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Biomedical subjects

W J Mann

Publications and source records attributed to W J Mann.

At least 55 records · Page 3Linked to original sources
PubMed2001

[Ultrasound characteristics of lateral cervical space-occupying lesions].

UNLABELLED: Sonography of the head and neck mainly focuses on tumours of the lateral neck. Even though most of these masses are enlarged lymph nodes, other tumors have to be considered. AIM: To determine whether different pathological cervical masses display a characteristic sonographic morphology. METHOD: On the basis of 530 sonographical findings in the neck, typical ultrasound characteristics either in B-scan or in colour coded sonography were demonstrated. RESULTS: Apart from enlarged lymph nodes, it was possible to differentiate other occurrences such as branchial cysts, abscesses, laryngoceles, lipomas, neurinomas, glomus tumours, paragangliomas and also fibromas by their specific ultrasound appearance. CONCLUSION: Knowledge of characteristic ultrasound morphology allows the early detection of tumours and facilitates the distinction between benign and malignant lesions as well as malformations. Further diagnostic procedures and therapeutical strategies can therefore be planned more adequately.

Abscess↗
PubMed2001

[Dysphagia without clinically relevant pathological correlation: to exclude tumours of the floor of the mouth and the base of the tongue ultrasound diagnosis is mandatory].

In patients suffering from dysphagia, a tumour of the tongue and its base must be excluded. This is not always possible by means of endoscopy and palpation. In contrast it is possible to visualize deep-seated structures of this region by ultrasound. Unfortunately, this technique is rarely used, as shown in the cases demonstrated. We present five patients suffering from dysphagia for a long period of time (up to 30 years) where ultrasound was not performed and a tumour of the floor of the mouth and the base of the tongue was overlooked. Thus, adequate therapy was delayed, which proved to be especially relevant in three patients suffering from a malignoma. Three patients suffered from a malignant tumour of the base of the tongue. Up to two years passed between the beginning of dysphagia and the necessary surgical treatment. One of these patients even underwent psychological treatment for his symptoms. In two other patients a dermoid cyst and ectopic thyroid tissue were removed. In patients suffering from dysphagia with normal endoscopic findings and normal palpation of the neck ultrasound of the floor of the mouth and the base of the tongue is imperative. Tumours of this area can be detected early with high sensitivity and cost-effectiveness by ultrasound.

Adult↗
PubMed2001

Acute laryngotracheitis in the rat induced by Sendai virus: the influx of six different types of immunocompetent cells into the laryngeal mucosa differs strongly between the subglottic and the glottic compartment.

OBJECTIVES: Acute laryngotracheitis is a disease in which mainly the subglottic area is infected, whereas adjacent parts of the larynx, especially the narrow glottic fold, remain unaffected. The reason for the difference between these two directly adjacent regions is unknown. Therefore, in the present study the influx of dendritic cells, neutrophils, T and B lymphocytes, natural killer cells, and macrophages into the mucosa of different laryngeal compartments was investigated after Sendai virus infection in the rat. The aims were to study both the influx of immunocompetent cells and the adhesion of the pathogen and to correlate them to the different reactions of the laryngeal areas during pseudocroup. METHODS: Acute laryngotracheitis was induced by intranasal application of Sendai virus in brown Norway rats. This virus is exclusively pneumotropic in rodents and belongs to the parainfluenza virus type 1, the main pathogen of acute laryngotracheitis in children. The numbers of dendritic cells, neutrophils, T and B lymphocytes, natural killer cells, and macrophages were determined in the supraglottic, glottic, subglottic, and tracheal mucosa on days 2, 5, 7, and 14 after virus application. Furthermore, the nucleoprotein of the virus and major histocompatibility complex (MHC) Class II expression were detected immunohistologically on the laryngeal epithelium. RESULTS: All cell subsets entered the laryngeal mucosa during inflammation. The highest influx was detected among dendritic cells subglottically. This was accompanied by a strong virus adhesion and MHC Class II expression on the subglottic epithelium. In contrast, only a few immunocompetent cells entered the adjacent glottic mucosa, and on the glottic epithelium staining for virus nucleoprotein and MHC Class II expression was weak. CONCLUSIONS: The inflammatory response of the laryngeal mucosa shows great regional differences in this animal model during experimental viral infection. The response was characterized by a strong subglottic and a weak glottic reaction. A possible reason for this difference might be region-specific viral adhesion on the epithelium of the laryngeal areas, as well as differences in MHC Class II expression. Thus, these data agree with the clinical observation during acute laryngotracheitis and may explain why the subglottic part of the larynx is affected preferentially during pseudocroup. The molecular mechanisms mediating the different reactions await clarification.

Acute Disease↗
PubMed2000

[Radiofrequency ablation of the soft palate (somnoplasty). A new method in the treatment of habitual and obstructive snoring].

Twenty-nine patients (26 male and 3 female) with habitual or obstructive snoring and socially disturbing character were followed over a ten week period. All patients were treated with radiofrequency volumetric tissue reduction (RFVTR) of the soft palate. In 21 patients this operation was combined with other surgery of the upper airway, eight patients had soft palate reduction with RFVTR exclusively. With this method an electrode is positioned in the musculature of the soft palate submucosally. RFVTR may be performed under local anesthesia and has to be repeated if necessary. Ten weeks postoperatively 24 of 29 patients, respectively their social-partners, reported subjective reduction of snoring after the first treatment. Markable improvement of snoring was seen in 20 of 29 patients postoperatively and reduction of the respiratory-disturbance-index (RDI) for more than 10 was noticed in 7/29 patients polysomnographically. 5/8 patients who were treated with RFVTR exclusively, showed reduction of snoring and 3/8 patients had RDI-reduction for more than 10. We conclude, that RFVTR of the soft palate is successful in the treatment of snoring and may be helpful in the treatment of mild obstructive-sleep-apnea-syndrome (OSAS).

Aged↗
PubMed2000

Possible roles of nitric oxide in the physiology and pathophysiology of the guinea pig cochlea.

Two nitric oxide synthase isoforms (NOS-I and NOS-III) are present in the mammalian cochlea, and many regulatory functions of the inner ear could be mediated by NO. In this study, cochlear potentials and immunohistochemical measures were analyzed by changing the concentration of NO in the guinea pig during intracochlear and intravenous application of an NOS inhibitor and an NO donor. In anesthetized guinea pigs the NOS inhibitor NG-nitro-L-arginine-methylester (L-NAME) was applied by intracochlear perfusion or intravenously. The cochlear potentials and blood pressure were measured during and after the application. Cochleae were removed and prepared for morphological and immunohistochemical examinations by light and electron microscopy. The same series of experiments was performed with the NO donor S-nitroso-N-acetyl-penicillamine (SNAP). Cochlear potentials were not altered during intracochlear perfusion or intravenous application of L-NAME or SNAP. With intravenous application of the substances, significant alterations in the systemic blood pressure were seen. No morphological alterations were noted but in the immunohistochemical investigations significant changes were detected by electron microscopy. Several possible functions of NO in the inner and outer hair cells, stria vascularis and ganglion cells are discussed. Our results suggest that NO has a major effect on the physiology of the inner and outer hair cells.

Animals↗
PubMed2000

Patterns of chromosomal aberrations in metastasizing and nonmetastasizing squamous cell carcinomas of the oropharynx and hypopharynx.

Although several cytogenetic events of the tumor progression cascade have been identified in the past, the specific types of chromosomal alterations that lead to the development of lymph node metastases are still unknown. Operative specimens of 20 patients (10 patients with metastasizing tumors, 10 patients with nonmetastasizing tumors) with squamous cell carcinomas of the oropharynx and hypopharynx, along with the corresponding lymph node metastases, were investigated by quantitative DNA measurements and comparative genomic hybridization (CGH). Nonmetastasizing tumors (N0) displayed overrepresentations on chromosomes 10q (8 cases); 5p (7 cases); 3q and 20q (6 cases each); 8q (5 cases); 1p and 21q (4 cases each); 7p and 20p (3 cases each); and 2p, 15q, and 19q (2 cases each). Loss of chromosomal material was found on 5q, 9p, and 14q (2 cases each). Metastasizing tumors (N+) demonstrated overrepresentations on chromosomes 5p, 15q, and 22q (6 cases each); 3q and 11q13 (5 cases each); 20p and 21q (4 cases each); and 10q (3 cases). In 2 cases, an overrepresentation of the chromosomal arm 3q was accompanied by a loss of chromosomal arm 3p. Less frequent overrepresentations were observed on chromosomes 1q and 17q. Deletions were found on chromosomes 18q (3 cases), 3p, 4q, 5q, and 19p (2 cases each); and sporadic deletions occurred on 2q, 6q, 8p, 9p, 10p, 13q, 14q, 15q, and 16q. Whereas overrepresentations on chromosomes 1p and 7p occurred exclusively in N0 tumors, overrepresentations on chromosomes 1q, 11q, and 22q, along with deletions on 18q, were only observed in N+ tumors. Quantitative DNA measurements revealed a significantly higher percentage of aneuploid cells and a higher degree of DNA entropy in the N+ tumors. Chromosomal overrepresentations on chromosomes 1q, 8q, 11q, 18q, and 19q occurred more frequently in the metastases than in the corresponding primary tumors. Pairwise analysis of chromosomal alterations in the primary tumors and associated lymph node metastases revealed a genetic relationship, although a greater number of chromosomes on average were affected in the lymph node metastases. Quantitative DNA measurements demonstrated greater aneuploid values in the metastases. Recurring patterns of chromosomal alterations in N0 and N+ tumors were demonstrated in this study. In general, metastasizing tumors are characterized by overrepresentations on chromosomes 11q13 and 22q, and deletions on 18q. These aberrations suggest an elevation along the tumor progression cascade.

Adult↗
PubMed1999

The role of acoustic rhinometry in the diagnosis of adenoidal hypertrophy in pre-school children.

UNLABELLED: Adenoidal hypertrophy is a common problem in pre-school children and diagnosis depends mostly on evaluation of clinical symptoms and signs. Investigative techniques to assess adenoidal size often do not add to this information. Recent reports have suggested a role for acoustic rhinometry in this situation. A total of 49 children consecutively referred to the Department of Otorhinolaryngology, University of Mainz, with evidence of adenoidal enlargement underwent acoustic rhinometry pre- and post-operatively and were compared to an age-matched control group from a local kindergarten school. Adenoidal size was visually estimated at surgery and questionnaires were completed by parents of symptomatic children. Acoustic rhinometry was not able to differentiate controls (mean nasopharyngeal cross-sectional area 1.34+/-0.47 cm2, n = 35) from symptomatic children admitted for adenoidectomy (mean nasopharyngeal cross-sectional area 1.66 +/- 0.83 cm2, n = 42, P = 0.53). Acoustic rhinometry was advantageous for patients with adenoidal hypertrophy in two situations. Firstly a sub-group of patients with complete nasopharyngeal obstruction could be identified (P = 0.03) and secondly all patients with a postnasal space less than 1.2 cm2 clinically benefited from adenoidectomy. CONCLUSIONS: Acoustic rhinometry, in general, is not suitable for assessing adenoidal size in pre-school children. Physical limitations of currently available acoustic rhinometers are likely to explain the limited clinical value of this investigative technique.

Acoustics↗
PubMed1999

Laparoscopic surgery during pregnancy.

STUDY OBJECTIVE: To describe the benefits, complications, and safety of laparoscopic surgery during pregnancy. DESIGN: Retrospective case series (Canadian Task Force classification II-2). SETTING: Community academic medical center. PATIENTS: Nineteen pregnant women. INTERVENTIONS: Five (26.3%) appendectomies, seven (36.8%) ovarian cystectomies, five (26.3%) cholecystectomies, one diagnostic laparoscopy (5.3%), and one (5.3%) salpingectomy. In one woman, laparoscopy was converted to exploratory laparotomy to complete a difficult ovarian cystectomy, and a second patient required a minilaparotomy incision to remove the specimen. MEASUREMENTS AND MAIN RESULTS: No preterm labor or adverse perinatal outcome occurred, although one woman had irregular uterine contractions that promptly resolved with tocolytics. One patient delivered at 35 weeks' gestation and the rest carried their pregnancy to term, and all delivered normal infants. No malignancy was found on histopathologic examination of specimens. Hospital stay ranged from 1 to 4 days. CONCLUSION: Laparoscopic surgery can be performed safely in pregnant women. This series adds 19 cases to the approximately 141 reported in the literature. (J Am Assoc Gynecol Laparosc 6(2):229-233, 1999)

Adult↗
PubMed1999

[Significance of eosinophilic granulocytes in relation to allergy and aspirin intolerance in patients with sinusitis polyposa].

BACKGROUND: The development of nasal polyps might be influenced by different factors such as mucosal inflammation. Infiltration with eosinophils is a common finding, although in largely different quantitis. PATIENTS AND METHODS: We investigated 58 patients suffering from nasal polyps who were assigned for endonasal sinus surgery based on endoscopic and CT findings. Out of these patients, 52% have already had sinus surgery and had recurrent polyps. All patients were subjected to both, allergy testing and a functional in vitro test for aspirin intolerance. During surgery, tissue samples were gained and send for histological examination with special respect to eosinophil infiltration. RESULTS: Eosinophil infiltration was observed in 66% of all patients. 37 patients (64%) exhibited aspirin intolerance only, four (7%) had a positive allergy test only, in 9 patients (15%) both, allergy and aspirin intolerance were diagnosed. Allergy and aspirin intolerance were accompanied by eosinophil tissue infiltration. Eosinophil infiltration was more common and more severe if allergy and aspirin intolerance were found together compared with the tissue eosinophilia in patients with either one entity. CONCLUSION: This study confirms the importance of eosinophil infiltration in the pathogenesis of severe or recurrent nasal polyps based on allergy and aspirin intolerance. A coincidance of allergy and aspirin intolerance was found in an unexpected high number of patients.

Adult↗
PubMed1999

A 5-year residency curriculum in obstetrics, gynecology, and family medicine.

OBJECTIVE: To develop a curriculum for residents in obstetrics and gynecology that also provides training in family medicine. METHODS: We designed a 5-year curriculum with 36 months of obstetrics and gynecology, 12 of which are as chief resident, with a 4-month rotation through family medicine to meet the primary care requirements, and rotations of 1 month each in geriatrics and emergency medicine. The curriculum includes the 30 months of required rotations mandated by family medicine (three of which are in obstetrics and gynecology), with the 6 months' available elective time allocated to obstetrics and gynecology. RESULTS: The Residency Review Committee for Obstetrics and Gynecology accredited the curriculum, which meets the Accreditation Council for Graduate Medical Education Special Requirements for Family Medicine, in August 1996. CONCLUSION: This 5-year residency curriculum educates physicians in both obstetrics and gynecology, and family medicine, and graduates are eligible to pursue board certification in both specialties.

Curriculum↗
PubMed1998

Three-dimensional ultrasound evaluation in the head and neck.

We evaluated the use of a novel three-dimensional ultrasound imaging device in patients with various head and neck lesions. The investigated system was found to be a valuable adjunct to conventional ultrasound in head and neck evaluations. A disadvantage of the three-dimensional system was the need for expensive technical equipment.

Head and Neck Neoplasms↗
PubMed1998

[Long-term functional outcome of Laccourreye hemipharyngectomy-hemilaryngectomy with reference to oncologic outcome].

BACKGROUND: Various techniques for the treatment of hypopharyngeal malignancies are used to achieve disease control while preserving laryngeal function. PATIENTS AND METHODS: This study details the long-term results of 22 patients (ages 39-80; average age 57 years) following hemipharyngo-hemilaryngectomy (described by Laccourreye) for unilateral hypopharyngeal squamous cell carcinomas (G2-G3; T1-T4; N0-N3). Follow-up was 16-83 months (average 43) and included extensive speech and swallowing assessment. From 1989-1994 the procedure was performed in 26 patients. Two died within one year postoperatively, two were lost for follow-up, and 22 were included in this study. RESULTS: One patient developed recurrent disease with liver metastasis; two patients were successfully treated for recurrent disease. Two patients developed second primary tumors, while all others had no signs of recurrent disease. Fourteen patients had no difficulties eating or drinking. Six patients could only eat soft foods, and two patients required a gastrostomy feeding tube. Nineteen patients had a useful but hoarse voice, and three patients had severe difficulties when communicating. Modulation of voice was decreased because the supraglottic structures (mainly false cord and scar tissue) were used for phonation. Eighteen patients were completely satisfied with their voice. The tracheotomy was closed in 18 patients within six months, while four patients required a tracheostoma for more than two years. CONCLUSIONS: These data show that function-preserving surgical techniques can be successfully used in hypopharyngeal carcinomas even for patients with advanced disease. Useful functional results for swallowing, voice, and airway were achieved in most patients undergoing this procedure.

Adult↗
PubMed1998

Lateralized and bilateral olfactory function in patients with chronic sinusitis compared with healthy control subjects.

Results of this study demonstrated that a new olfactory test, the "Sniffin' Sticks," can be used to distinguish hyposmic patients with chronic sinusitis (n = 63) from control subjects. Dirhinic testing yielded improved olfactory sensitivity compared with monorhinic testing. However, dirhinic results were not significantly different from results obtained for the best nostril.

Adolescent↗
PubMed1998

Implementation of early discharges after uncomplicated vaginal deliveries: maternal and infant complications.

BACKGROUND: Short-stay obstetric stays have been the recent focus of many social and medical debates. We did a retrospective study of a large community teaching hospital's experience in making a safe transition to short-stay obstetrics. METHODS: Over a 10-month period, a multidisciplinary committee developed an intrapartum and postpartum education program to allow short hospital stays after uncomplicated vaginal deliveries. Computerized data were then retrieved on all uncomplicated spontaneous vaginal deliveries (DRG 373) from January 1994 to March 1995. RESULTS: During the study period, 554 women were discharged on the first postpartum day, resulting in three maternal readmissions and nine pediatric readmissions (combined readmission rate of 2.2%). This low readmission rate compared favorably with our experience with 2,563 uncomplicated vaginal deliveries from January 1991 to December 1993, immediately before the institution of the short-stay obstetrics program (combined readmission rate of 3.9%). The average hospital cost for a 1-day stay was $1,714 compared with $2,477 for a 2- to 3-day stay, representing a saving of only 31%. CONCLUSIONS: Early obstetric discharges after an uncomplicated spontaneous vaginal delivery can be safe and effective with appropriate patient selection and support.

Cost Savings↗
PubMed1998

Calcium channel blockers for prevention of noise trauma in otologic surgery.

One hundred patients were tested prior to otologic ear surgery in a prospective, randomized, double-blind study to assess the perioperative efficiacy of a calcium channel blocker (diltiazem) in preventing acoustical trauma during middle ear surgery. The patients were randomly divided into a therapy group (diltiazem), and a control group (placebo). Bone conduction hearing thresholds were examined preoperatively and followed at 1 day and 3 months postoperatively. Frequency-dependent changes in postoperative bone conduction and the number of patients with various degrees of postoperative hearing loss in both groups were statistically analyzed. The results indicated only a small postoperative hearing loss after ear surgery in both groups. There was a tendency for better results in the therapy group but this was not found to be statistically significant. Despite favorable results in animal trials utilizing different kinds of noise with the prophylactic application of diltiazem, further studies in humans will be needed to determine the role of calcium antagonist drugs in the prophylaxis or treatment of acoustical trauma.

Adolescent↗