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Biomedical subjects

P R Issing

Publications and source records attributed to P R Issing.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Ultrasound evaluation of characteristics of cervical lymph nodes with special reference to color Doppler ultrasound. A contribution to differentiating reactive from metastatic lymph node involvement in the neck].

BACKGROUND: Cervical mass due to lymphadenopathy is a common cause for consultation of an ENT specialist by patients. In many cases exact differentiation without biopsy between reactive and metastatic lymphnodes is difficult but crucial and necessary for each patient. Ultrasound is the imaging system with the highest sensitivity for the evaluation of pathological lymph nodes. However, differentiating benign and malignant lesions remains a problem. PATIENTS: In a prospective study, 138 cervical lymph nodes of 62 patients were evaluated according to conventional ultrasound criteria such as size, shape, brightness, demarcation, etc., and according to parameters of color doppler sonography such as intensity and localization of perfusion. The so called Pourcelot or resistance index, an objective parameter, was measured in order to examine a possible improvement of specificity in differential diagnosis of both entities. All lymph nodes were surgically removed and histologically examined after ultrasonography. RESULTS: 133 lymph nodes were evaluated in the study. Lymphadenitis was demonstrated in 72 cases, whereas 61 of the lumps showed metastases of squamous cell carcinoma of the head and neck region. Three patients with primary malignant lymphoma were excluded from the study. The conventional ultrasound parameters such as size, homogenity, shape and brightness did not reveal any substantial difference between the two groups. However, lymph node metastases significantly showed higher Doppler signals than the reactive ones. Most of the metastases were perfused in the periphery or had a diffuse spread of blood flow. The most valuable parameter from the prognostical point of view proved to be the Pourcelot Index with a threshold value less than 0.6 for metastases, which increased the specificity to 92% with a probability of p = 0.001. CONCLUSIONS: The results of this study demonstrate an increase of the ultrasound specificity in differentiation of pathological cervical lymph nodes using color flow imaging. Unfortunately, this method does not enable the physician to correctly diagnose the findings in all patients. Therefore histological evaluation is mandatory in all doubtful cases.

Adolescent↗
PubMed1999

[Bilateral basal cell adenoma of the parotid gland and miltiple cylindromas of the skin--is there a syndromal coincidence?].

BACKGROUND: Compared to the typical carcinomas of the upper aerodigestive tract the benign tumours of the salivary glands show significant histological diversity. Therefore correct histological diagnosis might be difficult even for the pathologist. Basal cell adenoma may have a multifocal origin and can be associated with cylindromas of the skin. PATIENTS: In 17 patients with an average age of 65.8 a basal cell adenoma of a major salivary gland was diagnosed with a slight preponderance of the female sex (10:7). RESULTS: One male patient showed a bilateral basal cell adenoma of the parotid gland and simultaneously multiple cylindromas of the skin in the head and neck region. There might be a syndromal coincidence, since histology revealed similar features of the salivary gland tumours compared to the skin neoplasias. The patient's history gave hints of a familial occurrence of the dermal cylindromas. CONCLUSIONS: In rare cases a basal cell adenoma of the dermal type may be associated with cylindromas of the skin suggesting a common histogenesis. Due to possible multifocal origin and the menacing risk of malignant transformation a thorough follow-up of the patients after surgical treatment is mandatory.

Adenoma↗
PubMed1999

Adenoid cystic carcinoma of the skull base.

Adenoid cystic carcinoma (ACC) is a slowly growing tumor with a particular tendency to infiltrate the surrounding tissue by perineural spread. The clinical diagnosis may prove difficult due to the submucons extension of the tumor, especially at the skull base. This article outlines the clinical characteristics, diagnostics, and treatment modalities in a series of 56 patients with an ACC in the head and neck diagnosed between 1970 and 1998 in 32 females and 24 males. The youngest patient was aged 24 years, the oldest 77 years. The average age was 54 years. In 16 patients the tumor originated in the paranasal sinuses or the nasopharynx and involved the skull base. As a rule, several months passed between the manifestation of the first symptoms such as pain, blocked nose, epistaxis, or diplopia and the initial clinical diagnosis. All patients received surgical treatment, however, complete microscopical resection could only be achieved in approximately one third of the cases. Therefore, nine patients were postoperatively treated with radiotherapy. The average survival rates of the patients with an ACC of the skull base were only 99 months as compared to 144 months in the patients without skull base involvement.

Journal Article↗
PubMed1999

Expression pattern of the plasminogen activator-plasmin system in human cholesteatoma.

The plasminogen activator-plasmin system plays a pivotal role in the delicately regulated process of extracellular matrix remodeling. Recent studies have shown that an imbalance of proteolytic enzymes over specific inhibitors in this system may lead to an aggressive, expanding, and infiltrating cellular phenotype. As cholesteatoma resembles a tumor in many ways, we investigated the pattern of expression for members of the plasminogen activator-plasmin system in 12 human cholesteatomas, using immunohistochemistry. As controls, 3 tympanic membranes and 4 ear canal skin specimens were used. In contrast to the tympanic membranes, all cholesteatoma specimens showed a strong expression of plasminogen at the basal epithelial cell layers. In ear canal skin, only the basal surface of the most basal epithelia stained discretely positive. The urokinase-type plasminogen activator (uPA) could be detected in the basal stratum of the cholesteatoma matrix and in the surrounding granulation tissue, while tissue-type plasminogen activator (tPA) was not detectable at all. Plasminogen activator inhibitor-1 (PAI-1) was expressed in both the granulation tissue and the granular cell layer of the matrix, but not in the basal epithelial cells; PAI-2 showed a pericellular expression pattern in the subbasal and granular cell layers. Neither uPA, tPA, nor the PAIs could be detected in tympanic membrane controls; ear canal skin showed the same staining pattern as cholesteatoma only for PAI-2. Our data demonstrate that there is a clear imbalance in favor of proteolytic activity in the basal epithelial layers of the cholesteatoma matrix, which might at least partly account for the aggressive behavior of this tumorlike lesion. Further, the pattern of expression resembles the pattern described for several epithelial malignancies.

Cholesteatoma, Middle Ear↗
PubMed1998

[Otogenic brain abscess].

BACKGROUND: Otogenic complications are rare but typical following acute or chronic ear infections like mastoiditis and cholesteatoma. A life-threatening sequela is the otogenic brain abscess located in the temporal lobe or cerebellum. PATIENTS: At the ENT Department of the Medical University of Hannover/Germany we treated 8 patients suffering from otogenic brain abscesses in the temporal lobe during the last three years. The average age of the 6 male and 2 female patients was 48 years. In 5 patients the abscess developed due to a cholesteatoma with superinfection. Three cases showed acute mastoiditis. All patients were operated using an otosurgical retroauricular approach, in five cases a classical radical mastoidectomy was performed. In two cases the abscess was reached via mastoidal approach and was subsequently drained. In two other cases the abscess was drained some days later by neurosurgical approach due to increased neurological symptoms. The other patients were treated with high-dosed antibiotics under regular clinical and radiological control. RESULTS: In 7 cases complete regression of the abscess was achieved. Five patients were discharged without further otological or central-nervous problems. One female patient developed severe meningitis with generalized thrombosis of the central blood sinus system and died in central circulatory failure. Two other patients developed a moderate psychopathologic syndrome and were admitted to rehabilitation institutions. CONCLUSIONS: The analysis of our patients shows that otogenic brain abscesses should be regarded especially as a severe complication of the untreated cholesteatoma. It is important to use modern imaging modalities like computer tomography or MRI for early detection of the intracerebral lesion and to perform an early otosurgical intervention. Under antibiotics and CT control, healing of this severe complication can be achieved in most cases. However, the danger of acute and chronic ear diseases has to be kept in mind in all medical disciplines.

Adult↗
PubMed1998

Cochlear implantation in patients with chronic otitis: indications for subtotal petrosectomy and obliteration of the middle ear.

Normally, active chronic suppurative otitis media is regarded as a contraindication for cochlear implantation. In case of a radical cavity after surgical treatment for cholesteatoma, the electrode covered by the epithelial lining of the mastoid will likely become exposed or extruded. Under these circumstances we suggest the subtotal petrosectomy, obliteration of the middle ear cleft with abdominal fat, and the blindsac closure of the external ear canal before cochlear implantation.Fourteen patients with chronic otitis media were successfully implanted with an intracochlear multichannel cochlear implant. After an average follow-up of 28 months a temporary facial palsy in one patient and an insufficient closure of a retroauricular fistula over the mastoid cavity in two cases were observed as postoperative complications. One patient with a tumefactive inflammatory pseudotumor developed a massive inflammation in the implanted ear 2 months after surgery which could not be controlled by conservative treatment. The implant had to be removed and after administration of cyclophosphamide she could be successfully reimplanted 7 months later.Implantation of a foreign body in a potentially infected space which communicates with the endocranium means a surgical challenge which can be managed by obliteration of the middle ear. In case of massive inflammation we prefer a two-stage procedure.

Journal Article↗
PubMed1997

[Diagnosis and therapy of lymphoid tumors of the orbits].

For the evaluation of neoplastic orbital lesions an interdisciplinary concept is crucial and includes modern imaging techniques as well as rhinosurgical approaches to the orbit. During a 14-year period 6 primary malignant orbital lymphomas and 9 cases of orbital pseudotumors were managed at our department. In most of the cases an exophthalmus with painful swelling of the eyelids, diplopia and a loss of vision were the clinical symptoms. Imaging using CT or MRI revealed homogeneous tissue formations that could not be clearly demarcated from adjacent orbital structures. By a rhinosurgical approach a biopsy was performed of each lesion without surgical complications. Following diagnosis the localized malignant lymphomas of the orbit were irradiated. In one patient systemic spread of tumor required multi-drug chemotherapy. Two patients died as the result of the sequleae of disseminated plasmocytomas. Patients with orbital pseudotumors were treated with systemic steroids. Two patients were also irradiated. No malignant transformation of any orbital pseudotumor was observed in this series. Our experiences show that careful histological evaluation of lymphoid orbital masses is necessary for correct diagnosis, especially since this has great impact on treatment and prognosis. Depending on the localization of a lesion medial orbitotomy by a rhinosurgical approach has proven to be a safe method for performing a biopsy or extirpating tumor.

Adult↗
PubMed1997

[Unusual metastasis of hypernephroma in the maxillary sinus].

BACKGROUND: Metastases of infraclavicular malignancies to the nose and paranasal sinuses are characterized by their untypical symptoms and late clinical manifestation. Metastases of renal carcinoma on paranasal cavities may be highly vasculared and can cause profuse bleeding. PATIENT: We report a rare case of a 60-year-old man who suffered from a large metastatic hypernephroma to the right maxillary sinus. Intermittent epistaxis and pain were the first symptoms. The patient had undergone a tumor nephrectomy six months previously. The endonasal biopsy of the vascular tumor caused abundant bleeding which required surgical treatment. RESULTS: The solitary metastasis was resected by a maxillectomy with closure of the large cavity with a microvascular latissimus dorsi flap. Additionally, a conservative treatment of interleukin-2 and alpha-interferon was administered. CONCLUSIONS: In case of a solitary metastasis of a renal carcinoma, a radical resection should be considered to improve the prognosis. The possibility of extensive perfusion should be taken into account when taking a biopsy of the lesion in order to be prepared for managing bleeding.

Biopsy↗
PubMed1997

[Axillary metastases of oropharyngeal carcinoma after pectoralis major flap].

Reconstruction of defects after resection of advanced head and neck tumours with the pedicled myocutaneous pectoralis-major-flap is a well established method of regional plastic surgery. A 66 year old female patient with an oropharyngeal squamous cell carcinoma was treated by surgery and radiotherapy in curative intention. A few months later a local recurrence could be resected by a lateral pharyngotomy while the defect was reconstructed with a myocutaneous pectoralis-major-flap. Together with another local relapse at the pectoralis-major-flap in the oropharynx a painless tough swelling developed in the ipsilateral axilla which revealed histologically as a lymph node metastasis of a squamous cell carcinoma. Because no second malignoma as a source for this metastasis could be found, a lymphogenous spread of the oropharyngeal carcinoma along the pedicle of the flap could be the most probable explanation for this rare event. As a conclusion of this observation all patients with pedicled reconstructions after resection of head and neck cancer should not only be examined in the tributary lymph node levels of the neck but also in the axilla during oncological follow up.

Aged↗
PubMed1996

[Tooth discoloration as a rare complication of septorhinoplasty].

BACKGROUND: Surgeons should thoroughly consider the clinical implications of elective surgery such as septorhinoplasty for functional and cosmetic improvement of the appearance of the nose. Complications may jeopardize the intended result of this surgery. CASE REPORT: We report on the rare complication of devitalization of two incisors in the maxilla with disturbing discoloration after performing a septorhinoplasty in a 23-year-old woman. The patient underwent a serial hydrogen peroxide bleaching and a root canal procedure. CONCLUSION: The osteotomy of a huge basal crista that compromised neurovascular dental supply could be a possible mechanism of this event. Even though such a complication after septorhinoplasty is extremely rare, patients should be informed of this eventually prior to surgery, if only for legal reasons.

Adult↗
PubMed1996

[Distant metastasis of renal cell carcinomas to the head-neck area].

BACKGROUND: Metastases of hypernephroma to the head and neck, especially to the larynx, are rare occurrences. PATIENTS: We report on two cases with solitary spread in the head and neck. A 73-year-old woman who underwent nephrectomy because of a hypernephroma six years ago had a manifestation in the right false vocal cord, which was resected by laser surgery. The specimen of the strumectomy in the other patient revealed a metastasis of an asymptomatic hypernephroma to the thyroid gland and finally led to correct diagnosis of the primary tumor. RESULTS: The female patient refused any further treatment and died of cachexia with tumor dissemination four months later. The other patient is still living with a local recurrence after palliative irradiation and administration of interleukin-2 and alpha-interferon. CONCLUSIONS: In absence of other tumor manifestations, choosing an adequate therapy can be difficult because of the long survival rates in some patients even after hematogenous spread and the unpredictable behavior of this malignancy.

Aged↗
PubMed1996

[Ionomer cement in cochlear implant surgery--applications and long-term outcome].

Over the last ten years about 850 cochlear implant operations were performed at the ENT department of Hannover Medizinische Hochschule. In most cases, intracochlear nucleus implants were used. For about two years the intracochlear Clarion device has also been used in 150 adults and children. For several years we have used ionomeric cement (lonocap, supplied by lonos, Seefeld/Germany) to fix the electrode array in the region of the posterior wall and the facial recess. Previously, the implant package was fixed by ionomeric cement. To evaluate the outcome of cement application, we conducted a prospective study of our implant patients during the period from 1991 to 1993. During regular reexamination over a period of two years postoperatively in 244 patients (122 male and 122 female patients, average age 17.6 years), we did not observe any complication related to the cement. Nearly all revision cases (n = 8) showed a stable contact between electrode array, bone, and cement. With increasing experience, we reduced the cement application and fixed the package with vicryl sutures in a precisely drilled bony bed. Contact of the cement with neural and cerebral structures should be avoided. In our experience ionomeric cement is a helpful tool in cochlear implant surgery with long-term stability and no rejection reactions.

Adolescent↗
PubMed1996

[Reconstructive surgery in the head-neck area with regional and free tissue transfer].

BACKGROUND: Operative treatment of head and neck cancer requires radical resection of the tumor with not only severe impairment of important functions like swallowing speech, and respiration but also aesthetic mutilation because of the exposed character of the head and neck region. Therefore the rehabilitation from a functional and cosmetic standpoint is an essential goal of treatment in addition to control of the malignant disease. Fortunately regional plastic surgery offers a variety of options for reconstruction of the defects to receive a solution tailored to each individual patient. PATIENTS: Between the years 1986 and 1996, 107 patients with advanced head and neck cancer were treated surgically by radical resection of the tumor and plastic reconstruction. In this study we made a retrospective analysis of the functional and aesthetic outcome of the techniques of reconstructive surgery we used for rehabilitation. The sex ratio was 79 males to 28 females. Average age was 59.4 years (ranging from 39 to 78 years). Most of the patients suffered from squamous cell carcinoma of the upper digestive tract (97 cases). The others included an adenocarcinoma of the paranasal sinuses (three cases), adenoid cystic cancer of the palate (two cases), squamous cell carcinoma of the temporal bone (two cases), two deep infiltrating basaliomas in the area of the nose and forehead and one chondrosarcoma of the neck. Our oncological concept includes a radical resection of the tumor and a onestep reconstruction of the defect, if the patient's general condition enables this approach. The surgical techniques we used include the approved pedicled myocutaneous flaps like the pectoralis major flap, latissimus dorsi flap (which can be also applied as a free microvascular tissue graft), temporalis muscle flap, and the free radial forearm flap. RESULTS: In previous years, the pedicled myocutaneous pectoralis-major- and latissimus-dorsi-flaps were used for reconstruction (n = 67), but the arc of rotation and the huge bulk of the graft are limiting factors for the indication of these techniques. The free forearm flap has increasingly been used to provide an excellent closure of large pharyngeal defects (n = 16), whereas the temporalis flap is useful for restoration after limited resection of the palate (n = 18). Beside these rather invasive procedures, aesthetic rehabilitation may be achieved with bone-anchored epithesis especially after exenteration of the orbit and ablation of the external ear in case of elderly patients with multiple morbidities (n = 5). In most cases, sufficient rehabilitation from the anatomical and functional point of view was possible even after large tumor resections. A main problem can be longstanding aspiration after resection of large areas of the pharyngeal mucosa (n = 8). Complications included eight cases of necrosis of the flaps and seven patients who developed significant seromas at the donor site. CONCLUSIONS: The potential of modern regional reconstructive surgery enables the surgeon to achieve anatomically and functionally rehabilitation in a one-step procedure in most cases, even after extended resection for head and neck cancer. One should be aware of the fact that these techniques do not offer a significant improvement of prognosis. As such, the aggressiveness of surgical therapy should remain in reasonable relation to the prognosis of the malignant disease.

Adenocarcinoma↗