Biomedical subjects
Publications and source records attributed to G Zechner.
Smoking disturbs health and causes inflammations und tumors in the upper respiratory tract. Passive smoking is also dangerous, especially for children of smoking parents. Health is incompatible with smoking.
Acanthosis nigricans maligna represents a true paraneoplastic syndrome being most frequently associated with adenocarcinoma of the stomach. We present the second case of the world literature of malignant acanthosis nigricans due to an early invasive squamous cell carcinoma of the vocal cord.
We present the Urbach-Whiete-Syndrome as a rare cause of hoarseness in children. As such patients often present initially to the E.N.T. surgeon, we should like to draw attention to this autosomal recessive condition. Only symptomatic treatment is possible, and genetic counselling should be considered. The diagnosis of the disease should be as prompt as possible.
The acquired cholesteatoma of the middle ear develops from shifted ectodermal epithelium. The transposition takes place in a typical way by ingrowth from canal wall or tympanic membrane lining similar to wound healing. A precondition is a perforative chronic otitis media. In our terminology, an atypical shift of epithelium is a retraction pocket over poorly aerated parts of the tympanum. The matrix, activated by supporting connective tissue, follows the same tissue kinetic principles as the epidermis. In case of cholesteatoma we have a discrepancy of vertical (keratinisation) and horizontal (migration) regeneration, creating a keratin-cystlike structure. The cells of Langerhans, which control epidermal growth and type of keratinisation, seem to play an important role. Their density is low in stressregions of the epidermis and in the active matrix of the cholesteatoma.
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Tubotympanic catarrh (otitis media with effusion) is a long-known disease. Today it has become a "fashionable disease", but is extremely important as the most frequent cause of hearing loss in children. The key to the disease is functional disability of the auditory tube. Therapeutic pitfalls and a significant lack of compliance on the part of the patient have definitely led to an increase in otitis media with effusion. We are sure that better diagnostic facilities for the detection of hearing loss in children has made the "silent syndrome" more prevalent. Therapy must aim to cure tubal dysfunction as soon as possible to enable clearance of the middle ear secretion and ventilation of the tympanon, in order to avoid the feared complications of adhesive otitis and atypical cholesteatoma. Prophylaxis is better than cure.
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The article reports on a male patient of 72 years of age suffering from rhinoliquorrhoea caused by meningoencephalocele. This disease pattern is in itself very rare, but in the case presented here it assumes a highly unique character by the concomitant clinical picture, namely, a combination with mucocele of the frontal sinus and by the case history (rhinoliquorrhoea without trauma and without meningitis).
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By means of human temporal bone slides we want to demonstrate that interruption of the so-called longitudinal endolymphcirculation causes a hydrops ahead of the block. This fact, proven by animal experiments, we observed in human specimens. Predominant locations are the anatomic narrows of the endolymphatic system: Isthmus of the endolymphatic duct, utriculoendolymphatic valve Bast, ductus reuniens. The different possible pathohistological data are: bony obliteration of the ductus endolymphaticus, embolic closure within the isthmic portion of the endolymphatic duct, blockage of the utriculoendolymphatic valve by the distended utricle or perilymphatic connective tissue strands, angled ductus reuniens in perilymphatic fibrosis.
By means of histological studies we could show: 1. Malfunction of the auditory tube is a reason for the development of the adhesive process and the retraction pocket. 2. The retraction pocket is the precursor of cholesteatoma, because of best conditions for the epithelial ingrowth. 3. Granulation tissue within the tympanic cleft is nutritive basis for the socalled matrix and allows the growth of the cholesteatoma. 4. We may have shown, that a cholesteatoma can develop inspite of an intact membrane, first of all if the pars fibrosa is lacking. 5. The cholesteatoma pushes inwards the distended tympanic membrane of the remnants of it. Resisting structures as the enwrapped long process of incus, the malleus or the tensor tendon allow the neck formation of the cholesteatoma. So the way is shown, which leads from serotubotympanitic catarrh and otitis media adhaesiva to adhesive process and cholesteatoma. The starting point is a tubal malfunction.
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In the course of 3 years we observed a considerable improvement of herpes zoster in 44 patients being treated with amantadine. The periods of pain and efflorescence were shortened to 1/3 of the values usually experienced and painful post-zoster complications did not occur. The therapeutic effect depends on a) beginning treatment with high doses as early as possible, b) combination of local and systemic administration of adamantine, c) continuation of treatment for several weeks with gradually reducing doses. Harmless side-effects which are easily controlled are dryness of mouth, slight fall in blood pressure and insignificant general stimulation. In old people half the standard dose should be given in the beginning and particular attention paid to symptoms of restlessness on account of a possible delirium. Severe disorders of renal function are a contraindication.
By means of histological observations we have tried to find morphological data on which to classify non-suppurative and suppurative chronic otitis media. There was also evidence of pathophysiological features which may have direct influence upon the development and behaviour of chronic inflammations of the tympanic cleft, such as disorders of ventilation and reaction of the mucoperiosteal layer. Local defence mechanisms, the species and virulence of infection also play an important role. It appears that the Eustachian tube is a very effective mechanical and immunological barrier against ascending infection which may perhaps be assisted by antibiotic treatment. Certainly non-suppurative chronic otitis media is more frequent now than in pre-antibiotic days.
Chemotherapy has not only changes the clinical picture but also the pathological features of otitis media. As a consequence, reactive forms of the middle ear mucosa include purulent inflammation as well as cellular proliferation and granulation. Complications result from defective healing caused by the inability of the mucosa to organize clearance of the tympanic cleft. Because of a lack of drainage, the effusion remains in situ and alters the function of the middle ear mucosa. Subsequently, the inflammatory reaction diminishes, as can be seen on smears from tympanic effusions. Leucocytes are more or less displaced by phagocytes. We also gave special attention to morphological details in the Eustachian tube. We could demonstrate the great importance of the mucosa as a defence mechanism against infection. The so-called tubal tonsil is an important part of the local immune organ system. The salivary glands adjacent to the tube provide a secretion, which allows the ciliary activity to function. Surface active substances in the secretion influence the opening mechanism of the tube. In disease states, disturbances of this secretion may prevent ventilation of the tympanic cleft.
Since about 20% of the patients in a headache clinic have ENT complaints an ENT specialist should be consulted for diagnosis and treatment. It is very important to know what structures in the head and neck are sensitive to pain for diagnostic and differential diagnostic purposes. Primary and secondary neuritis are headache mechanisms in otolaryngology and also tension headache, which is specially discussed. Rhinogenous contact headache and headache as cardinal symptom in various syndromes are also stressed as specific to ENT. Finally a scheme is given for investigating a headache patient from the otolaryngological point of view.