[Possibilities of endoscopic diagnosis in jaw surgery].
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Biomedical subjects
Publications and source records attributed to G Watzek.
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Tactile corpuscle-like structures were identified in a plexiform neurofibroma, which was localized on the right cranial hemisphere os a 16-year-old boy and had necessitated repeated surgery. These structures were studied by light and electron microscopy. The origin of their component cells is, however, still controversial. We believe to have accumulated sufficient evidence for a Schwann cell origin of these cells.
In cases with inoperable tumours of the head and neck some benefit may still be derived from cytostatics and radiotherapy. One treatment concept is based on intraarterial infusion therapy (bleomycin, methotrexate), while the systemic intravenous application of cytostatic substances (bleomycin, cyclophosphamide) is considered as an alternative of the intra-arterial approach is ruled out. Of the 31 intra-arterially and the 30 intravenously treated patients (all except 2 had squamous cell carcinomas), 64,5% and 20%, respectively, went into remission. This documents the validity of our treatment concept.
The commonly-chosen location for biopsy proof of generalized amyloidosis are the gingival, buccal and rectal mucous membranes. In 100 cases of unselected autopsy material, mucosal specimens were taken from these locations and searched for the presence of local amyloid deposits. Control specimens were obtained from the liver and kidneys. Evidence of local amyloid deposits were detected in 75 of the gingival, 56 of the buccal and 33 of rectal mucosa specimens. 30 cases showed positive findings of local amyloid in all 3 locations simultaneously. Histologically, the amyloid distribution strictly followed the pericollagenous pattern. Furthermore, the tendency towards amyloid deposition diminished with increasing age. No relationship to underlying basic disease was found. In view of the frequently extensive amyloid deposits and the special structure of the tissue we object to the use of specimens from gingival mucosa to prove the existence of generalized amyloidosis. It is suggested that of all examined tissue biopsies the rectal mucosa is most suited to this purpose. The morphological differences between the mode of deposition in local and in generalized amyloidosis are discussed on the basis of the literature, as well as our own results.
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Based on the authors' studies and on publications by others from the Vienna Department of Maxillo-facial surgery over the past 60 years common infections of the maxilla and face and the incidences and prognosis of their life-threatening complications and reviewed. Fatalities as expected became substantially less frequent after the introduction of antibiotics, but the number of deaths due to septicaemic abscesses in contrast to those due to local complications has fallen only slightly since penicillin usage. The danger of overrating the therapeutic potential of antibiotics is emphasized, and despite major advances in chemotherapy the discrimination between pathologies preferably treated surgically or conservatively has by no means changes.
In a light-, electronmicroscopic and autoradiographic study different types of nerve sheath tumors were classified. Their cellular population was quantitatively evaluated in the electron microscope. In the neurinoma the predominant cell was found to be the Schwann cell, but in the different types of neurofibromata a variable content of connective tissue cells was noted. T-HE DIFFUSE NEUROFIBROMATA SHOWED A QUANTITATIVE CELLULAR COMPOSITION SIMILAR TO NORMAL PERIPHERAL NERVES. In the plexiform neurofibroma a large number of fibroblasts were present and in the argyrophilic neurofibroma high content of perineurial cells was found. In autoradiographic sections the tumors showed in general a low proliferation rate (L.i. 1-3.6%). In the argyrophilic neurofibrom a higher labelling index (9.5%) was found.
50% of patients with periodontopathy, exhibited the presence of amyloid in the clinically-altered gums. The biopsy specimen of the gums was examined microscopically by means of the crossed polar method. Seemingly-normal gum biopsies were, in all cases, amyloid positive. Amyloid was detected in two out of ten cases of healthy mucosa libera of the cheek. It was assumed that this deposition of amyloid was the consequence of a locally-limited pathological process. These results cast doubt on the possibility of tracing the pericollagenic form of general amyloidosis through gingival biopsy. An alternative procedure would be to biopsy the mucosa libera of the cheek.
A follow-up study was carried out of the clinical symptoms and the radiological and histological alterations in five cases of neurofibromatosis (Recklinghausen's disease) with onset during early childhood. The clinical manifestation of the disease was predominantly restricted to the face. In the histological ultrastructural investigation different types of neurofibroma were detected (plexiform neurofibroma, argyrophilic neurofibroma and diffuse neurofibrma). Preliminary results are presented on the basis of a correlation between the clinical findings and the histological types of neurofibroma with special reference to the demarcation of the tumours, recurrence following surgical removal and the prognosis as to the clinical course of the disease. Nevertheless, definite conclusions will be possible only by continuous observation of a larger number of patients by means of standardized clinical, radiological and histological methods of investigation.
Forty patients with premature craniosynostosis of variable extent and severity were subjected to cephalometry. The majority of the children and adolescents involved had undergone bilateral cranial fenestration at age 6 months to 11 years. Lateral cephalometric radiographs were used for analysis. The measurements obtained were compared with normal values of comparable age groups. In two thirds of the patients examined facial skull growth was found to be impaired, the clinical appearance ranging from pronounced faciostenosis to abortive forms. In some cases the clinical appearance was normal. One of the conclusions derived from the cephalometric data is that inhibited growth primarily affects the anterior portions of the skull base, which are found to be shorter than normal. The defect appears to involve the spheno-ethmoidal, intersphenoidal and sphenofrontal synochondroses.
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Analysis of the 139 patients suffering from carcinoma of the tongue treated at the Klinik für Kieferchirurgie der Universität Wien between 1960 and 1970. In comparison with other studies, sex distribution, age distribution, etiological factors were gone into, methods of treatment were described and the results and prognoses indicated. A five year survival rate of 45.1% was found in patients operated on exclusively, which is considered favorable also in comparison with statements in the literature.
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In addition to a survey of differential diagnoses to be considered in cases of macroglossia, rare general disorders connected with macroglossia are pointed out. As shown especially in a case of primary amyloidosis, recognition of and differential diagnostic considerations with regard to macroglossia sometimes make it possible to diagnose a general disorder not yet recognized.