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The purification and properties of a Na+- and K+-activated ATPase from ox brain is described. The enzyme preparation is characterized by a high purity and a low content (<1%) of Mg++-stimulated ATPase. [ABSTRACT FROM AUTHOR]

Objectives: As results with cochlear implants have continued to improve, patients with some remaining cochlear function have become eligible for cochlear implantation. Thus, preservation of acoustic hearing after implantation has gained importance. Hearing preservation can be considered a benchmark for atraumatic implantation preventing neural degeneration from loss of residual hair cells or subsequent to local trauma. In this prospective study, the possibility of preserving low-frequency hearing in cochlear implantation using a modified surgical technique has been explored., Material and Methods: In a prospective study design, 14 subjects with considerable low-frequency hearing of 20-60 dB in the frequency range 125-500 Hz but with unsatisfactory speech understanding with hearing aids of < 35% monosyllabic word understanding were implanted with a MED-EL COMBI-40+ cochlear implant. The insertion depth was intentionally limited to 19-24 mm to prevent damage to low-frequency regions of the cochlea. Pre- and postoperative pure-tone thresholds were measured., Results: Hearing was conserved within 0-10 dB in 9/14 subjects and within 11-20 dB in 3/14; in 2/14 subjects hearing was completely lost in the implanted ear. Thus hearing could at least partially be conserved in 12/14 subjects (86%). Median threshold values decreased by 10, 15, 17.5 and 5 dB at 125, 250, 500 and 1000 Hz, respectively. Even high levels of hearing, e.g. 30 dB at 500 Hz, could be maintained after implantation in some subjects., Conclusions: This study reports successful conservation of hearing after cochlear implantation using a modified surgical technique. Even high levels of hearing could be maintained, showing that implantation of an intracochlear electrode can be performed atraumatically with preservation of functional structures.

The aim of this study was to determine the efficiency of labyrinth anesthesia - the intratympanic instillation of lidocaine--in the treatment of Ménière's disease and to recall a forgotten method. Twenty-four patients (15 male, 9 female), aged from 19.7 to 80.6 years (mean: 47.8 years) with the clinical diagnosis of unilateral Ménière's disease who underwent labyrinth anesthesia in our department were included in this retrospective study. After local anesthesia of the tympanic membrane, a solution of 4% lidocaine and furfuryladenine (Kinetin) was instilled into the tympanic cavity. Patient records, a questionnaire and a physical examination were used to evaluate vertigo control, hearing loss, tinnitus, and quality of life according to the AAO-HNS criteria before and after surgery. Postoperatively, 87.5% of patients reported at least a noticeable decrease of vestibular symptoms, 66.7% of these patients were free of attacks for an average of 26.5 months. Postoperative hearing was the same or even improved in 87.5% of our patients. Tinnitus was not affected in any individual. Based on the findings presented herein, we consider labyrinth anesthesia a practicable and, due to its safety, highly recommendable therapeutic option for patients suffering from Ménière's disease., (Copyright 2003 S. Karger AG, Basel)

The purpose of this study was to investigate the effect of systematic variations in stimulation rate and number of channels on speech understanding in 13 patients with cochlear implants who used the continuous interleaved sampling speech coding strategy. Reducing the stimulation rate from 1,515 to 1,730 pulses per second per channel to 600 pulses per second per channel resulted in decreased overall performance; the understanding of monosyllables and consonants was more affected than the understanding of vowels. Reducing the number of active channels below 7 or 8 channels decreased speech understanding; the identification of vowels and monosyllables was most affected. We conclude that vowel recognition with the continuous interleaved sampling strategy relies on spectral cues more than on temporal cues, increasing with the number of active channels, whereas consonant recognition is more dependent on temporal cues and stimulation rate.

In patients with some residual hearing and minor benefit from conventional hearing aids, the benefits of cochlear implantation have to be weighed carefully against eventual adverse effects. In this study, pre- and post-operative thresholds as well as functional results after cochlear implantation are reported; 17 of 44 implanted adults had residual hearing pre-operatively (mean threshold(250 to 4000 Hz): 106 dB HL) in the implanted ear. Residual hearing in the implanted ear could not, in general, be preserved post-operatively. Seventeen of 44 implanted children had some amount of residual hearing in the implanted ear pre-operatively (implanted ear: 114 dB HL; contralateral ear: 109.9 dB HL; mean thresholds(250 to 4000 Hz))). Contrary to the results in adults, residual hearing in the implanted ear remained statistically unchanged. Hearing in the contralateral ear increased significantly from 109.9 to 101.9 dB HL post-operatively. This increase was mainly attributed to maturation of the central auditory pathway. In adults with residual hearing, the monosyllable word recognition scores increased significantly from 9 per cent pre-operatively to 42 per cent post-operatively. Children with residual hearing tended to perform better on speech-related test material compared to children without prior auditory experience. Cochlear implantation is indicated in adults and children with residual hearing and minor benefit from conventional amplification. The contralateral ear in children should be considered for additional acoustical stimulation.

Objective: To investigate the interrelation between number of channels and stimulation rate in the continuous interleaved sampling strategy (CIS)., Subjects and Methods: Three of the first recipients of the new COMBI 40+ cochlear implant participated in consonant, vowel, number, and sentence tests. Speech understanding was evaluated for different combinations of number of active channels from two to twelve and stimulation rate per channel between 1,515 and 9,090 pulses per second., Results: The results indicate that the optimum number of active channels is not necessarily the maximum number of usable channels.

Twenty-one patients with squamous cell carcinomas of the head and neck were studied by immunoscintigraphy and immunoemission, computed tomography (ECT) using monoclonal antibody 174H.64 (Biomira Edminton) labelled with 99Tcm (Schwartz Method). Immunoscintigraphic results were compared with routine clinical assessments, including CT and ultrasonography, and were controlled by histopathological examination after surgery. All primary localizations (pT1 = 3, pT2 = 3, pT3 = 7, pT4 = 5; oropharynx 7, larynx 5, hypopharynx 3, oral cavity 3, lymph nodes 3) could be visualized, while 15 out of 18 neck lesions from tumor metastases could also be visualized (pN1 = 8, pN2 = 8, pN3 = 2). In one case with micrometastases in lymph nodes that could not be demonstrated by other methods, staging was upgraded by the immunoscintigraphic results. Three other micrometastases in lymph nodes could not be visualized. Distant metastases were suspected in 5 cases, three of which were confirmed either histologically or by radiography. Two of the cases with distant metastases were detected by the immunoscintigraphy. The present results indicate that immunoscintigraphy in combination with immuno-ECT can improve preoperative staging of head and neck carcinomas, especially with regard to metastatic neck disease, tumor recurrences and some cases of distant metastases.

1. The close relationship between an impaired nasal air passage or chronic diseases of the paranasal sinuses and the bronchial system seems to be generally accepted. 2. Any improvement of the nasal respiration and chronic infections of the sinuses obviously have a positive effect on pathologic lung function, bronchitis and asthma. Even though a causal connection between the treatment of the chronic nasal and paranasal infection and the decrease of pulmonary symptoms in chronic bronchitis and asthma could not be verified yet by valuable statistics, the transnasal surgery reduces heavy nasal symptoms in more that 90% of our cases. 3. We consider endonasal microsurgery to be the safest and most convenient technique in the treatment of chronic nasal and paranasal diseases. This minimal invasive surgery therefore is suitable as well for the treatment of recurrent diseases which unfortunately cannot be avoided in this area.

Since 1986 the high resolution CT in two planes is part of our preoperative diagnostic program for patients with chronic rhinosinusitis, acute, complicated rhinosinusitis and polyposis nasi. The importance of the CT for diagnosis, localization, and planning the operation shall be demonstrated.

Pathologic alterations of the turbinates are common in infectious diseases of the nose and paranasal sinuses. Over 300 patients were treated for paranasal sinuses disease from 1986 to 1989 by endonasal microsurgery. One-third of the patients were found intraoperatively to have alterations of the middle and inferior turbinate causing obstruction and functional disorders of the nose and sinuses. Our concept comprises a step-by-step microsurgical approach to the turbinates. The technique and the results are presented.

The renaissance of endonasal microsurgery is not only based on a deeper knowledge of the mucociliar clearance and better operation instruments but depends as well as on the improved radiological diagnosis provided by computed tomography. Since 1986, high-resolution computed tomography in two plains has been part of the authors' preoperative routine diagnostic program for paranasal sinus diseases at their clinic. One hundred and fifty-eight computed tomograms of patients with chronic rhinosinusitis, complicated acute rhinosinusitis, and polyposis nasi were reexamined. The involvement of the paranasal sinuses and abnormalities of the lateral nasal wall were analyzed. The anterior ethmoid is the most frequently affected area in all of the diseases. The computed tomogram is most important for the rhinosurgeon. The ethmoid cell system can be visualized without superimposing structures. Therefore even circumscript pathologic mucosa alterations and the extent of the disease can be defined. All this enables the surgeon to put forward an exact diagnosis and to plan a safe operation as regards important physiological structures of the nose and paranasal sinuses.

Monoclonal antibodies were used to examine the presence and nature of tumor associated macrophages and T-lymphocytes in 26 cases of squamous cell carcinoma of head and neck. The content of macrophages varied according to the differentiation of the carcinoma: high differentiation was evidenced by a labelling index by an index between 13.5% and 23.7%, poor differentiation from 27.4% to 35.8%. T-lymphocytes were found where tumors were inflamed, but there was no significant correlation between tumor differentiation and infiltrating T-lymphocytes. The present results that prognosis decreases with the increasing number of tumor associated macrophages in squamous cell carcinoma.

Initial combination drug regimens containing Cisplatin in patients with stage III and IV head and neck cancer produce a high percentage of clinical response. We initiated the current trial to assess the role of multimodality treatment (CT plus RT) versus CT alone in eliciting tumour response rates, and the duration of tumour free survival. Patients were randomised to CT followed by RT (arm A: 36 patients) or CT alone (arm B: 44 patients). Of 96 patients entered into this study 80 are evaluable at the time of analysis. There were 13 women and 67 men with a median age of 52 years and a median performance status of 90%. All of them presented measurable stage T4N0-3M0-1 or T3N2-3M0-1 carcinomas. The chemotherapy consisted of Cisplatinum, Bleomycin and Methotrexate and was given in 2 cycles over 35 days. Local radiotherapy with 6,000 rad followed. In arm B, 3 cycles of chemotherapy were given without radiotherapy. The overall tumour responses after CT were 75% in arm B, and 70% in arm A. After RT the tumour response fell to 59%. Median tumour remission was 4 months and median survival 11 months. Toxic effects were mild mainly consisting of alopecia, nausea and vomiting. Myelotoxicity was moderate, but significant renal or ototoxic side effects did not occur. 10 cases of Bleomycin related pulmonary fibrosis were found. Our main findings show that patients receiving 2 cycles of CT do not have a statistically shorter survival compared to those who were treated by CT plus RT.

1. Direct transplantation of tracheal homograft is not possible so far. 2. Tracheal wall can be preserved for homostatic transplant by Cialit-solution. 3. Cialit-preserved tracheal homografts must be implanted into the recipient's subcutis prior to use them as tracheal substitute. 4. This procedure is suitable also in human reconstructive surgery of the trachea for some "real difficult cases".

After all techniques for reconstruction of tracheal segments with trachea-homografts, known from the literature, have failed to show satisfactory functional results, we have carried out further experiments concerning this subject. Our main interest was focused on the following topics: 1. the regeneration pattern of the respiratory epithelium in the trachea, 2. possibilities of the conservation of trachea-transplants, 3. the behaviour of the receptor area against trachea homografts. We found, that in correspondence with clinical observations, even large circumferencial defected epithelial areas in the mucous layer of the trachea have been regenerated in a form of new mucous membrane which showed no morphological difference from normal structure. Segments of trachea can be preserved in Cialit solution. Prefixation in formaldehydsaline fixative improves the preservation of the tissue structure. Homografts obtained in the above described technique could almost always be made to heal, either directly in the trachea or in the subcutaneous tissue of the recipient-animals. The behaviour of the cartilage and the epithelium is demonstrated by histological methods as well as by scanning electronmicroscopy.

Otoconia from the maculae of the utricule and the saccule of normal mice and shaker mice have been examined by means of polarizing microscopy and scanning electron microscopy. X-ray dispersive analysis was used to determine the elements present in the crystals. The otoconia were found to be negative birefringent crystals. They are among the largest crystals found in mammalian tissues, many being 30-50 microns in length and 109-20 microns in diameter. The majority were calcite (calcium carbonate) crystals. Some crystals had a different morphological appearance and contained phosphorus (phosphate compound) as well as calcium. The phosphate content was much less and sometimes absent from utricular otoconia of shaker mice.