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Biomedical subjects

G Oberascher

Publications and source records attributed to G Oberascher.

At least 37 records · Page 2Linked to original sources
PubMed1988

[Cerebrospinal otorrhea--cerebrospinal rhinorrhea. The Salzburg concept of cerebrospinal fluid diagnosis].

The three following cerebrospinal fluid (CSF) examinations make it possible to identify even the smallest amounts of CSF in case of CSF otorrhoea and rhinorrhoea. 1. Immunological identification of beta 2-transferrin (Oberascher/Arrer) 2. Laboratory fluorescein identification (Oberascher/Arrer) 3. Endoscopic fluorescein detection according to Messerklinger. For screening, and as the method of choice, beta 2-transferrin identification is always used as a first step if there is a suspicion of liquorrhoea. Depending on the result and on further measures, both fluorescein tests are used additionally in diagnosis. Basing on practical experience gained recently, special attention is given to test analysis, the various possibilities of taking samples, and their means of transport or mailing. A newly developed diagnostic step-by-step plan is intended to emphasise the clinical significance by means of practical examples. This concept represents the present state of the art in CSF diagnosis and demonstrates that a much mor precise range of indication is possible in surgery of fractures of the base of the skull and CSF leaks if it is combined with an appropriate x-ray examination.

Brain Concussion↗
PubMed1988

[Identification of middle ear implants in high-resolution computerized tomography].

As a result of the increase in the use of computed tomography and the possibility of demonstrating very small structures, x-ray diagnosis is becoming more and more important in investigating complications after examined in patients as well as cadaver temporal bones by using high resolution middle ear computed tomography: 1. autologous/allogenic ossicular implants, 2. alloplastic implants made of ceramic, plastic or metal. As can be seen from our investigations the homografts and some of the implants are easily identifiable (autologous/allogenic ossicular implants, Ceravital and Frialit PORP/TORP and metal devices), are only partly identifiable (Fisch-Tef Platinum and Stainless Steel as well as Titan stapes pistons), hardly or not at all identifiable (PORP/TORP and stapes pistons made of plastic, e.g. teflon, silicone, plasti-pore). The same applies to ventilating tubes. Thus the position in the middle ear of metal tubes which have slipped can be seen clearly, whereas plastic tubes cannot be seen so well. It is of clinical importance that prosthesis dislocation is visible in CT so that should complications occur it is better possible to determine whether revision surgery is necessary. As, however, identification of various devices in CT is still not satisfactory, the manufactures must soon fulfil our demands for a contrast agent to be added to prosthesis.

Bioprosthesis↗
PubMed1988

[Dislocations and fractures of the ossicles--high resolution computerized tomography of the petrous bone].

As in traumatology of the head the HR-CT of the injured petrous bone is now the imaging method of choice. With axial and coronary slices one can show not only the different parts of the ear but also the course of the facial nerve and particularly the ossicles in the tympanon. The fractures are nice to show, also the soft tissue lesions like brainprolaps in the tympanon or hematotympanon because of the better density resolution in comparison to the conventional tomography with rather higher radiation dose especially for the eye lenses. Important are the slice thickness of 1.5 mm with special examination technique, that also small fractures of the pyramid particularly the labyrinthous organ and of the ossicles mostly associated with dislocations are detectable. Regarding that with the clinical possibilities there are particular consequences for the otosurgeon. The ossicular dislocations of other than traumatic cause are rare.

Adolescent↗
PubMed1987

[Preformed, autologous rib cartilage in the reconstruction of defects of the frontal bone].

The production of exactly fitting, preformed cartilage implants is described. These implants consist of rib cartilage chips that develop after 6 to 9 months' implantation under the thoracic and abdominal skin to a homogeneous and compact cartilage-connective tissue mass. The autologous implants are formed by using plastic shells that are perforated. This technique enables us to repair bone defects of the frontal and skull base region. As well as explaining the surgical procedure the advantages, disadvantages and indications are stressed.

Aged↗
PubMed1987

[High-resolution computed tomography in stapes surgery].

Early and delayed complications in the inner or middle ear may follow stapedectomy or stapedotomy and may require revision surgery. Nowadays high resolution middle ear computed tomography (HR-MCT) using a special interpolation technique can demonstrate the smallest structures of the middle ear space, such as the long process of the incus and stapes. Stapes prostheses can also be seen in this way, but to identify the prothesis exactly it is necessary to determine the position of the piston hook in relation to the incus and of the piston shaft to the foot plate and scala vestibuli. Two points were of particular interest to us: HR-MCT identification of various metal and plastic pistons. Clinical significance of HR-MCT in complications following surgery. As the result of our experimental research on cadaver temporal bones, pistons must still be divided into four groups based on their demonstration by HR-MCT: Group I (e.g. Stainless Steel Cup Piston): whole piston visible. Group II (e.g. McGee Stainless Steel Piston): only piston shaft. Group III (Fisch Teflon-Platinum Piston): only hook visible. Group IV (e.g. Fisch Teflon-Wire Piston): piston hardly visible or not at all. In groups I-III it is possible to discover whether the piston is too long or too short, whether it is dislocated or has slipped. Group IV pistons, hooks from group II and the shaft from group III must be changed to allow detection by x-rays. With plastic pistons it might be possible to add an x-ray agent.2+ improvements in manufacture appear to be necessary, dislocation of various prostheses can now be shown.(ABSTRACT TRUNCATED AT 250 WORDS)

Ear, Middle↗
PubMed1987

[Goldenhar syndrome and other ear abnormalities in HR-PCT].

The use of CT in hospitals in which also ENT departments are located will be useful in cases of osseous congenital disorders of the ear. In combination with the clinical and audiometric investigations CT of the temporal bone will be helpful for the indication of the operations to ameliorate the hearing.

Adult↗
PubMed1987

[The eustachian tube in HR computerized tomography. Imaging in the fetus, newborn infant and infant].

The lumen of the eustachian tube in foetuses, neonates and infants was demonstrated in cadaver temporal bones immediately after death by air and contrast medium using high-resolution computed tomography with axial and coronal projections. Special consideration was given to the deviation of the tube from the sagittal and horizontal plane and the functional unit consisting of the processes of tensor palatini muscle. At this stage of development the lumen of the cartilaginous portion shows a constant almost circular form, quite unlike the shape in adults. A well developed isthmus between the bony and cartilaginous part is absent. In a 6-month-old foetus the tube is horizontal to the base of the skull, whereas in a 6-month-old infant it forms an angle of approximately 10 degrees. The angle to the sagittal plane changes in the same period from approximately 37 degrees to 40 degrees. In a 6-month-old foetus the fibres of the tensor palatini muscle also run in an almost horizontal line because of the tiny processus pterygoideus and are forced into a steeper direction as a result of its gradual growth. As there is almost no fulcrum function, a tubal opening effect or mechanism of the muscle fibres at this stage of development seems extremely doubtful.

Cartilage↗
PubMed1987

[The Eustachian tube in HR computerized tomography. Imaging in the adult].

Until now the lumen of the Eustachian tube (ET) has always been shown by using histological sections of temporal bones, which were after decalcification embedded in paraffin blocks and serially sectioned. In order to avoid changes caused by this preparations, we applied contrast medium or air to the lumen of the ET of cadaver temporal bones resected immediately after exitus. It was therefore possible to demonstrate the lumen of the tube in high resolution computed tomography. In this way we could find clear variations of the lumen in the total length of the ET and divide it into five different topographically specific regions. Whereas the pars ossea is formed by certain bone formations and structures in various ways, the picture of the cartilaginous portion remains the same: At the connection of the pars ossea to the isthmus the lumen shows an almost circular form which becomes oval towards the end of the isthmus. This can also be found in the preisthmus portion. In the intermediate section the oval shape is interrupted and replaced by a double curve in the form of a reverse "S". We find once again in the pharyngeal section a well-formed oval lumen, which however is more pronounced than in the preisthmus portion. The intermediate section with its double curve is defined by us beside the isthmus region, as a further, second physiological isthmus in the course of the ET. Apart from that the demonstration of the lumen, that of the function unit of the tensor palatine muscle, processus pterygoideus and hamulus is also of special interest.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1986

A new method for using fluorescein to demonstrate oto- and rhinoliquorrhea. I. Sample preparation by electrophoresis and photometric identification of fluorescein.

We have described a new method for the identification of sodium fluorescein in cases of cerebrospinal fluid (CSF) leakage. To take samples, small sponges of Merocel are placed into the nostrils or external auditory canal, as indicated. They are left in situ for 12h after intrathecal injection of 5% sodium fluorescein. Fluorescein is identified by electrophoretic separation on 1% agarose gel and demonstration with the fluorescence photometer. This method of testing has various advantages: the use of small sponges enables collections of minimal amounts of CSF; potential sources of disturbance (e.g. hemoglobin, etc.) are eliminated; false-positive results are avoided; the time needed for sample analysis lasts only 10 min. All necessary materials and equipment, as well as the taking and analysis of samples, are described in detail. The method used was tested both clinically on patients and in the laboratory and its sensitivity is clearly illustrated.

Cerebrospinal Fluid Otorrhea↗
PubMed1986

Efficiency of various methods of identifying cerebrospinal fluid in oto- and rhinorrhea.

This paper describes methods of cerebrospinal fluid (CSF) leakage diagnosis which have been used in the post-war period. We have listed advantages and disadvantages and given our opinion as to the value of each method. In the form of comparison we have provided a detailed breakdown of the exact procedure of beta 2-transferrin identification used for the immunological diagnosis of CSF leakage. This method, which was developed further by us, is discussed with regard to the results of all sample analysis which have been carried out so far. The result of the discussion is to emphasize the many advantages of this method. In addition, there is a direct comparison made between the fluorescein method and the use of beta 2-transferrin.

Cerebrospinal Fluid↗
PubMed1986

[Immunologic cerebrospinal fluid diagnosis using beta-2-transferrin principles and method].

By using this method beta 2-transferrin, a protein variant can be identified. This variant is produced by neuraminidase activity of the brain and up to now could only be found in cerebrospinal fluid (CSF). In the analysis of CSF, by applying immunofixation with an antiserum and silver staining two bands, the beta 1-transferrin and the beta 2-transferrinband can be demonstrated. When examining serum, nasal secretion, tears, saliva and or other body fluids, only one band, the beta 1-transferrinband can be seen. It is therefore possible to identify CSF accurately. First of all methods of taking samples are explained and required analysis briefly described. Two points were of particular interest to us: The sensitivity of the method and Tracing of possible disturbing effects. Following several, different series of tests we got these results: 1 microliter pure CSF (that corresponds to approx. 1/50 of a drop) and 100 microliter CSF (two drops) per 1 ml nasal secretion can be identified by this method. It is possible that disturbing effects may be caused by blood contamination or a high protein content. For this reason haemoglobin must eliminated by using chromatography. Furthermore it is necessary to reduce a protein content of more than 5 g/l with ammonsulfat precipitation. If care is taken in respect of these two points disturbing effects can be avoided. In clinical application the immunological CSF identification seems to have a very high level of sensitivity and, in comparison with other methods many advantages.

Asialoglycoproteins↗
PubMed1986

[Initial clinical experiences with beta 2-transferrin in oto- and rhinorrhea].

We developed tests to measure beta 2-transferrin, and then used this method to investigate the efficiency of beta 2-transferrin in the diagnosis of cerebrospinal fluid rhinorrhea and otorrhea. We also assessed whether the immunochemical method satisfied the five requirements, which are important in the modern investigation of the cerebrospinal fluid (CSF): High rate of accuracy; Wide area of application; Rapid availability; High sensitivity; No risks to the patient. 14 patients known to be suffering from a CSF leakage were investigated with special attention to the above five points. Eight patients had a CSF otorrhea, five a rhinorrhea, and one patient had a post operative CSF leakage from a retroauricular wound. In temporal bone fractures with CSF leakage regular insertion of sterilized foam rubber sponges into the ear allows adequate samples to be collected. In CSF rhinorrhea with profuse leakage there is no difficulty in collecting enough fluid for analysis. If there is too little fluid or if the question of localization arises we insert sterile sponges, as for CSF otorrhea, into the right and the left of the nose as far as the nasopharynx. They are left in place for 6 hours to provide an adequate sample. The analysis of the samples of CSF otorrhea showed a protein content of 3-6 g/l whereas the samples of CSF rhinorrhea, especially from sponges, showed a content of up to 39 g/l.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Psychogenic vocalizations].

In the first case we are dealing with an eight year old boy who made grunting noises. The second case describes a seventeen year old school girl who suffered from barking coughing attacks. It should be pointed out that the symptoms mentioned had been already observed several months before a diagnosis was made. The actual cause in both cases could be traced back to a disturbed family situation. After a specialized treatment with individual and group discussion as well as the recommendation for behaviour-patterns the complete disappearance of symptoms could be noted in both patients. The pathomechanism was probably a conscious reaction to family conflicts which, however, continued subconsciously after therapy.

Adolescent↗
PubMed1985

[Otoneurologic testing in multiple sclerosis].

The values of the individual audiological and vestibular examination methods in multiple sclerosis (MS) diagnosis are discussed. Our experience shows that the most accurate indications are provided by acoustic stapedius reflex, brainstem auditory evoked potentials (BAEPs) and vestibular investigation. Other testing processes play only a minor part. Using the three methods mentioned, brainstem injuries can be shown to be present at an early stage. Hence one should always include them in MS-diagnosis as a matter of routine. Of the 85 patients we examined, 72 had definite MS and 13 probable (sub-division according to Mc Alpine criteria): all of them underwent acoustic stapedius reflex test and vestibular investigation (nystagmogram, caloric vestibular test according to Hallpike-Frenzel. The stapedius reflex measurements showed pathological findings of 64/54% and the vestibular test findings of 53/61%.

Adult↗
PubMed1985

[Otoneurologic findings in multiple sclerosis. Stapedius reflex, vestibular evaluation, early acoustic evoked potentials].

Symptoms such as tinnitus, hearing and taste disorders and facial palsy seldom occur in multiple sclerosis. Although ENT symptoms are few, vestibular and acoustic stapedius reflex tests combined with brainstem auditory evoked potentials (BAEPs) are available, and may give very useful evidence of the existence of MS. 52 patients with definite MS, and 13 patients with probable MS were examined (classified according to the McAlpine criteria). The vestibular and acoustic stapedius reflex tests were abnormal in 51%/61% and 61%/53% respectively of both groups. The corresponding figures for BAEP were 69% and 63%. The combination of the three tests on all patients showed at least one pathological finding.

Acoustic Impedance Tests↗
PubMed1985

[Animal bite injuries in the head and neck area and their care].

Animal bites in the head and neck vary in severity. Surgical treatment depends on the size, extent and site of the wound. Straightforward injuries need only to be cleaned and disinfected or may require simple surgery. Extensive, complex bites must be treated by the techniques of plastic-reconstructive surgery. Good cosmetic results can only be achieved in this way. Lacerations should be treated immediately. Bites with loss of tissue can be treated immediately by flaps, skin or composite grafts or revascularised flaps. Usually however, the wound is covered by gauze impregnated with ointment or artificial skin. Two to three weeks after granulation the lesion is reconstructed. An anti-tetanus injection must be given for every animal bite. Simple bites do not require antibiotics, but extensive wounds do. The indication for rabies vaccination is described and questions concerning the treatment of injuries caused by rabid or suspected-rabid animals are clearly explained.

Adult↗
PubMed1985

[Therapy of dirt tattooing].

Untreated traumatic tattoo leads to bad cosmetic results. A case of traumatic tattooing is reported, the possibilities of treatment described and the importance of immediate treatment emphasized.

Blast Injuries↗