Experiences with the silicone T-tube in man and dog.

Silicone T-tubes are particularly useful for long-term stenting of the laryngotracheal airway. Silicone is useful when non-autogenous non-reactive soft material is wanted for use in the human and animal body. Two case reports illustrate the use of the silicone T-tube.

Irresectable bronchial carcinoid with a 32-year natural history. A report of two cases treated with Neodymium-YAG-laser, initially misinterpreted as small cell lung cancer.

Two patients are described with bronchial carcinoid. In both, the initial diagnosis was small cell lung carcinoma (SCLC). This diagnosis was discordant with the clinical course; a second evaluation yielded the diagnosis of carcinoid. Good palliation was achieved with YAG-laser therapy.

Diagnostic application of a monoclonal antibody against small cell lung cancer.

A monoclonal antibody (MOC-1) directed against an antigen present in small cell lung cancer (SCLC) was used for diagnostic purposes. After screening of biopsy specimens of lung tumors, MOC-1 was found to react with SCLC (n = 10) and adenocarcinoma of the lung (4 of 9 cases). Except for a few cells in a poorly differentiated tumor, the reaction with squamous cell cancer was negative (n = 6). Staining with MOC-1 by an immunoperoxidase technique on imprints of biopsy specimens procured by rigid bronchoscopy was found to be a reliable and rapid method for diagnosing SCLC (16 of 17 positive). All cytologically proven bone marrow and pleural metastases of SCLC were found by staining on a cytospin preparation with MOC-1. Moreover, in three cytologically negative cases, MOC-1-positive cells were detected.

Three years' anaesthetic experience with the Groningen Nd YAG laser coagulation technique.

The use of the Neodymium YAG Laser technique in the palliative treatment of tracheo-bronchial tumors in 47 patients is described and the merits of the coagulation and anaesthetic techniques are discussed.

Microendoscopic surgery of the hypopharyngeal pouch with the CO2 laser.

In 1964 we started to treat hypopharyngeal (Zenker's) diverticula endoscopically, using the procedure described by Dohlman. With the increase in the number of patients (350), the technique and the instruments used have improved. This paper describes the technique, which involves exposure of the tissue bridge between esophagus and diverticulum with the aid of a specially designed scope and subsequent severance with the CO2 laser of this bridge under microscopic control. The use of an operating microscope and the laser is a great improvement in endoscopic treatment of hypopharyngeal diverticula.

Leiomyo(sarco)ma of the oesophagus.

Leiomy(sarco)mas of the oesophagus are rare tumours, which often cause ill-defined disturbances in the passage of solid food. The diagnosis can be established by simple radiological examination and endoscopy. There is no infiltration of the mucosa and it is undesirable to take biopsy specimens from such tumours through intact mucosa. The treatment of choice of leiomyoma is enucleation; that of leiomyosarcoma is resection.

Microendoscopic surgery of the hypopharyngeal diverticulum using electrocoagulation or carbon dioxide laser.

In 1964 we started to treat hypopharyngeal (Zenker's) diverticular endoscopically, using the procedure described by Dohlman. With the increase in the number of patients (274 patients up until 1982), the technique and the instruments used have improved. This paper describes the technique we have used since 1981, which involves exposure of the tissue bridge between esophagus and diverticulum with the aid of a specially designed scope and subsequent severance of this bridge under microscopic control. In 12 cases the bridge was severed by electrocoagulation, while the CO2 laser was used for this purpose in another 12 cases. Both techniques have given good results. Essential advantages or disadvantages of either of these methods could not be elicited. We regard the use of an operating microscope as a great improvement.

A simple endoscopic intubation technique in esophageal obstruction.

Endoscopic intubation was effected in 42 cases of malignant esophageal stenosis during the period 1979-1981. The stenosis was dilated with the aid of thermoplastic probes passed through a rigid esophagoscope of sufficient length, whereupon a tube was introduced under endoscopic control and left in situ in the malignant stricture. This "rigid" technique is suitable for process confined to the esophagus. Introduction of the tube requires adequate endoscopic skill and is not devoid of risk. Perforation, the gravest risk, occurred in two cases. Proximal tube migration was observed in five patients.

Colon-interposition as replacement for the esophagus. A follow-up study.

The longterm results of the use of colon-interposition as a substitution for the esophagus have been studied. Colon-interposition was carried out in eleven patients. There was one operative death. A second child died of an unknown cause nine years and eight months after operation. Nine patients could be studied from sixteen years and nine months to thirteen months after the operation. In six patients a satisfactory result has been achieved. One child is staying in a psychiatric infirmary. Feeding problems due to recurrent fistulae have led to growth retardation in another patient, while a third patient has regurgitation symptoms. A study of the case histories gives insight into the many early and late complications which occur in this operative procedure. The colon-interposition is a complicated procedure and should only be carried out in centers for pediatric surgery, because of its specific indication, its technique and the occurrence of complications afterwards. The development of alternative, less complicated, methods leaves a restricted indication for colon-interposition.

Flexible fiberoptic endoscopy in difficult intubations.

Intubation problems sometimes occur very suddenly and can be divided into two groups. The expected ones include the patients with a short neck and long teeth, cellulitis of the tongue, large oropharyngeal tumors, obstructing laryngeal tumors, congenital and acquired maxillofacial deformities, ankylosis of the temporomandibular joints, fractures or ankylosing spondylitis of the cervical spine, and all patients with a history of previous intubation problems. Unexpected problems can arise in patients who combine large incisors and canines with an inability to open the mouth wide, or when the glottis is invisible because the epiglottis is immobile. The first concern in these cases is to restore consciousness, for the conscious patient shows tonus and this facilitates identification of anatomical landmarks. A 60 cm bronchofiberscope provided with a tube and a freely movable end of 30 cm is suitable. Shorter flexible scopes are not adequate.

Intramural diverticulosis of the esophagus.

A description is given of the etiology and pathology of intramural esophageal diverticulosis as so far discussed in the literature. In view of the course and the clinical findings in two young patients in whom this diagnosis was established, it is suggested that intramural diverticulosis develops as a result of a devolopmental disorder in the autonomic nervous system.

Insufflation esophagoscopy.

A new electroscope has been designed from the conventional Haslinger tubes. The new rigid scope combines the advantage of air insufflation in the flexible system with the therapeutic possibilities of the rigid tubes and is trustworthy in the following esophageal procedures; a) finding entrance of severe strictures; b) introducing nasogastric feeding tubes; c) extraction of foreign bodies; d) tumor coagulation/spur in hypopharyngeal diverticuli; e) washing and suction in cases with severe food retention; f)making tumor smears in patients with clotting disorders; g) taking substantial biopsies with an optical forceps, and h) objective photodocumentation of esophageal pathology.