Role of endothelium in the production of polyblasts (mononuclear wandering cells) in inflammation. 1926

Reproduced from Archives of Pathology & Laboratory Medicine. 1926;1:41–63, with permission from the American Medical Association.Also see page 67 for a current review of the subject matter discussed in this manuscript.

[Value of fine needle aspiration biopsy in diagnosis of cervical masses]

Fine needle aspiration is a widely used diagnostic tool. Its use for the evaluation of head and neck masses remains somewhat controversial. This retrospective study analyses all patients presenting with neck masses investigated by fine needle aspiration in our institution from January 1997 to December 1998. 372 fine needle aspirations were performed. Cytological diagnosis was possible in 91%. Sensitivity was found to be 100%, specificity 99% and accuracy 99.7%. When including indeterminants in the false-negatives, overall sensitivity is 73%, overall specificity 100% and overall accuracy 90%. There were no complications, and in particular no suprainfection and no tumoural spread at the puncture site. We conclude that fine needle aspiration is a sensitive and specific modality which is very helpful in the diagnostic work-up of a neck mass.

[Residual bacterial contamination of rhinoscopes used in ENT consultation after cleaning with a pad impregnated with a disinfectant]

INTRODUCTION

The duration of the official disinfection procedure of a Hopkins rhinoscope agreed by the hospital hygiene authorities may be a handicap in a busy ENT consultation. A shortened procedure is sometimes used, but without risk assessment.

OBJECTIVE

To determine the risk of contamination of the endoscope used for rhinoscopy after simple manual cleaning with a pad impregnated with a disinfectant solution (Neosabenyl).

PATIENTS AND METHOD

In 60 patients undergoing rhinoscopy at our ENT policlinic, a nasal swab as well as the endoscope were examined bacteriologically. The nasal physiological flora and specifically Staphylococcus aureus were semiquantitatively analysed on each specimen. In 50 patients, the rhinoscopes were simply cleaned with an impregnated pad, whereas in 10 patients the official disinfection procedure with glutaraldehyde was applied.

RESULTS

25 out of the 50 endoscopes (50%) which were manually cleaned with the impregnated pad, were still contaminated with bacteria. Among the 12 (20%) identified healthy carriers of S. aureus, 7 (58%) showed a rhinoscope still contaminated with S. aureus after cleaning with the pad. The overall risk of contaminating the following patient with S. aureus is 14%. None of the 10 endoscopes cleaned and disinfected with glutaraldehyde were contaminated.

CONCLUSIONS

Simple manual cleaning and disinfection with an impregnated pad is insufficient and carries the risk of contaminating the following patient. This emphasises the need to follow the recommended cleaning and disinfection procedures even in a small or busy practice.

[The role of the head and neck surgeon in difficult intubation]

The place of the Head and Neck Surgeon in the management of the difficult airway. The Head and Neck Surgeon may help the anesthetist to secure the airway, in elective or emergency situations. This paper presents his endoscopic (rigid bronchoscopy, flexible bronchoscopy, endoscopically controlled transtracheal puncture) and surgical intubation techniques, and when to use them within a standard algorithm for difficult airway management.

[Evaluation of combined neurosurgical and trans-facial excision of extensive rhinosinus tumors infiltrating the anterior skull base]

Rhino-sinusal tumors are rare, representing approximately 0.3% of all cancers and 3% of tumors of the upper respiratory and digestive tracts. In cases in which the tumor has infiltrated the anterior cranial base, the treatment of choice is a surgical resection by combined neurosurgical and transfacial approach giving the best possible exposition for the excision. The resection is associated with various reconstruction techniques according to the extent of the defect. Sixteen patients with rhino-sinusal tumors extending to the anterior cerebral cavity were operated at the ENT clinic of the CHUV in Lausanne between 1977 and 1997. The transfacial and neurosurgical combined approach is rarely curative (30% 5 years survival rate, 80% local recurrence during follow-up), but is still justified, given that its disabling side-effects are scarce. It offers an acceptable quality of life and prevents complications inherent to the natural development of tumors. Pre- or postoperative radio- and chemotherapy, as well as skull base reconstructions using bone grafts or a micro-anastomosed flap give rise to complications which worsen significantly the overall prognosis and should therefore be avoided as much as possible. Still, this heavy surgery remains indicated, because it prevents the numerous complications of the natural course of the disease and offers an acceptable quality of life with only few side-effects.

Long-segment congenital tracheal stenosis: treatment by slide-tracheoplasty

BACKGROUND/PURPOSE

The prognosis of long-segment funnel-shaped congenital tracheal stenosis improved with surgical management by enlargement-tracheoplasty with a pericardial patch. However, the final outcome is not always satisfying mainly because of the complications related to the pericardial graft and because of misdiagnosed associated cardiovascular malformations. The objective of the report is to show a further improvement of the prognosis by a thorough preoperative planning and the use of a slide-tracheoplasty for the cure of the stenosis, to avoid the major drawbacks of enlargement tracheoplasties.

METHODS

Two children, 7 months and 3 years old, underwent a bronchoesophagoscopy, spiral computed tomography, an echocardiogram, and a heart catheterization. The tracheal stenosis and the associated severe cardiovascular malformations were cured during a single operative session under cardiopulmonary bypass; the tracheal stenosis was corrected by a slide-tracheoplasty.

RESULTS

The postoperative period was remarkably uneventful and the recovery extremely quick (hospital stay of 18 and 17 days). The midterm results are excellent, and the tracheal growth is not impaired (follow-up of 3 1/2 and 3 years).

CONCLUSIONS

According to the authors' experience and to the literature, the slide-tracheoplasty seems to be the most efficient surgical procedure for correction of long-segment funnel-shaped congenital tracheal stenosis. But the success of the treatment depends also on a complete preoperative diagnosis allowing a 1-stage surgical treatment of all associated thoracic malformations.

Anaesthesia for tracheal resection: report of 17 cases

PURPOSE

Laryngo-tracheal stenosis remains a major complication after prolonged intubation or tracheostomy. Surgical resection with end-to-end anastomosis carries the best long term prognosis. For the anaesthetist, however, this procedure represents a most challenging situation.

METHODS

Since 1993, we have used high frequency jet ventilation (HFJV) for tracheal resection. This paper describes the technique and the results of our series including 7 adults and 10 children.

RESULTS

There were no adverse haemodynamic or ventilatory consequences due to HFJV. Oxygenation was well maintained during the HFJV period. Sixteen of the 17 patients had a good outcome. Despite the good result of the resection-anastomosis, one child still suffers from an associated posterior glottic stenosis.

CONCLUSION

Since the introduction of HFJV for surgery of tracheal stenosis in our institution no complication of this ventilatory technique has occurred. It reduces the manipulation of the ventilation system and the period of apnea, thus decreasing the risk of hypoxaemia. The good access to the surgical field contributes to the success of resection-anastomoses in laryngo-tracheal stenosis.

[The current status of broncho-esophagoscopy in otorhinolaryngology]

Most bronchoscopies and esophagoscopies are currently performed with flexible instruments by the respective specialist. Thus the field of bronchoesophagology is in danger of being fragmented; neither the pneumologist nor the gastroenterologist have the complete overview of the upper respiratory and digestive tract. This review shows that number of pathologic conditions in the ENT area and the mediastinum involve the upper respiratory as well as the digestive tract, and thus underscore the need for combined tracheobronchial and esophageal endoscopy. Mastering of rigid and flexible endoscopy is mandatory to be efficient in diagnostic and therapeutic broncho-esophagoscopy. The ENT specialist is in the best position to maintain an overview of this whole field. New developments in broncho-esophagoscopy are presented and discussed in terms of cost effectiveness.

[Proximal humeral multiple fragment fractures--failures after T-plate osteosynthesis]

Dislocated compound fractures of the proximal humerus are often difficult to treat. The choice of treatment influences the final functional result. From 1984-1991 108 patients with dislocated compound fractures of the proximal humerus were operated with a T-plate osteosynthesis, retrospectively examined and classified according to the Neer-Classification. At an average follow up time of 5 years 72 patients had a clinical and radiological examination. 68% of these patients with 3-fragment fractures and 80% with 4-fragment fractures showed a modest to unsatisfactory result caused by fracture biology, imprecise fracture reduction or poor surgical procedure. Incorrect position of T-plates and inadequate material were distinguishable. The T-plate which was widely used in the late eighties for internal fixation has to be considered a failure for these particular types of fractures and should be limited for Collum chirurgicum fractures.

[Cricothyreotomy using the Quicktrach coniotomy instrument set]

Percutaneous cricothyroidotomy may be a lifesaving procedure for airway obstruction, which cannot be relieved by endotracheal intubation and can be performed with specially designed instruments. A new device, the "Quicktrach", was evaluated by an anatomical preparation, flow and resistance measurements, and puncture of the cricothyroid membrane in 55 corpses. The size of the parts of the instrument (needle, plastic cannula, depth gauge) in relation to the size of the larynx is adequate, thus there is little likelihood of perforation of the posterior wall of the larynx. Resistance of the plastic cannula is sufficiently low to allow for adequate ventilation. The duration of time until the cannula is positioned properly in the trachea is significantly shorter, when an incision prior to the puncture is done (83 +/- 88 seconds without incision versus 35 +/- 41 seconds with incision; mean +/- SD). The "Quicktrach" is easy to apply even by inexperienced persons. The incidence of damage to the larynx (lesions including fractures of the thyroid, cricoid and 1. tracheal cartilage in 18%; soft tissue injury in 9%) is relatively high, however considering the live saving character of the procedure these numbers appear to be acceptable. Technical problems which occur with the use of the device are discussed and suggestions for improvement are made.

Osteitis Fibrosa

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