Biomedical subjects
Publications and source records attributed to C Beck.
In a histochemical and electron microscopical study the pathogenesis of otosclerosis was investigated. The morphological changes in the extra- and intracellular space indicated a complex metabolic disturbance of all tissue components. The observed chondrocytic chondrolysis stressed the role of the cartilage remnants in the otic capsule as an etiological factor. There was morphological evidence of a superimposed enzymatic defect.
A variety of congenital or acquired diseases may cause macroglossia. We report the case study of a 25 year old patient with Down's Syndrome who developed macroglossia after injury to the tongue from a self-inflicted bite. Conservative therapy for one month through wound revision, antibiotics and antiphlogistics was only successful in controlling infection but failed to prevent the occurrence of a massive macroglossia. This latter problem could only be managed through reconstructive surgery. Histological studies of tissue taken from the tongue revealed the presence of an interstitial edema containing protein, but without evidence for mucopolysaccharides, glycogen or amyloid. A network of dilated blood and lymphatic vessels with partial stenoses caused by organized thrombosis and proliferation of endothelial cells could be observed, suggesting the presence of a congenital lymphangio-hemangioma. However, we believe that these findings were the result of the obliteration of lymphatic and blood vessels through trauma and inflammation to produce the patient's macroglossia.
Since 1974 we have treated 59 patients suffering from unilateral and bilateral (two patients) Morbus Menière with intratympanal application of gentamycin-sulfate. In contrast to earlier attempts using this method, we did not try to destroy the vestibular apparatus, but taking into our considerations the recent findings about the pathophysiological mechanism of Morbus Menière, only to damage the secretory epithelium, thus preventing the endolymphatic hydrops. Releave from symptoms could be obtained in more than 90% of our patients.
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Unilateral vocal cord paralysis is the prime indication for vocal cord Teflon injection. The functional results in 38 patients are considered and it can be seen that this treatment has a favorable influence not only on cordal atrophy but also on the hypofunctional dysphonia. Depending upon the clinical findings Teflon may be injected into one or both cords and also several times into the same cord. No tissue reaction was seen and the functional results in both situations were good.
Since 1973 we have used intralaryngeal injection of Teflon for vocal improvement in cases of unilateral vocal cord paralysis, postoperative scarring of the vocal cord and hypofunctional dysphonia. So far we have treated 84 patients. Teflon is the best substance to use, it remains at the place of instillation, keeps its shape and is not resorbed. As immediate reactions we have observed sporadic oedematous swellings of the injected vocal cord. No long-term reactions are know. The functional results are vocal improvement without restriction of the respiratory passage.
A boy 14 years is described who had partial agenesis of the right lateral sinus. Following thrombophlebitis of the left lateral sinus secondary to mastoiditis he developed progressive visual impairment due to papilledema. This was cured by vein graft between the right lateral sinus and the right external jugular vein.
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We used a body plethysmograph to determine airway resistances in 485 cases of laryngeal and tracheal stenoses. 143 cases who had resistances exceeding 60 mm H2O/l.a.sec underwent surgery. A vocal cord was laterally fixed in 49 patients suffering from bilateral recurrent paralysis. Optimal results were obtained at a postoperative resistance level of 30 mm H2O/l.a.sec (standard value: 14.77 +/- 6.53 - n - 387). The patients could carry out work of medium intensity and had a steady voice. We performed tracheal interventions in 94 cases of tracheal stenoses. A mean postoperative resistance of 29.9 mm HWO/l.a.sec, with a tracheal diameter of 7-8 mm was attained. In practice, only a few patients found the remaining obstruction a hindrance, during work of maximal intensity. No recurrences were observed after treatment. Airway resistance exceeding 150 mm H2O/l.a.sec were found in 13 new admissions and 73 times in those undergoing therapy. In these cases asphyxiation threatens. These patients must be tracheotomized or intubated immediatly.
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Due to its course in the pharyngeal space, the trunk of the glossopharyngeal nerve can be damaged during tonsillectomy which results in paralysis of the soft palate and impairment of the sense of taste. These symptoms may recede within two years but permanent damages can be seen as well. They can be treated by logopedia and relaxation therapy.
We used a body-plethysmograph to determine air-way resistances in 485 cases of laryngeal and tracheal stenoses. We decided in 143 cases to intervene after observing resistance exceeding 60 mm H2O/l and sec. A vocal chord was lateral fixated in 49 patients suffering bilateral recurrent paralysis. Optimal results were obtained at a postoperative resistance level of 30 mm H2O/l and sec (standard value: 14.77+/-6.53--n = 387). The patients could carry out work of medium intensity and had a steady voice. We performed tracheal interventions in 94 cases of tracheal stenoses. A mean, post-operative resistance of 29.9 mm H2O/l and sec, with a tracheal diameter of 7--8 mm was attained. In practice, only a few patients found the remaining obstruction a hindrance during work of maximal intensity. No recurrences were observed after treatment. Airway resistances exceeding 150 mm H2O/l and sec were found in 13 new admissions and 73 times in those undergoing therapy. In these cases asphyxiation threatens. These patients have to be tracheotomized or intubated immediately.
The traditional classification of tracheotomy in superior, media and inferior is not important. It only is important that the tracheotomy tube is in a tensionless position and does neither irritate the larynx nor the thyreoid gland. This can be obtained by strict conservation of at least the first tracheal ring and by dissection of the isthmus of the thyreoid gland.
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44 inferior meatal antrostomies in 32 patients have been followed over a period of 2 years. Control of the results by means of sinuscopy, ultrasonography, x-ray's, biopsies and subjective as well as objective findings revealed good results in 89% of the patients. Closure of the fenestration occurred in 29,5% but had no bearing on the recurrency rate of sinusitis. Improvement was noticeable even after closure. Allergy did not play an important role. Mucociliary transport was evident through the window, permitting adequate ventilation and drainage.