[DRGs in Germany. Significance for ENT medicine].
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Diagnosis-Related Groups↗
Biomedical subjects
K Hörmann
Publications and source records attributed to K Hörmann.
[Serum concentrations of soluble adhesion molecules sICAM-1 and sVCAM-1 in patients with malignant ENT tumors].
BACKGROUND: Adhesion molecules are implicated in various stages of tumor progression and metastasis. Soluble forms of intercellular adhesion molecule-1 (sICAM-1) and vascular cell adhesion molecule-1 (sVCAM-1) were recently described. The aim of this study was to determine a differences in concentration of these molecules in patients with head and neck squamous cell carcinoma (HNSCC) compared to healthy controls. PATIENTS AND METHODS: We investigated the circulating levels of sICAM-1 and sVCAM-1 in sera from patients with various head and neck squamous cell carcinomas (n = 52) as well as from normal, healthy controls (n = 35). Serum concentrations were determined as serum immunoreactivity by using a quantitative sandwich enzyme immunoassay technique. For statistical analysis, the Student's t-test was performed. RESULTS: The majority of the patients with HNSCC were found to have high concentrations of sICAM-1 and sVCAM-1. The mean level of sICAM-1 in patients was 313 ng/ml and in the control group 237 ng/ml (p = 0.0005). The mean level of sVCAM-1 in patients was 624 ng/ml and in the control group 435 ng/ml (p = 0.009). The concentrations of sICAM-1 and sVCAM-1 were significantly higher in HNSCC patients. CONCLUSIONS: These results show the difference in expression of these adhesion molecules in patients with HNSCC compared to healthy controls. Endothelial adhesion molecule determination may find clinical applications in the follow-up of cancer therapy. For this reason, studies incorporating the longitudinal follow-up of patients are required.
Biomarkers, Tumor↗
[Nitinol stent implantation in benign esophagotracheal fistula].
The self-expanding nitinol stent is easy to handle and well tolerated. It offers an improved method in the treatment of perforations of the upper aerodigestive tract. It is easily implantable with rigid and flexible endoscopes. A 45-year-old female patient developed a tracheal necrosis after polytrauma and protracted intubation and ventilation. The permanent cuff pressure caused a 5-cm long fistula located at the posterior trachea 3 cm above the carina. After stabilization of the general condition and spontaneous reduction of the fistula length to 2 cm, we implanted the silicon-covered esophageal stent. Daily bronchoscopic examination was done before and after implantation of the stent. Two days after implantation, we were able to remove the blocked tracheostomy tube. Immediately oral nutrition was possible without complications. Because of its easy and fast application without any complications, the new type of nitinol stent is a promising alternative for ear, nose, and throat patients in bad general condition to provide fast and safe treatment in benign tracheoesophageal fistulas.
Alloys↗
[Follicular dendritic reticulum cell sarcoma in a cervical lymph node].
Follicular dendritic cells (FDC) constitute an essential component of B cell follicles, normally serving as antigen-presenting cells and as cells regulating the germinal center reaction. FDC sarcoma is a very rare tumor. We report the case of a 55-year-old male patient who showed persistent cervical lymph node swelling. On biopsy the tumor consisted of spindle cells with nuclear atypia. Immunophenotypic investigation of the tumor tissue revealed a FDC sarcoma of a cervical lymph node. The tumor cells were characterized immunohistochemically especially by the expression of CD21 and focal expression of CD68. In conclusion, FDC sarcoma has to be considered in cases of tumors of uncertain origin in cervical lymph nodes, tonsils, soft palate, or nasopharynx. For clinical practice, it is important to note that sarcomas in cervical lymph nodes are not necessarily metastases but can be primary tumors.
Biopsy↗
[Tongue base reduction with radiofrequency energy in sleep apnea].
BACKGROUND AND OBJECTIVE: Tongue base reduction with temperature-controlled radiofrequency for the treatment of obstructive sleep apnea syndrome is a minimally invasive technique. Repeated application leads to a progressive shrinking of the tissue. PATIENTS AND METHODS: In our study, we summarize the experiences gained from 100 tongue base reductions and compare them with the pilot study that was recently published. An intensified treatment scheme was used with higher amounts of energy applied per treatment session. Visual analogue scales were used for the assessment of postoperative pain and functional parameters. Regular follow-up visits were scheduled to evaluate postoperative complications. RESULTS: Postoperative pain was mostly mild or moderate. Paraoperative complications were not observed. The overall rate for postoperative complications was 8%, with 2% mild and 5% moderate complications. One severe complication--a tongue base abscedation--was observed. Using para- and postoperative antibiotic prophylaxis reduced the rate of complications. Functional parameters such as taste or swallowing were not affected. CONCLUSIONS: Our results underline the safety of the procedure and demonstrate the minimal para- and postoperative morbidity. The increased amount of energy applied per session has not led to an increase in postoperative morbidity.
Abscess↗
Millet, a potentially life-threatening allergen.
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Allergens↗
[Combined surgical and prosthetic therapy of severe obstructive sleep apnea--a case report].
We report on a 41-year old patient who complained of loud snoring, excessive daytime sleepiness and chronic nasal obstruction. Clinical findings were septal deviation and enlarged turbinates, tonsillar hypertrophy with velar webbing and pharyngeal narrowing. Polysomnography revealed severe obstructive sleep apnoea syndrome with an apnoea-hypopnoea index (AHI) of 51.7/h. As the patient refused nCPAP therapy, we performed septoplasty with conchotomy and an uvulopalatopharyngoplasty with tonsillectomy. Snoring and excessive daytime sleepiness disappeared completely and the AHI decreased to 31.1/h. The mandibular advancement device Snorban was subsequently fitted. We found a complete resolution of OSAS. The AHI was 4.4/h. The postsurgical polysomnographic results were stable two years after surgery. However, the patient discontinued using the oral device as he did not feel any additional benefit when using it. The combination of UPPP and mandibular advancement device can resolve a severe OSAS.
Adult↗
[Modified hyoid suspension for therapy of sleep related breathing disorders. operative technique and complications].
BACKGROUND: : Concerning the therapy of obstructive sleep apnea (OSA) the discrimination between either retropalatal or retrolingual site of obstruction seems to be an oversimplification. Thus modern surgical concepts address both anatomical areas. Minimal invasive surgical techniques treating the soft palate have recently been developed while there is still an ongoing development concerning the base of tongue. METHODS: A less invasive modification of the hyoid suspension to the thyroid cartilage, originally described by Riley, is presented as treatment modality for sleep related breathing disorders. Between October 2000 and March 2001, 14 patients underwent modified hyoid suspension within a multi-level surgery concept. The operative technique manages with only one wire-suture and does not include myotomies and intersection of the ligamenta stylohyoidea. RESULTS: All together 10 male and 4 female subjects with a mean age of 50.9 years were included in the analysis. Preoperatively the mean apnea hypopnea index (AHI) was 18.4. The procedure was well tolerated. Neither increased postoperative pain nor increased requirement of analgetics was observed. Substantial side-effects were one case of seroma and 9 cases of transitory dysphagia. The retrolingual airway space increased significantly after surgery. CONCLUSIONS: These preliminary results are promising. The presented modified hyoid suspension is time-effective and shows less postoperative morbidity. Therefore it might become a suitable treatment modality within the multi-level surgery concept for sleep related breathing disorders.
Adult↗
[Anti-angiogenesis - a therapy concept in the treatment of head and neck carcinomas? A review].
BACKGROUND: Head and neck squamous cell carcinoma (HNSCC) is an aggressive malignancy that is now the sixth most common neoplasm in the world. Despite numerous advances in treatment, the long-term survival has remained the same for the last 25 years. Angiogenesis has been shown to be important for HNSCC tumour growth and metastasis. Therefore, inhibitors of angiogenesis are a new class of anti-neoplastic substances that might be a powerful complement to conventional therapy in HNSCC. MATERIAL AND METHODS: The role of angiogenesis in HNSCC as well as preclinical and clinical trials concerning inhibitors of tumor-angiogenesis are discussed here. RESULTS: Many of the investigated angiogenesis inhibitors demonstrated anti-tumor effects in preclinical and clinical trials. In a few cases, partial remission was observed. CONCLUSIONS: Anti-angiogenic therapy will undoubtly have the potential to change standard tumor therapies. Some anti-angiogenic substances appear to be promising candidates for a clinical use in the therapy of HNSCC.
Adult↗
The phosphodiesterase 4 inhibitor roflumilast is effective in the treatment of allergic rhinitis.
BACKGROUND: The beneficial effects of phosphodiesterase 4 (PDE4) inhibitors in allergic asthma have been shown in previous preclinical and clinical studies. Because allergic rhinitis and asthma share several epidemiologic and pathophysiologic factors, PDE4 inhibitors might also be effective in allergic rhinitis. OBJECTIVE: The main objective of this study was to investigate the efficacy of oral roflumilast (500 microg/day) in allergic rhinitis. METHODS: In a randomized, placebo-controlled, double-blinded, crossover study, 25 subjects (16 male, 9 female; median age, 28 years) with histories of allergic rhinitis but asymptomatic at screening received roflumilast (500 microg once daily) and placebo for 9 days each with a washout period of at least 14 days in between treatment periods. In each of the treatment periods, controlled intranasal allergen provocation with pollen extracts was performed daily beginning the third day of treatment, each time approximately 2 hours after study drug administration. Five and 30 minutes after each allergen provocation, rhinal airflow was measured by means of anterior rhinomanometry and the subjective symptoms obstruction, itching, and rhinorrhea were assessed by means of a standardized visual analog scale. RESULTS: Rhinal airflow improved almost consistently during the 9 days of roflumilast treatment, and it was significantly higher at study day 9 on roflumilast in comparison with placebo, a result also found for itching and rhinorrhea. With respect to the subjective obstruction score, a significant difference in comparison with placebo could be demonstrated within 4 days. CONCLUSION: This study shows that a PDE4 inhibitor, roflumilast, effectively controls symptoms of allergic rhinitis. Thus PDE4 inhibitors might be a future treatment option not only in allergic asthma but also in allergic rhinitis or the combination of the 2 diseases.
3',5'-Cyclic-AMP Phosphodiesterases↗
Tonsillectomy with argon plasma coagulation (APC): evaluation of pain and hemorrhage.
OBJECTIVE: Argon plasma coagulation (APC) offers a new possibility for tonsillectomy (TE) because of its effective hemostasis and limited penetration depth of the coagulation zone. The APC dissector allows dissection and hemostasis in a one-step procedure. The aim of this prospective, randomized, single-blinded study was the evaluation of pain and hemorrhage of the "hot" argon-plasma-coagulation tonsillectomy (TE(APC)) compared with a conventional "cold" non-electrosurgery tonsillectomy (TE(Conv)). METHODS: Two hundred one consecutive patients undergoing tonsillectomy were included in a single-blinded, randomized, prospective study with stratification in two age groups. RESULTS: There was no statistical significant difference between TE(APC) and TE(Conv) in the intensity of postoperative pain and primary or secondary hemorrhage in both age groups. In the TE(APC) group, the mean duration of tonsillectomy was significantly reduced by more than 50% in both age groups (P <.01). The blood loss was 90% decreased in the TE(APC) compared with the TE(Conv) in both age groups (P <.01). CONCLUSIONS: The APC technique does not face the general problem of electrosurgery or thermal coagulation techniques in which the postoperative pain is often increased compared with conventional cold techniques. It offers an innovative new tonsillectomy method with significant reduced blood loss and surgical time.
Child↗
Long-term results of inferior turbinate reduction with argon plasma coagulation.
OBJECTIVES: Surgical reduction of the inferior turbinates is a commonly used therapy in patients with hyperplastic inferior turbinates when medical management remains ineffective. Current surgical methods have disadvantages (e.g., necessity of nasal packing, extended postoperative swelling, and high costs). Theoretical considerations render argon plasma coagulation (APC) a promising new therapeutic approach. STUDY DESIGN: In a prospective study, 121 patients with chronic nasal obstruction were treated for inferior turbinate reduction with APC. Hyperplasia of the nasal turbinates was diagnosed rhinoscopically and endoscopically and confirmed rhinomanometrically. The mean follow-up period was 12 months, ranging from 10 to 16 months. The treatment results were evaluated by a questionnaire, rhinomanometric findings, and electron microscopic studies of the nasal mucosa. In 50 patients a ciliary function test was performed preoperatively and postoperatively. METHODS: Argon plasma coagulation, a high-frequency electrosurgery, has been used for volume reduction of the inferior turbinate in local anesthesia. RESULTS: Seventy-six percent of the patients reported an improvement of the postoperative swelling within the first week. After 6 weeks, macroscopically the turbinates were re-epithelialized by normal mucosa in 63% of the patients. Electron microscopic studies after 3 months verified normal cilia. After 12 months, 83% of the patients stated that they had a better nasal airflow than preoperatively. Crust formation was minimal. No bleeding or impaired ciliary function occurred. Ninety-five percent of the patients were willing to undergo the same operation again. CONCLUSION: The long-term results have proved APC to be an effective and easy-to-perform alternative for inferior turbinate reduction with comparable results to other established surgical methods.
Adolescent↗
The relationship between allelic imbalance on 17p, p53 mutation and p53 overexpression in head and neck cancer.
The huge majority of head and neck squamous cell carcinoma (HNSCC) show alterations of p53 either on the genetic level or on the protein level. Allelic imbalance (AI)/loss of heterozygosity (LOH) on 17p at the p53 locus is frequent in HNSCC. However, the complex relationship between these phenomena is poorly understood in HNSCC. We investigated one group of 39 HNSCC for: a) allelic imbalance on 17p using 4 microsatellite markers located throughout this chromosomal arm; b) mutations of p53 in exons 5-9; and c) overexpression of p53 using two antibodies located on opposite ends of the protein. AI/LOH was detected in 44% at the locus TP53, rising to 69% when regarding all 4 markers on 17p. Therefore, our data are in line with the assumption of additional tumour suppressor genes on 17p in HNSCC. A nuclear accumulation of p53 (51%) was independent from the antibody and the recognised epitope. At the first glance there was no correlation between overall p53 mutation (36%) and overexpression. However, it appeared that, with very few exceptions, only nonsense mutations did not lead to p53 overexpression, while missense mutations did. As overexpression of p53 was 15% more frequent than p53 mutations and only 35% of the tumours with p53 overexpression carried a p53 mutation, our data support the hypothesis of additional mechanisms of p53 overexpression. AI/LOH at the p53 locus in 83% of all tumours with a p53 mutation is in line with Knudson's theory of inactivation of tumour suppressor genes.
Allelic Imbalance↗
Cylindrical cell carcinomas of the paranasal sinuses do not show p53 alterations but loss of heterozygosity at 3p and 17p.
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Carcinoma↗
Delayed anterior ischemic optic neuropathy after neck dissection.
There are only 2 published cases of anterior ischemic optic neuropathy (AION) occurring after neck dissection, to our knowledge. We report a case of bilateral AION following neck dissection, discuss the differential diagnoses, and compare the features of this case with those of previously described cases. There were none of the previously described risk factors for the development of AION after head and neck surgery (eg, hypotension, facial edema, or sudden massive hemorrhage) in this case, but there was prolonged diffuse postoperative bleeding. Also, the symptoms did not arise before the fifth postoperative day as they did in the other cases. Prolonged, mild postoperative bleeding is a risk factor for AION. Visual loss during the entire first postoperative week has to be regarded as a complication of surgery, requires the exclusion of several differential diagnoses, and must not be confounded with the patient's confusion or symptoms of withdrawal.
Adult↗
Expression of basic fibroblast growth factor protein and its down-regulation by interferons in head and neck cancer.
BACKGROUND: Angiogenesis is crucial for tumor growth and metastasis. In several tumors, microvascular density has been shown to correlate with metastasis and aggressiveness. Basic fibroblast growth factor (bFGF) has potent angiogenic activity and has been identified in a wide variety of malignancies including head and neck squamous cell carcinomas (HNSCC). Material and Methods Frozen sections of 50 HNSCC were immunostained for von Willebrand factor and bFGF. Microvessels were counted by light microscopy; bFGF expression was studied at the light and electron microscopic level. Laryngeal cancer cell line HlaC79 was incubated with interferon (IFN) alpha and beta. bFGF quantification was performed by ELISA, and antiproliferative effects were determined by BrdU assay. RESULTS: The mean number of blood vessels (77.5 +/- 23.7) is significantly increased in HNSCC compared with controls (17.1 +/- 5.9). bFGF protein expression was detected in all HNSCC but not in control tissue. An correlation between bFGF expression and mean number of microvessels was found (p <.001). However, no correlation between bFGF expression and the main clinicopathologic features was shown. The long-term exposure (144 hr) of HNSCC cells to noncytostatic concentrations of IFN alpha and beta (>10 U/mL) down-regulated the protein production of bFGF. CONCLUSION: bFGF expression and angiogenesis are enhanced in HNSCC. The higher microvessel density in HNSCC with strong bFGF expression supports the importance of bFGF for tumor angiogenesis. IFN alpha and beta treatment leads to a down-regulation of bFGF expression independent of their antiproliferative effects, suggesting that IFN treatment might result in a reduction of angiogenesis in HNSCC.
Adult↗
[Adenotomy and adenotonsillectomy--useful in recurrent acute otitis media?].
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Adenoids↗
[Tonsillectomy with the argon-plasma-coagulation-raspatorium - a prospective randomized single-blinded study].
BACKGROUND: The Argon-Plasma-Coagulation (APC) offers an innovative possibility for the tonsillectomy combined with a high-frequency technology. Aim of our study was to inves-tigate the differences between this high-frequency-technology and the traditional tonsillectomy. No reports exist in the use of the APC in the tonsillectomy. METHODS: Argon-Plasma-Coagulation tonsillectomy (TE-APC) was compared with the traditional blunt dissection tonsillectomy (TE-trad) with hemostasis by compression and bipolar coagulation. 133 patients were stratified in two age groups in a clinical prospective randomised study. RESULTS: Average surgical time and blood loss were markedly decreased in the TE-APC group (p<0,01). There was no significant difference between the two techniques concerning postoperative pain, otalgia, and primary or secondary haemorrhage. In the TE-APC group more extensive fibrin layer appeared after surgery. In the TE-APC patients' group, there was a slightly higher consume of analgetics in some postoperative days. CONCLUSIONS: The one-step dissection and coagulation procedure leads to an almost bloodfree woundground and to a reduction of operation-time. The self-limited and effective coagualative properties of the APC-method leads to a controlled penetration depth. The often associated extensive post operative pain and uncontrolled tissue- damage, known from electrical and lasersurgical techniques, was not found in TE-APC-patients-group.
Adolescent↗