Geschichte und Zukunft der Kryochirurgie in der Dermatologie

CRYOTHERAPY was known in ancient times. CRYOSURGERY, however, is a young speciality. In 1812, the French surgeon Larrey blocked pain conduction in amputations by using ice packs. Sir James Arnott was probably the first who achieved more than - 20 °C with salt-ice mixtures, as known from cookery. He designed his own equipment and published some results in palliation of tumours between 1819 and 1879. In 1877 Cailletet in Paris demonstrated liquefaction of O 2 and CO by high pressure. The practical use of liquid refrigerants, however, began with the industrial liquefaction of air by Linde in 1895 when Dewar and Weinhold designed isolated vessels for the storage of such coolants. White in 1899 was the first to use spray devices as well as cotton swabs for application. Whitehouse in New York developed more sophisticated spray devices for tumour therapy. In 1910 Gold propagated liquid oxygen despite of the danger of explosion. In the meantime, Pusey (1907) in Chicago had begun to work with CO 2 using the Joule-Thomson-effect of gas decompression. He was one of the first physicians who noted the extraordinary cryosensitivity of pigment cells. 50 years later, Wilson et al. propagated freons (fluorinated hydrocarbons) with low boiling points. Up to - 41 °C were possible. Today, these substances are obsolete because of environmental problems. A spray with nonfluorinated hydrocarbons is still available. With - 55 °C it is as insufficient as freons for tumour therapy. More effective is N 2 O (- 88,8 °C). Liquid refrigerants began to prevail after World War II when N 2 became freely available, with smaller devices for precise application and control. In Germany, the Dresden workgroup around Matthaus, Scholz and Sebastian were the most active in that field. Now, only 3 groups of refrigerants are still important: CO 2 (- 78 °C) for non neoplastic lesions, N 2 O (- 88,8 °C), especially for oral or genital surfaces, and N 2 (- 195,8 °C) for tumours. We expect guiding new developments from cryo-immunotherapy.