[First experiences with a new nickel-titanium piston with a shape memory feature]

BACKGROUND

The aim of this study was to describe a new stapes prosthesis with memory characteristics for wire crimping (SMart-Piston).

PATIENTS AND METHODS

This technique was used in 15 patients (mean age 43.4 years; range 28-71) undergoing routine stapes surgery. SMart-Piston prostheses with a shaft diameter of 0.5 mm and length ranging from 4.25-4.5 mm were used. Heat induced wire crimping was performed by CO2 laser in five patients, and by bipolar diathermy forceps in ten patients. In 15 patients, postoperative audiological testing was performed at an average 21.9 days and in another 10 again after 435 days following surgery.

RESULTS

The median observed air-bone-gap (ABG) postoperatively was 8.7 dB+/-7.7 dB. A total of 73% of all patients had an ABG of 10 dB or less, and all patients had less than 20 dB. In the ten patients controlled after 435 days, the ABG was 4.4 dB+/-2.4 dB. It was lower than 10 dB in all individuals.

DISCUSSION

A critical point in every stapes surgery, the prosthesis fixation to the incus, is greatly facilitated by this novel technique. Long-term results in a larger group of patients are pending.

Equipment-independent reference values for dopamine transporter imaging with 123I-FP-CIT

AIM

Reliable reference values are helpful to interpret and compare the results of dopamine transporter imaging with SPECT. Since semi-quantitative reference values cannot be easily transferred between imaging equipments, this study aimed to establish equipment independent normal values for the true striatal binding of 123I-FP-CIT.

PATIENTS, METHODS

Specific striatal FP-CIT binding of 6 healthy volunteers and 26 patients with essential tremor were used to generate a reference range by applying an equipment specific resolution dependent factor to compensate for recovery effects. This factor has been determined previously by a series of standardized phantom measurements of an anthropomorphic basal ganglia phantom. Herewith, the resulting DAT binding values represent the expected true specific binding in the striatum.

RESULTS

On average, true specific striatal binding was 5.83 +/- 0.96 in healthy controls, 5.25 +/- 0.67 in patients with essential tremor and 5.36 +/- 0.75 in the entire study cohort.

CONCLUSION

These preliminary results may serve as a basis for the generation of a generally accepted equipment independent reference range for dopamine transporter imaging with 123I-FP-CIT. By a simple phantom measurement that can be accomplished within one day factors related to specific imaging equipment and processing can be corrected for, resulting in specific binding values which may enable a more standardized interpretation of dopamine transporter scans.

Ursachen, Therapie und Komplikationen bei der Frakturversorgung des Unterkiefers – eine retrospektive Analyse von 10 Jahren

BACKGROUND

Fractures of the mandible are a common form of facial injury. The aetiological factors associated with mandibular fractures and the trends in these factors over a 10-year period are reported.

METHODS

A retrospective survey was carried out of 724 patients presenting with a fracture of the mandible over the 10-year-period 1994-2003. Patients; records were reviewed and analyzed according to age, sex, cause of injury, anatomic site of fracture, treatment and postoperative complications.

RESULTS

Over the 10-year-period the rate of mandibular fractures remained constant (mean 40,7%). There were no changes in the age group (mean 33,3 years) or in the higher prevalence in male (male-female-ratio 2,3 : 1). The major causes of fractures were assaults (38,6%) and accidental fall (27,3%). The most common fracture site was the condylar region (47,0%) followed by the angle (29,4%). Most fractures were treated by closed reduction until 2002, thereafter surgical treatment increased noticeable. The complication rate was 8,9% and the most common complications were hardware exposure and infection.

CONCLUSION

Fractures of the mandible are a prevalent form of facial injury. Aetiological factors show no significant change over the 10-year-period. Complication-rate is low and will support the tendency towards surgical treatment.

Digitale Foto- und Videoarchivierung in der HNO

Digital media have become standard documentation tools in modern ENT clinics. To date, multiple formats are generated by variable data sources. Old fashioned archiving techniques with numerous print-outs, hard copies or even slides would soon generate an unmanageable data flood and require costly manpower for proper and precise maintenance. It has become obvious that data archiving is the prime challenge for modern hospital information technology. Multiple computerized multimedia archives exist and offer promising solutions for collecting and managing these data. From a clinical point of view, not only data centralisation but also interactions with existing network components and hospital information technology systems have to be made available. Here, we describe variable data sources and formats, centralisation techniques, networking options and discuss available digital documentation solutions.

[The neurotrophic ulcer of the N. trigeminus]

Trigeminal trophic ulceration is a rare clinical entity after an injury to the sensitive root of the trigeminal nerve, mostly due to therapy for trigeminal neuralgia. Other rare causes are Wallenberg's syndrome or a history of removal of acoustic neuroma. After weeks to years, a slowly progressive ulceration develops due to autonomic dysfunction and the patient manipulation because of serious chronic paresthesia. Finally, in many cases, a significant defect of the nasal arch develops. In spite of typical clinical signs and location, diagnosis is made late in most cases. Reviewing the literature, two cases are presented and diagnostic problems and difficulties of the most effective therapeutic approach are discussed.

Squamous cell carcinoma of the oropharynx: Ki-67 and p53 can identify patients at high risk for local recurrence after surgery and postoperative radiotherapy

PURPOSE

To assess the prognostic value of biologic (p53, Ki-67) and clinical factors in squamous cell carcinoma of the oropharynx after radical surgery and postoperative radiotherapy (RT).

METHODS AND MATERIALS

Between 1985 and 1995, a total of 102 patients with 104 tumor sites were entered onto the study. Fifty-five primary tumors (53%) involved the tonsils, 26 (25%) the soft palate, and 23 (22%) the base of the tongue. Median age was 53 years (range 36-80 years). The clinical T- and N-categories (UICC 1997) were: T1 (30), T2 (47), T3 (22), T4 (5), N0 (33), N1 (28), N2 (42), and N3 (1). Histologically-clear margins were achieved in all patients by initial surgery. Postoperative RT to the primary and regional lymphatics was given, to a total of 60 Gy in 6 weeks, and single daily fractions of 2 Gy. The expression of the nuclear p53- and Ki-67-labeling index (LI) was investigated by immunostaining using the monoclonal antibodies DO-7 and MIB 1. The nuclear p53-intensity (p53-I) was graded into 4 categories (0/+/++/) by densitometry. Median follow-up was 43 months (range 14-132 months).

RESULTS

Cancer-specific survival, disease-free survival, and locoregional tumor control rates were 74%, 69%, and 75%, respectively, at 5 years. Significant prognostic factors for disease-free survival were: T-category (T1/2: 77% vs. T3/4: 53%, p = 0.02), tumor site (tonsils: 79% vs. soft palate: 70% vs. base of tongue: 45%, p = 0.05), duration of RT (< or = 46 days: 80% vs. > 46 days: 60%, p = 0.04), Ki-67 LI (< or = 20%: 84% vs. > 20%: 49%, p = 0.006) and p53-I (0/+: 56% vs. ++/ : 79%, p = 0.008). A significant prognostic impact on locoregional control was noted for the duration of RT (< or = 46 days: 86% vs. > 46 days: 68%, p = 0.01), tumor site (tonsils: 88% vs. soft palate: 67% vs. base of tongue: 51%, p = 0.02), Ki-67 LI (< or = 20% LI: 87% vs. > 20% LI: 56%, p = 0.018), and the p53-I (0/+: 58% vs. ++/ : 88%, p = 0.0006). On multivariate analysis, the p53 nuclear intensity (p = 0.002) and the Ki-67 index (p = 0.01) remained the only significant factors for locoregional control.

CONCLUSION

Ki-67 labeling index above 20% and a weak p53 nuclear intensity (0/+) are both able to identify patients with squamous cell carcinoma of the oropharynx being at high risk for local recurrence after surgery and postoperative RT. Consequently, in this subgroup an intensification of treatment may be contemplated in prospective trials.

[Clinical and diagnostic findings of sialolithiasis]

INTRODUCTION

Sialolithiasis is one of the most common diseases of the salivary glands. Within the scope of a retrospective analysis we report on our clinical and diagnostic findings in the largest patient group suffering from sialolithiasis reported in literature.

MATERIAL AND METHODS

Between 1987 and 1997, data from 635 patient histories and follow-up examinations were systematically collected and analysed to look for typical symptoms of sialolithiasis, locations of stones and possible risk factors.

RESULTS

Sialoliths predominated among patients aged 30 and 70 years, with no male/female predilection. A total of 78.9% of all calculi were detected in the submandibular ducts and 21.1% in the ducts of the parotid glands. The sublingual gland and the smaller salivary glands were not affected. A simultaneous stone disease of the urinary tract or the bile duct system occurred by chance (4.3%). Even regular medication in cases of other systemic diseases cannot be considered cofactors in pathogenesis.

CONCLUSION

Diagnosis of sialolithiasis is the result of careful consideration of patient histories demonstrating typical symptoms and clinical examination. Sonography is the first choice of imaging. Pathogenesis of sialolithiasis seems to be based on local factors within the salivary ducts and glands.

[Long-term results of extracorporeal peizoelectric shock wave lithotripsy of parotid stones]

OBJECTIVE

To evaluate prospectively the recently developed method of extracorporeal shock-wave treatment of stones of the parotid gland.

PATIENTS AND METHODS

76 patients with symptomatic, sonographically proven, solitary stones of the parotid gland (36 females, 40 males; aged 2-80 years) were treated with extracorporeal piezoelectric shock-wave lithotripsy (ESWL) after failed conservative management (sialagogues, gland massage, duct bougie dilation).

RESULTS

Parotid stones were no longer demonstrable after a mean follow-up time of 48 (6-71) months in 38 of the 76 patients; they were symptom-free and no new stones had formed. A residual, but symptom-free, stone was found in another 20 patients (26%) of whom 13 (17%) reported marked improvement after ESWL. No change from pretreatment symptoms occurred in five patients (7%) so that operative removal had to be performed. The success rate of the lithotripsy was independent of size and site of the stone.

CONCLUSION

ESWL is the method of first choice in the treatment of parotid gland stones after unsuccessful conservative treatment and obviates operative gland removal in most cases.

Nodal CT density and total tumor volume as prognostic factors after radiation therapy of stage III/IV head and neck cancer

PURPOSE

To determine whether the immunohistochemical expression of proliferation-associated antigens (proliferating cell nuclear antigen, MIB1) and the nuclear p53 reactivity in addition to total tumor volume, nodal CT density and T and N category are predictive for overall survival and locoregional tumor control in patients with squamous cell carcinoma of the head and neck region.

MATERIALS AND METHODS

Between October 1989 and September 1993, 87 patients with biopsy proven head and neck cancer were randomly allocated to receive radiation alone or simultaneous radiation and chemotherapy as part of a multicenter trial with a total of 298 randomized patients. There were only inoperable lesions in UICC (1992) stage III (8%) and IV (92%). Radiotherapy was delivered with 180 cGy twice daily up to a total dose of 7020 cGy in 51 days. Three cycles of 2340 cGy each were separated by a rest period of 11 days. Chemotherapy consisted of cis-DDP, 5-fluorouracil and leucovorin and was repeated on days 22 and 44. Routinely-processed paraffin-embedded sections were stained using monoclonal antibodies for detection of proliferation-associated antigens (MIB1 and PCNA) and p53 oncoprotein to determine the labeling index (LI). In addition, the total tumor volume and the percentage of necrosis were measured using CT data. The median follow-up was 3.9 years (range 1.9-5.0 years).

RESULTS

The overall survival and locoregional control for all 87 patients were 34 and 39% at 3 years, respectively. The addition of chemotherapy resulted in a better overall survival (27 versus 47%, P = 0.03) but did not influence locoregional control (31 versus 47%, P = 0.08). In univariate analysis, nodal CT density (P < 0.0001), total tumor volume (P < 0.0001), age (P = 0.001) and the MIB1-LI (P = 0.04) had a significant impact on overall survival. However, in the final Cox model only the nodal CT density (P = 0.0003) and age (P = 0.05) were independent prognostic factors for survival and only the nodal CT density (P = 0.0006) was an independent prognostic factor for locoregional control. The expression of the p53 oncoprotein was not found to have a clear predictive value.

CONCLUSION

Nodal CT density, total tumor volume and age will remain the relevant prognostic factors in stage III/IV head and neck cancer.

Cryopreservation of anchorage-dependent mammalian cells fixed to structured glass and silicon substrates

This paper describes a procedure for the cryopreservation of anchorage-dependent cells in a predefined position on microstructured glass or silicon substrates. During freezing and thawing, cells retain their location on the substrate, and an individual comparison and identification of cells before and after preservation are possible. To utilize this advantage, a good adherence and a high survival rate are important. It can be shown that adhesion of mouse fibroblasts (NIH-3T3) to substrate strongly influences the survival rate: 94% of cells grown for 16 h before freezing were judged to be alive after thawing. Widely spaced cells are best suited to cryopreservation on substrates. The different patterns of adhesion of cells to substrates when incubated for 1, 3, 6, and 16 h, were visualized by total internal reflection microscopy (TIRM).

Characterisation of cell movement by impedance measurement on fibroblasts grown on perforated Si-membranes

Mouse fibroblasts grown on perforated Si-membranes (pore diameter approximately 10 microns have been studied to clarify cell locomotive ability. The cell motility was microscopically monitored by a time-lapse video system and, simultaneously, the impedance of the growing cells was measured every 5 s. The correlations between observed cell activities and measured impedance events are discussed and classified. The method is sensitive and allows discrimination between signals arising from translocation of single cells and those arising from filopodia activities. Both cell and filopodia motion could be detected. Designs of microdevices fabricated in semiconductor technology are presented.

Pain in ambulatory patients with lung or colon cancer. Prevalence, characteristics, and effect

BACKGROUND

Few studies have evaluated the epidemiology and effect of pain in ambulatory patients with cancer who are undergoing active therapy. This information is needed to develop strategies for supportive care in this population.

METHODS

The prevalence and characteristics of pain were determined in a prospective survey of ambulatory patients with lung or colon cancer. To reduce bias and acquire comprehensive information, the methodology used face-to-face interviews by trained quality assurance analysts, a multifaceted assessment instrument, and multivariate statistical analysis.

RESULTS

In a telephone interview, "persistent or frequent" pain during the previous 2 weeks was reported by 57 of 145 (39.3%) patients with lung cancer and 52 of 181 (28.7%) patients with colon cancer; 91 of these patients (47 lung and 44 colon) were interviewed in detail. All patients had excellent performance status, and with the exception of pain location, there were no significant differences between the two tumor types. One-third of the patients had more than one discrete pain. Median pain duration was 4 weeks (range, less than 1 week-468 weeks), and average pain intensity was moderate. Approximately 90% of patients experienced pain more than 25% of the time. Pain interfered moderately or more with general activity and work in approximately half of the patients; more than half reported moderate or greater pain interference in sleep, mood, and enjoyment of life. Multiple regression analysis revealed that the daily frequency of pain, the intensity of the worst pain, the score on a mood scale, and the frequency of the worst pain accounted for 58.7% of the variance in average pain intensity. Likewise, 52.1% of the variance in a derived measure of pain interference in function was explained by the mood score, frequency of the worst pain, number of pains, and pain intensity.

CONCLUSIONS

These data indicate that pain is prevalent among well-functioning ambulatory patients and substantially compromises function in approximately half of the patients who experience it. Pain is a complex symptom; aspects other than intensity, such as frequency, strongly influence its effect.

Normal keratinization in a spontaneously immortalized aneuploid human keratinocyte cell line

In contrast to mouse epidermal cells, human skin keratinocytes are rather resistant to transformation in vitro. Immortalization has been achieved by SV40 but has resulted in cell lines with altered differentiation. We have established a spontaneously transformed human epithelial cell line from adult skin, which maintains full epidermal differentiation capacity. This HaCaT cell line is obviously immortal (greater than 140 passages), has a transformed phenotype in vitro (clonogenic on plastic and in agar) but remains nontumorigenic. Despite the altered and unlimited growth potential, HaCaT cells, similar to normal keratinocytes, reform an orderly structured and differentiated epidermal tissue when transplanted onto nude mice. Differentiation-specific keratins (Nos. 1 and 10) and other markers (involucrin and filaggrin) are expressed and regularly located. Thus, HaCaT is the first permanent epithelial cell line from adult human skin that exhibits normal differentiation and provides a promising tool for studying regulation of keratinization in human cells. On karyotyping this line is aneuploid (initially hypodiploid) with unique stable marker chromosomes indicating monoclonal origin. The identity of the HaCaT line with the tissue of origin was proven by DNA fingerprinting using hypervariable minisatellite probes. This is the first demonstration that the DNA fingerprint pattern is unaffected by long-term cultivation, transformation, and multiple chromosomal alterations, thereby offering a unique possibility for unequivocal identification of human cell lines. The characteristics of the HaCaT cell line clearly document that spontaneous transformation of human adult keratinocytes can occur in vitro and is associated with sequential chromosomal alterations, though not obligatorily linked to major defects in differentiation.

Basement membrane formation by malignant mouse keratinocyte cell lines in organotypic culture and transplants: correlation with degree of morphologic differentiation

Six malignant C3H mouse epidermal cell lines (HEL-30, HEL-37, HELP I, HELP IV, HD II, H3L), with different capacities for epidermal differentiation, were analyzed for their organized growth behavior and basement membrane (BM) formation in organotypical cultures in vitro and after transplantation into syngeneic mice. Expression and deposition of five BM components (type IV collagen, laminin, bullous pemphigoid antigen, fibronectin, heparan sulfate proteoglycan) were determined on frozen sections by indirect immunofluorescence. Additionally, synthesis and secretion of BM components by the line HEL-30 (in submersed cultures) were identified by metabolic labeling and immunoprecipitation. Morphologic differentiation features and formation of a structured BM were studied by electron microscopy. All cell lines were tumorigenic and invasive but nevertheless able to synthesize BM constituents in vitro and in vivo, although pronounced variations in the expression and the polarity and continuity of deposition were found. Irrespective of the amount of BM components synthesized, none of the cell lines formed a structured BM in organotypical cultures in vitro. After transplantation the production of BM components was improved and the newly formed epithelia were separated from the mesenchyme by a structured BM. The formation of BM occurred whether the epithelial cells were in immediate contact with the mesenchyme or separated by a 1 to 2 mm thick native collagen gel. Deposition of BM constituents and formation of BM structures occurred both at the superficial epithelium and around invading cell cords. The studies clearly demonstrated that malignant epidermal cells maintain their capacity to synthesize BM components. The extent of production and the polarity of deposition of the constituents and the quality of BM formation were usually higher in well differentiated cell lines and obviously correlated well with their preserved degree of differentiation. Comparable to normal keratinocytes, formation of structured BM requires interaction with living mesenchyme but occurs independently of direct epidermal-mesenchymal contact.

Effect of growth environment on spatial expression of involucrin by human epidermal keratinocytes

Involucrin, the major protein precursor of the cornified envelope, is expressed during terminal differentiation of human keratinocytes, both in vivo and in vitro. In epidermis, the onset of synthesis is several layers above the basal layer, but in stratified cultures of keratinocytes on tissue culture plastic involucrin synthesis begins in the first suprabasal layer. To investigate the reason for this premature expression, the distribution of involucrin was studied in epidermis from different body sites, in organotypic cultures and in transplants of keratinocytes onto nude mice. We found that premature expression was not associated with poor morphological differentiation, because involucrin synthesis began immediately above the basal layer even when distinct basal, spinous, granular and cornified layers were formed in organotypic cultures recombined with dermis. The site of involucrin expression in culture did not depend on the number of cornified layers present. The only conditions which resulted in an upward shift in the site of synthesis were in 3-week old transplants on nude mice. We conclude that the site of onset of involucrin synthesis is not determined by the degree of morphological differentiation of the tissue, and discuss other factors which may be involved.

[In vitro study of the cytotoxicity and selectivity of 7 beta-hydroxycholesterol]

Since the mid seventies different groups of scientists have reported unanimously a cytotoxic effect of 7 beta-OH-cholesterol on tumor cell cultures. The effect on normal soma cells and a therewith associated possible tumor-specific selectivity however, is contrarily described. The present results confirm the cytotoxic effect of the substance against tumor cells. Further a high suppression in cell function of dividing soma cells by 7 beta-OH-cholesterol could be found. Thus the substance does not fulfill the hope for a selective drug in tumor therapy.