Search PubMed⌕ Search

Biomedical subjects

P K Plinkert

Publications and source records attributed to P K Plinkert.

At least 19 recordsLinked to original sources
PubMed2003

[The use of disposable instruments of a high performance polymer for tonsillectomy and adenoidectomy].

Cases of the new variant Creutzfeldt-Jakob disease (vCJD) in human beings have to be anticipated in Germany. In subclinical vCJD, the accumulation of prions in lymphoid tissue has been identified prior to their manifestation in cerebral tissue. The remarkable resistance of prions to standard methods of sterilisation questions the safety of reusing metallic surgical instruments. The transmission of vCJD via such reusable surgical instruments in tonsillectomies and adenoidectomies cannot be excluded. In this study, 96 tonsillectomies and adenoidectomies were performed with disposable instruments made of a high performance polymer (Aesculap, Tuttlingen). No increase in the number of intra- or postoperative complications was evident. These disposable instruments may represent an alternative to reusable metallic surgical instruments in potentially infected patients or in patients desiring the use of disposable instruments during their operation for safety reasons.

Adenoidectomy↗
PubMed2003

[Multimodal treatment strategy for Langerhans cell histiocytosis at head and neck manifestations].

Langerhans cell histiocytosis (LCH) is a rare disorder with different clinical features. An established standardized treatment does not exist.We present a case report of a patient with localized LCH of the temporal bone and discuss the interdisciplinary treatment strategies. We reviewed the international literature and summarized the current knowledge. Beside a wait and see policy in cases without symptomatic disease, surgery, radiotherapy or chemotherapy, and combinations of these options are used as treatment modalities. While surgery or radiotherapy are preferred in localized (symptomatic) lesions, stage-adapted chemotherapeutic regimens are the treatments of choice in disseminated disease. Treatment selection depends on the individual clinical features.

Adolescent↗
PubMed2003

[Haemostatic disorders in ENT patients. Part 2: Pathophysiology, diagnostics, clinical feature and therapy].

In the first part of the medical education article on haemostatic disorders in ENT patients the basic physiology of haemostasis and main diagnostic tools were presented and discussed. The second part presents disorders of the coagulation system,thrombocyte function and blood vessels with special emphasis on clinical practice in ENT surgery. In this context, haemophilia A and B, von Willebrand disease and different forms of thrombocytopenia are of main clinical importance. Some underlying diseases such as malignomas, renal and hepatic insufficiency in combination with drug therapy (e.g.anticoagulants and thrombocyte function inhibitors) play an important role in clinical practice as well. Sepsis and haemorrhage may lead to disseminated intravascular coagulation (DIC). Beside a systematic review, important haemostatic disorders are illustrated with case reports.

Adolescent↗
PubMed2003

[Expression of members of the cadherin-/catenin-protein family in juvenile angiofibromas].

BACKGROUND: Angiofibromas are benign, but locally aggressive tumors occurring nearly exclusively in adolescent males. Pathogenesis of this fibrovascular neoplasm is still unknown. Detection of beta-catenin gene mutations and immunohistochemical localization of beta-catenin only in the nuclei of stromal cells has been proposed as evidence for the stromal cells to be the neoplastic cells in angiofibromas (Abraham et al., 2001). METHODS: Paraffin embedded tissue of 13 angiofibromas was analysed immunohistochemically for expression of E-cadherin, N-cadherin, alpha-catenin, beta-catenin and gamma-catenin. RESULTS: In all angiofibromas stromal cells showed in their cytoplasm and their nuclei strong immunoreaction for beta-catenin. In 10 out of 13 angiofibromas strong immunoreaction was also observed in endothelial cells covering the irregular lined vascular spaces. While gamma-catenin was detected in 7 out of 13 angiofibromas in the stromal cells and endothelial cells, N-cadherin was found only in the stromal cells in 8 out of 13 angiofibromas. No significant immunoreaction in angiofibromas was seen for E-cadherin and alpha-catenin. CONCLUSIONS: Proof of strong beta-catenin-expression in stromal cells and endothelial cells stress possible importance of the APC/beta-catenin-pathway in angiofibromas, but gives no certain evidence for the assumption that stromal cells may be the neoplastic cells. As beta-catenin can increase sensitivity of the androgen receptor, it may be assumed that the increased beta-catenin-expression in angiofibromas is involved in the typical growth stimulus of this tumor in adolescent males.

Adolescent↗
PubMed2003

[Malignant transformation of a tubular adenoma in the paranasal sinuses?].

BACKGROUND: Whereas a tubular adenoma is a unique finding within the paranasal sinuses, intestinal adenocarcinomas are especially in patients with long-term exposure to wood dust, common tumours in this location. CASE: In a 65 year old joiner endonasal sinus surgery performed to treat suspected chronic pansinusitis brought up by chance the histological finding of a tubular adenoma. As the patient at first refused surgical revision, but magnetic resonance imaging during follow-up revealed evidence for a space occupying lesion affecting the ethmoid and sphenoid sinuses revision surgery took place one year later. Histopathological evaluation now found a papillary adenocarcinoma. Clinical follow-up and magnetic resonance imaging one year after second surgery found no evidence for tumour recurrence. CONCLUSIONS: Progression of a tubular adenoma to an adenocarcinoma like in the adenoma-carcinoma model well known for colorectal carcinomas has so far not been observed within the paranasal sinuses. But, an adenocarcinoma already present at the time of first surgery can not be ruled out completely in the presented case as histopathological evaluation may have failed to detect an adenocarcinoma in the available specimens after first surgery. Either malignant transformation of a tubular adenoma had occurred or proof of an adenocarcinoma has failed with misdiagnosis of a tubular adenoma. A tubular adenoma as well as an adenocarcinoma require complete resection and careful clinical and radiological follow-up to avoid adenocarcinoma development from a tubular adenoma or to detect an adenocarcinoma by histological evaluation of the whole specimen.

Adenocarcinoma, Papillary↗
PubMed2002

[Hereditary telangiectasia, recurrent laryngeal nerve paralysis, tumor in the neck area. When you need the expertise of an ENT specialist].

Numerous internal diseases can express themselves in the form of ENT manifestations. Epistaxis is one of the most common emergencies seen by the ENT specialist. Possible underlying systemic etiologies may be hypertension, systemic anticoagulation or even rare entities such as hereditary hemorrhagic telangiectasia. Internal-medical conditions underlying hoarseness are usually injuries to the recurrent nerve with lesions of the thyroid gland and mediastinum being prominent. Modern electrophysiological techniques permit early prognostication of the chances of healing a vocal cord paresis. A number of surgical procedures for improving vocal problems in the treatment of irreversible paresis are available. Unclear cervical swellings prompt a wide range of possible differential diagnoses that differ dramatically in terms of both treatment and outcome. For this reason, a rational, interdisciplinary diagnostic work-up is essential. In light of the risk of delaying the diagnosis and worsening the outcome, uncritical primary sampling of such tissue must be avoided.

Diagnosis, Differential↗
PubMed2002

[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↗
PubMed2002

[Pharyngeal reconstruction after salvage pharyngolaryngectomy in recurrent tumors].

BACKGROUND: Total pharyngeal reconstruction after salvage pharyngolarynectomy in recurrent tumors after primary surgery or radiation therapy may be performed by ENT surgeons in the oncologic field. PATIENTS: We report on six patients that underwent salvage pharyngolaryngectomy and total pharyngeal reconstruction. METHODS: In three cases pharyngeal reconstruction was performed as a two-stage procedure with deltopectoral flaps. One of these patients died before the completion of reconstruction. In three other patients the reconstruction was performed with a tubed pectoralis major myocutaneous flap including one patient after a failed reconstruction with a jejunum segment. or fistula prevention we applied silicon stents in three patients and self-expanding Nitinol stents in three other patients. RESULTS: Of five successfully reconstructed patients two fed orally, one fed combined orally and via PEG and two fed via PEG. CONCLUSIONS: Summarizing our experiences the use of silicon tubes and nitinol stents has proved its worth. Experiences with a larger number of patients must be collected in the future.

Adult↗
PubMed2002

[Evaluation of the tinnitus retraining therapy as combined with a cognitive behavioral group therapy].

BACKGROUND: The study evaluates the effectiveness of a Tinnitus Retraining Therapy as combined with a cognitive behavioral group therapy. PATIENTS AND METHODS: 95 patients suffering from chronic tinnitus (mean age 49,3 years) were included. 16 of these 95 participants served as a waiting list control group. The participants were divided into 3 treatment groups. Group 1 was fitted with wideband noise generators, group 2 with hearing aids. The 3rd group was not supplied with any device. After a detailed audiological and psychological examination and tinnitus counseling all patients took part in a cognitive behavioral therapy for a period of 3 months. RESULTS: 64,5% of our patients improved significantly after the initial group therapy. In contrast, the patients of the waiting list control group showed no significant improvement. This initial treatment effect could be maintained over the period of control. We were unable to show significant advantages of noise generators as compared to cognitive behavioural group therapy alone. CONCLUSION: The Tinnitus Retraining Therapy combined with a cognitive behavioral group therapy is an effective treatment in patients with chronic tinnitus.

Acoustic Stimulation↗
PubMed2002

[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↗
PubMed2002

[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↗
PubMed2002

[Hereditary hemorrhagic telangiectasia (Osler's disease). An interdisciplinary challenge].

BACKGROUND: Hereditary hemorrhagic telangiectasia (HHT or Rendu-Osler-Weber disease) is an autosomal dominant inherited disease of the fibrovascular tissue. More than 90% of patients have recurrent nosebleeds. Therefore, ENT physicians often have a key position for diagnosis and management of the disease. Epistaxis can severely reduce the quality of life, but visceral lesions are also life threatening. METHODS: This paper provides a review of the literature about the disease, its diagnosis, preventive measures, and therapy of the different manifestations. RESULTS AND CONCLUSIONS: Physicians should be especially aware of gastrointestinal telangiectases, arteriovenous malformations (AVM) of the lungs, liver, and brain. A screening is recommended at least for pulmonary AVM.

Diagnosis, Differential↗
PubMed2002

[Aetiology of Angiofibromas: Reflection on their Specific Vascular Component].

BACKGROUND: Even though numerous theories have speculated either on the vascular or fibrous tumour component as tissue of origin, aetiology of angiofibroma still remain unclear. Histological investigations recently led Beham and coworkers to the assumption that angiofibromas have to be considered as vascular malformations. METHODS: After giving a literature review of the various theories on tumour origin the proposal to consider angiofibromas as vascular malformations is discussed on an embryological base. Taking typical clinical features of the tumour and knowledge of vasculogenesis into account a new explanation for origin of the vascular tumour component is presented. RESULTS: The vascular component of angiofibromas can be explained embryologically due to incomplete regression of the first branchial arch artery (vascular atavism). This vessel arises regularly between embryological day 22 and 24 and recedes during regular development completely until delivery via temporary formation of a vascular plexus. In the late stages of embryological development remnants of the plexus are found at the area of the sphenopalatine foramen, the typical site of angiofibroma origin. Incomplete regression of the vascular plexus of the former first branchial arch artery may form the vascular component of an angiofibroma arising due to growth stimulation at the time of adolescents. CONCLUSIONS: Incomplete regression of the first branchial arch artery presenting an atavism is suited to explain the vascular tumour component of angiofibromas considering main tumour characteristics (origin in the posterior nasal cavity close to the sphenopalatine foramen, main blood supply from the maxillary artery with possible feeders arising from the internal carotid artery). Our embryological contributions support to define angiofibromas as vascular malformations.

Adolescent↗
PubMed2002

[Influence of interaural time- and level differences on the binaural interaction components in normal adults].

BACKGROUND: Binaural interaction components of auditory brainstem responses have long been studied and its beta-wave has been shown to be correlated with directional hearing ability. As patients with auditory processing disorders such as patients with some sorts of learning disabilities frequently have difficulties with binaural processing it seems sensible to use binaural interaction components in the diagnosis of these disorders. METHODS: In order to obtain normal values and to investigate the influence of interaural time (ITD) and level differences (ILD) binaural interaction components were measured in 21 adults. Interaural time differences varied between 0 and 1.2 ms and interaural level differences between 0 and 30 dB. RESULTS: beta-latencies increased significantly as interaural time differences increased while beta-amplitudes did not change significantly. In measurements with higher interaural time differences detection of the beta-wave was only rarely possible. The effect of interaural level differences on beta-latencies was less pronounced and not significant as well as the influence of interaural level differences on beta-amplitudes. CONCLUSIONS: In the present study it could be shown that the beta-wave of the binaural interaction waveform is present in almost every normal hearing subject. As amplitudes show a considerable variation beta-latencies seem to be of higher diagnostic value than amplitudes.

Acoustic Stimulation↗