Uwe Eichfeld

Determination of temperature elevation in tissue during the application of the harmonic scalpel

The temperature elevation in tissue during the application of the harmonic scalpel (UltraCision, operating frequency 55 kHz; Ethicon Endo-Surgery, Norderstedt, Germany) was determined using thermocouples of a specific design. In experiments with and without perfusion, two different scalpel blades were applied to three different kinds of pig tissue (lung parenchyma, tongue, parotid gland) in various configurations. Temperature elevations by more than 40 degrees C were found at 1 mm distance from the blade, whereas at distances of more than 5 mm, perfusion removed the heat very efficiently. The differences in the heating potential of the two blades were small and, at a distance of 2 mm, the temperature elevation did not exceed 6 degrees C at all. In histological investigations, the damaged area between blade and parenchyma was determined. No morphologic indications of thermal damage were found at a distance of more than 2 mm. It is concluded that, during application of the harmonic scalpel, a safety margin of 3 mm from sensitive structures should be kept.

Evaluation of ultracision in lung metastatic surgery

BACKGROUND There are very few studies on the histological outcome of lung metastatic surgery using the Ultracision particularly in deeper areas of the lung. METHODS In a prospective study, we resected 24 lung metastases from 18 patients using the Ultrasonic scalpel (Ethicon Endo-Surgery, Norderstedt, Germany). We analyzed the risk of bleeding and air leakage as well as the histopathological features of the resection area. RESULTS There was no intraoperative bleeding and, in 72%, no intraoperative air leakage. The resection surface was closed with a suture. In 8 cases, the metastases were located deeply, near the hilus of the lobe which did not necessitate a lobectomy. Histologically, occluded blood vessels as well as occluded small bronchioli under 0.1 cm were observed. There was no evidence of deep tissue destruction. No postoperative complications occurred. CONCLUSIONS Ultracision in metastatic lung surgery is an appropriate method of treatment with minimum risk of bleeding or air leakage. This procedural approach allows for adequate resection of lung metastases while sparing a generous amount of healthy lung tissue.

Die Recurrensparese als Intubationsschaden

Abstract.Introduction: Vocal cord paralysis is a important complication in thyroid gland surgery. A prospective study was conducted ascertain the frequency of laryngeal nerve palsy not caused by surgical trauma. Patients and Methods: Two hundred and ten patients were investigated laryngoscopically pre- and postoperatively after short-term intubation in the course of operations far removed from thorax or neck region. We noted the inner diameter of the tube, intubation problems, the qualification of the anaesthesiologist and the positioning of the patient. Results: Preoperatively we found previously unknown unilateral laryngeal nerve palsy in 1.9 % of cases. Postoperatively there were pathological findings of vocal cords in 13 patients (6.2 %). In 10 patients a direct lesion (oedema, rubor, haematoma, granuloma) was established. Three patients (1.4 %) were found to have a movement disorder caused by a neural lesion without morphological findings, leading to restitutio ad integrum in two of three cases after 6 months. Conclusion: The frequency of intubation-related recurrent nerve palsy is 1.4 % transiently and 0.5 % permanently. The reasons are discussed. Preoperative laryngoscopic investigation of vocal cords should be carried out before intubation.Zusammenfassung.Einleitung: Wir untersuchten, ob für die Recurrensparese nach Schilddrüsenoperation andere Ursachen als das Operationstrauma verantwortlich sein könnten. Patienten und Methode: Prospektiv wurden 210 Patienten prä- und postoperativ nach Kurzzeitintubation bei halsferner Operation laryngoskopisch untersucht und Liegedauer und Innendurchmesser des Tubus, Intubationsschwierigkeiten, Qualifikation des Anaesthesisten sowie die Lagerung des Patienten erfaßt. Ergebnisse: Präoperativ konnte in 1,9 % eine bisher unbekannte Recurrensparese diagnostiziert werden. Postoperativ fanden sich in 13 Fällen (6,2 %) pathologische Stimmlippenbefunde. Bei 10 von 13 Patienten war eine direkte Schädigung (Ödem, Rötung, Hämatom, Granulom) nachweisbar. In 3 Fällen (1,4 %) fand sich eine Bewegungsstörung bei morphologisch unauffälligem Befund mit Restitutio ad integrum in 2 von 3 Fällen nach 6 Monaten. Schlußfolgerungen: Die intubationsbedingte Recurrenspareserate beträgt 1,4 % passager (permanent 0,5 %). Die Ursachen sind multifaktoriell und werden diskutiert. Zu empfehlen ist aus forensischen Gründen die Erhebung eines laryngoskopischen Stimmlippenbefundes vor jeder Intubation.

INFLAMMATORISCHER PSEUDOTUMOR DER LUNGE BEI HILUSLYMPHKNOTENHISTOPLASMOSE

Summary. The article deals with the case of an inflammatory pseudotumour of the lung in conjunction with histoplasmosis of the hilar lymph glands in a 35-year-old immunocompetent woman in a non-endemic area. She had been suffering from headaches and painful swelling of the lower legs, reddening and hyperthermia for 1.5 years. In addition to the above-mentioned symptoms she also complained of a typical flush syndrome which had begun a year later. The main paraclinical finding was a round mass in the right lung in chest radiography. After considering various differential diagnostic possibilities, thoracotomy and resection of the upper lobe of the right lung were performed. The histological diagnosis of the material removed was that of an inflammatory pseudotumour of the lung, combined with histoplasmosis of the hilar lymph glands. Following a postoperative period without complications, antimycotic treatment was performed. The discussion includes whether the simultaneous occurrence of these two diseases is coincidental or whether there is a causal relation between the two. The authors also discuss various treatments with reference to the relevant literature.Zusammenfassung. Beschrieben wird der Fall eines inflammatorischen Pseudotumors der Lunge, kombiniert mit einer Hiluslymphknotenhistoplasmose außerhalb eines Endemiegebiets bei einer immunkompetenten 35 jährigen Patientin. Seit eineinhalb Jahren litt die Patientin an Kopfschmerzen und schmerzhaften Schwellungen der Unterschenkel, einhergehend mit Rötung und Überwärmung. Weiterhin beschrieb die Patientin typische Flush-Anfälle, die vor einem halben Jahr hinzugekommen seien. Hauptbefund war ein röntgenologisch festgestellter suspekter runder Verschattungsherd in der rechten Lunge. Nach Abklärung der differentialdiagnostischen Möglichkeiten wurde eine Oberlappenresektion rechts durchgeführt, die histologische Aufarbeitung der Operationspräparate ergab einen inflammatorischen Pseudotumor der Lunge bei gleichzeitig bestehender Histoplasmose der Hiluslymphknoten. Nach einem komplikationsfreien postoperativen Verlauf wurde eine antimykotische Behandlung angeschlossen. Diskutiert werden das möglicherweise zufällige gleichzeitige Auftreten zweier Krankheitsbilder bzw. deren kausale Beziehung sowie das therapeutische Vorgehen mit Blick auf die einschlägige Literatur.

Response to TNF-α Is Increasing Along with the Progression in Barrett’s Esophagus

Background and AimsBarrett’s esophagus, a metaplasia resulting from a long-standing reflux disease, and its progression to esophageal adenocarcinoma (EAC) are characterized by activation of pro-inflammatory pathways, induced by cytokines.MethodsAn in vitro cell culture system representing the sequence of squamous epithelium (EPC1 and EPC2), Barrett’s metaplasia (CP-A), dysplasia (CP-B) to EAC (OE33 and OE19) was used to investigate TNF-α-mediated induction of interleukin-8 (IL-8).ResultsIL-6 and IL-8 expressions are increasing with the progression of Barrett’s esophagus, with the highest expression of both cytokines in the dysplastic cell line CP-B. IL-8 expression in EAC cells was approx. 4.4-fold (OE33) and eightfold (OE19) higher in EAC cells than in squamous epithelium cells (EPC1 and EPC2). The pro-inflammatory cytokine TNF-α increased IL-8 expression in a time-, concentration-, and stage-specific manner. Furthermore, TNF-α changed the EMT marker profile in OE33 cells by decreasing the epithelial marker E-cadherin and increasing the mesenchymal marker vimentin. The anti-inflammatory compound curcumin was able to repress proliferation and to activate apoptosis in both EAC cell lines.ConclusionThe increased basal expression levels of IL-8 with the progression of Barrett’s esophagus constrain NFκB activation and its contribution in the manifestation of Barrett’s esophagus. An anti-inflammatory compound, such as curcumin, could create an anti-inflammatory microenvironment and thus potentially support an increase chemosensitivity in EAC cells.

Das gut differenzierte fetale Adenokarzinom (pulmonaler endodermaler Tumor) der Lunge als Sonderform des pulmonalen Blastoms

Zusammenfassung Pulmonale Blastome sind eine seltene, heterogene Gruppe maligner pulmonaler Mischtumoren. Unter diesen stellt das gut differenzierte fetale Adenokarzinom der Lunge eine Sonderform ohne sarkomatöse Entartung dar, dessen Diagnostik an eine subtile pathohistologische Untersuchung gebunden ist. In der vorgestellten Kasuistik werden erstmalig ein bilaterales Vorliegen dieses Tumors referiert und therapeutische Strategien dieser Tumorentität diskutiert.Summary Pulmonary blastomas are a rare and heterogeneous group of malign pulmonary tumors. Among them the well-differentiated fetal adenocarcinoma of the lung (pulmonary endodermal tumor) acts as a special entity of pulmonary blastoma. The diagnosis is based on a subtle pathohistological examination. In our case report we describe a bilateral manifestation of this tumor and discuss therapeutic strategies.

Häufigkeit und klinische Symptomatik der doppelseitigen Recurrensparese nach Schilddrüsenoperation

Die Haufigkeit der permanenten doppelseitigen Recurrensparese (>1 Jahr persistierend) nach Schilddrusenoperationen bei praoperativ frei beweglichen Stimmlippen betragt in der vorliegenden Untersuchung (n=1126) 0,3%. Fur die Erstoperation einer nichtmalignen Struma wurde eine permanente doppelseitige Pareserate von 0,1%, fur Karzinomoperationen von 0,9% und fur Operationen von Rezidivstrumen von 1,9% ermittelt. Die unmittelbar postoperative klinische Symptomatik doppelseitiger Paresen reichte von Beschwerdefreiheit (n=4) bei beidseits inkompletter Parese uber Heiserkeit (n=4) bis zu hochgradiger Dyspnoe (n=4). In diesen Fallen waren im postoperativen Intervall von Minuten uber 3–4 Stunden bis zu 5 Tagen Reintubation und Tracheotomie erforderlich. Die Grunde fur die variable Symptomatik liegen im Ausmas der Recurrens-schadigung und der daraus resultierenden Stellung der Stimmlippen begrundet.