RESUMEN
BACKGROUND: Despite advances in endoscopic sinus surgery, frontal sinus obliteration is still indicated in some cases. Current options for obliteration include autologous and synthetic materials. The use of ß-tricalcium phosphate as a resorbable bone graft substitute is a good alternative for frontal sinus obliteration. This study aimed to report our experience with this material. METHODS: A retrospective chart review of patients who underwent frontal sinus obliteration at our clinic between 2008 and 2013 was performed. Demographic data, indications, previous surgery, and immediate and late complications were examined. Information on persisting symptoms and patient outcomes was collected using a telephone questionnaire in February 2016. RESULTS: None of the patients underwent further surgery for frontal sinus disease. All of them reported a good cosmetic result and symptom improvement. CONCLUSION: ß-tricalcium phosphate is a good, safe and cost-effective material for frontal sinus obliteration.
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Sustitutos de Huesos/uso terapéutico , Fosfatos de Calcio/uso terapéutico , Seno Frontal/cirugía , Mucocele/cirugía , Enfermedades de los Senos Paranasales/cirugía , Anciano , Anciano de 80 o más Años , Regeneración Ósea , Femenino , Hueso Frontal/cirugía , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Terapia Recuperativa/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: HPV infections play a major role in the pathogenesis of squamous cell carcinomas of the head and neck. Regarding benign papillomas, the role of HPV is still uncertain. MATERIALS AND METHODS: To clarify this issue, 100 exophytic papillomas of the oral cavity, pharynx and larynx were subjected to histopathological and molecular pathological examination. Excision biopsies were taken from 62 male and 38 female patients with an age range of 18 to 87 years. Biopsies were tested for p16 expression by immunohistochemistry and analyzed for HPV subtypes 6/11 (low-risk), 16/18 and 31/33/53 (high-risk) by chromogenic in situ hybridization. RESULTS: HPV infections were verified molecularly in 34 % of biopsies; in all cases with the low-risk HPV subtypes 6/11. Only one case showed infection with both 6/11 and 31/33/53 subtypes, but not subtype 16/18; whereas expression of p16 was found in 67 %. The rate of positive molecular verification of HPV infection (in situ hybridization) was highest in the laryngeal lesions with 61.1 %, followed by the oral cavity with 52.9 %, and lowest in pharyngeal lesions (21.5 %). Recurrent papillomas were seen in 18 cases (18 %), of which 14 were molecularly positive for HPV (in situ hybridization). A correlation between inflammatory infiltration and HPV infection could be verified in 82 %. CONCLUSION: Our data demonstrate an important role of HPV infection for the development of benign papillomas of the head and neck region. Furthermore, there is a positive correlation between HPV infection and recurrent papillomas. Therefore, a molecular morphological HPV analysis of papillomas could provide important prognostic data.
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Neoplasias de Cabeza y Cuello/epidemiología , Recurrencia Local de Neoplasia/epidemiología , Papiloma/epidemiología , Infecciones por Papillomavirus/epidemiología , Lesiones Precancerosas/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Causalidad , Comorbilidad , Femenino , Alemania/epidemiología , Neoplasias de Cabeza y Cuello/microbiología , Neoplasias de Cabeza y Cuello/patología , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/microbiología , Recurrencia Local de Neoplasia/patología , Papiloma/microbiología , Papiloma/patología , Infecciones por Papillomavirus/microbiología , Infecciones por Papillomavirus/patología , Lesiones Precancerosas/microbiología , Lesiones Precancerosas/patología , Prevalencia , Factores de Riesgo , Adulto JovenRESUMEN
BACKGROUND: Initial results on the application of the water-jet in a parotidectomy setting in an animal study demonstrate that there are morphologic changes which do, and some which do not, affect the clinial function of the facial nerve due to the different jet sizes and operating pressures used. In a further study the histomorphometric data of the facial nerve dissected by the water-jet should be evaluated and correlated to the different sizes of jet and operating pressures. MATERIAL AND METHODS: In total, 102 nerves (in 14 beagles) which had been dissected by water-jets of different sizes and operating pressures were evaluated. After an observation period of 21 days, including documentation of the clinical function of the facial nerve, the nerves were dissected. The number of nerve fibers and the diameter of the different nerve fibers were then evaluated. RESULTS: All nerve fibers dissected with jet sizes of 120 and 150 µm showed an identical cumulative frequency of fiber diameters. All nerve fibers dissected with a water-jet of 200 µm showed morphologic and clinical abnormalities and--in terms of nerve fiber diameters--clear differences to the nerve fibers dissected with 120- or 150-µm jets. Altogether, there is a decrease in fiber diameter along the nerve course. CONCLUSION: Our data show a shift of larger diameters of the nerve trunk to smaller diameters in the terminal nerve fibers. This phenomenon has not been described in the literature to date and is probably not due to the water-jet. Additionally, our data show that 22% of the original nerve fiber damaged by the water-jet is sufficient to preserve the nerve's clinical function.
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Disección/efectos adversos , Traumatismos del Nervio Facial/patología , Parálisis Facial/patología , Glándula Parótida/cirugía , Animales , Disección/instrumentación , Perros , Nervio Facial/patología , Humanos , Presión Hidrostática , Masculino , Fibras Nerviosas/patología , Glándula Parótida/patologíaRESUMEN
BACKGROUND: The postoperative facial nerve palsy is a complication after parotidectomy which one is afraid of. The waterjet seems to be a surgical technic which allows separating different tissues without destroying important structures like vessels and nerves. MATERIAL AND METHODS: Totally, 106 nerve preparations, done by the waterjet of 14 beagles, were evaluated. According to a defined procedure during parotidectomy by waterjet different cones and pressure were used. After a period time of 21 days the trunk, the frontal branch and both oral branches of the facial nerve of both sides were dissected. The tissue preparation was done using the standard technic for EM-sections. RESULTS: There are mainly changes due to the preparation like the reduction of nerve fibers and fibrosis depending which cones and pressure has been used. CONCLUSION: Therefore neither the size of the jet (120 or 150 µm) nor the operating pressure of 40 to 60 or 80 bar plays an important role for the function of the facial nerve. Damage to the nerve is mainly due to the preparation technic and the application time. Using the 200 µm jet there is regularly facial nerve damage.
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Disección/efectos adversos , Traumatismos del Nervio Facial/patología , Parálisis Facial/patología , Glándula Parótida/cirugía , Animales , Axones/patología , Disección/instrumentación , Perros , Nervio Facial/patología , Humanos , Presión Hidrostática , Masculino , Fibras Nerviosas/patología , Glándula Parótida/patología , Complicaciones Posoperatorias/patologíaRESUMEN
We report the rare case of a posttraumatic intraorbital fistula. The patient was referred to our clinic with a suspected complication of acute sinusitis. The patient reported recurrent swelling of the eyelid with a temporal fluctuation during the day. Eyesight was normal. In the presence of acute rhinogenic infection, computer tomography of the paranasal sinuses demonstrated a shadow on the ethmoid bone and ipsilateral maxillary sinus. Clinical investigation and laboratory parameters excluded an infection. A kick to the head by a horse could be documented on patient interview. By means of angio-MRI an arteriovenous fistula of the orbit could be diagnosed.
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Fístula Arteriovenosa/diagnóstico , Traumatismos Cerrados de la Cabeza/complicaciones , Arteria Oftálmica/anomalías , Arteria Oftálmica/diagnóstico por imagen , Arteria Oftálmica/patología , Diagnóstico Diferencial , Femenino , Traumatismos Cerrados de la Cabeza/diagnóstico , Humanos , Persona de Mediana Edad , RadiografíaRESUMEN
Infections due to the Mycobacterium tuberculosis of the head and neck region mainly affect the cervical lymph nodes. We report a rare case of paranasal sinus tuberculosis. The patient presented as an emergency with right-sided headache and epiphora. Clinical, radiological and laboratory results yielded a diagnosis of acute exacerbated chronic sinusitis with meningeal affection resulting from transmigration. Histological and molecular investigations confirmed mycobacterial infection of the paranasal sinuses.
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Enfermedades de los Senos Paranasales/diagnóstico , Tuberculosis/diagnóstico , Diagnóstico Diferencial , Endoscopía , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de los Senos Paranasales/patología , Enfermedades de los Senos Paranasales/cirugía , Senos Paranasales/patología , Senos Paranasales/cirugía , Reacción en Cadena de la Polimerasa , Tomografía Computarizada por Rayos X , Tuberculosis/patología , Tuberculosis/cirugíaRESUMEN
Papillomas are rare tumors that originate from the mucosa. They may appear in the nose, paranasal sinuses, oral cavity, larynx, trachea, or the skin. Papillomas are mainly asymptomatic and are therefore mostly diagnosed coincidentally. In contrast, laryngeal papillomatosis may cause stridor, dyspnoea, and hoarseness. A viral cause of the disease seems likely, especially human papilloma virus. Mechanical irritation is also a possible reason when the nose, oral cavity, or oropharynx is affected. All papillomas, independent of their origin, may recur, and have the possibility of malignant degeneration in common. The therapy of choice is complete surgical excision. Regarding laryngeal papillomatosis, laser vaporisation or excision using the CO(2)laser is recommended. Because retreatments using conventional modalities are frequently necessary, especially in the case of laryngeal papillomatosis, adjuvant therapies are applied with the aim of reducing the recurrence rate and prolonging the interval between treatments.
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Antineoplásicos/uso terapéutico , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/terapia , Laringectomía/métodos , Papiloma/diagnóstico , Papiloma/terapia , Terapia Combinada , Humanos , Neoplasias Laríngeas/etiología , Papiloma/etiologíaRESUMEN
Extracorporeal shock wave lithotripsy is a rather new therapeutical method in the treatment of sialolithiasis. The objective was to evaluate retrospectively the results of the extracorporeal shock wave lithotripsy therapy performed with a Minilith SL 1 lithotripter on 167 out-patients with symptomatic stones (average size 5.94 mm) of the salivary glands over an observation period of seven years. A successful treatment with total stone disintegration was achieved in 51 (31 per cent) patients. In 92 (55 per cent) patients treatment was partially successful, with disappearance of the symptoms but a sonographically still identifiable stone. Treatment failure occurred in 24 (14 per cent) patients who then underwent surgery. The mean follow-up period was 35.6 months (minimum three, maximum 83), after which 83.2 per cent of the initially successfully treated patients were still free of symptoms.Therefore, extracorporeal shock wave lithotripsy, as a non-invasive treatment alternative with few side effects, is an efficient technique for the therapy of sialolithiasis in selected patients.
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Litotricia/métodos , Cálculos de las Glándulas Salivales/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Estudios de Seguimiento , Humanos , Litotricia/efectos adversos , Masculino , Persona de Mediana Edad , Enfermedades de las Parótidas , Estudios Retrospectivos , Enfermedades de la Glándula Submandibular/terapia , Resultado del TratamientoRESUMEN
BACKGROUND: Hereditary angioedema (HAE) is extremely rare and clinically characterized by recurrent and self-limiting skin, intestinal and life threatening laryngeal edema. Because of the danger of asphyxiation, it is vital that acute attacks of laryngeal edema be interrupted immediately. The aim of this study is to provide information on the incidence, diagnosis and treatment of laryngeal edema with upper airway obstruction in general and due to HAE. METHODS: 102 patients with swelling of the larynx and difficulty in breathing (stridor) and 21 patients with a manifest HAE were surveyed at the Department of Otorhinolaryngology, Head and Neck Surgery of the Ludwig-Maximilians-University of Munich from 2001 to 2004. RESULTS: 63% of the laryngeal swellings with airway obstruction were due to radiotherapy in cancer and the intake of ACE-Inhibitors. Just 22% were due to allergic reactions. Only one patient (< 1%) suffered from HAE. All patients were treated with intravenous steroids and anti-histamines successfully, except the HAE patient. After emergency coniotomy the patient was treated with purified C1 inhibitor concentrate (C1-INH). CONCLUSIONS: According to our experience almost all patients with laryngeal swelling and upper airway obstruction react well to the standard therapy with steroids and anti-histamines. In contrast these drugs have no effect on HAE. Replacement therapy with C1-INH has proved to be effective. The challenge is to realize whether an airway obstruction is due to HAE or not. In this case, careful observation, the right medication and an appropriate airway management are lifesaving. The possibility of sudden airway obstruction and asphyxiation must be discussed with these patients and their relatives.
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Obstrucción de las Vías Aéreas/etiología , Angioedema/diagnóstico , Edema Laríngeo/etiología , Adulto , Anciano , Obstrucción de las Vías Aéreas/diagnóstico , Obstrucción de las Vías Aéreas/terapia , Angioedema/genética , Angioedema/terapia , Terapia Combinada , Proteínas Inactivadoras del Complemento 1/deficiencia , Dimetindeno/uso terapéutico , Quimioterapia Combinada , Femenino , Humanos , Intubación Intratraqueal , Edema Laríngeo/diagnóstico , Edema Laríngeo/terapia , Masculino , Persona de Mediana Edad , Prednisolona/análogos & derivados , Prednisolona/uso terapéuticoRESUMEN
INTRODUCTION: This paper presents our experience with a navigation system for functional endoscopic sinus surgery. In this study, we took particular note of the surgical indications and risks and the measurement precision and preparation time required, and we present one brief case report as an example. MATERIALS AND METHODS: Between 2000 and 2004, we performed functional endoscopic sinus surgery on 368 patients at the Ludwig Maximilians University, Munich, Germany. We used the Vector Vision Compact system (BrainLAB) with laser registration. The indications for surgery ranged from severe nasal polyps and chronic sinusitis to malignant tumours of the paranasal sinuses and skull base. RESULTS: The time needed for data preparation was less than five minutes. The time required for preparation and patient registration depended on the method used and the experience of the user. In the later cases, it took 11 minutes on average, using Z-Touch registration. The clinical plausibility test produced an average deviation of 1.3 mm. The complications of system use comprised one intra-operative re-registration (18 per cent) and one complete failure (5 per cent). Despite the assistance of an accurate working computer, the anterior ethmoidal artery was incised in one case. However, in all 368 cases, we experienced no cerebrospinal fluid leaks, optic nerve lesions, retrobulbar haematomas or intracerebral bleeding. There were no deaths. DISCUSSION: From our experience with computer-guided surgical procedures, we conclude that computer-guided navigational systems are so accurate that the risk of misleading the surgeon is minimal. In the future, their use in certain specialized procedures will be not only sensible but mandatory. We recommend their use not only in difficult surgical situations but also in routine procedures and for surgical training.
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Enfermedades de los Senos Paranasales/cirugía , Senos Paranasales/cirugía , Cirugía Asistida por Computador/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Alemania , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Enfermedades de los Senos Paranasales/diagnóstico , Cirugía Asistida por Computador/instrumentación , Resultado del TratamientoRESUMEN
A common phenomenon in cancer patients is a suppressed cell-mediated immunity, characterized by the inability of immune effector cells to mount efficient anti-tumor responses. Immunosuppressive factors, released by the tumor, contribute to this phenomenon and thus to tolerance. Prostaglandins, catalyzed by the cyclooxygenases (COX-1 and COX-2) from arachidonic acid, are one class of these factors. Since at least one of the COX enzymes is often expressed at high level in human cancers, the enzymes were ascribed a causal role in tumor etiology and progression. Non-steroidal antiinflammatory drugs (NSAIDs) like aspirin, which block COX activity, have demonstrated their antitumor effects in preclinical and clinical trials. Pro-apoptotic and anti-angiogenic effects in tumor cells may account for this activity. In addition, by inhibiting the release of prostaglandins from the tumor and by blocking COX activity in immune effector cells, NSAIDs may also bias the function of immune cells towards a more tumoricidal phenotype. We show here that tumor cells inhibit the physiological function of immune cells, and that NSAIDs restore this function. These data contribute to an understanding of the antineoplastic effect ascribed to NSAIDs and support the prophylactic use of these drugs in high-risk patients.
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Carcinoma de Células Escamosas/inmunología , Inhibidores de la Ciclooxigenasa/farmacología , Neoplasias de Cabeza y Cuello/inmunología , Inmunidad Celular/efectos de los fármacos , Inmunidad Celular/fisiología , Macrófagos/inmunología , Monocitos/inmunología , Antiinflamatorios no Esteroideos/farmacología , Aspirina/farmacología , Complejo CD3/inmunología , Celecoxib , Línea Celular Tumoral , Células Cultivadas , Técnicas de Cocultivo , Curcumina/farmacología , Inhibidores de la Ciclooxigenasa 2/farmacología , Dinoprostona/biosíntesis , Regulación hacia Abajo , Citometría de Flujo , Humanos , Inmunohistoquímica , Pirazoles/farmacología , Fracciones Subcelulares/inmunología , Sulfonamidas/farmacologíaRESUMEN
Sinonasal undifferentiated carcinoma (SNUC) is a rare tumor of the nasal cavity and paranasal sinuses first described in 1986. Olfactory neuroblastoma and SNUC may appear quite similar on histological examination. Due to the fact that olfactory neuroblastoma has a much better prognosis, a distinction with SNUC has to be drawn. We report a case of SNUC and describe the role of immunohistochemistry in making an accurate histological diagnosis. In addition, potential factors influencing the development of SNUC described in the literature and current treatment modalities are discussed. Despite aggressive and multimodal treatment regimens, the outcomes of patients suffering from SNUC have remained dismal. A randomized controlled clinical study could be the basis for determining the optimal treatment for SNUC.
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Carcinoma/diagnóstico , Cavidad Nasal , Neoplasias Nasales/diagnóstico , Neoplasias de los Senos Paranasales/diagnóstico , Seno Esfenoidal , Biomarcadores de Tumor/análisis , Carcinoma/patología , Carcinoma/cirugía , Quimioterapia Adyuvante , Terapia Combinada , Diagnóstico Diferencial , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Cavidad Nasal/patología , Cavidad Nasal/cirugía , Estadificación de Neoplasias , Neoplasias Nasales/patología , Neoplasias Nasales/cirugía , Neoplasias de los Senos Paranasales/patología , Neoplasias de los Senos Paranasales/cirugía , Radioterapia Adyuvante , Base del Cráneo/patología , Seno Esfenoidal/patología , Seno Esfenoidal/cirugíaRESUMEN
Chronic tonsillitis is a common disease entity which, on account of the possibility of the tonsils becoming a focus of infection, must not be made light of. The patient's complaints are highly uncharacteristic, and it is not always possible to establish the diagnosis on the local findings alone. Rather, the patient's history and general state of health must also be considered when considering the diagnosis. By reason of the pathogenesis, the treatment of choice can only be tonsillectomy.
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Infecciones Bacterianas/diagnóstico , Tonsilectomía , Tonsilitis/diagnóstico , Absceso/diagnóstico , Absceso/etiología , Absceso/cirugía , Adulto , Infecciones Bacterianas/etiología , Infecciones Bacterianas/cirugía , Niño , Enfermedad Crónica , Humanos , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/etiología , Infecciones Estreptocócicas/cirugía , Streptococcus pyogenes , Tonsilitis/etiología , Tonsilitis/cirugíaRESUMEN
An appropriate indication for laser tonsillotomy is non-infectious obstructive hyperplasia in children. As a rule, these children suffer from pronounced rhonchopathy, which may be associated with episodes of apnea. Furthermore, disordered articulation and problems with eating have also been described. With increasing age hyperplastic tonsils may repeatedly become inflamed, with the result that tonsillar tissue undergoes changes that further the development of chronic tonsillitis. The indication for tonsillotomy should, however, not be applied in children older than 6 years. In children beyond this age tonsillectomy is recommended, not least due to the fact that the immunological "learning phase" is usually complete around the age of 6.
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Terapia por Láser , Tonsila Palatina/cirugía , Tonsilectomía , Niño , Preescolar , Humanos , Hiperplasia/patología , Hiperplasia/cirugía , Tonsila Palatina/patología , TonsilitisRESUMEN
BACKGROUND: Clinical outcome of patients with head and neck squamous cell carcinoma (SCCHN) depends on several risk factors like the presence of locoregional lymph node or distant metastases, stage, localisation and histologic differentiation of the tumour. Circulating tumour cells in the bone marrow indicate a poor prognosis for patients with various kinds of malignoma. The present study examines the clinical relevance of occult tumour cells in patients suffering from SCCHN. PATIENTS AND METHODS: Bone marrow aspirates of 176 patients suffering from SCCHN were obtained prior to surgery and stained for the presence of disseminated tumour cells. Antibodies for cytokeratin 19 were used for immunohistochemical detection with APAAP on cytospin slides. Within a clinical follow-up protocol over a period of 60 months, the prognostic relevance of several clinicopathological parameters and occult tumour cells was evaluated. RESULTS: Single CK19-expressing tumour cells could be detected in the bone marrow of 30.7% of the patients. There is a significant correlation between occult tumour cells in the bone marrow and relapse. Uni- and multivariate analysis of all clinical data showed the metastases in the locoregional lymph system and detection of disseminated tumour cells in the bone marrow to be statistically highly significant for clinical prognosis. CONCLUSION: The detection of minimal residual disease underlines the understanding of SCCHN as a systemic disease. Further examination of such cells will lead to a better understanding of the tumour biology, as well as to improvement of diagnostic and therapeutic strategies.
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Médula Ósea/patología , Carcinoma de Células Escamosas/patología , Células Neoplásicas Circulantes/patología , Neoplasias de Oído, Nariz y Garganta/patología , Biomarcadores de Tumor/análisis , Biopsia con Aguja , Estudios de Seguimiento , Humanos , Técnicas para Inmunoenzimas , Queratinas/análisis , Metástasis Linfática/patología , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Neoplasia Residual/patología , Pronóstico , Estadística como AsuntoRESUMEN
Although squamous cell carcinoma of the head and neck region very rarely metastasize to the skeleton, epithelial cells have been found in bone marrow aspirates of these patients. This observation reflects the general spread of the disease, indicating a poor clinical prognosis with a much higher risk of developing local or distant recurrences. In a first attempt to characterize the phenotypic properties, the expression of the major histo-compatibility complex (MHC) class I antigens on bone marrow micrometastases was assessed. It has been shown that the down-regulation of these molecules is a potential mechanism to escape from HLA class I restricted lysis by cytotoxic T-cells. The significance of reduced MHC class I expression might be relevant for the survival of residual metastatic cells in the bone marrow of patients with squamous cell carcinoma of the head and neck region. Bone marrow aspirates were screened for individual disseminated epithelial cells using the immunoalkaline phosphatase technique with monoclonal antibodies to the epithelial differentiation marker cytokeratin 19 (CK19), as described previously. Specimens containing CK19-positive cells were colabelled with the monoclonal antibody W6/32. The loss of MHC expression is not related to the tumor stage but clearly to the degree of differentiation: 6 out of 7 patients with low-grade SCCHN, but only 3 out of 13 patients with medium-grade SCCHN showed a complete loss of MHC class I molecules. This finding could indicate the reduced prognosis of undifferentiated SCCHN. The lack of MHC class I expression could encourage the survival of residual tumor cells in the bone marrow of patients with SCCHN that evade immunosurveillance.
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Antígenos de Neoplasias/análisis , Neoplasias de la Médula Ósea/secundario , Carcinoma de Células Escamosas/secundario , Neoplasias de Cabeza y Cuello/inmunología , Antígenos de Histocompatibilidad Clase I/análisis , Escape del Tumor/inmunología , Anticuerpos Monoclonales/inmunología , Antígenos de Neoplasias/inmunología , Biomarcadores de Tumor/inmunología , Neoplasias de la Médula Ósea/inmunología , Carcinoma de Células Escamosas/inmunología , Carcinoma de Células Escamosas/patología , Diferenciación Celular , Humanos , Técnicas para Inmunoenzimas , Vigilancia Inmunológica , Queratinas/inmunología , Linfocitos T Citotóxicos/inmunologíaRESUMEN
BACKGROUND: Tenascin, an extracellular matrix glycoprotein, is transiently present in embryonic tissue, in benign granulation tissue, but also in several highly anaplastic tumors like fibrosarcoma, melanoma and squamous cell carcinoma of the skin. This study was performed to validate elevated Tenascin serum levels as a possible marker for head and neck squamous cell carcinomas (HNSCC). PATIENTS AND METHODS: Tenascin serum levels were evaluated in patients with primary (n = 92) and with recurrent (n = 28) HNSCC. Patients with benign, non inflammatory ear, nose and throat diseases (n = 16) served as the control. The Tenascin serum levels were measured by ELISA (Aventis). RESULTS: Serum Tenascin concentrations of patients with benign ENT diseases ranged between 0.37 and 2.19 micrograms/ml (n = 16, mean +/- SD: 1.23 +/- 0.59 micrograms/ml), of patients with HNSCC (primary diagnosis) between 0.05 and 8.75 micrograms/ml (n = 92, mean +/- SD: 1.81 (1.36 micrograms/ml) and of patients with recurrent HNSCC between 0.53 and 10.0 micrograms/ml (n = 28, mean +/- SD: 2.78 +/- 2.2 micrograms/ml). CONCLUSION: We found a significant elevation of Tenascin serum levels only in patients with higher tumor stages (T4/UICC4) (p < 0.01/p < 0.1) or recurrent disease compared to Tenascin serum levels in healthy controls. Thereby Tenascin serum levels cannot be used clinically as a routine serum marker for the control of head and neck cancer. Further investigations are necessary to evaluate whether the measurement of Tenascin levels as tumor markers could offer additional information to the clinical outcome of patients with HNSCC.
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Biomarcadores de Tumor/sangre , Carcinoma de Células Escamosas/sangre , Neoplasias de Cabeza y Cuello/sangre , Tenascina/sangre , Carcinoma de Células Escamosas/patología , Diferenciación Celular/fisiología , Neoplasias de Cabeza y Cuello/patología , Humanos , Recurrencia Local de Neoplasia/sangre , Estadificación de NeoplasiasRESUMEN
Suppressed cellular immunity is common in patients with squamous cell carcinoma of the head and neck (HNSCC). It was demonstrated in previous studies that administration of interleukin 2 (IL-2) results in enhanced antitumoral immunity in vitro as well as in vivo. Since the serum half-life of IL-2 is relatively short, repeated applications are necessary to achieve therapeutically effective serum concentrations, but this strategy might cause severe side effects. Therefore, methods that provide high local cytokine levels over a prolonged period of time without the need for repeated injections are desirable. Gene therapy as an innovative treatment approach using tumor cells stably transduced to produce IL-2 might meet these criteria. In vitro manipulated tumor cells, if readministered in the vicinity of non-manipulated tumor cells, may enhance a specific anti-tumor response in vivo without systemic side effects. The present manuscript reviews the current literature dealing with IL-2-protein and -gene therapy with special emphasis on head and neck cancer. Our own in vitro results with IL-2 gene therapy in conjunction with published data from other authors argue in favour of an in vivo approach for this therapeutic strategy that is currently in progress in our department.
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Carcinoma de Células Escamosas/terapia , Terapia Genética , Interleucina-2/genética , Neoplasias de Oído, Nariz y Garganta/terapia , Animales , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/inmunología , Humanos , Neoplasias de Oído, Nariz y Garganta/genética , Neoplasias de Oído, Nariz y Garganta/inmunología , Resultado del TratamientoRESUMEN
BACKGROUND: Parapharyngeal lesions are rare. Tumors arising in the parapharyngeal space can be silent clinically for a long period of time. Physical findings like dislocation of the pharyngeal walls or cervical swelling are often recognized by chance. MATERIAL AND METHODS: Representing three cases of parapharyngeal tumors the differential diagnosis of parapharyngeal masses and the importance of the magnetic resonance imaging will be shown. CONCLUSIONS: Mostly, parapharyngeal masses are represented by salivary gland tumors (40%-50%). The second most common tumors in the parapharyngeal space are neurogenic tumors (17%-25%). Paragangliomas are the third group of common parapharyngeal lesions (10%-15%). A mixed group of lesions like branchial cleft cysts, lymph nodes and hematogenic tumors represent the remaining part of the parapharyngeal masses (10%-33%). Most of the lesions (80%) are benign. Because of the magnetic response imaging a reliable preoperative diagnosis is possible in more than 80% of the tumors. The surgical management may also be influenced by the location of the tumor shown in the magnetic resonance imaging.
Asunto(s)
Adenoma Pleomórfico/diagnóstico , Neoplasias de Cabeza y Cuello/diagnóstico , Hemangiopericitoma/diagnóstico , Imagen por Resonancia Magnética , Neurilemoma/diagnóstico , Neoplasias de la Parótida/diagnóstico , Adenoma Pleomórfico/cirugía , Diagnóstico Diferencial , Femenino , Neoplasias de Cabeza y Cuello/cirugía , Hemangiopericitoma/cirugía , Humanos , Masculino , Persona de Mediana Edad , Neurilemoma/cirugía , Neoplasias de la Parótida/cirugíaRESUMEN
Recombinant IL-2 protein has shown many immunostimulatory effects in a variety of human tumors. However, the clinical use of rIL-2 is limited by common and serious side effects after systemic administration. IL-2 expression plasmids may circumvent these drawbacks, producing high local IL-2 concentrations that cause limited or no systemic side effects. Due to the superficial growth of squamous cell carcinoma of the head and neck (HNSCC) are readily accessible for direct intratumoral injection and therefore an optimal target for such a gene therapy approach. There has been evidence for local and systemic activation of immune cells by peritumoral injections of IL-2 in patients with advanced HNSCC (Whiteside et al. 1993; Cortesina et al. 1994; De Stefani et al. 1996). We now perform a placebo-controlled, dose-rising study of the safety and tolerability of a single intratumoral injection of hIL-2 plasmid at four dose levels formulated in DOTMA/Chol in patients with primary untreated head and neck squamous cell cancer (HNSCC) TNM stage II-IV. The patients will be monitored for the occurrence of any adverse reactions to the given medication. In addition, we will determine whether the intratumoral administration of the plasmid induces and or enhances tumor-specific host responses at the immunological and or clinical level.