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M Bloching

Publications and source records attributed to M Bloching.

At least 19 recordsLinked to original sources
PubMed2007

[Invasive aspergillosis of the skull base with orbit infiltration].

BACKGROUND: [corrected] Aspergillosis of the paranasal sinuses is subdivided into noninvasive and invasive types, depending on invasion of the tissue. The invasive form often occurs in immunodeficient patients and can be divided further into granulomatous, chronic invasive, and acute fulminating forms. CASE REPORT: We report the clinical course of an immunosuppressed 64-year-old male with invasive aspergillosis originating from the sphenoid sinus with infiltration of the orbit and intracranial extension into the cavernous sinus. The patient was referred to our hospital with loss of vision, ptosis, and ophthalmoplegia of 3-month duration. Additionally he suffered from diabetes mellitus II and kidney failure after kidney transplantation. After CT scanning, endonasal sinus debridement and decompression of the orbit were carried out immediately. Histology revealed invasive aspergillosis. Postoperatively, both systemic and local antimycotic therapy and antibiotic treatment were performed. According to recommendations of the Undersea and Hyperbaric Medicine Society, cerebral abscess is a certain indication of hyperbaric oxygenation. We decided to attempt therapy for that as well. The patient died 3 weeks after surgical intervention due to carotid dissection. CONCLUSION: Invasive aspergillosis of the paranasal sinuses and the skull base of immunsuppressed patients is usually lethal because of intracranial complications. Therefore, fast diagnosis using CT and MRI and surgical and antimycotic therapy are necessary.

Antifungal Agents↗
PubMed2007

[Intracochlear schwannoma as a cause of a deafness: a case report].

Inner ear extension caused by schwannomas, which can cause hearing loss, tinnitus and vertigo, is an extremely rare finding. We report a male patient who presented with progressive hearing loss as well as tinnitus in the right ear. Despite rheologic infusion therapy with glucocorticosteroids at another hospital, the patient showed an explicit hearing loss and vertigo related to the right ear. In the pure tone audiogram, we found complete deafness of the right ear, the equilibriometry with caloric testing showed complete loss of the labyrinth. In the HR-MRI, a structure appeared in ranges of the basal and middle cochlea with enhancement of the contrast medium. From the MRI aspect, this appeared to be a small intracochlear schwannoma. As a differential diagnosis, a chronic granulation is also possible. In agreement with the patient, we decided to control the structure clinically every 6 months using MRI; no further growth of the structure appeared. A precise imaging via HR-MRI is required to detect intracochlear schwannomas. Observation is an appropriate option for patients who have serviceable hearing. Surgical exploration can be recommended in cases of progressive diseases and growth into the inner ear with recurrent vertigo attacks. The option of radiotherapy for the treatment of intrameatal acoustic neurinomas should be considered.

Adult↗
PubMed2007

[Stomal metastases after translaryngeal tracheotomy (TLT) according to Fantoni: a rare complication].

The translaryngeal tracheotomy (TLT) according to Fantoni with rigid endoscopy is well known and easy to execute. In our department we have used this method since 2002. In 17 patients suffering from carcinomas of the upper aerodigestive tract, we performed a TLT. Peri- and postoperative complications were examined. In 17 patients there were no intraoperative complications. As an early complication we found in one case a dislocation of the tracheostomy tube postoperatively. In one patient we observed metastases in the prior TLT stoma as a major late complication. Another patient also probably suffered from metastases in the prior TLT stoma. We did not find tracheoesophageal fistulas or stenosis of the trachea. Iatrogenic neoplastic seeding of squamous cell carcinomas of the upper aerodigestive tract is a serious complication. Our experience with these two cases and a review of the literature indicates that in patients with head and neck cancer, pull procedures for placement of TLT tubes may induce metastases by direct implantation of tumor cells because of contact between the TLT tube and the primary tumor cells. TLT according to Fantoni cannot be recommended for the treatment of cancer of the upper aerodigestive tract. Methods of tube insertion that avoid such contact, e.g., Ciaglia, surgical tracheostomy, should be preferred.

Aged↗
PubMed2007

[Screening of modified polyethylene surfaces for tissue engineering of chondrocytes].

BACKGROUND: Reconstructive surgery needs high requirements of substitutes for cartilages. The availability of autologous material is limited. The use of implants can cause inflammatory reactions. Therefore the biocompatibility of porous polyethylene should be improved by masking the synthetic surface with autologous cells. The polyethylene surface was functionalized by collagen, in order to enhance the contact between polyethylene and the surrounding cells. METHODS: The modified surfaces were characterized and tested by an in vitro screening with primary human chondrocytes. RESULTS: The modification of polyethylene surfaces by collagen coating increased the life time of chondrocytes growing at this surface. The effect was independent of the former functionalization. CONCLUSIONS: It is possible to cultivate chondrocytes on polyethylene surfaces. The results have to be proven in a long-term animal experimental study.

Biocompatible Materials↗
PubMed2006

[Prophylactic parathyroidectomy for familial parathyroid carcinoma].

In contrast to primary hyperparathyroidism, parathyroid carcinoma is a rare disease. In patients with hyperparathyroidism jaw tumor (HPT-JT) syndrome, caused by germline mutations in HRPT2, the development of parathyroid carcinoma is estimated to be 10-15%. This review summarizes the clinical and molecular genetic data of about 100 patients in the literature and three of our own cases. Unfortunately, osteofibromas, which might enable timely diagnosis of HPT-JT syndrome, occur in only about 30% of patients; about 80% have uniglandular disease. Based on the current data, a general recommendation to perform prophylactic parathyroidectomy cannot be given. However, thorough screening of patients at risk is mandatory. Of note in patients thought to have sporadic parathyroid carcinoma, germline HRPT2 mutations are found in up to 20%. Hence, any patient with parathyroid carcinoma should undergo HRPT2 mutation analysis.

DNA Mutational Analysis↗
PubMed2006

[Counselling versus a self-help manual for tinnitus outpatients: a comparison of effectiveness].

BACKGROUND: Counselling is a basic psychological intervention for chronic tinnitus the effectiveness of which has not yet been evaluated. SCIENTIFIC QUESTION: The therapeutic effect of counselling was compared to that of a self-help manual. Outcome was analysed for tinnitus disability, tendency to become chronic, and accompanying psychiatric disorders. METHODS: A total of 75 tinnitus outpatients were randomly assigned to group counselling (n=35) and self-help (n=40). Tinnitus disability, general psychological disturbances, depression, anxiety, coping and illness beliefs were measured using questionnaires (TQ, SCL-90-R, BDI, BAI, FKV, KKG) administered before and after treatment and at a 6-month follow-up. Psychiatric disorders (DSM-IV) were assessed using the CIDI. RESULTS: Counselling and the self-help manual had a significant effect on tinnitus disability, showing most profit for participants with a high level of tinnitus distress. The significant reduction in tinnitus distress was maintained at the 6-month follow-up. There was, however, no difference between the two treatment-groups. Effect-sizes for patients with DSM-IV-diagnoses were smaller. CONCLUSION: For tinnitus outpatients without psychiatric comorbidity, self-help manuals can be an effective first treatment.

Adolescent↗
PubMed2006

[Ultrastructural changes in human nasal mucosa in rhinitis medicamentosa].

BACKGROUND: Long-term abuse of decongestive nasal drops causes rhinitis medicamentosa due to cytotoxic and ciliary-toxic effects. Nasal obstruction is caused by rebound swelling when the decongestive effect has disappeared. The patient starts using nasal drops more frequently as a result of tachyphylaxis. PATIENTS AND METHODS: Tissue samples from human inferior turbinates from 22 patients who had overused decongestive nose drops were taken during nasal surgery and preserved in phosphate-buffered paraformaldehyde or glutaraldehyde. Ultrathin sections were cut. The samples were dehydrated and embedded in Araldit. The findings were photo-documented using a light- and transmission electron microscope. Biopsies from ten patients without chronic inflammation of the nasal mucosa were used as controls. RESULTS: The electron microscopic investigations revealed epithelium showing severe damage corresponding to regions with hyperplastic and metaplastic changes. Loss of ciliated cells was observed. Under a thick basal membrane, ultrastructural changes to the endothelial lining, such as openings and rupture of the basal lamina, were detected. Prominent endothelial cells were conspicuous. CONCLUSIONS: Rhinitis medicamentosa is a drug-induced injury to human nasal mucosa associated with the prolonged abuse of topical nasal decongestants. Loss and destruction of ciliated epithelial cells are the morphological correlation to the disturbance of mucociliary clearance. Endothelial cells of capillaries, in particular, revealed ultrastructural changes indicative of increased permeability with consecutive interstitial edema.

Administration, Intranasal↗
PubMed2006

[Idiopathic orbital inflammatory syndrome (orbital pseudotumors): diagnosis and therapy].

BACKGROUND: Pseudotumors of the orbit comprise a group of idiopathic inflammatory processes and are, except for endocrine orbitopathy, the most common reason for exophthalmos in adults. Orbital pseudotumors, also called idiopathic orbital inflammatory syndrome (IOIS), can be determined from orbital involvement in systemic fibrosing diseases. Finding the correct diagnosis can be challenging. Due to the topographic relations of the orbit to neighbouring structures, a multidisciplinary cooperation is highly recommended. CASE REPORT: We report a case of a 42-year-old woman with unilateral exophthalmos. Additionally we found impaired motility of the affected bulbus, ptosis and reduction of visual acuity. Orbital MR imaging demonstrated dense fibrotic masses filling the whole orbita including the extraocular muscles as well as the optic nerve. Tissue specimens were extracted while performing orbital decompression via a lateral orbitotomy. Histological examination revealed a lymphatic infiltration and fibrotically destroyed tissue containing the lacrimal gland. After surgical decompression, oral steroid therapy and immunotherapy, a recovery of the visual loss could be seen. CONCLUSIONS: Intraorbital fibrosclerosing pseudotumors often require a difficult long-term treatment. Therapeutic options are steroid therapy, immunotherapy, radiotherapy and surgery. The diagnostic steps include blood tests, ultrasound, CT and/or MRI as well as histological differentiation. Solid tumors and orbital involvement in diseases of the hematopoetic system have to be excluded. Since intraorbital fibrosis can be accompanied by manifestations in various other organs, a complete investigation of the body and thorough follow up are crucial.

Adult↗
PubMed2005

[Sclerotherapy with OK-432 for cystic tumors in the neck region].

BACKGROUND: The intralesional injection of OK-432 has been proposed as an effective treatment of lymphangiomas and ranulas. The aim of this study was to review our experience with sclerotherapy of benign cervical cysts as an alternative method to surgical extirpation. PATIENTS AND METHODS: We performed a case note review of six patients who received OK-432 injections in a concentration of 0.01 mg/ml between March 2002 and December 2003. RESULTS: Disappearance of the lesions was achieved after one to three injections in all patients. We found a complete remission in two of six patients and a marked reduction in four of six patients. There were no significant complications observed. CONCLUSION: OK-432 is an effective alternative in the treatment of benign cervical cysts, but it is very important to exclude malignancy-associated diseases before instillation of OK-432. Long-term results will be awaited.

Adolescent↗
PubMed2005

[Gradenigo syndrome--still a threatening complication of otitis media].

Intracranial complications of acute otitis media are rare in the time of a specific antibiotic therapy. We report about the case of a 13-year-old female patient with an incompletely cured otitis media which was followed by a petrous apicitis presenting abducens nerve palsy. She was successfully treated by a combination of surgical intervention, high dose intravenous antibiotics, systemic corticoid-therapy and hyperbaric oxygen therapy.

Abducens Nerve Diseases↗
PubMed2005

[Orbital foreign bodies -- diagnostics, therapy and management].

BACKGROUND: Orbital foreign bodies constitute an interdisciplinary challenge, diagnosis being especially difficult because of inconspicuous entrance orifices. Indication for the removal of an orbital foreign body has always to be decided upon individually taking into account the benefits and risks resulting from an operation. The latter is particularly indicated if there are acute and chronic functional restrictions or inflammatory reactions either present or to be expected. The objective of our study was to produce systematic guidelines concerning the therapeutic procedure of dealing with orbital foreign bodies with a view to a benefit-risk assessment. PATIENTS AND METHODS: Over the last ten years ten patients with an orbital foreign body were treated in our Department, four of them requiring acute attention. CTs were taken of all patients. Only in one case additional MRTs were produced. Eight out of ten patients underwent operation, of which seven resulted in a complete removal of the foreign body. In the case of two patients we decided against an operation after interdisciplinary consultation. RESULTS: In our view the imaging--providing diagnostics by means of computer tomography is the most promising method for determining a foreign body in the orbit. Decision for an operative removal of a foreign body was invariably taken interdisciplinary in cooperation with an ophthalmologist. Surgical approach was chosen in accordance with the localisation of the foreign bodies. None of the patients suffered from a loss of vision or a restriction of functions as a result of the operation. CONCLUSIONS: In the indication the foreign material is of essential importance. Orbital foreign bodies that have been present in the tissue for a longer time can be allowed to stay, unless loss of functions are progressive. Loss of vision always being a consequence of the initial trauma.

Adolescent↗
PubMed2004

[The ring-pin anastomosis technique. Long-term clinical experiences with the mechanical ring-pin system for microvascular anastomoses in reconstructive head and neck surgery ].

BACKGROUND: Microvascular anastomosis remains one of the most critical aspects of free tissue transfer. Since microsurgical suture techniques are complicated and time-consuming, other techniques of anastomosis have been created. One of these is the ring-pin system. METHODS: Between January 1996 and October 2001, 48 patients underwent reconstruction with a free radial forearm flap. In 20 patients the venous anastomosis was carried out using a ring-pin system with end-to-end technique. The clinical results were compared to the other 28 patients in whom the anastomosis was sutured with 9-0 prolene. RESULTS: In the group using ring-pin anastomosis ( n=20), two flaps showed venous congestion within 24 h postoperatively. After revision the flaps were well perfused. In the other group with sutured vessels ( n=28), a transplant became ischemic in one patient due to venous thrombosis and had to be partly removed. The time of anastomosis was considerably shortened by the use of the ring-pin system. CONCLUSIONS: The venous end-to-end-anastomosis using the ring-pin system can be carried out relatively easily and rapidly after a comparatively short period of training. Long-term results have shown good tissue tolerance of the material and sufficient blood circulation of the grafts.

Anastomosis, Surgical↗
PubMed2004

[Functional reconstruction of the supraglottic region with a free radial forearm flap and septal cartilage to rehabilitate swallowing].

BACKGROUND: Patients with supraglottic laryngectomy often complain about persisting dysphagia because the resection includes the most important protective mechanisms of the airway. The additional resection of parts of the tongue base or the lateral hypopharyngeal wall leads to increasing aspiration problems. PATIENTS AND RESULTS: Reconstruction of the supraglottic region with a free radial forearm flap and septal cartilage in extended oro-hypopharyngeal and laryngeal carcinomas was carried out in seven patients from 1997 to 2002. In one patient, the reconstruction was performed in a second stage procedure after extended endoscopic laser resection. In four patients, the temporary tracheostomy was closed, and in five total oral feeding was possible. CONCLUSIONS: Preliminary results show that a functional reconstruction of the supraglottic region with a free radial forearm flap and septal cartilage to reconstruct the epiglottis helps to avoid chronic aspiration and to preserve the larynx.

Aged↗
PubMed2004

Mucoceles of the sphenoid sinus.

PURPOSE: Mucoceles of the sphenoid sinus represent 1-2% of all paranasal sinus mucoceles. The aim of this paper is to report our experiences in patients with mucoceles of the sphenoid sinus. PATIENTS AND METHOD: In a period of 4 years, we observed six patients in whom a mucocele of the sphenoid sinus was suggested pre- or intraoperatively. Symptoms and signs included headache, visual loss and palsies of the III and VI cranial nerve. All patients were investigated by MRI and/or CT. Imaging findings were compared with operative and/or histological findings. RESULTS: In three cases there were simple mucoceles, in one case we found a tumour (nasopharyngeal carcinoma) associated mucocele and in two cases, malignant tumours (carcinoma, chordoma) imitated a mucocele. The diagnosis of simple mucoceles was no problem at all by imaging. Difficulties made the two malignant tumours and the tumour associated mucocele. In the first two cases, repeated histological samples were necessary to make the final diagnosis. CONCLUSION: Mucoceles of the sphenoid sinus should be investigated and handled very carefully with regard to differential diagnoses and tumour associated cases.

Adult↗
PubMed2004

[Indications of HR-CT in the early postoperative phase of stapedotomy].

PURPOSE: This is an analysis of high-resolution computed tomography (HR-CT) performed in patients with and without symptoms after stapes surgery during the early postoperative phase. MATERIALS AND METHODS: We examined 37 patients who underwent stapes surgery between January 1995 and December 2000. HR-CT of the temporal bone was performed in axial and coronal planes with 1-mm-slice thickness and table feed. A reoperation was performed in 7 patients. CT findings were compared with clinical follow up and surgical findings. RESULTS: All patients showed postoperative opacification of the tympanic cavity and external auditory canal as well as partial opacification of the mastoid on CT scans. A dislocation of the prosthesis was found in 11 cases and air bubbles were seen in the vestibule of 5 patients. In one case, small bone fragments were detected in the vestibule. In 6 of 7 cases, CT results were confirmed by retympanotomy. CONCLUSIONS: Due to overlapping of normal and pathological findings in the early postoperative period, indications for HR-CT are limited in this period.

Adult↗
PubMed2004

[Management of periorbital and orbital infections].

BACKGROUND: Infections of the orbit and of the periorbital region are not uncommon. Even today they constitute a serious problem, in spite of modern antibiotic treatment, with a potential risk of lethal complications. Orbital infections are most prevalent in children and adolescents. The acute orbit has many causes, but the most frequent is an occurrence secondary to acute rhinosinusitis. PATIENTS AND METHODS: Based on clinical cases, different causes and the present state of diagnosis are presented. The discussion deals with therapeutic strategies depending on the stage according to the current classification of orbital inflammation. CONCLUSIONS: Orbital and periorbital inflammations represent a demanding challenge for interdisciplinary cooperation between ophthalmologists, ENT specialists and radiologists. In some cases maxillofacial surgeons and neurosurgeons have to be included as well. Accurate diagnosis and treatment may lead to the resolution of the infection and avoid ocular sequel or endocranial complications as well as a fatal outcome.

Anti-Bacterial Agents↗
PubMed2004

[Materials used in reconstructive surgery of the orbit].

Orbital traumas and tumour operations may cause defects the operative management of which sets high requirements on the surgeon. For covering defects, transplants or implants are available. There is a risk of inflammation due to the free contact of the implants to the cavity of the inner nose or the sinus. Today, implants made from titanium, porous polyethylene, PDS (poly-p-dioxanon) foils, and ceramic materials are preferred. Alternatively, autogenous transplants can be used. These are immunologically harmless but they are of only limited availability. Moreover, a second operation for taking the transplants with creation of a donor defect is necessary.

Biocompatible Materials↗