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Biomedical subjects

Thomas Verse

Publications and source records attributed to Thomas Verse.

At least 19 recordsLinked to original sources
PubMed2007

Prevalence of ocular manifestations in hereditary hemorrhagic telangiectasia.

BACKGROUND: Hereditary hemorrhagic telangiectasia (HHT) is a systemic disorder of the fibrovascular tissue. Few data have been published on the frequency of ophthalmologic manifestations. The aim of this study was to assess this frequency. METHODS: A prospective observational cross-sectional study was conducted in a multitude of clinical practices and in a tertiary referral center. The main outcome measure was the number of vascular malformations detected by an ophthalmologic inspection of the retina and the conjunctivae in both eyes in a random sample of patients with HHT. RESULTS: No retinal telangiectases were observed in any of the 75 patients (150 eyes) examined. Conjunctival telangiectases were detected in 28 of 74 patients (47 of 148 eyes). CONCLUSIONS: The prevalence of retinal telangiectases seems to be lower than 1/75 (< 1.3%). This data does not justify screening procedures to detect retinal telangiectases. Ophthalmologists should be aware of the symptoms of HHT and its systemic character.

Adult↗
PubMed2006

Multilevel surgery for obstructive sleep apnea: short-term results.

OBJECTIVE: To determine the efficacy of a new multilevel surgical protocol for obstructive sleep apnea (OSA). STUDY DESIGN AND SETTING: Sixty patients with moderate to severe OSA because of multilevel pharyngeal obstruction were enrolled into this prospective, controlled clinical trial after clinical examination, endoscopy, and polysomnography. Surgery included uvulaflap, tonsillectomy, hyoid suspension, and radiofrequency treatment of the tongue base (group A). A second group did not receive hyoid suspension (group B). In both groups, nasal surgery was performed if necessary. Polysomnography and Epworth Sleepines Scale (ESS) were recorded at baseline and 2 to 15 months after surgery. RESULTS: In group A, the mean apnea-hypopnea index (AHI) decreased significantly after surgery (38.9 +/- 20.0 vs 20.7 +/- 20.6, P < 0.0001), whereas in group B the AHI did not. All secondary variables (minimal oxygen saturation, mean oxygen saturation, arousal index), and the ESS significantly improved in group A with only changes in arousal index and ESS reaching levels of significance in group B. CONCLUSION: The presented protocol including the hyoid suspension proved to be effective in the treatment of OSA, whereas surgery without hyoid suspension was less successful. EBM RATING: B-2b.

Adult↗
PubMed2005

Management of radiation-induced tracheocutaneous tissue defects by transplantation of an ear cartilage graft and deltopectoral flap.

Patients suffering from head and neck cancer often require temporary tracheostomy during therapy. The tracheostomy can usually be closed when postoperative swelling decreases and swallowing ability recovers. However, some patients, especially after adjuvant radiotherapy, may develop severe chronic wounds resulting in persistent tracheocutaneous fistula. Local wound care and plastic reconstruction strategies are required in such cases. We present two patients with head and neck cancer treated with primary surgical regimen including temporary tracheostomy and adjuvant radiotherapy. Both patients developed a persistent, poorly healing wound with persistent tracheocutaneous tissue defect. After local debridement and wound care, the peristomal necrotic tissue was excised down to the level of the trachea. The defect of the anterior tracheal wall was closed with a autogenous ear cartilage graft. The graft was harvested from the cavum conchae and sutured to the tracheal defect. The soft tissue defect was covered by transposition of a well-vascularized, fasciocutaneous deltopectoral flap. In both cases, the flaps healed satisfactorily. The donor defect was closed primarily. Complications were not observed in these two cases. A flexible tracheo-bronchoscopy showed no stenosis of the trachea at the site of cartilage graft transplantation. In conclusion, treatment of persistent radiated tracheocutaneous defects by cartilage graft and deltopectoral flap turned out to be a safe and reliable procedure which can be performed as a one-stage method with low morbidity at the donor site.

Cutaneous Fistula↗
PubMed2005

Volumetric tissue reduction in radiofrequency surgery of the tongue base.

OBJECTIVES: Radiofrequency surgery is a minimally invasive technique for the treatment of the tongue base in sleep-disordered breathing. The aim of this study was to evaluate the changes in upper airway anatomy induced by radiofrequency surgery with MRI. STUDY DESIGN AND SETTING: 10 patients with sleep-disordered breathing were treated with radiofrequency surgery at tongue base. MRI measurements were performed before and after surgery with the help of a recently published protocol. RESULTS: The mean total number of energy delivered per patient was 4750 +/- 1641 Joule. Relevant changes could be observed neither for tongue volume or dimension nor for retrolingual space. CONCLUSIONS: Changes in upper airway anatomy could not be demonstrated. The effects of radiofrequency surgery of the tongue base may more likely be a result of changes in upper airway collapsibility. SIGNIFICANCE: Functional effects of surgical interventions in sleep-disordered breathing should be considered in addition to mechanistic concepts alone.

Adult↗
PubMed2005

Palatal implants for primary snoring: short-term results of a new minimally invasive surgical technique.

OBJECTIVE: To determine the safety and efficacy of a new soft palate implant procedure for the reduction of snoring. STUDY DESIGN AND SETTING: Fifteen healthy patients with primary snoring due to palatal flutter were enrolled into this prospective study after clinical and endoscopic examination and polysomnography. The average age of the patients was 41.2 +/- 8.6 years with a body mass index of 26.2 +/- 2.5 kg/m2. The Anti-Snoring Device consists of a delivery tool with a cylindrical implant of braided polyester filaments. Under local anesthesia, three implants intended for permanent implantation were placed into the soft palate. Snoring-related symptoms were assessed by visual analogue scales (VAS), polysomnography, and the SNAP system at baseline and 90 days postoperatively. RESULTS: All implants were placed without complications. Only minor discomfort was reported in four cases within the first three days postprocedure. At the 90-day follow-up snoring was reduced from 7.3 +/- 1.6 to 2.5 +/- 2.1 (VAS, P < 0.01) and from 347 +/- 239 to 264 +/- 168 snoring sounds/hour (SNAP, P > 0.05). Polysomnography did not show any deterioration of sleep or breathing. Speech, swallowing, and taste were unchanged. CONCLUSION: The Anti-Snoring Device is a new surgical tool offering a simple and minimally invasive procedure. Our data demonstrate that the treatment is safe and effective with good patient acceptance. Further patient follow-ups are needed to evaluate the long-term results.

Adult↗
PubMed2005

Anatomic changes after hyoid suspension for obstructive sleep apnea: an MRI study.

OBJECTIVE: To assess the effects of isolated hyoid suspension on subjective and objective parameters of obstructive sleep apnea and to evaluate changes in upper airway anatomy with the help of standardized magnetic resonance imaging. STUDY DESIGN AND SETTING: Fifteen patients received isolated hyoid suspension. Changes in respiratory disturbance index were assessed with polysomnography, and anatomical changes with standardized magnetic resonance imaging. Snoring, daytime sleepiness, and functional parameters were assessed with questionnaires. Lateral x-ray cephalometry was performed preoperatively. RESULTS: Mean respiratory disturbance index was reduced from 35.2 +/- 19.1 to 27.4 +/- 26.2. Forty percent of the patients were classified as responders. Daytime sleepiness improved significantly. Relevant changes in upper airway anatomy could not be detected. There were no remarkable differences between responders and nonresponders in regard to imaging. CONCLUSIONS: Hyoid suspension is effective only in a subgroup of patients and does not lead to relevant changes in airway diameters in the awake patient. Magnetic resonance imaging and x-ray cephalometry do not add additional information for patient selection. SIGNIFICANCE: The reported clinical effects of hyoid suspension are more likely due to functional changes in airway collapsibility than to an enlargement of the upper airway.

Adult↗
PubMed2005

Long-term results of palatal implants for primary snoring.

OBJECTIVE: To determine the safety and efficacy of the Pillar Palatal Implant System over a 1-year follow-up period. STUDY DESIGN AND SETTING: In this prospective study, 40 healthy adult patients with primary snoring due to palatal flutter were treated after clinical, polysomnographic, and endoscopic examination. Under local anesthesia 3 implants were placed into the soft palate. Postoperative morbidity and functional parameters were assessed. Snoring and daytime sleepiness were assessed before and 90, 180, and 360 days after surgery. Objective data were obtained by polysomnography and SNAP-recording before and 90 days after treatment. RESULTS: All implants were placed without complications. A total of 13 implants partially extruded uneventfully in 10 patients. Functional parameters remained unchanged. After 1 year, snoring was reduced from 7.1 +/- 1.9 to 4.8 +/- 2.5 (Visual-Analogue-Scale, P < 0.05) and daytime sleepiness from 6.1 +/- 3.2 to 4.9 +/- 3.1 (Epworth-Sleepiness-Scale, P < 0.05). SNAP data and polysomnography parameters showed clinically irrelevant changes. CONCLUSION: Our data demonstrate a significant decrease in snoring and daytime sleepiness over a period of one year.

Adult↗
PubMed2005

In vitro analysis of matrix proteins and growth factors in dedifferentiating human chondrocytes for tissue-engineered cartilage.

CONCLUSIONS: With ongoing culture and dedifferentiation of chondrocytes, significant changes in the expression patterns of various collagens and the insulin-like growth factor (IGF) receptor were detected. The latter could play an important role in the differentiation of human chondrocytes. OBJECTIVE: Tissue engineering represents a promising method for the construction of autologous chondrogenic grafts for reconstructive surgery. So far, little is known about the expression of markers for cell proliferation and differentiation in cultured chondrocytes. MATERIAL AND METHODS: Human chondrocytes were isolated from septal cartilage (n=5) and held in primary cell culture. Cells were harvested after 24 h and 6 days. Proliferation was analyzed using an Alamar Blue assay. The differentiation of the cells was investigated using bright field microscopy, the expression patterns of various proteins using immunohistochemistry and the expression of distinct genes using a microarray technique. RESULTS: The chondrocytes showed strong proliferation (Day 0: 16.7+/-0.7 fluorescent units; Day 5: 52.4+/-2.2 fluorescent units) from the third day of cell culture in medium without growth factors. From this point onwards, a dedifferentiation of the chondrocytes could be observed. In cell culture, the chondrocytes expressed collagen 1 and 10 without expression of collagen 3. After 6 days of cell culture, they expressed collagen 2. The chondrocytes showed constant low expression of the fibroblast growth factor-2 receptor, but constant high expression of vascular endothelial growth factor, matrix metalloproteinase (MMP)2 and MMP9. The cells never expressed the epidermal growth factor receptor. The proportion of IGF receptor-expressing cells diminished significantly during cell culture.

Cartilage↗
PubMed2005

Radiofrequency surgery of the soft palate in the treatment of snoring. A placebo-controlled trial.

STUDY OBJECTIVES: Recent publications have demonstrated a reduction in snoring with radiofrequency (RF) surgery of the soft palate. Yet so far, all published data has been based on non-controlled trials. DESIGN: Aim of this study was to assess the efficacy of RF surgery of the soft palate in a randomized, placebo-controlled trial. SETTING: Outpatients department at university hospital, department of otorhinolaryngology. PATIENTS: 26 patients with primary snoring (AHI < 15, BMI < 35). INTERVENTIONS: Patients were treated with temperature-controlled RF surgery of the soft palate under local anesthesia. In accord with a randomization protocol they received 2 sessions of RF surgery (total amount of energy: 3.300 Joule) or placebo (insertion of device needle without energy delivery). MEASUREMENTS AND RESULTS: Snoring was evaluated by the bed partner with 10 cm visual analogue scales. 23 patients completed the study; 12 received RF-surgery and 11 received placebo. Snoring scores did not change in the placebo group (8.4 +/- 1.6 to 8.0 +/- 2.3) while improving in the RF-group (8.1 +/- 1.3 to 5.2 +/- 2.4). The difference between the groups was statistically significant (p < 0.05). CONCLUSION: RF-surgery was significantly better than placebo, although the reduction in snoring was only moderate in our group of patients. This study underlines the necessity for well-controlled clinical trials in the treatment of snoring.

Adult↗
PubMed2004

Radiofrequency surgery of the soft palate in the treatment of snoring: a review of the literature.

STUDY OBJECTIVES: Radiofrequency surgery of the soft palate presents a promising alternative for the treatment of snoring. The aim of this study was to give an overview of the current literature and to quantify the results in terms of a meta-analysis of treatment efficacy. METHODS: Current databases were searched for publications concerning the treatment of snoring with radiofrequency surgery up to January 2003. Only original articles published in peer-reviewed journals were taken into consideration. RESULTS: The review is based on 22 publications, mostly consisting of prospective noncontrolled clinical trials. Snoring was assessed with the help of visual analogue scales or snoring scores provided by the bed partner. In all these trials, a significant reduction of snoring was reported. Postoperative morbidity was low, but complication rates differed substantially. CONCLUSIONS: According to all of the published material, radiofrequency surgery of the soft palate leads to a significant reduction of subjective snoring, and snoring is reduced to a tolerable level. Nevertheless, these findings will have to be confirmed by controlled clinical trials.

Humans↗
PubMed2004

Antimicrobial safety of a preservative-free nasal multiple-dose drug administration system.

Recent technical developments in metered-dose pumps allow preservative-free nasal drug application with multiple-dose systems, avoiding the cytotoxic and allergic problems of preservatives. The use of the 3K System as a representative of those systems is demonstrated as microbiologically safe and without risk for the user and for the product during shelf life, under challenge up to 24 weeks, as well as under worst-case conditions with heavy bacterial contamination on the outlet surface. Therefore, the authors assess preservative-free pump systems as the new gold standard for mucosal drug application.

Administration, Intranasal↗
PubMed2004

Changes in daytime sleepiness, quality of life, and objective sleep patterns in seasonal allergic rhinitis: a controlled clinical trial.

BACKGROUND: It has long been assumed that allergic rhinitis leads to daytime sleepiness and a deterioration of nocturnal sleep, yet systematic studies have only been rarely conducted in this field. OBJECTIVE: The aim of the present study was to investigate the effects of seasonal allergic rhinitis on subjective and objective sleep patterns, quality of life, and daytime sleepiness in otherwise healthy subjects in comparison with nonallergic volunteers. METHODS: Twenty-five patients with seasonal allergic rhinitis and 25 healthy volunteers were enrolled in this prospective, controlled clinical trial. Daytime sleepiness and quality of life were assessed with the help of questionnaires (Epworth Sleepiness Scale, SF-36); 2 consecutive nights of fully attended polysomnography were performed before and during the pollen season of 2002. RESULTS: Statistically significant differences between groups were found in respect to changes in daytime sleepiness and selected parameters of quality of life. Impairment of daytime sleepiness and quality of life were related to the severity of the disease. Statistically significant differences were also found for selected parameters of the sleep studies, although the changes were only minimal, and all values were within normal ranges. CONCLUSION: Seasonal allergic rhinitis leads to increased daytime sleepiness, as well as to an impairment of quality of life, depending on the severity of the disease. Objective measurements revealed a statistically significant influence of seasonal allergic rhinitis on selected sleep parameters, but changes were not of clinical relevance. Daytime sleepiness seems to be related to the condition itself rather than to an impairment of nocturnal sleep.

Adult↗
PubMed2004

Combined radiofrequency surgery of the tongue base and soft palate in obstructive sleep apnoea.

OBJECTIVE: To investigate the safety and efficacy of combined temperature-controlled radiofrequency volumetric tissue reduction of the tongue base and soft palate in obstructive sleep apnoea. MATERIAL AND METHODS: A total of 20 patients with obstructive sleep apnoea and combined palatal and retrolingual obstruction were included in a non-randomized clinical trial and 51 combined treatments were performed under local anaesthesia. Postoperative pain was assessed using visual analogue scales. Functional parameters, daytime sleepiness and quality of life were assessed using questionnaires (Epworth Sleepiness Scale, Short Form-36) before and 12 weeks after the last treatment session. Concurrently, polysomnography was performed on two consecutive nights. Results The mean postoperative pain score dropped from 5.6 at Day 1 to 0.6 at Day 7. Painkillers were taken for a mean of 3.3 days. There were no postoperative complications or changes in functional parameters. Daytime sleepiness improved significantly (p<0.05). The mean respiratory disturbance index was reduced from 25.3+/-11.4 to 16.7+/-15.3 (p<0.05). Six out of 18 (33%) patients were cured after a mean of 2.7 treatment sessions. CONCLUSION: Combined radiofrequency volumetric tissue reduction of the tongue base and soft palate is a safe and effective treatment for obstructive sleep apnoea.

Body Mass Index↗
PubMed2004

Reconstruction of anterior nasal septum: back-to-back autogenous ear cartilage graft.

OBJECTIVES/HYPOTHESIS: The ideal material for reconstructing the nasal septum in the deficient nose has not been found. Since 1986, the authors have used autogenous cartilage from the cavum conchae to successfully correct the anterior septum and the associated cartilaginous saddle. The long-term results in 26 patients with a destroyed septum and a saddle nose are reported. STUDY DESIGN: Retrospective study. METHODS: The mean age of the patients at surgery was 40.2 years, and the mean number of previous nasal procedures was 1.6. Because 11 patients had septal perforations and insufficient septal cartilage or bone, ear cartilage grafts from the cavum conchae were harvested through an anterolateral approach. A special incision was used to divide the concave ear cartilage while preserving the posterior perichondrium. This produced a stable, balanced back-to-back graft. The graft was 2.5 to 3 cm long, long enough to allow reconstruction of the anterior septum and to correct part of the saddle nose deformity. The rest of the conchal cartilage was used to fill the remaining cartilaginous saddle. Follow-up investigations included photographs and visual analogue scales of the patients' symptoms and satisfaction. RESULTS: After a mean interval of 36.7 +/- 22.3 months, the back-to-back grafts showed no macroscopic signs of resorption. Graft position and shape remained intact after transplantation. All noses were adequately projected and mobile. All patients but one were satisfied with the functional and esthetic result. With a score of 4 representing the level of satisfaction as "very good," the mean score of the patients was 3.2 +/- 0.79. The saddle of the nose completely disappeared in 65.4% of patients, was minimally visible in 23.1%, and was slightly present in 11.5%. Nasal breathing improved considerably in 21 patients, remained the same in 4 patients, and worsened in 1 patient. The mean score of all patients for nasal breathing was 7.3 +/- 1.87 on a visual analogue scale of 0 to 10, with 10 representing satisfaction as "very good". CONCLUSION: The back-to-back autogenous ear cartilage graft is a viable, stable, and balanced graft for functional and aesthetic reconstruction of the anterior nasal septum and cartilaginous saddle deformity in patients with a severely traumatized and deficient septum.

Adolescent↗
PubMed2004

Novel approaches to primary snoring.

Snoring is a widespread disorder, mostly affecting middle-aged men. Snoring is not harmful in itself, but may lead to social impairment. Therefore, snorers often seek for medical advice and effective treatment. Sleep studies are mandatory especially when surgical procedures are intended. Due to the lack of reliable objective snoring analysis, the evaluation by the bed partners is the most relevant criteria in estimating treatment success. Body weight and behaviour patterns are crucial in the treatment of snoring. Furthermore, oral appliances and other implements may be beneficial. Various kinds of surgical procedures are available, soft palate techniques being the most widespread. Minimally invasive procedures are safe and effective in the majority of patients. Temperature controlled radiofrequency tissue ablation offers much potential in the treatment of primary snoring. Furthermore, a system is currently being developed which is supposed to stabilise the soft palate with the help of implants.

Humans↗
PubMed2004

Expression of collagen and fiber-associated proteins in human septal cartilage during in vitro dedifferentiation.

Chondrocytes surrounded by extracellular matrix are responsible for the maintenance of the cartilage as a functional entity. It is well accepted that chondrocytes cultivated for tissue engineering dedifferentiate in cell culture. We characterized the expression of different collagens and collagen related proteins in differentiated (primary) and cultured nasal chondrocytes by using microarray gene expression analysis and immunohistochemical staining. The genes for collagen subunits 1alpha1 (Col1alpha1) and 1alpha2 (Col1alpha2) were activated during a cell culture period of 5 and 20 days whereas Col2alpha1 could be detected both in differentiated and dedifferentiated chondrocytes. The long-term cell culture revealed a late activation of the Col3alpha1, Col4alpha1 and Col11alpha1 genes as well as biglycan, fibromodulin and lumican. In addition, short- and long-term cell culture resulted in down-regulation of Col9alpha1, Col9alpha2, Col9alpha3, Col10alpha1, Col18alpha1, ColQ and chondroadherin. The decorin gene showed up-regulation in short-term cell culture, but down-regulation in long-term culture. Immunohistochemical staining of the different cell populations confirmed the mRNA data for collagen type 1, 2, 3, 4, 9alpha2, 9alpha3, 18 and decorin. Because of their up-regulation in cultured chrondrocytes the collagen types 1, 3, 4 and 11 as well as biglycan, fibromodulin and lumican may be markers for dedifferentiation. The collagen types 9, 18 and Q as well as decorin and chondro-adherin revealed down-regulation and, presumably, represent markers for the differentiation of chondrocytes.

Biglycan↗
PubMed2003

Recent developments in the treatment of obstructive sleep apnea.

Modern sleep medicine has been in existence for only 20 years and therefore has to be regarded as a comparatively recent field of specialization. For this reason it is not surprising that there are numerous new trends and developments concerning the treatment of sleep-related breathing disorders. This review focuses on developments in the treatment of obstructive sleep apnea (OSA) over the last 5 years.The review is based on a Medline bibliographic search using the key words 'treatment', 'obstructive sleep apnea' and 'sleep-related breathing disorders' and covers papers published since 1997, including references in these articles. In respect to conservative treatments the following important developments were found. Oral devices were shown to be effective in about 50-70% of patients with OSA, but at this stage it is not possible to predict in which patients successful treatment can be expected. As subjective compliance averages only about 50%, thermoplastic devices used as trial devices provide a reasonable alternative to reduce costs. Automatic continuous positive airway pressure (CPAP) units have been shown to cut costs when used for pressure titration in severe sleep apneics during the day or when used in so-called split-night procedures in appropriate cases. Nasal CPAP has proven to be effective in children, showing higher compliance rates than in adults. The development of mouth-pieces provides the possibility of using CPAP orally, e.g. after nasal surgery. Electrical stimulation of the tongue muscles shows promising preliminary results. Nevertheless, further research in this field is necessary. In the field of surgery, the most valuable development has been tissue reduction using radiofrequency energy, which has been shown to be effective and minimally invasive. Other fundamentally new surgical techniques have not been attempted within the last 5 years; instead, development in this area appears to be defined by a combination of previously known methods (so-called multilevel surgery) and optimized methods of patient selection. Such combined surgical procedures has achieved success rates of about 70%. Taking all these developments into account, CPAP therapy remains the gold standard for treatment of patients with OSA; yet the low long-term compliance rates of 60-70% have to be regarded as a major challenge warranting further effort.

Adolescent↗