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Biomedical subjects

H E Eckel

Publications and source records attributed to H E Eckel.

At least 73 records · Page 4Linked to original sources
PubMed1998

Phonatory results after laser surgery for glottic carcinoma.

OBJECTIVE: To identify the influence of type and extent of surgery on postoperative voice parameters after endoscopic laser resection for glottic carcinoma. SETTING AND DESIGN: A multidisciplinary university-based head and neck cancer center. Objective and subjective measures of voice were correlated with type and extent of surgery following a standardized classification in a prospective study including 80 patients. SUBJECTS AND METHOD: The postoperative mechanism of phonation was assessed by videostroboscopy 6 months after surgery at the earliest. A phonetogram was produced, and its area was calculated (relative phonetogram (RP)) in relation to a gender-different normal phonetogram. Two speech therapists (ST) and a trained otolaryngologist (TO) rated each voice independently for communication ability in a grade from 1 (poor) to 5 (near normal). RESULTS: After simple cordectomy the means were as follows: RP = 24.8%, TO = 3.26, and ST = 3.33. When the anterior commissure was completely preserved, mean results were better (RP = 34%, TO = 3.92, ST = 3.83). Results were worse after extended cordectomy (RP = 14.7%, TO = 2.82, ST = 3.00) and transglottic resection (RP = 13.7%, TO = 2.30, ST = 2.86) but were similar within these two groups. The parameters RP TO, and ST do not differ significantly between the group who had speech therapy after surgery (n = 33) and the group who did not (n = 47). Voice production at glottic level yields better results for every parameter than supraglottic substitute phonation. The amount of tissue removed was less significant. CONCLUSION: Postoperative phonatory results correlate with the postoperative mechanism of phonation. There is no linear correlation with the amount of tissue removed. Comparison of similar types of resection preservation of the anterior commissure plays a key role. From the data in this study, there is no evidence for a significant benefit from speech therapy. The parameter RP is an effective and relatively simple parameter to complete auditory voice assessment.

Carcinoma↗
PubMed1998

[Early detection of profound hearing loss in children. Results of screening students in Rhine schools for the deaf and hearing impaired in Cologne].

OBJECTIVE: Early detection and adequate and timely rehabilitation of profound deafness in children is accepted as an important aim of preventive child health care. Ideally, rehabilitation of congenital deafness should not be delayed beyond the age of six months. The present study seeks to determine whether this goal has been achieved in Germany in the 1990s. PATIENTS AND METHODS: The medical charts of 314 profoundly hearing impaired pupils at the schools for the hearing impaired in Cologne, Germany, were reviewed. All available data on the time of first suspicion and the final diagnosis were collected. In addition, the families of these children were interviewed using a standardized questionnaire. RESULTS: The mean age at first suspicion was 2.1 years, the mean age at the time of final diagnosis was 2.6 years (median: 2.0 years). Breaking down the whole cohort into three subgroups according to the year of birth revealed obvious differences between these subgroups. The final diagnosis for those born from 1974 to 1979 (n = 70) was confirmed in 48.6% at the age of two years, in 46.3% for those born from 1980 to 1985 (n = 121), and in 65.8% for those born from 1986 to 1991 (n = 114) at the age of two. The diagnosis was significantly delayed for children of immigrants (n = 96), where the mean age at diagnosis was 3.7 years as opposed to 2.0 years for the native German population. Of the 314 children, 304 where supplied with hearing aids and five with cochlear implants. Once the audiological diagnosis had been established, no further delay in rehabilitation was noticed. CONCLUSION: Although highly sensitive, cost effective, and non-invasive screening methods (transient evoked otoacoustic emissions and auditory brainstem response audiometry) for the early detection of profound inborn hearing impairment are now available, the current state of early identification of these disorders is inadequate. The reason for this is the lack of a universal and nationwide neonatal screening program. The results of this study indicate that the pure availability of sophisticated screening methods is insufficient if they are not included in a universal screening program.

Child↗
PubMed1998

[Voice quality after partial laser laryngectomy].

BACKGROUND: We conducted a prospective study to investigate voice quality after transoral endolaryngeal laser surgery in terms of ability to communicate effectively. Eighty patients with T1 or T2 glottic carcinoma were enrolled in the study. The main objective was to identify the influence of type and extent of surgery on postoperative voice parameters after endoscopic laser surgery. MATERIAL AND METHODS: The postoperative mechanism of phonation was assessed by videostroboscopy six months after surgery at the earliest. A phonetogram was produced and its area calculated (relative phonetogram, RP) in relation to a gender-specific normal phonetogram. A speech therapist (ST) and a trained otolaryngologist (TO) rated each voice independently for communication ability in a grade from 1 (poor) to 6 (near normal). RESULTS: After simple cordectomy the mean values were as follows: RP = 24.8%, TO = 3.26, ST = 3.33. When the anterior commissure was completely preserved mean results were better (RP = 34%, TO = 3.92, ST = 3.83). Results were worse following extended cordectomy (RP = 14.7%, TO = 2.82, ST = 3.00) and transglottic resection (RP = 13.7%, TO = 2.30, ST = 2.86), but similar within these two groups. The parameters RP, TO, and ST do not differ significantly between the group who had speech therapy after surgery (N = 33) and the group who did not (N = 47). Voice production at glottic level yields better results for every parameter than supraglottic substitute phonation. The amount of tissue removed was less significant. CONCLUSION: We conclude that postoperative phonatory results correlate with the postoperative mechanism of phonation. There is no linear correlation with the amount of tissue removed. Comparing similar types of resection preservation of the anterior commissure plays a key role. From the data in this study there is no evidence of a significant benefit from speech therapy. The parameter RP is an effective and relatively simple parameter to complete auditive voice assessment.

Endoscopy↗
PubMed1998

Emergency stenting of malignant obstruction of the upper airways: long-term follow-up with two types of silicone prostheses.

We report on 10 patients with severe malignant "mixed-type" obstruction of the proximal trachea or distal trachea plus both main stem bronchi. They had far-advanced inoperable tumors (esophageal cancer in 4 patients, lung cancer in 3, and recurrent laryngeal, uvular, and thyroid cancers in 1 each). Emergency treatment consisted of a dilating bougie maneuver followed by the insertion of a large one-way (4 patients) or Y-shaped (6) silicone prosthesis. Subsequent to the intervention, there was long-lasting clinical improvement. The median survival from stent insertion was 8 months for all patients irrespective of tumor type; it was 5 months for lung carcinoma patients and 8 months for those with esophageal cancer. The results are in accordance with those of other studies using different therapeutic modalities. Stent exchange proved necessary in 5 patients. The main reasons were continuing tumor growth beyond the proximal and distal boundaries and recurrent productive bronchial infection. Patients died of pneumonia (4 patients), pulmonary lymphangitic spread (1), heart failure (2, one of whom also had pneumonia), and fatal hemorrhage (1). As of December 1995, 3 patients were still alive, 2, 5, and 8 months after stent implantation. As evidenced by clinical efficacy and length of palliation, endoscopic placement of silicone-based one-way and bifurcated prostheses in far-advanced tumor of the central airways is technically feasible and ethically justifiable.

Aged↗
PubMed1997

CO2 laser surgery for verrucous carcinoma of the larynx.

BACKGROUND: The verrucous carcinoma (VC) is a low grade malignant tumor. Treatment strategies of VC of the larynx are topics of the ongoing discussion, and the role of the carbon dioxide laser therapy in the management remains unclear to date. STUDY DESIGN/MATERIALS AND METHODS: From 1986 to 1995, 21 patients with glottic VC were treated with transoral carbon dioxide laser surgery. Follow-up ranged from 6 to 122 months (mean 52). RESULTS: In T1 lesions, a complete removal of the tumor was possible with laser-cordectomy in ten cases and with extended laser cordectomy in four cases. In seven patients suffering from T2 carcinoma, a partial laser laryngectomy was performed. There was no tumor-related death in this series. No patient required laryngectomy or radiotherapy. CONCLUSION: The results presented here are superior to those previously reported with radiotherapy. They add further support to the observation that surgery is the better treatment option for VC of the larynx. Based on the results of this study, recommended treatment for T1 and T2 VC is oncologic CO2 laser surgery in combination with a meticulous follow up for early recognition of local recurrence.

Adult↗
PubMed1997

Plastination of the larynx for whole-organ sectioning.

Whole-organ sectioning is an important technique for the assessment of laryngeal pathology. Since currently established methods require prior decalcification which causes morphological changes, the critical border area between cartilage and surrounding soft tissue cannot be investigated in the same specimen and morphometric studies are not possible. Plastination is a laboratory technique that has previously demonstrated its capacity to overcome these shortcomings. In so doing water and lipids are replaced by curable polymer within the laryngeal cells making decalcification unnecessary. In the present study, more than 50 human larynges were processed using block plastination (BP) and sheet plastination (SP). For BP the complete organ was plastinated as a whole and then cut into thin serial sections. For SP the fresh organ was sliced first and plastinated in a second step. Findings demonstrated that SP allowed for the production of whole-organ sections within a period of 1 week only. Section thicknesses were as thin as 15 mm using a diamond wire saw and an ultramilling device. Sectioning was possible in both coronary and horizontal planes. Following BP, specimens were cut in an industrial cutting machine to thicknesses of about 0.6 mm. Shrinkage of tissue was less than 10% for both methods. In all, SP was technically superior to routine paraffin histology, although cutting equipment is very expensive and delicate in handling. At present the technique of BP is the method of choice for macromorphometrical investigations on serial sections of the human larynx.

Acetone↗
PubMed1997

[99mTc-MDP-SPECT for detection of subclinical mandibular infiltration of squamous epithelial carcinoma].

UNLABELLED: A prospective study was performed to compare the sensitivity and accuracy of ultrasound (US), computed tomography (CT), and single photon emission computed tomography (SPECT) as a bone scan to detect subclinical invasion of the mandible by squamous cell carcinoma of the oral cavity and floor of mouth. METHODS: The present study reports data on 35 patients with squamous cell carcinoma of the oral cavity. SPECT, mandibular orthopantomography (OPG), US, CT and magnetic resonance imaging (MRI) were performed as well as histologic examination of resected mandibles. Transverse slices of 12 mm thickness were reconstructed for SPECT and semi-quantitative assessment of radionuclide uptake was performed with a scoring system based on comparisons of tracer uptake in the mandible to that in an unaffected part of the mandible. Lesion to non-lesion count ratios in the mandible in 3 h SPECT images were calculated. OPG, US and CT were evaluated for comparison. RESULTS: In 12/35 patients, histologic examination showed carcinoma infiltrating mandibular bone. SPECT correctly predicted mandibular invasion in 11/12 cases, with no false-positive results. CT detected correctly 3/12 lesions, while OPG and ultrasound each demonstrated 2/12 tumors. CONCLUSION: Bone SPECT was found to provide an accurate means for assessing tumor invasion to the mandible by intraoral squamous cell carcinoma. As a complementary study to one of the other imaging modalities it was shown to have a high specificity, indicating that it should be performed routinely in patients with suspect mandibular bone involvement by causes.

Adult↗
PubMed1997

[Indications, technic and results following Sedlacek-Kambic-Tucker reconstructive partial resection of the larynx].

Management of laryngeal carcinoma located at the anterior commissure remains controversial. Local control rates with radiotherapy or surgery are not as good as those seen after treatment of midcord lesions. The vertical partial laryngectomy with epiglottic reconstruction (VPLER) may be a more successful approach to such lesions. The charts of all patients treated for larynx carcinoma between 1991 and 1996 at the authors' institutions were reviewed to identify those patients treated with VPLER as described by Sedlacek in 1965, Kambic in 1976 and Tucker in 1979. Indications for performing surgery and outcome data of patients were collected and analyzed according to the indications for surgery, surgical technique, perioperative complications, oncological outcomes and functional results. Twelve patients were identified that had been treated with VPLER. Indications for surgery included five patients with local recurrences following endoscopic laser partial laryngectomies, four cases with previously untreated primary tumors at the anterior commissure (T2 N0-2 M0), two with local recurrences following radiotherapy, and one with recurrence following frontolateral partial laryngectomy. There were no postoperative complications except for one laryngocutaneous fistula that required secondary repair. All patients were able to swallow at the tenth postoperative day. All had their tracheostomies closed after completion of wound healing, (a mean of 17 days after surgery). Phonatory results were usually poor. Two local recurrences occurred during the follow-up period. However, both patients were salvaged with total laryngectomies and have since been free from disease. All other patients are alive and well. Our findings show that VPLER is an effective surgical approach for carcinoma at the anterior commissure of the larynx that cannot be adequately managed with transoral laser surgery or simple frontolateral partial laryngectomy. This study demonstrates that the procedure can be successfully applied to the treatment of local recurrences following initial radiotherapy or surgery. No major complications occurred in our study.

Adult↗
PubMed1997

Clinical and laboratory evaluation of a new thin-walled self-expanding tracheobronchial silicone stent: progress and pitfalls.

BACKGROUND: Although widely established in the management of malignant airway lesions, currently available tracheobronchial prostheses made of silicone have their drawbacks resulting from rigidity and wall thickness. Therefore we present clinical follow-up data obtained with a novel thin-walled expandable prototype silicone airway stent (Polyflex stent, Willy Rüsch AG, Kernen, Germany) in 19 patients. METHODS: Seventeen of 19 patients had tracheobronchial complications of infiltrating cancer: five had respiratory-digestive fistulas, 14 had mixed-type obstructions (mucosal infiltration plus extrinsic compression), and two had diffuse tracheal hemorrhages from the tumor surface (three patients had more than one complication). Two of 19 patients had benign postintubation stricture and malacia. Overall, 33 stents were implanted either simultaneously or in a consecutive manner. Scanning electron microscopy was performed both on prototype stents and on other available silicone stents for comparison. RESULTS: The treatment improved the patients' clinical condition substantially. The mechanical properties of the new prosthesis were excellent. Important stent-associated side effects were early mucus retention (n = 7), infolding of the inner silicone layer (n = 2), and stent dislodgment (n = 2). As of February 1997, 10 patients have died of causes unrelated to stent placement. Seven patients with malignant airway disease are still alive from 2 weeks up to 7 months after initial treatment. Scanning electron microscopy of explanted and unused prototypes suggested that an extremely ragged luminal microstructure may contribute to the firm adhesion of secretory material and that technical smoothing of the surface avoids such complications. CONCLUSIONS: The novel self-expandable silicone airway stent may be a promising addition to commonly used stent types. Short-term and medium-term management of fistulas, tumor surface bleeding, and strictures (malignant and benign) is satisfactory. Scanning electron microscopy of stents provides information on peculiar features of microstructure and material that may be of use in clinical research and technical innovation.

Adult↗
PubMed1997

Endoscopic laser resection of supraglottic carcinoma.

Forty-six patients with infiltrating supraglottic carcinoma were treated prospectively for cure between 1986 and 1992 with transoral laser resection of the primary. Nine primaries were classified as T1, and 37 as T2. Thirty-three had staged unilateral or bilateral neck dissections, and 16 had postoperative radiotherapy. All patients were followed up for 2 to 8 years unless they died. Of the 46 patients, 33 are alive without disease, 8 died with disease, and 5 died of intercurrent disease. Among the 8 patients who died with disease, 4 had uncontrollable local or regional recurrences, and 4 had distant metastases but were free of local or regional recurrence. Calculated overall survival was 59% and adjusted survival was 72% after 5 years. Four patients had tracheostomies perioperatively, and 2 required temporary postoperative tracheostomies. The remaining 40 patients needed no artificial airway other than orotracheal intubation for the endolaryngeal intervention. Thirty-seven patients relearned undisturbed deglutition within 2 weeks from surgery, and 4, within 4 weeks. However, 5 (10.9%) patients failed to relearn swallowing and consecutively underwent "completion" total laryngectomy. Among them were the two patients who had previously had unsuccessful surgical or radiologic treatment of their primaries and the patient with a history of oral cavity carcinoma. This study confirms that transoral laser resection can effectively control early supraglottic carcinoma. Tracheostomies are not routinely required, and phonatory function is not compromised. However, transoral laser resection could not steadily preserve undisturbed deglutition in the patients included in this study. Patients with histories of unsuccessful attempts of other larynx-sparing therapeutic modalities or of previous major head and neck interventions were not successfully managed with transoral laser resection in this series. Criteria for patient selection remain to be established.

Adult↗
PubMed1997

[Drug treatment of invasive aspergillosis of the paranasal sinuses].

Aspergillosis belongs to the group of mycotic diseases of the paranasal sinuses. The invasive forms, and particularly the fulminant forms, are potentially fatal. Primary surgical intervention with complete removal of the mycotic mass should be performed. Additionally an antimycotic drug therapy with amphotericin B must be started. In a review of the literature, there is no case surviving an extended invasive aspergillosis after failure of the operative therapy and after failure of the postoperative amphotericin B treatment. We report an interesting case of a complete remission of an invasive, partially fulminant aspergillosis of the paranasal sinuses and frontal and basal regions. After incomplete removal of the mycotic mass by an endo- and extranasal approach, we started postoperative drug therapy with amphotericin B. Under this treatment the mycosis progressed. Additionally the patient developed severe renal side effects requiring suspension of the treatment. At this time, we started a combined antimycotic drug therapy with liposomal amphotericin B (AmBisome) and itraconazol. Within 10 weeks there was complete clinical and radiologic remission. The patient died 63 weeks after this treatment because of a fulminant bacterial pneumonia. Post mortem examination showed no aspergillosis in the skull base, the paranasal sinuses, or in the lung. The question arises as to whether this drug combination of liposomal amphotericin B (AmBisome) and itraconazol is a real alternative to high-risk surgical interventions in this region.

Amphotericin B↗
PubMed1997

[Progressive hearing loss in children with hearing aids].

BACKGROUND: The possibility of hearing aid induced deterioration was first described in 1939 (Berry 1939, Holmgren 1939). Since then numerous studies discussed this problem controversely. However, it is undisputed that in cases of profound sensorineural hearing loss in childhood powerful hearing aids are necessary for maturation and auditory and speech development. An increase of progressive sensorineural hearing loss in the last three years in children with profound sensorineural hearing loss fitted with hearing aids (2 children in 1993, 6 children in 1996) drew our attention to this problem. METHOD: Over a period of four years, we collected the data of 16 children with progressive hearing loss. RESULTS: The comparison of the duration of the hearing aid use since fitting and the maximum output level fail to explain this increase. Moreover our strategy in hearing aid fitting remained unchanged during this period especially with regard to SSPL max. We also performed an analysis of the childhood disorders associated with the sensorineural hearing losses. This analysis provided no further information for the increase of hearing loss. CONCLUSION: There is no evidence that powerful hearing aids damage hearing and induce progressive sensorineural hearing loss in childhood. Therefore we believe that there is no need to change our hearing aid fitting strategy particularly with regard to the maximum output level up to 135 dB SPL measured in situ. The increase in the number of progressive cases in the last two years indicates the necessity of further investigations in this field.

Child↗
PubMed1997

Sheet plastination of the larynx for whole-organ histology.

Whole organ serial sections of the larynx are recognized to improve the assessment of laryngeal pathology. The human larynx with its complex anatomy of different types of tissue with their marked differences in hardness complicate the cutting process. The methods established are either very costly, time consuming and prone to artefacts, or sections are too thick for a histological work-up. Prior decalcification causes major shrinkage, thus morphometry is not feasible. We describe a technique of sheet plastination to produce whole-organ sections which allows a full-scale histological investigation without prior decalcification. Deep-frozen larynges are cut into 4-micron-thick sections using an ordinary slicing machine. Slices are dehydrated in acetone and plastinated in Biodur E50/E7/ AE10/E700. These specimens are cut into sections of about 80 microns thickness using a diamond-wire saw. An ultra-milling device reduces the section thickness down to about 10 microns. Surface staining of different kinds like Richardson, methylene blue or Paragon yields sufficient contrast for exact diagnosis. Deplastination and consecutive paraffin-like staining is possible, but results are not yet fully satisfying. Histological sheet plastination produces almost artefact- and shrinkage-free whole-organ sections in a period of about 1 week. The technique is useful for studies of micromorphometry or tumor spread. Theoretically, application of immunohistochemical staining methods seems to be possible. This might lead to mapping the proliferation activity of laryngeal cancer as it is presented on whole-organ sections.

Artifacts↗
PubMed1997

[No evidence for hearing aid-induced progressive pediatric hearing loss in the Cologne region].

Progressive hearing loss during childhood caused by a hearing-aid induced deterioration has been discussed controversely since 1939. However, it is unchallenged that in cases of profound sensorineural hearing loss in infancy and early childhood powerful hearing aids are necessary for auditory and speech development. Due to an increase of progressive hearing losses during the last 4 years, we discussed the possible causes and the probability of hearing aid induced progressions once more. Our study consists of two investigations: First, all patients since 1993 suffering from progressive hearing loss among all hearing impaired children in the department of Audiology and Pedaudiology of the ENT-Hospital of Cologne were taken into account. Second, all children of the Rheinische school for hearing impaired children were investigated. The evaluated data included the degree of severity and etiology of the hearing loss, the duration of the hearing aids use and the amplification of the hearing aid. 23 children were diagnosed with a progressive hearing loss in the period. We observed a massive increase over these years. No correlation between the duration of the hearing aid usage and the maximum output level was found. Furthermore, there was no difference between the causes of the hearing losses between the children of the school and the children with progressive hearing loss. At the moment, we do not see any reason to change our strategy for fitting hearing aids. The increase of progressive cases in the last 2 years should be the reason for further investigations in this field.

Adolescent↗
PubMed1996

Airway endoscopy in the interdisciplinary management of acute epiglottitis.

INTRODUCTION: Acute epiglottitis (AE) continues to cause life-threatening airway obstruction in children. The aim of this retrospective study was to evaluate deficiencies in the management of AE, to clarify the role of airway endoscopy, and to establish the cause of death in this disease. MATERIAL: The subjects of our retrospective study were 24 children with AE treated in the paediatric intensive care unit (PICU) of the University of Cologne between 1980 and 1994. The records of all patients were reviewed. RESULTS: Laryngoscopy with fibreoptic or small rigid endoscopes allowed accurate diagnosis of AE, particularly in patients presented with atypical clinical signs. Furthermore, endoscopic information of the degree of inflammation were helpful in the critical decision, whether artificial airway was required. The number of patients managed without intubation increased (8% vs. 45%) since airway endoscopy became available in 1989. No evidence of beta-lactamase-producing strains of Haemophilus influenzae was observed. The most remarkable finding was the high mortality in AE (12.5%). Affected children were admitted in poor post-hypoxia conditions following outdoor cardiorespiratory arrest. CONCLUSION: The most decisive factor to decrease mortality seems to be timely appropriate presentation at referring centres, if AE is suspected or stridor remains unclear. Fibreoptic airway endoscopy represents a major step forward in the management of acute epiglottitis, and this requires close interdisciplinary collaboration between paediatricians, anaesthetists and otorhinolaryngologists.

Acute Disease↗