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Biomedical subjects

K Hörmann

Publications and source records attributed to K Hörmann.

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

[Diagnosis and treatment of insect venom allergy. An important allergic issue for the ear, nose and throat specialist].

The increasing incidence and the potentially life-threatening reactions to venom stings indicate the necessity for otolaryngologists to have a basic knowledge of the diagnosis and treatment of venom allergy. The diagnosis of insect venom allergy is based on the history, skin prick testing (ideally performed as a titration series), and in vitro analysis of specific IgE antibodies to venoms. An emergency medication kit should be prescribed for the patient in case of future venom stings, comprising an H1-blocking antihistamine, a steroid and an adrenaline pen for self-injection. Subcutaneous allergen-specific immunotherapy (sSIT) is the standard treatment to avoid allergic reactions following venom stings in the future. SIT is indicated following all immediate-type reactions to venom stings; contraindications relate to the general recommendations of allergen-specific immunotherapy. Aqueous as well as alum-adsorbed depot allergen preparations can be used for subcutaneous injections. The important dose-increase phase can be performed using conventional, cluster, rush or ultra-rush schedules. Specific immunotherapy is successful in nearly 90% to 100% of patients after 3-5 years of treatment.

Arthropod Venoms↗
PubMed2005

[Plastic surgery of skin defects in the face. Principles and perspectives].

The difficulties in facial reconstruction derive from the unique character of the face and the availability of local matching tissues. Facial reconstructive surgery must aim at a functionally and aesthetically rehabilitated patient. The performance of facial plastic surgery requires an understanding and the application of many important principles. The aim of this paper is to review the critical factors to be considered in the management of surgical wounds by second-intention healing, primary closure, skin grafting, and repair with local or distant free flaps. The key concepts useful in flap choice and implementation are discussed. In addition, an overview of new developments in tissue engineering and gene therapy as they relate to facial plastic surgery is provided.

Face↗
PubMed2005

[Tonsillotomy with the argon-supported monopolar needle--first clinical results].

BACKGROUND: Primary management of tonsillar hyperplasia in children is tonsillectomy. Recent data from clinical case-series are clearly in support of the hypothesis that tonsillotomy with the CO2-laser seems to be effective and is noted to have less postoperative bleeding and less pain as compared to tonsillectomy. For the first time we used a monopolar argon-supported needle for tonsillotomy in the following study. METHODS: Fifty patients (age: 4.58 years; SD +/- 2.33) with benign tonsillar hyperplasia were recruited. For tonsillotomy we used the monopolar argon-supported needle. The outcome measures were postoperative pain, capability of oral intake, consumption of analgesics and postoperative bleeding. RESULTS: No postoperative bleeding occurred. Post-operative pain hardly occurred and could easily be controlled. The third postoperative day analgesics intake was under one portion per day (mean: 0.91; SD +/- 1.26). Capability of oral intake and swallowing was normal on the seventh postoperative day. CONCLUSION: It was concluded that tonsillotomy, using the monopolar argon-supported needle, is a valid treatment for benign tonsillar hyperplasia in children, which can be performed with slight post-operative pain and a low risk for postoperative bleeding. It offers good dissection and haemostasis abilities. Compared to the CO2-laser the monopolar argon-supported needle does not require any laser safety precautions.

Child↗
PubMed2005

[Finding the appropriate therapy with the help of sleep endoscopy].

Nasal continuous positive airway pressure (nCPAP) ventilation is the gold standard in the treatment of obstructive sleep apnea (OSA). For patients with CPAP-intolerance and for those tolerating the CPAP-mask but without success, surgical strategies are of growing interest. There are several surgical concepts which combine different surgical procedures on both the velopharyngeal and the retro-lingual section of the upper airway. The case presented here describes the failed CPAP-therapy in an OSAS-patient who tolerates the CPAP-mask. The apneas and hypopnoes could not be reduced by using the CPAP-mask, even more they increased under CPAP-ventilation. Performing a video-documented sleep-endoscopy of the upper airway (under physiological sleep patterns) the location of the obstruction could be identified. After performing a hyoid suspension in combination with a radiofrequency therapy of the base of tongue the apneas and hypopneas decreased. Only by using the sleep endoscopy the reason for the failed CPAP-therapy could be identified and therefore the surgical protocol succeed. To what extend the sleep video endoscopy becomes a standardized procedure in sleep labs warrants further investigations.

Aged↗
PubMed2005

[Physiology, role and neuropharmacology of yawning].

Yawning is a physiological event that can be divided into three distinct phases: a long inspiratory phase, a brief acme and a rapid exspiration. The reason for yawning is not yet well defined. However this semi-voluntary event increases vigilance and aims to alert when drowsiness occurs. Yawning may have an important role for social communication. The neuropharmacology of yawning is complex and knowledge of its mechanisms is incomplete. While under the control of several neurotransmitters, yawning is largely affected by dopamine. Dopamine may activate oxytocin production in the paraventricular nucleus of the hypothalamus, oxytocin may then activate cholinergic neurotransmission in the hippocampus, and finally acetylcholine might induce yawning via the muscarinic receptors of the effectors. In fact, this scheme is simplified. Many other molecules can modulate yawning, such as nitric oxide, glutamate, GABA, serotonin, ACTH, MSH, sexual hormones and opium derivate peptides.

Acetylcholine↗
PubMed2004

[Effect of high frequency application on the tongue base. In vitro results of "radiofrequency application" on the porcine tongue base].

BACKGROUND AND OBJECTIVE: A newly developed radio-frequency monopolar needle electrode was evaluated in vitro on porcine tongues. PATIENTS AND METHODS: Porcine tongues with different tissue temperatures (20+/-1) degrees C and (32+/-2) degrees C were coagulated for 90 s. In a second step, 23 coagulations at 7 W were applied (34+/-2) degrees C. RESULTS: The volume of the lesion correlated well with increasing temperature. In step two, the mean energy was 238 J and the mean volume of the lesion was 507 mm(3) (100+/-15)%. Prolonged energy application did not correlate with a larger volume of the lesion. CONCLUSION: The new radio-frequency needle electrode can reduce tongue volume in a precise and controlled manner (SD+/-15%).

Animals↗
PubMed2004

[Type I hypersensitivity to a silicone tube after laryngectomy].

While irritation of the tracheal mucosa is a common finding after laryngectomy, specific hypersensitivity to tracheal tubes or their components is extremely rare and has only been documented as a contact allergy. In this case report, we present type I hypersensitivity to tracheal tube components for the first time. The patient regularly used a special silicone tube for swimming after laryngectomy and complained about increasing tracheal irritation during and after the use of this tube. A standard skin prick test with common aeroallergens and a skin patch test with standard, rubber and adhesive allergens as well as with parts of the silicone tube was performed. Different parts of the tracheal tube were also tested with a scratch test. Total IgE as well as specific IgE for latex allergens was measured. Both skin prick and patch tests were negative. No specific IgE for latex allergens was detected. The scratch test generated strongly positive reactions against native tube material. The positive findings in the skin tests demonstrate specific hypersensitivity to the tracheal tube or its components in terms of a type I hypersensitivity. The causative component remains unclear.

Carcinoma, Squamous Cell↗
PubMed2004

[Intensity modulated radiotherapy (IMRT) of head and neck tumors. Increased biological effectiveness in high-risk situations by "integrated boost" therapy].

Primary tumors of the paranasal sinuses are rare entities which, because of precarious localization and frequently diffuse propagation into neighbouring cavities and the skull base, pose a significant therapeutic problem. Even after complete surgical resection, local relapses are frequent. Postoperative radiotherapy is therefore usually indicated. Intensity modulated radiotherapy (IMRT) is a new technique that helps creating dose distributions that conform closely to the target volume while maximally sparing the organs at risk. This results in the possibility of applying escalated doses to the target while still keeping the incidence of side effects low. What is especially appealing is the possibility of shaping the dose distribution within the target in such a way that areas with a presumably high tumor cell load receive increased doses, a concept which is best described by the term "integrated boost". We present the case of a patient with a sinunasal carcinoma and describe the implications of the clinical implementation of this technique.

Biopsy↗
PubMed2004

[Alcohol related diseases of the head and neck].

Chronic consumption of alcohol is an accepted social custom worldwide. In the upper aerodigestive tract, local morphologic, metabolic and functional alterations can be present due such consumption. Gastroesophageal reflux or alterations in sleep structure are typical examples of functional disorders. While alcohol was initially described as a risk enhancer only in smokers, a number of epidemiological studies have now shown that chronic alcohol consumption increases the risk of head and neck cancer independently of exposure to tobacco smoke. In addition, alcohol leads to an accumulation of pathologic microbes within the mucosa, leading to chronic infection. Susceptibility to carcinogens and cell proliferation in the mucosa are increased, resulting in genetic changes with the development of dysplasia, leucoplakia and carcinoma. Chronic alcohol consumption is correlated with an increased risk of cancer and increased mortality in a dose-dependent relationship. A number of biologically plausible mechanisms exist by which alcohol may cause cancer.

Alcoholism↗
PubMed2004

[Cell adhesion proteins in external auditory canal cholesteatoma].

BACKGROUND: External auditory canal cholesteatoma (EACC) is a rare entity in otolaryngology, which is histomorphologically identical with middle ear cholesteatoma. The cause of EACCt is, however, still not clear. The aim of this study was to describe the expression of beta-catenin, MMP-2, and MMP-9 in EACC matrix compared to the normal auditory meatal skin (AMS). METHODS: Thirteen specimens were obtained during surgical procedure. EACC and AMS specimens were immunostained with antibodies for beta-catenin, MMP-2, and MMP-9. RESULTS: Only the basal layers of the EACC specimens were positive for beta-catenin. The suprabasal layers showed diminished or negative immunostaining for beta-catenin. In all layers, AMS was homogeneously positive for beta-catenin. In contrast, the immunostaining for the gelatinases was equally increased in all layers of EACC, whereas AMS was weekly positive. CONCLUSION: The reduced immunoreactivity for beta-catenin may have been present because of the lessened cell-cell adhesion in the suprabasal layers of EACC. The increased expression of the metalloproteinases might point at an increased lack of integrity of EACC matrix. Recent studies revealed a balance between disintegrating and stabilising factors in normal tissue, which is disturbed in inflamed and neoplastic tissue. In EACC matrix, an imbalance of these factors, represented by reduced beta-catenin and increased gelatinase expression, is possible. Increased desquamation, the accumulation of keratin debris, and loss of tissue-stability support our findings.

Adult↗
PubMed2004

[Snoring/sleep apnea--surgically curable].

INTRODUCTION: Obstructive sleep apnea (OSA) is characterized by nocturnal collapsing of the upper airways. Nasal continuous positive airway pressure (nCPAP) ventilation is the gold standard in the treatment of obstructive sleep apnea syndrome (OSAS). Long-term compliance rates do not exceed more than 60 to 70%. Alternative multi-level surgeries are of interest, combining procedures at the level of the base of tongue and the soft palate in order to stabilize the airway. Preliminary results suggested the hyoid suspension as one part of the multi-level surgery concept to be of high effectiveness. Therefore this study investigated the outcome of the hyoid suspension and compared it with the CPAP therapy. METHODS: Between March 2001 and February 2003, 66 patients with OSA were treated with a hyoid suspension in combination with surgeries at the base of tongue, the soft palate or the nose (always performed by the same surgeon). All patients underwent a pre- and postoperative polysomnography in the sleep lab. Daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS). Mean age was 52,1 years, the mean body mass index (BMI) was 28,04 kg/m(2). RESULTS: The mean apnea-hypopnea-index (AHI) was 38,9121,10/h before operation and 19,25+/-19,64/h after operation (p<0,0001). More statistically significant changes were found for the arousal index, the oxygen saturation and the ESS (p<0,05). After surgery 57,6% of the subjects (38/66) were regarded as cured (reduction of AHI > or =50% and below 15/h). Another 21,2% (14/66) improved (reduction of AHI >20%). Altogether 78,8% of the patients were counted as responders. CONCLUSION: Multi-level surgeries based on the hyoid suspension show the effectiveness of this concept. This surgical strategy could be equal to the CPAP mask, especially in cases of CPAP intolerance.

Adult↗
PubMed2004

[Specific immunotherapy in inhalative allergy to rat epithelium].

BACKGROUND: The only causal treatment that can be offered to allergic patients apart from allergen avoidance is specific immunotherapy. Its efficacy depends on the specific allergen the patient is allergic to, the quality of the extract, the total amount of allergen administered to the patient and the administration schedule. METHODS AND PATIENT: Our patient suffered from inhalative allergy to rat epithelium with severe rhinoconjunctivitis and bronchial asthma. She regularly worked with laboratory rats as a biologist. A job-shift was impossible for the patient, and so was allergen avoidance. We therefore decided to treat the patient with specific immunotherapy. Treatment was performed as in-patient procedure with Rush-Immunotherapy in dosage increase phase. Maintenance injections were administered as out-patient. RESULTS: As early as some months after induction of the therapy, the patient felt subjective symptom relief, blood samples taken revealed decrease of total IgE and specific IgE towards rat epithelium. Therapy was continued for 18 months, specific IgE against rat epithelium could not be detected any more. The patient does not claim any allergy symptoms when working in the rat laboratory any more. CONCLUSIONS: Even in unusual allergies, specific immunotherapy can be indicated. In our patient, specific immunotherapy to rat epithelium lead to complete symptom relief and enabled the patient to practise her profession without restraints.

Adult↗
PubMed2004

[Multi-level surgery for obstructive sleep apnea. Preliminary objective results].

BACKGROUND: Nasal continuous positive airway pressure (nCPAP) ventilation is the gold standard in the treatment of obstructive sleep apnea (OSA). Unfortunately nCPAP does not exceed long-term compliance rates of much more than 60 percent. Therefore, surgical strategies are of growing interest in this field. Today, so called multi-level surgeries are favored which combine at least one surgical procedure on both the velopharyngeal and the retrolingual section of the upper airway. The Mannheim concept combines at least one surgical procedure to the soft palate (UPPP or Uvulaflap) inclusive tonsillectomy and a hyoid suspension and/or a radiofrequency procedure on the base of tongue. METHODS: In between July 2000 and February 2003, 139 patients with OSA were included in the protocol. By now 46 patients finished the follow-up. Mean age was 51.9 years, the mean body mass index was 28.5 kg m (- 2). All patients underwent as well preoperatively as postoperatively a fully attended polysomnography in the sleep lab using standard criteria. Daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS). RESULTS: Before surgery the mean apnea-hypopnea-index (AHI) was 36.5 +/- 22.2, the mean ESS score was 10.4. Postoperatively the mean AHI decreased to 24.9 +/- 21.6 (p < 0.01) and the mean ESS score to 7.1 (p < 0.05). After surgery 39.1 % of the subjects were regarded as cured (reduction of AHI > or = 50 % and below 15). Another 30.4 % were substantially improved (reduction of AHI > 20 %). Altogether 69.6 % of the patients were counted as responders. Cure rates decreased with increasing AHI and BMI. The hyoid suspension showed a positive effect on the treatment success. CONCLUSIONS: The presented concept shows inferior success rates than other more invasive concepts. This might be due to the abandonment of the mandibular osteotomy with genioglossus advancement.

Adult↗
PubMed2004

[Principals of high frequency surgery].

Electrosurgical instruments are routinely and daily applied at a variety of indications in Otorhinolaryngology. They can be used for cutting, coagulation and devitalisation. All have in common that the high frequency energy is transported into the tissue via an instrument and by this causes a thermal change. Depending on the duration and characteristic of the electricity a vaporisation of the tissue is effected through coagulation, devitalisation and carbonisation. The knowledge of the effects on the tissue by the choice of the different instrument parameters and application systems is essential for an ingenious therapeutically indication. In principal the following application methods for electrosurgery by modulation of the high frequency parameters are distinguished: the monopolar and the bipolar coagulation and devitalisation and the monopolar and the bipolar cutting. This article deals with the physical basis, the effects in the tissue as well as the single application methods of the high frequency surgery.

Electrocoagulation↗