Dermal microvasculature and tissue selective thinning techniques (ultrasound and water-jet) of short-time expanded skin in dogs.

Certain reconstructive procedures, like auricular reconstructions, require thin and well-vascularized skin. The aims of this study were to analyze if the increased survival of expanded skin flaps was due to morphologic changes of the dermis, if thinning of short-time expanded skin was possible without harm to the microcirculation and if tissue selective cutting methods could be used to resect subcutaneous fat without damaging its vessels. Eighty-two 200-ml expanders were implanted into the trunk regions of 26 beagles and filled immediately with sterile saline. In the first series of experiments, the expansion was terminated after intervals of 0.5-5 weeks and dermal vessels were analyzed morphometrically. In the second series the expanded flaps were raised after 2 weeks and thinned solely surgically or with the additional use of an ultrasonic knife or with cutting by water jet. In contrast to sham flaps, the expanded skin showed only very few areas of necrosis and these were located superficially in most cases. The relative volume of the dermal vessels and their quantity showed a significant increase after the expansion. Additionally, the subcutaneous tissue could be thinned down to 0.4 mm with the water-jet-cutter. Findings demonstrated that the method used could create a well-vascularized skin flap of minimal thickness that could be very helpful for special reconstructive procedures.

[Isolated histiocytosis X as rare differential diagnosis of indistinguishable neck lymph node swelling. A case report]. / Die isolierte Histiozytosis X als seltene Differentialdiagnose der unklaren Halslymphknotenschwellungen. Ein Fallbericht.

Cervical lymphadenopathies are widespread diseases in otorhinolaryngology. There are many differential diagnoses which have to be considered when swelling persists. To gain further information it is advisable to perform sonographically controlled fine needle aspiration biopsy (FNP). If there is no reliable result, it is necessary to remove a lymph node. We report on the rare case of isolated histiocytosis X in lymph nodes. A 63-year-old male had noticed a swelling of the right side of the neck about 6 weeks previously. The preliminary examinations (FNP/blood examinations) revealed no pathological findings. Only the histological examination delivered the diagnosis of histiocytosis X. Systemic manifestation was excluded by staging examinations. No further therapy was necessary after lymph node extirpation. The report demonstrates how to diagnose and treat this rare disease.

[Suction-irrigation attachment for the flexible endoscope without integrated operating channel]. / Saug-Spül-Erweiterung für flexible Endoskope ohne integrierten Arbeitskanal.

BACKGROUND: Endoscopic inspection of the larynx in patients with long-term intubation or patients pharyngolaryngeal injuries is frequently obscured by blood and other secretions. We developed a simple procedure to improve visibility. METHODS: A flexible 4-mm endoscope without an operating channel is inserted into an 18-French suction tube through one branch of a Y-shaped connecting tube (Fig.1). Fluid can be aspirated between the endoscope and the surrounding tube. The site can be flushed in a similar manner. RESULTS: In all examined patients (n = 11) we successfully aspirated fluid (blood/saliva/etc.). CONCLUSIONS: Our proposed suction and irrigation attachment for flexible 4-mm endoscopes without an operating channel permits reliable aspiration under endoscopic inspection, simplifying endoscopic visualization of laryngeal or pharyngeal findings.

[Ultrasound imaging of nasal bone fractures with a 20-MHz ultrasound scanner]. / Ultrasonographische Darstellung von Nasenbeinfrakturen mit einem 20-MHz-Ultraschallgerät.

High frequency B-scan ultrasonography is a proven method for the assessment of skin tumors and evaluation of the thickness of skin and cartilage layers. Only limited studies have used sonography to examine bony structures. Our goal was to evaluate the importance of ultrasonography in the diagnosis of nasal fractures. Patients with clinical and/or radiological evidence for such fractures were also examined with 20 MHz B-scan ultrasonography. Results of sonography demonstrated a significant correlation with the nasal fractures present, indicating that additional radiographic examinations are unnecessary in certain cases.

[Ultrasound diagnosis of orbital floor fractures: an alternative to computerized tomography?]. / Sonographie von Orbitabodenfrakturen: Eine Alternative zur Computertomographie?

BACKGROUND: Plain radiography of the paranasal sinuses (Water's view) may fail to demonstrate typical signs of orbital floor fractures. To resolve questionable cases, computed tomography (CT) is performed. B-mode ultra-sonography (US) is investigated concerning its reliability and as a possible alternative to CT. The replacement of standard radiological techniques in primary evaluation will be discussed. METHODS: A skull was used to assess the visualization of the bony floor in the ultrasound-technique. Fifteen patients with suspected fractures of the orbital floor were investigated with plain radiographs, ultrasound of both orbits in closed-eyelid technique, and CT scans. The findings were compared. RESULTS: Thirteen patients were found to have apparent fractures in CT scans. These fractures were also diagnosed on ultrasound. In three patients, ultrasonographic localization was imprecise. These fractures were located behind the lower orbital rim or far posteriorly. Plain radiographs showed positive fracture signs only in five patients. Localization was not possible. The application of the ultrasound probe was well tolerated. CONCLUSIONS: B-mode ultrasonography is a valuable and inexpensive technique to visualize orbital floor fractures. It should be employed in primary evaluation patients with suspected isolated orbital floor fractures prior to taking plain radiographs of the paranasal sinuses. Computed tomography should be used in suspected complex fractures and questionable orbital fractures.

[Ultrasound measurement of skin and cartilage thickness in healthy and reconstructed ears with a 20-MHz ultrasound device]. / Ultrasonographische Haut- und Knorpeldickenmessungen an gesunden und rekonstruierten Ohren mit einem 20-MHz-Ultra-schallgerät.

BACKGROUND: The surgical reconstruction of the external ear according to Weerda is a proven method to correct malformed or amputated auricles. Our goal was to test the usefulness of high-frequency ultrasound in measurement of layer-thickness of auricles. METHOD: Using a 20-MHz B-Mode ultrasonographic method (Dermascan C, adn-Medizintechnik, Hamm, Germany) we measured the thickness of skin and cartilage layers in patients with normal auricles (n = 47) and reconstructed auricles (n = 15) in vivo. RESULTS: The average thickness of the cutis of normal auricles was 0.8 mm, the subcutis and the cartilage layer 0.6 mm thick on average. In reconstructed auricles, the thickness of the cutis averaged 1.0 mm, the subcutis 1.1 mm, and the cartilage layer (to the extent that it could be visualized) 3.0 mm. DISCUSSION: The results demonstrate a good approximation of the thicknesses of the different layers (cutis and subcutaneous tissue) in reconstructed and natural external ears, but the cartilage of the reconstructed auricles is clearly thicker. CONCLUSIONS: The 20-MHz B-Mode ultrasound is suitable for examining the methods of plastic surgery in malformed auricles. Based on the demonstrated results, surgical modifications should be assessed in future.

[Kikuchi lymphadenitis. A contribution to the differential diagnosis of cervical lymph node swelling of unknown origin]. / Kikuchi-Lymphadenitis. Ein Beitrag zur Differentialdiagnose der unklaren Halslymphknotenschwellung.

According to its morphological appearance, Kikuchi's disease is also called "histiocytic necrotizing lymphadenitis". This disorder was first described in Japan in 1972 as a benign lymphadenopathy of the neck. In Germany only a few cases have been reported by pathologists, whereas most clinicians are unaware of the existence of this rare disease, which can easily be mistaken for malignant lymphoma. In 1993 three cases of Kikuchi's lymphadenitis were treated at the ENT Department of the University of Lübeck. Patients' ages ranged from 15 to 30 years old. Except for cervical adenopathy, findings in blood tests, viral serology and radiological imaging were unremarkable. While fine needle aspirations were suspicious for malignant lymphoma, a final diagnosis of self-limiting "Kikuchi's lymphadenitis" was established histologically from excised lymph nodes. In our opinion early extirpation of lymph nodes and consultation of a pathologist are necessary to make a correct diagnosis without delay. Thus, in patients with Kikuchi's lymphadenitis unnecessary staging procedures and treatment can be avoided.