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Biomedical subjects

T Brusis

Publications and source records attributed to T Brusis.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Determination of hearing loss and disability assessment from pure tone audiometry and speech audiometry in occupational noise-induced hearing loss].

BACKGROUND: Occupational hearing loss is the most accepted occupational disease. The assessment should be conducted in accordance with the "Königsteiner Merkblatt" which appeared in the fourth completely revised edition in 1996. Determination of degree of disability is mainly based on speech audiometry. Adapted complete word understanding is most important. In special cases only sinus-tone audiometry is used for the assessment. Knowledge about common and uncommon schedules is important for the assessment. METHODS AND PATIENTS: The results of 200 audio metrical examinations in case of professional hearing loss have been evaluated with eight different schedules. Four of these schedules for determination of hearing loss are based on sinus tone audiometry. Boenninghaus and Röser's schedule uses speech audiometry under consideration of simple and adapted complete word understanding. Lehnhardt's schedule uses sinus-tone and speech audiometry for determination of degree of disability. Further on it is shown that the complete word understanding is the most important parameter for the quantitative determination of permanent noise induced hearing loss. It is even possible to determine the degree of disablement only using the complete word understanding. For all cases, the eight schedules were used to calculate the average hearing loss and the average degree of disability. Further on it was shown in how many cases-according to each schedule-a degree of disability of less than 10%, 10 to 15%, 20%, and more than 20% was calculated. RESULTS AND CONCLUSION: Comparing these eight schedules, it was shown that the use of adaptec complete word understanding increases the number of cases with 10% and 20% degree of disability. Using Röser's schedule of 1980, the number of minimal handicap increases. With the new "Königsteiner Merkblatt" a 10% degree of disability is reached more easily than it was previously.

Audiometry, Pure-Tone↗
PubMed1996

[Suprahyoid pharyngotomy for surgical therapy of malignant and benign oral and hypopharyngeal tumors].

Many cases of oropharyngeal and hypopharyngeal neoplasms without diffuse infiltration of the larynx or mandible cannot be treated effectively by a transoral approach. In such cases a lateral and/or median translingual pharyngotomy can permit effective surgical therapy. However, these surgical techniques require greater effort and violate uninvolved tissues, such as the lip, mandible and floor of the mouth. In contrast to this, a suprahyoid pharyngotomy can be a simple and precise approach to the oropharynx and hypopharynx, and provide the shortest distance to the pathological process. The excellent exposure given to the oropharynx and hypopharynx offers a more exacting macroscopic identification of tumor margins and minimizes possible injuries to vital neurovascular structures. The wound created can usually be closed primarily without the need for regional flaps. These factors allow a faster healing of the wound and better rehabilitation, as well as avoiding delays in postoperative radiation therapy. Over the past 6 years a suprahyoid pharyngotomy was performed in eight patients. Five patients underwent resections of an oropharyngeal cancer while three patients required resections of benign neoplasms of the tongue base. In the cases of oropharyngeal cancer, a suprahyoid pharyngotomy was performed in combination with a unilateral or bilateral neck dissection. A tracheotomy was required in six patients. Three patients underwent postoperative radiation therapy. No locoregional recurrences were found in these patients, with a median follow-up of 20.8 months.

Adenocarcinoma↗
PubMed1995

[Expert assessment within the scope of the sudden deafness disease picture].

Claims for medical liability mostly arise when a patient believes that his sudden deafness was not accurately diagnosed, diagnosed too late or insufficiently or was not well treated. Guided by seven expert opinions potential problems in indemnity were depicted. A clear misdiagnosis of sudden hearing loss (e.g., a hearing loss taken for eustachian tube disorder) will lead to an accusation of malpractice if the doctor cannot prove an accurate otological examination and appropriate diagnostic studies. The burden of proof lies with the doctor. A further consequence of a missed diagnosis is a delay in treatment. In the literature the good prognostic factor of early treatment has been stressed but without delineating a clearcut line between "in time" and "too late". An accusation of malpractice by insufficient treatment (pills instead of infusions) has risen. Since an unequivocal treatment is not established and various modalities of therapy are still controversial, disputes could be settled more easily. The validity of "no treatment" may be considered but requires accurate diagnosis and the patient must give informed consent. Such a procedure is justifiable, even from an ethical standpoint, when the patient fully understands and agrees.

Adult↗
PubMed1994

[Brain damage after tonsillectomy?].

We report on a 47-year old male patient who developed persistent postoperational bleeding after tonsillectomy, which made tamponading of the pharynx necessary. Even though the patient left the hospital after one week with a haemoglobin value of 10.6 g% and without any complaints, he developed personality changes and later severe neurological symptoms which led to the diagnosis of hypoxic brain damage as suggested by a variety of neurologists and psychiatrists. The diagnosis was finally disproved by a brain biopsy revealing the existence of Jakob-Creutzfeldt disease, a degenerative inflammatory disease due to a slow virus infection. By this final diagnosis the reproach of a maltreatment could be ruled out. The accidental coincidence of the tonsillectomy and the beginning of the Jakob-Creutzfeldt disease had led to the incorrect diagnosis of an operation-caused brain damage. A relation to the tonsillectomy could be ruled out by an extensive neurological examination using every possible diagnostic aid including brain biopsy.

Brain↗
PubMed1993

[Jatho stoma reconstruction--cannula-free, self-anchored tracheostomy in laryngectomy patients].

Since 1987 we are using a tracheostoma construction technique proposed by Jatho in 1976. A vertical incision is made in the anterior wall of the trachea. A triangular skin flap is interdigitated into the slit. The slit is additionally held open by a thread on each side of the trachea which leads through the periods of the subclavial bone and from there through the skin. 34 patients, who were operated on according to this technique were followed up during a period between 3 and 43 months. None of them needed a cannula to keep the stoma open. Four of these patients underwent a revision procedure analogue to that one described above. These results are compared to the results from conventional stomal construction and various stoma plasty techniques found in literature.

Follow-Up Studies↗
PubMed1993

[Pharyngeal tuberculosis as a differential diagnosis to carcinoma].

The differential diagnosis of pharyngeal tumors includes malignomas as well as chronic inflammatory processes. Squamous cell carcinoma is the most prevalent malignoma of the pharynx, representing about 90% of all malignomas of the head and neck. Malignant lymphomas, lymphoepithelial tumors (Schmincke's tumor) and anaplastic carcinomas are less prevalent. Amelanotic melanoma, rhabdomyosarcoma and extramedullary plasmocytoma are rare malignomas of the pharynx. Infectious diseases may also be a cause of pharyngeal tumors which have been reported to be associated with mycobacterial infections, syphilis, leproma, malleus and anthrax. Sarcoidosis and Wegener's granulomatosis are chronic inflammatory diseases of unknown etiology. We report a case of a 65-year-old female with an 11-year history of a slowly progressing tumor of the nasopharynx who had been admitted to hospital with suspicion of a malignoma.

Aged↗
PubMed1992

[Intralesional therapy with natural interferon-beta in refractory squamous epithelial cancers of the ENT area].

It has been the aim of the present investigation to study the effect of intratumorally applied human fibroblast interferon (nIFN-beta; Fiblaferon 5 for the first two weeks, and Fiblaferon 3 three times a week) in a phase-II clinical trial of thirteen patients with advanced head and neck squamous cell carcinomas. All of the patients had failed established therapeutic modalities before and could not be treated by conventional procedures. nIFN-beta was injected intratumorally and its effect on tumour size was assessed by an independent, second observer as well as via CT and MR imaging. All assessments were done prior to treatment, 8 weeks after beginning treatment and at 16 weeks. Three female and ten male patients with primary tumours of the hypopharynx (n = 5), the larynx (n = 4), the oropharynx (n = 1), the glandula submandibularis (n = 1), the oral cavity (n = 1) and the oesophagus (n = 1) have undergone outpatient treatment three times a week. Tumour size showed no change in six patients while progressive disease occurred in seven cases after eight weeks of treatment. Radiological findings did not change in the nine patients continuing treatment while five showed progressive disease. There were no serious local or systemic side effects due to the intratumoral nIFN-beta treatment. The survival time was 9.73 months after the onset of nIFN-beta treatment.

Adult↗
PubMed1992

Hearing loss as a sequel of lumbar puncture.

Only a few case reports have been published about hearing impairment following lumbar puncture, and not all were thoroughly documented by audiograms. We present nine cases of hearing loss following myelography, lumbar puncture, and spinal anesthesia. We speculate that this rare complication arises only in persons with a wholly or partially patent cochlear aqueduct, and occurs via the release of perilymphatic fluid in the cerebrospinal space. Hearing loss was seen in eight of the nine patients in the lower frequencies, and in six of the nine patients on both sides. Recovery to normal hearing was noticed in six of the nine patients. Transient hearing loss may occur more often than it is generally assumed, and the symptom can remain unnoticed. Since not all of these hearing losses proved to be fully reversible, we suggest informing patients about this complication for medicolegal reasons.

Adult↗
PubMed1991

[History of esophagoscopy].

Since the middle of the 19th century very many experts have endeavoured to develop the oesophagoscopy following two different principles of oesophagus examination. Some tried to transfer the technique of indirect laryngoscopy on the oesophagus by using a larynx speculum. In order to achieve an insight into the oesophagus they separated its closed upper end by means of special retracting instruments. Various instruments were developed for this purpose (by Voltolini, Semeleder, Stoerk, Bevan, Waldenburg, Mackenzie) which however not proved to be effective. Mostly angled or jointed tubes came into use which were stretched after insertion. More successful were those applying simple straight tubes. Except for Stoerk it was Kussmaul who had a sword-swallower swallow a tube instead of a sword. Today flexible fiberglass endoscopes are used as well as rigid tubes.

Esophagoscopy↗
PubMed1991

[Results of follow-up after uvulopalatopharyngoplasty].

200 of 300 patients who were operated on because of strident snoring or of a sleep apnoea syndrom were examined in a follow-up study. In 93.5% turbinectomy was performed simultaneously, in 50% septum plasty, and in 9.5% endonasal revision of the sinus. On Improvement of snoring was noted in 81.5% of the patients, cessation or improvement of the apnoea in 83%. Daily tiredness was reduced in 65% of the operated patients, and partner problems were solved in 78%. Recommendation for operation was given in 75.5% of the cases. Due postoperative complaints and the lack of results, however, 21.5% could not, and 3% restricted their recommendation to others to undergo surgery. The satisfactory results and the high acceptance of the operation confirmed uvulopalatopharyngoplasty as a solid and efficient operation to help patients suffering from an obstructive sleep apnoea syndrome. If the operation is performed carefully and cautiously, there is no fear of negative consequences such as rhinophonia and difficulties in swallowing.

Aged↗
PubMed1991

[Hearing disorders following spinal anesthesia].

In the few case reports of hearing loss following spinal anesthesia, complete recovery of the hearing impairment has always been described. In nine cases with hearing loss following not only spinal anesthesia but also myelography and dural puncture, the hearing of three patients did not recover or only partly returned. Two cases went to court for malpractice. Their suits could be dismissed because it appears likely that this rare complication arises only in persons with a wholly or partially unobliterated aquaeductus cochleae due to loss of perilymphatic fluid into the cerebrospinal space. Hearing loss was seen in eight of nine patients in lower frequencies around 30-40 dB. In six patients there was impairment on both sides. Recovery of normal hearing occurred in six of the nine patients. Transient hearing loss may occur more often than is generally assumed, and the symptom may remain unnoticed when a severe post-dural puncture syndrome with headache, dizziness, and nausea dominates the attention of the patient. Not all cases of hearing loss proved to be fully reversible, but the individual risk for this complication is not predictable. The use of fine-gauge needles may reduce the leakage of cerebrospinal fluid through the dural puncture and thus lower the incidence.

Adult↗
PubMed1990

[Hypoglossal nerve paralysis following tonsillectomy].

Lesions of the lingual nerve and the glossopharyngeal nerve following tonsillectomy are rare but can be expected because of their anatomical course. What is extremely rare is a lesion of the hypoglossal nerve, whose course behind the carotid artery protects it from direct injury. The few cases described in the literature are thought to have been caused by inflammatory processes. It became necessary to look for other causes when, after a regular tonsillectomy, a hypoglossal palsy became evident in the absence of any inflammation. In an experiment, it was possible to demonstrate that both the insertion of a spatula and of an intubation spatula caused a strain of the hypoglossal nerve when the spatulas were inserted in the lateral lingual region. The nerve was distended by as much as 1.3 cm. The more the head was reclined, the more the nerve was distended. It would seem probable that this extension of the hypoglossal nerve causes its palsy following tonsillectomy.

Adult↗
PubMed1990

[History of surgical interventions in the paranasal sinuses].

Hippocratices was the first to describe lesions that obstruct the nasal passages. Andreas Vesalius described the maxillary, frontal, and sphenoid sinuses. Mikulicz, Lothrop and Claoué are considered to have been the first to perform inferior meatal antrostomy of the maxillary sinus. Siebenmann was apparently the first to recommend suprameatal antrostomy in the middle meatus, which is now fashionable again. Grünwald, Hajek, Killian, Halle and Uffenorde developed endonasal ethmoid surgery to an established procedure.

Endoscopy↗
PubMed1990

[Inner ear hearing loss following cerebrospinal fluid puncture: a too little appreciated complication?].

Lumbar puncture for myelography, spinal anaesthesia and aspiration of cerebrospinal fluid is a very common procedure. Although it has been known for a long time that hearing impairment may be a late complication, only a few case reports have been published, and not all have included audiograms. We present nine cases of hearing loss following myelography, lumbar puncture and spinal anaesthesia. It appears likely that this rare complication arises only in subjects with a wholly or partially patent cochlear aqueduct, allowing loss of perilymphatic fluid into the cerebrospinal space. Hearing loss was seen in eight of nine patients in the lower frequencies and in six of nine patients on both sides. Hearing recovered in six of nine patients. Transient hearing loss may occur more often than is generally assumed, and the symptom can remain unnoticed. Since not all of these hearing losses proved to be fully reversible, we suggest to inform patients about this complication for medico-legal reasons.

Adult↗