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Biomedical subjects

J A Werner

Publications and source records attributed to J A Werner.

At least 19 recordsLinked to original sources
PubMed2002

[The sentinel node concept in head and neck squamous cell carcinoma--a critical analysis in 100 patients].

BACKGROUND: The value of Sentinel Node (SN) concept is a current issue in clinical oncology. Few investigations deal with SN biopsy in head and neck squamous cell carcinomas (HNSCC). For this reason the SN concept was investigated based on the results of the so far largest group of 100 patients. METHOD: Three groups of patients were investigated. Group 1: In 30 patients (6 x oral cavity, 24 x oropharynx) a dynamic lymphoscintigraphy was performed. Group 2: 60 previously untreated patients (12 x oral cavity, 23 x oropharynx, 16 x larynx, 9 x hypopharynx); neck lymph node status on ultrasound imaging: 39 x N0, 5 x N1, 16 x N2, intraoperative identification of the SN during neck dissection (ND) accomplished according to the extent of assumed lymphogenic metastatic spread; postoperative comparison of the histological result of the SN with the neck dissection specimen. Group 3: 10 previously treated patients (1 x oral cavity, 5 x oropharynx, 1 x larynx, 3 x hypopharynx) in whom an intraoperative SN biopsy was performed. RESULTS: Group 1: In 20/30 patients a cervical lymph drainage could be visualized on dynamic lymphscintigraphy and an activity enrichment above the mean metastatic region could be identified transcutaneously. Group 2: In 34 patients the tumorfree SN1 reflected the regional lymph node status. In 9 patients an isolated tumor metastasis (pN1) was found in the intraoperatively identified SN1 and in a further patient in the SN2 (pN1). CONCLUSION: The results of SN biopsy are encouraging in cases of clinical N0-necks. Nevertheless the data demonstrates that extensive investigations followed by a critical analysis of the results are required. The presented results suggest that the value of the SN concept seems to be of minor importance in cases of advanced lymphogenic metastatic spread.

Adult↗
PubMed2001

Experimental and clinical results of Er:YAG laser stapedotomy.

BACKGROUND AND OBJECTIVE: At the beginning of the 1980s, different laser types were used for stapes surgery to reduce potential harm to inner ear structures through manipulation with conventional instruments during stapedotomy. Most clinical studies were carried out with the CO2 or the argon laser. The Er:YAG laser has been used rarely in patients with otosclerosis. STUDY DESIGN/MATERIALS AND METHODS: In an experimental study on 54 human petrous bones, the optimal laser energy parameter for dissection of the posterior stapes crus and the footplate perforation were determined. With these parameters, stapedotomy was carried out with the Er:YAG laser in 29 patients with otosclerosis with a conventional dissection of the incudostapedial joint and the stapedius muscle tendon. The Er:YAG laser was used (60 or 100 mJ, 3-6 pulses) for dissection of the posterior stapes crus and footplate perforation. RESULTS: No intra- or postoperative complications were observed in all 29 patients. Vertigo and hearing loss were not observed intra- or postoperatively. The postoperative hearing results (improvement of the air-bone gap) was in all cases satisfactory (median remaining air bone gap, 8.1 dB). The median operation time was 29 minutes (15-42 minutes) and did not show a significant prolongation in comparison to the conventional technique. In 1 of the 29 patients, the footplate perforation needed to be carried out conventionally. CONCLUSION: For the first time, Er:YAG laser parameters have been optimized and refined in a human petrous bone model and were then used in a clinical setting. According to the presented results, the Er:YAG laser seemed to be a very suitable instrument for stapedotomy.

Adult↗
PubMed2001

Ultrasound-guided piezoelectric extracorporeal shock wave lithotripsy of parotid gland calculi.

PURPOSE: The introduction of piezoelectric extracorporeal shock wave lithotripsy (ESWL) has changed therapy for salivary calculi. This method seems especially suitable for treating calculi in the parotid gland. The purpose of this study was to evaluate ESWL in patients with such calculi. METHODS: From November 1990 to November 1999, all patients with sialolithiasis of the parotid gland were treated with piezoelectric ESWL. Three different lithotriptors were used over the 9-year study period. Results were analyzed according to both the patients' clinical status and follow-up sonograms. RESULTS: In total, 42 patients (21 women, 21 men; mean age, 59 years) were treated with ESWL. The mean follow-up period for all patients was 63 months (range, 7-96 months). After ESWL had been performed, 71% of the patients were completely free of symptoms, and 21% had marked improvement of their symptoms. Sixty-seven percent were completely free of calculi, and 27% had a marked reduction in the size of their calculi. Adverse effects of ESWL included temporary glandular swelling (4 patients), blood-tinged salivary secretions (9 patients), petechiae on the skin surface (3 patients), and parotid abscess (1 patient). CONCLUSIONS: ESWL is an outpatient procedure that can be performed without anesthesia and with scarcely any discomfort for patients. Conventional surgical procedures such as subtotal parotidectomy may be almost entirely replaced by ESWL because of the excellent treatment results and a very low rate of complications associated with ESWL. ESWL should be considered the treatment of choice for parotid calculi.

Adult↗
PubMed2001

Current concepts in the classification, diagnosis and treatment of hemangiomas and vascular malformations of the head and neck.

There are many different classifications of vascular anomalies. As the correct classification of the vascular lesion has a direct influence on therapy it is difficult to decide which treatment should be considered as the treatment of choice. Based on an extensive review of the literature and personal experience of the treatment of more than 200 patients with hemangiomas or vascular malformations of the head and neck, a clinical classification is described that allows vascular lesions to be categorized in order to plan purposeful treatment. In general, hemangiomas represent the main group of vascular lesions in infancy and childhood. They are usually apparent a few weeks after birth and are characterized by an initially rapid growth of epithelial cells, followed by spontaneous involution. Hemangiomas should be differentiated from vascular malformations that are present at birth but may not be evident clinically. Spontaneous involution of vascular malformations has never been reported, whereas laser therapy can induce involution of hemangiomas at an early stage in a majority of cases. In certain situations steroids or surgical removal may seem to be the appropriate therapy of choice. In contrast, vascular malformations have to be treated according to their histopathology and location, as well as their hemodynamic features as shown radiographically with angiography. The accurate diagnosis of vascular anomalies is essential for further treatment, as shown by clinical experience at the University of Marburg.

Arteriovenous Malformations↗
PubMed2001

Transcriptional repression of the human fibronectin gene in laryngeal squamous cell carcinoma cells.

PURPOSE: The aim of the experiments was to analyze the mRNA expression pattern and verify the repression of FN gene expression in laryngeal squamous cell carcinoma (SCC) cells in comparison with benign mucosal keratinocytes. METHODS: Messenger RNA from SCC cells and benign keratinocytes was reverse transcribed and subjected to PCR following differential display (DD) analysis of the amplicons. Northern hybridization was carried out to confirm the reduction of the FN-mRNA expression in both laryngeal SCC cells and larynx carcinoma biopsies, in contrast to adjacent normal mucosa. Quantitation of protein synthesis was performed with homogenates of fresh tumor biopsies and their normal phenotypes, as well as of benign keratinocytes and laryngeal SCC cell lines, respectively, using ELISA. In the liposome-mediated transient transfection assay, FN promoter activity was analyzed by linking the FN promoter sequence to the chloramphenicol acetyltransferase (CAT) reporter gene. Transfection efficacy was monitored by co-transfection with pGL3 control vector. RESULTS: A 191 bp mRNA fragment revealing a 99% homology with the human FN-mRNA was detected, the expression of which was repressed 20 times as much in SCC cells as compared to benign phenotypes. Northern hybridization confirmed the distinctly reduced expression of FN-mRNA in both laryngeal SCC cells and larynx carcinoma biopsies, in contrast to adjacent normal mucosa. The quantitation experiments showed a correlation between the range of FN synthesis and the expression of FN-mRNA in cell lines and the biopsies which were used. The 1.28 kb FN gene promoter drove expression of the CAT reporter gene, which was similar to the FN-mRNA expression showed by DD and Northern hybridization. CONCLUSIONS: The mechanisms leading to the low level of FN in many tumors have not yet been sufficiently investigated. Our findings suggest that the decrease of FN in laryngeal SCC cells is transcriptionally regulated.

Base Sequence↗
PubMed2001

Standard variant venous dysplasia of the cerebellum in a patient suffering from Muenke's syndrome and tinnitus.

BACKGROUND: Muenke's syndrome is a rarely seen craniosynostosis syndrome. Bilateral or unilateral coronal craniosynostosis, brachydactyly, tarsal and carpal coalitions are the typical clinical findings. Sensorineural hearing loss is reported in more than 30% of the affected patients. In patients with Muenke's syndrome intracranial vascular dysplasia has not been reported yet. PATIENT AND METHODS: A 13-year-old boy suffering from Muenke's syndrome reported a pulsating left-sided light tinnitus. Clinically a bluish formation was found at the lower part of the left-sided ear drum. In order to clarify the cause of the tinnitus and the bluish formation, extensive diagnostics (e.g. audiometry, magnet resonance tomography, magnet resonance phlebography, angiography) were carried out. RESULTS: Audiometry found a left sensorineural hearing loss with a conductive component. Radiological investigations found a standard variant venous dysplasia of the left petrous bone to be the reason for the tinnitus. CONCLUSION: Awareness of intracranial vascular dysplasia should be noted in individuals with Muenke's syndrome especially in cases of clinically suggestive symptoms like pulsating tinnitus.

Adolescent↗
PubMed2001

Value of sentinel lymphonodectomy in head and neck cancer patients without evidence of lymphogenic metastatic disease.

OBJECTIVE: Only few communications deal with the value of sentinel node (SN) biopsy for head and neck squamous cell carcinoma (HNSCC). Based on the results of 38 investigated patients with clinically N0-neck the feasibility of SN biopsy in HNSCC is critically discussed. PATIENTS AND METHODS: Thirty-eight previously untreated patients with clinically N0-neck were staged by intraoperative SN biopsy. After intraoperative identification of the hottest node (SN(1)) and further less tracer accumulating lymph nodes (SN(2), SN(3)), patients were treated by different types of neck dissection (ND), adjusted to the location and extent of the primary tumour. Postoperatively the histologic results of the SN(1-3) and the entire ND specimen were compared. RESULTS: The stage of cervical metastatic disease was demonstrated by a disease-free SN(1) in 32 patients. In five patients an isolated metastasis could be proven in the intraoperatively identified SN(1), while in the remaining patient an isolated metastasis was found in the SN(2). CONCLUSION: Intraoperative SN biopsy seems to be valuable for the detection of occult lymph node metastases in HNSCC. This method might help to limit the extent of ipsilateral ND, if used as an intraoperative staging procedure to investigate the first draining tracer accumulating lymph nodes (SN(1-3)).

Adult↗
PubMed2001

Steroid hormone receptors in parotid gland cystadenolymphoma (Warthin's tumour).

The aetiopathogenesis of cystadenolymphoma is mostly unknown. Cystadenolymphomas have a significantly higher incidence in the male than the female population. This might be as a result of endocrine dependency in this kind of tumour. The purpose of the present study was to determine the sex hormone receptor status in cystadenolymphoma. Tissue samples of cystadenolymphoma, pleomorphic adenoma and normal samples of the parotid gland were examined immunohistochemically for oestrogen and progesterone receptors. Progesterone-positive cells could be found in the salivary duct system of normal glands and in the epithelial components of cystadenolymphomas. There was no evidence for the presence of oestrogen receptor in any sample studied. The evidence of progesterone receptors in cystadenolymphoma may implicate a potential role of endocrine factors in the development of this tumour.

Adenolymphoma↗
PubMed2001

[Status of the controversial discussion of the pathogenesis and treatment of chronic otitis media with effusion in childhood].

BACKGROUND: Chronic otitis media with effusion is one of the most common diseases in childhood. The causes of otitis media are unclear as far as their importance is concerned. METHOD: Extensive search in the German and Anglo-saxon literature with following presentation of the results. RESULTS: The original idea of a mechanical obstruction of the eustachian tube by the adenoids seems to be insufficient. Inflammatory mechanisms as a result of pathogenic germs in the middle ear fluid stand opposite to immunomodulating mechanisms as relevant causes of chronic otitis media with effusion. There are references which lead to the importance of allergic co-mechanisms individually. The controversial discussion of the pathophysiology of chronic otitis media with effusion is illustrated by the different opinions of optimal treatment modalities. Varying medical treatment opportunities exist while centrally the importance of the use of antibiotics is controversial. Based on the absence of long lasting effects of medical treatments, there are groups supporting a wait-and-see policy. Concerning the long-term effects of operative treatment, the importance of isolate tubes insertion in opposition to a combined treatment modality (adenotomy and tubes) is controversial. The actual debate focusses on adenotomy or adenotonsillectomy without operating the middle ear as treatment modality in patients with otitis media with effusion. CONCLUSIONS: Economic and social importance of this disease forces further investigations in pathogenesis and optimizing of medical and operative treatment modalities.

Adenoidectomy↗
PubMed2001

[Historical outline on the nomenclature of neck lymph nodes as a basis of neck dissection classification].

BACKGROUND: The neck dissection classification is based considerably on the organization of the lymph nodes of the neck. Terminology and anatomical allocation of nearly 300 cervicofacial lymph nodes repeatedly changed since the beginning of the 20th century. METHODS: Analysis of the literature on neck lymph node organization with reference to the development of the neck dissection classification. RESULTS: The first fundamental nomenclature of the neck lymph nodes is founded on the work of Rouviére (1932). Suárez (1963) described the functional neck dissection on the basis of the fascial compartmentalization of the neck. Lindberg (1972) left the predominantly anatomically correlated grouping of the cervical lymph nodes as described by Rouviére and divided the lymphatic system of the neck on basis of pathophysiological mechanisms. The attention regarding the location of occult metastases led to the description of the selective neck dissection. Since the fundamental work of Shah et al. (1981) there was a multiplicity of more or less slight changes of the neck node regions. These changes were again basis for new neck dissection terminologies. A new classification was introduced in the year 2000 as the revised version of the American Head and Neck Society. CONCLUSIONS: The revised version of the neck dissection classification can reduce former controversies, particularly regarding an optimized intraoperative allocation of the lymph nodes and a simplified terminology of the selective neck dissection. With the goal of a standardization of the neck dissection forms it remains to be seen if the proponents of the functional neck dissection after Suárez consider the extent of the neck dissection in patients with N0 neck in favor of the selective neck dissection.

Anatomy↗
PubMed2001

Value of neck dissection in patients with squamous cell carcinoma of unknown primary.

Lymph node metastases of cancer of an unknown primary (CUP syndrome) are responsible for 3-5% of the malignant diseases in the head and neck area. More than 70% of these patients show lymph node metastases of an unknown squamous cell carcinoma. The survival depends immediately on number and location of lymph node metastases. For a curative approach modified radical neck dissection combined with postoperative radiation therapy with or without chemotherapy should be considered in N1-N3 lymph node status. A radical neck dissection with postoperative radiation therapy should only be approved in cases of infiltration of the internal jugular vein, the accessory nerve and/or the sternocleidomastoid muscle. The different prognosis of patients with upper cervical and lower cervical lymph nodes should influence the indication and the extent of a neck dissection in the contralateral N0 neck.

Carcinoma, Squamous Cell↗
PubMed2001

Intraoperative sentinel node biopsy in patients with squamous cell carcinomas of the head and neck--experiences using a well-type NaI detector for gamma ray spectroscopy.

The sentinel node (SN) biopsy in an actually discussed topic. The use of a well-type NaI detector for gamma ray spectroscopy (WTD) beside the use of a handheld gamma probe (HGP), is investigated. In 18 patients suffering from a head and neck squamous cell carcinoma (HNSCC) with different lymph node status an intraoperative SN biopsy was accomplished with a HGP. 64 separately taken lymph nodes were supplied to an additional measurement in a WTD. A tumor-free SN represented the tumor-free lymph node status in 9 patients. In 5 cases an isolated tumor metastasis could be proven in the SN. SN biopsy has no meaningfullness in cases of advanced metastatic spread ipsilaterally, but possibly in contralateral N0-neck. In 64 separately investigated lymph nodes an activity enrichment could be proven in the WTD. With this procedure small count rates could be determined in contrast to the HGP. The distinction of weakly enriching lymph nodes was less favourable with the HGP but successful with the WTD. The additional use of a WTD offers a more exact distinction of intranodal disintegration rates of the draining lymph nodes. The WTD may increase the security of intraoperative SN biopsy.

Biopsy, Needle↗
PubMed2000

Vascular remodeling and the local delivery of cytochalasin B after coronary angioplasty in humans.

OBJECTIVES: This study sought to determine the safety, feasibility and outcome of local delivery of cytochalasin B at the site of coronary angioplasty. BACKGROUND: Previous failures in the pharmacologic prevention of restenosis may have been related to inadequate dosing at the angioplasty site as a result of systemic drug administration. Alternatively, although previous experimental protocols have typically targeted control of excess tissue growth (intimal hyperplasia), it now appears that overall arterial constriction (vascular remodeling) is the major contributor to late lumen loss. Cytochalasin B inhibits the polymerization of actin and has proved to be a potent inhibitor of vascular remodeling in animal models. METHODS: In this phase I, multicenter, randomized, controlled trial, cytochalasin B (or matching placebo) was administered to the site of a successful balloon angioplasty using a microporous local delivery infusion balloon. RESULTS: The rate of drug delivery at a constant infusion pressure varied significantly from patient to patient (range 1.7 to 20.2 ml/min), perhaps related to a variable constricting effect of the atherosclerotic plaque on the infusion balloon. The minimal stenosis diameter after the procedure was slightly better in the active drug group (1.86 +/- 0.44 vs. 1.49 +/- 0.63 mm, p < 0.03), but this difference was not seen at four to six weeks. Although the study was not powered for clinical outcomes (n = 43), the combined end point (death, nonfatal infarction or repeat revascularization) was encountered in 20% of the patients receiving cytochalasin B and in 38% of the patients receiving placebo. Clinical restenosis occurred in 18% of the treatment group and 22% of the placebo group. There were no significant differences between groups in biochemical or electrocardiographic variables. CONCLUSIONS: Cytochalasin B can be safely administered by local delivery after successful coronary angioplasty and warrants further study of its efficacy in reducing restenosis.

Adult↗
PubMed2000

Functional anatomy of lymphatic vessels under the aspect of tumor invasion.

In the human body there are about 800 lymph nodes, of which 300 are located in the head and neck area. The lymphatic system begins with initial finger-shaped lymphatic vessels consisting of valveless lymphatic capillaries and precollectors with valves. The precollectors become collectors and transport the lymph to the so-called lymph stems. These vessels lead into the right and left lymphatic duct and into the jugular trunk of the head and neck region. At the end they join into the blood circulation at the junction point of the jugular and subclavian veins. On the basis of the morphology of the initial lymphatics, these are probably the main port of entry of tumor cells. Investigations demonstrate the active invasion into the lymphatic system of melanoma cells. The preference of melanoma cells to adhere to the extracellular fibronectin of the endothelial cells may be a reason for the privileged invasion of the melanoma cells in the lymphatic system, because the extracellular matrix is not protected by a continuous basal lamina like blood vessels. Based on the directed movement of melanoma cells towards the fiber felt, there might be regulative mechanisms influencing the process of targeted adhesion.

Endothelium, Lymphatic↗
PubMed2000

[Treatment of the hypertrophic inferior turbinate. 1].

Chronic nasal obstruction is a common disorder, mostly caused by hypertrophied inferior turbinates. If there is inadequate response to conservative medical management, the inferior turbinates should be reduced. The choice of treatment is mainly influenced by whether the nasal airway obstruction is due to hypertrophic mucosa or to an enlarged turbinate bone. The first part of this review describes the various surgical modalities for treatment of swelling of the turbinal mucosa. The indications, advantages, disadvantages, complications, and controversies of each modality (submucous diathermy, cryosurgery, infra-red coagulation, argon-plasma coagulation, radiofrequency, laser surgical techniques) are reviewed and discussed.

Chronic Disease↗