Anleitung für eine vollständige Kehlkopfpräparation

Zusammenfassung Anhand von 9 Abbildungen wird eine Methode zur Kehlkopfpräparation beschrieben, bei der sämtliche Knorpel, Gelenke und Muskeln dargestellt werden. Nach Ablösung des Schildknorpels und des Hypopharynx werden die Mm. postici und arytaenoidei isoliert, die Cricoarytaenoidgelenke sowie die Arytaenoidknorpel präpariert und die Mm. laterales eingeschnitten. Ein Horizontalschnitt durch den Ringknorpel und die median-sagittale Spaltung des proximalen Fragmentes liefern schließlich den Zugang zu den inneren Kehlkopfweichteilen.     

Mobile intraventricular cyst of the third ventricle treated with stereotactic puncture. Report of a case

A case of a pedunculated arachnoid cyst within the third ventricle is presented. The cyst was small so as not to appear as a significant expanding lesion on CT. The clinical history, however, suggested intermittent increase of the intracranial pressure. On CT there was some widening of the lateral and third ventricles, while the fourth ventricle had normal width. This finding in combination with the clinical history prompted further neuroradiologic examinations, including pneumoencephalography and ventriculography. The presence of a pedunculated mobile cystic lesion within the third ventricle was shown and its nature further elucidated by stereotactic puncture combined with contrast injection into the cyst. After emptying of the cyst, the patient has been free of symptoms during an observation time of 2 years. The diagnostic and differential diagnostic aspects are discussed and the value of traditional neuroradiologic methods emphasized.     

Accuracy of an anthropometric estimate of the muscle and bone area in a transversal cross-section of the arm

To standardize the maximal static force (Fo) of the arm flexors, the accuracy of an anthropometric method for estimating the mid-arm cross-sectional muscle and bone area (MBA) was investigated. This was done by comparing the anthropometrically determined area (MBA.A) with the area measured by means of computerized tomography (MBA.S). In the same way, the accuracy of Heymsfield's equations (Heymsfield et al., 1982) for predicting MBA (MBA.H) from anthropometric measures was tested. MBA.A was significantly larger than MBA.S, the relative difference increasing with the thickness of the subcutaneous fat layer. This difference was attributed to a 27% underestimation of the fat layer thickness as measured with the skinfold caliper. Women being fatter than men, this caused the standardized maximal static force (Fo/MBA) to be lower in women than in men. MBA.H was 12% smaller than MBA.S. This may have been due to a difference in the way of measuring the arm circumference between the present authors and Heymsfield et al.     

Flow requirements for the Bain breathing circuit during anaesthesia for caesarean section

We studied the relationship between arterial carbon dioxide tension (PaCO2) and fresh gas flow (FGF) during use of the Bain breathing circuit for Caesarean section anaesthesia. Thirty-one patients undergoing Caesarean section were anaesthetised using the Bain circuit with intermittent positive pressure ventilation. The PaCO2 were measured at FGF of 70 ml X kg-1 X min-1, 80 ml X kg-1 X min-1, and 100 ml X kg-1 X min-1. The FGF requirement to maintain a given PaCO2 during Caesarean section anaesthesia is the same as the requirements for nonpregnant subjects, despite the increase in carbon dioxide production associated with pregnancy. This is probably because the total FGF determined by body weight and given during Caesarean section anaesthesia is 15-20 per cent higher than nonpregnant levels, due to the weight gain associated with pregnancy. A FGF of 100 ml X kg-1 of pregnant weight/min maintains PaCO2 of 4.44 kPa predelivery, which is in the desirable range of PaCO2 during Caesarean section.     

Localized osteolysis in stable, non-septic total hip replacement

We are reporting four cases of extensive, localized bone resorption adjacent to a rigidly anchored, cemented total hip replacement. None of these hips showed evidence of infection on clinical, bacteriological, or pathological evaluation. The tissue from the regions of osteolysis showed sheets of macrophages and foreign-body giant cells invading the femoral cortices. Abundant methylmethacrylate particulate debris was present in the tissues, but polyethylene wear debris was absent. The histological appearance of this tissue resembled that reported about loosened total hip implants with the exception of the synovial-like layer at the cement surface. The cases reported here show that aggressive bone lysis may occur around stable cemented total hip arthroplasties without the presence of sepsis or malignant disease.     

Spectral analysis of infant EEG and behavioral outcome at age five

Power spectral and discriminant analysis techniques were used to compare EEG records obtained at term and at 3 months past term from 5 groups of varying risk and developmental outcome. The groups were: healthy full-terms; healthy pre-terms with normal outcomes; sick pre-terms with normal outcomes; sick pre-terms with delayed development; sick pre-terms with later neurological problems. The EEG samples recorded at term were identified as belonging to the correct subject group at 52-70% accuracy, 20% being chance for 5 groups. The accuracy varied with the 4 classes of EEG patterns used. The individual subjects were also classified into their correct groups with few exceptions. Similar success was obtained with EEG samples selected from recording at 3 months past term. The predominant power spectral discriminating features were changes in intra- and inter-hemispheric coherence, and increased power, particularly in the middle and higher frequency range. Thus, computer analyses of EEG samples, using features not readily identified visually, differentiated risk from non-risk infants and also differentiated infants with substantial neonatal medical complications who have good or poor developmental outcomes.     

Study on extensive lymph node dissection: metastatic lymph nodes in papillary carcinoma of the thyroid

Bilateral cervical lymph node dissection was performed in 71 cases of papillary thyroid carcinoma, considered to be relatively early cases because of mobility, irrespective of the size of tumor or presence of node enlargement. Of these, 33 cases received additional node dissection of the anterosuperior mediastinum through longitudinal sternotomy. The number of lymph nodes examined per subject averaged 89.9, the number of metastatic nodes was 13.8, and metastasis was noted in 88.7% of all cases. Lymph node metastasis tended to be more frequent on the affected side, but was simultaneously scattered over the whole cervical area. As to sites, metastasis of paratracheal nodes on the affected side occurred at a frequency of 66.2%, inferior and superior jugular nodes at 62.0% and 59.0% respectively, pretracheal nodes at 50.7%, and tracheoesophageal nodes at 47.9%. The high incidence of para- and pretracheal nodes suggests that the lymph flow in this direction is of great importance in metastasis. In fact, lymph nodes in the mediastinum, which were directly continuous with these nodes, showed as high as 39.4% metastasis in cases of anterosuperior mediastinal extirpation. This extensive node dissection is considered to be very preferable as at least the agony of survival with carcinoma can be lessened.     

Pharmacokinetics of intravenous bepridil in patients with coronary disease

The pharmacokinetics of intravenous bepridil (1-[2-(N-benzylanilino)-1-(isobutoxymethyl)ethyl]pyrrolidine ) were studied in 16 patients undergoing cardiac catheterization for evaluation of coronary disease, all with normal base-line hemodynamic and renal functions. Ten patients received 3 mg/kg and six patients received 4 mg/kg of bepridil infused over a period of 30 min. Plasma bepridil concentrations were measured by HPLC and analyzed by model-dependent and model-independent methods. The mean (+/- SD) maximum plasma bepridil concentrations at the end of the infusion were 2047 +/- 820 ng/mL (3 mg/kg) and 2478 +/- 1426 ng/mL (4 mg/kg). Postinfusion bepridil concentrations were best described by a two-compartment open model. The model-dependent harmonic mean distribution and elimination half-lives were 1.7 h (range: 1.1-2.2 h) and 19.7 h (range: 8.0-61.9 h), respectively. The harmonic mean elimination half-life from model-independent analysis was 14.9 h (range: 7.4-64.0 h). The arithmetic means of other model-independent kinetic parameters were systemic clearance, 0.524 +/- 0.215 L X kg-1 X h-1; Vd, 15.3 +/- 10.9 L/kg; and Vdss, 10.1 +/- 6.0 L/kg. Model-dependent and model-independent estimates of half-life and clearance agreed reasonably well. Bepridil was well tolerated, effecting little or no change in central hemodynamics or EKG intervals. The extensive distribution and relatively slow clearance of bepridil account for its long elimination half-life. Intravenous bepridil appears to be a safe calcium (II) antagonist that is suitable for once-a-day dosing.