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Biomedical subjects

H Rudert

Publications and source records attributed to H Rudert.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Cochlear implant for non-deaf patients?].

BACKGROUND: Cochlear implants have proven to be the method of choice for postlingually deafened adults. The great success of this application requires discussion of the degree in which the indication for cochlear implantation should be expanded to include patients with residual hearing. METHOD AND PATIENTS: Following an initial discussion of the term deafness, we present the preoperative and postoperative results in five patients with residual hearing. These patients achieve a certain degree of speech recognition with their well fitted hearing aids. However, their aided speech intelligibility did not exceed 30% with the standardized Freiburg monosyllabic word test at 70 dB. In each case the worse hearing ear was treated with a cochlear implant. Speech discrimination in silence and noise are compared with the results of a group of postlingually deafened cochlear implant patients. RESULTS: The five patients are very satisfied with the cochlear implant and use the telephone to communicate with unknown partners. They score 100% in the standardized four-syllable number test above 55 dB and they document a loss of speech discrimination between 0 and 25% within the open-set monosyllabic word test. The mean increase of best monosyllable intelligibility by the cochlear implant over the hearing aids is 65%. Using the innsbruck sentence test the patients score 100% at 70 dB; with the Göttingen sentence test, the mean result is 75%. Their mean results in noise are also very good, 76% at 10 dBS/N and 57% at 5 dBS/N respectively. None of these patients use the hearing aid on the untreated, better hearing ear. CONCLUSION: A multichannel cochlear implant lead to a significant improvement of speech comprehension in these patients with residual hearing. We can successfully implant patients with minimal benefit of their well fitted hearing aids. Our group is too small to be able to define general selection criteria. For the time being we use as an audiological indication a open-set monosyllabic word intelligibility of not more than 30% at 70 dB with well fitted hearing aids.

Adolescent↗
PubMed1998

[Modified posterior Dennis and Kashima cordectomy in treatment of bilateral recurrent nerve paralysis].

BACKGROUND: A number of different surgical methods are described in the literature to enlarge the glottic gap in patients with bilateral recurrent nerve paralysis with an excessively small glottic gap. The latest method is the posterior chordectomy described by Dennis and Kashima. PATIENTS AND METHODS: Twenty-three patients with bilateral recurrent nerve paralysis were treated between 1993 and 1997. In the first 5 patients, a muscular triangle as described by Dennis and Kashima from the posterior part of the muscular portion of the vocal fold was resected. Later on, the surgical procedure was extended by additional resection of muscular tissue from the anterior two-thirds of the vocal fold. Preoperative and postoperative data were carefully assessed in a prospective setting. Subjective data such as limitation of physical exertion and ability to communicate were documented. There was objective documentation by spirometry and phoniatric-logopedic assessment of voice quality parameters. Generally, it takes a number of months until the final permanent state is reached. The minimum follow-up was therefore at least 6 months with a mean of 16 months. RESULTS: The follow-up of the 23 patients showed that the surgical technique as originally described by Dennis and Kashima does not always improve breathing sufficiently in the long run. A repeat chordectomy was required in three out of five patients with this technique. The modified technique with additional muscle resection of the anterior two-thirds of the vocal fold resulted in the desired long-term enlargement of the glottic gap in 16 out of 18 patients. Spirometric controls showed a significant improvement of respiration. However, some voice quality parameters showed a significant reduction as expected. Despite this, the overall communication ability was described as only slightly reduced by the patients themselves. CONCLUSIONS: By the modified posterior laser chordectomy, the glottic gap is widened on a long term, though less than after an arytenoidectomy. The compromise between reduction of voice quality and dyspnoea is better than after arytenoidectomy. The preservation of the laryngeal sphincter is important in that it prevents the latent aspirations that are occasionally observed and achieves a certain adduction of the vocal folds with phonation. The surgical procedure is technically simple, may be repeated, and never needs a tracheostomy.

Adult↗
PubMed1998

Ultrasound-guided interstitial Nd: YAG laser treatment of voluminous hemangiomas and vascular malformations in 92 patients.

In many cases voluminous vascular anomalies of the head and neck region are still treated with conventional surgery, although neodymium:yttrium-aluminum-garnet (Nd:YAG) laser therapy offers a valuable treatment alternative. Ninety-two patients with voluminous hemangiomas and vascular malformations were treated with interstitial Nd:YAG laser therapy (power density, 1300 to 3300 W/cm2), partly complemented by a noncontact-mode Nd:YAG laser light application (energy density, 1000 to 2500 J/cm2). The vascular tumors had a diameter of more than 3 cm in at least two dimensions. Treatment was carried out under ultrasound and manual control. Nearly 60% of the patients (n = 55) showed a complete clinical regression. Thirty-three patients (35.8%) had a partial regression and were satisfied with the treatment outcome. Four patients were treated unsuccessfully with the laser, and three of them subsequently underwent conventional surgery. Only nine of the 92 patients (9.8%) showed cosmetic or functional impairments. The results of this first consecutive series study with a retrospective clinical evaluation of the interstitial Nd:YAG laser therapy of voluminous hemangiomas and vascular malformations in a large patient group demonstrate a high effectiveness of this novel therapy modality.

Adolescent↗
PubMed1997

[Treatment of recurrent epistaxis in Rendu-Osler-Weber disease].

Rendu-Osler-Weber disease is an autosomally dominant inherited disease which affects the connective tissue of blood vessels. The major symptom is recurrent epistaxis for which still exists no generally recommended treatment. Treatment modalities discussed in the literature include bilateral closure of the nostrils, brachytherapy, vessel embolization, hormone therapy, dermoplasties, as well as different kinds of laser therapies. Advantages and disadvantages of single treatment modalities are discussed. Dermoplasty and laser therapy seem to be the most suitable treatment procedures currently available for recurrent epistaxis in affected patients. Treatment carried out with the argon, KTP or ND:YAG laser has proven to be suitable as initial therapy. In most cases the additional use of long-term applications of a soft nasal ointment allows a lasting successful treatment. Our experiences show that dermoplasty should be reserved for cases with continued bleeding despite laser treatment but only rarely offers a long-term cure in the sense of a total recovery from epistaxis.

Aged↗
PubMed1997

p53 serum antibodies as prognostic indicator in head and neck cancer.

p53 antibodies are a new serological parameter of unknown potential in patients with malignancies. Their occurrence has been described in various types of cancer patients. The mechanism underlying the immunization process is still unclear. We investigated the incidence of p53 serum antibodies in 143 head and neck cancer patients with an enzyme-linked immunosorbent assay. The posttherapy course of two matched study groups (n = 38 each), one p53-antibody-seropositive and one p53-antibody-seronegative, was followed up for 24 months. Thirty-nine head and neck cancer patients (27.3%) were seropositive for p53 antibodies. During the follow-up, the p53-antibody-seropositive patients accounted for more local tumor recurrences (n = 12 versus n = 8) and more tumor-related deaths (n = 11 versus n = 5) than did seronegative patients, and second primary tumors (n = 9 versus n = 0) occurred exclusively in seropositive patients. In total, therapy failures (recurrences, tumor-related deaths, second primaries) were observed in 17/38 cases (44.7%) in the p53-antibody-seropositive group and in 8/38 cases (21.1%) in the p53-antibody-seronegative group. These results, after a follow-up of 2 years, seem to indicate a prognostic value of p53 serum antibodies for therapy failure in patients with head and neck cancer.

Adult↗
PubMed1997

Cemento-ossifying fibroma of the petromastoid region: case report and review of the literature.

The cemento-ossifying fibroma (COF) is a mesodermal, non-odontogenic tumour of ectopic multipotential periodontal membrane blast cells. It is aggressive, locally destructive, and has a high recurrence rate. A case report of COF of the petromastoid region is presented. This location has not been described until now. Trauma may act as a trigger to sudden growth of the atopic periodontal tissue. Due to the aggressive behaviour of this tumour and its frequent recurrence radical surgery is needed.

Adult↗
PubMed1997

[Endonasal coagulation of the sphenopalatine artery in severe posterior epistaxis].

BACKGROUND: Until a few years ago the surgical method of choice in treating uncontrollable nosebleeds from the posterior part of the nose was the transantral ligation of the maxillary artery as described by Seiffert (Caldwell-Luc approach). We introduce a surgical method to expose and coagulate the sphenopalatine artery through an endonasal approach. METHOD: The middle meatus of the nose is exposed with a self supporting nasal speculum under the microscope (focus: 300 mm) and the maxillary sinus is opened through the posterior fontanelle. The medial wall of the maxillary sinus is removed from this opening to its end. Three to five millimeters posterior to this site, the foramen sphenopalatinum is exposed. The osseous lateral margin of the foramen is resected with the drill and the fossa pterygopalatina is thereby opened from the nose. The sphenopalatine artery can be exposed all the way to its origin from the maxillary artery and then coagulated. RESULTS: Thirty-one patients with severe epistaxis have been operated by this method since October 1993. No postoperative complications were observed in any cases. Thirty patients have had no further nosebleed since than (average follow-up 22.9 months). In one case of a patient with renal insufficiency a nose bleed occurred 15 day postoperatively following dialysis. It was controlled by ligation of the anterior ethmoid artery and of the peripheral branches of the external carotid artery. CONCLUSION: The endonasal coagulation of the sphenopalatine artery is the safest method to control bleeding from the posterior parts of the nose. It can be performed by anyone who is familiar with endonasal surgery. The disadvantages of the transanteral ligation of the maxillary artery as described by Seiffert (Caldwell-Luc approach, ligation not sufficiently peripheral) are avoided. The only competing method would be the embolization of the sphenopalatine artery which can not be applied in every hospital and which has a higher complication and failure rate. Since October 1993 when this method was introduced no additional bellocq tamponade was required in epistaxis.

Adult↗
PubMed1997

[Complications of endonasal surgery of the paranasal sinuses. Incidence and strategies for prevention].

BACKGROUND: Complications of endonasal surgery continue to occur despite improved optical instruments and surgical techniques. The clinical course of our patients was analysed to develop strategies for a safer surgical technique. PATIENTS: At the Department of Otorhinolaryngology, Head and Neck Surgery, University of Kiel, 1172 patients (2010 operated sides) were treated between 1986 and 1990 for chronic sinusitis by endonasal paranasal sinus surgery. RESULTS: The following intraoperative complications were observed: dural injury in 0.8% of the patients (0.5% of the operated sides), retrobulbar hematomas in 0.25% of the patients (0.15% of the operated sides), and hemorrhages requiring transfusion in 0.8% of the patients (0.5% of the operated sides). No injuries of the orbital muscles, the optic nerve, or the carotid artery were observed. Endonasal dacryocystorhinostomy was performed in 195 patients, 15% of whom had previously had paranasal sinus surgery. Endonasal frontal sinus surgery type II or III was performed in 40 patients between 1953 and 1993. A past surgical history-mostly extranasal frontal sinus surgery according to Ritter-Jansen and Lathrop-was found in 80% of these patients. Of 12 mucoceles of the frontal sinuses, 10 had developed after extranasal procedures whereas two developed spontaneously. CONCLUSION: This analysis shows that the occurrence of severe intraoperative complications can be minimized if certain guidelines are followed. When operating in an anterior-posterior direction, one should, to the extent possible, preserve the ethmoid bulla and the middle turbinate as anatomical landmarks as long as possible. The ethmoid bulla indicates the upper margin of the infundibulum even after removal of the uncinate process. There is no danger of injuring orbital structures if one identifies the maxillary ostium on a line going parallel to the floor of the main nasal cavity from the lowest point of the bulla in a posterior direction. The anterior wall of the bulla also forms the posterior wall of the frontal recess. As long as it is preserved it protects the base of the skull when identifying the frontal ostium. The endonasal enlargement of the frontal sinus ostium as a frontal sinus drainge type II or III is safe if the spina nasalis frontalis and the base of the frontal sinus are removed with a drill in an anterior direction. When opening the ethmoid sinus in an anteroposterior direction, an additional imaginary line through the ethmoid bulla running parallel to the floor of the nasal cavity and therefore also to the base of the skull should be observed and not crossed cranially. The medial blade of the middle turbinate represents an important guide to protect the rima olfactoria. It must therefore be preserved. Exposure of the sphenoid sinus should always be performed transnasally near to the septum and below the sphenoid ostium but never through the ethmoid to prevent damage of the optic nerve or the carotid artery. Observation of these guidelines and anatomical structures will prevent mistakes and wrong approaches in the context of endonasal surgery.

Chronic Disease↗
PubMed1997

[Nd:YAG laser therapy of recurrent epistaxis in hereditary hemorrhagic telangiectasia].

BACKGROUND: Epistaxis is the leading symptom of hereditary hemorrhagic teleangiectasia (HHT). Over the last years several laser systems have been used for therapy. Only a few studies have published results of Nd:YAG laser therapy evaluating a larger number of patients. PATIENTS AND METHODS: From 1987 through 1996, forty-one patients with HHT were treated with a Nd:YAG laser due to recurrent epistaxis at the Department of Otorhinolaryngology of Kiel University. Thirty-two patients were followed-up over a period of at least 24 months. A centripetal technique was used for endonasal laser light application (15-25 Watts; 0.1-0.5 s), i.e., the laser light was applied from the periphery towards the center of the angiodysplasia. Intensive preoperative and postoperative nasal care with ointments was performed. RESULTS: Bleeding frequency and intensity decreased in 30 (94%) patients. Duration of the therapeutical success differed individually and varied from seven weeks to 14 months. Repeated laser therapy was necessary in 27 of 32 patients. CONCLUSION: The Nd:YAG laser is a suitable tool in the treatment of epistaxis in HHT. This procedure is less traumatic, less painful, and can be repeated multiple times. Nd:YAG laser therapy and other therapeutic options cannot obtain a lasting cure of Rendu-Osler-Weber syndrome. However, in the vast majority of cases recurrent nasal bleeding as the dominant symptom can be reduced in frequency as well as in intensity.

Adult↗
PubMed1997

Expression of a novel mRNA in human head and neck squamous cell carcinoma cells.

AIMS: The differential display reverse transcription polymerase chain reaction (DDRT-PCR) technique was used to search for differences between the mRNA expression profiles of squamous cell carcinoma (SCC) cell lines established from head and neck tumours and normal keratinocytes from the mucosa of the upper aerodigestive tract. METHODS: Total RNA prepared from both cell types was reverse transcribed into cDNA then amplified in a PCR mixture. To compare the electrophoretic patterns, mRNAs were amplified by nested PCR using specific oligonucleotides. Additionally, using labelled cDNA probes, northern hybridisation was carried out on three cancer cell lines of different origin, a biopsy from a parotid gland pleomorphic adenoma, healthy mucosa, and keratinocytes. RESULTS: Comparison of the separated bands revealed a fragment with a differential expression pattern in the SCC cells. This cloned sequence of a 336 base pair mRNA fragment exhibited no significant homology with known transcripts. Additionally, after amplification and sequencing of the 3' end of the fragment no homology with a known human gene sequence was found. However, low homology with a genomic sequence of a nematode was found. Northern hybridisation confirmed the selective expression of this fragment in SCC cells versus the cancer cell lines of different origin, the biopsy of the pleomorphic adenoma, keratinocytes, and healthy mucosa. CONCLUSIONS: This is the first differentially expressed human genome transcript of squamous cell carcinoma of the head and neck identified by DDRT-PCR. It may prove useful, in the future, to characterise this tumour type.

Base Sequence↗
PubMed1997

Indication, incidence and management of blood transfusion during sinus surgery: a review over 12 years.

The number of reports about blood transfusion-related HIV and hepatitis virus infections is increasing, presently. Thus, it should seriously be considered to inform the patient of any anticipated blood loss necessitating a transfusion of blood products. This is especially necessary for surgical procedures with only a low risk for high blood loss, such as endonasal surgery as a common otorhinolaryngological procedure. However, reports about the incidence of blood transfusion during this kind of surgery are very rare. The medical histories of 6,296 patients who underwent sinus surgery between 1982-1993 in the Department of Otorhinolaryngology at the University of Kiel were analyzed. Twenty-nine of these patients received a transfusion. Risk factors for required blood, the necessity of pre-operative information and the recommendation policy for pre-operative donation of autologous blood are discussed. The intra-operative blood losses of 120 patients who did not require a transfusion and who underwent sinus surgery in 1986 and 1989, were analyzed. The transfusion rate was 0.46% on average during the 12-year period. The incidence of blood transfusion and the amount of intra-operative blood loss decreased after combination of endonasal surgery with controlled intra-operative hypotension (0.07%; p < 0.01). Risk factors for the necessity of a transfusion in these cases were extensive polyposis and purulent exacerbation of the disease. There are risks for a blood transfusion in endonasal surgery. Every transfusion carries a certain risk for the infection with HIV or hepatitis, therefore every patient should be informed about the possibility of a blood transfusion prior to the operation. Endonasal microscopic sinus surgery performed by well-trained surgeons, combined with controlled intra-operative hypotension lowered the risk for a transfusion significantly (p < 0.01).

Adolescent↗
PubMed1997

Alpha 1-receptors at pre-capillary resistance vessels of the human nasal mucosa.

The aim of the present study was to further characterise the alpha-adrenoceptors in pre-capillary arteries of the human nasal mucosa. Mucosa was obtained from patients undergoing endonasal surgery. From the isolated conchae small arteries (diameter: 90-220 microns) were dissected, avoiding any direct traumatisation. The arteries were mounted to a Mulvany-Halpern wire myograph allowing isometric registration of the vessel constriction. Receptor subtypes were characterised using the agonists noradrenaline, phenylephrine and oxymetazoline, and the antagonists prazosine and yohimbine. The EC50 values of the three agonists were in the micromolar range, whereas the Emax values differed. When maximal responses to the agonists were expressed as a percentage of a potassium-induced constriction, values for noradrenaline, phenylephrine and oxymetazoline amounted to 110%, 78% and 21%, respectively. The agonist effects were almost completely blocked by the alpha 1-receptor antagonist prazosine, whereas yohimbine, the alpha 2-receptor antagonist, did not affect the agonist responses. From these results it is concluded that the adrenoceptors in pre-capillary arteries of the mucosa in human central concha are of the alpha-type. Since the decongestive effect of alpha 2-receptor agonists is beyond any doubt, this subtype of the adrenoceptor must be present on the venous capacitance vessels.

Adrenergic alpha-1 Receptor Antagonists↗
PubMed1996

Response to trimethoprim/sulfamethoxazole in Wegener's granulomatosis depends on the phase of disease.

We prospectively studied trimethoprim/sulfamethoxazole (T/S) in inducing remission in 'initial phase' Wegener's granulomatosis (WG), and in sustaining remission in generalized WG, in 72 patients in various disease stages. Nineteen patients with initial phase WG received T/S (2 x 960 mg/day). Another 24 patients with generalized WG received the same dose of T/S (group A) and were compared with 21 patients receiving no further treatment after standard therapy (group B). Eight patients were given T/S plus low-dose prednisone (group C). Eleven of 19 patients (58%) with initial phase WG achieved complete or partial remission lasting a median 43 months (range 6-88 months). Of the remaining eight (42%), five showed local disease progression, and three developed generalized WG. In group A (T/S alone, generalized WG), 10/24 (42%) suffered a relapse after a median 13 months (range 4-58 months). In group B (generalized WG, no further treatment) 29% of patients relapsed after a median 22.5 months (range 18-26 months). All eight patients treated with T/S plus low-dose prednisone (group C) suffered serious relapse after 2-24 months. T/S induced long-term remission in > 50% of patients with initial phase WG; however, neither T/S alone nor T/S plus low-dose prednisone sustained remission in generalized WG.

Adult↗
PubMed1995

DNA amplification for the in vitro detection of Candida albicans in head and neck squamous cell carcinomas.

DNA was extracted from whole cells of Candida albicans and digested with HindIII restriction enzyme. After electrophoresis in a segment of the lane containing between 800 and 1200 base pairs (bp) of DNA fragments, a 1.1-kilobase (kb) fragment was found that hybridizes to biopsied tumor cells from head and neck squamous cell carcinomas (SCC). From the nucleotide sequence of the putative gene locus, primers were synthesized for use in a polymerase chain reaction (PCR) with DNA extracted from 18 SCC of the upper aerodigestive tract. After 30 cycles of amplification all tumors were found to contain sufficient amplified DNA to be detected in polyacrylamide or agarose gels. In contrast, template DNA from lymph nodes and malignant lymphomas failed to generate positive signals under these conditions. However, samples of DNA obtained from head and neck SCC cells in vitro, Candida glabrata, and Candida parapsilosis after PCR were found to contain homologous sequences. Application of this technique to head and neck SCC biopsies may help to identify quickly the presence of concurrent candidal species.

Base Composition↗
PubMed1995

Morphological studies on the pathogenesis of Reinke's edema.

Light microscopy of vocal cord mucosa in patients with Reinke's edema revealed highly ramified fissured spaces in the subepithelial tissue that were generally lined with flat cells. The ultrastructure of the parietal cells resembled fibroblasts whose cytoplasmic extensions overlapped in two to three layers in some places. Cell contacts were not observed. Neither electron microscopy nor immunohistochemical testing with antibody against laminin demonstrated a basal membrane. It was possible to distinguish between light and dark cells in the specimens examined. The cytoplasm of the light cells contained intermediate filaments, mitochondria, lysosomes, coated vesicles, caveolae and broad cisternae of rough endoplasmic reticulum. The dark cells were more numerous and typically exhibited a well-developed endoplasmic reticulum and free ribosomes. The parietal cells showed no immunoreaction against human vascular endothelial cells. Immunohistochemical demonstration of mesenchymal intermediate filaments using antibody against vimentin yielded a positive reaction for some of the cells in the walls of the crevices and subepithelial tissue. It was also possible to demonstrate a few cells with monoclonal antibody against macrophages (KiM6). These findings contradict the concept of lymphatic distension in cases of Reinke's edema. Since the parietal cells seen resembled synoviocytes in their structure and immunohistochemical reactions, findings indicate that the hollow spaces of Reinke's edema develop like neobursae from mechanical strain.

Adult↗
PubMed1995

[Partial endoscopic resection with the CO2 laser in laryngeal carcinomas. II. Results].

This study presents the results of CO2 laser surgery in the curative treatment of 114 carcinomas of the vocal cord (Tis:8, T1a:88, T1b:10, T2:8) and 30 supraglottic carcinomas (T1:4, T2:11, T3:8, T4:7). In 21 patients with supraglottic carcinomas, additional radiotherapy was applied. Eleven patients underwent neck dissection. For the group of vocal cord carcinomas, 104 of 114 patients were free of recurrences after laser surgery. The ten recurrences were treated by irradiation (n = 3), repeated laser surgery (n = 3), and salvage laryngectomy (n = 3). One patient refused further treatment and died tumor related. 113 of 114 patients with glottic are without evidence of disease. For the group of patients with supraglottic carcinomas, six patients died without evidence of local disease. Two patients died of secondary malignancy without evidence of local recurrence. Four patients died of their tumor. Today, eighteen patients are without evidence of local or metastatic disease. In fourteen of these patients, the follow-up is longer than two years. Our data indicate that the oncological outcome after laser surgery is comparable to conventional open partial resection, whereas the functional outcome especially in supraglottic carcinomas is superior following laser surgery. In comparison to radiotherapy, the oncological outcome after laser surgery is better and functional results are only slightly inferior. Laser surgery should therefore take its place as an established treatment of supraglottic and glottic carcinomas.

Aged↗
PubMed1995

[Emergency therapy of traumatic orbital hematoma with acute visual impairment].

Midfacial injuries, surgery of the orbit or the paranasal sinuses as well as retrobulbar anesthesia can be the cause of a traumatic laceration of the ophthalmic artery and/or its branches prompting an extensive orbital hemorrhage with consecutive blindness. Since the neurosensory retina does not tolerate an ischemia of more than 1-3 hours, therapy has to be emergent: an extensive lateral horizontal canthotomy and vertical cantholysis, and if the hypertony of the globe persists, splitting of the periorbita in the temporal lower lid region are mandatory. The surgical details are presented.

Emergencies↗