Biomedical subjects
Publications and source records attributed to W Wicke.
We report 10 patients undergoing pharyngo-laryngectomy in whom the pharyngeal defect was reconstructed with a free jejunal graft. This method is technically demanding. The advantages are excellent healing due to the excellent blood supply of the edges of the graft, and the almost unlimited supply of jejunum. The use of this method is justified by the immediate restoration of deglutition.
A new method of surgical rehabilitation of the voice is being presented. A shunt is introduced between the trachea and the hypopharynx or the entrance to the oesophagus, by the use of a jejunal graft which is sutured isoperistaltically. By microsurgical anastomoses the jejunum is revascularized by the cervical vessels. Seven patients, having undergone total laryngectomy because of carcinoma of the larynx, have been treated by this procedure. In one case a venous thrombosis developed and the graft had to be resected. The other patients regained a voice, able to meet all requirements of daily life. The voice shows a remarkable low phonatory pressure, a good modulation capacity and a phonatic duration of up to 20 seconds.
The jejunal graft with microsurgical vascular anastomoses is now recognised as one of the most reliable methods for reconstructing large and various defects of the upper aero-digestive tract. After resection of T4-tumours and reconstruction of phonation, deglutition and aesthetics 50% of our patients could be resocialized within the first postoperative month.
After laryngopharyngectomy and reconstruction of the upper digestive tract, a free jejunal graft can be anastomosed in an isoperistaltic direction end-to-end to the trachea and the hypopharynx in order to form a shunt for vocal rehabilitation. Following placement of the shunt, no special care is required nor does any patient show any aspiration. Because of a low-flow resistance of the shunt, patients so treated possess long-lasting phonation with loud and modulated voices.
The fundamental concept in vocal rehabilitation after laryngectomy is the tracheo-hypopharyngeal shunt. The usual contemporary methods possess numerous disadvantages. In order to improve the results a syphon-fashioned shunt with free transplanted jejunum between the tracheal stump and the hypopharynx is created (stimulated by K. Ehrenberger). Aspiration can be avoided by means of the autonomic peristalsis of the implant. The procedure has been performed in 7 cases. One developed necrosis of the loop. The other patients possess a clear voice.
In 87 persons who had to undergo plastic surgery of the auricle an evaluation was carried out of the motives for undergoing such surgery, on the one hand, and of the late results of the success of surgical intervention, on the other. The motives for undergoing surgery clearly suggest a significant psychological component, so that the intervention must most likely be regarded as a psycho-prophylactic measure. As concerns the results, it is striking that the evaluation given by the patients has been better (subjective evaluation) than that given by the doctors (objective evaluation), the subjective evaluation sometimes differing from the objective one.
The capillaries of the spiral limbus in the cochlea of the laboratory rat were investigated under light and electron microscopy. A stereological examination of the capillary volumes of specimens injected with horseradish peroxidase was performed. The volume of capillaries amounted to 2.87%, and, as such, is very high. The ultrastructure of the capillaries showed continuous endothelial cells and basal laminae, discontinuous pericytes and varying relations towards the surrounding tissue. Morphological criteria, such as microvilli and plasmalemmal vesicles, suggest a significant transendothelial transport. The causes for the abundance of vessels in the spiral limbus are discussed: the transport of oxygen to the perilymph and the need of substances for the formation of the tectorial membrane seem to be important factors. The transport processes are obviously controlled by the endothelial cells as well as by the spiral limbus cells.
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34 cases of perforation of the oesophagus are reported, partly treated at the surgical and partly at the E.N.T. department. Air emphysema of the throat or of the mediastinum and/or escape of the contrast medium was observed in all patients. The main cause of perforation was endoscopic examination. The patients partly underwent conservative and partly surgical therapy, both groups showing similar mortality rates. Small perforations in the upper third of the oesophagus can be treated conservatively, whereas perforations in the lower two thirds, especially with involvement of the pleura, pericardium or peritoneum, need rapid surgical intervention, as the prognosis improves in relationship to the rapidity with which treatment is instituted following perforation.
Investigation into the vascularization of the Ganglion spirale of the rat showed an irregular, loose network of capillaries, with a somewhat denser vacularization of the marginal areas of the ganglion; the horseradish peroxidase benzidine test according to Sugar was used to demonstrate the vessels. At least of the blood supply of the ganglion is effected via the vessels which run parallel to the nerve fibres through the osseous canals from the modiolus into the Rosenthal canal. The density of vascularization of the Ganglion spirale is surprisingly small, namely 1.89% by volume. The comparative figure for the Ganglion spirale, also measured by means of stereological methods, is approximately 6.8% by volume, whilst the vessels in the Nervus cochlearis occupy 2.1% by volume. The vascularization density of the ganglion corresponds roughly to that of the Cortex cerebri. Electro-microscopical tests have shown that there are unfenestrated capillaries with a small number of pinocytotic vesicles. Possible conclusions as to the permeability of the capillaries are discussed in the paper. The blood supply of the Ganglion spirale has so far received only little attention. In the case of internal ear diseases of vascular genesis, attention is mainly given to changes in the vessels of the lateral wall of the cochlea. Experimental findings, however, show the high sensitivity of the nervous apparatus of the cochlea in the case of disturbed blood supply.
A hearing aid with dynamic compression and the very same one without dynamic compression were used for an examination of 13 patients with recruitment who were hard of hearing with respect to sound perception. The maximum degree of speech discrimination possible to be reached was determined. Although in general the hearing aid with dynamic compression yielded better results, the differences between the two aids were, however, small and showed a high scattering range. Thus, we have to draw the conclusion that the lacking 100% speech discrimination in the case of recruitment-positive disorders with respect to sound perception is not due to distorted sound volume dynamics.
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Acetylcholinesterase was demonstrated in the ganglion cells of the vestibular ganglion of the rat with Karnovsky's method. The acetylcholinesterase content was evaluated after a 24 hours incubation time by means of a three-grade scale. The cell size was determined by a particle size analyser. No correlation between the two values could be established. A comparison with the spiral ganglion showed a slightly lower acetylcholinesterase content in the vestibular ganglion. The content of acetylcholinesterase in the vestibular ganglion cells seems to be lower than in the spinal ganglion cells.
Békésy audiometry equipment was used for investigations carried out in 15 test persons to study the intensity differentiation threshold. We tried to find the degree of intensity required to recognize given dB changes in the intensity. The results achieved very well coincide with those established by other authors. It was possible to statistically prove the volume dependence of the intensity differentiation threshold, it was, however, not possible to establish any frequency dependence. The relations of our result with the SISI test are under discussion.
The report covers the therapeutic results achieved after using cytostatic drugs in 104 patients treated at the 1st Oto-Rhino-Laryngological Univ. Hospital, Vienna, between 1967 and 1975. The breakdown according to the tumor histology shows that squamous cell carcinomas accounted for the highest per centage, i.e. 53%; laryngeal tumor prevails according to the tumor localization. In 42 patients it was not possible to positively influence the disease; 45 patients showed a disruption or a slowdown of the progress of the disease; in 17 patients all measurable criteria of the disease receded (classification according to Karnofsky). Even if the average survival time after the commencement of the therapy amounted to only about 6 months, it was nevertheless possible to positively influence the progress of the disease by means of cytosatic therapy.
A review of 18 cases of laryngectomy on account of tumour recurrence following chordectomy revealed a high incidence of post-operative salivary fistulae. The tumour recurrence was extensive, as seen from the extirpated larynx specimen, in spite of regular laryngological check-up examinations. Tumour recurrence rends to be localized in the anterior commissure and sometimes infiltrates into the prelaryngeal area. The poor long-term prognosis is stressed.
Acetylcholinesterase has been demonstrated in the spiral ganglion cells by the method of Karnovsky and Roots. After incubation for 24 h the content of AchE was measured with the help of a three-stage scale. 22% of the cells showed strong, 50% medium and 28% weak AchE activity. Within the spiral ganglion perikarya, the enzyme was equally distributed.
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