Biomedical subjects

W Bergler

Publications and source records attributed to W Bergler.

At least 19 recordsLinked to original sources

PubMed2001

[Nitinol stent implantation in benign esophagotracheal fistula].

The self-expanding nitinol stent is easy to handle and well tolerated. It offers an improved method in the treatment of perforations of the upper aerodigestive tract. It is easily implantable with rigid and flexible endoscopes. A 45-year-old female patient developed a tracheal necrosis after polytrauma and protracted intubation and ventilation. The permanent cuff pressure caused a 5-cm long fistula located at the posterior trachea 3 cm above the carina. After stabilization of the general condition and spontaneous reduction of the fistula length to 2 cm, we implanted the silicon-covered esophageal stent. Daily bronchoscopic examination was done before and after implantation of the stent. Two days after implantation, we were able to remove the blocked tracheostomy tube. Immediately oral nutrition was possible without complications. Because of its easy and fast application without any complications, the new type of nitinol stent is a promising alternative for ear, nose, and throat patients in bad general condition to provide fast and safe treatment in benign tracheoesophageal fistulas.

Alloys↗

PubMed2001

Paraoxon sensitive phenylvalerate hydrolase in assessing the severity of acute paraoxon poisoning.

INTRODUCTION: Intoxications with organophosphorous compounds, especially paraoxon, are frequent. Organophosphorous compounds inhibit serine hydrolases such as acetylcholine, butyrilcholine, and carboxyl esterases although acetylcholine and butyrylcholine are too sensitive to paraoxon to be useful markers of severity. They cannot show a dose-dependent inhibition during an acute organophosphorous compounds exposure because maximal enzyme inhibition is reached at very low organophosphorous compounds concentrations. PURPOSE: To determine in vitro the dose-effect relationship between the activity of the paraoxon-sensitive phenylvalerate hydrolase, a member of the carboxvl esterases family, and the paraoxon dose, and to assess its utility as a putatively less sensitive enzyme marker to monitor the severity of an acute paraoxon intoxication. MATERIALS AND METHODS: Phenylvalerate hydrolase and butyrylcholine activities were determined in serum of nine healthy human volunteers before and after addition of different concentrations of paraoxon. The determination of phenyl-valerate hydrolase activity was carried out using a modification of the method described by Johnson. A commercially available kit was used to measure butyrylcholine activity. RESULTS: Paraoxon inhibits phenyl-valerate hydrolase activity at concentrations above 10 M. Maximal inhibition (approximately 50% of baseline) is achieved at concentrations above 2.5 x 10(-7) M. The IC50 value of paraoxon for phenyl-valerate hydrolase is 34+/-2 nM. The uninhibited phenyl-valerate hydrolase activity is due to paraoxon-resistent isoforms. Paraoxon begins inhibiting butyrylcholine activity at concentrations above 10(-9) M. At concentrations above 5 x 10(-5) M, no butyrylcholine activity is measulrable. The IC50 value of paraoxon for butyrylcholine is 150+/-23 nM. CONCLUSION: The paraoxon-sensitive subunit of phenyl-valerate hydrolase shows dose-dependent inhibition when exposed to paraoxon in vitro, but it is even more sensitive than butyrylcholine to paraoxon inhibition. Determinations of phenyl-valerate hydrolase activity to assess the severity of an acute organophosphorous compounds poisoning cannot be recommended, but phenyl-valerate hydrolase may have utility in worker surveillance.

Biomarkers↗

PubMed2001

Tonsillectomy with argon plasma coagulation (APC): evaluation of pain and hemorrhage.

OBJECTIVE: Argon plasma coagulation (APC) offers a new possibility for tonsillectomy (TE) because of its effective hemostasis and limited penetration depth of the coagulation zone. The APC dissector allows dissection and hemostasis in a one-step procedure. The aim of this prospective, randomized, single-blinded study was the evaluation of pain and hemorrhage of the "hot" argon-plasma-coagulation tonsillectomy (TE(APC)) compared with a conventional "cold" non-electrosurgery tonsillectomy (TE(Conv)). METHODS: Two hundred one consecutive patients undergoing tonsillectomy were included in a single-blinded, randomized, prospective study with stratification in two age groups. RESULTS: There was no statistical significant difference between TE(APC) and TE(Conv) in the intensity of postoperative pain and primary or secondary hemorrhage in both age groups. In the TE(APC) group, the mean duration of tonsillectomy was significantly reduced by more than 50% in both age groups (P <.01). The blood loss was 90% decreased in the TE(APC) compared with the TE(Conv) in both age groups (P <.01). CONCLUSIONS: The APC technique does not face the general problem of electrosurgery or thermal coagulation techniques in which the postoperative pain is often increased compared with conventional cold techniques. It offers an innovative new tonsillectomy method with significant reduced blood loss and surgical time.

Child↗

PubMed2000

Expression of basic fibroblast growth factor protein and its down-regulation by interferons in head and neck cancer.

BACKGROUND: Angiogenesis is crucial for tumor growth and metastasis. In several tumors, microvascular density has been shown to correlate with metastasis and aggressiveness. Basic fibroblast growth factor (bFGF) has potent angiogenic activity and has been identified in a wide variety of malignancies including head and neck squamous cell carcinomas (HNSCC). Material and Methods Frozen sections of 50 HNSCC were immunostained for von Willebrand factor and bFGF. Microvessels were counted by light microscopy; bFGF expression was studied at the light and electron microscopic level. Laryngeal cancer cell line HlaC79 was incubated with interferon (IFN) alpha and beta. bFGF quantification was performed by ELISA, and antiproliferative effects were determined by BrdU assay. RESULTS: The mean number of blood vessels (77.5 +/- 23.7) is significantly increased in HNSCC compared with controls (17.1 +/- 5.9). bFGF protein expression was detected in all HNSCC but not in control tissue. An correlation between bFGF expression and mean number of microvessels was found (p <.001). However, no correlation between bFGF expression and the main clinicopathologic features was shown. The long-term exposure (144 hr) of HNSCC cells to noncytostatic concentrations of IFN alpha and beta (>10 U/mL) down-regulated the protein production of bFGF. CONCLUSION: bFGF expression and angiogenesis are enhanced in HNSCC. The higher microvessel density in HNSCC with strong bFGF expression supports the importance of bFGF for tumor angiogenesis. IFN alpha and beta treatment leads to a down-regulation of bFGF expression independent of their antiproliferative effects, suggesting that IFN treatment might result in a reduction of angiogenesis in HNSCC.

Adult↗

PubMed2000

[Tonsillectomy with the argon-plasma-coagulation-raspatorium - a prospective randomized single-blinded study].

BACKGROUND: The Argon-Plasma-Coagulation (APC) offers an innovative possibility for the tonsillectomy combined with a high-frequency technology. Aim of our study was to inves-tigate the differences between this high-frequency-technology and the traditional tonsillectomy. No reports exist in the use of the APC in the tonsillectomy. METHODS: Argon-Plasma-Coagulation tonsillectomy (TE-APC) was compared with the traditional blunt dissection tonsillectomy (TE-trad) with hemostasis by compression and bipolar coagulation. 133 patients were stratified in two age groups in a clinical prospective randomised study. RESULTS: Average surgical time and blood loss were markedly decreased in the TE-APC group (p<0,01). There was no significant difference between the two techniques concerning postoperative pain, otalgia, and primary or secondary haemorrhage. In the TE-APC group more extensive fibrin layer appeared after surgery. In the TE-APC patients' group, there was a slightly higher consume of analgetics in some postoperative days. CONCLUSIONS: The one-step dissection and coagulation procedure leads to an almost bloodfree woundground and to a reduction of operation-time. The self-limited and effective coagualative properties of the APC-method leads to a controlled penetration depth. The often associated extensive post operative pain and uncontrolled tissue- damage, known from electrical and lasersurgical techniques, was not found in TE-APC-patients-group.

Adolescent↗

PubMed2000

Serum levels of vascular endothelial growth factor in patients with head and neck cancer.

Angiogenesis is now considered to be crucial for tumor growth and metastasis. In several tumors, microvascular density has been shown to be correlated with metastasis and aggressiveness. Vascular endothelial growth factor (VEGF) is a secreted endothelial cell-specific mitogen, which is induced by hypoxia and is angiogenic in vivo. VEGF has been identified in a wide variety of malignancies including head and neck squamous cell carcinomas (HNSCC). We investigated the circulating level of VEGF in sera from patients with various head and neck squamous cell carcinomas (n = 71) as well as from healthy normal controls (n = 47). Serum VEGF concentrations were determined as serum immunoreactivity by using a quantitative sandwich enzyme immunoassay technique. For statistical analysis, the Wilcoxon 2-sample test and Kruskal-Wallis test were performed. The majority of the patients with HNSCC were found to have high concentrations of serum VEGE The levels of VEGF in the sera of patients with cancer ranged from below the detection limit to 937.1 pg/ml (mean, 144.5 pg/ml). In contrast, the VEGF serum levels in 47 healthy individuals ranged from below the detection limit to 168.1 pg/ml (mean, 32.7 pg/ml), VEGF serum concentration being significantly higher in HNSCC patients (P = < 0.001). These findings indicate that a positive angiogenesis regulator such as VEGF might function as an endocrine growth factor, particularly for solid HNSCC tumors and may be a useful marker for clinical monitoring.

Adult↗

PubMed2000

[Emergency tracheotomy in Göttingen minipigs. Comparison: standard technique versus Nu-Trake cricothyrotomy set].

STUDY OBJECTIVE: To compare the time required, success rate and complication rate of the standard surgical approach for cricothyrotomy versus a prepacked kit in regard to the experience of the surgeon. METHODS: The cricothyrotomies were performed in Goettingen mini-pigs (n = 14) under general anaesthesia. 7 different surgeons (2 Otorhinolaryngologists, 2 Emergency Physicians, 3 medical students) used each technique (standard surgical approach and Nu-Trake device) once to perform the cricothyrotomy without prior practice. RESULTS: The fastest time to do the cricothyrotomy with Nu-Trake was 40 s, the slowest 93 s and the mean time of all 7 surgeons was 58 +/- 18 s. Using the standard approach it took 42 s up to 154 s until ventilation with a mean time of 106 +/- 48 s. The use of Nu-Trake was significantly faster than the standard surgical approach (p < 0.05, t-test). Otorhinolaryngologists were quicker using the standard technique (46 s versus 58 s with Nu-Trake), whereas each surgeon of the other two groups (emergency physicians and medical students) was quicker with the Nu-Trake Set (58 +/- 21 s) than with the conventional method (135 +/- 18 s). The number of complications was similar with both methods, but a difference was detected in the type and severity of the complication: An injury of the posterior tracheal wall was observed twice with Nu-Trake. CONCLUSIONS: Experienced personnel should maintain the standard surgical approach for cricothyrotomy. Inexperienced personnel can use the Nu-Trake device which was found to be quicker as it facilitates the procedure, but causes more severe complications. We recommend to practise cricothyrotomy regularly in human cadavers, in the animal model if possible or on mannequins to be sufficiently trained in advanced airway management.

Animals↗

PubMed2000

[Coexpression of VEGF and bFGF is associated with increased vascular density in head and neck carcinomas].

BACKGROUND: Angiogenesis is crucial for tumor growth and metastasis. In several tumors, microvascular density has been shown to correlate with metastasis and aggressiveness. Vascular endothelial growth factor (VEGF) and basic Fibroblast Growth Factor (bFGF) are known to have potent angiogenic activity. Their expression has been identified in a wide variety of malignancies including head and neck squamous cell carcinoma (HNSCC). Aim of our study was to investigate the role of co-expression of VEGF and bFGF for angiogenesis in HNSCC. MATERIAL AND METHODS: Cryostat sections of 51 primary HNSCC were immunostained for VEGF and bFGF using a standard streptavidin-biotin complex procedure. To evaluate angiogenesis, endothelial cells were stained immunohistochemically using anti-vWF polyclonal antibody. Microvessels were quantified by counting vessels in a x200 field in the most vascular area of the tumor. RESULTS: 25/51 (49%) of the investigated carcinomas showed co-expression of both factors (VEGF+/bFGF+), while 6/51 (11.7%) carcinomas only expressed VEGF and 13/51 (25.5%) carcinomas expressed bFGF. 7/51 (13.7%) tumors showed no expression of these factors (VEGF-/bFGF-). Carcinomas with a co-expression of VEGF and bFGF showed a significantly increased mean microvessel density (88.3 +/- 24.4) compared to tumors expressing only VEGF (77 +/- 16.8) or bFGF (71.1 +/- 15.8) (p = 0.022) or tumors with no expression of both factors (51.1 +/- 13.4) (p < 0.001). The association of VEGF and bFGF expression level was not significant (p = 0.178). CONCLUSIONS: The positive correlation of the co-expression of angiogenic VEGF and bFGF with increased microvessel density underlines the importance of both factors for tumor angiogenesis in HNSCC. VEGF and bFGF might act cooperatively in the process of neovascularization in human head and neck cancer.

Adult↗

PubMed2000

Gabapentin "add-on therapy" for idiopathic chronic hiccup (ICH).

The efficacy of cisapride, omeprazole, and baclofen (COB) for treatment of idiopathic chronic hiccup (ICH). was proven in several studies. The combination is considered, at present, to be "therapy of choice" for this condition. Substituting gabapentin for baclofen in baclofen resistant ICH cases can occasionally be successful. We present here cases where gabapentin was used successfully in combination with cisapride and omeprazole (COG/one patient) or as an "add-on" with cisapride, omeprazole, and baclofen (COBG/three patients). We conclude that, with baclofen and gabapentin, we are in possession of two substances that are, as a part of a combination therapy, quite effective for ICH. Because of the far more extensive experience with baclofen, we use it as a first-line therapy, together with omeprazole and cisapride. In cases where the results are not entirely satisfactory, the addition of gabapentin should be considered.

Acetates↗

PubMed2000

Argon plasma coagulation for inferior turbinate reduction.

Surgical reduction of the inferior turbinate remains a widely used therapy for nasal obstruction caused by hyperplastic turbinates. Current methods are costly and time-consuming, require nasal packing, and cause extended postoperative swelling. Argon plasma coagulation (APC) is a new, innovative technique in otorhinolaryngological surgery that is based on high-frequency electrical current. The current is transmitted through ionized argon gas (plasma) contact-free to the tissue surface and creates a coagulation and devitalization zone with limited penetration. Forty-five patients with nasal obstruction were treated under local anesthesia for reduction of the inferior turbinates with APC. Seventy-six percent of the patients reported an improvement of postoperative swelling within the first week. After 3 months, 86% reported having better nasal airflow than they had before the operation. Macroscopically, after 4 weeks the turbinate was covered by normal mucosa in 51% of the patients. Crust formation was minimal, and no bleeding occurred. Turbinate reduction with APC is an alternative technique with many advantages, and the results are comparable to those of standard techniques. Ninety-five percent of the patients were satisfied with the operation.

Argon↗

PubMed2000

Expression of 92-kDa type IV collagenase correlates with angiogenic markers and poor survival in head and neck squamous cell carcinoma.

MMP-9, which degrades extracellular matrix, is believed to play a crucial role in tumor invasion and metastasis. Angiogenesis is also perceived as an important step in tumor growth and metastasis. The aim of this study was to investigate the expression of MMP-9 in tumor samples of HNSCC patients and to study a possible correlation to angiogenic markers. Cryostat sections of 52 HNSCC tumors were immunostained for MMP-9, bFGF and VEGF using a standard streptavidin-biotin complex procedure for light microscopic investigation. Microvessel density (MVD) was determined by staining of endothelial cells immunohistochemically using anti-vWF monoclonal antibody. MMP-9 positive staining was detected in 27/52 (52%) of the tumors. MMP-9 immunoreactivity did not correlate with the main clinicopathological characteristics of the patients (localisation, T-stage, N-stage, histological grading), but correlated with worse survival of the patients. MMP-9 negative tumors showed a significant lower mean MVD per microscopic field than MMP-9 positive tumors (p<0. 001). There was a significant association of MMP-9 and VEGF expression (p<0.05). The presence of MMP-9 in HNSCC cancer and the positive correlation with MVD and VEGF expression supports the theory that MMP-9 functions as a regulator of tumor angiogenesis supporting endothelial cell invasion. MMP-9 and VEGF might act co-operatively in the process of neovascularization in human head and neck cancer.

Adult↗

PubMed1999

Intravenous paraoxon (POX) exposure: coagulation studies in mini pigs.

The in vivo effects of the organophosphorus compound (OPC) paraoxon (POX) on blood coagulation of mini pigs were assessed by measuring the partial thromboplastin time (PTT), prothrombin time (PT), fibrinogen, factor V, factor VII, factor VIII, antithrombin III, protein C, and platelet count. The mini pigs were randomly assigned to a POX-treatment group (n = 9) receiving 54 mg POX kg(-1) BW(-1) or the control group (n = 9). Measurements were carried out over a period of 150 min after poisoning. The exposure to POX did not have any influence on measurements of PT, factor VIII, factor VII, factor V, antithrombin III, protein C, or fibrinogen compared to the control group evaluated by rank order test (ROT) during the time of observation (150 min). Changes seen in the intrinsic coagulation followed a biphasic pattern corresponding to an early sympathomimetic phase with PTT-shortening and a decrease of the platelet count, and a late vagal phase, with PTT-prolongation. The hypercoagulability seen in the sympathomimetic phase is probably due to a massive release of catecholamines from the adrenals. Previous studies showed in vitro no coagulation activating effect of POX. The hypocoagulability in the vagal phase shown by the PTT-protongation is probably due to POX influencing platelet function or its inhibition of clotting factors, which are serine proteases, or a combination of the two.

Animals↗

PubMed1999

[Detection of serum concentration of carbohydrate-deficient transferrin (CDT) in patients with head-neck carcinomas].

It is now well known that chronic alcohol abuse is an important factor for developing head and neck squamous cell carcinoma (HNSCC). While hospitalized, these patients are at great risk for developing an unexpected alcohol-withdrawal syndrome. Compared to common markers of alcohol abuse, carbohydrate-deficient transferrin (CDT) has been found to be more sensitive and specific. It is therefore very useful for detecting alcoholism and controlling compliance of alcohol withdrawal. We analyzed the serum concentrations of CDT, liver enzymes and mean corpuscular volume in 49 male patients with HNSCC. Elevated CDT levels were found in more than 25% of patients who earlier denied a history of chronic alcohol abuse. Over one-third of these patients developed an alcohol-withdrawal syndrome. These findings demonstrated that analysis of elevated CDT serum levels was a valuable method for detecting chronic alcohol abuse and recognizing patients at risk for developing an alcohol-withdrawal syndrome post-operatively.

Alcohol Drinking↗

PubMed1999

[Controlled cosmetic dermal ablation in the facial region with the erbium:YAG laser].

The erbium: YAG laser (wavelength 2940 nm; pulse duration 0.350 ms; pulse energy 0.1-1.7 J) allows vaporization of very thin skin layers without scarring and minimal lateral thermal injury due to an extremely short pulse duration. It permits exact ablation of relatively large areas of facial skin. We report our results with 216 patients following treatment for different facial lesions (facial wrinkles, acne scars, syringomas, and circumscribed sebaceous gland hyperplasia) using a new erbium: YAG laser system. Good-to-excellent cosmetic results were obtained in these patients. Our findings show that the erbium: YAG laser is an elegant and promising new method for the treatment of facial lesions.

Cicatrix↗

PubMed1999

Hereditary hemorrhagic telangiectasias: a challenge for the clinician.

Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease) remains a challenge for all clinicians, as in about 80% of cases nasal bleeding is the first manifestation of this disease, which is characterized by a clinical triad of multiple telangiectasias, recurrent hemorrhages and familial occurrence. Although in the last few years there has been diagnostic and therapeutic progress, a cure for this rarely life-threatening but often burdening and handicapping disease is still not possible. We have reviewed head and neck presentations, diagnostic and therapeutic features, as well as new insights into the molecular genetics of the disease and local treatment now available.

Diagnosis, Differential↗

PubMed1999

Age-dependent altered proportions in subpopulations of tonsillar lymphocytes.

Age-related changes in functional subsets of lymphocytes may influence the potential to build up immune responses. In particular, the capacity of tonsillar lymphocytes to counter infections may be altered during ageing. In order to address this question we investigated the proportional distribution of several subsets of tonsillar T and B cells with regard to ageing. Tonsils were derived from 119 patients between 2 and 65 years of age. Lymphocyte subsets were monitored by three-colour fluorescence of relevant CD markers in flow cytometry. As a general tendency the percentage of CD3+ T cells steadily increased whereas that of CD19+ B cells decreased at the same time. No significant differences were observed between lymphocytes of patients with and without inflammatory history of the tonsils. The percentage of CD8+ T cells declined whereas that of CD4+ T cells increased during the same time span. CD45RA+ T cells increased during the first two decades of life and gradually decreased thereafter. In contrast, CD45RO+ T cells showed an opposite trend. No differences were seen in the population of CD3-/CD56+ natural killer (NK) cells. The mature B cell marker CD40 showed no significant changes during ageing. However, CD38+ B cells, representing B cells of late maturation stages, dramatically declined up to the age of 65. In a similar manner the CD5+ subpopulation of B cells decreased during ageing. Substantial changes in major tonsillar T and B cell populations as shown in this study may have an impact on the ageing process of the immune system.

Adolescent↗

PubMed1999

Argon plasma coagulation for the treatment of hereditary hemorrhagic telangiectasia.

OBJECTIVES: Patients with (HHT) often suffer from recurrent epistaxis, which poses considerable therapeutic problems. Theoretical considerations render argon plasma coagulation (APC) a promising new therapeutic approach. STUDY DESIGN: In a prospective study 12 patients (aged 8-68 y) who presented with a long history of treatment for epistaxis were treated with telangiectasia in the nasal mucosa. After 2 weeks and again after 4 months the treatment results were evaluated by questionnaire. METHODS: APC is based on high-frequency electric energy transmitted through ionized argon gas to the tissue in a noncontact mode. Coagulation and desiccation of tissue are limited to 1 to 2 mm of penetration and therefore risk of tissue damage is low. Coagulative effects are best in tissue with high electrical conductivity, especially blood vessels. RESULTS: All patients were satisfied with the postoperative results. Frequency and intensity of bleeding were significantly reduced. All patients reported better postoperative results than with any other treatment they had received previously. CONCLUSION: First clinical experience shows that APC is a useful alternative for the treatment of telangiectasia in the nasal mucosa and should be a therapeutic option for this disease.

Adolescent↗

PubMed1998

[Argon plasma coagulation in treatment of hereditary hemorrhagic telangiectasia of the nasal mucosa].

Patients with hereditary hemorrhagic telangiectasia (M. Osler-Rendu-Weber disease) often suffer from recurrent epistaxis that poses considerable therapeutic problems. Dermoplasty, electrocoagulation, laser coagulation, iridium brachytherapy and systemic administration of estrogens have been proposed for treatment. Until recently argon plasma coagulation (APC) was not used in ENT surgery, but theoretical considerations render APC a promising therapeutic method for controlling nasal bleeding. Coagulation of tissue is limited to 1-2 mm of penetration and therefore risk of damage to adjacent tissue is low. Effects are best in tissues with high electric conductivity, especially for coagulating bleeding lesions and blood vessels. We have now treated four patients with telangiectasias in the nasal mucosa who had long histories of treatment for epistaxis. The patients were satisfied with the postoperative results and the frequency and intensity of bleeding were significantly reduced. Initial clinical experiences show that APC is a useful alternative for the treatment of bleeding telangiectasias in the nasal mucosa.

Adult↗