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Biomedical subjects

M Jungehülsing

Publications and source records attributed to M Jungehülsing.

At least 37 records · Page 2Linked to original sources
PubMed2000

Rare benign tumors: laryngeal and hypopharyngeal lipomata.

Lipomata of the larynx and the hypopharynx are very rare benign lesions; as they look macroscopically like retention cysts, their diagnosis is usually made after surgery. Sometimes, lipomata of the hypopharynx become very large and life-threatening. Plain fluoroscopy and fluoroscopy aided with barium often fail to depict the lesion if it is localized subepiglottically; standard barium swallow examination and computed tomography allow an accurate diagnosis to be made in many cases, although magnetic resonance imaging is still more accurate and allows not only a more specific diagnosis of the lesion, but also a better depiction of the origin of the frequently pedunculated tumor and its extension into the parapharyngeal space. This paper adds 6 cases of hypopharyngeal and 1 case of laryngeal lipoma to the literature and discusses modern diagnostic and therapeutic strategies.

Aged↗
PubMed1999

[Sjögren syndrome and bilateral MALT lymphoma of the parotid gland].

Sjögren's syndrome is an important autoimmune disease in the head and neck. Patients have an increased arrival risk of up to 6% per year for developing B-cell lymphomas, including mucosa-associated lymphoid tissue (MALT) lymphomas. The following case report shows this relation and the difficulty of differentiating clinically recurrent swelling of the parotid gland in Sjögren's syndrome from malignant lymphoma. A 64-year-old woman had a 2-year history of indolent, recurrent swelling of both parotid glands. Blood examination showed elevated ESR and a hypergammaglobulinemia. Immunosuppressive therapy produced no improvement. Two years after the diagnosis of Sjögren's syndrome, swelling of the left parotid gland persisted. Superficial parotidectomy of the left side was performed and histopathological examination revealed a MALT-related lymphoma. Subsequent parotidectomy of the right side also showed infiltration of the gland by a MALT lymphoma. Postoperative radiation therapy was given. During the follow-up period no recurrence or systemic disease was detected. Patients with Sjögren's syndrome should be examined regularly by the otolaryngologist. If a lymphoma cannot be ruled out, open biopsy must be considered for histological diagnosis. Prognostic factors for developing a lymphoma are possibly a high ESR and hypergammaglobulinemia. Further prognostic factors have to be evaluated.

Blood Sedimentation↗
PubMed1999

Management of acute inflammatory childhood stridor.

BACKGROUND AND OBJECTIVE: Acute epiglottitis, bacterial tracheitis, and severe viral laryngotracheobronchitis continue to cause life-threatening airway obstruction in children. The aim of this retrospective study was to evaluate deficiencies in treatment, to clarify the role of airway endoscopy, and to identify current reasons for fatalities in these diseases. MATERIALS AND PATIENTS: During the observation period from 1980 to 1996, we identified 61 patients treated in the pediatric intensive care unit of the University Hospital of Cologne for severe inflammatory airway obstruction. RESULTS: Critical points in the appropriate airway management were (1) the confirmation of the admission diagnosis, (2) whether an artificial airway or rigid tracheobronchoscopy was required; and (3) appropriate timing of extubation. Since 1989 airway evaluation with flexible or small, rigid endoscopes was used to confirm the diagnosis and to determine the appropriate management. Endoscopic findings were extremely helpful to decide not to intubate and to monitor in the pediatric intensive care unit first. Three patients with acute epiglottitis died after out-of-hospital cardiorespiratory arrest. CONCLUSION: Endoscopy should be a part of every established treatment protocol of childhood stridor. The most decisive factor to decrease mortality seems to be timely presentation to a referral center.

Airway Obstruction↗
PubMed1999

Magnetic resonance sialography.

To evaluate a new noninvasive sialographic technique, we applied a new magnetic resonance technique to 10 healthy volunteers and 21 patients with lesions of the parotid gland. In addition to the usually performed T(1) and T(2) cross-sectional sequences, a heavily T(2)-weighted sequence (TR = 3600 msec, TE = 800 msec) was performed that allowed depiction of the fluid-filled parotid duct system. Twenty-one patients with benign as well as malignant parotid gland pathologies were examined: sialadenitis (n = 6), sicca syndrome (n = 2), pleomorphic adenoma (n = 4), carcinoma of the parotid gland (n = 2), lymphoepithelial carcinoma (n = 1), cystadenolymphoma (n = 3), non-Hodgkin's lymphoma (n = 2), and congenital duct dilatation (n = 1). Stenseńs duct was reliably depicted in all volunteers and patients. The primary branching ducts were reliably depicted in all normal cases. Intraglandular and extraglandular duct dilatations and duct strictures were well depicted in patients with chronic sialadenitis. Sialolithiasis with a calculus obstructing the duct was demonstrated in 2 cases. In conclusion, Initial experience indicates that magnetic resonance sialography can be applied successfully to investigate the duct system of the parotid gland. The usually performed cross-sectional MRI (T(1)- and T(2)-weighted images, gadolinium-DTPA) depicts the internal architecture of the parotid gland with high reliability. Magnetic resonance sialography with heavily T(2)-weighted images adds important information about the ductal system. Because it is completely noninvasive, the only contraindications are the ones generally accepted for MRI.

Adult↗
PubMed1999

Prognostic significance of Ki-67 (MIB1), PCNA and p53 in cancer of the oropharynx and oral cavity.

Up to now results concerning the prognostic value of tumor proliferation markers in squamous cell head and neck carcinoma have been equivocal. Beside biological reasons, different treatment modalities are hypothetically responsible for contradictory findings. The aim of this study was to investigate the relationship between proliferative capacity, represented by the immunohistochemical labeling index of proliferation markers Ki-67, PCNA and p53 status, and treatment failure in a matched-pair study design of recurrent and non-recurrent carcinoma initially treated with primary surgery combined with curative post-operative radiation. From a group of 239 patients with T1-T3 carcinoma of the oropharynx or oral cavity, 28 patients with recurrent disease were selected and matched with 28 patients with non-recurrent disease regarding stage and location of tumor as well as age and therapy. All patients received primary surgery combined with post-operative radiation. Immunohistochemistry determined the p53 status and the PCNA and MIB1 (Ki-67) labeling index. The Ki-67 labeling index was significantly (p=0.032) higher in tumors from patients suffering from treatment failure (mean=59. 1%) than in non-failures (mean=50.5%). Carcinoma with a Ki-67 (MIB1) labeling index above the median (53.7%) of the general study population showed a mean time to relapse of 45 months (n=25), whereas mean time-to-relapse was 61.7 months for those cases (n=31) below the median of the general study population (p=0.029). The PCNA labeling index did not correlate significantly with tumor recurrence (mean=50.2% for treatment failures, 45% for non-failures, p=0.31), nor with time-to-relapse (p=0.26). Forty-six percent of tumors showed p53 over-expression. However, there was no significant correlation between p53 over-expression and tumor recurrence or time-to-relapse. We present the largest series of oropharyngeal and oral cavity carcinoma investigated by immunohistochemistry in a controlled study. We conclude that a high Ki-67 labeling index is an indicator for treatment failure in these patients. Like other investigations for different head and neck subsites, we found no relationship between p53 or PCNA status and tumor prognosis. Our data, obtained from a group of patients treated with a combination of surgery and post-operative irradiation, show that for squamous cell carcinoma of the oropharynx and oral cavity the detection of Ki-67 is an unfavorable prognostic factor.

Adult↗
PubMed1999

Turban tumour with involvement of the parotid gland.

Familial autosomal dominant cylindromatosis (FADC, turban tumour syndrome, Brooke-Spiegler-syndrome and many more, MacKusick catalogue numbers 123850, 313100) is a rare hereditary disease usually presenting in the second or third decade. With female preponderance dermal cylindromas predominantly arise in hairy areas of the body with approximately 90 per cent on the head and neck. Transformation to malignancy seems to be scarce. Although cylindromas of the skin resemble basal cell adenomas of the salivary gland, there is usually no salivary gland involvement. On the other hand, patients with basal cell adenomas of a salivary gland usually do not show dermal lesions. We report one of the rare cases of FADC combined with multiple basal cell adenomas of the parotid glands and present a review of the literature.

Adenoma↗
PubMed1999

Effects of systemic steroid treatment in chronic polypoid rhinosinusitis evaluated with magnetic resonance imaging.

BACKGROUND: The aim of this prospective study was to evaluate the efficacy of a combined (local and systemic) steroid therapy on the extent of chronic polypoid rhinosinusitis and patient symptoms. METHODS AND PATIENTS: Subjects of this study were 20 patients with severe chronic polypoid rhinosinusitis with total or subtotal narrowing of the all sinuses. A nasal budesonide spray (2 x 0.1 mg/day) and an oral fluocortolone medication with a daily reduction during a 12-day period (total dose: 560 mg = group 1) and a 20-day period (total dose: 715 mg = group 2), respectively, were administered. Before and after the steroid treatment we evaluated the extent of the sinusitis with MRI and patient symptoms with symptom-related questionnaires. RESULTS: A significant reduction (> 30%) of the chronic polypoid rhinosinusitis was observed in 50% of MRI findings. The steroid effect on polypoid masses was heterogeneous in different anatomic areas (maxillary sinus 40%, anterior ethmoid 19%, posterior ethmoid 33%, sphenoidal sinus 61%, frontal sinus 46%). Most sinusitis-related symptoms were distinctly diminished in most patients (80%). No major side effects were observed. CONCLUSIONS: A combined short-term steroid therapy is highly effective in chronic polypoid rhinosinusitis, reducing the mucosal inflammation mainly in the large sinuses and reducing the incidence of symptoms significantly. However, this therapy was insufficient in the anterior ethmoid and cannot replace the current surgical treatment concept of the osteomeatal complex in CPR. The indication for such a short-term steroid therapy is the preoperative treatment. It facilitates functional endoscopic sinus surgery by reducing the extent of surgical procedures, the time, and thereby the risks of sinus surgery.

Administration, Inhalation↗
PubMed1998

Potential role of transoral laser surgery for larynx carcinoma.

BACKGROUND AND OBJECTIVE: The treatment of larynx carcinoma is not settled to date. This prospective study evaluates the potential role of transoral laser surgery (TLS) for larynx carcinoma in a large series of unselected patients from a single institution. MATERIALS AND METHODS: A total of 504 consecutive patients with previously untreated carcinoma of the larynx were seen from 1986-1994. Their treatment modalities and results were prospectively evaluated. RESULTS: TLS was used in 290 patients (58%), total laryngectomy in 130 (26%), conventional partial laryngectomies in 31 (6%), and radiotherapy in 34 (7%). Nineteen (4%) had no curative treatment. Uncorrected actuarial survival for all patients with glottic carcinoma stages I and II treated with laser surgery (n = 202) was 80.2%, cause specific survival 96.7%, and local control 85.8%. Uncorrected actuarial survival for all patients with supraglottic carcinoma stages I and II treated with laser surgery (n = 40) was 49.0%, cause specific survival 78.6%, and local control 87.3%. CONCLUSION: TLS was the most important single treatment modality in this large series of unselected patients. It is a safe and time- and cost-effective alternative to radiotherapy for early stage larynx carcinoma.

Carbon Dioxide↗
PubMed1998

[Magnetic resonance sialography. A new diagnostic method for imaging salivary duct patency].

The new technique of non-invasive magnetic resonance (MR) sialography was evaluated for normal and various pathologic conditions of the parotid gland. Ten volunteers and 15 patients with various symptomatic diseases of the parotid gland were tested in the present study. Diseases included pleomorphic adenoma, cystadenolymphoma, carcinoma ex pleomorphic adenoma, ductal carcinoma, adenoid cystic carcinoma, lymphoepithelial carcinoma, non-Hodgkin's lymphoma, sialolithiasis, sialadenitis, Heerfordt's syndrome and congenital duct ectasies. In addition to the usually performed T1 and T2 cross-sectional sequences a heavily weighted T2 sequence (TR 3600, TE 800) was performed and allowed depiction of a fluid-filled parotid duct. Results showed that the main parotid and primary branching ducts were depicted reliably in all normal cases and all patients, except one with sicca syndrome. Pathological conditions such as duct dilatations, duct strictures, obstructing duct calculus and irregular shapes and courses of the ductal system were demonstrable. While X-ray sialography obtained a higher resolution, only MR sialography was able to depict dilated ducts proximal from a complete obstruction, as well as all ductal cysts. Our findings show that MR sialography can be applied successfully to investigations of the parotid gland system. There have been no contraindications or complications to date because MR sialography is non-invasive. The technique will also allow the salivary ducts and lesions to be differentiated from the course of the facial nerve.

Constriction, Pathologic↗
PubMed1997

[99mTc-MDP-SPECT for detection of subclinical mandibular infiltration of squamous epithelial carcinoma].

UNLABELLED: A prospective study was performed to compare the sensitivity and accuracy of ultrasound (US), computed tomography (CT), and single photon emission computed tomography (SPECT) as a bone scan to detect subclinical invasion of the mandible by squamous cell carcinoma of the oral cavity and floor of mouth. METHODS: The present study reports data on 35 patients with squamous cell carcinoma of the oral cavity. SPECT, mandibular orthopantomography (OPG), US, CT and magnetic resonance imaging (MRI) were performed as well as histologic examination of resected mandibles. Transverse slices of 12 mm thickness were reconstructed for SPECT and semi-quantitative assessment of radionuclide uptake was performed with a scoring system based on comparisons of tracer uptake in the mandible to that in an unaffected part of the mandible. Lesion to non-lesion count ratios in the mandible in 3 h SPECT images were calculated. OPG, US and CT were evaluated for comparison. RESULTS: In 12/35 patients, histologic examination showed carcinoma infiltrating mandibular bone. SPECT correctly predicted mandibular invasion in 11/12 cases, with no false-positive results. CT detected correctly 3/12 lesions, while OPG and ultrasound each demonstrated 2/12 tumors. CONCLUSION: Bone SPECT was found to provide an accurate means for assessing tumor invasion to the mandible by intraoral squamous cell carcinoma. As a complementary study to one of the other imaging modalities it was shown to have a high specificity, indicating that it should be performed routinely in patients with suspect mandibular bone involvement by causes.

Adult↗
PubMed1997

[Indications, technic and results following Sedlacek-Kambic-Tucker reconstructive partial resection of the larynx].

Management of laryngeal carcinoma located at the anterior commissure remains controversial. Local control rates with radiotherapy or surgery are not as good as those seen after treatment of midcord lesions. The vertical partial laryngectomy with epiglottic reconstruction (VPLER) may be a more successful approach to such lesions. The charts of all patients treated for larynx carcinoma between 1991 and 1996 at the authors' institutions were reviewed to identify those patients treated with VPLER as described by Sedlacek in 1965, Kambic in 1976 and Tucker in 1979. Indications for performing surgery and outcome data of patients were collected and analyzed according to the indications for surgery, surgical technique, perioperative complications, oncological outcomes and functional results. Twelve patients were identified that had been treated with VPLER. Indications for surgery included five patients with local recurrences following endoscopic laser partial laryngectomies, four cases with previously untreated primary tumors at the anterior commissure (T2 N0-2 M0), two with local recurrences following radiotherapy, and one with recurrence following frontolateral partial laryngectomy. There were no postoperative complications except for one laryngocutaneous fistula that required secondary repair. All patients were able to swallow at the tenth postoperative day. All had their tracheostomies closed after completion of wound healing, (a mean of 17 days after surgery). Phonatory results were usually poor. Two local recurrences occurred during the follow-up period. However, both patients were salvaged with total laryngectomies and have since been free from disease. All other patients are alive and well. Our findings show that VPLER is an effective surgical approach for carcinoma at the anterior commissure of the larynx that cannot be adequately managed with transoral laser surgery or simple frontolateral partial laryngectomy. This study demonstrates that the procedure can be successfully applied to the treatment of local recurrences following initial radiotherapy or surgery. No major complications occurred in our study.

Adult↗
PubMed1996

Airway endoscopy in the interdisciplinary management of acute epiglottitis.

INTRODUCTION: Acute epiglottitis (AE) continues to cause life-threatening airway obstruction in children. The aim of this retrospective study was to evaluate deficiencies in the management of AE, to clarify the role of airway endoscopy, and to establish the cause of death in this disease. MATERIAL: The subjects of our retrospective study were 24 children with AE treated in the paediatric intensive care unit (PICU) of the University of Cologne between 1980 and 1994. The records of all patients were reviewed. RESULTS: Laryngoscopy with fibreoptic or small rigid endoscopes allowed accurate diagnosis of AE, particularly in patients presented with atypical clinical signs. Furthermore, endoscopic information of the degree of inflammation were helpful in the critical decision, whether artificial airway was required. The number of patients managed without intubation increased (8% vs. 45%) since airway endoscopy became available in 1989. No evidence of beta-lactamase-producing strains of Haemophilus influenzae was observed. The most remarkable finding was the high mortality in AE (12.5%). Affected children were admitted in poor post-hypoxia conditions following outdoor cardiorespiratory arrest. CONCLUSION: The most decisive factor to decrease mortality seems to be timely appropriate presentation at referring centres, if AE is suspected or stridor remains unclear. Fibreoptic airway endoscopy represents a major step forward in the management of acute epiglottitis, and this requires close interdisciplinary collaboration between paediatricians, anaesthetists and otorhinolaryngologists.

Acute Disease↗
PubMed1995

[Rhinomanometric analysis of vestibular stenoses of the nose].

UNLABELLED: The distinction of the resistance in the nasal vestibule (valve area) and cavity (turbinates, septum deviations, crest, spine) is important for the settlement of the operative course in nasally impaired patients. Collapsed valves, free floating polyps, spines, and other turbulence producing factors in the nose are characterized in active anterior rhinomanometry (AAR) as decreased ¿percentage of flow increase¿ (deltaV150-300). This parameter allows no distinction between underlying anatomical factors. Other patients have increased resistance in the vestibule area that is static; rhinomanometry is unable to document these instances. The aim of this study was to investigate the influence of the vestibule dilator on nasal flow, and to determine if the diagnostic findings of AAR could be improved by the data obtained from the measurement with the dilator. METHODS: To prove the influence of the vestibule dilator on the nasal airflow, we determined typical rhinomanometric parameters in 20 nasally healthy and 40 nasally impaired persons with and without the dilator. For the measurements, we used a computer-aided rhinomanometer (Rhinodat K, Heinemann Medizintechnik, D-Hamburg). Tubular vestibule dilators were produced from silicon guide rails of tracheal tubes (Rüschelit, Fa. Rüsch, D-Kernen) and individually adapted to the patient's vestibule, ensuring dilation between the external ostium and the nasal isthmus. RESULTS: Active interior rhinomanometry revealed a significant effect of the vestibule dilator in repeated application (mean variation 3%). Total nasal flow showed a mean increase of about 48% with the dilator. In AAR, we found 5 patients with decreased deltaV150-300 below 25%. To demonstrate the presence of vestibule stenosis, we compared the changes of deltaV150-300 is AAR with and without dilator. In rhinomanometry with the dilator, deltaV150-300 of patients with vestibule stenosis showed physiological values. In these patients, mean difference of deltaV150-300 between conventional rhinomanometry and rhinomanometry with a vestibule dilator was significantly higher (47,2%) than observed in all other persons (3,8%). The static vestibule resistance in the total nasal resistance was obtained by calculating the difference between nasal flows with and without the dilator. CONCLUSIONS; Stenosis in the nasal vestibule could be proved and measured via active anterior rhinomanometry using a vestibule dilator. Data obtained from this method are helpful in functional assessment of nasally impaired patients, particularly to answer the question of whether the vestibule requires surgical treatment.

Adult↗