[Unilateral lung transradiency. Swyer-James or MacLeod syndrome].
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Adult↗
Biomedical subjects
G Kahle
Publications and source records attributed to G Kahle.
Late manifestations of traumatic lesions of the anterior skull base.
The authors review their experience in detecting occult traumatic dural lesions. In a retrospective study covering the period from January 1, 1984 to December 31, 1996, 23 patients were evaluated for occult traumatic dural lesions. Clinical presentation, diagnostic work-up, and management of the dural lesions were analyzed.The clinical presentations of the previously undetected dural lesions of the anterior skull base were meningitis in eight cases, cerebrospinal fluid (CSF) rhinorrhea in eight cases, both meningitis and CSF rhinorrhea in five cases, and a pulsating swelling in the region of the right upper eyelid in one case. In another case a fracture of the posterior frontal wall was detected incidentally on the preoperative CT scan performed prior to surgery for chronic sinusitis. One patient had a CSF fistula of the lateral skull base in addition to the frontobasal fistula. The interval between trauma and diagnosis varied from 1 to 48 years. Dural lesions were localized by high-resolution CT, fluorescein nasal endoscopy, CT cisternography, and MRI. Intraoperative exposure of the dural lesions and duraplasty were possible in all cases. During the first attempt successful repair of the dural lesions was accomplished in 22 (95.7%) of the 23 patiants. Two interventions were necessary to close a CSF leak of the cribriform plate.Modern clinical and radiologic diagnostic methods should be employed to search for an occult dural lesion in patients with recurrent meningitis, meningitis caused by upper airway pathogens, or CSF rhinorrhea. The patient will remain at risk of potentially fatal meningitis until the lesion is appropriately repaired by duraplasty.
Journal Article↗
[Etiology of hepatosplenomegaly with concomitant diarrhea and vomiting? Systemic mastocytosis (malignant form)].
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Aged↗
[Localization of cAMP-selective phosphodiesterase in the mammalian eye by (3H)-rolipram].
It has been shown that inhibition of phosphodiesterase (PDE) or an increase in intracellular cyclic adenosine monophosphate (cAMP) can lower the intraocular pressure in mammalian eyes. The PDE inhibitor rolipram binds with high affinity to a cAMP-dependent PDE. In the following study, receptors for rolipram in the mammalian eye are determined by autoradiography. About 1050 histological sections of rabbit (albino and pigmented), rat, monkey (baboon and marmoset) and human eyes were examined concerning rolipram-binding sites in different structures. The highest specific binding of rolipram to the ciliary body epithelium was seen in human, rabbit and baboon eyes. Marmoset eyes showed the highest specific binding in the ciliary body muscle, rat eyes in the retina. Specific binding was consistently high in the ciliary body epithelium and therefore at the site of aqueous humor formation. Because of these results and the known mode of action of rolipram, one can assume a close connection between rolipram-binding sites and the regulation of intraocular pressure.
3',5'-Cyclic-AMP Phosphodiesterases↗
[Chemotherapy of juvenile angiofibroma--an alternative?].
Since February 1979, 22 juvenile angiofibromas have been treated among 312 tumors of the skull base managed in the ENT Department, Fulda. According to a general staff consensus the treatment of choice was complete surgical removal. This was achieved in 20 cases with one operation and in one case with two operations. In addition to removal of tumor, functional and aesthetic aspects had to be considered as aims of operative treatment, including among others preservation of the facial skeleton, infraorbital nerve, nasolacrimal drainage system and vision. In rare cases complete excision of the tumor is not possible. The value of cytostatic therapy is demonstrated in one patient with uncommonly advanced disease. Considering the extensive regression of tumor achieved in this case after chemotherapy with Adriamycin and decarbazine, one has to raise the question if the chemotherapeutic approach was more than just palliative. From our experience chemotherapy should be considered a possible alternative to radiation in the management of unresectable juvenile angiofibromas.
Adolescent↗
[Papillary tumor of the endolymphatic sac].
A papillary neoplasm that was presumed to originate from the endolymphatic sac was described by Heffner in 1989. This tumor was considered to be a "low-grade adenocarcinoma" because of its behavior: slow growth, local destruction and failure to metastasize. The clinical manifestations are hearing loss, vertigo, facial nerve paralysis and/or cerebellar disorders. Endolymphatic sac tumors have previously been mistaken for such neoplasms as paraganglioma, choroid plexus papilloma and carcinoma, adenomatous tumor of the middle ear and secondary metastases. The diagnosis of this neoplasm is facilitated by CT and MRI. The treatment of choice is total removal of tumor as soon as possible and requires clinical awareness of this rare but important pathologic entity.
Adenoma↗
Magnetic resonance imaging after frontal sinus surgery with fat obliteration.
The obliteration of the frontal sinus via an osteoplastic approach is performed with the aim of achieving a permanent 'switching off' by final and conclusive clearing out. For this, freshly harvested abdominal fat has shown itself to be the best clinically. It is possible to demonstrate the vitality of fat transplanted into the frontal sinus without an operation, i.e. by a macroscopical and histological examination using magnetic resonance imaging (MRI). The magnetic resonance examinations were carried out on a supraconductive 0.5 T Magnet (Gyroscan T.S.II, Philips Medicine Systems, Eindhoven, Netherlands) with a quadrature (square) head spool. We produced T1-weighted spin echo images (TR: 450-550 ms; TE: 20-25 ms), T2-weighted fast spin echo images or in double-echo technique in transverse orientation (Turbo SE or TR: 2000-2500 ms; TE: 50-90 ms) and short tau inversion recovery (STIR) sequences for fat suppression (TJ: 140 ms; TR: 1400 ms; TE: 30 ms). The fat implanted into the frontal sinus of 11 patients aged 22-65 years, having undergone an osteoplastic frontal sinus operation with obliteration, was examined post-operatively by MRI. Objectives were the time-dependent distribution of portions of vital fatty or connective tissue, the eventual development of necroses or cysts as well as recurrences, inflammatory complications or re-epithelization of the frontal sinus four to 24 months post-operatively. In only six out of 11 cases was vital fatty tissue found. Fatty necrosis occurred five times, whereas in four cases a transformation into granulation tissue and in one case into connective tissue could be seen. All 11 patients were complaint-free. Long-term observations are needed to see if differences in the recurrence rate of frontal sinus disease are dependent on whether the implanted fat remains vital or necrosed and transformed.
Adipose Tissue↗
[Behavior of fatty tissue in frontal sinus obliteration].
The purpose of obliterating the frontal sinus is to provide a permanent solution to the underlying problem. The material of choice for obliteration is freshly removed abdominal fat. Using magnetic resonance imaging, one can assess the vitality of fat tissue in an obliterated frontal sinus without surgery. Eight patients ranging in age from 22 to 65 years underwent osteoplastic frontal sinus surgery with fat obliteration. The freshly implanted abdominal fat was postoperatively investigated using magnetic resonance tomography. The magnetic resonance examinations were carried out on a supraconductive 0.5 T Magnet (Gyroscan T S II, Philips Medicine Systems, Eindhoven, Netherlands) with a square head spool. We produced T1-weighted spin echo images (TR: 450-550 ms, TE: 20-25 ms), T2-weighted fast spin echo images or in double echo technique in transverse orientation (Tubo SE or TR-2000-2500 ms, TE: 50, 90 ms) and STIR sequences for fat suppression (TJ: 140 ms, TR: 1400 ms, TE: 30 ms). Our goal was to determine the time-dependent distribution of vital fat or fibrous tissue, development of necrosis, cysts, recurrences, inflammatory complications, or re-epithelization of the frontal sinus. Six to 24 months postoperatively, we found vital fat tissue in only three of eight cases. In the other five cases fat necrosis was present. The frontal sinus was filled by granulation tissue or fibrous tissue (once). It is not yet possible to determine when the fat changes to connective tissue. This process varies between individual patients. All eight patients were free of symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)
Adipose Tissue↗
[Scar formation in the cornea after photorefractive keratectomy].
The morphologic correlate of the so-called subepithelial haze after photorefraktive keratectomy (PRK) has not yet been decided. Excimer laser keratectomy 100 microns in depth was performed in an eye that was scheduled for enucleation. Three months after surgery a dense scar was diagnosed with the slit lamp. After enucleation the cornea was investigated by light microscopy. The thickness of the scar was less than 1 micron in most sections with a maximum of 5 microns. This surprising finding explains the predominantly scattering power of the subepithelial haze, which results in a relatively good visual acuity of 20/30 to 20/25 in most clinical cases.
Aged↗
[Unilateral caudal cranial nerve paralysis in extracranial carotid dissection].
Focal cerebral ischemic symptoms, Horner's syndrome and mostly ipsilateral headache are the characteristic clinical triad of extracranial carotid artery dissection. Lower cranial nerve palsies seem to be uncommon and rare. By means of two cases with identical clinical symptoms and of a literature review we make clear, that ipsilateral lower cranial nerve palsies, especially a hypoglossal nerve palsy, are not uncommon. Without focal cerebral ischemic symptoms they can be the only sign of extracranial carotid artery dissection. Computed tomography of the skull base with regard to the high cervical internal carotid artery is as an usually quickly available examination an alternative to magnetic resonance imaging.
Aortic Dissection↗
Temporary unilateral amaurosis with pneumosinus dilatans of the sphenoid sinus.
Pneumosinus dilatans (PSD), first described by Meyes in 1898, is an abnormal dilatation of one or more of the paranasal sinuses without bony erosion. The term sinus pneumocele indicates the presence of bony erosion. Review of the literature from 1968 to 1992 revealed 24 cases of idiopathic PSD and 17 cases of pneumocele of various paranasal sinuses. PSD occurred most commonly in the frontal sinus. Males were more often affected than females. The average age for males ranged from 16.5 for the maxillary sinus to 35.5 years for the sphenoid sinus. Pneumoceles occurred most commonly in the maxillary sinus. The average age for males ranged from 29 years for the frontal sinus and 47 years for the ethmoid sinus. Two patients (1 pneumocele and 1 PSD) had a temporary loss of vision. We report the case of a 37-year-old mountain climber who experienced temporary loss of vision in his left eye above 3000 m. Vision returned below 2000 m. High resolution computed tomography scan revealed pneumosinus dilatans of the sphenoid sinus with dehiscence of the optic canal on the left side. Endonasal microendoscopic resection of the anterior wall of the left sphenoid sinus was performed. The patient has remained symptom-free after 2 years of follow-up. Pneumosinus dilatans should always be considered in the differential diagnosis of sudden visual loss associated with atmospheric pressure changes.
Case Reports↗
[The emergency: traumatic aneurysm in the area of the head-neck].
Bleeding of aneurysm of cervical arteries is an emergency situation in ENT surgery. Compression of trachea and big cervical veins together with blood loss needs immediate treatment. Three cases are demonstrated presenting diagnostic and therapeutic management of one spontaneous respectively posttraumatic aneurysm of the inferior thyroid artery, and two aneurysms of lingual respectively facial artery after tonsillectomy. Interventional angiography plays an important role in overcoming such problems. Intravasal application of a platinum coil stops bleeding of the aneurysm and surgical revision of the neck can be avoided.
Adenoidectomy↗
[Eye injuries in squash].
BACKGROUND: Since 1968, when the first commercial squash center has opened in Hamburg, squash has become very popular in Germany. Squash is played between two players in a closed court using racquets and a hollow rubber ball which could reach a maximum speed up to 225 km/h. According observations of English and American ophthalmologists there is an increased risk to get an eye injury in this game. Because of the isolation by the former existing wall, Berlin-West was an ideal place to study the ocular hazards of playing squash. METHODS: In 1991 about 40,000 squash players existed in Berlin-West playing on 118 courts of 13 commercial squash centers. During January to October 1991 case records of all hospitals with an emergency eye ambulance and of the eye residents were investigated, furthermore all patient records of 1989 and 1990 of the eye clinic of the university hospital Rudolf Virchow, department Charlottenburg, were examined retrospectively. RESULTS: All over 234 sports-related eye injuries were registrated, 78 (33.3%) patients sustained the injury during a squash game, 43 (18.4%) during soccer and 34 (14.5%) during playing tennis. 71 squash players were treated in an hospital ambulance, of these 15 required admission. A total of 206 injuries were sustained by the players. The majority of injuries were superficial, but in 12 cases occured an hyphaema and in 13 an angle recession. In all admitted patients visual recovery was good, during the clinical follow up there were no perimetric, ophthalmoscopic or tonometric impairments. The initial loss of visual acuity of the injured eye compared to the other side was on the average 4.5 lines, at dismissal from the hospital it was on the average 2 lines. CONCLUSION: Because of the increased risk to get an eye injury during a game of squash, players should be encouraged to wear proper eye protection i.e. closed eye guards according to standards of North-American testing organisations.
Adolescent↗
[Increase in beta-adrenergic receptors in rabbits in long-term local administration of beta-blockers].
Chronic application of beta-blockers often induces tachyphylaxia of unknown origin. After long-term topical pretreatment of pindolol and timolol in rabbit eyes (up to 12 weeks, twice a day) beta 2-adrenergic receptors were localized and quantified with autoradiographic methods. Frozen sections of albino rabbit eyes were labelled with [125I] cyanopindolol. Quantification revealed a significant increase in the density of beta 2-receptors after premedication with pindolol in the ciliary body and the corneal epithelium. This increase was detectable after 2 weeks of premedication and reached its maximum after 4 weeks. After premedication with timolol a significant increase of beta 2-receptors in the epithelium of the ciliary body and the corneal epithelium was visible. Following pindolol over an equivalent time-course, to that of timolol administrations, an increasing number of beta 2-receptor sites was also observed. No significant changes were visible for either kind of premedication investigated (pindolol/timolol) in the corneal endothelium, the lens or the choroid. Chronic application of topically instilled beta-blocking agents leads to a significant increase in receptor density in ocular structures that are involved in aqueous humor production. This up-regulation of beta 2-adrenergic receptors might explain the intraocular events at receptor level in relation to the phenomenon of tachyphylaxis.
Administration, Topical↗
Temporal bone fractures: high resolution CT.
Apart from midfacial traumas, laterobasal fractures are the most common skull base injuries the ENT surgeon has to deal with. These fractures often appear in combination with more or less extensive further skull or brain injuries. In these cases interdisciplinary co-operation with the neurosurgeon is necessary. Today, development of high resolution computed tomography makes it possible to define priorities in treatment of these patients exactly.
Adult↗
[Traumatic vascular wall lesion of the basilar artery with consecutive basilar artery thrombosis].
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Adult↗
[Analysis of photo-ablation products of excimer and erbium:YAG laser treated human corneas. Combined gas chromatography/mass spectroscopy].
The photoablation products from human cadaver corneas treated with an excimer laser (192 nm) or an erbium: YAG laser (2.94 microns) were qualitatively analyzed using a combined gas chromatography mass spectrometry (GC/MS) system. GC/MS is the most sensitive analyzing system in use today for molecules with a relative molecular mass of 40 to 400. More than 20 different types of molecules were detected; most of them were identified as alkanes. Comparison of the two types of laser showed larger fragments and fewer different types of molecules after excimer laser treatment than after erbium: YAG photoablation. We postulate that the smaller molecules after erbium: YAG treatment indicate a greater heat during photoablation than with excimer laser treatment.
Alkanes↗
Gas chromatographic and mass spectroscopic analysis of excimer and erbium: yttrium aluminum garnet laser-ablated human cornea.
The photoablative products from human cadaver corneas treated with lasers were investigated using gas chromatography and mass spectroscopy. The photoablations were done separately with an excimer laser (193 nm) and with an erbium: yttrium aluminum garnet (Er:YAG) laser (2.94 microns). More than 20 different types of molecules with a molecular weight of 40-400 mass units could be identified, most of which were found to be alkanes. The comparison of the two types of laser ablations showed larger fragments and fewer types of molecules present after excimer laser treatment than after Er:YAG photoablation.
Cornea↗