Hals- Nasen- und Ohrenklinik Gießen

This study aimed to investigate the practice of apitherapy - using bee products such as honey, pollen, propolis, royal jelly and bee venom to prevent or treat illness and promote healing - among German beekeepers and to evaluate their experiences with these therapies. A questionnaire incorporating two instruments on beekeepers' physical and mental health and working practice was included in three German beekeeping journals and readers were asked to complete it. The instrument included questions on the use of apitherapy. Simple descriptive methods, bivariate correlation, cross-tabulation and one-way ANOVA were used to analyze the data. Altogether 1059 completed questionnaires were received. The beekeepers reported the most effective and favorable therapeutic effects with honey, followed by propolis, pollen and royal jelly. The factors associated with successful experiences were: age, number of hives tended, health consciousness, positive experiences with one product and self-administration of treatment. Beekeepers were asked for which condition they would employ propolis and pollen. They reported that they used propolis most frequently to treat colds, wounds and burns, sore throats, gum disorders and also as a general prophylactic, while pollen was most commonly used as a general prophylactic and, less frequently, in treating prostate diseases. No adverse experiences were reported. The potential benefit of bee products is supported by the positive experiences of a large group of beekeepers who use some of these products to treat a wide range of conditions. The indications and treatments given here may be important in selecting bee products and designing future trials.

Aerosolized amiloride normalizes the excessive sodium absorption cystic fibrosis (CF) respiratory epithelium. The aims of this study were to assess the dose-effect relationship and the duration for which amiloride inhibits Na+ transport, to determine acute and chronic pharmacokinetics, and to test the effect of acute aerosolized amiloride on the amount of sputum expectorated. The effect of inhaled amiloride was assessed principally by nasal potential difference (PD) measurements. Amiloride serum levels were measured in 23 patients after inhalation of different doses of aerosolized amiloride. Twenty CF patients inhaled amiloride (10(-3)M) or a placebo in a double-blinded, randomized order, and sputum production was quantitated. The results of this study showed that maximal initial PD inhibition was achieved by 6 x 10(-3)M of amiloride. The duration of inhibition of PD (effective time until return to 50% delta PD [ET50] after nasal administration) was dose dependent (10(-3)M, 39 +/- 0.8 minutes; 10(-2)M; 133 +/- 14 minutes). Amiloride serum levels were below 2.5 ng/ml in 20 of 28 patients; levels were above 5 ng/ml only within 4 hours after high dose inhalation (10(-2)M). In the double-blinded, crossover study, more sputum was expectorated after amiloride inhalation as compared with that after a placebo (P < 0.05). In conclusion, the bioelectric effects of amiloride and serum levels after inhalation are dose dependent, and amiloride is effective at inducing sputum expectoration in CF.

UNLABELLED: Infestation with larvae (maggots) is known as myiasis. Ophthalmomyiasis externa refers specifically to infestation that involves the lids and conjunctiva in man. Ophthalmomyiasis which originates from Germany is unusual, because the vector of the Oestrus ovis larvae is most prevalent in the warm climate of Mediterranean countries. The sheep nasal botfly (Oestrus ovis sp.) is responsible for most cases of external ophthalmomyiasis. This case report gives a detailed description of the larvae, their life cycle and an overview of infestations in Germany as well as the therapy of ophthalmomyiasis. CASE REPORT: At the end of August 1999, a 28-year-old man attended the outpatient department of Giessen University Eye Clinic with a foreign body sensation in his left eye. He reported that something hit his left eye while he was climbing on his motorbike in the early evening hours. Shortly afterwards he had a foreign body sensation in his left eye. On history taking he reported no other ophthalmologic problems in the past. Slitlamp biomicroscopy revealed white, vivid, approximately 1.5-mm-long, light-sensitive maggots on the conjunctiva and under the upper lid. These were removed mechanically and the conjunctiva rinsed with saline. Local therapy was not applied. CONCLUSION: Infestation with larvae of O. ovis has to be considered not only in tourists from Mediterranean countries, but also in Germany in the late summer.

In vivo hearts show fine beat to beat temporal variation during normal sinus rhythm (NSR). These changes have been termed “heart rate variability” (HRV). Accurate measurements of the beat to beat variation have enable investigators to determine the parameters of HRV.1 Routine assessment of HRV is derived from measurements of QRS-to-QRS (RR) intervals in the surface ECG. Activation of the heart starts with impulse formation in the sinus node and ends with excitation of the ventricular myocardium resulting in a QRS complex. Therefore, RR interval variation is likely to be the result of both sinus and atrioventricular (AV) node action. However, the relative contribution of each structure to HRV is not known. We hypothesised that, by calculating and comparing HRV during NSR and different pacing manoeuvres, we would be able to elucidate the relative contribution of both nodes to HRV. Therefore, we measured and compared HRV during AAI pacing (elimination of impulse formation in the sinus node) and VAT pacing (elimination of contribution of the AV node). Twenty consecutive patients were studied during diagnostic electrophysiological testing. Informed written consent was obtained from all subjects. A time period of 600 seconds was used to calculate HRV during each pacing manoeuvre and NSR. HRV of NSR was calculated twice before and after the pacing manoeuvres. AAI pacing was done at a pacing rate 15% faster than the sinus rate, and VAT pacing with an AV delay of 80 ms. For pacing manoeuvres, an external AV …

12 primary neuroblastomas (NB) of different maturation stages, 2 ganglioneuromas (GN), and 2 neuroblastoma cell lines were analysed for RNA expression of the protooncogene N-myc and the gene encoding the nerve growth factor receptor (NGF-r) by Northern-blots, RNA-dot-blots and for receptor presence by immunohistological procedures. In 4 tumors with strongly elevated RNA expression of N-myc the NGF-r RNA expression was weak or absent. In all 8 tumors with highly increased NGF-r transcription no N-myc expression was detectable. These results, indicating an inverse relationship between N-myc and NGF-r expression, could help in establishing markers for differentiation, and thus prognosis, in neuroblastoma.

BACKGROUND: With regard to its favorable physical properties, silicon nitride ceramic is considered as biomaterial for human medical application. Minor controversy exists about the biocompatibility of the material. METHODS: Cytotoxicity testing, cell viability and morphology assessment was performed applying the L929-mice fibroblast cell culture model in a direct contact assay. Testing materials were silicon nitride ceramics of different surface properties and titanium alloy as a reference. Polyvinylchloride served as a negative control. The cells were stained with bisbenzimide and propidium iodine for double fluorochromasia viability testing, and evaluated by inversion-fluorescence microscopy. Scanning electron microscopy was applied to additionally investigate cell morphology. RESULTS: No cytotoxic effects were observed on the silicon nitride ceramic samples; moreover cell morphology remained the same as on titanium. Avital cells were present exclusively on PVC. The cell growth in the silicon nitride samples showed no significant differences compared to titanium. Cell counts on all polished surfaces showed significantly higher numbers. Scanning electron microscopy revealed typical fibroblast morphology with filiform extensions. CONCLUSION: The current results indicate a favorable biocompatibility of silicon nitride ceramic. Cell growth, viability and morphology are comparable to parameters of titanium. Polished surfaces appear to promote cell growth. Further in vivo studies are mandatory prior to human medical application. Owing to its favorable physiochemical properties, especially its superior resistance to mechanical stress, silicon nitride could serve as a biomaterial for osteosynthesis of bone with mucosal attachment.

AIMS: We aimed to evaluate the long-term safety and efficacy of the STENTYS self-apposing paclitaxeleluting stent (STENTYS-PES) in bifurcation lesions in routine clinical practice. METHODS AND RESULTS: The primary endpoint of the study was the composite major adverse cardiac events (MACE: cardiac death, myocardial infarction, clinically driven target lesion revascularisation, or emergent bypass surgery) assessed at six months after enrolment. This was reported in 21 patients (10.1%), mainly due to clinically driven target lesion revascularisation (TLR). At 12 months, 27 patients experienced MACE (13.0%). CONCLUSIONS: The long-term results of OPEN II show that the STENTYS-PES is safe and effective in the treatment of all-comers with coronary bifurcation lesions.

Serum samples of patients suffering from diabetes mellitus were tested for complement-fixing and non complement-fixing islet cell antibodies, antinuclear antibodies and circulating immune complexes. There was no correlation between circulating immune complexes or antinuclear antibodies and secondary diabetic complications. A close relationship was found between the ICA titer and complement fixation of ICA. The incidence of ICA at the onset of the disease was higher in the patients under the age of 10 (85%) and decreased with increasing age up to 45% in patients with onset above age 20. In five patients being positive and four patients being negative for ICA at onset of disease, changes and fluctuations in antibody titers were observed over 38 months. Since manifestation of diabetes mellitus is believed to be an endpoint of a long lasting autoimmune process, our observations indicate that the autoimmune phenomena are merely indicators of ongoing autoimmune reactions not necessarily reflecting the state of autoaggression or islet cell destruction.

The parotid gland function was examined in 31 patients with thyroid carcinoma treated with radio-iodine. Beside enhanced values of sodium concentration, protein concentration and alpha-amylase activity following each therapy, a continuous reduction of flow rate and alpha-amylase activity is found according to the cumulative total dose. The importance of glandular kallikrein und phosphohexoseisomerase (PHI) are discussed with regard to their possible role in glandular damage. A comparison is made with chronic recurrent parotitis, and therapeutical aspects are considered. On the whole the present investigation shows that radio-iodine therapy causes damage to the parotid gland, which normally leads to measurable effects after cumulative doses of 470 mCi.

We report on the first German "melanoma screening week" (Offenbach Melanoma Week). According to the model of the Melanoma/Skin Cancer Detection Week in Dayton/Ohio, the population of Offenbach (100.000 inhabitants) were informed about cutaneous malignant melanoma and its early recognition by means of public media, in particular the local press; the people were asked to participate in a voluntary screening including examination of the entire skin. These examinations were offered in 5 local dermatological practices on 5 working days during the European Week Against Cancer in May, 1988, under the auspices of the Hessian Cancer Society. With 2 to 4 dermatologists daily volunteering, a total of 697 persons were screened. Their average age was 48 years. An illustrated brochure ("Red Light for Black Cancer") with instructions for self-examination of the skin served as a consultation basis and memory aid. The screening week was concluded by a 3-hour's question time ("The citizen asks - the expert answers"). The most surprising result of this campaign was the fact that - contrary to earlier experience - 76% of the persons seeking advice were well aware of "black" cancer. The sole new melanoma detected was an extended lentigo maligna melanoma on the right cheek, which had not been noted during a prophylactic medical examination (!) 2 weeks before. The high public awareness of melanoma and the extremely low percentage of undetected melanomas in Hesse are most probably the result of the 8-year's educational campaign against "black" cancer.

Einleitung: Fluoroskopisch geführte Herzkathetereingriffe gehen mit einem Strahlenrisiko für Patient und Personal einher. Wir verwenden daher bei der Katheterablation von SVTs bei Patienten ohne angeborenen Herzfehler (AHF) ein primär vollständig röntgenstrahlenfreies Vorgehen und analysierten deren Anteil für das Jahr 2013 retrospektiv.

OBJECTIVE: This retrospective multicenter study aimed to evaluate surgical versus conservative treatment in patients with hypopharyngeal and laryngeal cancer under real world conditions. METHODS: This study included 2307 patients diagnosed with hypopharyngeal or laryngeal squamous cell carcinoma (SCC) in five German tertiary head and neck centers between 01/2004 and 12/2014. Overall, 783 patients with advanced SCC consecutively underwent laryng(opharyng)ectomy (L(P)E). Patient chart data regarding age, sex, tumor location, TNM status, grading, indication for L(P)E, treatment modalities, R status, postoperative complications, and hospitalization time were analyzed. Patients with lacking data and incomplete staging and those who refused treatment or did not comply with the recommended treatment were excluded from survival analysis. RESULTS: A slight but significant increase was observed in L(P)E, referring to an increasing rate of tumor recurrence. While T1/2N0M0 laryngeal and hypopharyngeal cancer patients showed comparable overall survival (OS) for surgical and conservative treatment, surgery showed significantly better OS in lymph node-positive individuals and locally advanced tumor stages. Tumor recurrence occurred in more than one-third of the cases. In particular, in early glottic cancer recurrence, L(P)E represents a curative and safe treatment option, whereas in supraglottic and hypopharyngeal cancer, L(P)E was associated with reduced survival rates. Notably, 36% of patients with supraglottic cancer and 59% of patients with hypopharyngeal cancer recurrence could only be treated with palliative care. CONCLUSION: Comparable survival rates were demonstrated for cT1/2N0M0 laryngeal and hypopharyngeal SCC compared with primary chemo-/radiotherapy and larynx-preserving surgery. Better OS was achieved after surgery in nodal-positive patients and in those with locally advanced disease. Tumor recurrence should be anticipated in up to 39% of cases. Glottic cancer recurrence can be successfully and safely treated with L(P)E, whereas OS is reduced in hypopharyngeal cancer and possibly in supraglottic cancer.

Tonsillectomies are the most frequently performed ENT surgical procedures and are potentially beset with a number of possible complications. Post-operative secondary hemorrhage still remains the most frequent complication despite improvements in surgical techniques and preoperative diagnostic evaluations. Besides unsuitable operative techniques, disturbances of circulation and wound infections, disturbances of hemostasis may play an important part. The objective of this paper was to examine the relative frequency of platelet functional disorders as a possible cause for secondary hemorrhage after tonsillectomies. In the past, most of these have been related to medication use. Eighty-nine patients were studied and historically showed no predisposition increased hemorrhage per se or in their families or gave reasons for other factors favoring secondary hemorrhage. The diminution or lack of collagen or ADP-induced agglutination served as an indication for a platelet functional disorder. Ten percent of the 89 patients experienced secondary hemorrhage, with platelet functional disorders proved in 40% of these patients. Because of these results a correlation was attempted between secondary hemorrhage and abnormal deficits of collagen and ADP-induced agglutinations in platelet functional tests, but this was not found. Necessary preoperative studies was attempted screening for hemostasis as well as medico-legal aspects connected with the prescription of medicines inhibiting platelet agglutination, especially use of acetylsalicylic acid before tonsillectomies, are discussed.

To evaluate the transcranial magnetic stimulation in the early diagnosis of traumatic facial palsy 7 patients with an incomplete Bell's palsy were examined. The clinical examination, electric stimulation and magnetic stimulation were performed daily from the 2nd day until the 6th day, at the 12th day and three months after onset of the disease. The mean latency of the surface potential of the orbicularis oculi muscle after electrical stimulation was 2.7 msec. On the healthy side the answer following transcranial ipsilateral cisternal magnetic stimulation was detectable after 6.8 msec. From the beginning no response could be recorded on the affected side. After clinical restitution of the Bell's palsy after three months there was still no response. On the other hand, the controlateral, cortical transcranial magnetic stimulation was not significantly reduced. In conclusion, the cisternal transcranial magnetic stimulation gives no further information beyond the clinical examination. The cisternal stimulation is useful, if a clinical examination is impossible e.g. in an unconscious patient after head injury.

Die funktionellen Ergebnisse nach Implantation künstlicher Linsen sind in zahlreichen Publikationen dargestellt worden. Schwerwiegende morphologische Veränderungen — es seien nur Hornhautdystrophien und zystische Makulaschädigungen genannt — sind bei ihrem Auftreten leicht erkennbar. Sie führen die Statistik der Komplikationen an.

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

UNLABELLED: Surface modification of intraocular lenses (IOL) have improved the quality of cataract surgery. Heparin surface-modified (HSM) IOL are implanted for special indications (e.g., recurrent uveitis, cataract surgery for children, preoperative synechia) because of decreased postoperative inflammatory reactions and higher long-term biocompatibility. Nevertheless, secondary cataract, precipitates and fibrinous membranes appear. The YAG laser is used for treatment. METHODS: PMMA intraocular lenses with or without a heparin monolayer were exposed to Nd:YAG laser. The experiment was performed under BSS using different energy levels and distances to the IOL. The heparin monolayer was stained with toluidin blue. Subsequently, the surface of the intraocular lenses was examined with light and scanning electron microscopy. RESULTS: The YAG laser marks of HSM IOL and PMMA IOL showed no morphological differences. Microexplosions and pressure waves of the Nd:YAG laser cleared parts of the heparin monolayer in the area of the laser spots dependent on energy distance to the IOL. Even "breakdown" behind the HSM IOL without any PMMA lesion shown circular destruction of the heparin monolayer. CONCLUSIONS: The heparin surface defect of HSM IOL after YAG laser treatment should be taken into consideration, because a decreased heparin effect in vivo could be possible.

Dysphagia refers to painless impairment of the transport of liquid or solid food from the oral cavity to the stomach. If pain accompanies swallowing, this is termed odynophagia, and discomfort when swallowing saliva suggests a globus pharyngis. Swallowing disorders can occur during any one or all phases of bolus transport. The causes are manifold, due to the involvement of central control areas within the brain as well as the peripheral nervous system. The diagnosis consists of a detailed case history as well as screening forms and questionnaires. In Germany, the gold standard diagnostic procedure is flexible (video-)endoscopic evaluation of swallowing. Videofluoroscopy and electrophysiological examinations complement the diagnosis. Therapeutic options comprise functional strategies and rehabilitative exercises. However, the most important task of otorhinolaryngologists, in addition to the primary surgical treatment of tumors in the area of the upper swallowing tract (taking into account the preservation of swallowing structures), is the assessment of posttreatment dysphagia with the option of individualized surgical measures to improve swallowing.

HÄufig ist eine HÒrgerÄteversorgung allein nicht ausreichend, um im Altag alle HÖr- und Kommunikationssituationen zu bewÄltigen. Daher werden zusÄtzliche technische Hilfsmittel notwendig. Es wird ein Überblick Über verschiedene Systeme und GerÄte gegeben, in dem die verschiedenen Kommunikationsmittel dargestellt und durch Beispiele belegt werden. In ErgÄnzung zu HÖrgerÄten wird auf den Audioeingang, auf die Induktions-/Telefonspule sowie auf drahtlose Kommunikationshilfen und ZubehÖr fÜr Radio und Fernsehen eingegangen. Zu den Kommunikationshilfen, die ohne HÖrgerÄt Verwendung finden, gehÖren Infrarotanlagen, ZubehÖr fÜr Telefon und TÜrklingel, ZusatzgerÄte und Hilfsmittel fÜr das Telefon sowie verschiedene Therapiehilfen bei HÖr- und SprechstÖrungen. Auf diverse Formen der HÖrhilfen, wie vibrotaktile Systeme, Kochleaimplantate und Mittelohrimplantate wird abschliessend ebenfalls verwiesen. Unter BerÜcksichtigung der Heil- und Hilfsmittelrichtlinien werden Aspekte zur Verordnung der hier vorgestellten HÖr- und Kommunikationshilfen diskutiert.

The reconstruction of the ossicular chain when the stapes crura are absent presents a difficult problem in achieving satisfactory functional results in the treatment of chronic oitis media by tympanoplasty. When the malleus handle is present, the cases have been treated mostly by repositioning part of an incus or a piece of cartilage between the malleus handle and the mobile footplate. The problem becomes more difficult in tympanoplastic management of old radical cavities with no ossicules apart from the stapes footplate. Apart of repositioning a part of incus or a cartilage strut between the fascial graft and the footplate, the author has tried, in the management of these cases during the last 3 years, a new "umbrella type" of prosthesis made entirely of tragal cartilage. This prosthesis enables a good resting surface for the new tympanic membrane and the hearing improvement seems to be greater than that resulting from other types of ossicular reconstruction.