Search PubMed⌕ Search

Biomedical subjects

H G Kempf

Publications and source records attributed to H G Kempf.

At least 19 recordsLinked to original sources
PubMed2005

[Malignant transformation of a juvenile papilloma in a 11 year old boy].

BACKGROUND: The juvenile laryngeal papilloma is the most common benign neoplasm in children. Often the entity shows an elongated recurrent course of disease with an expansion into the tracheo-bronchial system. Sporadic malignant transformation in adults with a papilloma was reported after treatment with radiotherapy alone or in combination with the intake of additional toxins (e. g. nicotine). Similar reports of a malignant transformation of juvenile papillomas without additional risk factors is very rarely reported. CASE REPORT: We report about an 11 year old boy, who suffered from a juvenile laryngeal papilloma. The multiple laser surgical procedures and a therapy with interferon resulted in a short-term remissions. A tracheotomy was inevitable. Seven months after the first diagnosis of the papilloma a regional metastatic squamous cell carcinoma was found. In spite of combined radiotherapy and chemotherapy the boy died 11 months later. CONCLUSIONS: The spontaneous malignant transformation of a juvenile papilloma in a squamous cell carcinoma is extremely rare. The surgical intervention as well the radiotherapy and chemotherapy using interferon was unsuccessful due to the high grade of malignancy. In view of the very short time interval between first diagnosis of juvenile papilloma and the subsequent malignant transformation, one must consider either the potential presence of a very aggressive form of papilloma or alternative two coincident independent diseases.

Antineoplastic Agents↗
PubMed2005

[Granular cell tumor -- a rare tumor lesion of submandibular gland origin].

RATIONALE: Granular cell tumors are rare entities with manifestations in nearly all organ systems. Appearance in salivary glands is observed in singular cases. CASE REPORT: We report a 54 years old female patient with a painless submandibular tumor lesion. Using a submandibular approach the tumor was totally removed with the submandibular gland. Histologically a benign granular cell tumor was diagnosed. The immunohistological examination revealed positive for S-100 antigen and vimentin, negative for KL1 antigen. The clinical follow-up for about 3 years was without complications or tumor recidive. CONCLUSIONS: A differential diagnosis of a submandibular mass is the rare manifestation of a benign granular cell tumor. The neurogen origin can be proven immunohistologically by positive S-100 antigen detection. The complete surgical resection is the therapy of choice.

Biomarkers, Tumor↗
PubMed2000

Mastoiditis and acute otitis media in children with cochlear implants: recommendations for medical management.

Acute otitis media (OM) or mastoiditis is a very dangerous condition for the ear after cochlear implantation. However, acute OM is very common in childhood and can occasionally occur in an implanted ear. Most cases of acute OM can be successfully treated with intravenous high-dosage antibiotics. In cases of mastoiditis and clinical signs of mastoid abscess, retroauricular drainage is necessary to prevent infection of the implant bed. In a series of 366 children given implants (1 to 14 years), acute OM occurred in 5.6% during a follow-up period of 1 to 8 years. Seven ears had to be opened by means of myringotomy. Five ears were opened by retroauricular incision with mastoid revision on the implanted side. Adenoidectomy and use of ventilation tubes before cochlear implantation, as well as careful subtotal mastoidectomy during the implantation, can reduce the incidence of acute OM in children after implantation. Early and subsequent treatment with operative mastoid drainage can prevent implant loss and should be performed at the implantation center.

Acute Disease↗
PubMed1999

[Temporal bone fracture after head trauma causing rhinoliquorrhea and meningitis].

We report our experience in managing a temporal bone fracture after head trauma that had no apparent clinical signs. Recurrent CSF rhinorrhea and meningitis lead to extensive diagnostic procedures. Operative exploration of the temporal bone demonstrated a fracture line along the horizontal part of the carotid artery. The location of the fracture did not cause such typical symptoms as hearing impairment, facial paralysis, vertigo or tinnitus. Only CSF liquorrhea through the Eustachian tube indicated a fracture at the lateral skull base.

Cerebrospinal Fluid Rhinorrhea↗
PubMed1999

Complications in pediatric cochlear implant surgery.

In a retrospective analysis we evaluated the intra and postoperative complications in children who underwent cochlear implantation between 1984 and 1993 at the Medizinische Hochschule Hannover. The data and records of 366 children were collected and analyzed. Relevant parameters were major complications such as significant infection, intraoperative bleeding, facial nerve injury, implant loss and device failure, as well as lesser complications, including delayed wound healing, chronic pain and vertigo. Late complications such as cholesteatoma or electrode dislocations were also registered. Cases of acute otitis media were managed with conservative treatment. Data presented indicate that cochlear implant surgery in children is a reliable and safe procedure with a low percentage of severe complications. Problems related to ear surgery can occur and should be manageable with standard procedures. Careful operative techniques and sufficient personal experience can help avoid severe post-operative problems.

Adolescent↗
PubMed1999

[Complications of cochlear implant surgery in children and adults].

BACKGROUND: In a retrospective analysis we evaluated the complication rate in 697 patients after cochlear implantation between 1985 and 1995 (366 children, 331 adults; 604 Nucleus, 50 Clarion and 42 other implants). RESULTS: Intraoperatively in 74 cases (10.6%) total or partial cochlear obliteration was found, a CSF gusher occurred in 7 cases. Minor complications such as seroma (8 adults), wound infections (14 patients), emphysema, and swelling were successfully treated with conservative methods and drugs. Seven (2.1%) adults showed facial nerve palsy postoperatively with incomplete recovery only in 2 of them (0.6%). No permanent facial nerve palsy was observed in children. Cholesteatoma developed in 18 adults (5.4%), which was treated by revision surgery. CONCLUSIONS: In conclusion, cochlear implant surgery is a safe procedure with a low complication rate. However, Cochlear implantation should be performed by well experienced ear surgeons who can properly handle intraoperative and postoperative problems. The patients should be informed about the typical risks of ear surgery including implant removal due to infection or technical defects, facial nerve palsy, vertigo and, especially in adults, increased tinnitus.

Adolescent↗
PubMed1999

[Sonographic diagnosis of metastatic renal cell carcinoma to the head and neck region].

In the area of the head and neck metastases from distant primary tumours are rare in comparison to the common squamous cell carcinomas of the upper respiratory and digestive tract. Thus correct preoperative diagnosis may be difficult. Two cases with distant metastases of renal cell carcinoma to the head and neck region are presented in this report. In a 60-year-old male patient, diagnostic evaluation of unilateral epistaxis revealed a radioopacity of the maxillary sinus, six months after removal of a renal cell carcinoma. In the second case a slowly progressive indolent swelling of the left neck developed in a 56-year-old man six years after resection of a renal cell carcinoma and two years after surgical treatment of a pancreatic carcinoma. Following clinical examination, modern imaging techniques with special emphasis on colour Doppler sonography with a Siemens Quantum 2000 were used for diagnostic evaluation in both patients. Sonography of metastatic renal cell carcinoma to the maxillary sinus revealed complete opacity of the antrum. The cervical mass proved to the inhomogeneous and hypoechogenic and was difficult to distinguish from the lower parotid lobe and the vessel sheath. A common feature of both tumours was a high degree of perfusion which could be confirmed by superselective angiography. The histological examination of the surgical specimen showed an isolated metastasis of a renal cell carcinoma in both cases. In patients with a history of renal cell carcinoma the possibility of distant spread to the head and neck region should be taken into account even after a long period of complete remission. Colour Doppler sonography facilitates the distinction between the normally well perfused secondary tumours and squamous cell carcinomas which usually only have a minimal blood supply. Because of the high risk of profuse bleeding a biopsy should only be performed in the operating theatre.

Carcinoma, Renal Cell↗
PubMed1999

[Ultrasound evaluation of characteristics of cervical lymph nodes with special reference to color Doppler ultrasound. A contribution to differentiating reactive from metastatic lymph node involvement in the neck].

BACKGROUND: Cervical mass due to lymphadenopathy is a common cause for consultation of an ENT specialist by patients. In many cases exact differentiation without biopsy between reactive and metastatic lymphnodes is difficult but crucial and necessary for each patient. Ultrasound is the imaging system with the highest sensitivity for the evaluation of pathological lymph nodes. However, differentiating benign and malignant lesions remains a problem. PATIENTS: In a prospective study, 138 cervical lymph nodes of 62 patients were evaluated according to conventional ultrasound criteria such as size, shape, brightness, demarcation, etc., and according to parameters of color doppler sonography such as intensity and localization of perfusion. The so called Pourcelot or resistance index, an objective parameter, was measured in order to examine a possible improvement of specificity in differential diagnosis of both entities. All lymph nodes were surgically removed and histologically examined after ultrasonography. RESULTS: 133 lymph nodes were evaluated in the study. Lymphadenitis was demonstrated in 72 cases, whereas 61 of the lumps showed metastases of squamous cell carcinoma of the head and neck region. Three patients with primary malignant lymphoma were excluded from the study. The conventional ultrasound parameters such as size, homogenity, shape and brightness did not reveal any substantial difference between the two groups. However, lymph node metastases significantly showed higher Doppler signals than the reactive ones. Most of the metastases were perfused in the periphery or had a diffuse spread of blood flow. The most valuable parameter from the prognostical point of view proved to be the Pourcelot Index with a threshold value less than 0.6 for metastases, which increased the specificity to 92% with a probability of p = 0.001. CONCLUSIONS: The results of this study demonstrate an increase of the ultrasound specificity in differentiation of pathological cervical lymph nodes using color flow imaging. Unfortunately, this method does not enable the physician to correctly diagnose the findings in all patients. Therefore histological evaluation is mandatory in all doubtful cases.

Adolescent↗
PubMed1999

Adenoid cystic carcinoma of the skull base.

Adenoid cystic carcinoma (ACC) is a slowly growing tumor with a particular tendency to infiltrate the surrounding tissue by perineural spread. The clinical diagnosis may prove difficult due to the submucons extension of the tumor, especially at the skull base. This article outlines the clinical characteristics, diagnostics, and treatment modalities in a series of 56 patients with an ACC in the head and neck diagnosed between 1970 and 1998 in 32 females and 24 males. The youngest patient was aged 24 years, the oldest 77 years. The average age was 54 years. In 16 patients the tumor originated in the paranasal sinuses or the nasopharynx and involved the skull base. As a rule, several months passed between the manifestation of the first symptoms such as pain, blocked nose, epistaxis, or diplopia and the initial clinical diagnosis. All patients received surgical treatment, however, complete microscopical resection could only be achieved in approximately one third of the cases. Therefore, nine patients were postoperatively treated with radiotherapy. The average survival rates of the patients with an ACC of the skull base were only 99 months as compared to 144 months in the patients without skull base involvement.

Journal Article↗
PubMed1998

[Tullio phenomenon after cochlear implantation].

The Tullio phenomenon is defined as an acoustically inducible vestibular disorder that was first described in 1929. In an animal experiment Tullio provoked acoustic oscillations at the labyrinth followed by signs of imbalance. In the literature this phenomenon can be found in healthy but sensitive persons as well as in patients with Meniere's disease and patients with lesions between the stapes, footplate and the membranous labyrinth caused by fractures, stapes dislocations, labyrinthitis or perilymphatic fistulas. In this case report a patient complained about vertigo after cochlear implantation provoked by acoustical stimulation at a sound pressure level above 90 dB independent of the cochlear implant (CI). During tympanoscopy we found scar tissue surrounding the ossicles after CI. After disconnecting the ossicular chain no vertigo or nystagmus could be provoked. After CI regular ENT examinations and appropriate explorations of postoperative complaints are necessary. Vertigo especially requires very careful diagnostic procedures.

Acoustic Stimulation↗
PubMed1998

[Congenital subglottic laryngeal stenosis in 2 brothers with chondrodysplasia syndrome (Keutel-Gabriel syndrome)].

BACKGROUND: Keutel-Gabriel syndrome (chondrodysplasia) is a rare autosomal recessive disease. The patients have characteristic malformations such as midfacial hypoplasia, brachytelephalangia, and hearing loss as leading symptoms. PATIENTS: We report about two brothers with clinical and radiological features of Keutel-Gabriel syndrome. Congenital subglottic laryngeal stenosis was also present in both. In the younger brother an emergency tracheotomy had to be performed. In a staged procedure the stenosis was successfully treated with laryngotracheoplasty according to Cotton. CONCLUSIONS: This is the first description of a congenital subglottic laryngeal stenosis with Keutel-Gabriel syndrome. To avoid long-term tracheotomy, a tracheoplasty with autologous cartilage should be performed.

Adolescent↗
PubMed1998

[Otogenic brain abscess].

BACKGROUND: Otogenic complications are rare but typical following acute or chronic ear infections like mastoiditis and cholesteatoma. A life-threatening sequela is the otogenic brain abscess located in the temporal lobe or cerebellum. PATIENTS: At the ENT Department of the Medical University of Hannover/Germany we treated 8 patients suffering from otogenic brain abscesses in the temporal lobe during the last three years. The average age of the 6 male and 2 female patients was 48 years. In 5 patients the abscess developed due to a cholesteatoma with superinfection. Three cases showed acute mastoiditis. All patients were operated using an otosurgical retroauricular approach, in five cases a classical radical mastoidectomy was performed. In two cases the abscess was reached via mastoidal approach and was subsequently drained. In two other cases the abscess was drained some days later by neurosurgical approach due to increased neurological symptoms. The other patients were treated with high-dosed antibiotics under regular clinical and radiological control. RESULTS: In 7 cases complete regression of the abscess was achieved. Five patients were discharged without further otological or central-nervous problems. One female patient developed severe meningitis with generalized thrombosis of the central blood sinus system and died in central circulatory failure. Two other patients developed a moderate psychopathologic syndrome and were admitted to rehabilitation institutions. CONCLUSIONS: The analysis of our patients shows that otogenic brain abscesses should be regarded especially as a severe complication of the untreated cholesteatoma. It is important to use modern imaging modalities like computer tomography or MRI for early detection of the intracerebral lesion and to perform an early otosurgical intervention. Under antibiotics and CT control, healing of this severe complication can be achieved in most cases. However, the danger of acute and chronic ear diseases has to be kept in mind in all medical disciplines.

Adult↗
PubMed1998

Cochlear implantation in patients with chronic otitis: indications for subtotal petrosectomy and obliteration of the middle ear.

Normally, active chronic suppurative otitis media is regarded as a contraindication for cochlear implantation. In case of a radical cavity after surgical treatment for cholesteatoma, the electrode covered by the epithelial lining of the mastoid will likely become exposed or extruded. Under these circumstances we suggest the subtotal petrosectomy, obliteration of the middle ear cleft with abdominal fat, and the blindsac closure of the external ear canal before cochlear implantation.Fourteen patients with chronic otitis media were successfully implanted with an intracochlear multichannel cochlear implant. After an average follow-up of 28 months a temporary facial palsy in one patient and an insufficient closure of a retroauricular fistula over the mastoid cavity in two cases were observed as postoperative complications. One patient with a tumefactive inflammatory pseudotumor developed a massive inflammation in the implanted ear 2 months after surgery which could not be controlled by conservative treatment. The implant had to be removed and after administration of cyclophosphamide she could be successfully reimplanted 7 months later.Implantation of a foreign body in a potentially infected space which communicates with the endocranium means a surgical challenge which can be managed by obliteration of the middle ear. In case of massive inflammation we prefer a two-stage procedure.

Journal Article↗
PubMed1997

[Patients with trauma-induced deafness--rehabilitation using a cochlear implant].

Deafness due to bilateral temporal bone fractures is a dramatic consequence for the injured patients. Out of more than 1000 patients in Hannover which received a cochlear implant we analyzed the medical history of 44 patients (36 male, 8 female, average age of adults: 41 years) which were implanted after posttraumatic deafness (Nucleus device n = 33, Clarion device n = 11). Postoperatively the patients underwent an auditory rehabilitation program. Most of them (84%) reached open set speech understanding. Results are different caused by additional damage of auditory nerve fibers and posttraumatic central lesions. Due to the risk of posttraumatic fibrosis of the cochlea, implantation should be performed early and can be recommended to the patient if bilateral deafness is diagnosed. In the case of auditory nerve damage brain stem implants offer new possibilities.

Adolescent↗
PubMed1997

Complications of cochlear implant surgery in children.

OBJECTIVE: To evaluate the intraoperative problems and postoperative complications in children receiving cochlear implants. STUDY DESIGN: A retrospective analysis of the clinical records of 366 children, aged 1 to 14 years, who had received cochlear implants. RESULTS: Intraoperatively, obliteration of the cochlea occurred in 66 patients, cochlear dysplasia in 8, and CSF leakage in 7, and nearly 5% of patients had signs of infection in the mucosa of the middle ear. Postoperatively, early complications occurred in 1% to 2.5% of patients: flap complications, electrode dislocation, facial nerve problems, and incorrect insertion of the electrode. Delayed complications included otitis media and stimulation of the facial nerve. CONCLUSION: Proper preparation of the implantation site, experienced and well-trained surgeons, and awareness of the operative and postoperative risks are necessary.

Adolescent↗