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Biomedical subjects

M Weidenbecher

Publications and source records attributed to M Weidenbecher.

At least 37 records · Page 2Linked to original sources

[Development of the larynx and trachea following division of the cricoid cartilage and segmental resection of the trachea in the growth stage. An animal experiment study].

Laminotomy as described by Réthi, and segmental tracheal resection with end-to-end anastomosis have proved useful in the adult for the treatment of stenoses of the larynx. In children, the question arises why these may interfere with the growth of the larynx and trachea. A vertical split of the cricoid cartilage followed by stabilization of the larynx by the temporary introduction of a Montgomery silicone T-tube was carried out on four kittens aged four to six weeks. A segmental tracheal resection with end-to-end anastomosis was performed on other animals of the same age. When the animals had stopped growing, the larynx and trachea were investigated both endoscopically and histologically. Following laminotomy the larynx underwent remodelling, resulting in an oval shape, the lumen being wide and the function of the vocal cords normal. Following segmental resection of the trachea, a circular stenosis was found, as a result of irregular growth of the sutured tracheal cartilages. In none of the animals, however were either functional disorders or respiratory distress to be observed. Thus, laminotomy or segmental resection of the trachea can be employed during the formative years without fear of clinically relevant growth disorders.

Age Factors↗

[Juvenile nasopharyngeal fibroma. Report of experiences].

The juvenile nasopharyngeal angiofibroma is a rare and histologically benign tumour of the adolescent male. The aetiology and site of origin are unknown. The diagnosis can easily be made by the symptoms, the typical angiographic pattern and the endoscopic picture. Complete surgical extirpation is superior to all other modalities such as radiotherapy and hormonal treatment. To reduce the enormous blood flow into the tumour, the ligation of the external carotid artery, or the embolisation of the feeding vessels are the best presurgical methods. The technique of tumour removal differs according to the size of the tumour. A great therapeutic problem are those tumours which grow through the skull base and invade the sella, the optic nerve or the cavernous sinus. These tumours should be removed as radically as possible. Small areas of intracranial tumour could remain in order to preserve the optic nerve or the pituitary. These small areas respond very well to 4000 rads. Of 14 patients treated between 1972 and 1981, 12 tumours (types I and II) could be removed completely (recurrence rate 0%), 2 neoplasms ( typ III and IV) which were removed incompletely, received 4000 rads directed at the intracranial remnant, and showed no tumour progression within 4 and 6 years. The preoperative use of hormones (2 cases) showed no effect on the tumour size, especially not on intraoperative loss of blood.

Adolescent↗

[Therapy of lymphangioma in the head and neck region].

20 patients with a lymphangioma of the head and neck were observed after surgery over follow-up intervals of 3 to 13 years. In six children the tumor removal had to be subtotal in order to preserve vital organs. Though small areas of tumor were left no recurrent tumor growth was observed in this group. In 14 patients the tumor was surrounded by a capsule, in six newborns and children the tumor showed an infiltrating growth, which led to difficulties in breathing and swallowing. Out of the 14 radically operated patients, three had a recurrence after 1-2 years. In the six function conservating and not radical operated children, in whom small areas of tumor were left, no recurrence was noticed within 3-13 years.

Adolescent↗

[General partial resection of the mandible in para-osteal cancers of the mouth and oropharynx].

The mandibles of 24 patients with a squamous cell carcinoma of the floor of the mouth or the tongue or the tonsils (all were T2N1b and T3N1b), were histologically examined. It could histologically be shown, that the bone will be destroyed by 2 modalities: 1. Atrophy of the mandible, caused by the pressure of the tumor, leaving the periosteum intact 2. Infiltration of the tumor into the bone. Tumor cells could not be found in the lymphatic system of the periosteum. Since the periosteum is a barrier against tumor growth, the indicator for the resection of the mandible was made after shaved off the periosteum. Resulting from our findings we propose the following concept: 1. If the tumor reaches the mandible (distance tumor to bone = 0 mm) or is fixed to the periosteum and the compacta shows no errosion, after shaving off the periosteum, the mandible can be preserved. 2. If the tumor grows through the periosteum, a marginal resection of the mandible is necessary. 3. If the bone shows errosion, a partial resection of the anterior part of the mandible or a hemimandibulectomy is indicated.

Carcinoma, Squamous Cell↗

[Permanent interstitial implantation of 125iodine in case of carcinomas of the oral cavity and the oropharynx. Preliminary report].

The authors present their first experiences gained during the last year with the permanent implantation of 125iodine seeds in thirty patients suffering from carcinomas of the oral cavity and the oropharynx. The properties and advantages of 125iodine, the method of implantation, the dosimetry and the problems of radioprotection are particularly underlined. In every case, we apply pre- or postoperative external radiotherapy, i.e. we expose the primary tumor to a dose of 50 Gy fractionated in the usual manner over four or five weeks. This combined treatment is intended to overcome the resistance to therapy of ORL malignomas and to obtain a high local rate of tumor control and a low rate of functional and cosmetic troubles.

Brachytherapy↗

[Vascular considerations and technique-planning for pectoralis major myocutaneous island flaps (author's transl)].

The relevant distribution of the blood vessels originating from the thoracoacromial artery and the technique used to raise the pectoralis major myocutaneous island flap are described. The nutrient vessel to this flap is the thoracoacromial artery and its pectoral branches. After giving off its axillary vessels this artery with its vein crosses the upper edge of the pectoralis minor muscle and passes between the pectoralis major and minor muscles. There its branches extend over an area bordered by the second and sixth rib and the mammary and parasternal lines. The skin underlying this area is supplied by branches of the internal mammary artery and on its deep surface by branches of the thoracoacromial artery. Preservation of the thoracoacromial vein as well as artery is also necessary in this creation of a viable pectoralis major myocutaneous island flap.

Humans↗

[Flap-reconstruction in mouth and oropharynx. A clinical comparison of methods (author's transl)].

The possible methods for plastic reconstruction after resection of malignant tumors in the mouth and oropharynx are reported. A total of 165 patients, operated upon between 1973 and 1980, has been reviewed. The tumor was located 26 times in the tongue, 4 times within the base of the tongue, 27 times in the floor of the mouth, 10 times in the floor of the mouth and in the tongue and 80 times in the tonsils. For reconstruction 8 times the deltopectoral flap, 51 times the forehead flap, 42 times the tongue flap, 7 times the myocutaneous sternocleido-mastoideus island flap were used. 8 times other methods were applied, like for instance skin grafts, and in 41 cases a primary closure of the defect was possible. Complete necrosis of the flap were rare, more frequent in contrast were partial dehiscences with or without a fistula. Thus in the forehead flap 5 times a necrosis occurred whereas in 15 cases a dehiscence was seen. Even better results were achieved for the deltopectoral- and tongue flap. In contrast, the skin island of the myocutaneous sternocleidomastoideus flaps all became necrotic, but only once a temporary fistula developed. Of the pectoralis myocutaneous island flaps the first two became necrotic, probably due to lack of surgical experience. Taking into account the surgical expenditure, the functional as well as cosmetical results, the methods may be scaled according to clinical value as follows: The pectoralis major myocutaneous island flap and the tongue flap equally range on the first place, followed by the myocutaneous sternocleidomastoideus island flap, and on the 3. and 4. place by the deltopectoral and forehead flap.

Humans↗

[The treatment of tracheal stenosis by segmental resection (author's transl)].

In the past we treated most tracheal stenoses by creating a temporary open groove with subsequent reconstruction. This method has led to unsatisfactory results in some cases and has the disadvantage of a long duration of treatment. Therefore, we replaced it by segmental resection of the trachea with an end to end anastomosis. During the last 5 years 16 patients between 28 and 57 years of age with scar stenosis or malacia of the trachea have been operated successfully. In 12 patients a tracheostomy or an open groove were present and were included in the resection 11 times and left in place once. The tracheal defects resulting from resection were of a length of 1--5.5 cm. They could in all cases be bridged by mobilization of the trachea, upper laryngeal release and fixation of the head in a flexed position. The respiration is normal in 14 patients while 2 show a slight impairment. We conclude that because of the good functional results and the short duration of treatment (maximally 3 weeks) transverse resection of the trachea with an end to end anastomosis should be preferred over other operative procedures in the therapy of tracheal stenosis.

Adult↗

[Closure of tracheo-esophageal fistulae after chronic intubation (author's transl)].

Tracheo-esophageal fistulae caused by prolonged intubation can be life-threatening to the patient involved. Older techniques for the closure of these fistulae were generally unsafe in infected tissues, were replete with complications, and had to be done in multiple stages. We describe a single-stage procedure for closure of posterior tracheal wall defects. A partially deepithelialized cervical flap is rotated between the sutured esophagus and the trachea. This reconstructed posterior wall is resistent to the presence of a cannula. In order to prevent recurrence of the fistula (if further respiratory treatment is needed), a small nasogastric tube or a long Penrose drain placed in the esophagus should serve as feeding tubes.

Female↗

[The behavior of the facial nerve in vitamin A and thalidomide induced atresia auris congenita. A microsurgical and histological animal study (author's transl)].

Atresia auris congenita may include either a complete or incomplete paralysis of the facial nerve as well as a possible abnormal course of its tympanic segment. Pregnant Wistar rats were given high doses (50,000, 80,000 or 100,000 USP units) of vitamin A and (10,15 or 20 mg) Thalidomide on the 8th, 9th, 10th and 11th days of gestation. The animals were then sacrificed, and the temporal bones and the medulla oblongatas of the fetuses and the adult rats were examined microsurgically and histologically. In contrast to previous reports in the literature, no significantly abnormal courses of the nerve could be found. These findings corresponded to those of 62 endaurally operated human ear malformations. The paralysis of the facial nerve in these patients seems due to a reduced diameter of the nerve and not to a malformation of its nucleus.

Animals↗

Chronic mechanical trauma in the aetiology of oro-pharyngeal carcinoma.

Tumours of the oral cavity and the oropharynx account for 12% of the malignancies in our patient material. The group of patients included a high percentage of smokers (83%), heavy drinkers and persons neglectful of oral hygiene. The majority of the patients mainly male were labourers or (small) farmers. In contrast to other reports in the literature, chronic mechanical trauma due to sharp remaining teeth, less than ideal fillings, badly fitting dentures or unsuitable denture-bearing tissue, and loose anchoring attachments were frequently present. Commensurate with the clinical findings, permanent damage to the covering squamous epithelium was demonstrated histologically. In addition to all forms of inflammation, parakeratosis and hyperkeratosis, dysplasia, including carcinoma in situ, and manifest carcinomas also presented. Surface-inert dentures and regular oral hygiene must therefore be considered an important requirement for the prevention of oral-cavity carcinoma.

Alcohol Drinking↗

[Is the prophylactic hemithyreoidectomy indicated in radical neck dissection? (author's transl)].

To find an explanation for tumor-recurrences around the tracheostoma, in 59 cases of squamous cell cancer of larynx, hypopharynx, oropharynx and tongue the ipsilateral hemithyreoidectomy was included into the tumorexstirpation and radical neck dissection. This histological work up of the thyroid showed no evidence of metastases within the gland. However in cases of extended metastasis or difficult surgical approach to the prae- and paratracheal areas the hemithyreoidectomy is advised.

Humans↗

Recurrent basal cell carcinoma of the facial region -- a clinico-pathological challenge.

The observation that the majority of patients with basal cell carcinomas of the face presenting for surgical treatment did previously have radiotherapy or have undergone inadequate excision due to cosmetic considerations of the surgeon, induced us to review our own case material. According to this reassessment, a concept of radical removal was developed which took particular account to the direction of growth of basal cell carcinoma into the depth. Of considerable importance seems to be the unequivocal marking of the excised material prior to its histological work up and the additional removal of sub-focal specimens for separate histological examination.

Basal Cell Carcinoma↗

[Primary covering of oropharyngeal defects after block resection of large malignant tumors (author's transl)].

The covering of defects in ablative oral surgery is associated with particular problems because, in order to avoid the formation of salivary fistulas, a primary closure should be aimed at. Between 1973 and 1975 86 carcinomas of the floor of the mouth, the tongue or the oropharynx were treated by block resection including radical neck dissection without preoperative radiation in 28 Cases the forehead flap and in 20 cases the tongue flap were employed. While the foreheaded flap necessitates the preservation of the ipsilateral A. carotis externa, the tongue flap can be used even if the ipsilateral lingual artery is sacrified. The tongue flap has functional and cosmetic advantages in comparison to the forehead flap. The temporarily transsected mandibula was refixed by compression plates without intermaxillary wiring.

Forehead↗

[The neck after radical neck-dissection. A follow-up study (author's transl)].

In 200 patients with uni- or bilateral neck dissections the long range cosmetic results, subjective complaints, and the neurologic status were studied at postoperative time intervals between 3 months and 10 years. The main disorders were related to both the absence of resected, tumor-involved structures and to hyperesthesia of the lateral neck skin. The function of the muscle portions of the shoulder was less disturbed than expected, and recovered with some time and training. Cases with bilateral neck dissections showed postoperative edema of the head, being resorbed, with a little persisting submental edema. Postoperative irradiation gave rise to an increasing number of neuralgiform symptoms.

Arm↗

[Olfactometry after transethmoidal surgery for cerebrospinal fluid rhinorrhoea and after head injury (author's transl)].

After transethmoidal exposure and closure of the dural defect olfactory assessments were made on 26 patients with frontal dural dehiscence. Different methods for both unilateral and bilateral assessment were applied. The incidence of abnormalities were evaluated and these were compared with a second group of 52 patients who had suffered head injury without cerebrospinal fluid rhinorrhoea. There was no significant difference in the frequency of anosmia. The practical advantage of the transethmoidal approach to the floor of the anterior cranial fossa is emphasized.

Cerebrospinal Fluid Rhinorrhea↗

[Meatoplasty with allogenic preserved cartilage. Histomorphological model in animal experiments (author's transl)].

The reconstruction of the posterior wall of the external acoustic meatus destroyed by surgery or a cholesteatoma is necessary for the complete restoration of function. For this purpose, allogen cartilage preserved in thiomersalate has been transplanted on the anterior wall of the air-containing mastoid bone in 160 clinical cases. The histomorphological reaction of the recipient to unilaterally uncovered transplant material has previously been unknown. In 10 guinea pigs, 15 fenestrated bullae (hypotympanum equivalents) were closed with cartilage transplants fixed in place with tissue adhesive. After a period varying between 7 1/2 and 11 months, the walls of the bullae with the transplant were then examined histomorphologically. Despite the variations in the period in situ, the avital cartilage transplant, which remained largely constant in volume and shape, was always to be found. It was tolerated without reaction and was "enveloped"--also on the primarily uncovered surface--by a capsule of bone and connective tissue. In no case was rejection observed. Marked foreign-body reaction was, however, found in the vicinity of the tissue adhesive, which was absorbed only slowly. The clinically well-known tissue-compatible and complication free behaviour of the allogenic cartilage transplant preserved in thiomersalate, is thus explained by the histomorphological findings. In contrast, the fact that marked foreign-body reaction was demonstrable even after almost one year, suggests that tissue adhesive should not be used.

Animals↗