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Biomedical subjects

J Spaeth

Publications and source records attributed to J Spaeth.

At least 19 recordsLinked to original sources
PubMed2001

Intraoperative radiotherapy for pre-irradiated head and neck cancer.

BACKGROUND AND PURPOSE: Radiotherapy of recurrent head and neck tumours is limited in dose due to pre-treatment up to normal tissue tolerance doses. Surgery alone is limited by the problems related to pre-surgery, post-radiation fibrosis, and infiltration of tumours into nerves and vessels too closely to be completely removed. Our aim was to evaluate the possible role of intraoperative radiotherapy (IORT) in such tumours treated with palliative intent. METHODS: In the last 10 years, we performed 113 intraoperative irradiations in a total of 84 pre-irradiated patients with head and neck cancer. The patient data were evaluated with regard to palliative effect, complications of treatment, recurrence and survival after IORT. RESULTS: Palliation of symptoms, as assessed by clinical evaluation, was achieved in 88% of symptomatic patients, often just by removal of large exophytic or exulcerating tumours, with IORT preventing their immediate recurrence after surgery. The complication rate did not exceed that expected after surgery alone. The median survival after IORT was 6.8 months, with a median time to local tumour recurrence or progression of 3.7 months. CONCLUSION: Intraoperative irradiation can be used as a palliative treatment option in pre-treated head and neck tumours with satisfactory results. With large and infiltrating tumours, however, recurrences or tumour progression occur close to the IORT portals, thus rendering this method unsuitable for achieving long-term control in such extended tumours.

Adult↗
PubMed1997

The paranasal sinuses in CT-imaging: development from birth to age 25.

Available data about the size of the different sinuses to date are derived from anatomical or radiological studies. In order to verify or possibly correct the findings of other authors we evaluated the cranial computed tomography (CT)-images of more than 5600 patients. We measured the sex-linked and age-dependent width and length of the four sinuses for both sides in axial sections. For the first time we have a clear picture of the development of the paranasal sinuses for both sexes from birth until the age of 25 years. Our results confirm general ideas concerning the size of the sinuses. Moreover they provide new details, especially about the first occurrence and the course of development in different stages since we found each sinus already present in 1.5% (frontal sinus) to 94% (ethmoid cells) of the newborn of both sexes. Finally, we can state that the periods of expansion are equal in both sexes (ethmoid cells) or last up to 2 or 3 years longer (frontal sinus) in male patients. In agreement the sinuses of both sexes differ between 5.4% (sphenoid sinus) and 17.1% (frontal sinus) in definitive size with statistically significant differences in later ages. The data about sphenoid sinuses deserve special attention since they show a large variability in size (up to 214% in one direction) as well as in shape.

Adolescent↗
PubMed1997

[Palliative intraoperative irradiation of recurrent neck lymph node metastases in the head and neck area].

BACKGROUND: In the course of a malignant tumor disease, metastases in the regional lymph nodes commonly are linked with poor prognosis. Especially in cases of recurrence after surgery and radiation therapy, curative management of the disease can rarely be achieved. Therefore several palliative treatment modalities have been developed. Intraoperative radiation therapy represents one of them it allows a single high-dose irradiation of a region which, in light of the global tumor disorder, cannot be cured by surgical intervention. METHODS/ PATIENTS: Between 1989 and 1994, 70 patients with recurrent metastases in the head and neck lymph nodes were treated with IORT in the ENT Department of the University Hospital Aachen in collaboration with the Radiation Department. Since some patients were irradiated up to four times, 91 operations (77 under general anesthesia and 14 under local anesthesia) and irradiations were performed. During the procedure each, patient had to be transported twice from the standard operating suite to the radiation unit and back. RESULTS: Regarding the palliative intention of IORT in these cases, we mainly evaluated parameters which had an influence on quality of life of the patients: duration of hospitalization, pain treatment, removal of necrotic tumor mass, and safety of treatment. Depending on the general condition, the patients stayed in the hospital for 3-56 days (median: 10 days). In almost every case, mental and to some extent physical integrity was restored for some time after the disfiguring tumor on the neck had been removed. In nearly 90%, pain treatment could be reduced (e.g., discontinuation of opiate treatment) or further progression could be avoided (74%). Despite the transportation only few complications occurred, which primarily involved healing disturbances (n = 8), fistulas (n = 3), and edemas of the arm (n = 2; after primary treatment of breast cancer). There was no serious infection observed under prophylactic antibiotic treatment in 74% of the cases. Local tumor control (LTC), which only was of minor interest in this treatment group, was possible depending on the extent of tumor resection that could be achieved during the surgical approach: R0 resection = > 50% LTC/R1 resection = > 40% LTC/R2 resection (72.5% of the cases) = > 24.8% LTC. Follow-up of the surviving patients lasted 6-26 months (mean: 14.4 months) but generally did not allow an exact assessment of the time of tumor control. CONCLUSIONS: IORT of recurrent metastases in the head and neck region in our opinion represents an effective alternative for palliative treatment. Important aspects of the patients' quality of life could be improved, and patients were then able to take part in social life again for some time. On the other hand tumor control was not to be expected since in most of the cases only an incomplete tumor resection was achieved. However, the extent of resection substantially affects local tumor control in the head and neck region.

Combined Modality Therapy↗
PubMed1996

[Development of the spheno-ethmoid paranasal sinus system using axial computerized tomography imaging].

BACKGROUND: Exact knowledge of age- and sex-related development of the paranasal sinuses is essential to assess their role in infantile diseases in the midface region. Moreover it helps to minimize the risk in case of therapeutic intervention. METHODS/PATIENTS: On the basis of more than 5600 axial computed tomographic images (CT images) we evaluated the sex-related size (width and length) and evidence of the different sinuses from birth to age 25 focussing on the central part of the paranasal sinuses, the ethmoidal cells, and the sphenoidal sinuses. RESULTS/CONCLUSIONS: The sphenoethmoidal complex is of special interest in early ages since it is already completely developed in newborns (ethmoidal cells: 94% for both sexes) or at least shows a rapid development during the first decade. After age 8, both sinuses are almost regularly represented on CT with identical percentages as an indication of common origin. This is confirmed by only slight differences in size between the two sexes (ethmoidal cells: 5,7 - 10,1%: sphenoid sinuses: 5,4-9,7%) after termination of expansion and by similar periods of expansion (ethmoid cells: until age 10, female, to 14, male and female in length; sphenoidal sinuses: until age 14, female, to 15, male and female) which partly differ from the other sinuses. However, the difference between male and female sinuses is statistically significant primarily at later ages (age 25: length of sphenoidal sinuses: p < 0.0001/width of ethmoidal cells: p = 0.0117/length of ethmoidal cells: p = 0.0072). The definitive size of the ethmoidal cells (male: width 16.4 mm x length 40.7 mm: female: 14.9 mm x 38.5 mm) agrees with the results obtained from anatomic and radiologic studies. In contrast, we found substantial variability in both directions (up to 214%) for the sphenoidal sinuses. Since on almost 60-70% of the CT images the intersphenoidal septum was not represented, we can provide more detailed data about the whole sphenoidal complex (male: width 31.0 mm x length 24.5 mm; female: 29.4 mm x 26.9 mm). In conclusion, our findings agree with the data from other studies using different methods. Moreover we can determine size of the different sinuses at any time between birth and age 25 for both sexes. The ethmoidal cells and the sphenoidal sinuses are highly significant in early infantile paranasal sinus diseases.

Adolescent↗
PubMed1996

Sedation in allergic rhinitis is caused by the condition and not by antihistamine treatment.

Sedation is regarded as a common side-effect of most H1-antihistamines. This view must be accepted, yet can hardly be assessed under treatment of allergic disorders. Since central sedative potency is hard to evaluate, different methods of measurement have been introduced in the four phases of clinical investigation. While tests of high complexity in early trials can detect true central effects, they seem to have the disadvantage of not taking into consideration the important interactions of drugs with the disorder. Therefore, we used a visual analog scale (VAS) as an instrument to demonstrate sedative effects in five clinical studies carried out between 1989 and 1994 with a total number of 1070 patients. Thereby, we could assess the result of the different components of the central interaction. In 1989, in a double-blind, placebo-controlled trial, we could show that the vigilance of patients suffering from seasonal allergic rhinitis increased significantly more under treatment with an antihistamine (mizolastine) than under placebo. From 1992 until 1994, we compared azelastine nasal spray either by the double-dummy technique with oral antihistamines (cetirizine, loratadine, and astemizole) or by the double-dummy or placebo-controlled design with monotherapy or combined therapy with azelastine tablets. A marked or statistically significant improvement of vigilance was found for all compounds (loratadine: P < 0.0001; cetirizine: P < 0.0254; and azelastine nasal spray: P < 0.1409 to P < 0.0001). Even when taking azelastine as oral application, patients, in spite of the warning, reported a similar increase in vigilance (P < 0.2628 to P < 0.0001). Finally, we assessed the range of physiologic vigilance using the same VAS in healthy volunteers. In conclusion, we could prove that in all trials the baseline values of vigilance of untreated symptomatic patients were far below physiologic condition and improved under treatment to the upper range of healthy persons. Therefore, any sedative properties of modern H1-antihistamines should not limit their therapeutic use, since the truly threatening sedation results from the disorder itself.

Arousal↗
PubMed1995

Glenohumeral ligaments and shoulder capsular mechanism: evaluation with MR arthrography.

PURPOSE: To evaluate the efficacy of magnetic resonance (MR) arthrography in identification of the glenohumeral ligaments (GHLs) and to determine the location of abnormalities of the GHL, joint capsule, and labrum. MATERIALS AND METHODS: MR arthrograms were evaluated retrospectively in 46 patients with a history of shoulder instability, impingement syndrome, or pain of unknown cause. Imaging findings were correlated with surgical observations. RESULTS: The superior, middle, and inferior GHLs were identified on MR arthrograms in 39 (85%), 39 (85%), and 42 (91%) of the 46 patients, respectively. In diagnosis of tears of the superior, middle, and inferior GHLs, MR arthrography had a sensitivity of 100%, 89%, and 88% and a specificity of 94%, 88%, and 100%, respectively. CONCLUSION: Findings at MR arthrography can help accurate identification and demonstration of the integrity of the GHL and labrum and can help in staging of abnormalities. The large number of abnormalities depicted in the middle and inferior GHLs suggests that both might be important in the maintenance of glenohumeral joint congruity.

Adult↗
PubMed1994

Cystic degeneration and calcification of muscle: late sequelae of compartment syndrome.

Cystic degeneration and calcification of the leg are uncommon late sequelae of compartment syndrome. Previously reported cases have all involved the anterior compartment of the leg. We present a 68-year-old man with a mass in the superficial posterior compartment of the leg who presented 37 years after the initial trauma and ischemic myonecrosis. MRI was useful in establishing the diagnosis and early surgical intervention. The mass was excised and closed primarily over a drain. Patient was followed up for 29 months, and there were no secondary infections, chronic sinus formation, or recurrences. Based on our experience and the available literature review, we recommend considering either excision and primary closure, or repeated needle aspiration of the mass. Packing the wound and delayed closure may lead to secondary infection, chronic sinus formation, and lower limb amputation as potential complications.

Aged↗
PubMed1993

Detection of hypervascular brown tumors on three-phase bone scan.

A patient with hyperparathyroidism secondary to chronic renal failure had multiple bony lesions with increased activity on both immediate static as well as delayed scintiphotos. One lesion in the distal femur was also exceptionally hot on the flow phase. Plain radiographs demonstrated lytic lesions with sclerotic margins and a narrow zone of transition. Open biopsy revealed histology consistent with brown tumor (osteoclastoma).

Acetabulum↗
PubMed1993

[How badly does the "normal-hearing" young man of 1992 hear in the high frequency range?].

In the course of a clinical study we examined young men believed to have normal hearing. Volunteers with a positive history for noise deafness were excluded from further study. Normal hearing was verified by pure-tone audiometry if the hearing loss did not exceed 15 dB for each test tone between 250 Hz and 8000 Hz. As this limit is far below normative threshold values (DIN ISO 7029) we expected to find a large number of otological normal subjects. Using pure-tone audiometry, ABR and noise exposure, we found that 65% of the young male volunteers (mean age 25 years) did not meet the criteria for audiologic normality. The pure-tone thresholds for these subjects were comparable to the expected levels of their fathers' generation.

Adult↗