are useful if not altered by radiotherapy. Larger fistulas can be closed with pectoralis major flaps. If these methods fail and there is a large defect in the pharynx, free tissue transplants can be used. For this purpose the "single" or "double" jejunal patch can be recommended. The double patch is used for fistulas with large skin defects, since the outer patch from which the mucosa is removed will take split skin. If there is severe infection and tissue alteration by radiotherapy, free omentum transplantation is an excellent method for closure of a fistulas, since in addition to immunological reactivity it easily takes split skin. the vanous methods mentioned are not equal in their applications and are used depending on the size of defect present. In particular, the use of intestinal grafts depends on the general health of the patient affected.

Fistula↗
PubMed1993

[Functional results and survival probability of tumor patients after reconstruction of the mouth cavity and oropharynx using a microvascular radial forearm flap].

In tumor surgery of the oral cavity and oropharynx function and quality of life should be maintained and large resection margins to avoid recurrences. For these purposes the radial forearm flap has proved to be a versatile tissue transfer since it is thin and pliable and has a long vascular pedicle. From 1987 to 1991 we used the radial forearm flap in performing 70 reconstructions of the oral cavity and oropharynx after resection of squamous cell carcinomas. Forty-six patients had carcinomas of the oropharynx, while 24 patients had carcinomas of the oral cavity. The indications for these reconstructions were tumors of the oral cavity and oropharynx greater than T2 which after resection were not suitable for primary closure of the defect. Thirty-seven patients died during the follow-up period, with 36% dying within the first 2 years after operation. Fifty-five percent of these patients died of recurrences, 17% of metastases and 11% of intercurrent diseases. In 17% of cases the cause of death was unknown. The 2-year survival probability was 52% (Kaplan Meier). Our results show that reconstructions with the radial forearm flap do not improve survival rates when compared to the general survival rate in these cases despite a possibly larger resection margin allowing a more radical tumor resection. Thirty-one of the 33 patients still alive underwent following examinations. Forty-six percent of the patients with tumors of the oropharynx and 57% of the patients with tumors of the oral cavity had severe difficulties in swallowing.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Pedicled and microvascular reanastomosed transplants for reconstruction in the head-neck area].

The introduction of the pectoralis major myocutaneous flap has opened up new dimensions for reconstruction following radical resection of advanced oral and pharyngeal malignancies. We report our 12-year experience with 89 patients in whom reconstruction with a pectoralis major flap was performed. The advantage of this technique is that it involves a single-stage reconstruction; moreover, the carotid artery is protected after neck dissection and soft tissue defects can be remodelled with the added bulk of the myocutaneous flap. On the other hand, the applicability of the technique is limited by the rigidity of the flap and the length of the vascular pedicle. These problems were solved by free tissue transfer. The excellent functional and aesthetic results of reanastomosed transplants have led to the myocutaneous pectoralis major flap being replaced at the Department of Otolaryngology in Tübingen.

Adult↗
PubMed1992

Regeneration of respiratory epithelia in the rat after free grafting.

Following free grafting of septal mucosa from the rat to the rectus abdominis muscle, the mucosal membrane was found to degenerate into a flat squamous epithelium with loss of the majority of differentiated epithelial cells. Both the goblet cells and ciliated cells regenerated from stem cells, which appear in large numbers 2 days after transplantation. Microvilli were found initially on the surfaces of developing ciliated cells and were replaced 21 days post-grafting by cilia. The number of goblet cells during regeneration at first exceeded that of the ciliated cells, but decreased with the passage of time. After 4 months there were more ciliated cells, with the respiratory epithelium now appearing no different than the initially transplanted nasal mucosa.

Abdominal Muscles↗
PubMed1992

[Wegener's granulomatosis: otologic and clinico-immunologic aspects].

Clinical, audiometric and immunological data of 26 patients with histological proven Wegener's granulomatosis are presented. In 21 patients the middle ear was involved with serous otitis media, adhesive process or subacute otitis media. 28 of 36 audiometric examinations showed a mild to moderate sensorineural hearing loss. One ear did not recover from a sudden deafness in the early stage of the disease despite of immunosuppressive therapy. Beside clinical and morphological findings in Wegener's granulomatosis the detection of anticytoplasmic antibodies against neutrophil granulocytes (ANCA) is a reliable method in diagnosing the disease. In the present study, the serum of 19 out of 26 patients with histologically proven Wegener's granulomatosis was examined for ANCA by immunofluorescence test. In high activity stage of Wegener's granulomatosis all sera showed a positive ANCA-test. 39 patients with systemic vasculitis served as controls. Only two sera from patients with leucocytoclastic vasculitis and two with panarteriitis nodosa were ANCA positive. The follow-up (35 serum probes) of 8 patients showed no ANCA after immunosuppressive induced remission. In four histologically detected cases of recurrence ANCAs were positive again. ANCAs are very useful in primary diagnosis of Wegener's granulomatosis as well as in the follow-up. In addition, the analysis reveals, that immunosuppressive therapy with cyclophosphamide and prednisone facilitates complete remission and a long survival rate of patients with Wegener's granulomatosis.

Adult↗
PubMed1992

[Reconstructions in the head and neck area using a free latissimus dorsi flap].

Deep defects of the head and neck involving different layers require plastic reconstruction with bulky flaps. We present our experience in the use of the free latissimus dorsi flap in head and neck reconstruction and point out its advantages to the pedicled latissimus dorsi flap. The latissimus dorsi flap not only is useful for conturing the head and neck but also to fill out large cavities due to operation. It further can be used for reconstruction of the oral cavity and pharynx after extended tumour excision.

Head and Neck Neoplasms↗
PubMed1992

[Life saving glance diagnosis in type IIb multiple endocrine neoplasia].

Medullary carcinoma of the thyroid gland is a feature of multiple endocrine neoplasia, type IIb (MEN IIb). The cancer frequently gives rise to metastases in early life. Marfanoid habitus and virtually pathognomic mucosal ganglioneuromas, often situated on the tongue, enable early diagnosis. These stigmata should alert the clinician to the possibility of MEN IIb before medullary carcinoma is clinically manifest. We now believe that it is reasonable to perform a total thyroidectomy in children with the typical physical appearance of this syndrome regardless of age since medullary carcinoma of the thyroid gland appears in almost every case. Calcitonin, a hormone secreted by the C-cells, serves as a plasma tumor marker. Intravenously administered, pentagastrin is a potent secretagogue which is very useful in the early diagnosis of either primary or recurrent medullary carcinoma. With this pentagastrin test, a laboratory screening program is possible allowing the clinician, specialist, to recognize the syndrome.

Biomarkers, Tumor↗
PubMed1992

Computed tomography (CT) and magnetic resonance imaging (MRI) in T-stage evaluation of oral and oropharyngeal carcinomas.

174 CT and 32 MRI investigations were carried out on patients with carcinomas of the mouth and oropharynx. The methods were compared and their value in predicting the pre-therapeutic T-staging studied. The combination of CT and clinical examination was able to improve the T-staging considerably compared with clinical examination alone. MRI was superior to CT in delineating the tumour margins in 78% of patients. T1-weighted and gradient echo sequences after intravenous gadolinium injection were particularly useful. Nevertheless, T-staging based on clinical and CT-findings was changed in only 5% of patients by MRI. MRI is especially useful in T1 tumours and in cancer of the base of the tongue. MRI should also be used instead of CT were dental fillings obscure the region of interest. If there are good MRI facilities and an experienced team available MRI can be used before CT.

Diagnostic Errors↗
PubMed1992

Regeneration of free grafted respiratory epithelium on severely altered lamina propria.

The lamina propria of nasal mucosa has been thought to play a key role in function and metabolism of respiratory epithelia by allowing exchange of various substances and migratory cells from blood vessels into the epithelium. Here we show that the lamina propria of mucosa transplanted to rat rectus abdominis muscle looses its typical structure and becomes vascularized connective tissue. In the subepithelial space of free grafted respiratory epithelia nasal glands, ducts and nerves degenerate and are no more detectable 3 weeks after transplantation. By contrast the epithelial cell layer regenerates, resulting in a healthy appearing mucosa. Histological and functional controls revealed that regenerated respiratory epithelium lies on a layer of vascularized connective tissue and displays normal cellular differentiation and ciliary function. The present experiments demonstrate that the lamina propria can be replaced by vascularized connective tissue without functional loss of the overlaying epithelium. Thus the results argue against a key role of lamina propria in mucosal function.

Abdominal Muscles↗
PubMed1992

Direct observation of living laryngeal carcinoma cells during invasion of healthy cell formation.

After cloning of laryngeal carcinoma cells from tumor fragments obtained during surgery, the behavior of pure tumor cells was investigated under the inverted microscope. In tissue culture flasks, separately grown tumor cell layers and fibroblast layers were cocultured to visualize the invasion of malignant cells into healthy tissue. Using a time-lapse camera, the cells were recorded. The tumor cells often penetrated the healthy cell formation in a wedge-shaped cell formation. Near the tumor front, an elevated cell motility was found accompanied by continuous changes in the cell shape. Intercellular gaps were broader in the front line than in the more posterior parts of the tumor cell formation. The profound motility of the carcinoma cell enabled selected cells to leave the tumor cell formation completely and to migrate as single cells through healthy tissue. Eventually, some of the single tumor cells migrating through the fibroblast layer moved back to the tumor cell formation. Thus they left healthy appearing tissue behind which was earlier infiltrated by a malignant cell.

Cell Movement↗
PubMed1992

[Mucociliary activity of free transplanted respiratory epithelium].

The function of free grafted respiratory epithelium was investigated in inbred rats. In nine of ten animals it could be shown that the respiratory epithelium not only regenerated as an epithelial surface lining but also regained mucociliary activity. The grafted epithelium was able to secrete mucus, which was equal in protein fragmentation to the secretion of normal nasal mucosa. The grafted respiratory epithelium showed normal ciliary function which could be demonstrated by recording the ciliary beat pattern present and by subsequent histological examination. Morphologically, a regular structure of ciliae (9 + 2) was found on the upper pole of the regenerated ciliated cells.

Animals↗
PubMed1991

Cellular differentiation after free grafting of respiratory epithelia.

Since there have been few investigations on the free grafting of respiratory epithelia, the aim of our present experiments was to establish whether it was possible to carry out such grafting in an animal model. Purebred strains of Lewis blood group rats were used to avoid host-versus-graft rejections of mucous membrane transferred from a donor to a recipient animal. Respiratory epithelia from the nasal septum were transplanted to the rectus abdominis muscle. Muscle and epithelial layers were then removed 4 months later. Using light and electron microscopy the function of the grafted ciliated epithelia--i.e. of the ciliated and goblet cells--could be demonstrated. These findings showed that respiratory epithelia heal when grafted onto a recipient site which has an adequate blood supply but do not lose their initial differentiation or functions. The results obtained in this experiment are important clinically for reconstruction of the respiratory tracts.

Abdominal Muscles↗
PubMed1991

Reduction of complication rate at radial forearm flap donor sites.

The radial forearm flap has become a versatile tissue transfer in head and neck surgery, especially in the reconstruction of the pharynx and oral cavity. Still, many surgeons avoid its application because of the possible donor site complications. In 29 of 51 patients who were operated between July 1987 and April 1990 at the Department of Otorhinolaryngology in Tübingen, we evaluated the function and aesthetic appearance of the radial forearm donor site after surgery. We found a much lower complication rate compared to some reports in the literature. With a questionnaire, the patients were asked how they judged the function and appearance of the forearm donor site. Further tests were made to detect a possible reduced mobility of the hand, and to measure the strength of the hand. Postoperative complications and their management as well as our concept of dealing with the radial forearm flap donor site to minimize complications are discussed.

Consumer Behavior↗