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Biomedical subjects

H E Eckel

Publications and source records attributed to H E Eckel.

At least 19 recordsLinked to original sources
PubMed2006

Single modality and multimodality treatment of nasal and paranasal sinuses cancer: a single institution experience of 229 patients.

AIMS: To assess the single and multimodal treatment results and prognostic factors for sinonasal carcinoma. METHODS: Overall survival (OS), disease-specific survival (DSS), local control (LC), and disease-free survival (DFS) in 229 patients with sinonasal carcinoma treated from 1967 to 2003 were calculated. Prognostic factors were univariately and multivariately analyzed. The median follow-up period for survivors was 126 months. RESULTS: 32% of the patients were operated only, 47% underwent multimodal therapy, and 20% were treated without operation. The 5-year OS rate was 41%, and the DSS rate was 51%. The LC rate was 64%, and the DFS rate was 34%. Prognostic for DSS were M status (p<0.001), UICC stage (p<0.001), T classification (p=0.001), N status (p=0.002), intracranial tumor infiltration (p=0.008), infiltration of the pterygopalatine fossa (p=0.02), infiltration of the skull base (p=0.021), infiltration of the orbita (p=0.041), and the type of therapy (p<0.001): The 5-year DSS rate was 63% for patients operated only, 56% for all operated patients, 46% for patients undergoing surgery and radiotherapy, but only 21% for patients treated with radiotherapy+/-chemotherapy. Multivariate analysis revealed that T classification (p=0.042), N classification (p=0.035), M classification (p=0.007), UICC stage (p=0.038), and type of therapy (p=0.038) were independent prognostic factors for DSS. CONCLUSIONS: Radical surgery is recommended for stage I/II sinonasal carcinomas. Stage III/IV carcinomas still have a poor prognosis, but multimodal treatment seems to favor the outcome.

Adolescent↗
PubMed2004

[Olfactory dysfunctions. Epidemiology and therapy in Germany, Austria and Switzerland].

INTRODUCTION: Olfactory dysfunction has been reported to affect more than 200,000 patients a year in the USA. The aim of this survey was to obtain comparable epidemiological data and treatment information on olfactory dysfunction in German speaking countries. METHODS: Questionnaires were sent to all otorhinolaryngology departments in Germany, Austria and Switzerland; 52% of hospitals completed the survey. RESULTS: An average of 46 patients with olfactory dysfunction were treated per hospital every month. Hyp- and anosmia were most commonly caused by inflammatory diseases of the nose/paranasal sinuses (53%), respiratory dysfunction (19%), or postviral conditions (11%). Steroids were used most frequently for pharmacological treatment (topically 82%; orally 65%). Approximately one third of the clinics used B vitamins, or zinc; 80% of the hospitals performed surgery to treat underlying diseases. Acupuncture and smell training was used by approximately 20%. CONCLUSION: A total of 79,000 patients per year are treated for olfactory dysfunction in German hospitals. The vast majority of these disorders (72%) is caused by sinunasal diseases. The quality control of therapeutic strategies is urgently needed.

Austria↗
PubMed2003

Hoarseness after laryngeal blunt trauma: a differential diagnosis between an injury to the external branch of the superior laryngeal nerve and an arytenoid subluxation. A case report and literature review.

Arytenoid subluxation is a well-known cause of hoarseness due to incomplete glottic closure with intact inferior laryngeal nerves after severe laryngeal trauma. We report the case of a young man presenting after laryngeal blunt trauma with hoarseness, easy fatigue during phonation, marked difficulty with his high-pitch and singing voice and decreased phonation time, but intact function of both inferior laryngeal nerves, intact endolaryngeal mucosa sensibility and normal CT scans of the larynx and the neck. Due to the asymmetric anteromedial position of the right arytenoid with incomplete glottic closure, the primary diagnosis was arytenoid subluxation, and the patient was referred for instantaneous relocation therapy. The stroboscopic and electromyographic diagnosis of a unilateral paresis of the external branch of the right superior laryngeal nerve caused the therapy to be changed. Without repositioning, the patient had a total recovery of voice quality when the paresis receded 2 months later. In conclusion, the unilateral paresis of the external branch of the superior laryngeal nerve after laryngeal blunt trauma is reported here for the first time. Although the clinical findings are familiar sequelae of thyroid surgery, they may be misdiagnosed as arytenoid subluxation after laryngeal blunt trauma. Stroboscopy and electromyography permitted the correct diagnosis.

Adult↗
PubMed2003

[Cricohyoidopexy (CHP) and Cricohyoidoepiglottopexy (CHEP). Indication, complications, functional und oncological results].

BACKGROUND: Subtotal laryngectomy with Cricohyoido(epiglotto)pexy (CHEP and CHP) is a commonly used surgical procedure in France, Italy and North America, but it is rarely carried out in Germany,where most laryngeal carcinomas staged T1-T3 are resected endoscopically or with total laryngectomy. OBJECTIVE: To identify indications for the CHEP and CHP in a setting that uses endolaryngeal procedures as a standard approach to organ preserving surgery in laryngeal cancer patients. PATIENTS: Nineteen patients with primary (n=15) or recurrent (n=4), supra- or transglottic carcinoma or carcinoma of the anterior commissure staged (r)T1b-4N0-2cM0 were treated with subtotal laryngectomy with CHEP (with or without neck dissection/radiotherapy) between October 1997 and June 1999. RESULTS: Undisturbed deglutition without aspiration and respiration without tracheotomy was achieved in 17/19 patients. Three patients showed temporary pneumonia from aspiration and two patients needed further treatment for endolaryngeal synechia. Three patients died of unrelated causes. Four patients were diagnosed with local recurrence: Two of them died from tumor, two patients had curative total laryngectomy as salvage surgery. Fourteen patients are living free of disease 24-40 months after therapy. CONCLUSION: CHEP is a subtotal laryngectomy with increased postoperative morbidity, but good functional results. Assuming a scrupulous indication for the extended tumors the oncological results of the CHEP are satisfying, too.

Adult↗
PubMed2002

[Perioperative mortality in otorhinolaryngology tumor surgery].

BACKGROUND: Perioperative mortality is an important factor for quality assurance in surgery. For ENT-surgery only sparse data has been published. PATIENTS AND METHODS: A retrospective analysis of 1054 interventions performed on 775 consecutive patients treated surgically for benign and malignant tumors of the head and neck was conducted during a 3-year period in 1995-1998. RESULTS: Of these patients, 34.1% were female and 65.9% male. Age ranged from 4-88 years with a mean age of 54.8 years. 489 patients (63.1%) were treated for malignoma and 286 for benign tumors (36.9%). 0.9% (n = 7) of our patients (n = 775) died during the first 30 days after surgery. That means 0.66% of all surgical interventions (n = 1054) were followed by post-operative mortality. DISCUSSION: In otorhinolaryngological surgery, post-operative mortality seems to be acceptable and low compared to other medical disciplines. The challenge for surgery must be to reach and preserve low perioperative mortality rates in the future. Finding the individually correct indication for surgical treatment must be guaranteed in order to reach this aim.

Adolescent↗
PubMed2002

[Quality assurance indicators in an ENT practice].

BACKGROUND: According to German legislature, hospitals have to implement quality assurance (QA) programs, which are of particular importance in times of ongoing structural changes in healthcare. Amongst other internal methods of QA, indicators measuring the quality of total hospital performance can reflect medical outcome and the activities of physicians, nurses, and administrators. METHODS: Five indicators for measuring total hospital performance and for controlling total medical outcome were used in this study. RESULTS: Evaluation was time consuming, and some indicators showed a wide range, which could be explained by external reasons independent from internal quality. Valid values could be ascertained in the field of administrative quality, whereas in contrast the assessment of medical quality seemed to be more difficult. CONCLUSION: Due to current developments in German healthcare, the application of quality assurance methods such as the presented system of indicators is recommended.

Evaluation Studies as Topic↗
PubMed2002

Indications, complications, and surgical techniques for pediatric tracheostomies--an update.

BACKGROUND: With the decrease of life-threatening obstructive upper airway infections and the ongoing improvement of intensive care medicine, the role of tracheostomy in children has been changing considerably, until now. The aim of this study was to establish data regarding indications, complications, and techniques of pediatric tracheostomy, which would reflect the current state of science. METHODS: The authors analyzed the international literature as well as their own experience with 25 children less than 6 years of age who were operated on between 1980 and 1996. RESULTS: Literature proved to be very heterogeneous in terms of terminology, patient groups, operation techniques, indications, and complications. Within the past decades, long-term intubation and congenital anomalies of the upper respiratory tract have become increasingly prevalent, whereas inflammatory diseases were less and less an indication for tracheostomy. Endotracheal intubation as an alternative has resulted in less frequent tracheostomies in general. Today, children can be ventilated for months without considerable complications. However, individual, clinical, and fiberoptical controls are necessary. Tracheostomy-related complications have not changed significantly. Fatalities are mostly caused by the underlying disease. The most frequent causes of tracheostomy-related death are cannula obstruction and accidental decannulation. The most frequent early complications are pneumomediastinum, pneumothorax, wound complications, and bleedings. Subsequent complications most often are granulations and tracheal stenosis. CONCLUSIONS: The authors' research agreed widely with that in the literature. However, no tracheostomy-related death occurred. Possibly, this was because of their operative technique. In the opinion of the authors, establishing a cartilage window facilitates cannula exchange and reduces the risk of a fatal accidental decannulation.

Age Distribution↗
PubMed2001

Prevalence, distribution, and viral load of human papillomavirus 16 DNA in tonsillar carcinomas.

BACKGROUND: Oncogenic human papillomaviruses (HPV) DNA have repeatedly been observed in many head and neck carcinomas (HNSCCs), and HPV infections are currently considered a possible factor in the etiology of these tumors. However, the reported prevalences of HPV-DNA in HNSCC are variable. In the current study the authors used highly sensitive polymerase chain reactions (PCRs) to analyze the occurrence of viral sequences in 98 carefully stratified HNSCCs. The authors determined the load and localization of HPV DNA in a subset of tonsillar carcinomas and their metastases. METHODS: Nested PCR and an HPV16 specific single step PCR were used to screen 98 HNSCCs for HPV DNA for genital- and Epidermodysplasia verruciformis (EV)-associated HPVs. Typing was performed by direct sequencing and/or sequencing of cloned amplimers. In two patients HPV16 subtypes in tonsillar carcinomas and their metastases were compared by amplification and sequencing of the long control region of the virus. In a subset of HPV16 positive tonsillar carcinomas and their metastases, localization and viral load were determined using laser assisted microdissection and real time fluorescent PCR, respectively. RESULTS: Altogether 25 HNSCCs (26%) were found to be HPV positive. Stratified according to the tumor localization, the frequency of HPV positive lesions was 18% in the oral cavity, 45% for oropharynx, 25% for hypopharynx, 8% for nasopharynx, and 7% for larynx. The highest HPV DNA prevalence (58%) was found in tonsillar carcinomas. The high risk HPV type 16 was found in 84% of positive HNSCCs, in 14% of which EV-associated HPVs were detected. Human papillomavirus sequences were detected in 64% of biopsies with normal mucosa from 11 patients with positive carcinomas. As a control group, 14 tumor free tonsils were analyzed. In none of these specimens were HPV sequences detected. Viral long transcriptional control region sequences in homologous metastases were identical with those in primary tumors and the load values in both locations were roughly comparable. Viral loads differed substantially in different areas of one tumor. Statistical evaluation of data related to clinicopathologic parameters showed a significant linkage of HPV with tonsillar carcinomas compared to other locations. Furthermore, a significant correlation of HPV status of tonsillar carcinomas with tumor grading and alcohol consumption was found. CONCLUSIONS: Our study shows a preferential association of HPV-DNA with tonsillar carcinomas. The data support the view of HPV negative and positive tonsillar carcinomas being different tumor entities and conventional cancer risk factors being of less importance in HPV-infected individuals. The HPV genome is located in the cancer cells, whereas the infection of normal mucosa is a rare event. Data on quantification of HPV16 in tonsillar tumors and their metastases showed mean viral loads comparable to other HPV associated malignancies.

Adult↗
PubMed2001

Intensified hyperfractionated accelerated radiotherapy limits the additional benefit of simultaneous chemotherapy--results of a multicentric randomized German trial in advanced head-and-neck cancer.

PURPOSE: To demonstrate the efficacy of radiochemotherapy (RCT) as the first choice of treatment for advanced unresectable head-and-neck cancer. To prove an expected benefit of simultaneously given chemotherapy, a two-arm randomized study with hyperfractionated accelerated radiochemotherapy (HF-ACC-RCT) vs. hyperfractionated accelerated radiotherapy (HF-ACC-RT) was initiated. The primary endpoint was 1-year survival with local control (SLC). METHODS AND MATERIALS: Patients with Stage III and IV (UICC) unresectable oro- and hypopharyngeal carcinomas were randomized for HF-ACC-RCT with 2 cycles of 5-FU (600 mg/m(2)/day)/carboplatinum (70 mg/m(2)) on days 1--5 and 29--33 (arm A) or HF-ACC-RT alone (arm B). In both arms, there was a second randomization for testing the effect of prophylactically given G-CSF (263 microg, days 15--19) on mucosal toxicity. Total RT dose in both arms was 69.9 Gy in 38 days, with a concomitant boost regimen (weeks 1--3: 1.8 Gy/day, weeks 4 and 5: b.i.d. RT with 1.8 Gy/1.5 Gy). Between July 1995 and May 1999, 263 patients were randomized (median age 56 years; 96% Stage IV tumors, 4% Stage III tumors). RESULTS: This analysis is based on 240 patients: 113 patients with RCT and 127 patients with RT, qualified for protocol and starting treatment. There were 178 oropharyngeal and 62 hypopharyngeal carcinomas. Treatment was tolerable in both arms, with a higher mucosal toxicity after RCT. Restaging showed comparable nonsignificant different CR + PR rates of 92.4% after RCT and 87.9% after RT (p = 0.29). After a median observed time of 22.3 months, l- and 2-year local-regional control (LRC) rates were 69% and 51% after RCT and 58% and 45% after RT (p = 0.14). There was a significantly better 1-year SLC after RCT (58%) compared with RT (44%, p = 0.05). Patients with oropharyngeal carcinomas showed significantly better SLC after RCT (60%) vs. RT (40%, p = 0.01); the smaller group of hypopharyngeal carcinomas had no statistical benefit of RCT (p = 0.84). For both tumor locations, prophylactically given G-CSF was a poor prognostic factor (Cox regression), and resulted in reduced LRC (log-rank test: +/- G-CSF, p = 0.0072). CONCLUSION: With accelerated radiotherapy, the efficiency of simultaneously given chemotherapy may be not as high as expected when compared to standard fractionated RT. Oropharyngeal carcinomas showed better LRC after HF-ACC-RCT vs. HF-ACC-RT; hypopharyngeal carcinomas did not. Prophylactic G-CSF resulted in an unexpected reduced local control and should be given in radiotherapy regimen only with strong hematologic indication.

Adult↗
PubMed2001

Prognostic value of laryngeal electromyography in vocal fold paralysis.

OBJECTIVE: To analyze the value of electromyography in predicting recovery from acute neurogenic vocal fold paralysis. STUDY DESIGN: Prospective case series. SETTING: University-based hospital of otorhinolaryngology-head and neck surgery. PATIENTS: Ninety-eight patients (56 women, with a mean age of 62.2 years; 42 men, with a mean age of 39.8 years) with 111 paralyzed vocal folds. The causes were varied, with thyroid surgery (53 cases) and idiopathic palsy (18 cases) being the predominant factors. INTERVENTION: Prognostication was based on electromyography performed no earlier than 14 days after onset of palsy. Findings were classified as neurapraxy, axonotmesis, and neurotmesis. Prognosis is inherent in this classification, since neurapraxy is presumed to resolve completely within 8 to 12 weeks, whereas axonotmesis is most likely to be followed by impaired vocal fold mobility. MAIN OUTCOME MEASURES: Vocal fold mobility after 6 months. RESULTS: In 102 vocal folds, some palsy of various degree persisted after 6 months. Free mobility of the paralyzed vocal fold was restored in 9 cases. By means of laryngeal electromyography, defective recovery, defined as absence of completely free vocal fold mobility, was predicted correctly in 94.4% of cases (68/72). For complete recovery, prognosis was accurate in only 12.8% of cases (5/39). CONCLUSIONS: The detection of neural degeneration by laryngeal electromyography allows the prediction of poor functional outcome with sufficient reliability in an early phase of the disease process. Conversely, the absence of signs of degeneration does not imply that complete recovery is to be expected.

Adult↗
PubMed2001

[Bilateral recurrent laryngeal nerve paralysis].

This paper seeks to provide the reader with a state-of-the-art review of the aetiology, diagnosis and clinical management of bilateral recurrent nerve paralysis. The recurrent laryngeal nerves are more frequently involved in bilateral paralysis than any other cranial nerve. Most of the underlying lesions are iatrogenic, with thyroid surgery being the single most important causative factor. However, a variety of different reasons can lead to such a condition. Whenever the aetiology is uncertain, a complete diagnostic work-up is mandatory. Massive stridor on inspiration is the key symptom. Indirect laryngoscopy confirms the diagnosis. Laryngeal electromyography is of great value because it differentiates between paralysis and ankylosis of the cricoarytenoid joint. Moreover, in many cases, laryngeal electromyography yields reliable prognosis of clinical outcome. While unfavorable results can be predicted with high accuracy, correct prognosis of complete recovery is more difficult. Clinical management is surgical in the vast majority of cases. A variety of endoscopic techniques for widening the glottic airway are available today and are discussed in detail. Compared to permanent tracheostomy, these procedures have much less impact on the patient's quality of life and should be preferred whenever possible. Since such an operation is irreversible, a decision should be made only in the presence of a reliable electrophysiological prognosis and/or after 6-9 months of watchful waiting. Inevitably, voice quality is traded for airway normalisation. However, modern surgical techniques accomplish very tolerable phonatory results. Timing, type and extent of surgery need to be customised for every patient individually.

Humans↗
PubMed2001

[Unilateral and bilateral recurrence of inferior laryngeal nerve paralysis].

Unilateral recurrent nerve paralysis leads to glottic insufficiency, causing a significant lack of vocal ability. In contrast, bilateral palsies present with stridor on inspiration due to glottic stenosis. Most of the underlying lesions are iatrogenic, with thyroid surgery being the single most important causative factor. However, a variety of different reasons can lead to such a condition. Whenever aetiology is uncertain a complete diagnostic work-up is mandatory. Indirect laryngoscopy confirms the diagnosis. Laryngeal electromyography is of great value because it differentiates between paralysis and ankylosis of the cricoarytaenoid joint. Moreover, in many cases laryngeal electromyography provides a reliable prognosis of clinical outcome. While unfavorable results can be predicted with high accuracy, correct prognosis of complete recovery is more difficult. Speech therapy is the treatment of choice in case of unilateral recurrent nerve palsy. Only if a significant glottal gap persists medialization procedures may become useful for voice improvement. Endoscopic as well as open approaches are available for this purpose. Bilateral recurrent nerve palsies need to be addressed surgically in the vast majority of cases. Today, a variety of endoscopic techniques for widening the glottic airway are available. Compared to permanent tracheostomy these procedures have much less impact on the patient's quality of life and should be preferred whenever possible. Inevitably, voice quality is traded for airway normalisation. However, modern surgical techniques accomplish very tolerable phonatory results.

Functional Laterality↗
PubMed2001

Surgical treatment for hypopharynx carcinoma: feasibility, mortality, and results.

This study seeks to evaluate treatment modalities, mortality after surgery, survival, and local control rates for a consecutive cohort of patients with cancer of the hypopharynx treated according to a prospective protocol that favors surgery as an initial approach to the disease. The charts of 228 consecutive patients with previously untreated hypopharyngeal squamous cell carcinoma were reviewed. Outcome measures (overall survival, disease specific survival, and local control) were calculated using the Kaplan-Meier estimator. Of 228 consecutive patients, 136 (59.6%) were found suitable for initial surgical treatment. Of the remaining 92 patients, 18 (7.9%) had nonresectable lymph node metastases, 16 (7.0%) had unresectable primary tumors, 13 (5.7%) refused surgery, and 13 (5.7%) presented distant metastases during initial diagnostic evaluation. Of those who had surgery, 46 had larynx-sparing procedures, 54 had total laryngectomy, and 36 had total laryngo-pharyngectomy. None of the patients who had surgery died postoperatively. Actuarial 5-year overall survival was 27.2% for all 228 patients, 39.5% for the 136 patients with surgical treatment, and 61.1% for the 46 patients who were treated with larynx-sparing procedures.

Adult↗
PubMed2001

Local recurrences following transoral laser surgery for early glottic carcinoma: frequency, management, and outcome.

Although transoral laser surgery (TLS) for the treatment of early stage glottic carcinoma is now widely used, the patterns of local recurrences, related re-treatment methods, and results have not been documented comprehensively. Two hundred fifty-two patients with glottic carcinoma stage I or II were treated for cure with TLS alone and followed up for 24 to 139 months (mean, 62 months). Their charts were retrospectively reviewed to identify local recurrence patterns. Thirty-five patients (13.9%) presented with local recurrences or second laryngeal primaries 4 to 84 months (mean, 23 months) after initial treatment. Of the 161 patients classified T1N0M0, 21 (13.0%) suffered local recurrences, and in the 91 classified T2N0M0, 14 (15.4%) tumors recurred. If tumors recurring more than 60 months after initial treatment are considered second primary tumors rather than recurrences, then only 18 (11.2%) of 161 patients classified T1N0M0 would have had a recurrence. However, the difference in local control between patients with stage I versus stage II disease would still not be significant (p = .41). Of the 35 patients with local recurrences, 16 (45%) were managed with total laryngectomy, 10 (28.6%) with further TLS, 4 (11.4%) with partial laryngectomy, and 2 (5.7%) with radiotherapy, and 3 (8.6%) had no curative treatment. Accordingly, 16 patients (45.7%) with local treatment failure could be treated with further organ-sparing treatment methods. The actuarial overall survival, disease-specific survival, and organ preservation rates 5 years after the diagnosis of recurrent disease were 43.6%, 74.6%, and 33.7%. Transoral laser surgery leads to local control rates that are comparable to those found after radiotherapy for lesions classified T1 and leads to slightly better control rates for lesions classified T2, but the results are inferior to those achieved with conventional partial laryngectomy. However, if local recurrence occurs, then more re-treatment options are available after TLS as compared to initial radiotherapy or open surgery.

Carcinoma, Squamous Cell↗
PubMed2001

Concurrent glottic and tracheal stenoses: restoration of airway continuity in end-stage malignant disease.

Six patients known to have inoperable esophageal carcinoma presented with stridor due to both malignant tracheal stenosis (with additional respiratory-digestive tract fistula in 2 patients) and bilateral vocal cord paralysis. Patency was restored by endotracheal stenting plus unilateral cordotomy. Four patients had immediate relief. Two patients required enlargement of the vocal cord incision. One of them declined reoperation and underwent tracheostomy. The stent function was uneventful, with no dislodgment or mucus impaction. The fistula seal was complete, with no aspiration through the newly shaped glottic orifice. The peak expiratory flow increased from 24.4% +/- 9.7% of predicted normal before the procedure to 40.5% +/- 13.7% after the procedure. Restoration of airway continuity in serial laryngotracheal stenoses by a combined approach is a feasible technique in end-stage cancer patients. It effectively relieves respiratory distress and ensures voice preservation. In addition, it may avoid the risks of tracheotomy.

Aged↗
PubMed2001

Atresia of the trachea following repeated percutaneous dilational tracheotomy.

Percutaneous dilational tracheotomy (PDT) and conventional tracheostomy are still competing methods to provide an airway for intensive care patients requiring assisted ventilation. Tracheal stenosis is a late complication for any tracheostomy and long-term intubation. However, late complications in PDT have not been extensively studied. This article is the first to report on total atresia of the subglottic larynx and cervical trachea after PDT. The dimension of the lesion is visualized by three-dimensional reconstructed CT scan. The etiology of this condition is discussed.

Dilatation↗