PubMed Health⌕ Search

Biomedical subjects

T Brusis

Publications and source records attributed to T Brusis.

At least 19 recordsLinked to original sources
PubMed1997

[Parastomal tumors after laryngectomy: etiology and therapy].

BACKGROUND: Parastomal neoplasm after total laryngectomy for laryngeal carcinoma represents an extremely serious complication and one of the most formidable therapeutic problems encountered by the head and neck surgeon. Studies about the etiology of parastomal neoplasm have been controversial. The factors most strongly implicated in parastomal neoplasm have been recurrence spawned by metastases to deep cervical lymph nodes, undetected neoplasm at the margin of the laryngectomy resection, neoplastic cell implantation by pre-operative tracheotomy, and the development of an additional primary. PATIENTS: To clarify the controversial aspects of parastomal neoplasm etiology, a systematic analysis of parastomal neoplasm after laryngectomy was performed using data from 10 patients who developed parastomal neoplasm. RESULTS: Parastomal neoplasm occurred in 7.9%. The tumor site of the primary laryngeal carcinoma was found in 9/10 cases in the subglottic, supraglottic, or transglottic area. These tumor sites correlate with areas of a lymphatic vessel concentration and an increase of intralaryngeal lymphatic drainage. In average the parastomal neoplasms appear 10.3 months after the laryngectomy. Therapy was unsuccessful in spite of extensive surgical interventions. CONCLUSIONS: If the laryngeal carcinoma was resected with margins of healthy tissue, lymphatic metastasis to the pretracheal and paratracheal cervical lymph nodes is the probable cause of parastomal neoplasm. This could be the consequence of the continuous lymphatic drainage between the supraglottic and subglottic area with a midline crossing and an lymphatic outlet to the pretracheal and paratracheal cervical lymph nodes. The cervical metastasis formation cannot be detected due to the limitations in the assessment of small lymph nodes and the inability to ascertain with confidence the presence or absence of metastasis in any one lymph node in ultrasonography, computed tomography, and magnetic resonance imaging and due to the limitations in the removal of lymph nodes in the pretracheal and paratracheal area by means of a functional or radical neck dissection. The method of treatment should be in cases of a subglottic or a supraglottic laryngeal carcinoma an ipsilateral and contralateral pretracheal and paratracheal lymph node removal in combination with the laryngectomy.

Aged↗
PubMed1996

[Perforation of the ear drum. On the history of paracentesis and grommet insertion].

As early as 1649, Jean Riolan the Younger pierced an ear drum, after which the patient's hearing improved. This occurred as a result of an accidental ear drum injury while cleaning an ear canal with an ear-spoon. In 17th and 18th centuries, several pioneers in medicine (Thomas Willis, Antonio Mario Valsalva, William Cheselden) conducted experiments in an effort to ascertain the function of the ear drum in hearing. At the end of the 18th century, ear drum perforation, like perforation of a cataract, was indiscriminately performed by itinerent quacks and "physicians" in England, France, and Germany. Ear drum perforation was performed in many places even for the healing of deaf and dumb. Astlee Cooper reported about success with ear drum perforation in 1800 and listed strict indications. He recommended the operation only in the presence of obturation of the Eustachian tube. Because of the negative results of indiscriminate ear drum perforation, the operation soon acquired a bad reputation and was not performed for decades. It was only Herrmann Schwartze who reintroduced paracentesis into the daily practice of otorhinolaryngology. He was director of the royal ENT clinic in Halle and published a trailblazing treatise on the indications, value, and success of this operation. Since physicians had soon realized that spontaneous healing tendencies of the ear drum quickly lead to closure of an artificial perforation, many physicians tried different techniques to obtain a permanent opening. Gruber resected half of the ear drum--unsuccessfully. Others put foreign bodies into the ear drum apertures, such as catgut, whalebone rods, and lead wires. In his textbook of 1845, Martell Frank first described a grommet made of gold foil. Politzer experimented with a hard rubber ring but later abandoned his attempts because of lack of success. Voltolini manufactured an open hollow ring of gold foil or aluminium, which had to be fixed at the handle of the malleur. Armstrong described a "new" therapy for chronic secretory otitis media consisting of inserting a vinyl tube into the ear drum. While he was not the inventor of the grommet, he was the first to reintroduce grommets in the middle of the 20th century. Theromoparacentesis was performed as early as 1867 by Voltolini, who performed this operation using a galvanic cautery device. After more than 100 years, the Japanese physician Saito reintroduced thermoparacentesis into the therapy of tube ventilation disorders. Paracentesis, grommet insertion, and thermoparacentesis are among the most successful treatments currently available to the ENT specialist when used properly. They are treatments with a long history.

Europe↗
PubMed1996

[Determination of hearing loss and disability assessment from pure tone audiometry and speech audiometry in occupational noise-induced hearing loss].

BACKGROUND: Occupational hearing loss is the most accepted occupational disease. The assessment should be conducted in accordance with the "Königsteiner Merkblatt" which appeared in the fourth completely revised edition in 1996. Determination of degree of disability is mainly based on speech audiometry. Adapted complete word understanding is most important. In special cases only sinus-tone audiometry is used for the assessment. Knowledge about common and uncommon schedules is important for the assessment. METHODS AND PATIENTS: The results of 200 audio metrical examinations in case of professional hearing loss have been evaluated with eight different schedules. Four of these schedules for determination of hearing loss are based on sinus tone audiometry. Boenninghaus and Röser's schedule uses speech audiometry under consideration of simple and adapted complete word understanding. Lehnhardt's schedule uses sinus-tone and speech audiometry for determination of degree of disability. Further on it is shown that the complete word understanding is the most important parameter for the quantitative determination of permanent noise induced hearing loss. It is even possible to determine the degree of disablement only using the complete word understanding. For all cases, the eight schedules were used to calculate the average hearing loss and the average degree of disability. Further on it was shown in how many cases-according to each schedule-a degree of disability of less than 10%, 10 to 15%, 20%, and more than 20% was calculated. RESULTS AND CONCLUSION: Comparing these eight schedules, it was shown that the use of adaptec complete word understanding increases the number of cases with 10% and 20% degree of disability. Using Röser's schedule of 1980, the number of minimal handicap increases. With the new "Königsteiner Merkblatt" a 10% degree of disability is reached more easily than it was previously.

Audiometry, Pure-Tone↗
PubMed1996

[Suprahyoid pharyngotomy for surgical therapy of malignant and benign oral and hypopharyngeal tumors].

Many cases of oropharyngeal and hypopharyngeal neoplasms without diffuse infiltration of the larynx or mandible cannot be treated effectively by a transoral approach. In such cases a lateral and/or median translingual pharyngotomy can permit effective surgical therapy. However, these surgical techniques require greater effort and violate uninvolved tissues, such as the lip, mandible and floor of the mouth. In contrast to this, a suprahyoid pharyngotomy can be a simple and precise approach to the oropharynx and hypopharynx, and provide the shortest distance to the pathological process. The excellent exposure given to the oropharynx and hypopharynx offers a more exacting macroscopic identification of tumor margins and minimizes possible injuries to vital neurovascular structures. The wound created can usually be closed primarily without the need for regional flaps. These factors allow a faster healing of the wound and better rehabilitation, as well as avoiding delays in postoperative radiation therapy. Over the past 6 years a suprahyoid pharyngotomy was performed in eight patients. Five patients underwent resections of an oropharyngeal cancer while three patients required resections of benign neoplasms of the tongue base. In the cases of oropharyngeal cancer, a suprahyoid pharyngotomy was performed in combination with a unilateral or bilateral neck dissection. A tracheotomy was required in six patients. Three patients underwent postoperative radiation therapy. No locoregional recurrences were found in these patients, with a median follow-up of 20.8 months.

Adenocarcinoma↗
PubMed1995

[Expert assessment within the scope of the sudden deafness disease picture].

Claims for medical liability mostly arise when a patient believes that his sudden deafness was not accurately diagnosed, diagnosed too late or insufficiently or was not well treated. Guided by seven expert opinions potential problems in indemnity were depicted. A clear misdiagnosis of sudden hearing loss (e.g., a hearing loss taken for eustachian tube disorder) will lead to an accusation of malpractice if the doctor cannot prove an accurate otological examination and appropriate diagnostic studies. The burden of proof lies with the doctor. A further consequence of a missed diagnosis is a delay in treatment. In the literature the good prognostic factor of early treatment has been stressed but without delineating a clearcut line between "in time" and "too late". An accusation of malpractice by insufficient treatment (pills instead of infusions) has risen. Since an unequivocal treatment is not established and various modalities of therapy are still controversial, disputes could be settled more easily. The validity of "no treatment" may be considered but requires accurate diagnosis and the patient must give informed consent. Such a procedure is justifiable, even from an ethical standpoint, when the patient fully understands and agrees.

Adult↗
PubMed1994

[Brain damage after tonsillectomy?].

We report on a 47-year old male patient who developed persistent postoperational bleeding after tonsillectomy, which made tamponading of the pharynx necessary. Even though the patient left the hospital after one week with a haemoglobin value of 10.6 g% and without any complaints, he developed personality changes and later severe neurological symptoms which led to the diagnosis of hypoxic brain damage as suggested by a variety of neurologists and psychiatrists. The diagnosis was finally disproved by a brain biopsy revealing the existence of Jakob-Creutzfeldt disease, a degenerative inflammatory disease due to a slow virus infection. By this final diagnosis the reproach of a maltreatment could be ruled out. The accidental coincidence of the tonsillectomy and the beginning of the Jakob-Creutzfeldt disease had led to the incorrect diagnosis of an operation-caused brain damage. A relation to the tonsillectomy could be ruled out by an extensive neurological examination using every possible diagnostic aid including brain biopsy.

Brain↗
PubMed1993

[Jatho stoma reconstruction--cannula-free, self-anchored tracheostomy in laryngectomy patients].

Since 1987 we are using a tracheostoma construction technique proposed by Jatho in 1976. A vertical incision is made in the anterior wall of the trachea. A triangular skin flap is interdigitated into the slit. The slit is additionally held open by a thread on each side of the trachea which leads through the periods of the subclavial bone and from there through the skin. 34 patients, who were operated on according to this technique were followed up during a period between 3 and 43 months. None of them needed a cannula to keep the stoma open. Four of these patients underwent a revision procedure analogue to that one described above. These results are compared to the results from conventional stomal construction and various stoma plasty techniques found in literature.

Follow-Up Studies↗
PubMed1993

[Pharyngeal tuberculosis as a differential diagnosis to carcinoma].

The differential diagnosis of pharyngeal tumors includes malignomas as well as chronic inflammatory processes. Squamous cell carcinoma is the most prevalent malignoma of the pharynx, representing about 90% of all malignomas of the head and neck. Malignant lymphomas, lymphoepithelial tumors (Schmincke's tumor) and anaplastic carcinomas are less prevalent. Amelanotic melanoma, rhabdomyosarcoma and extramedullary plasmocytoma are rare malignomas of the pharynx. Infectious diseases may also be a cause of pharyngeal tumors which have been reported to be associated with mycobacterial infections, syphilis, leproma, malleus and anthrax. Sarcoidosis and Wegener's granulomatosis are chronic inflammatory diseases of unknown etiology. We report a case of a 65-year-old female with an 11-year history of a slowly progressing tumor of the nasopharynx who had been admitted to hospital with suspicion of a malignoma.

Aged↗
PubMed1992

[Intralesional therapy with natural interferon-beta in refractory squamous epithelial cancers of the ENT area].

It has been the aim of the present investigation to study the effect of intratumorally applied human fibroblast interferon (nIFN-beta; Fiblaferon 5 for the first two weeks, and Fiblaferon 3 three times a week) in a phase-II clinical trial of thirteen patients with advanced head and neck squamous cell carcinomas. All of the patients had failed established therapeutic modalities before and could not be treated by conventional procedures. nIFN-beta was injected intratumorally and its effect on tumour size was assessed by an independent, second observer as well as via CT and MR imaging. All assessments were done prior to treatment, 8 weeks after beginning treatment and at 16 weeks. Three female and ten male patients with primary tumours of the hypopharynx (n = 5), the larynx (n = 4), the oropharynx (n = 1), the glandula submandibularis (n = 1), the oral cavity (n = 1) and the oesophagus (n = 1) have undergone outpatient treatment three times a week. Tumour size showed no change in six patients while progressive disease occurred in seven cases after eight weeks of treatment. Radiological findings did not change in the nine patients continuing treatment while five showed progressive disease. There were no serious local or systemic side effects due to the intratumoral nIFN-beta treatment. The survival time was 9.73 months after the onset of nIFN-beta treatment.

Adult↗
PubMed1992

Hearing loss as a sequel of lumbar puncture.

Only a few case reports have been published about hearing impairment following lumbar puncture, and not all were thoroughly documented by audiograms. We present nine cases of hearing loss following myelography, lumbar puncture, and spinal anesthesia. We speculate that this rare complication arises only in persons with a wholly or partially patent cochlear aqueduct, and occurs via the release of perilymphatic fluid in the cerebrospinal space. Hearing loss was seen in eight of the nine patients in the lower frequencies, and in six of the nine patients on both sides. Recovery to normal hearing was noticed in six of the nine patients. Transient hearing loss may occur more often than it is generally assumed, and the symptom can remain unnoticed. Since not all of these hearing losses proved to be fully reversible, we suggest informing patients about this complication for medicolegal reasons.

Adult↗
PubMed1991

[History of esophagoscopy].

Since the middle of the 19th century very many experts have endeavoured to develop the oesophagoscopy following two different principles of oesophagus examination. Some tried to transfer the technique of indirect laryngoscopy on the oesophagus by using a larynx speculum. In order to achieve an insight into the oesophagus they separated its closed upper end by means of special retracting instruments. Various instruments were developed for this purpose (by Voltolini, Semeleder, Stoerk, Bevan, Waldenburg, Mackenzie) which however not proved to be effective. Mostly angled or jointed tubes came into use which were stretched after insertion. More successful were those applying simple straight tubes. Except for Stoerk it was Kussmaul who had a sword-swallower swallow a tube instead of a sword. Today flexible fiberglass endoscopes are used as well as rigid tubes.

Esophagoscopy↗
PubMed1991

[Results of follow-up after uvulopalatopharyngoplasty].

200 of 300 patients who were operated on because of strident snoring or of a sleep apnoea syndrom were examined in a follow-up study. In 93.5% turbinectomy was performed simultaneously, in 50% septum plasty, and in 9.5% endonasal revision of the sinus. On Improvement of snoring was noted in 81.5% of the patients, cessation or improvement of the apnoea in 83%. Daily tiredness was reduced in 65% of the operated patients, and partner problems were solved in 78%. Recommendation for operation was given in 75.5% of the cases. Due postoperative complaints and the lack of results, however, 21.5% could not, and 3% restricted their recommendation to others to undergo surgery. The satisfactory results and the high acceptance of the operation confirmed uvulopalatopharyngoplasty as a solid and efficient operation to help patients suffering from an obstructive sleep apnoea syndrome. If the operation is performed carefully and cautiously, there is no fear of negative consequences such as rhinophonia and difficulties in swallowing.

Aged↗
PubMed1991

[Hearing disorders following spinal anesthesia].

In the few case reports of hearing loss following spinal anesthesia, complete recovery of the hearing impairment has always been described. In nine cases with hearing loss following not only spinal anesthesia but also myelography and dural puncture, the hearing of three patients did not recover or only partly returned. Two cases went to court for malpractice. Their suits could be dismissed because it appears likely that this rare complication arises only in persons with a wholly or partially unobliterated aquaeductus cochleae due to loss of perilymphatic fluid into the cerebrospinal space. Hearing loss was seen in eight of nine patients in lower frequencies around 30-40 dB. In six patients there was impairment on both sides. Recovery of normal hearing occurred in six of the nine patients. Transient hearing loss may occur more often than is generally assumed, and the symptom may remain unnoticed when a severe post-dural puncture syndrome with headache, dizziness, and nausea dominates the attention of the patient. Not all cases of hearing loss proved to be fully reversible, but the individual risk for this complication is not predictable. The use of fine-gauge needles may reduce the leakage of cerebrospinal fluid through the dural puncture and thus lower the incidence.

Adult↗