Clinico-anatomic study of the spina nasalis ossis frontalis and its role within the scope of frontal sinus surgical approach

BACKGROUND: During endonasal frontal sinusotomy using the sharp spoon (endonasal frontal sinus surgery type II according to Draf or May and Schaitkin) a solid piece of bone is frequently encountered anterior to the neo-ostium. This bone may be referred to as a "nasal spine". A prominent spine may render a sinusotomy difficult or even impossible. METHODS: A maximum endonasal frontal sinusotomy was performed on 36 anatomical specimens by means of a sharp spoon producing neo-ostia of 7 x 5 mm on average. The dimensions of the remaining nasal spine were measured subsequently together with the diameter of the inferior frontal sinus, the thickness of the anterior frontal sinus wall, and the distance from the neoostium to the anterior ethmoidal artery. RESULTS: Almost every specimen (97%) showed a relevant nasal spine. The average height of the spine was 10 mm. The anterior-posterior dimension was 6 mm on average. A correlation was found between the nasofrontal angle and the a.-p. dimension of the spine: the more acute the angle, the thicker the spine was. In three out of four specimens the neo-ostium was separated by just one anterior ethmoidal cell from the anterior ethmoidal artery. CONCLUSIONS: In the majority of the specimens a sufficient endonasal approach to the frontal sinus could be obtained by enlarging the natural ostium as described by Draf or May and Schaitkin. The anterior ethmoidal artery is a valuable landmark for locating the ostium. The maximum diameter of the frontal sinus approach in frontal direction can be estimated by measuring of the nasofrontal angle.     

Diagnostic value of intravenous cholangiography within the scope of laparoscopic cholecystectomy

This work aimed to see whether (1) biofeedback is useful and (2) whether it needs to be combined with psychotherapy in sexually abused patients with anismus. Fifteen women aged 41.2 +/- 4.1 years who had experienced sexual abuse in childhood (9 cases) or adulthood (6 cases) and complained of symptoms of irritable bowel disease were studied. Anismus was recorded during anorectal manometry in all cases. Patients were free to choose biofeedback and/or group psychotherapy and/or individual psychotherapy. When necessary, psychoactive drugs were prescribed after a psychiatric evaluation. Initially all the patients chose biofeedback and none accepted psychotherapy. Eight patients accepted psychotherapy after several weeks of biofeedback. Thirteen patients completed the study: 5 treated by biofeedback alone, 5 with biofeedback and group therapy, and 3 with biofeedback and individual psychotherapy. Eight women recovered completely from their symptoms, only two of whom had had biofeedback without psychotherapy. Conclusion: Biofeedback alone was not always sufficient to cure abused patients, but was chose initially by all the patients. It could initially be a middle path between somatic treatment and psychotherapy, at a time when patients are not yet ready to undertake the latter.     

Acoustic emission analysis of human bones within the scope of clinical diagnosis

Fractures occurring in human bones produce an acoustic signal, analysis of which permits an evaluation of its source. In the industrial setting acoustic emission analysis (AEA) is used to non-invasively monitor the function of stressed technical systems or parts of systems. During servicing and monitoring of technical systems, acoustic signals emitted by cracks or material deformation are located with the aid of a few acoustic sensors and evaluated for risk-identification purposes. With appropriate technology, therefore, both cortical and trabecular bone can be monitored by acoustic emission analysis. A search is currently ongoing for suitable acoustic technology capable of assessing the extent and location of bone defects and predicting associated risks of fractures occurring. In the present study a system for the measurement and analysis of acoustic emission is described which permits the measurement and analysis of acoustic signals obtained from processed and fresh human and porcine femora. In slightly modified form this system was then used to assess the type and extent of acoustic emission obtained from explanted human femora exposed to cyclical torsional loading until fracture occurred.     

Indications for middle ear obliteration within the scope of cochlear implant management

BACKGROUND: Cochlear implants have gained worldwide acceptance as a reliable method of rehabilitation of profoundly hearing-impaired patients. Due to thorough patient selection major postoperative complications rarely occur and are flap related in most cases. Deafness can develop during chronic suppurative otitis media, either coincidentally or secondary to the medical treatment; normally this condition is regarded as a contraindication for cochlear implantation. In cases with a mastoid cavity after surgical treatment for cholesteatoma, the electrode covered only by the epithelial lining will likely become exposed or extruded. Therefore we suggest the obliteration of the middle ear cleft with abdominal fat and the blindsac closure of the external ear canal before cochlear implantation in these conditions. PATIENTS: The average age of our 12 patients was 48 years, whereas the youngest was 2 1/2 years of age. Due to chronic inflammatory ear disease. 11 patients had a mastoid cavity on both ears. Eight patients had a cholesteatoma, the chronic bone destroying process in the temporal bone of two female patients was considered as a fibroinflammatory pseudotumor. The child had a congenital deafness in both ears with a Mondini dysplasia in CT scan. She had already developed two episodes of pneumococcal meningitis which was caused by a defect in the stapes footplate through which a liquor-filled cystic sac herniated in the middle ear. Because of a massive liquorrhoea after opening of the sac, we decided to obliterate the middle ear cleft after successful insertion of the electrode array. RESULTS: All active electrodes of 10 Nucleus implants (Cochlear) and two Clarion devices (Advanced Bionics Corp.) were successfully inserted in the cochlea of the 12 patients. After an average follow-up of 15 months, a temporary facial palsy in one patient and an insufficient closure of a retroauricular fistula over the mastoid cavity in two cases were observed as postoperative complications. One patient with a fibroinflammatory pseudotumor developed a massive inflammatory reaction in the implanted ear two months after cochlear implantation, which could not be controlled by conservative treatment. The implant had to be removed and local conditions settled after administration of immunosuppressive treatment with cyclophosphamide. The patient received a new implant seven months ago. CONCLUSIONS: Implantation of a foreign body in a potentially infected space which communicates intracranially means a surgical challenge which can be managed by obliteration of the middle ear after subtotal petrosectomy with abdominal wall fat combined with a reliable closure of the external ear canal. In case of massive inflammation we would prefer a two-stage procedure.     

What is the role of contact lenses within the scope of electronystagmography?

BACKGROUND: During electronystagmography it is necessary to correct detective vision for calibration, smooth pursuit, and saccadic eye movements. Therefore more and more people use contact lenses instead of normal glasses. Given the lack of detailed information about this phenomenon, in the current literature we decided to investigate the influence of soft contact lenses on electronystagmography. The aim of this study was to find out differences in the results of electronystagmography between using glasses or contact lenses. METHODS: Our investigation involved 20 vestibular healthy human subjects with myopia. In the first part of the examination they used their contact lenses and in the second part they were wearing normal glasses. After measuring the calibration potential we wanted to see if contact lenses would increase the rate of artifacts in the electronystagmogram. Then we attempted to determine whether contact lenses would an influence on the registration of the optokinetic nystagmus. Induced saccadic eye movements were recorded and analysed. RESULTS: Contact lenses had a negative influence neither on the calibration potential nor on the rate of artifacts. The latency of the saccadic eye movements also showed no differences between both parts of this investigation. Only the velocity of the saccades and the gain value during the optokinetic test were reduced when glasses were used. CONCLUSIONS: Contact lenses may stimulate the secretory function of the lacrimal gland and thus decrease friction forces. It is also possible that the reduced image size produced or the reduction-effect of minus by glasses in near sighted persons negatively influences eyeball velocity. In summary, our study demonstrates that contact lenses do not have a negative influence on electronystagmography. Therefore electronystagmographic studies of patients with contact lenses are permissible for purposes of documenting a medical opinion.     

Management of violent acts within the scope of a pedagogic concept of self and social development--or: talking with school children about violence

In order to deal with physical aggression in schools it is necessary to develop an educational concept in which the teachers parallel to their observations of the subject orientated learn-track include the relationship- and the self-development-track (three-track-education). In this concept of classifying dialogs which follow the conflict situations have equal importance to other events during school-lessons. The dialogs take place parallel to the lessons. This method requires a flexible organisation of the lessons in which the pupils are used to work on their own. An extension of the teachers competence is necessary. The extension of competence is related to a close observation of social events and to a development of models to explain the problematic behavior of pupils. If it becomes possible for example to interpret part of the pupils' behavior as scenic acting this new point of view may lead to new solutions. The educational concept is orientated on a model of psychoanalytical explanation in which the current situation stands in the foreground. The problem which thus becomes apparent can be now be handled by reconstructing the exterior events (interactions) and by the symbolic presentation of the interior perception (annoyance, anger, rage). Thus the pupils learn to deal with their inner turbulences in the constructive manner. For the acting in the public forms of making amends are practised. Physical aweness and fitness is seen as an important base for self- and social processes. The work of a man within a boys' group and of a woman within a girls' group offers the possibility of sexual identity.     

Vulvar and vaginal reconstruction after surgical treatment for gynecologic cancer

The goal of reconstructive surgery is to restore anatomy and function. Sexual activity is an important criterion for reconstruction. Wound healing, postoperative rehabilitation, and a positive self-image also can be restored with the creation of a neovagina or neovulva.     

The value of aspiration cytology within the scope of triple diagnosis of palpable breast changes

The diagnostic value of aspiration cytology and the overall diagnostic quality of the so-called triple test (aspiration cytology, mammography and physical examination) in the evaluation of palpable breast masses were investigated in a retrospective study. 608 histologically evaluated cancers and 224 benign lesions were investigated. A main purpose of the study was to find out whether the triple diagnostic test can replace surgical biopsy and thereby reduce the number of unnecessary biopsies. All lesions triple-diagnosed as malignant were histologically proved to be malignant, i.e. there were no false positive results. The rate of false negative results was found to be within the range reported for false negative results in fresh frozen sections. Based on these results we state that the dogmatic statement "every palpable mass in the breast must be excised" should be replaced by the recommendation "every palpable mass must be assessed and clarified". A great number of retrospectively unnecessary biopsies can be avoided by a systematic use of the triple diagnosis. The diagnostic safety of this method is close to that of open biopsy. In all cases where positive or negative concordant triplets are found, histological confirmation by biopsy can be avoided. Patients with benign lesions can be thoroughly followed up by repeated physical and radiological examinations. Patients with triple diagnostic malignant results can be adequately treated. Lesions for which triple diagnosis yields neither benign nor malignant, must be biopsied: This is also necessary in all cases with suspicious findings in mammography without a palpable mass, if the equipment for stereotactic or ultrasound- guided biopsies is not available.(ABSTRACT TRUNCATED AT 250 WORDS)     

Extragenital diseases in geriatric-gynecological surgical cases

Of the surgical cases accumulated in 18 departments of Obstetrics and Gynecology in West Berlin from 1960 through 1969 6662 major procedures were performed on women of at least 60 years of age. In 282 cases (4,2%) surgery was carried out for primarily extragenital gynecological disorders: 119 malignant tumors, 16 benign tumors, and 147 other diseases of extragenital orgin. The postoperative mortality of these patients (89 deaths; 29,8%) was markedly higher than that observed for the whole group (7,7%). This difference may have been caused by the greater extensiveness of the underlying disease in the former group as well as the unsatisfactory utilization of preoperative diagnostic procedures found in some instances. The cooperation with surgeons prior to and during surgery may still be improved upon. In 98 patients (1,5%) operative procedures for additional surgical disorders were performed simultaneously. Especially in those cases where additional appendectomies were carried out, it appears that total abdominal hysterectomy and bilateral salpingo-oophorectomy might have been the treatment of choice for the underlying disease.