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Biomedical subjects

T Kühnel

Publications and source records attributed to T Kühnel.

12 recordsLinked to original sources
PubMed2005

[Therapy of bony and fibrous contractures and buccal defects after noma using the temporalis muscle flap].

METHODS: A prospective pilot study was conducted on 12 patients to establish whether, under the difficult conditions prevailing in a developing country, the temporalis muscle flap is suitable as a safe and single-stage procedure for the repair of buccal defects combined with fibrous or osseous contractures of the temporomandibular joint. RESULTS: The surgical procedures were performed from 1998 to 2000 in the Hôpital National du Niamey (Republic of Niger). Primary healing was achieved with all grafts. Local clinical and radiological follow-up (in Niger) was performed on seven patients after 12 and 24 months. Mouth opening of at least 1.5 cm was achieved in all cases, although there was virtually no use of physiotherapy to prevent scar contracture. DISCUSSION: By contrast with expensive and surgically more complex reconstructions, our use of this procedure shows that even where medical conditions are less than ideal, a satisfactory functional and cosmetic result can be achieved in the long-term.

Adolescent↗
PubMed2005

Mirror system for photodocumentation in plastic and aesthetic surgery.

Photodocumentation of the face before aesthetic or plastic surgery is of fundamental importance for at least three reasons: it is an aid to surgical planning, it can be used for illustrative purposes in discussions with the patient, and it satisfies medico-legal requirements for documentation. To achieve efficient and economic documentation of preoperative and postoperative status in aesthetic and reconstructive plastic procedures, the mirror system described here permits the required planes to be documented in a single photograph. The simple and inexpensive technical design allows six planes to be documented in constant and, therefore, comparable quality. Because the patient's data are also documented with the photographic record, the potential for mistaken patient identity is eliminated. No technical training is needed to operate the device and it can, therefore, be readily used by ancillary medical personnel. In a typical nasal surgery department performing about 150 rhinoplasty procedures per annum, the mirror system offers cost and time savings generated as a result of reducing the documentation burden by 750 photographs.

Documentation↗
PubMed2003

Prognostic value of nuclear survivin expression in oesophageal squamous cell carcinoma.

Survivin, a new member of the family of apoptosis inhibitors, is expressed almost exclusively in proliferating cells, above all in cancers. Subcellular localisation and prognostic implications of the survivin protein have not yet been determined in oesophageal squamous cell carcinoma. The survival of 84 patients with oesophageal squamous cell carcinomas was correlated with the extent of immunohistochemical survivin expression in tumour cell nuclei. Tumours were scored positive when >5% cells stained positive. Patients were followed up for at least 5 years or until death. In normal oesophageal squamous cell epithelium, some cytoplasmic survivin expression was detected in the basal cells, whereas proliferating cells showed nuclear staining of survivin. Nuclear expression of survivin was also detected in 67 cancers (80%). The mean survival for patients of this group (28 months, range 20-36) was significantly less than that for patients without survivin expression in the tumour cell nuclei (108 months, range 62-154, P=0.003). Using univariate analysis, nuclear survivin expression (P=0.003), tumour depth (P=0.001), lymph node metastasis (P=0.003) and stage (P<0.001) were the best predictors of survival. In contrast, cytoplasmic survivin staining was noted in 53 (63%) tumours and had no prognostic relevance. In conclusion, the analysis of nuclear survivin expression identifies subgroups in oesophageal squamous cell cancer with favourable (survivin(-)) or with poor prognosis (survivin(+)). We suggest that the determination of nuclear survivin expression could be used to individualise therapeutic strategies in oesophageal squamous cell cancer in the future.

Adult↗
PubMed2002

[Interdisciplinary endoscopic outpatient management of connatal dacryocystoceles].

Dacryocystocele may represent a rare type of connatal stenosis of the lacrimal duct. If conservative measures fail and in case of secondary inflammation, probing or regular surgery is usually recommended. We report on 15 neonates suffering from 18 connatal dacryocystoceles which were presented to the clinic of ophthalmology at the 16th (6 - 44) day of life. There was a definite female preponderance (65 %). Conservative treatment (external massage, at times i. v. antibiotic therapy) had proven to be ineffective. The neonates were subjected to outpatient nasal endoscopy and the ballooning cyst of the inferior nasal meatus was managed by endoscopic marsupialization in 14 cases applying local anesthesia. Two nasal cysts had to be operated on in general anesthesia due to obstructing local anatomy which obviated endoscopical microsurgery. Three additional dacryocystoceles have been detected incidentally in 2 neonates being subjected to surgery in general anesthesia for choanal atresia and lacrimal probing respectively. The corresponding dacryocystoceles were managed by concomitant endonasal microsurgery. We advocate interdisciplinary (ophthalmological and rhinological) outpatient examination in all neonates with suspected dacryocystoceles. Diagnosis is based on palpation, probing and nasal endoscopy applying local anesthesia together with mucosal decongestion. Microsurgical marsupialization immediately follows and will lead to persisting relief of symptoms.

Ambulatory Surgical Procedures↗
PubMed2001

Evaluation of powered instrumentation in out-patient revisional sinus surgery.

A feasibility study was carried out to prove the benefits of powered instrumentation, i.e. microdebrider in revisional surgery under local anaesthesia of chronic sinusitis in out-patients. Acceptance by the patients was investigated by questionnaire. Out-patient surgery is well tolerated by the majority (79.2%) of patients. Ninety-four percent would undergo the treatment again if necessary. An operation under general anaesthesia could be avoided in the cases we submitted to investigation. The cost-effectiveness of the method is thus an important consideration, despite calculating high prime costs and rather expensive, expendable instrumentation. Special consideration is attributed to a new feature added to the debrider device. To improve out-patient care, we developed an integrated electrocoagulation unit which supplements the microdebrider. It proved to be effective and easy to use. Bleeding was reduced to a minimum. Hence, nasal packing could be avoided in all out-patient cases. The possibility of causing severe complications using the microdebrider-technique is not eliminated as was shown in the anatomical specimens. Based on our experience, reduction of strong bony structures is subject to limitations at present. We therefore recommend the use of microdebriders for soft tissue manipulations, especially in revisional surgery. The microdebrider proved to be a significant advantage in out-patient surgery for recurrent sinusitis.

Adolescent↗
PubMed1998

Histochemical detection of lymphatic drainage pathways in the middle nasal meatus.

Following extensive middle meatal antrostomy, even without manipulation inside the maxillary sinus, a reactive edema of the maxillary sinus mucosa may be subsequently detected. A presumptive correlation has been established between this particular mucosal reaction and insufficient maxillary lymphatic drainage. Histochemical examination of the lymphatic drainage pathways was carried out on surgical specimens. During the performance of surgical maxillary fenestrations, 80 surgical specimens of the middle nasal meatus were obtained including adjacent parts of the medial maxillary wall. The specimens were subjected to visualization of lymphatic vessels based on the histochemical detection of 5'-nucleotidase according to Werner (1993). Both the nasal and the maxillary sinus mucosa showed a distinct superficial and deep longitudinal lymphatic capillary network (15-200 mu phi) with an orientation towards the natural maxillary sinus ostium. The density of the network increased from cranial to caudal, from dorsal to ventral and reached maximum density at the natural maxillary ostium. Lymphatic vessels of the maxillary sinus mucosa were thin but numerous in comparison to nasal vessels. The maxillary lymphatic capillary network showed direct connections to the nasal vessels, not only along the mucosal folds of the primary maxillary sinus ostium, but also in most cases (57%) transmurally through the natural bony gaps of the uncinate process. Grünwald's theory (1910) which states that lymphatic drainage of the maxillary sinus is established exclusively along the mucosal pane through the natural ostium was disproved. Maxillary mucosal congestion subsequent to extensive middle meatal antrostomy may be explained by ablation of the intramural and transmural lymphatic drainage pathways.

5'-Nucleotidase↗
PubMed1996

[How traumatising is mechanical mucous membrane care after interventions on paranasal sinuses? A histological immunohistochemical study].

OBJECTIVE: Endonasal sinus surgery lead to more or less circumscribed mucosa defects exposing the underlying bone. Healing of these wounds is accompanied by crust formation, which may be subjected to mechanical debridement. It is not known whether this wound care impaires or facilitates wound healing. METHODS: Following sinus surgery, 72 crusts were removed from the operative site after having taken endoscopic photographs choosing different postoperative intervals. Mucosal biopsies were taken from beneath the crusts. All specimen were submitted to routine histological serial sections as well as immunohistochemical staining of epithelium. RESULTS: Local debridement of crusts avulsed parts of epithelium in 23% of cases during the first postoperative week. There was no histological evidence of avulsed epithelium with crusts removed the second week. This figure later increased to 16%. Possible trauma to regenerating mucosa cannot be predicted solely by the appearance of crusts. CONCLUSION: In principle, large crusts may disturb ventilation and drainage, causing secondary mucositis. Local care is mandatory in these cases. According to our examinations, mechanical debridement of wounds must respect the time-dependent irritability of the healing wound. There is little risk of impairing epithelization during the second week after surgery and the chance of sustaining the healing process is best.

Biopsy↗
PubMedDate not supplied

Endonasal frontal sinusotomy in surgical management of chronic sinusitis: a critical evaluation.

Frontal sinusotomy was performed on 110 patients undergoing routine endoscopic endonasal ethmoidectomy and the minimum diameter of the frontal sinus neo-ostium was determined intraoperatively. A total of 82 patients could be subjected to follow-up and redetermination of the neo-ostium diameter 13 months later. A postoperative CT was scheduled in 62 cases. The average minimum diameter of the frontal sinus neo-ostium, measured intraoperatively, was 5.6 mm (0-11 mm). After completion of wound healing, 81% of the frontal sinuses could be explored by probing or even inspected by rigid endoscopy. The average minimum diameter of the neo-ostia determined postoperatively was 3.5 mm (0-11 mm). Patients exhibiting aspirin sensitivity or diffuse nasal polyposis showed a more pronounced scarred constriction of the frontal sinus access compared to other cases. Neo-ostia exceeding 5 mm intraoperatively were preserved with a considerably higher percentage than those with diameters of less than 5 mm. Radiologically, the fenestrated frontal sinuses frequently showed continued or even increasing mucosal congestion. No conclusive relationship was found to exist between such post-operative clouding and frontal sinus accessibility (endoscopy and/or probing) or patient complaints. The investigations confirm the safety and reliability of frontal sinusotomy in surgical management of chronic paranasal sinusitis. The mucosa of the frontal sinus often reacts to surgery in the form of persistent or even newly developing mucosal swelling to which a specific pathophysiological significance cannot always be attributed.

Adult↗