Biomedical subjects
Publications and source records attributed to K G Rose.
A series of 51 patients is described who were treated surgically for a Zenker's diverticulum. The surgical techniques available and the results of treatment are discussed. This report emphasises the usefulness of the diverticulofixatio described by Koenig. This was especially useful in elderly patients in poor general condition.
The laryngo-tracheo-oesophageal cleft is marked by a missing anatomical separation of the oesophagus and the larynx. The cleft can be restricted to the dorsal part of the larynx (type I), extend to the upper area of the trachea (type II) or involve the whole of the trachea (type III). In reviewing our three cases and 82 cases in the literature, clinical features, diagnosis, and therapy of this rare condition are presented. The condition leads almost always to life-threatening disturbances in the form of asphyxia and aspiration pneumonia. The diagnosis is made through direct laryngoscopy. Radiological demonstration of swallowing and tracheo-oesophagoscopy are necessary additional investigations. In many cases further severe malformations of organs are found, i.e., oesophageal atresia and tracheo-oesophageal fistulae. Despite early detection the prognosis remains unfavourable with a mortality of 46%. With few exceptions, an early operative correction of the defect is required. Access to the dorsal laryngeal area is achieved usually by a lateral pharyngotomy. Difficulties arise in securing adequate closure of the dorsal larynx, because of lack of sufficient tissue material. Despite secure closure of the laryngo-tracheo-oesophageal cleft, disturbances of swallowing often persist. Development of speech is not impaired.
Swabs were taken from 100 patients suffering from chronic otitis media or mastoiditis before operation to identify bacteria and their sensitivity to antibiotics. Recommendations are made concerning local or general preoperative treatment.
To improve the local rate of success or the conversion of cancers of the cavum oris and of the oropharynx which are inoperable because of their local situation, preoperative radiation is carried out in cases where this is appropriate. The radiation and the radical operation must be coordinated with each other. For this purpose the borders of the cancer are marked by tatooing them with ink. The tatooing makes it possible both to judge the effects of the radiation accurately and to locate the borders of the tumor with the naked eye after radiation treatment in apparently healthy tissues. In this way it is possible to perform the radical operation with an adequate safety margin around the pre-therapeutic borders of the tumor. With this method the rate of success in tongue-body, tongue-ground and tonsil cancers can be improved.
Nearly a half of laryngo-tracheal cicatrical stenoses following long-term intubation are found at the level of the cricoid cartilage. Early and correctly-performed tracheotomy can prevent this complication in almost all cases. The best results of surgical treatment can be expected after transverse partial resection of cricoid and upper trachea or after Réthi's laminotomy. In 14 patients after cricotomy a bone graft from the manubrium sterni was inserted, to separate permanently the free borders of the divided cricoid cartilage. Operative technics and the results of treatment are presented.
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The radio-immuno-assay of the pituitary hormone prolactin represents the basis for a functional differentiation of the so-called chromophobic adenomas. Two thirds of these tumors produce this hormone. For a long period of growth these adenomas are localized in the middle of the sella turcica. Their first direction of growth is towards the sinus sphenoidalis. At the ENT-clinic of the Cologne University two prolactin producing adenomas have been detected as the cause of suspected changes of the sinus sphenoidalis. The need for an endocrinological diagnosis in cases of unknown processes of the sinus sphenoidalis, the indication for surgery, and the medicamental treatment of these tumors with 2-Br-alpha-Ergocriptine (Parlodel) is discussed.
The survival rate of patients suffering from malignant epithelial tumours of the oral cavity and oropharynx remains at present discouragingly low. According to various publications which have appeared in the last few years, it would seem that it is possible to achieve improved results in this field by giving radiation therapy of 40-50 Gy prior to radical surgery. With the application of modern techniques in radiotherapeutics, the incidence of serious post-operative complications in areas of tissue previously irradiated is nowadays very slight. Due to the fact that during radiotherapy the neoplasma either reduces in volume or even disappears completely, its limits must be recorded without fail before treatment is begun. Explanation of the therapeutical concept and initial results.
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If conventional treatment fails, vidian neurectomy is a viable alternative for therapy of chronic rhinitis with recurrent polyposis of the nose and sinuses. From a neuroanatomical point of view beneficial and adverse effects of this surgical procedure are discussed. According to our own investigations and experiences, vidian neurectomy should be performed together with clearing out of the sinuses in every case. Beginning with this precondition a new surgical approach was developed: the vidian nerve is detected through a transethmoidal route in the pterygoid canal at the bottom of the sphenoid sinus and dissected using the operation microscope.
Seventy-five patients with histologically confirmed abnormalities of the facial skeleton and pharynx, including the mouth and base of the tongue, were examined by computer tomography. The advantages of simultaneous demonstration of the soft tissues and bones in localised space-occupying lesions are pointed out. Accurate comparison between pre-operative descriptions and findings at operation in 30 cases showed high diagnostic accuracy. Conventional, multi-dimensional film tomography is being increasingly replaced by computer tomography.
Twentyfour chemodectomas (non-chromaffin paragangliomas) of the neck seen in 20 patients are presented. The investigation including angiography and the surgery in respect to risk factors and preoperative assessment is discussed. The long term results are also presented. Special note is made of the familial incidence since two twin brothers who had bilateral tumours are included.
After isogeneic, allogeneic and allogeneic second-set tracheal transplantations gradually different morphological signs of a chronic host-versus-graft reaction in the wall of the transplants are observed. In no case there was a complete necrosis by rejection evident.
In the first ten days after transplantation isogeneic and allogeneic tracheal transplants keep their epithelium, showing metaplasia as a sign of distinct regenerative activity in this time. In various degrees dependent on the constellation of experiments there are only signs of a weak chronic rejection. After more than 280 days again a stratified epithelium can be seen. In exeptional cases mucosa of second-set-transplants only show an obvious rejection reaction.
An unusual case of Echinococcus cysticus infection of the neck, face and skull is reported. The disease was misdiagnosed for several years as tuberculosis of the lymph nodes and consequently incorrectly treated. Definitive therapy required radical surgery.
Report of gross findings and survival rates in 148 cases of tracheal transplants in and between isogeneic strains of rats. The results imply that the composite graft of tracheal tissue apparently possesses only minor organ specific antigenicity.
Thirteen cases of nasopharyngeal carcinoma (NPC) and 16 cases of non-NPC tumors in the nasopharynx or in adjacent locations were investigated clinically, immunologically, and pathologically. All tumors were classified according to the TNM classification, and the stage and course of the disease was correlated with the histological tumor type, the T- and B-cell distribution in tumor tissue and in the peripheral blood, as well as with antibody titers against Epstein-Barr virus (EBV). The results showed a positive correlation of decreased T- and B-cells in tumor tissue and of decreased T-cells in the peripheral blood with the extend of the tumor in both NPC and non-NPC cases, with some exceptions of lymphocyte rich neoplasms (lymphoepithelial carcinoma and malignant lymphoma). Antibodies against EBV (early antigen and capsid antigen) became progressively elevated with increasing tumor stage in NPC-cases but not in non-NPC cases. The latter, however, was observed only in two histological types of NPC's: anaplastic carcinoma and lymphoepithelial carcinoma; titers in the remaining tumor types stayed insignificant.
In 12 patients with tumorous or chronic-inflammatory diseases of the skull and the skullbase the results of conventional and computer-tomography were compared with the operative findings. The computer-tomography of the most important regions is demonstrated by individual examples. The preliminary results indicate, that computer-tomography is reliable in evaluation of the extend of pathological processes. Therefor follow-up data after treatment were obtained by computer-tomography only.