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Biomedical subjects

K W Delank

Publications and source records attributed to K W Delank.

34 records · Page 2Linked to original sources
PubMed1996

[Pathophysiology of post-traumatic anosmia].

BACKGROUND: Head injury is one of the most common causes of olfactory disturbances. The incidence of posttraumatic anosmia depending from the severity of the injury lies between 5% and over 80%. METHODS: Clinical assessments were performed in 26 cases with posttraumatic anosmia using subjective olfactometric tests. Additionally, morphological studies were performed in 26 other patients, who died between 36 hours and six weeks after head injuries. RESULTS: Frontal basal injuries as well as minor occipital blows are capable of causing complete olfactory loss. About one-third of all patients were not aware of their chemosensory deficits, especially when associated neurological deficits occurred. Moreover, the studies show that: 1: The vulnerability of the fila olfactoria varies extremely and depends on unknown, highly individual parameters. 2: Trauma can induce local hemorrhage within the olfactory tracts and bulbs without any other intracranial lesions. 3: An intracerebral contusion is often misunderstood as the direct substrate of a posttraumatic anosmia. However, in a number of cases it is merely the sign of a strong injuring force, potentially capable of injuring the fila or the olfactory bulbus. CONCLUSIONS: The findings indicate that the pathophysiology and biomechanics of posttraumatic anosmia should be the subject of critical discussion.

Accidents, Traffic↗
PubMed1995

[Traumatology of the facial skull in bicycle accidents].

About 15% of all traffic-related personal injuries involve bicycles. In 1989, 67,085 injuries involving bicyclists were registered in West Germany. The city of Münster is a particularly suitable site for studies of bicycle-related injuries because a high percentage of employees and students ride bicycles to work. The severity of bicycle injuries depends on the degree to which the head is traumatized. However, studies concerning trauma to the head in bicycle-related injuries are rare. The risk and the distribution of facial injuries in bicyclists is analyzed within the present study, which covers 78 patients with a total of 88 cranial fractures. The zygomatic and alveolar and orbital regions were most frequently fractured (35%), including 7% blow-out fractures. Thirty-three percent were fractures of the mandibular region, 12% of the bony nose. The soft tissue of the face was injured in 72% of all patients. Middle-aged male patients are more likely to suffer severe bicycle-related injuries. Bicyclists with a significant blood alcohol concentration are more likely to be involved in accidents that are their own fault. The results show that the helmets generally worn are not sufficient to prevent most facial injuries.

Accidents, Traffic↗
PubMed1995

[Quantitative evaluation of the Romberg test].

Simple and economical measuring platforms are available to aid the ENT clinician in examining vestibulospinal disorders. The aim of our study was to quantitatively interpret Romberg test measurements. Calculating the area between the zero line and the curves in sagittal and lateral direction--for the Romberg test with closed and open eyes--enables a quantification of body sway. For the evaluation of data, we developed a triangular diagram which allows a graphic representation and quantifies vestibulospinal reaction at a glance. We assessed a group of 80 persons without any symptoms of peripheral or central vestibular system disturbance. Selected patients complaining of vestibular disorders are helpful in demonstrating the objective and quantitative interpretation of the Romberg test, which is often analysed in a more subjective way.

Adult↗
PubMed1995

[Tumors in otorhinolaryngological surgery].

The most frequent tumors of the head and neck region are squamous cell carcinomas located within the oro- and hypopharynx [37%] or the larynx [36%]. They are clinically associated with chronic hoarseness dysphagia and swelling of the lateral neck. The general physician should pay attention to these initial symptoms, so that most of the tumors can be found noninvasively and at an early stage. Palpation and inspection are sensitive tools for the primary examination of many types of head and neck cancer. In addition, flexible or rigid endoscopy and high-resolution imaging are useful. Modern treatment of early head and neck cancer can be minimally invasive. The laser technique, new biocompatible implants for the reconstruction of postoperative defects and progress in radiotherapy complete the classic management of head and neck cancer.

Carcinoma, Squamous Cell↗
PubMed1995

[Posturographic registration of body sway after odor stimulation].

The methods of "reflex olfactometry" are rarely able to detect simulated anosmia because of the lack of reproducible correlations between stimulus and intensity of reaction. Interactions between the olfactory and vestibulospinal systems have not yet been investigated. Thirty persons with normosmia and 21 patients with anosmia were studied using a posturographic platform. Only in subjects with normosmia were body sway increases statistically significant in an anterior-posterior direction after the application of an olfactory nerve stimulant. Stimulations of the trigeminal nerve cause both in subjects with normosmia, and anosmia an increase in body sway occurred in a sagittal and lateral direction. The recording of vestibulospinal reactions during platform posturography after application of an olfactory stimulations enables quantification of body sway. These responses can also be useful in differentiating real from stimulated anosmia.

Acetates↗
PubMed1994

[Metastasis of benign pleomorphic adenoma].

A case of metastasing pleomorphic adenoma of the parotid gland, which was definitely benign, is reported. 11 years after the first operation of the tumour, which is suspected to have been removed insufficiently, there was a second local recurrence. In routine x-ray of the thorax the metastasis was seen peripherally in the thorax. Using DNA-Cytophotometry the benign character of both specimens could be confirmed. The fact that such a tumour can even produce metastases, proves its easy implantability. This leads to a critical discussion of each intervention, which is not definitive, including fine needle aspiration biopsy. There are only few indications for preoperative invasive interventions.

Adenoma, Pleomorphic↗
PubMed1994

[Long-term results of lateral rhinotomy with medial maxillo-ethmoidectomy].

Functional and cosmetic results in 93 patients were analysed on average at 42 months after lateral rhinotomy and medial maxilloethmoidectomy. The rate of postoperative complications was 11.8%. The final cosmetic result was more than 1 year postoperatively satisfactory or better in 93.1% after osteoclastic and in 97.8% after osteoplastic lateral rhinotomy. 38.7% of the patients suffered from different postoperative complaints. The main problems were endonasal crusting, hypaesthesia in the V2 region, olfactory dysfunction and epiphora. Considering the results neither the rate of complications nor the cosmetic outcome are critical as usually mentioned in the literature. However, the rate of other different problems complained by the patients postoperatively give reason to add alternative oncosurgical procedures like midfacial degloving and endoscopic techniques, to the general operative repertoire of a hospital.

Adolescent↗
PubMed1994

[Sense of smell before and after endonasal surgery in chronic sinusitis with polyps].

Although olfactory dysfunction is a common clinical symptom in patients with chronic sinusitis, there are few written reports about the nature, frequency and therapeutic accessibility of the various dysosmias. We analysed pre- and postoperative olfactory function in 78 patients suffering from chronic sinusitis with nasal polyposis. Using a squeeze bottle technique we were able to detect preoperative hyposmia and/or dysfunction of olfactory discrimination in 40% and anosmia in 36%. Only 22% of these patients complained spontaneously of disabilities in smell. Endoscopic surgery improved hyposmias and anosmias in 71% and preoperative dysfunctions of olfactory discrimination in 61%. Postoperative thresholds for 2-phenylethanol and dimethyldisulfide worsened in 9% of all patients. Postoperative olfactory discrimination deteriorated in 11%. Preoperative and postoperative olfactory functions were not predictable in individual cases when nasal polyposis was limited. However, mechanical blockage of the nasal airway was just one of many other pathophysiological factors causing olfactory loss in patients with chronic sinusitis.

Adolescent↗
PubMed1993

[Morphology and rhinologic importance of intumescentia septi nasi anterior].

The intumescentia septi nasi anterior is a protuberance on each side of the anterior part of the nasal septum containing "cavernous" tissue. None of the previous studies devoted to the general aspects of endonasal "cavernous" tissue refer to the incidence and rhinological function of the intumescentia. This investigation revealed an incidence of more than 80% in 170 individuals without any rhinological symptoms. The external morphology observed in 7 cadavers indicated a close topographical correlation of the position of the middle turbinate, the depth of the lateral nasal wall and the extension of the intumescentia. Histological examination showed a glandular mass interspersed with a dense vascular network similar to the "cavernous" tissue found within the lateral turbinates. Various filling conditions of the intumescentia have no significant influence on rhinomanometrical parameters and the quantity of nasal airflow. However, visualization of the endonasal flow within a nasal model containing the septal protuberance indicated that the intumescentia considerably alters the quality and local velocities of the endonasal airstream. Considering the results of the study, the intumescentia must be regarded as a completely normal formation of particular rhinophysiological importance, which, up until now, has not been mentioned in rhinosurgery.

Adolescent↗
PubMed1993

Tumors of the nasal cavity occurring after hypophysectomy.

Olfactory neuroblastoma and malignant melanoma of the nasal cavities as second primary tumors after resection of pituitary adenomas in two patients are described. These cases, which seem to be the first documented in the literature, demonstrate the problems in diagnosis and treatment. Because of its rare occurrence, a second primary tumor may not be suspected when symptoms develop in the region of a previous hypophysectomy. A close follow-up after hypophysectomy for pituitary adenoma is recommended for the early detection of a second primary tumor. Pathogenetic considerations are discussed.

Aged↗
PubMed1992

[Clinical relevance of malignant lateral branchial cyst].

We analyzed 7 patients with so called "maligne lateral cervical cysts" regarding the controversies in the literature. Primary tumors of oropharyngeal sites were discovered in all these cases of "branchiogenic carcinoma" rising the final diagnosis of cystic metastases. Diagnostic tonsillectomy is supposed to be important to solve this problem of differential diagnosis. The issue of malignant transformation in cysts of branchial cleft origin has to be recognized as being an oncological artifact. We argue that the "maligne lateral cervical cyst" does'nt exist as a proper entity. In analogy to the principles of the treatment of oropharyngeal cancer ipsilateral neck dissection and wide local excision of the cyst followed by radiation therapy is the suggested plan of therapeutic management. Search for a possible unknown primary tumor within the oropharynx must be continued over years.

Adult↗
PubMed1992

[Olfactory sensitivity in adenoid hyperplasia].

Olfactory sensitivity was assessed in 37 children aged between 5 and 12 years before and after adenectomy. Olfactory detection thresholds for 2-phenylethanol and dimethyldisulphide, as well as the ability to distinguish 8 other odours, were measured using a squeeze bottle test. The results suggest that preoperative olfactory detection thresholds in subjects with severe nasal obstruction attributable to adenoid hypertrophy are higher than in those with less severe nasal obstruction. The olfactory detection thresholds improved after adenectomy in cases with high preoperative nasal obstruction indices. The olfactory detection threshold remained relatively unchanged in cases with less severe adenoid hyperplasia. In contrast, improvement in olfactory discrimination was observed in all children, irrespective of the degree of preoperative nasal obstruction.

Adenoidectomy↗
PubMed1991

[Heat radiation--an essential factor of heat transport in caloric vestibular tests? Current experimental findings].

According to the accepted theory, in vestibular testing the caloric stimulus is transported from the auditory canal to the lateral semicircular canal by heat conduction via the bone. Some findings, however, are not consistent with this concept, e.g. the short latency of the vestibular response, and the fact that removing of the osseous bridge does not stop the transport of heat to the semicircular canal. Physically there are three modes of heat transport: conduction, convection, and radiation. So far, only the first two have been discussed with regard to vestibular calorization, however, they fail to explain the findings mentioned above. We carried out experiments on 10 cadaveric temporal bone specimens in order to evaluate the possible effect of heat radiation. With experimental conditions strictly regulated (specimens kept in climate box, 37 degrees C, saturated humidity, standardized irrigation of the auditory canal with 50 ml of water of 50 degrees C in 15 sec., temperature measured by thermistors at selected points of the specimen), the deviation in repeated experiments was within 0.1 degree C. In normal temporal bones a spreading of heat along the osseous structures was found in accordance with heat conduction via the bone. Then the bony bridge between posterior frame of the tympanic membrane and the lateral canal was removed along with the tegmen tympani, leaving the auditory canal and labyrinth connected only by a small anterior-inferior strut. The rise of temperature in the lateral canal, however, was not delayed and reduced, as expected, but faster and greater than in the original situation. If, now, a reflecting shield was inserted in the cleft between tympanic membrane and labyrinth the heat transfer was dramatically reduced. A similar effect could be achieved in the intact middle ear by a shield or by filling the cavity with gel. Convection as means of heat transport could be excluded. The experiments show that heat transport in the vestibular calorization is a complex process, which besides heat conduction involves radiation as an essential factor. This explains a number of experimental and clinical findings that, so far, had been unclear.

Bone Conduction↗
PubMed1991

Transport of heat in caloric vestibular stimulation. Conduction, convection or radiation?

Experiments in temporal bone specimens were carried out under strictly controlled conditions: temperature (37 degrees C) and humidity kept constant; standardized irrigation of the external ear canal by an automated system (in 15 s, 50 ml of water, 11 degrees C above temperature of specimen), thermistor probes of 0.2 mm diameter placed in different parts of the specimens. In the intact temporal bone such an irrigation causes a rise in temperature with a gradient from the external ear canal across the bony bridge to the lateral semicircular canal as expected with heat conduction. After removal of the bony bridge, which is the main route for heat conduction, the rise in temperature in the lateral semicircular canal is greater and faster than in the intact specimen. This effect again is drastically reduced by placing a reflecting shield between tympanic membrane and labyrinth. In the intact middle ear inserting a reflecting shield or filling the cavity with gel also reduces the heat transfer to the labyrinth, although the bony routes for heat conduction are left untouched. The experiments prove that radiation plays an important part in heat transfer in caloric stimulation.

Caloric Tests↗
PubMed1990

[Olfactory neuroblastoma--tumor entity or complex clinical picture?].

Clinical and radiological findings in seven cases of olfactory neuroblastoma are reviewed and discussed in the light of the international literature. The report provides further evidence of difficulties related to the predictability of the condition's clinical course, diagnosis, and therapeutic consequences. Moreover, the lack of uniform CCT and NMR features indicates that the discussion about the genesis, the biological action, the terminology, and therapy of these tumors has not yet reached a conclusion.

Adolescent↗