Cathrine Juncker

The Influence of an Arterial and Venous Air Embolism on the Hearing Level in Laboratory Mini Pigs

We examined the influence of an experimental venous and arterial air embolism on the hearing level in laboratory mini pigs. Before and after the injection of air a threshold ABR was measured in anaesthetized mini pigs (n=15). A venous air embolism was performed in 6 animals: no changes in the hearing level or in the interpeak latencies Jewett wave V-I were observed in any of the animals before, during or after the application of air. In 9 animals the arterial embolism was done, 2 animals died and had to be excluded. In 6 animals out of 7 a hearing loss was observed starting after the injection of 40 ml air and finally ending in deafness for these 6 animals. The detected hearing loss is probably of cochlear origin, as no prolongations of the interpeak latencies of Jewett wave V-I at 90 dB HL were observed prior to the deafness. Our results show that air bubbles in the arterial circulation lead to cochlear damage ending in deafness. Our research indicates that decompression sickness, which is comparable to the arterial air embolism, is more often the cause of a sensorineural hearing loss after diving than previously believed.

Paraoperative change of sleep-disordered breathing in healthy snorers and sleep apnea patients compared to preoperative values.

BackgroundPatients with sleep-disordered breathing often show upper airway narrowing due to anatomical factors, which can be treated surgically. The paraoperative risk for sleep apnea patients is discussed from different points of view. We studied the effects of general anesthesia which is mainly used for surgery on the degree of disordered breathing.MethodsAfter two nights of polysomnographie 20 healthy subjects with snoring, light or severe sleep apnea were scheduled for surgery of the nose, the paranasal sinuses, the tonsils and/or the soft palate. A common screening device for disordered breathing was installed preoperatively. The raw data for snoring, oxygen saturation, heart rate and body position were edited visually in order to match them with polysomnography. Preoperative results were compared to the four hours following extubation and the first postoperative night.ResultsNeither the respiratory disturbance indexes (RDI) nor the oxygen saturations nor the times of snoring differed significantly during the three examinations. Worsening was only found in the subgroup with predominantly mixed apnea. There was only one patient with a modified uvulo-palato-pharyngoplasty(UPPP) who had to be reintubated twelve hours after surgery due to massive oropharyngeal swelling. Patients without palatal surgery did not show any complications.ConclusionAccording to our experience surgically treated sleep apnea patients without any other cardiopulmonary disease may be kept in the general ENT ward. After oropharyngeal surgery intensive wound controls are required.

Expression of Epidermal Growth Factor Receptor in Lymph Node Metastases of Head and Neck Squamous Cell Carcinomas

Background: An overexpression of the epidermal growth factor (EGF) receptor has been found in a wide variety of malignancies including squamous cell carcinomas of the head and neck. The overexpression of EGF receptor is of increasing interest because of a possible contribution to metastasis. Primary tumors and metastasis may differ in the expression of EGF receptor and provide a basis for metastasis. Material and Methods: This study examined the expression of the cell-surface receptor for EGF on 30 cervical lymph node metastases and on 30 primary squamous cell carcinomas of the oropharynx and the oral cavity. Immunoreactive receptor was localized using a mouse monoclonal antibody which reacts with sequences in the external domain of the receptor. Results: We saw a significant higher expression of EGF receptor in lymph node metastases than in primary tumors (p = 0.005). Examining the primary tumors, there was no correlation between the EGF receptor level and tumor localization or TNM-stage. On the other hand, we did find an interesting correlation between EGF receptor level and grading of the tumors, EGF receptor expression being significantly higher in G3 than in G1-G2 tumors (p = 0.001). Conclusions: EGF receptor system may play an important role in regulating the growth of head and neck cancer, and the process of metastasis and elevated EGF receptor level might characterize more metastatic tumors. The significant correlation between EGF receptor level and the histological grading suggests that EGF receptor expression may identify biologically more aggressive tumors.

Gigantischer Tumor der äßeren Nase

Abb. 3 b Nach chirurgischer Abtragung mit dem Skalpell ✜ 41jähriger, stark adipöser Patient, der sich wegen einer insbesondere nächtlichen Nasenatmungsbehinderung und zunehmender Schwierigkeiten bei der Nahrungsaufnahme vorstellte. Er gab an, daß die Schwellung der äußeren Nase seit einem Jahr bestehe. Nebenbefundlich fällt eine Rosazea der Gesichtshaut bei mangelhafter Hauthygiene auf. Der Patient ist alkoholabhängig, 6 bis 7 Flaschen Bier werden jeden Tag konsumiert.

The Influence of an Insecticide on the Function of the Eustachian Tube

Organophosphorus compounds in the form of insecticides are in widespread use and have recently attracted considerable interest as environmentally toxic agents. As little is known about the effect of environmental toxins on the tubal function in the ear, we studied the middle ear pressure necessary to force the eustachian tube to open (POL = pressure opening level) under physiological conditions in laboratory mini pigs and under the influence of an i.v. organophosphorus compound (Paraoxon). The median POL in the untreated animals was 6.4 kPa (n = 8). After intoxication with Paraoxon the median POL increased to 12.0 kPa (n = 8). Tubal instillation of surfactant in intoxicated pigs reduced the POL to a median of 7.3 kPa (n = 8), while in non-intoxicated animals (n = 4) it also lowered the POL, though not significantly. These results suggest that organophosphorus compound interferes with the surfactant-dependent tubal patency.

Die Messung der Lebensqualität bei Patienten mit Kopf-Hals-Tumoren

Die Lebensqualitats(LQ)-Messung in der HNO-Onkologie ist weit hinter anderen Fachbereichen zuruck. Existierende Mes-instrumente fur die LQ-Messung aus anderen Bereichen lassen sich nur bedingt auf die

Das adenoid-zystische Karzinom derTränendrüse: Fallbericht

Fragestellung: Das adenoid-zystische Karzinom ist ein seltener Tumor, aber es ist die hAufigste bOsartige Geschwulst der TrAnendrUse. Anhand eines Fallberichts sollen das therapeutische Vorgehen und die Prognose des adenoid-zystischen Karzinoms der Glandula lacrimalis diskutiert werden. Patient und Methode: Wir berichten Uber einen 30jAhrigen Patienten, der sich mit einer Ptosis links und einer MotilitAtsstOrung beim Blick nach links oben vorstellte. Seit 6 Monaten klagt der Patient Uber eine HypAsthesie der Haut am lateralen Lidwinkel links. Das Kernspintomogramm zeigte eine Raumforderung im Bereich der linken TrAnendrUse. Nach bioptischer Diagnosesicherung eines adenoid-zystischen Karzinoms der TrAnendrUse fUhrten wir eine Exenteratio orbitae mit Resektion der lateralen knOchernen Orbitawand durch. Ein mikroskopischer Knochenbefall lag nicht vor. Nach 9 Monaten trat ein erstes Rezidiv in der Regio temporalis auf. Ergebnisse und Schlussfolgerungen: Dieser Fall ist typisch fUr den Verlauf von adenoid-zystischen Karzinomen der Glandula lacrimalis. Schon nach 9 Monaten trat trotz der In-sano-Resektion ein erstes Rezidiv auf. Es stellt sich die Frage, inwieweit man mit einer noch radikaleren Technik, mit einer «En-bloc-Resektion» der knOchernen Orbita, das Rezidiv hAtte vermeiden kOnnen. Weinstein und Conley untersuchten das adenoid-zystische Karzinom der Glandula parotis und fanden, dass auch mit einer radikalen Therapie die Prognose nicht entscheidend verbessert werden kann. Diese Ergebnisse fanden auch Lee und Mitarbeiter fUr die TrAnendrUse. UnabhAngig vom operativen Vorgehen bleibt die Langzeitprognose schlecht: nach 15 Jahren leben weniger als 20% der Patienten. Wir gehen daher davon aus, dass auch durch ein noch radikaleres Vorgehen dieses Rezidiv nicht sicher hAtte vermieden werden kOnnen.