Malte Erik Wigand

Excretion of the mono- and divalent ions in relation in relation to flow rate in Bartter's and pseudo Bartter's syndromes in parotid saliva. Comparative studies to the syndrome of Conn.

SummaryIn three patients, one with Bartters syndrome and two with pseudo-Bartters syndrome, the excretion pattern of mono- and divalent ions of the parotid saliva was studied as a function of flow rate. The results were compared with those observed in normal adults and in two patients with Conns syndrome.In both Bartters and pseudo-Bartters syndromes, salivary K+ secretion was more than two times higher if compared with the corresponding flow rates. Other symptoms of the complex alterations of electrolyte transport in Bartters and pseudo-Bartters syndromes were the increased salivary excretion of calcium, magnesium, bicarbonate and inorganic phosphorus. Na+ reabsorption was slightly decreased in the patient with true Bartters syndrome, and moderately increased in pseudo-Bartters syndrome.The typical feature in the two patients with Conns syndrome showed to be an excessive increase of salivary sodium reabsorption. The total amount of sodium actively reabsorbed by the duct system (J*ac), exceeded the normal range by about a factor of 2–3. Simultaneously, and in contrast to Bartters syndrome, the flow-dependent concentrations of bicarbonate were markedly and those of magnesium slightly lower. The concentrations of potassium and inorganic phosphorus were moderately elevated, whereas those of calcium were markedly increased.Quantitative as well as qualitative differences in the salivary electrolyte patterns in these diseases provide strong arguments against an exclusive role of aldosterone in the pathogenesis of the electrolyte disturbances in Bartters and pseudo-Bartters syndrome.Experiments on human parotid glands clearly demonstrate that alterations of transepithelial electrolyte transport in this disease are not only confined to the different segments of the renal tubulus, but seem to be a symptom of a generalized disturbance of electrolyte transport.ZusammenfassungIm pilocarpinstimulierten Parotisspeichel wurde beim Bartter- (n=1), Pseudo-Bartter- (n=2) und Conn-Syndrom (n=2) die Konzentration der mono- und bivalenten Ionen als Funktion der Flußrate untersucht. Des weiteren wurde nach einem mathematischen Ansatz von Knauf und Frömter (1970) die gesamte aktive Na+-Rückresorption einer Parotis sowie die passive Leckpermeabilität des Gangsystems für Na+ berechnet.Führendes speichelchemisches Symptom desBartter- undPseudo-Bartter-Syndroms war eine Steigerung der aktiven K+-Sekretion, wobei der Normbereich um mehr als das Doppelte überschritten wurde. Die Na+-Reabsorption, die im Kontrollkollektiv mit 171±12 µ Äq/min berechnet wurde, verhielt sich unterschiedlich: leicht erniedrigt beim eehten Bartter-Syndrom, gering erhöht beim Pseudo-Bartter-Syndrom. Die flußratenbezogene Exkretion von Ca und z.T. auch Mg war bei allen Bartter-Kranken gesteigert. In ähnlicher Weise bestanden für die Anionen HCO−3 und anorg. Phosphat deutlich erhöhte Werte.Im Unterschied zu diesen Befunden war der Elektrolyttransport beimConn-Syndrom durch eine exzessive Zunahme der Na+-Reabsorption gekennzeichnet. Trotz vermehrter Leckpermeabilität des Gangsystems wurde der Normbereich um den Faktor 2–3 überschritten. Die flußratenbezogene Konzentration von K+ und anorg. P war leicht, die des Ca stark erhöht. Erniedrigte Werte kennzeichneten die Bicarbonatsekretion — im Gegensatz zum Bartter-Syndrom.Aufgrund der qualitativen und quantitativen Differenzen in der Speichelchemie beider Krankheitsbilder ist es zweifelhaft, daß Aldosteron allein für den veränderten Elektrolyttransport beim Bartter-Syndrom verantwortlich ist.

Katecholamingehalt adrenerger Nerven in Speicheldrüsen mit gestörter Elektrolytausscheidung bei Urämie

SummaryIn uremia characteristic changes of salivary electrolyte excretion were observed. These changes can partially be reproduced by sympathomimetic agents. The study was performed to find out changes in adrenergic innervation of salivary glands or indirect morphological proofs for increased sympathetic tone in uremia. The formaldehyde-induced fluorescence method for the histochemical demonstration of catecholamines and histochemical enzyme reactions for AChE and G6PD were applied to biopsy material of parotid glands of uremic patients with known salivary electrolyte excretion and to Gl. submaxillaris of albino rats in experimental uremia. In patients with chronic uremia in the parotid parenchyma a rarefication of fluorescent adrenergic nerve terminals and a more or less pronounced depletion of catecholamine stores within them was found regularly. In experimental uremia of rats the innervation pattern remained the unchanged while the catecholamine fluorescence was clearly diminished indicating depletion of adrenergic nerve terminals as well. Quantitative estimation of the catecholamine content of various organs in experimental uremia of rats confirm our findings. Sodium balance and binding capacity of adrenergic nerve terminals for catecholamines seem to be closely associated as reported for DOCA-hypertension in rats.ZusammenfassungBei Urämie werden charakteristische Veränderungen der Exkretion von Speichelelektrolyten beobachtet. Diese Veränderungen können teilweise durch Sympathomimetica reproduziert werden. Es lag daher nahe, bei Urämie nach Veränderungen in der adrenergen Innervation der Speicheldrüsen oder indirekten morphologischen Hinweisen für einen „erhöhten Sympathicotonus“ zu suchen. Mit der Methode der Formaldehyd-induzierten Fluorescenz zum histochemischen Katecholaminnachweis und dem histochemischen Enzymnachweis für AChE und G6PD wurden Biopsiematerial von menschlichen Ohrspeicheldrüsen urämischer Patienten mit bekannter Speichelelektrolytexkretion und Gll. submaxill. von Albinoratten mit experimenteller Urämie untersucht. Bei Patienten mit chronischer Urämie wurde im Parotisparenchym stets eine Verringerung der Anzahl der durch Formaldehyd-induzierte Katecholaminfluorescenz nachweisbaren adrenergen Nerven beobachtet. Bei experimenteller Urämie der Ratten blieb das Innervationsmuster unverändert, während die Katecholaminfluorescenz deutlich herabgesetzt war und damit ebenfalls eine Entspeicherung der adrenergen Terminalfasern anzeigte. Quantitative Katecholaminbestimmungen in Herz, Niere und Gl. submaxillaris der Ratten mit experimenteller Urämie bestätigen diesen Pefund. Gesamtkörpernatrium und Speicherungskapazität adrenerger Terminalfasern für Katecholamine scheinen eng miteinander verknüpft zu sein, wie dies für den DOCA-Hochdruck der Ratten bereits bekannt ist.

Laserendoskopie in Pharynx, Larynx und Trachea

SummaryOn the basis of our experience with a CO2 laser, gained at the ENT Department of the Erlangen University Hospital, an attempt is made to represent the advantages and disadvantages of laser treatment as compared with conventional methods, and to list the indications for its use. Over a period of one year, the CO2 laser was employed through the endoscope in the pharynx, larynx and trachea in a total of 108 patients.The advantages described in the literature, for example accurate cutting, minimal traumatisation, the absence of postoperative edema and freedom from pain, are also found with conventional microsurgery — in fact cutting with the scalpel is certainly more accurate — while a certain thermal damage to the surrounding tissue is unavoidable with the laser. Temporary neuralgia has been observed following resection with the laser in the supraglottis, oropharynx and hypopharynx. Healing of the surgical wound, epithelialization and the formation of scar tissue, and the postoperative function are dependent upon the site, size and depth of the wound and not on the “cutting technique”. In the case of large wounds, healing is even delayed as a result of the sloughing of coagulation necrosis.The real advantages are of a different nature: bloodless, contact-free and accurate surgery also in the cavities that are difficult of manual access, such as the nasopharynx — these are the essential features of laser surgery. When healing is complete, the organic and functional results are impressive.On the basis of a thoroughgoing photographic documentation of the findings and the course of healing in selected cases subjected to surgery of the pharynx, larynx and trachea, the most important indications are discussed. These include choanal atresia and peritubal adenoids.Among the benign lesions, using the laser makes sense in particular in the treatment of haemangioma and papilloma, and of cicatricial stenoses. In the case of lesions of unclear dignitiy, the smaller they are, the less the laser is indicated — in conformity with the oncological requirement for an accurate histological diagnosis and resection, based on histological criteria, with wide margins in the healthy tissue.

Ionisiertes Calcium und Totalcalcium im Parotisspeichel bei Normalpersonen und essentiellen Hypertonikern

SummaryThe development of Ca2+-selective disk-electrodes and of a synthetic Ca2+-carrier has led to an enhanced technique of determination of the ionized calcium in the parotid saliva. In ten male and eight female normal persons and in nine patients with essential hypertension the salivary calcium concentration was examined.Both the ionized and the total calcium was by 22% resp. 16% lower in normal females than in normal males. Increasing salivary flow rates rised the calcium concentration with almost unchanged quotients of Ca2+/Catotal. In hypertensive patients an elevated Ca2+-concentration was observed, also the total calcium was significantly increased. The salivary flow rate influenced the Ca2+/Catotal quotient considerably in this group.

Beeinflussung speichelchemischer Parameter in Abhängigkeit vom Menstruationszyklus

SummaryThe influence of different sexual hormone levels during menstrual cycle on the composition of human parotid saliva was investigated.During midcycle there were significantly enhanced concentrations of ionized calcium, total calcium, inorganic phosphate and sodium in parotid saliva. The changes in chloride concentrations were parallel to that of sodium and the excretion of potassium was inverse to that of sodium. The maximal output of total protein andα-amylase was found during midcycle and menstruation.

Clinical outcome of partial ethmoidectomy for chronic rhinosinusitis

Since its introduction endoscopic sinus surgery (ESS) for the treatment of chronic rhinosinusitis (CRS) has been focused on the management of the ethmoids, differentiating between partial and total ethmoidectomy. The classification of the underlying process of ethmoiditis and the selection of the adequate surgical procedure are still open questions. The aim of this investigation was to evaluate a minimally invasive ESS procedure. We present a retrospective analysis of 112 cases of bilateral circumscribed ethmoiditis after partial ethmoidectomy performed by a single surgeon investigated by questionnaires and endoscopic follow-up. A comparison of symptoms and the subjective judgment of the patients before and after surgery showed that postoperative subjective scores of nasal obstruction and rhinorrhea improved in up to 90%, with no distinct differences between primary intervention (n=98) and revision (n=14). Ninety percent of all patients considered surgery successful. Signs of active rhinosinusitis were found in less then 20% of patients after partial ethmoidectomy. This demonstrates that partial ethmoidectomy is an effective treatment for CRS affecting only part of the ethmoid.

Restitutio ad integrum: the kingsway of otorhinolaryngological surgery.

Abstract. In general, surgical procedures are confined to curative or palliative measures converting the original anatomy into auxiliary configurations. Otorhinolaryngology, among other disciplines, is often privileged to offer normalization of both the bony superstructure and its epithelial surfaces. A general trend to such restitutional procedures has emerged during recent decades, though radical transformations are still popular. Utilizing endoscopic sinus surgery, middle-ear microsurgery and endo-microscopic laser surgery of the upper aerodigestive tract as paradigms, this literary analysis tries to propagate preservation of the natural form as an ideal. Endoscopic access, staged and multidirectional approaches and computer-aided navigation belong to the related surgical armature. Looking at the functional end results, the higher expense of training and costs appears to be rewarding.

Malignant tumors of the anterior cranial skull base

Malignant tumors of the anterior cranial skull base are still a challenge for radical surgical treatment. Several different techniques and approaches have been developed over the years and the results, with mortality rates over 50%, are still not encouraging.Here we present our results of an interdisciplinary, onestage, neurohino transfronto-transbasal surgical approach in twelve patients with such tumors.The long-term survival rate in our patients is now 83% with a mean postoperative follow-up of 19.3 months. Two patients died due to early recurrencies and metastasis after 10 and 13 months after initial treatment and postoperative irradiation.Another five patients with a follow-up of 34.2 months have had tumor recurrencies diagnosed at 19.5 months postoperatively. These patients have survived their recurrent tumor for 14.7 months.Five patients, 41% of the whole group, have been living without evidence of tumor recurrence for between 2 and 35 months.

Kallikreinexkretion im Parotisspeichel bei Ratten mit verschiedenen Hochdruckformen

SummaryA technique for continuous and quantitative collection of parotid saliva — including salivary flow rate determination — for in vivo experiments in rats is described. Excretion of kallikrein-like activity in parotid saliva of rats with various forms of arterial hypertension (genuine, renovascular and DOCTMA-salt hypertension) was studied. Kallikrein excretion was measured by its esterolytic activity.The levels of kallikrein-like activity in parotid saliva of normotensive control rats ranged between 2.5–4.0 mU/min during salivary flow stimulation with pilocarpine. In all forms of experimental hypertension salivary excretion of kallikrein-like activity was increased 2–4 fold. This increase was not related to the activity of the renin-angiotensin system.

Cyclisches AMP im menschlichen Parotisspeichel bei arterieller Hypertonie und unterschiedlicher Plasma-Renin-Aktivität

SummarySince the salivary glands are rich of norepinephrine, cyclic AMP as second messenger of β-adrenergic function was determined in the parotid saliva of patients with arterial hypertension. The cAMP was determined in correlation to the flow rate by the radio-isotope dilution test of Gilman. The corresponding plasma renin activity was determined by radioimmunoassay. In patients with normal renin hypertension and with high renin hyper-tension an increase of the cAMP concentration up to six times the normal range could be observed, while in low renin hypertension the values were similar to those of a normal control group. The increased secretion of cAMP could be inhibited by propanolol. The conclusion is, therefore, that the β-adrenergic system is activated in normal and high renin hypertension.