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S Kösling

Publications and source records attributed to S Kösling.

At least 19 recordsLinked to original sources
PubMed2007

[Secondary amaurosis after infraorbital injury with a wooden foreign body].

We report a 68-year-old male who had orbital trauma from a bicycle accident. His vision was initially normal but deteriorated over 8 days to complete blindness. After 13 days, when he first consulted a physician, clinical investigation revealed total ophthalmoplegia, ptosis, and chemosis. Computed tomographic scan showed fractures of the medial orbital wall, orbital floor, and posterior ethmoid with dislocation into the orbital apex near the optic nerve. The patient was sent to our department for optic nerve decompression. Clinical examination showed induration and an already healed infraorbital entry wound suggesting an orbital foreign body, which was confirmed by ultrasound. Renewed analysis of CT scans in different window settings could clearly demonstrate a wooden foreign body in the lower eyelid. Additionally, a diffuse inflammation in the orbital apex was diagnosed. The foreign body was removed and decompression of the orbita and optic nerve was performed. Antibiotics and corticosteroids were administered i.v. Unfortunately, no visual improvement could be achieved.

Aged↗
PubMed2007

[Intracochlear schwannoma as a cause of a deafness: a case report].

Inner ear extension caused by schwannomas, which can cause hearing loss, tinnitus and vertigo, is an extremely rare finding. We report a male patient who presented with progressive hearing loss as well as tinnitus in the right ear. Despite rheologic infusion therapy with glucocorticosteroids at another hospital, the patient showed an explicit hearing loss and vertigo related to the right ear. In the pure tone audiogram, we found complete deafness of the right ear, the equilibriometry with caloric testing showed complete loss of the labyrinth. In the HR-MRI, a structure appeared in ranges of the basal and middle cochlea with enhancement of the contrast medium. From the MRI aspect, this appeared to be a small intracochlear schwannoma. As a differential diagnosis, a chronic granulation is also possible. In agreement with the patient, we decided to control the structure clinically every 6 months using MRI; no further growth of the structure appeared. A precise imaging via HR-MRI is required to detect intracochlear schwannomas. Observation is an appropriate option for patients who have serviceable hearing. Surgical exploration can be recommended in cases of progressive diseases and growth into the inner ear with recurrent vertigo attacks. The option of radiotherapy for the treatment of intrameatal acoustic neurinomas should be considered.

Adult↗
PubMed2007

[Primary nasal natural killer/T-cell lymphomas: classification and clinicopathological features].

BACKGROUND: Nasal NK/T-cell lymphomas are rare malignancies in Europe or North America. Histological diagnosis is difficult, because tumors imbedded in large necrotic areas and neoplastic infiltrates may be admixed with small lymphocytes, plasma cells, eosinophils, and histiocytes, and thus the process could be misdiagnosed as chronic inflammation. Progression of the disease leads to septal perforation and may also result in destruction of the hard palate, and if left untreated it ends fatally. This introduced the term "lethal midline granuloma", a term which should not be used any more. MATERIAL AND METHODS: Clinical features, pathohistology, and current classification of primary nasal NK/T-cell lymphomas are described against the background of the recent literature and a case report. RESULTS: Immunophenotyping is essential for the diagnosis. Tumor cells are uniformly infected by Epstein-Barr virus, which could be verified by EBER in situ hybridization. Immunohistochemically, tumor cells are positive for CD56, cytoplasmic CD3epsilon, and CD2 and they express cytotoxic molecules like granzyme B, TIA-1, GMP17, and perforin. Therapeutic options are radio- or radiochemotherapy. On average, 2- and 5-year survival rates of 50% are obtained in stages I and II. The prognosis of advanced tumor stages is very poor. CONCLUSIONS: Immunohistochemical and molecular genetic early diagnosis is of crucial prognostic relevance.

Adolescent↗
PubMed2006

["Descending necrotizing mediastinitis" due to deep neck infections. Incidence and management].

BACKGROUND: "Descending necrotizing mediastinitis" (DNM) is a rare but potentially life-threatening complication of deep neck infections caused by the rapid downward spread of a oropharyngeal infection along the facial planes into the mediastinum. MATERIAL AND METHODS: Between June 1997 and December 2004, 6 patients with DNM were treated in our department. The primary etiology was a peritonsillar abscess in 2 cases, a parapharyngeal abscess in 3 cases and in 1 case an odontogenic abscess. Most patients presented with risk factors such as diabetes mellitus or alcoholism, the mean age was 44.3 years and the mean duration of signs before diagnosis was 6.3 days. Thoracotomy was associated with the cervical approach in 4 cases and tracheostomy was also performed in 4 cases. RESULTS: Four patients were successfully treated, the mean duration of hospitalisation was 48.2 days and 2 patients died from sepsis and multiorgan failure despite intensive treatment. CONCLUSIONS: Descending necrotizing mediastinitis must be detected as soon as possible. The mean symptoms are persistent complaints after treatment of oropharyngeal infections, which may be masked by analgetic treatment. Only an immediate computer tomographic scanning, aggressive surgical drainage and debridement of the neck and the mediastinum can reduce the high mortality rate.

Adult↗
PubMed2005

[Gradenigo syndrome--still a threatening complication of otitis media].

Intracranial complications of acute otitis media are rare in the time of a specific antibiotic therapy. We report about the case of a 13-year-old female patient with an incompletely cured otitis media which was followed by a petrous apicitis presenting abducens nerve palsy. She was successfully treated by a combination of surgical intervention, high dose intravenous antibiotics, systemic corticoid-therapy and hyperbaric oxygen therapy.

Abducens Nerve Diseases↗
PubMed2005

[CT findings in isolated laryngeal trauma].

UNLABELLED: The purpose of this article is a retrospective analysis of cases with suspected laryngeal trauma. The clinical importance, possibilities and limits of computertomographic diagnostics in laryngeal trauma are discussed. PATIENTS AND METHODS: Between 1992 and 2003 we performed high resolution computed tomography (CT) in 7 patients after an isolated laryngeal trauma with a standardized examination protocol. RESULTS: Following CT findings we made: one fracture of the thyroid cartilage, two fractures of the cricoids cartilage, one luxation of the arytenoids cartilage and four extensive soft tissue swelling of the larynx. One of the patients showed no lesions on CT. In another patient we found an intensive increase of density of arytenoids cartilage as sign of an arytenoids necrosis. CONCLUSION: High resolution spiral computed tomography is the method of choice to detect or exclude laryngeal fractures after an isolated neck trauma. Special parameters are necessary for detection of subtle pathological findings. In the estimation of mucosal or vocal cord changes the CT is inferior to endoscopy.

Adult↗
PubMed2004

Mucoceles of the sphenoid sinus.

PURPOSE: Mucoceles of the sphenoid sinus represent 1-2% of all paranasal sinus mucoceles. The aim of this paper is to report our experiences in patients with mucoceles of the sphenoid sinus. PATIENTS AND METHOD: In a period of 4 years, we observed six patients in whom a mucocele of the sphenoid sinus was suggested pre- or intraoperatively. Symptoms and signs included headache, visual loss and palsies of the III and VI cranial nerve. All patients were investigated by MRI and/or CT. Imaging findings were compared with operative and/or histological findings. RESULTS: In three cases there were simple mucoceles, in one case we found a tumour (nasopharyngeal carcinoma) associated mucocele and in two cases, malignant tumours (carcinoma, chordoma) imitated a mucocele. The diagnosis of simple mucoceles was no problem at all by imaging. Difficulties made the two malignant tumours and the tumour associated mucocele. In the first two cases, repeated histological samples were necessary to make the final diagnosis. CONCLUSION: Mucoceles of the sphenoid sinus should be investigated and handled very carefully with regard to differential diagnoses and tumour associated cases.

Adult↗
PubMed2004

[Indications of HR-CT in the early postoperative phase of stapedotomy].

PURPOSE: This is an analysis of high-resolution computed tomography (HR-CT) performed in patients with and without symptoms after stapes surgery during the early postoperative phase. MATERIALS AND METHODS: We examined 37 patients who underwent stapes surgery between January 1995 and December 2000. HR-CT of the temporal bone was performed in axial and coronal planes with 1-mm-slice thickness and table feed. A reoperation was performed in 7 patients. CT findings were compared with clinical follow up and surgical findings. RESULTS: All patients showed postoperative opacification of the tympanic cavity and external auditory canal as well as partial opacification of the mastoid on CT scans. A dislocation of the prosthesis was found in 11 cases and air bubbles were seen in the vestibule of 5 patients. In one case, small bone fragments were detected in the vestibule. In 6 of 7 cases, CT results were confirmed by retympanotomy. CONCLUSIONS: Due to overlapping of normal and pathological findings in the early postoperative period, indications for HR-CT are limited in this period.

Adult↗
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↗
PubMed2002

[Parapharyngeal space-occupying lesions. Differential diagnosis based on case examples].

INTRODUCTION: Parapharyngeal tumors account for only 0.8% of all head and neck tumors which often presents the problem of preoperative diagnosis. Up to 80% of parapharyngeal tumors are benign. PATIENTS: Starting November 1995 to March 2001, 16 patients with parapharyngeal tumors and 1 retropharyngeal abscess were treated. The median age was 54 years. Only 2 patients demonstrated peripheral nerve lesions preoperatively. RESULTS: 17 tumors and the retropharyngeal abscess were excised via transcervical approach, with an extension by parotidectomy and temporary mandibular split in 1 case. Histological entities were pleomorphic adenomas in 5 cases, a ganglioneurinoma, neurinoma of the vagal nerve and metastasis of a squamous cell carcinoma in 2 patients each, furthermore neuroblastoma, extramedullary plasmocytoma, T-cell lymphoma, and hemangioma in 1 patient each. CONCLUSIONS: We demonstrate the differential diagnosis of parapharyngeal tumors as well as their diagnostic and therapeutic management. The tumors should be excised by a transcervical approach to protect cervical vessels and nerves, which is limited by a transoral approach.

Adolescent↗
PubMed2001

CT and MR imaging after middle ear surgery.

This article describes the current value of imaging in patients after stapes surgery and surgery after chronic otitis media including cholesteatoma. Possibilities and limits of computed tomography (CT) and MRI are described and most important investigation parameters are mentioned. After otosclerosis surgery, CT is the method of first choice in detection of reasons for vertigo and/or recurrent hearing loss in the later postoperative phase. CT may show the position and condition of prosthesis, scarring around the prosthesis and otospongiotic foci. Sometimes, it gives indirect hints for perilymphatic fistulas and incus necrosis. MRI is able to document inner ear complications. CT has a high negative predictive value in cases with a free cavity after mastoidectomy. Localized opacities or total occlusion are difficult to distinguish by CT alone. MRI provides important additional information in the differentiation of cholesterol granuloma, cholesteatoma, effusion, granulation and scar tissue.

Cholesteatoma↗
PubMed2000

[The value of spiral CT in the staging of carcinomas of the oral cavity and of the oro- and hypopharynx].

PURPOSE: To compare spiral and conventional CT in the staging of carcinomas of the oral cavity, the oropharynx and hypopharynx. METHOD: Retrospectively 101 conventional CTs and prospectively 107 spiral CTs were analyzed regarding to correct T and N staging. CT results were compared with histological staging. RESULTS: In conventional CT, there were correctly staged 85% of T stages (T1 62%, T2 74%, T3 81%, T4 94%) and 85% of N stages (N0 79%, N1 71%, N2 89%, N3 94%). Spiral CT showed correct results in 84% of T stages (T1 67%, T2 74%, T3 88%, T4 95%) and in 86% of N stages (N0 82%, N1 78%, N2 90%, N3 93%). No statistically significant differences could be found between both CT methods. CONCLUSION: In spite of the tendency of improved diagnosis of T1, N0 and N1 stages no clear improvement in the staging of carcinomas of the oral cavity, the oropharynx and hypopharynx could be expected by spiral CT.

Adult↗
PubMed2000

[The pharynx following tumor-surgery interventions. The variability of the clinical images in conventional fluoroscopic diagnosis].

The present study gives a survey of radiological findings after surgical treatment of laryngeal and pharyngeal carcinomas, whereby the surgical procedures and the localisation of tumours found special consideration. One important point of view of modern surgery is the improvement of quality of life. By reason of this point the role of reconstructive surgery will become increasingly important. Representative radiographs between 1997 and 1999 are discussed to show the difficulties to distinguish between normal and pathological postoperative findings after operations of hypopharyngeal diverticula, after partial and total laryngectomy as well as after different methods of surgical reconstructions of pharynx. The examinations which are shown were realized with the conventional radioscopy. Hereby the normal radiological findings and their comparison to the particular postoperative specials rank first. Furthermore the early and late postoperative complications are mentioned. A variety of surgical procedures in treatment of laryngeal and pharyngeal carcinoma make new demands on the postoperative diagnostic possibilities especially on the postoperative pharyngography. The variability of the postoperative radiographs complicates the differentiation between normal and pathological radiological findings and only the exact knowledge of the performed surgical procedure allows their differentiation.

Carcinoma↗
PubMed1999

[Stress X-ray of the ankle joint: a cost-benefit analysis].

Over an 18-month period findings of stress X-ray of the ankle and medical records of 112 cases were analyzed retrospectively as to indications, results and therapeutic consequences. The analysis showed that critical setting of indications can reduce the frequency of stress X-ray of the ankle and thus lower the total costs. The introduction of guidelines could be advantageous at medical training institutions.

Ankle Injuries↗
PubMed1998

[Mesenteric lymphadenopathy in Yersinia enterocolitica infection].

We report a case of previously undiagnosed Yersinia enterocolitica infection in a 46-year old woman. She consulted her physician because of continual weight loss and physical lassitude. A leucocytosis was found. Sonography revealed an excessive enlargement of abdominal lymph nodes. A malignant lymphoma was suspected and the patient underwent a staging by CT. There the disease was limited on mesenteric and retroperitoneal lymph nodes. Bone marrow biopsy and CT-guided lymph node biopsy did not confirm a systemic lymphatic disease. The patient did not undergo a special therapy. After six months, CT showed a clear regression of enlarged lymph nodes. Finally, a previous Yersinia enterocolitica infection of immunotype 03 could be proved serologically. At this time, the patient had no complaints. Diagnostic and differential diagnosis of benign abdominal lymph node enlargement are discussed based on literature.

Biopsy↗
PubMed1998

[Dual phase spiral CT in hepatic hilar masses].

PURPOSE: To develop optimal parameters for dual-phase spiral CT and to test it in hepatic hilar processes. METHODS AND MATERIALS: 15 patients without and 20 patients with suspected hhp underwent dual-phase spiral CT. Maximum intensity projections (MIPs) of arterial and portal venous phase were calculated for assessment of relation between hhp and hepatic hilar vessels. RESULTS: Optimal parameters were: 150 ml contrast material with 4 ml/s, 20-s delay, 24-s spiral duration, 5 mm slice thickness, 7-8 mm/s table speed, 2 mm reconstruction increment. The localisation and spread of hhp could be optimally estimated on axial scans. Various hhp showed a different type of enhancement. 12 of 20 lesions caused an alteration of hepatic vessels. CONCLUSION: Dual-phase spiral CT is valuable in characterising and assessing spread and operability of hhp. The calculation of MIPs should be performed only when preparing an operation.

Aged↗