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Biomedical subjects

P Jecker

Publications and source records attributed to P Jecker.

At least 19 recordsLinked to original sources
PubMed2007

[Tonsillectomy technique: bipolar scissors vs raspatory: results of a case control study in 138 patients].

BACKGROUND: Postoperative bleeding is the major complication in tonsillectomy, and pain the most common side effect. The use of bipolar scissors versus blunt dissection tonsillectomy were compared in this study in order to evaluate postoperative bleeding and pain, as well as operative time. METHODS: In this case control study, 138 patients with the diagnosis of chronic tonsillitis, mononucleosis or a peritonsillar abscess were divided into two groups. A total of 78 patients were operated using bipolar scissors while 60 patients underwent tonsillectomy by blunt dissection. Operating time, frequency of postoperative bleeding and the postoperative pain score were compared between these two groups. RESULTS: The average operating time in the bipolar scissor group showed a tendency to be shorter than in the blunt dissection group (mean 4.1 min), although this did not reach a level of statistical significance. No differences were seen in pain scores or in the incidence of postoperative bleeding. CONCLUSION: The data documented in this study show that tonsillectomy with bipolar scissors might represent a surgical option to reduce surgical time in a larger patient group. Postoperative pain and the incidence of postoperative bleeding did not show any statistical difference between the two surgical techniques.

Adolescent↗
PubMed2007

[Staging of esophageal cancer using ultrasound].

The early diagnosis of esophageal cancer is crucial for the prognosis of the disease. In contrast to cancer of the upper aerodigestive tract, the mucosa of the esophagus is not visible without the appropriate equipment. In addition to endoscopy, imaging of the esophagus is crucial for early detection of the esophageal cancer. Ultrasound of the esophagus can be performed easily and--in contrast to other imaging techniques--without side effects. Different modes of ultrasound can be performed. First, transcutaneous ultrasound allows one to detect tumors of the upper esophagus and its passage into the hypopharynx. Second, endosonography allows one to detect pathologies of the other esophageal regions including the passage into the stomach. The present review discusses the impact of both techniques against the background of the international literature.

Esophageal Neoplasms↗
PubMed2006

[Intraoperative ultrasound in surgery of the parotid and the head-and-neck region].

Sonography of the head-and-neck region is well established in the preoperative diagnostic process of tumorous lesions. Its intraoperative use to localise small tumours, however, has been rarely investigated to date. We applied intraoperative ultrasound to 19 patients who underwent parotid surgery and evaluated the following criteria: intraoperative tumour presentation, scan quality, comparison between sonographic visualisation and tumour detection by palpation, histological tumour borders as well as postoperative complications. All lesions were reproduceable by intraoperative ultrasound and could be demonstrated in sufficient quality. None of the 19 parotid tumours could be identified by palpation pre- and intraoperatively. All tumour capsules remained intact, the tumours were completely removed and no postoperative complications were observed. Problems of ultrasound application may arise due to significantly altered anatomic landmarks while surgical preparation proceeds. Intraoperative ultrasound is fast, dynamic and feasible under sterile conditions. Especially in parotid surgery with small, non-palpable tumours, intraoperative ultrasound supports minimal-invasive surgery.

Head and Neck Neoplasms↗
PubMed2006

[Treatment of sensorineural hearing loss in acute viral otitis media with intratympanic dexamethasone and hyaluronic acid in comparison with intravenous therapy].

BACKGROUND: Intratympanic dexamethasone with hyaluronic acid has shown to be an effective treatment of the inner ear damage in sudden hearing loss and Menière's disease. It is not known yet if the same applies to the toxic inner ear damage in acute viral otitis media. PATIENTS: Retrospectively, 26 patients who suffered from acute viral otitis media with sensorineural hearing loss were examined with regard to the improvement of their inner ear hearing loss. Twelve patients were treated with intravenous therapy only, consisting of hydroxyethyl starch, pentoxifylline and prednisolone. Fourteen patients additionally received intratympanic injections, consisting of dexamethasone and hyaluronic acid once acute inflammatory changes subsided. The inner ear hearing loss was evaluated by means of standard bone-conduction audiometry. RESULTS: Neither local nor systemic side effects of the intratympanic injections occurred. During treatment no significant difference in the improvement of bone-conduction thresholds in any frequency was seen between the two groups. CONCLUSIONS: Intratympanic injections of dexamethasone with hyaluronic acid do not result in any additional benefit on the sensorineural hearing loss in acute viral otitis media compared to intravenous therapy alone. A reason might be the post inflammatory changes of the round window membrane or the toxic nature of the acute viral infection affecting the inner ear.

Acute Disease↗
PubMed2005

[Necessity for blood transfusion in head and neck surgery].

INTRODUCTION: Sometimes, use of blood products is necessary in head and neck surgery, but blood transfusion also entails risks for the patients and causes high costs for the department. Therefore, we examined the surgical procedures in our department and analysed how often transfusion of blood was necessary and which expenses were incurred. METHODS: Of 3989 operations performed in 1989, 187 patients were found to be at an increased risk for blood loss. The costs for blood group analysis (euro 23.16), cross-testing (euro 13.91) and the transfusion itself (euro 70.35) were estimated in each patient. RESULTS: In 1998 more than 60% of the 187 patients had undergone extensive head and neck surgery for advanced squamous cell carcinoma. Only 17 patients (<15%) received nearly 45% of all units of stored blood transfused that year. In patients who had undergone skull base surgery, the probability of receiving blood was 30%. The transfusion-related costs were estimated to be euro 20,000 during the observation period. Potential savings could have been achieved in cross-testing. CONCLUSION: Preparations should be done on an individual basis. Such preparations are sometimes unnecessary even in patients undergoing surgical procedures with a high risk for blood loss.

Blood Grouping and Crossmatching↗
PubMed2005

[Ultrasound of hypopharyngeal and oesophageal cancer: possibilities and limitations to staging and planning of therapy].

Sonographic examination of the hypopharynx and the extrathoracic oesophagus can be difficult. Therefore, most surgeons prefer to utilise CT or MRI scanning. Surgery is planned on the basis of endoscopic findings combined with radiologic information. The aim of the present prospective study was to demonstrate that the combination of ultrasonography and endoscopy provides a sufficient basis for the planning of surgical interventions in patients suffering from hypopharyngeal cancer or cancer of the proximal oesophagus. In 10 patients with squamous cell carcinoma of the hypopharynx/proximal oesophagus (8T4, 2T2) and 2 patients with a T4 squamous cell carcinoma of the larynx, both preoperative CT and ultrasound were performed and compared with the extent of the tumour seen during endoscopy. With ultrasound, the T4 tumours of the hypopharynx were recognized well as opposed to the T2 tumours which were not detected. The CT results were similar. An infiltration of the proximal oesophagus was seen with both imaging techniques in all affected patients. In contrast to CT, intralaryngeal tumour spread was not seen with ultrasound as long as the laryngeal skeleton was intact. The retropharyngeal region could also not be examined by ultrasound. Nevertheless, these results show that in all patients included in this study the extent of the tumour could have been estimated correctly by using ultrasound plus endoscopic examination alone. The reliable examination of this anatomically difficult region, however, requires examiner experience.

Carcinoma, Squamous Cell↗
PubMed2005

[Diagnostic use of ultrasound for examination of the nose and the paranasal sinuses].

Ultrasound is commonly performed to diagnose pathological processes of the neck and the salivary glands. In contrast, pathological changes of the sinuses and the bony structures of the face are only rarely examined sonographically. This paper deals with the diagnostic scope of ultrasound in the case of orbital and nasal fractures as well as for cases of sinus pathology excluding acute sinusitis. 51 patients with different diseases of this area were examined using US and X-ray or CT scan. Fractures of the nose could all be diagnosed correctly by ultrasound, which is of clinical importance if children or pregnant patients are examined. Blow-out fractures of the orbit were not detected. In contrast, pathological changes of the orbit itself could be distinguished sufficiently well from those infiltrating the orbit and originating from the sinuses. Real-time examination allows the detection of infiltration of orbital muscles and the bulb of the eye better than any other imaging method.

Carcinoma, Renal Cell↗
PubMed2005

[Comparison of the sonographic detection of experimentally induced squamous cell carcinoma compared with the histological image].

BACKGROUND: Malignant tumours of the head and the neck are characterised by typical signs of malignancy in greyscale- and colour-coded sonography. Sometimes, such criteria cannot be verified, and in such cases it remains unclear whether typical changes do not exist or whether we just cannot detect them with our high-end ultrasound units. We therefore compared our sonographical findings with the histology obtained in experimentally induced tumours. METHODS: Experimental squamous cell carcinoma was induced subcutaneously in nude mice (n = 18), using four different cell lines. Ultrasound examination of the tumours was performed after 98 and 112 days, respectively, Central necrosis, rupture of the capsule as well as the presence of central and peripheral blood vessels were documented before the tumours were excised. They were then sliced in the same direction as sonography had been carried out before. Blood vessels were stained using CD31. RESULTS AND DISCUSSION: 16 tumours grew subcutaneously. In ultrasound imaging, the capsule was always intact, and subcapsular vessels were detected in every tumour. Central necrosis was seen in 10/16 tumours by sonography, but in 15/16 tumours on histological examination. The failure of sonography in detecting necrosis did not correlate with the size of the tumour. Centrally located vessels were found in 12/16 tumours using colour-coded sonography. Histology, however, showed their presence in all 16 tumours. Interestingly, the failure of sonography in detecting vessels did not correlate with tumour size. It seemed that the detection of such vessels was particularly difficult in those tumours which grew very fast. This finding explains why we often find such vessels in small tumours but not in large specimens, where they would normally be expected.

Animals↗
PubMed2004

[Interdisciplinary therapy management in malignancy of the paranasal sinus tumors in children].

BACKGROUND: Malignant tumors of the paranasal sinuses, such as rhabdomyosarcoma or Ewing's tumors, often have a mesenchymal origin. In the recent years, several prospective, randomized, multicenter studies have demonstrated a better outcome after new oncology therapy protocols. PATIENTS AND RESULTS: In the period from January 2000 to June 2001, we operated 610 patients with sinus disease. Only 23/610 were children or teenagers (3.8%). Half of the juvenile group suffered from chronic sinusitis, but 5/23 (22%) had a malignoma of the paranasal sinuses. In the adult population, malignoma was diagnosed in less than 1% of cases. We diagnosed and treated, in cooperation with our radiology, pathology and children's hematooncology department, one rhabdomyosarcoma, two malignant peripheral neuroectodermal tumors (PNET), one myelosarcoma and one malignant lymphoma in the paranasal sinuses. Two patients died. SUMMARY AND CONCLUSION: These five cases of paranasal sinus malignomas are discussed in relation to their history and clinical course. We suggest that interdisciplinary treatment involving otorhinolaryngology, pathology, children's hematooncology, radiology and radiation therapy is obligatory for the therapy and for the best possible outcome of such cases.

Adolescent↗
PubMed2004

Presence of dendritic cells, T lymphocytes, macrophages, B lymphocytes and glandular tissue in the human fetal larynx.

OBJECTIVE: The laryngeal mucosa starts to be exposed to infectious agents immediately after birth. The course of laryngeal infections in young children differs significantly from that in adults. The first line of defense encountered by an inhaled infectious agent is the mucosa-associated immune system, which includes immunocompetent cells and secretory components. The cellular elements are partially organized in a typical morphological pattern known as mucosa-associated lymphoid tissue (MALT). Differences in the ability of young children and adults to react to a laryngeal infection raise the questions of whether and to what extent immunocompetent cells are already present in the larynx at birth. These questions were investigated in this study. MATERIAL AND METHODS: Dendritic cells, T lymphocytes, B lymphocytes, macrophages and glands were examined and detected in an (immuno-)histological study of 8 fetal larynges (14th-22nd week of gestation). RESULTS: Immunocompetent cells and glands were present mainly in the epi- and subglottic regions and ventricular folds, whereas the glottis was largely spared. The pattern of distribution was scattered and no organized MALT was seen. CONCLUSION: Essential cell populations of a mucosa-associated immune system for the initiation of an immune response may exist in the human larynx at birth.

Antibodies, Monoclonal↗
PubMed2003

[The need for 24-h double probe pH monitoring in the diagnosis of laryngo-pharyngeal reflux].

BACKGROUND: Laryngopharyngeal reflux disease (LPRD) can have various causes. Because LPRD differs from gastroesophageal reflux disease (GERD), the pH monitoring has to be performed directly next to the entrance of the larynx. This is now possible using a new system called pH-RESPONSE. METHODS: The ambulatory pH was monitored using the double probe pH-RESPONSE in 20 patients with suspected LPRD. The number of refluxes, the number of long refluxes and the period in which the pH was below 4 were compared at the level of the larynx with the data from the esophageal electrode. The DeMeester score was also determined. RESULTS: The system was well tolerated by 19/20 patients. In 12 patients a GERD could be proved and ten also had LPRD. Surprisingly, these patients had no typical signs such as heart burn. The number of refluxes measured in the esophagus was a third that of the larynx. The average time of pH below 4 was 30 min. CONCLUSION: The pH-RESPONSE easily allows ambulatory 24 -h double probe pH monitoring to diagnose LPRD. Because large differences were found between data form the esophagus from the level of the larynx, 24-h double probe pH monitoring should be a standard procedure before starting any therapy for LPRD.

Esophagus↗
PubMed2003

[Results in terms of hearing results after surgical closure of labyrinthine fistulas].

OBJECTIVES: We investigated the results achieved in terms of hearing in 36 patients who had each undergone resection of a cholesteatoma and closure of a labyrinthine fistula. PATIENTS AND METHODS: These patients included 28 who had a fistula of the semicircular canal, in 7 of them with an opened perilymphatic space. In 8 cases we found a fistula of the cochlea, with with a perilymphatic leak 7 in of them. We compared the sensorineural threshold before and after surgery and also the results in the two groups. Patients who were deaf preoperatively were excluded from further analysis. RESULTS: Hearing did not improve in any of the patients (n=5) who were deaf preoperatively. There was no significant difference in changes to the hearing threshold between patients with fistula of the cochlear and those with fistula of the semicircular canal with opened perilymphatic space; nor did patients with a fistula of the semicircular canal without perilymphatic leakage have a better outcome than patients with an open membranous labyrinth. CONCLUSIONS: The outcome of cholesteatoma resection and closure of the fistula in a single operation was good. Perilymphatic leakage seems to be predictive of a poorer result in terms of hearing.

Audiometry, Pure-Tone↗
PubMed2003

[Rare tumors of the parotid gland. Lymphadenoma of a sebaceous gland and extracranial metastasis from glioblastoma].

Tumors of the parotid gland can be benign or malignant lesions.The pathophysiology of rare tumors of the parotid gland is often not sufficiently explored in this paper two rare histological entities are described. In one patient a benign sebaceous lymph-adenoma was histologically diagnosed. This type of tumor accounts for only 0.196 of all adenomas. The international literature is not conclusive about whether the tumor originates in the parotid gland itself or in the parotid lymph nodes. The second patient presented with a metastasis from a glioblastoma in the parotid gland. Again, the mechanism for metastasis of an intra-cerebral tumor to the parotid gland remains unknown. Iatrogenic seeding during a neurosurgical intervention is a probable explanation. The actual clinical course of his patient and the cases described in literature render surgical removal of such a metastasis questionable.

Adenoma↗
PubMed2002

[The history of head and neck sonography].

Although today ultrasound is well accepted in the diagnosis of head and neck diseases, often little is known about the young history of this technique. Many pioneers, physicians and engineers were involved in the development of the technique. In this article the history of ultrasound in general and of ultrasound of the head and neck is reflected.

History, 19th Century↗
PubMed2001

Splenectomy of rats selectively reduces lymphocyte function-associated antigen 1 and intercellular adhesion molecule 1 expression on B-cell subsets in blood and lymph nodes.

Splenectomy increases the number of B cells in the blood of humans and animals. It is unknown whether this is due to changes in migration, proliferation, or both. The numbers of naïve (IgD(+)IgM(+)), memory (IgD(-)IgM(high)), newly formed (IgM(high)CD90(high)), early recirculating follicular (IgM(low)CD90(high)), recirculating follicular (IgM(low)CD90(-)), and marginal zone (IgM(high)CD90(-)) phenotype B cells were determined in control and splenectomized rats by flow cytometry. All subsets increased significantly in the blood after splenectomy. Because surface molecules are involved in the regulation of migration and proliferation, their expression (lymphocyte function-associated antigen 1 [LFA-1], intercellular adhesion molecule 1 (ICAM-1), L-selectin, alpha4-integrins, CD44, major histocompatability complex class II, interleukin 2 receptor-alpha chain) was determined on B- and T-cell subsets of both groups. B cells, but not T cells, showed a significantly reduced LFA-1 and ICAM-1 expression in blood and lymph nodes, whereas the expression of the other surface molecules analyzed remained unchanged. The down-regulation of these molecules did not influence the adherence of B cells to high endothelial venules in vitro. In vivo, however, ICAM-1(low)-expressing B cells migrated significantly faster through lymph nodes (ICAM-1(low) 41 +/- 5 hours versus ICAM-1(high) 58 +/- 3 hours), whereas proliferation of B cells in bone marrow, lymph node, and blood remained unchanged. Thus, the presence of one organ is necessary for appropriate expression of LFA-1 and ICAM-1 on B cells in other, distant organs. The more rapid transit of ICAM-1(low) B cells through lymph nodes may be responsible for the increased B-cell number in the blood after splenectomy.

Animals↗