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Biomedical subjects

M Bloching

Publications and source records attributed to M Bloching.

At least 37 records · Page 2Linked to original sources
PubMed2004

[Experiences with a new plate-like implant system (Ti-Epiplating System) for rehabilitation of orbital and midfacial defects].

BACKGROUND: Since Tjellstrom introduced in 1977 percutaneous osseointegration, the importance of osseointegrated implants has increased in the head and neck region. Implants and craniofacial surgery technology have been permanently improved and the use of extraoral osseointegration has expanded considerably. The surgical reconstruction of the exenterated orbit provides often only poor aesthetic results. Therefore the rehabilitation of complex midfacial structures is an indication for osseointegrated retained facial prostheses. METHODS AND MATERIAL: The international literature has been reviewed concerning the topic of osseointegration for the retention of orbital and midfacial prostheses. A new plate-like implant system is introduced. We report about our experiences with the "Ti-Epiplating System". DISCUSSION: The "Ti-Epiplating System" is available since 2001. For every location in the head and neck there exists a specially shaped plate. The "Ti-Epiplating System" is fixed subperiostally with normal bone screws, the same as used in traumatology. In cases of extended resections with less bone substance left, the application is simplified. The osseointegration time is reduced to a minimum of 6 weeks. Postoperative radiation is possible. CONCLUSION: The improved application of the "Ti-Epiplating System" is beneficial in the reconstruction of extended craniofacial defects with osseointegrated implants.

Bone Plates↗
PubMed2004

[Erdheim-Chester disease as differential diagnosis in bilateral exophthalmos].

This report describes the case of a patient who had symmetrical exophthalmos, periorbital xanthelasmas and reduced vision. Next to Wegener's granulomatosis the differential diagnosis of Erdheim-Chester disease is discussed. It concerns a rare systemic histiocytosis of unknown etiology. Above all, the skeleton system with symmetrical long bone osteosclerosis is affected. Manifestations in the area of the orbit have seldom been reported with bilateral retrobulbar infiltrations, exophthalmos, diplopia, compression of the optic nerve and periorbital xanthelasmas.

Adult↗
PubMed2004

[Indications and surgical technique of the endonasal decompression of the optic nerve from an HNO medical viewpoint].

BACKGROUND: Acute and chronic progressive compression of the optic nerve is mostly caused by tumors and trauma. Special knowledge about the pathophysiological mechanisms of the nerve injury is necessary in all clinical disciplines managing optic nerve neuropathy. Hence, the technique, the indications and limitations of the endonasal endoscopic decompression procedure of the optic nerve will be described from an otolaryngological point of view. METHODS: On the basis of our own experience and the international literature, the indications and limitations of the endonasal-endoscopic approach for optic nerve decompression are described and critically reviewed. CONCLUSIONS: The management of optic nerve neuropathy, especially in cases of severe trauma, remains controversial. Because the data of the present clinical trials are mostly not evidence based, an efficient transfer of relevant guidelines or recommendations into the clinical practice is difficult. Therefore, the indication for optic nerve decompression surgery, especially in traumatic optic nerve neuropathy, must be individualized.

Decompression, Surgical↗
PubMed2003

[The role of MRI in suspected inner ear malformations].

PURPOSE: This is a prospective analysis of the value of MRI in suspected inner ear malformations. MATERIALS AND METHODS: In 50 patients (43 children and young adults, 7 adults) with suspected inner ear malformation MRI (1.5 T) was performed. In addition, 42 of these patients underwent CT. For the analysis of the inner ear structures, the constructive interference in steady state (CISS) sequence with 0.7 mm slice thickness was used. Functional tests revealed a sensorineural hearing loss or deafness in 82 temporal bones (TB) and a combined hearing loss in 4 TB. The hearing loss was unilateral in 14 patients. MRI and CT findings were compared. RESULTS: Imaging findings were normal in 58 TB. The pathological findings included inner ear malformations (35 TB), inflammatory changes (4 TB), partial obliteration of labyrinth (2 TB) and congenital aural atresia (1 TB). An isolated absence of the cochlear nerve (1 TB) could only be found by MRI. In the remaining cases, an inner ear malformation was diagnosed by MRI and CT with the same confidence but MRI was superior in displaying the fine details. CONCLUSIONS: MRI will become the method of choice in the diagnosis of inner ear malformations.

Adolescent↗
PubMed2003

[Pyoderma gangrenosum and orbital pseudotumor].

Pyoderma gangrenosum belongs to the chronic, neutrophilic and necrotic dermatoses. These very painful, inflammable and purulent skin-ulcers often arise after injury or surgical intervention. About half of the patients suffer from systemic disease, for example hematological, gastrointestinal or rheumatic diseases. Our report includes a 77-year-old female with a multilocular emergence of pyoderma gangrenosum following surgery for an orbital pseudotumor. An additional lesion was detected on her anterior neck. Because the possibility of wound-infection was suspected, the lesion was treated locally and with a systemic antibiotic therapy. After this treatment the condition of the wound deteriorated. Upon dermatological examination, pyoderma gangrenosum was identified and a immunosuppressive therapy with corticosteroids and cyclosporin was initiated. As a result of this treatment the lesion healed slowly--with the formation of typical, atrophic and reticular scars. A connection between the pyoderma gangrenosum and the orbital pseudotumor can, on the basis of similar clinical and structural characteristics, not be excluded. A related disease was not diagnosed in this patient. Recurrence can be predicted in patients who have had skin injuries, therefore strict observation is required.

Aged↗
PubMed2002

[Origin of shoulder pain after "neck dissection". Importance of the cervical plexus].

BACKGROUND: The role of sensitive parts of the cervical plexus for the development of neuropathic pain is not yet clear. Our study investigated the correlation between shoulder pain and cervical plexus damage after different types of neck dissection (ND). MATERIAL AND METHODS: The sensitivity for warm/cold and sharp/blunt was tested in the dermatomes of C2, C3, C4, and the minor occipital nerve. Shoulder pain was measured semiquantitatively by a rating scale. RESULTS: Motion-dependent shoulder pain was observed 6 months postoperatively in 50% after resection and in 29.2% after preservation of these structures. Pain occurred more frequently following radical ND than after modified radical types 1 and 3 ND. DISCUSSION: Our investigations showed that the superficial cervical plexus function is assessable by cutaneous sensitivity tests. The minor occipital nerve seemed to be less affected. Fewer pain symptoms in cases with preserved cervical plexus could be demonstrated. We can conclude that preservation of the superficial cervical plexus is important to diminish postoperative shoulder pain.

Cervical Plexus↗
PubMed2001

[Orbital space-occupying lesions. Practical aspects of imaging].

During the period 1992-1998,we diagnosed orbital tumors in 23 cases at the MLU Halle-Wittenberg. In the intraconal compartment we mostly saw cavernous hemangiomas and neurogenic tumors. Lymphomas and a primary meningioma were located in the extraconal space. Beneath the periosteum, bony processes, tumors of the sinuses, dermoid-and epidermoid-cysts normally occur, but we only observed metastases and hematomas. Furthermore,tumors of the lacrimal gland and inflammatory lesions were diagnosed. Orbital tumors are uncommon lesions, whose location in the orbit gives an important hint to differential diagnosis, because a high percentage of various pathologies is located in special compartments of the orbit. According to our results,the MRI-scan is usually sufficient for differentiation and for preoperative planning in order to reduce the X-ray dose of the lens. CT-scans with contrast are sometimes necessary for examining bone destroying processes and for planning the surgical approach to removing the tumor. X-rays of the skull widely lost their importance in the exact diagnostic of orbital tumors. B-scan ultrasonic imaging is reserved for screening and follow-up examination. Despite the use of MRI and CT scanning, the histological examination remains necessary.

Combined Modality Therapy↗
PubMed2001

[In vitro determination of the cytotoxic activity of saliva samples of smokers].

BACKGROUND: The question arised whether saliva can be included in populations monitoring of high risk groups for the development of head and neck squamous cell carcinomas. Cytotoxic mechanisms strongly influence the carcinogenesis of squamous cell carcinomas. PATIENTS AND METHODS: Saliva specimen of 131 abusing and non-abusing probands were tested on their biological (cytotoxic) effects to draw conclusions on the individual cancer risk. To determine the cytotoxic activity of saliva, we used the "plating efficiency index" of lungfibroblasts of the chinese hamster. RESULTS: We found significantly increased cytotoxic effects in the saliva of smoking probands (p < 0.002). Regularly combined smoking and drinking of alcohol led to a highly significant increased risk of cytotoxic saliva in the tested persons (odds ratio: 17.4; p < 0.005). CONCLUSIONS: Including patients with head and neck squamous cell carcinomas, ongoing studies must prove the practical relevance of this biomarker for estimating the relative cancer risk in the upper aerodigestive tract.

Adult↗
PubMed2001

[Ames test as biomarker].

BACKGROUND AND OBJECTIVE: The incidence of squamous cell carcinomas in the upper aerodigestive tract has increased worldwide. The main risk factors are chronic tobacco and alcohol consumption. The detection of high-risk persons is important because early diagnosis of these tumors provides a good chance for permanent healing. Biomonitoring programs may help to give precise information about the individual cancer risk among smoking and drinking persons. The aim of this study was to evaluate the Ames test as a biomarker to detect the genotoxicity of saliva. PATIENTS AND METHODS: Saliva specimens of 131 probands were investigated for their genotoxic effects using the Ames test. RESULTS: Our results showed an increased trend of genotoxic activity in the saliva of smokers. A highly significant additional increase of genotoxicity was measured in smoking and drinking individuals. CONCLUSIONS: Our study shows that the Ames test could be used to show genotoxic effects in saliva specimens. In combination with other biomarkers, this test may help to develop a valid concept for detecting cancer-endangered people.

Adult↗
PubMed2001

[Sonographic imaging of upper eyelid tarsal radii when changing the direction of vision].

AIM: Aesthetic and reconstructive surgery of the upper eyelid attempts to restore aesthetic or functional deficits. Knowing of the anatomic relationships in these structures is very important. The aim of our study was to assess by ultrasound the upper eye lid tarsal curvature changes depending on movement of the bulbus. METHODS: In 50 people with healthy eyes we measured the diameter of the upper eyelid tarsal plate, the cornea, the bulbus and additionally the intraocular pressure. In measuring the upper eyelid tarsal plate we used transpalpebral ultrasound in a non contact mode with a 7.5 MHz linear array scanner, with the bulbus in median and in abduction position. RESULTS: In healthy eyes the diameter of the upper eye lid tarsal plate changes depend on movement of the bulbus. The mean diameter of the upper eye lid tarsal plate over the bulbus in medium position was 19.3 +/- 3.8 mm versus 30.1 +/- 6.3 mm in abduction position. This difference is statistically significant (p < 0.05). CONCLUSIONS: The results of the study indicate, that using ultrasound with a 7.5 MHz linear array scanner is appropriate for objective evaluation of relative changings of the upper eye lid tarsal plate diameter. The obtained data showed significant differences and must be taken into account when considering cosmetic and functional surgery of the upper eye lid, f. e. lidloading in facial palsy with gold or platinum implants.

Exophthalmos↗
PubMed2000

[Micronuclei as biological markers for the detection of local cancer transformation in the upper aerodigestive tract].

A lot of different endogenous and exogenous factors are accused to promote squamous cell carcinomas in the upper aerodigestive tract. Main risk factors are the chronic tobacco- and alcohol consumption. The fact, that many patients develop syn- or metachronic carcinomas in this area was first described by Slaughter et al. 1953 and explained with the phenomenon of field cancerisation. Concerning to this hypothesis the whole mucosa of the upper aerodigestive-tract is premalignant damaged. In our study the micronucleus-frequency was determined as a biomarker for the genetic injury to prove the fieldcancerisation on the cellular level at 159 people (control-group, abuser, patients with HNSCC). Our results confirm the hypothesis of fieldcancerisation of the mucosa of the upper aerodigestive-tract at strong tobacco- and alcohol consumers and patients with head and neck squamous cell carcinoma. Furthermore there is a highly statistically significant correlation between increasing micronucleus frequency and increasing tobacco abuse. As a final result of our study the micronucleus assay seems to be of good value to show a genotoxic damage in healthy mucosa at people with a high risk to develop HNSCC, but it's not usable to give any answer if and when such carcinomas arise.

Alcohol Drinking↗
PubMed2000

Lymphepithelioma-like carcinoma of the lacrimal gland.

In this report a patient with a lymphoepithelioma (LE)-like carcinoma of the lacrimal gland is described for the first time in the literature. LE-like carcinomas outside the nasopharynx rarely occur in the major and minor lacrimal glands of natives of Greenland, Inuit or natives of southern China. The patient's tumor was extirpated using a Kronlein approach followed by total parotidectomy and modified radical neck dissection on the ipsilateral side after the detection of suspicious lymph nodes by ultrasound transmission. Adjuvant radiochemotherapy with cisplatin and 5-fluorouracil was then carried out. Three years later there is no sign of recurrence. As a result of this case we recommend careful examination of the orbit and lacrimal gland in cases of LE-like cancer with an unidentified primary tumor.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2000

Exfoliative cytology of normal buccal mucosa to predict the relative risk of cancer in the upper aerodigestive tract using the MN-assay.

The high frequency of second or third primary tumors was first explained by Slaughter et al. with the concept of field cancerisation. Another theory postulates micrometastatic lesions as a reason for this phenomenon. The micronuclei (MN)-assay was evaluated to provide evidence for the concept of field cancerisation and to quantify the premalignant field change of normal mucosa in order to predict the individual cancer risk. MN-assay was carried out in 55 patients with squamous cell carcinoma of the head and neck, in 16 patients with a leucoplakia and in 99 healthy controls. A detailed questionnaire for population monitoring was completed. Buccal cytosmears of healthy mucosa of the study participants were examined for the MN count per 1000 cells. There was a direct correlation between tobacco abuse and increasing MN count as a sign of a cytogenetic damage of buccal mucosa cells. Alcohol did not influence the formation of MN. Both buccal sites were damaged in the same degree as proof of field cancerisation. The relative cancer risk (odds ratio) for smoking healthy controls with a definite MN frequency was estimated. Our study underscores the importance of the MN-assay as a biomarker to predict the relative cancer risk in the upper aerodigestive tract under suspicion of the individual susceptibility and the exposition to known carcinogenic agents such as tobacco and alcohol. The concept of field cancerisation was confirmed.

Biomarkers↗
PubMed2000

[Endoscopic treatment of iatrogenic esophageal perforation].

BACKGROUND: Esophageal perforations are the most frequent complications of endoscopy of the upper gastrointestinal tract. Life-threatening consequences such as mediastinitis, septic disease, or multiple organ failure are possible. Traditional surgical and conservative methods of treatment should be distinguished. In serious cases, thoracotomy in particular is a high-risk operation. PATIENTS AND RESULTS: This case demonstrates the successful endoscopic treatment of an esophageal perforation with mediastinal empyema by fibrin gluing. CONCLUSIONS: Esophageal perforations up to 20 cm aboral and a maximum diameter of 1.5 cm could be treated by rigid endoscopical fibrin gluing. High-risk patients could be managed effectively avoiding extensive surgery.

Aged↗
PubMed2000

[Diagnosis and treatment of necrotizing fasciitis of the head and neck region].

BACKGROUND: Necrotizing fasciitis of the head and neck is a rare occurrence. It spreads rapidly along fascial planes causing extensive necrosis; it often results in gangrene of the overlying skin. Mostly involved are immunodeficient patients with banal infections of the upper aerodigestive tract, small traumas, but also after surgical procedures. The "Federal Health Agency" of the Federal Republic of Germany estimates a number of 40 cases a year in Germany for all regions of the body. The mortality is about 20%-50% dependent on the localisation of this soft tissue infection. PATIENTS: Four cases of necrotizing fasciitis of the head and neck region, which were treated at the ENT-Department of the Martin Luther University Halle-Wittenberg since 1995, were described. RESULTS: Despite aggressive surgical debridement and intensive care medicine two patients died because of streptococcus-associated-toxic-shock-syndrome. In all patients we found a diabetes mellitus as a known risk factor for this necrotizing soft tissue disease. In two of four patients with cervical involvement mediastinitis was diagnosed as a complication. The CT-scan showed this mediastinal spread only in one case. CONCLUSIONS: Only rapid diagnosis and surgical treatment with radical debridement can influence the disease positively. Thoracal CT-scan is necessary in all cases of cervical necrotizing fasciitis because of the high risk of mediastinal involvement. A strong complication is a streptococcus-associated-toxic-shock-syndrome, which should be prevented because it is often associated with a lethal outcome. Penicillin G and clindamycin are advocated for antibiotic treatment.

Adult↗
PubMed1999

[Manifestation of epidermolysis bullosa acquisita (EBA) in the ENT area].

Epidermolysis bullosa acquisita (EBA) is a rare, chronic, acquired bullous autoimmune dermatosis. It is characterized by the formation of IgG autoantibodies against type VII procollagen of anchoring fibrils with subepidermal formation of bullous lesions and consequent scarring. The epidemiology of this disease and its characteristic clinical findings cannot be completely surveyed at present due to the limited number of available publications. In general, bullous lesions form on the entire integument and can also involve mucosa. The development of scar-related adhesions on the mucosa of the upper airways and esophagus can lead to serious complications that are difficult to treat. We report our experience in managing a 44-year-old male patient in whom the diagnosis of EBA was established in 1993 on the basis of multiple persistent bullous lesions involving the eye, nose, skin and oral, pharyngeal and laryngeal mucosa. After failing previous medical and surgical therapies, interdisciplinary management resulted in the control of active lesions with extracorporal phototherapy and cyclosporin A.

Adult↗