In 6 healthy volunteers, intravenous infusions of nitroglycerin 4.8 and 10.6 micrograms/min yielded mean steady-state plasma concentrations of 0.5 +/- 0.02 and 0.82 +/- 0.04 ng/ml as determined by a gas chromatographic/mass spectrometric method. The plasma concentrations reached in the same subjects 17 h after application of Nitroderm TTS 5 and 10 with in vivo release rates of 3.7 and 5.7 micrograms/min were 0.28 +/- 0.01 and 0.37 +/- 0.01 ng/ml, respectively. Thus, 75% of the quantity of nitroglycerin released by the systems passed into the circulation. The inter-individual and intra-individual variations in plasma concentrations were similar for both modes of administration. The nitroglycerin-induced morphological changes in the fingerpulse wave were clearly dose-dependent, but it seems that this pharmacodynamic parameter is determined less by the plasma concentration than by the nitroglycerin content of the vascular wall.

In severe craniofacial-frontobasal injuries the optic nerve is quite often damaged. We report the findings and the visual outcome in 21 patients with severe mid-face fractures, who underwent primary optic nerve decompression after showing an afferent pupillary defect. During the subcranial exploration and the optic nerve decompression, fractures of the optic canal were found in 13 cases; a dislocated bone fragment could be removed in 6 patients. 9 eyes remained blind, but another 9 eyes regained good final visual acuity between 0.5 and 1.0. We conclude that fractures of the optic canal and dislocated bone fragments are often causes of optic nerve damage in mid-face injuries. The primary subcranial decompression of the optic nerve is a safe method to prevent secondary damage.

From 1.1. 1983 to 31.3. 1983 we used lyophilised allogenic costal cartilage as reconstruction material in middle ear surgery in 53 patients. Reconstructions of the posterior bony canal wall were performed in cholesteatoma surgery in 89% of the cases. Lyophilised cartilage was also used for the restoration of a traumatic defect in the posterior bony canal wall, for the reconstruction of an atretic ear and an old radical cavity, for closing of a bony defect in the roof of the mastoid, and shaping a cartilaginous columella, or modiolus. Lyophilised cartilage fulfills its function completely in 87% of the cases. 5 reconstructions of the posterior bony canal wall were moderately sunk in. The ears were however dry and free of an inflammation. Both the ear canal and the drum were easy to survey. In 2 cases of a recurrent cholesteatoma, the lyophilised cartilage was extensively destroyed. There were no problems, such as incompatibility, host-versus graft reaction, infection or distortion of the cartilage. With regard to our results, we recommend lyophilised allogenic costal cartilage as reconstruction material in circumscribed defects of the bony ear canal and in bony defects of the skull base of the ear, if larger and thicker pieces of cartilage, as can obtained from the patient's ear, are necessary.(ABSTRACT TRUNCATED AT 250 WORDS)

Osteoradionecrosis (ORN) of the mandible is one of the most dreaded complications in the treatment of cancer of the head and neck. If conservative and surgical treatment have not been successful, very often the only remaining solution is surgical intervention into the bone continuity of the mandible. In a group of eight patients suffering from ORN of the horizontal ramus of the lower jaw we gathered first experiences with hyperbaric oxygen therapy in combination with an operation to preserve the bone continuity (debridement of the bone and closing of the soft tissues). Hyperbaric oxygen was given during a time span of 13 to 52 hours (average: 36 hours). It was only with those two patients who received more than 50 hours of hyperbaric oxygen therapy that we achieved our aim of "total recovery from ORN of the mandible while saving its bone continuity". In one case where there was no clinically manifest recidivation of the tumour, the tumour showed rapid growth under hyperbaric oxygen therapy. In three cases partial resection of the mandible had to be performed without reconstruction for cure of ORN. Despite the loss of bone continuity these patients are only slightly cosmetically impaired and nutrition causes no problems. In two patients ORN still exists. On the basis of our first experiences with a small group of patients and in accordance with various publications, we conclude that hyperbaric oxygen therapy is a significant adjunct in the treatment of the mandible if a well-founded diagnosis is established and if it is followed by a well-adjusted therapy.