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The paper describes the evaluation of magnetic resonance imaging (MRI) following osteoplastic flap procedure with fat obliteration. MRI scans performed in patients after surgery between 1st January 1986 and 31st December 1997 were evaluated. Outcome parameters were time-dependent changes in the distribution of adipose or connective tissue, development of necroses or oil cysts, recurrences, inflammatory complications, or mucocoeles. Eighty-six postoperative MRI scans from 51 operations were evaluated. In 19 cases between two and five MRI scans were available. Time between surgery and the last MRI scan was 24.1 months on average. We found five mucocoeles. The amount of adipose tissue depictable on the last scan was less than 20% in the majority of cases (53%) and more than 60% in only 18% of cases. Statistical tests and modelling showed a significant decrease of adipose tissue with time, with a median half-life of 15.4 months in a subgroup with at least two MRIs. MRI is at times the most valuable diagnostic tool after frontal sinus obliteration using adipose tissue. The method has some limitations with regard to detection of small (recurrences of) mucocoeles and differentiation between vital adipose tissue and fat necroses in the form of oil cysts. In difficult cases long-term MRI follow-up is necessary for definitive evaluation.

A series of substituted tetrahydropyrrolo[2,1-b]oxazol-5(6H)-ones and tetrahydropyrrolo[2,1-b]thiazol-5(6H)-ones was synthesized from amino alcohols or amino thiols and keto acids. A pharmacological model based on the results obtained with these compounds led to the synthesis and evaluation of a series of isoxazoles and other monocyclic compounds. These were evaluated for their ability to enhance glucose utilization in cultured L6 myocytes. The in vivo hypoglycemic efficacy and potency of these compounds were evaluated in a model of type 2 diabetes mellitus (non-insulin-dependent diabetes mellitus), the ob/ob mouse. 25a(2S) (SDZ PGU 693) was selected for further pharmacological studies.

Beta-adrenergic receptors were localized and quantified with autoradiographic methods in frozen sections of eyes of albino rabbits using [125I]cyanopindolol and [3H]dihydroalprenolol. Quantification in albino rabbits revealed highest β2-adrenoceptor densities in the ciliary body, the corneal epithelium and the corneal endothelium. Moreover, the iris showed significant amounts of specific binding, whereas the retina and sclera are nearly free of these receptors.

Sinus thrombosis has rarely been associated with closed head injury; more often, thrombosis of the sigmoid or transverse sinus is caused by otogenic inflammations or tumours, or occurs during pregnancy. Symptoms are frequently vague, while untreated thrombus progression may be fatal due to venous congestion and infarction. We report a 32-year-old man presenting with right hearing loss, tinnitus and headache 2 days after a closed head injury. Neurological examination showed no additional abnormality. The EEG showed focal bifrontal slowing. CT revealed a fracture of the occipital bone. MRI and MRA demonstrated complete thrombosis of the right sigmoid and transverse sinuses. After 2 weeks of intravenous heparin therapy followed by warfarin, the patient's hearing improved and MRI and MRA showed complete recanalisation of the sigmoid and transverse sinuses. Venous sinus thrombosis can be an undetected sequel to head injury. Appropriate imaging studies should be carried out to enable therapy to be started as soon as possible.

The osteoplastic flap procedure with fat obliteration has been hailed as the gold standard of definitive frontal sinus procedures for chronic inflammatory disease. The value of magnetic resonance imaging (MRI) in postoperative follow-up has not yet been sufficiently examined.All postoperative MRI scans performed in patients undergoing surgery between January 1, 1986, and December 31, 1996 were evaluated. The outcome parameters were time-dependent changes in the distribution of fatty or connective tissue and development of necroses or oil cysts, as well as recurrences, inflammatory complications, or mucoceles.Sixty-eight operations were performed in the specified period and a total of 73 postoperative MRI scans from 45 operations were available for evaluation. In 16 cases, between two and five MRI scans were available. The individual time between surgery and the last MRI scan ranged from two weeks to 130 months with an average of 30.1 months. We found four mucoceles 34, 49, 106, and 130 months, respectively. Three of the mucoceles were diagnosed on the first postoperative MRI scan. In the fourth case the mucocele had not been seen on the previous scan. The amount of adipose tissue depictable on the last scan was less than 20% in the majority of cases (58%) and more than 60% in only 18% of cases, although in the latter group the time between surgery and MRI was less than 7 months in half the cases.MRI is the most valuable diagnostic tool after frontal sinus obliteration using adipose tissue. Despite the good soft tissue differentiation, the method has some limitations with regard to detection of small recurrent mucoceles and differentiation between vital adipose tissue and fat necrosis in the form of oil cysts. In these difficult cases, long-term MRI follow-up is necessary for definitive evaluation. We therefore recommend MRI 1, 2, and 5 years after osteoplastic frontal sinus surgery with obliteration.

Surgery is the most common treatment for angiofibromas, but the approach is still a major point of discussion. Five cases of angiofibroma with typical localisation were treated surgically by an endonasal approach at the Fulda Academic Teaching Hospital from 1994 to 1997. This article presents an analysis of the clinical findings, computer tomography and magnetic resonance imaging, preoperative embolization, operative technique and complications. Endoscopic and radiologic follow-up ranging from 5 to 39 months excluded any residual tumour or recurrence. The endonasal microendoscopic approach with adequate preoperative embolization should be considered as an useful technique for removing tumours with considerable size without using an external incision.

Despite increasing advances in endonasal frontal sinus surgery, obliteration of the frontal sinus is necessary in some cases for definitive clearing frontal sinus pathology. Reviewing the literature and considering pathophysiological aspects, successful obliteration of the frontal sinus depends on the complete removal of the mucosa and a sufficient closure of the nasofrontal duct, but not on the material used for obliteration, if special considerations are taken into account and foreign materials are avoided. Complete removal of the mucosa has to include removal of the inner bony cortex of the frontal bone. Occlusion of the nasofrontal duct is achieved with a sufficiently fixed fibrous layer.

The operative treatment and radiation therapy of jugulotympanic paragangliomas (JTP) are still a matter of controversial discussion. In spite of various improvements during the last 50 years, selecting the appropriate treatment modality (surgery, radiation, or observation) is still a challenge.During a 16-year period, 44 patients with 45 JTP (10 at level A/B and 35 at level C/D according to Fisch) were seen at the ENT-department in Fulda. Forty-one cases were treated surgically.Complete resection was possible for level A/B in 100% of the patients (n = 10). Residual tumor was demonstrated for level C in 23% of the patients (5/22) and for level D in 40% (4/10) with a median follow-up time of 69 months. In two cases residual tumor was treated by radiation. Six patients with residual paraganglioma tissue were maintained under observation without any evidence of tumor progression (median follow-up time 39 months). We report one death after the attempt to resect a large residual paraganglioma that had already caused brain stem compression. A sufficient duraplasty could not be achieved following radiation therapy.Complete tumor resection of jugulotympanic paragangliomas of levels A and B is often possible without injury to the cranial nerves. Extensive tumors present difficulties in complete tumor resection and increase the risk of cranial nerve injuries. Advanced paragangliomas therefore require an individualized therapeutic regime including surgery, radiation therapy, and observation of tumor growth.

It has been shown that inhibition of phosphodiesterase (PDE) or an increase in intracellular cyclic adenosine monophosphate (cAMP) can lower the intraocular pressure in mammalian eyes. The PDE inhibitor rolipram binds with high affinity to a cAMP-dependent PDE. In the following study, receptors for rolipram in the mammalian eye are determined by autoradiography. About 1050 histological sections of rabbit (albino and pigmented), rat, monkey (baboon and marmoset) and human eyes were examined concerning rolipram-binding sites in different structures. The highest specific binding of rolipram to the ciliary body epithelium was seen in human, rabbit and baboon eyes. Marmoset eyes showed the highest specific binding in the ciliary body muscle, rat eyes in the retina. Specific binding was consistently high in the ciliary body epithelium and therefore at the site of aqueous humor formation. Because of these results and the known mode of action of rolipram, one can assume a close connection between rolipram-binding sites and the regulation of intraocular pressure.

A papillary neoplasm that was presumed to originate from the endolymphatic sac was described by Heffner in 1989. This tumor was considered to be a "low-grade adenocarcinoma" because of its behavior: slow growth, local destruction and failure to metastasize. The clinical manifestations are hearing loss, vertigo, facial nerve paralysis and/or cerebellar disorders. Endolymphatic sac tumors have previously been mistaken for such neoplasms as paraganglioma, choroid plexus papilloma and carcinoma, adenomatous tumor of the middle ear and secondary metastases. The diagnosis of this neoplasm is facilitated by CT and MRI. The treatment of choice is total removal of tumor as soon as possible and requires clinical awareness of this rare but important pathologic entity.

Since February 1979, 22 juvenile angiofibromas have been treated among 312 tumors of the skull base managed in the ENT Department, Fulda. According to a general staff consensus the treatment of choice was complete surgical removal. This was achieved in 20 cases with one operation and in one case with two operations. In addition to removal of tumor, functional and aesthetic aspects had to be considered as aims of operative treatment, including among others preservation of the facial skeleton, infraorbital nerve, nasolacrimal drainage system and vision. In rare cases complete excision of the tumor is not possible. The value of cytostatic therapy is demonstrated in one patient with uncommonly advanced disease. Considering the extensive regression of tumor achieved in this case after chemotherapy with Adriamycin and decarbazine, one has to raise the question if the chemotherapeutic approach was more than just palliative. From our experience chemotherapy should be considered a possible alternative to radiation in the management of unresectable juvenile angiofibromas.

The obliteration of the frontal sinus via an osteoplastic approach is performed with the aim of achieving a permanent ‘switching off’ by final and conclusive clearing out. For this, freshly harvested abdominal fat has shown itself to be the best clinically. It is possible to demonstrate the vitality of fat transplanted into the frontal sinus without an operation i.e. by a macroscopical and histological examination using magnetic resonance imaging (MRI). The magnetic resonance examinations were carried out on a supraconductive 0.5 T Magnet (Gyroscan T.S.II, Philips Medicine Systems, Eindhoven, Netherlands) with a quadrature (square) head spool. We produced T1-weighted spin echo images (TR: 450–550 ms; TE: 20–25 ms), T2-weighted fast spin echo images or in double-echo technique in transverse orientation (Turbo SE or TR: 2000–2500 ms; TE: 50–90 ms) and short tau inversion recovery (STIR) sequences for fat suppression (TJ: 140 ms; TR: 1400 ms; TE: 30 ms). The fat implanted into the frontal sinus of 11 patients aged 22–65 years, having undergone an osteoplastic frontal sinus operation with obliteration, was examined post-operatively by MRI. Objectives were the time-dependent distribution of portions of vital fatty or connective tissue, the eventual development of necroses or cysts as well as recurrences, inflammatory complications or re-epithelization of the frontal sinus four to 24 months postoperatively. In only six out of 11 cases was vital fatty tissue found. Fatty necrosis occurred five times, whereas in four cases a transformation into granulation tissue and in one case into connective tissue could be seen. All 11 patients were complaint-free. Long-term observations are needed to see if differences in the recurrence rate of frontal sinus disease are dependent on whether the implanted fat remains vital or necrosed and transformed.

The purpose of obliterating the frontal sinus is to provide a permanent solution to the underlying problem. The material of choice for obliteration is freshly removed abdominal fat. Using magnetic resonance imaging, one can assess the vitality of fat tissue in an obliterated frontal sinus without surgery. Eight patients ranging in age from 22 to 65 years underwent osteoplastic frontal sinus surgery with fat obliteration. The freshly implanted abdominal fat was postoperatively investigated using magnetic resonance tomography. The magnetic resonance examinations were carried out on a supraconductive 0.5 T Magnet (Gyroscan T S II, Philips Medicine Systems, Eindhoven, Netherlands) with a square head spool. We produced T1-weighted spin echo images (TR: 450-550 ms, TE: 20-25 ms), T2-weighted fast spin echo images or in double echo technique in transverse orientation (Tubo SE or TR-2000-2500 ms, TE: 50, 90 ms) and STIR sequences for fat suppression (TJ: 140 ms, TR: 1400 ms, TE: 30 ms). Our goal was to determine the time-dependent distribution of vital fat or fibrous tissue, development of necrosis, cysts, recurrences, inflammatory complications, or re-epithelization of the frontal sinus. Six to 24 months postoperatively, we found vital fat tissue in only three of eight cases. In the other five cases fat necrosis was present. The frontal sinus was filled by granulation tissue or fibrous tissue (once). It is not yet possible to determine when the fat changes to connective tissue. This process varies between individual patients. All eight patients were free of symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

Focal cerebral ischemic symptoms, Horner's syndrome and mostly ipsilateral headache are the characteristic clinical triad of extracranial carotid artery dissection. Lower cranial nerve palsies seem to be uncommon and rare. By means of two cases with identical clinical symptoms and of a literature review we make clear, that ipsilateral lower cranial nerve palsies, especially a hypoglossal nerve palsy, are not uncommon. Without focal cerebral ischemic symptoms they can be the only sign of extracranial carotid artery dissection. Computed tomography of the skull base with regard to the high cervical internal carotid artery is as an usually quickly available examination an alternative to magnetic resonance imaging.

Chronic application of beta-blockers often induces tachyphylaxia of unknown origin. After long-term topical pretreatment of pindolol and timolol in rabbit eyes (up to 12 weeks, twice a day) beta 2-adrenergic receptors were localized and quantified with autoradiographic methods. Frozen sections of albino rabbit eyes were labelled with [125I] cyanopindolol. Quantification revealed a significant increase in the density of beta 2-receptors after premedication with pindolol in the ciliary body and the corneal epithelium. This increase was detectable after 2 weeks of premedication and reached its maximum after 4 weeks. After premedication with timolol a significant increase of beta 2-receptors in the epithelium of the ciliary body and the corneal epithelium was visible. Following pindolol over an equivalent time-course, to that of timolol administrations, an increasing number of beta 2-receptor sites was also observed. No significant changes were visible for either kind of premedication investigated (pindolol/timolol) in the corneal endothelium, the lens or the choroid. Chronic application of topically instilled beta-blocking agents leads to a significant increase in receptor density in ocular structures that are involved in aqueous humor production. This up-regulation of beta 2-adrenergic receptors might explain the intraocular events at receptor level in relation to the phenomenon of tachyphylaxis.

Since 1968, when the first commercial squash center has opened in Hamburg, squash has become very popular in Germany. Squash is played between two players in a closed court using racquets and a hollow rubber ball which could reach a maximum speed up to 225 km/h. According observations of English and American ophthalmologists there is an increased risk to get an eye injury in this game. Because of the isolation by the former existing wall, Berlin-West was an ideal place to study the ocular hazards of playing squash.In 1991 about 40,000 squash players existed in Berlin-West playing on 118 courts of 13 commercial squash centers. During January to October 1991 case records of all hospitals with an emergency eye ambulance and of the eye residents were investigated, furthermore all patient records of 1989 and 1990 of the eye clinic of the university hospital Rudolf Virchow, department Charlottenburg, were examined retrospectively.All over 234 sports-related eye injuries were registrated, 78 (33.3%) patients sustained the injury during a squash game, 43 (18.4%) during soccer and 34 (14.5%) during playing tennis. 71 squash players were treated in an hospital ambulance, of these 15 required admission. A total of 206 injuries were sustained by the players. The majority of injuries were superficial, but in 12 cases occured an hyphaema and in 13 an angle recession. In all admitted patients visual recovery was good, during the clinical follow up there were no perimetric, ophthalmoscopic or tonometric impairments. The initial loss of visual acuity of the injured eye compared to the other side was on the average 4.5 lines, at dismissal from the hospital it was on the average 2 lines.Because of the increased risk to get an eye injury during a game of squash, players should be encouraged to wear proper eye protection i.e. closed eye guards according to standards of North-American testing organisations.

Bleeding of aneurysm of cervical arteries is an emergency situation in ENT surgery. Compression of trachea and big cervical veins together with blood loss needs immediate treatment. Three cases are demonstrated presenting diagnostic and therapeutic management of one spontaneous respectively posttraumatic aneurysm of the inferior thyroid artery, and two aneurysms of lingual respectively facial artery after tonsillectomy. Interventional angiography plays an important role in overcoming such problems. Intravasal application of a platinum coil stops bleeding of the aneurysm and surgical revision of the neck can be avoided.

Cerebral arterial infarction is a very rare condition during the neonatal period. In recent times, cerebral infarctions with an atypical bland course are reported in healthy, unsuspected newborns. For the first time, we saw focal seizures and a transient syndrome of inappropriate ADH secretion in a full-term, male newborn with an infarction of the middle cerebral artery as the first sign of this disorder. On the basis of these rare clinical manifestations, the literature about neonatal cerebral infarction is reviewed. The diagnostic possibilities and prognostic expectations are discussed. It is the aim of this case report to call attention to this rare disease in order to avoid a delay in diagnosis and therapy, even if the initial manifestations are atypical.

Results of excimer laser keratomileusis in 26 myopic sighted eyes are presented. The follow-up was at least 9 months. The base-line refraction was -4.48 +/- 1.81 D (range: -1.4 to -9.25 D). After 3 months 85% were within +/- 1 D from the intended refraction. The such defined success rate after 6 months was 87.5%, after 9 months 88%, and after 12 months 92%. One month after surgery we found an overcorrection of +1.45 +/- 1.22 D decreasing to +0.27 +/- 0.94 D at three months, becoming an undercorrection of -0.24 +/- 0.76 D after six, and -0.32 +/- 0.69 D after nine months, and of -0.36 +/- 0.6 D after one year. Stability within the measurement error (+/- 0.25 D) appeared in 79% of the treated eyes six months after treatment. Three patients have been excluded from the study group because they did not follow the protocol. Subepithelial haze occurred in all patients, becoming most intense after 3 months, gradually clearing over the next months. With appropriate steroid medication, the refractive effect may be modulated. Complications as steroid glaucoma, recurrent erosion, loss of acuity, or extensive corneal scarring seem to be very rare.

Laser keratomileusis with the excimer laser (193 nm) is a new method of refractive surgery. With this procedure a thin lenticule is ablated from the central cornea with submicron precision. The refraction changes achieved in 13 eyes ranged from 1.5 to 7.5 dpt. With this correction 92% of the treated eyes were within 1.0 dpt either way at 3 months after surgery, but after 6 months this proportion decreased to 77%. The best-corrected visual acuity recovers within 1 months to preoperative values. In all patients a slight subepithelial haze was detected with the slit-lamp in the early postoperative phase, but cleared within 4-6 months to a clinically non-significant level.

Two cases of congenital unilateral deafness in otherwise normal children are presented. X-ray examination showed a partition of the inner ear canal in one of them. A review of the literature showed this lesion to be very rare, but it is more frequent in combination with other malformations such as the Klippel-Feil-syndrome, Wildervanck-syndrome and Thalidomide embryopathy. The second child showed an extensive malformation of the cochlear and vestibular parts of the inner ear and of the internal auditory meatus. The vestibulocochlear nerve was absent. An arachnoidal cyst protruding into the tympanic cavity formed the only boundary between the middle ear and the cerebrospinal fluid. This resulted in relapsing meningitis and a postmeningitic hearing loss on the other side. A tympanoscopy and closure of the connection between the tympanic cavity and the internal auditory meatus stopped the ascending infections.