[Suspected rare manifestation of a thyroglossal and lateral cervical cyst-a diagnostic and therapeutic approach]

A 34-year-old female patient presented to our department with a 1.5 cm midline cystic lesion of the neck. A second cystic mass was found in level 2 of the left lateral neck. Following complete resection, histopathological examination revealed the diagnosis of a dystopic papillary thyroid carcinoma. Total thyroidectomy and bilateral neck dissection were performed. The patient developed transient postoperative hypoparathyroidism. The specimen showed four intraparenchymal parathyroid glands. Treatment with radioactive iodine was conducted.

[Management of traumatic tracheal injuries: presentation of a rare case and review of the literature]

BACKGROUND

Traumatic injuries of the tracheobronchial system are rare, but a big challenge for the clinician in early diagnosis and optimal management in the prevention of high fatality and morbidity.

PRESENTATION OF THE CASE

We present the case of a patient with suicidal deep cervical stabbing wound and consecutive subtotal transsection of the trachea. The patient was treated by an interdisciplinary team and emergency operation was performed after admission to the hospital. Intubation was done through the stabbing wound and the knife was removed intraoperatively. After removal the knife an end-to-end reanastomosis of the trachea was performed. There were no further injuries of large vessels or the oesophagus. The long term result showed, with the exception of a unilateral palsy of the recurrent laryngeal nerve and consecutive minor dysphonia, no further morbidity.

CONCLUSIONS

The management of tracheobronchial injuries consists, depending on the severity, of emergency operation, in cases of tracheal rupture, haemorrhage or oesophageal injury, or of selective operation, in cases of minor injury and clinically stable patient. In the diagnostic pathways, the clinical examination is followed by radiologic imaging, angiography, computer tomography, and tracheo-bronchio-esophagoscopy. Particularly dangerous are total tear-offs of the trachea, tracheal contusions, tracheal or oesophageal fistula and postoperative stenosis of the trachea. The prognosis of the patient is largely dependent on an early diagnosis and good interdisciplinary management.

[Comparison between the Eppendorf histograph and the Licox system for determination oxygen partial pressure in tumor tissue]

BACKGROUND

The oxygenation of a tumor is certainly one of the major facts influencing the response to treatment. pO2 measurement in tumor tissue can be done by using the Eppendorf-histograph. In recent years the Licox-system (GMS) was developed for oxygen tension measurement in tissues and fluids under clinical routine conditions and for research work. Aim of the present study was to assess the suitability of the Licox-system in drawing up histograms of pO2 values in tumor tissues.

METHOD

Histograms of the distribution of oxygen tension in twelve tumors were prepared with both measuring systems in parallel. Investigations were performed on rats with isotransplanted R1H rhabdomyosarcomas in continuous intravenous anesthesia with Fentanyl and Dormicum. Ventilation with a mixture of air and oxygen was applied through a tracheostoma. Arterial pressure and body temperature were analysed and balanced continuously.

RESULTS

No correspondence between data of both measuring methods could be found.

CONCLUSIONS

Because of constructional advantages the Eppendorf-histograph seems to be comparatively more suitable in drawing up histograms of oxygen tension tumor tissue.

MRT in der präoperativen Diagnostik der chronischen Sinusitis im Vergleich mit der CT

PURPOSE

To determine the value of MRI in the preoperative evaluation of chronic paranasal sinusitis and to compare the results with CT and intraoperative findings.

METHOD/MATERIALS

42 patients with clinical signs of chronic paranasal sinusitis underwent MRI after CT evaluation on one day, with subsequent functional endoscopic sinus surgery on the next day. Coronary CT was obtained with 5-mm slices and table-feed in the prone position, while MRI was performed in the supine position with coronary T2-TSE + pd and coronary and transverse HASTE, each with 5-mm slice thickness. Aquisition time in MRI was less than 8 minutes. Two radiologists reviewed the CT and MRI scans for signs of sinusitis and detection of anatomical landmarks. The results were correlated with the intraoperative findings.

RESULTS

MRI offered no artifacts of dental work and showed more often high quality pictures than CT. CT and MRI demonstrated a good correlation in the detection of mucosal pathologies (kappa = 0.46-0.87) and anatomic variants (kappa = 0.55-0.86). All important anatomical structures could be evaluated sufficiently with MRI for preoperative management. Both diagnostic tools showed an unsatisfactory correlation with intraoperative findings in the ethmoidal complex and maxillary sinus (tau = -0.08-0.3).

CONCLUSIONS

MRI is a fast and reliable alternative to preoperative CT in examining paranasal sinuses and offers a good visualization of mucosal changes. CT and MRI both give an unreliable representation of the ethmoidal complex.