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Biomedical subjects

Jochen A Werner

Publications and source records attributed to Jochen A Werner.

At least 37 records · Page 2Linked to original sources
PubMed2005

Intraoperative lymphatic mapping in cases of midline squamous cell carcinoma.

OBJECTIVE: To analyze the value of intraoperative lymphatic mapping in cases of midline primary head and neck squamous cell carcinoma (HNSCC) in clinically staged N0 necks. MATERIAL AND METHODS: Eleven patients with HNSCC of the epiglottis (2 T1, 6 T2, 3 T3), all of whom were staged with a neck status of N0 using sonography and CT, underwent intraoperative peritumoral (99m)Tc-nanocoll injection (4 sites; 45 MBq), radiolabeled detection and analysis of up to 3 hot sentinel nodes (SNs) during elective neck dissection. RESULTS: Gamma probe use revealed bi- and unilateral intranodal tracer uptake in 6/11 and 5/11 patients, respectively. In 2/6 patients with bilateral intranodal tracer uptake an SN with an isolated metastasis was found at one neck site while the other four patients were tumor-free in the SNs. Of the five patients with unilateral intranodal tracer uptake, three had radiolabeled SNs containing isolated metastases whereas two had no cancer detected, giving a total occult cancer rate of 45% (5/11). No cancer was found in non-labeled nodes. CONCLUSIONS: Intraoperative lymphatic mapping correctly identified the stage of metastatic disease. Unilateral tracer uptake represented the pathway of occult metastatic spread in 3/5 patients and the disease-free neck status of both neck sites in 2/5 patients. No patient had occult bilateral cancer. Future investigations should be done to determine whether intraoperative lymphoscintigraphy can guide the indication for unilateral only or bilateral neck dissection in these patients.

Aged↗
PubMed2005

Head and neck cancer in the elderly: a cohort study in 40 patients.

INTRODUCTION: In the industrialized nations of the Western hemisphere the age group beyond 75 years will grow steadily, requiring special attention by medical professionals in the future. With regard to these expectations 40 patients, beyond the age of 75 and who were first diagnosed to suffer from squamous cell carcinoma of the upper aerodigestive tract, were analysed. MATERIAL AND METHODS: Forty patients diagnosed and treated between 1998 and 2003 for head and neck squamous cell carcinoma (HNSCC) were analysed. RESULTS: Laryngeal carcinoma was noted in 80% of the patients. All types of treatment were tolerated well. Patient compliance was generally good and the rate of complications was low. CONCLUSION: The results of the present study show that HNSCC in elderly patients should be treated with curative intention. Age itself should never be a sole factor in deciding which curative therapy should be undertaken. Exceptions could be made in patients with severe general comorbidity.

Age Factors↗
PubMed2005

A new instrument for minimal access surgery in cochlear implantation.

OBJECTIVE: Evaluation of usefulness and benefits of a new hand-held retractor for minimal invasive technique in cochlear implantation. SETTING: Tertiary medical center. PATIENTS: : Fourteen consecutive patients (age: 1-83; 4 = female and 10 = male) received a cochlear implant in minimal invasive technique using the new hand-held retractor. INTERVENTION: Standardized operation procedure in minimal invasive technique for cochlear implantation. A short retroauricular incision is used to perform the mastoidectomy with posterior tympanotomy and cochleostomy. RESULTS: The hand-held retractor allows drilling of the bony well for the receiver-stimulator package under direct vision from an anterior position of the surgeon. The sub-periosteal pocket is performed while maintaining continuous suction of irrigating fluids with no further assistance needed. CONCLUSION: With the new retractor, up to 70% of time to create the bony well is saved compared to previously used instrumentation. The retractor might be further useful in different fields of surgery where the operating field needs to be visualized with the integrated suction and light-device under protection of the surrounding tissue.

Adolescent↗
PubMed2005

Treatment considerations for head and neck cancer in the elderly.

As life expectancy increases, surgeons can expect an increasing number of geriatric patients. In turn, the number of elderly patients presenting with head and neck cancer is likely to increase. Management of this subpopulation has become a source of debate because there is a paucity of randomized data regarding the effect of age on treatment response and morbidity associated with the treatment of head and neck cancer. The management of head and neck cancer in the elderly depends on the patient's age and general condition, the stage of disease, the effects of treatment on quality of life (such as speech and swallowing), patient and family wishes, and active physician participation in continued care. Elderly patient's comorbid conditions need appropriate attention especially if surgery is to be undertaken. The aim of this review is to examine the current literature in an attempt to develop an approach to the treatment of the elderly patient with head and neck cancer and to define the pertinent issues that require further study.

Age Factors↗
PubMed2005

Natural history and control of epistaxis in a group of German patients with Rendu-Osler-Weber disease.

INTRODUCTION: Epistaxis is the most common symptom of a complex, genetically determined vasculopathy, which is known under the notion hereditary hemorrhagic telangiectasia (HHT, Rendu-Osler-Weber-syndrome). This study was initiated to gain more knowledge about the natural history of epistaxis in a German HHT-population. PATIENTS AND METHODS: Data of 49 HHT patients were ascertained by interviewing these patients with a standardized disease specific questionnaire. Patients' files were retrospectively reviewed for data concerning age, gender, past medical history, laboratory parameters, number of hospital admissions for epistaxis, conservative and operative types of therapy, treatment results and follow-up. MAIN RESULT: Epistaxis was the first and most prominent symptom in 93% of the patients and could be triggered most frequently by stress. Half of the patients had experienced first episodes of epistaxis in childhood, but usually epistaxis did not become troublesome before the age of 35 years. The effects of hormonal changes or therapies with systemic hormones were inconclusive with regard to impact on epistaxis. Patients with septal perforations had to be admitted for inpatient epistaxis treatment more frequently than patients with an intact nasal septum. An overall reduction of frequency and intensity of epistaxis could be achieved in 89% of the patients through the daily use of nasal lubricants and a minimum of two treatment sessions with the Nd:YAG laser. However in none of the cases the treatment results were permanent. More than 50% of the patients, who had been screened for visceral arteriovenous malformations, were positive for pathologic vascular lesions. PRINCIPAL CONCLUSION: The natural history of epistaxis in German HHT patients is similar to previously described entities from other parts of the world. First clinical signs of HHT may be present at an earlier age than previously thought.

Adolescent↗
PubMed2004

Endoscopic sentinel lymphadenectomy as a new diagnostic approach in the N0 neck.

Sentinel lymphadenectomy was developed to reduce the extent of surgical interventions in cancer patients. The sentinel node (SN) concept was first established for melanoma and breast cancer; within some years, it also became increasingly popular for head and neck cancer. As soon as the required sensitivity of the method proves to be feasible in the daily clinical routine, the discussion about the best surgical approach to single or multiple SN(s) will arise. Different objectives may here compete with each other. The incision should render the best exposure of the operation site and should be expandable in case further lymph node regions have to be dissected. Finally, a good functional as well as a good cosmetic result is desirable. Endoscopic lymph node excisions were performed in patients suffering from squamous cell carcinoma of the upper aerodigestive tract located in different sites (1x uvula, 2x epiglottis, 1x glottis). In preoperatively performed ultrasonic imaging (B-mode-ultrasonography), N0 necks were assessed. In contrast to previously reported endoscopic techniques in humans, the presented method requires no insufflation of carbon dioxide or external retraction of the skin. Following laser surgical resection of the primary tumor, the SN and further lymph node(s) with accumulation of tracer substance were identified and resected endoscopically via an incision that was afterwards extended to a normal neck dissection incision. Reports of histopathologic examination of the sentinel node(s) were compared to the respective neck dissection specimens. The presented method may help to reduce the degree of invasiveness frequently attributed to sentinel lymphadenectomy once the method has been established for head and neck cancer.

Aged↗
PubMed2004

Treatment of benign tracheal stenosis utilizing self-expanding nitinol stents.

We assessed the results of self-expanding metallic stent insertion into benign proximal tracheal stenosis in patients not appropriate or unfit for surgical repair. Proximal benign tracheal stenoses had occurred in 11 patients (7 men, 4 women, mean age 68.8 years) after long-time intubation (n = 6), tracheostomy (n = 4), or chondropathia (n = 1). Fourteen self-expanding nitinol stents were placed in the patients under general anesthesia with endoscopical and fluoroscopical guidance. Stent insertion was successful in all cases and led to immediate relief of the morphological and functional airway obstruction. No immediate complications were noted. During the mean follow-up period of 67.5 weeks we observed one recurrent dyspnea 3 months after implantation and granuloma formation at the stent insertion site in another patient. Both complications were successfully treated with additional stent insertion in one case and laser resection of granulomas in the other. Self-expanding nitinol stents should be considered for the treatment of benign proximal tracheal obstruction in selected patients for whom surgical repair is contraindicated.

Adult↗
PubMed2004

The sentinel node concept in head and neck cancer: solution for the controversies in the N0 neck?

BACKGROUND: The majority of patients with head and neck squamous cell carcinoma (HNSCC) who have a clinical N0 neck undergo neck dissection (ND) even though no lymph node metastases may be detected. With this background, our investigation critically analyzes the value of sentinel lymphadenectomy. METHODS: Ninety patients with HNSCC, all staged with an N0 neck, underwent intraoperative 99mTc-radiolabeled detection of up to three hot nodes (SN1-3) during elective ND and primary site resection. RESULTS: Sentinel lymphadenectomy (SN1-3) detected occult metastatic spread in 20 (22%) of 90 patients, whereas failure occurred in three of 90 patients. Metastatic spread was directed to level II in the majority (66.7%) of cases. If only the SN1 had been examined, the procedure would have failed in nine (39%) of 23 patients. CONCLUSION: Sentinel lymphadenectomy correctly identified the stage of metastatic disease in 97% of patients in cases in which up to three sentinel nodes were identified. If only the lymph node with the highest tracer activity had been excised, 39% of cancer-positive necks would have been missed. Selective ND identified metastatic disease in the additional 3% of patients.

Carcinoma, Squamous Cell↗
PubMed2004

Value of sentinel lymphadenectomy in head and neck cancer.

The increasing interest in the so-called sentinel node concept, which has recently been adapted to squamous cell carcinomas of the upper aerodigestive tract, can be explained by encouraging results in other tumor entities. Although the publications on this topic do not yet allow a final judgment on the significance of sentinel lymphadenectomy in head and neck squamous cell carcinoma, early results emphasize the importance of this new diagnostic and therapeutic concept. The basic prerequisite is a detailed knowledge of the existing method-specific limitations in this anatomic region. Critical and careful evaluation of the sentinel node concept is mandatory prior to its application to other tumor entities. Sentinel lymphadenectomy for head and neck cancer may prove helpful if the indications for its use are clearly defined.

Carcinoma, Squamous Cell↗
PubMed2004

Effectiveness of radiochemotherapy on lymph node metastases in patients with stage IV oropharyngeal cancer.

Radiochemotherapy plays a leading role in the treatment of patients with advanced squamous cell carcinomas (SCC) of the oropharynx. The aim of the present study was to estimate its effectiveness on lymph node (LN) metastases. Seventeen patients with advanced UICC stage IV oropharyngeal SCC (1xT2, 4xT3, 12xT4, 2xN1, 15xN2) were observed prospectively. They were treated with radiochemotherapy (total radiation doses 60-70.6 Gy). One to four months after neck dissection (ND) was performed. Specimens were histologically examined for metastases according to the neck levels obtained from. Local control was achieved in 14/17 (82.4%) patients and regional-in 10/17 (58.8%) patients. Of 566 LN studied, 29 exhibited signs of involvement. Two from 29 were found in neck level I, 20/29 in II, 6/29 in III and 1/29 in IV. In 13/29 LN the metastases had completely regressed under treatment whereas 16/29 LN (7 patients) contained vital tumoral tissue. The observed high incidence of vital LN metastases, which abide the radiochemotherapy, advocates further studies, concerning the value of planed ND after radiochemotherapy.

Adult↗
PubMed2004

Characterization of lymphoid infiltrates in chronic obstructive sialadenitis associated with sialolithiasis.

BACKGROUND: Chronic obstructive sialadenitis is characterized by acinar atrophy, lymphocytic infiltrates and progressive fibrosis. The immunological mechanisms involved in the pathogenesis of this disease are, for the most part, unknown. The aim of the present study was to characterize the lymphocytic infiltrates in chronic obstructive sialadenitis associated with sialolithiasis. METHODS: Paraffin-embedded tissue samples from 23 affected submandibular glands were immunostained for T-cells (CD3, CD4, CD8), cytotoxic T-cells (granzyme B), B-cells (CD20), plasma cells (CD38) and macrophages (Ki-M1P). RESULTS: CD4-positive subsets were the predominant cells, and they were located mainly periductally. Isolated intraepithelial CD8-positive cytotoxic T-cells associated with ductal epithelial cell destruction were observed in all cases. B lymphocytes were restricted to lymphoid follicles located periductally and around intralobular ducts. In early stages of the disease, a large number of CD38-positive plasma cells were distributed diffusely in the periacinar area. With progression of the disease, conspicuous clusters of plasma cells were located especially between atrophic acini adjacent to fibrotic tissue. An intimate relation between the lymphocytic infiltrates and the ductal epithelium, the target of the inflammatory process, was observed. CONCLUSION: The composition and distribution of inflammatory cells suggest that intraepithelial infectious agents may be the cause of the inflammatory reaction and the progressive fibrosis in this disease.

Bacterial Infections↗
PubMed2004

The lymphatic system of the major head and neck glands in rats.

Many studies concerning therapy and also investigations on lymphogenic metastatic spread of head and neck malignancies require animal models. This article completes the existing findings with regard to the lymphatic system of the head and neck region of the rat. Investigations (light microscopy, immuno-histochemistry, enzyme histochemistry, lympho-graphy) on architecture, distribution and density of the intraglandular lymphatic flow of the major head and neck glands (infraorbital lacrimal gland, extraorbital lacrimal gland, Harderian gland, parotid gland, major sublingual gland, mandibular gland and thyroid gland) in rats were performed. Architecture of the seven major head and neck glands in rats do not differ from other regions of the upper aerodigestive tract. While the Harderian gland shows the highest density of lymphatics, within the major sublingual gland only scare lymph vessels could be identified. Distribution and density of initial lymphatics influence directly the transmission of inflammatory and malignant diseases. The presented results are the morphologically and anatomically basis to initiate further investigations in the rat animal model emphasizing special questions concerning the lymphatic system of the major head and neck glands e.g. lymphatic drainage and new treatment concepts in cases of lymphogenic metastatic spread.

Animals↗
PubMed2004

Chlamydia pneumoniae IgA seropositivity and sudden sensorineural hearing loss.

A prospective study was designed to evaluate a possible role of an endured infection with Chlamydia pneumoniae or Chlamydia trachomatis as a cause for sudden sensorineural hearing loss. For this in 60 patients with a first episode of a sensorineural hearing loss and-60 sex-matched and aged-matched controls, following a complete otoneurological diagnosis blood tests for IgA, IgM and IgG with regard to Chlamydia pneumoniae and trachomatis were evaluated. We found a statistically significant higher prevalence of IgA positivity of Chlamydia pneumoniae in patients with sudden sensorineural hearing loss (chi2-test, p < 0.017). For this, Chlamydia pneumoniae may be a possible cause for sudden sensorineural hearing loss. A targeted antibiotic therapy, as it has been discussed for myocardial infarction, might possibly open an additional treatment option for sudden sensorineural hearing loss.

Adolescent↗
PubMed2003

The value of screening for multiple arterio-venous malformations in hereditary hemorrhagic telangiectasia: a diagnostic study.

Occult visceral arterio-venous malformations (AVMs) may be a constant threat to patients suffering from hereditary hemorrhagic telangiectasia (HHT), also known as Rendu-Osler-Weber syndrome (M. ROW). HHT patients predominantly become symptomatic through chronic, recurrent epistaxis, a symptom that can alert physicians at an early stage of the disease. The purpose of this study was to investigate whether occult, visceral arterio-venous malformations could be detected by screening imaging studies in patients suffering from HHT. In a comprehensive diagnostic study, Rendu-Osler-Weber patients were examined for potential visceral arterio-venous malformations by physical examination and non-invasive imaging techniques. The Department of Otolaryngology of the Philipps University of Marburg is a major referral center and coordinated the screening procedures. Thirty-five individuals with the presumed diagnosis of HHT gave informed consent to the screening investigations. Eighteen of 35 individuals were found to suffer from visceral vascular malformations; most of the AVMs were diagnosed in the lung, but also the liver, spleen, brain and eyes were affected. Six patients could be treated preventively by arterial embolization for AVMs of the lung, liver and brain. Comprehensive screening for occult AVMs in HHT patients seems to be justified to avert potential complications in this group of patients.

Adolescent↗
PubMed2003

Functional anatomy of the lymphatic drainage system of the upper aerodigestive tract and its role in metastasis of squamous cell carcinoma.

BACKGROUND: Although there is a significant understanding of the vascular anatomy of the upper aerodigestive tract (UADT), there is less detailed knowledge of the architecture and drainage patterns of the lymphatic system. Detailed knowledge of the lymphatic system is critical for understanding the role of sentinal node identification in the management of different cancers. METHODS: We have combined microscopic techniques with in vivo and in vitro lymphographic studies to survey the architecture and drainage patterns of the lymphatic system of the UADT in 850 organ specimens. RESULTS: These studies show an interaction of superficial and deep lymphatic networks that vary in density but have a constant distribution characterized by predictable patterns of lymph drainage into the regional lymph nodes. CONCLUSIONS: Detailed knowledge of the lymphatic system of the UADT contributes to a better understanding of the patterns of metastatic spread of carcinomas of the UADT and provides a strong rationale for the practice of sentinel node identification in the management of these tumors.

Carcinoma, Squamous Cell↗
PubMed2003

Value of endotracheal tube safety in laryngeal laser surgery.

BACKGROUND AND OBJECTIVES: Due to the increased popularity of laryngeal laser therapy, surgeons and anesthesiologists are inevitably confronted with questions concerning the choice of the most efficient endotracheal tube (ETT) for laryngeal laser surgery, especially with regard to possible endolaryngeal tube fires, or combustions. The purpose of this study was to determine the current practice in endolaryngeal laser surgery in Germany. STUDY DESIGN/MATERIALS AND METHODS: A questionnaire was sent to 152 ENT Departments in Germany, care was taken that the responders could send back the questionnaire anonymously. Among other questions the participants were asked for the number of lasersurgical treatments of the larynx performed in the past, the usual type of ETTs in use, whether other safety precautions were taken during CO2 laser surgery of the larynx and for intraoperative complications like tube ignition, fires or combustions. RESULTS: Eighty six of the 152 addressed ENT departments replied. In laryngeal laser surgery, 59/86 departments regularly use special laser tubes in daily routine (74.5%). In about 20,000 lasersurgical procedures, 15 incidents of ETT fire have been reported. In six of the reported 15 cases a tube fire occurred despite the fact that special laser tubes had been utilized. CONCLUSIONS: The present study could demonstrate that the use of special laser tubes does not necessarily protect against ETT fire. Thus, even when using special laser tubes other safety measures should be taken. In view of the maximum safety for the patient it has to be stated, that the safety during surgery correlates definitely with the experience of the surgeon. The weakest point of ETTs is usually situated in the cuff region.

Humans↗
PubMed2003

Transforming growth factor beta in chronic obstructive sialadenitis of human submandibular gland.

BACKGROUND: The exact pathomechanism of inflammation progress and fibrosis in chronic obstructive sialadenitis is unknown. The aim of the present study was to assess whether there is an association between transforming growth factor beta (TGF-beta) and fibrogenic process of chronic sialadenitis. METHODS: Tissue samples of 12 patients with chronic sialadenitis and 4 normal tissue samples of the submandibular gland were examined immunohistochemically for identification of TGF-beta. TGF-beta1 messenger RNA (mRNA) expression was analysed semiquantitatively using reverse transcription polymerase chain reaction and gel electrophoresis to correlate its expression levels with stages of the disease. RESULTS: TGF-beta positive cells could be found in the secretory duct system of all examined samples. However, an intense TGF-beta immunoreactivity was observed in inflamed salivary glands. With progress of disease TGF-beta1 mRNA expression increases significantly. CONCLUSION: Expression of TGF-beta in chronic sialadenitis and its apparent increase in advanced stages of the disease, suggests that this growth factor may play a role in glandular fibrosis.

Chronic Disease↗