[Emergencies in general practice, 7. Epistaxis--diagnosis and therapy].
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Diagnosis, Differential↗
Biomedical subjects
G Grevers
Publications and source records attributed to G Grevers.
[Emergencies in general practice, 2. Acute tonsillitis. Differential diagnosis and complications].
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Acute Disease↗
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↗
Fluorescence staining of oral cancer using a topical application of 5-aminolevulinic acid: fluorescence microscopic studies.
INTRODUCTION: Topical application of 5-aminolevulinic acid (5-ALA) by means of a rinsing solution has been shown to be a promising new procedure in the diagnosis of oral malignancies. However, for assessing the reliability of this method regarding fluorescence-guided tumor resections and photodynamic therapy, further information on the distribution and penetration depth of 5-ALA-induced protoporphyrin IX (PPIX) in the tissue is needed. METHODS: 24 patients suffering from oral cancer were included in this investigation. Biopsies were taken immediately after fluorescence examination and either used as native sections for immediate fluorescence microscopic examination (n = 3) or shock frozen in liquid nitrogen and prepared as frozen sections (n = 46). Fluorescence imaging and digital image processing were utilized in order to determine the presence of PPIX in regions of various histologies as well as the penetration depth of PPIX into solid tumor. RESULTS: PPIX fluorescence in the tissue was limited to the epithelium. Both normal and dysplastic epithelium showed PPIX fluorescence. In the stroma, no PPIX fluorescence was found. In some cases (n = 3/4) invasive carcinomas did not show PPIX fluorescence, while the adjacent or overlying normal epithelium was strongly fluorescent. The penetration depth of PPIX after topical application of 5-ALA was found to be limited to less than 1 mm. CONCLUSION: PPIX fluorescence induced by topical application of 5-ALA can be very useful in the determination of superficial tumor margins. However, due to the limited penetration depth there is a risk of not accurately recognizing the infiltration depth of solid tumors. The aim of further investigations will be to assess the tissue distribution and depth of penetration of PPIX following systemic application of 5-ALA.
Aminolevulinic Acid↗
[Local reconstruction of partial auricular defects].
INTRODUCTION: Partial auricular defects are often caused by resection of skin tumors. These patients are mainly older and often in reduced general condition. Therefore very expenditure surgical approaches seem to be dangerous. SURGICAL APPROACH: In most cases the resection of the tumor is possible in local anaesthesia. The reconstruction should be started after maintenance of the final histology. Next to the defect, the localisation leads to the right way of surgical treatment. Localized defects of the helical rim or auricular dorsum, concha and lobulus can be corrected with easy-to-perform local tissue transfers and flaps. Complex auricular defects with additional surgical steps like a neck dissection need general anaesthesia. As result of the preselected patients surgical single step reconstruction-procedure are preferable. In these patients, because of the size of the defect, previous operations or radiation larger local flaps from the neck region or the scalp are necessary. RESULTS AND CONCLUSION: With limited surgical expenditure most patients can obtain an aesthetically satisfying result. This avoids stigmatisation in an area that is hard to hide, which is important to elderly patients as well.
Age Factors↗
Anterior skull base trauma during endoscopic sinus surgery for nasal polyposis preferred sites for iatrogenic injuries.
OBJECTIVE: To determine typical locations for traumatic lesions of the anterior skull base during endoscopic sinus surgery. STUDY DESIGN: In this retrospective study 12 patients were included who had undergone endoscopic sinus surgery for nasal polyposis and were referred to the author for revision surgery after iatrogenic trauma of the anterior skull base during the procedure. Each patient had been operated by a different surgeon, all of the physicians being in an advanced stage of their surgical career and being board certified otolaryngologists. RESULTS: During endoscopically controlled revision surgery, all lesions could be detected, 10 of them being located in the ethmoid roof, while one injury had occurred in the lateral lamella of the cribriform plate and another one in the olfactory groove between the medial turbinate and the nasal septum. CONCLUSION: In contrast to reports in the literature, the preferred site for anterior skull base injuries during endoscopic sinus surgery in our group was not the lateral lamella of the cribriform plate, but the anterior part of the ethmoid roof, just behind the frontal recess. Apparently the course of the ethmoid roof might be misinterpreted during sinus surgery even by surgeons who are familiar with the operative technique.
Endoscopy↗
[Rhinitis, sore throate and otalgia... Benign common cold or dangerous infection?].
One of mankind's most common illnesses is rhinitis, which almost regularly leads to involvement of the paranasal sinuses. Acute sinusitis is a consequence of a viral infection which, by damaging the mucosa, opens the door to bacterial superinfection. The aim of treatment is to cure the acute inflammation, re-establish normal drainage and ventilation, and prevent the development of "rhinosinugenic" complications. Acute otitis media is also preceded by viral damage to the mucosa. In children, acute otitis media is favored by the short, straight Eustachian tube, and often by adenoids. The therapeutic aim of antibiotic treatment and decongestive nose drops is to re-establish the draining function of the tube. Children who suffer from otitis media several times a year, need adenoidectomy. Acute tonsillitis, or quinsy, should be distinguished in particular from infectious mononucleosis. It is imperative to recognize a peritonsillar abscess, which requires more aggressive treatment.
Adult↗
Diode laser treatment of hyperplastic inferior nasal turbinates.
UNLABELLED: Background and Objective Different laser types have been used for the treatment of hyperplastic inferior nasal turbinates. The clinical experiences of its treatment by means of a diode laser are presented. Study Design/Materials and Methods A total of 76 patients suffering from nasal obstruction due to hyperplastic inferior nasal turbinates were treated with a continuous diode laser (wavelength of lambda = 940 nm, laser parameter 10 W/energy/turbinate 5 kJ) in "noncontact" mode and under local anesthesia. All patients were refractory to conservative medical treatment. Fifty patients (26 of 50 [52%] with allergic rhinitis and 24 of 50 [48%] with vasomotor rhinitis) were included into this clinical trial with a follow-up of 1 year. The study was conducted by a questionnaire, photo documentation, allergy test, mucociliary clearance test, rhinomanometry, acoustic rhinometry, conventional radiology of the paranasal sinuses, and histology. RESULTS: The mean operation time took 6 min/turbinate, no nasal packing was necessary and no immediate complications (e.g., major bleeding) were observed. During the first 2-4 weeks, nasal obstruction was correlated to the extent of postoperative edema and nasal crusting. Statistical analysis revealed significant improvement of the nasal airflow (rhinomanometry) and nasal cavity volume (acoustic rhinometry) 6 months and 1 year after laser surgery, respectively. A total of 86% of the patients described a subjective improvement of nasal airflow 6 months and 76% of the patients 1 year after laser treatment. The mucociliary function test showed no significant variation in comparison to the preoperative measurements 1 year after laser treatment. CONCLUSION: Diode laser treatment of hyperplastic inferior nasal turbinates is a useful procedure, which can be performed as an outpatient surgery under local anesthesia, resulting in a controlled coagulation and ablation of the soft tissue. The short operation time and the good results provide an excellent patient acceptance.
Adolescent↗
[Highly malignant T-cell non-Hodgkin lymphoma (nasal type) of the hard palate].
The monomorphic clinical aspect of destructive mid-face lesions is characterised by inflammation, induration and granulomatous transformation. This feature can be caused by various infections, toxical noxa, Wegener's Granulomatosis and different neoplasms. The case of a 19 year old patient with EBV associated nasal type T-cell lymphoma located at the hard palate is presented. The diagnostic approach and difficulties in diagnosing this entity assessing by using multiple biopsies, serological and molecularbiological detection of EBV association and immunohistochemistry for atypic T-cells are elucidated. In the presented case the treatment with chemotherapy and irradiation following a well-defined therapy concept leaded to a three year recurrence-free survival so far. The comparison of the key-histological findings and the major differential diagnoses is mandatory to establish the final diagnosis of lymphoma. This is the basement for treating this disease with combined chemotherapy and irradiation for optimizing survival.
Adult↗
Initial experience in the treatment of oral leukoplakia with high-dose vitamin A and follow-up 5-aminolevulinic acid induced protoporphyrin IX fluorescence.
The aim of photodynamic diagnostics is complete visualization of all neoplastic lesions in a tumorous organ after the application of a tumor-selective photosensitizer. We explored the potential benefit of a combination of retinyl palmitate for the treatment of oral leukoplakias and follow-up diagnosis of malignant tissue by using 5-aminolevulinic acid (5-ALA) as a fluorescence marker. Semiquantitative measurements were performed following the topical application of 5-ALA in six patients. After biopsy and histological evaluation of tissue specimens the patients were treated with escalating doses of retinyl palmitate. After treatment periods ranging from 4 to 8 weeks 5-ALA was again applied for photodetection of persisting fluorescence. In all cases prior to retinyl palmitate treatment a prominent red fluorescence indicated tissue dysplasia. Eight weeks after treatment with retinyl palmitate decreased red fluorescence intensities were found, and repeated histological evaluations showed no persistent signs of dysplastic lesions. Our initial experience shows that high doses of retinyl palmitate can be useful for treating dysplastic lesions in the upper aerodigestive tract and can be monitored with 5-ALA induced protoporphyrin IX fluorescence.
Adult↗
Closure of recurrent frontal skull base defects with vascularized flaps -- a technical case report.
Techniques for vascularized reconstruction of the anterior cranial fossa floor defects causing recurrent cerebrospinal fluid fistula are discussed in this report. The closure employs the use of local random- or axial-pattern vascularized flaps in simple cases. In complicated cases (for instance, status after repeated exploration) the tissue of the cranial base is severely compromised and shows low potential for healing. Non-vascularized grafts only add avital scars to the already present ones leading to recurrent fistulas. Free vascularized flaps show more mechanical strength and less scar contraction, resistance to infections and survive better in a compromised surrounding, thus leading to long term sealing in such cases. The technical issues of vascularized closure of defects of the frontal skull base are discussed in this report.
Bone Diseases↗
Involvement of inferior turbinate mucosa in chronic sinusitis--localization of T-cell subset.
BACKGROUND: In chronic sinusitis (CS), different subsets of leukocytes are involved in development of persistent inflammation of the nasal mucosa. The localization and differentiation of these infiltrating lymphocytes may help us to understand the inflammatory interactions in the epithelium, lamina propria, and seromucous glands of the nasal mucosa in CS. METHODS: We examined frozen sections of inferior turbinates from 14 patients with nonallergic CS and 10 normal nonallergic controls. We used the avidin-biotin-peroxidase (ABC) technique with monoclonal antibodies against CD3 (total T cells), CD4 (T-helper/inducer cells), CD8 (T-suppressor/cytotoxic cells), CD22 (B cells), CD56 (natural killer cells), elastase (neutrophil granulocytes), eosinophil cationic protein (eosinophil granulocytes), and CD68 (macrophages). RESULTS: We found significant increases (P < 0.05) of CD3, CD4, and CD8 T cells and B cells in the nasal mucosa of patients with CS. The number of CD68 cells and eosinophils showed no significant rise. CONCLUSIONS: The different types of leukocytes play a key role in the defense of the respiratory tract. The analysis of the distribution of cells in the epithelium, mucosa, and glands of the inferior turbinate confirmed that nonallergic CS is, in fact, chronic, bacterial rhinosinusitis involving the inferior turbinates, and that the pathomechanism is therefore different from that of nasal polyposis.
Adolescent↗
Detection of squamous cell carcinoma of the oral cavity by imaging 5-aminolevulinic acid-induced protoporphyrin IX fluorescence.
OBJECTIVES: Early cancer detection is the best way to improve the prognosis of patients with oral cancer. Therefore this study presents quantitative fluorescence measurements and results in the visualization of cancerous oral mucosa with 5-aminolevulinic acid (5-ALA)-induced protoporphyrin IX (PPIX). METHODS: Time progression and type of porphyrin accumulation were analyzed in neoplastic and surrounding healthy tissue of 58 patients with a suspected cancer of the oral cavity by measuring emission spectra of 5-ALA-induced PPIX fluorescence. Fluorescence images in the red and green spectral range from the tumor tissue were recorded with a charge-coupled device camera. RESULTS: After topical application of 0.4% 5-ALA and incubation for 1 to 2.5 hours, all patients revealed higher intensities of red fluorescence in neoplastic tissue compared with the surrounding normal tissue. Maximum contrast was reached after 1.5 hours of incubation. In 13.8% (n = 8) of the patients, additional findings like dysplasia, carcinoma in situ, primary tumor, secondary carcinomas, and tumor branches were found by means of fluorescence marking in contrast to white light examination. An evaluation of the biopsy specimens resulted in a specificity of 60% and a sensitivity of 99%. CONCLUSIONS: As a fluorescent marker, PPIX could represent a possible new diagnostic tool to detect early malignant and secondary lesions in the oral cavity. In addition, 5-ALA-induced PPIX fluorescence is promising as a useful intraoperative tool for determining adequate surgical margins of resection. Further investigations aim to assess this diagnostic procedure as a sensitive and clinically reliable method for patients with oral cancer.
Adult↗
Endonasal laser surgery with a new laser fiber guidance instrument.
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Chronic Disease↗
A pilot series demonstrating fluorescence staining of laryngeal papilloma using 5-aminolevulinic acid.
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Administration, Topical↗
Sialolithiasis: MR sialography of the submandibular duct--an alternative to conventional sialography and US?
PURPOSE: To determine the value of magnetic resonance (MR) sialography for the diagnosis of sialolithiasis by comparing results prospectively with those of ultrasonography (US) and digital sialography. MATERIALS AND METHODS: MR sialography was prospectively performed with T2-weighted three-dimensional (3D) constructive interference in steady-state (CISS) and rapid acquisition with relaxation-enhancement (RARE) sequences in 24 patients suspected of having sialolithiasis. Evoked salivation was used as contrast material. T1-weighted spin-echo and T2-weighted turbo spin-echo MR imaging also were performed. The results were then compared with those of US and digital sialography, with the latter as standard of reference. RESULTS: The 3D CISS images were significantly (P: <.05) superior to RARE images for demonstrating the submandibular ductal system, followed by T2-weighted turbo spin-echo images (P: <.01) and T1-weighted spin-echo images (P: <.001). The sensitivity and specificity were 100% and 80%, respectively, for CISS MR sialography and 80% and 100%, respectively, for RARE MR imaging. The sensitivity and specificity of US were both 80%. CONCLUSION: MR sialography with evoked salivation is noninvasive and allows delineation of the submandibular ductal system and detection of sialoliths with accuracy that is similar to that of digital sialography and superior to that of US.
Humans↗
[Polyposis nasi--effective treatment without operation? Broad etiological spectrum, individual therapy].
Various factors are thought to be involved in the etiology and pathogenesis of nasal polyps. The clinical symptoms include nasal obstruction, hyposmia or anosmia and recurrent sinusitis. At the cellular level eosinophilic granulocytes appear to have an important role to play, the growth, differentiation and degranulation of which is apparently controlled by interleukin 5. In the present study, practically relevant aspects of the pathophysiology, diagnosis, treatment and diagnostic differentiation of the various types of polyps are discussed, with the latter point also being examined for its importance with regard to therapeutic consequences.
Diagnosis, Differential↗
Autofluorescence imaging and spectroscopy of normal and malignant mucosa in patients with head and neck cancer.
BACKGROUND AND OBJECTIVE: An early detection of oral cancer might improve the patient's prognosis. We present preliminary results of autofluorescence photodetection of cancerous oral mucosa. MATERIALS AND METHODS: 49 patients were investigated altogether. In 30 patients, malignant and healthy oral mucosa were excited with violet light (lambda = 375 to 440 nm). Images were recorded by a sensitive CCD camera. Spectrophotometric analysis in the green spectral range was performed on tumorous and innocuous mucosa in 36 patients. RESULTS: In 13 patients (43.3%), tumors were subjectively better distinguishable from their surroundings through a reduction of green autofluorescence than by ordinary inspection. Tumor detection abilities varied for different locations and tumor morphologies. Spectral analysis showed contrasts in autofluorescence intensities between tumor and normal tissues in 34 patients (94.4%). Autofluorescence spectra of normal mucosa varied both inter- and intraindividually. CONCLUSIONS: Using violet excitation light, camera-based autofluorescence photodetection in the green spectral range presented a highly promising tool for the diagnosis of oral malignomas in almost half of the cases examined. The possible ways on how the obtained results could serve to find a more advanced method for a precise tumor detection in the oral cavity are being discussed.
Adult↗