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Biomedical subjects

R Leuwer

Publications and source records attributed to R Leuwer.

At least 19 recordsLinked to original sources
PubMed2005

[G-DRG System 2005. Analysis and evaluation of significant changes from the viewpoint of HNO medical science].

With the release of the new Global Case Agreement by Self Administration in Public Health on the 16 September 2004, the adjustment of the G-DRG System for the year 2005 was completed. Otorhinolaryngology, and head and neck surgery face several changes in the fields of diagnosis and procedural coding (ICD-10-GM 2005, OPS-301 2005), G-DRG case allocation, and extra reimbursements for special interventions. Despite some considerable improvements, substantial problems remain unsolved. This paper presents and comments on the key points of the G-DRG System for 2005 for otorhinolaryngology, and head and neck surgery.

Diagnosis-Related Groups↗
PubMed2005

[Histomorphological study of experimentally induced canalolithiasis].

Free otoconia in the posterior semicircular canal (pSCC) are regarded as the main reason for benign paroxysmal positional vertigo. We investigated the distribution of otoconia in the membranous labyrinth of guinea pigs (n = 34) after a defined rotatory/angular kinetic acceleration. The angular kinetic energy of the rotatory experiment produced a dislocation of the otoconia and sometimes of the complete gelatinous otolithic membrane of the utricular and saccular macula. The otoconia could be observed in all three semicircular canals but predominated in the dark cell areas of the utricular side of the lateral SCC. A total obstruction of the semicircular canal could never be seen. Close to the lateral crista, perilymphatic hemorrhage could frequently be observed. The saccular otoconia were located in the amalgamation between endolymphatic membrane and saccule. The results of this histological study can form the basis for different theories about the genesis of canalolithiasis and cupulolithiasis and the vertigo which accompanies them.

Acceleration↗
PubMed2005

[Influence of botulinum toxin on myogenous facial pain].

OBJECTIVE: Can chronic pain of the masticatory muscles be positively affected by low dose injection of botulinum toxin (BTX-A)? METHODS: Twenty patients suffering chronic myofacial pain were questioned and examined after injection of 25-50 U Dysport into the affected muscles over a period of 8 weeks. RESULTS: Four weeks after injection of BTX-A patients reported a significant reduction of pain (p <0.001, paired t-test. Power of performed test with alpha 0.050:1.000). Then the pain remained constant over the next 4 weeks. Concurrently a significant increase of mandubular range of movement was observed (p <0,05, Wilcoxon signed rank test). CONCLUSIONS: Even though lacking placebo control the findings suggest that patients suffering chronic myofacial pain may benefit from injection of low dose BTX-A into the affected muscles.

Adult↗
PubMed2003

[Sonography of the larynx--an alternative to laryngoscopy?].

PROBLEM: The aim of this study was to determine whether the pictorial results obtained from B-mode ultrasonography duplicate those of laryngeal endoscopy and whether there are any additional advantages when using ultrasonography. PATIENTS AND METHODS: A total of 22 patients with various diseases of the larynx were examined ultrasonically with the ultrasound plusing a Sonoline Elegra as well as with a '7.5 L40' and a 'VF 13/5' linear array. In order to compare both methods directly, reference data were prepared and contrasted. RESULTS: All of the laryngeal lesions recognised in the endoscopic investigation were also demonstrable by the use of ultrasound, although minor changes were difficult to detect. In one case, ultrasonography suggested the presence of an infiltration of the thyroid cartilage, otherwise no additional information was available using this method. CONCLUSIONS: Using ultrasonography, the image quality of the larynx is worse than that of the soft tissue of the neck, which is determined by the air-mucous membrane boundary as well as the (ossified) cartilaginous skeleton. Thus, ultrasonography is useful in cases of larger laryngeal lesions, while there is no advantage in the detection of small processes.

Adult↗
PubMed2003

[Preliminary results for superficial parotidectomy using the ultrasonically activated scalpel (Ultracision Harmonic Scalpel)].

BACKGROUND: The high density of blood vessels in the parotid gland, the direct vicinity to the facial nerve and the narrow surgical situs require efficient intra- and postoperative hemostasis. The ultrasonic scalpel (US) accomplishes both tissue dissection and vessel coagulation simultaneously by an ultrasonically activated shear movement of 55 500 Hz. The combination of hemostasis and tissue dissection particularly qualifies US for use in surgery of the parotid gland. Until now, there have been no published studies about application of US in surgery of the parotid gland. METHOD: 20 patients with benign parotid tumors treated with a conventional technique of superficial parotidectomy and 20 patients with a superficial parotidectomy using the ultrasonically activated scalpel were examined in regard to intra- and postoperative hemostasis, wound healing and postoperative pain. Also, the quality of the histopathological specimen obtained by US was evaluated. RESULTS: In 85 % (17/20) of superficial parotidectomy efficient intraoperative hemostasis did not require electrocoagulation. In 15 % (3/20) of parotid tumors additional bipolar electrocoagulation were required because of venous bleeding from vessels exceeding 2.0 mm in diameter. Postoperative bleeding did not occur at all. Wound healing was uneventful in all cases. Surgery-related postoperative pain was not intensified. Time of operation was shortened. Histopathological evaluation, especially in the margin area, was not impaired. CONCLUSION: The US offers tissue dissection with effective intra- and postoperative hemostasis. The combination of simultaneous tissue dissection and hemostasis enables a good overall view and control of the surgical site. In addition, based on the mechanical function the US has only a minimal thermal effect on neighboring tissues and enables controlled tumor resection without damaging the facial nerve.

Adult↗
PubMed2003

[Oropharyngeal vocal tract space during singing--comparison of tactile-kinesthetic and auditory perception with objective endoscopic findings].

BACKGROUND: In this study we compared the perceived diameter of the vocal tract's oropharyngeal part with the diameter that was determined endoscopically. METHODS: 28 singers (13 male, 15 female) were examined with transnasal fiberscopic pharyngoscopy while singing the vowels /a/, /i/ and /u/ in 4 different timbres (normal, opened, covered, dumpled) and 3 different pitches (chest/modal register, subjective comfortable pitch for singing, head/falsetto register). The tactile-kinesthetic and auditive rating of the singers, the auditive rating of a singing teacher and the visual-endoscopic analysis of three laryngologists were compared. RESULTS: The tactile-kinesthetic and auditory self-perception of the singers was quite different from the auditive perception of a singing teacher and visual endoscopic findings of the laryngologists. The singers had the impression that the different singing timbres (normal, opened, covered, dumpled) influence oropharyngeal vocal tract space during singing. They judged the vowel itself and the pitch as having very little influence. Based on his auditory perception, the singing teacher also rated that the timbre plays an important role for the oropharyngeal vocal tract space but he found vowels to be the parameter with the greatest impact. Via visual endoscopic examination we found that, among the three parameters (vowel, timbre, pitch), the different vowels are most influential on the oropharyngeal vocal tract space. Analysis of video sequences revealed that pitch and timbre are less important. CONCLUSION: Subjective tactile-kinesthetic and auditory perception of the singers differs from auditory perception of the singing teacher as well as from endoscopic findings. The endoscopically determined oropharyngeal vocal tract space during singing the vowels /i/ or /u/ tends to be larger compared to the oropharyngeal vocal tract space while singing the vowel /a/.

Adult↗
PubMed2003

[New aspects of the mechanics of the auditory tube].

The aim of the present article is to describe the mechanical components of the auditory tube and the role of these components in auditory tube function. Particular attention will be given to those aspects which have not been sufficiently dealt with in the past, such as the role of the isthmus region, the function of the lateral mucosal folds, the significance of the of the surfactant proteins and the pathophysiology of the patulous auditory tube. Special attention is given to the tensor veli palatini muscle and its physiology. Because of its isometric contraction, the function of this muscle depends on so-called hypomochlia changing the direction of its force. In the context of this article, the three hypomochlia involved are the pterygoid hamulus, Ostmann's fatty tissue and the medial pterygoid muscle. The so-called "Eppendorf-maneuver" is depicted for the first time.

Biomechanical Phenomena↗
PubMed2002

[The "Costen Syndrome" - Which Symptoms Suggest that the Patient may Benefit from Dental Therapy?].

INTRODUCTION: Since the thirties the hypothesis of a direct connection between temporomandibular disorders (TMD) and tinnitus/otalgia has been discussed. The thesis of this possible connection is often named after one of the earliest and most vehement supporters as "Costen Syndrome". This review is aimed to elucidate the present state of the discussion from the Dentist's point of view. DIAGNOSIS/EPIDEMIOLOGY/THERAPY OF TMD: Diagnostic research criteria which define TMD are not standardized. Despite high prevalence and strong demand for treatment of TMD there is still a lack of a commonly accepted standard therapy and the potential benefit from a therapeutic point of view is still controversial. TMD AND TINNITUS/OTALGIA:: Concurrence of TMD and tinnitus by a common underlying cause is still unproven. By contrast a causal link between certain forms of TMD and otalgia is obvious. CONCLUSION: A lack of clear definitions and standards for the diagnosis of TMD is the main hinderance to prove a causal relationship especially between TMD otalgia. However patients seeking care for otalgia with no identifiable otologic cause may benefit from dental therapy. Therefore future studies should focus on well defined subgroups of TMD to investigate a link between otalgia/tinnitus and TMD.

Dental Care↗
PubMed2002

[Postoperative nausea and vomiting--pathophysiology, prophylaxis and treatment].

Postoperative nausea and vomiting (PONV) are among the most common complications in operative medicine. Especially patients undergoing middle ear surgery or adenotonsillectomy are frequently associated with PONV (70 %). Furthermore, emesis carries the risk of severe postoperative complications and is associated with additional costs and distress in patient management. If the patient carries a high risk for postoperative emesis, the patient should receive a prophylactic antiemetic therapy. 5-HT 3 receptor antagonists are highly effective in prevention and management of PONV. This review will discuss pathophysiology, prophylaxis and treatment of postoperative nausea and vomiting after E.N.T. surgery.

Anesthetics↗
PubMed2001

[Stereoscopic simulation of ear surgery intervention with a novel 3D computer models].

INTRODUCTION: The presentation of the surgical anatomy of the temporal bone by standard anatomical figures is not suitable for otosurgical training. For the comprehension of its complex morphology temporal bone drilling is inalienable. Aim of the present cooperation was to gain an interactive real-3D program for the simulation of specific laterobasal surgical approaches. METHODS: The program was derived from a standard horizontal section of a human temporal bone using a Siemens Somatom Plus 4 Tomograph. The slice thickness was 1 mm, the image matrix was 512. The Voxel-Man-system was used to built up the application for unix workstations. RESULTS: Each step of a surgical approach to the temporal bone can be performed by the present computer model. Calculation in a stereo mode even allows spatial 3D-perception when using red/green glasses. CONCLUSIONS: This program is a novel tool to simulate critical aspects of otosurgical procedures on a computer. Up to now the lack of tactile and kinesthetic information does not allow to renounce individual temporal bone drilling.

Computer Simulation↗