Biomedical subjects

H E Eckel

Publications and source records attributed to H E Eckel.

At least 55 records · Page 3Linked to original sources

PubMed1999

Cricoid cartilage necrosis after arytenoidectomy in a previously irradiated larynx.

Several open and endoscopic surgical techniques are available to provide an adequate airway for patients with bilateral vocal cord paralysis. Transoral laser arytenoidectomy has repeatedly been reported to be a reliable and effective minimally invasive procedure for airway restoration. To our knowledge, there have been no previous reports of serious complications, other than poor vocal results, aspiration, and failed decannulation in individual patients, that have resulted from this intervention. We report a case in which arytenoidectomy led to severe complications and death. Prior irradiation is suspected to be a causative factor. To prevent such an outcome, we believe that operative settings should be chosen that avoid deep thermal injury of the laryngeal framework.

Arytenoid Cartilage↗

PubMed1999

Morphometric measurements of the cartilaginous larynx: An anatomic correlate of laryngeal surgery.

BACKGROUND: The increasing application of sophisticated methods of laryngeal framework surgery requires a profound knowledge of the size and proportions of the human larynx and its cartilaginous components. Only inadequate data regarding this subject have so far been accessible. The aim of this study was to collect exact and reliable morphometric data of the human laryngeal framework. Materials and Methods Larynges from 98 corpses (52 male, 46 female) were removed during autopsy 4-64 hours postmortem and processed without delay or fixation. Following a standard routine for preparation, 28 parameters were measured on thyroid cartilage, cricoid cartilage, arytenoid cartilage, epiglottis, and the larynx as a whole organ. None of the patients had histories or visible signs of laryngeal disease. Anatomical preparations were performed with customary surgical tools and morphometric measurements then carried out with a pair of compasses and a caliper rule. RESULTS: A total of 5,100 measurements was performed on 98 larynges. These included, aside from evaluation of the whole organ, identification of the internal and external diameters of the cricoid cartilage, height and length of the thyroid alae in different planes, angle of thyroid alae, height of arytenoid cartilage, width and length of epiglottic cartilage, and position of the anterior commissure related to the thyroid cartilage. The results provide a full scale of data determining the size and extent not only of the cartilaginous components, but of the laryngeal framework as a whole. Mean values, standard deviations, and sample sizes are given for every parameter separately for both sexes. CONCLUSION: This study provides a comprehensive and detailed description of the dimensions of the adult human larynx.

Adult↗

PubMed1999

[Stenoses of the upper airways. Lung function, local resistance and load compensation. A review].

In benign laryngotracheal stenosis the amount of respiratory deterioration rather than the crude morphologic appearance will determine whether or not surgical measures such as dilatation or resection should be applied. This review focuses on currently available and newly developed diagnostic tools to assess the functional importance of central airway obstruction. After an outline of upper airway physiology is formulated, spirometric measurements at rest are collected. Among these, Peak Expiratory Flow Rate (PEF) proved to be the simplest and most reliable parameter to monitor an obstructing lesion of the upper airways. A novel technique for fibrobronchoscopic assessment of glottic and tracheal resistance is presented in detail. In contrast to usual tests of total airflow resistance which cannot distinguish between central and peripheral contributions, this test identifies the pressure-flow-relationship created exclusively by the local lesion. In serial stenoses, it indicates which is of higher clinical impact. Patients with upper airway obstruction complain of impaired exercise capacity. They tend to hypoventilate with imminent respiratory muscle fatigue. Therefore, spiroergometry may play a role in defining the point of incomplete compensation of a central load. The decision to operate will depend upon up the degree of physical capacity required to compensate for the stenosis.

Airway Obstruction↗

PubMed1999

Management of acute inflammatory childhood stridor.

BACKGROUND AND OBJECTIVE: Acute epiglottitis, bacterial tracheitis, and severe viral laryngotracheobronchitis continue to cause life-threatening airway obstruction in children. The aim of this retrospective study was to evaluate deficiencies in treatment, to clarify the role of airway endoscopy, and to identify current reasons for fatalities in these diseases. MATERIALS AND PATIENTS: During the observation period from 1980 to 1996, we identified 61 patients treated in the pediatric intensive care unit of the University Hospital of Cologne for severe inflammatory airway obstruction. RESULTS: Critical points in the appropriate airway management were (1) the confirmation of the admission diagnosis, (2) whether an artificial airway or rigid tracheobronchoscopy was required; and (3) appropriate timing of extubation. Since 1989 airway evaluation with flexible or small, rigid endoscopes was used to confirm the diagnosis and to determine the appropriate management. Endoscopic findings were extremely helpful to decide not to intubate and to monitor in the pediatric intensive care unit first. Three patients with acute epiglottitis died after out-of-hospital cardiorespiratory arrest. CONCLUSION: Endoscopy should be a part of every established treatment protocol of childhood stridor. The most decisive factor to decrease mortality seems to be timely presentation to a referral center.

Airway Obstruction↗

PubMed1999

Magnetic resonance sialography.

To evaluate a new noninvasive sialographic technique, we applied a new magnetic resonance technique to 10 healthy volunteers and 21 patients with lesions of the parotid gland. In addition to the usually performed T(1) and T(2) cross-sectional sequences, a heavily T(2)-weighted sequence (TR = 3600 msec, TE = 800 msec) was performed that allowed depiction of the fluid-filled parotid duct system. Twenty-one patients with benign as well as malignant parotid gland pathologies were examined: sialadenitis (n = 6), sicca syndrome (n = 2), pleomorphic adenoma (n = 4), carcinoma of the parotid gland (n = 2), lymphoepithelial carcinoma (n = 1), cystadenolymphoma (n = 3), non-Hodgkin's lymphoma (n = 2), and congenital duct dilatation (n = 1). Stenseńs duct was reliably depicted in all volunteers and patients. The primary branching ducts were reliably depicted in all normal cases. Intraglandular and extraglandular duct dilatations and duct strictures were well depicted in patients with chronic sialadenitis. Sialolithiasis with a calculus obstructing the duct was demonstrated in 2 cases. In conclusion, Initial experience indicates that magnetic resonance sialography can be applied successfully to investigate the duct system of the parotid gland. The usually performed cross-sectional MRI (T(1)- and T(2)-weighted images, gadolinium-DTPA) depicts the internal architecture of the parotid gland with high reliability. Magnetic resonance sialography with heavily T(2)-weighted images adds important information about the ductal system. Because it is completely noninvasive, the only contraindications are the ones generally accepted for MRI.

Adult↗

PubMed1999

Prognostic significance of Ki-67 (MIB1), PCNA and p53 in cancer of the oropharynx and oral cavity.

Up to now results concerning the prognostic value of tumor proliferation markers in squamous cell head and neck carcinoma have been equivocal. Beside biological reasons, different treatment modalities are hypothetically responsible for contradictory findings. The aim of this study was to investigate the relationship between proliferative capacity, represented by the immunohistochemical labeling index of proliferation markers Ki-67, PCNA and p53 status, and treatment failure in a matched-pair study design of recurrent and non-recurrent carcinoma initially treated with primary surgery combined with curative post-operative radiation. From a group of 239 patients with T1-T3 carcinoma of the oropharynx or oral cavity, 28 patients with recurrent disease were selected and matched with 28 patients with non-recurrent disease regarding stage and location of tumor as well as age and therapy. All patients received primary surgery combined with post-operative radiation. Immunohistochemistry determined the p53 status and the PCNA and MIB1 (Ki-67) labeling index. The Ki-67 labeling index was significantly (p=0.032) higher in tumors from patients suffering from treatment failure (mean=59. 1%) than in non-failures (mean=50.5%). Carcinoma with a Ki-67 (MIB1) labeling index above the median (53.7%) of the general study population showed a mean time to relapse of 45 months (n=25), whereas mean time-to-relapse was 61.7 months for those cases (n=31) below the median of the general study population (p=0.029). The PCNA labeling index did not correlate significantly with tumor recurrence (mean=50.2% for treatment failures, 45% for non-failures, p=0.31), nor with time-to-relapse (p=0.26). Forty-six percent of tumors showed p53 over-expression. However, there was no significant correlation between p53 over-expression and tumor recurrence or time-to-relapse. We present the largest series of oropharyngeal and oral cavity carcinoma investigated by immunohistochemistry in a controlled study. We conclude that a high Ki-67 labeling index is an indicator for treatment failure in these patients. Like other investigations for different head and neck subsites, we found no relationship between p53 or PCNA status and tumor prognosis. Our data, obtained from a group of patients treated with a combination of surgery and post-operative irradiation, show that for squamous cell carcinoma of the oropharynx and oral cavity the detection of Ki-67 is an unfavorable prognostic factor.

Adult↗

PubMed1999

Effects of systemic steroid treatment in chronic polypoid rhinosinusitis evaluated with magnetic resonance imaging.

BACKGROUND: The aim of this prospective study was to evaluate the efficacy of a combined (local and systemic) steroid therapy on the extent of chronic polypoid rhinosinusitis and patient symptoms. METHODS AND PATIENTS: Subjects of this study were 20 patients with severe chronic polypoid rhinosinusitis with total or subtotal narrowing of the all sinuses. A nasal budesonide spray (2 x 0.1 mg/day) and an oral fluocortolone medication with a daily reduction during a 12-day period (total dose: 560 mg = group 1) and a 20-day period (total dose: 715 mg = group 2), respectively, were administered. Before and after the steroid treatment we evaluated the extent of the sinusitis with MRI and patient symptoms with symptom-related questionnaires. RESULTS: A significant reduction (> 30%) of the chronic polypoid rhinosinusitis was observed in 50% of MRI findings. The steroid effect on polypoid masses was heterogeneous in different anatomic areas (maxillary sinus 40%, anterior ethmoid 19%, posterior ethmoid 33%, sphenoidal sinus 61%, frontal sinus 46%). Most sinusitis-related symptoms were distinctly diminished in most patients (80%). No major side effects were observed. CONCLUSIONS: A combined short-term steroid therapy is highly effective in chronic polypoid rhinosinusitis, reducing the mucosal inflammation mainly in the large sinuses and reducing the incidence of symptoms significantly. However, this therapy was insufficient in the anterior ethmoid and cannot replace the current surgical treatment concept of the osteomeatal complex in CPR. The indication for such a short-term steroid therapy is the preoperative treatment. It facilitates functional endoscopic sinus surgery by reducing the extent of surgical procedures, the time, and thereby the risks of sinus surgery.

Administration, Inhalation↗

PubMed1999

Bone density measurements of the paranasal sinuses on plastinated whole-organ sections: anatomic data to prevent complications in endoscopic sinus surgery.

OBJECTIVE/HYPOTHESIS: Although anatomic data regarding the gross anatomy of the paranasal sinuses are available, severe complications of endonasal sinus surgery (ESS) are frequently reported. To understand and to avoid these complications, density of bony walls of the paranasal sinuses were studied in this report. Special attention was given to the analysis of the bone density in regions where minor and major complications occur in ESS. METHODS: Thirty cadaver heads were embedded in epoxy resin. The plastic blocks were sectioned with a diamond-coated wire saw into 1.0-mm thick, parallel slices in axial, coronal, and sagittal planes for 10 specimens each. The slices were x-rayed and scanned with a computerized image analyzing system. For each specimen the bone density in 12 regions of interest was measured. RESULTS: Besides the macroscopic examination of the plastinated specimens, a bone density analysis based on x-ray films is presented. Lowest bone density was found at the lateral wall of the sphenoid sinus (3.31 +/- 0.99 mm aluminum [Al]); highest density was measured at the roof of the sphenoid sinus (12.91 +/- 1.75 mm Al). Overall bone density in female specimens was 0.41 mm Al (mean) lower than in male specimens. CONCLUSIONS: This study is the first to use plastinated whole-organ serial sections and bone density images for the analysis of potential complications in ESS. The illustration of regions with minor and major bone density of the paranasal sinuses and the ethmoid floor as presented in this study may help the novice sinus surgeon to minimize the risks of ESS and to avoid severe complications.

Absorptiometry, Photon↗

PubMed1999

Measuring in situ central airway resistance in patients with laryngotracheal stenosis.

OBJECTIVES: To evaluate a newly developed bronchoscopic technique for the assessment of intratracheal pressures. STUDY DESIGN: In situ measurement of central airway resistance in 20 consecutive spontaneously breathing subjects. Thirteen patients had benign glottic or subglottic stenosis. Seven patients without central airway disease served as normal control subjects. METHODS: A pressure catheter was introduced into the trachea via the working channel. The pressure swing was measured upstream and downstream of the stenosis. Central airflow was monitored simultaneously using a commercial pneumotachograph attached to a mouthpiece. Data acquisition frequency was 500 Hz. Prestenotic and poststenotic inspiratory and expiratory resistances could be calculated and displayed from the raw data off-line. RESULTS: Inspiratory and expiratory resistances measured in mid-trachea or below the stenosis (subglottic) were 0.36 +/- 0.13 and 0.35 +/- 0.13 kPa.s/L for the control subjects (C), 1.11 +/- 0.47 and 0.65 +/- 0.26 kPa.s/L for patients who did not need to be operated on (NOOP), 7.11 +/- 7.19 and 3.35 +/- 2.25 kPa.s/L respectively for those who required surgical correction (OP). Supraglottic inspiratory and expiratory resistances for C were 0.22 +/- 0.09 and 0.25 +/- 0.06 kPa.s/L, for NOOP 0.15 +/- 0.10 and 0.14 +/- 0.11 kPa.s/L, and for OP 0.26 +/- 0.13 and 0.24 +/- 0.07 kPa.s/L respectively. The cut-off point for surgical correction was estimated to be > 2.5 kPa.s/L of inspiratory resistance. Concurrent expiratory values showed a considerable overlap between OP and NOOP. No correlation could be established between local resistance values and dyspnea score. CONCLUSIONS: In situ subglottic flow-pressure tracing in spontaneously breathing patients who present with benign obstruction of the upper airways is well tolerated and may help to identify patients who need surgical correction.

Adult↗

PubMed1999

Morphology of the human larynx during the first five years of life studied on whole organ serial sections.

The morphologic development of the human larynx during the first years of life is poorly understood to date. This study used plastinated whole organ serial sections to determine the growth and structure of the infant larynx. The larynges of 43 children 1 to 60 months old were plastinated. Whole organ serial sections were obtained by cutting the resulting specimen with a diamond band saw. The slices were then submitted to computer-assisted morphometric investigation. We found that the subglottic airway rapidly increases in size during the first 2 years of life. Further growth follows a linear mode. The relative proportion of the mucosal lining decreases likewise. In contrast to that in adults, and comparable to that in most mammals, the cartilaginous glottis accounts for 60% to 75% of the vocal folds' length at <2 years. No sexual dimorphism of the larynx exists during childhood. This study supplies detailed morphometric data on the growth and structure of the human larynx during the first years of life. It is the first to use plastinated whole organ serial sections for morphology of the pediatric larynx. Therefore, this study provides quantitative anatomic data of clinical interest that have not been available to date.

Child, Preschool↗

PubMed1999

[Value of the relative phonetogram (RP) for the evaluation of organic dysphonias].

UNLABELLED: The phonetogram in a recognized element of voice evaluation, but its relation to perceptual voice quality is unclarified. The phonetograms area is easy to measure since the existence of efficient computer software. So information about frequency and intensity range can be united in one single parameter. The individual phonetogram area in relation to a gender- and training-specific normal value constitutes the "relative phonetogram (RP)". A prospective evaluation of the relative phonetogram was performed by means of a statistical analysis of its correlation to perceptual voice assessment (grade/rough/breathy) and to maximal phonation time. The acoustic parameters jitter, shimmer, SNR were examined in the same way, to allow for comparison of the RP's importance with the importance of common "objective" features in the identical group of patients. 114 patients with two subsets are included: 61 patients after partial laryngectomy (laser or conventional surgery), 53 patients with different glottic pathologies. The perceptive evaluation was done by a trained jury of an ENT-specialist and a speech therapist. The phonetogram and the maximal phonation time were measured by a trained medical student with regard of the examination references publicated by the Union of European Phoniatrics. The computer software for area measurement was MSImageProPlus, the one for sound analysis was Dr. Speech (Tiger Electronics). Statistical program: SPSS 8.0. RESULTS: The comparison between the two subsets of patients shows lower RPs for partial laryngectomy than for other patients in all degrees of hoarseness. In both subsets there is a correlation between RP and hoarseness values: the average values of RP differ significantly in dependence of grande. This is even more marked for the patients after laryngeal surgery. Furthermore high RPs are only present in patients with (relatively) high maximal phonation time, and mean RP correlates with maximal phonation time. A correlation between the parameters of sound analysis and the score of "grade" exists, but is not as marked as for the RP. CONCLUSION: The significance of the RP's mean value for subsets of 15-20 patients has been demonstrated. It is justified to interpret a certain variance of this parameter as difference in the degree of hoarseness. In this context, the importance of the mean RP is higher than the importance of jitter, shimmer, SNR (when measured with the above mentioned computer program, which allows no evaluation of parameter combinations). Therefore this parameter could be interesting for comparison of dysphonic patients, for instance after glottic cancer treatment.

Adult↗

PubMed1998

Epidemiology and etiology of acquired hearing disorders in childhood in the Cologne area.

Because of their serious consequences for all aspects of development, severe hearing disorders in children are an important clinical entity. A better understanding of the epidemiology and etiology of acquired hearing disorders may potentially lead to more effective prevention. Marked differences in the epidemiology of acquired hearing disorders are reported in the literature. In order to illuminate the problem of acquired disorders and to define current etiological causes with special regard to ethnological factors in the Cologne area, we started a retrospective study. A total of 314 children in residence at the school for hearing impaired children in Cologne were investigated. We also obtained concise data on the structure of the population in order to determine prevalence of acquired hearing disorders in the German and immigrant portions of the population. We found an overall prevalence of 0.43 per thousand for severe hearing disorders and deafness. German children were most frequently affected by acquired, and non-German children by hereditary hearing disorders. The most common causes of acquired severe hearing disorder were the perinatal complex of premature delivery, anoxia and hyperbilirubinuria or kernicterus. Other causes were congenital rubella infections and meningitis in early childhood. The accumulation of perinatal etiologies seems to be the reason for the remarkable majority of acquired hearing disorders among German children. One reason might be progress in neonatology which exerts two effects. It decreases perinatal mortality but increases perinatal complications like acquired hearing impairment. The incidence of congenital rubella in Germany has decreased during recent years, reaching a low level.

Child↗

PubMed1998

Hyoid bone malformation confirmed by 3-dimensional computed tomography.

We describe the case of a young woman with pain on turning her head attributable to a malformation of the hyoid bone. Diagnosis was established using spiral computed tomography with the patient's neck in the position of greatest discomfort and with 3-dimensional reconstruction of the hyoid bone. Prior conventional radiography and magnetic resonance imaging did not aid in finding a diagnosis. After surgical removal of both greater cornua of the hyoid bone there was a complete relief of symptoms.

Adult↗

PubMed1998

Potential role of transoral laser surgery for larynx carcinoma.

BACKGROUND AND OBJECTIVE: The treatment of larynx carcinoma is not settled to date. This prospective study evaluates the potential role of transoral laser surgery (TLS) for larynx carcinoma in a large series of unselected patients from a single institution. MATERIALS AND METHODS: A total of 504 consecutive patients with previously untreated carcinoma of the larynx were seen from 1986-1994. Their treatment modalities and results were prospectively evaluated. RESULTS: TLS was used in 290 patients (58%), total laryngectomy in 130 (26%), conventional partial laryngectomies in 31 (6%), and radiotherapy in 34 (7%). Nineteen (4%) had no curative treatment. Uncorrected actuarial survival for all patients with glottic carcinoma stages I and II treated with laser surgery (n = 202) was 80.2%, cause specific survival 96.7%, and local control 85.8%. Uncorrected actuarial survival for all patients with supraglottic carcinoma stages I and II treated with laser surgery (n = 40) was 49.0%, cause specific survival 78.6%, and local control 87.3%. CONCLUSION: TLS was the most important single treatment modality in this large series of unselected patients. It is a safe and time- and cost-effective alternative to radiotherapy for early stage larynx carcinoma.

Carbon Dioxide↗

PubMed1998

[Etiology of moderate and profound deafness in childhood].

UNLABELLED: The present study sought to determine the etiology of bilateral profound hearing losses in children living in Germany. Additionally, a comparison with the data of previous investigations in the available literature was used to update causes now known through medical progress. PATIENTS AND METHODS: The medical charts of 314 profoundly hearing-impaired pupils at schools for the deaf in Cologne, Germany, were reviewed. All available data on possible etiological factors were collected. In addition, the families of these children were interviewed using a standardized questionnaire. RESULTS: Sixty children were found to have bilateral sensorineural hearing losses averaging 30 to 60dBHL within the frequency ranges of 500-2000 HZ, while 254 had bilateral hearing impairments of 60 dBHL or greater. The etiology of the hearing disorder could be determined in 218 of the children. Eighty-two children suffered from hereditary deafness and 136 from acquired hearing losses. The etiology could not be determined in 96 children. Hereditary causes included 34 children with mendelian autosomal dominant losses, 46 with autosomal recessive losses and two children with genetic but non-mendelian causes. Immigrants to Germany (mostly from Turkey and the former Soviet Union) were found significantly more frequently among the students of these schools, than among the total population of the Cologne area. In this group of students, autosomal recessive deafness was particularly common as compared to the overall native population. Acquired hearing disorders were broken down into three subgroups: prenatal, perinatal and postnatal disorders. A prenatal etiology was considered in 32 children, 21 of whom had known congenital rubella infection. This entity was significantly less common among younger children. A perinatal etiology was considered in 60 children. Causative factors were birth asphyxia, apnea and/or hyperbilirubinemia. Forty-four children had deafness attributed to postnatal causes, with bacterial meningitis (n = 31) being the most important single factor. The findings reported indicate changing trends for causes of hearing loss in children with severe hearing impairment in Germany.

Adolescent↗

PubMed1998

[Cervical actinomycosis. A rare differential diagnosis of parotid tumor].

Actinomycosis is currently an uncommonly diagnosed human disease. However, it can still complicate trauma to the respiratory and digestive tracts, including operative procedures. A patient with cervicofacial actinomycosis commonly gives a history of recent dental manipulation which usually, involves extraction of a mandibular molar. The common initial symptoms of infection--such as, sudden onset of cervicofacial pain, swelling, erythema, edema and suppuration--can be absent. Infection due to actinomyces is a well-known mimic of malignancy is clinical, radiological and pathological findings. In the case described a 65-year-old man had a mass in his right parotid area. Because of its painless rapid growth with infiltration of the mandible as demonstrated by clinical findings and CT and MRI scans, we established an initial diagnosis of salivary gland malignancy. Salivary gland biopsy then revealed a histological picture of infection due to actinomyces. Therapy was initiated with intravenous amoxicillin and sulbactam. After 20 days of treatment diseased soft tissues and bone were resected. To prevent a relapse the patient received oral clindamycin for 6 weeks. After a followup of two years, the patient has remained free of disease.

Actinomycosis, Cervicofacial↗

PubMed1998

[Indicators for quality evaluation of inpatient patient care in an ENT clinic].

According to the law (Section 137 SGBV) in Germany, hospitals have to implement quality-assurance (QA) programs, which are now of particular importance in times of ongoing structural change in health care. External as well as internal methods of QA are well established and can serve as parameters for single processes and outcomes in most cases. However, there is still an urgent need for methods measuring the quality of total hospital performance. Indicators are powerful instruments for this purpose. They reliably reflect clinical outcome, physicians' and nurses' activities, administration and can be regarded as instruments for general hospital performance in otorhinolaryngology. We describe the process of definition, development and application of quality indicators for measuring quality in health care. Furthermore, we present a critical overview of selected indicators in otorhinolaryngology, general medical indicators and indicators concerning administrative problems. Because of current developments in German health care the application of quality assurance methods similar to the system of indicators presented is strongly recommended.

Germany↗

PubMed1998

Nasal cocaine abuse presenting as a central facial destructive granuloma.

We describe a 36-year-old patient with an aggressive, midline intranasal and naso- and oropharyngeal destructive process. For months the patient denied heavy abuse of nasal cocaine, but finally admitted it. Necrosis and atrophy of the inferior and middle nasal turbinates bilaterally, prominent naso and oropharyngeal ulcers, nasal septal as well as hard palate perforation were observed clinically. Repeated biopsies revealed focal areas of chronic inflammation and necrosis, but there was no evidence of vasculitis or granuloma formation. Since serum was slightly positive for antineutrophil cytoplasmic antibody, the initial diagnosis was Wegener's granulomatosis. In the United States there have been a few reports on a new cocaine-associated syndrome presenting as an aggressive, midline, intranasal and intrapharyngeal destructive process mimicking limited Wegener's granulomatosis and midline reticulosis. We report the first such case in Europe and offer guidelines for the diagnostic work-up of such cases.

Adult↗