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Biomedical subjects

T Schrom

Publications and source records attributed to T Schrom.

At least 19 recordsLinked to original sources
PubMed2007

[Is orbital exenteration indicated for extensive primary mucosal melanomas of the sinunasal system?].

Primary mucosal melanomas are most frequently localized in the sinunasal system. Orbital involvement must be excluded in the mostly advanced tumor stage. The aim of our study was to find possible indications for orbital exenteration in the T3-4 sinunasal tumor stage. We evaluated 14 treatment courses at our department from 1988 to 2004. The analysis disclosed orbital involvement in 43 % of the patients. The one patient submitted to orbital exenteration had a survival of only 28 months, which was not relevantly longer than in the other 9 patients with a T3-4 tumor stage (median survival of 27 months) or to the two patients with purely palliative treatment (survival of 10 and 21 months). We conclude that, due to the high generalized metastasis rate, radical surgical procedures can only prolong survival in individual cases of advanced-stage sinunasal tumors. Orbital decompression should be considered with reference to the quality of life.

Aged↗
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↗
PubMed2006

[The ti-epiplating system in bone anchored hearing AIDS].

The advent of bone-anchored hearing aids with titanium implants has markedly improved patient management. There are two systems on the market for performing the requisite osseointegration. The aim of our study was to evaluate the Ti-Epiplating system, since no data have been published on this in the literature thus far. Between November 2002 and March 2005, we anchored the BAHA snap coupling via the Ti-Epiplating system in 8 patients in a single session. The patients were followed-up at regular intervals to assess clinical and audiometric results and subjective satisfaction. The postoperative hearing threshold with the BAHA was in the former bone conduction range. In the Freiburg speech test, a significant improvement was found for monosyllables (free-field), and the hearing loss for numbers showed a mean reduction from 75 to 30 dB. There has been no implant loss in our collective thus far. Good to very good results were evaluated for the quality of life in the "International Inventory of evaluation of hearing aids" (IIEH). Clinics that use Medicon's osteosynthesis system can safely and reliably achieve inexpensive and audiometrically successful BAHA management by a comparatively simple surgical procedure.

Aged↗
PubMed2006

[Measurement of skull thickness by ultrasound].

BACKGROUND: The presurgical diagnostic for measurement of skull thickness for implantations of epithesis or bone anchored hearing aids is limited on computed tomography (CT) of petrosal bone up to now. Testing of ultrasound for measurement of skull thickness is the aim of our study . MATERIAL AND METHODS: 20 patients has been included, which had got a computed tomography of nasal sinus, skull or petrosal bone. The potential localisations of implantations have been measured by 3D-reconstruction of computed tomography. The results have been statistical compared by sonographic investigations (7.5 MHz Soundhead) at the same localisation. RESULTS: The mean skull thickness has been 5,2 mm in computed tomography. Comparison has described a mean skull thickness of 4,2 mm in sonography. Statistical comparison has shown that ultrasound has been measured statistical significant too small. CONCLUSIONS: The skull thickness can be described and measured by sonography. However mean skull thickness has been measured statistical significant too small. In spite of this, conclusions relating to presurgical diagnostic, for instance for the implantation of epithesis and bone anchored hearing aids, can be drawn by sonographic data.

Cochlear Implantation↗
PubMed2006

[Sensorineural hearing loss in LEOPARD syndrome].

The rare multiple lentigines (LEOPARD) syndrome represents a complex of skin, cardiac, skeletal, inner ear and other malformations. There is marked variability in expression of the syndrome. We report on a 20 year old man, showing typical lentiginosis, a retardation of growth, tachycardiac conduction abnormality, ophthalmologic manifestations and a sensorineural hearing loss. Pathogenesis, clinical and differential diagnostic aspects are discussed in this case report. The early diagnosis of a senosorineural hearing loss is useful in order to provide appropriate rehabilitation. When lentiginosis is diagnosed, it is important to consider further abnormalities such as cardiomyopathy, which can be associated with a high mortality.

Adult↗
PubMed2006

[Histopathology after implantation of lid weights].

BACKGROUND: Various implants are used to treat lagophthalmos in facial paralysis. The implantation of gold or platinum eyelid weights (lid loading) is being used increasingly. Histological changes have not yet been systematically examined in the implant capsule during explantation of the eyelid weight. MATERIAL AND METHODS: Of 26 explanted implants, 18 implants in 17 patients were followed-up using light microscopy from 1997 to 2004. We semi-quantitatively evaluated the density of the inflammatory infiltrate and recorded the occurrence of foreign bodies in the tissue. The inflammatory infiltrate was also immunohistochemically examined to characterize cellular composition. RESULTS: In the semi-quantitative examination of inflammatory infiltration density, 60% of the gold implants showed a moderately dense or dense inflammatory infiltrate, while there was moderately dense infiltration in only 12.5% of the platinum implants. The immunohistochemical examination revealed a mixed lymphocytic inflammatory infiltrate which tended to a preponderance of B lymphocytes (humoral response). This is typical of unspecific chronic inflammation. CONCLUSIONS: Both gold and platinum are suitable for treating lagophthalmos, however, platinum has a higher density and better biocompatibility than gold.

Equipment Failure Analysis↗
PubMed2006

[Increasing incidence of wasp stings in otorhinolaryngological practice].

BACKGROUND: Wasp sting injuries can be lethal due to generalized reactions and edematous obstruction of the upper respiratory system. Due to media reports and our own observations, the consequences of the 2004 "plague of wasps" should be examined for the ear, nose, and throat (ENT) region. PATIENTS AND METHODS: Wasp sting injuries treated during the years 2002 to 2004 were evaluated in a retrospective study with respect to frequency, localization, therapy, occurrence of allergic reactions, and other complications. RESULTS: In 2002 to 2004, the number of patients with wasp sting injuries tripled. The occurrence of stings in the ENT region increased from 20% to more than 40%, with a strong rise in enoral and endolaryngeal stings after accidental swallowing or inhalation of wasps. The medical treatments employed proved the existence of sufficient therapeutic strategies. CONCLUSIONS: The treatments demonstrate a clear increase in wasp sting injuries in the year 2004. The main climatic cause was the European record summer of 2003, in which wasps multiplied.

Adolescent↗
PubMed2006

[Ultrasound of the upper eyelid to evaluate tarsal curvature in facial palsy].

BACKGROUND: Treatment of paralytic lagophthalmos involves surgical repair, requiring exact knowledge of eyelid anatomy. While there are extensive studies on anatomical eyelid measurements in healthy eyes, no data exist on the changes in the functional anatomy of the upper eyelid in paralytic lagophthalmos. The aim of this study, was to examine by ultrasound the upper lid tarsus during changes in the patient's line of vision, and to answer the question of whether there are changes in the curvature radius of the tarsus, caused by facial paralysis with resultant lagophthalmos. MATERIAL AND METHODS: Two groups were formed. The first group consisted of 50 subjects with healthy eyes, and the second contained 47 patients with paralytic lagophthalmos. The upper lid tarsal radius, when looking straight ahead and in the abducted position, was determined by ultrasound with a 7.5 MHz scanner in the non-contact mode, and then compared statistically. RESULTS: Both groups showed a highly significant difference in the tarsus curvature, when looking straight ahead and in the abduction position. While there was no significant difference between both groups in the abduction position, they differed significantly when looking straight ahead. Also, a significant difference was noted, between the eyes of healthy subjects and the healthy eye in patients with facial palsy. CONCLUSION: The changes in curvature of the tarsal plate, when looking straight ahead, can be explained by the loss of tone in the paralyzed Orbicularis Occuli muscle. This means, that in addition to the lagophthalmos resulting from facial paralysis, changes occur in the functional anatomy of the upper eyelid, which must be considered during surgical correction. Additionally, the physiological loss of tone of the upper eyelid tarsal plate, which comes with age, has a certain influence.

Eyelid Diseases↗
PubMed2006

[Lipoma of the cerebellopontine angle - a case report].

BACKGROUND: Lipomas of the cerebellopontine angle are rare. Until today in the english literature only isolated cases are described. The most frequent symptoms are: hearing loss (62,2 %), vertigo (43,3 %) and tinnitus (42,2 %). With the help of MRI intracranial lipomas can be diagnosed almost certainly. PATIENT: A 26 year old patient presented himself to our outpatient departement with recurrent vertigo and tinnitus since two months. Electronystagmography and caloric testing showed a unilateral weakness of the right vestibular organ. Audiometric examination revealed a Normacusis on the right side. BERA resulted in borderline prolonged interpeaklatency on the right side, wave I-V. MRI showed a ca. 5x8x11 mm Lipoma of the right cerebellopontine angel which surrounded the vestibulocochlear nerve. In contrast to schwannomas which are often described in this area the lesion did not enhance contrast medium. On the native T1 sequence the tumor was hyperintense and fat-supression images confirmed the tumor to be fat in origin. Because of the minor symptoms and the small size of the tumor we recommended a BERA after six months and an MRI every year. CONCLUSION: The therapeutic options of a lipoma of the cerebellopontine angel depend on the clinical symptoms and a radiologic confirmed progression of size. Because of the received data until today an operative therapy is only indicated when symptoms clinically can not be treated or the leason seems to be a well differentiated liposarcoma.

Adult↗
PubMed2006

[Evaluation of a new lid implant for rehabilitation of the paralyzed eye].

BACKGROUND: Since 1999 the platinum chain is being used as implant to correct lagophthalmos, which promises, due to its flexibility, lower postoperative complications. The lack of mandatory results reported in the literature, prompted us to survey all surgeons using the platinum chain in order to learn of the complications they had experienced. METHODS: A questionnaire was sent to 30 surgeons to survey results and complications associated with the implantation of the platinum chain to treat lagophthalmos. Complications like contouring, migration and extrusion of the implant occurred. RESULTS: Complications observed were bulging of the implant in 12 cases (5,7 %), 4 migrations of the implant (1,9 %), in 7 cases a frank extrusion (3,3 %), a ptosis of the upper eyelid in 8 cases (3,8 %), a corneal astigmatism in 3 cases (1,4 %) and in one case an infection of the upper eyelid (0,5 %). In 2 cases (0,9 %) the patients lamented a mechanical irritation of the upper eyelid. CONCLUSION: Implantation of eyelid weights is a straightforward and reversible procedure for the surgical therapy of lagophthalmos. Through the use of the platinum chain as implant the postoperative complications are to be regarded as small in total. With that the effectiveness of the procedure can be increased compared to rigid gold implants.

Blepharoptosis↗
PubMed2005

[Effects of magnetic resonance tomography on upper eyelid implants].

BACKGROUND: For the therapy of lagophthalmos in facial palsy, gold (99.99%), platinum (99.95%) and platinum/iridium (97%/3%) alloy weights are implanted into the upper eyelid. Investigations on the MRI compatibility of the different eyelid implants with 1.5 and 3.0 Tesla-MRT-systems, which are often used for the diagnosis of head and neck tumours, are still missing. METHODS: Three different eyelid implants made of pure gold, pure platinum and a platinum/iridium alloy were tested in vitro. As parameters, temperature changes, movements of the implants and picture artefacts of the different implants were determined using a 1.5 and 3.0 Tesla MR system. The deflection forces of the implants were evaluated by thread test, lying in a Petri dish and floating in a water bath. RESULTS: No rise in temperature was recorded in any implant. On the water surface, all three implants changed their positions and floated towards the magnetic field. The velocity of the implants increased in the 3.0 Tesla system. Increasing the frictional resistance by lying the implants in a Petri dish, there was no movement in the 1.5 or 3.0 Tesla systems. In addition, no movement of the implants could be observed in the thread test. All implants made few artefacts, with gold showing the least artefacts. CONCLUSION: MR imaging at 1.5 or 3.0 Tesla may be performed safely for warming up or dislocation of the implant in patients with eyelid implants made of pure gold, pure platinum or a platinum/iridium alloy.

Artifacts↗
PubMed2005

[Implantation of lid weights for therapy of lagophthalmos].

BACKGROUND: The aim of this study was to compare the clinical outcome and complication rate of rigid gold implants and flexible platinum chains in 96 patients treated for lagophthalmos. PATIENTS AND METHODS: We treated 50 patients with peripheral facial palsy and lagophthalmos using rigid gold implants and 46 using a flexible platinum chain. Besides subjective assessment by the patients, reduction of lagophthalmos, improvement of visual acuity, and pre- and postoperative grade of keratopathy were evaluated. RESULTS: Both groups showed a statistically significant reduction of lagophthalmos and keratopathy and increase of visual acuity. Postoperative complications were observed in both groups. Two extrusions occurred in the group receiving gold implants. The incidence of corneal astigmatism and bulging of the implant was statistically significantly lower in the platinum chain group. CONCLUSIONS: The use of flexible platinum chains instead of rigid gold implants for therapy of lagophthalmos leads to a reduction of the complication rate, thus improving the clinical outcome.

Equipment Failure Analysis↗
PubMed2005

[Lidloading and intraocular pressure].

BACKGROUND: Implantation of rigid gold or platinum lid weights (lidloading) represents the most common method for therapy of patients with lagophthalmus as a result of facial palsy. In a more recent approach also flexible platinum chains have been used. Glaucoma has frequently been described as a contraindication for lidloading. The aim of this study was to proof if lid weights lead to an increase of the intraocular pressure (IOP). PATIENTS AND METHODS: In a prospective study the IOP has been measured before and after implantation of 46 rigid gold implants and 39 flexible platinum chains in patients with paralytic lagophthalmos. RESULTS: Neither the implantation of rigid gold implants nor the use of the flexible platinum chain lead to a statistically significant change of the IOP. There was also no difference between the two groups. CONCLUSION: With this study we could demonstrate that glaucoma is not an absolute contraindication for the use of lid weights in patients with paralytic lagophthalmos. Moreover a lid weight is easily removable if complications should occur.

Contraindications↗
PubMed2005

[Transmastoidal resection of an endaural encephalocele--a case report].

BACKGROUND: There are transmastoid, transtemporal and combined approaches for surgical management of endaural encephaloceles. The advantages of a transmastoid approach are the exploration and option of surgical treatment of the middle ear cavity without craniotomy. Nevertheless there are recent studies preferring the transtemporal or combined approach because of the better survey. PATIENT: We present a 27-year old male patient, who developed hearing loss and otorrhea of the right side. He underwent middle ear surgery associated with cholesteatoma three times before. On examination there was a smooth pulsatile mass taking origin in the roof and almost filling the external auditory canal. High-resolution CT and MRI scans of the petrous bone demonstrated a spherical soft tissue mass communicating with the middle cranial fossa. The encephalocele was exposed and resected through a transmastiodal approach. Behind the cele a relapsing cholesteatoma was found and resected in the same session. The laterobasilar defect was sealed with ear cartilage and a perichondrium flap. CONCLUSION: There are three different surgical approaches to manage laterobasilar encephaloceles. Due to the history of a previous cholesteatoma we performed a transmastoidal approach. A transtemporal approach alone would have failed to notice the relapsing cholesteatoma and would have led to a greater trauma.

Adult↗
PubMed2005

[Contouring of a rigid eyelid implant: indication for the replacement with the platinum chain].

BACKGROUND: The resultant lagophthalmos at peripheral facial palsy can lead to keratopathy of varying degrees. In surgical therapy of lagophthalmos some implants to preserve a sufficient eyelid closure have been described. Besides to the use of magnets, silicone slings or palpebral springs the importance of the gold implantation (lidloading), first described by Illig in 1958, has increased. Unfortunately all of these techniques have often shown unwanted side effects. The platinum chain is a new implant which promises, due to its flexibility, lower postoperative complications. PATIENTS: We present two case reports to show the platinum chain's advantages compared to the older implants. The two patients developed a unsightly contouring (with threatening extrusion) of the rigid gold implant after lidloading. These gold implants were therefore replaced in one step by the platinum chain. RESULTS AND CONCLUSIONS: The further process was complication-free. In our opinion, in spite of the small case number, the new developed platinum chain can lead to a reduction of postoperative complications after lidloading. In complications with the rigid gold implants, such as contouring or extrusion, these implants can mostly be replaced in one step by corresponding platinum chains.

Adult↗
PubMed2005

[Rehabilitation of the olfactory sense after laryngectomy -- the larynx bypass].

BACKGROUND: Patients after laryngectomy lose their previous sense of smell, since air normally circulates via the tracheostoma and active air intake through the nose is no longer possible. The larynx bypass with a throat mask is an aid here. Nasal air circulation is made possible by this connecting piece between the mouth and tracheostoma. MATERIALS AND METHODS: Twenty patients (17 men and 3 women, mean age 60 years) who underwent laryngectomy between November 2003 and February 2004 were examined using Sniffin' Sticks with and without the larynx bypass. Moreover, patients were asked about the practicability of the larynx bypass using a visual analog scale (VAS). In addition to larynx bypass function, we were also interested in the handling for the laryngectomized patients. RESULTS: Overall, patients were able to correctly identify more items with the larynx bypass. The results were significantly better with than without the larynx bypass (p < 0.001). However, the first application of the larynx bypass was considered cumbersome. The median VAS was 5. CONCLUSION: Patients had a better sense of smell with the larynx bypass. However, due to its rather moderate practicability, the larynx bypass does not seem to be suited for daily use in its present form.

Aged↗