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350 Basaliome wurden mit einem errechneten Sicherheitsabstand (in Abhangigkeit vom Tumordurchmesser) exzidiert. Die histologische Untersuchung der Exzisate erfolgte zunachst durch einen ublichen vertikalen Querschnitt. Daruber hinaus wurde routinemasig die Gesamtausenzirkumferenz der Exzisate histologisch dargestellt. Uber die Ezisionsgrenze hinausreichende horizontale Tumorauslaufer konnten so lokalisiert und einer nochmaligen Exzision zuganglich gemacht werden. Fur die nicht im Gesunden exzidierten Basaliome werden Korrelationen zwischen Tumordurchmesser und Sicherheitsabstand sowie fur verschiedene histologische Basaliomtypen dargestellt.

Seit etwa 3 Jahren legen wir bei der praoperativen Diagnostik der primaren Varikose einen Schwerpunkt auf die Licht-Reflexions-Rheographie. Die Wertigkeit dieser Methode zur Erkennung einer venosen Abflusstorung und zur Beurteilung ihres Schweregrades ist inzwischen unbestritten. Aufbauend auf den Arbeiten von Maier und Deichmann war unser Interesse, die Wertigkeit der LRR zur Indikationsstellung und zur prospektiven Beurteilung des zu erwartenden OP-Erfolges festzustellen.

Our knowledge of the effects of drugs on the inner ear is extremely insufficient when compared to their effects on other organs. The role of drugs commonly recommended for therapy of inner ear disorders (such as, procaine, antihistaminics, diuretics, osmotics, corticoids and substances changing blood viscosity) has yet to be clarified since the clinical effects of these pharmaceuticals or vasoactive substances often cannot be confirmed by experimental study. Under present circumstances, the use of definitive therapy to prevent deafness has only limited application--as in thyroid hormone substitution to prevent deafness from cretinism.

Absorbable synthetic suture material (Vicryl, PDS) alone was used for wound closure in 1860 surgical interventions on the skin. The PDS suture is totally inert in intracutaneous tissue, and proved superior to the Vicryl suture. In combination, PDS sutures can also be used intracutaneously as well as conventionally. Additional advantages of absorbable material are the possibility of meandering and everted stitches in continuous intracutaneous sutures, no need for removal in most cases, and avoidance of intracutaneous scar dehiscences because of the good durability of the suture material.

A safety distance of 1 cm from the excision margin as well as, frequently, removal of the regional cervical lymph nodes are usually recommended to ensure radical excision of carcinomas of the lower lip. Investigations on 32 such carcinomas revealed that a safety distance of 3-5 mm is sufficient, if the edge of the excised tissue is histologically controlled. 109 carcinomas of the lower lip were re-examined in order to settle the question of prophylactic dissection of the lymph nodes. The low metastasis rate of 1.8% suggests that prophylactic dissection of the lymph nodes is not necessary in these patients. However, 95% of all tumors classified as T1 according to the current T-classification by the IUAC for carcinomas of the lower lip occurred in this group of patients.

The infiltration depths of 1421 basal cell carcinomas (BCC) were determined by means of the mid and basic sections of excised tumor specimens. According to our findings, BCC shows peripheral spreading in the majority of the cases. Deep infiltration primarily occurs in large tumors, scirrhous forms, tumors with exophytic growth or ulceration, and particularly in recurrent BCC. Because of the asymmetric infiltrative growth in depth, conventional evaluation of the mid-section does not provide satisfactory information on the question of radical removal in depth. Therefore, histological control of excisional margins is absolutely essential at least in the tumors mentioned above. The proportion of the tumors with subtotal excision in depth at the first operation was 5.9% for primary BCC and 14.8% for recurrent BCC. In almost all these cases, radical removal could be achieved by re-excision into a deeper layer.

Two-stage excision of skin tumors provided an opportunity for histological evaluation of implanted PDS or Vicryl suture material. Our findings showed a weak or absent tissue response to PDS sutures that was detectable for up to 100 days and a moderately pronounced tissue response to Vicryl that, in rare cases, was evident for up to 80 days. The tissue response to both materials depended on the depth of the implanted suture material. A persistent inflammatory reaction was provoked particularly by Vicryl, a polyfilament suture, when it was embedded near the skin surface. Contact between parts of the suture and the skin surface, which is encouraged by the wick effect of the Vicryl suture, frequently led to suture infection. To avoid infections it is important to place the knot of the stich below the dermis, since the suture ends of the knot decrease the surface-suture distance. A more-or-less horizontal, butterfly-shaped interrupted suture that extends upward is recommended to ensure secure placement of the knot at the lower border of the corium.

In einem Patientengut von 136 Patienten mit insgesamt 153 operierten Extremitaten wurden bestimmt die Haufigkeit einer Insuffizienz der Vena saphena parva, die hamodynamische Auswirkung einer Vena saphena Parva-Insuffizienz mittels der Licht-Reflexions-Rheographie sowie eine postoperative Erfolgskontrolle mit Hilfe der LRR zur Beurteilung der funktionellen Verbesserung der Krossektomie bzw. des Strippings der Vena saphena parva.

Bei den Prakanzerosen Lentigo maligna und Morbus Bowen sowie bei Hautmalignomen wie spinozellularem Karzinom, Dermatofibrosarkoma protuberans und malignem Histiozytom sind auch nach einer Exzision, welche durch histologische Querschnittsuntersuchung bestatigt im Gesunden erfolgte, Rezidivierungen in loco bekannt. Ursache hierfur sind klinisch nicht erkennbare Anteile des Tumors im Randbereich, welche meist asymmetrisch und nicht an der ganzen Zirkumferenz vorhanden sind. Um solche Auslaufer festzustellen, bedarf es einer histologischen Kontrolle des gesamten Schnittrandes.

The wide variety of dermatologic surgical procedures has resulted in a corresponding choice of wound dressings. Considering the chemical and physical properties as well as the function of the dressings, standardized dressing techniques can be performed with relatively few materials. This saves both time and money.

At the excision of 1083 basal cell carcinomas, the clinically detectable diameters and the safe margins along the tumor border were calculated. The excision edges were histologically controlled. 115 of the 1083 tumors showed diameters exceeding 20 mm. The frequency of excisions with negative or positive edges corresponded to the safe margin and depth of the incision. Our results showed that even for large tumors a safe margin of more than 5 mm is seldom appropriate. The excision should always include the subcutaneous tissue as well as the underlying tissue, if the site of the lesion permits it. The excised edges should be histologically controlled with regard to radical excision. Our findings are illustrated by an exemplary case.

Von 1981 bis Mitte 1988 sind an der Universitats-Hautklinik Tubingen insgesamt 3200 Patienten wegen Hauttumoren primar operativ behandelt worden. Fur die Nachsorge von 1045 Melanompa-tienten wurde eine eigene Nachsorgeambulanz installiert. Fur die anderen Hauttumoren bei ca. 2000 Patienten war dies aus personellen Grunden nicht moglich. Die Nachsorge dieser Patienten wurde durch ein Brief system in Zusammenarbeit mit den niedergelassenen Kollegen organisiert. Wahrend die Nachsorge beim Melanom nahezu luckenlos moglich war, gelang dies bei den anderen onkologischen Patienten erst mit Einfuhrung eines computergestutzten Nachsorgesystems mit Hilfe des interdisziplinaren Tumorzentrums der Universitat Tubingen.

For histologic control of excisional margins, routinely fixed tumor specimens or under certain conditions, specimens fixed immediately in warm formalin are processed in the histology laboratory. Strips are then cut from the undersurface, edge and cross section of the specimen and processed further by routine paraffin techniques until HE-stained sections of the entire periphery and midsection are available. The average follow-up time was of 4 years with a recurrence rate of 0.4 per cent.

Of nine possible mechanisms for the formation of non-sandy, wind-erodible aggregates from a more homogeneous soil or sediment, five are found to be widespread in arid and semiarid regions. In approximate order of significance, the most important mechanisms are tension and compression fracturing of shrinkable mud or soil during wet/dry cycles; tension fracturing and molding by compression during freeze/thaw cycles; direct abrasion (corrosion); fracturing and aggregation produced by salt efflorescence; and mechanical disturbance of surface materials by animals. A sixth mechanism (in soils) is by surface films, colloidal matting, or cements. Minor mechanisms are: floatation and lofting of foam and fracturing caused by hydration expansion or other chemical weathering of fine-grained bedrock. The flocculation of small particles in a water suspension or wet mud is a possible minor mechanism not yet observed. Surface soils and sediments with more than 28% clay and more than 2% organic material formed wind-erodible aggregates, but organic-poor materials did not. Calcareous loams, silt loams, silty clay loams, and clay loams formed wind-erodible aggregates, but non-calcareous materials of the same textures did not. Salt efflorescence was locally a major mechanism for production of wind-erodible aggregates. An experiment with expandible (high smectite content) clay shows that wet/dry cycles (such as might result from several summer rain showers on a dry lake bed) can produce wind-erodible aggregates without high temperatures or lengthy droughts and in the absence of salt efflorescence. For example, cold-climate clay dunes (now inactive) fringe ephemeral lakes in deflation basins in Montana at windy semiarid sites with short hot summers and intensely cold winters.

Fur lese-rechtschreibschwache Schuler aller Altersstufen und ihre Familien werden in Zusammenarbeit mit dem Lehrstuhl Lernpsychologie der Universitat Essen und der padagogisch-psychologischen Ambulanz der gemeinnutzigen Helga Breuninger GmbH (LRS-Zentrum an der Universitat Essen) Behandlungprogramme entwickelt, uberpruft und durchgefuhrt.

Comparing laryngectomized patients with deaf persons whose disablement in terms of German law is approximately of the same degree, the former seem to be better off in respect of communication due to the availability of better substitute aids. The first step in any rehabilitation-programme is comprehensive information and instruction of the patient, his family and also of his employer by the surgeon, the speech therapist and if necessary by a social worker. Speech rehabilitation may be the most important aspect of such a programme, but reintegration into the family and professional rehabilitation but also not be neglected. The patient should be given an official invalid status without delay to protect him against unwarranted dismissal, and, after having discussed other and minor problems, a timetable to teach him the oesophageal speech is set up; in this regard, we prefer the aspiration method. The patient is informed about oesophageal speech and the use of electronic devices in speech rehabilitation and also about a neoglottis voice. The article demonstrates the character of the resulting "substitute" voice by means of sonagraphic pictorial representations; this also comprises an assessment of the quality of the voice by neutral observers. The problems arising with a neoglottis due to the communication of oesophageal and respiratory tract are discussed and compared with those with oesophageal speech where the voice-forming system and the respiratory system are kept completely separate. Taking the great range of the various situations into consideration, the physical and emotional status and the course of acquiring oesophageal speech are described. The results are partly contradictory to earlier publications. The importance of teamwork in the care of these patients is emphasized.

A case report about psychogenic sighing attacks in a 9 year old girl, which made school attendance and living at home impossible, is presented. Subsequently a review of the literature is given. Sighing was previously regarded as a ventilatory disorder. The author disagrees with this concept and presents evidence indicating that psychogenic sighing should be regarded as a phoniatric disorder e.g. laughing and weeping and not as a ventilatory disorder.

Since her birth, a 24-year-old woman had suffered from an extensive epidermal verrucous nevus on her left trunk. Because of its severe disfigurement and resulting negative psychosocial impact, the nevus was first removed in 1980 by means of a high-speed fraise; the cosmetic results, however, were not altogether satisfactory. Excision was attempted again in 1983 using both dermatome and high-speed fraise; this time, the cosmetic outcome was excellent.

With preactivation, the threshold of stapedial reflex activity can be lowered by 20-30 dB. From these measures of the normal and reduced reflex threshold, an extrapolation may be performed down to the hearing threshold. Thus, the hearing threshold can be determined for every single frequency from 0.125 to 4 kHz if the reflex is elicitable up to 8 kHz.

The influence of artificially induced impedance changes on the frequency response of the middle ear has been investigated in three experienced listeners. The tensor-reflex has been simulated by application of positive and negative air-pressure to the outer ear canal. In this test-situation, the thresholdshift ("l) obtained is greatest in the surrounding of the first resonance of the middle ear ("l = 8 dB at 500 Hz). For bone-conduction, the effect is weaker by about 2 dB than for air-conduction. The change in sound transmission is constant for all SPL's and is mainly due to the impedance change of the middle ear. In contrast the influence of the stapedial reflex is strongly dependent on SPL. In the range between hearing-threshold and 70 dB (HL) the attenuation is only 2 dB below l kHz. At higher levels the attenuation may amount to 30 dB. Thus excitation of the cochlea remains nearly constant. We suppose that the intensity-dependent influence of the stapedius reflex on sound transmission is due to a change of the stapes motion. The regulating device works without considerable distortion but with an attack-time of about 100 ms. The phenomenon of conductive recruitment in otosclerosis is probably due to the lack of this regulating effect by the fixed stapes. One function of the stapedial reflex could be the protection of the ear from high amplitudes during phonation and shouting. Furthermore, because frequencies above l kHz are also attenuated, a protective function of the stapedial reflex in industrial noise exposure can be assumed.

1. An Ratte, Meerschweinchen und Goldhamster wurden die Reaktionen des Blutdrucks auf rasche Auskuhlung und Erwarmung und deren Beeinflusbarkeit untersucht.