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Biomedical subjects

P R Issing

Publications and source records attributed to P R Issing.

48 records · Page 3Linked to original sources
PubMed1996

[Indications for middle ear obliteration within the scope of cochlear implant management].

BACKGROUND: Cochlear implants have gained worldwide acceptance as a reliable method of rehabilitation of profoundly hearing-impaired patients. Due to thorough patient selection major postoperative complications rarely occur and are flap related in most cases. Deafness can develop during chronic suppurative otitis media, either coincidentally or secondary to the medical treatment; normally this condition is regarded as a contraindication for cochlear implantation. In cases with a mastoid cavity after surgical treatment for cholesteatoma, the electrode covered only by the epithelial lining will likely become exposed or extruded. Therefore we suggest the obliteration of the middle ear cleft with abdominal fat and the blindsac closure of the external ear canal before cochlear implantation in these conditions. PATIENTS: The average age of our 12 patients was 48 years, whereas the youngest was 2 1/2 years of age. Due to chronic inflammatory ear disease. 11 patients had a mastoid cavity on both ears. Eight patients had a cholesteatoma, the chronic bone destroying process in the temporal bone of two female patients was considered as a fibroinflammatory pseudotumor. The child had a congenital deafness in both ears with a Mondini dysplasia in CT scan. She had already developed two episodes of pneumococcal meningitis which was caused by a defect in the stapes footplate through which a liquor-filled cystic sac herniated in the middle ear. Because of a massive liquorrhoea after opening of the sac, we decided to obliterate the middle ear cleft after successful insertion of the electrode array. RESULTS: All active electrodes of 10 Nucleus implants (Cochlear) and two Clarion devices (Advanced Bionics Corp.) were successfully inserted in the cochlea of the 12 patients. After an average follow-up of 15 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 fibroinflammatory pseudotumor developed a massive inflammatory reaction in the implanted ear two months after cochlear implantation, which could not be controlled by conservative treatment. The implant had to be removed and local conditions settled after administration of immunosuppressive treatment with cyclophosphamide. The patient received a new implant seven months ago. CONCLUSIONS: Implantation of a foreign body in a potentially infected space which communicates intracranially means a surgical challenge which can be managed by obliteration of the middle ear after subtotal petrosectomy with abdominal wall fat combined with a reliable closure of the external ear canal. In case of massive inflammation we would prefer a two-stage procedure.

Adipose Tissue↗
PubMed1995

[Noninvasive evaluation of intracochlear pressure. II. Study findings in patients with Meniere's disease, fluctuating deep tone hearing and peripheral vestibular vertigo].

The tympanic membrane displacement technique (TMD) is aimed at evaluating intracochlear and intracranial pressure changes non-invasively. Therefore, the present paper describes the findings in patients with Ménière's disease where an increase in volume of the endolymphatic spaces is discussed. It should be investigated to which extent a change in the intracochlear pressure corresponds to different stages of the disease. It could be described that the intracochlear pressure does change over a certain period of persisting Ménière's, but that there is no extensive increase in intracochlear pressure between the attacks. The glycerol test as well as the acute attack (case report on one patient) are, however, characterised by distinct patterns. The same holds true for the late-stage Ménière's. It could be demonstrated that the functional patency of the cochlear aquaeduct in patients with long-term Ménière's history is reduced. This finding is surprising and should be investigated further. In essence, the TMD technique enables to better characterise Ménière patients, but it should not be a tool of routine diagnosis of the disease. In some audiological patients, it can also be beneficially applied (10).

Adolescent↗
PubMed1995

[Carcinoma of the temporal bone--current diagnostic and therapeutic aspects].

BACKGROUND: Carcinoma of the external ear canal and the middle ear is a rather rare event and is especially seen in patients with chronic inflammatory ear disease. PATIENTS: Between 1993 and 1994, we treated seven patients with such a tumor, of which six proved to be a squamous cell carcinoma and one presumably adenocarcinoma. In three patients, the malignoma developed in a radical cavity of the ear and caused a facial palsy. Only two patients were without any discharge of the ear. Beside facial palsy, hemorrhagic otorrhea and otalgia were the leading symptoms. One patient presented with a bilateral painless swelling of the neck due to lymph node metastasis. Diagnosis was made by means of biopsy in only three patients and on the basis of a resected specimen after mastoidectomy in four patients. Angiography and computed tomography and magnetic resonance imaging studies were performed prior to treatment to determine the extent of the tumor. RESULTS: The tumor was resected by petrosectomy, parotidectomy, and neck dissection in 5 patients. Three times the margins of the histological specimen were free of tumor. Lymph node metastasis in the neck were seen in 5 cases, while distant metastasis did not occur. Two patients underwent primary irradiation, but a postoperative radiation therapy was performed five times. To date, three patients died after one year follow-up. CONCLUSIONS: Carcinoma of the temporal bone is a rare tumor, which can be treated only in case of early diagnosis.

Adenocarcinoma↗
PubMed1995

[Langerhans cell histiocytosis of the temporal bone].

BACKGROUND: The localized form of the Langerhans cell histiocytosis was referred to earlier as eosinophilic granuloma, which has the best prognosis of all histiocytosis syndromes concerning survival. The non-malignant proliferative disorder of the histiocytic system is still of unknown etiology. Characteristic radiographic signs are osteolytic lesions. PATIENT: We report on an otologic manifestation of a 20-year-old man's temporal bone, which developed three years after a successful treatment of an eosinophilic granuloma of the mandible. RESULTS: Surgery and low-dose irradiation led to a complete remission of the disease. Other manifestations of the disease were not detected until now. CONCLUSIONS: In the presence of chronic aural discharge, Langerhans cell histiocytosis must bei considered in differential diagnosis and a histopathological examination should be performed.

Adult↗
PubMed1995

[Jugular vein thrombosis as incidental ultrasound finding in tumor patients].

At present thrombosis of the internal jugular vein is an uncommon event that is now more frequently associated with diagnostic or therapeutic catheterization. If an apparent spontaneous thrombosis occurs, malignancy should be considered in the differential diagnosis. Two cases of clinically asymptomatic thrombosis of the internal jugular vein are presented. A 69-year-old female patient with metastasizing renal cell carcinoma had bilateral thrombosis and a 73-year-old male with a small laryngeal carcinoma had a unilateral thrombosis. Increased blood coagulability as part of a paraneoplastic syndrome was considered to be the possible etiology. The role of sonography in the diagnosis is emphasized.

Aged↗
PubMed1994

[Primary clinical manifestation of tuberculosis as an incidental finding in the head and neck area].

Between 1988 and 1992 12 patients were seen who had findings leading subsequently to the diagnosis of tuberculosis. The average age was 50 with a range from 22 to 88 years. Women outnumbered the male by 10 to 2 cases. The number of German patients equalled that of foreign patients. Tuberculosis was mainly localised in the cervical lymph nodes in 6 cases. One patient was seen with manifestation in each case at the palate, larynx, nasopharynx, cheek, parotis and middle ear. Diagnosis was made by histology alone six times, by evidence of acid-fast rods once and by both means in 5 cases. Preoperatively a malignant neoplasm was suspected in most patients, and neither CT nor ultrasound revealed a hint to tuberculosis. Tine-test was positive in all patients. Only in 3 patients was there an evidence of acid-fast rods in sputum and gastric juice. None of them suffered from AIDS. They were treated by combination of rifampicin, ethambutol, isoniazid and partially with pyrazinamide. No relapse was observed to date.

Adult↗
PubMed1994

[A clinically relevant variation of the superior thyroid artery].

Usually the superior thyroid artery is a branch of the external carotid artery. During a functional neck dissection in order to remove a metastasis of a tongue cancer we observed a variation of the origin of the vessel that was interesting from the surgeon's point of view. The artery rose from the A. carotis communis 3.5 cm below the bifurcation of the common carotid artery. Normally in this region no vessels leave the common carotid artery and therefore the knowledge of such variations is important for the exact identification of the neck vessels during surgery to avoid a fatal mix-up with the internal carotid artery.

Arteries↗
PubMed1993

[Langerhans cell histiocytosis of the tonsil].

Langerhans cell histiocytosis (histiocytosis X) of the tonsil is a rare disorder of histiocytic proliferation with a broad spectrum of clinical symptoms. We report on a case of a solitary histiocytosis of a unilateral tonsillar palatine. To exclude a mesenchymal tumour a 32-year old male with a hyperplasia of the left tonsil underwent surgery. The histopathological examination revealed a solitary infiltration of Langerhans cells. We found a morphologically remarkable intraepithelial hyperplasia of Langerhans cells (S-100 protein positive) on contrast to the opposite side. The CT scans of the neck, thorax, abdomen and pelvis and the bone marrow puncture could not detect any further manifestation of the disease. Therefore, we refrained from systemic therapy. Up to now the patient is without any relapse of the disease for a period of 16 months.

Adult↗
PubMed1993

[Arteriovenous hemangioma of the facial nerve. Case report and review].

Hemangioma of the facial nerve is a rare cause for sensorineural hearing loss. Such was found in a 50-year-old patient with a history of slowly progressive, unilateral deafness. Pure-tone audiogram showed only residual hearing in the left ear. A stapedial reflex could not be elicited, nor could brainstem evoked potentials be recorded. Cranial CT showed a widened internal auditory meatus, while a Gadolinium MRI revealed an enhancing process of the left cerebellopontine angle. Via a translabyrinthine approach a tumor of the facial nerve was found and resected completely. Histopathologic examination demonstrated an arteriovenous hemangioma.

Cranial Nerve Neoplasms↗
PubMed1990

[Clinico-anatomical findings of the nasodental nerve].

To avoid neuralgic pain as consequence of damaging the nasodental nerve during surgical treatment of chronic maxillary sinusitis by the Caldwell-Luc-approach, the accurate knowledge of the nasodental nerve's course might be useful for the surgeon. Therefore, the anatomy of this nerve was evaluated by dissection of 23 human specimens. The nasodental nerve is the largest single branch of the infraorbital nerve's Rr. alveolares superiores anteriores. The first course of the nasodental nerve in the roof of the maxillary sinus has a (mean) length of 14 mm on the right and 16 mm on the left side. Mostly it accompanies the infraorbital nerve in the canalis infraorbitalis and leaves this common channel 4 mm on the right and 6 mm on the left behind the infraorbital foramen. The next part of the nerve, which is orientated from laterocranial to mediocaudal, is found in the front wall of the antrum Highmori and has a length of 18 mm at the right and 20 mm at the left. Next it leaves the sinus through a tiny channel at the angle between the front and the medial wall of the maxillary sinus. On the last course, the nerve runs in the lateral wall of the nose 8 mm at the right and 9 mm at the left behind the rim of the apertura piriformis.

Aged↗
PubMed1989

[Further studies of the clinical anatomy of the craniocervical region].

In this publication, some special aspects of the topography in the nuchal region were examined as anatomical support for the dorsal approach to the posterior cranial fossa. The suboccipital muscles rectus capitis posterior minor and rectus capitis lateralis were measured concerning important characteristics as for instance their length and width. The proportions of some muscles arising from the atlas and the relations of the vertebral artery to defined points were evaluated.

Cervical Vertebrae↗