[No conclusion can be drawn].
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Biomedical subjects
Publications and source records attributed to H Schiratzki.
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In order to study the effect of a purulent infection in the sinus cavity on the uptake of radionuclide in the surrounding bone, two series of experiments were performed; one using 45Ca-chloride (T1/2 = 153 d), that was given intravenously in a dose of 50 MBq to the previously infected animal, and in the other 99Tcm-DP was used in a dose of 530-1600 MBq. The animals were killed 4-6 hours later and analyzed using an autoradiographic technique and histological examination. Chronic unilateral infection of the maxillary sinus was induced experimentally according to the technique described by Kumlien and Schiratzki (1985). An acute unilateral maxillary sinusitis was induced experimentally according to Johansson et al. (1988). An increased uptake of 99Tcm-DP in the bone surrounding the sinus cavity with an infected mucosa could be seen. This uptake could be seen four days after induction of an acute, purulent, pneumococcal sinusitis, and five months after the induction of an purulent, chronic sinusitis. No increase in uptake could be seen in the mucosa of the sinus with purulent infection. The beta-emitting nuclide gave better resolution in autoradiography than did the gamma-emitting nuclide, and would give better possibilities in identifying structures; however, the specificity to bone of 45Ca was not high enough to be suitable.
If the posterior part of the upper esophageal sphincter (UES) were to lag behind due to the presence of dense tissue strands between the sphincter and the prevertebral ligament, as suggested in the literature, it would be impossible to use the larynx as a radiographic indicator of the location of the UES at intraluminal pressure measurements. The goal of this investigation was to study UES behavior during induced movements in autopsy specimens and to search for dense fibrous strands between the UES and the prevertebral fascia. Histologic studies of frozen sections and paraffin sections showed a loose fatty tissue in the prevertebral space. There were no dense connective tissue strands. Autopsy specimens were used in experiments mimicking the laryngeal/UES elevation during swallowing. The results of this study indicate that the larynx and the UES move as one entity. When one is attempting to register the UES movement during swallowing, the laryngeal skeleton can therefore serve as a radiographic indicator of the UES movements.
By means of simultaneous cineradiographic and manometric examinations using closely positioned microtransducers the maximal pressure of the upper oesophageal sphincter was found at a level 20 mm below the plane of the vocal folds and 6 mm above the level of the cricoid arch. The sum of these 2 distances is in accordance with the distance between the vocal fold level and the lower border of the cricoid arch given in the literature. This implies that the high pressure zone of the upper oesophageal sphincter corresponds to the pars fundiformis of the cricopharyngeus muscle. The lower part of the inferior pharyngeal constrictor and the upper circular muscle fibres of the oesophagus contribute to the sphincter. When the bolus approached the sphincter, the pressure decreased and during bolus passage the pressure was below or well below half of the resting pressure. The pressure profile disclosed no signs of muscular dyscoordination or discontinuity of the upper oesophageal sphincter.
Over the last twelve years 44 patients suffering from spasmodic dysphonia have been seen at Huddinge hospital. There were 34 women and 10 men. 22 of these patients were for various reasons not regarded as candidates for surgery. The opposite applied to the remaining 22 patients. The outcome of a temporary nerve block guided us (the surgeons and the patients) whether to operate or not. 12 patients were thus operated upon by means of resection of the right recurrent laryngeal nerve. The immediate post-operative result was excellent in 11 of 12 patients but the voice deteriorated in 4 patients. They had revision surgery with a successful result in 3 of them. Also the other 7 patients deteriorated to some extent but not to the degree that revision surgery was necessary. It is our hypothesis that recurrencies are caused by reinnervation of the sectioned nerve.
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The view held over the last six decades that coniotomy often leads to subglottic stenosis has recently been called into question. In this study 203 electively performed coniotomies were analysed. The operation was found to be much simpler than tracheostomy. No severe intra- or postoperative complications occurred. Six months after decannulation 61 patients operated on were alive and accessible to follow-up examination. No evidence of subglottic stenosis was found. The main disadvantage was a relatively high frequency of voice disorder.
Seventy-eight preschool children considered to be suffering from long-standing secretory otitis media on the basis of a combination of impaired or abolished mobility of the tympanic membrane and conductive deafness, were examined consecutively. All children underwent bilateral paracentesis. Those children whose ears contained mucous secretion subsequently constituted a prospective longitudinal study group. On the same occasion as the paracentesis was performed, 24 children with bilateral or unilateral mucous secretion in their ears underwent adenoidectomy. Thirty-five non-adenoidectomized children with mucous secretion in one or both ears served as controls. Both groups were followed up for 24 months. At the end of this period they were compared with respect to the state and mobility of the eardrum, a pure tone average audiogram and middle ear impedance. No difference was detected between the two groups. It is therefore concluded that the preventive and therapeutic effects of adenoidectomy on secretory otitis media are doubtful.
Sixteen patients with paralytic dysphonia were treated with Teflon injection in the paralyzed vocal fold. Trained voice pathologists rated the pre- and postinjection voices on a 5-point scale for each 11 voice characteristics. Among these, aphonia, breathiness, and hypofunction diminished significantly after injection. The perceptual evaluation was correlated with acoustic data from long-time-average spectrum analysis, fundamental frequency distribution analysis, and waveform perturbation analysis. In this acoustic assessment, systematic changes were found in the long-time-average spectra, which agreed well with the perceptual data. In 12 of 16 patients the voice was both perceptually and acoustically improved after Teflon injection.
The view held for the last 60 years that coniotomy often leads to subglottic stenosis has recently been called into question. In the present study 103 elective coniotomies are analysed. The operation was much easier than tracheotomy, and there were no severe complications during or after operation. Six months after decannulation 31 patients were alive and 28 available for follow-up examination. No evidence of subglottic stenosis was found. The main disadvantage of this operation would seem to be a tendency for the development of voice changes.
The penicillin concentration in the nasopharyngeal secretion after penicillin administration was studied in 33 patients undergoing tonsillectomy. Benzylpenicillin was either administrated by the intravenous or the intramuscular route in doses of 0.6-1.2 g. Phenoxymethylpenicillin was given perorally in doses of 0.5-1.0 g. The secretion from the nasopharynx was collected prior to the operation both in a disposable collector and on a filter paper disc. A serum sample was also drawn prior to and immediately after the operation. The serum penicillin concentration reached levels of 16.0 mg/l, 5.8 mg/l and 3.6 mg/l (mean values) when given by the intravenous, the intramuscular and the peroral route, respectively. The mean penicillin concentration in nasopharyngeal secretion was 1.6 mg/l, 0.3 mg/l and 0.3 mg/l for these three administration modes. In the majority of cases the concentration of penicillin in the nasopharyngeal secretion exceeded the minimum inhibitory concentration for Streptococcus pneumoniae (0.006-0.12 mg/l).
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Rhinomanometry is an objective method for determining nasal patency; its reliability and relevance as an aid in defining and solving problems connected with nasal obstruction have, however, received scant attention. In the present study more than 200 subjects were submitted to rhinomanometry--most of them only by the posterior technique. In 50 of these subjects duplicate determinations of the pressure drop across the nose at the flow rate of 0.3 l/s were made within a short interval; the coefficient of variation was 20--25 per cent. The rhinomanometric values in a small group showed a day-to-day variation of 55 per cent. Because rhinomanometry allows only a moderate level of accuracy the method is unsuitable for detecting a borderline case. As the influence of the variability of the method is smaller in large materials, rhinomanometry is more suitable for comparison of groups than of individual patients.
Extraction of hard, spherical foreign bodies from the esophagus has been accomplished with the use of a Dormia basket in combination with esophagoscopy. The Dormia basket was originally designed for the extraction of stones from the urinary tract.
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A prospective controlled study was made on the effect of adenoidectomy performed on 105 children. For various reasons, mainly severe long-standing nasal obstruction, 29 children were omitted from the study. The remaining 76 children were randomly divided into two groups, one adenoidectomy, and one control. Both groups were slightly reduced in number due to drop out. Thus 36 adenoidectomized children were followed during one year and 35 children during two years. The corresponding numbers for the children in the control group were 37 and 33. The incidence of common cold, purulent and serous otitis media and moderate nasal obstruction was compared in the two groups. A considerable reduction in the incidence of these variables was observed in both groups. The occurrence of moderate nasal obstruction was reduced more among the operated than among the unoperated children. The difference was only slightly significant during the first and not at all during the second year. Regarding the other variables, the differences were not significant, implying that adenoidectomy seems to have no effect on the incidence of common cold, serous and purulent otitis media.
A cineradiographic examination of 9 healthy subjects showed asynchronous movement of a manometric device in relation to movement of the upper esophageal sphincter (UES) during deglutition. A single sensor placed within the UES high pressure zone at rest registered pressures existing outside this zone during the major part of deglutition. The manometric device must therefore comprise at least three sensors placed at different levels and about 10 mm apart if consistent pressure recording within this zone is to be achieved. In order to evaluate the pressure profile within the sphincter adequately, cineradiographic determination of the orientation of the measuring device is necessary. This was made possible by insertion of two mutually perpendicular radiopaque indicators into the catheter.