Biomedical subjects

W J Mann

Publications and source records attributed to W J Mann.

At least 19 recordsLinked to original sources

PubMed2007

[Practicability of a surgical multilevel therapy in patients with obstructive sleep apnea].

BACKGROUND: Obstructive sleep apnea syndrome is a "systemic disease" of the upper airways and the upper digestive tract. The concept of multilevel surgery takes account of the fact that the location of the obstruction frequently cannot be identified precisely. PATIENTS AND METHODS: In this retrospective study over 4 years, data on 25 patients (median age 49.9 years) with moderate to severe OSAS treated with a surgical multilevel therapy were statistically evaluated. The treatment carried out consisted in reduction of the inferior turbinate, if necessary combined with septum plasty, and conventional uvulopalatopharyngoplasty (UPPP), combined with tonsillectomy and radiofrequency therapy of the base of the tongue if appropriate. Pre- and postoperative clinical and polysomnographical checks were performed. RESULTS: The mean apnea-hypopnea index (AHI) was 39.2+/-19.7/h before surgery. Postoperatively a highly significant reduction of AHI to 16.5+/-9.9/h (p<0.0001) was seen. In 13 out of 25 patients (52%) the disease was cured (AHI<20 and 50% reduction). In 23 patients the AHI improved. In 15 patients AHI was reduced by more than 50%. CONCLUSION: Multilevel surgery should be considered as an alternative for patients suffering from OSAS, especially in view of the poor long-term results in patients who receive CPAP therapy or are intolerant to CPAP.

Adult↗

PubMed2007

[Tonsillectomy technique: bipolar scissors vs raspatory: results of a case control study in 138 patients].

BACKGROUND: Postoperative bleeding is the major complication in tonsillectomy, and pain the most common side effect. The use of bipolar scissors versus blunt dissection tonsillectomy were compared in this study in order to evaluate postoperative bleeding and pain, as well as operative time. METHODS: In this case control study, 138 patients with the diagnosis of chronic tonsillitis, mononucleosis or a peritonsillar abscess were divided into two groups. A total of 78 patients were operated using bipolar scissors while 60 patients underwent tonsillectomy by blunt dissection. Operating time, frequency of postoperative bleeding and the postoperative pain score were compared between these two groups. RESULTS: The average operating time in the bipolar scissor group showed a tendency to be shorter than in the blunt dissection group (mean 4.1 min), although this did not reach a level of statistical significance. No differences were seen in pain scores or in the incidence of postoperative bleeding. CONCLUSION: The data documented in this study show that tonsillectomy with bipolar scissors might represent a surgical option to reduce surgical time in a larger patient group. Postoperative pain and the incidence of postoperative bleeding did not show any statistical difference between the two surgical techniques.

Adolescent↗

PubMed2007

[Staging of esophageal cancer using ultrasound].

The early diagnosis of esophageal cancer is crucial for the prognosis of the disease. In contrast to cancer of the upper aerodigestive tract, the mucosa of the esophagus is not visible without the appropriate equipment. In addition to endoscopy, imaging of the esophagus is crucial for early detection of the esophageal cancer. Ultrasound of the esophagus can be performed easily and--in contrast to other imaging techniques--without side effects. Different modes of ultrasound can be performed. First, transcutaneous ultrasound allows one to detect tumors of the upper esophagus and its passage into the hypopharynx. Second, endosonography allows one to detect pathologies of the other esophageal regions including the passage into the stomach. The present review discusses the impact of both techniques against the background of the international literature.

Esophageal Neoplasms↗

PubMed2006

[Cogan's syndrome: a diagnostic challenge].

Classical Cogan's syndrome is a disease of the inner ear with participation of the eyes, typically involving keratitis. If no objectively assessable optical symptoms are present, a diagnosis is difficult. Additional nonspecific symptoms can, combined with inner ear participation, suggest Cogan's syndrome. Between 2001 and 2003, we documented the course of two patients with Cogan's syndrome. As indicated in the literature, organ related symptoms could be related to a generalized vascular illness. In addition to the usual otological symptoms with cochleovestibular dysfunction and symptoms of typical and atypical ocular manifestations, other non-specific changes were found. Interstitial keratitis was diagnosed in one patient while in the second objective ophthalmological symptoms failed. The symptoms could be improved by systemic and local administration of corticosteroids and immunosuppressive therapy, however, progression of inner ear deafness could not be stopped in one patient and a cochlear implant was necessary.

Adult↗

PubMed2006

[Chronic eustachian tube dysfunction and its sequelae in adult patients with cleft lip and palate].

BACKGROUND: While almost all children with cleft palate develop eustachian tube dysfunction, this tends to normalize with age although it remains impaired in a number of patients. METHODS: Eustachian tube function was evaluated by tympanometry in 40 patients with an average age of 19.9 years. The number of patients with chronic otitis media, a sequelae of chronic eustachian tube dysfunction, was determined microscopically and from the patient's history. Hearing was assessed by pure tone RESULTS: Eustachian tube dysfunction was found bilaterally in 25% of the patients and unilaterally in 6%, while chronic otitis media was found in 32.5% and 12.5%, respectively. The hearing level did not differ between the side of the cleft and the opposite side (P=0.562). CONCLUSION: Nearly a third of the adult patients still suffered from eustachian tube dysfunction. Pathological tympanograms and chronic otitis media usually occurred bilaterally. A relationship between the side of the cleft and the side on which the eustachian tube dysfunction or its sequelae occurred was not apparent. The main reason seems to be the continuing bilateral muscular insufficiency in opening the eustachian tube.

Adolescent↗

PubMed2006

[Intraoperative ultrasound in surgery of the parotid and the head-and-neck region].

Sonography of the head-and-neck region is well established in the preoperative diagnostic process of tumorous lesions. Its intraoperative use to localise small tumours, however, has been rarely investigated to date. We applied intraoperative ultrasound to 19 patients who underwent parotid surgery and evaluated the following criteria: intraoperative tumour presentation, scan quality, comparison between sonographic visualisation and tumour detection by palpation, histological tumour borders as well as postoperative complications. All lesions were reproduceable by intraoperative ultrasound and could be demonstrated in sufficient quality. None of the 19 parotid tumours could be identified by palpation pre- and intraoperatively. All tumour capsules remained intact, the tumours were completely removed and no postoperative complications were observed. Problems of ultrasound application may arise due to significantly altered anatomic landmarks while surgical preparation proceeds. Intraoperative ultrasound is fast, dynamic and feasible under sterile conditions. Especially in parotid surgery with small, non-palpable tumours, intraoperative ultrasound supports minimal-invasive surgery.

Head and Neck Neoplasms↗

PubMed2006

Initial experience with intraoperative ultrasound in navigated soft tissue operations of the neck and below the base of the skull.

AIM: Ultrasound (US) is a cost effective and time saving examination method for diseases of the neck,and can be used without any known side effects or limitations. US tied into modern navigation devices may significantly improve intraoperative orientation in regions with soft tissue characteristics. METHODS: 22 patients with soft tissue tumours of the head and neck underwent surgical procedures assisted by CAS system LandmarX (Medtronic) in combination with the US system DynaVievP II (Aloka). Clinical feasibility of using intraoperative US in navigated surgical procedures has been investigated by paying particular attention to the surgical approach, possible interferences from surgical instruments and time consumption. RESULTS: In the case of soft tissue shift, US can provide a sequence of a section of the operative field and, without delay, an instant comparison with the preoperative imaging data set. The feasibility of using this method is severely limited by the additional preparation required, the unfamiliar handling during surgery, and design-related matters. CONCLUSIONS: Integrating US into a navigation device could provide additional useful information for a more controlled resection of soft tissue disease of the neck and below the base of the skull.

Cervical Vertebrae↗

PubMed2005

Increased PGE2 levels in nonmalignant mucosa adjacent to squamous cell carcinoma of the head and neck.

OBJECTIVE: The cyclooxygenases (COX) 1 and 2 are the rate-limiting enzymes of prostaglandin E(2) (PGE(2)) synthesis, and the upregulation of COX-2 has been reported in tumors of different origins. The aim of our study was to quantify the PGE(2) expression in squamous cell carcinoma and surrounding mucosa, to analyze the potential of acetylsalicylic acid (ASA) for reducing PGE(2) levels in these tissues, and to improve our understanding of potential tumor-derived stimulation of surrounding mucosa by PGE(2). STUDY DESIGN AND SETTING: Intracellular PGE(2) levels in primary head and neck squamous cell carcinoma (HNSCC) and the surrounding mucosa at 1 and 2 cm distance were analyzed ex vivo by ELISA. Subsequently, we treated in vitro tumor and normal mucosal cells from turbinates with recombinant PGE(2) and ASA, and quantified intracellular PGE(2) levels. RESULTS: We observed high PGE(2) levels in the tumor samples and in tumor-surrounding mucosa. The addition of PGE(2) and arachidonic acid to tumor cell cultures resulted in no further increase in intracellular PGE(2) levels, while ASA reduced PGE(2) levels by up to 40%. In normal epithelial cell cultures, less PGE(2) (6% of that found in the tumor cells) was expressed, but stimulation with PGE(2) resulted in levels comparable to those of the tumor samples. CONCLUSION AND SIGNIFICANCE: We conclude that HNSCC and the surrounding mucosa express high levels of PGE(2). This expression is reduced efficiently by ASA. We propose a stimulation of PGE(2) expression in the epithelium surrounding HNSCC by tumor-derived PGE(2) with a potential impact on tumor growth.

Carcinoma, Squamous Cell↗

PubMed2005

[Ocular tilt reaction. A rare complication after acoustic neuroma surgery].

Visual disturbances after acoustic neuroma surgery are very rare complications. We present a patient with diplopia after a middle fossa approach for resection of an acoustic neuroma. The patient presented ocular torsion and tilts of subjective visual vertical which is typical for the ocular tilt reaction. It is generally agreed that this reaction is secondary to a dysfunction of the tonic bilateral vestibular inputs that stabilize the eyes and head in a normal upright position in the roll plane. It has also been described after denervation of the utricle and injury of the brain stem.

Adult↗

PubMed2005

[Chronic rhinosinusitis. What is new from the last 25 years?].

Chronic rhinosinusitis (CRS) appears to be of increasing relevance epidemiologically. Despite progress in elucidating the role of eosinophilia as well as aspirin intolerance and eicosanoid mediators, the pathophysiology remains obscure. Endonasal sinus surgery has become the treatment of the choice for CRS patients with and without nasal polyposis, particularly if conservative treatment fails. Long-term studies indicate that a minimally invasive approach with microscopic and endoscopic procedures is preferable to radical surgery. Powered instrumentation or computer-aided surgery are still controversially discussed, but certainly can be very helpful in the hands of an experienced surgeon, especially to minimize surgical trauma and save surgical time. The complex therapeutic concept needs to be individually tailored to the disease of the patients and to the heterogeneous etiologic aspects.

Chronic Disease↗

PubMed2005

Cervical adult rhabdomyoma presenting as a rapidly growing mass in a patient with diffuse large B-cell non-Hodgkin's lymphoma.

BACKGROUND: Adult rhabdomyoma is a rare mesenchymal tumor, which generally grows slowly and is mainly localized in the head and neck area. PATIENT AND METHODS: We report the extraordinary case of a rapidly growing adult rhabdomyoma in a 73-year-old man. The patient was treated for diffuse large B-cell non-Hodgkin's lymphoma with CHOP therapy (doxorubicin, cyclophosphamide, vincristine, and prednisone). Comparison of the respective computed tomography scans showed prominent enlargement of 35% in the tumor mass volume on the right side of the neck within 3 months. The tumor was highly suspicious for lymphoma. Surgical resection was performed. RESULTS: Histological examination revealed a tumor which was composed of tightly packed polygonal cells with a PAS-positive granular or vacuolated cytoplasm, occasionally with cross-striations. Immunohistochemically, the cells were positive for desmin, myogenin, Myo-D1, but negative for S-100. Due to these characteristic morphologies, adult rhabdomyoma was diagnosed. CONCLUSION: This is the first report on an adult rhabdomyoma with a proven rapid enlargement. The possible pathomechanisms are discussed.

Aged↗

PubMed2005

Rapid Rhino: A new pneumatic nasal tamponade for posterior epistaxis.

OBJECTIVES: Some of these measures to control posterior epistaxis cause loss of nasal respiration and put the patient on those related risks. STUDY DESIGN AND METHODS: The efficiency of a new pneumatic nasal tamponade (Rapid Rhino) was compared with a choanal balloon tamponade that has been used in our department for years in a prospective randomized study in patients with posterior epistaxis. The new pneumatic tamponade was used on the affected side only and nasal ventilation of the contralateral side was possible. RESULTS: Because of the successful use of the new pneumatic tamponade in most of the patients, epistaxis could be controlled without bilateral obstruction of nasal respiration. The use of the new pneumatic tamponade was evaluated to be less painful by the patients than choanal balloon tamponade. CONCLUSION: In an adapted therapeutic regime, the new pneumatic tamponade seems to have its place before using bilateral nasal respiration obstructing measures.

Aged↗

PubMed2005

The effects of short-term immunotherapy using molecular standardized grass and rye allergens compared with symptomatic drug treatment on rhinoconjunctivitis symptoms, skin sensitivity, and specific nasal reactivity.

BACKGROUND: The efficacy and safety of short-term immunotherapy with molecular standardized allergens (STI) has been demonstrated by double-blind placebo-controlled clinical trials. The aim of this study was to compare STI with symptomatic drug treatment. METHODS: Forty-eight patients with rhinoconjunctivitis to grass and/or rye pollen were treated either with STI (ALK(7), n = 24) plus anti-allergic drugs or anti-allergic drugs, alone (n = 24) in a prospective, randomized study. Symptoms and use of drugs were reported in patient diaries and titrated nasal provocation and skin prick tests were performed at baseline, before, and after season. RESULTS: Median overall symptom (P = 0.022, U test) and medication scores (P = 0.003) were significantly lower in the STI group, as was the result for a simultaneous analysis of conjunctival, nasal, and bronchial symptom scores and medication (P = 0.005). Sensitivity in the nasal provocation test decreased in the STI group but not in the drug-treated group. These differences became significant directly after STI (P = 0.027) as well as after the grass pollen season (P < 0.001). Skin sensitivity did not change in the STI group but increased in the drug-treated group after season, with a significant difference between the two groups for the erythema (P < 0.001). CONCLUSIONS: STI reduces grass pollen-induced rhinoconjunctivitis symptoms and drug use, and specific nasal reactivity and skin sensitivity, more efficiently than a standard symptomatic treatment.

Adolescent↗

PubMed2004

[Otological findings in adults with isolated cleft palate or cleft lip, jaw, and palate].

BACKGROUND: Children with cleft palate often develop middle ear ventilation disorders due to chronic Eustachian tube dysfunction. This may lead to hearing loss. The insertion of ventilation tubes is a widely accepted measure to avoid sequelae of middle ear ventilation disorders and hearing loss. On the other hand, long-term therapy with ventilation tubes may inflict iatrogenic complications. The objective of the study was the evaluation of otoscopic and audiometric long-term findings in adult cleft patients who had been treated with ventilation tubes since childhood when chronic otitis media with effusion had been observed. PATIENTS AND METHODS: Ninety-two cleft palate patients had been followed up otoscopically and audiometrically for years. The average age was 19.3 years (minimum: 14, maximum: 39 years) at the time the last status was taken. RESULTS: Otoscopy revealed a perforation of the tympanic membrane in 3.8% of the 184 ears. 12% of the patients developed cholesteatoma, however three quarters of these occurred after age 11. 86.4% of the 92 patients had normal hearing in pure tone audiometry. CONCLUSION: Compared with adult cleft patients who did not receive ventilation tubes, our patients had a similar low incidence of eardrum perforations but a higher incidence of cholesteatomas while hearing loss occurred less often. Whether the higher incidence of cholesteatomas is caused iatrogenically or due to a longer follow-up period remains unclear. Whether the use of long-lasting ventilation tubes affects the incidence of cholesteatomas must be proved in further studies.

Adolescent↗

PubMed2004

[Interdisciplinary therapy management in malignancy of the paranasal sinus tumors in children].

BACKGROUND: Malignant tumors of the paranasal sinuses, such as rhabdomyosarcoma or Ewing's tumors, often have a mesenchymal origin. In the recent years, several prospective, randomized, multicenter studies have demonstrated a better outcome after new oncology therapy protocols. PATIENTS AND RESULTS: In the period from January 2000 to June 2001, we operated 610 patients with sinus disease. Only 23/610 were children or teenagers (3.8%). Half of the juvenile group suffered from chronic sinusitis, but 5/23 (22%) had a malignoma of the paranasal sinuses. In the adult population, malignoma was diagnosed in less than 1% of cases. We diagnosed and treated, in cooperation with our radiology, pathology and children's hematooncology department, one rhabdomyosarcoma, two malignant peripheral neuroectodermal tumors (PNET), one myelosarcoma and one malignant lymphoma in the paranasal sinuses. Two patients died. SUMMARY AND CONCLUSION: These five cases of paranasal sinus malignomas are discussed in relation to their history and clinical course. We suggest that interdisciplinary treatment involving otorhinolaryngology, pathology, children's hematooncology, radiology and radiation therapy is obligatory for the therapy and for the best possible outcome of such cases.

Adolescent↗

PubMed2004

Presence of dendritic cells, T lymphocytes, macrophages, B lymphocytes and glandular tissue in the human fetal larynx.

OBJECTIVE: The laryngeal mucosa starts to be exposed to infectious agents immediately after birth. The course of laryngeal infections in young children differs significantly from that in adults. The first line of defense encountered by an inhaled infectious agent is the mucosa-associated immune system, which includes immunocompetent cells and secretory components. The cellular elements are partially organized in a typical morphological pattern known as mucosa-associated lymphoid tissue (MALT). Differences in the ability of young children and adults to react to a laryngeal infection raise the questions of whether and to what extent immunocompetent cells are already present in the larynx at birth. These questions were investigated in this study. MATERIAL AND METHODS: Dendritic cells, T lymphocytes, B lymphocytes, macrophages and glands were examined and detected in an (immuno-)histological study of 8 fetal larynges (14th-22nd week of gestation). RESULTS: Immunocompetent cells and glands were present mainly in the epi- and subglottic regions and ventricular folds, whereas the glottis was largely spared. The pattern of distribution was scattered and no organized MALT was seen. CONCLUSION: Essential cell populations of a mucosa-associated immune system for the initiation of an immune response may exist in the human larynx at birth.

Antibodies, Monoclonal↗

PubMed2004

Immunohistochemical localization of cyclooxygenase isoforms in the organ of Corti and the spiral ganglion cells of guinea pig cochlea.

Prostaglandins have been used in experimental models and clinical studies for the therapy of sudden hearing loss and tinnitus with conflicting results. However, little is known about the rate-limiting enzymes of prostaglandin synthesis in the inner ear, the generally constitutively expressed cyclooxygenase 1 (COX-1) and the distress-inducible cyclooxygenase 2 (COX-2). To extend our knowledge concerning the physiological expression and localization of these two enzymes, immunohistochemical stainings of the guinea pig cochlea were performed. Light microscopical analysis revealed a homogenous distribution of COX-1 within nearly all cell types of the organ of Corti, but no COX-1 expression in the cuticular plates of pillar cells. COX-2 was found to be expressed in all cell types, with much stronger expression in Hensen cells, neighboring Deiters cells and cuticular plates of outer hair cells. Both COX-1 and COX-2 immunoreactions were also found in the spiral ganglion. We conclude that both COX subtypes are expressed in the guinea pig cochlea under physiological conditions. The prominent expression of the distress-inducible COX-2 isoform in cell types under mechanical stress during noise reception might support the hypothesis of a cytoprotective function of COX products in hearing and in cellular stress situations like intense noise exposure.

Animals↗

PubMed2004

Quantitative DNA measurement in oropharyngeal squamous cell carcinoma and surrounding mucosa.

OBJECTIVE: The appearance of local recurrences, distant metastases and second primary tumors limit the survival rate of patients with head and neck squamous cell carcinomas. The presence of genetic alterations at the resection margins is an indicator of inadequate excision and a predictor of local failure. DESIGN: To receive insight into the genetic abnormalities in the mucosa surrounding oropharyngeal cancers, we performed a quantitative DNA measurement in the primary tumor and the surrounding areas. RESULTS: We found a high level of DNA irregularity in primary tumors. The DNA irregularity decreased in specimens taken at a distance of 1 and 2 cm from the tumor margin. CONCLUSIONS: The genetically altered field is thought to determine the risk for recurrence of a second tumor. We therefore believe that the genetic analysis of tissue surrounding the tumor could become a feasible diagnostic procedure to determine the individual risk for local recurrence or second primary tumors.

Adult↗