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T Deitmer

Publications and source records attributed to T Deitmer.

At least 37 records · Page 2Linked to original sources
PubMed1993

[Angiographic embolization as an alternative to ligation of the maxillary artery in nosebleed].

In our hands angiographic embolisation for epistaxis proved to be a good alternative to surgical occlusion of the maxillary artery. We used this approach in cases in which neither nasal packing nor other local treatment such as coagulation were successful and the bleeding site was within the region of the maxillary artery. The reported cases were all successfully controlled for several months. There were no side effects or complications as is sometimes reported. We can recommend embolization as an alternative procedure in such cases of epistaxis.

Adult↗
PubMed1993

[Evaluation of nasal patency].

The subjective estimation of nasal breathing, the flow in anterior rhinomanometry, nasal peak flow and the results of acoustic rhinometry have been investigated in 30 patients before and after decongestion of the nasal mucosa. The aim of this study was to compare the different methods in view of their results. The effect of decongestion can be seen in all methods. A regression analysis showed no significant correlation between these methods. We found the best correlation between subjective estimation and the flow in anterior rhinomanometry at 75 Pa on the side of the better flow. The decisive drawback of the acoustic rhinometry is the fitting between nosepiece and nostril. Because of the influence of extranasal factors on the results of the peak flow measurement, anterior rhinomanometry seems to be the most reliable method to assess nasal air flow.

Acoustics↗
PubMed1993

The effect of different preparations of nasal decongestants on ciliary beat frequency in vitro.

Ciliated cells from the nasal mucosa of normal persons were collected in culture medium and exposed to either oxymetazoline without preservatives, oxymetazoline with preservatives, xylometazoline with preservatives, or sham (culture medium). There was a significant decrease in ciliary beat frequency only by the two drugs with preservatives after 20 min. After substitution of the test media with culture medium ciliary action did not recover in any group.

Cells, Cultured↗
PubMed1993

[Nose and paranasal sinus malignancies with reference to occupational medicine aspects. A case study].

Asbestos is a well known inhalant cancerogenic substance, causing not only mesothelioma but also cancer of the respiratory mucosa of the bronchi. Exposure can also cause non-malignant alterations of the pleura or lung, which can be assessed radiologically. Since asbestos can also induce malignant tumors of the nose and sinuses, we identified 50 patients from the files of the ENT Department Münster and tried to complete questionnaires concerning occupation and occupational hazards using informations from insurance companies as well as at least one chest x-ray. This material could be obtained in 19 patients. Nine of the 19 patients had x-ray findings that could be associated with asbestos exposure, but in none of these 9 cases was massive occupational exposure to asbestos probable. In only two of the nine cases was definite occupational exposure to asbestos not able to be excluded. A control group was not established, since statistical calculations of significance would have been problematic in a number of the 19 patients even if a control group did exist. From the questionnaires we have found an unexpected incidence of dusty workplaces (as seen with textile workers, wood-dust workers, cement workers, quarrymen and millers). A correlation between various types of sinonasal tumors and asbestos exposure could not be made.

Asbestos↗
PubMed1992

[Legal cases on the correlation between exposure to asbestos fiber dust and laryngeal cancer].

In Germany the causal relationship between laryngeal carcinoma and occupational exposure to asbestos is under discussion. We report on 30 cases of laryngeal carcinoma for which compensation was considered, since an occupational contact with asbestos was confirmed or suspected. We looked especially for signs of non-tumorous lesions related to asbestos exposure in radiography or CT of the chest. Such signs could be detected in 12 individuals. In Germany compensation for an occupational disease can be granted only, if e.g. the relevance of asbestos exposure is sufficiently probable, with special regard to other noxious influences such as cigarette abuse. Asbestosis of the larynx cannot be diagnosed specifically; we, therefore suggest proving the relevance of asbestos exposure in respect of signs of tumorous or non-tumorous lesions in the chest.

Aged↗
PubMed1992

Effect of low frequency air oscillations on nasal mucociliary transport.

Air oscillations of 16 Hz and pressure differences of 200 mmHg were applied to the nose of 30 volunteers. The mucociliary transport was measured by the saccharin test. Tests under the same circumstances were performed with and without oscillations on the same person within the same day. There was a significantly faster mucociliary transport during air oscillations. The possible mechanisms for this effect are discussed.

Adult↗
PubMed1992

[Spinal endoscopy in the detection of problems caused by continuous spinal anesthesia].

Continuous spinal anaesthesia has a number of advantages, but there are a number of drawbacks as well: difficulties in threading the catheter, distribution of the local anaesthetics and the development of cauda equina syndrome. Spinaloscopy was done to visualize the fate of catheters during and after their insertion, as well as the distribution of local anaesthetics injected through these fine-bore catheters. METHOD. The studies were conducted in preserved and fresh cadavers donated to the Anatomic Institute for Medical Studies. The spinal column from T12 to S1, together with the back musculature (in order to preserve the normal curvature of the spine) were removed from the cadaver. Spinaloscopy was done with a 4 mm endoscope with a 0 degree optic (Storz, Tutlingen, FRG). All observations were made from the lumbosacral region of the dissected preparation. In this fashion, it was possible to observe the insertion of the spinal needle used to introduce the catheter into the subdural space. The distribution of local anaesthetics injected through a 22-gauge spinal needle or a 28-gauge catheter was shown by injecting 0.5% hyperbaric bupivacaine colored with a small amount of 1% methylene blue. Pictures were taken 15, 30 and 45 s after beginning the injection. RESULTS. Difficulty in threading the catheter: our observations indicate that the difficulty in inserting microbore catheters is most likely due to inserting the needle too far. It is impossible for the catheter to bend and be inserted into the subarachnoid space. In many cases the catheter encountered the anterior wall of the spinal canal and would slide along various structures. Distribution of the drug: the injection is better dispersed with a 22-gauge needle and it completely fills the subarachnoid space. The local anaesthetics injected through the 28-gauge nylon catheter (Kendall Healthcare, Mansfield, Mass.) are distributed in the dependent portions of the spinal canal. If high doses and a high concentration are injected, the distribution pattern may result in an overconcentration in some parts of the subarachnoid space. Possibility of trauma: the catheter stretches around the roots, the potential for trauma is that untoward stress may be applied to the root, either during full insertion of the catheter or during its withdrawal. CONCLUSION. Spinaloscopy was done in a non-fixated anatomic spinal column preparation with a 4 mm 0 degree endoscope (Storz, Tuttlingen, FRG). Based on our observations, we conclude: The catheter should only be inserted 2 cm into the subarachnoid space. This may decrease the risk of malpositioning. After the tip of the catheter has reached the subarachnoid space, the stylet should be with drawn 2 or 3 cm to minimize the risk of nerve injury and/or bleeding.

Anesthesia, Spinal↗
PubMed1992

[Subdural intra-arachnoid spread of local anesthetics. A complication of spinal anesthesia].

Accidental subdural injections and catheterisations are a complication of epidural and spinal anaesthesia. The incidence of subdural spread in myelographies is estimated to be over 10% by the spinal technique. With spinaloscopy in an anatomic human model, we analysed the puncture process and the influence of different needle types on the incidence of subdural injection. We compared 22-gauge Sprotte, Quincke, and 18-gauge Tuohy needles in median and paramedian approaches with various bevel orientations. METHOD. The studies were performed in a preserved and recently expired cadaver donated to the Institut für Anatomie, Westfälische Wilhelms-Universität, Münster. The spinal column from T12 to S1, together with the back musculature (in order to preserve the normal curvature of the spine), were removed from the cadaver. Spinaloscopy was performed with a 4-mm endoscope with a 0 degree optic (Storz, Tuttlingen, Germany). All observations were made in the lumbosacral region of the dissected preparation. The endoscope was inserted from the caudal end of the spinal canal and, depending on the observations being made, the spinal canal was filled with air or artificial cerebrospinal fluid (CSF). To obtain information on the distribution of local anaesthetics injected into the subarachnoid space, 0.5% bupivacaine was coloured with a small amount of 1% methylene blue. The distribution of the coloured anaesthetic was clearly visible during and after injection. RESULTS. Needle insertion: Multiple observations were made using median or paramedian advancement of the needle into the spinal canal. With all needles, including the pencil-point, we saw an unexpected inward movement of the dura to the epidural space before penetration. This dural movement was independent of the direction of the dural fibres in the lumbar area. Distribution of local anaesthetics: Our observations indicate that difficulty with injecting drugs occurred when needle insertion was stopped too close to the dura, especially with the Sprotte needle. After manually registered penetration of the dura, the lateral opening of the needle only partially penetrates the dura. This allows CSF to appear in the needle hub, and injection into the vertical subdural space is possible. In all cases with the Sprotte needle, we could reproduce deposition of methylene-blue-coloured local anaesthetics into the subdural space. With the Quincke and Thuohy needles, it was not possible to deposit local anaesthetics into the subdural space in this model. CONCLUSION. Spinaloscopy was done in a non-fixated anatomic preparation of a spinal column with a 4-mm, 0 degree endoscope. From these observations we conclude that both manually registered penetration of the dural and the appearance of CSF in the needle hub can mimic correct needle position. Especially with the lateral opening of the Sprotte needle, deposition of local anaesthetics in the subdural space is possible.

Anesthesia, Spinal↗
PubMed1992

[Current understanding of mucociliary transport].

This review article deals with current understanding of mucociliary transport and its significance for clinical practice. The ultrastructure of cilia and principles of mucociliary clearance in the upper respiratory tract are outlined. Practicable diagnostic measures described are the saccharine test, vital cytological sampling of the nasal mucosa and electron microscopy for ultrastructural studies. Special pathologies such as the immotile cilia syndrome and mucoviscidosis are outlined in their relation to mucociliary transport. Recommendations are given as to how mucociliary transport might be influenced therapeutically.

Ciliary Motility Disorders↗
PubMed1991

[Otologic findings in adult patients with lip, jaw, palate clefts].

In a clinical study 27 adults with cleft lip and palate (mean age 21.9 years) were examined to look for long-term results of hearing and pathology of the tympanic membrane. 69.2% of the ears showed normal hearing; the threshold of mean hearing loss never exceeded the 20 dB-level. Slight changes of the tympanic membrane could be seen in 48.2%, severe changes in 16.7%.

Acoustic Impedance Tests↗
PubMed1991

[Bridge synechiae of the larynx following long-term intubation].

Following long-term intubation there seems to be an increasing incidence of stenosis of the larynx and the upper trachea. In the larynx the common site of stenosis is the posterior commissure, with is difficult to treat. We report on three cases of post-intubation synechia bridging the glottic space in the region of the vocal process. In literature reports and in our experience, this kind of stenosis seems to be linked with a tracheotomy, which was performed to prevent severe damage to the trachea or larynx. In clinical diagnosis this synechia can easily be confused with bilateral palsy of the vocal cords. From this synechia fettering the vocal cords and arytenoids problems during intubation may arise. It can be treated by cutting it endoscopically without stenting the larynx.

Adolescent↗
PubMed1991

[Clinical aspects of laryngeal imaging techniques].

The surgical anatomy and physiology of the larynx, some typical diseases that affect it, and the clinical diagnostic procedures are reviewed. The emphasis is on the aspects useful in deciding whether diagnostic imaging is indicated and interpreting the images. The diagnostic tools of the ENT clinician are therefore described, with reference to what can be diagnosed easily and what questions may remain open and can better be solved by imaging procedures.

Humans↗
PubMed1990

[A pathophysiologic thesis of the development of laryngeal cancer].

Mucociliary transport in the subglottic region was assessed in 45 of 75 human larynges that had been removed for carcinoma. These were marked with India ink and observed through an operating microscope. Normal mucociliary pathways in this region are known to be symmetric, conducting all of the mucus of the bronchial tree effectively to the posterior commissure for passage into the hypopharynx. None of the examined larynges showed normal transport patterns. The alteration of mucociliary flow as an early effect of tumor development is not likely. It is therefore concluded that these abnormal mucociliary transport patterns existed before tumor development and wee probably genetically coded. Such an ineffective clearance of airborne pollutants from the subglottic space with prolonged contact times may promote carcinogenesis. This might explain the known variable risk for carcinogenic susceptibility.

Animals↗
PubMed1990

[Possible pathogenesis of swimming sinusitis].

To investigate the pathogenesis of swimmer's sinusitis, a group of 20 swimmers and 20 controls were interviewed and examined. Clinical examination was followed by rhinomanometry, sonography of the maxillary sinuses, a saccharin test to assess mucociliary transport in the nose, and a viable cytological sampling of the nasal mucosa. Anamnesis showed a preponderance of symptoms of sinusitis and chronic rhinitis in the swimmer group, as well as a reddening of the nasal mucosa and a swelling of the adenoids. Sonography showed mucosal thickening in the antrum in more cases among the swimmers. Rhinomanometry, the saccharin test, and viable cytological sampling revealed no significant differences between the groups. It is argued that pathogenesis is more probable through cooling of the skin of the face and the whole body than through entrance of water into the upper respiratory tract.

Adolescent↗
PubMed1990

[Laryngeal carcinoma and asbestos exposure. A critical review of the literature].

Based on a comprehensive review of the literature with special reference to methodology of the studies, the author observes a causality between laryngeal carcinoma and occupational asbestos exposure. It is suggested that under special circumstances a laryngeal carcinoma should be approved as an occupational disease in relation to asbestos exposure in the Federal Republic of Germany.

Asbestos↗