Biomedical subjects
Publications and source records attributed to V Jahnke.
Polysomnography measurements were performed before and 8 weeks after surgery (UPPP). Most of the cases showed a decrease in the number and duration of apnoea phases. Oxygen saturation increases.
The symptom dysphagia is defined and an interdisciplinary team approach emphasized. A step like diagnostic approach in oropharyngeal dysphagia is described, including transnasal pharyngo-laryngo-fiber endoscopy, videofluoroscopy and the "modified barium swallow." First, all of the organic changes causing oropharyngeal dysphagia must be recognized, both "typical ENT diseases" and malignant tumors of the oropharynx and hypopharynx, which are usually diagnosed only at an advanced stage. Of particular interest is postoperative dysphagia with or without aspiration. If there is no evidence of an organic cause in the field of otorhinolaryngology, in making a differential diagnosis dysfunction of the upper esophageal sphincter and a "globus pharyngis" have to be ruled out.
The matrix of the spiral limbus is obviously a special form of the intercellular substance. In the present study, the rat's spiral limbus was investigated by electron microscopy after fixation with ruthenium red and tannic acid and immunofluorescence to demonstrate matrix components. Collagen types I, II, V, VI, VII, IX and XI and fibronectin were not observed. Collagen type II and cartilage-specific proteoglycans, however, occurred in large quantities. The basal lamina of interdental cells and inner sulcus cells did not contain any collagen type IV, while the basal lamina of the capillaries had only minor amounts. Laminin and nidogen appeared in large amounts in the basal lamina. After fixation with tannic acid, the matrix between the interdental cells and the capillaries contained 20- to 22-nm-thick single and irregularly running fibrils as well as plaques of a fine granular material. After fixation with ruthenium red, 30- to 60-nm-thick, electron-dense granules occurred and most probably consisted of proteoglycans. These findings indicate that the composition of the matrix of the spiral limbus is similar to that of cartilage but not identical.
Aural polyps or granulation tissue, though usually due to infection, may represent a neoplasm, the most frequent malignant tumour in childhood being rhabdomyosarcoma. We report a 9-year-old boy from whom an aural polyp was removed 4 years ago, with the histological diagnosis of a botryoid (alveolar type) rhabdomyosarcoma. Surgery and chemotherapy with cyclophosphamide, vincristine, adriamycin and actinomycin D were followed by a local recurrence 2 years later. This was treated by chemotherapy and irradiation with 50 Gy; the child has now been free of disease for 2 years. Rhabdomyosarcoma of the ear has a considerably improved cure rate with newer treatments if the diagnosis is made early by biopsy.
In recent years several tachykinins have been identified in the airway sensory nerves. Since the physiological and pathophysiological effects of neuropeptides depend on their functionally relevant concentrations and presence of specific receptors in the target tissue, specimens of enlarged turbinates and nasal polyps were removed in 11 patients and examined for the presence of vasoactive intestinal peptide (VIP) receptors. An intensive color reaction was observed in the cytoplasm of the tubular mucosa cells in polyps and turbinates as well as in the epithelium and submucosal glands. Since both these tissues reacted with VIP receptor antibody, noncross-reacting antibody against dendritic reticular cells (DRC 6-B7), nonspecific binding is possible, however it also must be speculated that the unspecific binding is overlaying specific binding. In addition a large number of cells located diffusely or in close association in the subepithelium and interstitial tissue stained only with VIP-specific antibody, indicating specific receptor binding. The color reaction is limited to the cell membrane and the cytoplasm of these cells was clearly eosinophilic. These cells were located in close proximity of the blood vessels, very indicative for active migration. Since VIP-positive nerves are also located near the blood vessels an activation process of these cells with subsequent release of enzymes and other active proteins is possible, thus influencing the inflammatory response.
We report three patients with metastases to the ENT-region mimicking a primary malignant tumour. A 36-year-old woman presented with vertigo, sudden hearing loss, partial facial palsy and headaches. CT scan suggested a meningioma or an acoustic neuroma. Histological examination of the neoplasm removed surgically showed a metastasis from an amelanotic melanoma. A 38-year-old woman with nodules in the tongue had dysphagia. The history revealed that she had been treated successfully with chemotherapy for a carcinoma of the uterine cervix one year ago. Histological examination of a tongue biopsy showed a metastasis from the uterine carcinoma. The primary tumour was in complete remission. The third patient was treated for recurrent epistaxis. Physical examination showed a tumour in the right nasal cavity. A CT scan showed a tumour of the ethmoid cells and of the maxillary sinus, protruding into the nose. Histology and immunohistology proved a metastasis from a primary carcinoma of the liver. Ultrasound and CT scan of the liver confirmed the diagnosis.
The prevalence of dysphagia in the elderly ("presbyphagia") is probably still underestimated, though this disorder represents a major geriatric problem; special attention is necessary to prevent malnutrition, dehydration and aspiration pneumonia. Primary presbyphagia due to physiological, age-related changes of the swallowing mechanism must be differentiated from secondary presbyphagia attributable to diseases which are more frequent in the elderly. Transnasal pharyngo-laryngo-fiberendoscopy, videofluoroscopy and the "modified barium swallow" are of particular value in the diagnostic approach to presbyphagia. The possibilities of treatment are limited. They are aimed at dietary adjustments, compensatory mechanisms based on the properties of the volume and consistency of the food, proper feeding position and help by other persons. Individual swallowing exercises by a speech therapist are particularly valuable. Surgical procedures for the treatment of underlying organic disorders are less often indicated in presbyphagia.
Technique and results of the first 10 free jejunal grafts after pharyngolaryngectomy are presented. End-to-side venous anastomosis and end-to-side pharyngojejunostomy instead of end-to-end techniques are proposed. Hospital mortality was 0 and as minor complications 1 uncomplicated fistula of the proximal and 1 stenosis of the distal anastomosis along with 1 wound infection were seen. There were no vascular complications and no graft loss. All patients were able to swallow and to eat thus an excellent quality of life was achieved.
The diagnostic procedure for the symptom oropharyngeal dysphagia is described from an otorhinolaryngologic point of view, with emphasis on an interdisciplinary team approach. The various methods used in modern otorhinolaryngology both by the practitioner and the clinician are discussed with regard to a step-like diagnostic approach. The diagnosis should be made on the basis of aetiology, anatomy and function. First all organic changes causing oropharyngeal dysphagia must be recognized, both "typical ENT diseases" and malignant tumors of the oropharynx and hypopharynx which are usually diagnosed only in an advanced stage. If there is no evidence of an organic cause in the field of otorhinolaryngology, as a differential diagnosis a dysfunction of the upper esophageal sphincter and a "globus pharyngus" have to be ruled out.
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Cavernous haemangioma of the paranasal sinuses is very rare. We describe the X-ray and CT findings in a case of cavernous haemangioma which originated from the mucous membrane of the maxillary sinus and eroded the bony boundary of the sinus.
A new diagnostic imaging is presented which demonstrates the blood flow in addition to the usual ultrasonic image. Motion pictures show both the direction of the blood flow in different colours and the speed in variable intensity of the colour. Thus vessels of only 0.5 mm diameter may be identified. In otorhinolaryngology, the vascular supply of space-occupying lesions can be determined quantitatively in a noninvasive way. Lymphomas may be differentiated from vascular tumours and malformations. Preoperatively, vessels adjacent to the tumour may be identified. This method is particularly useful in the evaluation of thyroid and salivary gland disorders.
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Surgery for cancer of the tongue and floor of the mouth has become more varied and generally more conservative, influenced by advances in oncology and modern reconstructive methods. Combined therapy is favored, with postoperative irradiation and sometimes adjunctive chemotherapy, using cis-platinum. T1 carcinomas of the tongue and floor of the mouth can be treated with either wide local excision or irradiation alone, but surgery is the preferred method. T2-T4 tumors treated by resection combined with radiation therapy promise the best results. The indications and principles of the most important operative procedures are discussed: local excision; partial and total glossectomy; excision of the floor of the mouth with marginal mandibular resection; composite resection. Mandible sparing operations such as a modification of the "pull through" technique described by Stell or temporary splitting of the mandible are oncologically safe in many cases. A radical neck dissection is indicated in each carcinoma of the tongue or floor of the mouth with palpable lymph nodes. If no nodes are palpable, an elective neck dissection appears justified in view of the high frequency of clinically occult lymph node metastases. Reconstructive measures following radical tongue and floor of the mouth operations are required for regaining mobility of the remaining tongue, for reconstruction of the floor of the mouth and for replacement of the mandible. For immediate reconstruction, the most frequently used technique is the pectoralis major myocutaneous flap which has largely replaced the previously employed local and regional flaps. A significant problem remains with mandibular reconstruction.
In rhinology, electron microscopy has been a useful research tool for the past 15 years, but provided only a few direct clinical applications. In this review, the author's work on the human nasal mucosa and the studies of other investigators are discussed, with the emphasis on allergic reactions and disturbances of the autonomous nervous system as well as the immotile cilia syndrome.
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The lack of mucociliary transport causes chronic inflammations in the upper and lower respiratory tract and in the middle ear mucosa. The mucosa of 4 female patients with Kartagener's syndrome was studied by means of TEM (transmission electron microscopy) and SEM (scanning electron microscopy) and compared with the fine structure of normal cilia which were also found in these areas. All specimens studied showed, to a different extent, alterations in the fine structure of the axonemata, especially the absence or malformed ATP-ase dynein arms, the lack of spokes and/or the misarrangement of microtubuli within the cilia. The importance of this congenital anomaly - "immotile cilia" - is discussed with the trias of Kartagener's syndrome.
The fundamental morphologic aspects of acute and chronic allergic reactions, as well as endonasal polyps in allergic patients and disturbances of the autonomic nervous system were studied by means of electron microscopy. Characteristic changes are described which differ according to the stage of the allergic reactions; they are discussed in relation to the altered function of the allergic nasal mucosa.