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Kryochirurgie I. Kryochirurgie, Kryotechnik, Kryonekrose Ultrastrukturelle Morphologie der Kryoläsion

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Neue Entwicklungen in der Dermatologie

Zusammenfassung

Nach einer historischen Darstellung der Entwicklung der Kälteanwendung in der Medizin werden die kryobiologischen Grundlagen und phasenorientierte Kryoläsion — physikalische Phase, Gefäßphase und immunologische Phase — dargestellt.

Dabei werden die für eine optimale kälteinduzierte Zellzerstörung notwendigen Gefriergeschwindigkeiten (100° C/min) und Auftaugeschwindigkeiten (höchstens 10° C/min) herausgearbeitet; unter Einhaltung dieser Kriterien stellt sich die Kryoläsion an der Haut dreidimensional dar.

Nur im Zentrum der Vereisung (Zone I) findet sich die für eine optimale Zellzerstörung notwendige „homogene Nucleation“. Eine Gegenüberstellung der beiden Sondensysteme (offenes Sprayverfahren/Kontaktverfahren) durch Messung der Eisballausdehnung und damit der Nekrosetiefe spricht eindeutig für die Anwendung des offenen Sprayverfahrens in der Dermatologie bei Verwendung von flüssigem Stickstoff.

Die elektronenmikroskopischen Befunde zeigen die kälteinduzierten Veränderungen bei Kryoläsion.

Summary

After a historical review on the development of the medical use of cryo, the cryobiological basics and the phases of the cryolesion — physical phase, vascular phase and immunological phase — are shown.

The speed of freezing (100° C/min) and the speed of thawing (max 10° C/min), which are necessary for an optimal cryo-induced cell-destruction, are evaluated; if these parameters are followed, the cryolesion of the skin shows a threedimensional form.

The “homogeneous nucleation”, which is necessary for an optimal destruction of the tumor-cells, is found only in the center of the lesion (zone 1). A comparison of the two systems of probes (open spray-system vs. contact-system) is made by measuring the range of the iceball, i.e. the depth of the necrosis, showing the evident superiority of the open spray-system using liquid nitrogen as the freezing medium.

The electron-microscopical results show the cryo-induced necrosis of cryolesions.

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  1. Universitäts-Hautklinik, Eppendorf, Martinistr. 52, 2000, Hamburg 20, Deutschland

    Priv.-Doz. Dr. med. E. W. Breitbart, G. Schaeg, M. Jänner, W. Rehpenning & A. Carstensen

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Breitbart, E.W., Schaeg, G., Jänner, M., Rehpenning, W., Carstensen, A. (1988). Kryochirurgie I. Kryochirurgie, Kryotechnik, Kryonekrose Ultrastrukturelle Morphologie der Kryoläsion. In: Hornstein, O.P., Hundeiker, M., Schönfeld, J. (eds) Neue Entwicklungen in der Dermatologie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-73581-3_5

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