[Automatic guided endoscopy in nasal sinus surgery].
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Humans↗
Biomedical subjects
P A Federspil
Publications and source records attributed to P A Federspil.
[The custom made septal button].
Septal defects only warrant therapy when symptomatic. If surgical closure is not requested, the defect may be closed by a septal button. Prefabricated buttons are not an option for all sizes of defects. Moreover, they may even increase the size of the perforation. The problem can be elegantly solved by a custom made septal button, which minimizes the button's movements within the defect. With the aid of an intranasal cast, a silicone button is individually fabricated. From 1997 through 2004, 57 patients aged 19-85 years were treated by a custom made septal button. At the time of follow-up, 75% of patients still had the button in situ, and they were most satisfied with subjective all over improvement by 83% (+/-20%) on a visual analogue scale. Main symptoms improved significantly (p<0.05). Even though not all patients can be satisfactorily treated, we believe the custom made septal button to be an alternative if there are contraindications to surgery or in case of patient refusal.
Adult↗
[Antibiotic therapy in otorhinolaryngology].
First, the general principles for an antibiotic therapy are stated. The indications have to be well thought through. Frequent viral ENT infections, as well as numerous bacterial infections, should not be treated with antibiotics. Due to the current antibiotic sensitivity of the main ENT pathogens, the antibiotic choice for an empiric therapy is emphasized, and also the advantage of an optimized therapy based on the results of Gram stain (supercalculated empiric therapy) and an antibiogram (specific therapy). Pus characteristics may be the first step in diagnosing the pathogens. The degree of severity of an infection determines the oral or parenteral route of administration. As a rule, antibiotic therapy has to be checked after 2-3 days. The grouping of the different ENT infections with a similar spectrum of pathogens gives a better view of the therapeutic principles and reduces repetitions. The current recommendations for antibiotic treatment of numerous ENT infections with different degrees of severity are indicated. After the presentation of the appropriate antibiotics with their current spectrum of efficacy, the initial therapy, treatment in case of penicillin allergy, and of severe cases and complications or therapeutic failure are mentioned.
Anti-Bacterial Agents↗
[Surveillance of postoperative nosocomial infections in ENT medicine].
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Cross Infection↗
[Prion diseases].
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Clinical Trials as Topic↗
[Force-based local navigation in robot-assisted implantation bed anlage in the lateral skull base. An experimental study].
Excellent precision, miss of retiring, reproducibility are main characteristics of robots in the operating theatre. Because of these facts their use for surgery in the lateral scull base is of great interest. In recent experiments we determined process parameters for robot assisted reaming of a cochlea implant bed and for a mastoidectomy. These results suggested that optimizing parameters for thrilling with the robot is needed. Therefore we implemented a suitable reaming curve from the geometrical data of the implant and a force controlled process control for robot assisted reaming at the lateral scull base. Experiments were performed with an industrial robot on animal and human scull base specimen. Because of online force detection and feedback of sensory data the reaming with the robot was controlled. With increasing force values above a defined limit feed rates were automatically regulated. Furthermore we were able to detect contact of the thrill to dura mater by analyzing the force values. With the new computer program the desired implant bed was exactly prepared. Our examinations showed a successful reaming of an implant bed in the lateral scull base with a robot. Because of a force controlled reaming process locale navigation is possible and enables careful thrilling with a robot.
Biomechanical Phenomena↗
[Diagnosis of prion diseases].
Prion diseases are histologically characterized by a spongiform encephalopathy. The early symptoms of Creutzfeldt-Jakob disease (CJD) and variant Creutzfeldt-Jakob disease (vCJD) are unspecific. To date, the definite diagnosis can only be made by histological examination of central nervous tissue, i.e. brain biopsy or post mortem. Therefore, diagnostic tests are being elaborated that suffice with cerebrospinal fluid or blood. Unlike the sporadic form of Creutzfeldt-Jakob disease, that involves the central nervous system exclusively, in the variant of the Creutzfeldt-Jakob disease the lymphoreticular system including the tonsils is involved, too. Hence, a tonsillar biopsy can be performed instead of a brain biopsy. In particular, the diagnostic criteria of both CJD and vCJD are described.
Adult↗
[Transmission of spongiform encephalopathies (prion diseases)].
The transmissible spongiform encephalopathies (TSE), or prion diseases, constitute a form of degenerative disorders of the central nervous system, which are characterized by a typical spongiform histological pattern and a fatal course. According to Prusiner's theory, its agent consists of a protein without any nucleic acid, the "proteinaceous infectious agent", or prion. This is a pathologically folded form of the normal prion protein (PrPC), and then called PrPSc. TSE are observed in different mammals including humans. In humans, they include Creutzfeldt-Jakob disease (CJD), Gerstmann-Sträussler-Scheinker syndrome (GSS), fatal familial insomnia (FFI), Kuru and the new variant of the Creutzfeldt-Jakob disease (vCJD). The longest known TSE is scrapie in sheep. Since 1984 the bovine spongiform encephalopathy (BSE) and since 1996 the variant Creutzfeldt-Jakob disease have been documented. This paper gives an overview on the pathogenesis, epidemiology and the clinical features of the different prion diseases.
Animals↗
[Bone anchored hearing aids always bilateral!].
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Adolescent↗
[Telemedicine: interaction between clinic and general practice].
BACKGROUND: The rapid development of information and communication technologies has led to a change of many practical aspects of professional and private life. These technologies also influence interactions between hospitals and outpatient units. METHODS: This paper provides an overview over current telemedical developments with effects on interactions between in- and outpatient units. RESULTS AND CONCLUSIONS: Probably the most important application of telemedicine in Germany is not distant patient care but an improved communication structure between different health care providers. Candidates for first routine applications are electronic medical reports and teleconsultations. The widespread use of telemedicine will be accompanied by an increased standardisation in medicine.
Forecasting↗
[Squamous epithelial carcinomas of the external ear].
BACKGROUND AND OBJECTIVE: Squamous cell carcinoma of the pinna seems to be associated with a worse prognosis as compared to other locations. PATIENTS/METHODS: We studied 88 patients treated between 1975 and 1990 for a squamous cell carcinoma of the pinna. RESULTS: Lymph node metastases were present in eight cases (9%) prior to treatment. Treatment was intended to be curative in 83 patients (94%). Tumor therapy was operative in all cases. Radiotherapy was instituted postoperatively in three patients; five patients (5.7%) died due to the tumor. Of 83 curatively treated patients, only 2 died of tumor progression. The survival rate was 98% after 2 years and 95% after 5 years. The recurrence rate was 7% after 1 year, 13% after 2 years, and 18% after 5 years. The outcome with regard to local tumor control and survival was significantly poorer when neck metastases were present. CONCLUSIONS: We recommend tumor excision with wide margins (5-10 mm) as first-line treatment. Neck dissection with parotidectomy is indicated when suspicious lymph nodes are detected by ultrasound sonography, the tumor diameter is > 4 cm, cartilaginous invasion is present, and vertical tumor thickness is > 5 mm.
Adult↗
[Acinic cell carcinomas of the parotid gland. A retrospective analysis].
BACKGROUND AND OBJECTIVE: Acinic cell carcinoma of the parotid gland is a rare malignant tumor, which is generally regarded as low grade. However, rapidly fatal courses do occur. PATIENTS AND METHODS: Eighteen patients with acinic cell carcinoma were studied retrospectively who had undergone treatment between 1968 and 1997 at the University Ear, Nose, and Throat (ENT) Hospital in Homburg (Saar), Germany and between 1994 and 1997 at the Marienhospital ENT Hospital in Stuttgart, Germany. RESULTS: The distribution of the T category (UICC 1997) was as follows: T1 n = 8, T2 n = 7, T3 n = 1, and T4 n = 2). Treatment was exclusively surgical in 14 cases and a combination of surgery and postoperative radiotherapy in 4 cases. The recurrence rate according to Kaplan-Meier was 6% after 3 years and 19% after 5, 10, and 15 years. The survival rate was 87% after 3 years and 73% after 5, 10, and 15 years. None of the 12 patients with low-grade tumors according to Batsakis et al. (1979) died from the tumor, whereas survival at 5 years was only 33% for 6 high-grade tumors (p = 0.02). CONCLUSIONS: We recommend complete surgical removal of the tumor, in general by total parotidectomy. Postoperative radiotherapy may be useful in advanced high-grade tumors.
Adolescent↗
[Robotics. A new dimension in otorhinolaryngology?].
Robots have entered into many aspects of human life, including operative medicine. However, current medical robots have nothing in common with anthropomorphic robots as known in science fiction novels. We distinguish manipulators, working on a master-slave principle, from robots. Robots can be defined as "automatically controlled multitask manipulators, which are freely programmable in three or more axes." The success of robots is based on their precision, lack of fatigue, and speed of action. Potential fields of application for manipulators lie in endonasal surgery and for robots in lateral skull base surgery, including mastoidectomy and drilling a cavity for implantable hearing systems and cochlear implants. We performed a number of experiments at the department of anatomy with respect to robotic lateral skull base surgery. This paper reviews the current use of manipulators and robots in operative medicine and their potential applications in otorhinolaryngology.
Equipment Design↗
[Hyper-IgE syndrome with ENT manifestations. Overview and case report of successful therapy with high dosage i.v. immunoglobulin].
Hyperimmunoglobulin E syndrome (Hiob syndrome or Buckley syndrome) is a rare disorder of the immune system that can show characteristic manifestations in the head and neck. Typical symptoms are fever, recurrent urticarial rashes, lymphadenitis, and bacterial infections of the skin and various parenchymatous organs. Diagnosis is established by elevated serum IgE concentrations with the absence of any signs of allergy or parasitic disease. We present our clinical experiences in managing of a 29-year old woman whose hyper IgE syndrome was diagnosed initially during of the treatment of lymphatic hyperplasia of the base of the tongue although she had typical symptoms of hyper IgE syndrome for some years. High-dose intravenous immunoglobulin therapy (IVIG) was found to be well-tolerated and effective. More than one year after a single course of immunoglobin therapy symptoms markedly improved. Current knowledge and therapeutic options in hyper IgE syndrome are discussed. We recommend that IVIG be considered as one of the first choices in the treatment of hyper IgE syndrome.
Adult↗
[Hiccup].
Hiccup is defined as involuntary contractions of the diaphragm and the auxiliary respiratory muscles, mostly in irregular series, followed by glottic closure, thereby producing a typical "hiccupping" inspiration. This is a physiologic phenomenon, which already exists in utero. Hiccup is believed to be a gastrointestinal reflex; however, function and the reflex arch are hypothetical. Acute hiccup is distinguished from pathological, chronic hiccup, defined by a duration executing 48 h, or recurrent episodes. Among approximately 100 causes for hiccup, the most common are located in the gastrointestinal tract, with gastro-esophageal reflux as the most important. While the respiratory effect is generally negligible, alkalosis may ensue in tracheotomized patients due to hyperventilation. A stepwise management plan for patients with hiccup is presented. If simple physical maneuvers and causal therapy fail, or causal therapy is impossible, the treatment of choice is medical, with baclofen. Interruption of the reflex arch may be causal therapy or be considered as a last resort.
Adult↗
[Prosthetic management of craniofacial defects].
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Adult↗
[Pleomorphic parotid adenomas and their recurrence].
Even today, a wide variety of techniques are performed in parotid pleomorphic adenoma surgery, ranging from enucleation to total parotidectomy. This study reports the results of our experiences. Among a total of 587 surgically treated parotid lesions at the Homburg/Saar University ENT Department from 1968 through 1991, 205 were parotid pleomorphic adenomas. Among these, 166 patients received primary surgery at our department. Twenty-one enucleations led to 3 recurrent tumors (14%), while 108 superficial parotidectomies had 3 recurrences (2.8%). Fifteen extended superficial parotidectomies also produced 3 recurrences (20%) and 22 total parotidectomies had one recurrent case (4.5%). The overall recurrence rate was 6%, but increased to 8.3% in 5 years, 9.5% in 10 years and 12.5% in 15 years follow-up. The "true" overall recurrence rate after 10 years was estimated to be between 9.5 and 20% and that for lateral parotidectomies between 4.4 and 13%. Patients younger than 30 years of age at the time of primary surgery developed a tumor recurrence in 17% of all cases. The overall recurrence rate following secondary surgery was 13%. Clinical findings and surgical techniques for resections of pleomorphic adenomas and their recurrences are discussed. Segmental parotidectomy is the preferred treatment, but may have to be changed locally to enucleation in some cases in order to preserve the facial nerve.
Adenoma, Pleomorphic↗