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J Hartwein

Publications and source records attributed to J Hartwein.

At least 19 recordsLinked to original sources
PubMed2001

[Primary carcinoma of the ear canal. Clinical aspects, intratemporal growth behavior and surgical strategy].

BACKGROUND AND OBJECTIVE: The symptoms and microscopic findings in carcinoma of the external auditory meatus are often unspecific and misinterpreted as recurrent otitis externa. A definite diagnosis is therefore often delayed, frequently resulting in advanced tumor stages with unfavorable prognosis at the time of diagnosis. PATIENTS/METHODS: In a retrospective analysis of 11 of our own patients and four cases from the Wittmack collection, the clinical data and course of this disease were examined with particular focus on the intratemporal bone growth pattern and possible surgical strategies. RESULTS: Histopathologically, all cases consisted of squamous cell carcinoma of variable differentiation, with predomination of higher tumor stages (T2-T4: 93.3%) and little initial lymph node metastases (N+: 14.3%; M+: 0%). Osseous destruction was present (almost obligatory) in 93.3% (determined histopathologically and radiologically with CT). Follow-up (to a maximum of 6 years) after surgical resection and postoperative irradiation shows local recurrence at an average of 10 months in 40% of the cases, with a metastasis rate of 44.4%. Mean overall survival is 29.7 months, and 45.5% of the patients experience an average tumor-free period of 46.4 months. The most important prognostic factor in this context is the initial tumor stage. CONCLUSION: In regard to prognosis of external auditory meatus carcinoma, early diagnosis is of vital importance. Especially older patients (50-80 years) who previously have had no history of ear disease should undergo early computer tomographical examination and biopsy in cases of recurrent external otitis.

Aged↗
PubMed1999

A comparative study of sonographic and histopathologic findings of tumorous lesions in the parotid gland.

OBJECTIVE: The purpose of this study was to clarify which histopathologic features are visualized on sonograms by comparing sonomorphologic and histopathologic analyses of parotid tumorous lesions on the same plane. STUDY DESIGN: Boundaries, shapes, echo intensity level, distribution of internal echoes, and acoustic enhancement on sonograms of 86 parotid tumorous lesions were retrospectively compared with the histopathologic findings. RESULTS: Unclear boundaries on sonograms corresponded to abundant connective tissue with scattered tumor cell nests. Polygonal shapes on sonograms were revealed to represent tumor cell infiltration on histopathologic sections. The "very hypoechoic" lesions showed significantly high ratio of cystic areas (P < .05) in Warthin tumor. The weakly hyperechoic structures on sonograms were connective tissue, hyaline, and necrotic and keratinized materials. Attenuated posterior echoes were observed in malignant tumors with abundant connective tissue and metaplastic bone formation. CONCLUSIONS: To facilitate correct sonographic diagnosis, it is important to ascertain the correlation between sonomorphology and histopathology.

Adolescent↗
PubMed1999

Statistical study for sonographic differential diagnosis of tumorous lesions in the parotid gland.

OBJECTIVE: The purpose of this study was to clarify characteristic sonomorphologic features of parotid lesions statistically and to propose new criteria for the differential diagnosis. STUDY DESIGN: Eighty-six tumorous lesions were analyzed with regard to the following sonomorphologic features: boundary, shape, echo intensity level, distribution of internal echoes, and acoustic enhancement. Stepwise polychotomous logistic regression analysis was performed to assess characteristic sonographic features. As dependent variables, we used "pleomorphic adenoma," "Warthin tumor," "malignant tumors" and "other benign lesions"; as predictor variables, we used the aforementioned sonomorphologic features. Proportion of the occurrence of each dependent variable was calculated. RESULTS: Lobular shape and homogeneous internal echoes predicted pleomorphic adenoma. A lesion with multiple anechoic areas would be Warthin tumor with very high sensitivity. Malignant tumors showed either heterogeneous internal echoes without characteristic structures or polygonal shape. CONCLUSIONS: These sonomorphologic features should be observed to make more exact differential diagnoses for operation and therapy planning.

Acoustics↗
PubMed1994

[Site and epidemiology of mucoepidermoid carcinoma. Analysis of 327 cases].

The salivary gland registry of the University of Hamburg (1965-1992) comprises a total of 327 mucoepidermoid carcinomas (MEC). MEC occur between the age of 5 and 96 years, most frequently in the sixth and seventh decade of life. The average age lies below 50 years (48.9 years). There is a slight predisposition of females (56.3%). Nearly 60% of all MEC care localised in the major salivary glands. The parotid gland is the most frequent localisation (53.5%) followed by the palate (17.4%). MEC are less frequent in the submandibular and sublingual glands, such as the minor salivary glands of the oropharynx and the cavity of the mouth. 53.2% of all MEC's can be classified as highly differentiated, the remaining 46.8% as poorly differentiated. MEC's of the palate are predominantly highly differentiated (72.0%). Among the variants of MEC, cystic (25.4%), clear cell (11.0%) and oncocytic (0.6%) tumours can be observed. MEC's of the clear cell type tend to originate from minor salivary glands (69.5%). MEC of childhood and adolescence (8.6%) are preferably seen in the parotid gland (46.4%) and the palate (39.3%). Up to the 20th year of life, cystic tumours and tumours of the clear cell type are comparatively more frequent.

Adolescent↗
PubMed1994

[Histology of mucoepidermoid carcinoma. Analysis of 327 cases].

The mucoepidermoid carcinomas of the salivary glands (MEC) show histologically a wide spectrum of differentiation from solid epidermoid tumours to cystic mucous-filled tumours. Epidermoid cells, mucous cells and intermediate cells are the main cellular components. Besides clear cell (11.0%) and oncocytic (0.6%) variants and "cystic" (25.4%) tumours can be observed. According to the per cent of mucous cells and cystic spaces of the total tumour mass different degrees of histomorphologic differentiation can be distinguished. Therefore highly differentiated MEC (53.2%) with more than 50% mucous cells and cystic spaces, respectively low-differentiated MEC (46.8%) showing less than 50% mucous cells and cystic spaces can be subclassified. In respect of the therapeutic proceeding it should be recognized that the histopathological subclassification of MEC of the salivary glands (7) is based on morphological criteria only. It may not be equalized with a grading of malignancy since even highly differentiated MEC can grow infiltratively, sometimes osseo-destructively, to recur locally and to metastasize predominantly into the regional lymph nodes. Consequently the histopathological subclassification of MEC does not allow certain prognosis in individual cases.

Carcinoma, Mucoepidermoid↗
PubMed1993

[Radical parotid surgery of metastatic malignant melanoma].

With an increasing incidence of the malignant melanoma we also have to expect an increasing number of metastases of the parotid lymph nodes. Up to now there are no definite guidelines concerning the surgical treatment of these metastases. What is important is the question whether the facial nerve should be resected or retained. Between 1987 and 1991 in the ENT-clinic of the University Hamburg-Eppendorf eight patients were treated for metastases of a malignant melanoma in the parotid gland. The clinical course demonstrates that there is no indication for a radical surgical treatment of these patients. It neither leads to a delayed appearance of distant metastases, nor does it improve the life expectancy.

Adult↗
PubMed1993

[Facial paralysis in benign parotid tumor: case report and review of the literature].

Generally, typical symptoms are significant for malignant parotid tumours: The infiltration of surrounding structures and facial paralysis. A case is reported where a benign parotid tumour (lymphadenitis) caused facial paralysis. Parotidectomy and the removal of the lymph node near the stylomastoid foramen led to complete restitution. A review of the literature of the past 40 years mentions 16 cases of benign neoplasms of the parotid gland that caused facial paralysis, such as pleomorphic adenoma, Warthin's tumour, oncocytoma, benign parotid cysts, chronic parotitis, lymphadenitis and parotid abscess.

Adult↗
PubMed1993

[Clinical aspects and histopathology of middle ear tuberculosis].

During the past few decades the clinical features of middle ear tuberculosis have changed. Hence, clinical differentiation between tuberculous and non-specific proliferative otitis media and mastoiditis is now difficult. Between 1986 and 1992 five cases of tuberculous otitis media were treated surgically in the ENT-Dept. of the University of Hamburg, representing 0.2% of all performed middle ear operations. According to our experience the therapy of choice is the open mastoid cavity with subsequent chemotherapy to avoid recurrent infections. The advantages of this procedure are proven by actual histopathological findings as well as by the analysis of historical microsections of the Wittmaack temporal bone collection: according to these findings, two different types of histopathological alterations can be differentiated.

Adult↗
PubMed1992

["Crown-cork tympanoplasty"--a method for complete reconstruction of the tympanic membrane].

The crowncorktympanoplasty is a technique for the total reconstruction of the tympanic membrane, recommended in cases of ear malformation, blunting-phenomena and total deficiency of the membrane caused by chronic otitis media. Autologous tragal composite graft is used for the myringoplasty. While the cartilage faces to the middle ear cavity, the overflapping perichondrium is layed on the bony meatal wall in the manner of a crowncork. 10 cases performed in the last two years are reported. In each one an intact tympanic membrane could be reached. In average, the ear bone gap could be reduced for 18.5, 17.5, 16.5 and 13.5 dB in the frequencies of 500, 1000, 2000 and 4000 Hz.

Adolescent↗
PubMed1992

[Ossification of the stapedius tendon as a rare cause of conductive hearing loss].

Ossification of the stapedial tendon is a very rare cause of conductive hearing loss. In addition to a review of the literature, two further cases of unilateral hearing impairment are reported. In both cases, division of the ossified tendon led to a complete disappearance of the middle-ear problem. Apart from middle ear malformations, infections of the middle ear may also give rise to ossification of the stapedial tendon.

Audiometry, Pure-Tone↗
PubMed1992

[Dose-finding study for hyperfractionated, accelerated radiotherapy plus simultaneous carboplatin administration in patients with locoregionally advanced head and neck cancer].

Therapy of large inoperable squamous cell-carcinomas of the head and neck is considerably problemful. Combined simultaneous radio-chemotherapy with carboplatin and radiotherapy with hyperfractionated accelerated radiation is small effective than conventional monofractionated radiotherapy alone and may reduce side effects. Aim of the following study was dosage optimisation of the applicated carboplatin.

Carboplatin↗
PubMed1992

[The acoustics of the open mastoid cavity (so-called "radical cavity) and its modification by surgical measures. I. Physical principles, experimental studies].

Up to now the importance of the outer ear for the sound transmission is nearly neglected in the otosurgical literature. Nevertheless, surgical procedures can cause severe alterations in the anatomy of the outer ear channel. Necessarily variables which take influence on the acoustic behaviour of the outer ear can get changed by these surgical manipulations. By means of in-situ measurements of the sound-pressure-level near the tympanic membrane the influence of the ear channel/mastoid cavity volume as well as of the size of the outer meatus on the resonance frequency is investigated. In a model of variable volume and several sizes of outer meatus there can be found that the course of resonance-caused sound-pressure augmentation depends on two determining factors: due to the physical-acoustical conditions (Helmholtz-resonator) the peak of the resonance-caused augmentation shifts to lower frequencies the smaller the outer meatus and the larger the volume of the channel/mastoid cavity. Viceversa, an augmentation of the external meatus and an obliteration of the cavity causes a higher resonance frequency. Within values for the volume and the meatal size as can be found in radical cavity surgery the resonance frequency varies in a wide range from 1260 up to 3175 Hz. There is no substantial influence on the amplitude of the sound-pressure augmentation. Measurements undertaken in a temporal bone specimen underline these results: as well as in the model alterations of cavity volume and meatal size lead to partial extensive shiftings of the resonance frequency.(ABSTRACT TRUNCATED AT 250 WORDS)

Acoustics↗
PubMed1992

[The acoustics of the open mastoid cavity (so-called "radical cavity") and its modification by surgical measures. II. Clinical studies].

The acoustic resonance of a severely altered outer ear channel (radical mastoid cavity) is investigated in a series of 18 patients who underwent revision surgery by means of in-situ measurements of the sound-pressure-level near the tympanic membrane. While the average volume of the open cavity differs from the normal ear channel for the factor 2.5, the size of the external meatus is--in average--only 20% larger. This leads to an average frequency in patients with open cavity of 1939 Hz, more than 1000 Hz less than in a series (n = 20) of normal ears (average resonance frequency: 2942 Hz). The altered acoustic behaviour of the open cavity leads to partial extensive discrepancies of the resonance-caused sound-pressure augmentation in the frequencies of 3 and 4 kHz, which are important for speech perception. The average difference is more than 10 dB (SPL). Proved surgical techniques of cavity obliteration and meatoplasty can lead to a nearly normalized acoustic behaviour of the outer ear in a statistic significant way. Due to these surgical procedures, an average postoperative resonance frequency of 2421 Hz could be reached in our patients. Especially, the resonance-caused sound-pressure augmentation in 3-4 kHz could nearly be equalized to such of a normal outer ear. Differences in the acoustic behaviour of the outer ear as can be found between patients with an open mastoid cavity and normal ears can almost be eliminated surgically.(ABSTRACT TRUNCATED AT 250 WORDS)

Acoustics↗
PubMed1992

[Histological studies of the behavior of the dentin ossicular prosthesis in the human middle ear].

The Dentine Ossicular Prosthesis (DOP)--introduced in the ENT-Department, University of Hamburg in 1986--has proved its worth clinically in more than 300 cases. In the meantime six of the prostheses had to be removed for various reasons. They had remained in the middle ear over a period between 2-5 and 47 months. The prostheses were investigated undecalcified by the Donath sawing and grinding technique. Prostheses in a nearly bland surrounding show a partial invagination in fibrous connective tissue without severe reaction of the prosthesis itself, whereas in prostheses removed from the neighbourhood of inflammatory processes or recurrent cholesteatoma a partial resorption of dentine with subsequent new bone formation could be observed. Due to the trouble-free clinical and histological performance in the human middle ear, the Dentine Ossicular Prosthesis can be well recommended as an alternative material in ossiculoplasty.

Adolescent↗
PubMed1992

[Intramuscular hemangioma of the posterior wall of the pharynx. Diagnosis and differential diagnosis].

We report on the case of a seven-year old boy who developed an enlarged swelling of the oropharynx. Clinical examination revealed a well demarcated cystic tumour. Histopathologically the diagnosis of an intramuscular haemangioma could be made because of the multitude of vascular spaces filled with erythrocytes lying between bundles of smooth muscles. Such a lesion coming from the posterior wall of the oropharynx is not described in literature. In differential diagnosis the angiosarcoma and the arteriovenous aneurysm must have been involved since there were multiple arteries and veins lying close together in couples. Moreover the adenotomia carried out one and a half year earlier prompted us to think about the possibility of a traumatic arteriovenous fistula.

Arteries↗
PubMed1992

Neurinoma of the facial nerve.

A case of facial neurinoma is reported. There was a progredient facial palsy persisting for one year. While X-ray examination as well as CT and MR did not show a pathological finding, classical topodiagnosis resulted in mastoidectomy, during which a neurinoma of 0.5 x 0.8 cm could be removed. The defect was reconstructed by an auricular nerve graft, with satisfactory functional results.

Adult↗
PubMed1992

[Diagnosis and differential diagnosis of squamous epithelial metaplasia in the parotid gland].

The authors report a case of proliferating squamous epithelium in the necrotic edge of multifocal oncocytic adenomatous hyperplasia of the parotid gland. A correct histological diagnosis is of great clinical relevance and difficulty, since similar findings can occur in mucoepidermoid carcinoma. The various cell types in the parotid gland and their roles in neoplasia are discussed.

Adenoma↗