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Biomedical subjects

K W Delank

Publications and source records attributed to K W Delank.

At least 19 recordsLinked to original sources
PubMed1999

[Infection frequency and type of bacteria after tympanostomy tube drainage in childhood: gilded-silver tubes versus silicone tubes].

Otorrhea is the most common complication after tympanostomy tube insertions. In Germany there are currently two commonly used types of tympanostomy tubes: silicon tubes (ST) and gilded silver tubes (GT). Previously published in vitro studies by Tajima uncovered a positive correlation between the silicon concentration in culture fluid and the rate of growth of Staphylococcus aureus. Our study retrospectively evaluates the types of bacteria and rates of otorrhea after ST and GT insertions. The present study was undertaken to determine which of these tubes had a higher incidence of otorrhea and then whether silicon tubes stimulated the growth of certain types of bacteria, such as Staphylococcus aureus. In all, 186 ST and 59 GT were placed in 245 ears of 144 children. Both ST and GT were separated into three groups: first insertion of a tympanostomy tube, second implantation and insertion of a tympanostomy tube in an infected ear in the course of a mastoidectomy. No differences between ST and GT in causing otorrhea were found in the three groups. Nevertheless, ST in comparison to GT was associated with a higher incidence of infections with Pseudomonas aeruginosa. In contrast, a higher incidence of Staphylococcus aureus related to ST could not be proved. Twenty percent of the ears with mastoiditis were found to have Pseudomonas aeruginosa, but none of these ears implanted with a GT developed postoperative otorrhea. Our findings show that GT should be used when a ventilation tube is used during a mastoidectomy. Further, it is tenable to implant only GT because postoperative otorrhea in many cases is caused by insufficient water protection and water is frequently polluted with Pseudomonas aeruginosa.

Bacteria↗
PubMed1999

[Nasal T-cell lymphoma as a differential diagnosis of the midline granuloma syndrome].

BACKGROUND: The lethal midline granuloma is a heterogeneous disorder and the pathogenesis is likely to be complex. Advances in immunocytochemical phenotyping and molecular genetics suggest that in several cases the origin have been proven to be malignant lymphomas, especially of T-cell lineage. PATIENT: The present clinical and pathological cases of a 35-year-old woman shows how difficult it is to establish the precise diagnosis of lethal midline granuloma (LMG). The patient presented with recurrent infections of the paranasal sinuses. Later she developed infiltrates and ulcerous lesions of the nose, paranasal sinuses, and the base of the skull clinically consistent with a LMG. Immunohistologic studies using monoclonal antibodies led to the positive diagnosis of peripheral lymphoma of T-cells. RESULTS: Several surgical interventions and explorations revealed a diffuse infiltration and partly necrotic lesions of the tissue. After identification of a T-cell lymphoma by histological examination, the patient received megavoltage irradiation of 45 Gy. Additional chemotherapy with alkylating agents was given. Two years after treatment the patient achieved and remained in remission. CONCLUSION: The midline granuloma syndrome is a mutilating process produced by a number of diseases that progressively destroy the nose, paranasal sinuses and other regions of the midface. Infectious, neoplastic and idiopathic forms have been described. The specific diagnosis must be ascertained, as the treatment is different depending of the etiology of the disease. Sinonasal lymphomas constitute a important distinct clinicopathologic entity which may present as lethal midline granuloma. They seems to be strongly associated with Epstein-Barr virus. Aggressive therapy with radiotherapy and chemotherapy can stop the progress of the midfacial destruction. The correct treatment is still discussed controversially.

Adult↗
PubMed1998

[Aneurysmal hemorrhage as a complication of paracentesis].

Aneurysms of the temporal part of the carotid artery are unusually rare. The literature contains only a few previous reports dealing with hemorrhage from such malformations. In the present case massive bleeding occurred from a right-sided intrapetrous aneurym after myringotomy, which was performed as treatment for bilateral secretory otitis media. Due to the absence of any specific symptoms and the masking effect of middle ear glue preoperative identification of the aneurysm was not possible. Subsequent angiography showed the large fusiform extension of the intrapetrous aneurysm as well as multiple intracranial aneurysms. Leakage from the aneurism was closed definitively with muscle, fascia lata and a gelatin-resorcin-formalin-glue (Cardial). In order to apply the tissue patch the hypotympanic site of the aneurism was exposed using a posterior otosurgical approach. Due to extensive intracranial collateralization to the vertebral arteries bleeding persisted even after ligation of both carotid arteries. Temporary cardiac asystole was then induced to allow safe closure of the aneurysm. Following surgery the patient sustained loss of hearing in her ear and a partial peripheral facial palsy.

Aneurysm, Ruptured↗
PubMed1998

Olfactory function after functional endoscopic sinus surgery for chronic sinusitis.

One hundred and fifteen patients suffering from chronic sinusitis were observed to analyse the prevalence of olfactory dysfunction and the influence of FESS. Pre-operative questionnaires were supplemented by examination of olfactory thresholds and discrimination. Pre-operatively, 58% of the collective were aware or complained of any olfactory deficit. However, the olfactory tests demonstrated that of the collective 52% were hyposmic and 31% anosmic. Eight per cent of the hyposmic patients presented with an isolated reduction of their ability to discriminate odours. Post-operative improvements were found in 70%. Normosmia was post-operatively achieved in 25% of the hyposmic patients, but only in 5% of the anosmic patients. Olfaction changed to the worse in 8% after FESS. Therefore, the prevalence of olfactory dysfunction in chronic sinusitis is pre-operatively higher, and the rate of improvement is lower than generally assumed. The extent of sinus disease as measured by the degree of intranasal polyposis correlates with olfactory dysfunction. Resections of the middle turbinate may have a negative effect on olfaction, due to damage to the olfactory fila or alteration of the normal aerodynamic pattern within the olfactory cleft. However, this hypothesis is based on a few observations and needs to be verified by further investigations.

Adolescent↗
PubMed1996

[Pathophysiology of post-traumatic anosmia].

BACKGROUND: Head injury is one of the most common causes of olfactory disturbances. The incidence of posttraumatic anosmia depending from the severity of the injury lies between 5% and over 80%. METHODS: Clinical assessments were performed in 26 cases with posttraumatic anosmia using subjective olfactometric tests. Additionally, morphological studies were performed in 26 other patients, who died between 36 hours and six weeks after head injuries. RESULTS: Frontal basal injuries as well as minor occipital blows are capable of causing complete olfactory loss. About one-third of all patients were not aware of their chemosensory deficits, especially when associated neurological deficits occurred. Moreover, the studies show that: 1: The vulnerability of the fila olfactoria varies extremely and depends on unknown, highly individual parameters. 2: Trauma can induce local hemorrhage within the olfactory tracts and bulbs without any other intracranial lesions. 3: An intracerebral contusion is often misunderstood as the direct substrate of a posttraumatic anosmia. However, in a number of cases it is merely the sign of a strong injuring force, potentially capable of injuring the fila or the olfactory bulbus. CONCLUSIONS: The findings indicate that the pathophysiology and biomechanics of posttraumatic anosmia should be the subject of critical discussion.

Accidents, Traffic↗
PubMed1995

[Traumatology of the facial skull in bicycle accidents].

About 15% of all traffic-related personal injuries involve bicycles. In 1989, 67,085 injuries involving bicyclists were registered in West Germany. The city of Münster is a particularly suitable site for studies of bicycle-related injuries because a high percentage of employees and students ride bicycles to work. The severity of bicycle injuries depends on the degree to which the head is traumatized. However, studies concerning trauma to the head in bicycle-related injuries are rare. The risk and the distribution of facial injuries in bicyclists is analyzed within the present study, which covers 78 patients with a total of 88 cranial fractures. The zygomatic and alveolar and orbital regions were most frequently fractured (35%), including 7% blow-out fractures. Thirty-three percent were fractures of the mandibular region, 12% of the bony nose. The soft tissue of the face was injured in 72% of all patients. Middle-aged male patients are more likely to suffer severe bicycle-related injuries. Bicyclists with a significant blood alcohol concentration are more likely to be involved in accidents that are their own fault. The results show that the helmets generally worn are not sufficient to prevent most facial injuries.

Accidents, Traffic↗
PubMed1995

[Quantitative evaluation of the Romberg test].

Simple and economical measuring platforms are available to aid the ENT clinician in examining vestibulospinal disorders. The aim of our study was to quantitatively interpret Romberg test measurements. Calculating the area between the zero line and the curves in sagittal and lateral direction--for the Romberg test with closed and open eyes--enables a quantification of body sway. For the evaluation of data, we developed a triangular diagram which allows a graphic representation and quantifies vestibulospinal reaction at a glance. We assessed a group of 80 persons without any symptoms of peripheral or central vestibular system disturbance. Selected patients complaining of vestibular disorders are helpful in demonstrating the objective and quantitative interpretation of the Romberg test, which is often analysed in a more subjective way.

Adult↗
PubMed1995

[Tumors in otorhinolaryngological surgery].

The most frequent tumors of the head and neck region are squamous cell carcinomas located within the oro- and hypopharynx [37%] or the larynx [36%]. They are clinically associated with chronic hoarseness dysphagia and swelling of the lateral neck. The general physician should pay attention to these initial symptoms, so that most of the tumors can be found noninvasively and at an early stage. Palpation and inspection are sensitive tools for the primary examination of many types of head and neck cancer. In addition, flexible or rigid endoscopy and high-resolution imaging are useful. Modern treatment of early head and neck cancer can be minimally invasive. The laser technique, new biocompatible implants for the reconstruction of postoperative defects and progress in radiotherapy complete the classic management of head and neck cancer.

Carcinoma, Squamous Cell↗
PubMed1995

[Posturographic registration of body sway after odor stimulation].

The methods of "reflex olfactometry" are rarely able to detect simulated anosmia because of the lack of reproducible correlations between stimulus and intensity of reaction. Interactions between the olfactory and vestibulospinal systems have not yet been investigated. Thirty persons with normosmia and 21 patients with anosmia were studied using a posturographic platform. Only in subjects with normosmia were body sway increases statistically significant in an anterior-posterior direction after the application of an olfactory nerve stimulant. Stimulations of the trigeminal nerve cause both in subjects with normosmia, and anosmia an increase in body sway occurred in a sagittal and lateral direction. The recording of vestibulospinal reactions during platform posturography after application of an olfactory stimulations enables quantification of body sway. These responses can also be useful in differentiating real from stimulated anosmia.

Acetates↗
PubMed1994

[Metastasis of benign pleomorphic adenoma].

A case of metastasing pleomorphic adenoma of the parotid gland, which was definitely benign, is reported. 11 years after the first operation of the tumour, which is suspected to have been removed insufficiently, there was a second local recurrence. In routine x-ray of the thorax the metastasis was seen peripherally in the thorax. Using DNA-Cytophotometry the benign character of both specimens could be confirmed. The fact that such a tumour can even produce metastases, proves its easy implantability. This leads to a critical discussion of each intervention, which is not definitive, including fine needle aspiration biopsy. There are only few indications for preoperative invasive interventions.

Adenoma, Pleomorphic↗
PubMed1994

[Long-term results of lateral rhinotomy with medial maxillo-ethmoidectomy].

Functional and cosmetic results in 93 patients were analysed on average at 42 months after lateral rhinotomy and medial maxilloethmoidectomy. The rate of postoperative complications was 11.8%. The final cosmetic result was more than 1 year postoperatively satisfactory or better in 93.1% after osteoclastic and in 97.8% after osteoplastic lateral rhinotomy. 38.7% of the patients suffered from different postoperative complaints. The main problems were endonasal crusting, hypaesthesia in the V2 region, olfactory dysfunction and epiphora. Considering the results neither the rate of complications nor the cosmetic outcome are critical as usually mentioned in the literature. However, the rate of other different problems complained by the patients postoperatively give reason to add alternative oncosurgical procedures like midfacial degloving and endoscopic techniques, to the general operative repertoire of a hospital.

Adolescent↗
PubMed1994

[Sense of smell before and after endonasal surgery in chronic sinusitis with polyps].

Although olfactory dysfunction is a common clinical symptom in patients with chronic sinusitis, there are few written reports about the nature, frequency and therapeutic accessibility of the various dysosmias. We analysed pre- and postoperative olfactory function in 78 patients suffering from chronic sinusitis with nasal polyposis. Using a squeeze bottle technique we were able to detect preoperative hyposmia and/or dysfunction of olfactory discrimination in 40% and anosmia in 36%. Only 22% of these patients complained spontaneously of disabilities in smell. Endoscopic surgery improved hyposmias and anosmias in 71% and preoperative dysfunctions of olfactory discrimination in 61%. Postoperative thresholds for 2-phenylethanol and dimethyldisulfide worsened in 9% of all patients. Postoperative olfactory discrimination deteriorated in 11%. Preoperative and postoperative olfactory functions were not predictable in individual cases when nasal polyposis was limited. However, mechanical blockage of the nasal airway was just one of many other pathophysiological factors causing olfactory loss in patients with chronic sinusitis.

Adolescent↗
PubMed1993

[Morphology and rhinologic importance of intumescentia septi nasi anterior].

The intumescentia septi nasi anterior is a protuberance on each side of the anterior part of the nasal septum containing "cavernous" tissue. None of the previous studies devoted to the general aspects of endonasal "cavernous" tissue refer to the incidence and rhinological function of the intumescentia. This investigation revealed an incidence of more than 80% in 170 individuals without any rhinological symptoms. The external morphology observed in 7 cadavers indicated a close topographical correlation of the position of the middle turbinate, the depth of the lateral nasal wall and the extension of the intumescentia. Histological examination showed a glandular mass interspersed with a dense vascular network similar to the "cavernous" tissue found within the lateral turbinates. Various filling conditions of the intumescentia have no significant influence on rhinomanometrical parameters and the quantity of nasal airflow. However, visualization of the endonasal flow within a nasal model containing the septal protuberance indicated that the intumescentia considerably alters the quality and local velocities of the endonasal airstream. Considering the results of the study, the intumescentia must be regarded as a completely normal formation of particular rhinophysiological importance, which, up until now, has not been mentioned in rhinosurgery.

Adolescent↗
PubMed1993

Tumors of the nasal cavity occurring after hypophysectomy.

Olfactory neuroblastoma and malignant melanoma of the nasal cavities as second primary tumors after resection of pituitary adenomas in two patients are described. These cases, which seem to be the first documented in the literature, demonstrate the problems in diagnosis and treatment. Because of its rare occurrence, a second primary tumor may not be suspected when symptoms develop in the region of a previous hypophysectomy. A close follow-up after hypophysectomy for pituitary adenoma is recommended for the early detection of a second primary tumor. Pathogenetic considerations are discussed.

Aged↗