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Biomedical subjects

G J Ridder

Publications and source records attributed to G J Ridder.

At least 37 records · Page 2Linked to original sources
PubMed2003

[The preconditioning and prelamination of pedicled and free microvascular anastomised flaps with the technique of vacuum assisted closure].

BACKGROUND: Since the technique of vacuum assisted closure has been clinically introduced, the possibilities in reconstructive head and neck surgery have greatly increased. Preconditioning and prelaminating allows a pedicled or free flap plasty to be epithelialized on both sides before the flap gets transferred to its future location. METHODS: We describe the technique of preconditioning and prelaminating of pedicled and free microvascular anastomised flap plasties and we report our experience with 5 cases. Our results are compared with data from the literature. RESULTS: The procedures concerned take only little time and the flap gets optimally prepared for its task in view of the postoperatively modified hemodynamics. By preconditioning, the flap to be lifted is prepared for the future centralised blood supply exclusively via the pedicle vessel without leaving the donor side. Thereby the skin island of such flaps can be increased in size over the natural angiosomes without an increased risk of necrotisation. CONCLUSIONS: By the technique of prelamination, skin or mucosa tissue may be applied onto both sides of the flap so that it can resist the biochemical and mechanical tasks which will be required after transposition. Especially for the reconstruction of defects in the upper aerodigestive tract this is a great advantage, since the inner side of the flap has to resist saliva which represents one of the most aggressive secretions in the human body.

Adult↗
PubMed2002

[Long term compliance with an oral protrusive appliance in patients with obstructive sleep apnoea].

BACKGROUND AND OBJECTIVE: Oral protrusive devices (OPD) are increasingly used in primary snoring and mild-to-moderate obstructive sleep disordered breathing. Due to evidence of reduced compliance with the well established standard treatment of nasal positive airway pressure (CPAP) and reports of patient preference for OPD treatment, particularly in mild cases, OPD may be considered another treatment alternative. PATIENTS AND METHODS: We contacted 192 patients suffering from obstructive sleep breathing disorder, who were treated between May 1996 and September 2001 with an OPD. The patients" use of the device was evaluated, as were any reasons for ceasing to use the device. RESULTS: 105 patients (54.4%) regularly used the appliance after a mean time of 22.7 12.3 month. 21 patients (10.9%) showed no primary compliance and stopped had using the device before the first somnographic follow-up after a mean time of 3.8 months. In this investigation 76 patients (80,2%) were classified as responders and 19 patients (20.8%) as primary non-responders. 22 responders (11.4%) demonstrated no secondary compliance after a mean of 21.9 8.8 months and the discontinued OPD treatment themselves. In 21 patients (10.9%) the nightly respiratory parameters decreased after a mean of 23.0 11.7 months; hence, those patients required CPAP. The cumulative risk using the device after four years as prescribed was 32.2%. We found a correlation between patient compliance, body-mass index and the amount of teeth in the upper and lower jaws. CONCLUSION: OPD compliance seems to be lower than frequently expected. Regular follow-up investigations are necessary to ensure adequate treatment. Poor dental status and an excess body-mass index reduce patient compliance.

Adult↗
PubMed2002

[Intraoral protrusion devices in obstructive sleep apnea. Dental findings and possible treatments].

BACKGROUND: Oral protrusive devices are regarded as an alternative treatment option for snoring and mild to moderate obstructive breathing disorders. In addition to the polysomnographic indication based on the respiratory and somnographic findings, healthy stomatognatic conditions with sufficient dental retention for the device are essential for a successful treatment. PATIENTS AND METHODS: The sleep laboratory of the University Hospital of Freiburg i. Br. referred 112 patients with obstructive sleep apnea to the Department of Orthodontics for treatment with an oral protrusive device. All patients were examined clinically and with a panoramic radiograph with regard to continuous treatment. RESULTS: To maximize treatment success and minimize dental side effects, close collaboration with dental colleagues is necessary in treatment with an oral protrusive device. CONCLUSIONS: Acute periodontitis, periodontal lesions, insufficient dental anchorage, and temporomandibular symptoms can result in unwanted dental side effects and therefore limit the indication of this therapeutic approach.

Adult↗
PubMed2002

[Endoscopically-assisted adjustment of an oral appliance in patients with obstructive sleep apnoea].

BACKGROUND: The treatment effect of patients suffering from obstructive sleep apnoea/hypopnea (OSAHS) with an oral appliance is considerably varied, and its clinical outcome is unpredictable. The aim of our investigation was to examine the changes in pharyngeal airway size at different degrees of mandibular protrusion in order to assess the therapeutic efficacy in relation to the amount of protrusion. METHODS: Fifteen patients with the polysomnographic diagnosis of mild to moderate OSAHS were included in this prospective study. Nasal video endoscopy of the pharynx was done with the patients in supine position at four different degrees of mandibular protrusion do assess the changes of airway size. After 3 - 4 weeks a control polysomnography was carried out, with the mandible in optimal protrusion. RESULTS: The pharyngeal diameter did not increase linearly to the amount of mandibular protrusion. In the polysomnographic examination the respiratory variables were significantly increased. None of the patients in this group was classified as a non-responder to the oral appliance therapy. CONCLUSIONS: The endoscopically-assisted adjustment of the mandibular protrusion appliance is an additional tool to optimise treatment effectiveness. The increase in pharyngeal diameter is not proportional to the amount of mandibular protrusion.

Adult↗
PubMed2002

[PFAPA Syndrome: Current Standard of Knowledge and Relevance for the ENT Specialist].

BACKGROUND: The symptoms fever, aphthous stomatitis, pharyngitis and cervical lymph node enlargement are among the most frequent complaints that particularly make children and adolescents consult an ENT specialist. In cases where these symptoms occur periodically, a PFAPA syndrome may be present. PATIENTS AND METHODS: We report on an atypical process in a 22 year old woman in whom the PFAPA syndrome first occurred during early infancy with recurrences since adolescence. RESULTS: Since the age of eight months the patient suffered from periodically occurring fever and pharyngitis with cervical lymph node enlargement. Therefore, by age four a tonsillectomy was performed and the symptoms disappeared. At age 15 similar symptoms occurred again with fever thrusts over approximately four to five days with temperatures up to 39.8 degrees C associated with pharyngitis, weakness and cervical lymphadenitis. Those symptoms relapsed periodically every four weeks. Treatment regimens with different antibiotics, Dimepranol and Inosin did not show any effect. Hyper-IgD syndrome and cyclic neutropenia were excluded. There were no signs for a humoral or cellular immune defect or a juvenile idiopathic arthritis. CONCLUSIONS: It is often very difficult to make the right diagnosis in a child or a young adolescent presenting with periodically occurring fever. So far the PFAPA syndrome is relatively unknown. Nevertheless, we think that it should be considered in the differential diagnosis by the ENT specialist patients with periodic fever, aphthous stomatitis, pharyngitis and cervical lymphadenopathy.

Adult↗
PubMed2001

Epiglottic tuberculosis: differential diagnosis and treatment. Case report and review of the literature.

A case of a 40-year-old man with tuberculous involvement of the epiglottis suffering from unsuspected pulmonary tuberculosis is described. The laryngeal lesions were primarily considered to be highly suspicious for a neoplastic process rather than an infectious one. After diagnosis, the patient was treated according a standard protocol and followed up for a period of 2 years. He is still free of disease. The clinical presentation, diagnosis, pathological findings, and therapy of the condition are described. The differential diagnosis and management of epiglottic tuberculosis are reviewed and discussed. Even though these cases are rare, otorhinolaryngologists should keep in mind the possibility of tuberculosis in the differential diagnosis of laryngeal tumors, as the incidence of tuberculosis in developed countries is steadily increasing.

Adult↗
PubMed2001

Cheilitis granulomatosa Miescher: treatment with clofazimine and review of the literature.

Cheilitis granulomatosa Miescher is a rare condition of unknown cause characterized by intermittent lip swelling that gradually persists and causes cosmetic deformity. We report the case of a young woman with cheilitis granulomatosa as a monosymptomatic manifestation of Melkersson-Rosenthal syndrome successfully treated by the antileprosy agent clofazimine, and propose clofazimine as an alternative treatment in cases refractory to corticosteroids. The differential diagnosis and current methods of treatment are summarized, and the literature is reviewed and discussed.

Adolescent↗
PubMed2000

[Parotid involvement in cat scratch disease: a differential diagnosis with increased significance].

BACKGROUND: Bartonella henselae is the causative agent of cat-scratch disease (CSD), an inflammatory infection of the lymph nodes. So far, only few cases of atypical manifestations in the head and neck, especially manifestations in the parotid gland have been reported. PATIENTS AND METHODS: Between January 1997 and June 1999 seven patients with manifestations of CSD in the parotid gland were observed at the ENT-department Freiburg. The positive diagnosis was confirmed serologically by an indirect immunofluorescence assay and by detection of Bartonella henselae-DNA with PCR-amplification and subsequent hybridization or sequencing. RESULTS: An intraglandular abscessed lymphadenitis was found in five patients, two of these cases were based on a Parinaud's oculoglandular syndrome. A diffuse affection of the parotid gland, initially misinterpreted as a parotid tumor, was seen in two patients. CONCLUSIONS: Antibiotic treatment is recommended in order to reduce the duration of the disease, in cases of pain and lymph node abscesses. In uncommon manifestations of CSD, the nosological assignment can be difficult on the basis of the heterogeneous symptomatic in the individual patient and the CSD diagnosis can only be confirmed by serology or PCR-based techniques. CSD should be considered in the differential diagnosis of all equivocal masses in the head and neck, even in unusual localisations like the parotid gland.

Abscess↗
PubMed2000

[Neck abscess as primary manifestation of head and neck carcinoma: implications for diagnostic management].

BACKGROUND: Neck abscesses and deep neck infections are common diseases in the field of otorhinolaryngology. However, malignant lymph node metastases presenting as abscesses are uncommon and have rarely been described up to now. PATIENTS: A retrospective review between March 1997 and August 1999 was conducted of 40 patients with deep neck abscesses. RESULTS: In five patients (12.5%) the histological diagnostics revealed a malignancy. From these, in 3 cases the cervical abscess was the primary clinical symptom of an oropharyngeal as well as a hypopharyngeal carcinoma. With further 2 patients, the neck-abscess was located as first clinical sign of a metachronous lymph node metastases after oropharyngeal carcinoma. Aerobic bacteria were recovered in 18 patients, anaerobes alone in 3 and mixed aerobic and anaerobic bacteria in 6 patients. Bartonella henselae was recovered in 7, Mycobacterium tuberculosis in 3 and Actinomyces israelii in 1 patient. CONCLUSIONS: A biopsy of the abscess wall is recommended in establishing the diagnosis. The indication for a simultaneous panendoscopy--especially in patients with typical risk for malignancies--to exclude a primary tumor in the aerodigestive tract should be regarded generously. Neck abscesses should be considered in the differential diagnosis of head and neck carcinoma.

Abscess↗
PubMed2000

Laryngeal sarcoidosis: treatment with the antileprosy drug clofazimine.

Sarcoidosis is a chronic systemic granulomatous disease that occasionally affects the larynx. When the larynx is affected, the symptoms are frequently mild, but severe airway obstruction can occur. Although systemic corticosteroids are helpful, patients may become refractory to further drug administration. The current methods of treatment are here summarized, and the patient literature is reviewed. We also report a case of a young patient suffering from laryngeal sarcoidosis successfully treated by the antileprosy agent clofazimine and propose it as an alternative treatment of laryngeal sarcoidosis in patients refractory to corticosteroids.

Adult↗
PubMed1998

Ovarian-like stroma in an invasive mucinous cystadenocarcinoma of the pancreas positive for inhibin. A hint concerning its possible histogenesis.

A female patient with a mucinous cystadenocarcinoma originating from a mucinous cystadenoma of the pancreas is presented. The cystic tumour was diagnosed 3 years before and was treated with interventional external and internal surgical drainage before radical resection was accomplished by left hemipancreatectomy. Histology showed simultaneous occurrence of mildly dysplastic and invasive malignant epithelium. Immunohistology revealed inhibin-positive cells in the ovarianlike stroma of the tumour. The demonstration of ovarian-like stroma positive for inhibin suggests that this could be a hamartoma with dispersed sex-cord stroma, which would explain the predominance of the female gender in mucinous cystic tumours of the pancreas.

Adult↗
PubMed1998

Carcinoma of the ampulla of vater: determinants of long-term survival in 94 resected patients.

This retrospective study details 94 patients after surgical resection of carcinoma of the ampulla of Vater to determine prognostic factors. The tumour was limited to the ampulla of Vater in 32%, invaded the duodenal wall in 34%, infiltrated 2 cm or less into the pancreas in 22%, and invaded more than 2 cm into the pancreas and/or other adjacent structures in 11%. Curative resection was accomplished in 97% of cases. After exclusion of perioperative deaths the 1-, 5- and 10-year survival rates were 79.6%, 38.2%, and 31.6%, respectively with a median survival of 3.68 years. 26 patients survived more than five and 15 patients more than ten years. In an univariate analysis advanced tumour size, poor tumour grading, lymph node metastases and advanced UICC stage significantly decreased survival. Comparison of short and long survivors confirmed tumour size, lymph node status and UICC stage as significant prognostic factors. In a multivariate analysis (Cox model), only tumour size was a statistically independent predictor of prognosis. The survival probability increased with each year a patient survived after resection. When a patient had already survived five years after resection, the probability to survive another five years was 83%. Careful clinicopathologic staging is important for the prognosis after resection.

Adult↗
PubMed1997

What constitutes long-term survival after surgery for hilar cholangiocarcinoma?

BACKGROUND: Hilar cholangiocarcinomas are rarely considered to be resectable and specific data regarding long-term survival are not available. METHODS: A retrospective single center experience from 1971 and 1995 details long-term survival among 339 patients who underwent surgery for adenocarcinoma of the hepatic duct bifurcation. Tumor removal was accomplished by resection of the bile duct bifurcation either alone (33 patients), in combination with hepatic resection (77 patients), or combined with hepatic and vascular resection (41 patients). Thirty-two patients underwent total hepatectomy and liver transplantation. In 188 patients the tumor was unresectable and palliative internal or external biliary drainage was established. The resectability rate was 49.2% and rose to 54% after inclusion of liver transplantation. The clinicopathologic features of 32 5-year survivors were compared with patients whose survival was less than 5 years. RESULTS: Thirty-two patients survived longer than 5 years after surgical treatment of hilar cholangiocarcinoma; 22 of these patients (69%) were still alive at last follow-up. Twenty-six long-term survivors had primarily undergone resection; 4 received liver transplants. There was 1 long-term survivor beyond 5 years after both exploratory laparotomy and subsequent percutaneous transhepatic drainage, and palliative hepatojejunostomy. Long-term survival after resection was significantly associated with less advanced tumor stages. Lymph node involvement and residual tumor were the primary prognostic factors both in a multivariate analysis after resection and in the cohort of long-term survivors. Nevertheless, long-term survivors were still at a significant risk to die from tumor recurrence. CONCLUSIONS: Radical resection offers the best possibility of prolonged survival with a good quality of life for patients with hilar cholangiocarcinoma.

Bile Duct Neoplasms↗
PubMed1997

Resectional surgery of hilar cholangiocarcinoma: a multivariate analysis of prognostic factors.

PURPOSE: To define the prognostic factors after surgical resection of bile duct carcinomas at the hepatic bifurcation. PATIENTS AND METHODS: The retrospective single-center experience details 151 patients after surgical resection of central bile duct carcinoma performed between 1971 and 1995. Tumor removal was accomplished by resection of the bile duct bifurcation either alone (group I, n = 33), in combination with hepatic resection (group II, n = 77), or combined with hepatic and vascular resection (group III, n = 41). Survival analysis was performed by the Kaplan-Meier method and the relationship between each of the clinicopathologic variables and survival was assessed by the log-rank test. Multivariate results were confirmed using Cox regression. RESULTS: The overall hospital mortality rate was 9.9% and depended on the extent of resection (group 1, 6.1%; group II, 7.8%; group III, 17.1%). After exclusion of hospital deaths, the overall patient survival rate was 28.4% at 5 and 15.5% at 10 years, with a median survival duration of 2.05 +/- 0.23 years. Univariate survival analysis identified tumor size, lymph node metastases, residual tumor stage, and tumor grading as factors with a statistically significant prognostic impact. Survival prognosis was not influenced by the site of the tumor according to the classification of Bismuth and Corlette, extent of resection, International Union Against Cancer (UICC) stage, perineural and vascular invasion, age, or sex. In a multivariate Cox analysis, only lymph node metastases and residual tumor stage proved to be of independent prognostic significance. CONCLUSION: Resection of central bile duct carcinoma is feasible in many patients and a favorable outcome after resection is mainly determined by curative resection and the absence of lymph node metastases.

Adult↗
PubMed1996

Favourable prognosis of cystadeno- over adenocarcinoma of the pancreas after curative resection.

This report details nine patients after curative surgical resection of histologically proven mucinous cystadenocarcinoma of the pancreas and compares the prognosis with ductal adenocarcinomas. Cystadenocarcinomas represented 2.1% (10/ 466) of a total of 466 patients who underwent surgical exploration and 5.5%, of all curatively resected carcinomas of the exocrine pancreas at Hanover Medical School from 1971 to 1994. Forty percent of adenocarcinomas and 90% of cystadenocarcinomas were resectable. A curative R0 resection was possible in all patients with cystadenocarcinoma and 85 % with adenocarcinoma. Six of the patients with cystadenocarcinoma were female and three were male. Their median age was 54 +/- 12 years (range: 44 to 81 years). Four cystic neoplasms were located in the head, one in the head and body, three in the tail, and one in the body and tail of the pancreas. There was no hospital mortality in this group. The prognosis after resection of cystadenocarcinomas was significantly better compared to ductal adenocarcinomas of the pancreas. The Kaplan-Meier survival was 89% vs 52% after 1 year, and 56% vs 13% at 5 years. Our results indicate the favourable prognosis of cystadeno- over ductal adenocarcinomas of the pancreas in a cohort of patients with curative tumour resection.

Adult↗