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Biomedical subjects

H Rudert

Publications and source records attributed to H Rudert.

At least 73 records · Page 4Linked to original sources
PubMed1992

[Treatment of hemangioma with the neodymium:yttrium-aluminum-garnet laser (Nd:YAG laser)].

Laser therapy and in particular Nd:YAG laser therapy has become of increasing importance amongst the various methods of treating haemangiomas. Nd:YAG laser radiation penetrates deep into the tissue. To avoid undesirable results of treatment, certain treatment guidelines must be observed: to protect the tissue from serious heat damage, the Nd:YAG laser radiation should be applied exclusively with simultaneous tissue cooling. Depending on the location of the haemangioma, this is carried out with ice cubes (if possible, not containing air bubbles) or with an ice-cold Ringer solution. The depth of penetration of the laser radiation can be increased by tissue compression with a piece of ice or with a special glass disc. In very voluminous haemangiomas, the laser light is additionally applied via a bare fibre directly on to the vascular tissue. The laser power densities we use are between 500 and 3,000 watts/cm2. The power chosen depends on the tissue effect of the laser radiation. Blanching of the vascular tissue without carbonisation is aimed at. With consistent observance of the treatment guidelines specified, haemangiomas should be treated as early as possible with the Nd:YAG laser. The treatment principle of "wait and see" is often advocated, but we consider to be obsolete, since cosmetically and functionally unsatisfactory residual scars may remain even after complete haemangioma regression. Moreover, the progressive haemangiomas which often lead to complications cannot be distinguished from regressive haemangiomas. Last but not least, the child and the parents should be spared the (in some cases appreciable) psychological strain of a haemangioma.

Adolescent↗
PubMed1992

[Mucoepidermoid cancer of the larynx. Case report and review of the literature].

Mucoepidermoid carcinoma (MEC) is classified among the salivary gland tumours and is most commonly found in the parotid gland. It rarely occurs in the larynx. There have been only 87 cases of laryngeal MEC reported in the literature. We report on an MEC of the vocal cord in a 75-year-old man, with a thickened right vocal cord without any loss of movement. The initial diagnosis was squamous cell carcinoma. One year after radiotherapy a tumour recurrence developed. Because the patient refused to laryngectomise, a tumour resection with the CO2 laser was performed twice. To date, the patient has been free from disease for more than five years. The true incidence of this type of neoplasm could be higher than is believed because of its frequent misdiagnosis as squamous cell carcinoma.

Aged↗
PubMed1992

Laryngeal paraganglioma and pregnancy.

Paraganglioma is an uncommon tumor of the larynx. We present a 30-year-old woman with a paraganglioma which took a heretofore not described clinical course. The first clinical sign was persistent hoarseness, when she was 26 weeks pregnant. A histological examination of a piece of the reddish, racemose tumor removed during microlaryngoscopy revealed only some slight nonspecific inflammatory changes. The patient remained free of symptoms following this operative procedure until 3 years later when she presented with a recurrence of hoarseness and a laryngeal tumor and was 25 weeks pregnant. Histology showed a laryngeal paraganglioma in the same supraglottic localization as before. Histological studies failed to confirm the obvious suspicion that the episodic growth of the paraganglioma may have been induced by estrogen or gestagen. To date, 6 years after the removal of the tumor, there has been no recurrence.

Adult↗
PubMed1992

Organ-limited laryngeal amyloid deposits: clinical, morphological, and immunohistochemical results of five cases.

Five cases of organ-limited laryngeal amyloid deposits with no evidence of systemic disease are reported in detail and classified immunohistochemically. In four of the five cases the amyloid reacted with anti-A lambda antibodies and in one case with anti-A kappa antibodies. Four of our five female patients had already passed the fifth decade of life. One was 11 years old. Hoarseness was the predominant symptom in four cases, in which we found amyloid deposits in the glottic area. Only one patient, with amyloid deposits in the aryepiglottic fold, complained of pain. The therapy of choice of idiopathic, localized, or organ-limited amyloid deposits without underlying disease may be local excision. In one of the cases reported in this paper, a laryngofissure was performed, and in another a partial laser resection was performed. No therapy was performed in three of our five cases. In the larynx, as in many other locations and only if possible, removal at intervals is more feasible than radical resection, because these amyloid tumors grow slowly.

Amyloidosis↗
PubMed1992

[Use of the Nd:YAG laser in otorhinolaryngology].

The Nd:YAG laser is suitable for the treatment of various otorhinolaryngological clinical disorders. These include the palliative reduction of tumor size in sites with difficult access, treatment of hemangiomas and reduction of hyperplastic turbinates. Within certain limits, other indications are treatment of recurrent epistaxis and recurrent polyposis. Palliative reduction of malignancies in the nasopharynx, esophagus, and bronchial system (laser power density: 1500-8000 W/cm2) must sometimes be carried out in several sessions in order to avoid complications due to the laser (i.e., perforation of the bronchial or esophageal wall, lesions of adjacent vessels or nerves). Nd:YAG laser treatment of hemangiomas (500-3000 W/cm2) can lead to excellent results. To avoid excessive thermal lesions, vascular tissue is cooled with ice cubes or with an ice-cold Ringer's solution. The laser process is continued until the onset of tissue blanching. Carbonizations of the tissue are to be avoided. In Nd:YAG laser therapy of hyperplastic lower nasal conchae (approx. 1000 W/cm2), results are based on submucous scarring in which the covering epithelium is maintained. The objective of Nd:YAG laser treatment of recurrent epistaxis in patients with Osler's disease (500 W/cm2) is to reduce the incidence of hemorrhage. Use of the laser in recurrent polyposis is best confined to patients who refuse conventional surgical revision operations. Laser light (500-3500 W/cm2) should only be applied for a short period of time (0.5 s) to avoid creating a rarefying osteitis.

Airway Obstruction↗
PubMed1991

[Subglottic metastasis of multiple myeloma. Case report and review of the literature of laryngeal plasmacytoma].

A total of 111 cases of laryngeal plasmacytoma have now been reported. The disease may present either as a primary extramedullary plasmacytoma (n = 90) or as a metastasis of a multiple myeloma (n = 21). The distinction between these two types is very important in therapy and prognosis. We report a subglottic plasmacytoma in a 48-year-old woman. Investigations showed bone marrow infiltration, osteolysis and light chain expression in serum, indicating generalized disease. Therefore polychemotherapy was given, during which complete macroscopic and microscopic regression of the laryngeal plasmacytoma was observed. However, 14 months later, the patient died of renal failure due to systemic progression of the multiple myeloma.

Airway Obstruction↗
PubMed1990

Description and clinical importance of the lymphatics of the vocal fold.

Findings of the presence of lymphatics in the subepithelial connective tissue layer of the true vocal cord range from the statement that lymphatics are absent to the observation that a dense lymphatic network exists. This is undoubtedly a result of the different methods of examination. The entire extent of a lymphatic system can be shown by either an enzyme histochemical demonstration of the 5'-nucleotidase activity in the lymphatics, or electron microscopy, which is more elaborate. These two methods are used to describe a subepithelial lymphatic network of varying density in 80 human vocal folds, which--contrary a frequent assumption--is not interrupted in the area of the free margin of the true vocal cord. Under the squamous epithelium, the density of the lymphatic system, which is very high in the arytenoid region, decreases continuously toward the anterior portion of the true vocal cord. It is exactly in the region in which the lymphatic system is the sparsest that almost all cancers of the true vocal cord develop. This finding is highly significant, in view of the low incidence of lymphogenous metastasis formation in T1-glottic cancers.

5'-Nucleotidase↗
PubMed1989

[Equipment for CO2 laser surgery].

The laryngoscope designed by Kleinsasser is the most suitable for CO2 laser surgery of the larynx. This laryngoscope has been modified by two aspiration tubes mounted on the outside and opening only a short distance above the distal end of the endoscope. The expansion laryngoscope designed by Weerda is very suitable for the hypopharynx. We have shortened this endoscope by 5 cm for work in the oropharynx. The double-cupped forceps designed for microlaryngoscopy was modified by the addition of aspiration tubes. Several instruments have been developed to protect the soft tissues of the larynx from aberrant laser radiation. Their shaft has been fitted with aspiration canals to improve the extraction of smoke.

Equipment Design↗
PubMed1989

[The clinical picture of paranasal sinus diseases and demands made by the ear, nose and throat physician on the radiologist].

We know today that chronic and recurrent sinusitis is caused by obstruction of the infundibulum in the anterior ethmoid bone. The primary goal of modern microscopic and endoscopic surgery for paranasal sinusitis by infundibulotomy is the restoration of ventilation and drainage of the sinuses. Meticulous radiographic delineation of the small structures of the hiatus semilunaris by computed tomography coupled with endoscopic evaluation is the most important diagnostic method. In the majority of cases the coronal plane is preferred. The axial plane is mandatory only for evaluation of the frontal sinuses.

Adult↗
PubMed1989

[Squamous epithelial carcinoma and undifferentiated carcinoma of the inner nose and paranasal sinuses].

272 patients with tumours of the nasal cavity and paranasal sinuses were followed up from 1949 until 1982 at the ENT Department of the University Hospital in Kiel. 53% of the tumours were classified as squamous cell or undifferentiated carcinomata. At an early stage such tumours cause nonspecific symptoms which may mimic those of chronic sinusitis. Early diagnosis is usually hindered by the occult growth within the facial skeleton and especially by the minor symptoms caused by tumours of the paranasal sinuses. In contrast, tumours of the nasal cavity cause symptoms at an early stage and consequently are diagnosed early. The majority of cases with tumours of the paranasal sinuses present at an advanced stage (T3 to T4) in 70% of cases. The most common site of squamous cell carcinoma is the maxillary sinus (50%). Distant metastases and regional lymph node metastases are rarely seen at presentation regardless of the size of the primary tumour. Metastases usually indicate a tumour dependent death in the near future. The main prognostic indicators are the size of the tumour (significantly worse prognosis for T4 in comparison to T2 or T3 tumours) and the localisation (significantly better prognosis for tumours of the floor of the nasal cavity or the nasal septum compared to tumours of the paranasal sinuses). The age of the patient or the degree of differentiation of the tumour did not influence on the survival rate. Tumour-dependent deaths rarely occur after more than five years. Patients were assigned to two treatment groups and matched according to the tumour stage. One group received surgery only, whereas the second group received a combined treatment of surgery with subsequent radiotherapy. There was a significant difference between the two groups in favour of the surgical treatment. According to these data we recommend surgical excision without postoperative irradiation in cases where complete removal of the tumor has been histologically proven.

Age Factors↗
PubMed1988

[Distribution of lymph vessels in the plica vocalis of the human. A light microscopy, enzyme histochemistry and electron microscopy study].

Results of studies on the presence of lymphatic capillaries in the plica vocalis are shown, using improved methods of preparation. Immediately after laryngectomy, followed by immediate fixation of the non-pathological plicae vocalis, large lymphatic capillaries can be easily identified in the specimen. Lymphatic capillaries, which cannot be seen in conventional light microscopy, are now histochemically demonstrated with a marker of 5' nucleotidase. These histochemical results are confirmed by electron microscopy. Using a combination of both methods, a different quantity of subepithelial lymphatic capillaries can be visualised over the whole length and width of the plica vocalis. Lymphatic capillaries below the stratified squamous epithelium in the region of the anterior commissure grow gradually more numerous up to the folds of the arytenoid cartilage. Hence, in contrast to previous studies, the superficial lymphatic capillary system of the laryngeal mucosae is not separated into a supraglottic and subglottic lymphatic net of the vocal cord.

5'-Nucleotidase↗
PubMed1988

[Microscope and endoscope-assisted surgery of inflammatory diseases of the paranasal sinuses. Value of the Messerklinger infundibulotomy].

Insights into the importance of the infundibulum of the anterior ethmoid bone in the etiology and pathogenesis of chronic paranasal sinusitis, based above all on the studies of Messerklinger, have resulted in a fundamental change in our concept of therapy: the main objective of any treatment must be the restoration of ventilation and drainage of the paranasal sinuses in the region of the semilunar hiatus. Its function in the healing of paranasal sinus diseases parallels the significance of the Eustachian tube for the healing of inflammatory lesions of the middle ear. In many cases, the objective is attained by infundibulotomy, using Messerklinger's technique. Our technique differs from that described by Messerklinger and Wigand: we use the surgical microscope and a self-retaining nasal speculum. It is thus possible to operate with both hands, as in microsurgery of the ear and the larynx. Moreover, the operations can be taught and learned via an observation tube. Since the introduction of this technique which can be extended at any time to complete endonasal surgery of the maxillary, ethmoid and sphenoid sinuses, extranasal operations on the paranasal sinuses have become exceedingly rare. The results have been checked in a newly established paranasal sinus clinic.

Endoscopes↗
PubMed1988

[Morphologic changes in the epithelium of myocutaneous pectoralis major islands flaps. A light and electron optic study].

On a long-term basis, the epithelium of pectoralis major flaps incorporated in the mouth and the oropharynx is macroscopically and microscopically very similar to the sourrounding mucosa. Light microscope and electro microscopic investigations show that the type of keratinization of the epithelium of this flap has changed from orthokeratosis to parakeratosis which is typical for the mucosa of the mouth. The possible reasons for these changes, which, to our knowledge, have not been described before, are discussed.

Biopsy↗
PubMed1988

[Laser surgery in ENT surgery].

From a number of medically useful lasers, mainly the neodymium YAG and the carbon dioxide laser are employed in otorhinolaryngology. Until now, the neodymium YAG laser has been used only for coagulation of vessels in Osler's disease and for palliative treatment of malignant tracheo-oesophageal disease. However, the deep coagulation necrosis of the adjacent tissues severely restricts its use. The most widely utilised laser in ENT surgery is the carbon dioxide laser. Its main effect of precise cutting with an extremely fine zone of coagulation reduces bleeding after incision considerably. Secondary tissue reactions, delayed healing, decreased fibroblast activity and maybe more prominent subepithelial scarring, limit its use especially in the glottic region. Therefore, minor vocal cord alterations such as vocal nodules, cysts or polyps suitable for excision with scissors, should not be removed by laser. Optional indications are Reinke's oedema, intubation granulomas and contact pachydermas. Clear advantages of laser use are seen in the treatment of juvenile papillomas of the vocal fold and of smaller vocal cord carcinomas or recurrences after irradiation therapy of these. The carbon dioxide laser is superior to all other indications in the removal of large and obstructing laryngeal carcinomas to prevent tracheostomy. Very reliable is its use in the ablation of lingual tonsillar tissue to improve or eliminate symptoms in recurrent lingual tonsillitis. Transoral resection of small malignant lesions in the oral and pharyngeal cavity may be performed in analogy to electric cautery. The advantages of the laser compared to electrical surgery are a smaller postoperative oedema and less pain, as well as good spontaneous epithelialisation of defects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Sudden deafness caused by rupture of the round window membrane. Surgical indications, course and prognosis].

Tympanotomy was performed on 39 of 247 patients with sudden hearing loss between 1980 and 1982. In 23 cases a round window membrane defect was found. Evaluation of the indications, intraoperative findings and postoperative course allows the following conclusions to be drawn. Only in patients treated in the second week was the rate of success significantly higher than the spontaneous remission rate in patients without perilymphatic fistula. If there is no improvement in the hearing level in the first week after covering a round window membrane defect the prognosis is poor. Stabilization of the hearing is complete in the first three weeks after treatment. Prognosis in extensive membrane defects with large perilymphatic fistulas is definitely worse than in small round window membrane defects. The best results were achieved for the following groups: physical exertion/barotrauma, sudden deafness, progressive hearing loss despite drug therapy.

Aprotinin↗