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Biomedical subjects

H E Eckel

Publications and source records attributed to H E Eckel.

At least 91 records · Page 5Linked to original sources
PubMed1996

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

OBJECTIVE: We evaluated the long-term prognosis of stents placed on an emergency basis in the trachea and its bifurcation for malignant stenosis. METHODS: We retrospectively analyzed all bronchologic treatments of obstructing airway lesions from January 1993 to December 1995. RESULTS: 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 tumor (esophageal cancer: n = 4; lung cancer: n = 3; recurrent laryngeal, uvula, and thyroid cancer: n = 1 each). Emergency treatment consisted of a dilating bougie maneuver followed by the insertion of a large one-way (n = 4) or Y-shaped silicone prosthesis (n = 6). After the intervention, there was a long-lasting clinical improvement. Median survival from stent insertion was 8 months for all patients irrespective of tumor type; it was 5 months for patients with lung carcinoma and 8 months for those with esophageal cancer. The results are in accordance with other studies using different therapeutic modalities. Stent exchange was necessary in five patients. Main reasons were continuing tumor growth beyond the proximal and distal boundaries and recurrent productive bronchial infection. Patients died of pneumonia (n = 4), pulmonary lymphatic spread (n = 1), cardiac failure (n = 2), and fatal hemorrhage (n = 1). As of December 1995, three patients were still alive 2, 5, and 8 months after implantation. CONCLUSIONS: As evidenced by clinical efficiency and length of palliation, endoscopic placement of silicone-based one-way and bifurcational prostheses in far-advanced tumor of the central airways is technically feasible and ethically justifiable.

Aged↗
PubMed1996

[Endolaryngeal surgical procedures in glottis expansion in bilateral recurrent nerve paralysis].

OBJECTIVE: Subtotal cordectomy and posterior cordectomy have repeatedly been recommended as surgical interventions restoring the airway, for the treatment of bilateral vocal cord paralysis. The objective of this study was to assess the effectiveness of transoral laser cordectomy and posterior cordectomy as compared to laser arytenoidectomy and to compare the respiratory and phonatory results of these minimally invasive procedures. MATERIAL AND METHODS: Forty patients with bilateral vocal cord paralysis were included in a prospective study and operated upon to improve their laryngeal airways. Twenty-two patients had cordectomy, 13 had arytenoidectomy, and 5 had posterior cordectomy. Lung function tests and voice analysis were obtained preoperatively and postoperatively. Subclinical aspiration was determined by endoscopic evaluation of the larynx during deglutition. The results were compared to determine the relative effectiveness of the three surgical methods. RESULTS: Flow volume spirograms documented equally improved flow rates in both groups. Final voice evaluation revealed maximum phonation time. Peak sound pressure levels and frequency range were reduced in all 28 patients, but phonatory results varied considerably in each group. Subclinical aspiration was noticed in 5 out of 10 patients after arytenoidectomy, but in none of 18 patients after cordectomy. Four previously tracheotomised patients were decannulated within 2 weeks after surgery, while the other 24 patients had no perioperative tracheotomies. CONCLUSION: Transoral laser cordectomy and arytenoidectomy are equally effective and reliable in the management of the restricted airway. Cordectomy and posterior cordectomy offer the advantage of uncompromised deglutition after surgery. Although no clinically relevant aspiration occurred in any of the patients, cordectomy should be considered as the method of choice in patients for whom subclinical aspiration could be potentially harmful due to coexisting pulmonary or cardiac disease. Phonatory outcome is not predictable with both surgical procedures. Subtotal cordectomy and posterior cordectomy are easier and faster to perform, and subclinical aspiration is not encountered with these procedures.

Airway Resistance↗
PubMed1996

[Interdisciplinary therapeutic concept in severe bacterial infections of the central respiratory tract in childhood].

BACKGROUND: Apart from all advances made in the management of central airway infections, Acute Epiglottitis (AE) and Bacterial Tracheitis (BT) continue to be causes of life-threatening airway obstruction in children. The aim of this retrospective study was to evaluate deficiencies in the diagnostical protocol, to clarify the role of airway endoscopy in acute childhood stridor, and to identify current reasons for fatalities in these diseases. MATERIAL: In the observation period between 1980-92, we found 12 patients suffering from BT and 21 from AE managed in close cooperation of the involved disciplines at the pediatric intensive care unit of the University of Cologne. RESULTS: Laryngoscopy with fiberoptic or small rigid endoscopes allowed in awake cooperative children accurate diagnose of AE, and the exclusion of supraglottic inflammation in BT without complications. Furthermore, additional endoscopic information of the degree of inflammation was helpful in the next critical decision, whether artificial airway or rigid tracheobronchoscopy was required. Nasotracheal intubation was necessary in 76% of our patients, in one child tracheostomy was performed (5%). Premature extubation necessitating reintubation occurred in 33% of the children suffering from BT. In these patients, our method of advancing a flexible endoscope for tracheoscopy through the respiration tube failed because of a low tube diameter. Another remarkable finding was the high mortality in AE (14%). Affected children were admitted in poor post-hypoxia conditions following outdoor cardiorespiratory arrest. CONCLUSION: In the analysis of the clinical course we found three decisive turning points in managing the disorder; First, the confirmation of the correct admission diagnosis; second, the decision, as to whether an artificial airway should be established; and third, the proper time of extubation. The most decisive factor in decreasing mortality seems to be timely, appropriate presentation at referral centers if AE or BT is suspected. Clinically, progressive management of childhood stridor requires close cooperation between the Pediatric, Anesthesiologic, and ENT Departments. Fiberoptic endoscopy as a guide to current airway management is a major step forward and should be a part of every established protocol.

Airway Obstruction↗
PubMed1996

Repeatedly successful closure of the larynx for the treatment of chronic aspiration with the use of botulinum toxin A.

Botulinum toxin A was used preoperatively to temporarily paralyze the intrinsic laryngeal muscles to hinder movements during the healing period after operation. In addition, toxin was injected into the cricopharyngeal muscle to allow a better passive drainage of the saliva into the esophagus. We treated six patients. Three suffered from chronic aspiration problems after multiple lower cranial nerve lesions, and three patients were apallic (after stroke and major brain injury). Two weeks before scheduled operation, we injected the toxin into the posterior cricoarytenoid muscles, the aryepiglottic muscles, and the vocalis muscle on both sides, as well as the cricopharyngeal muscle. The amount of injected toxin varied between 1.0 and 1.4 mL, equal to 200 to 280 units of botulinum toxin A (Dysport). After a complete palsy of these muscles (controlled by direct electromyography), a closure of the larynx was performed. After laminotomy and exposure of the intralaryngeal structures, the false vocal cords were mobilized and adapted with sutures. Because involuntary movements of the intralaryngeal musculature were absent, primary healing without complications occurred in all cases. Aspiration and related complications disappeared in all patients. In addition, the intensity of patient care could be considerably reduced. Preoperative use of botulinum toxin A allows sufficient laryngeal closure. This procedure is especially useful in the treatment of children and young adults, preserving the ability of later speech rehabilitation because of the return of voluntary movements of the intrinsic laryngeal muscles 6 months after the injection. Furthermore, this technique, as minimal surgical intervention, can be performed in high-risk patients.

Adolescent↗
PubMed1996

[Nosocomial infections in head and neck surgery. 1].

Hospital-acquired or nosocomial infections are infections that are neither present nor incubating at the time of admission. They must become manifest by 48 h after admission. They raise significantly the morbidity, mortality, and economic burden of the underlying disease. Nosocomial infections occur in 2.5-9.5% of all hospitalizations. They are mainly found in intensive care units and surgical wards. Urinary tract infections are the most frequent, followed by wound infections, pneumonia, infections of the skin and mucosa, bloodstream infections and others. The major pathogens causing nosocomial infections are Staphylococcus aureus, Escherichia coli, enterococcus and Pseudomonas. Methicillin-resistant pathogens must be considered. In Germany the direct costs of excessive hospital stays exceed 3 billion DM annually. Preventive measures reduce current nosocomial infections. The CDC suggest that these measures include a trained hospital epidemiologist, an infection control nurse, an active surveillance program and data feedback to surgeons about their wound infection rates.

Adult↗
PubMed1996

[Nosocomial infections in head and neck surgery. 2. A prospective study].

Nosocomial infections are defined as infections that occur during hospitalization but were not present at admission. Nosocomial infections have been found to occur in 6% of all hospitalizations and are present mainly in intensive care units and surgical wards. These infections extend the time of hospitalization and therefore increase the cost of care. Between July and December 1993, all nosocomial infections occurring in 304 patients of the surgical ward of the University ENT Department, Cologne, were recorded prospectively. These were classified into wound, implant, urinary tract, respiratory, skin or mucosal infections, nosocomial bacteremias and gastrointestinal infections. The overall prevalence of nosocomial infections was 15.4%. Of these, 9.2% were postoperative wound infections, 2.6% respiratory infections, and 2.3% infections of the skin and mucosa. The incidence of urinary tract infections was 0.7%, while bacteremias occurred in 0.3%. No implant or gastrointestinal infections occurred. Microbial analysis demonstrated 9 gram-positive and 15 gram-negative bacterial and 8 candidal infections. Nineteen cultures were negative. Among the bacteria cultured three were methicillin-resistant. The time of hospitalization was extended from a normal average of 9.52 days to 25.7 days. The distinct risk of a nosocomial infection in the treatment of hospitalized patients requires and accurate documentation of all acquired infections. Determination of the source of infection, the method of spread and microbial analysis including the spectrum of organism resistance is necessary in order to decrease the infection rate and to prevent establishment of a nosocomial infection. These requirements at the least are an important part of quality control in the surgical disciplines.

Cross Infection↗
PubMed1996

[Section plastination of the larynx for histology of whole organ sections].

Whole-organ sections of the larynx have evoked the laryngologists' interest for a long time. Established techniques for histological preparation do exist, but these are time-consuming and result in frequent artifacts. Owing to their thicknesses the slices prepared are usually not suitable for a complete histological work-up. The technique of plastination is an established and gentle method for tissue preservation. We describe the technique of sheet plastination to produce whole-organ sections that allow full-scale histological investigation. Deep-frozen larynges are cut into 4-mm-thick sections, dehydrated in acetone and plastinated in epoxy resins. During plastination, fat and lipids are replaced by curable polymer, making decalcification unnecessary. Specimens are cut into thin sections using a diamond-wire saw. An ultra-milling device reduces the section thickness down to about 10 microns. Staining is possible using a variety of special plastination stains, while all routine stains are also applicable after deplastination. Sheet plastination produces artifact- and shrinkage-free whole organ sections in about 1 week. The technique is useful for studies of micromorphometry or tumor spread and can be used to evaluate quickly possible tumor erosion of the laryngeal skeleton after laryngectomy. Since such erosion is one of the criteria for postoperative radiotherapy in many centers, earlier information could make planning easier.

Artifacts↗
PubMed1995

[Rhinomanometric analysis of vestibular stenoses of the nose].

UNLABELLED: The distinction of the resistance in the nasal vestibule (valve area) and cavity (turbinates, septum deviations, crest, spine) is important for the settlement of the operative course in nasally impaired patients. Collapsed valves, free floating polyps, spines, and other turbulence producing factors in the nose are characterized in active anterior rhinomanometry (AAR) as decreased ¿percentage of flow increase¿ (deltaV150-300). This parameter allows no distinction between underlying anatomical factors. Other patients have increased resistance in the vestibule area that is static; rhinomanometry is unable to document these instances. The aim of this study was to investigate the influence of the vestibule dilator on nasal flow, and to determine if the diagnostic findings of AAR could be improved by the data obtained from the measurement with the dilator. METHODS: To prove the influence of the vestibule dilator on the nasal airflow, we determined typical rhinomanometric parameters in 20 nasally healthy and 40 nasally impaired persons with and without the dilator. For the measurements, we used a computer-aided rhinomanometer (Rhinodat K, Heinemann Medizintechnik, D-Hamburg). Tubular vestibule dilators were produced from silicon guide rails of tracheal tubes (Rüschelit, Fa. Rüsch, D-Kernen) and individually adapted to the patient's vestibule, ensuring dilation between the external ostium and the nasal isthmus. RESULTS: Active interior rhinomanometry revealed a significant effect of the vestibule dilator in repeated application (mean variation 3%). Total nasal flow showed a mean increase of about 48% with the dilator. In AAR, we found 5 patients with decreased deltaV150-300 below 25%. To demonstrate the presence of vestibule stenosis, we compared the changes of deltaV150-300 is AAR with and without dilator. In rhinomanometry with the dilator, deltaV150-300 of patients with vestibule stenosis showed physiological values. In these patients, mean difference of deltaV150-300 between conventional rhinomanometry and rhinomanometry with a vestibule dilator was significantly higher (47,2%) than observed in all other persons (3,8%). The static vestibule resistance in the total nasal resistance was obtained by calculating the difference between nasal flows with and without the dilator. CONCLUSIONS; Stenosis in the nasal vestibule could be proved and measured via active anterior rhinomanometry using a vestibule dilator. Data obtained from this method are helpful in functional assessment of nasally impaired patients, particularly to answer the question of whether the vestibule requires surgical treatment.

Adult↗
PubMed1995

Lung function changes and exercise-induced ventilatory responses to external resistive loads in normal subjects.

AIM: The aim of this study was (1) to assess the value of common lung function variables in the follow-up of patients with obstructive lesions of the larynx and trachea and (2) to study the respiratory response to progressive upper airway stenosis at rest and during exercise. METHODS: Lung function tests, including vital capacity (VC), residual volume (RV), total body plethysmographic resistance (RT), specific body plethysmographic resistance (Rs), total body plethysmographic resistance at low inspiratory/expiratory flows (Rlo), forced expiratory volume in 1 s (FEV1), peak expiratory flow rate (PEF), peak inspiratory flow rate (PIF), maximum expiratory flow at 50% VC(MEF50) and maximum inspiratory flow at 50% VC(MIF50) were performed in 14 normal subjects with added external resistive loads (inner diameter of circular orifice: 15, 10, 8, 6 mm; equivalent to surface areas of 177, 79, 50 and 28 mm2, respectively), applied in random order. The relative sensitivity of each variable to detect a stepwise decrease in orifice size by evoking 'relevant' obstructive responses was calculated. In addition, ventilatory and gaz exchange responses to loaded breathing (10-, 8- and 6-mm orifices, randomly inserted) during steady-state bicycle exercise (80 and 160 W) were assessed in a subgroup of 10 subjects. RESULTS: The gradual increase of external load did not influence static lung volumes (VC, RV). MEF50/MIF50 (1.63 +/- 1.03 at baseline) remained essentially unchanged, consistent with the rigid nature of the obstructive device. PEF was superior in reproducing the transition from unloaded over mild (15 mm) and moderate (10 mm) to high grade (8 mm) central obstruction. Except for mild loads, PIF was equal in sensitivity to PEF. At high grade (8 mm) and severe loads (6 mm), no difference in sensitivity could be established between RT, Rs, FEV1, PIF and PEF. However, they were all superior to Rlo. Compared to unloaded breathing, ventilation across the 10- and 8-mm orifices at both rest and exercise produced a continuous significant increase in oxygen uptake (VO2). Respiratory rate (RR) fell, and a simultaneous enlargement of tidal volume (VT) was observed to maintain or even enhance minute ventilation (VE). However, ventilation across the 6 mm orifice was associated with a substantial decline in VO2, VCO2 and VE relative to the preceding load (8 mm) CONCLUSIONS: It is suggested that the experimental use of inspiratory and expiratory extrinsic loads can mimic rigid obstructive lesions of the larynx and trachea. Among all conventional lung function values, PEF and, to a certain degree, PIF, seem to be the best suitable follow-up parameters to assess airway mechanics before and after surgical/endoscopic procedures. Upper airway stenosis involving surface areas of no more than 50 mm2 can be overcome using adequate respiratory compensation. But any additional narrowing below this limit will result in hypoventilation, inappropriate oxygen uptake and retention of CO2. Thus, experimental evidence indicates that laryngotracheal obstruction within a critical range below 50 mm2 surface area (diameter of circular orifice < 8 mm) compromises respiratory efforts enough to be of clinical importance.

Adult↗
PubMed1995

Transoral laser resection with staged discontinuous neck dissection for oral cavity and oropharynx squamous cell carcinoma.

Transoral laser resection of oral cavity and oropharynx squamous cell carcinoma (OOSCC) is a widely accepted approach in the absence of cervical lymph node metastases. This study investigated the results of transoral laser surgery and discontinuous neck dissection (ND) for OOSCC with clinically obvious or suspected cervical node metastases. One hundred seventeen patients with infiltrating oral carcinoma were treated for cure with transoral resection of the primary and staged ND. Twenty-nine primaries were classified as T1, 50 as T2, 35 as T3, and 3 as T4. Lymph node metastases were identified in the ND specimen of 36 patients. All patients were followed for a minimum of 3 years unless they died. Estimated tumor-related survival after 5 years is 81% for stage I and II disease of the oral cavity, 86% for stage I and II disease of the oropharynx, 73% for stage III disease of the oral cavity, 65% for stage III disease of the oropharynx, and 21% for stage IV disease of the oral cavity and the oropharynx. Local and regional control of cancer was achieved in 72 (62%) of the 117 patients. Forty-five local and regional recurrences were diagnosed during the follow-up period. Two patients died of distant metastases with no evidence of local or regional recurrence. The combination of transoral laser resection and staged ND for the treatment of OOSCC seems to offer satisfactory cure rates for a selected group of patients. These two minor surgical interventions cause less morbidity than commando-type surgery and lead to low perioperative mortality and morbidity.

Adult↗
PubMed1995

Occult neck disease.

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Carcinoma, Squamous Cell↗
PubMed1995

[Whole organ plastination in otorhinolaryngology].

Total organ sections have proven to be useful in the evaluation of the clinical growth behavior of malignant tumors. However, histologic techniques using tissues embedded in celloidin or paraffin are difficult to produce and require extensive amounts of time. Total organ plastination is a method superior to the aforementioned techniques. The number of artefacts is also greatly reduced by avoiding the need for decalcification. After removal of fat and dehydration, specimens can be placed in epoxy resin. Following evacuation and hardening of specimens, parallel sections can be separated with a diamond wire saw for precision slicing, with section thicknesses ranging from several centimeters to as small as 40 microns. The loss in material caused by slicing is as little as 0.3 mm per section. A further benefit of this method is the relatively large amount of time saved. The entire procedure yielding complete plastinated specimens requires a time period of approximately 40 days. The plastinated specimens are transparent, odorless and fixed and are ideal for instructional and research purposes. Deplastination for the purpose of further diagnositic study is also achievable with a minimum of technical effort.

Epoxy Resins↗
PubMed1995

[Peak flow measurement in patients with laryngeal and tracheal stenoses. A simple and valuable spirometric method].

Body plethysmographic and spirometric indices can be used for routine examinations of obstructive lesions of the larynx and upper trachea. Total resistance, forced expiratory volume in 1 sec (FEV1) and the S-shaped flow-pressure loop can show clinically significant extrathoracic stenoses. We have now also measured peak inspiratory flow (PIF) and peak expiratory flow (PEF) with a peak flow meter. Easy handling was compared with good reliability of the measurements and possible detection of laryngeal lesions. Extrathoracic stenoses caused turbulent flow, with a flow-dependent increase in total resistance (Rtot). This resistance increased only with severe stenoses, while mild stenoses were often not detected. Peak expiratory flow reacted earlier than did peak inspiratory flow and seemed to be the most reliable parameter for detecting an extrathoracic stenosis. Testing was easy to perform and was usually reproducible. Patients with additional peripheral obstructive stenoses required a more specific examination.

Airway Obstruction↗