[Basics, methods and indications for objective olfactometry].
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Chemoreceptor Cells↗
Biomedical subjects
M Wolfensberger
Publications and source records attributed to M Wolfensberger.
Surgical treatment of early oral carcinoma-results of a prospective controlled multicenter study.
PURPOSE OF THE STUDY: To assess whether early stage (pT1-2,pN0-1) oral cavity carcinoma is adequately treated by radical surgical resection alone. MATERIAL AND METHODS: Prospective multicenter study. Of 105 patients with cT1-2 cN0-1 oral carcinoma treated in conformity with the study design, 12 had to be excluded because of tumor-positive margins or pN stage > N1. The remaining 93 patients were monitored for at least 2 years. RESULTS: Seventeen patients had local or regional recurrence develop. In 12 of the 17 patients locoregional control was achieved by second treatment. Overall, the 4-year disease-specific survival probability was 94%. Patients treated initially without selective neck dissection had significantly higher recurrence rates than those with neck dissection, although the survival probability was not adversely affected. CONCLUSIONS: Early (pT1-2, pN0-1) squamous cell carcinoma of the oral cavity is adequately treated by surgery alone, provided the resection margins are tumor free. On the basis of the presented data, we would also advocate routine selective neck dissection.
Adult↗
[Thoughts on hospital length of stay after tonsillectomy].
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Cost Savings↗
Parent satisfaction 1 year after adenotonsillectomy of their children.
BACKGROUND: Tonsillectomy is one of the most frequent as well as one of the most controversial operations performed in childhood. OBJECTIVE: To assess the expectations of parents before tonsillectomy and to assess their satisfaction 1 year after surgery. STUDY DESIGN: 664 children undergoing (adeno-)tonsillectomy were enrolled in a nation-wide prospective multicenter study. The child's medical history, clinical findings, and indication for tonsillectomy were recorded by the physicians at the time of surgery. The parents were asked to fill out a questionnaire and to list all symptoms from which they expected relief at the time of surgery and to assess the subjective benefit of the surgery 1 year post-operatively. Five-hundred and seventy six of the 664 patients' parents (87%) returned the follow-up questionnaire. RESULTS: 88% of the (adeno-)tonsillectomies were performed because of documented recurrent febrile tonsillitis or obstructive symptoms such as sleep apnea or snoring with restless sleep and daytime irritability. The number of episodes of febrile sore throat dropped from a mean of 6.7 in the year prior to surgery to a mean of 1.5 in the year after surgery (P<0.001). Obstructive symptoms disappeared in 80% of cases, 524 parents (91%) were satisfied with the benefit, 159 parents (28%) regretted not having arranged to have surgery performed earlier. CONCLUSION: Our study shows that parents assess the outcome of tonsillectomy not with regard to one main symptom (e.g. recurrent sore throat) but with regard to a number of complaints. It also shows a high rate (91%) of parent satisfaction after tonsillectomy. For the indications studied, tonsillectomy remains the treatment of choice and should not be delayed or even denied to those children.
Adenoidectomy↗
Multicenter investigation of 1,036 subjects using a standardized method for the assessment of olfactory function combining tests of odor identification, odor discrimination, and olfactory thresholds.
"Sniffin' Sticks" is a test of nasal chemosensory performance that is based on penlike odor-dispensing devices. It is comprised of three tests of olfactory function: tests for odor threshold, discrimination and identification. Previous work has already established its test-retest reliability and validity in comparison to established measures of olfactory sensitivity. The results of this test are presented as a composite TDI score--i.e., the sum of results obtained for threshold, discrimination and identification measures. The present multicenter investigation aimed at providing normative values in relation to different age groups. To this end, 966 patients were investigated in 11 centers. An additional study tried to establish values for the identification of anosmic patients, with 70 anosmics investigated in five specialized centers where the presence of anosmia was confirmed by means of olfactory evoked potentials. For healthy subjects, the TDI score at the 10th percentile was 24.5 in subjects younger than 15 years, 30.3 for ages from 16 to 35 years, 28.8 for ages from 36 to 55 years and 27.5 for subjects older than 55 years. While these data can be used to estimate individual olfactory abilities in relation to a subject's age, hyposmia was defined as the 10th percentile score of 16- to 35-year-old subjects. Our latter study revealed that none of 70 anosmics reached a TDI score higher than 15. This score of 15 is regarded as the cut-off value for functional anosmia. These results provide the basis for the routine clinical evaluation of patients with olfactory disorders using "Sniffin' Sticks."
Adolescent↗
Determination of polychlorinated dibenzo-p-dioxins and dibenzo-furans in solid residues from wood combustion by HRGC/HRMS.
PCDD/PCDF were determined in solid samples from wood combustion. The samples included grate ashes, bottom ashes, furnace ashes as well as fly and cyclone ashes. The solid waste samples were classified into bottom and fly ash from native wood and bottom and fly ash from waste wood. For each of the four classes concentration distribution patterns from individual congeners, the sums of PCDD/PCDF and the international toxicity equivalents (I-TEQ) values are given. The I-TEQ levels of fly ash from waste wood burning can be approximately up to two thousand times higher than the values from fly ashes of natural wood. The I-TEQ levels in bottom ashes from waste wood combustion systems are as low as the corresponding ashes from the combustion of native wood. Grate ash samples from waste wood combustion systems with low carbon burnout show high levels of PCDD/PCDF.
Benzofurans↗
Sniffin'Sticks: a new olfactory test battery.
The olfactory test battery "Sniffin'Sticks" comprises a perception threshold test, an odour discrimination test and an odour identification test. The purpose of this study was to examine the suitability of the Sniffin'Sticks for use in everyday practice and to obtain (at least provisional) normal values. Thirty normosmic and 15 anosmic volunteers were examined with the Sniffin'Sticks and the "University of Pennsylvania Smell Identification Test" (UPSIT). All three Sniffin'Sticks tests distinguish between normosmics and anosmics in a highly significant manner. The good correlation of the individual tests with each other and with the results of the UPSIT documents the reliability of the test results. Critical mention must be made of the overly complex determination of the olfactory threshold. In conclusion, the Sniffin'Sticks test battery provides a validated instrument adapted to European conditions for the examination of olfactory disorders. It has proven successful in everyday clinical practice and constitutes a major aid for compiling medical certificates.
Humans↗
Assessing olfactory function in laryngectomees using the Sniffin'Sticks test battery and chemosensory evoked potentials.
OBJECTIVES/HYPOTHESIS: Laryngectomees are often considered to be completely anosmic. The aim of this study was to determine whether anosmia in laryngectomees reflects diminished transport of odorants to the olfactory epithelium or olfactory epithelial damage. STUDY DESIGN: Twenty-five laryngectomees were examined psychophysically using the Sniffin'Sticks test battery. All patients rated the degree of their subjectively perceived deficit on a rating scale. Chemosensory evoked potentials were also recorded in 11 of 25 patients. RESULTS: Sixteen patients complained very little about their smell deficit, even though the psychophysical testing found 18 patients to be anosmic and 7 hyposmic. Olfactory potentials could be recorded in only 7 of the 11 patients who received this evaluation, despite the fact that all 11 perceived, at least vaguely, the olfactory stimulus, H2S, during the recording sessions. No meaningful correlation between the psychophysical and electrophysiological data was observed. CONCLUSIONS: The psychophysical data revealed the laryngectomees to be either functionally anosmic or hyposmic. The olfactory evoked potential data suggested that at least in two thirds of the laryngectomized patients the olfactory system had some function, even up to 22 years after surgery. Because patients in everyday situations find ways to bring odorants to the olfactory mucosa, the low number of complaints about subjectively perceived deficits is reasonable.
Adult↗
[Follow-up after histologically verified radical resection of early cancers of the mouth cavity: results of a prospective multicenter study].
INTRODUCTION: Early stage oral cavity carcinoma is curable in most cases. This study follows the course of early stage squamous cell carcinoma of the oral cavity after radical surgical resection, in order to assess the necessity of further treatment modalities. MATERIAL AND METHODS: In a prospective multicentric study, 110 patients with T1-T2 and N0-N1 (without capsular invasion) squamous cell carcinoma of the oral cavity were enrolled. All patients were treated exclusively by surgical resection with histopathologically proven negative margins. RESULTS: Among 96 patients (14 excluded because of positive margins), followed-up for 3 years, 18 presented a local or regional recurrence. In 12 of these 18 loco-regional control was reestablished by second treatment. Overall, the 4-year disease-specific survival probability was 94%. Patients treated initially by selective neck dissection had significantly lower recurrence rates than those without neck surgery. CONCLUSION: Early (T1-2, N0-1) squamous cell carcinoma of the oral cavity is adequately treated by surgery alone. The surgical procedure should include margin-free resection of the primary combined with selective neck dissection. Systematic postoperative radiotherapy does not appear necessary. Neck dissection is advocated in N0 patients as well.
Carcinoma, Squamous Cell↗
[Endonasal dacryocystorhinostomy: technique and results].
BACKGROUND: Endonasal dacryocystorhinostomy has recently become an important alternative to the classical external Toti procedure. OBJECTIVE: To analyse the outcome after endonasal dacryocystorhinostomy. METHODS: For this purpose 28 of 34 patients treated by endonasal dacryocystorhinostomy between May 1994 and November 1998 were investigated. RESULTS: After an average follow-up of 28 months, 23 of the 28 patients (82%) are free of symptoms. Two additional patients became symptom-free after revision surgery. The total success rate is 89%. The only complications seen were 2 cases of asymptomatic synechiae and one case of mild hyposmia. CONCLUSIONS: Endonasal dacryocystorhinostomy is a rapid, safe, and elegant method for the treatment of post-saccal nasolacrimal duct obstructions.
Dacryocystorhinostomy↗
[Appropriateness of antibiotic prescription in ENT surgery].
INTRODUCTION: Although extensive studies on the use of antibiotics during and after surgery exist, antibiotics are still used too liberally. PURPOSE: To analyse the appropriateness of antibiotic use in ENT surgery. PATIENTS AND METHODS: Retrospective study of all surgical procedures performed at the Department of Otolaryngology, Head and Neck Surgery of the University of Basel between April and June 1999. Of the 174 procedures 30 were classified clean, 50 clean-contaminated (group A), 69 clean-contaminated (group B), 14 contaminated, and 11 dirty. RESULTS: 9% of all patients received inappropriate antibiotic prophylaxis and 4% inappropriate primary antibiotic treatment. 22% of antibiotic prophylaxis, 39% of primary antibiotic treatments and 29% of secondary antibiotic treatments were considered inappropriate. DISCUSSION: The too liberal use of antibiotics during and after surgery is largely due to the surgeon's fear of infectious complications. Only a peer-review process of all antibiotic prescriptions can reduce the inappropriate use of antibiotics.
Antibiotic Prophylaxis↗
[Sniffin'Sticks: a new system for olfactory assessment in routine clinical practice].
INTRODUCTION: The Sniffin'Sticks test battery consists of a short screening test and tests for odor detection thresholds (using n-butanol), odor discrimination and odor identification. We evaluated the usefulness of this new test in clinical practice and propose normative values. MATERIAL AND METHODS: In the present study 30 normosmic and 15 anosmic volunteers as well as 35 patients with various olfactory dysfunctions were examined. RESULTS: All four Sniffin'Sticks tests were able to separate normosmics and anosmics in a highly significant manner. Even a small decrease in olfactory performance was detectable in elderly patients. For practical purposes the sensitivity of the test for screening test was found to be too low. The good correlation between the individual Sniffin'Sticks tests and the correlation between the Sniffin'Sticks test battery and the "University of Pennsylvania Smell Identification Test" (UPSIT) test battery and the "University of Pennsylvania Smell Identification Test" (UPSIT) document the reliability of these tests. CONCLUSIONS: Our findings show that the Sniffin'Sticks are well suited to assess olfactory performance in clinical practice.
Adult↗
The role of acoustic rhinometry in the diagnosis of adenoidal hypertrophy in pre-school children.
UNLABELLED: Adenoidal hypertrophy is a common problem in pre-school children and diagnosis depends mostly on evaluation of clinical symptoms and signs. Investigative techniques to assess adenoidal size often do not add to this information. Recent reports have suggested a role for acoustic rhinometry in this situation. A total of 49 children consecutively referred to the Department of Otorhinolaryngology, University of Mainz, with evidence of adenoidal enlargement underwent acoustic rhinometry pre- and post-operatively and were compared to an age-matched control group from a local kindergarten school. Adenoidal size was visually estimated at surgery and questionnaires were completed by parents of symptomatic children. Acoustic rhinometry was not able to differentiate controls (mean nasopharyngeal cross-sectional area 1.34+/-0.47 cm2, n = 35) from symptomatic children admitted for adenoidectomy (mean nasopharyngeal cross-sectional area 1.66 +/- 0.83 cm2, n = 42, P = 0.53). Acoustic rhinometry was advantageous for patients with adenoidal hypertrophy in two situations. Firstly a sub-group of patients with complete nasopharyngeal obstruction could be identified (P = 0.03) and secondly all patients with a postnasal space less than 1.2 cm2 clinically benefited from adenoidectomy. CONCLUSIONS: Acoustic rhinometry, in general, is not suitable for assessing adenoidal size in pre-school children. Physical limitations of currently available acoustic rhinometers are likely to explain the limited clinical value of this investigative technique.
Acoustics↗
[Anterior pseudodiverticulum after laryngectomy].
An anterior neopharyngeal pseudodiverticulum is a mucosal pouch located between the tongue and hypopharynx due to an epiglottis-like posterior tissue band that forms after total laryngectomy. This condition has rarely been mentioned in literature. Incidence, symptoms, treatment, and possible etiologic factors were examined. Twenty post-laryngectomy patients were questioned about swallowing disorders and were examined clinically and by barium swallow. Eleven patients were found to have a pseudodiverticulum, of which 9 patients suffered from dysphagia. We found no correlation between the formation of a pseudodiverticulum and radiotherapy or post-laryngectomy complications. All symptomatic patients were treated by dissecting the posterior tissue band endoscopically with a CO2-laser, bringing complete relief of symptoms in 8 of 9 patients. Our study showed that the anterior pseudodiverticulum can be a frequent cause of dysphagia after laryngectomy. It can easily be diagnosed clinically and radiologically. Endoscopic treatment with a CO2-laser is simple and effective.
Adult↗
Localization and coexistence of atrial natriuretic peptide (ANP) and neuropeptide Y (NPY) in vertebrate adrenal chromaffin cells immunoreactive to TH, DBH and PNMT.
Antisera specific for mammalian atrial natriuretic peptide (ANP) and neuropeptide Y (NPY) were applied to examine, in immunofluorescence, the occurrence of cells immunoreactive to ANP and NPY in the adrenal organs of mammals, birds, reptiles, amphibians, and bony fish. Catecholamine-containing cells were identified using antisera against tyrosine-hydroxylase, dopamine-beta-hydroxylase, and phenylethanolamine-N-methyl-transferase. In all vertebrates studied, immunoreactivities to ANP and NPY occurred in adrenal chromaffin cells but were absent from the cortex or its homolog, the interrenal. The majority of immunoreactivities to ANP and NPY was confined to the adrenaline cells. In mammals, the number of ANP-immuno-reactive cells (60%-80% of the total cell population) exceeded that of the NPY-immunoreactive cells (35%-45%). In birds, reptiles, and Amphibia, the numbers of ANP-immunoreactive (35%-40%) and NPY-immunoreactive (30%-35%) cells were in a similar range. The bony fish showed a density of both ANP-immunoreactive (80%-90%) and NPY-immunoreactive (35%-40%) cells. In all species studied, immunoreactivities to ANP and NPY partially coexisted. Generally, 30%-55% of the ANP-immunoreactive cells also contained NPY-immunoreactivity. In rat, coexistence amounted to almost 100% and in quail to 95%. Except for the rat, three subpopulations of chromaffin cells seemed to occur: ANP-immunoreactive non-NPY-immunoreactive, ANP-immunoreactive+NPY-immunoreactive, and NPY-immunoreactive non-ANP-immunoreactive cells. Thus, adrenal ANP and NPY share a conservative history and coexist as early as at the level of bony fish. The endocrine actions of ANP and NPY derived from medullary cells on cortical cells as found in mammals might be based on an ancestoral paracrine system. In submammalians, ANP and NPY may not only act as endocrine hormones, but also influence steroid-producing interrenal cells in a paracrine manner, and act as modulators on chromaffin cells.
Adrenal Medulla↗
[Diagnostic procedures in obscure cervical nodes in adults].
Cervical masses in adult patients should be regarded as metastatic until proven otherwise. Work-up must therefore begin with a thorough search for a possible primary cancer. 90% of all head and neck primaries that present with a cervical mass are located in the oral cavity, pharynx or larynx. Pain [particularly otalgia], dysphagia, nasal obstruction, unilateral hearing loss, and hoarseness are the most common key symptoms of these tumors. Cancer cannot always be ruled out, even with regression of symptoms following antibiotic treatment or normal laboratory findings. If no primary lesion is found, then fine-needle aspiration biopsy of the neck mass is indicated. Only if fine-needle aspiration biopsy fails to come up with a diagnosis, should open [whenever possible excisional] biopsy be performed.
Adult↗
[Fibrovascular polyps of the esophagus].
Fibrovascular polyps of the esophagus account for 0.5-1% of all esophageal tumors. These are usually pedunculated lesions that originate below the upper esophageal sphincter. Etiology is unknown. Histological examination typically shows a fibrovascular stroma, which is covered by non-keratinizing squamous epithelium. Seventy-five percent of all patients are male, and are usually between 40 and 70 years of age. Most fibrovascular polyps cause few but non-specific symptoms. Occasionally they are regurgitated into the oral cavity and may then give rise to choking episodes and even fatal aspiration. Fibrovascular polyps are best diagnosed by endoscopy and/or radiography. Differential diagnosis includes carcinoma and intramural myoma. Once diagnosis is made, surgical removal, is indicated by either transoral or lateral cervical approaches. With adequate treatment prognosis is excellent.
Actins↗
[Clinical aspects in oral, pharyngeal and laryngeal carcinoma--results of an overall Swiss cohort study].
Squamous cell carcinomas of the oral cavity, pharynx and larynx cause early symptoms and are fairly accessible. Nevertheless, in more than half of cases they are diagnosed at an advanced stage. This paper identifies patients at high risk of developing one of these carcinomas, describes the typical clinical findings and shows how, with a high index of suspicion and a proper examination technique, diagnosis at an earlier stage could be achieved. The study is based on the data of 636 patients with squamous cell carcinoma of the oral cavity (174 patients), oropharynx (177), hypopharynx (97), and larynx (188). 87% of the patients were male, and 90% were aged between 40 and 80 years. 85% of the patients smoked and drank alcohol regularly. The key symptoms were pain, dysphagia, hoarseness, a painless neck mass, or a visible ulcerating lesion. On average a 4-month period elapsed from the onset of symptoms to the histological diagnosis. The diagnostic delay was significantly shorter in patients with pain or visible organic changes (ulcerating lesions, neck masses) than in patients with functional symptoms (dysphagia and hoarseness).
Adult↗