Aktuelles aus dem Medizinrecht

Ohne Zusammenfassung     

Pusteln aus dem Kuhstall

A 54-year-old cattle farmer presented with crusty purulent plaques in the neck area. The clinical picture and microscopical proof of hyphae in the skin smear combined with Wood’s lamp testing led to the diagnosis of Tinea barbae, a mycological infection of the skin transmitted by cattle (typically Trichophyton verrucosum). Therapy with itraconazole 200 mg q.d. p.o. and miconazole ointment 1×/day over 2 weeks was successful. This case report and its image are designed to bring attention to this rarely diagnosed pathology.     

Fremdkörperentfernung aus dem Tracheobronchialsystem im Kindesalter

Zusammenfassung Aus dem Zeitraum Januar 1989 bis Juli 1997 wurden 103 starre Tracheobronchoskopien im Kindesalter an der Universit?tsklinik für HNO-Heilkunde in Tübingen ausgewertet. Indikation war in 84% der F?lle der Verdacht auf eine Fremdk?rperaspiration, weitere Indikationen waren kongenitale Fehlbildungen, Sch?den nach Langzeitintubation oder der Verdacht auf Tracheomalazie. Wir haben retrospektiv alle starren Bronchoskopien mit Verdacht auf Fremdk?rperaspiration bei Kindern bis zum abgeschlossenen 11. Lebensjahr ausgewertet (n=84). Es zeigte sich in 69% der F?lle ein oder mehrere Fremdk?rper, die sich bis auf 1 Fall mit dem starren Bronchoskop entfernen lie?en. Es kam in keinem Fall zu ernsten Komplikationen wie einer Blutung oder der Notwendigkeit zur Tracheotomie. Die Fremdk?rperentfernung mit dem starren Bronchoskop ist ein komplikationsarmer und effektiver Eingriff. Bei klinischem oder anamnestischem Verdacht auf Aspiration eines Fremdk?rpers sollte sofort eine Bronchoskopie durchgeführt werden. Eingegangen am 15. Dezember 1997 Angenommen am 7. April 1998     

Mittheilungen aus dem Gebiete des einfachen und eitrigen Mittelohrkatarrhs

Ohne Zusammenfassung     

Narkoseeinflüsse auf akustisch evozierte Potentiale aus dem Colliculus inferior und dem auditiven Cortex beim Meerschweinchen

Summary The influence of Aethyl-urethane and Nembutal upon different parameters of evoked responses from the inferior colliculus and auditory cortex were analyzed by means of implanted electrodes. Aethyl-urethane showed marked changes of the responses from both areas of the auditory pathway, while Nembutal caused no changes of potentials recorded from the inferior colliculus. Against that the results from the auditory cortex indicate that here recordings from awake animals are a prerequisite to obtain uneffected responses. Furthermore no significant differences of the effect of narcosis could be found at the level of the auditory cortex between young and old guinea pigs.

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Mit Unterstützung der Deutschen Forschungsgemeinschaft (DFG)     

Gewebeentnahmen aus dem tiefen Kopf-Hals-Bereich mit einer neuen sonographiegesteuerten, halbautomatischen Mikrostanze

In der Diagnostik pathologischer Ver?nderungen im Kopf-Hals-Bereich haben sich Methoden wie die Feinnadelaspirationszytologie (FNP) und Stanzbiopsien klinisch vielfach etabliert. Die FNP erm?glicht ultraschallgesteuert eine exakt lokalisierte Gewebeentnahme mit geringer Invasivit?t. Nachteile der Methoden sind die oftmals schlechte Biopsiequalit?t der FNP sowie die h?here Invasivit?t der Stanzbiopsien.     

Heterotransplantationen menschlicher Tumoren aus dem HNO-Bereich auf thymusaplastische nackte Mäuse

Ohne Zusammenfassung     

Gewebeentnahmen aus dem tiefen Kopf-Hals-Bereich mit einer neuen sonographiegesteuerten, halbautomatischen Mikrostanze

Fine needle aspiration biopsy (FNAB) under ultrasound control is an established diagnostic procedure for the head and neck region. Because of the disintegration of tissues, the diagnostic value of the method is limited resulting in only moderate specificity. In a prospective study, we performed a new, semi-automatic biopsy method in patients who had been diagnosed with sonographically confirmed pathologic masses in the head-neck region. This biopsy is carried out with a spring-loaded biopsy pistol which uses a disposable 20-gauge, specially designed cutting needle. Because this method combines the low invasiveness of FNAB with the high specificity of an excisional biopsy, a high tissue quality is obtained. Comparing these bioptic results with those of subsequent excisional biopsies proves that this new method yields a sensitivity of close to 100% for the detection of lymph node metastases of squamous cell carcinomas (SCC). The tissue cylinders have a reproducible size and allow ultrastructural investigations in the transmission electron microscope (TEM) on the ultrastructural level. Due to the excellent tissue preservation in the biopsy cylinders, ultrastructural studies, using transmission electron microscopy, may be carried out with the biopsy material. Furthermore, following paraffin embedding of biopsy cylinders, serial sections may be obtained for special staining techniques, and immunohistological investigations are possible which may serve as an adjunct in the diagnosis of, e.g., lymphoproliferative lesions with a sensitivity of 96%. Summarizing, the new semi-automatic biopsy technique obtains tissue probes of high quality with low invasiveness which enables highly sensitive diagnosis of head and neck lesions.     

Aktuelles zu HPV-induzierten Oropharynxkarzinomen

Oropharyngeal squamous cell carcinoma (OSCC) is associated with oncogenic human papillomavirus (HPV) infection in 30?C40% of all cases in Germany. The use of PCR and?/?or in situ hybridisation to detect HPV in tumour tissue is used in combination with p16 immunohistochemistry to reliably distinguish HPV-related and HPV-unrelated OSCC. The distinct biological behaviour of the HPV-related subset of OSCC results in a more favourable prognosis. This might be the result of a greater response to chemotherapy and radiotherapy as seen in recent studies. Ongoing and future clinical trials will stratify for HPV status. If the results of these prospective, randomized trials are consistent with the preliminary results of recent studies, HPV status will be of enormous clinical relevance in the future.     

Die Elektroneurographie des Nervus recurrens mittels lupenendoskopischer EMG-Ableitung aus dem Kehlkopf des wachen Patienten

Summary Electromyography of the larynx in the awake patient using zoom-endoscopy provides an earlier diagnosis of recurrent laryngeal nerve diseases by recording action potentials of the posterior cricoarytenoid muscle.Not in every case the type of nerve lesion (neuropraxy, neurotmesis, axonotmesis) could be determined by the EMG alone. Therefore, neurography of the recurrent laryngeal nerve was investigated.With respect to the mixed innervation of the larynx by both the more sensible superior and the motoric inferior laryngeal nerve a reflex arc can be examined. The upper laryngeal nerve of the contralateral side was stimulated transcutaneously. The afferent reflex arc leads to the ganglions of the vagus nerve and its central nuclei, its efferent motor neurons conduct reflex activity via the recurrent and upper laryngeal nerves back to the larynx. Using this indirect stimulation of the recurrent nerve the time interval between the stimulus and the reaction of the laryngeal muscles is longer than with stimulation of the recurrent laryngeal nerve of the ipsilateral side enhancing conduction time measurements.First clinical results are demonstrated.