The objective was to compare the radial strength and expansile precision of self-expanding stents and balloon-expandable stents in a human cadaver bifurcation model. Seven different self-expanding (LUMINEXX, JOSTENT SelfX, JOSTENT SelfX hrf, Sinus-Repo, Sinus SuperFlex, Easy Wallstent, SMART) and four different balloon-expandable stent models (Palmaz, Sinus Stent, SAXX Medium, JOSTENT peripheral), each type 10 stents (total n = 110 stents) were implanted into the common iliac arteries of human cadaver corpses. The maximum stent diameter was 10 mm for all models. After stent implantation, the specimens were filled with silicone caoutchouc. After 24 h, the vascular walls including the stents were removed from the hardened casts. Diameters were taken and the weight of the cast cylinders was measured in air and in purified water to calculate the volume of the bodies (according to Archimedes Law) as a relative but precise degree for the radial strength of the implanted stents. The cylindrical casts of the self-expanding stents showed lower mean diameters (8.2 +/- 1.0 mm) and mean volumes (0.60 +/- 0.14 ml/cm) than in the balloon-expandable stent group (10.1 +/- 0.3 mm and 0.71 +/- 0.04 ml/cm, respectively; p < 0.01). The nominal maximum diameter of 10 mm was not achieved in any of the self-expanding stents, but this was achieved in more than 70% (29/40) of the balloon-expandable stent specimens (p < 0.05). The variation between achieved volumes was significantly larger in self-expanding (range: 0.23-0.78 ml/cm) than in balloon-expandable stents (range: 0.66-0.81 ml/cm; p < 0.05). Self-expanding stents presented considerably lower radial expansion force and lower degree of precision than balloon-expandable stents.

High radial strength and low elastic recoil are important requirements of any stent design. Ex vivo tests unlike in vitro physical testing facilitate a realistic evaluation of the inherent stent characteristics. The model used in this study proved to be uniformly valid for physical stent design testing.

A 55-year-old man was referred to our department with bleeding from a painless tumor located at the left parietal region of the head which had been progressively growing for a period of 2 years. Physical examination showed a fist-sized pediculated mass overlying the left parietal region and the auricle. The partly livid and ulcerated surface of the tumor was interspersed with light-yellow chalky material. The mass was totally excised. Infiltration of the skull was not observed. Histopathological examination led to the diagnosis of a giant pilomatricoma. Pilomatricoma is a rare, benign skin neoplasm that originates from hair matrix cells and is most frequently located in the head and neck region.

Zusammenfassung Hintergrund Das kutane Plattenepithelkarzinom (kPEK) als weltweit zweithäufigster Hauttumor ist überwiegend an Kopf und Gesicht lokalisiert. Aufgrund der steigenden Anzahl älterer Menschen und der dadurch zunehmenden Inzidenz gewinnt es in den letzten Jahren an Relevanz im HNO-Fachgebiet. Material und Methoden Diese Übersichtsarbeit basiert auf einer selektiven Literaturrecherche in PubMed, der deutschen und europäischen Leitlinie sowie klinikeigenen Erfahrungen. Ergebnisse Ätiologisch ist neben der chronischen UV-Exposition eine Störung des körpereigenen Abwehrsystems zunehmend bedeutend. Die vertikale Tumordicke ist mit dem höchsten Risiko einer Metastasierung und eines Lokalrezidivs assoziiert. Weitere bedeutende Risikofaktoren sind: horizontaler Tumordurchmesser, Entdifferenzierung, Desmoplasie, perineurales Wachstum und Lokalisation im Gesicht. Zumeist ist die Exzision mit histologischer Schnittrandkontrolle als Therapie ausreichend. Bei klinischem Verdacht auf lokoregionäre Metastasen sollen je nach Lokalisation des Primärtumors die drainierenden zervikalen Lymphknotenlevel ausgeräumt werden. kPEK der oberen Gesichtshaut und der Ohrmuschel metastasieren bevorzugt zuerst in die Glandula parotidea. Mit der Zulassung des PD-1-Antikörpers Cemiplimab in Europa steht erstmals ein Wirkstoff zur Behandlung fortgeschrittener, chirurgisch oder durch Strahlentherapie nicht therapierbarer kPEK zur Verfügung. Schlussfolgerungen Die grundsätzlich sehr niedrige Mortalität des kPEK erhöht sich erheblich, wenn Metastasen auftreten. Dementsprechend sollen sich bildgebende Verfahren, chirurgische Therapie und Nachsorgeintervalle an den Risikofaktoren orientieren. Hierdurch können Metastasen oder Lokalrezidive frühzeitig erkannt und die Prognose verbessert werden.

Various interdisciplinary guidelines recommend that in-patients at risk of venous thromboembolism should receive pharmacologic prophylaxis. Among the anticoagulants low-molecular-weight heparins (LMWH) and fondaparinux can be considered the medications of choice because of the favorable pharmacokinetic properties when compared with unfractionated heparin. Treatment with vitamin K antagonists has to be interrupted in patients undergoing major surgery or invasive procedures. Oral anticoagulation has to be temporarily replaced by short-acting anticoagulants such as LMWH in order to prevent thromboembolic complications (anticoagulation bridging). Although LMWHs have not been approved for this clinical setting their efficacy and safety has been demonstrated in several recent studies. Detailed recommendations for prophylaxis of venous thromboembolism in otorhinolaryngology are lacking although numerous surgical procedures are considered to be associated with a significant risk of thromboembolism. A strategy for pharmacologic prophylaxis of venous thromboembolism and anticoagulation bridging in otorhinolaryngology is proposed.