Ergebnisse einer In-vitro-Studie und erster klinischer Anwendung eines kombinierten Ho:YAG-/Nd:YAG-Lasers

BACKGROUND AND OBJECTIVE: A combined Ho:YAG/Nd:YAG laser produces light with properties similar to the beams of the mainly coagulating Nd:YAG laser and the cutting CO2 laser alone. PATIENTS/METHODS: The combined laser was tested in vitro on pig tissue. Additionally, we used this new combined tool for enoral operations. RESULTS: An effect of the pulsed Ho:YAG laser was explosive-like tissue disruption and sprinkling of fragments. Simultaneous use of the Nd:YAG laser resulted in an enlarged zone of coagulation. Clinically, the laser-assisted intervention was inferior to the classic operational methods. CONCLUSIONS: Comparing the established CO2 laser and the Ho:YAG laser, the latter showed only the advantage of delivery via a flexible fiber. Sprinkling of tissue fragments and wide incisions are oncologically problematic. We conclude that this new tool is of minor value for otorhinolaryngologists and head and neck surgeons.     

Morphologische und funktionelle Veränderungen der Nasenschleimhaut nach nCPAP-Therapie

BACKGROUND AND OBJECTIVE: The treatment success of nCPAP therapy (nasal continuous positive airway pressure) depends partly on the relief of symptoms and partly on long-term patient acceptance and the related avoidance of complications. Nasal complaints constitute the most frequently reported side effects and, together with problems of mask application, are among the primary factors causing an nCPAP-therapy to be prematurely discontinued. PATIENTS/METHODS: To assess the morphological changes of the nasal mucosa during nCPAP-therapy, we excised specimens of nasal mucosa tissue in twelve patients with obstructive sleep apnea syndrome (OSAS) both before and 3-10 months after establishing nCPAP-mask acceptance. The specimens were examined by electron microscopy. RESULTS: In all these patients, acceptance of the CPAP mask marked the initial part of therapy. In addition, mucociliary clearance was assessed by the saccharin test before and after therapy. In all patients, the nasal epithelium underwent fundamental changes upon CPAP therapy, which became manifest as modifications in the shape of epithelial cells, conglutination and clumping of the microvilli, and the appearance of immunocompetent cells. Once patients were nCPAP mask compliant, mucociliary clearance was distinctly prolonged in all cases. CONCLUSIONS: A successful therapeutic concept should provide normalization of room temperature and air humidity once nCPAP mask compliance has been achieved, and include regular assessment of the condition of the mucosa in the upper respiratory tract. Only by these measures can nasal complications be countered or therapy be applied at an early stage.     

Genetic imbalances in preinvasive tissue of hypopharynx provide evidence for cytogenetic heterogeneity

Multiple chromosomal aberrations have been reported in head and neck squamous cell carcinoma (HNSCC). But less information is available on specific patterns of chromosomal amplifications which distinguish different areas of head and neck tumors. To elucidate genetic mechanisms causing the aggressive growth and high proliferation of hypopharyngeal squamous cell carcinoma (SCC), we performed reverse chromosome painting (RCP) on a total of eight hypopharyngeal SCC including invasive carcinoma and preinvasive tissue. Five hypopharyngeal invasive carcinomas showed amplifications on chromosome 3q. Furthermore, we detected gains on chromosomes 11q and 6p. Compared to the histologically classified preinvasive tissues, we found amplified alterations on chromosome 6p, 11q and 12q, but none of them showed gains on chromosome 3q. This observed heterogeneity in hypopharyngeal SCC might reflect a specific role of chromosome 3q as a late event in the highly invasive capacity of these SCC.     

Combined endoscopic–transcutaneous surgery in parotid gland sialolithiasis and other ductal diseases: reporting medium- to long-term objective and patients′ subjective outcomes

Objective was to assess the medium to long-term results and patients′ perceive of success after combined sialoendoscopic and transcutaneous access in salivary gland diseases. A retrospective analysis was performed in a tertiary referral centre. A total of 19 patients have been treated with a combined sialoendoscopic and transcutaneous access. The main indication was sialolithiasis in 89.5 % of cases (n = 17), in 2 of these cases simultaneous complications were treated. Other indications included treatment-resistant stenosis and traumatic transection of the parotid duct. Intraductal stents were placed in 52.6 % of the cases. Patients were evaluated by clinical investigation, ultrasound examination and by a questionnaire to assess patients perceive of success. As a result the treatment was successful in 89.5 % of all cases, and in 94.1 % of the patients with sialolithiasis. Parotidectomy was required in two patients, as reconstruction of the ductal system was not possible intraoperatively (sialolithiasis, n = 1) or was unsuccessful (stenosis, n = 1). Prerequisites for successful treatment were the endoscopic access to the pathology, the possibility to reconstruct the duct and recovery of gland function postoperatively. A mean follow-up time for successfully treated patients was 40.67 months. All patients were satisfied with the results and reported a significant reduction in symptoms and improvement of their perceived quality of life (p = 0.001 each). As conclusion the combined access is a valuable alternative treatment in patients with sialolithiasis. Additional indications may include treatment-resistant stenosis and injuries to the parotid duct. However, the indication in stenosis needs to be carefully weighed up.     

Chronic sorrow in next of kin of patients with multiple sclerosis

The well-being of patients' next of kin can be an important factor with regard to the care and rehabilitation of patients with multiple sclerosis (MS). The aim of this qualitative study was to explore the presence and meaning of chronic sorrow in a group of next of kin of patients with MS. Using a semistructured interview guide as a basis, 44 next of kin were interviewed. The results showed that 35 (80%) of the participants were considered to have chronic sorrow based on predetermined criteria. Three main themes characterized the meaning of chronic sorrow: loss of security, loss of sense of community in family life, and loss of joy and recreation. This study indicates that nurses need to devote greater attention to the well-being of next of kin, offering support programs to help them cope with chronic sorrow.     

Die Kranialisation der Stirnh?hle Indikationen, Technik und Ergebnisse Indikationen, Technik und Ergebnisse

Die osteoplastische Stirnh?hlenoperation mit Obliteration hat sich heute weitgehend in der Therapie von pathologischen Prozessen der Stirnh?hle etabliert, die nicht über einen endonasalen Zugang erreicht oder dauerhaft drainiert werden k?nnen. In einigen F?llen mu? jedoch die Stirnh?hlenhinterwand aufgrund ausgedehnter Frakturen, bei entzündlichen Prozessen oder wegen Tumorbefalls entfernt werden, so da? die Kranialisation der Stirnh?hle zur Anwendung kommt. Wir berichten von 8 Patienten, bei denen eine Kranialisation der Stirnh?hle durchgeführt wurde. Indikationen dafür waren eine kombinierte Trümmerfraktur der Vorder- und Hinterwand der Stirnh?hle (n = 3), eine Pyozele der Stirnh?hle mit ausgedehnter Destruktion der Hinterwand (n = 4) und ein gro?es Osteom der Stirnh?hle, das von der Hinterwand ausging (n = 1). In allen F?llen wurde über einen Bügelschnitt die Stirnh?hlenhinterwand und die Schleimhaut komplett entfernt und die Stirnh?hle zur Nase hin mit einem Bindegewebetransplantat verschlossen. Die Stirnh?hlenvorderwand wurde entweder nach osteoplastischer Er?ffnung rückverlagert oder in gleicher Sitzung mit Tabula externa rekonstruiert. Der Nachbeobachtungszeitraum betrug im Durchschnitt 1,8 Jahre mit einer Spannweite von 11 Monaten bis zu 8 Jahren. Alle Patienten wurden postoperativ klinisch und durch ein bildgebendes Verfahren (CT oder MRI der Nasennebenh?hlen) untersucht. In allen F?llen trat kein Rezidiv der entzündlichen bzw. tumor?sen Erkrankung und keine Sp?tkomplikation auf. Die ?sthetischen Ergebnisse waren sehr zufriedenstellend. Die Kranialisation der Stirnh?hle ist eine erfolgversprechende therapeutische Variante der klassischen osteoplastischen Stirnh?hlenoperation mit Fettobliteration.     

Morphologische und funktionelle Ver?nderungen der Nasenschleimhaut nach nCPAP-Therapie

Hintergrund und Fragestellung. Der Therapieerfolg einer nCPAP-Therapie (“nasal continuous positive airway pressure”) ist einerseits abh?ngig von der Linderung der Beschwerden und andererseits von der Langzeitakzeptanz und der hiermit verbundenen Vermeidung von Komplikationen. Nasale Beschwerden sind die h?ufigsten Nebenwirkungen und neben den Maskenproblemen die wichtigste Ursache, weshalb eine nCPAP-Therapie frühzeitig unterbrochen wird.     

Phase II study with pirarubicin in pretreated progressive head-neck neoplasms]

Sixteen heavily pretreated patients (pts) (4 surgery + chemotherapie + radiotherapy; 4 chemotherapy + radiotherapy: 6 surgery + radiotherapy; 2 chemotherapy) and one previously untreated patient, who refused surgery and or radiotherapy, all with progressive disease, with advanced squamous cell carcinoma of the head and neck were included in a phase II study with pirarubicin 60 mg/m2 i.v. day 1 every 3-4 weeks (CT). All pts received at least one course of CT. 15 pts were evaluable for response, all 17 pts were evaluable for toxicity. Female (male ratio 1/16; mean age 56 (42-68) yrs, mean performance status 70% (50-70). Seventeen pts received a mean of 3 (1-8) courses, 2 pts had received only one course of CT. Response and toxicity were assessed according to WHO classification. Results after 1-8 courses of CT: 1 (7%) complete remission; 1 (7%) partial remission; 9 (60%) no change; 4 (26%) progressive disease. No toxicity of grade IV was observed. Mean duration of remission 16 weeks. Median survival time 7 (1-10) months. 9 pts died and 8 pts are alive; six of them had progressive disease.