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

  • E. W. Breitbart
  • G. Schaeg
  • M. Jänner
  • W. Rehpenning
  • A. Carstensen

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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Literaturverzeichnis

  1. 1.)
    Abiin, R J, Soanes, WA, Gonder, M J.: Prospects for cryo-immunotherapy in cases of metastasizing carcinoma of prostate. Cryobiology 8, 271–279 (1971).CrossRefGoogle Scholar
  2. 2.)
    Ablin, R J.: Cryosurgery of the rabbit prostate. Comparison of the immune response of immature and mature bocks. Cryobiology 11, 416–422 (1974).PubMedCrossRefGoogle Scholar
  3. 3.)
    Ablin, R J.: Cryo-immunotherapy: clinical and experimental considerations of the immune response. In: Normal and Abnormal Growth of the Prostate (Goland, Ed., Chas. C. Thomas, Springfield, 111. 788–832 (1975).Google Scholar
  4. 4.)
    Ablin, R J.: Immunological aspects of cryosurgery. An overview of recent experimental and clinical developments and their implications. In: Cryoimmunology (Simatos; Strong; Türe, Eds., Inserm. Paris, 62, 237–259 (1977).Google Scholar
  5. 5.)
    Ablin, R J, Fontana, G, Helpap, B. and the Cryoimmunotherapeutic Study Group: Cryoimmunothe- rapy. A conference report. Tumor Diagnose. 2, 246–249 (1981).Google Scholar
  6. 6.)
    Anderson, N G, Green, J G, Mazur, P.: Centrifugal freezing. I. A system for rapid freezing of aqueous cell suspensions. Nat. Cancer Inst. Monogr. 21, 415–430 (1966).PubMedGoogle Scholar
  7. 7.)
    Araki, T.: Freezing injury in mitochondrial membranes. II. Degradation of phospholipid in rabbit liver mitochondria during freezing and storage at low temperatures. Cytobiology 14, 151–159 (1977).Google Scholar
  8. 8.)
    Arnott, J.: The treatment of Cancer by the regulated application of an anaesthetic temperature. J. Churchill, London. 1851.Google Scholar
  9. 9.)
    Asahina, E.: Freezing process and injury in isolated animal cells. Fed. Proc. 24, 5183–5187 (1965).Google Scholar
  10. 10.)
    Asahina, E, Emura, M.: Types of cell freezing and the post thawing survival of mammalian ascites sarcoma cells. Cytobiology 2, 256–262 (1966).Google Scholar
  11. 11.)
    Asahina, E, Hisada, Y, Emura, M.: Survival of mammalian tumor cells frozen and thawed very rapidly. Low. Tem. Sci. Serg. B. (Sapporo) 25, 81–96 (1967).Google Scholar
  12. 12.)
    Balthasar, K.: Gezielte Kälteschäden in der Großhirnrinde der Katze. Dtsch. Z. Nervenheilk. 176, 173–199 (1957).CrossRefGoogle Scholar
  13. 13.)
    Bank, HP, Mazur, P.; Visualization of freezing damage. J. Cell Biol. 57, 729–742 (1973).PubMedCrossRefGoogle Scholar
  14. 14.)
    Bartholin, T.: De Nivis Uso Medico. Haubold, Kopenhagen. 1661.Google Scholar
  15. 15.)
    Baust, J G.: Mechanism of cryoprotection in freezing tolerant animal systems. Cryobiology 10, 197–205 (1973).PubMedCrossRefGoogle Scholar
  16. 16.)
    Bennet, J H.: On Cancerous and Cancroid Growth. Knox and Sutherland, Edinburgh, 237–238 (1849).Google Scholar
  17. 17.)
    Bowers, WD, Hubbard, R W, Daum, R C, Asbaugh, P, Nilson, E.: Ultrastructural Studies of Muscle Cells and Vascular Endothelium Immediatly after Freeze-Thaw. Injury. Cryobiology 10, 9–21 (1973).CrossRefGoogle Scholar
  18. 18.)
    Brandt, EJ, Riera, C, Orsini, F, Shulman, S.: Cryoimmunology - The booster phenomenon. Cryo- ‘biology 3, 382 (1967).Google Scholar
  19. 19.)
    Breitbart, E W: Neue Gesichtspunkte in der kryochirurgischen Behandlung von Neubildungen der Haut. In: Operative Dermatologie (Salfeld, Ed., Springer, Berlin Heidelberg, New York, 230–233 (1978).Google Scholar
  20. 20.)
    Brodthagen, H.: Local Freezing of the skin by Carbon Dioxide Snow. Munksgaard, Copenhagen. 1961.Google Scholar
  21. 21.)
    Cahan, W G.: Five years of cryosurgical experience: benign and malignant tumors with hemorrhagic conditions. In: Cryosurgery (Rand; Rinfret; Leden, Eds., Chas. C. Thomas, Springfield, 111. 388–409(1968).Google Scholar
  22. 22.)
    Cohnheim, J.; „Lectures on General Pathology”. (McKee, Ed., New Sydenham, Society, London 1889.Google Scholar
  23. 23.)
    Cooper, A J, Eraser, J D.: Autoallergic responses induced by cryoabiation of normal kidney tissue. In: Cryoimmunology (k. Simatos; k. Strong; k. Türe, Eds., Inserm. Paris, 62, 261–266 (1977).Google Scholar
  24. 24.)
    Dreutw, H Die Behandlung des Lupus durch den praktischen Arzt nebst histologischen Untersuchungen. Klin. Wschr. 47, 1216 (1904).Google Scholar
  25. 25.)
    Farrant, J, Wollgar, A E.: Possible relationship between the physical properties of solutions and cell damage during freezing. In: „The Frozen Cell” (Wolstenhohne; O’Connor, Eds., Ciba Foundation Symposium, Churchill, London. 97–114 (1970).Google Scholar
  26. 26.)
    Farrant, J.: Some mechanisms of freezing injury. In: Latest Development in Cryosurgery (Haschek, Ed., Wiener Med. Akademie. 23–32 (1972).Google Scholar
  27. 27.)
    Farrant, J, Morris, G J.: Thermal Shock and Dilution Shock as the Cases of Freezing Injuring. Cryobiology 10, 134–140 (1973).PubMedCrossRefGoogle Scholar
  28. 28.)
    Fraser, J, Gill, W.: Observations on ultra-frozen tissue. Brit. J. Surg. 54, 770–776 (1967).PubMedCrossRefGoogle Scholar
  29. 29.)
    Gage, A A, Koepf, S, Wehrle, D, Emmings, F: Cryotherapy for cancer of the lip and oral cavity. Cancer (Philad. 18, 1646–1651 (1965)Google Scholar
  30. 30.)
    Gage, A, Fazekas, G, Rilea, E.: Freezing injury to large blood vessels in dogs. Surgery 61, 748–751 (1967).PubMedGoogle Scholar
  31. 31.)
    Gage, A A.: Cryotherapy for oral cancer. JAMA (Chicago) 204, 565–569 (1968).Google Scholar
  32. 32.)
    Gage, A A, Meenaghan, M A, Natiella, J B.: Sensitivity of pigmented mucosa and skin to freezing injury. Cryobiology 16, 348–361 (1979).PubMedCrossRefGoogle Scholar
  33. 33.)
    Gerhardt, C: Lupus-Behandlung durch Kälte. Dtsch. med. Wschr. 11, 699–700 (1885).CrossRefGoogle Scholar
  34. 34.)
    Giampapa, V C, Changyul, O, Aufses, A H.: The vascular effect of cold injury. Cryobiology 18, 49–54(1981).PubMedCrossRefGoogle Scholar
  35. 35.)
    Gill, W, Fraser, J, Carter, D C.: Repeated freeze-thaw cycles in cryosurgery. Nature (Lond. 219, 410–413 (1968).CrossRefGoogle Scholar
  36. 36.)
    Gill, W, Fraser, J, Da Costa, J, Beazley, R.: Amer. Surg. 36, 437–445 (1970).Google Scholar
  37. 37.)
    Gill, W, Da Costa, J, Fraser, J.: The control and predicability of the cryolesion. Cryobiology 6, 342–353 (1970).CrossRefGoogle Scholar
  38. 38.)
    Graeves, R J.: Preservation of antigens and antibodies. Fed. Proc. 24, 253–258 (1965).Google Scholar
  39. 39.)
    Grunner, O G.: A treatise on the Canon of Medicine of Avicenna. Luzac & Co., London 1930 vii.Google Scholar
  40. 40.)
    Grusel, E O, Roberts, M S, Veenema, R J.: Regression of prostatic cancer following sequential cryotherapy of the prostate. J. Urol. (Baltimore) 108, 928–932 (1972).Google Scholar
  41. 41.)
    Hausaman, J E.: Gefrierversuche in vitro und in vivo als Grundlage für die klinische Anwendung der Kryochirurgie. Zahn-Mund-Kieferheilk. 62, 497–505 (1974).Google Scholar
  42. 42.)
    Hausamen, J E.: Klinische und experimentelle Untersuchungen zur Kryochirurgie im Kiefer- und Gesichtsbereich. Die Quintessenz, Berlin, 1974.Google Scholar
  43. 43.)
    Helpap, B, Grouls, V, Yamashita, K, Breining, H.: The proliferative response of the spleen in cryosurgery. Cryobiology 13, 54–60 (1976).PubMedCrossRefGoogle Scholar
  44. 44.)
    Helpap, B, Grouls, V, Lange, U, Breining, H, Lymberopulos, S.: Morphologic and cell kinetic investigations of the spleen after repeated in situ freezing of liver and kidney. Path. Res. Pract. 164, 167–177(1979).PubMedCrossRefGoogle Scholar
  45. 45.)
    Helpap, B.: Der kryochirurgische Eingriff und seine Folgen. Morphologische und zellkinetische Analyse (Doerr; Leonhardt, Eds., Thieme, Stuttgart, New York. 65–70 (1980).Google Scholar
  46. 46.)
    Kanetake, H.: Cryoimmunologic investigations of the rabbit kidney. Invest. Urol. 14, 373–377 (1977).PubMedGoogle Scholar
  47. 47.)
    Karow, A M, Schlafer, M.: Ultrastructure-function correlative studies for cardiac cryopreservation. IV. Prethaw ultrastructure of myocardium cooled slowly (2° C/min) or rapidly (70° C/min) with or without dimethyl sulfoxide (DMSO). Cryobiology 12, 130–143 (1975).PubMedCrossRefGoogle Scholar
  48. 48.)
    Klein, H, Braess, P, Ganz, H.: Untersuchungen zur Kryotherapie an den großen Halsgefäßen beim Menschen. Arch. klin. exp. Ohren-, Nasen-, Kehlkopfheilk. 205, 307–311 (1973).CrossRefGoogle Scholar
  49. 49.)
    Kimura, H.: Comparative immunological studies on cryosurgery and operation using moloney murine sarcoma virus induced primary tumors in BALB/c mice. Gann 69, 507–515 (1978).PubMedGoogle Scholar
  50. 50.)
    Kreyberg, L, Rotnes, P L.: La stase expérimentale méthode pour la mettre en guidance au moyen des préparations speciales. C. R. Soc. Biol. 106, 895–897 (1931).Google Scholar
  51. 51.)
    Kreyberg, L.: Local freezing. Proc. roy. Soc. Biol. 147, 427–439 (1947).Google Scholar
  52. 52.)
    Langer, S, Reiferscheid, MMöglichkeiten und Grenzen der Kryotherapie in der Chirurgie. Aktuelle Chir. 10, 307–314(1975).Google Scholar
  53. 53.)
    Leibo, S P, Farrant, J, Mazur, P, Hanna, M G, Schmith, L H.: Effects of freezing on marrow stem cells suspensions: interactions of cooling and warming rates in the presence of PVP, sucrose or glycerol. Cryobiology 6, 315–332 (1970).PubMedCrossRefGoogle Scholar
  54. 54.)
    Leibo, S P.: Preservation of mammalian cells and embryos by freezing. In: Cryoimmunology (Si matos; Strong; Turc, Eds., Inserm. Paris, 62, 311–334 (1977).Google Scholar
  55. 55.)
    Lenz, H, Preussler, H.: Regenerations- und Reparationszustände der Carotis nach Kryochirurgie. Z. Laryng. Rhinol. 52, 381–393 (1973).Google Scholar
  56. 56.)
    Le Pivert, P, Balique, J G, Clermont, A, Frappart, L.: Predictability of cryonecrosis by tissue imped- ancemetry. LMM (Cryotherapy n° 2) 15, 385–403 (1979).Google Scholar
  57. 57.)
    Lewis, T.: Observations upon the reactions of the vessels of the human skin to cold. Heart 15, 177–208(1930).Google Scholar
  58. 58.)
    Lewis, R B.: Cold Injury. In: In Conference on Cold Injury: Transactions of the first conference June 4- 5, 1951 (Ferrer, Ed., Connecticut, Hildreth, Press. Inc. 24–26 (1952).Google Scholar
  59. 59.)
    Licht, S H.: Therapeutic Heat and Cold. (Licht, Ed., New Haven, Conn) 1965.Google Scholar
  60. 60.)
    Lindo, S, Daniels, F.: Cryosurgery of the junctional nevi. Cutis 16, 492–496 (1975).Google Scholar
  61. 61.)
    Lovelock, J E.: The haemolysis of human red blood-cells by freezing and thawing. Biochem. bio- phys. Acta (Amst). 10, 414–426 (1953).CrossRefGoogle Scholar
  62. 62.)
    Lovelock, J E.: The denaturation of lipid-protein complexes as a cause of damage by freezing. Proc. roy. Soc. Med. 147, 427–433 (1957).Google Scholar
  63. 63.)
    Lutzeyer, W, Lymberopoulos, S, Rautenbach, R, Werner, U.: Skalpell für die Kältechirurgie. Acta Mediotechnica 18, 28–30 (1970).Google Scholar
  64. 64.)
    Luyet, B J, Gehino, M P.: Life and Death at Low Temperatures. Normandy, Missouri, Biodynami- ca. 341–347 (1940).CrossRefGoogle Scholar
  65. 65.)
    Lymberopulos, S, Lutzeyer, W, Breining, H.: Die Kryochirurgie der Niere. II. Der nahtlose kryochirurgische Nierenparenchymeingriff ohne Nierenstielabklemmung. Urologie 8, 136–164 (1969).Google Scholar
  66. 66.)
    Mazur, P.: Kinetics of water loss from cells at subzero temperatures and the likehood of intracellular freezing. J. gen. Physiol. 47, 347–369 (1963).PubMedCrossRefGoogle Scholar
  67. 67.)
    Mazur, P.: The role of cell membranes in the freezing of yeast and other single cells. Ann. N.Y. Acad. Sci. 125, 658–676 (1965).PubMedCrossRefGoogle Scholar
  68. 68.)
    Mazur, P.: Theoretical and experimental effects of cooling and warming velocity on the survival of frozen and thawed cells. Cryobiology 2, 181–191 (1966).PubMedCrossRefGoogle Scholar
  69. 69.)
    Mazur, P, Schmidt, J.: Interactions of cooling velocity on the survival of frozen and thawed yeast. Cryobiology 5, 1–17 (1968).PubMedCrossRefGoogle Scholar
  70. 70.)
    Mazur, P.: The freezing of the biological system. Science 168, 939–949 (1968).CrossRefGoogle Scholar
  71. 71.)
    Mazur, P.: Physical and chemical changes during freezing and thawing of cells with special references to blood cells. Bibl. Haematol., Basel 29, 764–777 (1968).Google Scholar
  72. 72.)
    Mazur, P, Leibo, S P, Farrant, J, Chu, E H Y, Hanna, M G, Schmith, L H.: Interactions of cooling rate, warming rate and protective additive on the survival of frozen mammalian cells. In: „The Frozen Cell” (Wolstenhome; O’Connor, Eds., Churchill, London. 69–88 (1970).Google Scholar
  73. 73.)
    Mazur, P.: The Role of Intracellular Freezing in the Death of Cells Cooled at Supraoptimal Rates. Cryobiology 14, 251–272 (1977).PubMedCrossRefGoogle Scholar
  74. 74.)
    Mazur, P.: Mechanisms of injury and protection in cells and tissues at low temperatures. In: Cryoimmunology (Simatos; Strong; Turc, Eds., Inserm. Paris 62, 37–60 (1977).Google Scholar
  75. 75.)
    Meryman, H T.: Mechanics of freezing in living cells and tissue. Science 124, 515–521 (1956).PubMedCrossRefGoogle Scholar
  76. 76.)
    Meryman, H T.: Physical limitation of the rapid freezing method. Proc. roy. Soc. Med. 147,452–459 (1957).CrossRefGoogle Scholar
  77. 77.)
    Meryman, H T, Williams, R J, Douglas, M S J.: Freezing injury from „solution effects” and its prevention by natural or artificial cryoprotection. Cryobiology 14, 287–302 (1977).PubMedCrossRefGoogle Scholar
  78. 78.)
    Neel, H B, Ketcham, A S, Hammond, W G.: Cryonecrosis of normal and tumor-bearing rat liver potentiated by inflow occlusion. Cancer (Philad). 28, 1211–1218 (1971).CrossRefGoogle Scholar
  79. 79.)
    Neel, H B, Ketcham, A S, Hammond, W G.: Requisites for successful cryogenic surgery of cancer. Arch. Surg. 102, 45–48 (1971).PubMedCrossRefGoogle Scholar
  80. 80.)
    Persidsky, M D.: Lysosomes as primary targets of cryoinjury. Cryobiology 8, 482–488 (1971).PubMedCrossRefGoogle Scholar
  81. 81.)
    Polge, C, Schmidt, A U, Parkers, A S.: Revival of spermatozoa after vitrification and dehydration at low temperatures. Nature (London) 164, 66 (1949).CrossRefGoogle Scholar
  82. 82.)
    Pusey, W A.: Use of carbon dioxide snow in the treatment of nevi and other lesions of the skin. JAMA (Chicago) 49, 1354–1356 (1907).Google Scholar
  83. 83.)
    Rapatz, G, Nath, J, Luyet, B J.: Electron microscope study of erythrocytes in rapidly frozen mammalian blood. Biodynamica 9, 83–94 (1963).PubMedGoogle Scholar
  84. 84.)
    Reite, C B.: Mechanical forces as a cause of cellular damage by freezing and thawing. Biol. Bull. 131, 197–203 (1966).PubMedCrossRefGoogle Scholar
  85. 85.)
    Rothenborg, H W.: Cutaneous circulation in rabbits and human before, during and after cryosurgical procedures measured by xenon-133 clearance. Cryobiology 6, 507–514 (1970).PubMedCrossRefGoogle Scholar
  86. 86.)
    Salt, R W.: Principles of insect cold-hardiness. Ann. Rev. Entomol. 6, 55–74 (1961).CrossRefGoogle Scholar
  87. 87.)
    Schattenberg, P J, Totovic, V, Helpap, B, Breining, H, Lymberopoulos, S.: Path. Res. Pract. 163, 334–352(1978).PubMedCrossRefGoogle Scholar
  88. 88.)
    Schmidt, J J, Fraser, J.: An estimation of tissue damage and thermal history in the cryolesion. Cryobiology 11, 139–147 (1974).CrossRefGoogle Scholar
  89. 89.)
    Schrott, K M, Sigel, A, Schmidt, T.: Das Verhältnis zwischen Sondengröße, Gefriergeschwindigkeit und Zelltod in der Kryotherapie. Urologe 8, 164–167 (1969).PubMedGoogle Scholar
  90. 90.)
    Schrott, K M, Sigel, A.: Untersuchungen über die Gefriergeschwindigkeit des neuen Kältedüsensystems. Urologe 9, 295–297 (1970).Google Scholar
  91. 91.)
    Sguazzi, A, Bracco, D.: A historical account of the technical means used in cryotherapy. Minerva med. 65, 3718–3722 (1974).PubMedGoogle Scholar
  92. 92.)
    Shulman, S, Brandt, E J, Yantorno, C.: Studies in cryo-immunology. II. Tissue and species specificity of the autoantibody response and comparison with iso-immunization. Immunology 14,149–158 (1968).PubMedGoogle Scholar
  93. 93.)
    Stiff, P J, Murgo, A J, Zaroulis, C G, Deris, M F, Clarkson, B D.: Unfractionated Human Marrow Cell Cryopreservation Using Dimethylsulfoxide and Hydroxyethyl Starch. Cryobiology 20, 17–24 (1983).PubMedCrossRefGoogle Scholar
  94. 94.)
    Uyeda, K, Nakayasu, K, Kishimoto, S, Tanna, K, Sotomatsu, S.: Electromicroscopic studies of cryosurgery in the dermatological field. In: Proceedings of the XV International Congress of Dermatology, Mexico. 565–567 (1977).Google Scholar
  95. 95.)
    Uyeda, K, Nakayasu, K, Kishimoto, S, Tanna, K, Sotomatsu, S.: Electron microscope observation of epidermal cells and infiltrated cells in the verrucous lesions after cryosurgery. J. clin. Electron Micr. 12,5–6 (1979).Google Scholar
  96. 96.)
    Van Venrooij, G E P N, Aersten, A M W J, Hax, W M A, Verrergaert, P H J T, Verhoeven, J J, Van der Vorst, HA.: Freeze-etching: freezing velocity and crystal size at different locations in samples. Cryobiology 12, 46–61 (1975).PubMedCrossRefGoogle Scholar
  97. 97.)
    Weiss, L, Armstrong, J A.: Structural changes in mammalian cells associated with cooling to -76° C. J. Biophys. Biochem. Cytol. 7, 673–677 (1960).PubMedCrossRefGoogle Scholar
  98. 98.)
    White, A C.: Liquid air in medicine and surgery. Med. Red. 56, 109 (1899).Google Scholar
  99. 99.)
    Wood, T H, Rosenberg, A M.: Freezing in yeast cells. Biochem. biophys. Acta (Amst). 25, 78–87 (1957).CrossRefGoogle Scholar
  100. 100.)
    Yantorno, C, Soanes, W A, Gonder, M J, Shulman, S.: Studies in cryo-immunology. I. The production of antibodies to urogenital tissue in consequence of freezing treatment. Immunology 12, 395–399(1967).PubMedGoogle Scholar
  101. 101.)
    Yon, J.: Structure et dynamique conformationnelle des protéines. Hermann, Paris, 67–104 (1969).Google Scholar
  102. 102.)
    Zacarian, S A, Stone, D, Clater, M.: Effects of cryogenic temperature on microcirculation in the golden hamster cheek pouch. Cryobiology 7, 27–39 (1970).PubMedCrossRefGoogle Scholar
  103. 103.)
    Zade-Oppen, A M M.: Posthypertonic hemolysis in sodium chloride systems. Acta physiol. scand. 73, 341–364(1968).PubMedCrossRefGoogle Scholar
  104. 104.)
    Zappi, E, Shulman, S.: Cellular and humoral response after freezing damage of the rabbit testis and epididymis. Fed. Proc. 30, 416 (1971).Google Scholar
  105. 105.)
    Zappi, E, Shulman, S.: Cryo-immunization: the cold propagation in the target tissue and the resulting volume of the lesion. Cryobiology 8, 235–243 (1971).PubMedCrossRefGoogle Scholar
  106. 106.)
    Zappi, E, Nemirovsky, M, Shulman, S.:Contralateral epididymo-orchitis after cryoinjury to the male rabbit gonad. Immunology 25, 891–903 (1973).PubMedGoogle Scholar
  107. 107.)
    Zappi, E, Nemirovsky, M, Shulman, S.: Cellular and humoral responses of autosensitized rabbits to a testis cryo-injury. Immunology 26, 477–488 (1974).PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1988

Authors and Affiliations

  • E. W. Breitbart
    • 1
  • G. Schaeg
    • 1
  • M. Jänner
    • 1
  • W. Rehpenning
    • 1
  • A. Carstensen
    • 1
  1. 1.Universitäts-Hautklinik, EppendorfHamburg 20Deutschland

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