Denys John Loeffelbein

Repair of oronasal fistulas with human amniotic membrane in minipigs

We evaluated the use of multilayer human amniotic membrane (HAM) as a grafting material for the repair of mid-palate oronasal fistulas in seven Berlin minipigs. After two weeks, three animals had the fistulas repaired with multilayered HAM grafts, three had them repaired with a collagen-based dermal substitute (INTEGRA((R)), Integra Life Sciences, Plainsboro, NJ, USA), and one fistula was left untreated to serve as a control. Grafts were interposed between the oral and nasal mucosa, traversing the fistulas. After healing for 40 days, the pigs were killed for clinical, histological, and immunohistochemical examination. Two of the three fistulas closed with HAM were successful, the diameter of the third was reduced in size, and there was no change in the diameter of the fistula in the control. This study shows successful closure of oronasal fistulas in minipigs using interposed grafts of cryopreserved HAM, and offers promise as a simple and effective technique for tension-free closure of such fistulas.

A bioartificial surgical patch from multilayered human amniotic membrane—In vivo investigations in a rat model

The study was performed to evaluate the suitability of glycerol-cryopreserved human amniotic membrane (HAM) as a surgical patch, far from its common use in ophthalmic surgery. In vivo experiments in rat models were performed to study the degradation patterns, biocompatibility, postoperative tissue formation and its suitability for abdominal wall closure. Degradation and thickness of the membranes were assessed over a period of 60 days after subdermal implantation of monolayer and multilayer HAM in 96 immunocompetent and immunosuppressed rats. The tissue response was mild, and histological analysis evaluated that multilayer application and immunosuppression prolonged graft survival significantly. In a second rat model, another 18 animals were monitored over a period of 28 days after abdominal wall reconstruction with multilayered HAM. Polypropylene mesh (Prolene) and polyglactin910/polydioxanon patches (Ethisorb) served as controls. Gross examination and histological analysis proved that multilayer HAM was a sufficient material for abdominal wall closure in comparison with the polypropylene mesh and was superior to the polyglactin910/polydioxanon patch. Additionally, significantly reduced postoperative intraabdominal adhesions were observed when compared to the polyglactin910/polydioxanon patch. This study demonstrates that HAM is a biocompatible, resorbable surgical patch in a rat xenotransplantation model and serves as a mechanically sufficient material for abdominal wall closure in a small animal model. These findings are encouraging and justify further research for the use of cryopreserved human amniotic membrane in soft tissue repair.

Bronchoscopy screening in primary oral squamous cell carcinoma: a 10-year experience

Squamous cell carcinoma (SCC) in the head and neck is associated with synchronous or metachronous carcinomas of the lung. Preoperative pulmonary screening is advocated and may be done by bronchoscopy, thoracic radiograph, computed tomography (CT), or positron emission tomography (PET) with CT (PET/CT fusion). We evaluated the role of bronchoscopy in patients with primary oral SCC to ascertain the incidence of synchronous malignancies of the lung. We retrospectively reviewed a decades experience of screening by bronchoscopy in 570 pathologically confirmed and previously untreated patients with oral SCC (188 female, 382 male). Univariate and multivariate analyses were done after evaluating the incidence of synchronous lesions and the clinical and histological features of the index tumour. Investigation by bronchoscopy showed disease in 166 patients, and malignancy of the lung in 9 (2%). The Union International contre le Cancer (UICC) stages I and II oral SCC were significantly associated with a synchronous malignancy of the lung (p=0.038). We recommend the use of bronchoscopy even in early tumour stages. Some patients had their treatment altered because of its use, including upstaging, diagnosis of distant and unresectable disease, and investigation of second primary malignancies.

Die Leishmaniasis – eine parasitäre Erkrankung als Differenzialdiagnose maligner Mundschleimhauterkrankungen. Fallbericht und Literaturübersicht

Although parasitel infections in northern Europe are rare, it must be considered as differential diagnosis of malignant tumours of mucous membrane. With increasing tourisms in endemic areas, infections with parasite pathogen are spreading in non-endemic areas as well. In this case a mucous membrane malignancy with clinical feature of ulcer on unusual location was imitated. In this reported case the patient suffers with hepatitis c, causing cirrhosis of the liver and making a liver transplantation necessary. In this patient a history of a leishmaniosis which had been treated successful by the tropical institute is reported, but because of a new actually leishmaniosis-infection a liver transplantation is contraindicated. Under oral therapy with Miltefosin (IMPADIVO) a remission was successful. The leishmaniosis is a classical tropical disease. WHO reported a morbidity of nearly 12 million people in 88 countries around the world especially in tropical areas. Repeatedly infections in northern Europe caused by the phlebotonus-sandflies are described. Therefore leishmaniosis must be considered as differential diagnosis in suspect lesions of mucous membrane.