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Biomedical subjects

W Stoll

Publications and source records attributed to W Stoll.

At least 19 recordsLinked to original sources
PubMed2001

[Voice change and laryngeal obstruction caused by a median thyroglossal duct cyst].

Thyroglossal duct cysts are common primary neck tumors, resulting from remnants of the ductus thyroglossus. They can occur at any point along the migratory path of the thyroid gland anlage until the 2nd or 3rd decade of life. The usual symptoms leading to the diagnosis are painless midline neck masses orfistulas. Despite their close proximity, the cysts normally do not affect the larynx. We report on the eighth case mentioned in the world literature of a thyroglossal duct cyst invading the larynx in a 62-year-old patient. Preoperatively, the voice of the patient sounded metallic, and the frequency of the voice field was reduced. Postoperatively, the voice onset was physiological, and the voice increased by an octave in the higher frequencies. The intonation of the voice was steady. The analysis of formants of the vowels "a" and "i" showed that the fourth formant of the vowel "i" was lower in frequency postoperatively.

Follow-Up Studies↗
PubMed2001

[Oncocytic neoplasms of the parotid gland. Differential diagnosis, clinical course and review of the literature].

BACKGROUND AND OBJECTIVE: Oncocytic neoplasms of the salivary glands are rare. PATIENTS/METHODS: We report on seven cases of oncocytic neoplasms of the parotid gland (one multifocal nodular oncocytic hyperplasia, five oncocytomas, and one oncocytic carcinoma). RESULTS: While the history, clinical presentation, and histology of all oncocytic neoplasms showed no characteristic differences, intraoperatively the well-differentiated oncocytic carcinoma displayed an infiltrative, locally aggressive growth pattern. A local carcinoma recurring 7 years later corresponded to the primary tumor. There were no metastases. Immunohistochemistry revealed that all oncocytic neoplasms were positive for markers of cytokeratins (KI-1) and negative for markers of carcinoembryonal antigen (CEA), S-100 protein, and smooth muscle actin (SMA). In contrast to the benign neoplasms, the oncocytic carcinoma showed an increased rate of proliferating cells (MIB-1) and a strongly positive reaction with the antibody MA-903 against high molecular weight cytokeratins. CONCLUSIONS: In a review of the literature, we could identify a group of locally aggressive, low-grade oncocytic carcinomas with a considerably better prognosis, similar to that of our case. The therapeutic significance of these findings is discussed.

Adenoma, Oxyphilic↗
PubMed2001

[Differential perilymph fistula diagnosis].

If sudden unilateral deafness accompanied by vertigo and spontaneous nystagmus on the afflicted side occurs during birth, a perilymph fistula with rupture of the round window membrane caused by pressure has to be considered. A 35-year-old pregnant patient was presented with the aforementioned symptoms on the day she gave birth to triplets. During examination, surditas and a paranasal hyposensitivity were found on the right side. Furthermore, a spontaneous nystagmus on the affected side occurred which was not suppressed by fixation. The nystagmus was apparent as a direction-fixed gaze nystagmus. Saccades during smooth pursuit testing as well as a lack of the auriculofacial reflex during contralateral stimulation of the deaf ear could be observed. Magnetic resonance imaging (MRI) of the skull revealed a fresh hemorrhagic cavernoma of the cerebellar pedunculi. This rare lesion caused a nerve compression of the fifth and eighth cranial nerve due to perifocal edema. Neurosurgical intervention was not necessary because of subsequent spontaneous resorption of the lesions and abatement of the deafness within a few days.

Adult↗
PubMed2001

Cortical reorganization in patients with high frequency cochlear hearing loss.

Animal research has shown that tonotopic representation in the auditory cortex is not statically fixed in the adult organism but can be altered after deafferentation. The present study examines the plasticity of the human auditory cortex in patients with high frequency cochlear hearing loss by means of magnetoencephalographic measurements. The data show that the cortical map can reorganize such that cortical neurons deprived of their usual most sensitive afferent input now respond to tone frequencies adjacent to the frequency range of the partial hearing loss. The results suggest that deafferentation due to cochlear damage in adults may lead to functional reorganization of auditory cortical structures.

Acoustic Stimulation↗
PubMed2001

[Extended indications for decompression of the optic nerve: a differentiating analysis of restriction of the visual function, also in comatose patients].

BACKGROUND: The care of indirect traumatic optic neuropathy is still treated differently. Special diagnostic and therapeutic difficulties exist in comatose patients without definable visual acuity and in patients with complex failure of the visual field with central visual acuity still receiving sufficiently. METHOD: The total collective of optic nerve decompressions within the period between January 1992 and August 2000 was comprised of 66 patients. 18 of these 66 patients (average age: 40.5 years) were comatose and required critical care. 3 of the 48 consciousness-clear patients showed post-traumatically different defects of the visual field with a visual acuity of 0.3, 0.4 and 1.0. The indication for surgical decompression in both groups was based on the ophthalmological findings and the CT-finding of traumatization of the optic nerve, or the orbit apex respectively. RESULTS: During the subsequent postoperative examinations (on average 12.3 months postoperatively) five patients within the group of the unconscious patients showed a normal visual acuity (0.9-1.0), 3 patients a visual acuity of 0.7, 0.4 and 0.3 and one a visual acuity of 0.1. Six patients remained amaurotic. Three patients died from the general consequences of injury. Improvement of visual field and correction of stereoscopic function occurred in all patients, operated on primarily because of the described visual defects. CONCLUSIONS: Due to these results the indication for the decompression of the optic nerve should find special consideration in comatose patients and in cases of severe restriction of the visual field.

Accidental Falls↗
PubMed2001

[Is the rigid hypopharyngo-esophagoscopy for suspected foreign body impaction still up to date?].

BACKGROUND: The increasing use of flexible esophagoscopes leads to controversies regarding the current status of rigid hypopharyngo-esophagoscopy in case of suspected foreign body impaction. METHODS: In a retrospective investigation we analyzed 309 open tube hypopharyngo-esophagoscopies performed for suspected foreign body impaction. RESULTS: In 108 patients (35.0 %) a foreign body was detected endoscopically. 69 Patients (22.3 %) had other pathologic findings within the upper digestive tract. 72 % of the foreign bodies and 83 % of the pathologic findings were localized within the hypopharynx or the cervical esophagus. CONCLUSIONS: The superior diagnostic and therapeutic properties of the classical rigid endoscopy in this area underlines its still actual status in patients with suspected foreign body impaction.

Adolescent↗
PubMed2001

Optic nerve decompression in the comatose and conscious patients after trauma.

OBJECTIVE: To investigate the efficacy of early optic nerve decompression in comatose and conscious patients with indirect traumatic optic neuropathy. STUDY DESIGN: Retrospective analysis of 65 optic nerve decompressions. METHODS: The total collective of optic nerve decompressions comprised 65 patients treated within the period between February 1987 and December 1998. Thirteen of these 65 patients (average age, 32 y) were comatose and required critical care treatment, so visual acuity could not be measured. The indication for surgical decompression in all patients was based on the ophthalmological examination and the finding on computed tomography (CT) scan of a lesion inside the optic nerve canal or the orbit apex, respectively. RESULTS: In the comatose patients the time interval between trauma and surgery was 16.1+/-12.1 hours (mean +/- standard deviation). During the subsequent postoperative examinations (on average, 12.3 mo postoperatively) five patients showed a normal visual acuity (20/20), two patients a visual acuity of 20/30 and 20/50, and one a visual acuity of 20/200. Three patients (three eyes) remained amaurotic. Two patients died of the general and severe consequences of injury. The beneficial visual acuity results achieved within the group of comatose patients were equivalent to those achieved within the group of patients who were conscious during the preoperative examination. The success rate, defined as an improvement of three lines with a final visual acuity of at least 20/1000, was 57.7% versus 61.5%. CONCLUSION: The results confirm our concept of early decompression of the optic nerve, based on close interdisciplinary cooperation and the ophthalmological findings.

Adolescent↗
PubMed2000

[Kinetoses].

Motion sickness is a well known nausea and vomiting syndrome whose physical signs occur during travel by sea, automobile, airplane, and space. This review describes current concepts concerning the aetiology, nature and therapy of this common phenomenon. Motion sickness involve a neural mismatch or confusion between the vestibular, visual, and proprioceptive systems. Therapy is directed towards decreasing conflicting sensory input, controlling nausea, and speeding the process of adaptation.

Humans↗
PubMed2000

[Significance of the SISI test within the scope of expert assessment of noise-induced hearing loss].

BACKGROUND AND OBJECTIVE: Proof of cochlear hearing loss is an essential prerequisite for the diagnosis of noise deafness. For this purpose, the Königsteiner instruction leaflet (Königsteiner Merkblatt) recommends among other items the SISI test. PATIENTS/METHODS: The results of the SISI test at 1 and 4 kHz were analysed for 100 expert opinions of noise (200 ears). RESULTS: 10% of the subjects showed at 1 and 4 kHz a positive and 44% a negative result. At 1 kHz, 46% indicated a negative result and at 4 kHz a positive result. In the group with a negative SISI test at both frequencies, 74% demonstrated characteristics of pseudohypacusis. There was no correlation between a retrocochlear hearing disorder and a negative SISI test. CONCLUSIONS: Our analysis demonstrated that the negative SISI test is more often evidence of pseudohypacusis rather than a retrocochlear disorder. Consequently, the validity of a negative SISI test is limited.

Adult↗
PubMed2000

Effect of ethanol on dynamic visual acuity during vertical body oscillation in healthy volunteers.

Visual orientation is the most important sensory input during locomotion (e.g. walking, driving a car, riding a bicycle). We investigated dynamic visual acuity (DVA) during vertical body-oscillations (amplitude 5 cm; frequency 1.5 Hz) in 12 healthy subjects before and twice after ethanol consumption. During oscillation, vertical eye movements were recorded under two test conditions: with eyes closed (EC) and during DVA testing. A significant increase in vertical eye-amplitude after ethanol ingestion occurred only during EC tests, as a possible sign of vestibular hyperreaction. During vestibular stimulation alone (EC), ethanol did not affect the phase shift between stimulus and eye movements. However, when the subjects were given an additional visual stimulus (DVA), the post-alcohol phase shift rose significantly. Surprisingly, the post-alcohol phase shift values for the two test conditions showed no significant differences. After ethanol ingestion we found no changes in static visual acuity but a significant loss of DVA. Volunteers with a change of DVA threshold (DVAT) showed significantly (P = 0.004) higher post-alcoholic changes in the phase shift. In summary, low doses of ethanol disturbed the visually guided oculomotor response during fixation of an earth-fixed target while the observer was subject to linear vertical acceleration. This effect led to an increasing delay between the beginning of body and eye movements. The consequence was an increasing phase shift and thus a decrease in DVA during whole-body oscillation which was comparable to movements during human locomotion.

Acceleration↗
PubMed2000

The localization of an imaginary target under the influence of caloric vestibular stimulation in healthy adults.

It is well known that fixation of an imaginary target (IT) can influence the vestibulo-ocular reflex, but reports on the effect of peripheral vestibular stimulation on the localization of an IT are still lacking. In a prospective study, errors in pointing towards an IT without and after cold caloric vestibular stimulation (VS) were investigated in 24 right-handed volunteers with the head tilted backwards by 60 degrees. After the stationary target had been extinguished for 120 s each subject had to point towards the target position as remembered in darkness. The vestibular response was recorded by electronystagmography. Without VS 73% of the volunteers showed a systematic horizontal pointing error towards the right side. VS led to an increased horizontal pointing error in the direction of the slow phase of the induced nystagmus and the degree of deviation showed a significant (P = 0.001) positive correlation (r = 0.32) with the amplitude of the calorically induced nystagmus. In summary, an IT is not merely a useful visual stimulus for influencing the vestibulo-ocular reflex during linear and angular acceleration. A peripheral vestibular stimulation is itself able to change the position of an IT significantly and the extent of deviation shows a significant correlation with the amplitude of the evoked nystagmus.

Adult↗
PubMed2000

Dynamic visual acuity during linear acceleration along the inter-aural axis.

We investigated visual-vestibular interactions during linear acceleration along the inter-aural axis. Eighteen healthy volunteers and two patients with central neurological diseases were subjected to transaural linear acceleration in the direction of gravity force (frequency: 0.5-1.5 Hz; amplitude: 5 cm). During linear acceleration, eye movements were recorded under three test conditions: eyes closed (EC), while staring at an imaginary target (IT) and during the testing of dynamic visual acuity (DVA). As parameters of evaluation we used the amplitude of horizontal eye movements, phase shift and the decrease of DVA threshold (DVAT). Under all test conditions, eye amplitude increased with rising stimulus frequency and exceeded, especially in the higher frequency range, a hypothetically calculated eye amplitude for smooth pursuit. The combination of a visual and vestibular input (DVA and IT) led to a better compensation (lower phase shift) than under vestibular stimulation alone (EC). Eye movements during low-frequency stimulation depended more on the visual system while responses in the higher frequency range were mainly triggered by the otolith organ. At 1.5 Hz the compensatory function of the visual-vestibular system was limited (rising phase shift) and DVAT decreased even in a significant number of healthy subjects. Patients with diseases of the central nervous system showed a higher phase shift and thus a stronger decrease of DVAT (two levels) already at a stimulus frequency of 1.25 Hz.

Acceleration↗
PubMed2000

A pilot study of autofluorescent endoscopy for the in vivo detection of laryngeal cancer.

OBJECTIVES: To determine the advantage of autofluorescent endoscopy for the identification of laryngeal cancer. STUDY DESIGN: This is a prospective, multicenter clinical study. We investigated whether autofluorescent endoscopy using the Lung Imaging Fluorescent Endoscopy (LIFE)-Lung System (Xillix, Olympus) is capable of identifying early cancer of the larynx, especially in comparison with conventional white-light endoscopy and microscopic laryngoscopy. Benign lesions as well as microinvasive and invasive squamous cell carcinoma of the larynx were investigated. For logistic reasons and because of the pilot character of this study, the number of patients was limited. METHODS: Sixteen patients having 24 laryngeal lesions of both benign or malignant character were subsequently examined by autofluorescent endoscopy, white-light endoscopy, and microscopic laryngoscopy. Based on optical appearance, and for each method separately, the lesions were classified as malignant or not. The visual results were documented and histologically verified. RESULTS: The sensitivity of autofluorescent endoscopy for laryngeal cancer detection was more than 90% and therefore higher than that of white-light endoscopy and microscopic laryngoscopy. However, as far as laryngeal cancer is concerned, the specificity of autofluorescent endoscopy was very low. Many of the false-positive results were due to inflammation, hypervascularization, and edema. CONCLUSION: Autofluorescent endoscopy is advantageous only in the hands of an experienced ENT specialist. Although it does not replace the combination of white-light endoscopy and a critical evaluation of the clinical symptoms of the individual disease, it can profitably complement them. Autofluorescent endoscopy can help in determining whether microscopic laryngoscopy performed with general anesthesia should be recommended urgently to the patient. Microscopic laryngoscopy remains the best method for the identification of malignant lesions, if it is combined with obtaining taking multiple biopsy specimens. Confirmation of the results of this pilot study with a larger series of patients is desirable.

Adult↗
PubMed2000

Efficacy of botulinum toxin A for treatment of upper esophageal sphincter dysfunction.

OBJECTIVES: To investigate the efficacy of botulinum toxin A (BTA)-induced chemodenervation of the upper esophageal sphincter (UES) in patients with dysphagia and UES dysfunction. STUDY DESIGN: Prospective clinical trial in 10 selected patients with pure UES dysfunction. METHODS: In each patient 30 units of BTA were injected into the UES under brief general anesthesia. Videofluoroscopic swallowing study (VSS) was done and a clinical symptom score was determined before and after treatment. RESULTS: On VSS relative opening of the UES improved in all patients (mean +/- SD: 47 +/- 14% before versus 71 +/- 24% after treatment; P < .01). Hypopharyngeal retention or laryngeal penetration of barium was significantly reduced in four of seven patients. Clinical symptom scores improved in all patients. One patient was free of symptoms, mild dysphagia persisted in six patients, and moderate dysphagia persisted in three patients. CONCLUSIONS: Our results support the use of BTA in selected patients with pure UES dysfunction. Its efficacy is limited by the possibility of a persistent structural stenosis of the UES and the risk of BTA diffusion into the larynx or hypopharynx.

Adult↗