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Biomedical subjects

H Stammberger

Publications and source records attributed to H Stammberger.

99 records · Page 6Linked to original sources
PubMed1980

[The treatment of housedustmite-allergy-three years' experience with hyposensitization with D.pteronyssinus-Preparations (D.P.) (author's transl)].

A group of 88 patients has been treated with D.P-hyposensitization for various allergic diseases ranking from rhinopathic to severe asthmatic symptoms. They all had a typical case history, showed a +++positive skintest reaction to D.P. plus at least a class-two RAST. Furthermore a scratchtest with dustsamples collected in the patients' home was performed and on positive reactions the items concerned (pillows, carpets, matraces etc.) were removed or replaced. Patients with multiple allergies or other complicating diseases were not evaluated in this study. All patients were treated with Allpyral-Semi-Depot preparations of D.P., by subcutaneous injections. Of 25 patients whose treatment is finished by now, all showed relief of their symptoms, 20 of them are free of symptoms 21/2 up to 18 months after end of treatment. Only 5 have shown recidives so far, which disappeared again when treatment was continued. The total PNU-dose applied averaged 8700 PNU per patient, with a maximum of 22800 PNU. The first signs relief showed when (an average of) 870 PNU were applied; at an average of 3000 PNU, patients for the first time were free of symptoms. Total treatment time varied from 6 to 16 months. No correlation was found between sex, age of the patient, or intensity or duration of the symptoms and the total PNU-dose needed for relief. Based on correct indication, hyposensitization with D.P. extracts today can be as successful as hyposensitization treatment in pollenallergies.

Allergens↗
PubMedDate not supplied

Aspergillosis of the paranasal sinuses x-ray diagnosis, histopathology, and clinical aspects.

Aspergillosis is not a rare disease of the paranasal sinuses; more than 80 cases were reported from 1976 to 1982 in the University ENT Clinic at Graz, Austria. Of 59 patients studied, 27 presented almost metal-dense x-ray shadows resembling foreign bodies in one of the sinuses. By means of light and electron microscopic investigations as well as x-ray fluorescence analysis, it can be demonstrated that these areas are equivalent to local enrichment of calcium phosphate in the center of the noninvasive fungal masses in the sinuses. A detailed description of the histopathology of Aspergillus fumigatus is given. For clinical diagnosis, the detection of almost metal-dense x-ray shadows in the absence of foreign-body history in our experience may be regarded as almost certain for aspergillosis of the paranasal sinuses.

Absorptiometry, Photon↗
PubMedDate not supplied

Endoscopic surgery for mycotic and chronic recurring sinusitis.

Chronic sinusitis and its complications are often caused or perpetuated by fungi. In Europe and North America Aspergillus species are the most common contaminants of the sinuses, with relatively few cases of mycoses caused by Mucor, Candida, Penicillium, Cladosporium, and Fusarium reported in the literature. Although Aspergillus and Mucor are mainly saprophytic, they may cause severe, potentially lethal complications. Consequently, therapy should include complete removal of the mycotic masses and prevention of reinfection. In nearly all cases in our experience, fungal diseases of the maxillary sinuses are secondary diseases, the pathologic conditions for which are created by chronic recurring sinusitis. Nasal endoscopy has shown that in most cases of recurring sinusitis, infection spreads from the nose into the larger sinuses, mostly from an infected anterior ethmoid. Maxillary and frontal sinuses are fully dependent on the pathophysiologic conditions in the anterior ethmoid because their ventilation and drainage pass through its complicated system of fissures and clefts into the middle nasal meatus. Endoscopic endonasal surgery of the diseased ethmoid is therefore an important element in our treatment schedule. Stenotic and/or chronically infected areas of the anterior ethmoid are identified by conventional or computed tomography. These areas then undergo endonasal operation under the guidance of rigid endoscopes. Diseased mucosa is removed, narrow or stenotic areas are widened, and the natural maxillary sinus ostium is enlarged. In many cases it is possible to remove all mycotic masses through this new window. Fenestration into the inferior nasal meatus is unnecessary with this method, and the sinus mucosa is usually left untouched. For follow-up treatment, instillations of antimycotic or antibiotic ointments are used. Even in cases of massive mucosal changes, the dependent sinuses, such as the frontal or maxillary sinuses, usually heal spontaneously after this procedure without having been treated directly. More than 140 patients with mycotic sinusitis, 48 of whom were studied and followed up for this paper, were treated by us during the last 8 years. The endoscopic surgical technique we have developed is described in detail.

Adult↗
PubMedDate not supplied

Headaches and sinus disease: the endoscopic approach.

Headaches can be of sinugenic origin even if this cause may not be suspected from the case history. Endoscopy of the lateral nasal wall with rigid cold light endoscopes in combination with polytomography or computed tomography usually will reveal the underlying causes hidden from the unaided eye, the operating microscope, and standard x-ray examination. Small lesions in the lesser cells of the ethmoid complex may give rise to headaches, especially when located in the key areas of the ethmoid infundibulum or frontal recess. Many anatomic variations of the structures in the middle meatus can narrow the stenotic clefts even more and thus predispose to more or less intense contact of opposing mucosal surfaces. This may impede or block ventilation and drainage of the ethmoid and surrounding larger sinuses and thus affect those as well. After identification of these underlying causes, functional endoscopic sinus surgery with usually minimal operations often can provide dramatic relief of symptoms that may have been present for months or even years. The neuropeptides recently were newly identified as a group of mediators besides the neurotransmitters noradrenalin and acetylcholine. Substance P (SP) is one of the most important neuropeptides that we can identify in the human nasal mucosa. It mediates pain impulses to the cortex via afferent C fibers. Simultaneously from polymodal receptors in the nasal mucosa, local reflexes are mediated by SP via an axon reflex, causing vasodilatation, plasma extravasation ("neurogenic edema"), and hypersecretion. The receptors can be stimulated by chemical and caloric irritants and also mechanical irritants such as pressure. The pressure exerted on nasal mucosa by polyps or mucosal swelling due to other reasons in the ethmoid clefts, cells, and narrow spaces apparently can be enough to trigger an SP-mediated pain sensation via afferent C fibers. Over the axon reflex an initially small lesion may lead in a vicious circle to quite significant symptoms. The model of "referred pain" explains why the pain is not necessarily felt at its origin, but may be projected onto corresponding dermatomes. The pain-mediating function of SP can be blocked selectively by capsaicin, the pungent component of red pepper, which leads to desensitization of the receptors and degeneration of the afferent C fibers without affecting other sensory qualities. In patients with vasomotor rhinitis we were able to block all the patients' symptoms including headaches by topical administration of capsaicin. After identification of underlying causes with endoscopy and CT, lesions and contact areas should be operated upon if medical treatment fails.(ABSTRACT TRUNCATED AT 400 WORDS)

Capsaicin↗
PubMedDate not supplied

Video-endoscope versus endoscope for paranasal sinus surgery: influence on stereoacuity.

A matter of debate is whether the use of a video-endoscope impairs visual orientation and manual precision in endonasal surgery. We investigated the influence of video-endoscopy compared to endoscopy on stereoacuity in a model of the nasal cavity. Twenty medical staff members were asked to touch defined points in a spatial model of the nasal cavity as quickly as possible and in correct order using 0 degree and 30 degrees endoscopes, looking directly through the endoscope or looking at a video monitor connected to a CCD camera on the endoscope. Time, number of omissions of points and faults in point sequence were recorded. Manipulations were significantly quicker when the "operative field" was seen directly through the endoscope compared to orientation from the monitor for both 0 degree endoscope 96 +/- 4.7 s. vs. 108 +/- 5.6 s. and 30 degrees endoscope 84 +/- 3.9 s. vs. 96 +/- 5.5 s. (+/- SEM). There was no difference in number of omissions and faults in sequence between "endoscope" and "video-endoscope." The fact that the use of a video-endoscope did not increase the number of faults in our experiment does not support the notion that performing endoscopic sinus surgery using a monitor is unsafe. In the hands of the participants who were experienced with the endoscope, however, the use of a video-endoscope slowed down manipulations to a significant degree. To which extent this may be due to the effect of training or to superiority of the endoscope per se will remain a matter of discussion until a group of experienced video-endoscopists will have repeated the study.

Endoscopy↗
PubMedDate not supplied

Is monocular perception of depth through the rigid endoscope a disadvantage compared to binocular vision through the operating microscope in paranasal sinus surgery?

Vision through the endoscope is strictly monocular. Perception of depth (stereopsis) during ethmoid surgery through the operating microscope would be expected to be superior due to binocular view. To investigate whether monocularity of the endoscope is a disadvantage in paranasal sinus surgery, we compared stereoacuity in a model of the nasal cavity using a headlamp, an operating microscope, and a 0 degree-Hopkins-endoscope. Twenty volunteers were asked to touch defined points in a spatial model of the nasal cavity. Due to the configuration of the model, which allowed binocular vision of all contact points with headlamp, performance was significantly better than with optical instruments. Manipulations were performed faster with the endoscope than with the microscope. Under microscopic guidance more faults in point sequence were made than with the endoscope. Various monocular phenomena obviously allow sufficient spatial orientation through the endoscope, so that monocularity of the endoscope appears not to be a disadvantage for quick and safe manipulations during functional endoscopic sinus surgery.

Depth Perception↗
PubMedDate not supplied

Endoscopic removal of an intraorbital "tumor": a vital surprise.

We present the first case report of an endoscopic removal of a living worm, species Dirofilaria repens, from the orbital cavity. As of today, over 410 cases of Dirofilaria repens infections in man are recorded in world literature, six of which were localized in the orbital cavity. In Austria we know of four cases of an infection with this parasite, but none in the orbit. Dirofilaria repens is widespread only in the Old World, particularly in Southern and Eastern Europe, in Asia Minor, and in Central and Southern Asia. The highest prevalence of the disease is recorded in Italy (181 cases). In clinical practice, the infections have mostly been misdiagnosed as a neoplasia, usually benign but sometimes malignant. Under the assumption of an intraorbital tumor, the endoscopic transnasal revision of the orbital cavity was performed, as this approach promised to be least traumatic and best suited for the lesion, resulting in complete removal of the live worm. In unclear lesions in the head and neck, and infection with Dirofilaria repens should be considered as a differential diagnosis.

Austria↗