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Biomedical subjects

H Stammberger

Publications and source records attributed to H Stammberger.

At least 19 recordsLinked to original sources
PubMed2005

Combined endoscopic surgery and radiosurgery as treatment modality for olfactory neuroblastoma (esthesioneuroblastoma).

OBJECT: Treatment of esthesioneuroblastoma (olfactory neuroblastoma) has been considerably improved by microsurgical techniques. Nevertheless, these rare tumours of the frontal skull base are still associated with high rates of tumour recurrence and mortality, thus remaining a challenge even for experienced surgeons. A novel therapeutic approach that combines endoscopic sinus surgery and Gamma Knife radiosurgery is presented here. Taking into account the rarity of the disease the present study comprises a relatively large series of patients treated in a similar manner. METHODS: 14 patients (8 males, 6 females) aged 27-75 years (median 38) were treated between May 1993 and December 2003. This series comprises 12 newly diagnosed esthesioneuroblastomas. Two more patients had already previously undergone surgery (24/39 months earlier). Paranasal and nasal endoscopic sinus surgery was performed. Marginal irradiation doses ranging from 15-34 Gy were given to the residual tumours by means of radiosurgery (Gamma Knife) involving 1-7 isocentres within 3 months after surgery. Median follow-up is 58 months (range 13-128). RESULTS: There was no mortality. In all patients tumour control was achieved within the treated area. 4 patients underwent a second radiosurgical procedure 6-79 months (median 34 months) after initial radiosurgery. One patients had to undergo an additional craniotomy because of extensive neoplastic infiltration, 1 developed postoperative liquorrhea, 1 case was complicated by bilateral frontal sinusitis. All patients complained of nasal discharge and crusts. Karnovsky Index--preoperatively ranging from 80%-100%--remained stable in 12 patients, an improvement was observed in 2 cases. CONCLUSIONS: Based on the favourable results recorded so far, the combination of endoscopic sinus surgery and radiosurgery can be considered a promising treatment option for esthesioneuroblastoma that merits further consideration.

Adult↗
PubMed2004

Giant hamartoma of the retro- and parapharyngeal region. Case report and review of literature.

Hamartoma designates a tumor-like, non-neoplastic malformation, or in-born error of tissue development, often with an abnormal mixture of tissue indigenous to the region. In the head and neck, epithelial and mesenchymal hamartomas are uncommon. We present the case of a 9-year-old boy with a huge hamartoma of 800ml (cm(3)) volume of the right retro- and parapharyngeal region. It had fully occluded the nasopharynx, indented the base of the tongue and left a minimal airway passage transorally. Food uptake was severely hampered by the lesion. The patient underwent a combined transoral and external approach for complete resection of the tumor. This is the first reported case of a retro- and parapharyngeal hamartoma with metaplastic bone formation in the literature and further more, the largest hamartoma in head and neck ever reported in this age group.

Biopsy, Fine-Needle↗
PubMed2004

[From when on can fungi be identified in nasal mucus of humans?].

BACKGROUND: Fungal spores are frequent in air and their occurrence in the nasal mucus appears to be a common finding within the adult population, as we were able to show in recent studies. 91,3 % of CRS patients but also healthy controls grew positive fungal cultures out of their nasal mucus. The potential role of fungal elements in nasal mucus for the pathogenesis of CRS, with or without polyposis, is currently investigated intensely and discussed very controversially. However, it was still unknown, as of when fungi could be cultured from nasal mucus in humans. We attempted to identify this point of time, in the nasal mucus of neonates. METHODS: In our study we examined nasal mucus from 30 neonates immediately after birth, on the first and fourth day post partum, and after two and four months of life. The samples obtained with sterile cotton swabs were cultured on agar plates. Fungal cultures were identified either conventionally by microscopy or with molecular techniques. To show whether fungi in nasal mucus of newborns were acquired by contamination during birth, mucus of the maternal vagina was examined as well. RESULTS: Just after birth we found in 6 of 30 (20 %) of our neonates positive fungal cultures out of their nasal mucus, in 3 of them Candida albicans, probably due to contamination passing the maternal vagina as cultures of vaginal mucus of their mothers were positive for Candida albicans too. Positive fungal cultures were obtained in 2 of 29 (7 %) neonates on the second and in 4 of 26 (15 %) neonates on the fifth day of life. In all our cases initial presence in nasal mucus contamination just after birth or on the second day of life was limited to one day only. None of the 12 of 30 (40 %) neonates with positive fungal cultures from nasal mucus in the first 5 days of life showed clinical symptoms of nasal fungal colonisation. Besides Candida albicans, Penicillium sp., Cladosporium cladosporioides, Acremonium polychromum, Beauveria bassiana and Epicoccum nigrum could be detected in the first 5 days of life. After the second month of life, examination of nasal mucus yielded positive fungal cultures in 8 of 11 (72 %), after four months even 17 of 18 (94 %) of babies, with a wide array of different species. CONCLUSIONS: Fungi can be cultured from nasal mucus as soon as contact with the environmental air exists. Furthermore, a transfer of fungi from the mother's birth canal into the nose during birth is possible. Presence of fungal spores is common but not persistent in the nose of babies in the first days of life. However, after four months the situation is similar to the one in adults: fungal cultures can be obtained from almost everyone's nose. Therefore fungal spores must be considered a normal content of nasal mucus. Fungal spores are inhaled with every breath, some stick to the mucus, are transported to the nasopharynx and swallowed. This does not cause any clinical symptoms and is therefore not a pathological finding at all.

Adult↗
PubMed2003

[Incidence and detection of fungi and eosinophilic granulocytes in chronic rhinosinusitis].

BACKGROUND: Chronic Rhinosinusitis (CRS) is the most common chronic disease in the United States. Though for Europe no data are available, we have to assume that the situation is similar. Although the disease is defined very well by clinical symptoms, up to date the etiology and pathogenesis of chronic rhinosinusitis are unknown. CRS is considered to be multifactorial, with thickening of the mucosa and formation of polyps as an end stage of the disease. Treatment of choice includes corticosteroids and/or endoscopic or microscopic surgery. Antibiotics only help, if there is an acute bacterial exacerbation of the disease. They are not able to cure chronic rhinosinusitis per se. In 1999 Mayo Clinic researchers published data concerning the incidence of so-called "allergic" fungal sinusitis (AFS) in their patients suffering from chronic rhinosinusitis, demonstrating the majority of patients investigated presenting those criteria. Our own initial data from 2000 confirmed their findings. MATERIAL AND METHODS: In an open prospective study fungal cultures were obtained from nasal mucus of 238 consecutive patients suffering from CRS. As control group acted 23 members of our staff, who did not show any evidence for CRS. In addition, in 37 CRS patients surgical specimens (mucus and tissue) were investigated histologically for evidence of eosinophilic granulocytes and fungal elements. RESULTS: Using new techniques for fungal detection in culture and histology as proposed by Mayo Clinic researchers, positive detection of fungal cultures of the mucus of our CRS patients developed from 7 % in the past up to 87 % at present. 91.3 % of our control group yielded a positive result in fungal culture. Histologically, eosinophilic clusters were evident in 94.6 % and fungal elements were detected in 75.5 % within the mucus of 37 surgical CRS patients. Overall, 89.2 % of our surgical patients thus fulfilled the criteria of so-called AFS. Compared to our findings in the past, our latest results show an increase of 80 % in detection of fungal elements in our CRS patients. In all we were able to identify 654 positive fungal cultures in 238 CRS patients and 23 healthy controls respectively. 88 different genera grew, with 2.4 different species per patient and 3.1 different species per healthy control, on average. CONCLUSION: Utilizing new techniques of fungal culturing out of the mucus of CRS patients and healthy controls, the number of positive fungal cultures increased dramatically from 7 % to 87 % in our patients and 91.3 % in healthy controls respectively. To obtain these results it is crucial to perform special techniques of mucus sampling and pretreatment for culturing as well as for histological investigations. Our results show, that with suitable techniques fungi can be identified in almost everybody's nose, CRS patient or healthy. When inhaled, those airborne fungi are only "in transit" through the nose. Positive fungal cultures from nasal secretion therefore have to be considered normal findings. The reason for this delayed recognition has to be attributed to our inadequate methods in the past. In contrast to healthy controls, clusters of eosinophils and fungal elements are present simultaneously within the mucus of CRS patients and appear to be a marker of the disease.

Chronic Disease↗
PubMed2003

[Respiratory epitheloid adenomatoid hamartoma of the nasal cavity--case report and review of the literature].

BACKGROUND: Hamartomas are tumour-like malformations, resulting from excessive proliferation of otherwise normal local tissue components. Hamartomas of the nasal cavity and paranasal sinuses are relatively rare, especially respiratory epithelial adenomatoid hamartomas. This benign lesion is characterized by a glandular proliferation originating from the surface of the respiratory epithelium. In the German speaking literature this entity has not been described before. PATIENT AND RESULTS: We report the case of a 51-year-old white female, presenting with a respiratory epithelial adenomatoid hamartoma of her left nasal cavity. The patient suffered from nasal obstruction. The CT scan showed a soft tissue like lesion obstructing the patient's left choana. After local resection of the tumour, which originated from the superior turbinate through functional endoscopic sinus surgery the patient's symptoms were gone. Follow-up after six months showed no evidence of recurrence. CONCLUSION: The histopathological differential diagnosis of respiratory epithelial adenomatoid hamartomas includes inverted papilloma and adenocarcinoma. Therefore the histological recognition of these hamartomas impacts on therapy. Misinterpretation as a true neoplasm may result in unnecessarily radical surgery. Local surgical resection is the treatment of choice for this lesion.

Adenocarcinoma↗
PubMed2003

Fungal biodiversity--as found in nasal mucus.

The biodiversity of fungi isolated from the nasal mucus of patients suffering from chronic rhinosinusitis and from healthy persons was monitored over 28 months. Mucus samples were obtained by flushing the noses of patients with saline or by endoscopic sinus surgery. Fungi from mucus were cultivated on agar plates. Identification was performed microscopically and by polymerase chain reaction with subsequent sequencing of the ribosomal internal transcribed spacer region. Altogether, 619 strains of fungi were cultivated from 233 subjects. Eighty-one species were identified, with a maximum of nine different species per person. The most prevalent isolates belonged to the genera Penicillium, Aspergillus, Cladosporium, Alternaria and Aureobasidium. Whereas Aspergillus and Penicillium spp. occurred in more or less the same numbers throughout the year, Cladosporium spp., Alternaria spp. and Aureobasidium pullulans showed a significantly higher occurrence during late summer and early autumn.

Adolescent↗
PubMed2003

[The basidiomycete Schizophyllum commune in paranasal sinuses].

In the last fifty years, only 22 medical cases involving the basidiomycetous fungus Schizophyllum commune were reported. In a period of three years we have examined 270 patients suffering from chronic rhinosinusitis as well as from mycoses (fungus balls) within the paranasal sinuses. Either nasal mucus or fungal concrement from the sinuses were cultured and the resulting cultures identified microscopically. In cases, where a reliable identification of the fungi was not possible, DNA was extracted for molecular examination. The internal transcribed spacer (ITS) region of the ribosomal gene-cluster was amplified with fungus specific primers and sequenced thereafter. In addition, DNA of all fungi growing with sterile white mycelium was amplified with the primer pair scom1/scom2r, which is specific for S. commune. Altogether, within a three years period S. commune was isolated in twelve patients. It can be assumed, that with the presented methods S. commune will be found much more frequently in patients suffering from diseases of the nasal sinuses.

Adult↗
PubMed2002

Combination of surgery and gamma knife radiosurgery--a therapeutic option for patients with tumors of nasal cavity or paranasal sinuses infiltrating the skull base.

UNLABELLED: The purpose of this study was to investigate whether patients operated for skull base-infiltrating malignant tumors of the nasal cavity and/or the paranasal sinuses benefit from an additional Gamma knife radiosurgery. CASE SERIES: eight consecutive patients, (male: female ratio = 1:1, mean age = 52 years, range 34 to 79 years) presented with 2 cyclindric cell carcinomas, 2 adenocarcinomas, 2 malignant neuroblastomas, 1 squamous cell carcinoma, 1 amelanotic melanoma. Tumor stages (UICC) were: 1 T1, 3 T2, 3 T3, 1 T4, all N0, all M0. All patients were primarily treated surgically and 4 weeks later received additional stereotactic radiosurgery. Follow-up was based on computerized tomography (CT), magnetic resonance imaging (MRI), endoscopy, and biopsy. The course of disease was compared to tumor courses with surgery but without radiosurgery reported in literature. Four times endoscopic endonasal surgery (EES), once EES in combination with fluorescein technique, once EES plus external approach of frontal sinus, once lateral rhinotomy was performed. All 8 cases underwent radiosurgery (Leksell gamma knife) 4 weeks after surgery. Thirty six months after radiosurgery 6 patients were alive (4 patients without evidence of disease, 1 patient with pulmonary metastasis but without local recurrence, 1 patient with regional metastasis but no local recurrence), 1 patient died 11 months after treatment due to disease, 1 patient died due to a second malignancy. No negative or adverse effects due to radiosurgery were observed. The combination of microsurgery with Leksell Gamma knife radiosurgery appears to be an encouraging therapeutic option. To date no adverse effects have been observed in the presented cases.

Adult↗
PubMed2001

Multislice CT-image-guided endoscopic sinus surgery using an electromagnetic tracking system.

Our objective was to assess the practicability and accuracy of a computer-assisted multislice CT-guided frameless electromagnetic tracking for endoscopic sinus surgery. Eighty-two patients with various paranasal sinus diseases were evaluated. Prior to surgery, axial multislice spiral-CT scans with 2.5-mm collimation, 0.8-mm reconstruction increment, and a pitch of 3 were acquired. After Ethernet transfer of the CT data set to the guidance system, coronal and sagittal images were reconstructed. For intraoperative navigation the Insta Trak System (Visualization Technology, Boston, Mass.) was used. Navigational procedures are described in detail in the paper. Accuracy was assessed by means of visual landmarks which could be clearly identified endoscopically as well as on CT images. A second parameter for accuracy was calculated by the system itself as the root mean square (RMS). The system was able to display the position of the aspirating tip relative to anatomical structures with an average accuracy of 0.70 +/- 0.40 mm. Root mean square values showed a mean value of 0.40 +/- 0.20 mm. During surgical procedures the Insta Trak System provides the surgeon with additional image-based information to the endoscopic view. The device accuracy is high and the system proves to be practicable and efficient in ENT surgery.

Adolescent↗
PubMed2001

[Treatment results in 25 patients with Graves' ophthalmopathy between 1998 and 2001].

In our outpatient clinic 25 patients with Graves' ophthalmopathy were treated, 21 women, mean age 58.8 years (range 19-74 years) and 4 men, mean age 47.5 years (range 38-56 years). In the female group two showed euthyroid Graves' ophthalmopathy and one Hashimoto's disease; in the male group one showed euthyroid ophthalmopathy. Treatment was done depending on the findings of the NOSPECS-classification in identical way for each group. Final results were obtained three and six months after therapy, at that time all patients were euthyroid. In five patients (two men and three women) sicca-treatment was sufficient because the ophthalmopathy improved by therapy of the thyroid disease only. Three women were treated by oral steroids over three months and had a complete remission. Nine women were treated by oral steroids and external radiation, six of them showed major improvement but in one case orbital decompression had to be done. Somatostatin therapy was done over six months in six women who showed no change after oral steroids plus radiation. Out of them five showed major improvement but in spite of a positive octreoscan in one case orbital surgery had to be performed. Two men were treated by oral steroids and external radiation without change of disease, somatostatin therapy was not done because of a negative octreoscan. With the exception of one nonsmoking woman in whom orbital surgery had to be done, the treatment results were worse in smokers.

Adult↗
PubMed2001

Olfactory neuroblastoma (esthesioneuroblastoma): report of six cases treated by a novel combination of endoscopic surgery and radiosurgery.

Microsurgical techniques have considerably improved the results of surgical treatment for esthesioneuroblastoma (olfactory neuroblastoma). Nevertheless, these rare tumours of the frontal skull base are still associated with high rates of tumour recurrence and mortality, thus remaining a challenge even for experienced surgeons. A novel therapeutic approach that combines endoscopic sinus surgery and radiosurgery (gamma knife) is presented here. Six patients (3 males, 3 females) aged between 27 and 75 years (median 38 years) were treated between August 1993 and July 1999. Following paranasal and nasal endoscopic sinus surgery, marginal irradiation doses ranging from 16 to 34 Gy were applied radiosurgically involving up to 7 isocentres. At present, the median follow-up period is 57 months (range: 9 - 79 months). Without mortality, tumour control was achieved in all patients. One patient, who had to undergo additional craniotomy because of extensive neoplastic infiltration, developed postoperative liquorrhea. In another case the clinical course was complicated by a bilateral frontal sinusitis. All patients complained of nasal discharge and crusts. However, a preoperative Karnovsky Index ranging from 80 to 100 % remained stable in four patients whereas an improvement was observed in two patients. Based on the favourable results observed so far, the combination of endoscopic sinus surgery and radiosurgery can be considered as promising new option for the treatment of esthesioneuroblastoma that merits further investigation.

Adult↗
PubMed2001

Development of molecular methods for identification of Schizophyllum commune from clinical samples.

In the last 50 years, to our knowledge, only 16 cases of diseases caused by Schizophyllum commune in humans have been reported. Within only 6 months, we found four isolates of this basidiomycetous fungus, obtained from patients suffering from chronic sinusitis. The cultures of the isolated fungi showed neither clamp connections nor fruiting bodies (basidiocarps), which are distinctive features for S. commune, but fast-growing cottony white mycelium only. This was harvested, and DNA was extracted. The internal transcribed spacer region of the ribosomal DNA (rDNA) was amplified with fungus-specific primers, and the PCR products were sequenced. Two strains of S. commune, collected from branches of a European hornbeam (Carpinus betulus) and a tree of heaven (Ailanthus altissima), respectively; four specimens from the herbarium of the Institute of Botany, Karl-Franzens-University Graz; and two strains from internationally known culture collections (CBS 340.81 [ATCC 44201] and CBS 405.96) were investigated in the same way. The sequence data of all strains were compared and showed homology of over 99% in this 660-bp-long fragment of rDNA. With these results, a map of restriction enzyme cutting sites and a primer set specific for S. commune were created for reliable identification of this human pathogenic fungus.

Base Sequence↗
PubMed2001

Prognostic impact of molecular analyses in adenoid cystic carcinomas of the salivary gland.

BACKGROUND: Adenoid cystic carcinoma (ACC) of the salivary gland is a generally slow-growing but highly malignant neoplasm with a remarkable capacity for recurrence. Prognosis is greatly influenced by the histological subtype (tubular, cribriform or solid), presence of tumour at the margins, anatomic size, and lymph node metastases. However, none of these parameters has proven to be an unequivocal predictor of disease activity. Therefore, the current study was undertaken to investigate the prognostic value of molecular markers. PATIENTS AND METHODS: Samples from 22 patients, including 4 patients with recurrent disease, were included in the study. By means of immunohistochemistry, the staining pattern of p53, bcl-2, P-glycoprotein, glutathione S-transferase, and topoisomerase as well as sequence analyses of p53 were performed. These molecules were chosen because of their proven association with poor prognosis and therapy resistance in other malignancies. RESULTS: Homozygous p53 mutations were found in all of the 4 recurrent tumors. The other proteins were detected in some tumors, but showed no correlation with histological subtype or recurrence of tumor. CONCLUSION: The results of the current study emphasize the prognostic value of a p53 alteration as an independent prognostic marker. Further, it could be demonstrated for the first time that proteins known for their association with radio- and chemotherapy resistance can be overexpressed in some ACCs suggesting that those molecules could influence the outcome of new therapeutical approaches.

Biomarkers, Tumor↗
PubMed2001

Magnetic resonance imaging patterns of the development of the sphenoid sinus: a review of 800 patients.

Accurate knowledge of age-related development and pneumatisation of the paranasal sinuses has become an important issue in diagnosing paranasal sinus diseases in infants and young adults. Magnetic resonance imaging (MRI) has the potential to assess bone marrow conversion and pneumatisation of the paranasal sinuses. We retrospectively reviewed 800 children aged 0-14 years undergoing brain MRI for various indications. T1-weighted sagittal and T2-weighted axial scans were evaluated for bone marrow conversion and development of pneumatisation of the sphenoid sinus. The sphenoid sinus had a uniformly low signal intensity on T1-weighted images in all children less than four months old. Signal intensity began to change to hyperintense marrow at the age of four months. Onset of pneumatisation was observed in 19% at the age of 12-15 months. Pneumatisation was complete in all patients older than 10 years. In conclusion, these data can be used as baseline standards of normal age-related development of the sphenoid sinus and can be of great value for the diagnostic and therapeutic management of pathologic conditions of the child's sphenoid sinus and its surrounds.

Adolescent↗