Prevalence and Predictors of Sexual Dysfunction (SD) after Treatment of Localized Rectal and Anal Cancer (LRAC)

PURPOSE/OBJECTIVE(S)

SD is possible after treatment of LRAC and is associated with distress and impaired quality of life. We report the prevalence of SD in our LRAC patients treated with curative intent. We also evaluate patient/treatment-related factors associated with SD.

MATERIALS/METHODS

LRAC patients from 2010-2022 were identified. Consented patients were surveyed and patient/treatment factors were collated from medical records. Sexual function (SF) was measured using the Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF). The impact of disease/treatment on SF since treatment was measured using the SF Questionnaire Medical Impact Scale (SFQ-MIS). FSFI ≤ 19.2 and IIEF ≤ 32.2 were considered SD based on the mean scores of SD patients in the primary literature. SFQ-MIS ≥ 15.5 was used to dichotomize responses into "at least some impact" versus "at least no impact." Spearman rank correlations examined correlations between FSFI/IIEF and factors. Comparisons involving componential domains and factors were based on a two-sided Mann-Whitney test. RT dose, surgery, the extent of lymphadenectomy, T stage, and time since treatment were factors assessed in all patients. In females, dilator use during RT, tumor distance (TD) from the anterior vaginal wall and whole vagina, and V25Gy, V45Gy, and mean dose to the anterior vaginal wall and whole vagina were other factors assessed. In males, TD from the neurovascular bundle (NVB), V25Gy, V45Gy, and mean dose to NVB was used.

RESULTS

Forty-five patients (13.5% response rate) completed study surveys (62% males; 80% white; 71% rectal cancer patients). The median age and time since treatment were 63 and 4 yrs. respectively. RT doses ranged from 25 - 54Gy. The overall prevalence of SD was 58% (71% in females; 50% in males). The proportion of patients who reported at least some SF impact was 56% (53% in females; 57% in males). There was a marginal association between higher total IIEF and receipt of surgery (p = 0.059). A correlation of 0.44 was seen between total IIEF and TD from upper NVB-the strongest among all comparisons. In the domains of IIEF, statistically significant associations were found between intercourse satisfaction (ISAT) and TD from upper NVB (p = 0.004), overall satisfaction (OSAT) and TD from lower NVB (p = 0.040), and ISAT and T stage (p = 0.047). There were marginal associations between TD from upper NVB and OSAT (p = 0.052), orgasm (p = 0.063), and erectile dysfunction (p = 0.097). There was a marginal association between V25Gy to the anterior vaginal wall and pain during penetrative sex (p = 0.095). No other association with FSFI or its domains was significant.

CONCLUSION

SD is prevalent in a large majority of patients studied (58%). In males, higher TD from NVB was associated with better overall SF, better intercourse, and overall satisfaction. While a higher proportion of females had SD, no significant associations were found in females likely due to their small sample size.

The Impact of Mutations of BRCA1/2 Genes in Patients with Breast Cancer on Treatment Outcomes Following Radiation Therapy (RT)

PURPOSE/OBJECTIVE(S)

BRCA1/2 mutations in isolated cancer cells have been shown to enhance radiosensitivity, but it is not known if similar mutations in breast cancer (BC) patients yield improved responses to RT. We analyzed a large, national, previously unexamined dataset to determine if patients with BRCA1/2 mutations receiving RT achieve longer disease-free survival (DFS) and overall survival (OS) than patients with wild-type (WT) BRCA genes.

MATERIALS/METHODS

The study used the nationwide Flatiron Health electronic health record (EHR)-derived de-identified database to select patients with Stage 0-III BC. Patients with known BRCA1/2 status were eligible if treated with RT≤ 1 year from diagnosis. Demographic data for patients with mutated and WT BRCA1/2 were compared using ANOVA and Chi-square tests. DFS was calculated from the start of RT until local/ distant recurrence or death and censored after the last clinic visit. Kaplan Meier estimates and multivariable Cox-proportional models (MVA) were used to compare DFS and OS for mutated and WT BRCA1/2 patients, for clinical stage, biomarkers (ER/PR/HER2), and surgery type (lumpectomy vs mastectomy).

RESULTS

The study group of 1561 Stage 0-III BC patients included 1482 patients (95%) with WT BRCA and 79 patients (5%) with BRCA1/2 mutations (31 patients with a mutation of BRCA1, 46 patients with a mutation of BRCA2, and 2 patients with both mutations). Patients with BRCA1/2 mutations were younger (median: 51 vs 56, p = 0.004), diagnosed at higher clinical stage (Stage 0: 0% vs 0.2%, I: 31.6% vs 48.5%, II: 48.1% vs 34.0%, III: 20.3 vs 17.4%, p = 0.016), and more often grade 3 (60.8% vs 39.9%, p<0.001) than those with WT BRCA. Mastectomy was performed more often for patients with BRCA1/2 mutations (60.8% vs 31.5%, p<0.001). When BRCA1 and BRCA2 mutations were compared, BRCA1 patients were younger (median: 44 vs 52, p = 0.006), more often ER/PR negative (51.6% vs 13%, p<0.001), and had higher stage tumors (T1: 32.3% vs 47.8%; T2: 38.7% vs 28.3%, p = 0.032). On MVA, comparison of BRCA1/2 mutations vs WT BRCA identified no differences in DFS or OS.

CONCLUSION

In spite of pre-clinical data demonstrating increased radiosensitivity for BRCA1/2-mutated BC cells lines, this large, previously unexamined dataset found BRCA1/2 mutations did not predict an improved OS or DFS for patients who received RT. When compared with WT BRCA patients, patients with BRCA1/2 mutations were found to have tumors of higher grade and clinical stage and to undergo more mastectomies. In a comparison with BRCA2-mutated patients, patients with mutations of BRCA1 were younger, more often ER/PR negative, and more likely to have high-stage tumors. The survival data and the advanced stage of BRCA1/2-mutated tumors suggest that the effect of BRCA1/2 mutations on radiosensitivity in vitro may be nullified by the aggressive behavior of BRCA1/2-mutated tumors in vivo.

Liver Fat and Its Association with Time to Biochemical Failure (TTBCF) after Definitive Treatment to the Prostate

PURPOSE/OBJECTIVE(S)

Elevated body mass index (BMI) is associated with an increased risk of biochemical failure (BCF); however, BMI may not best capture underlying health. We examined a different metric, liver fat, which may better approximate the body's metabolic state, to see its association with time to biochemical failure (TTBCF) in patients treated definitively for prostate cancer.

MATERIALS/METHODS

Of 210 patients who received a PSMA PET/CT at our institution, we identified 60 men treated with either prostatectomy or definitive radiation without androgen deprivation therapy who developed BCF. BCF was defined as PSA ≥ 0.2 ng/mL if treated with prostatectomy or PSA nadir + 2 ng/mL for those treated with definitive radiation. All prostatectomy patients had a post-op PSA < 0.1. Liver fat was evaluated via the non-contrast portion of respective PSMA PET/CT scans. Average Hounsfield Units (HU) of the liver were used to split individuals into high (≤ 56.1) and low (> 56.1) liver fat. A threshold of 56.1 HU was chosen as it corresponds to 5.56% liver fat, or the 95th percentile of non-obese, non-diabetic controls. Liver fat was quantified by converting HU to proton density fat fraction (PDFF) using the formula: PDFF = -0.582*HU + 38.214. Median TTBCF was estimated using Kaplan Meier methods, and Cox Proportional Hazards Regression was used for covariate adjustment.

RESULTS

Forty-four patients were classified as having high liver fat (HLF) and 16 as having low liver fat (LLF). Patients with HLF were more likely to have a higher BMI, have high risk disease, undergo surgery, and have shorter TTBCF (Table). When adjusted for NCCN risk category and treatment type, HLF was associated with twice the risk of BCF per unit time (aHR = 2.02, 95% CI [1.09 - 3.73], p = 0.03). With additional adjustment for BMI (continuous), HLF was no longer an independent predictor of TTBCF (aHR = 1.75, 95% CI [0.94 - 3.25], p = 0.08).

CONCLUSION

In this small study of patients who had biochemical failure after completing definitive treatment to the prostate, those with liver fat ≥ 5.56% were more likely to fail sooner, adjusting for risk category and treatment type. This project suggests that a man with elevated liver fat, on average, experiences a shorter interval free from prostate cancer.

Pre-Treatment Trends in Child-Pugh Score as an Indicator of Post-Treatment Survival in Patients Receiving Liver SBRT for HCC

PURPOSE/OBJECTIVE(S)

We sought to understand the value of Child-Pugh (CP) score trends prior to undergoing stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma in patients with advanced cirrhosis, as an indicator of post-treatment morbidity and mortality. We hypothesize that an uptrend in CP score prior to RT increases risk of post-treatment cirrhosis progression, or death.

MATERIALS/METHODS

We retrospectively reviewed all patients who underwent definitive SBRT for HCC between 2014-2022 in our health system. Most patients were referred for treatment in the 2nd or 3rd line setting, allowing us to determine CP score at multiple points before SBRT. Response to treatment was evaluated with RECIST or mRECIST criteria. Acute treatment toxicities were assessed by CTCAE v5. OS was assessed using the Kaplan-Meier method, and differences between groups were evaluated using log-rank test.

RESULTS

A total of 61 patients were identified, 26 had an immediate pre-SBRT CP score of A5, 11 with A6, 10 with B7, 4 with B8, 4 with B9, 5 with C10, and 1 with C11. Median prescribed dose was 40Gy in 5fx. Median OS of all patients was 24 months. When stratified by CP category, median OS for CP A was not reached (NR) at time of analysis, CP B had a median OS of 14.8mo, and CP C with 1.9mo (p < 0.01). Local control rate at 6mo was 87.5%. 5 patients (8.3%) had CTCAE grade 2 acute toxicity. 10 patients had CP score progression of 2pts or more within 6mo after treatment, and 7 patients had a cause of death attributed to end stage liver disease. Median time interval between HCC diagnosis and start of RT was 338 days. In this time interval, patients with a CP score increase of 2 pts or more prior to starting RT had a median OS of 362 days, compared to NR for patients without increase (p = 0.02). When excluding the CP A group, patients with 2 pt increase had median OS of 362 days vs 445 days (p = 0.34). Again excluding the CP A group, patients with a 1 pt increase had median OS of 362 days vs NR (p = 0.23). Of 9 patients who had a pre-RT CP score increase of 2 pts or more, 7 experienced continued CP progression after treatment.

CONCLUSION

In this multi-institutional retrospective analysis, we found 24 patients with advanced CP B/C cirrhosis who underwent SBRT, none of whom received orthotopic liver transplant. While CP C patients did relatively poorly, we find that some patients with CP B cirrhosis may tolerate SBRT well with good oncologic effect. When taking pre-treatment CP score increase into consideration, we saw a trend but no statistical significance indicating that a pre-SBRT increase in CP score may be associated with worse OS after treatment among CP B/C patients. We conclude that there may be a subset of patients with advanced cirrhosis who, if well selected, are appropriate candidates for SBRT. We suggest a novel use of the CP score and pre-RT trends as an additional clinical tool to aid in decision making when selecting patients. We also suggest that patients with marked up-trending scores pre-treatment have a high likelihood of continued cirrhosis progression after treatment.

[Teaching otorhinolaryngology in times of COVID-19: to what extent can digital formats replace face-to-face teaching?]

OBJECTIVE

Due to the coronavirus disease 19 (COVID-19) pandemic, postgraduate training in otorhinolaryngology in 2020 was transferred completely from face-to-face to digital teaching. This paper assesses whether this change was possible without a reduction in the quality of teaching and learning.

METHODS

Results of final written examinations were compared for the years 2016-2020, and the results of the teaching evaluation by the students for 2017-2020. The evaluation by students in 2020 included additional questions related to the switch from face-to-face to digital teaching. Additionally, the lecturers and teachers were asked for their assessments.

RESULTS

Results of the final written examination did not show any significant differences between 2016-2019 and 2020. Students were highly satisfied with the digital format, but values did not reach the level of former years with face-to-face-teaching. Especially the interaction with patients and the teaching of manual skills were rated lower in the digital format. Lecturers emphasized the additional workload for preparation of digital teaching.

CONCLUSION

The results of written examinations showed no difference between digital and face-to-face teaching. Online communication and interaction were reduced and regarded as cumbersome by students and faculty. Digital solutions providing more interaction and active participation are required. The digital format is more appropriate for teaching basic knowledge than for teaching practical skills.

A-43 Effects of Subthreshold Exercise on Post-concussive Symptom Endorsement and Cognition: A Pilot Randomized Clinical Trial

Purpose: The current study examined the effects of subthreshold exercise on symptom endorsement and neurocognitive functioning in adolescents with persisting concussion symptoms (&gt;1 month). Methods: Sixteen participants (age M = 16.2, SD = 1.4) with persisting concussion symptoms were randomly assigned to control or subthreshold exercise intervention groups (Leddy et al., 2019). Participants engaged in concussion education before assignment to 6 weeks (3x weekly) of intervention: control (stretching) or subthreshold exercise. Both groups completed evaluations at baseline, midpoint, and follow-up, including a hybrid battery of assessments (yielding composites of processing speed and memory), a concussion symptom scale (PCS-R), and psychological inventories. Results: Both the intervention group and control group reported significant reduction in concussive symptom severity during the study period (PCS-R Change M = -21.29, SD = 13.54). Baseline endorsement of anxiety significantly differed across groups (p &lt; 0.05); when controlling for anxiety, the intervention group demonstrated greater reduction in symptom endorsement compared to controls (F(1,13) = 7.30, p &lt; 0.05, partial eta2 = 0.40). In contrast, after controlling for performance validity and the baseline anxiety difference, there was no significant difference (p &gt; 0.05) in processing speed performance (partial eta2 = 0.14) or memory performance (partial eta2 = 0.11) by intervention group. Both groups remained generally intact normatively from the baseline to the follow-up evaluation across measures. Conclusions: Current results support the use of subthreshold exercise to reduce persisting symptoms of concussion post-acutely; additionally, results suggest that anxiety significantly impacted response to intervention. Lastly, there was no effect on cognitive indices by the intervention, suggesting that subthreshold exercise may have less impact on cognition than symptom endorsement in the post-acute phase of recovery.

Loss of Consciousness is Associated with Increased Neurocognitive Intra-Individual Variability Following Sports-Related Concussion

Purpose

Traditional markers of concussion severity, including loss of consciousness (LOC), retrograde amnesia (RA), and post-traumatic amnesia (PTA), have been inconsistently associated with neurocognitive performance following sports-related concussion. The purpose of this study was to evaluate whether LOC, RA, and PTA influence a particular aspect of post-concussion cognitive functioning—across-test intra-individual variability (IIV).

Methods

Concussed athletes (N=119; 77.3% male) were evaluated, on average, 8.55 days post-concussion (SD=11.27; Mdn=4 days) via clinical interview and neuropsychological assessment. Primary outcomes of interest included two measures of IIV-an average standard deviation (ASD) score and a maximum discrepancy (MD) score-computed from 18 norm-referenced variables.

Results

A one-way ANCOVA adjusting for time since injury revealed a significant effect of LOC on the ASD (F(1, 116)=6.78, p=.010, ηp2=.055) and MD (F(1, 116)=5.65, p=.019, ηp2=.046) scores, such that athletes with LOC displayed significantly greater IIV than athletes without LOC. In contrast, measures of IIV did not significantly differ between athletes who did and did not experience RA or PTA (all p>.05).

Conclusion

LOC, but not RA or PTA, was associated with greater variability, or inconsistencies, in cognitive performance following concussion. This suggests that LOC may be a relevant consideration when evaluating post-concussion cognitive dysfunction. IIV has recently been established as a sensitive measure of cognitive functioning in a variety of clinical samples and has been associated with underlying neurobiological integrity. Taken together, our results implicate LOC as a possible contributing factor of less efficient cognitive functioning following concussion and may help detect athletes at risk for poor clinical outcomes.

Differential chemokine expression patterns in tonsillar disease

Expression profiles of CXC- and CC-chemokines in various forms of tonsillar disease were studied to evaluate whether certain chemokines play a predominant role in a specific subset of tonsillar disease. Total RNA was isolated from 89 biopsies (21 hyperplastic palatine tonsils, 25 adenoids, 16 chronic inflammatory palatine tonsils and 27 chronic inflammatory palatine tonsils with histological prove of acute inflammation), reverse transcribed and subjected to PCR amplifying IL-8, Gro-alpha, eotaxin-1, eotaxin-2, MCP-3, MCP-4 and RANTES. 2% agarose gel electrophoresis revealed a predominance of IL-8 in the chronic inflammatory palatine tonsil group compared to tonsillar hyperplasia. Furthermore, eotaxin-2 was strongly overexpressed in adenoid samples compared to chronic inflammatory specimens. Our data suggest that the majority of diseases related to adenoid formation are mediated via an eotaxin-2 expression, whereas chronic inflammatory tonsillitis is associated with IL-8 upregulation. These data imply that adenoids are related to a Th-2, and chronic inflammatory tonsillitis to a Th-1 based immune response.

Causes of death among cancer patients

Background

The purpose of our study was to characterize the causes of death among cancer patients as a function of objectives: (i) calendar year, (ii) patient age, and (iii) time after diagnosis.

Patients and methods

US death certificate data in Surveillance, Epidemiology, and End Results Stat 8.2.1 were used to categorize cancer patient death as being due to index-cancer, nonindex-cancer, and noncancer cause from 1973 to 2012. In addition, data were characterized with standardized mortality ratios (SMRs), which provide the relative risk of death compared with all persons.

Results

The greatest relative decrease in index-cancer death (generally from > 60% to < 30%) was among those with cancers of the testis, kidney, bladder, endometrium, breast, cervix, prostate, ovary, anus, colorectum, melanoma, and lymphoma. Index-cancer deaths were stable (typically >40%) among patients with cancers of the liver, pancreas, esophagus, and lung, and brain. Noncancer causes of death were highest in patients with cancers of the colorectum, bladder, kidney, endometrium, breast, prostate, testis; >40% of deaths from heart disease. The highest SMRs were from nonbacterial infections, particularly among <50-year olds (e.g. SMR >1,000 for lymphomas, P < 0.001). The highest SMRs were typically within the first year after cancer diagnosis (SMRs 10-10,000, P < 0.001). Prostate cancer patients had increasing SMRs from Alzheimer's disease, as did testicular patients from suicide.

Conclusion

The risk of death from index- and nonindex-cancers varies widely among primary sites. Risk of noncancer deaths now surpasses that of cancer deaths, particularly for young patients in the year after diagnosis.

Second-line treatment of recurrent HNSCC: tumor debulking in combination with high-dose-rate brachytherapy and a simultaneous cetuximab-paclitaxel protocol

BACKGROUND AND PURPOSE

After the failure of first-line treatment, the clinical prognosis in head and neck cancer (HNSCC) deteriorates. Effective therapeutic strategies are limited due to the toxicity of previous treatments and the diminished tolerance of surrounding normal tissue. This study demonstrates a promising second-line regimen, with function preserving surgical tumor debulking, followed by a combination of postoperative interstitial brachytherapy and a simultaneous protocol of cetuximab and taxol.

PATIENTS AND METHODS

From January 2006 to May 2013, 197 patients with HNSCC were treated with brachytherapy at the University Hospital Schleswig-Holstein Campus Lübeck, including 94 patients due to recurrent cancer. Within these, 18 patients were referred to our clinic because of early progressive disease following first- or second-line treatment failure. They received the new palliative regimen. A matched-pair analysis including recurrent tumor stage, status of resection margins, tissue invasion and previous therapy was performed to evaluate this treatment retrospectively. Overall survival (OS), disease-free survival (DFS), functional outcome and treatment toxicity was analyzed on the basis of medical records and follow-up data.

RESULTS

DFS and OS of the study group were 8.7 and 14.8 months. Whereas, DFS and OS of the control group, treated only by function preserving tumor debulking and brachytherapy, was 3.9 and 6.1 months respectively. This demonstrates a positive trend through the additional use of the cetuximab-taxane protocol. Furthermore, no increase of therapy induced toxicities was displayed.

CONCLUSION

Pre-treated patients with a further relapse benefit from the 'cetuximab-taxane recurrency scheme'. It seems to be a valuable complement to interdisciplinary and multimodal tumor therapy, which improves OS and results in acceptable toxicity.

Phase I study of capecitabine combined with radioembolization using yttrium-90 resin microspheres (SIR-Spheres) in patients with advanced cancer

BACKGROUND

This was a prospective single-centre, phase I study to document the maximum tolerated dose (MTD), dose-limiting toxicity (DLT), and the recommended phase II dose for future study of capecitabine in combination with radioembolization.

METHODS

Patients with advanced unresectable liver-dominant cancer were enrolled in a 3+3 design with escalating doses of capecitabine (375-1000 mg/m(2) b.i.d.) for 14 days every 21 days. Radioembolization with (90)Y-resin microspheres was administered using a sequential lobar approach with two cycles of capecitabine.

RESULTS

Twenty-four patients (17 colorectal) were enrolled. The MTD was not reached. Haematologic events were generally mild. Common grade 1/2 non-haematologic toxicities included transient transaminitis/alkaline phosphatase elevation (9 (37.5%) patients), nausea (9 (37.5%)), abdominal pain (7 (29.0%)), fatigue (7 (29.0%)), and hand-foot syndrome or rash/desquamation (7 (29.0%)). One patient experienced a partial gastric antral perforation with a capecitabine dose of 750 mg/m(2). The best response was partial response in four (16.7%) patients, stable disease in 17 (70.8%) and progression in three (12.5%). Median time to progression and overall survival of the metastatic colorectal cancer cohort was 6.4 and 8.1 months, respectively.

CONCLUSIONS

This combined modality treatment was generally well tolerated with encouraging clinical activity. Capecitabine 1000 mg/m(2) b.i.d. is recommended for phase II study with sequential lobar radioembolization.

[The shortage of qualified staff in Germany: a survey on head physicians' expectations of young doctors]

BACKGROUND

The shortage of medical specialists in Germany has led to increased competition between hospitals, particularly in the recruitment of young skilled doctors. The quality of training appears to be the critical factor in a clinic's recruiting process. At the same time, the suitability of candidates is decreasing. There is currently no data on the suitability of candidates for otorhinolaryngology, nor are there any forecasts about the labor shortage in this speciality.

METHODS

We compiled a questionnaire according to accepted guidelines, which was then sent to 160 ENT departments by email. We asked about the size and location of the department and the number of applicants that were suitable or unsuitable. Finally, we asked about the current availability of staff as well as the requirements set by the head physician.

RESULTS

The response rate was 34% (54 questionnaires). Departments received an average of 20 applications per year, of which 36% were unsuitable. Departments received more applications in the new German states than in the old; however, no difference in the quality of candidates was seen. University hospitals receive almost three times more applications than other hospitals. The size of the department correlates with the number of applications and quality of the candidates. Almost 60% of chief physicians expected the lack of qualified staff to worsen in the future. However, 40% of chief physicians of large departments (> 50 beds) expected the situation to improve or remain unchanged. Chief physicians' main expectations of candidates included commitment, independent learning and team spirit.

CONCLUSIONS

A broad and structured residency program for new employees is the most important factor in the recruitment of new physicians. Large departments and university hospitals have advantages here. The expectations of head physicians differ from those of young staff in terms of commitment and autonomous learning.

[A prospective evaluation of psychometric items in patients with nasal deformities]

BACKGROUND

Patient satisfaction with surgical outcome is essential in plastic reconstructive surgery, yet no German-language psychometrically validated instrument exist for assessing satisfaction with surgery in the head and neck area. Previously, the short form of the "Frankfurter Selbstkonzeptskalen/FSKN" showed mixed results in a sample of patients undergoing correction of microtia.

MATERIAL AND METHODS

This short form was tested in 22 patients following septorhinoplasty and in 24 following tonsillectomy, regarding its psychometric characteristics.

RESULTS

While showing good practical characteristics and content validity, there were disappointing results in responsiveness to change and known group's discriminant validity.

CONCLUSIONS

Beside sample size, different psychological mechanisms in more common malformations of the head neck area, especially in patients with nasal deformities, have to be further explored as they are not sufficiently represented in the short form of FSKN.

[Brachytherapy in combination with function-preserving surgery of cancer of the paranasal sinus]

BACKGROUND

Prognosis of patients with advanced/recurrent cancer of paranasal sinuses and orbit with infiltration of the skull base is very bad. Radical surgery does not improve prognosis. A disadvantage of the radical surgery is the functional loss and the residual cosmetic defect. We present the results of a function-preserving surgery in combination with interstitial, image adapted brachytherapy (IABT) for the treatment of these cancers.

METHODS AND PATIENTS

Ten patients with paranasal sinus cancer and 16 patients with sarcomas (n=26) were retrospectively analysed. After a maximum tumor resection (mostly R1-R2 resections), 2-12 flexible afterloading plastic tubes were implanted. The postoperative IABT total dose was 10-25 Gy in 2.5 Gy fractions twice daily fractions for 5 days.

RESULTS

In all cases the eye was obtained without functional damage. The IABT was well tolerated. The visual and cosmetic results were satisfactory. Postoperative complications occurred in 7 out of 26 cases without a serious long-term adverse event. Significant radiation-induced complications were found in patients with orbital or skull base involvement. The three years overall survival was 60% for rhabdomyosarcoma, and 33% for the paranasal sinus cancers.

CONCLUSIONS

These results show that a combined treatment of function-preserving surgery and a IABT is a feasible, successful and well-tolerated option for curative, salvage and palliative therapy for selected patients with advanced or recurrent carcinoma of the paranasal sinuses and orbit.

[Structured residency training program for otolaryngology: a trendsetting principle]

A concept for an ORL residency training program is necessary because of personnel bottlenecks, quality assurance and benchmarkings. We have created a 2.5 years' program, which is based on 6 pillars: 1. Acquisition of the necessary specialist knowledge by the resident in self-study. 2. Weekly attendance of training lectures according to a study timetable, a monthly specialist seminar to discuss case examples. 3. Weekly presentation by the resident on an article from the current literature, alternating with a presentation on cases and a morbidity and mortality conference. 4. Annual 60 min learning target test. 5. Definition of a surgical training calendar oriented to the new national ORL training regulations. 6. Internal operation course with preparative exercises in anatomy and visit to an operations course at a renowned otolaryngology clinic each year. After 2.5 years of the training time a revision course is introduced. In this way a basic training will be guaranteed for all residents, which can be assessed by the annual test. Finally, the construction of a further training curriculum should lead to an improved transparent training, a higher standard of quality and improved staff satisfaction.

[A rare cause of facial asymmetry: nasoalveolar cyst: a clinical report]

Nasoalveolar cysts are rare nonodontogenic cysts that develop from the soft tissue in the mucobuccal area of the nasal ala. Their origin is a residuum of the nasolacrimal canal.

CLINICAL CASE

A 45-year-old woman had been aware of a painless tumor at the base of the nose and in the region of the left nasal ala for several months. We diagnosed a nasolabial cyst, which was extirpated in toto through a combined transvestibular-transnasal approach.

[Brachytherapy in combination with function-preserving surgery. An interdisciplinary challenge]

A multimodal, interdisciplinary approach known as intensity-modified brachytherapy is a promising alternative for patients with advanced head and neck cancer infiltrating the orbita and skull base. An 87-year-old man presented with a recurrence of squamous cell carcinoma of the medial corner of the left eye that had been locally resected and irradiated by external beam radiotherapy multiple times. The cancer was resected with preservation of the eye with close margins, implantation of afterloading catheters, and reconstruction of the defect with a median forehead flap. The patient was irradiated with a total radiation dose of 30 Gy IMBT. After 1 year, there was no evidence of locoregional recurrence. The background of this therapeutic process and analysis of the current literature regarding this interdisciplinary treatment of head and neck cancer infiltrating the orbita and skull base are discussed based on this case report.

Endothelial and epithelial expression of eotaxin-2 (CCL24) in nasal polyps

BACKGROUND

Nasal polyposis is mostly associated with eosinophilia of mucosal tissue. This points to the implication of CC chemokines in nasal eosinophilia. Recently the CC chemokine eotaxin-2 (CCL24) was identified. This study was initiated to localize the cellular source, analyze expression of mRNA, and quantify protein synthesis of CCL24.

METHODS

Specimens of nasal inferior turbinates from controls and polypous tissue from patients suffering from chronic polypous sinusitis were collected. Furthermore, fibroblasts and epithelial cells were cultured. CCL24 protein was analyzed by immunohistochemistry and ELISA, expression of mRNA by SQ-RT-PCR.

RESULTS

CCL24 was observed in endothelial and epithelial cells. Specimens from patients expressed significantly (>2fold) more CCL24 mRNA than controls. Fibroblasts and unstimulated cells did not express CCL24 mRNA. Upon stimulation with TNF-alpha, INF-gamma, IL-4, or costimulation with TNF-alpha and INF-gamma CCL24 mRNA was significantly enhanced (3.2-19.6%). In controls, fibroblast, and unstimulated cells CCL24 protein was below detection limit. Most polyps comprised significant amounts of CCL24 (mean 0.24 ng/mg). TNF-alpha, INF-gamma or IL-4 induced CCL24 protein (0.1-0.3 ng/ml) in epithelial cells. Costimulation with TNF-alpha and IL-4 (0.1-30 and 1-30 ng/ml, respectively) synergistically induced synthesis of CCL24 protein (0.18-0.31 ng/ml).

CONCLUSION

In nasal polyps endothelial and epithelial cells are obviously the main source of CCL24, which was shown for transcription (mRNA) and production (protein) levels and was associated with diseases. Results gave evidence of CLL24- directed migration of cells from inside (the bloodstream) to the epithelial side (mucosa) in eosinophilic inflammatory diseases, e.g. nasal polyposis.

Incidence and clinical background of posttonsillectomy bleeding related blood transfusion over 12 years

Economies in National Health Systems forces ENT surgeons to review their indications for outpatient tonsillectomy. Therefore, it is important to preoperatively identify special risk groups who frequently have extensive posttonsillectomy bleeding with the need of a blood transfusion. Aim of this study was to estimate the incidence for posttonsillectomy bleeding related blood transfusion, to identify risk factors associated with the need for blood transfusion and to release guidelines for posttonsillectomy bleeding of high risk patients. A retrospective study was done on the medical history of 1720 patients who underwent tonsillectomy for chronic tonsillitis between 1982-1993 in the ENT Department at the University of Kiel. The average transfusion rate was 0.52%. End Stage Renal Disease and hypertension combined with a preoperatively decreased Hb and Hct were the risk factors identified leading to a transfusion. These patients should not get a tonsillectomy as an outpatient procedure. The Hb, Hct, PT, PTT, blood type and crossmatch should be drawn and assessed prior to tonsillectomy. We recommend immediate treatment of secondary hemorrhage in those high risk patients under general anesthesia to avoid severe complications.

A newly discovered function of palatine tonsils in immune defence: the expression of defensins

The palatine tonsils have an undoubted role in the immune defence system. After antigen contact an effective adaptive immune response by B- and T-cell lymphocytes will be released. In addition the palatine tonsils seem to exert influence to the defence by the innate immune system. Therefore, we studied the ability of palatine tonsils to express different alpha and beta defensins and to find out any distinctions in chronic inflamed tonsils. Total RNA of 49 specimens of hyperplastic tonsils and chronic tonsillitis with pathological provided evidence of Actinomyces israelii was isolated using TRIzol protocol, reverse transcribed and the HNP-1, HNP-4, HBD-1 and HBD-2 gene expression densitometric determined, standardised in relation to glycerinaldehyd-3-phosphatdehydrogenase gene expression, after a semiquantitative polymerase chain reaction was performed. mRNA of HNP-1, HNP-4, HBD-1 and HBD-2 was detected in tissue samples, but their amount differed within the two defensin families and tissue of origins. HBD-1 was detected in all 49 tissues of hyperplastic tonsils and chronic tonsillitis. Only in chronic inflamed tonsils the amount of HBD-2 mRNA expression was significant increased. In these specimens also mean relative expression rate of all defensins was observed to be manifestly increased. Palatine tonsils express mRNA for different alpha and beta defensins and this expression suggest a newly supposed function in immune defence: the participation in the innate, non-adaptive immune system. Thus, palatine tonsils have a potentially influence in the growth and control of the physiological mouth bacteria by their bactericidal activity.

Anthocyanin production from Vaccinium pahalae: limitations of the physical microenvironment

Physical microenvironmental parameters conducive to production of flavonoids in vitro from continuous Vaccinium pahalae suspension cultures were examined first in shake flask culture experiments, and results were used to guide adaptations of a bioreactor production environment. Anthocyanin pigments were primarily concentrated in smaller aggregates up to 519 microm diameter. Agitation at 150 rpm and routine use of a mechanical scraper to periodically retrieve cells thrown out of solution was sufficient to keep productive plant cell aggregates in bioreactor suspension. A set up for enhanced irradiance with mercury lamps providing an average of 240 micromol m(-2) s(-1) PPF at the inner surface of the bioreactor vessel was required to sustain anthocyanin productivity through a 10-day production cycle.

A comparative study of chemokine rantes detection using ELISA and Western blot

Chemokines in biological sample are frequently found at very low level. Further, concentrations of chemokines which were measured in the same tissue detected with different methods often differ in literature. Therefore, RANTES concentrations were quantified by application of sandwich enzyme-linked immunosorbent assay (ELISA) and Western blot analyses. The sensitivity of ELISA was found to be much higher than that of Western blot. Additionally, the detection time differed considerably as well. For biological and biochemical characterization of chemokines it is essential to implement the optimal purification and detection techniques. With an understanding of the technical procedures and some pitfalls, chemokine detection can be applied more reliably.

Case report: galactography-guided wire localization of an intraductal papilloma

Galactography is used to evaluate spontaneous unilateral nipple discharge by catheterization of the duct orifice and instillation of radiopaque contrast material. The most common cause of a bloody discharge is an intraductal papilloma which appears as a smooth lobulated intraluminal filling defect or a solitary obstructed duct on galactography. Carcinomas may be the cause of up to 13% [1] of abnormal nipple discharge and cannot be reliably distinguished from papillomas at galactography. Thus any intraductal filling defect or irregularity in symptomatic patients should be surgically evaluated to obtain a tissue diagnosis. Unfortunately, the histologic examination of the biopsy specimen does not always identify the lesion seen at galactography [2]. A potentially more reliable method of locating lesions identified on galactography is described. Chow, J. S. (2001). Clinical Radiology56, 72-73.

The utility of ultrasonographically guided large-core needle biopsy: results from 500 consecutive breast biopsies

Five hundred ultrasonographically guided large-core needle breast biopsies of solid masses were performed in 446 women. Histopathologic results were correlated with imaging findings. Ultrasonographically guided large-core needle biopsy resulted in diagnosis of malignancy (n = 124) or severe atypical ductal hyperplasia (n = 4) in 128 lesions (26%). In the remaining 372 lesions (74%), ultrasonographically guided large-core needle biopsy yielded benign pathologic results. Follow-up of more than 1 year (n = 225), results of surgical excision (n = 50), or both were obtainable in 275 (74%) of the benign lesions. No malignancies were discovered at surgical excision or during follow-up of this group of benign lesions. There were no complications related to large-core needle biopsy that required additional treatment. Ultrasonographically guided large-core needle biopsy is a safe and accurate method for evaluating breast lesions that require tissue sampling.

Atypical ductal hyperplasia and ductal carcinoma in situ as revealed by large-core needle breast biopsy: results of surgical excision

OBJECTIVE

This investigation compares the frequency of histologic underestimation of breast carcinoma that occurs when a large-core needle biopsy reveals atypical ductal hyperplasia or ductal carcinoma in situ with the automated 14-gauge needle, the 14-gauge directional vacuum-assisted biopsy device, and the 11-gauge directional vacuum-assisted biopsy device.

SUBJECTS AND METHODS

Evaluation of 428 large-core needle biopsies yielding atypical ductal hyperplasia (139 lesions) or ductal carcinoma in situ (289 lesions) was performed. The results of subsequent surgical excision were retrospectively compared with the needle biopsy results.

RESULTS

For lesions initially diagnosed as ductal carcinoma in situ, underestimation of invasive ductal carcinoma was significantly less frequent using the 11-gauge directional vacuum-assisted biopsy device when compared with the automated 14-gauge needle (10% versus 21%, p < 0.05) but was not significantly less frequent when compared with the 14-gauge directional vacuum-assisted device (10% versus 17%, p > 0.1). For lesions diagnosed initially as atypical ductal hyperplasia, underestimation of ductal carcinoma in situ and invasive ductal carcinoma was significantly less frequent using the 11-gauge directional vacuum-assisted biopsy device compared with the 14-gauge directional vacuum-assisted device (19% versus 39%, p = 0. 025) and with the automated 14-gauge needle (19% versus 44%, p = 0. 01).

CONCLUSION

The frequency of histologic underestimation of breast carcinoma in lesions initially diagnosed as atypical ductal hyperplasia or ductal carcinoma in situ using large-core needle biopsy is substantially lower with the 11-gauge directional vacuum-assisted device than with the automated 14-gauge needle and with the 14-gauge directional vacuum-assisted device.

Mammographic and sonographic appearances of nodular adenosis

OBJECTIVE

We determined whether nodular adenosis of the breast possesses any pathognomonic features on imaging studies.

CONCLUSION

The imaging features of nodular adenosis are often benign-appearing and can be indistinguishable from other ellipsoid, circumscribed, or hypodense masses. Occasionally, nodular adenosis may appear suggestive of malignancy. Pathologic evaluation by excisional or large core needle biopsy is necessary for diagnosis.

[hBD-2 gene expression in nasal mucosa]

BACKGROUND

Chronic sinusitis is one of the frequent inflammatory diseases and has a complex pathogenesis. A substantial factor seems to be recurrent bacterial infections. Pseudomonas aeruginosa (PA) frequently can be found in nasal smears of patients with persistent sinus symptoms after sinus surgery. Lately a new antimicrobial peptide of epithelial origin, human Beta-Defensin-2 (hBD-2), with a strong antibacterial effect against PA could be identified within lesional skin scales of patients suffering psoriasis. Aim of this study was to investigate hBD-2-mRNA expression in nasal cells and tissue.

METHODS

Total RNA was extracted from nasal polyps and turbinates following TRIzol protocol. Epithelial cells and fibroblasts of nasal human tissue were isolated and cultivated. The cells were stimulated with PA using different time points and different concentrations. Total RNA was isolated as mentioned above, reverse transcribed and amplified in a Semi-quantitative Reverse Transcriptase PCR (SQRT-PCR) with genespecific hBD-2 primers.

RESULTS

PA induces time- and dose-dependently hBD-2 gene expression in nasal epithelial cells. Unstimulated epithelial nasal cells were able to express hBD-2 mRNA constitutively, whereas nasal fibroblasts showed no hBD-2 mRNA expression. Nasal polyps showed a comparable less hBD-2 gene expression then nasal turbinates.

CONCLUSIONS

hBD-2 possibly mediates a specific, early starting antimicrobial defense strategy of the nasal mucosa. This hypothesis would explain persistent infections with PA through diminished hBD-2 gene expression.

Cyfra 21-1: a serological help for detection of distant metastases in head and neck cancer

Local and neck recurrences of squamous cell carcinoma of the head and neck (SCCHN) can mostly be detected early when the patient has regular follow-ups. Distant metastases though usually remain undiscovered until they produce clinical symptoms. Since Cyfra 21-1 correlates with the tumor size and stage in SCCHN, we looked for possible connections between Cyfra 21-1 increases and the development of distant metastases. The sera of 830 patients with SCCHN were tested for Cyfra 21-1. The levels were compared with the clinical run of the patients. When Cyfra 21-1 levels rose above the threshold of 3.3 ng/ml (71 out of 830) staging procedures were performed. Tumor growth was found in 50 out of 71 patients with elevated Cyfra levels (70.4%). Cyfra serum levels in those cases either represented development of distant metastases (27 out of 71), or local and neck recurrences. The results of this study show that Cyfra 21-1 is a suitable and helpful serological parameter for the follow-up of patients with SCCHN. In the event of an elevation of Cyfra 21-1 above the threshold during follow-up, we would recommend the performance of a thoracal CT-scan and abdominal omi ultrasound as staging procedures.

Gynecomastoid hyperplasia: imaging findings in six patients

This case series describes the radiologic appearances of gynecomastoid hyperplasia of the breast in our experience. The clinical histories, breast images, and histopathologic findings in six women were reviewed. At mammography, there was no abnormality in two women, an enlarging asymmetric density in three women, and a nodule in one woman. Breast ultrasonography showed a hypoechoic nodule in one woman. Gynecomastoid hyperplasia has a varied radiologic appearance.

Transcriptional repression of the human galactocerebrosidase gene in squamous cell carcinomas of the larynx

Alterations of gene expression in squamous cell carcinoma (SCC) cell lines derived from the larynx and keratinocytes derived from adjacent normal mucosa of the larynx have been studied using the mRNA differential display technique. Lane-to-lane comparison of reverse transcribed mRNA showed a strong repression of a 148 bp fragment in SCC cells. The fragment was reamplified and cloned. Sequencing revealed a 99.3% homology with a region in exon 17 of the human galactocerebrosidase (GALC) gene. Northern blot analysis confirmed the differential expression of this gene in both carcinoma cell lines and laryngeal SCC biopsies in contrast with corresponding normal mucosa. To provide further evidence for the differential expression rate, both types of cells were transiently transfected with a 152 bp (-176 to -24) high regulatory promoter element of the 5' flanking region of the GALC gene. Results of 3 independent transfection experiments indicated a 16-fold repression of the GALC gene expression in SCC cells compared with benign keratinocytes. However, neither mutation nor other alterations of the promoter sequence were detected. Expression of the GALC gene is thus greatly affected in SCCs of the larynx.

Technical problems with protein extraction of chemokines featuring RANTES

Chemokines are known to be one of the sources for eosinophilic tissue infiltration in eosinophilic inflammation. Detection of beta-chemokines such as RANTES was possible in nasal tissue with or without eosinophilic infiltration. The concentration of chemokines which has been measured in the same tissue differs often in the literature. Aim of this study was to compare the different techniques of protein extraction and help to understand and interpret the investigation on RANTES secretion. Tissue of nasal polyps, inferior and middle turbinate was cut into halves and every half on its own pulverized using liquid nitrogen. The protein extraction was performed either with citric acid solution (pH 2.5) or phosphate buffered saline (PBS). The samples were then lyophilized. The concentration of RANTES was measured by a specific double sandwich ELISA. Using the citric acid technique the average concentration of RANTES in middle turbinates was 1.3 ng/mg, in inferior turbinates 1.6 ng/mg and in polyps 2.6 ng/mg tissue, using the PBS technique respectively 0.6 ng/mg, 0.5 ng/mg and 0.8 ng/mg tissue. Our data revealed a mismatch of 3.3:1 for polyps (citric acid: PBS), 3.2:1 for inferior and 2.2:1 for middle turbinates, respectively. Consequent comparison between the results of different techniques was not possible. Of special interest was also the fact that different techniques had different efficiencies of protein extraction in different tissues. Present statements on RANTES concentrations as a prognostic factor in nasal tissues need a technically careful standardization as far as this study shows.

Image-guided core breast biopsy of ductal carcinoma in situ presenting as a non-calcified abnormality

OBJECTIVE

Ductal carcinoma in situ (DCIS) typically presents as calcifications which are detected mammographically. Our aim was to evaluate the less common presentations of ductal carcinoma in situ diagnosed by image-guided core biopsy and correlate with histopathologic diagnoses.

METHODS AND MATERIAL

Imaging and histopathologic findings were retrospectively reviewed in 11 patients with ductal carcinoma in situ diagnosed at core biopsy that presented as noncalcified radiographic abnormalities.

RESULTS

Mammography showed non-calcified, circumscribed nodules, ill-defined nodules and architectural distortion. In two patients, no mammographic abnormality was detected. Sonography showed circumscribed, round or oval, solid masses; irregular, heterogeneous masses; and a tubular structure. Histopathologic diagnoses included multiple architectural subtypes and ranged from low to high nuclear grade.

CONCLUSION

Although image-guided core biopsy diagnosis of ductal carcinoma is typically made when sampling calcifications, DCIS can be diagnosed following biopsy of non-calcified masses or distortion. There is no correlation between histopathologic subtype and radiologic appearance.

Large-core needle biopsy of nonpalpable breast lesions

CONTEXT

An increasing number of nonpalpable abnormalities requiring breast biopsy are being identified due to the widespread use of screening mammography. Large-core needle biopsy (LCNB) has become an alternative to surgical excision.

OBJECTIVE

To determine whether LCNB is a safe and accurate technique to evaluate nonpalpable abnormalities found on breast imaging studies.

DESIGN AND SETTING

Case series at an institutional referral center from August 1, 1991, to December 31, 1997.

PATIENTS

A total of 1643 women with 1 or more suspicious breast abnormalities received LCNBs (n = 1836 lesions).

INTERVENTION

The LCNB of the breast uses a 14- or 11-gauge needle with stereotactic localization or ultrasound guidance.

MAIN OUTCOME MEASURE

Utility and potential limitations of LCNB compared with the criterion standard, surgical excision after wire localization.

RESULTS

Of the 1836 breast lesions sampled, 444 (24%) were found to be malignant. A total of 412 (22%) were found to be malignant on the initial LCNB and 202 repeat biopsies yielded 32 additional malignancies. Complications were infrequent: 1 patient experienced a superficial infection and 1 developed a pneumothorax after LCNB.

CONCLUSION

Image-guided LCNB is a reliable diagnostic alternative to surgical excision of suspicious nonpalpable breast abnormalities.

Fibrous nodules found at large-core needle biopsy of the breast: imaging features

PURPOSE

To describe the imaging and histologic features of large-core needle biopsy (LCNB) specimens of fibrous nodules.

MATERIALS AND METHODS

Of 853 breast masses in which LCNB was performed, 38 (4%) revealed histologic findings of fibrous nodules. Repeat biopsy was performed in 16 lesions (surgical excision, 13 lesions; repeat LCNB, three lesions). The mammographic and ultrasonographic findings in these 16 cases, the histologic LCNB findings, and the repeat biopsy findings were retrospectively reviewed.

RESULTS

Repeat biopsy findings confirmed the diagnosis of fibrous nodules in 15 of the 16 masses. In one mass, repeat LCNB findings showed a fibroadenoma. The imaging features of the fibrous nodules varied. Five nodules (33%) manifested as masses with indistinct margins; six (40%), as circumscribed masses. In four cases (27%), imaging suggested malignancy. None were calcified masses. An additional 22 masses had circumscribed or indistinct borders and were diagnosed with LCNB as fibrous nodules. None of these masses had suspicious findings, and repeat biopsy was not performed.

CONCLUSION

Fibrous nodules usually manifest as masses with circumscribed or indistinct margins but can have findings suggestive of malignancy. LCNB can reveal histologic findings consistent with this diagnosis. In all masses in which repeat biopsy was performed, the diagnosis of a fibrous nodule was confirmed or another benign stromal lesion was diagnosed.

RANTES production by cytokine-stimulated nasal fibroblasts: its inhibition by glucocorticoids

Nasal fibroblasts play an important role in both nasal polyposis and nasal allergic diseases and they are known to release a number of proinflammatory cytokines, including GM-CSF, IL-8 and IL-6. The aim of this present work was to investigate whether cytokine-stimulated nasal fibroblasts release biologically active RANTES as well as to study the effect of corticosteroids on the ability of nasal fibroblasts to produce the cytokine. Measurements of RANTES by ELISA demonstrated that RANTES is constitutively secreted spontaneously (21+/-4 vs. 19+/-6 ng/ml, respectively p>0.05). Stimulation of these cells with either TNF-alpha, IL-1beta or IFN-gamma induce further release of RANTES in a dose-dependent manner with TNF-alpha being the most potent stimulus. RANTES mRNA expression in nasal fibroblasts correlated with the amount of protein released in the culture supernatant upon cytokine stimulation. Moreover, chemotaxis studies demonstrated that the nasal-derived RANTES was biologically active on eosinophils. Betamethasone and hydrocortisone were found to downregulate RANTES mRNA expression in TNF-alpha-stimulated fibroblasts. These observations suggest that RANTES released by nasal fibroblasts may regulate eosinophil recruitment in nasal disease while glucocorticoids may inhibit the influx of these cells by suppressing the production of RANTES.

Large-needle core biopsy: nonmalignant breast abnormalities evaluated with surgical excision or repeat core biopsy

PURPOSE

To classify lesions initially considered nonmalignant at large-needle core biopsy that were subsequently surgically excised or sampled at repeat biopsy.

MATERIALS AND METHODS

From August 1, 1991, to December 31, 1996, 1,032 breast abnormalities (214 malignant and 818 nonmalignant lesions) were sampled at large-needle core biopsy. Of the nonmalignant lesions, 112 (14%) abnormalities were studied. Twenty-four abnormalities were subsequently excised because of discordant imaging and pathologic findings; 41 may have been missed at biopsy (25 were surgically excised, and 16 were sampled at repeat biopsy); 40 were surgically excised as recommended by the pathologist; and seven were excised for other indications.

RESULTS

None of 24 abnormalities excised because of discordant findings was malignant. Among the 41 possibly missed lesions, infiltrating ductal carcinoma was found in one lesion that was removed surgically and in one sampled at repeat biopsy. Among the 40 lesions recommended for excision by the pathologist, 16 malignancies were found (ductal carcinoma in situ, 11; infiltrating ductal carcinoma, three; phyllodes tumor, two). None of the remaining seven lesions was malignant.

CONCLUSION

Correlation of the technical quality of the biopsy, imaging features, and pathologic findings resulted in 96 surgical excisions and 16 repeat biopsies of lesions initially considered nonmalignant. Eighteen additional malignancies were identified.

Increased eotaxin-mRNA expression in non-atopic and atopic nasal polyps: comparison to RANTES and MCP-3 expression

Eosinophilic tissue infiltration of nasal mucosa typical for allergic rhinitis and chronic polypous sinusitis may be due to chemotactic activity of chemokines specific for eosinophils. The CC-chemokines eotaxin, RANTES and MCP-3 have been postulated to be involved in the recruitment of eosinophils to certain inflamed tissues. To explore their possible role in chronic polypous sinusitis we examined eotaxin-, RANTES- and MCP-3-gene expression in human nasal polyps and normal human nasal mucosa of patients undergoing endonasal surgery for treatment of chronic polypous sinusitis. Using gene-specific primers in semi-quantitative reverse-transcriptase polymerase-chain-reaction experiments we found elevated expression of eotaxin- and RANTES-mRNA but no MCP-3-mRNA in non-atopic and atopic nasal polyps when compared to normal nasal mucosa.

Crystal structure of the phosphatidylinositol-specific phospholipase C from the human pathogen Listeria monocytogenes

The X-ray crystal structure of the phosphatidylinositol-specific phospholipase C (PI-PLC) from the human pathogen Listeria monocytogenes has been determined both in free form at 2.0 A resolution, and in complex with the competitive inhibitor myo-inositol at 2.6 A resolution. The structure was solved by a combination of molecular replacement using the structure of Bacillus cereus PI-PLC and single isomorphous replacement. The enzyme consists of a single (beta alpha)8-barrel domain with the active site located at the C-terminal side of the beta-barrel. Unlike other (beta alpha)8-barrels, the barrel in PI-PLC is open because it lacks hydrogen bonding interactions between beta-strands V and VI. myo-Inositol binds to the active site pocket by making specific hydrogen bonding interactions with a number of charged amino acid side-chains as well as a coplanar stacking interaction with a tyrosine residue. Despite a relatively low sequence identity of approximately 24%, the structure is highly homologous to that of B.cereus PI-PLC with an r.m.s. deviation for 228 common C alpha positions of 1.46 A. Larger differences are found for loop regions that accommodate most of the numerous amino acid insertions and deletions. The active site pocket is also well conserved with only two amino acid replacements directly implicated in inositol binding.

Slight sequence variations of a common fold explain the substrate specificities of tRNA-guanine transglycosylases from the three kingdoms

tRNA-guanine transglycosylases (TGTs) are the enzymes catalyzing the base exchange required for the synthesis of the modified bases derived from 7-deazaguanine in prokaryotic, archaebacterial, and eukaryotic tRNAs. Unlike the eukaryotic and archaebacterial enzymes, the prokaryotic TGTs have been clearly identified and highly characterized both biochemically and structurally. The recent occurrence in sequence databases of archaebacterial and eukaryotic proteins homologous to the prokaryotic TGTs reveals that all TGTs unexpectedly adopt a common fold. Observed sequence variations at the active site correlate well with their specificities for the various 7-deazaguanine derivatives and the total conservation of the catalytic residues strongly favors a common catalytic mechanism for all TGTs.