Biomedical subjects

S Knipping

Publications and source records attributed to S Knipping.

At least 19 recordsLinked to original sources

PubMed2007

[Results after lidloading with rigid gold weights--a meta-analysis].

INTRODUCTION: For the surgical therapy of lagophthalmos rigid gold implants were used. There are a lot of studies using rigid gold implants with widely different complications. In the primary study the small amount of patients is often a problem. The aim of our study was to survey the postoperative results and complications after insertion of rigid gold implants and to statistically compare the results with a meta-analysis. MATERIAL AND METHODS: 38 publications on 1000 rigid gold implants were analyzed in the context of a meta-analysis of the postoperative results. RESULTS: Complete lid closure can be obtained in 84.5 % with the rigid gold implants. The postoperative complication rates were 13.4 % for bulging, 6.4 % for migration, 6.8 % for extrusion, 11.5 % for corneal astigmatism and 7.0 % postoperative infections. DISCUSSION: Lidloading is a very simple and reversible procedure for the surgical treatment of lagophthalmos. The statistical analysis in using rigid gold implants showed a significant rate of postoperative complications. To increase the effectivity of the treatment method these results should be taken into account for alternative implants.

Eyelid Diseases↗

PubMed2007

[Invasive aspergillosis of the skull base with orbit infiltration].

BACKGROUND: [corrected] Aspergillosis of the paranasal sinuses is subdivided into noninvasive and invasive types, depending on invasion of the tissue. The invasive form often occurs in immunodeficient patients and can be divided further into granulomatous, chronic invasive, and acute fulminating forms. CASE REPORT: We report the clinical course of an immunosuppressed 64-year-old male with invasive aspergillosis originating from the sphenoid sinus with infiltration of the orbit and intracranial extension into the cavernous sinus. The patient was referred to our hospital with loss of vision, ptosis, and ophthalmoplegia of 3-month duration. Additionally he suffered from diabetes mellitus II and kidney failure after kidney transplantation. After CT scanning, endonasal sinus debridement and decompression of the orbit were carried out immediately. Histology revealed invasive aspergillosis. Postoperatively, both systemic and local antimycotic therapy and antibiotic treatment were performed. According to recommendations of the Undersea and Hyperbaric Medicine Society, cerebral abscess is a certain indication of hyperbaric oxygenation. We decided to attempt therapy for that as well. The patient died 3 weeks after surgical intervention due to carotid dissection. CONCLUSION: Invasive aspergillosis of the paranasal sinuses and the skull base of immunsuppressed patients is usually lethal because of intracranial complications. Therefore, fast diagnosis using CT and MRI and surgical and antimycotic therapy are necessary.

Antifungal Agents↗

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

[Stomal metastases after translaryngeal tracheotomy (TLT) according to Fantoni: a rare complication].

The translaryngeal tracheotomy (TLT) according to Fantoni with rigid endoscopy is well known and easy to execute. In our department we have used this method since 2002. In 17 patients suffering from carcinomas of the upper aerodigestive tract, we performed a TLT. Peri- and postoperative complications were examined. In 17 patients there were no intraoperative complications. As an early complication we found in one case a dislocation of the tracheostomy tube postoperatively. In one patient we observed metastases in the prior TLT stoma as a major late complication. Another patient also probably suffered from metastases in the prior TLT stoma. We did not find tracheoesophageal fistulas or stenosis of the trachea. Iatrogenic neoplastic seeding of squamous cell carcinomas of the upper aerodigestive tract is a serious complication. Our experience with these two cases and a review of the literature indicates that in patients with head and neck cancer, pull procedures for placement of TLT tubes may induce metastases by direct implantation of tumor cells because of contact between the TLT tube and the primary tumor cells. TLT according to Fantoni cannot be recommended for the treatment of cancer of the upper aerodigestive tract. Methods of tube insertion that avoid such contact, e.g., Ciaglia, surgical tracheostomy, should be preferred.

Aged↗

PubMed2006

[Ultrastructural changes in human nasal mucosa in rhinitis medicamentosa].

BACKGROUND: Long-term abuse of decongestive nasal drops causes rhinitis medicamentosa due to cytotoxic and ciliary-toxic effects. Nasal obstruction is caused by rebound swelling when the decongestive effect has disappeared. The patient starts using nasal drops more frequently as a result of tachyphylaxis. PATIENTS AND METHODS: Tissue samples from human inferior turbinates from 22 patients who had overused decongestive nose drops were taken during nasal surgery and preserved in phosphate-buffered paraformaldehyde or glutaraldehyde. Ultrathin sections were cut. The samples were dehydrated and embedded in Araldit. The findings were photo-documented using a light- and transmission electron microscope. Biopsies from ten patients without chronic inflammation of the nasal mucosa were used as controls. RESULTS: The electron microscopic investigations revealed epithelium showing severe damage corresponding to regions with hyperplastic and metaplastic changes. Loss of ciliated cells was observed. Under a thick basal membrane, ultrastructural changes to the endothelial lining, such as openings and rupture of the basal lamina, were detected. Prominent endothelial cells were conspicuous. CONCLUSIONS: Rhinitis medicamentosa is a drug-induced injury to human nasal mucosa associated with the prolonged abuse of topical nasal decongestants. Loss and destruction of ciliated epithelial cells are the morphological correlation to the disturbance of mucociliary clearance. Endothelial cells of capillaries, in particular, revealed ultrastructural changes indicative of increased permeability with consecutive interstitial edema.

Administration, Intranasal↗

PubMed2004

[Neural control of the respiratory nasal mucosa].

Respiratory nasal mucosa fulfils the function of pretreating the inspired air. The periodic nasal cycle and pathologic functional disturbances of the endonasal tissue influence the nasal passages. The secretion of the seromucous glands and extravasation from the blood vessels are essential for mucocilliary transport. These physiological mechanisms are partially controlled by neural regulation. Besides classic neurotransmitter neuropeptides such as VIP, CGRP, SP and NPY, nitric oxide also shares this role. A network of sensory, sympathetic and parasympathetic nerve fibres protects the respiratory mucous membranes from external and internal irritation. In addition, blood vessels and glands are influenced by endothelial and humoral factors. For the different types of rhinitis, sensory neuropeptides and inflammatory mediators take part in the pathomechanisms and can lead to a so called neurogenic inflammation of the nasal mucosa.

Feedback↗

PubMed2004

[Management of periorbital and orbital infections].

BACKGROUND: Infections of the orbit and of the periorbital region are not uncommon. Even today they constitute a serious problem, in spite of modern antibiotic treatment, with a potential risk of lethal complications. Orbital infections are most prevalent in children and adolescents. The acute orbit has many causes, but the most frequent is an occurrence secondary to acute rhinosinusitis. PATIENTS AND METHODS: Based on clinical cases, different causes and the present state of diagnosis are presented. The discussion deals with therapeutic strategies depending on the stage according to the current classification of orbital inflammation. CONCLUSIONS: Orbital and periorbital inflammations represent a demanding challenge for interdisciplinary cooperation between ophthalmologists, ENT specialists and radiologists. In some cases maxillofacial surgeons and neurosurgeons have to be included as well. Accurate diagnosis and treatment may lead to the resolution of the infection and avoid ocular sequel or endocranial complications as well as a fatal outcome.

Anti-Bacterial Agents↗

PubMed2002

[Ultrastructural changes of the nasal mucosa in primary ciliary dyskinesia].

Primary ciliary dyskinesia syndrome (PCD) is a rare, autosomal receive disorder. Kartagener's syndrome is a subgroup of the PCD with situs inversus, bronchiectasis, and sinusitis. The symptoms results from an abnormal ultrastructural morphology of the cilia such as absence of dynein arms and other changes. As a consequence ciliary motility is disturbed. A 25-year-old man was examined because he suffered from recurrent severe pneumonia and Aspergillus infections of the lungs. On electron micrographs, ciliary abnormalities including deficiency of inner and outer dynein arms, dysmorphic outer dynein arms, and disorientation of the cilia were demonstrated. The diagnosis of PCD requires electron-microscopic investigations of the ciliated mucosa. Special attention should be given to ultrastructural changes of nasal or bronchial mucosa if a young patient suffers from recurrent severe respiratory infections.

Adult↗

PubMed2002

[Chronic rhinosinusitis in hypogammaglobulinemia. A morphological study].

Primary hypogammaglobulinemia (Bruton's disease) is a rare X-linked infantile immunodeficiency syndrome due to a B-cell defect. The patients suffer from acute and recurrent bacterial infections with chronic rhinosinusitis and chronic lung disorders. Immunoglobulin replacement therapy and antibiotics do not suffice in some cases, making sinus surgery to advance the drainage necessary. A 25-year-old man with hypogammaglobulinemia was treated with functional endoscopic sinus surgery and mucotomy of the turbinates. Tissue samples of the inferior turbinates were taken for histological and electron-microscopic examination. Immuno-electron-microscopic methods were carried out with antibodies against substance P and calcitonin gene-related peptide (CGRP). Morphological investigations to better understand pathophysiological changes in hypogammaglobulinemia are rare. Pathological changes in the glands and venous vessels could be demonstrated. A rich neural supply and participation of neuropeptides such as substance P and CGRP could play a role in the unspecific defense via neurogenetic inflammation in these cases.

Adult↗

PubMed2002

[Morphological changes of nasal and duodenal mucosa in patients with cystic fibrosis].

BACKGROUND: Cystic fibrosis (CF) is an inherited multisystemic disorder that results in generalized dysfunction of exocrine glands. In patients with cystic fibrosis dyscrinia with affection of exocrine glands function is a main problem of the upper and lower respiratory tract. In addition to chronic obstructive pulmonary disease, chronic sinusitis, nasal polyposis and hypertrophy of inferior turbinates with nasal airway obstruction are typical signs. To understand pathophysiological mechanisms in CF and to correlate morphological findings with clinical symptoms, investigations of nasal mucosa are important. METHODS: Tissue samples of inferior turbinates were taken during nasal surgery from 7 children, ranging from 3 to 11 years of age between September 1998 and May 2000. Histological sections were cut followed by a light- and electron microscopical examination (EM 902 A Zeiss). Additionally, specimens of duodenal mucosa were investigated. RESULTS: In comparison with sections of normal nasal mucosa the lamina propria mucosae shows different morphological changes. Under a thick layer of respiratory epithelium with a high portion of goblet cells and particulary vacuoles there is an edematous subepithelial area. The capillary layer is reduced and the seromucous glands show an atypical morphological structure with widely mucous cells and cystic dilatation. On an ultrastructural level the glandular cells show atypical and inhomogeneous glandular droplets in the supranuclear cell portion. A viscous secretion was detectable at the glandular lumen. The nucleus contains dispersed chromatin as a sign of increased activity and the structures of Golgi apparatus were obviously detectable. CONCLUSIONS: In respective literature studies on the different morphological changes on light- and electron microscopical level in CF-associated rhinopathies are rare. This histological study demonstrated various morphological changes of nasal mucosa and shows a correlation between the glandular dysfunction and the typical symptoms in CF. Additionally a comparison with ultrastructural findings of CF-enteropathies is proposed. These findings could help to look at new aspects in the pathophysiology for patients with CF.

Child↗

PubMed2002

[Regulation of the swelling mechanism in the inferior turbinate of human nasal mucosa].

BACKGROUND: The swelling mechanism of human nasal mucosa is based on a complicated vascular system and regulated by a variety of classical and peptidergic transmitters as well as by endothelial transmitters. The aim of this study was to elucidate this mechanism taking into account the distribution of these substances and the morphology of the different vessels. METHODS: Tissue specimens of human inferior turbinates were evaluated by light and electron microscopy. We used frozen sections to localize enzymes of the transmitter synthesis by histochemical and immunocytochemical methods. The distribution of classical neurotransmitters, neuropeptides (calcitonin-gene-related-peptide, neuropeptide Y, substance P and vasoactive intestinal polypeptide), enzymes producing neuronal NO (neuronal nitric oxide synthase, nicotine-amid-adenine-dinucleotide-phosphate-diaphorase) as well as endothelial transmitters such as endothelin and endothelial nitric oxide were examined. For ultrastructal examination the specimens were fixed in glutaraldehyde und osmium tetroxide, embedded in araldide, cut and double contrasted. RESULTS: Most of the axons and immunoreactivity of transmitters were located in the arterial part of the human nasal vascular system. In venous vessels only a spare innervation was observed, whereas in the subendothelial muscular bolsters of the cushion veins a rich nerve supply could be detected. Near the fenestrated subendothelial and periglandular capillaries no axons were found. Nasal vasculature is supplied by a equilibrated aminergic and cholinergic innervation. Mainly arterial vessels showed reactions to antibodies directed against endothelial transmitters. CONCLUSION: Because of the dense innervation of arteries and subendothelial venous muscular bolsters we conclude that the swelling mechanism of human nasal mucosa is mainly regulated by these structures. A dual (endothelial and neuronal) control exists in arterioles whereas the control in the subendothelial muscular swellings of the cushion veins appears to be mainly neuronal. The swelling of the nasal mucosa is achieved by an simultaneous relaxation of all smooth muscle cells, which leads to dilatation of arteries as well as venous sinuses. The drainage of the vascular bed is reduced by the venous muscular bolsters protruding into the lumen of the venous sinuses. Vice versa, a contraction of all smooth muscle cells leads to a contraction of the arteries and, consecutively, to a reduction of blood supply. Simultaneously the muscular bolsters are torn out of the lumen of venous sinusoids allowing blood drainage to be increased: nasal concha decongests.

Airway Obstruction↗

PubMed2002

[Immunoelectron microscopic findings in patients with allergic rhinitis].

BACKGROUND: In middle Europe the prevalence of allergic rhinitis is up to 15 % to 25 %. Allergic rhinitis is characterised by an inflammation of the nasal mucosa induced by different allergens. The patients suffer from symptoms like sneezing, rhinorrhea and nasal airway obstruction caused by morphological changes of the nasal mucosa. This symptomatology is considered to be a result of accumulation and activation of inflammatory cells. Further some neuropeptides like Calcitonin Gene Related Peptide (CGRP) and Substance P (SP) play an additional role in pathophysiology of allergic rhinitis. PATIENTS AND METHODS: Tissue samples from 28 human turbinates of patients with perennial rhinitis were taken during nasal surgery and preserved in phosphate-buffered glutaraldehyde or paraformaldehyde. Ultrathin sections were cut. The samples were dehydrated and embedded in Araldit. After polymerization an immunocytochemical staining-technique using a gold-labeled antibody was carried out. Immunostained structures were photodocumented by using a transmission electron microscope. RESULTS: In the lamina propria mucosae an extensive edema and several inflammatory cells like lymphocytes, plasma cells, eosinophiles and macrophages was found. The capillaries showed an activated endothelium. Immunoreactive nerve fibers were found in the periglandular tissue around the acini, ducts and in the glandular connective tissue. Neuroglandular synapses with dense core vesicles and positive immunoreactions to CGRP and SP could be detected. Neuropeptidergic axons were often observed near to plasma cells. CONCLUSIONS: In the edematous nasal mucosa an infiltration with different inflammatory cells was found. Using electron microscopical techniques nerve structures near the submucosal glands could be demonstrated. Immunoreactions to the neuropeptides CGRP and SP were detected in the periglandular nerves and in neuroglandular synapses. These findings demonstrate the direct nerve control of glandular functions in allergic rhinitis. CGRP is generally known to have a vasodilatatory effect and to stimulate the secretion of nasal seromucous glands. In addition, SP as a short-acting vasodilatator may induce vascular permeability and glandular secretion. These immunoelectron microscopical findings further elucidate pathomorphological mechanisms in allergic rhinitis.

Biopsy↗

PubMed2002

Abscess tonsillectomy for acute peritonsillar abscess.

Peritonsillar abscess (PTA) is a common but potentially serious complication of acute exudative tonsillitis. Several treatment guidelines have been described including needle aspiration, incision and drainage or abscess tonsillectomy. From January 1996 to September 2000 145 patients (53 female and 92 male, age range 3-95 years) were treated for PTA at the Department of Otorhinolaryngology, Head and Neck Surgery of the MLU Halle-Wittenberg, Germany. The highest incidence of PTA was observed in the second and third decades of life. Immediate abscess tonsillectomy was performed in 105 cases. This procedure, considered as safe and easy, has a lot of advantages. Compared with other treatments, it removes the abscess with amelioration of the trismus and dysphagia. Needle aspiration as the initial and only treatment was performed in 13 patients. In 20 patients without clinical improvement after aspiration, abscess tonsillectomy was undertaken. We conclude that immediately performed abscess tonsillectomy is an effective and safe treatment for peritonsillar abscess.

Abscess↗

PubMed2001

[Orbital space-occupying lesions. Practical aspects of imaging].

During the period 1992-1998,we diagnosed orbital tumors in 23 cases at the MLU Halle-Wittenberg. In the intraconal compartment we mostly saw cavernous hemangiomas and neurogenic tumors. Lymphomas and a primary meningioma were located in the extraconal space. Beneath the periosteum, bony processes, tumors of the sinuses, dermoid-and epidermoid-cysts normally occur, but we only observed metastases and hematomas. Furthermore,tumors of the lacrimal gland and inflammatory lesions were diagnosed. Orbital tumors are uncommon lesions, whose location in the orbit gives an important hint to differential diagnosis, because a high percentage of various pathologies is located in special compartments of the orbit. According to our results,the MRI-scan is usually sufficient for differentiation and for preoperative planning in order to reduce the X-ray dose of the lens. CT-scans with contrast are sometimes necessary for examining bone destroying processes and for planning the surgical approach to removing the tumor. X-rays of the skull widely lost their importance in the exact diagnostic of orbital tumors. B-scan ultrasonic imaging is reserved for screening and follow-up examination. Despite the use of MRI and CT scanning, the histological examination remains necessary.

Combined Modality Therapy↗

PubMed2001

[Electron microscopic studies of the rabbit nasal mucosa after short-term application of naphzoline nitrate].

BACKGROUND: Vasoconstricting nasal drops are applied frequently. Especially early ultrastructural alterations of the vessels were not examined up to now in animal models. Our goal was the systematic investigation of the submucosal vessels and the epithelium after topic application of naphazoline nitrate (Privin) in an animal model. METHODS: Three times daily over 6 days 3 ml of 0.1% naphazoline nitrate solution (Privin) were instilled into the right nasal cavity of 5 rabbits. At the 7th and 14th day an incisional biopsy of the lower nasal turbinate was carried out in ketamine/rompun anesthesia. RESULTS: In the naphazoline group the capillaries showed an edematous endothelium with narrowed lumina. Thrombosis of the arterioles were frequently observed. The more cubic epithelial cells had deciliated areas with microvilli. Venules, submucosal glands and the surrounding connective tissue was normally configurated. Analogous findings were also observed after 2 weeks. CONCLUSIONS: The disturbance of the microcirculation shows impressive endothelial alterations. These structural changes can result in nonreversible mucosal damages. A regeneration time of more than 1 week is assumable. Our results should be considered critically in order to prevent damages of the nasal mucosa.

Administration, Topical↗

PubMed2001

[Basic classical, peptidergic and nitrergic innervation pattern of human nasal glands--a histochemical and immunohistochemical study].

BACKGROUND: Seromucous glands are important components of the human nasal mucosa. The innervation patterns are relevant for understanding the control of the different physiological and pathophysiological glandular functions. Beside classic neurotransmitters some neuropeptides seem to influence the glandular secretion. METHODS: Tissue samples of 35 human inferior turbinates were taken during nasal surgery and preserved. Serial cryosections or paraffin sections were cut and incubated with antibodies either to Tyrosinhydroxilase or to Vasoactive Intestinal Peptide (VIP), Calcitonin Gene-Related Peptide (CGRP) and endothelial or brain Nitric Oxide Synthase (eNOS or bNOS). AChE- and NADPH-diaphorase-histochemistry were performed. RESULTS: Immunoreactive nerve fibers were found in the periglandular tissue around the acini, ducts and in the periglandular connective tissue. The density of positive immunoreactive structures depended on the different antibodies. VIP was found in contact to acinus cells, CGRP in the connective tissue around glandular cells. Particular immunoreactions to VIP and CGRP-antibodies could be detected near the glandular duct system. The eNOS-reactions were found in small capillaries near the acinus cells. CONCLUSIONS: Immunohistochemical and histochemical methods allow a detailed marking of nerval structures in nasal mucosa. The localization of neurons with different neurotransmitters and neuropeptides in the periglandular tissue confirms the direct nerval control of the diverse glandular functions. The detection of bNOS- and NADPH-d-positive structures around glandular cells and eNOS in the endothelium of periglandular capillaries suggests that NO takes an additional part in the regulation of nasal glands.

Adult↗

PubMed2000

[Electron microscopy studies of innervation of nasal mucosa glands in humans].

BACKGROUND: Seromucous glands are one of the main components of human nasal mucosa. The innervation pattern is important to understand the control of the different physiological glandular functions. In addition to light-microscopical findings electronmicroscopic investigations were performed to get more detailed information on the innervation of nasal glands. PATIENTS AND METHODS: Tissue samples of 16 human inferior turbinates were taken during nasal surgery and preserved in Unicryl or 3.5% phosphate-buffered glutaraldehyde. After fixation ultrathin sections were cut. Electron microscopical structures were photodocumented by using a transmission-electron microscope (EM 902 A Zeiss). RESULTS: Few axons were found in the periglandular tissue. No myo- or glandular-neural tight junctions could be identified. Unmyelinated nerve fibers showed typical components such as neurofilaments, neurotubules and mitochondria in their cytoplasm. An additional control of the glandular secretion by the vascular tone of the fenestrated capillary vessels will be discussed. CONCLUSIONS: Based on these ultramorphological findings further immunoelectron microscopical investigations will follow to demonstrate the various neurotransmitters and their distribution in periglandular axons.

Child↗

PubMed1999

[Unusual intra-extracranial extension of meningioma of the lateral skull base].

Extracranial meningiomas are rare tumors of the lateral skull base. A 37-year-old woman presented with tinnitus und progressive hearing loss of her right ear. A painful mass lesion was also palpable in her mandibular angle. CT and MRI scans revealed an intracranial mass with extension to the lateral skull base. These findings suggested the occurrence of a paraganglioma or meningioma. In a two-stage surgical procedure tumor was extirpated without functional impairment to the patient. Histology of the excised lesion demonstrated an endotheliomatous meningioma. Since an extracranial meningioma can present as a mass lesion of the lateral skull base, CT and MRI scans are essential in preoperative surgical planning.

Adult↗