Biomedical subjects
Publications and source records attributed to R Chilla.
The concentration of beta-adrenergic receptors was determined in rat and human parotid glands, in normal tissue as well as after sympathetic denervation of the rat, and in human sialadenosis. Receptor levels were clearly elevated after denervation of the rat and in sialadenosis. The possible implications of these findings for the etiology of human sialadenosis are discussed.
Protein and amylase content as well as the distribution of isoamylases were determined in the parotid and the submandibular glands of the rat following treatment with tolbutamide for 3-21 days. Significant changes were only observed in the submandibular glands in which, compared with the controls, the amylase activity decreased distinctly after 3 days but had increased 7-fold after 21 days of tolbutamide. These findings could be explained by secretion of epinephrine from the adrenal medulla supposed to take place independently of the effect of insulin and by the possible inhibition of a protein kinase involved in the process of protein secretion from the submandibular gland.
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The facial musculature of the rat was denervated by cutting the facial nerve. Over a period of 41 days no facial movements were observed. Acetylcholine receptor concentrations, determined by [125I]-alpha-bungarotoxin binding, increased sharply in the early stage of denervation (at day 10) and were still significantly higher than in the controls after 41 days. When cutting of the facial nerve was followed by immediate nerve repair (primary suture), facial movements returned on about day 16. The receptor concentrations reflected changes monitored by clinical observations. At day 10, when denervation of the facial muscles was still complete, receptor concentrations corresponded to those found in the permanently denervated muscles. At day 16 the reinnervated muscles of half the animals displayed muscle activity and had receptor concentrations identical to those found for normal (control) tissue. The other half of the animals, with no muscular activity detectable, had receptor concentrations as high as in permanently denervated tissue. After 23 days the receptor concentrations had essentially decreased to control levels and all rats had regained complete facial function.
The occurrence of adenoid cystic carcinomas of the parotid gland is relatively uncommon. From 1964-1974, we performed surgery on 20 patients with such tumors. In these patients, the course of the disease was characterized by local recurrences, the formation of hematogeneous metastases, and long survival times. We have found that patient prognosis is distinctly influenced by the histological type of the neoplasm. Thus, the tubular form has a much better prognosis than the cribriform or the solid types of tumors. On the basis of the "determinate survival rate" of our patients, we were unable to demonstrate a definite positive effect of either radical surgery or radiation therapy on the course of the disease.
Sialadenosis is a noninflammatory disease of the salivary glands of the head. It is observed in connection with endocrine disorders, malnutrition and neurologic diseases. The parotid glands are predominantly affected by a parenchymatous swelling. Based on morphologic and biochemical investigations it can be assumed that disorders of the gland's acinar protein secretion are responsible for sialadenosis. Changes in secretory behavior are caused by either excessive stimulation ('stimulatory proteodyschylia') or by inhibition of secretion ('inhibitory proteodyschylia'). The origin of these secretory disorders is very likely to be found in the vegetative nerve system. The pathophysiology of sialadenosis can therefore only be understood after elucidation of the physiologic mechanisms of salivary gland secretion. Research in the field of biophysical and biochemical principles underlying parotid secretion has made considerable progress in recent years. A comprehensive review of this new evidence is necessary for the understanding of experimental studies on the pathogenesis of sialadenosis.
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32 patients with malignant tumors of the oropharynx were treated by cryosurgery from 1973 to 1980. The majority of cases were inoperable patients (due to poor general condition) or inoperable tumors. Cryosurgery was applied nearly exclusively in combination with radiotherapy, often also combined with conventional surgical procedures. Even though the results are difficult to interpret owing to this combination of different forms of therapy, it becomes apparent that cryosurgery was unable to improve the prognosis of carcinomas of the oropharynx and that application of cryosurgery to these tumors is of doubtful palliative value.
In patients with unilateral facial nerve paresis the parotid reflex secretions of both sides were measured and chemically analyzed to investigate whether an alteration of composition and volume of parotid secretion could be demonstrated in facial nerve paresis, i.e., whether a functional influence of the facial nerve on the parotid gland could be recognized. Flow rate as well as protein and alpha-amylase concentrations were determined in the parotid secretions. A highly significant decrease of flow rates (ml/min) was observed on the paretic side whereas no differences could be found in the concentrations of protein and amylase. These results can be explained by assuming intratemporal anastomoses between the facial and glossopharyngeal nerves. An additional analysis by topodiagnostic criteria makes it likely that this anastomosing takes place only distal to the geniculate ganglion.
Histological re-examination of 64 adenoid cystic carcinomata showed that 15 of them were different tumours, mainly adenocarcinomata. The remaining 40 adenoid cystic carcinomata were solid in 6 cases, cribriform in 24 cases and tubular in 14 cases. No precise classification was possible in 5 cases of adenoid cystic carcinoma. Uncontrollable factors important for the prognosis of adenoid cystic carcinomata included the histological type and the site of the tumour: major salivary glands (28 cases), area of paranasal sinuses (11 cases) and minor salivary glands (10 cases). Adenoid cystic carcinomata of tubular type or situated in minor salivary glands had a relatively favourable prognosis related to survival rate, 'state of health' and tendency to recurrence. Controllable factors exerted a favourable influence on the commonly poor prognosis of adenoid cystic carcinomata. They included an early diagnosis and, because of the tendency to recurrence, radical surgery and radiotherapy. The poor long-term prognosis of this tumour was due to a tendency to local recurrence (80% of cases) and mainly haematogenous metastasis (37% of cases). Lymphogenous metastasis was less frequent (6% of cases).
The classical type of Wegener's granulomatosis encompasses a necrotizing granulomatous vasculitis of the upper and lower respiratory tracts and a necrotizing glomerulonephritis. As a rule, an initial involvement of the upper respiratory system in the nasal mucosa and paranasal sinuses is found. The terms "granuloma gangraenescens" and "midline disease" are frequently used at this stage of the disease. However, they should be abandoned and "Wegener's granuloma" preferred instead. A limited form of Wegener's granulomatosis has been described with pulmonary involvement which progresses without renal involvement. However, confinement of the disease to the upper respiratory system remains a controversial matter.
Cryosurgery of the larynx is still in a state of development. In the treatment of laryngeal papillomas cryosurgery has been quite successful. The use of cryosurgery in laryngo-hypopharyngeal carcinoma and in laryngeal stenosis is so far restricted to special indications (old age, risk patients). A combination of cryosurgery with telecobalt irradiation has proved valuable in the managemenmt of tumors. After the basic physics of laser radiation are explained, the principle mechanisms of interaction between the CO2-laser and human tissue are mentioned. This is followed by the description of the different indications for laser surgery in the larynx. A chordectomy and the opening of a subglottic stenosis with the laser beam are described and documented with photographs. Finally there is an outlook to an eventually broader spectrum of indications for laser surgery in the ENT-field.
Between 1969 and 1976, middle ear cholesteatomas were removed from 570 patients at the ENT Department of the University of Göttingen. 405 of these patients were examined for a determination of the rate of recurrent cholesteatomas and postoperative hearing function. 223 had radical ear operations or "open technique," while 182 had preservation of the posterior auditory canal wall (or "closed technique"). The rate of recurrent cholesteatomas in the "closed technique" patients was twice as high (30%) as in the "open technique" patients (15%). On the other hand, satisfactory improvement of hearing was almost twice as great in those patients in whom the posterior bony canal wall was preserved, even when radical surgery was combined with tympanoplasty.
A case of lingual nerve paresis following tonsillectomy is reported. As in all sensory disorders, assessment can be limited by the lack of objective procedures available. However, with lingual nerve involvement, electromyographic recording of trigemino-facial reflexes can be useful in determining causes of injury.
The parotid saliva test was evaluated in 31 patients with chronic pancreatitis proven by the secretin-pancreozymin test and failed to detect pancreatic insufficiency in the majority of the cases. According to this result the test cannot be recommended as a screening test for chronic pancreatitis.
Cryosurgery of the larynx is still in the stage of development. In the treatment of laryngeal papillomas cryosurgery has been quite successful. The use of cryosurgery in laryngo-hypopharyngeal carcinoma and in laryngeal stenosis is still restricted to special indications (old age, risk patients). A combination of cryosurgery and telecobalt irradiation has proven valuable in the management of tumors. After the basic physics of laser radiation are explained, the principle mechanisms of interaction between the CO2 laser on human tissue are mentioned. This is followed by the description of the different indications for laser surgery in the larynx. A chordectomy and the opening of a subglottic stenosis with the laser beam are described and documented with photographs. Finally, there is an outlook to an eventually broader spectrum of indications for laser surgery in the field of ent.
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An infraglottic atresia of the larynx with normally developed vocal cords necessitated postnatally an emergency tracheotomy after intubation attempts had failed. Laryngeal atresia is a very rare malformation. As in our example, it is in most cases accompanied by a tracheo-hypopharyngeal fistula which has to be interpreted ontogenetically. The survival chances of the newborn with this malformation are generally very poor.