Biomedical subjects

J Constantinidis

Publications and source records attributed to J Constantinidis.

At least 55 records · Page 3Linked to original sources

PubMed1998

[Larynx preserving surgery in carcinomas of the posterior hypopharyngeal wall by reconstruction with a free flap].

In a series of 9 patients with advanced carcinomas of the posterior wall of the hypopharynx (2 patients with T2 tumors and 7 patients with T4 disease), we tried to preserve the larynx with surgical therapy. The concept of laryngeal preservation consisted of lateral pharyngotomy with free flap reconstruction of the defect created by the tumor resection. A recommendation for surgery was given to each patient with a neoplasm in the posterior pharyngeal wall and tumor extension > 6 cm in diameter. The maximum tumor diameters ranged between 6.5 cm and 12.5 cm. Reconstruction was performed in 8 cases with radial forearm flaps while a jejunal transplant was used in one case due to the extension of tumor. During each surgical procedure an attempt was made to preserve the superior laryngeal nerves and transplants were adapted exactly to the resection defects. Seven patients achieved oral swallowing within three months of surgery, while one patient needed four months to swallow orally. One patient had persistent aspiration and still needs a percutaneous gastrostomy. Six patients were decannulated successfully, so that laryngectomy was avoided during postoperative follow-up. These results show that surgical therapy of advanced carcinoma of the posterior wall of the hypopharynx is possible with preservation of the larynx. Additionally, functional outcome after treatment of these patients with free flap reconstruction is comparable to other treatment modalities, such as radiochemotherapy.

Female↗

PubMed1998

[Calcifying pseudotumor of the orbits].

Orbital pseudotumor can be divided histopathologically into three basic types: lymphoid, granulomatous and sclerosing. Chronic lymphoid and granulomatous types may eventually transform into the sclerosing type. The calcifying orbital pseudotumor is a very rare disorder due to a chronic, idiopathic inflammatory process of the orbit. The granulomatous type shows a good response to steroids while radiotherapy is the method of choice for lymphoid lesions. In general, calcifying pseudotumors can be treated only by operative exploration and tumor removal. We report a patient with a calcifying pseudotumor of the orbital apex that was removed through an endonasal approach. Preoperative diagnostic procedures and differential diagnosis are discussed.

Adult↗

PubMed1998

[Treatment of deep neck infections].

BACKGROUND: The incidence of deep neck space infections has been significantly reduced by modern antibiotic therapy. These infections are relatively rare and yet the life-threatening complications merit special consideration by head and neck surgeons. PATIENTS: Seven cases of deep neck space infections as a consequence of purulent pharyngitis (3), peritonsillar abscess (2), retropharyngeal (1), and odontogenic (1) abscess are presented. Despite antibiotic therapy according to antibiogram all patients showed an increase in complaints with persisting febrile temperatures and rising inflammation parameters. Surgical intervention became necessary. In two cases the infection spread into the mediastinum. RESULTS: All patients were completely cured by means of early surgical intervention including extensive drainage of the primary focus, deep neck spaces and mediastinum, accompanied by intravenous antibiotic therapy. Tracheotomy was performed on one patient with increasing dyspnea. All patients had an uneventful recovery without major postoperative complications. CONCLUSIONS: The clinical course of the disease must be observed particularly closely even after starting antibiotic therapy and identification of the infectious focus. Antibiotic therapy may in some cases cover clinical symptoms. However, in the presence of abscess formation or necrotizing infections, antibiotics can prove to be ineffective. The optimum time for surgery is difficult to determine. Complete drainage of the neck spaces down to the mediastinum is a safe procedure to save the patients' life. This shortens the duration of the disease and prevents complications. The most common problems in the management of deep neck space infections are discussed.

Abscess↗

PubMed1997

[Possible indications for temporalis muscle flaps in plastic-reconstructive surgery of the head and neck].

BACKGROUND: In reconstructive plastic surgery, the temporalis muscle has proven to be a reliable and versatile flap for a wide field of indications. The temporalis muscle is a flat, fanshaped muscle with a generous blood supply and innervation from the trigeminal nerve. METHODS AND RESULTS: Based on our own experiences in a total of 25 cases (12 cases involving muscle transposition for mouth reanimation, six cases involving stabilisation of a duraplasty including protecting the internal carotid artery in one case, four cases involving reconstruction of the orbital floor or the base of the skull, and three cases involving recontouring the lateral face) and a review of the literature we give an up-to-date overview of the different indications for the temporalis muscle flap. These include: a) treatment of facial nerve paralysis, b) recontouring of the lateral face, c) reconstruction of skull base, orbita, and oropharynx, d) stabilization of duraplasty, e) protection of internal carotid artery, f) in temporomandibular joint surgery, and g) for obliteration in ear surgery. CONCLUSION: Because of the wide range of indications, the temporalis muscle flap remains a versatile and important tool in plastic reconstructive surgery.

Adolescent↗

PubMed1996

[Pneumosinus dilatans frontalis. Etiology, symptoms and surgical technique].

BACKGROUND: Pneumosinus dilatans of the frontal sinus is a very rare condition in which deformity is caused by progressive enlargement of the brow ridges and lower forehead. PATIENTS: Etiology of the reported two cases was unknown although some hypotheses have been presented. RESULTS AND CONCLUSIONS: We corrected the aesthetic deformity using an osteoplastic flap and removing horizontal bone chips from the anterior wall of the frontal sinus. Postaoperative results were satisfactory. In one case, obliteration of the sinus with fat was necessary, because of polypous mucosa.

Adult↗

PubMed1995

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↗

PubMed1995

[Synovial cell sarcomas of the head- and neck area].

The synovial cell sarcoma is a malignant soft tissue tumour which mostly occurs associated with or in a large joint. To date, the histogenetic origin has been discussed controversially and there is still no agreement as to whether it arises from normal synovium of joints, tendon sheaths or bursae, specialised forms of mesenchymal tissue (arthrogenous mesenchyma) or ordinary connective tissue. The tumour rarely occurs in the head and neck region. Only about 76 cases world-wide have been described up to now. We report on a case of a 30-year old man with a synovial cell sarcoma of the temporomandibular joint and a case of a 70-year old man with a synovial cell sarcoma of the hypopharynx. In the first case, although all possible therapeutical efforts were made (radical operation, radiotherapy, chemotherapy), recurrence of the tumour occurred locally, as well as metastases in the lungs and bones. The patient died three and a half years after the initial diagnosis of the tumour. The second patient suffered multiple metastases in the lungs and bones one year after operation followed by chemotherapy. To the present time there is no general agreement on how to treat synovial cell sarcomas, but without doubt first of all radical surgical excision must be performed if possible. Additional radiation and/or multidrug chemotherapy may be useful in special cases. In our opinion every case of synovial cell sarcoma should be published because it is of importance to get to know new aspects and therapeutical possibilities of this rare disease.

Adult↗

PubMed1995

[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↗

PubMed1995

[Current aspects of frontal sinus surgery. IV: On therapy of frontal sinus osteoma].

Osteomas are the most common benign tumors of frontal sinus. We evaluated 15 patients with osteomas of the frontal sinus who were managed between 1979 and 1992. The average duration of follow-up was 33 months. In 4 cases osteomas were removed completely via the endonasal route using a microscope and endoscope. We recommend performing a frontal sinus drainage-type 3 primarily. Indications are osteomas of the posterior wall of the frontal sinus located close to the infundibulum. For osteomas of the anterior wall and those located laterally or for very large osteomas we prefer the osteoplastic approach. Apart from the excellent exposure this latter procedure also provides good aesthetic results after carefully placed incisions and precise replacement of the bone flap. We recommend the bicoronal incision in patients with large frontal sinuses, women, or in the presence of good hair growth. Incisions are best placed in a frontal crease in patients with hair loss or a, small frontal sinus.

Adult↗

PubMed1995

[Current aspects of frontal sinus surgery. I: Endonasal frontal sinus drainage in inflammatory diseases of the paranasal sinuses].

Most conditions of the frontal sinus requiring surgery can now be managed successfully by endonasal procedures. According to Draf, 3 types of frontal sinus drainage occur. Surgical techniques and indications are described. In a retrospective study we evaluated 132/648 patients who were on average 5 years postoperative. Forty-two patients had type 1, 43 patients had type 2 and 47 patients had type 3 drainage. Endoscopy revealed a normal mucosa in 56-67%, whole polyps were found in 9-15%. There was no recurrence of an orbital or endocranial complication. According to our definition of surgical success, there was a success rate of 83.4% with type 1 drainage, 83.7% with type 2 drainage and 89.4% with type 3 drainage. If there was only little chance for successful endonasal surgery with type 3 drainage, an external osteoplastic frontal sinus operation was performed for definitive therapy.

Drainage↗

PubMed1995

[Current aspects of frontal sinus surgery. II: External frontal sinus operation--osteoplastic approach].

Most inflammatory diseases of the frontal sinus requiring surgery can now be managed successfully by endonasal procedures. There remain, however, a number of problematic cases in which optimal exposure of the entire frontal sinus is required with possible complete removal of the mucous membrane and sinus obliteration. These remain indications for osteoplastic frontal sinus surgery. Depending on the individual situation, incisions can be chosen that are bicoronal, placed in a frontal crease or positioned below the eye-brow. Surgical techniques are described in detail. Osteoplastic surgery of the frontal sinus with fat obliteration is a reliable and safe method, particularly for management of so-called "difficult" frontal sinuses.

Adipose Tissue↗

PubMed1995

[Aspects of frontal sinus surgery. III: Indications and results of osteoplastic frontal sinus operation].

The osteoplastic approach is indicated for frontal sinus surgery if optimal exposure of the entire frontal sinus is required for possibly complete removal of the mucous membrane and sinus obliteration. In a retrospective study we evaluated 75 patients whose osteoplastic frontal sinus operations were performed in Fulda between 1979 and 1992 and examined indications for surgery, complications and outcome. All patients were examined clinically and subjective complaints were recorded. Indications for surgery were trauma (43), acute and chronic infections (19), tumors (11) and sinus pneumatoceles (2). The overall aesthetic and functional outcome was excellent. Revision was necessary in one only patient, who had forced air into his frontal sinus by nose-blowing too early to create a threat of infection. No serious complications occurred, such as surgery-related meningeal injury or impaired or double vision. One patient needed a blood transfusion because of hemorrhage due to operation (1.3%). The main advantage of the coronal incision used was preservation of the supraorbital nerve bundle without subsequent nerve dysfunctions. Besides optimal exposure of the whole frontal sinus, precise replacement of the osteoplastic flap and choice of incision also lead to a good aesthetic result.

Abscess↗

PubMed1994

Neurofibrillary pathology in brains of elderly schizophrenics treated with neuroleptics.

The clinical histories of 102 schizophrenics who died at 70 years of age or older were reviewed. The incidence of neurofibrillary tangles (NFTs) was two times higher in the patients who received (74%) than in those who did not receive (36%) treatment with neuroleptics. The development of NFTs started earlier in the treated group. Further studies comparing brains of nine schizophrenics (average age, 86 years) who did not receive treatment with neuroleptics and seven age-matched cases who received neuroleptics, both with neurofibrillary pathology and neuritic plaques, showed characteristic differences. The numerical density of NFTs was slightly greater in the cornu Ammonis (CA1 and CA2) and subiculum of treated patients. Significantly lower numerical density and lower percentage of pretangles (stage 0) and early and mature tangles (stages 1 and 2) and increased number of end-stage tangles (stage 3) were found in the CA, subicular complex, and cerebral cortex of the treated group. These changes suggest accelerated neurofibrillary degeneration in neurons. A significant increase in the numerical density of tau-1-positive plaques was observed in sector CA1 of the CA (from 0.15/mm2 to 17.36/mm2), subiculum (from 0/mm2 to 16.62/mm2), temporal cortex (from 0.14/mm2 to 9.46/mm2), and occipital cortex (from 0.08/mm2 to 0.39/mm2). The higher numerical density of tau-1-positive plaques, but not of 4G8-positive plaques, indicates acceleration of neurofibrillary changes in the plaques of patients treated with neuroleptics. The significant decrease (20-25%) in the numerical density of neurons in the pyramidal layer of sectors 2-4 in the CA appears to be associated with accelerated neurofibrillary changes in neurons and plaques in the treated group. This study demonstrates that chronic treatment with neuroleptics--not schizophrenia itself--significantly increases the risk of more frequent, earlier, and accelerated development of neurofibrillary pathology in the brains of elderly schizophrenics.

Aged↗

PubMed1992

The adult and a new late adult forms of neuronal ceroid lipofuscinosis.

Three cases of the late adult form of neuronal ceroid lipofuscinosis (NCL) are reported. Two of these are siblings with a late clinical onset at ages 26 and 44 years. The third case, sporadic, has the oldest reported age for the onset of NCL, at 63 years and may be regarded as the first example of the "presenile" form of NCL. The clinical, morphological, histochemical, ultrastructural and genetic features of these three cases are discussed. The literature of the clinicopathological NCL cases with an onset at age of 25 and older is reviewed. The clinical and morphological differences between the late adult form and the presenile form of NCL as well as the difficulties in making the diagnosis are discussed.

Adult↗

PubMed1991

The dominant form of the pigmentary orthochromatic leukodystrophy.

The present report documents a family with three cases in two successive generations of pigmentary orthochromatic leukodystrophy (POLD). The clinical features of these cases and histochemical and ultrastructural investigations of two of the brains from successive generations are discussed. A review of the familial cases of POLD reported in the literature is also presented. Transmission of these cases was by a dominant inheritance. Onset of the clinical symptoms occurred at 42 to 54 years of age; duration of the disease was from 2-11 years, and death occurred at 45 to 57 years of age. Clinical manifestations of all three cases were severe headaches; bilateral pyramidal, pseudobulbar, cerebellar, and frontal release signs; gait disturbances; euphoria, or apathy; epileptic seizures; and dementia. The neuropathological pattern consists of slight cerebral atrophy, brownish discoloration of the cerebral white matter with demyelination and severe gliosis, sparing the sub-cortical U fibers; presence in the macrophages of lipid pigment granules that are sudanophilic, non metachromatic, and PAS and iron positive. The electron microscopic pattern of the lipid pigment in the macrophages is that of ceroid: electron-dense, membrane-bound intracytoplasmic lysosomes with curvilinear and/or fingerprint profiles.

Adult↗

PubMed1991

Tyrosine hydroxylase-immunoreactive neurons in paraventricular and supraoptic nuclei of the human brain demonstrated by a method adapted to prolonged formalin fixation.

We studied the distribution of tyrosine hydroxylase (TH) immunoreactive (IR) neurons in the adult human hypothalamus using a modification of the peroxidase-antiperoxidase immunohistochemical method which can be applied on autopsy brain material following prolonged formalin fixation. We observed that most of the TH-IR perikarya localized within the paraventricular (PVN) and supraoptic (SON) nuclei were large and showed homogeneous staining over the entire cytoplasm and processes. These results show that in the human brain a large population of neurons within the neurosecretory nuclei are able to synthesize a catecholamine.

Adult↗

PubMed1991

The hypothesis of zinc deficiency in the pathogenesis of neurofibrillary tangles.

Neurofibrillary tangles (NFT) in human encephalopathies of various etiologies may result from a common pathogenetic mechanism: a functional zinc decrease leading to a deficiency of the DNA metabolizing zinc-enzymes, giving rise to abnormal neuronal DNA and synthesis of pathological proteins: NFT. In encephalopathia Saturnica, zinc decreases in the hippocampus displaced by lead; in Guam's encephalopathy, calcium deficiency permits the entry in the brain of toxic metals that may displace zinc; in Boxer's dementia and some viral encephalitides, blood-brain-barrier (BBB) is altered and abnormal metals may reach the brain; in Down's syndrome and Alzheimer's disease precapillary and capillary amyloidosis disturbs the BBB, metals (iron and aluminium) are encrusted in the amyloid and their brain level increases, whereas zinc decreases especially in the hippocampus. A deficiency of the zinc enzymes of neuronal detoxication, of glutamate catabolism and of some neurotransmitters metabolisms may also contribute in the neuronal dysfunction of these encephalopathies. A non-toxic zinc compound crossing the BBB may be useful for the treatment of these encephalopathies and especially for Alzheimer's disease.

Alzheimer Disease↗

PubMed1991

Immunohistochemical distribution of corticotropin-like intermediate lobe peptide (CLIP) immunoreactivity in the human brain.

The immunocytochemical distribution of CLIP (corticotropin-like intermediate lobe peptide) or ACTH(18-39), a small biologically active peptide, was examined in the human brain, using a monoclonal antibody against this peptide. Groups of CLIP-immunoreactive cell bodies, small to medium size and bipolar or triangular in shape, were found in the basal hypothalamus extending from the retrochiasmatic region to the premammillary nuclei area. Immunoreactive fibers with varicosities, terminals and "pipe shape" structures, were distributed within the hypothalamus, limbic structures, the brainstem and spinal cord nuclei, forming a particularly rich network in the hypothalamus, the preoptic area, the septal region, the amygdala and the upper brainstem periaqueductal gray matter. The above neuroanatomical observations confirm and extend previous findings in animals, strengthening even more the possibility that this peptide may be involved in numerous behavioral, autonomic and physiological functions such as regulation of sleep-waking cycle, pain control and respiratory and cardiovascular regulation.

Adrenocorticotropic Hormone↗