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Biomedical subjects

K Hörmann

Publications and source records attributed to K Hörmann.

At least 19 recordsLinked to original sources
PubMed2001

[Treatment of therapy refractory chronic otitis externa by local injection of triamcinolone acetate crystalline suspension. Initial experiences].

BACKGROUND AND OBJECTIVE: External otitis is characterized by otalgia, otorrhea, itching, and hearing loss. Treatment usually consists of local application of corticosteroids and antibiotics. Chronic external otitis is accompanied by thickening of the skin in the external auditory channel. This reduces the effect of the applied substances. Local injection of suitable drugs may support the conservative treatment. The aim of the study was to evaluate the efficacy of local injection of triamcinolone acetonide in the external auditory channel. PATIENTS/METHODS: Thirteen patients with external otitis resistant to conservative treatment received an injection of triamcinolone acetonide in the external auditory channel. The improvement achieved was assessed by clinical examination and questionnaires. RESULTS: The symptoms improved substantially in all patients; most of the patients were cured completely. CONCLUSIONS: Our results demonstrate that local injection of triamcinolone acetonide is effective in the management of chronic external otitis.

Adult↗
PubMed2001

[Dyspnea caused by spontaneous hematoma of the oropharynx and larynx during marcumar therapy].

A patient with a history of tachycardiac atrial fibrillation and pulmonary embolism was admitted to the emergency unit with acute shortness of breath. The patient was on coumarin medication. Pulmonary embolism, heart failure, or pulmonary edema could be ruled out. Laryngoscopy revealed a huge hematoma of both valleculae extending to the lateral pharyngeal wall and the epiglottis. The epiglottic cartilage was displaced to the posterior pharyngeal wall. The INR was > 6. Prothrombin complex, vitamin K1, corticoids, and fresh frozen plasma were administered immediately. The patient was monitored--without tracheotomy--in the intensive care unit and received oxygen. In a patient with dyspnea, impaired ventilation has to be considered besides impaired perfusion or diffusion.

Aged↗
PubMed2001

[Sleep-associated respiratory disorders in childhood].

Sleep-related breathing disorders in children are common. Nearly 10% of preschool-aged children snore, and 1% of 4- to 5-year-old children present with an obstructive sleep apnea syndrome (OSAS), mostly due to an adenotonsillar hyperplasia. OSAS in children differs markedly from adults concerning etiology, clinical symptoms, polysomnographic findings, and course of the disease. Therefore, results of adult sleep medicine cannot easily be applied to children. The disease may result in pulmonary or systemic hypertension, failure to thrive, and neurocognitive misbehavior. Up to now, there is no consensus concerning diagnosis and therapy. In this article, we summarize and discuss what is known so far about sleep-related breathing disorders in children, focussing on the OSAS as the most important diagnosis for the ENT specialist.

Adenoids↗
PubMed2001

[Modified uvula flap in therapy of sleep-related breathing disorders].

BACKGROUND/OBJECTIVE: Velopharyngeal incompetence is a well described complication of uvulopalatopharyngoplasty (UPPP) for snoring or obstructive sleep apnea. A new uvulopalatal flap technique (UPF), first presented by Powell in 1996 was now modified by our team. The new technique intends to lateralize the posterior faucial pillars as the UPPP, entirely sparing uvulopalatal muscles. RESULTS: No statistical difference existed in change of AHI before and after surgery in all patients even though 14 patients had a statistically significant decrease in AHI (pre 19.2 +/- 19.6; after 8.2 +/- 9.8; p < 0.05). Snoring decreased clearly (p < 0.05) from 49.4% to 25.9%.

Adult↗
PubMed2001

[Follicular dendritic reticulum cell sarcoma in a cervical lymph node].

Follicular dendritic cells (FDC) constitute an essential component of B cell follicles, normally serving as antigen-presenting cells and as cells regulating the germinal center reaction. FDC sarcoma is a very rare tumor. We report the case of a 55-year-old male patient who showed persistent cervical lymph node swelling. On biopsy the tumor consisted of spindle cells with nuclear atypia. Immunophenotypic investigation of the tumor tissue revealed a FDC sarcoma of a cervical lymph node. The tumor cells were characterized immunohistochemically especially by the expression of CD21 and focal expression of CD68. In conclusion, FDC sarcoma has to be considered in cases of tumors of uncertain origin in cervical lymph nodes, tonsils, soft palate, or nasopharynx. For clinical practice, it is important to note that sarcomas in cervical lymph nodes are not necessarily metastases but can be primary tumors.

Biopsy↗
PubMed2001

[Tongue base reduction with radiofrequency energy in sleep apnea].

BACKGROUND AND OBJECTIVE: Tongue base reduction with temperature-controlled radiofrequency for the treatment of obstructive sleep apnea syndrome is a minimally invasive technique. Repeated application leads to a progressive shrinking of the tissue. PATIENTS AND METHODS: In our study, we summarize the experiences gained from 100 tongue base reductions and compare them with the pilot study that was recently published. An intensified treatment scheme was used with higher amounts of energy applied per treatment session. Visual analogue scales were used for the assessment of postoperative pain and functional parameters. Regular follow-up visits were scheduled to evaluate postoperative complications. RESULTS: Postoperative pain was mostly mild or moderate. Paraoperative complications were not observed. The overall rate for postoperative complications was 8%, with 2% mild and 5% moderate complications. One severe complication--a tongue base abscedation--was observed. Using para- and postoperative antibiotic prophylaxis reduced the rate of complications. Functional parameters such as taste or swallowing were not affected. CONCLUSIONS: Our results underline the safety of the procedure and demonstrate the minimal para- and postoperative morbidity. The increased amount of energy applied per session has not led to an increase in postoperative morbidity.

Abscess↗
PubMed2001

[Combined surgical and prosthetic therapy of severe obstructive sleep apnea--a case report].

We report on a 41-year old patient who complained of loud snoring, excessive daytime sleepiness and chronic nasal obstruction. Clinical findings were septal deviation and enlarged turbinates, tonsillar hypertrophy with velar webbing and pharyngeal narrowing. Polysomnography revealed severe obstructive sleep apnoea syndrome with an apnoea-hypopnoea index (AHI) of 51.7/h. As the patient refused nCPAP therapy, we performed septoplasty with conchotomy and an uvulopalatopharyngoplasty with tonsillectomy. Snoring and excessive daytime sleepiness disappeared completely and the AHI decreased to 31.1/h. The mandibular advancement device Snorban was subsequently fitted. We found a complete resolution of OSAS. The AHI was 4.4/h. The postsurgical polysomnographic results were stable two years after surgery. However, the patient discontinued using the oral device as he did not feel any additional benefit when using it. The combination of UPPP and mandibular advancement device can resolve a severe OSAS.

Adult↗
PubMed2001

[Modified hyoid suspension for therapy of sleep related breathing disorders. operative technique and complications].

BACKGROUND: : Concerning the therapy of obstructive sleep apnea (OSA) the discrimination between either retropalatal or retrolingual site of obstruction seems to be an oversimplification. Thus modern surgical concepts address both anatomical areas. Minimal invasive surgical techniques treating the soft palate have recently been developed while there is still an ongoing development concerning the base of tongue. METHODS: A less invasive modification of the hyoid suspension to the thyroid cartilage, originally described by Riley, is presented as treatment modality for sleep related breathing disorders. Between October 2000 and March 2001, 14 patients underwent modified hyoid suspension within a multi-level surgery concept. The operative technique manages with only one wire-suture and does not include myotomies and intersection of the ligamenta stylohyoidea. RESULTS: All together 10 male and 4 female subjects with a mean age of 50.9 years were included in the analysis. Preoperatively the mean apnea hypopnea index (AHI) was 18.4. The procedure was well tolerated. Neither increased postoperative pain nor increased requirement of analgetics was observed. Substantial side-effects were one case of seroma and 9 cases of transitory dysphagia. The retrolingual airway space increased significantly after surgery. CONCLUSIONS: These preliminary results are promising. The presented modified hyoid suspension is time-effective and shows less postoperative morbidity. Therefore it might become a suitable treatment modality within the multi-level surgery concept for sleep related breathing disorders.

Adult↗
PubMed2001

[Anti-angiogenesis - a therapy concept in the treatment of head and neck carcinomas? A review].

BACKGROUND: Head and neck squamous cell carcinoma (HNSCC) is an aggressive malignancy that is now the sixth most common neoplasm in the world. Despite numerous advances in treatment, the long-term survival has remained the same for the last 25 years. Angiogenesis has been shown to be important for HNSCC tumour growth and metastasis. Therefore, inhibitors of angiogenesis are a new class of anti-neoplastic substances that might be a powerful complement to conventional therapy in HNSCC. MATERIAL AND METHODS: The role of angiogenesis in HNSCC as well as preclinical and clinical trials concerning inhibitors of tumor-angiogenesis are discussed here. RESULTS: Many of the investigated angiogenesis inhibitors demonstrated anti-tumor effects in preclinical and clinical trials. In a few cases, partial remission was observed. CONCLUSIONS: Anti-angiogenic therapy will undoubtly have the potential to change standard tumor therapies. Some anti-angiogenic substances appear to be promising candidates for a clinical use in the therapy of HNSCC.

Adult↗
PubMed2001

The phosphodiesterase 4 inhibitor roflumilast is effective in the treatment of allergic rhinitis.

BACKGROUND: The beneficial effects of phosphodiesterase 4 (PDE4) inhibitors in allergic asthma have been shown in previous preclinical and clinical studies. Because allergic rhinitis and asthma share several epidemiologic and pathophysiologic factors, PDE4 inhibitors might also be effective in allergic rhinitis. OBJECTIVE: The main objective of this study was to investigate the efficacy of oral roflumilast (500 microg/day) in allergic rhinitis. METHODS: In a randomized, placebo-controlled, double-blinded, crossover study, 25 subjects (16 male, 9 female; median age, 28 years) with histories of allergic rhinitis but asymptomatic at screening received roflumilast (500 microg once daily) and placebo for 9 days each with a washout period of at least 14 days in between treatment periods. In each of the treatment periods, controlled intranasal allergen provocation with pollen extracts was performed daily beginning the third day of treatment, each time approximately 2 hours after study drug administration. Five and 30 minutes after each allergen provocation, rhinal airflow was measured by means of anterior rhinomanometry and the subjective symptoms obstruction, itching, and rhinorrhea were assessed by means of a standardized visual analog scale. RESULTS: Rhinal airflow improved almost consistently during the 9 days of roflumilast treatment, and it was significantly higher at study day 9 on roflumilast in comparison with placebo, a result also found for itching and rhinorrhea. With respect to the subjective obstruction score, a significant difference in comparison with placebo could be demonstrated within 4 days. CONCLUSION: This study shows that a PDE4 inhibitor, roflumilast, effectively controls symptoms of allergic rhinitis. Thus PDE4 inhibitors might be a future treatment option not only in allergic asthma but also in allergic rhinitis or the combination of the 2 diseases.

3',5'-Cyclic-AMP Phosphodiesterases↗
PubMed2001

Tonsillectomy with argon plasma coagulation (APC): evaluation of pain and hemorrhage.

OBJECTIVE: Argon plasma coagulation (APC) offers a new possibility for tonsillectomy (TE) because of its effective hemostasis and limited penetration depth of the coagulation zone. The APC dissector allows dissection and hemostasis in a one-step procedure. The aim of this prospective, randomized, single-blinded study was the evaluation of pain and hemorrhage of the "hot" argon-plasma-coagulation tonsillectomy (TE(APC)) compared with a conventional "cold" non-electrosurgery tonsillectomy (TE(Conv)). METHODS: Two hundred one consecutive patients undergoing tonsillectomy were included in a single-blinded, randomized, prospective study with stratification in two age groups. RESULTS: There was no statistical significant difference between TE(APC) and TE(Conv) in the intensity of postoperative pain and primary or secondary hemorrhage in both age groups. In the TE(APC) group, the mean duration of tonsillectomy was significantly reduced by more than 50% in both age groups (P <.01). The blood loss was 90% decreased in the TE(APC) compared with the TE(Conv) in both age groups (P <.01). CONCLUSIONS: The APC technique does not face the general problem of electrosurgery or thermal coagulation techniques in which the postoperative pain is often increased compared with conventional cold techniques. It offers an innovative new tonsillectomy method with significant reduced blood loss and surgical time.

Child↗
PubMed2001

Long-term results of inferior turbinate reduction with argon plasma coagulation.

OBJECTIVES: Surgical reduction of the inferior turbinates is a commonly used therapy in patients with hyperplastic inferior turbinates when medical management remains ineffective. Current surgical methods have disadvantages (e.g., necessity of nasal packing, extended postoperative swelling, and high costs). Theoretical considerations render argon plasma coagulation (APC) a promising new therapeutic approach. STUDY DESIGN: In a prospective study, 121 patients with chronic nasal obstruction were treated for inferior turbinate reduction with APC. Hyperplasia of the nasal turbinates was diagnosed rhinoscopically and endoscopically and confirmed rhinomanometrically. The mean follow-up period was 12 months, ranging from 10 to 16 months. The treatment results were evaluated by a questionnaire, rhinomanometric findings, and electron microscopic studies of the nasal mucosa. In 50 patients a ciliary function test was performed preoperatively and postoperatively. METHODS: Argon plasma coagulation, a high-frequency electrosurgery, has been used for volume reduction of the inferior turbinate in local anesthesia. RESULTS: Seventy-six percent of the patients reported an improvement of the postoperative swelling within the first week. After 6 weeks, macroscopically the turbinates were re-epithelialized by normal mucosa in 63% of the patients. Electron microscopic studies after 3 months verified normal cilia. After 12 months, 83% of the patients stated that they had a better nasal airflow than preoperatively. Crust formation was minimal. No bleeding or impaired ciliary function occurred. Ninety-five percent of the patients were willing to undergo the same operation again. CONCLUSION: The long-term results have proved APC to be an effective and easy-to-perform alternative for inferior turbinate reduction with comparable results to other established surgical methods.

Adolescent↗
PubMed2001

The relationship between allelic imbalance on 17p, p53 mutation and p53 overexpression in head and neck cancer.

The huge majority of head and neck squamous cell carcinoma (HNSCC) show alterations of p53 either on the genetic level or on the protein level. Allelic imbalance (AI)/loss of heterozygosity (LOH) on 17p at the p53 locus is frequent in HNSCC. However, the complex relationship between these phenomena is poorly understood in HNSCC. We investigated one group of 39 HNSCC for: a) allelic imbalance on 17p using 4 microsatellite markers located throughout this chromosomal arm; b) mutations of p53 in exons 5-9; and c) overexpression of p53 using two antibodies located on opposite ends of the protein. AI/LOH was detected in 44% at the locus TP53, rising to 69% when regarding all 4 markers on 17p. Therefore, our data are in line with the assumption of additional tumour suppressor genes on 17p in HNSCC. A nuclear accumulation of p53 (51%) was independent from the antibody and the recognised epitope. At the first glance there was no correlation between overall p53 mutation (36%) and overexpression. However, it appeared that, with very few exceptions, only nonsense mutations did not lead to p53 overexpression, while missense mutations did. As overexpression of p53 was 15% more frequent than p53 mutations and only 35% of the tumours with p53 overexpression carried a p53 mutation, our data support the hypothesis of additional mechanisms of p53 overexpression. AI/LOH at the p53 locus in 83% of all tumours with a p53 mutation is in line with Knudson's theory of inactivation of tumour suppressor genes.

Allelic Imbalance↗
PubMed2000

Delayed anterior ischemic optic neuropathy after neck dissection.

There are only 2 published cases of anterior ischemic optic neuropathy (AION) occurring after neck dissection, to our knowledge. We report a case of bilateral AION following neck dissection, discuss the differential diagnoses, and compare the features of this case with those of previously described cases. There were none of the previously described risk factors for the development of AION after head and neck surgery (eg, hypotension, facial edema, or sudden massive hemorrhage) in this case, but there was prolonged diffuse postoperative bleeding. Also, the symptoms did not arise before the fifth postoperative day as they did in the other cases. Prolonged, mild postoperative bleeding is a risk factor for AION. Visual loss during the entire first postoperative week has to be regarded as a complication of surgery, requires the exclusion of several differential diagnoses, and must not be confounded with the patient's confusion or symptoms of withdrawal.

Adult↗
PubMed2000

Expression of basic fibroblast growth factor protein and its down-regulation by interferons in head and neck cancer.

BACKGROUND: Angiogenesis is crucial for tumor growth and metastasis. In several tumors, microvascular density has been shown to correlate with metastasis and aggressiveness. Basic fibroblast growth factor (bFGF) has potent angiogenic activity and has been identified in a wide variety of malignancies including head and neck squamous cell carcinomas (HNSCC). Material and Methods Frozen sections of 50 HNSCC were immunostained for von Willebrand factor and bFGF. Microvessels were counted by light microscopy; bFGF expression was studied at the light and electron microscopic level. Laryngeal cancer cell line HlaC79 was incubated with interferon (IFN) alpha and beta. bFGF quantification was performed by ELISA, and antiproliferative effects were determined by BrdU assay. RESULTS: The mean number of blood vessels (77.5 +/- 23.7) is significantly increased in HNSCC compared with controls (17.1 +/- 5.9). bFGF protein expression was detected in all HNSCC but not in control tissue. An correlation between bFGF expression and mean number of microvessels was found (p <.001). However, no correlation between bFGF expression and the main clinicopathologic features was shown. The long-term exposure (144 hr) of HNSCC cells to noncytostatic concentrations of IFN alpha and beta (>10 U/mL) down-regulated the protein production of bFGF. CONCLUSION: bFGF expression and angiogenesis are enhanced in HNSCC. The higher microvessel density in HNSCC with strong bFGF expression supports the importance of bFGF for tumor angiogenesis. IFN alpha and beta treatment leads to a down-regulation of bFGF expression independent of their antiproliferative effects, suggesting that IFN treatment might result in a reduction of angiogenesis in HNSCC.

Adult↗