[Glottic laryngeal carcinoma. Tis, T1 and T2--long term results after laser resection]. / Glottische Larynxkarzinome. Tis, T1 und T2--Langzeitergebnisse nach Laserresektion.

BACKGROUND: Endoscopic laser resection is one treatment modality for early glottic carcinoma. Benefits are the preservation of laryngeal structure without tracheotomy, the short duration of treatment, low traumatisation and good functional results. METHODS: From 1989 to 1999, 143 patients with an isolated and previously untreated glottic squamous cell carcinoma were treated by CO2 endoscopic laser resection. The tumors were classified as carcinoma in situ (Tis) in seven cases, T1 tumor (T1N0M0) in 91 patients and T2 tumor (T2N0M0) in 45 cases. Median follow-up was 5 years. RESULTS: For the group of Tis and T1 carcinomas, 86 of 98 patients were free of recurrences. The 12 recurrences (12.2%) were treated by repeated laser surgery and laryngectomy (four patients). None of these patients died of tumor related causes. For patients with T2 carcinomas, the overall recurrence rate was 28.9% (13 patients). In six patients, a total laryngectomy had to be performed and one patient died because of tumor recurrence. The relapse free survival estimate using the Kaplan-Meier method was 87% for Tis and T1 carcinomas and 70% for T2 carcinomas. The overall laryngeal preservation rate was 95% for Tis and T1 carcinomas and 85% for T2 tumors. All recurrences occurred within 4 years of primary surgery. CONCLUSION: The results suggest that the oncological outcome after endoscopic laser surgery is comparable to conventional open partial resections.

[Rare mesenchymal lesions in siblings. Two case reports]. / Seltene mesenchymale Läsionen bei Geschwisterkindern. Zwei Fallberichte.

We report on a 15-month-old boy presenting a juvenile active ossifying fibroma in the right nasal cavity and the sibling, a 9-month-old girl with a mesenchymal hamartoma of the chest wall. The two lesions showed many similarities. Both lesions are present at the time of birth or in early life with local obstructive or compressive effects. The lesions have a similar mixture of mature and immature mesenchymal tissue with areas of ossification. The entities present a tumor-like development with an abnormal mixture of tissue indigenous to the specific area of the body without notable atypical cytologic features. These features are typical criteria for hamartoma lesions.

[Ossifying fibromyxoid tumor of soft parts]. / Ossifizierender fibromyxoider Tumor der Nasenhaupt- und Nasennebenhöhlen.

BACKGROUND: OMFT are nearly always benign, usually presented in soft tissue, of uncertain origin and tend to relapse. They are regarded as neoplasms of the adult, only three cases of children have been reported so far. PATIENT: A case of a 12-year-old boy is presented, for the first time, with an OMFT in the nasal cavity and the paranasal sinus. The diameter measured 9 centimetres. Histologically the tumor consisted of a myxoid matrix and showed areas of metaplastic bone. Most of the cells showed a spindleform and sometimes polymorphic hyperchromatic nuclei. The tumor expressed S-100 protein and vimentin. The cellularity was moderately high, the mitotic rate was very low. CONCLUSIONS: OMFT are rare neoplasms, the diagnosis should be verified histopathologically. Complete excision should be performed. A clinical follow-up is necessary.

Endotracheal balloon dilatation and stent implantation in benign stenoses.

BACKGROUND: Tracheal reconstruction is the treatment of choice in nontumorous tracheal stenoses, but recurrences and concomitant medical conditions limit this approach. We investigated the outcome after balloon dilatation and silicone stent implantation. METHODS: Forty-two patients with inoperable tracheal stenoses underwent balloon dilatation and afterward silicone stent implantation. Patients were divided into two groups, in group A 24 patients received tracheal stents as a temporary treatment. In group B, definitive stenting was done in 18 patients with severe concomitant medical conditions that did not allow for stent removal. RESULTS: Immediate results were satisfactory in all patients. In group A, stents could be removed in 12 patients after a mean interval of 20 months. Restenting was not required during the following 18.9 months. Twelve patients are still waiting for stent removal after a mean follow-up of 20 months. In group B, mean follow-up is now 48.4 months. Complications included retained secretions, dislocation, and granuloma formation. CONCLUSIONS: Stenting after balloon dilatation is safe and effective in benign tracheal stenoses. After temporary use, stents can be removed when local and general conditions permit. In all other patients, stenting proved beneficial for 5 years as more definitive treatment.

[Surgical rehabilitation of neuromuscular swallowing disorders with special regard to cricopharyngeal myotomy and glottopexy]. / Operative Therapie neuro-muskulärer Schluckinsuffizienzen unter besonderer Berücksichtigung der krikopharyngealen Myotomie und der Glottopexie.

UNLABELLED: Surgical Rehabilitation of Neuromuscular Swallowing Disorders with Special Regard to Cricopharyngeal Myotomy and Glottopexy. BACKGROUND: The surgical rehabilitation of patients with swallowing disorders caused by neuromuscular insufficiency with life-threatening aspiration presents a special challenge to the ENT-surgeon. METHODS: In a period of 5 years we decided on a surgical treatment in altogether 12 patients with paralytical dysphagia. In 6 patients we combined a cricopharyngeal myotomy with a complete closure of the glottis, in 5 patients we performed a sole cricopharyngeal myotomy. In another patient we restricted ourselves to glottopexy only. RESULTS: In all cases the dysphagia giving rise to the surgical intervention was regredient so far that the removal of the percutan endoscopic gastrostomy postsurgically was possible. 3 special cases are presented in detail. DISCUSSION: The main part of the therapy is the subtle and complete cricopharyngeal myotomy. Particulary good results are available with a combination of the latter with a reversible glottopexy. CONCLUSIONS: After the failure of conservative therapy the indication for a surgical treatment should be made on a large scale.

[Tracheal wall cyst. A rare cause of stridor in the adult]. / Trachealwandzyste. Eine seltene Ursache eines Stridors beim Erwachsenen.

A case of tracheal cyst is described in a 43-year-old man who was admitted with nonspecific symptoms of an obstruction in the upper respiratory tract. A CT scan of the thorax showed a solid tumor on the inner tracheal wall. Bronchoscopy revealed a tumor with a broad base and smooth surface that almost completely obstructed the trachea. Intraoperatively, the tumor was found to be a cyst and was successfully removed endoscopically. Tracheal cysts are quite rare and most of the reported cases have been confined to pediatric patients as a congenital disease. More frequently, congenital intraluminal cysts of the upper respiratory tract are found as epiglottic retention cysts and laryngoceles.

Management of swallowing disorders and chronic aspiration by glottic closure procedure.

We report an 18-year-old man with a posterior fossa tumor who had to undergo a partial resection of the tumor and supportive radiation therapy. Functional deficits of the lower cranial nerves, particularly the glossopharyngeal and vagal nerves, associated with severe swallowing disorders and refractory aspiration pneumonia were seen postoperatively. The admission to the intensive care unit (ICU) resulted from increasing respiratory failure accompanied by recurrent septic episodes. Nutritional support via nasogastric tube and later percutaneous endoscopic gastrostomy (PEG) were hampered by complications such as persistent sinusitis, local dermatitis surrounding the entrance of the PEG tube, and the development of duodenal ulcers. Furthermore, the use of continuous subglottic aspiration failed to prevent pulmonary infections. After a 9-week stay in the ICU due to inadequate antimicrobial therapy of aspiration pneumonia and the patient's persistent sepsis, a temporary surgical separation of airway and food passages was performed by glottic closure. Subsequently chronic aspiration stopped, and 3 months after admission to the ICU, the patient had stable vital organ function and was transferred to a surgical ward free of infections. Glottic closure was reversed successfully 7 months later. When compared with laryngeal function on admission, there was no more impairment. Thus, temporary glottic closure seems to be an efficacious treatment to prevent life-threatening septic complications in patients with refractory aspiration pneumonia.

[Risk assessment in ovarian hyperstimulation syndrome (OHS) using the machine learning system (Decision Master) in 155 in-vitro fertilisations and embryo-transfer (IVF/ET) cycles with a long stimulation protocol]. / Risikoerkennung des ovariellen Uberstimulationssyndroms (OHS) mit Hilfe des maschinellen Lernverfahrens "Decision Master" bei 155 In-Vitro-Fertilisation und Embryotransfer (IVF/ET)-Zyklen mit dem langen Stimulationsprotokoll.

In 155 selected IVF/ET cycles stimulated with the long protocol 25 cycles with severe OHS are included which turned up later on (purposely overrepresented). An inductive machine learning program is described both in informatics and medical essentials. It is tested whether there exists an algorithm for ruling out the above-mentioned complication in the follicular phase of the same cycle already. By cross validation 89% of the OHS could be predicted and proven by practical rules using hormone and ultrasound values to avoid similar events in ongoing or further cycles.

Mechanisms and avoidance of esophageal perforation by anesthesia personnel during laparoscopic foregut surgery.

BACKGROUND: This study retrospectively assesses the mechanisms of 13 esophageal or gastric injuries resulting from dilator or nasogastric tube placement during laparoscopic foregut surgery and is intended to assist in determining methods of prevention. METHODS: Information regarding esophageal or gastric injury during laparoscopic foregut surgery was obtained from six experienced laparoscopic surgeons. The specific mechanisms of injury were determined by discussion with the operating surgeon and review of the operative reports. RESULTS: Eleven cases of esophageal or gastric perforation occurred during bougie insertion and two perforations occurred secondary to nasogastric tube placement during Nissen fundoplication or Heller myotomy. Five perforations required conversion to open operation for repair including two delayed thoracotomies. The 13 injuries occurred during the performance of 1,620 laparoscopic foregut operations for an overall incidence of 0.8%. CONCLUSION: Foregut injury resulting from esophagogastric intubation during laparoscopic surgery is more common than expected. Risk factors include esophageal anatomy, intrinsic pathologic changes of the esophagus, and inexperience. Prevention must focus on close communication between the surgeon and anesthesiologist and safe techniques of dilator insertion.

In vitro fertilization: increased VLA (very late antigen) integrins and fibronectin after acrosome reaction.

The pattern of detectable adhesion molecules (AM) on human ejaculated spermatozoa used for in vitro fertilization (IVF) of human oocytes was evaluated. The percentage of spermatozoa with the alpha chains 3, 4, 5, and 6 of the integrins (also called very late antigens, VLA alpha 3, 4, 5, 6), the alpha V and the beta 3 chains, as well as the matrix proteins laminin and fibronectin, were determined by flow cytometry using monoclonal antibodies against integrins and matrix proteins before and after the acrosome reaction. This reaction was induced by the low-temperature method according to P. Sanchez, E. Töpfer-Petersen, R. J. Aitken, and W. B. Schill (1991, Andrologia 23:197-203) and monitored by the binding of FITC-conjugated Pisum sativum agglutinin. Twenty-three of 34 investigated semen samples fertilized at least one oocyte (fertile group) and 11 samples did not induce a pronucleus formation or cleavage of an oocyte (infertile group). Significant differences in the classical semen parameters between both semen sample groups could be shown only for the percentage of progressively motile spermatozoa (p = .046, U test). The spermatozoa of the fertile group showed a significantly higher expression of VLA alpha 3 (p = .045) and fibronectin (p = .048). Additionally, after the loss of the acrosome a significantly higher expression of alpha 4, alpha 5, and alpha 6 chains of integrins (p < .05) was detected in the fertile semen group. In contrast, the inducibility of the acrosome reaction differed only to a nonsignificant extent (p = .094). These data suggest that spermatozoa showing a higher expression of the alpha chains of the integrins after the acrosome reaction have a better fertilization rate in vitro.

[Nasal cavity and paranasal sinus malignancies in the ENT clinic of Charité since 1959]. / Nasenhöhlen- und Nasennebenhöhlen-Malignome an der HNO-Klinik der Charité seit 1959.

A retrospective analysis of 235 cases suffering from nasal and/or paranasal sinus malignant tumours who were admitted to the Charité ENT-Clinic between 1959 and 1989, is presented. 94 of the patients were women and 141 men, the mean age being 63.8 years (women) and 61.8 years (men), respectively. The most common histomorphological diagnosis was carcinoma (66%), followed by lymphoma/sarcoma (17%). 35% of all tumours originated in the nasal cavity, 38% in the maxillary sinus, 22% in the ethmoidal sinuses. At the time of admission many tumours had already invaded surrounding structures. Tumour invasion of the pterygopalatine fossa was noted in 52 patients, invasion of the orbit in 89 and of the skull base in 65 cases. Our therapy mainly depended on the histology of the tumours. 19% of all carcinomas were treated by surgery only, in 48% surgery and postoperative radiation was the therapy of choice. 59% of lymphomas/sarcomas were treated by radiation only. 100 out of these 227 patients treated because of sinus malignancy developed recurrencies. The 5-year survival rate was 30% in general, 29% for the years 1959-1970, 31% for the years 1971-1984 and for the T1 to T4 type cancers 54%, 38%, 19% and 19%, respectively.

[Anesthesia for laparoscopy in sterile patients]. / Narkose zur Laparoskopie bei Sterilitätspatienten.

During 5 years 382 laparoscopies were carried through in female patients with sterility in different kinds of anaesthesia (Intubation anaesthesia, spinal anaesthesia, and i.v. anaesthesia). We found the most advantageous results in the cases of i.v. anaesthesia with Ketamin and Diazepam.

[Multiple pregnancy following in vitro fertilization and embryo transfer]. / Zur Problematik einer Mehrlingsschwangerschaft nach In-vitro-Fertilisation und Embryotransfer.

In a 32 year old patient 14 eggs were harvested and inseminated with donor semen. Six embryos were transferred resulting in a triplet-pregnancy. In spite of a septic disease three preterm but healthy children were born by caesarean section 199 days after ET (male 1620.0; female 1180.0; male 1560.0). Up to nowadays there is not any handicap. We don't know a general but safe method for avoiding multiple pregnancies.

[Extracorporeal fertilization and embryo transfer]. / Extrakorporale Befruchtung (eF) und Embryotransfer (ET).

At first some problems of topic terms are demonstrated because the method is transferred from rodents and cattle. Therefore we should not term it a biotechnical but a biomedical approach involving the specific human and ethic aims. The eF and ET method is described and characterized as a systemic one which makes possible to improve the chances of numerous infertile couples and to elucidate some problems of early embryonic development. In spite of the tendency to standardize and to alleviate the method there is no reason to estimate it easy. In 1983 our three GDR groups performed 20 ET's over all but without an ongoing pregnancy until now.

[Use of ultrasonic folliculometry and LH determination in artificial insemination with donor semen]. / Die Anwendung der ultrasonographischen Follikulometrie und der LH-Bestimmung bei der artefiziellen donogenen Insemination.

The results of ultrasonic determinations of follicular growth and determinations of serum LH-levels were analysed in 34 patients who were artificially inseminated using cryopreserved donor semen (AID). 22 of them became pregnant. The ultrasonic findings had contributed to perform AID optimally, where as the determinations of LH did not surely indicate ovulation in each case. Frequency of inseminations per cycle was reduced by means of ultrasonic observations of follicle. The chance of success of artificial insemination using cryopreserved spermatozoa was decreased by delay of maturity of follicle. A peak of LH-concentration in serum was not detectable in 27 per cent of patients by one estimation daily.