Eckart Klemm

VALIDATION OF THE EORTC QLQ-C30 AND EORTC QLQ-H&N35 IN PATIENTS WITH LARYNGEAL CANCER AFTER SURGERY

The aim of this study was to test the validity of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Core Module (QLQ‐C30) and Head and Neck Module (QLQ‐H&N35) for patients who have undergone surgery due to laryngeal cancer.

Comorbid mental disorders in laryngectomees.

Objectives: This study attempted to determine the prevalence of mental disorders among laryngectomees and to assess the current status of the supplied psychooncological care. Patients and Methods: Patients who were laryngectomized between 1970 and 2001 were recruited at 6 different otolaryngology clinics in the region of Central Germany. 189 interviews were conducted. Structured clinical interviews (SCID) and standardized questionnaires (HADS, KFA) were used to assess patients’ mental health. The past and the current status of received psychotherapeutic care was evaluated. Results: 23% of the patients were diagnosed with mental disorders. The most frequently occurring disorder was alcohol dependency with 8%, followed by affective disorders (7% major depression, 5% minor depression). Only one patient was currently receiving psychotherapeutic or psychiatric treatment. Conclusion: Only a small fraction of the laryngectomy patients suffering from mental illness were receiving appropriate treatment.

Struck by lightning: Lichtenberg figures on a 19th-century wax model

Wax models in dermatology were used to a large extent until the 1930s as three-dimensional models to illustrate various pathologic conditions and in particular cutaneous signs of disease. As an example, a young woman who was struck by lightning and developed Lichtenberg figures is presented. Lichtenberg figures are a fernlike pattern on skin, characteristic of lightning. Such a wax model housed in the German Hygiene Museum Dresden, Germany, illustrates the significance of wax models and how, even today, they can play an important role in medical education.

Percutaneous dilatational tracheotomy using the tracheotomy endoscope

INTRODUCTION Open tracheotomies are safe procedures even when performed in high-risk patients by inexperienced surgeons. Reported complications associated with the wellknown percutaneous dilatational tracheotomy (PDT) techniques are due to either predilatory dissection or the downward forces applied to the surrounding tissues and posterior tracheal wall during dilation. The use of PDT has resulted in a range of complications that are difficult to quantify on a scientific basis due to the fact that more than half of the tracheotomized patients in intensive care units die from their underlying diseases. Additionally, late complications are seen less often by critical care physicians because they usually become apparent after discharge from the intensive care unit. These late complications become apparent during rehabilitation therapy or during check-ups by primary care physicians, who then refer these patients back into the realm of otorhinolaryngology. Despite the rapid evolution and improvements in PDT techniques, the discussion concerning its benefits, risks, and possible complications has continued in the medical community. Potential complications of current dilatational techniques include perforation of the posterior tracheal wall during puncture or insertion of the dilatational device, major bleeding, desaturation, hypoventilation, airway loss, tracheal tube punctures, cuff defect, and development of a tracheal stenosis. Tracheal stenosis following PDT may occur for numerous reasons, including cartilage fractures, displacement after PDT, or performing PDT at an incorrect location. The optimum level for a tracheostomy is between the second and fourth tracheal cartilages. We have developed a technique that combines the advantages of PDT using the Seldinger guidewire technique with rigid endoscopy, thus eliminating the risk of hypoventilation during the PDT. This innovative technique for PDT could be an alternative to current endoscopic techniques used during PDT. To secure the airway and prevent complications, we perform PDT using a rigid tracheotomy endoscope (TED) (Fig. 1).

Methods of administering superimposed high-frequency jet ventilation and the associated risk for aspiration in a model of tracheal bleeding.

Background: To determine the suitability of different superimposed high-frequency jet ventilation (SHFJV) application methods during tracheal bleeding. Objective: To determine the effect of SHFJV on the aspiration of blood during tracheal bleeding. Methods: A test lung was ventilated using SHFJV via a rigid endoscope, a jet laryngoscope and a 4-lumen jet catheter. Packed red blood cells (PRBCs) were injected into the artificial trachea caudally to the rigid endoscope and jet laryngoscope ventilation, and both caudally and cranially during ventilation via the 4-lumen jet catheter, and the migration of PRBCs during ventilation was studied using continuous video recording. Results: Migration of blood into the lower respiratory tract did not occur during SHFJV via the rigid endoscope and jet laryngoscope and via the 4-lumen jet catheter with the bleeding caudal to ventilation source. If the bleeding was cranial to the 4-lumen jet catheter ventilation, migration of blood into the lower respiratory tract was seen when reflux of blood reached the entrainment area. From this area, blood is transported within the jet stream into the lower respiratory tract. Conclusions: SHFJV protects the lower respiratory tract from blood aspiration in case of tracheal bleeding. During SHFJV via the 4-lumen jet catheter, aspiration of blood only occurs if bleeding is localized cranial to the 4-lumen jet catheter ventilation. In case of heavy tracheal bleeding, the jet sources should be positioned cranial to the site of bleeding.

Komplikationen der Tracheotomie und Strategien zu deren Vermeidung

Komplikationen bei Tracheotomien werden im Schrifttum nach Art und Schwere unterschiedlich definiert, was die Vergleichbarkeit erschwert und Fantoni (2006) veranlasste, international vergleichbare definitive Kriterien anzumahnen. Im vorliegenden Kapitel wurden nur Arbeiten einbezogen, die ein Mindestmas vergleichbarer Operationen der letzten 10–15 Jahre auswiesen, Metaanalysen eingeschlossen.

Percutaneous dilational tracheostomy (PDT) and prevention of blood aspiration with superimposed high-frequency jet ventilation (SHFJV) using the tracheotomy-endoscope (TED): results of numerical and experimental simulations

Abstract We describe an innovative computer-based method for the analysis of gas flow using a modified airway management technique to perform percutaneous dilatational tracheotomy (PDT) with a rigid tracheotomy endoscope (TED). A test lung was connected via an artificial trachea with the tracheotomy endoscope and ventilated using superimposed high-frequency jet ventilation. Red packed cells were instilled during the puncture phase of a simulated percutaneous tracheotomy in a trachea model and migration of the red packed cells during breathing was continuously measured. Simultaneously, the calculation of the gas-flow within the endoscope was numerically simulated. In the experimental study, no backflow of blood occurred during the use of superimposed high-frequency jet ventilation (SHFJV) from the trachea into the endoscope nor did any transportation of blood into the lower respiratory tract occur. In parallel, the numerical simulations of the openings of TED show almost positive volume flows. Under the conditions investigated there is no risk of blood aspiration during PDT using the TED and simultaneous ventilation with SHFJV. In addition, no risk of impairment of endoscopic visibility exists through a backflow of blood into the TED. The method of numerical simulation offers excellent insight into the fluid flow even under highly transient conditions like jet ventilation.

Feasibility and safety of dilatational tracheotomy using the rigid endoscope: a multicenter study

BackgroundFiberoptic tracheo-bronchoscopy is the most commonly used procedure for percutaneous dilational tracheotomy (PDT). However, PDT can be associated with major complications, including death. Furthermore it is unclear, whether the tracheal ring fractures may contribute to the development of tracheal stenosis after PDT nor whether tracheal ring fractures can be prevented by using a rigid endoscope for this procedure. The purpose of this study was to evaluate the feasibility of and the incidence of complications for PDT using the rigid tracheotomy endoscope (TED).MethodsIn a prospective multicenter observational study from 2006 to 2010, 180 adult patients in intensive care and those scheduled for ear, nose and throat surgery underwent PDT using TED. Data collection was performed using a structured protocol. The patients were observed according to PDT phase (phase 1: puncture, phase 2: dilatation and phase 3: cannula insertion). The descriptive data are given as the number (percent) of cases and the mean ± standard deviation (SD) where appropriate. The relationships between dichotomous and categorical parameters were analyzed using the chi-square test. P values ≤ 0.05 were considered significant.ResultsPDT was performed in 179 patients. The procedure time was 14.8 ± 6.2 (mean ± SD) minutes. Pneumothorax or procedure-related lethal complications did not occur. Other adverse events included tracheal ring fractures (17.1%), desaturations (6.8%), special incidents (6.2%), bleeding (5.5%), anesthesia complications (4.5%) and posterior tracheal wall injuries (1.1%).ConclusionThe use of TED in PDT is feasible, and the incidence of complications and adverse events was comparable with that of PDT using the flexible endoscope. Tracheal ring fractures in PDT cannot be avoided by the use of a rigid endoscope. With TED, the airway always remains open thus the use of jet ventilation via the TED during PDT is possible.

In Memoriam Christoph T. Bolliger

board members and friends of the journal informed of the latest developments and changes to the journal. He also successfully edited the book series Progress in Respiratory Research where he initiated many outstanding and award-winning volumes of which some have become true classics in the field such as Interventional Bronchoscopy and Clinical Chest Ultrasound . Over the years, a very close and pleasant collaboration developed with the publishing house and he became a valued advisor in publishing matters. We appreciated his friendly way to motivate people, his humour, his inspiration, his deep insight and clear vision for the journal and the book series. Chris Bolliger’s sudden and untimely passing on November 2 shocked the entire editorial team of Respiration . We have lost a true leader and an extremely successful Editor, a very warm-hearted person so full of life and energy. A part of Professor Christoph Bolliger remains in all of us who had the privilege to work with him. As one of the Associate Editors of the journal so correctly wrote: ‘You can replace the Editor-in-Chief, but you cannot replace this wonderful man’. He will be sorely missed by all of us and we will do everything to secure the journal’s future and foster its reputation as one of the leading journals in the field. Thomas Nold, Thomas Karger and Gabriella Karger and the Respiration team The publisher and the editorial staff of Respiration would like to express their sadness at the sudden passing of Professor Christoph T. Bolliger. We were first introduced to Chris Bolliger by Professor Heinrich Herzog, who invited him to join the Editorial Board of the journal Respiration back in 1995. In January 1998, Professor Bolliger officially became the new Editorin-Chief of Respiration . Full of enthusiasm about his new role, he announced his visions for the future of the journal in the first of his many editorials which was entitled ‘A Wind of Change’. Chris Bolliger was not just an excellent clinician and scientist, but also a passionate editor, who had many excellent ideas for the journal and the commitment and perseverance to realise his aims to the full. Thanks to his international network he was able to provide feedback on the latest trends in medical publishing and he was continuously striving to improve the quality of the journal. During the 15 years of his editorship, the number of submissions increased by almost 300%, the impact factor climbed up to 2.5 and the rejection rate increased from 43 to 76%. We saw the introduction of many new sections to the journal, e.g. Thematic Review Series, The Eye Catcher, and Interventional Pulmonology. He ensured the journal had a truly diverse group of dedicated Associate Editors covering all fields of respiratory medicine, supported by an international Editorial Board. Dr. Bolliger’s very popular newsletter ‘News in a Nutshell’ was put out twice a year to keep authors, reviewers, editorial Published online: December 13, 2012

Prof. Dr. med. Chris T. Bolliger

From 1999, he was associate professor and since 2002 full professor at the University of Stellenbosch in South Africa. Chris Bolliger was very active in the scientific world and published over 200 works including original papers, review articles and many articles in book series. He was active in the scientific organization of the European Respiratory Society for over 12 years and held various high positions until he reached Head of Clinical Assembly. As Editor-in-Chief of the journal Respiration , he put all his strength and effort into the furthering of the journal, and the good position the journal has achieved in the scientific world is largely due to his contributions over the years. Within his specialty field, he engaged himself significantly with interventional pulmonology and recently helped his colleagues in the organization of the first European congress on the topic. Professor Chris Bolliger has left a big hole in the clinical and scientific world both as a friend and as a colleague and we will miss him very much. He leaves behind a wife and three children and we would like to offer his family our heartfelt condolences.