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G Lehnerdt

Publications and source records attributed to G Lehnerdt.

15 recordsLinked to original sources
PubMed2006

[Myositis of the sternocleidomastoid muscle as a result of arthritis of the sternoclavicular joint].

This article describes a rare case of a myositis of the sternocleidomastoid muscle due to an acute septic arthritis of the sternoclavicular joint. A 51-year-old male in reduced condition was admitted to the Department of Otorhinolaryngology with a one-week history of a painless swelling of the sternocleidomastoid muscle associated with recurrent fever. Physical examination was otherwise unremarkable. An intravenous antibiotic therapy was initiated without improvement of the process, accordingly a specific infection or a malignancy was ruled out by biopsy. The positron emission tomography and magnetic resonance imaging finally revealed the diagnosis of a septic arthritis of the sternoclavicular joint as the causal focus of the infection. After an extensive surgical debridement and under continued antibiotic therapy the patient made an uneventful recovery. The acute septic arthritis of the sternoclavicular joint is an uncommon infection with an insidious onset and is often unrecognized until it spreads to adjacent structures leading to serious complications. This case emphasizes that a myositis of sternocleidomastoid muscle can be caused by an ascending infection due to an acute septic arthritis of the sternoclavicular joint. Clinical course, diagnosis and treatment of this uncommon disease are reviewed in this article.

Acute Disease↗
PubMed2006

["Ear camp" for children in Namibia. A field report].

BACKGROUND: Ear surgery is urgently needed in northern Namibia as many children cannot even be provided with hearing aids due to chronically discharging ears, not to forget possible complications of untreated cholesteatoma. METHODS: During the two "ear camps" in 2003 and 2004, 61 children (median age 12 years) and one adult were operated, mainly for (sub)total defects of the tympanic membrane (81 tympanoplasties). PATIENTS AND RESULTS: We performed tympanoplasty type I in 33 cases and type III in 48 cases, mostly using autogenous ossicles and titanium prostheses. In 39 cases, an antrotomy or mastoidectomy was also performed, while in six cases an open cavity had to be created because of a cholesteatoma. The tympanic membrane was reconstructed using tragal cartilage with overlapping perichondrium in an "underlay-technique". The closure rate after 6 months was about 80%, the average improvement in air conduction thresholds in the frequencies between 250 and 4,000 Hz was 13 dB. CONCLUSIONS: An "ear camp" can only be realised with the financial and material help of companies and private supporters. Therapy must be adapted to the limited local possibilities. The use of tragal cartilage with overlapping perichondrium is a safe technique for the reconstruction of a stable tympanic membrane. We have started to instruct local doctors in pre- and postoperative care in ear surgery in order to develop local competence. This will be continued in the next "ear camp".

Child↗
PubMed2006

p16(INK4alpha)/exon 2 mutations in squamous cell carcinoma of the head and neck region.

CONCLUSIONS: In the samples of squamous cell carcinoma (SCC) of the head and neck region studied, mutations of exon 2 were quite rare. In contrast to the other three mutations, the G to C transversion on position 169 (Ala57Pro) has been found in several other studies before. Further investigations on mutations of the other exons 1alpha, 1beta and 3 are necessary. OBJECTIVE: Alterations of p16(INK4A) have been found in different types of human cancer cell lines. The aim of this study was to perform a screening for alterations of exon 2 of different SCCs of the head and neck region. METHODS: Forty samples of different SCCs of the head and neck were collected by biopsy or surgical resection. Exon 2 was amplified by using the primers 5'-GGTGAGGGGGCTCTACACAAG-3' and 5'-GTCTCCCGGGCTGAACTTTC-3'. DNA was sequenced with the primer 5'-CGGGCTGAACTTTCTGTGCT-3'. RESULTS: Mutations were found in 4 of our 40 samples. One sample showed a G to C transversion on position 169 (Ala57Pro), a second sample from the same patient confirmed the latter transition but also contained a transition C to T on position 179 (Ala60Val). Another patient showed an already known polymorphism, a transition G to A at position 442 (Ala148Thr). The third case was a transversion C to A on position 213 (Asn71Lys).

Base Sequence↗
PubMed2005

Bilateral peritonsillar abscesses.

In the discussion about the management of the peritonsillar abscess (PTA) in regard to the pros and cons of tonsillectomy à chaud versus à froid, the risk of obscure contralateral abscesses is often neglected. To the authors' knowledge, there are only a few series of PTA being analyzed for the abscess rate of bilateral PTA. A group of 541 abscess tonsillectomies was retrospectively analyzed for the presence of a bilateral manifestation of peritonsillar abscess. Twenty-one patients (3.88%) had bilateral abscesses. None of these had been detected prior to the operation. Of the 541 patients, 2.22% had postoperative hemorrhages that had to be arrested under general anesthesia. Within the discussion about abscess tonsillectomy versus stab incision followed by interval tonsillectomy (à froid), the rate of almost 4% bilateral abscesses should be taken into consideration as dangerous complications such as mediastinitis could develop from the remaining abscess formation of the contralateral side.

Adult↗
PubMed2005

[Infections of the deep neck spaces with accompanying mediastinitis].

BACKGROUND: Infections of the deep neck spaces with accompanying mediastinitis are still a therapeutic problem with a high mortality. PATIENTS: We report on three patients with deep neck space infections and accompanying mediastinitis who have been treated in the Departments of Otorhinolaryngology at the Universities of Bochum and Essen in the past 2 years. In two patients the infection originated from a peritonsillar abscess and in one patient from an odontogenic infection. THERAPY: One patient was successfully treated by a tonsillectomy and drainage of the parapharyngeal abscess in conjunction with a thoracotomy because of a mediastinal abscess and bilateral pneumothorax. The second patient was cured by a tonsillectomy, wide cervical drainage und cervical mediastinotomy. The third patient with pre-existent alcohol abuse died because of multiorgan failure despite wide cervical und mediastinal drainage. CONCLUSION: In every deep neck infection a mediastinal involvement has to be taken into account. Fast diagnosis and treatment are essential for the prognosis of this life-threatening disease.

Drainage↗
PubMed2005

[Histological criteria and metastasis of squamous cell carcinoma of the pinna].

INTRODUCTION: According to the guidelines for cancer of the skin in the head and neck region of the German association of Otolaryngology, Head and Neck surgery squamous cell carcinoma (SCC) of the pinna are classified by using the current TNM system of skin cancer. As soon as cartilage is infiltrated, irrespective of other criteria like tumour size, SCC of the thin skin of the pinna are classified as T4 category. As therapy considerably depends on the TNM stage a review of the prognostic value of cartilage infiltration as well as other histological criteria seems to be justified. METHODS: Medical records of all patients (n = 36) being operated for SCC of the pinna between August 1988 and January 2004 at our department were retrospectively analysed with regard to a statistical correlation of histological criteria, cervical lymph node metastases and prognosis. RESULTS: In 36 cases a histological re-evaluation could be performed on the original tumour samples (34 male symbol : 2 female symbol; average age was 76 years, with an age interval of 54 - 99 years). 26 SCC cases were smaller than 2 cm, 8 cases between 2 and 5 cm and 2 cases bigger than 5 cm of size. 36 % of SCC cases had infiltration of the auricular cartilage. Statistical analysis did not show a statistical correlation of either cartilage infiltration, tumour size bigger than 2 cm or 1 cm, tumour grading and tumour depth with regard to lymph node metastases. DISCUSSION: According to our results, cartilage infiltration as single criterion of inclusion into a T4 category should be analysed cautiously. The anatomical peculiarity of the pinna where cartilage lies directly beneath very thin skin should be taken into account. A survey of a bigger group of patients e. g. as a multicenter study would be desirable for such a rare malignancy.

Aged↗
PubMed2005

[Smoking promotes the formation of peritonsillar abscesses].

INTRODUCTION: Smoking has not properly been investigated as a predisposing factor for the development of a peritonsillar abscess. METHODS: In a retrospective study a group of 541 abscess tonsillectomies--performed in the department of Otorhinolaryngology (University of Duisburg/Essen) between 1994-2003--was retrospectively analysed for smoking habits of the patients. Further on we investigated the influence of smoking on the risk for a postoperative haemorrhage. RESULTS: Smoking habits of 519/541 were known, 296/519 (57%) were smokers, which is much more than expected with regard to the prevalence of smokers in the German population. Beneath the 2.2% of patients with a postoperative haemorrhage that had to be arrested under general anaesthesia no statistical relation between the occurrence of a postoperative haemorrhage and smoking was found. CONCLUSION: Smoking could be an important predisposing factor for the development of peritonsillar abscess e. g. due to alteration of the mucosa and microbiological changes. We could not identify a statistical relation between smoking and the risk of a postoperative haemorrhage after tonsillectomy à chaud.

Adolescent↗
PubMed2005

Post-tonsillectomy haemorrhage: a retrospective comparison of abscess- and elective tonsillectomy.

CONCLUSION: There is no increased risk of postoperative haemorrhage for abscess tonsillectomies in comparison to elective tonsillectomies. OBJECTIVE: There is still controversy as regards the optimal management of peritonsillar abscess. Opponents of tonsillectomy à chaud cite an increased postoperative bleeding risk. Most authors who compared the risks of postoperative haemorrhage after tonsillectomy à chaud and tonsillectomy à froid did not take into consideration criteria such as the age and gender of the patients or the experience of the surgeon. We aimed to eliminate this bias by performing a retrospective study in which a large series of abscess tonsillectomies were compared with an age- and gender-matched group of elective tonsillectomies. MATERIAL AND METHODS: All patients had been operated on at the Department of Otorhinolaryngology, University of Duisburg-Essen between March 1994 and August 2000. There were 350 patients in the abscess tonsillectomy group (61% male, 39% female; mean age 31.8 years; range 3-88 years) and 311 in the elective tonsillectomy comparison group (61% male, 39% female; mean age 30.0 years; range 2-83 years). RESULTS: In the abscess tonsillectomy group, 9 patients (2.6%; confidence level 1.1-4.8%) had postoperative haemorrhages which required treatment under general anaesthesia, compared to 17 (5.5%; confidence level 3.2-8.6%) in the age- and gender-matched group of "selected" elective tonsillectomies. The difference between these two rates was not significant (p = 0.056). The fairly high rate of haemorrhages in the elective tonsillectomy group was mainly due to the effect of the age-matching procedure, which excluded a considerable number of usually unproblematic tonsillectomies for tonsillar hyperplasia in young children. Moreover, our results show that there is a learning curve for surgeons performing tonsillectomies with regard to postoperative haemorrhages.

Adolescent↗
PubMed2004

[Squamous cell carcinoma of the external ear. A carcinoma of old age which requires individualized therapy planning].

METHODS: Data for all patients with ear malignancies being operated in our department between August 1988 and March 2001 were retrospectively analyzed for tumor localisation, stage, biometric data, anesthesiological risk factors, therapy and recurrence of the disease. RESULTS: Thirty of 79 patients (29 male, one female; average age 77.2 years, range 54-99 years) with cutaneous malignancies of the external ear were diagnosed as SCC ( n=32 SCC). A total of 17 SCC were smaller than 2 cm, 12 were between 2-5 cm, and three were larger than 5 cm. Only two patients had regional nodal disease, none had distant metastases. The anesthesiological risk was estimated according to the recommendations of the American Society of Anesthesiologists (ASA); 16/30 patients were classified as group 3 or 4, having severe general disease with a decrease in vitality or even vital risks. A total of 24 SSC were primarily operated under local anesthesia. Depending on histology, localisation and size of the SCC local excision, partial or total removal of the auricle was performed. In the remaining 8/32 cases, the primary intervention was performed under general anesthesia, mostly in combination with an ipsilateral neck dissection and a superficial parotidectomy. In 8/32 cases, the SCC had to be re-operated after primary R1 resection. Altogether, eight patients received radiotherapy. In 5/32 cases there was a recurrence of the disease. The average follow-up period of the 13 patients who are still alive is 50 months (17-113). One patient died as a result of the metastasized SCC and 16 patients died due to other diseases. DISCUSSION: Considering the high age and the age-associated general diseases of the patients with SCC of the auricle, differentiation between a radical concept of therapy and its risks and possible therapy-related damage is important. Therefore, individual concepts such as partial removal of the pinna without neck dissection and parotidectomy for the N(0) stage are justified if relevant anesthesiological risk factors have to be taken into account.

Age Distribution↗
PubMed2004

[Long-term results of laser-tonsillotomy in obstructive tonsillar hyperplasia].

BACKGROUND: Carbon-dioxide-laser-tonsillotomy is reconsidered as a procedure to relieve patients in early childhood from obstructive symptoms caused by tonsillar hyperplasia such as snoring or sleep apnea without influencing the immunological function. METHODS AND PATIENTS: The protruding part of the tonsils was removed by a CO (2)-laser delivering 10 - 15 W. During 1993 to 2003, 83 children received laser-tonsillotomy, combined with adenoidectomy 51 children were available for follow-up with a standard questionnaire. The parents were surveyed in average 39 months postoperatively. 5 patients required a subsequent tonsillectomy due to a recurrence of tonsillar hyperplasia. Histological investigations were done. 15 children were reevaluated by clinical examination. RESULTS: Most of the patients were relieved from obstructive symptoms. There was no occurrence of postoperative hemorrhage or peritonsillar abscesses. The histological investigations on the specimens from later performed tonsillectomy (n = 5) showed no evidence of scarring opened crypts. The clinical examination did not reveal any signs of chronic infections. CONCLUSION: The tonsillotomy by carbon-dioxide-laser appears as a suitable and safe technique for the treatment of tonsillar hyperplasia without severe throat infection in early childhood.

Airway Obstruction↗
PubMed2003

[Surgical therapy of malignant melanoma of the external ear].

METHOD: The data from our patients of the last 10 years were evaluated in relation to survival and recurrence. RESULTS: Very different surgical therapy-in some cases due to refusal of the therapy suggested-was performed in eight patients (including wedge shaped excision as well as ablation of the auricle). The mean survival ranged from 40 months up to the present. One patient died due to a local recurrence and regional and systemic metastases. One patient experienced local recurrence but is still well 16 months after he underwent surgical revision. Two patients died independently of the tumor. DISCUSSION: Comparison of our results with those of other studies confirms that the extent of the applied resection has of minor effect on recurrence and survival for this disease. Tumor thickness is the most important independent prognostic factor.

Adult↗
PubMed2003

[A bone-destroying tumor of the maxilla. Reparative giant cell granuloma or brown tumor?].

Brown tumors are focal bone lesions caused by an increased osteoclastic activity and fibroblastic proliferation within a primary or more rarely secondary hyperparathyroidism. They are named after their typical brown hemorrhagic stroma with its also typical giant cell formations. We report the case of a 31-year-old pregnant patient with a rapidly growing tumor of her left maxilla whose first symptoms during pregnancy mimicked chronic sinusitis. After swelling of the cheek, diplopia, and recurrent epistaxis appeared, she was referred to our Department for further diagnostics. After CT scan, biopsy was performed under the presumption of a malignant process with the surprising histological result of a reparative giant cell granuloma. At the same time, hyperthyroidism and nodular goiter were diagnosed and further endocrinological examinations were planned. Not until a parathyroid adenoma was diagnosed after urgent operation of the maxillary process (loose molar teeth and displacement of the left bulbus) could the tumor be interpreted and detected within this context of primary hyperparathyroidism as a brown tumor. The brown tumor should be taken into consideration as a rare differential diagnosis of a bone-destroying process of the facial bones. We discuss the clinical signs, diagnostics, and therapy for this case as well as the relevant literature. The reparative giant cell granuloma represents an important differential diagnosis and cannot be distinguished from a brown tumor by histological examination or radiological findings without complete information about the clinical signs and the endocrinological status of the patient.

Adenoma↗
PubMed2002

Sensitization of trigeminal nociception specific for migraine but not pain of sinusitis.

Trigeminal pain processing was studied in 14 patients with unilateral migraine attacks and 14 age- and sex-matched patients with comparable unilateral headache from frontal sinusitis. Using a nociception-specific blink reflex method (nBR), a facilitation of nBR responses predominantly on the headache side was observed in migraine, but not in sinusitis. The facilitation of trigeminal nociception may be specific for migraine rather than a consequence of peripheral pain such as frontal sinusitis.

Acute Disease↗
PubMed2001

[Unilateral opacification of the paranasal sinuses in CT or MRI: an indication of an uncommon histological finding].

BACKGROUND: Clinical and radiological differentiation between subacute or chronic sinusitis and differential pathologies such as malignoma, inverted papilloma or mycosis can be very difficult. In some cases the CT- or MRI-scan shows a unilateral opacification of the paranasal sinuses. Which histological results can be found in patients with persisting sinusitis related problems and a unilateral opacification of the paranasal sinuses in the CT- or MRI-scan? There are only a few publications on this topic. PATIENTS: In a prospective study between June 1998 and November 1999 all patients who underwent surgery in our Department for subacute or chronic sinusitis problems were included into our study group if they had a unilateral opacification of the paranasal sinuses. Thereafter, the same neuroradiologist verified the unilateral radiological findings on CT or MRI, unaware of the clinical and histological findings. Cases with a pre-existing histological examination, previous operation or injury to the paranasal system were excluded from this study. Data on clinical symptoms, radiological and histological findings were analysed. RESULTS: 43 cases with unilateral opacified paranasal sinuses were diagnosed by means of CT or MRI. These were comprised of 24 males and 19 females with an average age of 43.6 years (range 6 to 88 years). The major findings of our study were as follows: Firstly unilateral opacification of the paranasal sinuses is often (19/43 cases or 43%) associated with diseases othe than simple chronic sinusitis (8 inverted papilloma, 5 malignoma, 3 mycoses and one brown tumor, one osteoidosteoma and one haemangioma). Secondly the incidence of significant pathology other than simple chronic sinusitis rises strikingly with increasing age of the patient. For instance pathologies other than simple chronic sinusitis were found in 14% (1/7) of cases in the under 16 years group, 27% (6/22) of cases in the 16-60 years group and in 86% (10/12) of cases in the over 60 years group. Concerning clinical signs of our patients with unilateral sinus opacity 7 of 11 patients (63%) with epistaxis and 3/5 with diplopia had histological findings other than simple chronic sinusitis. In contrast unilateral rhinorrhea, unilateral nasal congestion and cephalgia were not of predictive value. CONCLUSION: Unilateral opacification of paranasal sinuses in the CT or MRI is--especially at a higher age--an indice for a neoplasm or mycotic sinusitis and therefore an early histological diagnosis or operative treatment is always suggested.

Adolescent↗