Dieter Hellner

Interstitial high-dose rate brachytherapy with iridium-192 in patients with oral squamous cell carcinoma

Thirty-four patients with recurrent oral and oropharyngeal carcinomas were treated over a period of 4 years, by interstitial high-dose rate (HDR) brachytherapy (BT) using an iridium-192 source (Gammamed 2i and 12i equipment, Sauerwein, Germany) and fractionated application (1 up to 3 times, weekly recovery phases, single maximum dose 10 Gy). Pretreatment characteristics of patients in terms of irradiation (RT) and surgery differed (22 had external RT alone, with a total dose between 60.0 and 75.6 Gy; RT and surgery: 7; surgery alone: 1). The initial TNM-stages (UICC, Hermanek et al., 1987) of patients were: I = 2, II =3, III = 7, IV = 22. In the majority of cases, clinical indications for HDR-BT included tumour recurrence or progression following external RT, and second primary tumours of the oral cavity. Therapy was successful in most cases, i.e. complete remission: 11, partial remission: 16, no change: 2, progression: 5. Local control and overall survival rates, including patients surgically treated after BT, were at 6 months 58% and 62%, and 44% and 53% at 12 months, respectively. This type of treatment is recommended in patients with local recurrence or second primary tumours after previous external RT in the head and neck region. However, the benefit of interstitial HDR-BT remains questionable, particularly in patients with large tumours and lymph node metastases.

Blunt trauma lesions of the extracranial internal carotid artery in patients with head injury

Blunt trauma lesions of the extracranial internal carotid artery (ICA) are rare. In our hospital 18 patients with such an injury were diagnosed. All patients were involved in traffic accidents. Most of them had sustained head injuries with fractures of the skull, mandible or maxilla. The onset of neurological signs, most frequently hemiparesis, was usually delayed. 50 percent had bilateral ICA lesions but the clinical presentation was similar to those with unilateral lesions. Mortality of patients with ICA lesions was substantial (28%).

Primär solitäres malignes Schwannom des N. trigeminus

Der Artikel schildert den Fall eines primär solitären malignen Schwannoms des N. trigeminus. Er ergänzt die Weltliteratur auf 56 Fälle, wobei der Supraorbitalnerv zuvor lediglich 2mal betroffen war. Maligne Schwannome des Trigeminusnervs gehen zumeist vom N. alveolaris inferior aus. Der Nervenscheidentumor betrifft primär das männliche Geschlecht, das Durchschnittsalter der Patienten beträgt 44,2 Jahre. Der Symptomkomplex maligner Schwannome im Kopfbereich wird durch eine indolente Schwellung geprägt. Fernmetastasen oder lymphogene Absiedlungen sind nicht nachweisbar. Der Pleomorphismus der Tumorzellen macht den Einsatz histochemischer Verfahren in der Diagnostik sinnvoll. Die radikale Resektion, ¶z. T. mit adjuvanter Bestrahlung oder Chemotherapie, ist die Therapie der Wahl. Die 5-Jahres-Überlebensrate von Patienten mit malignem Schwannom des N. trigeminus beträgt 41,7%. We present the case of a primary solitary malignant schwannoma of the trigeminal nerve. A total of 55 cases have been described in the literature; however, in these cases two tumors were affecting the supraorbital branch. This nerve-sheath tumor usually affects men in the fifth decade of life. The main clinical sign of malignant schwannomas of the head and neck is an indolent swelling. Hematogenic or lymphogenic metastasis has not been described. Because of the pleomorphism of the tumor cells immunhistochemical study is important. The treatment of choice is radical resection, possibly with ¶adjuvant radio- or chemotherapy. The 5-year survival rate of malignant schwannoma of the trigeminal nerve is 41.7%.

Einsatz von Autointerponaten nach akuter Schädigung der Arteria carotis communis

The objective of our investigation was to study the patency rates of anastomoses in arteries, damaged by a balloon dilatation, in a training model of microvascular surgery. In general anaesthesia, a balloon dilatation was repeated 5 times in 31 left common carotid arteries of female Wistar rats (body weight: 250 to 350 g). A common carotid artery autograft of 4 mm was harvested 1 minute after reflow, turned 180 degrees, and reinserted into the artery. The reflow of the vessels was investigated by micro-Doppler ultrasound equipment. Autografts without balloon dilatation or any other intended damage were performed in further 26 common carotid arteries. In addition, in further 14 common carotid arteries the balloon dilatation was the sole damage. The vessels were harvested and investigated postoperatively after perfusion with 3% glutaraldehyde at 1 day, 7 days, and 1 month. The balloon dilatation in no instance caused an occlusion of the vessel as judged by the micro-Doppler ultrasound. One vessel was found to be occluded after reflow was allowed following insertion of the autograft in the group without balloon dilatation. However, this vessel proved to be patent after explantation (patency rate: 100%). In the group with balloon dilatation preceding the autograft insertion, by micro-Doppler ultrasound, 16 vessels were occluded and 14 were patent. At different times of follow-up, in this group the summarized patency rates were 50%. The patency differences in both groups with autografts proved to be significant, both after micro-Doppler imaging and by histological evaluation (p < 0.001). For clinical use the balloon dilatation is recommended to remove a thrombus or to dilate a spastic vessel segment in anastomized vessels threatening the success of microvascular flaps. In this training model of microvascular surgery we demonstrated the thrombogenic effect of balloon dilatation.ZusammenfassungDie Durchgängigkeit experimentell vorgeschädigter und mikrovaskulär anastomosierter Arterien wurde an einem Übungsmodell der Mikrovaskularchirurgie untersucht. Von 31 Wistar-Ratten (250 bis 350 g) wurde die linke Arteria carotis communis in Allgemeinanästhesie mit einem 2F-Ballonkatheter dilatiert. Danach wurde ein 4 mm langes Segment der Arteria carotis communis entnommen und nach Drehung um 180° reinseriert. Zum Vergleich wurden an 26 Arteriae carotis communes Interponate ohne intendierte Vorschädigung der Arterien durchgeführt. Bei weiteren 14 Arterien wurde nur eine Ballondilatation vorgenommen. Die Durchgängigkeit der Arterien wurde intravital mittels Mikro-Doppler-Sonographie (20 MHz) und histologisch zu unterschiedlichen Nachuntersuchungszeiten (Perfusionsfixierung) bestimmt. Die Ballondilatation als einzige schädigende Maßnahme führte zu keinem Gefäßverschluß. Wurde die Ballondilatation vor der Insertion des Gefäßsegmentes vorgenommen, resultierten in der Hälfte der Gefäße definitive Gefäßverschlüsse. Interponate ohne Vorschädigung waren zum Zeitpunkt der Perfusion in allen Fällen durchgängig. Die Unterschiede der Durchgängigkeitsraten zwischen beiden Untersuchungsgruppen waren für beide Untersuchungsmethoden signifikant (p<0,001). Für die klinische Anwendung ist die Ballondilatation zur Entfernung von Thromben mikrovaskulärer Anastomosen oder zur Dehnung von Gefäßspasmen empfohlen worden. In diesem Übungsmodell mikrovaskulärer Anastomosen konnte eindeutig der thrombogene Einfluß der Ballondilatation auf die Durchgängigkeitsrate mikrovaskulärer Interponate nachgewiesen werden.AbstractThe objective of our investigation was to study the patency rates of anastomoses in arteries, damaged by a balloon dilatation, in a training model of microvascular surgery. In general anaesthesia, a balloon dilatation was repeated 5 times in 31 left common carotid arteries of female Wistar rats (body weight: 250 to 350 g). A common carotid artery autograft of 4 mm was harvested 1 minute after reflow, turned 180°, and reinserted into the artery. The reflow of the vessels was investigated by micro-Doppler ultrasound equipment. Autografts without balloon dilatation or any other intended damage were performed in further 26 common carotid arteries. In addition, in further 14 common carotid arteries the balloon dilatation was the sole damage. The vessels were harvested and investigated postoperatively after perfusion with 3% glutaraldehyde at 1 day, 7 days, and 1 month. The balloon dilatation in no instance caused an occlusion of the vessel as judged by the micro-Doppler ultrasound. One vessel was found to be occluded after reflow was allowed following insertion of the autograft in the group without balloon dilatation. However, this vessel proved to be patent after explanation (patency rate: 100%). In the group with balloon dilatation preceding the autograft insertion, by micro-Doppler ultrasound, 16 vessels were occluded and 14 were patent. At different times of follow-up, in this group the summarized patency rates were 50%. The patency differences in both groups with autografts proved to be significant, both after micro-Doppler imaging and by histological evaluatio (p<0.001). For clinical use the balloon dilatation is recommended to remove a thrombus or to dilate a spastic vessel segment in anastomized vessels threatening the success of microvascular flaps. In this training model of microvascular surgery we demonstrated the thrombogenic effect of balloon dilatation.

Titanmagnete auf Implantaten als Hilfsmittel zur Rehabilitation nach Tumorbehandlung

Zusammenfassung Häufig brauchen Patienten nach einer Tumorresektion eine sich anschließende ästhetische und funktionelle Rekonstruktion mit prothetischer Rehabilitation. Oft steht nur wenig Platz für die Implantation zur Verfügung. Implantatlänge und Durchmesser müssen deshalb reduziert werden. Es kann zu einer Veränderung der Biomechanik mit evtl. Überlastung der Implantate kommen. Wir untersuchten 52 rekonstruierte Tumorpatienten mit insgesamt 189 Implantaten. Mit Hilfe von Titanmagneten können wir dabei ein neues Konzept vorstellen, um auch bei Problemfällen eine überwiegend zufriedenstellende prothetische Versorgung nach der Rekonstruktion zu erreichen. Summary After the resection of a tumor, many patients need a reconstruction with hard and soft tissue and also with sufficient dentures. Often, only little space is available for the implantation. Implant length and diameter have to be reduced, and the result is a change in the biomechanics with a possible mechanical overloading of the implant. We examined 52 tumor patients undergoing reconstruction with 189 implants. A new concept involving attachment with the help of magnets is presented, offering a satisfactory solution in these difficult cases after tumor resection and reconstruction.