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Biomedical subjects

M Grasl

Publications and source records attributed to M Grasl.

At least 19 recordsLinked to original sources
PubMed1996

Conventional vs accelerated fractionation in head and neck cancer.

From October 1990 to March 1994, 90 patients entered a prospectively randomised trial in head and neck cancer. All patients had verified squamous cell carcinoma and were referred for primary radiation therapy. Tumours originated in the oral cavity in 25, oropharynx in 37, larynx in 15 and hypopharynx in 13 cases. Patients' stages were predominantely T3 and T4 (71/90) and had lymph node metastases (60/90). Seventy-nine male patients and 11 female patients, with a median age of 57 years (range 37-76 years) were treated. Patients were randomised to one of three treatment options: conventional fractionation (CF) consisting of 70 Gy in 35 fractions over 7 weeks or continuous hyperfractionated accelerated radiation therapy (Vienna-CHART) or Vienna-CHART with administration of a single dose of mitomycin C on day 5 of treatment (V-CHART + MMC). By the accelerated regimen a total dose of 55.3 Gy was given in 33 fractions within 17 consecutive days. Acute mucositis was the main toxicity recorded in those patients treated by accelerated fractionation, although the overall duration of mucosal reaction did not differ in the three treatment groups. There was no influence on local toxicity if MMC was added to radiation therapy or not. Those patients treated with additional MMC experienced a grade III/IV haematological toxicity in 4/28 cases. Complete remission (CR) was recorded in 48% following CF, 79% after Vienna-CHART (P < 0.05) and 71% after Vienna-CHART + MMC. The overall local failure rates were 73%, 59% and 42% (P = NS) for patients treated by CF, Vienna-CHART and Vienna-CHART + MMC respectively.

Adult↗
PubMed1994

[Tubeless superimposed high frequency jet ventilation in high grade laryngeal stenoses].

UNLABELLED: Massive stenosis of the larynx may present a potentially life-threatening situation for the patient, requiring immediate measures to ensure a patient's airway. The aim of this prospective study was to evaluate potential benefits of Superimposed High Frequency Jet Ventilation (SHFJV) in patients requiring microlaryngeal surgery due to massive stenosis of the larynx. PATIENTS AND METHODS: 23 patients (age range 1.5 to 90 years) with laryngeal stenosis grade 2 and 3 according to the Cotton scale were ventilated using SHFJV. The duration of the SHFJV was 12 to 116 minutes. SHFJV was performed using a Bronchotron Respirator via a jet-laryngoscope. RESULTS: Arterial blood gases demonstrated paO2 between 71 and 295 mmHg and paCO2 of 28 to 81 mmHg. The mean FiO2 applied was 61.75 +/- 19.26. The airway pressure was measured at the tip of the jet-laryngoscope and was between 6 and 15 mmHg, and PEEP was 1 to 5 mmHg. In 13 patients a CO2 laser was utilised during surgery. DISCUSSION: In all patients SHFJV was performed without problems. Since the ventilation is delivered above any possible stenosis the danger of barotrauma is minimised. The surgeon obtains optimal visibility of the larynx and is not obstructed in the surgical procedure. SHFJV enables both the surgeon and the anesthetist to perform their respective duties and therefore increases the safety of the patient in the management of such a difficult problem as massive stenosis of the larynx.

Adolescent↗
PubMed1994

Distribution of immunoglobulins in squamous cell carcinoma of the head and neck.

The immune response with respect to immunoglobulin production in the tumor was investigated in 23 patients with advanced squamous cell carcinomas of the head and neck. Immunohistochemical staining with monoclonal antibodies against IgG, IgM, IgA, IgD and IgE in the tumor was compared to normal hypopharyngeal mucosa. For IgG, IgA and IgM no significant differences between tumor and control tissues could be found. In contrast, a high number of IgE-positive cells was counted in most squamous cell carcinomas compared to normal mucosa. Most of these cells appeared as plasma cells. Regarding IgD the differences between tumor and control tissues, were less pronounced but also significant.

Carcinoma, Squamous Cell↗
PubMed1993

[Experiences with disc lenses composed of silicone].

Our study presents the results with a silicone disc-lens (Adatomed 90D) over a postoperative period of 18 months. It includes 47 patients, 42 could be reexamined. The implantation was done after continuous circular capsulorhexis and phacoemulsification with a Faulkner-folder directly into the capsular bag. The implantation was sometimes difficult. Skill and experience of the surgeon are required. The IOL springs forth of the implantation forceps, which can lead to traumatization of the capsule and the iris. Three times the posterior capsule ruptured, in two cases the implantation was stopped because of vitreous pressure and the risk of rupturing the capsule. In 6 cases the rim of the anterior capsule ruptured during the implantation. Postoperatively one IOL had a sulcus position, all other IOLs were in the capsular bag. A deposit of viscoelastic substance (Healon) between the IOL and the posterior capsule in 34 cases (72%) was remarkable. In 14 cases (33%) it remained for 18 months. 16 times (38%) regeneratory after-cataract reached the central part of the capsule. The visual disturbance was different, in 6 cases (14%) a YAG-laser-capsulotomy was performed. An influence of the deposit of viscoelastic substance on the development of posterior capsule opacification could not be proved. 17 IOLs (40%) were minimally decentrated upwards. Only 11 cases (26%) had an excellent mydriatic pupillary reaction. The reason is not clear. 10 eyes (24%) developed iridocapsular synechia, 22 eyes (52%) foreign body giant cells and 20 eyes (48%) dispersed pigment on the IOL surface. The giant cells did not diminish.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

[Pectoralis major muscle island flaps. Personal experiences].

Fifty-six pectoralis major island flap procedures were carried out in 52 patients for the immediate reconstruction of defects after resection of head, neck or thoracic tumors. In 28 we used only a part of the muscle covered with meshgraft, in another 28 as a myocutaneous island flap. The complication rate was low: One partial flap necrosis, two bleedings postoperatively on the donor site, four fistulas (one required a second operation). One necrosis of ribs required the resection and covering with a latissimus dorsi flap. One patient died with mediastinitis. The functional aspects of the muscle donor site is stressed out.

Adult↗
PubMed1992

Radiation of jejunal interposition in T3-T4 upper aerodigestive tumours.

30 patients with T3 and T4 tumours of the upper aerodigestive tract had their tumours resected by pharyngolaryngectomy. This was followed by reconstruction of a gullet or creation of a siphon as a tracheohypopharyngeal shunt for voice restoration with a free jejunal autograft. All patients were treated postoperatively with 60Co gamma radiation, 6 MeV photons or 7.5 to 10 MeV electrons of a beta-tron, with a dose of 50-65 Gy in the area of the primary tumour and 50-65 Gy to the neck. 4 patients refused further treatment after a depth dose of between 16 and 32 Gy. Local recurrence occurred in 40% of cases. The survival rate was 36.6% (11/30) after a mean follow-up time of 21.5 months, although 2 patients died of intercurrent diseases without recurrence of their tumours. The results obtained justify active surgical intervention with postoperative irradiation even at an advanced stage of the tumour.

Aged↗
PubMed1992

[Atypical fractionation in advanced squamous-cell carcinomas of the head-neck area].

From May 1990 to May 1991, 23 patients with advanced, inoperable squamous cell cancers, clinically staged as III or IV, were treated by unconventional fractionation radiotherapy. Treatment consisted of a continuous hyperfractionated accelerated radiotherapy, delivering a total dose of 55.3 Gy within 17 consecutive days. In ten patients radiation therapy was combined with chemotherapy; 20 mg mitomycin C/m2, administered by intravenous bolus injection on day 5 of treatment. Apart from a confluent mucositis, treatment tolerance was good. Haematological toxicity from mitomycin C was minor and did not require any specific therapy. The mucosal reaction lasted six weeks (median duration) and was not thought to be increased by additional chemotherapy. In twelve of 23 patients a complete remission of the primary tumour was seen, in patients with lymph node metastases there was a complete response in 14 out of 20 patients. After a median follow-up of 18 months, ten of 23 patients have survived (8/23 without evidence of disease). Eleven patients have died due to local tumour progression and one patient died with distant metastases, being without evidence of local tumour. The advantage of this unconventional fractionation, which takes the described short potential tumour doubling time for head and neck cancers into account, is discussed.

Adult↗
PubMed1990

Modified triple procedure using a temporary keratoprosthesis for closed-system, small-incision cataract surgery.

In patients with corneal disease and cataract, the combined surgical approach yields quick rehabilitation and excellent visual results. Working on an open eye for cataract removal and posterior chamber lens implantation, however, makes the procedure risky and difficult. Using a temporary keratoprosthesis and a small-incision technique, surgery can be performed in a fully closed system, optimizing the safety and precision of the procedure.

Aged↗
PubMed1990

Iso-orientation areas in the foveal cone mosaic.

The quality of the foveal cone mosaic in human and primate retinas is a basic parameter of spatial vision function. The present study uses digital-texture analysis procedures to analyze the crystalline order of inner segment sections containing the rod-free portions of foveal cone mosaics. Definition of the cone cross-sectional centers made possible by adequate preprocessing allows precise mapping of lattice vertices and differentiation of hexagonal positions by procedures for direct neighbor recognition. In a further step, the existence of subunits within the hexagonal areas is revealed by the determination of axial orientation. The lattice of the subunits is characterized by similar orientation and high positional correlation of its hexagonal units. The axial orientation of the areas differs from that of neighboring subunits by angular shifts of 10-15 deg and linear series of nonhexagonal irregularities demarcate the borders. Although larger patches with continuous hexagonal order occur in the surrounding rod-free regions, elevated degrees of disorder (30%) are found within the foveolar center (ca. 300 cones). Analysis of a mosaic showing labeled B cones (Szél et al., 1988) demonstrates that lattice disorder is in part associated with the blue cone subpopulation. The foveal mosaic from a glaucomatuous eye reveals severe lattice degradation throughout the rod-free zone, presumably due to extensive receptor loss. The low-frequency superstructure results in local sets of sampling grids (5'-8') with differing orientational bias. Besides a horizontal/vertical difference of mosaic compression (ca. 1:1.15), the present analysis gives no hints for the existence of systematic meridional anisotropies at the receptor mosaic level. The study reveals a discontinuous organization of the foveal mosaic and points to possible sources for the induction and location of lattice disorder.

Adolescent↗
PubMed1990

Squamous cell carcinoma: infiltrating monocyte/macrophage subpopulations express functional mature phenotype.

Biopsies from 26 patients with advanced stage squamous cell carcinoma of the head and neck were investigated to determine the intensity of the inflammatory cellular infiltrate and the expression of leucocyte antigens. Mononuclear cell infiltration varied considerably between the individual patients and also within the tumour. Tumour-infiltrating cells consisted mainly of T lymphocytes and monocytes (Mo)/macrophages (M phi). Staining procedure with monoclonal antibodies (moabs) against Mo/M phi revealed different clusters of antigen expression: (1) moabs 27E10 and a-CD35 detected a subgroup of Mo/M phi with particular staining of perivasal Mo; (2) moab a-CD1 stained preferentially cells in tumour cell clusters; (3) moabs that reacted with cells of either typical M phi or dendritic morphology throughout the tumour-tissue: a-Fc gamma receptor I-III, a-class II antigens, a-CD4, Rm3/1, a-CD36 and 25F9. Thus, the majority of tumour-infiltrating mononuclear phagocytes were found to possess a rather mature phenotype. The number of Mo/M phi with mature phenotype within the tumours correlated with T lymphocyte infiltration in the tissue.

Antigens, CD↗
PubMed1989

Advanced laryngeal cancer: sonographic assessment.

Endoscopy permits visualization of the endolaryngeal spread of laryngeal tumors, yet the depth of tumor infiltration often remains unclear. The authors used high-resolution sonography in 37 patients with advanced laryngeal cancer to assess the tumors and the cervical lymph nodes. Sonographic findings were compared to operative and histologic reports. Sonography demonstrated histologically confirmed infiltration into the thyroid (n = 8) and cricoid cartilages (n = 1), preepiglottic space (n = 12), base of the tongue (n = 4), hypopharynx (n = 8), subglottic space (n = 3), and thyroid gland (n = 2). Except for the retrolaryngeal portion of the tumor, sonography was valuable in assessing extralaryngeal spread of advanced cancers. It enabled detection of subclinical lymph node metastases in four patients. Furthermore, invasion of the wall of the carotid artery was found in two patients. For evaluating the endolaryngeal and hypopharyngeal portions of the tumor, endoscopy remains mandatory.

Female↗
PubMed1989

[Non-freeze epikeratoplasty in recurrent pterygium].

We present five patients with recurrent pterygium. Prior to our surgical procedure the patients had had several surgical interventions as well as radiotherapy. Up to four-fifths of their corneal surface was covered by a multilayered pterygium including symblepharon scarring in the lower and upper lid, completely immobilizing the globe. The pterygium was removed, the conjunctival strains excised, and corneal abrasion was carried out with a rotating diamond tool. Finally, an optical non-freeze epikeratoplasty processed by the Non-freeze Barraquer-Krumreich-Swinger refractive set (BKS-1000) was sewn on the recipient cornea with a double running antitorque suture. In all patients, the epikeratoplasty donor cornea remained clear. In one patient there was a small pterygium recurrence, which was treated successfully with 5-fluorouracil.

Adult↗
PubMed1988

The triple procedure--results in cataract patients with corneal opacity.

Beginning in May 1984, we performed penetrating keratoplasties in combination with extracapsular cataract extractions and implantations of posterior chamber lenses in 21 patients. In addition to cataracts, 15 of these elderly patients presented Fuchs' dystrophy and 6 had corneal scars due to infectious or inflammatory corneal diseases. In 2 of the 21 eyes, keratoplasty was a repeat operation because of graft rejection or graft dystrophy. With a mean follow-up of 22 months, visual rehabilitation was satisfactory: 15 patients (71%) achieved a postoperative corrected visual acuity of 6/12 or better. Postoperative deviation from preoperatively calculated refractive lens power--the only major problem--remained within +/- 2 dptr in 95% (20 eyes), with an error of + 4 dptr in 1 eye (5%). In all 21 eyes, clear corneal grafts were obtained. Thus we consider the triple procedure to be the treatment of choice in cataract patients with corneas opacities.

Aged↗
PubMed1987

Effect of indomethacin on aqueous PGE2 levels in rabbits following ocular trauma.

Using a highly specific radioimmunoassay, post-traumatic aqueous PGE2 levels were measured in rabbit eyes treated with topical indomethacin aqueous solution, as well as in untreated eyes. In two groups of ten rabbits each, the surgical trauma consisted of corneoscleral incision (without injury to the iris); one of the two groups received prophylactic treatment (3 days) and therapeutic (21 days) indomethacin treatment. In two other groups of ten rabbits each, corneoscleral incision and iridectomy were performed. One group received indomethacin treatment as described above, while the other group was not treated. Surgery was performed in all 40 right eyes, the left eyes serving as controls. In 20 of the 40 left eyes, indomethacin therapy was applied. In all right and left eyes, aqueous samples were withdrawn 3 days and 21 days postoperatively, and PGE2 concentrations were determined. The results indicate that 3 days after corneal trauma and 3 days after corneal trauma plus iridectomy, there was a highly significant reduction in the elevated PGE2 concentrations as a result of indomethacin therapy. On postoperative day 21, indomethacin reduced even further the still slightly elevated aqueous PGE2 concentrations without, however, completely blocking prostaglandin activity. The latter was observed even in the control animals that were not operated upon; they showed minimal PGE2 levels in response to corneal puncture on postoperative day 3 for the purpose of drawing aqueous samples. Our study demonstrated that short-term indomethacin therapy has a significant inhibitory effect, but no unequivocal answers were found as to the value of long-term treatment.

Animals↗
PubMed1987

Evaluation of 50 silicone posterior chamber lens implantations.

This study presents our experience with 50 silicone intraocular lens (IOL) implants (STAAR Surgical Company, model AA-4004) in the posterior chamber. In the relatively short-term mean postoperative follow-up of seven months, the following complications were observed: iris chafing - pigmentary dispersion, 15 (30%); IOL tilt and decentration, 7 (14%); pseudophakodonesis, 6 (12%); fibrinous exudate, 3 (6%); luxation of one haptic in the anterior chamber, 1 (2%); IOL tears, 5 (10%). Visual acuity of 20/20 to 20/40 was obtained in 40 patients (80%). Although no severe consequences were noted, the long-term effects of the complications are unpredictable at present.

Aged↗
PubMed1986

Recent advances in preservation of viable corneal tissue.

Increasing numbers of preserved corneas are being transplanted as the demand for optimal bioavailability for donor corneas increases. McCarey-Kaufman (MK) short-term storage provides a sufficient endothelial cell viability for a maximum of only 4 days. Organ culture of corneoscleral discs extends post mortem storage times up to 4 weeks. K-Sol, a new cornea storage medium with 2.5% chondroitin sulfate, containing no calf serum as source of foreign protein and no dextran as artificial dehydrating agent, permits tissue to be used for at least 2 weeks after enucleation stored at 4 degrees C. The corneal endothelium was intact, as demonstrated by subsequent vital staining and phase microscope evaluation. Pachymetric measurements showed regular thinning profiles in 31 K-Sol preserved corneas for corneal transplantation, with a clear outcome after a preliminary average observation time of six months.

Adolescent↗
PubMed1986

[Temporary silicone oil implantation following vitrectomy in proliferative diabetic retinopathy].

Report on 23 patients with proliferative diabetic retinopathy who underwent silicone oil implantation due to recurrent intravitreal hemorrhages following pars plana vitrectomy. Postoperatively, it was possible to perform panretinal laser photocoagulation without difficulty or haste. After an average period of 4 months, silicone oil was removed from 10 eyes. Subsequent hemorrhages in 4 of these eyes are due to diabetic retinopathy, not to silicone oil. In 6 cases, silicone oil removal is planned for the near future; in a further 7 cases, silicone oil removal has been postponed because of the potential danger of further traction retinal detachment.

Diabetic Retinopathy↗