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Severe complications in endoscopic paranasal sinus surgery are rare, however, when they occur they are often fatal. Injuries to the optic nerve or the internal carotid artery mostly occur after penetration of the sphenoid sinus' anterior wall.We present the robot system "A 73" with its newly designed 4-canal-microendoscope and special instruments that meets the demands of endoscopic paranasal sinus surgery. A fully automated perforation of the sphenoid sinus' anterior wall was performed in five cadaveric specimens.The sphenoid sinus' anterior wall could be perforated without damaging the surrounding structures in all cases. Subsequently, the approach was enlarged to the desired diameter using telemanipulation mode. The analysis of both the transformation error and intraopertive accuracy showed values in the submillimeter range.Using a newly developed robotic system, a fully automated perforation of the sphenoid sinus' anterior wall was performed precisely and reproducibly. This approach can be enlarged in a telemanipulation mode.

Neurological impairment during pregnancy is also commonly found in otorhinolaryngology. Cranial nerve palsy, e.g. of the facial nerve or changes in signal processing of the hearing system, are described. Apart from changes in electrolyte balance, these neurological alterations are attributed to hormone fluctuations. The spontaneous remission of the neurological problems after delivery is frequently reported. This case report presents a 34 year pregnant patient suffering from binaural sensorineural hearing loss and tinnitus in the third trimester. Three weeks after delivery there was a spontaneous remission and a measurable improvement of the audiological findings. Although treatment with cortisone and antibiotics remained without effect, a pharmacological treatment during pregnancy has to be carefully and individually coordinated. An interdisciplinary approach in diagnostic and therapeutic measures together with gynaecologists appears obligatory.

In recent years computer-navigation systems have been commonly used in the field of otorhinolaryngology. Taking its limitations and possible failures into account, this technology is considered reasonable and helpful in routine paranasal sinus surgery, particularly in revision cases and complex approaches to the lateral skull base. We report on a patient with a large recurrent craniopharyngioma, and show that the use of intraoperative navigation might even be necessary to accomplish the desired postoperative outcome in certain cases. Future developments will demonstrate whether computer assisted surgery can extend the indications for operative procedures in complex anatomical regions.

Funktionsstorungen in der Graviditat sind auch im Kopf-Hals-Bereich keine Seltenheit. Paresen von Hirnnerven wie des N. facialis und Veranderungen der Reizverarbeitung des N. cochlearis sind bekannt. Den neurologischen Defiziten werden neben Veranderungen des Elektrolythaushaltes auch hormonelle Umstellungsprozesse zugeschrieben. Ein in diesem Zusammenhang haufig berichtetes Phanomen ist die spontane Remission der neurologischen Funktionsstorung im Intervall nach der Entbindung. In dieser Kasuistik wird der Fall einer 34-jahrigen Schwangeren vorgestellt, die im 3. Trimenon eine beidseitige sensorineurale Horminderung und Tinnitus beklagte. 3 Wochen nach der Entbindung kam es zu einem spontanen Sistieren der Beschwerden und zu einer objektiv messbaren Verbesserung der Befunde. Die im Akutstadium durchgefuhrte Behandlung mit Kortison und Antibiotika war ohne Wirkung. Demnach sollten medikamentose Therapieoptionen bei Schwangeren in solchen Fallen zuruckhaltend und individuell abgestimmt sein. Ein interdisziplinares Vorgehen mit den Gynakologen bei der Abstimmung der diagnostischen und therapeutischen Masnahmen erscheint obligat.

Schwannoma of the vestibular nerve is the most common tumor found in the inner auditory canal. If a schwannoma of the facial nerve is found unexpectedly during surgery, the original surgical plan may have to be changed. In our series, we describe the symptoms, diagnostic procedures and therapy of this infrequent, benign tumor. In particular, we want to analyse the influence of diagnostic techniques, such as magnetic resonance tomography and electrophysiology, on the diagnosis of these tumors.Between 1975 and 2001, we diagnosed 17 cases of facial nerve schwannoma in the inner auditory canal or the geniculate ganglion. All patients were treated surgically. In 16 cases, we used the enlarged middle fossa approach and in the remaining patient the translabyrinthine approach was used.In 11 cases, the facial nerve could be saved but in six the nerve had to be rebuilt with a transplant. During the first years of our study, palsy of the facial nerve was a frequent finding. In the later years, a hearing impairment and tinnitus became the most frequent symptoms.Advances in magnetic resonance imaging have, in many cases, facilitated the differentiation between schwannomas of the facial nerve and the vestibular nerve over the last years. Signal enhancement at the geniculate ganglion is important for the diagnosis of facial nerve schwannoma. In individual cases, we found significant findings using electrophysiological procedures. In three cases, the temporal delay was elongated. Based on these findings, the therapeutic procedures can be discussed together with the patients.

Sporadic vestibular schwannoma show a wide variability of their growth rate. Some tumors might remain quiescent for a long time without symptoms and other tumors might suddenly enlarge. Sometimes during surgical removal of tumors, it is useful to have a parameter for the prediction of the further growth potential of the schwannoma, especially if tumor resection results in functional impairment of the facial nerve. An often used histological parameter for growth rate of tumor cells is the proliferation index.In our study we observed a series of 50 patients with neurinoma of the vestibular nerve by "wait and scan". After the first magnetic resonance imaging (MRI) all patients were controlled by a second MRI. The time between the MRIs ranged between 3 and 26 months (median 9). In 45 of 50 patients a surgical removal of the tumor by transtemporal approach followed.The proliferation index (Ki-67) was identified in the histological tumor specimens. The next step was the correlation of proliferation index and "tumor doubling time" (TDT). The volume of the tumors was provided by measuring three diameters of the tumors in MRI and calculating the volume with a formula. The volume of the tumors were used to calculate tumor growth and TDT. 10 patients showed no tumor growth during follow up. The average TDT in 40 cases was 22 months (SD 16). In 33 cases we were able to determine a proliferation index, which showed an average score of 1.99 %. Statistical analysis showed a correlation between proliferation index and TDT with a coefficient of - 0.42 (s: 0.014). In two cases with relevant clinical tumor growth (TDT: 12 months), the MIB-1 index was nearly 0 % in different areas of the tumor specimen. May be in these cases, the cell proliferation declined just before operation. On the other hand we found one patient with a high proliferation index of 3.3 % and a rather long TDT of 19 months.The determination of proliferation can serve as a further decision guidance during surgery of vestibular schwannoma.

The excision of tumors of the pituitary gland is usually achieved via a transsphenoidal transnasal approach. In the past, alternative approaches were described for macroadenomas. Especially in tumors surrounding the internal carotid artery (ICA) and the optic nerve, the selection of the appropriate approach is of importance. We demonstrate the case of a second extensive relapse of a macroadenoma after primary transsphenoidal resection and radiation therapy. As the tumor enclosed both the ICA and left optic nerve, a median external approach via the upper midface was chosen. After the median skin incision and translocation of the upper parts of the nasal structure, the papyraceous lamina was removed bilaterally. The orbital tissue was laterally exposed with retractors, achieving a wide access to both carotids and optic nerves. The functional and aesthetic results were satisfactory. Compared with other approaches, this one provides a good exposure of both the ICA and optic nerve.

Between 1995 and 2001 we treated 12 patients with benign symmetric lipomatosis in the head and neck. The group comprised 11 men and 1 woman aged 34-62 (M=47). The most frequent complaints were diminished range of motion of the head and obstruction when eating or speaking. Combined lipectomy and liposuction were performed in all patients, with liposuction being carried out in a second session.The mean follow-up period was 3 years. The functional results were very satisfactory in all patients. Of the 12 patients, 9 were also satisfied with the aesthetic outcome.A recurrence occurred in three patients 1.5, 2, or 3 years after the operation. Severe complications were not observed.According to our experience, combined lipectomy and liposuction represents a successful procedure in treating benign symmetric lipomatosis in the head and neck region.Nevertheless, advantages and drawbacks of the two techniques should be equally considered prior to surgery.

Hintergrund. Die benigne symmetrische Lipomatose (Morbus Madelung) ist eine seltene Erkrankung unbekannter Atiologie, die durch das diffuse Wachstum nicht gekapselter Lipome charakterisiert ist. Patienten und Methode. Zwischen 1995 und 2001 haben wir 12 Patienten mit einem M.Madelung im Kopf- und Halsbereich behandelt.Es handelte sich dabei um 11 Manner und eine Frau im Alter von 34 bis 62 Jahren (M=47).Eine Einschrankung der Kopfbeweglichkeit und eine Behinderung beim Essen und Sprechen waren die haufigsten Beschwerden.Bei allen Patienten wurde eine kombinierte Lipektomie und Liposuktion durchgefuhrt,wobei die Fettabsaugung in einer zweiten Sitzung erfolgte. Ergebnisse. Der Nachbeobachtungszeitraum betrug durchschnittlich 3 Jahre. Die funktionellen Ergebnisse waren bei allen Patienten sehr zufriedenstellend.Neun von 12 Patienten waren auch mit dem asthetischen Ergebnis zufrieden.Bei 3 Patienten trat ein Rezidiv jeweils 1,5, 2 und 3 Jahre nach den Operationen auf.Schwerwiegende Komplikationen beobachteten wir nicht. Schlussfolgerungen. Nach unseren Erfahrungen stellt die kombinierte Lipektomie und Liposuktion ein erfolgreiches Vorgehen bei der Behandlung der benignen symmetrischen Lipomatose im Kopf- und Halsbereich dar.Vorund Nachteile beider Techniken sollten jedoch praoperativ berucksichtigt werden.

A combined Ho:YAG/Nd:YAG laser produces light with properties similar to the beams of the mainly coagulating Nd:YAG laser and the cutting CO2 laser alone.The combined laser was tested in vitro on pig tissue. Additionally, we used this new combined tool for enoral operations.An effect of the pulsed Ho:YAG laser was explosive-like tissue disruption and sprinkling of fragments. Simultaneous use of the Nd:YAG laser resulted in an enlarged zone of coagulation. Clinically, the laser-assisted intervention was inferior to the classic operational methods.Comparing the established CO2 laser and the Ho:YAG laser, the latter showed only the advantage of delivery via a flexible fiber. Sprinkling of tissue fragments and wide incisions are oncologically problematic. We conclude that this new tool is of minor value for otorhinolaryngologists and head and neck surgeons.

The localization of an upper airway collapse in snorers and patients suffering from obstructive sleep apnea was a subject frequently discussed in the last few years. Pharyngolaryngoscopy during sleep or drug-induced sleep allows evaluation of upper airway conditions.A total of 324 patients suffering from snoring or obstructive sleep apnea underwent flexible pharyngolaryngoscopy while awake and under propofol-induced sedation in the course of routine diagnostic procedures in the sleeping lab. In this study, the results of pharyngolaryngoscopy are compared to results of the Müller maneuver and polysomnographic recordings. The therapeutic consequences of this additional investigation are discussed.In 95% of cases snoring was observed during drug-induced sleep. A significant discrepancy was seen between results of the endoscopy while being awake (Müller maneuver) and during drug-induced sleep. The degree of collapse differed significantly in the area of the base of the tongue. Severe collapse was seen much more often with pharyngoscopy during drug-induced sleep compared to the results during the Müller maneuver.The collapsibility in the area of the base of the tongue correlated with higher results in the RDI (respiratory disturbance index) registered with standard polysomnography. Snoring and upper airway collapse were easily surveyed, and the pharyngolaryngoscopy during propofol-induced sleep proved to be a simple, safe, readily controllable and effective supplementary diagnostic device for the diagnosis and treatment of obstructive sleep apnea and snoring.

The treatment success of nCPAP therapy (nasal continuous positive airway pressure) depends partly on the relief of symptoms and partly on long-term patient acceptance and the related avoidance of complications. Nasal complaints constitute the most frequently reported side effects and, together with problems of mask application, are among the primary factors causing an nCPAP-therapy to be prematurely discontinued.To assess the morphological changes of the nasal mucosa during nCPAP-therapy, we excised specimens of nasal mucosa tissue in twelve patients with obstructive sleep apnea syndrome (OSAS) both before and 3-10 months after establishing nCPAP-mask acceptance. The specimens were examined by electron microscopy.In all these patients, acceptance of the CPAP mask marked the initial part of therapy. In addition, mucociliary clearance was assessed by the saccharin test before and after therapy. In all patients, the nasal epithelium underwent fundamental changes upon CPAP therapy, which became manifest as modifications in the shape of epithelial cells, conglutination and clumping of the microvilli, and the appearance of immunocompetent cells. Once patients were nCPAP mask compliant, mucociliary clearance was distinctly prolonged in all cases.A successful therapeutic concept should provide normalization of room temperature and air humidity once nCPAP mask compliance has been achieved, and include regular assessment of the condition of the mucosa in the upper respiratory tract. Only by these measures can nasal complications be countered or therapy be applied at an early stage.

Orbital pseudotumor is a nonspecific inflammatory process of unknown etiology that can be divided histopathologically into three basic types: granulomatous, lymphoid, and sclerosing. Between 1995 and 1998, 12 patients with pseudotumor orbitae were treated in the ENT Department of the University of Saarland. Histopathological examination showed granulomatous type of pseudotumor in six, lymphoid in three, and sclerosing in three patients. In seven cases the pseudotumor orbitae were medially located and in four cases laterally. In one patient nearly all orbital structures were infiltrated. Diagnostic biopsy was taken endonasally in six cases, via medical orbitotomy in two cases, and via lateral orbitotomy in four cases. Due to their good delimitation lymphoid and sclerosing tumors were extracted completely during diagnostic biopsy and patients were free of complaints after a few weeks. The six patients with granulomatous pseudotumor were treated primarily with steroids after the diagnosis had been definitely confirmed by histology. In three of those six cases a second course of steroid therapy had to be given, with positive results in two cases. Follow-up was between 6 and 28 months (mean 16 months). There were no postoperative complications. The clinical and radiographic presentation of the pseudotumors can vary greatly. Therefore, the differential diagnosis of specific infections or neoplasms can only be established through diagnostic biopsy. Different rhinosurgical approaches provide clear biopsy results and in some cases the pseudotumor is even completely removed.

We report the case of a 36-year-old women who was found to have a malignant tumor extending from the side of her right nasal cavity to the nasopharynx. Magnetic resonance imaging and computed tomography were not able to define the primary site of the tumor. Histologic evaluation demonstrated an undifferentiated squamous cell carcinoma. Because of the different treatment concepts for carcinomas of the nasal cavity and nasopharynx, we tried to identify the primary site by diagnosing Epstein-Barr virus (EBV) infection, which is associated with carcinoma of the nasopharynx. By using immunohistochemistry and polymerase chain reaction EBV could be identified in the cells of the carcinoma. This showed that the primary site of the tumor was located in the nasopharynx and resulted in the patient being treated with simultaneous radiochemotherapy.

Der Pseudotumor der Orbita ist ein unspezifischer entzundlicher Prozess dessen Genese unbekannt ist und der histologisch in 3 Gruppen unterteilt wird: der granulomatose, lymphoide und sklerosierende Typ. Zwischen 1995 und 1998 haben wir 12 Patienten mit einem Pseudotumor der Orbita behandelt. Es handelte sich dabei um Falle vom granulomatosen (n=6), lymphoiden (n=3) und sklerosierenden (n=3) Typ. Bei 7 Patienten war der Pseudotumor im medialen Bereich der Orbita und in 4 Fallen im lateralen Bereich lokalisiert. Bei einer Patientin lag eine diffuse Infiltration annahernd aller orbitalen Strukturen vor. Die Probebiopsie wurde in 6 Fallen endonasal, in 2 Fallen uber eine mediale Orbitotomie und bei 4 Patienten uber eine laterale Orbitotomie durchgefuhrt. Die gut abgrenzbaren lymphoiden (n=3) und sklerosierenden (n=3) Pseudotumoren konnten im Rahmen der Probebiopsie komplett entfernt werden, so dass die Patienten nach wenigen Wochen beschwerdefrei waren. Bei den 6 Patienten mit einem granulomatosen Pseudotumor wurde nach der definitiven Histologie eine primare Kortikosteroidtherapie durchgefuhrt. In 3 der 6 Falle kam es dadurch zu einem Ruckgang der Beschwerden mit kompletter Ausheilung. Bei den restlichen 3 Patienten war eine erneute Kortisontherapie erforderlich wobei diese nur in 2 Fallen erfolgreich war. Der Nachbeobachtungszeitraum betrug 6–28 (Mittel 16) Monate. Postoperative Komplikationen traten nicht auf. Die klinische Symptomatik und die radiologische Darstellung der Pseudotumoren kann sehr variabel sein, so dass nur durch eine Probebiopsie eine genaue Differenzierung von spezifischen Infektionen und malignen Raumforderungen moglich ist. Die rhinochirurgischen Zugange erlauben eine sichere Biopsie und in einigen Fallen auch eine komplette Entfernung des Pseudotumors.

Acute hearing loss following non-otologic surgery and general anesthesia is a rare occurrence. Deafness following anesthesia has more commonly been associated with spinal anesthesia or cardiopulmonary bypass surgical procedures. We present a case with unilateral cochlear dysfunction and sensorineural hearing loss after inguinal hernia operation. The literature is reviewed and the mechanisms causing hearing loss during anesthesia are discussed.

The incidence of deep neck space infections has been significantly reduced by modern antibiotic therapy. These infections are relatively rare and yet the life-threatening complications merit special consideration by head and neck surgeons.Seven cases of deep neck space infections as a consequence of purulent pharyngitis (3), peritonsillar abscess (2), retropharyngeal (1), and odontogenic (1) abscess are presented. Despite antibiotic therapy according to antibiogram all patients showed an increase in complaints with persisting febrile temperatures and rising inflammation parameters. Surgical intervention became necessary. In two cases the infection spread into the mediastinum.All patients were completely cured by means of early surgical intervention including extensive drainage of the primary focus, deep neck spaces and mediastinum, accompanied by intravenous antibiotic therapy. Tracheotomy was performed on one patient with increasing dyspnea. All patients had an uneventful recovery without major postoperative complications.The clinical course of the disease must be observed particularly closely even after starting antibiotic therapy and identification of the infectious focus. Antibiotic therapy may in some cases cover clinical symptoms. However, in the presence of abscess formation or necrotizing infections, antibiotics can prove to be ineffective. The optimum time for surgery is difficult to determine. Complete drainage of the neck spaces down to the mediastinum is a safe procedure to save the patients' life. This shortens the duration of the disease and prevents complications. The most common problems in the management of deep neck space infections are discussed.

In a series of 9 patients with advanced carcinomas of the posterior wall of the hypopharynx (2 patients with T2 tumors and 7 patients with T4 disease), we tried to preserve the larynx with surgical therapy. The concept of laryngeal preservation consisted of lateral pharyngotomy with free flap reconstruction of the defect created by the tumor resection. A recommendation for surgery was given to each patient with a neoplasm in the posterior pharyngeal wall and tumor extension6 cm in diameter. The maximum tumor diameters ranged between 6.5 cm and 12.5 cm. Reconstruction was performed in 8 cases with radial forearm flaps while a jejunal transplant was used in one case due to the extension of tumor. During each surgical procedure an attempt was made to preserve the superior laryngeal nerves and transplants were adapted exactly to the resection defects. Seven patients achieved oral swallowing within three months of surgery, while one patient needed four months to swallow orally. One patient had persistent aspiration and still needs a percutaneous gastrostomy. Six patients were decannulated successfully, so that laryngectomy was avoided during postoperative follow-up. These results show that surgical therapy of advanced carcinoma of the posterior wall of the hypopharynx is possible with preservation of the larynx. Additionally, functional outcome after treatment of these patients with free flap reconstruction is comparable to other treatment modalities, such as radiochemotherapy.

BACKGROUND The incidence of deep neck space infections has been significantly reduced by modern antibiotic therapy. These infections are relatively rare and yet the life-threatening complications merit special consideration by head and neck surgeons. PATIENTS Seven cases of deep neck space infections as a consequence of purulent pharyngitis (3), peritonsillar abscess (2), retropharyngeal (1), and odontogenic (1) abscess are presented. Despite antibiotic therapy according to antibiogram all patients showed an increase in complaints with persisting febrile temperatures and rising inflammation parameters. Surgical intervention became necessary. In two cases the infection spread into the mediastinum. RESULTS All patients were completely cured by means of early surgical intervention including extensive drainage of the primary focus, deep neck spaces and mediastinum, accompanied by intravenous antibiotic therapy. Tracheotomy was performed on one patient with increasing dyspnea. All patients had an uneventful recovery without major postoperative complications. CONCLUSIONS The clinical course of the disease must be observed particularly closely even after starting antibiotic therapy and identification of the infectious focus. Antibiotic therapy may in some cases cover clinical symptoms. However, in the presence of abscess formation or necrotizing infections, antibiotics can prove to be ineffective. The optimum time for surgery is difficult to determine. Complete drainage of the neck spaces down to the mediastinum is a safe procedure to save the patients' life. This shortens the duration of the disease and prevents complications. The most common problems in the management of deep neck space infections are discussed.

Endosonography is a diagnostic tool for the examination of tumors of the oral cavity. The pharynx is usually not assessable for conventional endosonography due to problems with the placement of the probe in deeper areas of the pharynx.A fingertop ultrasonography probe was combined with a stick allowing the user to locate the probe in deeper areas of the pharynx. The stick had two flexible joints and a device for attaching the probe in the front. We evaluated 48 patients with tumors of the posterior wall of the pharynx (n = 6), lateral wall of the pharynx (n = 7), tonsil (n = 17), sinus piriformis (n = 13), and nasopharynx (n = 5) during preoperative tumor endoscopy under general anesthesia. Thirty-two patients suspected of having a tonsillar abscess were examined under local anesthesia.The evaluation of the tumor dissemination and the determination of the relationship between the tumor and the internal carotid artery was excellent for tumors of the posterior and lateral wall of the pharynx. The investigation of tumors of the sinus piriformis and the nasopharynx was difficult and tumor growth could not be determined normally with endosonography. In four cases, retropharyngeal lymph nodes could be detected. The sensitivity for the diagnosis of tonsillar abscesses was 84%.Endosonography of the deeper areas of the pharynx seems to be a useful instrument for investigating growth of tumors at the lateral and posterior wall of the pharynx. Endosonographic results might be helpful for deciding between endoscopic and external approaches. Endosonography is not sufficiently sensitive for diagnosing tonsillar abscesses, but might be helpful in clinically difficult cases.

Butter is rich in lauric, myristic, and palmitic acids which are assumed to be hypercholesterolemic. The replacement of usual dietary fat by rapeseed oil induces a serum cholesterol decrease. The objective of the study consisted in measuring the influence of feeding different amounts of full-fat rapeseed or oil-rich rapeseed cake to dairy cows to improve the fatty acid composition of milk fat. The results demonstrate a significant increase of iodine number and spreadability of butter. The percentage of lauric+myristic+palmitic acid (LMP) decreased by about 18% of whole fatty acids. Stearic and oleic acid increased significantly but the percentage of trans octadecenoic acid increased too. It can be concluded that the special butter has a nutritionally improved fat characterized by an increase of cholesterol-lowering fatty acids (C18 and C18:1) and a decline of cholesterol-elevating fatty acids (LMP).

The content of 10 naturally occurring steroidal sex hormones (androgens and progestogens), their biosynthetic precursors and metabolites was determined in 62 samples of beef (bulls, steers, heifers). After enzymatic hydrolysis of their conjugates, the steroids were extracted from the tissue by liquid-liquid extraction and purified by solid phase extraction. The identification and quantification was carried out by GC-MS of the trimethylsilyl ethers. The progestogens progesterone and pregnenolone were quantitatively dominant (43.7 and 6.5 micrograms/kg respectively). The highest steroid concentrations were determined in female cattle.

A simple, selective and highly sensitive HPLC method for the routine determination of the biogenic amines in food is presented. Sample preparation is based on a rapid amine extraction using 10% trichloroacetic acid and a cation exchange column for extract purification. For the RP-HPLC analysis OPA/2-mercaptoethanol is used for the pre-column derivatisation, followed by fluorescence detection (Ex 345 nm, Em 440 nm). The effects of several factors are discussed. A separation of 15 biogenic amines is achieved within 70 min. The recoveries for histamine, tyramine, putrescine, cadaverine, tryptamine and beta-phenylethylamine are higher than 95%. The detection limits lie between 0.1-0.5 pMol/injection (20 microliters), depending on the amine and a good linearity is achieved in the range from 0.5-500 pMol (r0.99). The method has been applied for the determination of biogenic amines in swiss cheese, salami, milk, beer and wine, the repeatability is very good.

Microplates are smaller and more ductile than miniplates. We used microplates for fixation of fractures in children (seven cases), reconstruction of isolated frontal sinus wall fractures (39 cases), fixation of lateral mid-facial fractures (79 cases), fractures of the nasoethmoidal complex (14 cases), for different osteoplastic procedures (40 cases) and for laryngoplasty (three cases). Thirty fractures of the lateral mid-face were treated only with microplates. In these cases, reposition of the fractured bones was easily achieved and treatment was performed only a few days after the trauma. In 49 cases with unstable fractures after reposition, microplates and miniplates were combined for fixation. It is very important to assess the indications for different types of plates (miniplates or microplates) individually in every case. Because of the excellent biocompatibility of titanium and the low rate of local complications after internal fixation with microplates, it is usually not necessary to remove the plates.

We discuss the arguments dealing with removal of fixation devices and plates after osteosynthesis of facial bone fractures. As an experimental model for examining the soft tissue reaction to implants under standard conditions, an inguinal flap was prepared in 24 Wistar rats. Titanium mesh implants (10 x 8 x 0.3 mm) were then inserted into the flaps. Twelve implants were additionally bent to investigate histologically the influence of mechanical preparation on tissue reactions. Examination of all specimens was carried out with the technique of Donath and showed a thin capsule around the titanium implants but without any signs of infection. Around the bent areas of the implants there were minimal signs of local chronic inflammation without a capsule. Use of titanium microplates instead of miniplates in 89 patients with midfacial fractures diminished the rate of local complications. Based on our experimental and clinical results, indications for the different types of plates and the necessity for their later removal are discussed. Our present plates are only removed from the maxillary sinus wall and the alveolar ridge, after osteosynthesis in children, and in patients with local complications. If removal of the material is planned (because of the location), less expensive steel implants are used.

The electro-tactile elicitation of the stapedius muscle reflex is well known but not used in clinical practice. Despite a complex reflex pathway in the brainstem, correlations between reflex parameters and neurological impairments are still possible. We have developed a method for eliciting the electro-tactile stapedius muscle reflex and automatic analysis of different reflex parameters by using an analog-digital converter and a personal computer-integrated signal analysis system. Clinical investigations were carried out with a group of 55 healthy persons (control group), 13 patients with central facial palsies, 51 patients with multiple sclerosis (MS group) and 24 patients with absent acoustic-stapedius muscle reflexes. Findings demonstrated that the latency between stimulus and beginning of the reflex (L1) was significantly longer in the MS group compared with the control group. The best parameter for dividing the MS group into groups with different disability scores was S, which was the parameter for the increase in the L1 growth curve at different stimulus levels. Reproduction of the parameter S in repeated tests with different locations of the stimulus-electrode was excellent.

In a retrospective study we evaluated the clinical and histological datas of patients with squamous cell carcinomas of the head and neck to determine the influence of extranodal spread in metastases for the prognosis. Lymph nodes were dissected from the neck dissection specimens and investigated histologically with special regard to extranodal spread. 304 patients (58%) showed positive lymph nodes and 212 of this patients had additionally extranodal spread (70%). Hence, the rate of extranodal spread in the whole investigated group (522 patients) was 40%. For the patients with carcinomas of the hypopharynx the rate of extranodal spread was especially high (70%). Most extranodal spread could be found at levels 2, 3 and 4. We found a correlation between the appearance of extranodal spread and increasing T-stage. 5-year survival rates were greatly different for patients with no metastases (77%) and patients with extranodal spread (28%). We discuss the use of the criteria extranodal spread for the planning of adjuvant chemotherapy.

The purpose of the simulation was to design a specific cancer screening programme for squamous cell carcinomas of the head and neck to make detailed estimates of the outcomes of different screening programme options. Therefore, a mathematical model of screening (Eddy) was transformed and simulated with a computer programme. The model is designed as a Markov chain with 7 states and filled with clinical and epidemiological data. The results of the simulation are interpreted as representative for cancer of the oral cavity. Basing on the different system model outputs, mortality with and without screening, effect on life expectancy of the individual and the entire screened population, are discussed. For a screening interval of 6 months the increase in life expectancy for a person with cancer of the oral cavity is 5.3 years, for the entire population (men older than 40 years), however, life expectancy increases only by 9.8 days. The proportion of patients saved from tumour-associated death rose to 65%. The simulation showed a rapidly decreasing effect of the screening programme with longer screening intervals. Therefore, a public cancer screening programme is only useful with a screening interval of 6 months, and the effect on life expectancy is limited. For oropharynx and hypopharynx the possibilities of early stage detection of carcinomas are limited and nearly 60% of the cases with carcinoma of the larynx are already being treated at an early stage. The importance of public health education is emphasised.

The fatty acid composition of the fat in 197 food samples has been analyzed by gas liquid chromatography. The use of a 30 m capillary column coated with CPSil88 permitted the separation of the cis and trans isomers. The trans fatty acid content of milk and milk products ranged from 1.9 to 7.9%. Meat samples from ruminants contained 2.0-10.6% trans fatty acids. In pork fat the amounts were less than 0.5%. Sausages and other meat products contained high levels of pork fat. Therefore these samples contained less than 1% trans fatty acids, with the exception of some pure beef products. The amounts of trans fatty acids in foods which may contain hydrogenated oils ranged from 0 to 34.9%. In food samples with high levels of trans fatty acids lower contents of saturated fatty acids were analyzed.

Standard procedures for temporary mandibulotomy are medial or the lateral osteotomy. Median mandibulotomy is associated with destruction of anatomical structures in the floor of the mouth and with lateral osteotomy no preservation of the nervus alveolaris inferior is possible. Therefore, a modification of mandibulotomy is described with wide-field exposure, minimal functional defects and reduction of osteotomy-related complications. The first osteotomy is carried out vertically before the foramen mentale on the buccal compacta of the mandible. A second vertical osteotomy is placed on the lingual compacta posterior to the musculus myohyoideus. Horizontal osteotomies on the alveolar ridge and the basal ridge of the mandible are connected with the vertical osteotomies. Using a chisel, the lingual and the buccal part of the mandible are split sagittally with preservation of the nervus alveolaris inferior located in the buccal fragment of the mandible. The two parts of the mandible are divided to provide access to the oropharynx. Surgical approach to the fossa pterygopalatina and the parapharyngeal space is reached with dissection of the mucosa along the ascending mandible, subluxation in the mandibular joint and reflection of the mandible cranially and posteriorly. The wide access offers a lot of advantages especially in combination with a microvascular flap reconstruction. Fixation of the mandible is carried out with two titanium miniplates at the anterior vertical osteotomy. The wide areas of the split bone marrow, resulting from sagittal splitting, achieved an exact adaptation of the mandibular parts and an easy and sure fixation via miniplates. Therefore, post-operative radiation therapy can be started two weeks after the operation.(ABSTRACT TRUNCATED AT 250 WORDS)

The records of 68 patients with cancer of the floor of the mouth were reviewed. 56 patients underwent surgical management, 51 of them got additionally postoperative radiation. The tumour-specific five years' survival for patients with operation was 46%, 57% of treatment failures developed from local recurrence of the tumour. In 52% of all cases there was a spread to the lymphatic system in the histological evaluation. There was high incidence of false negative clinical examinations of the neck. Conservative neck dissection was the procedure of choice for clinically positive lymph nodes and for the elective management of the neck. Only advanced tumours showed involvement of the mandibular bone. Therefore a conservative management of mandibular resection was preferred. Radical tumour extirpation and histological controlling with serial sectioned specimens are methods of avoiding local tumour recurrence.

The intake of trans octadecenoic acids is estimated by a national consumption assay. The daily intake in West Germany differs between 3.4 g for women and 4.1 g for men. The consumption of trans fatty acids decreased in the last years, due to the progress in food technology and changes in nutritional habits. The main sources of trans fatty acids are partially hydrogenated vegetable fats just as well as ruminant and dairy fats.

The rate of hydrolysis of the synthetic trypsin substrate N alpha-benzoyl-L-arginine-p-nitroanilide was determined from turnover rate curves, when the trace elements zinc, iron, cobalt, and nickel were added in the concentration range from 0.9 . 10(-7) to 0.9 . 10(-3) mol Men+/l. The enzyme substrate ratio was 1:50. An influence on the activity of trypsin, depending on the element used and on its concentration could be determined. Cobalt and iron accelerated the enzyme's capacity of hydrolysis at all concentrations used, whereas addition of higher but not toxic amounts of zinc or nickel resulted in an inhibition.

Studies were carried out to investigate the effect of different pH values on the peptic digestion of soya protein in the presence and in the absence of Cu2+ ions. The studies were performed in vitro at a pH of 2.2 and 3.2, with 2.96 X 10(-5) mole of Cu2+ ions present in 11 of the reaction mixture. The reaction was carried out in a digestion apparatus permitting dialysis of the cleavage products. Different parameters were used as criteria of digestion, viz. the quantity of N contained in the reaction vessel (residue) and in the resulting dialysis products as determined by Kjehldahl microanalysis and automatic amino acid analysis, the proportions of digestion products found in the different molecular ranges after partition of Sephadex G 75 and the composition of amino acids in the cleavage products. From the distribution of the reaction products on the residue and dialysis products and on the different molecular ranges it was found that additions of Cu2+ ions at pH 2.2 produced a considerable inhibition of digestion. With a rise in pH to 3.2 peptic digestion decreased even without the addition of Cu2+. Supplementation of Cu2+ ions produced only a slight additional effect in the molecular range termed "exclusion limit". In the case of the amino acids tyrosine and phenylalanine it was found that an increase in pH changed the composition of peptides within the different molecular ranges. Additions of Cu2+ had no influence on the amino acid composition.

Kinetic experiments were made with pepsin in the presence of Cu2+ ions and additional Fe2+, Ni2+ or Zn3+ ions as sulphates. As a parameter of the pepsin activity the turnover-rate curves were determined with haemoglobin as a substrate. An important activation of the pepsin was obtained by Cu2+ additions of 5-10(-4) mole/1. When Cu2+ and Fe2+ ions were added to the reaction mixture at the same time, an additive effect of both metal cations was observed. A competitive effect of both metal cations was found in the combination of Cu2+/Ni2+ ions. Zn2+ addition did not influence the activation of pepsin caused by Cu2+ ions.

A total of 60 piglets of German Landrace weaned at the age of 2 weeks were fed ad libitum with isoenergetic diets of different proteins (casein + dried skim milk, soybean protein + dried skim milk, only soybean protein) and different protein levels in the diet (20, 27, 34, 40% in D.M.). After 4 weeks the piglets were homogenized and examined for their content of non essential amino acids in the whole body mass by ion exchange chromatography. On the fresh and dried material the content of the non essential amino acids Asx, Ser, Glx, Pro, Gly and Ala increased with the higher protein contents of the diet. Decreasing protein quality reduced the content of serine, whereas coincidently the concentration of glycine, especially on the protein levels of 20 and 27% in the diet increased. On the contrary the protein quality had no effect on the concentration of Asx, Glx, Pro and Ala. Related to the whole body protein the highest contents of the non essential amino acids, excepting serine, were found in piglets which got few protein of low quality. Influenced by the different protein supply the proportion of glycine to lysine varied from 1.28 to 2.17. The mentioned changes in the amino acid composition of the piglets are mainly discussed as shiftings in the proportion of organs and tissues and their protein composition.

A total of 60 piglets of German Landrace weaned at the age of 2 weeks were fed ad libitum with isoenergetic diets of different proteins (casein + dried skim milk, soybean protein + dried skim milk, only soybean protein) and different protein levels in the diet (20, 27, 34, 40% in D.M.). After 4 weeks the piglets were homogenized and examined for their content of essential amino acids in the whole body mass by ion exchange chromatography. On the fresh and dried material the contents of Thr, Val, Ile, Leu, Lys and Ser increased both with higher supply of protein and milk instead of soybean protein in the diet. The contents of Phe and Arg were only insignificantly changed by protein quality. Referred to the concentration of Met and Cys there were found higher standard deviations and interactions between protein supply and quality. The content of essential amino acids also was influenced by the protein quality of the diet, when related to the whole body protein. On the other hand a significant effect of increasing protein supply only took place if soybean protein was the single protein ingredient of the diet. Related to Lys the contents of Thr and Cys nearly were constant, whereas the amino acid/lysine proportion in the case of Met, Ile and Arg changed considerably.

In vitro experiments were carried out in order to investigate the influence of Cu++-ions on the tryptic hydrolysis of casein and soybean protein. The admixture of 10(-3) to 10(-2) Mol Cu++/l to the reaction preparations results in the activation of trypsin in both substrates. The further increase of the Cu++-concentration results in a decrease of the trypsin activity and, with casein as substrate, in trypsin inhibition. The effects are similar with the synthetic substrate N alpha-benzoyl-L-arginine-p-nitroamilide (L-BAPA), however, trypsin is already activated after the admixture of approximately 5 x 10(-6) Mol Cu++/l. Since the admixture of Cu++-ions in experiments with pepsin in similar concentrations as with trypsin also results in an activation, the question is being discussed whether the improved protein digestibility and the higher weight increase of pigs which received 250 ppm copper can be traced back to these effects.

In order to determine the influence of copper additives on the protein digestibility, the complex formation of proteins with Cu ions under acidic conditions (pH=2.2) was investigated. Isolated soja-protein (300 mg) resp. pepsin was mixed with 10 mumol (2.49 mg) CuSO4-5H2O and dialysed against low molecular complexing agents with increasing affinity towards copper ions. The experiments with soja-protein showed, that most of the Cu ions dialysed (97% of total Cu2+ content) without any addition of complexing agents, pepsin, however, had a lower percentage (83% of total Cu2+ content). The remaining copper ions in pepsin could only be removed by alanin and ammonium-tetramethylendithiocarbamate. Therefore it is concluded, that in the acidic range Cu ions only form complexes with pepsin, but not with soja-protein. This effect is due to the very low isoelectric point of pepsin. The determination of iron, nickel, and zinc in native proteins revealed, that at pH=2.2 iron and nickel are stronger linked to pepsin than to soja-protein; only zinc was loosely bound to both proteins.

Carcasses and organs of 36 broiler chicks originating from an extensive fattening experiment with differing proportions of tryptophan (0.65 and 0.93 g/16 g N) to the neutral amino acids (15.2, 18.3 and 22.0 g/16 g N) in feed were analyzed for amino acid contents. Aside from the whole carcasses, a selected muscle (M. fibularis longus), liver, small intestine, and brain were prepared from the animals and analyzed. The organ weights differed according to the live-weights with the exception of the brain, where no group differences were measured. The patterns of amino acids of carcasses and organs remained nearly constant with differing amino acid supply. The only remarkable effect was the increase of the proportions of proline and hydroxyproline in the carcass protein from 6.4 to 7.4 and from 1.6 to 1.8%, respectively, with the higher tryptophan supply indicating increasing proportions of connective tissue. No relationship between weight gain and collagen content (calculated from hydroxyproline content) could be detected. The frequently supposed antagonism between tryptophan and the neutral amino acids, especially at the border of blood and brain, caused no reduction in tryptophan content of brain with increasing supply of neutral amino acids. There was, however, a significant depression of the development of the animals and the other inner organs.