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Biomedical subjects

H Iro

Publications and source records attributed to H Iro.

At least 37 records · Page 2Linked to original sources
PubMed2004

[Complications with inflammatory diseases of the nasal sinuses].

The close localization of the paranasal sinuses both to the brain and the orbit can even today lead to severe and potentially lethal complications in patients with sinusitis. These incidents are rare, however, they should be duly diagnosed and treated since fatal outcome is described in 5-10% of cases. Current diagnosis and therapy for acute inflammatory complications and mucoceles of paranasal sinuses are presented in this article.

Eye Infections↗
PubMed2004

Sialoscopy--initial experiences with a new endoscope.

BACKGROUND: After the introduction of mini-endoscopes for the diagnosis of swelling of the major salivary glands there has been further development of materials and techniques. A new highly flexible semirigid sialoendoscope with high quality imaging (6000 pixels), an outside diameter of 1.1 mm, a working channel of 0.4 mm, and a separate channel for irrigation has been developed and we examined its clinical value. METHODS: We used the endoscope in 22 patients for diagnosis and treatment. RESULTS: Sialoendoscopy was achieved after dilatation of the papilla in all cases. The image (both in contrast and resolution) was excellent. We found sialolithiasis in 13, stenosis in 3, and sialodochitis in 3. Through the working channel we were able to insert instruments with success in seven cases with pathological findings. One patient developed a complication.

Adult↗
PubMed2004

Adaptation of a hexapod-based robotic system for extended endoscope-assisted transsphenoidal skull base surgery.

OBJECTIVE: To adapt a hexapod-based robotic system for use in extended endoscope-assisted transsphenoidal skull base surgery. METHODS: A robotic system (Evolution 1, Universal Robot Systems, Schwerin, Germany) based on a hexapod design with an attached seventh axis is used as instrument holder. The instrument interface is operated via a joystick control. An endoscope is applied to the instrument interface, which is tracked by a navigation system (Stealth, Medtronic, USA). RESULTS: The instrument holder was modified so that it could be applied in transsphenoidal surgery. Furthermore, translation and pivoting movements of the system were implemented, also a quick change between microscope and robotic-controlled endoscope was made possible. After extensive phantom testing two patients with large invasive pituitary adenomas were operated on using the robotic endoscope assistance during transsphenoidal surgery. The robotic assistance allowed the use of two additional instruments under endoscopic view. For example, drilling, suctioning, application of punches, as well as microsurgical tumor removal could be performed under endoscopic view. CONCLUSION: A robotic system could be adapted for use in endoscope-assisted transsphenoidal skull base surgery allowing simultaneous use of two instruments under endoscopic view. This opens new possibilities to extend transsphenoidal skull base surgery.

Adenoma↗
PubMed2003

[Facial nerve schwannoma in the inner auditory canal and geniculate ganglion].

BACKGROUND: Schwannoma of the vestibular nerve is the most common tumor found in the inner auditory canal. If a schwannoma of the facial nerve is found unexpectedly during surgery, the original surgical plan may have to be changed. In our series, we describe the symptoms, diagnostic procedures and therapy of this infrequent, benign tumor. In particular, we want to analyse the influence of diagnostic techniques, such as magnetic resonance tomography and electrophysiology, on the diagnosis of these tumors. PATIENTS: Between 1975 and 2001, we diagnosed 17 cases of facial nerve schwannoma in the inner auditory canal or the geniculate ganglion. All patients were treated surgically. In 16 cases, we used the enlarged middle fossa approach and in the remaining patient the translabyrinthine approach was used. RESULTS: In 11 cases, the facial nerve could be saved but in six the nerve had to be rebuilt with a transplant. During the first years of our study, palsy of the facial nerve was a frequent finding. In the later years, a hearing impairment and tinnitus became the most frequent symptoms. CONCLUSIONS: Advances in magnetic resonance imaging have, in many cases, facilitated the differentiation between schwannomas of the facial nerve and the vestibular nerve over the last years. Signal enhancement at the geniculate ganglion is important for the diagnosis of facial nerve schwannoma. In individual cases, we found significant findings using electrophysiological procedures. In three cases, the temporal delay was elongated. Based on these findings, the therapeutic procedures can be discussed together with the patients.

Adolescent↗
PubMed2003

[Advanced transfacial approach to extensive sellar adenoma of the pituitary gland].

The excision of tumors of the pituitary gland is usually achieved via a transsphenoidal transnasal approach. In the past, alternative approaches were described for macroadenomas. Especially in tumors surrounding the internal carotid artery (ICA) and the optic nerve, the selection of the appropriate approach is of importance. We demonstrate the case of a second extensive relapse of a macroadenoma after primary transsphenoidal resection and radiation therapy. As the tumor enclosed both the ICA and left optic nerve, a median external approach via the upper midface was chosen. After the median skin incision and translocation of the upper parts of the nasal structure, the papyraceous lamina was removed bilaterally. The orbital tissue was laterally exposed with retractors, achieving a wide access to both carotids and optic nerves. The functional and aesthetic results were satisfactory. Compared with other approaches, this one provides a good exposure of both the ICA and optic nerve.

Adenoma↗
PubMed2003

[Surgical therapy of Madelung's disease in the head and neck area].

PATIENTS AND METHODS: Between 1995 and 2001 we treated 12 patients with benign symmetric lipomatosis in the head and neck. The group comprised 11 men and 1 woman aged 34-62 (M=47). The most frequent complaints were diminished range of motion of the head and obstruction when eating or speaking. Combined lipectomy and liposuction were performed in all patients, with liposuction being carried out in a second session. RESULTS: The mean follow-up period was 3 years. The functional results were very satisfactory in all patients. Of the 12 patients, 9 were also satisfied with the aesthetic outcome.A recurrence occurred in three patients 1.5, 2, or 3 years after the operation. Severe complications were not observed. CONCLUSIONS: According to our experience, combined lipectomy and liposuction represents a successful procedure in treating benign symmetric lipomatosis in the head and neck region.Nevertheless, advantages and drawbacks of the two techniques should be equally considered prior to surgery.

Adult↗
PubMed2003

[Growth of sporadic vestibular schwannomas correlates with Ki-67 proliferation index].

BACKGROUND: Sporadic vestibular schwannoma show a wide variability of their growth rate. Some tumors might remain quiescent for a long time without symptoms and other tumors might suddenly enlarge. Sometimes during surgical removal of tumors, it is useful to have a parameter for the prediction of the further growth potential of the schwannoma, especially if tumor resection results in functional impairment of the facial nerve. An often used histological parameter for growth rate of tumor cells is the proliferation index. METHODS AND PATIENTS: In our study we observed a series of 50 patients with neurinoma of the vestibular nerve by "wait and scan". After the first magnetic resonance imaging (MRI) all patients were controlled by a second MRI. The time between the MRIs ranged between 3 and 26 months (median 9). In 45 of 50 patients a surgical removal of the tumor by transtemporal approach followed. RESULTS: The proliferation index (Ki-67) was identified in the histological tumor specimens. The next step was the correlation of proliferation index and "tumor doubling time" (TDT). The volume of the tumors was provided by measuring three diameters of the tumors in MRI and calculating the volume with a formula. The volume of the tumors were used to calculate tumor growth and TDT. 10 patients showed no tumor growth during follow up. The average TDT in 40 cases was 22 months (SD 16). In 33 cases we were able to determine a proliferation index, which showed an average score of 1.99 %. Statistical analysis showed a correlation between proliferation index and TDT with a coefficient of - 0.42 (s: 0.014). In two cases with relevant clinical tumor growth (TDT: 12 months), the MIB-1 index was nearly 0 % in different areas of the tumor specimen. May be in these cases, the cell proliferation declined just before operation. On the other hand we found one patient with a high proliferation index of 3.3 % and a rather long TDT of 19 months. CONCLUSIONS: The determination of proliferation can serve as a further decision guidance during surgery of vestibular schwannoma.

Cell Division↗
PubMed2003

Patterns of failure following radiation with and without chemotherapy in patients with nasopharyngeal carcinoma.

PURPOSE: Aim of this study was to retrospectively evaluate patterns of failure, results, and prognostic factors for patients with nasopharyngeal cancer (NPC) following radiotherapy (RT) with and without concurrent chemotherapy (RCT). PATIENTS AND METHODS: Between 1978 and 1999, a total of 101 patients with NPC were treated in our hospital, of whom 53 received external megavoltage RT alone with a median total dose of 76 Gy (1978-1988), and 48 patients had RCT (1989-1999). For RCT a combination of 5-FU and cisplatin was used together with a median total dose of 72 Gy. Patterns of relapse, survival rates and toxicity as well as prognostic factors were evaluated retrospectively. RESULTS: RCT was associated with a marked reduction in distant metastases: 6/48 (13%) vs. 17/53 (32%) after RT alone. Locoregional tumor persistence was only marginally lower with RCT: 10/48 (21%) vs. 17/53 (32%) following RT. Patients with RCT demonstrated a survival advantage compared to those with RT alone (5-year overall survival (OS): 64% vs. 44%, p = 0.1). OS, disease-specific survival and locoregional control rates were 53, 57, and 78% at 5 years and 47, 51 and 78% at 10 years, respectively. OS was significantly affected by histology (p = 0.007), the patients' age (p = 0.009) and gender (p = 0.01). CONCLUSION: This retrospective study provides further evidence that both reduction of distant metastasis and enhanced local tumor control by combined radiochemotherapy may be associated with improved survival rates in NPC compared to radiation alone. Concurrent RCT is therefore considered the preferable treatment option, however, confirmation in randomized trials is still warranted.

Adolescent↗
PubMed2002

[Metastatic esthesioneuroblastoma. Challenge in interdisciplinary combined modality therapy].

Esthesioneuroblastoma is a rare tumor, which in many cases is diagnosed at an advanced stage with an high recurrence rate and incidence of metastases. Regionary metastases predict a poor prognosis. There is no standard therapy approach for these tumors. The most widly accepted primary therapy is radical craniofacial enbloc resection followed by radiation therapy. Today chemotherapy is getting more important and is administered with curative intention. Multidisciplinary management results in significantly longer survival in advanced tumor stages and recurrence. A clinical staging system as well as histopathological grading according of Hyams could be from importance for selection and timing of the different therapeutic modalities. We present a case of a 34-year-old female patient who was diagnosed with an advanced olfactory neuroblastoma of the upper nasal cavity with bilateral cervical lymph node metastasis (modified Kadish-stage D). Craniofacial resection and bilateral neck dissection was performed, followed by postoperative radiotherapy. Reviewing the recent literature the different therapeutic approaches are compared and discussed.

Adult↗
PubMed2002

[Basic principles and concepts of enteral nutrition of ENT patients].

Patients suffering from head and neck cancer often show malnutrition even at the time of diagnosis. Therapeutic measures as surgery, radiation and antineoplastic chemotherapy additionally decrease the nutritional status. Therefore, an early supportive intervention is necessary in accordance to prognosis and quality of life. For many reasons, enteral nutrition has advantages to total parenteral nutrition. Percutaneous endoscopically guided gastrostomy (PEG) is the method of choice, for the application of enteral nutrition in most cases; special situations can be covered by using nasogastral feeding tubes, jejunostomy techniques, open surgical approach or radiologically guided gastrostomy. The industry provides a lot of different products suitable for nearly all patients. Furthermore, PEG facilitates the application of pharmacological agents, e.g. analgetics. However, the patient must be integrated in a network of professional care to ensure a safe nutrition therapy also in an outpatient setting.

Combined Modality Therapy↗
PubMed2002

[Findings in a high-risk group following asbestos exposure. Benefit of ENT examinations in patients with long-term exposure to asbestos].

BACKGROUND AND OBJECTIVE: Laryngeal diseases caused by exposure to asbestos are listed in the current German list of occupational diseases under number 4104. Parallel to a multicenter study to evaluate whether a CT scan should be included in the examinations for occupational diseases according to the German surveillance guidelines, an additional ENT examination was evaluated. PATIENTS AND METHODS: One hundred workers with a mean exposure time to asbestos of 20.9 years were given a complete ENT examination in 4 consecutive years (1993-1996). Radiological signs for asbestosis were observed in 21 cases and 58 participants had pleural affections caused by asbestos. Significant nicotine abuse was reported by 15 persons: 61 participants were ex-smokers and 24 had never smoked. Regular alcohol consumption was reported by 90% (11% more than 80 g/day). RESULTS: As documented in the literature, we found a high prevalence of laryngitis, especially in smoking patients. One patient had early laryngeal cancer (T1). CONCLUSION: The integration of an ENT examination into the German surveillance guidelines for occupational diseases should be discussed for patients with a high exposure to asbestos.

Aged↗
PubMed2002

Thin section arrays for I-FISH analysis of chromosome-specific imbalances in squamous cell carcinomas of the head and neck.

Thin section arrays of 20 head and neck squamous cell carcinomas were studied by I-FISH for gains (including amplification) and losses of specific genomic segments. These arrays allow the examination not only of a number of tumor sections but also of the surrounding margins and of inconspicuous control tissue in one experiment. All tumor sections examined significantly differed from the inconspicuous control tissues by containing more or less extensive cell populations with aberrant signal constitutions. In no case, however, did the aberrant population constitute the whole area of the section. Gains of signals were strikingly more frequent than were losses. All tumors showed significant gains of the segments examined, the highest differences between tumor and control sections were found for the segments 9q34 and 8q24, followed by 5p15.3 and 11q13. Amplifications were most frequently found of 11q13: 8 of the 20 tumors showed amplifications in more than 20% of the nuclei, while no nucleus with more than four signals was found in any of the control tissues (control: 0%). Amplifications of the target sequences on chromosomes 8 (14 tumors) and 9 (8 tumors) were observed in low but significant percentages of nuclei, no significant cell population was detected with an amplification of 5p15.3. Fourteen tumors exhibited a significant loss of 13q14, and only 8 tumors a significant loss at any other site. In the tumor margin sections, in most cases, the margins apparently were also affected by the one or the other of the genomic changes of the pertinent primary tumor. Nevertheless, there were, in some cases, also large differences depending on the way of analysis, but also on the specific signal constitution considered. Tumor stages T3 and T4 tended to have higher frequency of nuclei with gains of 5p15.3, 8q24, and 11q13 as compared to T2 tumors and less gains of 9q34 and loss of 13q14. With the exception of 8q24 and 13q14 alterations there was also a trend to higher percentages of aberrant nuclei in the margin of T3-4 tumors vs. T2 tumors.

Aged↗
PubMed2001

Translation initiation factor eIF-4G is immunogenic, overexpressed, and amplified in patients with squamous cell lung carcinoma.

BACKGROUND: Recently, the authors reported identification and cloning of several novel immunogenic antigens in squamous cell lung carcinoma. Of 14 corresponding genes, 9 mapped in an amplified chromosomal region with the gene for eIF-4G that was amplified most frequently. METHODS: Recombinant eIF-4G was expressed in E. coli and screened with sera from patients with squamous cell carcinoma of the lung and of the head and neck. Protein extracts from squamous cell carcinoma tissues were analyzed for eIF-4G expression by Western blot analysis. Mutation analysis was performed using an automatic DNA sequencer. RESULTS: The authors screened a spectrum of 33 heterologous sera from lung carcinoma patients and detected antibodies against eIF-4G in 5 of these sera (15%). They found no immune response to eIF-4G in 17 sera from squamous cell carcinoma tissues derived from the head and neck. In addition, no antibodies were found to eIF-4G in a group of 17 control sera from individuals without known tumor formation. Sequence analysis of the eIF-4G gave no indication of mutations. To analyze the expression of eIF-4G, a monoclonal antibody was used. Western blot analysis clearly showed overexpression in the tumor tissue compared with the corresponding normal lung tissues. CONCLUSIONS: The translation initiation factor eIF-4G is the first protein in which the gene shows amplification, has increased expression in a human tumor, and induces an immune response in patients. eIF-4G lends itself as a marker for the diagnosis of and possibly as a future therapeutic target in patients with squamous cell lung carcinoma.

Antibody Formation↗
PubMed2001

Transoral removal of submandibular stones.

OBJECTIVE: To assess transoral treatment of submandibular lithiasis. DESIGN: Study of a series of patients with submandibular stones undergoing transoral removal of the sialoliths. Duration of follow-up: 6 months to 7 years. SETTING: Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany, center for treatment of salivary stones. PATIENTS: Two hundred thirty-one patients (127 females, 104 males) suffering from submandibular lithiasis had a mean age of 41.7 years (age range, 12-86 years). Stone location was distal to the edge of the mylohyoid muscle in 115 patients and proximal to the gland in 102 patients (mean size of sialoliths, 6.3 mm [range, 2-30 mm]). Fourteen other patients had 2 separate stones, one within the hilum and a smaller more proximal one within the gland. INTERVENTIONS: Transoral removal of the stones under local anesthesia and preservation of the submandibular gland. MAIN OUTCOME MEASURES: Complete removal of the stones, complications, and recurrence of the stones. RESULTS: All 115 patients with distal stone location, 93 (91%) of 102 patients with stones of the perihilar region, and 9 (64%) of the 14 patients with 2 separate stones in the hilum and parenchyma were free of stones. Submandibulectomy had to be carried out in 4 patients (1.7%). Recurrence of lithiasis and damage to the lingual nerve remained below 1%. CONCLUSIONS: Transoral removal should be the treatment of choice in patients with submandibular stones that can be palpated bimanually and localized by ultrasound within the perihilar region of the gland.

Adolescent↗
PubMed2001

Interstitial brachytherapy with Ir-192 low-dose-rate in the treatment of primary and recurrent cancer of the oral cavity and oropharynx. Review of 318 patients treated between 1985 and 1997.

AIM: To evaluate the impact of postoperative interstitial brachytherapy with and without external radiotherapy in the treatment of primary and recurrent squamous cell carcinoma of the oral cavity and oropharynx. PATIENTS AND METHODS: Between 1985 and 1997, a total of 318 patients were treated by interstitial Ir-192 low-dose-rate brachytherapy as part of their primary (n = 236) or recurrent treatment (n = 82). There were 263 male (83%) and 55 (17%) female patients. The distribution of UICC (1997) stages was as follows: I (61 patients, 19%), II (71 patients, 22%), III (58 patients, 18%), IV (128 patients, 40%). The primary tumor site was located in the oral cavity in 201 patients (63%), in the oropharynx in 86 patients (27%), lower lip in 19 patients (6%) and other regions in twelve cases (4%). Treatment concepts did not vary over the time and were dictated by the initial tumor extension: a total of 175 patients (55%) received a combination of surgery, interstitial brachytherapy (23-25 Gy) and external radiotherapy (50-60 Gy), 60 patients (19%) surgery and interstitial brachytherapy (45-55 Gy) alone. Advanced disease not amenable to primary surgery was either treated by radiochemotherapy and interstitial brachytherapy in 39 patients (12%) or a combination of interstitial brachytherapy, external radiotherapy and interstitial hyperthermia in 44 patients (14%). RESULTS: Overall survival rates following primary and recurrent treatment were 50 +/- 4% and 29 +/- 5%, respectively, at 5 years (p < 0.0001). A significant impact on overall survival rate was noted for UICC stage: patients in stage I/II had survival rates of 64 +/- 5% and 57 +/- 10%, respectively, while patients in stage III/IV had survival rates of 39 +/- 5% and 15 +/- 5%, respectively, at 5 years (p < 0.0001). In addition, grading (p = 0.01) and hemoglobin levels (p = 0.05) had a significant influence on overall survival. Local tumor control rates for all patients were 74 +/- 3% and 57 +/- 7% at 5 years following primary and recurrent treatment (p = 0.01), respectively. The 145 patients treated for primary disease by a uniform concept of surgery, interstitial brachytherapy and external radiotherapy achieved excellent local control rates with 92 +/- 4% (stage I/II) and 65 +/- 6% (stage III/IV) at 5 years. Late treatment-related toxicity with soft tissue necrosis and/or osteonecrosis requiring mandibular resection was 7.5%. CONCLUSION: Local tumor excision followed by postoperative interstitial brachytherapy with and without external radiotherapy is associated with excellent locoregional control, a low risk of chronic sequelae and may therefore considered as a new approach avoiding mutilating radical surgery.

Brachytherapy↗
PubMed2001

[Results of an in vitro study and initial clinical application of a combined Ho:YAG-/Nd:YAG laser].

BACKGROUND AND OBJECTIVE: A combined Ho:YAG/Nd:YAG laser produces light with properties similar to the beams of the mainly coagulating Nd:YAG laser and the cutting CO2 laser alone. PATIENTS/METHODS: The combined laser was tested in vitro on pig tissue. Additionally, we used this new combined tool for enoral operations. RESULTS: An effect of the pulsed Ho:YAG laser was explosive-like tissue disruption and sprinkling of fragments. Simultaneous use of the Nd:YAG laser resulted in an enlarged zone of coagulation. Clinically, the laser-assisted intervention was inferior to the classic operational methods. CONCLUSIONS: Comparing the established CO2 laser and the Ho:YAG laser, the latter showed only the advantage of delivery via a flexible fiber. Sprinkling of tissue fragments and wide incisions are oncologically problematic. We conclude that this new tool is of minor value for otorhinolaryngologists and head and neck surgeons.

Animals↗